Newer posts are loading.
You are at the newest post.
Click here to check if anything new just came in.

May 06 2010

Can architecture cure cancer?

Cancer care doesn't have to mean grim hospital wards, believes Maggie's co-founder Charles Jencks: uplifting buildings benefit both body and soul. But are they just an architectural placebo?

In pictures: Maggie's Centres present and future

Charles Jencks would be the last person to claim that architecture could replace chemotherapy, but he's the first to argue that it can make a difference to cancer patients. As the driving force behind cancer care charity Maggie's, and a well-established architectural writer, Jencks often finds himself having to defend his views. The Maggie's Centre initiative, named after Jencks's wife, Maggie Keswick, who died of cancer in 1993, has grown from a one-off project to a mushrooming nationwide network – six existing buildings with more on the way, and a lengthening list of high-profile designers: Richard Rogers, Frank Gehry, Zaha Hadid, Rem Koolhaas. As the idea has taken off, so Jencks has come under fire from both the scientific community, who question the validity of his claims (or media distortions of them); and the design community, who wonder if Maggie's Centres aren't injecting more architecture into small healthcare facilities than they strictly need.

Jencks is not advocating some deterministic equation between architecture and health – as if the sight of a well-detailed staircase could somehow zap away a malignant tumour – but he does believes in what he calls an "architectural placebo effect". "A placebo is a phoney cure that works," he explains. "This is very hard for the medical profession to get their teeth around because they hate placebos but scientifically, placebos work in about 30% of cases that are psychogenic diseases. You have to believe in a placebo or it won't work, but if it works it's obviously working in some indirect way, through feedback in the immune system, let us say, or in the willpower of the patient to take a more strenuous exercise in their own therapy.

"You can imagine all sorts of ways in which architecture adds to the placebo effect," he continues, "and in that sense it's impossible to measure. Here's a funny insight: in a way, the carers are more important than the patients. Because if the carers are cared for, they turn up, they enjoy it and you create this virtuous circle, this mood in a Maggie's Centre which is quite amazing. So architecture helps do that because it looks after the carers. There's a lot of people who would quite rightly attack that notion, and I don't want to claim that we can yet prove it, but we hope to."

Jencks presents his case in a new book whose title succinctly sums up his approach: The Architecture of Hope. "It is my hope, and it was Maggie's hope, to live longer with cancer. And I think any cancer patient, if you dig not too deeply, they want to live. So is there an architecture that helps you live?"

If there is, Jencks argues, it is not to be found in the modern hospital. He describes the space in which Maggie herself received her weekly chemotherapy as a form of "architectural aversion therapy" – a windowless neon-lit corridor of Edinburgh's Western General Hospital. Many of us are familiar with similar spaces. In the industrial age, the design of healthcare buildings has been dictated by the demands of hygiene and efficiency: hard, sterile surfaces; bright, white spaces; long corridors; artificial ventilation systems. The template has been updated a little in the PFI age with atrium lobbies and toothpaste-coloured cladding, but these places are still overwhelmingly alienating.

Jencks and others, such as the Dutch academic Cor Wagenaar, believe that modernism created a rupture in the long, intimate relationship between architecture and health. That history stretches back to ancient Greece, where temple complexes such as Epidauros were about healing the spirit as well as the body, and even Stonehenge, which recent findings suggest may have been a hospital. Its modern roots lie in the Enlightenment, when it was first proposed that good design of the built environment could do more for public health than the medical profession could. In a way, Maggie's Centres reconnect with this "secret tradition", says Jencks. Yes, we need medical environments to cure us, but we also need to feel like people again, rather than patients. He is not alone in this. Witness the Circle group's recent hospital in Bath, designed by Foster and Partners, which feels more like a boutique hotel. They, too, are recruiting architects such as Richard Rogers and Michael Hopkins to rethink hospital design on a more humane scale. Or there's the AHMM's bright, fresh Kentish Town Health Centre, also nominated for last year's Stirling prize, or Gareth Hoskins' civic-minded health centre designs. Things are changing.

There's no great architectural secret at work in the design of Maggie's Centres. They are defined by inarguably positive qualities: light, space, openness, intimacy, views, connectedness to nature – the opposite of a standard-issue hospital environment. They are domestic in scale, centred around the kitchen, a place where you can make yourself a cup of tea and have an informal conversation. In Jencks's words, they are buildings that hug you, but don't pat you on the head. It's not just about giving people architecture, he argues – it's also providing information, relief, psychological, emotional and even financial support – all of which contribute to the urge to go on living. Nor is there any set of instructions for architects as to how to achieve these goals. Frank Gehry's building, for example, combines a crinkly-roofed fairy tale aesthetic with a serene view over Dundee on one side and a garden maze on the other. Zaha Hadid's outlet in Fife has been compared to a Stealth bomber – sharp and black on the outside, but mercifully calm and light inside. More recently, Richard Rogers's London Maggie's Centre shut out the city behind rhubarb-pink walls and opened up an oasis of intimate, domestic-scaled spaces, all capped by a protective roof.

The award of the 2009 Stirling prize to Rogers' building was another gesture of approval for the Maggie's Centre approach, but it also raised the question of whether they really needed such star names to design them. In addition to the six existing Maggie's Centres, there are another six under way, including designs by Dutch superstar Rem Koolhaas, the late Japanese architect Kisho Kurokawa and some of Britain's best-known names – Piers Gough, Chris Wilkinson, Ted Cullinan and Richard MacCormac. There are plans for as many as 23 buildings further down the line, even outposts in Hong Kong and Barcelona. If the brief is so relatively straightforward, why the starchitects? Is there a danger that Maggie's Centres are becoming more about prizes than patients – a free pass for virtuoso architects to get something built?

In Jencks's defence, Koolhaas and Hadid were fellow students of Maggie's. Gehry and co were lifelong friends of the couple. They just happened to hang out with future superstar architects. Besides which, Jencks says, without the media attention generated by these names, the charity would not have attracted the public donations that are enabling it to expand. Cancer affects up to one in three adults, after all. A great many people have been affected by Maggie's Centres already, and each of the new buildings hopes to serve a catchment area of two million people. "This was not thought of way back, that architecture would make such a difference to raising money," says Jencks. "And it's a double thing: it raises our profile, but it also gives us good buildings which last, so we benefit in the long term. I can't understand why other institutions haven't done the same."


guardian.co.uk © Guardian News & Media Limited 2010 | Use of this content is subject to our Terms & Conditions | More Feeds


May 05 2010

Remember 1983? I warn you that a Cameron victory will be just as bad | Jonathan Freedland

I would like to make a positive case for Labour, but the hour is late, and now it is Neil Kinnock's famous words that stir me

On the eve of the 1983 election – which, until this year, seemed destined to represent for ever the low watermark of Labour performances – a young member of the party's shadow cabinet delivered what was to be one of his most compelling speeches. Neil Kinnock knew a landslide defeat was imminent so, speaking in Bridgend, he sketched the world to come. "I warn you," he began, addressing a nation about to descend into the bitterest stretch of the Thatcher era. "I warn you not to be ordinary. I warn you not to be young. I warn you not to fall ill. I warn you not to get old."

It was a rhetorical masterpiece from a man whose oratory would later be much mocked. But its power was its prescience. Kinnock saw the Thatcherite tsunami that was coming and warned of the deluge that would follow.

This time even the most pessimistic Labourite cannot feel the certainty Kinnock had then: all kinds of permutation are still possible. But if the Labour vote crashes close to, or even below, 1983 levels, then David Cameron in Downing Street is the most likely outcome, whether governing as a minority, in alliance with the Lib Dems, or with a narrow majority of his own. What would he do if he gets there? What cautionary message might a 2010 Kinnock issue? For those still weighing their vote, here are a few salutary thoughts.

I warn you that a chance some have waited for all their adult lives will slip away, perhaps taking another generation to come around again: the chance to reform our rotten, broken electoral system. If Cameron wins, he will not only thwart any move to fairer voting, he will act fast to rig the system in his favour. Even neutrals agree that his plan to cut the number of MPs by 10% – presented as a mere cost-cutting measure – will be one of the grossest acts of gerrymandering in British political history. Cameron will redraw the boundaries so that his rivals lose seats and he gains them, locking in a semi-permanent Conservative majority. Reform of our absurd, unelected second chamber will be postponed indefinitely, enabling Cameron to pack the Lords with his mates and sugar daddies, including perhaps a few more of those businessmen who so obligingly sided with the Conservatives in condemning Labour's plans for national insurance.

If, on the other hand, Cameron is kept from Downing Street courtesy of a Labour vote tomorrow strong enough to make a Lib-Lab coalition plausible, then there's a clear chance for the 55%-plus majority who regularly vote for liberal or left parties to prevail and reform the system – ensuring that, from now on, the Conservatives hold power only as often as their minority status suggests they should. (They were always a minority party, even in the Thatcher heyday.) In other words, the victor tomorrow will get to set the rules for decades to come. This is a winner-takes-all election and the stakes could not be higher.

I warn you that the economy could slide back into despair. Maybe people have not paid attention to this argument because Gordon Brown has been making it, but the danger is real. A sudden shut-off of the public spending tap could well send a frail recovery staggering back into recession: the dreaded double-dip. It's happened elsewhere and could happen here. The US and other economies are seeing the tide turn, but that's because they've kept the public cash coming. Cameron's aim, played down in the rhetoric because it polled so badly, is to cut spending immediately, ushering in what he once proudly trumpeted as an "age of austerity".

If Britain were to return to recession, then brace yourself. For many, this last downturn has not quite felt like the worst since the Great Depression, whatever the economists say. Unemployment, house repossessions and bankruptcies are all fractions of what they were in the 1990s recession. That's not by accident. It's a function of Labour's active interventionism, which has sought to reduce the impact of the downturn on those at the sharpest end. Such state activity clashes with every Conservative instinct. Cameron still describes government as more problem than solution. Last time the Tories were in charge, dealing with a recession that was actually much less severe, the pain was greater and the weakest suffered most. There is nothing in current Tory policy – despite Cameron's final debate plea to the camera that it's "the most vulnerable, the most frail and the poorest" he truly cares about – to suggest it won't be like that again.

Indeed, there are at least three signs that point in a gloomy direction. First, despite all the austerity talk, the Tories have clung to their promise to give an inheritance tax break to the 3,000 richest families in the country. In the words of Nick Clegg, it's the "double-millionaires" Cameron wants to help. And yet, given the hole in the public finances, cash will have to come from somewhere. The obvious source – not that the Conservative leader has ever been challenged on it – is an increase in VAT. That's the most regressive of all taxes, inflicting disproportionate pain on the poorest: pain that will only deepen with the coming Tory assault on tax credits. A third cause for alarm can be expressed in three words: Chancellor George Osborne.

I warn you not to have an urgent need for the NHS. Sure, the Tories say they've ringfenced health spending, but check the small print. They plan to drop Labour's guarantee on waiting times. No longer will any patient be sure to see a cancer specialist within two weeks: under the Tories, that decision will be left to the consultant. Fine for the sharp-elbowed middle class, who are used to barging their way to the front of the queue. Not so good for the poorest who, all the data shows, struggle to get the most from public services.

I warn you not to be a single mother or widow. You'll get less than those who are married. Not that much less – about £3 a week – but just enough to know that the tax system regards you as a second-class citizen and to remind you of how life used to be under the Conservatives, when single parents were a routine target for public mockery and scolding.

I warn you that we will be back to the sterile relationship with Europe of the 1990s, a British government once again on the margins, but aligned this time with homophobes, rank antisemites and assorted apologists for fascism. Prepare within weeks for a Cameron stunt, demanding negotiations to "repatriate" powers back to Westminster. Britain is set once again to become the club bore of the EU, happily swallowing the agenda of economic liberalisation but moaning about sovereignty in the abstract, annoying the other members but never having the courage to up and leave.

Cameron won't have much choice in the matter. He'll be answerable to the newly-strengthened backbench hard right of his party, who will have veto power over his programme: he won't be able to govern without their votes. With their loathing of Europe, their disbelief in man-made climate change and their disproportionate ties to the City and finance, they will ensure Cameron sticks to the right and narrow.

Of course, it would feel better to make a positive case for Labour, echoing its promises on a living wage and a cap on predatory chargecard interest rates or its plans for green jobs. But the hour is late. Tomorrow is the day of decision. And we have been warned.

• More election comment from Cif at the polls


guardian.co.uk © Guardian News & Media Limited 2010 | Use of this content is subject to our Terms & Conditions | More Feeds


Older posts are this way If this message doesn't go away, click anywhere on the page to continue loading posts.
Could not load more posts
Maybe Soup is currently being updated? I'll try again automatically in a few seconds...
Just a second, loading more posts...
You've reached the end.

Don't be the product, buy the product!

Schweinderl