As the Onion once famously proclaimed  ”WHO announce – Human mortality remains stubbornly at 100%!”

We are creatures. Like other creatures on this planet. But we have evolved something special. Consciousness. With this consciousness comes both self-awareness and imagination, both of which allow us to know that we are mortal. We know we are going to die. We can imagine it. Our problem is…..how do we live with that?

I’ve just finished reading Ernest Becker’s “Denial of Death“. It’s probably one of the most challenging books I’ve ever read. He argues powerfully and convincingly that human beings have both qualities of “creatureliness” (by dint of having a body), and of “godliness” (by dint of our ability to handle symbols and to be able to imagine not just the here and now, but other times, other places and the lives of other people. In essence, we are both biological and symbolic organisms. He lays out the case that the fear of dying is at the heart of what it is to be human, that unlike other creatures which are driven by instinct, we are, instead, driven by this fear. I won’t go into detail in this post, but if you check out the link at the start of the paragraph you can read an excellent wikipedia summary of the book.

Every Saturday it seems there are people in the High Street collecting money for a charity for some disease or other – fight cervical cancer, fight breast cancer, fight diabetes, fight heart disease, fight some other disease. And what if we could for a moment conceive of a world where each, and all, of these diseases were eliminated? Would we still die?

I don’t think a fear of dying is a good basis for a life. I don’t like all the scaremongering of the “Well of Light Brotherhood” types who know with such certainty how the rest of us should be living our lives to reduce our chances of dying.

What do I believe instead?

That we should have a passion for living.

We all die. That’s a fact. It can’t be avoided but it shouldn’t be the one fact which determines how we are to live. Let’s accept our reality and do what we are here to do – live.

How passionate are you about living? What will you do TODAY to live fully and passionately?

What is the Well of Light Brotherhood? That sounds more terrifying than death itself, a Brotherhood with the grim knowledge of what is better for other people and the iron determination to better them whether they like it or not.

The novel tells the story of an elderly woman put away in a “home” by her son and his wife when her behaviour becomes difficult for them. The home is run by the “Well of Light Brotherhood”.

You know, it seems to me that health care these days is probably run by the same people!!

The study looked for 40 chronic conditions among the participants’ data. Researchers found that 42% of patients had one or more conditions and 23% had two or more. It also found that only 9% of those with coronary heart disease, had that one disease alone. Similarly, only 23% of those with cancer, had only cancer and no other long-term disease

Why is this such an important point? Well, as the authors of the paper say

“Any country with an ageing population is heading in this direction. All these countries are waking up to the problem. ”The status quo isn’t an option because it leads in the wrong direction.“ Prof Watt said that rather than more specialists, patients with multiple conditions “need someone who can oversee all the problems of a patient”. ”These patients need continuity, and we need ways of measuring how well care is joined-up.”

They highlight the need for more generalist approaches where the patient is seen in the context of their whole life, and that in particular people need continuity of care, co-ordination of care, and individualised care.

we’ve actually learned is that, whatever your level of cholesterol, reducing it further is beneficial.

“If we are going to prevent that half of cardiac or stroke deaths, then we’ve got to consider treating healthy people. ”It can’t be done any other way.”

What’s the alternative?
Broadening the focus at all stages.
Expand the story from a biophysical one to at least a biopsychosocial one and a story of a person replaces the story of a disorder.
Expand understanding from diagnosis of a lesion to understanding the emergence of an illness in the context of an individual’s life and a person can make sense of their experience.
Expand the interventions on offer beyond surgery and drugs to methods which increase vitality and resilience and a person can experience greater health.

Recommended reading -
Read Arthur Frank’s The Wounded Healer, Kleinman’s Illness Narratives or Cassell’s The Healer’s Art, to better understand the importance of narrative in the shift from biophysical to biopsychosocial.
Read Balint’s The Doctor, the patient and his Illness, Leader and Corfield’s Why do People Get Ill? Or Broom’s Meaning-full Disease to better understand the shift from a disease to an illness agenda.
Read Dan Siegel’s Mindsight, Doc Childre’s The Heartmath Solution or David Servan-Schreiber’s Healing without Freud or Prozac to understand the potential for interventions which don’t involve surgery or drugs.

The article is about a Norwegian research study which has estimated the amount of morbidity caused by prescribed drugs. By morbidity they mean things like -

new medical problems (adverse drug reactions, drug dependence and intoxication by overdose) and therapeutic failure (insufficient effect of medicines and untreated indications).

Of course if you have a look at the fine print on the little bits of paper included in packets of prescribed drugs you’ll be aware that the potential “new medical problems” they can cause is often a pretty extensive list. It’s interesting to see them considered as three separate categories however. All drugs have the potential to cause direct harm in the form of “adverse drug reactions”. We call these “side effects” and some are pretty minor, but some can end a person up in hospital, or even cause death (10,000 deaths a year in England was one estimate ). Most people are pretty aware of the potential that drugs can cause side effects. I think most people are probably also aware that too much of any drug will likely cause harm, and that’s the category “drug overdose”. Most frequently this is not a deliberate act of self-harm, but the taking of too high a dose to try and achieve the claimed effect of the drug – more painkillers, more sleeping tablets, more tranquilisers. The third category is “drug dependence” and I think a lot of people associate that with illegal drugs – heroin, cocaine etc. But in fact, drug dependence has both physical/chemical aspects related to the way a drug changes our inner environment, and psychological ones where people begin to believe they couldn’t stop or reduce their prescribed drugs.

This study goes beyond these three categories however, and includes “therapeutic failure”, again subdivided, this time into two categories – “insufficient effect” and “untreated indications”. In other words, where people take a prescribed drug and it doesn’t do what the doctor intended it to do. This occurs much more frequently than people think (despite the young doctor who told me she’d been trained – “if a patient takes an evidence based drug and doesn’t get better, either they haven’t taken the drug, or they are lying”). Dr Roses of Smith Kline Glaxo said -

“The vast majority of drugs – more than 90 per cent – only work in 30 or 50 per cent of the people,” Dr Roses said. “I wouldn’t say that most drugs don’t work. I would say that most drugs work in 30 to 50 per cent of people. Drugs out there on the market work, but they don’t work in everybody.”

The estimate of this drug-related morbidity in this study is just over a half of all the people who take a prescribed medicine. Is that a shocking figure? I think so.

When I trained as a GP, I was taught to take a holistic approach to patients, and to be cautious about prescribing. I was taught values which included not prescribing a “pill for every ill”. It seems that prescribing is on the up. (“Prescriptions for antidepressants have risen by 43% in the past four years to nearly 23 million a year, NHS figures reveal.” and “The total number of prescription items dispensed increased by nearly two thirds between 1998 and 2008,” )

Not only is there a pill for every ill now, but even people with no symptoms of illness are being prescribed life long medication in an attempt to prevent them becoming ill. Sadly, over half of those people, who aren’t actually sick, will suffer from this preventive strategy.

What happened to the medical value of “first do no harm”? Shouldn’t we developing ways of improving and sustaining human health which don’t involve using drugs which have such a potential to cause harm? And saving the drugs for the situations where their potential harms are outweighed by their potential benefits? That’s the strategy we employ at the NHS Centre for Integrative Care in Glasgow. It’s a strategy I’d like to see more of.

I swear the view from my window amazes me anew every single day. I mean, just look at THIS!
Goodness, what an amazing dance of water on the earth. I’ve never seen the clouds and mist caress the folds of the mountain like this.
Just beautiful

Tokyo Station by night.

I’m amazed to watch the constant snaking in and out of the station of the long, long trains they have here in Japan. From the 32nd floor here it looks like a giant train set (if only I had a bank of remote controls!)
But as I gaze down on all this activity I wonder, not just at the mind boggling complexity of making it all run so smoothly, but I wonder where everyone is going?
We’re a busy species, aren’t we?
Weird, therefore, to sit in the hermetic almost-silence of a high rise hotel room, watching, but not hearing anything other than the raindrops hitting the glass, and the muffled murmurings of the trains like waves breaking on the shore, or a distant creature breathing…..

When I turned fifty I celebrated with a flight in a hot air balloon.
Standing in that small basket, the intermittent roar and heat of a burner over my head, peering over the edge of the woven cane, entranced by the red earth of the Atlas mountains receding beneath my feet, was the strangest feeling.

Standing still as the world fell silently and effortlessly away below me.

That day changed my relationship with the planet.

Somehow, since then, I can be amazed by how still I can stand as the Earth spins and hurls through the seemingly almost empty solar system.

I remember that now as I squint out of the window of a plane to see only intense, bright, white light, which almost imperceptibly begins to sink away beneath me, revealing a blue sky above which deepens as it soars towards the heavens.
How do I feel so still, so whole, when below me is only white cloud which swirls, and thins, and disappears, revealing glimpses of the spinning Earth, and above me just the vast, deep, yet mostly empty sky?