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Archive for December, 2007

A couple of evenings ago on my way home from work, George Square in the centre of Glasgow looked like this

Glasgow december

George Square Glasgow December

George Square Glasgow Lights

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Every Christmas issue of the British Medical Journal, now known simply as the BMJ, has some really fun articles. I haven’t opened this year’s issue yet but when I picked it up from behind my door just now a study from old BMJ Christmas issue came to mind. It was a systematic review of the evidence base for the use of parachutes. In the introduction they say –

The perception that parachutes are a successful intervention is based largely on anecdotal evidence. Observational data have shown that their use is associated with morbidity and mortality, due to both failure of the intervention1 2 and iatrogenic complications.3 In addition, “natural history” studies of free fall indicate that failure to take or deploy a parachute does not inevitably result in an adverse outcome.4 We therefore undertook a systematic review of randomised controlled trials of parachutes.

The authors completely failed to find a single randomised controlled trial of parachute use! This article is typical of the BMJ Christmas editions. It’s funny, tongue in cheek, but thought-provoking and makes serious points through the use of humour. I love their conclusion –

Only two options exist. The first is that we accept that, under exceptional circumstances, common sense might be applied when considering the potential risks and benefits of interventions. The second is that we continue our quest for the holy grail of exclusively evidence based interventions and preclude parachute use outside the context of a properly conducted trial. The dependency we have created in our population may make recruitment of the unenlightened masses to such a trial difficult. If so, we feel assured that those who advocate evidence based medicine and criticise use of interventions that lack an evidence base will not hesitate to demonstrate their commitment by volunteering for a double blind, randomised, placebo controlled, crossover trial.

Any volunteers? (and, no, you’re not allowed to volunteer anybody else!)

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Wired magazine has an article about a Japanese architect and photographer, Kazuhiko Kawahara, who goes by the name of Palla, and who creates amazing mosaics of photographs on his website. He twists the images using symmetries and the results are very reminiscent of Escher prints.

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One of my main treats is to browse in a “Maison de la Press” in a French town and sit down in a cafe with a new purchase or two. I have certain favourite French magazines. One of them is called Senso. It is beautifully produced. I love the illustrations and there are really interesting articles about literature, movies and all aspects of cultural life. But one of the most enjoyable things is the French language itself. It’s a wonderful language for playing with words. Here’s an example –

Elle me donne les larmes aux mes yeux, parce que je suis epuisee.

This is by Nina Bouraoui, a writer. Translated, it says “She brought tears to my eyes, because I was exhausted”. The other meaning of the word “epuisee” is “out of print” – for a writer that’s a really clever word to use and conveys quite a special sense of exhaustion, doesn’t it?

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The slowleadership blog has an interesting post today. It’s about management and sales methods, but in particular it’s about an obsession with what can be measured –

For over a century, many academic disciplines — including business, more recently — have had a case of “physics-envy.” They believe that only “real” data is meaningful, only particles and precision make for real “science.”

The writers make the point that relationships are more important –

Selling is not at root, despite what web-searches will tell you, about process. It is about people and relationships and trust.

Well, it’s interesting isn’t it? You could say the same about health. Health care is ultimately about people and relationships and trust – not either only, or even primarily, about what can be measured. We’ve really forgotten that though in modern health care management. There’s been an obsession with targets and not only targets but targets of what can be measured. And in the midst of all that we’ve lost sight of the fact that medicine is a caring profession. It’s about people, it’s about relationships and it’s about trust.

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This is the title of a book by Gertrude Himmelfarb. Why did I try to read it? Well, it’s subtitle is “The British, French and American Enlightenments” and the phenomenon of the Enlightenment fascinates me. I have an anthology of Scottish Enlightenment writings edited by Alexander Broadie and I enjoyed Arthur Herman’s “The Scottish Enlightenment” and Christopher Berry’s “Social Theory of the Scottish Enlightenment”. The idea of Modernity is also fascinating and I thoroughly enjoyed Stephen Toulmin’s books on that (“Cosmopolis”, and “Return to Reason”). But the other reason was that I read in a newspaper that Gordon Brown, our PM, is a big fan of Himmelfarb’s work and has this particular work on his bookshelf. I’m not sure what makes Gordon Brown tick but he strikes me as a thoughtful man and I wondered what it was about this book that he found appealing.

Well, dear reader, I failed! I gave up. Here’s why………

In the prologue she goes to great lengths to diminish the French. In particular she attacks their Enlightenment agenda of reason, and is quite, quite scathing about Diderot and les philosophes. I found that pretty irritating. OK, I thought, it’s refreshing to read such a different and skeptical view of the French Enlightenment project, but as the pages turned it felt increasingly like she just dislikes the French and French thought and culture. Well, I don’t. I enjoy French thought and culture and their philosophes, but you don’t have to agree with everything an author writes. We can all have different opinions. But then she laid into the Scots, going to great lengths to try and make the case that the Scottish Enlightenment was really just a part of the British Enlightenment (whatever that was!) and going to even greater lengths to claim that the great Scottish thinkers of that time didn’t like to be known as Scots at all but preferred to downplay their Scottishness and claim Britishness instead! (now I see why Gordon Brown likes this!). OK, so she was really losing me now, and we’re still in the Prologue! I kept going though, but didn’t feel any greater affinity with the text.

However, I finally gave up when I got to the American Enlightenment and read –

America was, however, saddled with two problems that Britain was happily spared, the Indians and slavery, both of which proved to be very nearly intractable.

Ouch! Is it just me, or is there something very uncomfortable about that sentence?

She goes on –

For economic if for no other reasons, the displacement of the Indians was the precondition for the very existence of the settlers.

and

What they did have [the settlers] in addition to a clear recognition of their own interests and needs, was a strong sense of their superiority, as human beings, as Christians, and as citizens. “Savages”, in popular parlance, was almost synonymous with Indians….

Is she just unemotionally describing how things were in those days? Or is this a justification for these attitudes?

The problem of slavery was even more formidable than that of the Indians

There was a widespread and deeply held conviction of the ineradicable differences of the races and the inferiority of the blacks.

Now I don’t know if it’s just her style to write in this matter of fact way, but I found this whole section deeply disturbing. And I don’t get it either…..this is a description of some kind of “Enlightenment”? Some kind of “politics of liberty”?

However, I did find her very neat summary of the British, French and American Enlightenments very appealing –

The sociology of virtue, the ideology of reason, the politics of liberty – the ideas still resonate today.

I like that little phrase. I just don’t like this book. I didn’t finish it.

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shape and colour, originally uploaded by bobsee.

Ester once told me that her eye notices lines and shapes and until she said that I hadn’t considered the possibility. Instead I tend to notice colour.
When I saw this staircase in Nice I thought of you, Ester.

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