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Archive for January, 2008

It’s Burns Night. Robert Burns. Another of my local heroes. Well, not  Stirling man, but a Scot.

I think it’s good to have at least one poet as a hero!

Robert Burns

Here’s a voice thread of me reading Burns.

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Blogger’s Code of Conduct

Science bloggers meeting at the North Carolina Science Blogging Conference have been debating the need for a code of conduct. You may have come across some pretty offensive and aggressive commenting from science bloggers – I know I have! (See my Commenting Policy bottom right). I think it’s a great idea. O’Reilly and others have developed a blogger’s code of conduct.

Here’s the first draft –

We celebrate the blogosphere because it embraces frank and open conversation. But frankness does not have to mean lack of civility. We present this Blogger Code of Conduct in hopes that it helps create a culture that encourages both personal expression and constructive conversation.

1. We take responsibility for our own words and for the comments we allow on our blog.

We are committed to the “Civility Enforced” standard: we will not post unacceptable content, and we’ll delete comments that contain it.

We define unacceptable content as anything included or linked to that:
– is being used to abuse, harass, stalk, or threaten others
– is libelous, knowingly false, ad-hominem, or misrepresents another person,
– infringes upon a copyright or trademark
– violates an obligation of confidentiality
– violates the privacy of others

We define and determine what is “unacceptable content” on a case-by-case basis, and our definitions are not limited to this list. If we delete a comment or link, we will say so and explain why. [We reserve the right to change these standards at any time with no notice.]

2. We won’t say anything online that we wouldn’t say in person.

3. We connect privately before we respond publicly.

When we encounter conflicts and misrepresentation in the blogosphere, we make every effort to talk privately and directly to the person(s) involved–or find an intermediary who can do so–before we publish any posts or comments about the issue.

4. When we believe someone is unfairly attacking another, we take action.

When someone who is publishing comments or blog postings that are offensive, we’ll tell them so (privately, if possible–see above) and ask them to publicly make amends.
If those published comments could be construed as a threat, and the perpetrator doesn’t withdraw them and apologize, we will cooperate with law enforcement to protect the target of the threat.

5. We do not allow anonymous comments.

We require commenters to supply a valid email address before they can post, though we allow commenters to identify themselves with an alias, rather than their real name.

6. We ignore the trolls.

We prefer not to respond to nasty comments about us or our blog, as long as they don’t veer into abuse or libel. We believe that feeding the trolls only encourages them–“Never wrestle with a pig. You both get dirty, but the pig likes it.” Ignoring public attacks is often the best way to contain them.

What do you think? Anything in that draft you wouldn’t agree with?

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This rather technical study has suggested one of the reasons why drugs work better in some people than they do in others is down to the rest of that person’s life.

We’ve known for a long time that most drugs don’t do what they are designed to do for many of the people who take them. This is not just drugs like painkillers which are trying to modify a subjective experience, but even drugs whose effects are mainly objective right down at cell level, like anti-cancer drugs.

Some researchers are pursuing a genetic explanation for this and a whole new area known as pharmacogenomics has arisen with the hope of combining genetic testing with prescribing so that a particular drug can be chosen in the light of the patient’s genetic make-up which may make them more responsive to the drug in question.

This study is interesting because it looks to an environmental explanation instead and shows that diet and lifestyle strongly influence the effects of particular drugs.

As always, we’ll find that both explanations are partly right and partly wrong. The trick will be to understand how to use these discoveries in the best interests of patients.

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The Biopsychosocial approach to health is thirty years old this month. The what? Yeah, I bet it doesn’t mean much to you, does it? And that’s pretty amazing really. It shows how tenaciously orthodoxy clings to its old models. The dominant model in Western Medicine is the “biomedical” one, which seeks a biomolecular explanation for all illness. This is a materialistic and a reductionist understanding of illness. In fact, proponents deny the very reality of any illness which cannot be explained by molecular, physical changes in a body.

Thirty years ago, George Engel proposed the term “biopsychosocial” as an alternative mode of understanding. Essentially this approach considered that “the study of every disease must include the individual, his/her body and his/her surrounding environment as essential components of the total system.” It situated the individual in the inextricable contexts of his or her life. It proposed that the way to understand illness required a holistic understanding of a person, with every single person being different and unique. It was an argument against reductionism and for insights gained from understandings of the links and influences which exist within our living networks. More than that, it opened the door for psychosomatic medicine – the joining back together of the body and the mind, for so long considered as separate, almost vaguely related entities. There’s an awful lot of illness which is not explainable from a disease focussed approach. We can’t really reduce individual illness experience to a set of physical entities or lesions. And the other side of the coin is that Engel’s approach demanded a holistic understanding of health. From this perspective health is so much more than the mere absence of disease.

So why hasn’t it become the dominant model? And why do we still consider most illnesses as physical entities which we call diseases which can be treated with surgery to remove the lesions and drugs to fight the disorder?

Well, Engel himself gave us the explanation in advance. He said

… nothing will change unless or until those who control resources have the wisdom to venture off the beaten path of exclusive reliance on biomedicine as the only approach to health care

Those who control the resources still like to consider the world as made up of physical, separate objects; still think of disease as an entity to be fought and expelled. We have a better scientific explanation now but it’s still a long way from being the dominant model.

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David Corfield posted about an interesting study of the placebo effect. It describes a piece of research into the power of language to effect physical change. Hotel maids burn up a lot of calories through the very nature of their work which is physical from start to finish. But interestingly most of them reckon they do no exercise and their body size and shape isn’t much different from the average woman. The researchers took a group of hotel maids and divided them into two sub-groups, one of which received information in an interview about how many calories they were using up in their different chores. The other sub-group received no information. They found that all the maids’ body fat, waist-to-hip ratio, blood pressure, weight and body mass index measurements were consistent with their perceived level of exercise. One month later they found that in the educated group there was a decrease in their systolic blood pressure, weight, and waist-to-hip ratio — and a 10 percent drop in blood pressure. Observations by the team hadn’t shown any changes in the maids’ routines or physical exercise. So it was changing the state of mind which changed the state of the body.

In the report of this study, the writers find a critic who says that such a placebo effect cannot effect a physical change as placebo can only effect subjective changes. That’s such nonsense! And the article concludes with a great example of asthmatics being given a drug which would make their asthma worse, but being told it would make it better. They not only claimed their asthma was better but the objective lung function readings improved.

Words were originally magic

— Sigmund Freud

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I just came across a paper about “Post-traumatic Embitterment Disorder”. Apparently “embitterment” is a new term in psychological classification and this study aims to demonstrate that by using new questionnaires (what psychologists call “scales” to introduce a sense of measurability to what is a purely subjective phenomenon) they can show  “Post-traumatic Embitterment Disorder” is a “sub-type of adjustment disorders”. What they are trying to show is that some people who are so severely psychologically injured by a life event that they become “impaired” by it exhibit more bitterness about their experience than others do and the claim is that this constitutes a definable category of disorder.

I am so in two minds about this.

Here’s the positive side. I think everyone tries to make sense of their lives. It’s what we do. We want to understand our experience, to make some sense of it, and, unless we do that, it’s hard to be an effective “agent” of your own life. In other words, first we need to understand a situation, then we can make some choices to engage with it differently and so develop our own particular paths forward. If we can’t do that for ourselves, we need to get the help of others. Those others might be friends or loved ones, or might be other people in the community who have different skills and who might be able to help. One of those groups of people in the community is the professional health carers – a doctor, a nurse, a psychologist or a counsellor for example. If you take your story to one of these people, they’ll try to interpret it from a medical perspective.  A doctor, for example, is skilled at making a diagnosis – finding out whether or not you have a disease. But, diagnosis is about more than naming a disease. It’s a kind of understanding. It’s a kind of making sense of a patient’s experience. Without a diagnosis, a doctor can’t treat you effectively. So, if this new “diagnosis” helps some people to be better understood, then it’s useful.

Here’s the downside. First of all, a diagnosis declares an experience as a disease or illness. It’s not a healthy experience. Once the experience becomes classified as a disease or illness, then the way to change it, the way to provide help becomes one of treatment. Treatment of psychological illnesses tend to involve either prescribing a drug, or undertaking a talking therapy of some kind. A talking therapy which releases someone from a stuck way of thinking and therefore helps them understand their situation can well help that person to make different choices and so have a different experience. A drug solution makes sense if you can explain the experience materially – by showing some imbalance of chemicals in the brain for example – in such a situation a drug can be part of a solution too. It can help a person to find new ways of thinking by changing the way the brain functions. But when you take every experience of life and try to classify it and declare some of it as disorder or disease then you risk medicalising life and you risk reducing human experience to chemical imbalances which can be addressed with drugs. I don’t find that either life-enhancing, or a personally empowering way to live.

Bitterness? Is this a medical disorder? Is this a disease to be treated? Or is it part of an experience which needs to be understood in order to release someone from a stuck place? If someone is bitter, they are usually stuck. And without help they can find it hard to see things differently. So bitterness needs to be addressed, but do I need something like the “Bern Embitterment Scale” to be able to see this?

What do you think?

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herd of elephants
I’ve been to game reserves in South Africa a few times. I tell you, until you’ve been yourself, you’ve no idea how difficult it is to spot an elephant or a giraffe! Seriously! Huge big animals but in their natural habitat, really they’re not easy to spot. What gives them away? Movement. As you scan the bush, or a plain, or a hillside, the first thing which will catch your eye is a movement. If they stay stock still, they might be only yards away but you won’t see them till the last minute.
traffic jam of elephants
giraffe parent and child
zebra
rhino
tiny deer

Many animals are good at detecting scent change. The slightest whiff of a predator, or a human being, arriving on the scene and they pick it up.

Another example of how we give priority to change detection is noise. I’m sure you’ll have had the experience of a background noise suddenly stopping and it’s only at that moment when it ceases that you become aware it was even there. You notice it when it goes away, not when it stays the same.

Change impacts on us. It catches our attention. A recent study has examined this phenomenon and interestingly shows that we are much better at detecting auditory changes than visual ones. I’m not sure that holds true for everyone. One of the things that NLP teaches is how we have different processing preferences – by that they mean that some of us are especially good at processing visual information, others auditory, and yet others, kinesthetic. From what I can see the researchers who produced this study didn’t make any allowances for that.

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