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Archive for July, 2008

I was hoping to get here before the lavender was cropped and I just made it. Quite a few fields have been harvested already but I still found some in full bloom. What I can’t send you, unfortunately, is the smell of the lavender in the air. It gives you the sensation of the whole world having a lavender scent, and while that might sound as if it would be overwhelming, in fact, it isn’t. The scent of the growing lavender is somehow both more pervasive yet less intense than the cropped plant. Quite amazing.
I’m sure there are many parts of Provence where you can find the lavender, but I explored the area around the village of Valensole. Here’s one of the most prominent shops in the village –

valensole lavender shop

It’s a honey shop. A whole shop selling honey made by bees who live around the lavender fields. See how the lavender influences so much of life here? Not just in the colours of the fields, but influencing the colours of the paints used to decorate the shops and houses, and stimulating your nose with its scent and your taste buds through the honey.

Here’s a mural on a boarded up, disused shop –

valensole

Yes, the fields really do look like that. The lavender is grown in long rows on a very pale, sandy soil.

lavender fields

lavender fields

Some of the fields seem to stretch away forever………

lavender fields

And some have quaint ruins strategically left in the middle of the field for photographic reasons (just kidding!)

lavender fields

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Butterfly

Ever tried taking a photo of a butterfly? I can tell you, it ain’t easy! They just will NOT stay still! Here’s my best attempt so far……

butterfly

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Oh I like this!

A lot!

Very Scottish, very Glasgow. Great wall of sound music. And such great lyrics (know any other songs about social workers?) –

I`ll be at your side to console
when your standing on the window ledge
I`ll talk you back from the edge
I will turn your tide
be your shepherd and your guide
when you’re lost in the deep and darkest place around
may my words walk you home safe and sound
when you say that I’m no good and you feel like walking
I need to make sure you know that’s just the prescription talking
when your feet decide to walk you on the wayward side
up upon the stairs and down the downward slide
I will turn your tide
do all that I can to heal you inside
I`ll be the angel on your shoulder
my name is geraldine, I’m your social worker

I see you need me
I know you do

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hidden passion

See the passion flower hiding behind these leaves?

This made me think about passion. Passion must be one of the KEY ingredients of a good life I think. What makes a good teacher? Their passion. OK, you need a lot more than passion, but my argument is that those who are passionate about their teaching, passionate about their students’ learning, are the best teachers. What makes a good doctor? Passion. Passionate about his or her patients. Passionate about people, and about healing. Yes, I agree, a doctor needs a lot of knowledge and skill, but without passion for their work, they really aren’t such good doctors.
You could say this about any profession I reckon. If you are a professional and you’re not passionate about what you do, you’re in the wrong profession!
You can also say this about creative people – artists, musicians, writers and so on. Without passion for life, and for their creativity, they just don’t create such great works.
Bland isn’t good.
“Whatever….!” isn’t good.
Long live passion!

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Clinical epidemiology has been cleverly spun into something referred to as “Evidence Based Medicine” (“EBM”). It’s such a powerful spin that we are seeing the term “evidence based” being used widely now to justify any decision made by any authority – whether that be politicians, civil servants, educators or scientists. In fact, the phrase is thrown around so freely and unthinkingly that it’s quickly losing its original meaning, instead becoming a code term for “fact” or undeniable Truth. “Evidence based” is a label now which is supposed to convey that the statement to which it is attached has a high value. The idea of “evidence based” as promoted by those who use the term is founded on the belief that what constitutes “truth” is, however, almost exclusively, the physical and the measurable. Let me quote from  Maya Goldenberg, who wrote about this in Social Science and Medicine. Volume 62, Issue 11, June 2006 –

Reflecting on how the popular idea of “patient-centred care” remains largely unrealized in clinical practice, Van Weel and Knottneurus (1999) note that while physicians are encouraged to make diagnoses in physical, psychological, and social terms, “the EBM that is currently promoted either restricts itself to physical evidence alone, or casts such evidence at the top of a hierarchy that tends to devalue any evidence ‘lower down’”. The hierarchy of evidence promotes a certain scientistic accounting of the goals of medicine, which, the worry goes, is incommensurable with the proposed reorientation of medical practice toward the patient’s search for meaning in the illness experience. The bridging of scientistic “measure” and existential “meaning” has received some attention in the critical EBM literature with the general consensus that we need an “integrated” model of evidence that properly reflects modern health care’s constitution by diverse academic traditions—including the humanities, social sciences, and the pure and applied sciences—that rely on equally diverse notions of evidence. While EBM values evidence that is statistical in nature and general in its application, and therefore places quantitative data derived through the application of recognised study designs at the top of its pre-graded hierarchies of evidence, the phenomenological approaches rooted in hermeneutics, ethnography, sociology, and anthropology, regard evidence as primarily narrative, subjective, and historical in nature. Unlike the impersonal and generalisable measures undertaken in EBM, this conception of evidence is illustrated in case histories, clinical encounters, and qualitative studies such as in-depth interviews and focus groups. The features of the medical encounter and the illness experience emphasised by medical phenomenologists and proponents of a more “humane” medicine suggest the need to reconsider what constitutes the goals of medicine and flip EBM’s hierarchy of evidence on its head. The quantitative measures and generalisations that come out of controlled trials and biostatistical analysis are not conducive to the questions of meaning that medical phenomenology wants to address and make central to medicine.

Goldenberg helpfully nails down the key issues – “ While EBM values evidence that is statistical in nature and general in its application, and therefore places quantitative data derived through the application of recognised study designs at the top of its pre-graded hierarchies of evidence, the phenomenological approaches rooted in hermeneutics, ethnography, sociology, and anthropology, regard evidence as primarily narrative, subjective, and historical in nature” – The EBM approach is a statistical approach. It tells us something about probabilities, derived from studies of large, supposedly homogenous groups. It doesn’t give us certainty about either effectiveness of a treatment, or about prognosis, in any individual patient. Nor does it give us any insights into either the experience of illness, or the experience of therapeutic recovery for patients.
The use of clinical epidemiology alone in the application of health policy or therapeutic practice is neither rational nor sensible. Health and illness are experiential. Human experiences can only be conveyed by human beings. If we want a more humane form of medical practice which is a closer fit with individual reality then we need to develop our phenomenological understanding and give such research considerably greater consideration than we currently do instead of dismissing the unquantifiable as irrelevant.

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Chris Anderson of Wired magazine has published an interesting and provocative article about how “more is different”. It’s difficult to even visualise huge amounts of data, let alone analyze enormous data sets, but emerging technologies are giving us the tools to be able to interact with bigger and bigger datasets. A petabyte is 2 to the power of 50 (ie 1,125,899,906,842,624). This can be approximated to 10 to the power of 15 (1,000,000,000,000,000). Whilst this is truly a mind-bogglingly large number, Google servers process this much information every 72 minutes! But wait, it gets even more amazing! There are bigger numbers. An “exabyte” for example is 1,024 petabytes, and a “zetabyte” is 1,024 exabytes. Let’s not even go there yet! We can process such vast amounts of information by using large networks of computers and algorithms which handle the datasets as “clouds”. I like the “cloud” idea. You might already be familiar with it through the tool known as “tag clouds“. However, let’s get back to Chris Anderson’s article.

Anderson says that science has proceeded until now by making models then testing to see how well the models fit the data -“hypothesize, model, test”. This enables scientists to uncover the links between events which show us how those events come about (causation) and then make predictions about the future. This is a powerful method and has greatly increased human understanding. However,

There is now a better way. Petabytes allow us to say: “Correlation is enough.” We can stop looking for models. We can analyze the data without hypotheses about what it might show. We can throw the numbers into the biggest computing clusters the world has ever seen and let statistical algorithms find patterns where science cannot.

In other words, the ability to handle such vast amounts of information directly, allows us to uncover the correlations which exist and thereby to see patterns emerge right out of the data without pre-selecting the data with a hypothesis and a model.

Anderson has pushed this idea provocatively to claim this means the end of science as we know it and a lot of commentators have reacted to this with strong disagreement. The points made both by Anderson in his original article and by the commentators are stimulating and thought provoking.

George Dyson says

The massively-distributed collective associative memory that constitutes the “Overmind” (or Kevin’s OneComputer) is already forming associations, recognizing patterns, and making predictions—though this does not mean thinking the way we do, or on any scale that we can comprehend. The sudden flood of large data sets and the opening of entirely new scientific territory promises a return to the excitement at the birth of (modern) Science in the 17th century, when, as Newton, Boyle, Hooke, Petty, and the rest of them saw it, it was “the Business of Natural Philosophy” to find things out. What Chris Anderson is hinting at is that Science will increasingly belong to a new generation of Natural Philosophers who are not only reading Nature directly, but are beginning to read the Overmind.

This feels right to me. These new methods are not the death of science but are the beginning of scientific methods which will change the way we understand the world. Kevin Kelly says more along this line of thought

My guess is that this emerging method will be one additional tool in the evolution of the scientific method. It will not replace any current methods (sorry, no end of science!) but will compliment established theory-driven science. Let’s call this data intensive approach to problem solving Correlative Analytics. I think Chris squander a unique opportunity by titling his thesis “The End of Theory” because this is a negation, the absence of something. Rather it is the beginning of something, and this is when you have a chance to accelerate that birth by giving it a positive name. A non-negative name will also help clarify the thesis. I am suggesting Correlative Analytics rather than No Theory because I am not entirely sure that these correlative systems are model-free. I think there is an emergent, unconscious, implicit model embedded in the system that generates answers.

Maybe the contribution I’ve enjoyed most, however, is that made by Bruce Sterling, which begins this way –

I’m as impressed by the prefixes “peta” and “exa” as the next guy. I’m also inclined to think that search engines are a bigger, better deal that Artificial Intelligence (even if Artificial Intelligence had ever managed to exist outside science fiction). I also love the idea of large, cloudy, yet deep relationships between seemingly unrelated phenomena—in literature, we call those gizmos “metaphors. ” They’re great!

As is so often the case, Bruce Sterling puts his finger right on what’s interesting. He highlights the relationship between this way of viewing data sets and the way we use language. Metaphors are incredibly powerful tools. They can feel like a kind of magic, producing sudden, potentially profound insights, literally in moments. It’s exciting to think that the “petabyte age” will bring us similar tools to engage with a wide range of phenomena.

Finally, Oliver Norton brilliantly manages to make these mind-bogglingly large computations suddenly seem not so overwhelming at all by saying –

And I guess my other point is “petabytes—phwaah”. Sure, a petabyte is a big thing—but the number of ways one can ask questions far bigger. I’m no mathematician, and will happily take correction on this, but as I see it one way of understanding a kilobit is as a resource that can be exhausted—or maybe a space that can be collapsed—with 10 yes or no questions: that’s what 2 [10] is. For a kilobyte raise the number to 13. For a petabyte raise it to 53. Now in many cases 53 is a lot of questions. But in networks of thousands of genes, really not so much.

The complexities of life can seem overwhelming but I feel pretty excited by our human capacity to perceive patterns using all kinds of tools from “clouds” to “metaphors”. The drive to make sense of life, to find meaning and purpose, is a core human quality. Science, its new methods and its old ones, is one way of responding to this drive.

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Can’t remember the last time I disagreed with Iona Heath and in this week’s BMJ she’s written an article which, yet again, I fully agree with. She’s writing about the connection between respect and health.

The evidence that poverty undermines health is now overwhelming, and the task for every member of any society worthy of the name is to transform that knowledge into some form of redress. Each of the dimensions of poverty—low income, inadequate education, unemployment, poor housing, social isolation, and even the carrying of knives—have a common core, which is the attrition of hope, opportunity, dignity, and respect. All four are intimately related, and the erosion of one damages each of the others.

If we are serious about trying to improve the health of the population we need to shift our focus from a disease-driven agenda to a health-driven one and that will require us to tackle inequalities. As Dr Heath says, the link between poverty and ill health is well proven and it is totally unreasonable to expect doctors to improve the health of the population by trying to ameliorate the effects of the diseases caused by inequality.

She’s also right when she concludes –

Respect means facing the reality and the effects of inequality and injustice, both within society as a whole and within the health service, rather than believing that they can simply be managed away.

The problems of ill health cannot be managed away. The solutions don’t lie in more drugs, faster operations or “health service reform”. They lie in rediscovering that health is an individual human experience and by a focus on “hope, opportunity, dignity and respect”.

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de-chandeliered

Can you tell what this is? This table caught my eye as I wandered through the market. The scattering of the pieces on the green surface made it look like a real life version of Monet’s lilies. The sparkle was beautiful and I’d never seen something like this before.

Here’s another view

de-chanderliered

If you haven’t guessed yet, these are the crystals which are used to make chandeliers.

But here’s my question. If you’d never ever seen a chandelier before, could you imagine what one would look like from just looking at these pieces? If someone said to you “make a light from these”, would you know what to do if you hadn’t seen a completed one before? It’s a hard question to answer because we’ve all seen chandeliers before, but my point is that it’s pretty hard to imagine something whole if ALL you have is a view of some of the pieces. Let me push that just one step further. Have you ever experienced a room lit by a chandelier? Because it’s one thing to see a chandelier but it’s quite another to have the experience of a chandelier-lit room.

Here’s a photo of a chandelier I spotted in a shop window (just in case you haven’t actually seen one!)

chandelier

If that principle is correct, how much more difficult is it to imagine a person from an examination of bits of them? How can we know a human being by studying only some blood tests, or X-Rays, or even DNA? It’s not enough to study only the parts. We have to understand the whole. Following my analogy one step further, a healthy human being can only be known by studying the experience of health. Being able to describe a human being is not enough. We have to listen to their stories to understand their experience. That’s true of health and it’s also true of illness.

We are much more than the sum of our parts…….beautiful and amazing as the parts might be!

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art and life

Art imitating life. You’ve heard that before. Well, this photo doesn’t exactly show the same scene in the painting as I was witnessing across the other side of the Cours Mirabeau in Aix, but it strikes me as close enough to make me wonder…….

How do we see the world? Is it like painting? Do we construct an image of reality in our brains? And if we do, how “real” is that image? In many ways, the brain works a lot more like a painter creating a representation of what he or she sees, than it does like a camera, converting the light rays into a fixed image on film or disc. I like that. I like that the way we perceive the world involves creativity. Day by day, minute by minute, we create the reality we perceive.

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Daniel H Pink, who wrote “A Whole New Mind“, has written what he calls “America’s first business book in the Japanese comic format”. Now, I don’t know how you feel about comics, graphic novels and so on, but I know my mum really didn’t like them! She was never keen on the comics I used to look forward to every week, rather disdaining them as something inferior to “proper” books. But I liked them. And I still do. The graphic novel is whole art form in its own right and in France the “bandes dessinees” (sorry, don’t know how to get an “e acute”!) section of the bookshop is always VERY busy. I’ve picked up some utterly beautiful examples over the years. The graphic novel has developed in a very distinct way in Japan. They call it Manga. It’s this latter style which Daniel Pink has chosen for his latest book. You can actually read it online. Don’t be put off by its pitch as a business book. It’s a simple, easy to read, fun, but thought provoking self-development book.

He makes just six points, each of which is delivered to Johnny Bunko, an accountant who is bored with his job, by Diana, a sprite who appears when he breaks magical chopsticks (I know, I know, stay with me here, you have to take the genre as it is!). Here they are –

1. There is no plan (“It’s nice to believe that you can map out every step ahead of time and end up where you want. But that’s a fantasy. The world changes“)

2. Think strengths, not weaknesses (you know this one – it’s the positive psychology message)

3. It’s not about you (“the most successful people improve their own lives by improving others‘ lives”)

4. Persistence trumps talent (“practice and practice and practice some more”)

5. Make excellent mistakes (that’s a well-rehearsed one. One of the key messages of “Feel the Fear“)

6. Leave an imprint (“use your limited time here to do something that matters“)

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