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Archive for May, 2009

Can we have confidence in bankers? Can we have confidence in politicians? We have a wee phrase in Scots “A hae ma doots” (“I have my doubts”). Well in the middle of this breakdown of trust and confidence in our economic and political institutions, along comes a piece of research from Edinburgh University which has performed a meta-analysis of surveys and studies into fraud and malpractice by scientific researchers. Here’s the conclusion –

On average, across the surveys, around 2% of scientists admitted they had “fabricated” (made up), “falsified” or “altered” data to “improve the outcome” at least once, and up to 34% admitted to other questionable research practices including “failing to present data that contradict one’s own previous research” and “dropping observations or data points from analyses based on a gut feeling that they were inaccurate.” In surveys that asked about the behaviour of colleagues, 14% knew someone who had fabricated, falsified or altered data, and up to 72% knew someone who had committed other questionable research practices.

As the author points out, everything we know about scientific fraud tells us that it is grossly under-reported. These figures are pretty certain to be underestimates. To what extent, we don’t know. But even as they are, they are worrying. Scientists make great claims for themselves as the discoverers of “The Truth”. I’m always wary of people who claim only what they know or believe is true. However, let’s accept the hypothesis that the scientific method is THE best method for uncovering the truth about reality. The trouble is, there’s no such thing as “the scientific method”, there’s only what “scientists” do, and scientists, surprise, surprise, turn out to be as human as the rest of us. This study is of deliberate, conscious, admitted knowledge of fraudulent or questionable practice. The rates found, even if accepted as accurate (which would be foolish), are worrying. Add to that all the actions which are unintentional, unconscious and/or kept secret and what does that make you think? Can we trust scientists to be the beacons who show us the Truth, the whole Truth and nothing but the Truth?

One particular phrase certain struck me – “In both kinds of surveys, misconduct was reported most frequently by medical and pharmacological researchers.” – is that because these particular researchers are more honest than others, admitting their behaviour more? Or is it because such practice is more frequently found in medical and pharmacological research than it is in other areas?

“Evidence Based Medicine” (EBM), is undermined by the “evidence” produced by these researchers.

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Yesterday the BBC site posted an item about a patient’s experience of having MS. It was entitled “Living with a hidden illness”

This patient, Alison Potts, says this –

The boldest outward evidence of the disease appears in my MRI scans, but no one sees those. Together they tell the story of the last 15 years, each one showing an increasing forest of lesions in my nervous system – tiny white pin pricks running up and down my spine, like the mangled sheath of a damaged electric cable interrupting the flow of nerve signals around the body. They are the roadblocks on the map of my life. The kind of MS I have does not cause paralysis or hinder my mobility. On bad days I do have problems with balance and dizziness and numbness in my hands and feet. I have difficulty doing up the buttons on my five year olds clothes and everything falls through my hands. Crockery and glassware never last long in our house. My main symptoms are hidden. The most prevalent one is fatigue. I rarely wake in the morning feeling rested – but more like I have run a marathon with a bout of heavy flu, particularly if my sleep has been disturbed. Fatigue is not another word for tiredness. It is a total shutting down of the mind and body – a barrier comes down past which you cannot move on. It puts everything I plan to do under threat.

I think this is a great piece of writing. She makes it very clear that for her (as it also is for many patients with MS) it’s invisible symptoms which cause the greatest problem – dizziness, numbness, clumsiness and fatigue, in her case. As she says, the “boldest” evidence for her disease is in the MRI scans and nobody can see them (apart from the radiologist of course!). I’ve posted before about the dubious and non-linear relationship between scans and symptoms.

How do we address a patient who has these problems? A patient whose problems are “invisible“? At least in Alison’s case there are lesions which can be revealed by technology – the “tiny white pin pricks running up and down my spine” – and this will be her ticket to being taken seriously. Sadly, countless patients present to their doctors with equally disturbing and problematic symptoms, but in the absence of “lesions” they are dismissed as “the worried well”, or the problem somehow being a psychological one. I believe this is naive. Don’t we often see a disorder of the system? of the person? (of the “complex adaptive system“?) Such problems maybe only can be known through the patients’ narratives.

If Alison didn’t tell her story nobody would have any idea what she is experiencing. Don’t we need to acknowledge that in health care, and accept that health cannot be reduced to a simple materialistic “objective” phenomenon?

I think this little example is a great one and makes a clear case for the importance of addressing the phenomena of illness rather than the lesions of disease.

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I caught this tiny snippet of an interview with Brian Eno on BBC Radio 4 this morning.

eno (click his name!)

The subject of the piece was his curating of the Luminous festival at Sydney Opera House.

Here is Eno arguing that not only do we need imagination more than ever now that we have hit these crises in the world, but the faculty of imagination is the faculty which separates us from all the other animals.

I agree. We need to use our imaginations if we are to come up with new, different ways to make the world a better place.

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I’ve been thinking a lot recently about how everything is connected. Amy wrote a post about the relationship between Deleuze and Guatarri’s rhizomatics and social networking today (we’re often in tune that way!) I’m also reading Michael Frayn’s “The Human Touch” which wonderfully explores our embedded, connected existence, the centrality of our subjective perspective, and our active participation in the creation of the world we experience. The chapter I just read was entitled “Why the marmalade?”, a crystal clear examination of how we attempt to explain events (all explanations are partial, developing, multiple). This is the same ground of thought I’m also reading in an ancient two volume set of Alexander’s “Space, Time and Deity” which I just got through abebooks, having read about his work in Michael Ward’s “Planet Narnia” where he described how C S Lewis took on board Alexander’s idea about two kinds of experience – enjoyed and contemplated.

Well, I could go on….see how once you start to a pull at a thread you find it’s connected to everything else?

Here are some bridges and paths which caught my eye recently……

Heian Jingu Kyoto

Heian Jingu Kyoto

Kyoto

tokyo bay

Heian Jingu Kyoto

Fushimi Inari

Heian Jingu Kyoto

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It strikes me that in Japanese culture there is a great and sensitive understanding of the life, or the spirit, of stone. I was struck by that as I wandered through a couple of Japanese gardens recently. You just don’t see rocks like these in UK gardens, and there’s something about them which makes you SEE them when you might never have been used to seeing rocks before. Take a look at these examples and see if they change the way you notice stone over the next few days.

stone in the garden

stone in the garden

stone in the garden

stone in the garden

stone in the garden

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I am a great fan of Japanese gardens. They have a design aesthetic which is quite different from the one which is the basis of most UK gardens. One of the elements I especially enjoy is their use of water. There is something amazingly calming about reflecting on the reflections……

Heian Jingu Shrine reflections Kyoto

Heian Jingu Shrine reflections Kyoto

Heian Jingu Shrine reflections Kyoto

Heian Jingu Shrine reflections Kyoto

Heian Jingu Shrine reflections Kyoto

Heian Jingu Shrine reflections Kyoto

Heian Jingu Shrine reflections Kyoto

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While away on a trip to Japan recently I came across a news item about Bhutan’s development of a national happiness index. I’d read about this a few years ago and thought it was interesting but maybe just a gimmick or a passing fancy. I think it was the King of Bhutan who decided that instead of measuring and reporting the “GDP” (“Gross Domestic Product”) of the country each year, it would be more useful to measure and report the “GNH” (“Gross National Happiness”). Well, apparently others, including the IMF asked the rulers of Bhutan exactly how they thought they could measure such a thing, and this has encouraged a wide-ranging and elaborate process of developing and experimenting with “tools” to measure the GNH.
They decided that happiness involved significant achievements in each of nine core dimensions of which happiness and well-being were constituted.

1.    Psychological Well-being
2.   Time Use
3.   Community Vitality
4.   Culture
5.   Health
6.   Education
7.   Environmental Diversity
8.   Living Standard
9.   Governance
Each of these domains is made up a number of indicators and you can read descriptions of each of these dimensions and their indicators here

This work is way too vast to reproduce in a blog post but I encourage you to follow the link to the Bhutan government’s site about this and have a browse. The range of questions they ask is astonishing, comprehensive and holistic. They have a distinct cultural flavour which is appropriate to Bhutan but the general principles are certainly transferrable to other cultures. What fascinates me is the emphasis given by the this approach on the subjective experiences of the population. It seems a serious attempt to put the sum of personal experience above the sum of material goods and wealth.

When I returned home, I stumbled on the “New Economics Foundation”  who have produced an interesting report entitled “National Accounts of Well-being” which compares quality of life indices across 22 European countries. This work covers some similar domains to the Bhutan work, but it reads almost like a subset of that latter project. In particular they consider Personal well-being, Social well-being and Work well-being. Social well-being is split into Supportive relationships and Trust and belonging, whilst Personal well-being is split into Emotional well-being, Satisfying life, Vitality, Resilience and self-esteem, and Positive functioning (each of which are further subdivided)
The results of this European work can be explored in a fascinating interactive website here

I find both of these projects fascinating. They demonstrate serious attempts to value human experience over that of indicators of material production and consumption. What do you think?

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