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Archive for January, 2011

ice

What I love about something like this, is that if you dismiss it as "just ice", then you miss what's amazing about it. Look closely and you'll see patterns and configurations you've never seen before. In fact, this particular, specific spread of ice crystals will be unique. You will never see exactly this array of crystals of these specific sizes and angles ever again. Even though the ice begins to form out of "just water", it is impossible for anyone to predict which crystals will grow to which size and in which particular places. Isn't that amazing? Something as commonplace as water turning to ice is unpredictable in its detailed outcome. Imagine how much more difficult it is to know the future for something as complex as a whole human being……

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Iona Heath writing in the Public Library of Health Medicine journal nails the issue of disease mongering.

There are a number of issues to consider in relation to the problem of disease mongering. She particularly focuses on the use of pharmaceuticals for preventitive medicine reasons.

The first step has to be a genuine disentanglement of the medical profession from the pharmaceutical industry—there really is no such thing as a free lunch

Sadly, there is an enormous, unhealthy, amount of pharmaceutical industry influence on not only individual doctors, but on regulatory bodies, governments and the publication of so-called evidence on which policies and protocols are based. Until we tackle this influence, disease mongering will continue to grow apace.

Beyond this, there is a need for better science that has the integrity to demand more explicit acknowledgment of the limits of medical knowledge, less extrapolation beyond research findings, and much more responsible use of statistics, so that the true extent of the benefits and harms of proposed treatments can be properly understood.

There’s a terrible tendency these days for people to claim knowledge which enables them to make predictions about treatments with certainty. Human life is not certain, and, as human beings can be considered as complex adaptive systems, it is impossible to predict outcomes in detail in any individual case. Research trials and statistics are not the whole truth, and they never will be.

Most variables are distributed across a continuum, but despite this, the medical tradition has been to dichotomise the continuum into normal and abnormal

It is irrational to divide human phenomena into two discreet categories – normal and abnormal. It isn’t scientific to do that, and it certainly isn’t realistic. There is no such thing as some drugs which work and others which don’t. No drug has the same effects on everyone who takes it.

When doctors treat patients with diseases, progress can be assessed and the outcome is measurable. This means that if the patient responds to treatment, it can be continued; if not, the treatment can be stopped. When doctors treat people who are merely at risk of disease, the outcome is probabilistic, so whether disease is prevented or was never going to develop, the treatment continues indefinitely

I’m not sure it’s always so clear that a patient has responded to treatment, or at least, responded sufficiently to treatment. After all, who is to judge the “sufficiently”. However, I do agree with Dr Heath’s point that if you prescribe drugs to reduce risks you can never stop prescribing them. You are condemning those “at risk” to a lifetime of treatment as if they had a disease.

Part of the rationale for expenditure on the treatment of health risks is that it will reduce health costs in the long run, but such arguments do not stand up to close scrutiny. The costs of health care are highest during the year before death, regardless of the age at which death occurs. Everyone must die and be cared for while dying, and no amount of preventive pharmaceuticals can reduce the cost of providing this crucial end-of-life care

You don’t make people healthier by prescribing drugs, and you never achieve immortality. We all die, and the last year of life is the year we receive most health care.

Dr Heath’s final sentence is this –

Ultimately, the only way of combating disease mongering is to value the manner of our living above the timing of our dying.

Couldn’t put it better. We need to focus on health more than disease, and on living, more than dying.

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Yesterday was the annual celebration of the birth of Robert Burns. As a Scot I’m pretty familiar with some of his poems but last night the last verse of one his most famous poems suddenly struck me.

In his “To a Mouse”, the last verse reads…

Still thou are blest, compar’d wi’ me

The present only toucheth thee:

But, Och! I backward cast my e’e

On prospects drear!

An’ forward, tho’ I canna see

I guess an’ fear!

Burns wrote this poem in response to accidently destroying a mouse’s nest whilst ploughing a field. In this last verse he recognises the difference between human beings and other creatures in terms of mental processes. The mouse can only focus on the present. It deals with life in the here and now. Human beings on the other hand have the continuous tendency to think back to the past, reflecting on hardships, hurts and grievances, or to cast their minds forward into the imaginary future where they worry about all sorts of things that might befall them.

This isn’t a new idea of course, and Tolle has reinforced the concept in his “Power of Now”, but I think this is beautiful, compassionate, wise writing. He doesn’t preach. He doesn’t advise. He just states it as it is.

Our so human tendency to hang on to the past, and frighten ourselves with imaginary futures, robs us of the capacity other creatures have to be continually present in the here and now.

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Does the sky ever look exactly the same twice? I don’t think so.
However, yesterday, it looked SO different. I’ve never seen an effect quite like this. It’s almost like seeing clouds through ripples in water….

strange sky

strange sky

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Yesterday, the frost sparkled the whole of Stirling

frosty river forth

frosty stirling castle

frosty gowan hill

frosty wallace monument

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There are a depressingly large number of stories around about the inappropriate levels of influence drug companies have over government authorities who are responsible for developing, delivering and regulating health care. Most of the ones we read relate to the US and UK, but here’s one from France.
This is the story of a drug called Mediator which is supposed to be prescribed for diabetics to help them lose weight, but seems to have been prescribed to a lot of French people over the years whether they’re diabetic or not. As far back as the 1990s reports of deaths occurring in patients taking this drug began to emerge and the problem seemed so serious that the US, Switzerland and Spain all banned it. More recent studies have suggested between 500 and 2,000 French people may have died taking this drug. The question being asked is why did it take until November 2009 for the French authorities to act on the evidence?
The company which makes Mediator is Servier which is an old French family business with longstanding connections in the French establishment.

“Servier has shown an extraordinary capacity for escaping criticism,” said Socialist deputy Gerard Bapt, a cardiologist who has taken a close interest in the scandal. “The main reason is because it has been able to infiltrate all the relevant scientific committees working on this drug.” For Irene Frachon, “the conflicts of interest are palpable… Among the medical establishment, in the pharmaceutical and cardiological communities, there are people close [to the Servier laboratories].”

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Larry Dossey has written an article about harmony and chaos. As he rightly points out the concepts of harmony, order and “coherence” are so universally accepted as characteristics of a healthy system or organism that nobody really ever considers that this way of thinking might not completely capture the reality of health.
I suppose one area where I began to realise that health isn’t all about order and coherence was when I discovered that epileptic fits arise, not when the brain dissolves into the chaos of an “electrical storm” as was previously thought, but, rather when consistent waves of co-ordinated electrical activity wipe out the normal brain function. In other words, a seizure emerges out of rigidity, not chaos.
Healthy brain activity is probably more accurately represented as edge of chaos which can tip, on the one hand, into total chaos, or, on the other, into rigidity – neither of which is healthy.
It seems that studies on aging are beginning to highlight a similar issue. Both at the level of individual organs, like the heart, and at the level of the whole organism, it seems that as we age we lose a capacity to exist in some healthy zone of near chaos. In fact as we age we stiffen, we lose flexibility and, hence both resilience and adaptability.

“Chaos in bodily functioning signals health. Periodic [regular, rhythmic, coherent] behavior can foreshadow disease. Transitions to strongly periodic dynamics are observed in many pathologies, including Parkinson’s disease (tremor), obstructive sleep apnea, sudden cardiac death, epilepsy, and fetal distress syndromes, to name but a few.”

This makes a lot of sense when you consider the characteristics of complex systems. It’s true that you need a healthy level of “integration” ie of harmonious linkage between differentiated parts. However, for a system to be adaptable it must be flexible and for it to grow it needs to develop new patterns (a biological phenomenon known as “emergence”). Emergence only occurs when a system moves towards a “far from equilibrium” point, or some kind of tipping point. There are characteristics of complex systems known as “bifurcation points” where a system may go one way or another, and of “phase transitions”, where the whole behaviour of a system might suddenly change (for example, where liquid water turns to gaseous steam).
We are complex adaptive systems. We do need an incredibly intricate complex set of checks and balances, of feedback loops, of harmony and coherence. But we also need a bit of chaos, too much regularity can mean insufficient flexibility.

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