Archive for June, 2011

I recently came across this summary of Victoria Satir‘s approach to health and personal growth….

The Five Freedoms – Using Our Senses—Virginia Satir
Satir keenly observed that many adults learned to deny certain senses from childhood, that is, to deny what they hear, see, taste, smell and touch/feel.
The Five Freedoms are:
The freedom to see and hear what is here, instead of what “should” be, was, or will be.
The freedom to say what you feel and think, instead of what you “should” feel and think.
The freedom to feel what you feel, instead of what you “ought” to feel.
The freedom to ask for what you want, instead of always waiting for permission.
The freedom to take risks on you own behalf, instead of choosing to be only “secure”.


Satir’s Therapeutic Beliefs and Assumptions
Satir’s therapeutic model rested on the following assumptions, that:
The major goal in life is to become own choice makers, agents and architects of our life and relationships
All human beings at heart are beings of love and intelligence who seek to grow, express their creativity, intelligence, and basic goodness; need to be validated, connect, and find own inner treasure.
We are all manifestations of the same life energy and intelligence.
Change is possible. Believe it.
We cannot change past events, only the effects they have on us today.
Appreciating and accepting the past increases our ability to manage present
The most challenging tasks in life are relational. Simultaneously, relational tasks are the only avenue for growth. All challenges in life are relational.
We have choices, disempowering and empowering ones, especially in terms of responding to stress.
All efforts to produce change need to focus on health and possibilities (not pathology).
.People connect on similarities and grow on resolving differences.
Most people choose familiarity over comfort, especially in times of stress.
No task in life is more difficult as the role of parent. Parents do the best they can do given time the resources they “see” available to them at any given time.
Next to our role as parents, no task in life is more challenging. We all have the internal resources we need to access successfully and to grow.
Parents often repeat own familiar patterns, even if dysfunctional.

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A recent paper in the BMJ has argued that we should focus on the concept of “value” when making decisions about health care and health care spending.

“Value” is a simple concept to describe: useful outcomes divided by the cost of achieving those outcomes

This paper makes a couple of interesting points – not least that “useful outcomes” must be outcomes which are useful to the patient.

Value emphasises the importance of doing whatever we do efficiently. It also highlights the importance of viewing health and disease along a continuum of prevention; of early diagnosis followed by proactive intervention in long term conditions; and of linking healthcare to social care and public health. Most of all it emphasises that what matters to patients and population is not healthcare in itself but health. Healthcare is often a means to health, but it is not the only means. This highlights the importance of establishing a quality numerator in the value equation that truly describes outcomes that matter to patients. We think that quality should encompass clinical outcomes, outcomes reported by patients, and patients’ experiences, measured along whole pathways of care.

Whilst I support this argument and particularly appreciate the emphases on patient reported outcomes and patients’ experiences (which are almost entirely neglected by RCTs based on measurement of a narrow range of biological quantities), I think there’s a crucial missing part of their proposed spectrum of “prevention; of early diagnosis followed by proactive intervention in long term conditions” – health.

If we only start by considering disease and its prevention we will be caught up in an endless pursuit of moving targets. It’s important to be able to reduce the risks of preventable diseases, and it’s also important to treat disease, acute or chronic, but we’re only going to improve the health of the population and reduce the burden of disease if we understand what “health” is, and seek to create the conditions for optimal health.

Value in health care, therefore, has to include policies and processes consciously created to support and develop health, not just to try to prevent or treat disease.

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Pharmageddon – interesting title captured on the BBC News site.

It’s been coined in relation to a veritable epidemic of addiction to prescription drugs – I’ll say that again PRESCRIPTION DRUGS.

I believe I can safely say that over 80% of the inmates in the Pike County regional detention centre are in there for something dealing with their addiction to prescription drugs,” said Dan Smoot, director of law enforcement


the average age at which users first abuse prescription pills is 11. It’s a statistic that makes him angry. “We have basically robbed our children of a childhood.” The pill crisis, which some are calling pharmageddon, is only now receiving national attention.

There are just too many drugs being prescribed. Too many, too carelessly, and too easily. Add to this the toll from Adverse Drug Reactions, and the rapidly escalating drugs bills of all health services, and isn’t it about time we came up with a radically different health care strategy? One which emphasised health and non-pharmacological interventions as much as possible and reduced drug interventions to only where really necessary?

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What’s the world like from this angle?


view from the ground

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Strangely, a letter to the Lancet from a group of scientists, and an early day motion in Parliament calling for more human-based as opposed to animal-based testing of drugs, has gone fairly unn0ticed in the news. If I hadn’t just stumbled onto Sky News yesterday, I think I’d have missed it entirely.

The call is based on some pretty disturbing statistics –

Adverse drug reactions have reached epidemic proportions and are increasing at twice the rate of prescriptions.The European Commission estimated in 2008 that adverse reactions kill 197 000 EU citizens annually, at a cost of €79 billion. The cost of new medicines is rising unsustainably, creating an ever-increasing burden on the National Health Service (NHS). Meanwhile, many increasingly prevalent diseases, such as Alzheimer’s disease, diabetes, many cancers, and stroke, remain without adequate treatments. The major reason for the rising cost of new drugs is the fact that more than 90% of them fail in clinical trials
In the UK alone it’s reckoned that it costs £2 billion a year to treat patients suffering from adverse drug reactions.
However, the problem isn’t just that drugs are likely to produce different effects in humans from other animals. RCTs aren’t the best way to demonstrate harms. In fact, most harms from drugs don’t become apparent until they are actually used in large numbers of human beings (think if Thalidomide for one such memorable example).
Even if we could filter out drugs which cause a lot of harm, we still need to find ways to prescribe less drugs. As Ray Moynihan pointed out in last week’s BMJ, the evidence base for drugs is terribly corrupted by drug company funded research and publications –
In our collective zeal to summarise, we have too often ignored the fact that a vast and growing proportion of those original studies are industry sponsored, which means that they tend to exaggerate benefits and play down harms. Summarising that bias doesn’t make it go away. Medicine’s prized evidence base has become debased.
Maybe it’s time we worked harder to return to “first do no harm”.

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I always look forward to reading John Berger, ever since his classic four part documentary and book, entitled Ways of Seeing (see them all here)

I love his description of story where he looks up at the stars and sees story as the creation of the invisible lines which turn stars into constellations and how those constellations and their stories then influence the way we live (even at a simple level of navigation), and his other, related telling of how story joins up the steps we take to create a path, or a journey. Those ideas and descriptions have become such a part of how I see the world that, probably, I now realise, he didn’t exactly say either of those things, but the essence of his ideas has embedded itself in my psyche and the details now are more more personally mine.

His latest book is Bento’s Sketchbook (ISBN 978-1-84467-684-2) and I’ve had it on Amazon pre-order since I first became aware of it. It’s one of those books where you take it out of its cardboard packaging and immediately, I mean immediately, begin to read it. I took it everywhere with me, reading it on trains, in cafes, at work and in my house. I loved it. Completely loved it.

The book is based around the story that Spinoza, the philosopher carried around and drew in a sketchbook, but the actual book has never been found. John Berger decided, on receiving a blank sketchbook one day, to create the book Spinoza might have created. He does this by influencing the way he sees the world by bringing Spinoza’s writings to the front of his mind….in other words, he sort of puts himself into Spinoza’s shoes and sees the world from a Spinoza-Berger stance. (Oh, I’m not sure that really captures it!)

The book is about seeing. It’s about being aware, and really experiencing the present moment, and using drawing as a tool to enable that. This book completely inspires me to try to draw. I’ve had that thought many times, but can’t get the old school teacher’s judgement that I had “no artistic ability” out of my head. Time to banish that after all these years, I reckon. After all, what do you think? Don’t you think my photos show at least some artistic ability??

I normally include a few quotes from books I’ve loved but I’m not going to do that here. I don’t want to reduce it to quotes. This book is an experience and one which can’t be felt without seeing John Berger’s own sketches which heavily illustrate the words.

I can’t recommend this book highly enough. It is an inspiration and a call to wake up……go on, become a hero, not a zombie! (my words, not his!)

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I love it when light scatters into its multitude of colours….

the colours of light

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June, being the month of the longest day, and most hours of sunlight, is a good month to celebrate the light. From May into the summer months, the sun performs some spectacular displays over Ben Ledi – look at these –

monday evening

monday evening

monday evening

shafts of light

I’m always reminded at this time of year of C S Lewis’ story of the blind man whose sight is restored and having heard all his life about “light” asks to see it, but everyone can only point to sources of light, or to objects illuminated by light, but not to light itself.

So, through this month of June, why not see if you can find the light….and share a photo or two with your family or friends.


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