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Archive for 2012

Out of your head…and into your other brain

Posted in from the consulting room, health, tagged , , on December 21, 2012| Leave a Comment »

Your other brain?

You probably imagine that you do all your mental work – perceiving, analysing, thinking, feeling and so on – with your brain – that organ inside your skull. However, we’ve known for some time that there are networks of neurones around the hollow organs of the body, especially around the heart and the intestines. We’ve also discovered “neurotransmitters” originating from those parts of the body. So, at very least, we are aware that there are two way connections between the heart and the brain, and the gut and the brain.

A recent article in New Scientist magazine described the network around the gut and named it the “Enteric Nervous System” (ENS). There are around 500,000 neurones around the gut (where there are about 85 billion in the brain). Most surprisingly, alongside the 40 or so neurotransmitters in this network, two chemicals known to affect mood and mental functions, dopamine and serotonin, are also present. In fact, it is now thought that 50% of all dopamine is produced in the brain, and 50% in the ENS. Only 5% of serotonin is produced by the brain, and 95% of it in the ENS. This is quite astonishing when you consider the roles these hormones can play in our behaviour.

The other fascinating fact the author of the New Scientist article highlights is the presence of Lewy bodies in the ENS (these are the pathological lesions seen in the brains of patients with Parkinsons Disease), and patients with Alzheimer’s have characteristic lesions on both their brain and ENS neurones. Do those “neurological” diseases begin in the brain, or in the gut?

It’s good to see scientists discovering how interlinked our bodily systems are, and how difficult it is to reduce a person to parts – even the two parts of Mind and Body. Are those parts really such separate parts of they are so connected and inter-related?

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The National Drug Service

Posted in from the consulting room, health on December 17, 2012| 1 Comment »

An ad on STV caught my eye the other day. It was a public service ad from NHS Scotland and was exhorting people to be prepared for the Christmas and New Year holidays as their GP surgeries would be closed Tuesday and Wednesday on each of the next two weeks. So, “don’t run out of your repeat prescriptions”!

And I thought, this is the big idea in health care? Make sure patients realise their doctors won’t be working for two days in a row so DON’T RUN OUT OF YOUR DRUGS.

I thought I’d pop across and see what NHS24 were saying. They have a whole section called “Be Ready for Winter”. It’s got three pieces of advice –

1. Restock your medicine cabinet

2. Order repeat prescriptions

3. Note when your GP’s surgery closes

Then, on Friday, I read an article in New Scientist, entitled “A humane solution” which was advocating more human drug trials instead of animal ones, as the animal ones don’t show the potential problems when drugs are taken by humans. But here’s the bit in the article that whacked me between the eyes….the first sentence….

Adverse drug reactions are a major cause of death, killing 197,000 people annually in the European Union and upwards of 100,000 in the US

Why do we tolerate this?

How did a “Health Service” become a “Drug Service”?

 

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eye of the web

Posted in from the dark room, photography on December 9, 2012| 2 Comments »

DSC_0445

Everything we see is influenced by what’s already in our memories and our imagination……what do you see here?

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dawning the mist

Posted in from the dark room, photography on December 8, 2012| Leave a Comment »

DSC_0005

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Reducing risks

Posted in Uncategorized on December 7, 2012| 2 Comments »

If you suffered from a heart attack or a stroke you’d probably be interested in trying to reduce your chances of a second one. So here is something which apparently achieves the following results –

35 per cent reduction in risk for cardiovascular death
14 per cent reduction in risk for new heart attacks
28 per cent reduction in risk for congestive heart failure
19 per cent reduction in risk for stroke

Pretty impressive huh?
So what is this wonderful treatment?

“A heart-healthy diet rich in fruits, vegetables and fish” , according to a big study conducted by researchers at McMaster University.

In the report about the study was a little passing comment – “At times, patients don’t think they need to follow a healthy diet since their medications have already lowered their blood pressure and cholesterol — that is wrong,” said Mahshid Dehghan, the study’s lead author and nutritionist at McMaster University’s Population Health Research Institute”
That is actually such an important point. How many people are suckered into the belief that as long as they take drugs they can forget about trying to live a healthier life?

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Flu

Posted in from the consulting room, health on December 6, 2012| 1 Comment »

At this time of year there are queues of patients in the GPs’ surgeries standing in line waiting for flu jabs. I routinely receive emails from my employer (the NHS) exhorting me to have the flu vaccine.
I’m not joining in.
An elderly patient told me recently she attended her GP for a routine BP check from the nurse who asked her if she had been vaccinated for the flu yet. She said no, and as last year she had felt unwell for a few days afterwards, she said she would come back for it after a planned weekend break. The nurse said, nonsense, the flu jag doesn’t make you feel unwell, picked up a syringe in injected it into the patient’s arm. She was furious, and said she wasn’t well enough to enjoy her weekend away afterwards. I’m sorry, but this is no way to deliver health care.
Here’s where the story gets worse.
The Center for Infectious Disease Research and Policy in Minnesota has reviewed the evidence for the claims made about flu vaccination. What did they find?
Based on a comprehensive review of data published from 1967 to 2012, they found evidence for “consistent high-level protection is elusive,” the researchers concluded. Although vaccination was found to provide modest protection from infection in young healthy adults who rarely have complications of flu, the authors found that “evidence for protection in adults 65 years of age and older [who represent over 90% of deaths from flu] . . . is lacking.” Apparently in otherwise fit, healthy young adults flu immunisation can reduce their experience of illness by half a working day. In the elderly there is no evidence is protects them. (This study was reported in the BMJ with the headline “Belief not science is behind flu jab promotion, new report says”)
Yet, the NHS heavily pushes this immunisation.
On a related subject let’s think about Tamiflu which Roche persuaded governments around the world, including the UK, to stockpile supplies costing billions of dollars, on the basis of an evidence base which they continue to refuse to publish. In 2005, the UK agreed to buy £200 million of Tamiflu.
However, the evidence that Tamiflu would actually significantly prevent either the spread of flu, or the incidence of complications has all been based on studies carried out by Roche itself. The BMJ and the Cochrane Collaboration are leading a campaign to get Roche to release the data from their 8 out of 10 unpublished trials. In fact, the BMJ has set up a website.
When it comes to flu, the government seem prepared to promote and purchase, at huge cost, treatments with very, very sparse evidence bases.

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Global brain

Posted in from the reading room, life, science on December 2, 2012| 7 Comments »

Howard Bloom’s “Global Brain” [ISBN 0471419192] is a great and stimulating read. He describes “complex adaptive systems” as having five characteristics –

Diversity generators, conformity enforcers, inner judges, resource shifters and intergroup tournaments.

These are an interesting five characteristics to highlight (there are, of course, other characteristics of “complex adaptive systems”) and Bloom takes his time to describe in gripping and convincing detail how each of these characteristics has contributed to the evolution of life on this planet.

You could read this book as a critique of orthodox Darwinism – the selfish gene, individualised kind of Darwinism – with a very convincing case being made for group selection as a key part of the engine of evolution. He really does make a good clear case for group as opposed to individualised “survival of the fittest” evolution.

I especially like his first two characteristics – diversity generators and conformity enforcers.

All human beings create a sense of self out of the need to be an individual, to be unique, to be different, and the need to belong, to share, to connect and to fit in with others. Diversity generation creates difference, whilst conformity enforcement creates connections and rules.

Diversity generators and conformity enforcers also remind me of Thomas Berry’s lovely idea of wildness and discipline

However…….I ended up not satisfied with the relentlessly competitive theme. His other three characteristics all contribute to a series of survival of the fittest battles. I think there is truth in this but think for a moment about the human body. Our heart and our liver don’t fight each other for resources with the winner taking all. Something else happens – mutually beneficial relationships are established.

Mutually beneficial relationships are the key characteristic of integration, and integration strikes me as a key way in which Life evolves. Through increasing amounts of mutually beneficial connections, complex adaptive systems become both more complex and more adaptive.

It’s not all about competition.

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Winter moon

Posted in from the dark room, photography on December 2, 2012| 1 Comment »

The moon in the black winter sky

Full moon

now look really carefully and see the moon light the landscape ever so faintly (you might need to click through and look at the full size version of this)

November moon

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Life and death and choices

Posted in from the consulting room, from the reading room, health, life, tagged , on November 21, 2012| 2 Comments »

There was an amazing story recently in the NY Times about a Greek man living in the US. He was diagnosed with lung cancer in his mid 60s and given the prognosis of 9 months to live. He decided that instead expensive treatments and a costly funeral in the US, he would return to his native Greek island of Ikaria.

He moved back in with his parents and went to bed to be cared for by his wife and mother. But he started to feel strong enough to go out so reconnected with childhood friends and re-established his Sunday trips to church.

As the months passed he felt strong enough to do some gardening (a common activity on the island) and planted vegetables thinking he might not live to enjoy them, but he would enjoy growing them. Not only did he live to enjoy them but with his regular routines now of plenty of sleep, regular walks up the hill, spending time in the garden and in the evenings with his friends at the bar, and his weekly visits to the church he began to feel well enough to tackle the old, neglected family vineyard.

Three and a half decades on he is now 97, producing 400 gallons of wine a year from his vineyard and seems to be cancer free.

What can we learn from this inspirational story? Well, the author of the story in the NY Times concludes this –

If you pay careful attention to the way Ikarians have lived their lives, it appears that a dozen subtly powerful, mutually enhancing and pervasive factors are at work. It’s easy to get enough rest if no one else wakes up early and the village goes dead during afternoon naptime. It helps that the cheapest, most accessible foods are also the most healthful — and that your ancestors have spent centuries developing ways to make them taste good. It’s hard to get through the day in Ikaria without walking up 20 hills. You’re not likely to ever feel the existential pain of not belonging or even the simple stress of arriving late. Your community makes sure you’ll always have something to eat, but peer pressure will get you to contribute something too. You’re going to grow a garden, because that’s what your parents did, and that’s what your neighbors are doing. You’re less likely to be a victim of crime because everyone at once is a busybody and feels as if he’s being watched. At day’s end, you’ll share a cup of the seasonal herbal tea with your neighbor because that’s what he’s serving. Several glasses of wine may follow the tea, but you’ll drink them in the company of good friends. On Sunday, you’ll attend church, and you’ll fast before Orthodox feast days. Even if you’re antisocial, you’ll never be entirely alone. Your neighbors will cajole you out of your house for the village festival to eat your portion of goat meat

 

Those are probably reasonable conclusions but what inspires me most about this this story is the series of simple, pragmatic choices this man made. He didn’t set off to “beat cancer”, or to find the elusive magical cure. No, what he did was chose, moment by moment, day by day, to live. He might have died in his bed within days of returning to Ikaria. He would have had the death he chose, if that were the case. But he was not at any point focused on trying to determine the detailed outcomes.

Here is what inspires me about this story – at each stage he was focused on how he would live today and at no point did he think how to escape death.

Read the whole article here.

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Health in healthcare training

Posted in education, from the consulting room, from the reading room, health on November 20, 2012| 1 Comment »

I’ve long been bemused by the lack of reference to health in healthcare training. The standard clinical textbooks of Medicine not only have no chapters on health, books like Davidson, still a standard medical school text don’t even have an index entry for health.

Then the other day I stumbled on an old document from 1938 entitled “The Wheel of Health”, by G T Wrench MD. The content of the text is not what I want to mention today, but I’d like to share the following paragraphs from the author’s introduction.

Why was it that as students we were always presented with sick or convalescent people for our teaching and never with the ultrahealthy? Why were we only taught disease? Why was it presumed that we knew all about health in its fulness? The teaching was wholly one-sided. Moreover, the basis of our teaching upon disease was pathology, namely, the appearance of that which is dead from disease. We started from our knowledge of the dead, from which we interpreted the manifestations, slight or severe, of threatened death, which is disease. Through these various manifestations, which fattened our text-books, we approached health. By the time, however, we reached real health, like that of the keen times of public school, the studies were dropped. Their human representatives, the patients, were now well, and neither we nor our educators were any longer concerned with them. We made no studies of the healthy–only the sick.

 

1938! He could have written that today!

Does this not surprise you?

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