Archive for the ‘education’ Category

Just below the long bridge from the mainland to Ile d’Oleron, at low tide, you can see lots of people out gathering seafood, digging up the shells from the mud. I like this photo I took of them one day. I like the blue colour of the scene and the way people are scattered across the beach. I imagine they almost look like notes on a musical stave.

There’s a growing understanding of human beings, human behaviour and character which comes from taking an evolutionary approach. I think that sometimes it’s a bit overdone, but there are significant insights to be gained by taking this perspective.

For example, one way to understand the brain is to use the “triune” model – the idea that you can see three, distinct, regions or parts – the brain stem, the limbic system and the cerebral cortex. Taking an evolutionary perspective we can see that the vital life-sustaining functions of the brain stem are shared with many creatures much further back along the evolutionary tree than human beings. Then we can see the functions of social connection and the emotions which seem to be the domain of the limbic system….functions shared with other mammals. Finally, the cognitive functions of the cerebral cortex, and the development of the frontal regions in particular, are shared with higher primates. This model can help you to get a handle on brain function but it falls down when you take a too reductionist approach to it…..a common problem with a lot of neuroscience which, at worst, degenerates into a kind of phrenology. The brain is a much more complex, massively interconnected, distributed network. It can’t be so easily divided into three separate parts.

Psychologists often explain to people about the alarm function of the amygdala and how it developed to keep us safe as hunters and gatherers but that now that we live in urban environments, pretty free of daily predators, those ancient circuits have a tendency to alert us to imaginary existential threats, rather than real ones.

Last year I read “The Emotional Mind. The Affective Roots of Culture and Cognition” by Stephen Asma and Rami Gabriel which brilliantly places emotions in a central role in human behaviour by tracing the evolutionary path of affect. It wasn’t an easy read, and I was glad I’d read so much about neuroscience and evolutionary psychology before I came across it, but it really has helped me understand the emotions as “adaptive strategies”…..something I’ve explored in my book, “And not or”

As I was looking through my photo library I found this photo quite close to the one I’ve shared at the beginning of this post –

See any similarities?

Ha! Sometimes I think it helps to remind ourselves that we humans are part of Nature, not apart from Nature. We have a lot in common with all other forms of Life as we mutually strive to survive and thrive.

If remembering our hunter gatherer origins helps us to remember that, then it’s a good thing!

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I don’t deny there is a beauty in fog.

But when I looked out the window this morning and saw that the vineyard covered hillside had disappeared, the word “obscured” popped into my head.

Fog “obscures”. It prevents us from seeing the world so clearly. It draws the horizon closer, sets a nearer limit to our perception.

Well, with that in mind, I spotted an article in Wired magazine……”To fight disinformation we need to weaponise the truth

Through social media, mainstream media and mass media, we are being manipulated on a daily basis. We are bombarded with propaganda and advertising, trying to get us to think what someone else wants us to think, to buy what someone else wants us to buy, to believe what someone else wants us to believe, to vote they way someone else wants us to vote.

When I started this blog over a decade ago I chose the title “Heroes not Zombies” because I had an idea that we tend to drift through life on autopilot, but that if we wake up, become aware, and claim the authorship of our own stories, then we become the heroes of our own stories. But, of course, it’s not just that we drift along on autopilot, it’s that we allow others to sit in the driving seat.

So, here, in that Wired article, is a wake up call, but also a kind of education. The author explains how we are being manipulated.

Cybersecurity researcher Ben Nimmo describes Russia’s approach in terms of the “4Ds”: dismiss critics, distort facts, distract from other issues, dismay the audiences. And indeed Russia has been leading the way in using disinformation-based warfare against other nations. But others are now joining them.

The article is worth reading but I thought I’d summarise the 4 “Ds” here. Just so they are nice and clear. Just so that I don’t forget them.

  • DISMISS critics
  • DISTORT facts
  • DISTRACT from other issues
  • DISMAY audiences

So, as you browse through your timelines on your social media accounts today, or read the headlines on the front pages of the newspapers, or watch the news on TV, why not write these four words down on a post-it and see what the messages you are reading look like in the light of the 4Ds?

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I recently visited the Chateau de Clos Lucé in Amboise, in the Loire valley. This is where Leonardo da Vinci spent the last years of his life. He was invited to live there by François I in 1516. The king provided Leonardo with a place to live, 700 gold ecus a year, and financed his works, in turn for the pleasure of his company and daily discussions with him. Leonardo only lived three more years, dying in 1519, which is why, on this 500th anniversary year of his death, the chateau is hosting a major exhibition of his work. (As an aside I find it fascinating and inspiring that Leonardo was given free range “to dream and work” – what kind of society could we have if we funded creatives and academics to “dream and work” together, without goals, funding applications or publication demands?)

There are a number of Leonardo quotations around the chateau and the gardens. This one caught my eye –

You know that medicines when well used restore health to the sick: they will be well used when the doctor together with his understanding of their nature shall understand also what man is, what life is, and what constitution and health are. Know these well and you will know their opposites; and when this is the case you will know well how to devise a remedy.

After a lifetime career in Medicine, I’m less sure now that medicines do “restore health to the sick”. I think it’s biology which restores health. Human beings are complex adaptive systems, and all such organisms have both “self-healing” and “self-making” capacities. The best medicines stimulate those natural processes of healing. The next best support the processes. Many of the ones we use reduce symptoms, or reverse an imbalance in the body, both of which are reasonable goals and acts, but are they directly involved in restoring health to the sick? Do you think that’s just semantics? I don’t. I’d have a hope for the future that we’d develop the treatments which really do support and stimulate the natural processes of healing, and that’s what Leonardo says, in other language, at the end of that quotation – “when this is the case you will know well how to devise a remedy”.

When what’s the case?

Oh, yes, understand “what man is, what life is, and what constitution and health are”.

Ah! Well, there lies both the problem and the signposts to the solutions…..

A couple of years into my work as a General Practitioner I started to wonder what health is. Nobody taught us what health is at university, and the clinical training of a young doctor focuses on learning diagnostic and therapeutic techniques – identifying pathologies and treating disease states. I went back and looked at my Clinical Medicine textbooks. I searched the index for “health” – no entries. Nope, not one. That set me off on an exploration, looking for an understanding of what health is. The medical school textbooks were no help. Oh yes, there was that old World Health Organisation definition –

“a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

But all that really does is substitute the word “well-being” for “health”. It does suggest health is multidimensional – physical, mental and social – and it does suggest health is something positive, not just the absence of disease or infirmity. But does it really take us much further that irritating “Brexit means Brexit”?

While researching the issue of the absence of health in medical textbooks, I discovered there was a kind of parallel anomaly….biology textbooks didn’t have a definition of life. Really? Well, yes, it wasn’t uncommon to find a biology textbook without the word life appearing in the index.

So what is life?

One of the more satisfying descriptions I read was from Maturana and Varela’s, living organisms demonstrate a “self-making” capacity, which they termed “autopoiesis” and that lead me down the path of the complexity scientists and their definition of “complex adaptive systems”. I still find that a good starting place.

That leaves us with two more areas to explore, according to Leonardo. What is man? and What is a constitution? Remember he was writing 500 years ago, and we would probably now say “What is a human?”, rather than “what is man?”. Let’s leave constitution aside for just now, as it’s pretty embedded in the issues of what is a human and what is health?

What is a human being?

There have been a couple of books published recently which put this question centre stage again. Douglas Rushkoff’s “Team Human“, and Paul Mason’s “Clear Bright Future“. Both of these books are concerned about the impact of technology on human beings and on our societies. Rushkoff says –

being human is a team sport. We cannot be fully human, alone. Anything that brings us together fosters our humanity. Likewise, anything that separates us makes us less human, and less able to exercise our will.

In other words, he focuses on the innate sociability and need to act co-operatively in human beings. I’ve heard Paul Mason say at least two interesting definitions of what is a human – human beings “use energy to counter entropy” – in other words we are a creative species. And human beings are “co-operative, imaginative and linguistic” – the combination of which makes us a unique species.

All of these ideas are interesting to me. And I find it refreshing that these questions are coming to the fore now. Surely this is a timely and positive response to the mechanical, data and statistics driven reductionism which is so utterly de-humanising.

I continue to explore what it means to be human, and I find some of the more impressive answers in the works of philosophers, from the classical schools to Spinoza, Bergson and Deleuze (to name just a few!)

Of course, I could write about this for hours! Ha! Ha! But I’ll stop here and leave the possibility that these are questions you might like to pursue for yourself.

Let me summarise – because I think this is a lifetime project as well as potentially the basis for a whole curriculum –

  • What is Life?
  • What is a human being?
  • What is health?

The answers which appear from those studies could, possibly, give us the remedies of the future – the ones which actually do “restore health to the sick” – and, yes, more than that, allow us to create healthier societies filled with people who fulfil their potentials, creatively, co-operatively, and artistically…..can I even say “spiritually?”

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Look at this! I mean, just look at this! I know, it’s not one of my best, my sharpest photographs, but I was in the garden the other day and I heard this deep low buzzing sound. It wasn’t as deep as the humming-bird moths which will arrive when the buddleia bushes bloom later in the year, but it was a lot deeper than the various species of bees and wasps I usually hear in the garden. Luckily, when I turned to the sound I saw the source. This inch long jet black bee with iridescent blue wings. I quickly got my iPhone out of my pocket and did my best to snap a shot before the bee flew away. I have never seen anything quite like this. There were two or three of them buzzing around the flowers but they just never settled long enough to be able to focus a camera and take a nice close up (not yet anyway – I haven’t given up!).

I looked it up online and it seems this is a “violet carpenter bee”. Never heard of such a creature. What a thrill! What a delight! Made my day!

There’s an important lesson to learn here. I’m sure you’ll have come across “mindfulness”. It’s quite the thing these days. Mostly the term is used in relation to certain meditation practices and they are good ones. It seems that mindfulness meditation can have a lot of benefits, from easing depression and anxiety, to stimulating “neuroplasticity” (that’s the phenomenon of how the brain changes and develops itself). But even before the meditation practices were popularised Ellen Langer researched mindfulness in everyday life. She claims we can either go through life mindfully or mindlessly. Seems a clear choice, huh? How do we lead a more mindful life? Search for the new.

By new, she means what’s new to you. The trick, you see, is that every day is new. You have never lived this day before. Nobody has ever had, or ever will have, the same experience as you are going to have today. Once you are aware of that you can set out to be aware of what’s new.

Iain McGilchrist points out in “The Master and His Emissary” that our left cerebral hemisphere has a preference for what is familiar, whilst the right hemisphere thrives on curiosity – it leads us to seek out what’s new. His larger thesis is that we have become very left brain dominant in our present society and that some deliberate change of focus to the right brain might bring about a much more healthy, more integrated level of brain function.

I recently read a book by French author, Belinda Cannone, “S’émervieller”, which explores many of the ways we can bring a heightened sense of wonder and awe into our everyday lives. Bottom line is the same as Langer and McGilchrist say – seek out what’s new. And that’s exactly the experience I had the other day when this violet carpenter bee turned up amongst the garden flowers. Cannone gives various different examples of the places, times and activities which seem most likely to stimulate “l’émerveillement” (“amazement”) and the strongest one is “Nature”.

The thing is the natural world, especially the world of living forms, is constantly changing. Pretty much any time we spend in natural environments will be likely to gift us the delights of something new.

Let me just clarify what I mean by “new” in this piece. I mean it’s anything you haven’t seen before, heard before, smelled before, touched or tasted before. It’s also the newness of the present moment. You have never ever lived this present moment before, so what do you notice? Right here, right now. It’s also the encounter with anything you don’t know or don’t understand. These are the experiences which stimulate our curiosity and our drive to learn. They are the every day experiences of adventure and discovery.

From the Japanese art of forest bathing, to Richard Louv’s claim that we are suffering from “Nature-deficit disorder” which can be treated with a good dose of “Vitamin N” (Nature), to l’émerveillement, to mindfulness and neuroscience, it’s clear that one of the best ways to develop a healthier brain is to spend some time in Nature – whether that’s a forest, a beach, a park, or a garden. I recommend it.

You’ll be amazed.

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Common sense would tell you the world is made of things. We are objects surrounded by other objects. The left hemisphere of the brain is great at narrowing our focus so we can separate some of what we are looking at from its environment, and its connections. So I can stumble across this beautiful dandelion seed-head and focus the lens of my camera right onto “it”. Isn’t “it” gorgeous?

But then and object, or a thing, needs to have some kind of consistency for us to see it. I mean, look what happens a second or two later, when the wind blows –

It’s changed already! And why did it change? Because something happened. Some of the seeds blew away when the wind blew. So if I want to understand this “thing”, this “dandelion” that I’m looking at, I need to see more than what the first image can show me. I need to know that these plants we call dandelions have evolved a method of multiplying and thriving – they have created these astonishing little means of dispersal of their offspring, of their seeds. So when the wind blows, as it always does, these children of the parent plant will fly away to land somewhere else, maybe far away, maybe close by –

and then the cycle starts again with each seed germinating, pushing its roots down into the dark earth, and it’s leaves and flower up to reach the sun, and the bees and the butterflies and who knows how many other kinds of insects will come along and spread the pollen in the yellow flowers to fertilise them and produce these magnificent seed-heads again.

So this is what this object, this thing, called the dandelion does. And it’s hard to know to where to begin its story, but maybe we begin by following one single seed, blown on the wind. We don’t know which way the wind will blow, how far the seed will travel, whether or not the ground it lands on will enable it to germinate and whether or not it will be able to successfully grow into a green leafed, deep rooted, yellow flower and whether or not the insects will cross pollinate it with its neighbours, whether near or far, and produce seeds of its own.

So many unknowns.

But also, and here’s the point, so many happenings.

So many events.

So many occurrences.

This object, this thing, which we call a dandelion. Is it really reasonable to think of it as a thing? Or is it more useful to consider it as so many happenings.

That’s the point I heard the physicist, Carlo Rovelli, make in his interview with Krista Tippett, in an OnBeing podcast. Have a listen. He puts it more beautifully than I do. He says the universe isn’t made of stones, its made of kisses. (Not things, but happenings)

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Iain McGilchrist, in The Master and His Emissary, says we use our two cerebral hemispheres differently. The hemispheres, remember, control the opposite sides of the body, so the right control the left hand, and the left hemisphere control the right. It’s the same with vision where the right field of vision is the responsibility of the left hemisphere and the left field of the right hemisphere. I’m simplifying here, but you get the idea. In birds which have their eyes on the sides of their heads instead of in the front of their faces, each hemisphere controls the opposite eye but the idea is the same.

The right hemisphere supports a broad, vigilant attention. In a bird the left eye, therefore, is taking everything in to be aware of predators.

left eye

See how this duck is looking at me?

They use the left hemisphere to focus the right eye on details….for example, when picking out food.

right eye

There’s something else interesting about the field of view of interest to each hemisphere.

In we humans, the right hemisphere is more interested in what is far from us….


while the left is more interested in what is close up….



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Here’s a couple of thoughts – is the scientific method the way to be sure of things? And, is there only one scientific method?

What provoked those thoughts? An article in the Guardian citing research about jihadists

What kind of person becomes a jihadi terrorist? Specifically, what kind of educated person? The overwhelming majority of graduates recruited into Islamist terrorism studied engineering, science and medicine. Almost none are social science or arts graduates, according to research. The insight could have important implications.

Almost half (48.5%) of jihadis recruited in the Middle East and north Africa had a higher education of some sort, according to a 2007 analysis by Diego Gambetta that is cited in Immunising the Mind, a new paper published by the British Council; of these 44% had degrees in engineering. Among western-recruited jihadis that figure rose to 59%.

The author of the paper, Martin Rose, describes what he terms the “engineering mindset” which, he claims, makes science and engineering graduates more susceptible to jihadist indoctrination.

The culture of science teaching, says Rose, resolves all too easily into a right and wrong, correct and incorrect binary. This damages the ability of science and engineering students to develop the skills of critical examination.

……three specific traits that characterise the “engineering mindset”: first, it asks “why argue when there is one best solution?”; second, it asserts “if only people were rational, remedies would be simple”; and third, it appeals to those with an underlying craving for a lost order, which lies at the heart of both salafi and jihadi ideology.

It does seem that the jihadists see the world in a binary way – black and white, right and wrong etc – “That is perhaps why, in Isis-controlled territory, university courses in archaeology, fine art, law, philosophy, political science and sports have been eliminated, along with drama and the reading of novels.”

This claim that a training in science and engineering leads to seeing the world in binary ways and assertions of certainty is totally contrary to what I just read in “Sapiens” by Yuval Noah Harari. He describes a number of revolutions in human development – the agricultural revolution, the cognitive revolution and finally, the scientific revolution. Of the scientific revolution he says

The Scientific Revolution has not been a revolution of knowledge. It has been above all a revolution of ignorance. The great discovery that launched the Scientific Revolution was the discovery that humans do not know the answers to their most important questions…….modern people came to admit that they did not know the answers to some very important questions, they found it necessary to look for completely new knowledge.

This seems to suggest that scientists might be best placed to say “I don’t know”, rather than to make claims about the possession of “THE TRUTH”.

Isn’t a good scientist always unsure? Does a good scientist ever claim they have the complete, final, definitive knowledge or understanding of anything?

Well that’s what I thought about science until I oversaw a science student’s notebook one day. The scientific method described there was of “Observation; description; explanation; prediction; control”. That shocked me when I read it but suddenly a particular approach to science made sense to me. I hadn’t taken on board that the ultimate goal of science was control. I thought it was explanation – possible explanations!

But a little further on in “Sapiens” Yuval Noah Harari writes

In 1620 Francis Bacon published a scientific manifesto titled The New Instrument. In it he argued that ‘knowledge is power’. The real test of ‘knowledge’ is not whether it is true, but whether it empowers us. Scientists usually assume that no theory is 100 per cent correct. Consequently, truth is a poor test for knowledge. The real test is utility. A theory that enables us to do new things constitutes knowledge


Back to Bacon again! The sometimes claimed “father of the scientific method”. I never warmed to him with his desire to dominate Nature and human beings.

So also there are two kinds of empires, as rewards to those that resolve them. The one over nature, the other over men; for the proper and chief end of the true natural philosophy is to command and sway over natural beings; as bodies, medicines, mechanical works, and infinite other things

So maybe here’s the link – its a particular type of “scientific method” which is a quest for certainty in order to wield power.

Maybe it’s time for us to invest more in the humanities if that’s what is required to produce critical thinkers who can live with the reality of uncertainty.

Rose suggests that the British Council, the organisation funded by the UK to spread British cultural influence around the world, should involve itself in education reform, to “humanise” the teaching of scientific and technical subjects. A broader-based education would give vulnerable students the intellectual tools to develop an open-minded, interrogatory outlook – and to question authority, whether scientific, political, religious or scientific.

And maybe it’s time to promote a different scientific method – one based on wonder, curiosity, and the humble belief that we never know everything about anything.

But then, “que sais-je?”

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I graduated from Edinburgh University, with my medical degree, in 1978. The next four years were my foundational training to become a General Practitioner (I still think “Family doctor” is a nicer title).

Here’s four of the core teachings which I received.

Don’t practice “a pill for every ill”.

There was an assumption that drugs should only be prescribed if you thought they were really necessary. If you issued a prescription at the end of every consultation you weren’t practising good medicine.

Underlying this teaching was to prescribe as sparingly as possible.

If you refer your patient to a man with a knife, he’ll use it.

There were two aspects to this teaching – firstly, that you shouldn’t refer a patient to a hospital consultant unless you expected that doctor to treat the patient with their particular specialist skills. Secondly, a specialist was likely to try to treat your patient using only the particular specialist skills they had.

Underlying this teaching was to refer to secondary care as sparingly as possible.

Don’t arrange an investigation/test unless you think the results are likely to change what you otherwise propose to do.

I was taught that most diagnoses could be made on the basis of a good medical history supplemented with relevant clinical examination. Tests were only for when you couldn’t do that.

Underlying this teaching was to test as sparingly as possible.

The doctor is the drug.

This was a big one. Back in the 1980s Balint’s teaching still influenced General Practice, and Balint proposed that one of the most powerful therapies a doctor could offer was him or herself. The doctor-patient relationship was the most important part of therapy. Active listening, understanding, compassion, care and good communication were the core daily tools, employed with a sound knowledge of the natural history of diseases, the risks and harms of various potential treatments, and the ability to help patients to understand what they were experiencing, what this illness meant in their lives, and what they might do cope and to become well.

Underlying this teaching was to pay as much attention to, and to spend as much time with, each and every patient as was possible.

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I bet there’s a good chance you will look at this photo and it will touch your heart.

Looking after wee ones is SO important.

I wonder if we really honour and respect that enough?

Are our societies structured in the way which allows the wee ones to grow and thrive, to reach their full potential?

I think the solutions will lie in developing our heart intelligence, but we need our brain intelligence too.

For a data-driven, brain-focused approach, here’s a video of a presentation by Sir Harry Burns who was Scotland’s Chief Medical Officer until last year. It’s almost half an hour long, and some of it is pretty technical, but Harry Burns is expert at delivering the messages in clear, simple ways. I think the first twenty minutes or so of this presentation will startle you if you haven’t seen this kind of analysis before. The takeaway message is that the way we structure our society, in particular in the physical, emotional and social environments we create, powerfully influences the health and illness paths of individuals right from conception (or earlier?) and the first few months of life. (The last ten minutes or so of this particular presentation goes off into the “patient safety programme” – which is a different issue – in my opinion)

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In Eric Cassell’s “The Nature of Clinical Medicine”, he postulates that a key problem with Western Medicine is the focus on disease, at the expense of seeing, hearing and understanding the person who may, or may not, have the disease. At Medical School I was taught it was very bad practice to refer to “the gall bladder in bed 3” or to say “I admitted a case of pancreatitis last night”. Despite that we continue to think of disease as paramount in patient care, and we even create our health care services around the diagnosis and “management” of disease. Whole protocols of procedures are created, distributed and enforced around the concept of diseaes. Doctors and nurses are told what to do with a patient with disease X on the basis of “the best evidence”, where “the best evidence” refers to group studies which seek to “control for” individual factors – a process which prioritises the disease over the individual experience of it.

Eric Cassell enumerates “8 problems with using disease language”.

Disease names, for example, coronary heart disease or carcinoma of the breast, wrongly imply that a disease is a concrete thing (as opposed to an abstract concept) that can be found separate from the patient in whom it is found.

I read the phrase about disease being a concept, not a concrete thing, many years ago, and it had a big effect on me. Disease is exactly that – a concept. It’s a pattern of change which we name. Yet how many people, patients or health care professionals, think of a disease as being a thing? If you look at recent slogans used in health care, and in charity campaigns you’ll see the kind of thing. They are full of war metaphors about fighting this, beating that, kicking cancer’s butt, and so on. 

Disease names, for example, renal cell carcinoma or ulcerative colitis, incorrectly imply that the disease and its behavior are independent of the persons in whom they are found.

There are NO diseases which exist outside of people (or other living organisms). A disease is ALWAYS found in the context and the environment of the person who is suffering. 

Disease names, for example, lupus erythematosis or chronic obstructive pulmonary disease, mislead the unwary into believing that the name refers to one thing whose manifestations in individual patients are more alike than dissimilar. Just as the word tree refers to a class of things whose members are more alike than not, when, unless one wants to use trees or their wood, their variations are more important than their similarities.

What does every patient who attends an asthma clinic have in common? Asthma? How similar does that make them? Is this the most important fact to know about this person who is attending today? It’s individual differences, not the similarities, which are the most important.

Disease names, for example, multiple sclerosis or pneumococcal pneumonia, fool the unsuspecting into believing that what is referred to is a static entity, like the Bible, the Statue of Liberty, or the map of the New York City subways, rather than a constantly unfolding process that is never the same from moment to moment. The history of disease concepts depended on and furthered the classic separation of structure and function in which abnormal function was believed to follow from abnormalities in structure. This distinction seems to have been derived from the idea of form (which goes back to the Greeks) and its consequences that loomed large in 17th- and 18th-century medicine (King, 1978). The hard and fast distinction between structure and function itself is invalid. Structure is merely slower function, in that it changes at a lesser pace than the process called function—put in mind how bony structure changes in response to trauma or age so that it continues to perform its original function. Even the Statue of Liberty and the Parthenon are constantly changing.

As best I can understand, change is the nature of reality. There are no static entities. Even the ones which look static, are just changing more slowly, or less perceptibly. As Cassell says, “structure is merely slower function”.

Having named a disease within the patient, for example, diabetes mellitus or metastatic adenocarcinoma of the lung, physicians may be fooled into believing that they know what the matter is at this particular time and why. The disease may be the sole underlying reason why the patient is sick, but more often other factors—physical, social, or psychological (or all three)—have been crucial in the generation of the details of the illness and its losses of function (Cassell, 1979).

This is a common error. Just because an abnormal reading is found, that does not necessarily mean the explanation for the patient’s suffering has been found. For example, it has been clearly shown that there is no direct linear relationship between a lesion and the pain a patient is experiencing. Pain can change irrespective of the findings in the MRI scanner.

Disease names, for example, amyotrophic lateral sclerosis and psoriasis, inadvertently cause physicians to fall back on definitions of disease that are now accepted as outmoded because they fail to provide an adequate basis for treating the sick.

Disease names can, and do, change as we develop our understanding.

Using disease nomenclature to describe human sickness encourages the belief that only research into (molecular) mechanisms of diseases holds promise for understanding and treating human sickness.

You’ve probably encountered one of the ways in which “patient centred” is being used – pharmacogenomics. The idea that as long as we find not just the genetic code associated with a particular disease, but the genetic codes which seem to indicate responsiveness to certain drugs, then all we need is the genetic code. This isn’t to say that molecular or genetic research is not of value. It’s just not enough.

Finally, focusing on naming the disease takes attention away from the sick person.

Ultimately, this is Eric Cassell’s main message, and if only we made this the foundation principle of health care then we might have better medical education, more useful research, more effective treatments, and even health care organisations constructed around people, not diseases and drugs.

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