Feeds:
Posts
Comments

Archive for the ‘from the reading room’ Category

See this large rock just above the harbour in Biarritz? How does the sea make it to the shore when this rock is in the way?

The most obvious way is to go around it.

And that’s what most of the water does. It makes it way towards the shore, and back out to sea again by breaking against the rock and flowing around each side of it.

That’s one way to deal with an obstacle, with something standing in your way…..find a way around it.

But, wait, look at this…..

…the water has found another way as well.

It goes THROUGH the rock!

I suspect this has taken a very, very long time for wave after wave to make its way through a small crack in the rock, widening the gap slightly every time it passes through. But look at it now. Sometimes when a more substantial wave hits the far side of the rock it flows directly through the gap. Doesn’t happen every time. Just when the waves are big enough.

So, there’s the other solution. Keep going. Keep pushing up against the obstacle, looking for a gap, an opportunity, a way through, and once you find it, come back again and again. Each time, it’ll get easier. Each time the gap will get wider, the way will become broader.

Something else…..this is just beautiful to watch. Mesmerising even. Over the course of a few minutes you can see how the rock and the sea sculpt each other. It’s a delightful relationship.

Oh, and something else……Michel Serres, a French philosopher who died recently, used to describe human beings as “anticipation creatures”. I recently listened to an episode of one of my favourite podcasts, Onbeing, where the science journalist, Erik Vance, talked about “the drugs inside our head”. He was discussing the poorly understood but fundamentally important phenomenon known as the “placebo effect”, and one thing he said was that our brains are “prediction machines” (well, I hate the metaphor of “machine” applied to living organisms, but you get the point…).

Both Serres and Vance are talking about our incredible ability to spot patterns, so that we can predict the future. OK, not too far into the future, and not with 100% accuracy, but we don’t just notice the world, we anticipate it.

As I stood watching this phenomenon of the white surf gushing out of the mouth in the rock, I was quickly captured by the experience of anticipation, watching the swells on the surface of sea further out, trying to predict which would turn into waves big enough to pour through the rock.

It was hard to stop.

It was delightful.

Read Full Post »

Do you get those experiences where something catches your eye, then when you stop to reflect on it, its significance gets deeper and deeper?

Last week I was in Paris, and on one of the rainy days was heading for a restaurant at lunch time but this scene caught my eye. Despite the fact it was raining, I stopped and took a photo. In fact, I took two….the first time my camera slipped as I pressed the shutter and I only caught the top of the scooter!

These electric scooters are everywhere in Paris just now. You can hire one using an app and drop it off anywhere you like. In fact, that’s become a bit of a problem. People are falling over them on the pavements and sustaining injuries, so the authorities are starting to consider new regulations to control them.

I took the photo because I thought it looked funny. To see this serious gentleman either looking down at the scooter somewhat disdainfully made me smile. Then I thought maybe he’s actually thinking about jumping down onto it!

When I got home, I decided to find out who this man is – turns out he is “The Marquis de Condorcet”, a leading Enlightenment thinker and writer, a mathematician and philosopher. One of his most deeply held beliefs was “progress”. He thought we humans, through learning and communicating with each other, would steadily increase our understanding of the natural, social and political worlds, continuously progressing and improving society. “However, Condorcet stressed that for this to be a possibility man must unify regardless of race, religion, culture or gender”

The wikipedia entry on him goes on to say this –

Condorcet was concerned with individual diversity; he was opposed to proto-utilitarian theories; he considered individual independence, which he described as the characteristic liberty of the moderns, to be of central political importance; and he opposed the imposition of universal and eternal principles.

He was a champion of diversity, equality and individual freedom. But he was also a champion of thinking – that progress required us to deepen our understanding of the world and of each other, comparing and reflecting on our individual experiences. He campaigned against slavery and for women’s civil rights.

So, it took an electric scooter to get my attention, but I’m glad I’ve discovered Condorcet. I think we could learn something from him about the importance of values, diversity and justice.

Read Full Post »

In 1960, the French magazine, “L’Express” published a series of extracts from the writings of American and Russian scientists about what our world would be like in the year 2000.

It’s fascinating to read them, and reflect on how well those “scientific” predictions have worked out.

  • “voyages to the moon will be commonplace” – the last time people walked on the Moon was in 1972.
  • “and so will inhabited artificial satellites” – the International Space Station? There is one!
  • “all food will be completely synthetic” – maybe not, but an awful lot of it is “highly processed” and, apparently, not so healthy as the natural kind!
  • “The world’s population will have increased four fold but will have been stabilised.” – it doubled, but it’s still rising.
  • “Disease, as well as famine, will have been eliminated” – that old prediction! How often are we told science is about to end all disease? Was the last time the Human Genome Project? And famine? Sorry, not disappeared yet!
  • “There will be universal hygienic inspection and control” – ooh, that’s a bit scary…what’s that? Mass immunisation with a shift towards compulsory instead of voluntary? There are some life insurance products around which link your premiums to the number of steps you take daily, recorded on an wearable device which transmits the data to the insurance company.
  • “The problems of energy production will have been completely resolved” – still trying to break free from fossil fuels, nuclear power plants have turned out to be way more expensive than predicted (remember when we were promised nuclear generated electricity would be so cheap they wouldn’t have to charge for it?) and renewables have a long way to go…
  • “Knowledge will be accumulated in electronic banks and transmitted directly to the human nervous system by means of coded electronic messages” – wonder how came up with that one back in 1960? Did they foresee Google and Wikipedia? Maybe these knowledge banks don’t send their coded messages directly into our nervous systems but they do to our hand held screens.
  • “Natural reproduction will be forbidden. A stable population will be necessary, and it will consist of the highest human types, using artificial insemination from persons dead long enough that a true perspective of their lives and works, free from all personal prejudice, can be seen” – wow! This is the scariest one for me! Forced population control by preventing ALL natural pregnancies and genetically selecting on the basis of “a true perspective” of peoples’ lives and works long after they are dead! And, get this, because this is still a common one…..selected “free from all personal prejudice”. There’s a lot in this one and the foundational beliefs behind it are that “objective”, “rational” science can produce “the highest human types”.
  • “they will be able to shape and reshape at will human emotions, desires and thoughts and arrive scientifically at certain efficient pre-established collective decisions” – whoah! From the “neuro-marketing” techniques used by advertisers and merchandisers, to Cambridge Analytica, targeted, disappearing Facebook ads, Twitter bot accounts, WhatsApp groups, robot-calling targeted voters, fake news generated from edited videos….there’s a LOT going on with this one. Increasingly pyschologists and neuroscientists say influencing emotions rather than arguing rationally is a better way to get the results politicians and marketers want. But it’s the last part of the prediction that gives me the chills – “arrive scientifically at certain efficient pre-established collective decisions” – not supporting the creation of new ideas, encouraging critical thought and debate, but manipulating people into making the decisions you want them to take. Have a listen to this (or read the text) – a Guardian article on the new digital populists.

Read Full Post »

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?”

Read Full Post »

I was reading an interview with Harvard historian, Anne Harrington, who has written “Mind Fixers: Psychiatry’s Troubled Search for the Biology of Mental Illness”.

When I was at university I was taught there were two types of depression – reactive and endogenous – the former occurring in response to specific events, and the latter seen as an illness of internal origin. It was thought that talking therapies, as they’ve come to be called, were the best way of dealing with reactive depression but that endogenous was a biological problem which required drugs. One of the main themes which emerged from that thinking was the serotonin theory of depression which was the basis for the great commercial success of Prozac, a drug which influenced the levels of serotonin in the brain.

Well, it all changed. Psychiatrists stopped distinguishing between “reactive” and “endogenous” and moved to thinking of all depression as biological and, hence, all requiring treatment with drugs.

But that didn’t last. As Anne Harrington describes, in the late 90s, “a range of of different studies increasingly seemed to suggest that these antidepressants – although they’re helping a lot of people – when compared to placebo versions of themselves, don’t seem to do much better.” As the “gold standard” of drug effect is its performance over that of placebo, and drug after drug was shown not to be that much better, it got harder and harder to bring new drugs onto the market. She says –

“But it doesn’t mean that the drugs don’t work. It just means that the placebo effect is really strong. But the logic of clinical trials is that the placebo effect is nothing, and you have to be able to better than nothing. But of course if the placebo effect isn’t just nothing, then maybe you need to rethink what it means to test a drug”

This is the same observation as Irving Kirsch made in his “Emperor’s New Drugs”. In that book he drew a graph which I found very impressive –

 

 

The point he was at pains to make was the same as Anne Harrington’s – well, actually, he was trying to emphasise that just because the drugs didn’t seem much more effective than placebo didn’t mean that doctors should stop prescribing them. But the main point, I think, is –

Placebo is not nothing

It seems crazy to me that people make decisions about whether or not a treatment should be offered to patients solely on the basis of its statistical difference to placebo if those decisions then lead to the withdrawal of treatments which were helping thousands of patients.

If the placebo effect is not the same as doing nothing (and it is clear that it is NOT the equivalent of doing nothing) then we should be exploring just what it is. That will involve moving on from the stigma of trickery, because that’s how the placebo effect has been portrayed. “Dummy pills”, “inactive pills”, “mock treatments” producing real life changes in the patients who receive them, only to reveal to them that, ha! ha! you got nothing!

I think it’s interesting that it is in the area of psychiatry that this debate has emerged. Because we know something of the power of placebo on our mental states. But as we are whole, body/mind, non-dual beings. What influences our mental states, influences our bodily functions too. Placebo effects are not restricted to changes in mental states, they are seen throughout the body, influencing organs, cells and circulating levels of natural chemicals.

Here’s the other thing – if placebo is NOT the same as doing nothing but a drug doesn’t show a substantial and significant benefit over placebo, then what else can we offer the patient? What else will be at least as powerful as placebo, but less harmful than the drug?

What about exercise, nutrition, the creation of significant social relationships, engagement with natural environments, meditation, learning how to handle our emotions for starters? And not forgetting demanding that we do something about the conditions in which more and more chronic illnesses are emerging – both mental and physical – poverty, poor housing, inequality, polluted environments, industrial, chemical methods of agriculture and food production and so on – have a look at the perspective I described in “There still aren’t enough”, and in “Inequality and health”.

Read Full Post »

sinking boat

This is my last article in this series about health. I started by addressing the needs of health services, then continued with an exploration of how to move towards healthier communities so that more people might expect more years of healthy life. I began with shelter, exploring housing, then, food, education, and the environment.

Finally, I want to address the issue of inequality.

In Scotland, in 2008, life expectancy figures revealed that men living in one part of Glasgow could expect to live 28 years more than those in another part. This was publicised as the plight of “Shettleston man”, named after the area with the poorest male life expectancy. Twenty eight years of difference in two areas a mere 15 minutes away from each other.
Shocking? Of course. This wasn’t the full story. The number and severity of illnesses suffered by the men in poor Shettleston, were far greater than those living in the more affluent, Lenzie.
Since 2008, that picture has changed somewhat, partly because that dramatic figure was a result of high numbers of drug deaths. Ten years later the figures still show huge differences between the richest and the poorest parts of Glasgow. One area has a male life expectancy of 82, whilst in another it’s 66 – still a difference of 16 years.

This huge inequality in health experience and in life expectancy are closely linked to other inequalities, from income, employment, and housing to education.
For many years Richard Wilkinson and his partner, Kate Pickett have produced research evidence for inequality itself being one of the most significant factor in the production of these shocking statistics. It’s not just poverty, it’s inequality.
They’ve recently published more findings which explore the links between mental health, wellbeing and inequality. What they demonstrate is some of the potential mechanisms of the links between inequality and illness, through the psychological impacts which are part of the daily lives of the poorest communities.
We don’t live in isolation.
We can’t just exhort people to eat more healthily, smoke and drink less, and move more and expect the population to suddenly become healthier. We have to address the conditions in which people live. Unless we tackle inequality it’s going to be hard to bring better health to the majority of the population.
Many reports have shown how inequality around the world is on the increase. This article, in The New Yorker neatly summarises the findings of the French economist Thomas Piketty on this issue.

The famous “elephant graph” (so called because of its shape) shows what’s happened over the last four decades.

elephant graph

Is this inevitable?
Surely not. It wasn’t always the case, and it’s actually changing. If we want to change it in a different direction we’ll need to get to grips with ways in which the richest manage to grab and hoard their wealth.

A recent story reported that, in the US, Amazon, despite making a profit of $11.2 billion, they’ll not only be paying zero Federal tax, but will actually receive a tax rebate of $126 million.

It’s not only the richest corporations who work hardest to pay as little tax as they can. Individuals do too. The CEO of Ineos, the UK’s richest man, is moving to Monaco to save £4 billion in tax. His two wealthiest executives are following suit.

The “Panama Papers”, leaked from the offshore law firm, Mossad Fonesca, revealed, amongst other things

“the myriad ways in which the rich can exploit secretive offshore tax regimes. Twelve national leaders are among 143 politicians, their families and close associates from around the world known to have been using offshore tax havens. A $2bn trail leads all the way to Vladimir Putin. The Russian president’s best friend – a cellist called Sergei Roldugin – is at the centre of a scheme in which money from Russian state banks is hidden offshore. Some of it ends up in a ski resort where in 2013 Putin’s daughter Katerina got married. Among national leaders with offshore wealth are Nawaz Sharif, Pakistan’s prime minister; Ayad Allawi, ex-interim prime minister and former vice-president of Iraq; Petro Poroshenko, president of Ukraine; Alaa Mubarak, son of Egypt’s former president; and the prime minister of Iceland, Sigmundur Davíð Gunnlaugsson.”

 

The “Paradise Papers” are another big data leak related to a separate company showed many, many, similar examples

“Key revelations include:
Millions of pounds from the Queen’s private estate has been invested in a Cayman Islands fund – and some of her money went to a retailer accused of exploiting poor families and vulnerable people.
Prince Charles’s estate made a big profit on a stake in his friend’s offshore firm.
Extensive offshore dealings by Donald Trump’s cabinet members, advisers and donors, including substantial payments from a firm co-owned by Vladimir Putin’s son-in-law to the shipping group of the US commerce secretary, Wilbur Ross.
Twitter and Facebook received hundreds of millions of dollars in investments that can be traced back to Russian state financial institutions.
The tax-avoiding Cayman Islands trust managed by the Canadian prime minister Justin Trudeau’s chief moneyman.
The Formula One champion Lewis Hamilton avoided taxes on a £17m jet using an Isle of Man scheme.
Oxford and Cambridge and top US universities invested offshore, with some of the money going into fossil fuel industries.
A previously unknown $450m offshore trust that has sheltered the wealth of Lord Ashcroft.
The man managing Angola’s sovereign wealth fund invested it in projects he stood to profit from.
Apple secretly moved parts of its empire to Jersey after a row over its tax affairs.
How the sportswear giant Nike stays one step ahead of the taxman.
The huge tax refunds given by the Isle of Man to the owners of private jets.
Offshore cash helped fund Steve Bannon’s attacks on Hillary Clinton.
The secret loan and alliance used by the London-listed multinational Glencore in its efforts to secure lucrative mining rights in the Democratic Republic of the Congo.
A former UK minister who defended tax avoidance has a Bahamas trust fund.
The complex offshore webs used by two Russian billionaires to buy stakes in Arsenal and Everton football clubs.
Stars of the BBC hit sitcom Mrs Brown’s Boys used a web of offshore companies to avoid tax.
British celebrities including Gary Lineker used an arrangement that let them avoid tax when selling homes in Barbados.
Prominent Brexit campaigners have put money offshore.
The Dukes of Westminster pumped millions into secretive offshore firms.
A tax haven lobby group boasted of “superb penetration” at the top of the UK government before a G8 summit that was expected to bring in greater offshore transparency.
The law firm at the centre of the Paradise Papers leak was criticised for “persistent failures” on terrorist financing and money laundering rules.
Seven Republican super-donors keep money in tax havens.
A top Democratic donor built up a vast $8bn private wealth fund in Bermuda.
The schemes used to avoid tax on UK property deals.
The celebrities, from Harvey Weinstein to Shakira, with offshore interests.
How a private equity firm tried to extract £890m from a struggling care home operator by making it take out a costly loan.
Trump’s close ally Robert Kraft, the New England Patriots owner, is the longtime owner of an offshore firm.
One of the world’s biggest touts used an offshore firm to avoid tax on profits from reselling Adele and Ed Sheeran tickets.”

It’s only the wealthiest individuals and companies which go to such lengths to contribute less of their wealth to the societies in which they made their gains.
Meanwhile, at the other end of the scale, there is a growing evidence that increasing minimum wages is a great way to make positive impacts on populations.

A 2011 national study showed that low-skilled workers reported fewer unmet medical needs in states with higher minimum-wage rates. In high-wage states, workers were better able to pay for the care they needed. In low-wage states, workers skipped medical appointments

“Studies have linked higher minimum wages to decreases in low birth-weight babies, lower rates of teen alcohol consumption and declines in teen births. A 2016 study published in the American Journal of Public Health found that between roughly 2,800 and 5,500 premature deaths that occurred in New York City from 2008 to 2012 could have been prevented if the city’s minimum wage had been $15 an hour during that time, instead of a little over $7 an hour.”

None of these issues can be tackled in isolation. They need co-operation and collaboration. That should encourage us, because these are two of the greatest strengths of the human species.

 

Read Full Post »

Today’s woodprint is another Hokusai. It shows a group of five hunters warming themselves in front of a roaring fire in the middle of winter.
I think anyone looking at this will be struck by the vivid representation of the fire. The flames and smoke, maybe even the heat (because you can see heat sometimes, can’t you?” leap up as tall as the men and flow, driven by the wind, towards the mountains and the sky.
I then looked at the hunters. A curious group! Why is one of them actually sitting on the snow? Is he drunk? And another one, apparently determined to warm up his bum! Maybe he’d also been sitting on the snow and was now trying to dry his breeks! Then one of them who is warming his hands is obviously finding the fire so hot that while trying to get his hands as close as he can to the fire, he is simultaneously trying to get his face and his body away from it!
They do look a lively bunch, and I suppose my first thought was about human beings inventing fire and how much that had changed the course of history. Our ability to start fires and generate heat enables us to survive cold conditions, explore places we’d previously been unable to explore, as well as warding off wild animals, and greatly diversifying our diet once we applied fire as a method of food preparation (otherwise known as cooking!) – which reminds me about the Netflix series, “Salt, Fat, Acid, Heat” and, their, Cooked  by Michael Pollan. I’m a big fan of Michael Pollan, and often recall his fabulous, seven word best diet recommendation – “Eat food. Mostly plants. Not too much

But then my mind flipped to the more symbolic level and I saw in the woodcut two of the four great elements – fire and water. Fire in the hunter’s bonfire, and water in the form of snow and ice surrounding them.
Flames always reach upwards, don’t they? Which is probably partly why the alchemical symbol for fire is an upward pointing triangle. Traditionally, both, the fire and the upward pointing triangle, are associated with the male principle.

I’m not talking gender here, but the centuries old understanding of male and female principles as symbolic forces. The Sun, a fiery ball, is often associated with the male principle, while the Moon, with the female.

In the Tarot, The Emperor and the Empress make a similar pair.

In the yin yang symbol, which powerfully conveys the concepts of dynamism and wholeness, the feminine, yin, and the masculine, yang, are shown as equals.

Maybe it’s because my train of thought went off down that track of the unions of these forces, of the power of such coupling, but the next thing I noticed were the two trees on the right hand side of the image. The one, nested into the forked branches of the other. Am I just imagining something here? Or was Hokusai showing us something very important…..how reality is created by connections, by the embrace of fundamental principles or forces. That reminded me of Carlos Rovelli’s beautiful phrase where he explains why we should think in terms of events instead of objects –

The world is not a collection of things, it is a collection of events. The difference between things and events is that things persist in time, events have a limited duration. A stone is a prototypical “thing”: we can ask ourselves where it will be tomorrow. The world is made up of networks of kisses, not stones.
(from “Reality is Not What it Seems”)

I’ve written more about that idea in my book, “Unique in All the World”.

Read Full Post »

Older Posts »