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Archive for the ‘from the reading room’ Category

Did you know that Mills and Boon, the publishers of romantic novels, have a whole section dedicated to medical romance stories? Well, an Irish psychiatrist, Dr Kelly, has analysed about twenty of them and come up with some interesting findings. He found

marked preponderance of brilliant, tall, muscular, male doctors with chiselled features, working in emergency medicine.

He said they were commonly of Mediterranean origin and had personal tragedies in their pasts.

Oh well, that rules me out!

A spokesperson for Mills and Boon said

the medical setting offered much potential for human drama.

“We see exactly the same on televised medical dramas. In these kinds of professions, there is the need to remain emotionally distant, which spills over into private lives – there’s nothing more thrilling than a damaged hero.”

Hey, isn’t that all of us? Aren’t we all damaged heroes?

This little piece got me thinking though about the way doctors are portrayed in fiction and what kind of influence that has. I’ve wanted to be a doctor all my life. First stated that intent at the age of three! And it wasn’t a family connection. There were no medics in my family ever. What I do remember though is watching a soap opera on TV when I was a child – “Dr Finlay’s Casebook”. Dr Finlay was a Scottish GP working in the fictional village of ‘Tannochbrae’ (actually Callander, very close to where I was born and live now – Stirling). I was hugely impressed with Dr Finlay and I have deep seated memories of wanting to be a doctor like him. There were other doctors on TV then. Dr Kildare, for example. Couldn’t stand him! Waltzing around in his white coat like God’s gift to medicine! So, I guess, fictionalised doctors made an impact on me.

How about you? Which fictionalised doctors impress, or impressed you? Did any of them inspire you to become a doctor? or a nurse? Or even put you off the idea for life? Which doctor in fiction would you most like to be your personal doctor? Go on, tell me.

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I wrote recently about how paper extends our minds, and how that related to a book I was reading just now, Being There, by Andy Clark (review coming soon), and then along comes this article in the NY Times. OK, it’s pretty tongue-in-cheek, but funny how I should happen across it when I’m just reading about the extended mind concept. How often that kind of thing happens! Seems more than just a paying attention phenomenon. David Brooks, who wrote the opinion piece for the NY Times gives many examples of how he’s given up functions of his mind to technology – from becoming unable to navigate in his car without satnav, to being unable to remember anybody’s phone number ‘cos all his contacts numbers are in his smartphone, to following recommendations from TiVo, Amazon and iTunes for his entertainment.

He’s got a point though. We really are extending our minds by using technology this way. I heard a discussion on Radio Scotland this morning about the spread of broadband and the constant demand for faster and faster connections, and one of the interviewees said that he recently moved house and was without broadband for a couple of days and couldn’t believe just how disconnected and paralysed he felt. I’ve had that experience too. Being connected to the net is becoming an increasingly important part of the way my mind functions – from knowledge seeking, to memory stores, to inspiration and the making of new friends. I love it I must say, and Brooks’ view that we are losing function in the process is not something I share. I don’t care that I don’t know anybody’s phone numbers any more – that’s what the contact list is for! I don’t need to clutter up my brain with that! And I love how Web 2.0 tools help me find things I’m interested and and serves up so many fascinating, amusing and moving sites which stimulate my thinking and extend my networks and my mind.

What do you think? Are you enjoying extending your mind out beyond your personal brain? I guess if you don’t like it you don’t have to do it after all!

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Here’s an interesting study published in the Journal of Statistical Mechanics: Theory and Experiment …..woah!! Hold on there! Bear with me! I know that sounds a desperately uninteresting journal, but what this author, Gleiser, a physicist, has done is to study the characters in Marvel comics – you know, the superheros, the villains, and the others – 6486 characters in 12942 comics! Now I know you’re probably thinking what on earth are physicists studying Marvel comics for? Well, this is where it gets really interesting. There’s an increasing amount of interest in complex networks – we find them in all walks of life – physical systems, neuropsychological, biological and social systems. Gleiser used a collaborative networks model to analyse the Marvel characters. Basically, each character is a node and then the nodes are connected with lines to represent the relationships between the characters. It’s presented graphically which makes it instantly easy to understand – you’ll need to look at the original article to see that.

Here’s what he found –

All the superhero have loads of connections to other characters. In network theory they are “hubs” – in fact they are super-connected to many other characters. On the hand, the villains are very poorly connected. You can actually pick out the superheroes and the villains really easily from the network map. The reason for the poor connected-ness of the villains is apparently the rules by which the Marvel comic stories were constrained. They weren’t allowed to make villains attractive or to make evil appealing!

I think this is such an interesting piece of work for two reasons –

Firstly, it’s a great demonstration of the applicability of network science.

Secondly, it’s shows you one of the key characteristics of superheroes – get connected!

If you’d like to read more about network science I recommend your read Linked, by Barbarsi.

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JAMA (The Journal of the American Medical Association) has published a survey of the links between Medical Schools and the pharmaceutical industry in the US.

They found that 60% of departmental heads had a financial relationship with a drug company as a consultant, member of a scientific advisory board, a paid speaker, an officer, a founder, or a member of the board of directors.

Two thirds of departments at medical schools and large teaching hospitals had relationships with industry that involved research equipment, unrestricted funds, support for research seminars, residency and fellowship training, continuing medical education programmes, discretionary funds to buy food and drink, support for professional meetings, subscriptions to professional journals, and intellectual property licensing.

Overall, they say, 80% of clinical departments and 43% of non-clinical departments had at least one tie with industry.

Now, I don’t know about you, but that concerns me. That’s an awful lot of influence. What do you think the teachers think about it?

Despite these ties “more than two thirds of all chairs with a personal relationship with industry reported that their personal relationships had no effect on the various types of departmental functions. A similar percentage claimed that there was no effect on their personal financial status,” the authors say.

No problem. Nothing to see. Move along there………..

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I read a couple of great posts about how people use paper. Across on 43folders. wood.tang’s post about the backs of envelopes  was inspired by Merlin’s post entitled Making friends with paper. (really great little video embedded in that post by the way). Both these guys are making the point that they still use paper preferentially for certain tasks despite being keen on technological solutions. They make the point that there’s something different about interaction with paper. Read the comments from people to both these posts – they are also very interesting and inspiring.

This fits with a point being made in a book I’m reading at the moment – it’s Andy Clark’s Being There. He describes a concept of the extended mind. What he shows is how our physical interaction with the environment allows us to develop and use cognitive functions that our brains either just couldn’t do alone, or certainly couldn’t do so well. One simple example he gives is doing a jigsaw. We pick up the pieces, twirl them round in our fingers, hover them over different spaces and our brains, which are good at pattern-spotting, work with these movements and actions and our hands and brains then work seamlessly to solve the puzzle.

I know that since I started doing the morning pages about a year ago my own creativity and productivity has gone through the roof. This blog here is a good example of that.  Interestingly, I find I almost never ever go back to read anything I’ve written in those daily notebooks. That’s not how they work. It’s the act of writing longhand in a nice notebook which works with the brain to produce the end result – ideas, solutions, decisions etc etc.

How about you? What’s your relationship with paper these days?

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When I was recently on holiday on the Isle of Skye I popped in to An Tuireann for a look around, a bite of lunch (had fabulous home-made, thick chunky oatcakes and crab pate), and to log on to the net via their free wifi connection. While uploading photos to flickr, and writing a post or two for this blog, I got chatting to Mark Goodwin, the Literature Development Officer. A delightful and gentle man. He gave me a few postcards from the Poetry Box and I read the poems on them. They were so good! Here are some extracts I noted –

from At The Shrink, by Angela McSeveny –

I can hear the whisper of his pencil

Against the paper

As he jots down notes.

The point jerks like a seismograph

Measuring the impact of my answers.

I blurt out some startling truth

And watch, baffled,

When his right hand doesn’t move.

Well, I can tell you, that little segment got me re-thinking how I take notes! Amazingly, it had never occurred to me, until I read this, that the movement of my pen on the paper of the patient’s case record might be having an impact on the patient. But more than that, these lines also highlight for me how we all discriminate, categorise and judge what we see, hear, experience. A patient tells their story. I listen, hearing some parts more clearly than others, interrupting, or leading this way or that, according to my interest, and in the process create my version of their story…….which turns out, hopefully, to be similar, but, for sure, will be new, unique and different, co-authored by the pair of us.

from…Night Sister, by Elizabeth Jennings

How is it possible not to grow hard,

to build a shell around yourself when you

have to watch so much pain, and hear it too?

………..

You have a memory for everyone

None is anonymous and so you cure

what few with such compassion could endure

I never met a calling quite so pure.

Reading this again just now, made me think again about that study which measured doctors’ responses to others’ pain. But the last line is the one which really struck me – ‘I never met a calling quite so pure’. You don’t hear much about ‘calling’ any more. Sadly, the current ethos is one of reducing every health carer’s job to a list of tasks and competencies, then assuming that any person who can tick all the correct boxes will be able to carry out exactly the same job. It’s not like that. People matter. The personality, the values and the motivation of a health care worker will shine through, for good or for bad! The new way of selecting young doctors for training posts in the UK uses a computer-based questionnaire system and does not accept the submission of a cv for example, and the candidates for GP training are referred to only by their numbers (to prevent prejudice on the part of the selectors from the candidates’ surnames). How many have a ‘calling’, and would any selector rate such a claim?

And finally, from Elma Mitchell’s, ‘This Poem” –

……even the simplest poem

may destroy your immunity to human emotions

All poems must carry a government warning

Words can seriously affect your heart.

Oh, so true! How a word can sting, burn, wound, comfort, move, excite, quicken or slow the heart! One of my favourite writers is Raymond Carver. He can write both poetry and prose in a way that you can be moved to tears by a tiny handful of his words.

So, what do you think about the relationship between poetry and health? Have you any experiences you’d like to share?

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This headline caught my eye in today’s Guardian – ‘I was trapped into being alive’. It’s an interview with Robert Wyatt. Ah, Robert Wyatt…….now that takes me back to the late 60s, early 70s, when my friends and I were great Soft Machine fans. So I immediately start to think about that band and head off to youtube to see what I can find. Oh, delight, delight! In two vids there is a live recording of the Softs performing Out-bloody-rageous from the glorious Third album – now this might, or might not, be your cup of tea, but here’s the second part – with Robert Wyatt on drums, Elton Dean on sax, Hugh Hopper on bass and Mike Ratledge on the keyboards. I have this on vinyl (must get round to digitizing my three or four hundred albums!) but haven’t heard it for years!

I’ll leave you to explore more of you like, but this music was revolutionary in its time. It was fresh, exciting and innovative. It was real musicianship. Well, Robert Wyatt fell out of a window and broke his back paralysing him from the waist down for the rest of his life. In his solo career though, he has produced some of his greatest work. He has a most unusual singing voice. Here he is singing Elvis Costello’s Shipbuilding –

In the interview, he says that during his deepest depression in the 90s he was

quite unable to sleep. Couldn’t lie still, revolving in the bed all night, and Alfie had to go upstairs to sleep. Wheeling up and down the corridor at 20 miles an hour, I couldn’t stop. I couldn’t write. I lost my sight, I suddenly needed glasses. It felt like dying, but that would have been a release. Physically, as it turns out, I’m very resilient. I was trapped in having to be alive.

Wow! I think that’s an amazing statement. In fact, I meet quite a lot of people who have this kind of experience. Even in the midst of the most awful suffering they discover that they have some kind of life force, some determination to be alive, some resilience, which keeps them toe to toe with the struggle of living and denies them the escape of non-existence.

The final part of the interview really grabbed me too –

Wyatt says his work is instinctive. “A French journalist asked if my music was spiritual, and I said, ‘Only in the original sense of spirit meaning breath.’ I am a breathing animal. If anything, I get lower, not higher, in art to work things out, relying on animal instincts to guide me through what sounds right. Beyond that, it’s unknowable, verbally inaccessible.” He adds, with characteristic self-effacement: “That’s why I work with musicians.”

What a wonderful exploration of the concepts of spiritual versus animal instincts, weaving them together, blurring their distinctions, to focus on what he calls the “unknowable, verbally inaccessible”. Now, I love stories, and I love to write. I am a great fan of words and it delights me to hear my patients’ stories every day but one of the other bigger loves of my life is music. And I think dear, old Robert Wyatt has just hit the nail on the head and explained some of that to me. I know I’ve mentioned here a few times, Deleuze’s three ways of thinking, but this makes me realise that two of my most favourite ways of experiencing the world are through stories and through music.

So, from this little headline in the Guardian, I take a wander down memory lane, accessing almost forgotten parts of my being, find myself singing along to Shipbuilding, and musing about the totally bloody amazing thing it is to be a human being.

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Smart World starts by acknowledging the work of two others – Albert-Laszlo Barabasi and Andy Clark. I’ve just read Linked by Barabasi. (ISBN 0-452-28439-2) It’s a fascinating book about the rather young science of networks. I agree with the author, that understanding how networks are created and function is going to be absolutely key to our future direction in science.

A network, quite simply, is made up of nodes and links. One example is social networks. Think of a piece of paper with the names of several individuals on it and lines drawn between the names of people who know each other. It’s remarkable how quickly information can spread around such a network. Maybe you came across the movie “Six Degrees of Separation” – a story based on the premise that there are only an average of six links between any two human beings on the planet. Turns out that idea, which apparently came from a Hungarian short story, is pretty accurate. But there’s a twist…….sometimes the number of links is way less than six (even between people who don’t know each other). Other kinds of networks you are familiar with are the maps of flight routes you see published in airline magazines, the power grid, and, yes, our dear World Wide Web. In fact, everywhere you look, you’ll see networks. Everything is connected. Nothing exists in isolation.

To try and understand how networks develop and how they function, Barabasi takes you on a journey through the world of mathematicians, physicists, social scientists and engineers. It’s quite fascinating. In the process he describes a very clear evolution of this new science. Intially, complex networks were thought to be completely random. But randomly created networks produced by computer modeling turn out not look like real world networks. Real world networks don’t have random distribution of nodes. Some nodes are way more connected than others. Barabasi calls these hubs. Once you introduce the concept of hubs, the mathematical modeling of networks reveal what are known as “power laws” (this is a bit beyond me I’m afraid – maybe Phil can help explain these?) but, as I understand it, if you take a single quality or characteristic in nature, say, height of individual human beings, you’ll get a bell curve. Bell curves look symmetrical and they have steep sides ie there aren’t many “outliers”. Complex, natural networks however have node distributions which can’t be described by bell curves. Instead you get a small number of highly connected nodes (hubs) and a huge number of less connected ones. This characteristic produces incredibly resilient and fast networks.

Real life networks are highly resistant to damage and they adapt to change. You can take out lots of nodes and not make much difference to the functioning. To really damage them you have to go for the hubs. Take them out and you bring the system down catastrophically. So, the structure of networks provides both their greatest strength and their greatest weakness.

Barabasi gives masses of great examples, from epidemiological spread of viruses like HIV, to the functioning of international economic markets, to the spread of ideas throughout civilisations. But one of his most interesting analyses is his critique genetics.

How often do you read about “breakthroughs” in mapping the genetic “origins” of various diseases – all with the promise of predictive genetic tests and of treatments based on what is known as pharmacogenomics – finding which genetic precursors determine the responses to which particular drugs. He dismantles this reductionist view very effectively and promotes a network model instead – making what I find to be a convincing argument that the genetic bases of diseases won’t be found in mapping the genome but in mapping the networks of genes.

This shift in perspective is crucial. It drives us away from a reductionist consideration of elements and parts towards a holistic consideration of system function by understanding nodes and their connections. He even terms this “postgenomic biology”. I like it! However, it’s at this point that he suddenly disappoints. His chapter 13 is very odd. It’s entitled “Map of Life” and in it he takes this idea of postgenomic biology and applies it in a bizarrely reductionist way, predicting that the future of medicine will be in tests and highly individualised drugs based on eliciting these genetic maps. He thinks you won’t need consultations with doctors any more, just simple blood tests which will be computer analysed and targetted, tailored drugs will then be kind of published on demand and delivered to your door and, voila! you have your own special cure!  I’m sorry, but I don’t buy this. I mean, I believe that if we could produce a new generation of highly specific drugs rather than the blunderbust ones we use now that would be great, but what happened to this idea of the science of networks, and how they would change our understanding of everything? Suddenly Barabasi leaps into a reductionist model of disease and healing which is predicated on the idea that each individual is indeed an island. Hasn’t he just spent the rest of the book showing us the importance of mapping connections? Isn’t every individual in fact massively connected not only to other individuals but to all kinds of environments. Isn’t it impossible to understand an individual as context-free?

However, don’t let chapter 13 put you off. He really is onto something extremely important here. Once you start to think this way you see networks everywhere and you begin to understand the inescapable importance of connections, and, interestingly, of hubs. We’re at the beginning of this science and I think it’s pretty exciting.

Those of you who have read other posts on this blog will be familiar with my references to Deleuze. His philosophy of networks – he preferred the model of the rhizome – predates this scientific development and has probably been one of the important nodes from which this area of study has grown. You’ll also be familiar with the concept of the Complex Adaptive System which I believe is the best model we have so far for understanding human health and illness.

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Having just blogged about living with uncertainty, I stumbled across this –

Gilda

Gilda Radner, by the way, died in 1989, aged 42, from ovarian cancer.

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Darian Leader, co-author of Why do People Get Ill? has written an article about the proposal to expand CBT on the NHS in today’s Guardian. He points out that CBT (Cognitive Behavioural Therapy) has a high failure rate when considered over time. It is effective in the short term but many patients have either relapsed or developed other symptoms over an 18 month period. This is a common problem with a lot of medical care based on the very time-limited RCTs conducted for most treatments – in other words, whilst treatments can often be shown to do what they claim to do in the short term, very few several year long studies are conducted and pretty much almost NO whole of life ones which follow a life-course approach (please draw my attention to the right places if you know I’m wrong about this). This short-term-ist approach to health care keeps us all spinning round on the same hamster wheel. Until we tackle the harder questions of how to improve health, resilience, and the causes of disease, we’re going to be stuck with all these protocols of health care created on the back of short term solutions.

The issue of the problems with this current obsession with RCTs which are narrow in scope and short in duration is explored by Professor Paul Verhaeghe, Professor psychodiagnostics at Ghent University in his paper presented at Health4Life. There’s a twelve page pdf of his paper available at that link (It’s worth reading)

Darian Leader concludes –

Real mental health policy has to recognise that there are no easy answers, that human beings are complex and contradictory, and, most important, that we can never know in advance what will be best for a patient.

A true exploration of psychological suffering is perfectly possible in the framework of the NHS – if policymakers can think beyond mental hygiene and start listening to the patient.

How true! There are no easy answers. Human beings are complex and contradictory. It’s time to start listening to the patient.

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