Feeds:
Posts
Comments

Archive for the ‘health’ Category

 

I read about Irène Frachon the other day. She’s a French doctor who back in 2007 noticed a strange pattern of illness which seemed familiar to her. She noticed that a patient with “pulmonary hypertension” had developed the condition only after taking a particular medication for diabetes – “Mediator”. Then she came across one who had heart valve disease develop after the same drug. She remembered similar problems occuring with an earlier, but in some ways, similar drug, so started to investigate. It took several years, and the publication of a book, “Mediator 150mg. Combien de morts?” before the company Servier finally took the drug off the market. Various estimates of between 1300 and 1800 people may have died as a result of taking this drug.

It wasn’t the Mediator story itself which caught my attention (sadly, such drug stories are really not so rare), but it was Irène Frachon’s story. As she talks about her involvement in the Mediator story it is clear that from the very beginning it was not just her ability to recognise a pattern which was a great strength, it was her compassion and empathy which drove her to keep a single focus on the patients. This is what gave her the determination to have the problem recognised and dealt with. In fact, she is still astonished that neither the drug company, nor the regulators acted more quickly. She says “The elephant was in the room but everyone was turning their head away”. The story caused quite a disturbance in France (click through on my reference to Mediator to read a Lancet article about it) and has shone a light on drug company behaviour, the “spinelessness and credulity” of the regulator in relation to the drug companies, and the links between big business and politicians. But Dr Frachon fought on for the one single reason – to get justice for those who had been harmed. 

Where did she get this determination from? She says that as a girl she was inspired by the stories of Albert Schweitzer and his “empathie absolue” for those who suffered. When she heard those stories she decided to become a doctor. Interestingly, I would argue, those stories didn’t just prompt her to become a doctor, but to become a particular kind of doctor – one for whom “absolute empathy” was the core value.

A lot of thoughts arose for me when reading this article. Firstly, how lucky I have been to have encountered so many doctors, through my training and through my workplaces, who share this core value of empathy. It’s what characterises their everyday actions as well as their career choices. And, secondly, how stories we hear in childhood influence the rest of our lives.

I first said I wanted to be a doctor before I was 4 years old. But I didn’t come from a family where there were any doctors, so where did this come from? I don’t know but I do know I was very influenced by a fictional doctor – Dr Finlay – a GP in a small Scottish town who had all the characteristics of what would now be termed an “old fashioned family doctor”. I didn’t want to just be a doctor, I wanted to be a Dr Finlay kind of doctor. 

So, maybe one of the best things we can do is tell our children stories of inspirational, empathic people. Not that that should mean they all grow up to be doctors, but maybe they will take the core value of empathy into their adult lives.

What stories do you think influenced your career, or life choices? 

Read Full Post »

Can hugs make you healthier?

Here’s an interesting study from Carnegie Mellon University. The researcher, Sheldon Cohen, said

We know that people experiencing ongoing conflicts with others are less able to fight off cold viruses. We also know that people who report having social support are partly protected from the effects of stress on psychological states, such as depression and anxiety. We tested whether perceptions of social support are equally effective in protecting us from stress-induced susceptibility to infection and also whether receiving hugs might partially account for those feelings of support and themselves protect a person against infection.

 

The researchers measured over a two week period, frequencies of interpersonal conflicts, the level of perceived social support and receiving hugs in about 400 healthy adults. They then exposed the participants to a common cold virus and monitored in quarantine to assess infection and signs of illness.

The results showed that perceived social support reduced the risk of infection associated with experiencing conflicts. Hugs were responsible for one-third of the protective effect of social support. Among infected participants, greater perceived social support and more frequent hugs both resulted in less severe illness symptoms whether or not they experienced conflicts.

 

“This suggests that being hugged by a trusted person may act as an effective means of conveying support and that increasing the frequency of hugs might be an effective means of reducing the deleterious effects of stress,” Cohen said. “The apparent protective effect of hugs may be attributable to the physical contact itself or to hugging being a behavioral indicator of support and intimacy. Either way, those who receive more hugs are somewhat more protected from infection.”

Hugs, however they actually do their stuff, have long been one of my most favourite ways of staying healthy! (And even if they had no “protective effect”, they’d still be good, wouldn’t they?)

 

Read Full Post »

difference

Wouldn’t it be great if difference was seen to be something interesting, attractive, even beautiful?

If we could not just respect and tolerate difference, but encourage it and celebrate it?

Wouldn’t it be great if we didn’t try to make everyone the same?

Read Full Post »

Rainbow fountain

I’m using this photo of a rainbow appearing in a fountain because I think rainbows are a symbol of hope, as well as being a phenomenon which exists only in the presence of the subject (the observer), and a fountain which is symbolic for me, of the life force, that flowing healing energy which enlivens and heals us all.

Isaac Judaeus lived from 855 to 955. He was physician to the Fatimid rulers of Qairawan in Tunisia, and his works were amongst the first to be translated from Arabic into Latin at the time of the great translations which brought Arabic thought and science to the notice of the West. His books had a big influence on Western medieval medicine, still being read into the 17th century. There’s a small book of his, Guide for Physicians, which only exists in Hebrew translation, where he sets out his ethical conception of medical practice (remember this is writing from the 9th and 10th centuries). I’ve only read a few of his aphorisms, but this one, in particular, caught my eye.

Comfort the sufferer by the promise of healing, even when thou art not confident, for thus thou mayest assist his natural powers

What’s he saying here?

First of all that physicians should comfort the sufferer. Sadly, that’s an element of health care which patients don’t always experience. Shouldn’t physicians always offer care and comfort?

Secondly, they should do this “by the promise of healing”. He goes on to say “even when thou art not confident”. Wouldn’t this be deceit in some situations? One of my earliest experiences as a young doctor was admitting a very elderly, very ill lady to the ward where I worked. Her also very elderly daughters were hugging each other on the seat outside the ward, wringing their hands, crying and upset about what was happening to their mother. I thought I’d comfort them and said “Don’t worry. Your mother is in the right place now. I’m sure she will be fine” They smiled to me just as one of the nurses came out of the ward and called me aside. “That patient you just admitted doctor? She’s just died”. Well, that taught me a lesson. But it didn’t stop me practising with hope, practising with the expectation that there was a potential for things to go well. It just taught me never to assume I could accurately predict the future!

I still believe that. I believe none of us can predict the future….especially not in the case of the particular, the specific, individual circumstance. I was surprised many times throughout my career when patients did so much better than the textbooks would have predicted. So, I often thought, the truth is that as you look forward from this point in time, there are a whole range of potential paths leading from here into the future. In the situation of illness, some of those paths will be largely ones of decline, some of stumbling along, and some of steady, or sudden, improvement. And nobody, but nobody, can accurately predict which path this particular patient will take. Therefore, at each stage of the process, hope is not only possible, but is as reasonable an option as any other.

That’s what I understand about “the promise of healing” – it’s not really a promise, in the sense of a guarantee, but a potential (in the way we say something may be “full of promise”). And I think acting from that perspective contributed to the improvements patients experienced.

That’s the final part of Isaac Judaeus’s aphorism – “for thus thou mayest assist his natural powers”.

I can’t see there is any healing other than that brought about by the human being’s “natural powers”. I’d describe them now in terms of systems theory, or complexity theory. Those natural powers are the power shown in any “complex adaptive system” – the powers of self-regulation, self-defence, self-healing…..the “autopoietic” “self-making capacity” of a person.

Medical acts, medicinal substances, physicians’ interventions are only truly healing when they work with, not against, this capacity. That’s why doctors should always remain humble. It’s not what we do that heals. It’s what we stimulate and/or assist….the astonishing self-healing powers of the human being.

In contemporary thought, these “natural powers” Isaac Judaeus refers to are often wrapped up in the idea of the “placebo effect”, but, sadly, that’s a concept so entangled with ideas of trickery and deceit that the “self-healing” powers get lost in it.

So, here’s what I get from that old aphorism –

  • offer comfort and care
  • offer hope and the promise/potential of healing
  • and in so doing assist the natural or self-healing powers found in every human being

One of my hopes for the future of Medicine would be that we learn many other ways to assist those “natural powers”.

Read Full Post »

barometer

In the second part of the A to Z of Becoming, V stands for the verb “vary”.

I found this photo of an old barometer in my collection and it really captures something about the natural function of variation. A barometer is pretty constantly moving, responding continuously to the rising or falling of the atmospheric pressure. I’ve always thought it quite funny that one of the words on these old barometers is “variable” because I tend to think, when it comes to weather, when is anything other than “variable”?! But then, that’s probably down to my experience of living in Scotland for 60 years! I’ve never lived in a country where the weather is the same, day in, day out.

The truth is Nature is constantly varying because all of Nature is a dynamic phenomenon. And the Universe so loves diversity!

But there’s an interesting aspect of human experience, which is “tolerance”. All of our sensory systems have a tendency to tolerance. That is, when something new comes along we notice it, but once its been there for a bit, we stop noticing it. How often have you had the experience of suddenly becoming aware of a noise just when it stops?

Not quite the same as tolerance, but in some ways related, we also tend to move to the “back of our minds” the routines of our lives. This can lead to living on auto-pilot (or as I say in this blog, living like a zombie).

It’s good that a lot of things are dealt with on auto-pilot. What on earth would life be like if we had to think about every breath we take, if we had to initiate every beat of our hearts, if we had to actively, consciously digest all our food, and so on…..? What on earth would life be life if we had to be consciously aware all the time of every single sensory signal our body picks up, second by second?

But the problems come when we default our whole lives to auto-pilot. What happens then is that we tend to just keep repeating the same behaviours, having the same thoughts, feeling the same feelings, and, ultimately, neither making choices, nor creating any life anew.

So, it’s also good to disrupt the default, to break the routines, and raise our conscious level to higher state of awareness.

One way to do that is to vary something.

Walk a different way to work. Choose something different for breakfast. Read a different newspaper. Deliberately introduce a variation to your “normal” habits.

Go on, try it. Vary some things this week and see what that feels like.

Read Full Post »

creeper

One of the most striking characteristics of living organisms is change.

These little leaves I photographed in the garden at the weekend are gone now. (which reminds me of the importance of taking a camera everywhere and not hesitating to use it!)

I’m particularly conscious of change just now because I’ve just moved country. Maybe you’ve done that before, maybe even many times, but it’s a first for me. I don’t mean simply travel and holidays, I mean to actually relocate, to go and live in another country entirely, maybe especially in a country where the language is different.

But change has always fascinated me. The byline of this blog is “becoming not being”, not just because I have always resisted being pigeon-holed, or categorised, but because I really don’t think any human being can be understood as an object frozen in time.

That’s just not reality.

The more there is change within a system or organisation, the more we recognise it as “dynamic”, and is there any more dynamic phenomenon in the Universe than a conscious human being? Not only are all of our cells constantly changing, not only is our heart constantly beating, our lungs constantly filling and emptying, our complex immune systems and endocrine systems altering moment by moment, but our minds are never still.

It feels to me there is a constant flow of a life force through me. It never ceases. When it moves on, this physical me will have moved on, but the me of ideas, of thoughts, of creative expression, of ebb and flow between me and the others who share, or have shared, parts of this life with me, that will, in some ways, continue to flow.

Human beings live in both a constantly changing physical universe (some parts of which change very slowly indeed), and in a rapidly changing, shimmering, universe of consciousness. Really, is there anything in the Universe which changes as much (as constantly) as a human being?

As Heraclitus said so long ago, you really can’t step in the same river twice.

That’s why, as a doctor, it didn’t make sense to me to try to categorise patients. It didn’t make sense to me to reduce a person to a diagnosis. A person is a constantly changing, flowing, growing, developing phenomenon, not an object to fitted into a category, to be measured and classified.

Becoming not being………it’s about the reality of constant change.

 

Read Full Post »

In the second part of the A to Z of Becoming, R stands for Relish.

Relish is an interesting verb. To relish something you need to be absorbed in it, to be captured by it, to be very present and aware so that you are fully experiencing it.

You might relish a simple food, like this bread or fruit……

plum and bread

 

Or you might relish a complete experience…..(this next photo shows table set for lunch at Jordans Wine Farm in South Africa. The style of the restaurant, the view through the window, the delicious food and wine, and the great company of dear friends…..all go towards making this an experience to relish

 

photo

 

Whatever you relish this week, one thing I guarantee will enhance the experience, is to slow down. Take your time……..

 

my new motto

This is my new motto (I saw it on a wall in a village in France) – translated into English it says “Gently in the morning, not too fast in the evening”.

So, find something to relish this week – sink into the experience, absorb yourself in it, savour it, enjoy it….RELISH it!

Read Full Post »

Tiffany time Ginza

Money, money, money……time to change?

Oxfam recently reported that the 85 richest people in the world own as much wealth as the poorest HALF of the population of the world.

Oxfam said that this elite group had seen their wealth collectively increase by $668m (£414m) a day in the 12 months to March 2014. It found that it would take the world’s richest man – Mexico’s Carlos Slim – 220 years to spend his $80bn fortune at a rate of $1m a day

The rate of inequality is increasing rapidly. Thomas Picketty, the French economist whose book “Capital” has taken the world of economics by storm, has shown that this trend is set to continue because the returns on capital are so much greater than the rate of growth in the economy.

Is this accumulation of wealth into the hands of so few healthy? Is it just? Is it fair? Is it acceptable?

The extent to which inequality causes harm was laid out very clearly a few years back in “The Spirit Level” by Richard Wilkinson and Kate Pickett (no relation to Picketty!). Their work showed strong correlations between the degree of equality in a country and the extent of a wide range of social and health problems.

What can we do about it?

The Oxfam report makes a number of suggestions

With an endorsement from Andy Haldane, chief economist at the Bank of England, the report said a 1.5% billionaire wealth tax would raise $74bn a year – enough to put every child in school and provide health care in the world’s poorest countries.

A billionaire tax? Is there the political will in the world to deliver that? What else does Oxfam suggest?

a clampdown on tax dodging; investment in universal, free health and education; a global deal to eradicate extreme poverty by 2030; shifting the tax burden from income and consumption to capital and wealth; ensuring adequate safety-nets for the poorest, including a minimum income guarantee; equal pay legislation and promote economic policies to give women a fair deal; and the introduction of minimum wages and moves towards a living wage for all workers.

Herman Daly, who worked for the World Bank from 1988 – 1994 suggests two very interesting measures to tackle this growing problem.

we need a serious monetary diet for the obese financial sector, specifically movement away from fractional reserve banking and towards a system of 100% reserve requirements. This would end the private banks’ alchemical privilege to create money out of nothing and lend it at interest. Every pound and dollar loaned would then be a pound or dollar that someone previously saved, restoring the classical balance between abstinence and investment.

Now, there’s a fascinating idea! That money should represent something REAL in the world! With all these elaborate “financial instruments” money and measures of economic “health” of countries is becoming increasingly detached from real activities, real use of resources and real people. Maybe such a proposal could begin to shift the balance back from capital to labour? He also suggests

a small tax on all financial trades would reduce speculative and computerised short term trading, as well as raising significant revenue

That latter idea is what others call “the Robin Hood tax“.

So, there’s an interesting selection of ideas – a billionaire tax, a move towards 100% reserve requirements and a financial transaction tax. Which political party is trumpeting these ideas? Which political party is prepared to put tackling inequality these ways at the heart of its manifesto for upcoming elections?

Anyone? Anyone?

Read Full Post »

hollyhock

I recently stumbled across a reference to the paradigm of “relational science”. I hadn’t seen that term before but here are a list of characteristics of “relational science” with each one compared to its “Cartesian” counterpart.

  • PROCESS vs substance
  • BECOMING vs being
  • HOLISM vs atomism
  • RELATIONAL ANALYSIS vs either/or split analysis
  • MULTIPLE PERSPECTIVES vs dualistic objectivism/subjectivism split
  • COACTION vs split interaction
  • MULTIPLE FORMS OF DETERMINATION vs efficient/material causality

If you’d like to read about this in more detail google “Fundamental Concepts and Methods in Developmental Science: A Relational Perspective” – which is an article by Willis Overton and Richard Lerner. In that article the authors write –

As a derivation from these relational categories, the relational developmental systems paradigm characterizes the living organism as a spontaneously active, self-creating (autopoetic, enactive), self-organizing, and self-regulating nonlinear complex adaptive system. The system’s development occurs through its own embodied activities and actions operating in a lived world of physical and sociocultural objects, according to the principle of probabilistic epigenesis. This development leads, through positive and negative feedback loops created by the system’s action, to increasing system differentiation, integration, and complexity, directed toward adaptive ends.

Some of this language might be familiar to you from other posts I’ve written on this site, but I’ve never seen them pulled together as “relational science” or come across the concept of “relational developmental systems” before.

If change is the pervasive phenomenon which it seems to be, it makes much more sense to focus on process instead of arbitrarily separated parts. In terms of health, I think this means we need to understand the processes of repair, resilience and effective functioning of healthy organisms, not trap ourselves in the limited focus on pathological change within tissues or organs.

A focus on becoming instead of being also undermines the outcome based approaches to care which are so prevalent. Health is a dynamic, lived experiences, not a series of fixed states.

Multiple perspectives allow to understand illness much more fully – again, not limiting ourselves to the pathological changes within cells, tissues and organs, but taking on board the subjective phenomena of illness (pain, stiffness, breathlessness, dizziness, weakness etc), as well as the narrative of the person who is ill through which we make sense of the experience, and beyond all that, to situate the individual person’s illness within the contexts in which they live – their relationships, family, genes, work, social and environmental conditions etc.

Co-action shows that change comes about not least from the interactions between individuals. This knowledge gives us the opportunity to shift the perspective of health care from that of a doctor treating an object, to that of a doctor and a patient co-creating better health for an individual.

Last but not least, all of this thinking leads us to a consideration of the emergent nature of change in living organisms – which means we can never be completely certain how things are going to go in any individual situation. Something which, surely, should bring some healthy humility to the practice of Medicine.

You’ll see this is all entirely consistent with the features of complex adaptive systems, and of integral theory. And it is also utterly consistent with my blog byline of “becoming not being” which I first encountered in the study of Deleuze’s work.

I really think this “relational science” explains reality much better than the old, reductionist, mechanistic, linear paradigm which is still so prevalent.

Let me finish this post with a re-iteration of Overton and Lerner’s excellent summary –

the living organism as a spontaneously active, self-creating (autopoetic, enactive), self-organizing, and self-regulating nonlinear complex adaptive system

 

Read Full Post »

Autumn leaves

Hugs

heart in the keystone

I find Plato’s three “transcendentals” of Beautiful, Good and True a very fruitful concept to explore. When I first read about “integral theory” I was very taken by Ken Wilber’s four quadrants of the single-subjective, plural-subjective, single-objective and plural-subjective, and really liked the way the beautiful, the good and the true could be mapped onto that. (read a little more about that here)

Yesterday as I was looking through my photographs of autumn leaves I was enjoying finding the ones I considered to be the most beautiful.

The day before I was listening to a radio discussion about fairness. The concept of fairness seems to be innate, and the panel discussed a video of an experiment which seems to show how fairness is indeed innate in primates.

Last week I was struck again by the observation that most people seem to visit a doctor to make sense of something. In the Medical World, we refer to that making sense as ‘diagnosis’, and I’ve long since preferred to think of it as an understanding. Making sense of a pain, an itch, a dizziness, of anxiety or whatever, involves the co-creation of a credible story by the doctor and the patient working together.

As these three strands came together for me this morning, I got to thinking of the beautiful, the good and the true once more and two things occur to me.

Firstly, all three of these qualities are dynamic and relative. None of them are fixed. And none of them are universal at the level of the individual or particular. What is beautiful to me, might not be experienced as beautiful by you (on the other hand, we might agree!) And I don’t see beauty as a category either – at least, not as a yes or no kind of category – not as an either/or way of thinking. It’s not a box to tick.

Secondly, for me, I think the Good has a strong element of fairness. We tend to think of Justice as being about fairness, and it strikes me that I can ask myself how fair my judgements and actions are, as a way of considering how good they are. I do also think that the quality of integration is a key characteristic of all complex adaptive systems i.e. all living organisms, so an action or choice is better if it is more integrative (if it increases the mutually beneficial bonds between the well differentiated parts)

Thirdly, I see Truth as being about sense making. In some ways, the sense I make of my experience is the truth of it.

So, my current exploration of the beautiful, the good and the true, centres around wonder (émerveillement), fairness and integration, and sense-making.

I discover beauty through wonder. I am motivated to promote fairness and integration in the world. I make sense through the creation of narratives.

Read Full Post »

« Newer Posts - Older Posts »