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Archive for the ‘health’ Category

There are some fabulous TED talks but this one from Jill Bolte Taylor describing her experience of having a stroke in the left side of her brain is not only incredibly moving but might change the way you’ll think about your brain, your mind and even the nature of reality.
It is a great confirmation of Ian McGilchrist‘s work on how the left and right side of the brain can be shown to have unique and very different ways of approaching and engaging with the world. She also uses language entirely consistent with the work of Dan Seigel’s Interpersonal Neurobiology approach.

I urge you. Take a few minutes and watch this video. It’s an amazing story.

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I recently discovered the American Board of Integrative Holistic Medicine. They’ve obviously thought very carefully about the practice of medicine and how a doctor should carry out his or her work. I’m particularly impressed with their ten principles and I agree wholeheartedly with all of them.

So, here are their principles. I sign up. These are the colours I want to nail to the mast. Do you agree? If you’re a doctor, would you accept these principles for your practice?

1.    Optimal health is the primary goal of holistic medical practice, deriving from the conscious pursuit of the highest level of functioning and balance of the physical, environmental, mental, emotional, social and spiritual aspects of human experience. The result is a state of being fully alive, a condition of well-being transcending the mere absence or presence of disease.
2.    The Healing Power of Love: Integrative holistic physicians strive to relate to patients with grace, kindness and acceptance, emanating from the attitude of unconditional love as life’s most powerful healer.
3.    Wholeness: Illness is a dysfunction of the whole person – body, mind and spirit – or the environment in which they live, rather than simply a physical disorder or a random isolated event.
4.    Prevention and treatment: Integrative holistic practitioners promote health, prevent illness and manage disease processes. Integrative holistic medical treatment balances relief of symptoms with mitigation of causes.
5.    Innate healing power: All persons have innate powers of healing of body, mind and spirit. Integrative holistic physicians evoke these powers and help patients utilize them to affect the healing process.
6.    Integration of healing systems: Integrative holistic physicians embrace a variety of safe and effective options in diagnosis and treatment, including education for lifestyle changes and self-care, complementary approaches, and conventional drugs and surgery.
7.    Relationship-centered care: The quality of the relationship between physician and patient is a major determinant of healing outcomes which encourages patient autonomy and values the needs and insights of patient and practitioner alike.
8.    Individuality: Integrative holistic physicians expend as much effort in discerning a patient’s uniqueness as they do in establishing what disease may be present.
9.    Teaching by example: Integrative holistic physicians continually work toward the personal incorporation of the principles of holistic health, in turn profoundly influencing patients by their own example and lifestyle choices.
10.    Learning opportunities: All life experiences including birth, illness, suffering, joy, and the dying process are profound learning opportunities for both patients and integrative holistic physicians.

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A recent editorial in the BMJ asked a question you don’t often find in medical circles – how long should treatments be continued?
Even in acute disease, the evidence base for treatment duration is weak apparently, but when it comes to chronic disease, the situation becomes so complicated that it seems, it’s pretty much just avoided.
This hides two issues. Despite what drug companies and enthusiastic drug prescribers tell us, there are precious few genuine cures in modern medicine. We’re often presented with simplistic black and white claims about drugs which “work” or are “evidence based” as if acquiring those labels mean they are just a good thing, whereas, in reality most of those drugs don’t actually heal, or even enhance natural healing effects. They just modify symptoms. The second issue is related to the first, if these drugs don’t cure, do they give us better lives? Only you can assess your quality of life, so if you have to take a drug for decades, only you can decide if a drug-taking lifestyle a better one for you, but at least you should be told by whoever initiates your treatment, whether or not they expect you to have to take the drug for the rest of your life.
So next time your doctor is about to prescribe a drug for you, how about asking how long he or she expects you’ll have to take it, and if you really want to be challenging, ask what the evidence is for that expectation.

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Tim Parks’ excellent “Teach Us to Sit Still: A Sceptic’s Search for Health and Healing” was recently reviewed by one of the British Medical Journal’s Associate Editors.

By now you must be as bored as I was. And we still haven’t reached the dénouement. I don’t think that I shall be spoiling anything for anyone if I say that eventually he found that learning to meditate brought an end to the pains, although he doesn’t say whether he can pee any better.
Obviously this book wasn’t written for doctors, and I’m doubtful whether they will enjoy it much. They will have heard versions of this story many times before from their own patients whom they tried hard, but failed, to help. Indeed at one level this particular narrative is little more than a long and self absorbed account of the inner journey of a man desperately seeking meaning in and relief from chronic (but not incapacitating) symptoms, who eventually manages to find both through visipanna meditation. Yet before dismissing it entirely it’s worth remembering that the author is a successful writer and academic—one of his novels was shortlisted for the Booker prize—and probably a lot cleverer than we are.

You can tell he didn’t like it.
Having just read the book myself and found it thoroughly engaging, and thought provoking, I thought the BMJ’s review showed just what’s gone wrong with medicine with these days – doctors shouldn’t find patients’ stories boring. They shouldn’t find them irrelevant, nor should they believe that their own take on illness or health is superior to that of the person they are trying to help. What happened to compassion? When did human beings become the boring part of medicine? Interestingly, there are clues in Parks’ own text. Consider these two statements –

What’s the point of speaking when you’ve arranged to do proper clinical tests? The tests will speak for you.

and

Without evidence of organic damage pains were perhaps unimportant. At least to doctors.

I’ve had junior doctors tell me they are being taught exactly these views – that only clinical tests show the “truth” and that patients’ stories don’t matter. This doesn’t bode well for the future practice of medicine.

In fact Parks predicts the BMJ editor’s response –

Doctors had never wanted to go into detail over this, as if afraid that an exhaustive description of symptoms would mean losing themselves in a labyrinth of highly nuanced but irrelevant sensation.

But the editor is right. This is not an uncommon story. That, however, certainly does not make it boring. This is a good read. It’s an engaging and thoroughly honest, open account of a chronic problem which the best of “evidence based medicine” could do nothing to help. That too, is not an uncommon story.

Given that Tim Parks describes himself as a “skeptic” (though I think that label is much misapplied these days….seems the average “skeptic” is actually someone arrogantly convinced of the rightness of their own personal view, only doubting everybody else’s!), it’s interesting to find him saying this (comparing his mother and father’s evangelical Christian fundamentalism to their belief in modern “scientific” medicine”) –

..like doctors’ syrups, divine healing required no effort or self-knowledge on the part of the sufferer; neither my father nor mother paid much attention to their bodies.

One of the most important points he makes is –

Wasn’t it weird, in fact, the way everybody imagined that when you were ill all you had to do was go to a doctor and get yourself prescribed a medicine? How did that happen?

He’s right. How did that happen? And isn’t it weird? Health isn’t about getting a pill, and doctors don’t always know best. Trust me. I’m a doctor.

Finally, referring to John Launer’s suggestion that “MUS” should mean “Medically Unexplored Stories”, instead of “Medically Unexplained Symptoms”, the reviewer concludes –

Perhaps he’s right. If so, the moral of the story told by Parks is that intelligent, educated, and apparently rational people may think about their health and illnesses in ways that hardly begin to overlap with ours.

You know, it’s not about intelligence, education or rationalism, it’s the biotechnical doctors who have lost the plot. It’s their way of thinking which hardly begins to overlap with that of their patients, and as health is a personal and individual experience, the most important story is the patient’s one.

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Here’s an interesting study. Apparently people who have a good social network of friends and neighbours are likely to live longer.

In their study, which looked at over 300,000 people from four continents over a period of seven years, those with the strongest social networks fared best in terms of health outcomes and lifespan. They were nearly twice (1.5 times) as likely to be alive at any given age than those who were lonely.

The protective benefit from good relationships applies at all ages. It’s not just something which is good for the elderly.

These findings shouldn’t be a surprise. Human beings are social creatures. We need to love and to be loved to really thrive. As Christakis shows well in his “Connected” our social networks powerfully influence our lives. This study shows that this influence can mean the difference between life and death.

The dominant health paradigm seems to be take drugs – drugs to keep you well, drugs to make you better, drugs to keep you alive. We need a better paradigm than that. We need one which instead emphasises the importance of living and living well. Just as a recent study showed the importance of the living environment on health, this study shows the importance of the social environment. These studies shift the emphasis away from a mechanistic understanding of health to one where networks, context, relationships and the environment take centre stage. But there’s not profit in that for drug companies, is there? –

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There’s an interesting piece of research published recently studying the effect of living conditions on cancer. Jonah Lehrer has written about it here. It’s a study conducted on mice, not humans, but the results were pretty dramatic.

In short, the paper demonstrates that mice living in an enriched environments – those spaces filled with toys, running wheels and social interactions – are less likely to get tumors, and better able to fight off the tumors if they appear.

Having injected all the mice with melanoma cells, all the mice raised in the standard cages developed the cancer, but 17% of the ones in the better cages showed no cancer, and those which did had tumours 75% smaller than the other mice. These are hugely different outcomes. The researchers highlight a hormonal pathway in mice which could explain the connection between living conditions and tumour production. Jonah concludes –

It strikes me that we need a new metaphor for the interactions of the brain and body. They aren’t simply connected via some pipes and tubes. They are emulsified together, so hopelessly intertwined that everything that happens in one affects the other. Holism is the rule.

Hear, hear, yet again, Jonah Lehrer!

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What’s your vision for health care?
I remember once hearing a spokesperson for WHO (the World Health Organisation) being asked that question and he said his dream would be that every child in the world was vaccinated against every known disease at birth. I wondered what planet he was living on.
One vision is based on “mapping the genome”. When I heard the idea that one day we’ll all be given a map of all the diseases we might expect to suffer AND a predicted age of death, I had this image in my head of some 30 year old walking out of the laboratory clutching his gene certificate telling him he would live to 102, so engrossed with the result that he doesn’t notice the bus heading towards him as he steps out into the road……
The main vision for health care currently doesn’t involve much in the way of direct interventions to improve health, but rather, is about “managing” diseases – which means drugs, and more drugs.
One in ten of over 15 year olds in Scotland now take daily antidepressants, and look how the number of prescriptions over all is rising……

Is this the big idea? More drugs?

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Here’s a scenario to try with any health care professional you know –

Imagine a patient presents with an infection in their bladder (cystitis), with burning pain passing urine, frequent need to pass to urine and some blood in the urine. You send a sample of the urine to the lab and they grow “E Coli” (a commonly implicated bacteria) sensitive to “Trimethoprim” (an antibiotic). You prescribe the recommended “Trimethoprim”. What does it do?

The only correct answer is that it kills the bacteria.

So, how does the inflamed, swollen, bloody bladder wall return to normal?

Only through the body’s natural healing system.

Drugs have effects. Antibiotics in particular can kill bacteria which might otherwise cause us great harm. But prescribing a drug is only part of the job needing done. If we only prescribe a drug and do nothing to support or stimulate self-healing, then we leave healing to chance……as if healing isn’t part of a health care professional’s job.

So, here’s something I wonder about. Why don’t they teach how to heal people at medical school? Why do they only teach how to “manage” diseases, remove diseased tissue, or suppress symptoms?

There’s the BIG gap in biomedical practice – how do we encourage and develop healing?

Shouldn’t we be using approaches which focus on healing as well as those which focus on disease?

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The first time I saw Antony Gormley’s “The Field“, I was transfixed. The room filled with those hundreds of small terracotta creatures all gazing at me gazing at them!

It’s an image which has stayed with me ever since and it’s one I think all health care professionals should expose themselves to.

Every patient I see has something in common with some other patients I’ve seen. That’s the basis of “diagnosis” in the way biomedicine considers disease. But every patient I meet is different. No two have the same experience of this disease. No two tell the same story. And here’s another aspect to that…….nobody stays the same, the story constantly evolves and changes. Without attention to the present, without an open-ness to difference, we fail to see what makes every single human being unique and special.

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Myth 1

There are two kinds of treatments available – those which work, and those which don’t.

The real world isn’t so simple. There’s not a single treatment on the planet which “works” for every person who receives it. I’m sure the drug companies wish they did have such a product – it would have no competitors. Even treatments which work for most people, don’t work for ALL people.

Myth 2

The placebo effect is distinguishable from a pharmacological effect.

Randomised controlled trials typically have two groups. One group receives the study drug and the other, the placebo. If the improvements in the first group statistically exceed those in the second group, the drug is considered to be effective. However, the placebo effect occurs in both groups. It is impossible to know whether any individual in the first group has gained their improvements from the drug, and not from the placebo effect.

In clinical settings, with any individual patient, it is impossible to know whether the drug has “worked” or whether the improvement is due to placebo.

Myth 3

Giving a placebo is the same as doing nothing

This graph is from Irvin Kirsch’s “Emperor’s New Drugs“. It clearly shows that placebo and doing nothing are not the same.

Myth 4

The NHS only funds “evidence based” treatments.

51% of treatments rated by the BMJ group’s “Clinical Evidence” are of “unknown effectiveness”

Myth 5

Objective findings are of value, and subjective reports are value-less

Health is a lived experience. Only a person can report that experience. To dismiss the patient’s narrative is bad medicine.

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