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Archive for the ‘science’ Category

Complexity, evidence and intuition

Posted in from the consulting room, from the reading room, health, science on September 7, 2007| 6 Comments »

I’ve just read Kieran Sweeney’s “Complexity in Primary Care” (ISBN – 1-85775-724-6) and found it both stimulating and agreeable. I am SO glad that books like this are being published. I’ve read both of his previous books – “Complexity in Healthcare” and “The Human Effect in Medicine”. He’s one of those authors who is bringing the fairly new ideas of complexity science to the attention of clinicians, I think with the intention of trying to redress the balance a bit. Medicine has become very reductionist and limited in its approach and whilst this has paid off in dealing with acute diseases it hasn’t helped in dealing with chronic disease OR in the wider desire to maintain health. In addition to this, the modern thinking he scopes out in these books really has a chance of helping us to reclaim a much more human-centred practice of medicine.

Here’s a couple of quotes from the book which really struck me –

The requirements of medical research are limited by insisting that an answer should be numeric, otherwise it is not a real answer.

That reminded me of what I just posted the other day there about the value of patients words over numbers. It also reminded me of this – I once heard a dentist describe his experience of replacing a retired colleague in a specialist facial pain clinic. He didn’t know that his predecessor had devised a scoring system for pain and had trained all his patients to report a figure as a way of telling him how much pain they were experiencing. Apparently, this man would become quite frustrated with patients who tried to talk about themselves and would even say “Stop. Not another word! I want the next thing to come out of your mouth to be a number. Nothing else! On a scale of 0 to 20 how has your pain been?” The dentist who was telling me this story was quite baffled when he took over the clinic and saw one patient after another come in for follow-up consultations and just say “17” or “12” or “9”, then refuse to say another word. They were too frightened! He didn’t find their answers very useful.

It seems that a lot of what I’m reading just now is challenging me to think about non-rational thought, intuition, gut-feelings, whatever you call that way of understanding the world. In particular I’m reading Solomon’s “Joy of Philosophy” and loving it – he argues this point. See what Sweeney has to say about it –

At the theoretical level chaos and complexity can help us to synthesise evidence and intuition. They dignify the notion of intuition, and re-establish the importance of experience and wisdom, seeing them as emergent properties of the thousands of iterative, recursive interactions in consultations.

Oh, I like that! He’s showing that from basic principles of complexity science we can understand intuition is a way of knowing which arises through our interactions with each other. Thank goodness someone is making a call for us to develop a form of medicine which is greater than the sterile world of “Evidence Based Medicine” with its mind-numbing protocols and guidelines.

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Systems Biology?

Posted in from the reading room, science on September 7, 2007| 1 Comment »

The European Science Foundation (ESF) has published a Forward Look (FL) report System Biology: a grand challenge for Europe. They are seeking to raise awareness of this “novel” way of looking at biology. The quote really caught my eye

“There is a growing awareness in medical science that biological entities are ‘systems’ — collections of interacting parts.”

Well I never! Holism comes to mainstream science! Seriously, this is good news. I think one of the main reasons why medicine has hit its current ceiling on the relief of suffering in chronic disease is its predication on a reductionist model of biology. Complexity science and the study of chaotic systems AND the development of scientific research under the headings of psychoneuroimmunology and psychoneuroendocrinology are beginning to shift the ground away from the reductionists who think that the study of parts is sufficient to those who acknowledge that we in reality, we live in a messy, complex world, which can only be understood through a holistic approach which studies contexts and connections.

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Gut reactions? Intuition?

Posted in life, personal growth, philosophy, science on August 31, 2007| 1 Comment »

A couple of posts yesterday got me thinking about this whole “gut feelings” or “intuition” thing. First off, on the Petri Project, “No guts, No glory”, discusses the work of Gerd Girenzer, who has just published “Gut Feelings: The Intelligence of the Unconscious”. Apparently, Malcolm Gladwell’s “Blink” was based on Girenzer’s ideas. He’s shown that the apparently “rational” approach of making big lists of pros and cons before making a decision can lead to worse decisions than following your gut instincts. I particularly liked this quote –

One should also not overlook that in science itself, you need intuitions. All successful research scientists function, to a degree, on gut instincts. They must make leaps, whether they have all the data or not. And at a certain moment, having the data doesn’t help them, but they still must know what to do. That’s when instinct comes in.

Then on Christopher Richard’s wonderful SlowDownNow site he’s written “Creativity, the slow way where he writes about Guy Claxton’s “Hare Brain Tortoise Mind”. Apparently, Guy Claxton has coined the term the “undermind” for that mental function of slow knowing, or intuition. Christopher is so right when he says –

I appreciate science. I don’t want to give the wrong impression. But the scientific way of thinking now dominates how we think about everything. We have become myopic. Mathematics and science are the most valued subjects, but the arts are now second-class.

There are many ways to know something. Rationalism is good and has its place but there’s a kind of approach to science these days that seems to say that all that matters is what can be measured. Well, love, passion, well-being, health, meaning, purpose, beauty, aesthetics…….I could go on…..are not quantifiable. Yet they matter to us. We make our choices using more than rational thinking (and, don’t make the mistake of saying the alternative is “irrational” thinking). Intuition, aesthetics, and emotions all come into play, along with logic, in trying to lead an examined, worthwhile life.

Science, however, shouldn’t be limited to what can be measured. I think Deleuze had it right – science is a way of thinking – a way of thinking about function. Science helps us to understand how things work. But we also need to think about concepts, percepts and affects. It’s not “anti-science” to be clear about the limits of science.

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Health-related images from the Wellcome Library

Posted in education, from the dark room, health, photography, science on August 17, 2007| Leave a Comment »

The Wellcome Library specialises in the history of medicine. It’s based in London but has recently put online a collection of images which you are able to use freely under the Creative Commons License. The Head of Wellcome Images says,

Wellcome Images is an invaluable tool for teachers and researchers of medical history, health, clinical and biomedical sciences. Through visuals users are able to develop a more profound understanding of human and animal biology, and can use them in their research and teaching. What is unusual for a picture library of this nature, is that the online service is completely free.

The collection is grouped into six sets (each starting with the letter “W”!) –

  • Wellcome
  • War
  • Wonderful
  • Witchcraft
  • Wellness
  • World

Some of the images are startlingly beautiful. Go have a browse. This is an especially useful resource if you teach biological or health sciences.

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Clarke’s Three Laws of Prediction

Posted in life, philosophy, science on August 16, 2007| 5 Comments »

Arthur C Clarke proposed three “laws” or principles about prediction –

  1. When a distinguished but elderly scientist states that something is possible, he is almost certainly right. When he states that something is impossible, he is very probably wrong.
  2. The only way of discovering the limits of the possible is to venture a little way past them into the impossible.
  3. Any sufficiently advanced technology is indistinguishable from magic.

There’s a lot of noise these days about “anti-science” – I find this a strange term actually. It’s about as useful as “anti-art” or “anti-philosophy”. “Science” is not a discreet entity. It’s a way of thinking. Deleuze really clarified this for us. He said science was a way of thinking about function. That’s a good summary in my opinion. I enjoy science because it helps me to understand how things work (sometimes!). Deleuze went on to point out that philosophy was a way of thinking about concepts and art about percepts and affects. These great human endeavours – of science, philosophy and art – give us very different ways to think about our lives and the world we live in. Each way of thinking can potentially be illuminating. But it isn’t a competition. The one way of thinking takes nothing away from either of the others.

So when distinguished but elderly scientists claim that “science” is under attack, I fear they’re misguided. What they probably mean is that their world-view is being challenged. Scientists should challenge each other. They should continuously enter into rational debate with each other. But science (thinking about function) is only one way of understanding experience. What’s the science of love? What’s the science of poetry? What’s the science of Shakespeare? Yes, you can take a scientific approach to any of those subjects but there are better ways to understand love and literature.

Health is an interesting case. It’s actually hard to understand. We know when we’ve got it and when we haven’t, but what is it actually? Science can help us to understand a lot about health by helping us to find out how organisms function. But philosophy and art can also help us to understand health, because health is an idea, a concept and an experience too.

So when “scientists” dismiss experiences which they can’t make sense of, it is worth while considering what they have to say, but it’s important not to make the mistake of thinking they are telling the Truth, the Whole Truth and Nothing but the Truth. There’s more to life than understanding function and there’s more to life than we currently regard as possible. We, the human race, progress by not accepting that something is impossible. Progress involves discovering that much more is possible than you previously thought. Daniel Gilbert writes about this very nicely in his Stumbling on Happiness. He says when imagining the future we are always limited by what we know now. Futurologists tend to imagine versions of the present rather than the radically different futures which actually transpire.

I love life at the edge of discovery. It’s like magic.

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Bird videos

Posted in education, from the viewing room, science, video on August 14, 2007| Leave a Comment »

If you like nature programmes, or enjoy bird-watching, this site – birdcinema.com will be a treat for you.

It’s kind of a Youtube for videos of and about birds!

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The Happiness Hypothesis

Posted in books, from the reading room, philosophy, psychology, science on August 5, 2007| 4 Comments »

The Happiness Hypothesis by Jonathon Haidt. ISBN 978-0-099-47889-8.

This book is by a Professor of Social Psychology at the University of Virginia. The book’s subtitle is “Putting Ancient Wisdom and Philosophy to the Test of Modern Science”. I read it because it was one of three books about happiness discussed by Jean Kazez here. I really enjoyed it. His writing style is easy and at times humorous. He discusses the understanding of happiness from the perspective of ancient Buddhist and Greek thinkers and in the light of findings from cognitive science and the more recent positive psychology.

He makes a good case for the idea that happiness in the result of several factors – some genetic (the given of the physical functioning of an individual brain), some situational (the conditions of life) and some behavioural (the choices we make, the actions we take). I’ve not really considered the first of those before. I guess I’ve thought that things like happiness, depression, optimism and pessimism are all learned phenomena that emerge from the experience of the events which happen in an individual’s life and the sense that individual makes of those experiences, the stories they tell themselves and others about their life. Recently though, both with certain patients in my practice and with what I’ve been reading in that crossover area between neuroscience, psychology and philosophy, I’ve been coming to understand the more complex and intimate links between the body and the mind and between the physical and the subjective. So it makes sense to me that as we don’t all have either a body or a mind which functions exactly the same way as anybody else’s that experiences of positive and negative emotions will be present to different degrees in different people. What he refers to as a person’s “affective style” emerges from the interplay of approach and avoidance behaviours which is influenced both from their genetic make-up and their early life experiences. I find that a helpful concept.

He shed a light on quite a few other issues for me. I like this phrase –

…those who think money can’t buy happiness just don’t know where to shop

He then goes on to explain the different effects of spending money on objects as opposed to spending it on quality time and activities with loved ones.

He distinguishes pleasures from gratifications – a pleasure is a sensory and/or emotional delight. It’s transient and if repeated too often the brain adapts to the stimulus and the amount of pleasure drops (you might like ice cream but eat too much of it at a sitting and the pleasure payback fades). A gratification is an activity which fully engages you, draws on your strengths and allows you to lose your self-consciousness. Gratifications improve your mood for longer and you don’t tire of them in the way you tire of pleasures.

He comes down in favour of positive psychology and its emphasis on understanding your strengths and playing to them, linking this to the older idea of acquisition and development of virtues. What goes along with this is his emphasis on taking actions rather than passively sitting waiting for happiness to just float past.

It is vain to say that human beings ought to be satisfied with tranquility; they must have action; and they will make it if they cannot find it. (Charlotte Bronte)

I liked what he had to say about goals. I often find that talk of goal-setting lacks something but I found it quite hard to put my finger on why. Here’s the explanation. First from Shakespeare –

Things won are done; joy’s soul lies in the doing.

And from the scientific perspective he describes “effectance motive” – we are all driven to make things happen. We get more pleasure from striving towards our goals than we do in achieving them.

His conclusion is this –

Happiness is not something that you can find, acquire, or achieve directly. You have to get the conditions right and then wait.

And he recalls Tolstoy to point to the areas where we need to get the conditions right –

One can live magnificently in this world if one knows how to work and how to love…..

Through love and through work (in the broadest sense, not work just as employment) we can be engaged with others and with the world and we can experience the joy of making things happen, drawing on our strengths, building our characters, and experiencing meaningful lives.

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Proof

Posted in creativity, from the viewing room, movies, science, video on August 2, 2007| 4 Comments »

The movie {Proof} starring Gwyneth Paltrow, Anthony Hopkins and Jake Gyllenhaal got me thinking (well, there’s a surprise you might say!) It got me thinking about a number of issues. Here’s a couple of them.

How do you prove anything? The basis of the scientific method is (according to Popper) falsification. He meant that nothing can be proven but testing can reveal a hypothesis to be false – and so science progresses, coming up with more and more robust hypotheses which are harder to disprove. Of course, in mathematics, advances are made by writing “proofs” which are solutions to puzzles or dilemmas I suppose (don’t ask me, I’m not a mathematician!). A key part of this movie is how to show who actually wrote the groundbreaking “proof” – the father (Robert), or the daughter (Catherine)? What’s the solution? Well, can it be shown that the daughter could NOT have written the proof? If that can’t be shown, then her claim to have written it can gain strength.

OK, I know, that all sounds pretty convoluted. Don’t let that put you off. This is an intriguing and engaging movie, and not at all hard work!

So that’s the first theme – how do we know what we know? How can we ever be sure of anything?

The second one is the theme of how our traits, skills, and qualities come from our roots, from our origins. We can see qualities in ourselves that seem inherited and we can see some of our qualities in our children. We don’t start with a blank sheet, but neither do we start with a fully written script. We make our lives our own and each and every one of us is unique and different but there are threads that run through us which trail way, way back into other people’s pasts. Catherine seems destined to carry forward her father’s work having inherited his mathematical genius but she hopes she has not also inherited his madness. When her father dies, her challenge is to become herself in her own right. This reminded me of Kieslowski’s Blue.

In “Blue” Kieslowski considers how loss creates the possibility of new beginnings. The main character, Julie, loses her husband and her daughter in a car crash in the opening scenes of the movie and her way of dealing with her grief is to try to rid herself of all memories and connections with them. She tries to start again. But there’s no such thing as a clean sheet. Deleuze showed that we are in a continuous process of becoming and that in every present there is the past and the future. Interestingly, in “Blue” there is also the question of exactly who created a work. In this case, who composed the great music – Julie, or her husband? How can we know?

{Proof} also made me think about what it’s like for two people to create together and how, when it works well, what is created can NOT be attributed solely to one person. Yes, sure, an individual can sit alone and create, but something different manifests itself when the creative process is shared. I think that’s a good example of why its important to know a person within the contexts and connections of their life.

Here’s a fanvid of {Proof} – clips set to “I think I’m Paranoid”, by Garbage

And here are the last few scenes of Trois Couleurs; Bleu

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Why your uniqueness matters

Posted in from the reading room, health, life, science on July 19, 2007| 4 Comments »

The Guardian today has an article about a research paper published back in May in the British Journal of Psychiatry. There are more and more attempts to control the future in our society. Predictive statistical models are increasingly being used by everyone from supermarkets (to “target” their marketing to you on the basis of what they think you might like to buy), to social work (to give special help to young mothers who they think might give birth to children who will become criminals), to the criminal justice system (to try and predict re-offender probability), to (my main area of interest) health care (where the experience of groups is used to determine what interventions an individual should or should not recieve – so called “Evidence Based Medicine”).

The paper discussed in today’s Guardian shows that the margin for error between the group studies and individual outcomes is so great that –

When applied to individuals the margins of error are so high as to render any results meaningless.

Almost every day I have a discussion with patients about risks and choices. I always emphasise that the statistical predictions are based on groups and averages and that there is absolutely no way of knowing to what extent they are relevant to this individual.

We are all different. Nobody, but nobody, can tell an individual what their future holds and to pretend they can on the basis of statistical modelling which isn’t up to the job is potentially very harmful.

This heroes not zombies site is about encouraging people to become aware, to think, and to develop their uniqueness. We need to celebrate individuality and difference more and we need to understand that people matter more than statistics – especially in social work, justice systems and health!

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A site called TED

Posted in education, life, photography, science on June 28, 2007| 2 Comments »

If you haven’t discovered it yet, take a look at http://www.ted.com

There are loads and loads of interesting, educational and entertaining videos of presentations and talks.

Start here.  This is a talk by Frans Lanting, a wonderful nature photographer. It’s a slideshow of his own photos that he’s put together and narrates to tell the story of LIFE, of evolution, of how LIFE is about continual becoming (see that “becoming not being……” byline at the top of my blog? You can see why this talk appeals to me).

The photos are just stunning.

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