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knot on wood, originally uploaded by bobsee.

This was a log I walked past on Skye.
It caught my attention.
What did? Well, the hole did actually! It looked like a keyhole, or a secret, very small doorway, or maybe a wormhole in the universe? (Hey, you’d be amazed how the imagination can be stimulated by a walk in the country!)
Anyway, after the hole caught my eye then the swirling lines of the wood entranced me.
Take a look. You can look at this for a LONG time I think. The patterns, the colours, the sense of energies straining and twisting and bending the fibres of the wood and how they all swirl around a space…..and into that space, we can dive, deeper and deeper and deeper.
What do you think you might find, if you let your mind slip down this hole, like Alice, falling down the rabbit hole?

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Dry stane dyke, originally uploaded by bobsee.

This is what we call a “dry stane dyke” in Scotland. It’s an ancient art and it’s the making of walls with the stones as they are. They aren’t shaped or machined to fit and the art lies in fitting them together without using any cement or mortar to bind them together.
I love their organic uniqueness. They are glorious!
And I love how with time the lichens and the moss soften many of the hard edges and bring the greens and golds and the silvers to the shades of grey.
I love how they weather and how they fit so perfectly well into the fields.

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leaf, originally uploaded by bobsee.

Today in the UK, it’s Leaf Sunday. Apparently this is THE day when the leaves of autumn are supposed to look their most colourful. If you’d like a map of where in the UK to go ‘leaf peeping‘ then here’s one here.

This time of year always reminds me of a thing John Peel once told about on his radio show years and years ago. He suggested a nice thing to do at this time of year might be to go out and pick up a leaf that had fallen from the trees and write on the leaf the word “Hello” with black marker pen. Then someone walking along might see the leaf, pick it up and see the “Hello” and their day might be a better day. I know, sounds kinda ridiculous, doesn’t it? But go on, try it! And if you pick up any leaves with “Hello” on them, tell me about it, will you?

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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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 Now, here’s an interesting study. It’ll soon be published in the November issue of the American Journal of Public Health. There’s a way of considering the amount of health benefit from an intervention. It’s to assess the number quality-adjusted life-year gains per dollar invested. That is, not just benefits in terms of greater life expectancy, but also a measure of quality of life in those years. It’s a cost benefit analysis so the economic payoff is measured by assessing how much the intervention costs so you can work out how much it would cost to get the benefit of the better, longer lives. These researchers claim to have found an intervention which brings greater payoffs in these terms than most other interventions. What amazing new drug is this? Or is it a life-style change?

Nope.

You’re going to be surprised.  It’s reducing class sizes at school!

The class size reduction was from 22 – 25 kids per class, down to 13 – 17. From kindergarten through to Grade 3. The better education, produced better educational outcomes leading to better, less hazardous jobs and the ability to move out of poorer housing etc. I won’t bother you with the details of the figures here (you can follow the link and read more yourself if you like). But what I think makes this study especially fascinating is thinking out of the box.

These days we hear endless claims for technological fixes – from wonder drugs, to vaccines, to new claims for possible genetic engineering. But, historically, the greatest improvements in the health of populations do not come from medical interventions, they come from things like improving water supplies, sanitation, reducing overcrowding and so on. There’s been an enormous movement towards looking at smaller and smaller parts over the last couple of hundred years – reductionism. In the future we’ll see the greatest health gains by focusing holistically, considering the environments and contexts in which individuals are embedded and studying what happens within these systems instead of exclusively studying what happens at molecular levels.

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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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