Heroes Not Zombies

Flu

December 6, 2012 by bobleckridge

At this time of year there are queues of patients in the GPs’ surgeries standing in line waiting for flu jabs. I routinely receive emails from my employer (the NHS) exhorting me to have the flu vaccine.

I’m not joining in.

An elderly patient told me recently she attended her GP for a routine BP check from the nurse who asked her if she had been vaccinated for the flu yet. She said no, and as last year she had felt unwell for a few days afterwards, she said she would come back for it after a planned weekend break. The nurse said, nonsense, the flu jag doesn’t make you feel unwell, picked up a syringe in injected it into the patient’s arm. She was furious, and said she wasn’t well enough to enjoy her weekend away afterwards. I’m sorry, but this is no way to deliver health care.

Here’s where the story gets worse.

The Center for Infectious Disease Research and Policy in Minnesota has reviewed the evidence for the claims made about flu vaccination. What did they find?

Based on a comprehensive review of data published from 1967 to 2012, they found evidence for “consistent high-level protection is elusive,” the researchers concluded. Although vaccination was found to provide modest protection from infection in young healthy adults who rarely have complications of flu, the authors found that “evidence for protection in adults 65 years of age and older [who represent over 90% of deaths from flu] . . . is lacking.” Apparently in otherwise fit, healthy young adults flu immunisation can reduce their experience of illness by half a working day. In the elderly there is no evidence is protects them. (This study was reported in the BMJ with the headline “Belief not science is behind flu jab promotion, new report says”)

Yet, the NHS heavily pushes this immunisation.

On a related subject let’s think about Tamiflu which Roche persuaded governments around the world, including the UK, to stockpile supplies costing billions of dollars, on the basis of an evidence base which they continue to refuse to publish. In 2005, the UK agreed to buy £200 million of Tamiflu.

However, the evidence that Tamiflu would actually significantly prevent either the spread of flu, or the incidence of complications has all been based on studies carried out by Roche itself. The BMJ and the Cochrane Collaboration are leading a campaign to get Roche to release the data from their 8 out of 10 unpublished trials. In fact, the BMJ has set up a website.

When it comes to flu, the government seem prepared to promote and purchase, at huge cost, treatments with very, very sparse evidence bases.

Posted in from the consulting room, health | 1 Comment »

Global brain

December 2, 2012 by bobleckridge

Howard Bloom’s “Global Brain” [ISBN 0471419192] is a great and stimulating read. He describes “complex adaptive systems” as having five characteristics –

Diversity generators, conformity enforcers, inner judges, resource shifters and intergroup tournaments.

These are an interesting five characteristics to highlight (there are, of course, other characteristics of “complex adaptive systems”) and Bloom takes his time to describe in gripping and convincing detail how each of these characteristics has contributed to the evolution of life on this planet.

You could read this book as a critique of orthodox Darwinism – the selfish gene, individualised kind of Darwinism – with a very convincing case being made for group selection as a key part of the engine of evolution. He really does make a good clear case for group as opposed to individualised “survival of the fittest” evolution.

I especially like his first two characteristics – diversity generators and conformity enforcers.

All human beings create a sense of self out of the need to be an individual, to be unique, to be different, and the need to belong, to share, to connect and to fit in with others. Diversity generation creates difference, whilst conformity enforcement creates connections and rules.

Diversity generators and conformity enforcers also remind me of Thomas Berry’s lovely idea of wildness and discipline

However…….I ended up not satisfied with the relentlessly competitive theme. His other three characteristics all contribute to a series of survival of the fittest battles. I think there is truth in this but think for a moment about the human body. Our heart and our liver don’t fight each other for resources with the winner taking all. Something else happens – mutually beneficial relationships are established.

Mutually beneficial relationships are the key characteristic of integration, and integration strikes me as a key way in which Life evolves. Through increasing amounts of mutually beneficial connections, complex adaptive systems become both more complex and more adaptive.

It’s not all about competition.

Posted in from the reading room, life, science | 7 Comments »

Winter moon

December 2, 2012 by bobleckridge

The moon in the black winter sky

now look really carefully and see the moon light the landscape ever so faintly (you might need to click through and look at the full size version of this)

Posted in from the dark room, photography | 1 Comment »

Life and death and choices

November 21, 2012 by bobleckridge

There was an amazing story recently in the NY Times about a Greek man living in the US. He was diagnosed with lung cancer in his mid 60s and given the prognosis of 9 months to live. He decided that instead expensive treatments and a costly funeral in the US, he would return to his native Greek island of Ikaria.

He moved back in with his parents and went to bed to be cared for by his wife and mother. But he started to feel strong enough to go out so reconnected with childhood friends and re-established his Sunday trips to church.

As the months passed he felt strong enough to do some gardening (a common activity on the island) and planted vegetables thinking he might not live to enjoy them, but he would enjoy growing them. Not only did he live to enjoy them but with his regular routines now of plenty of sleep, regular walks up the hill, spending time in the garden and in the evenings with his friends at the bar, and his weekly visits to the church he began to feel well enough to tackle the old, neglected family vineyard.

Three and a half decades on he is now 97, producing 400 gallons of wine a year from his vineyard and seems to be cancer free.

What can we learn from this inspirational story? Well, the author of the story in the NY Times concludes this –

If you pay careful attention to the way Ikarians have lived their lives, it appears that a dozen subtly powerful, mutually enhancing and pervasive factors are at work. It’s easy to get enough rest if no one else wakes up early and the village goes dead during afternoon naptime. It helps that the cheapest, most accessible foods are also the most healthful — and that your ancestors have spent centuries developing ways to make them taste good. It’s hard to get through the day in Ikaria without walking up 20 hills. You’re not likely to ever feel the existential pain of not belonging or even the simple stress of arriving late. Your community makes sure you’ll always have something to eat, but peer pressure will get you to contribute something too. You’re going to grow a garden, because that’s what your parents did, and that’s what your neighbors are doing. You’re less likely to be a victim of crime because everyone at once is a busybody and feels as if he’s being watched. At day’s end, you’ll share a cup of the seasonal herbal tea with your neighbor because that’s what he’s serving. Several glasses of wine may follow the tea, but you’ll drink them in the company of good friends. On Sunday, you’ll attend church, and you’ll fast before Orthodox feast days. Even if you’re antisocial, you’ll never be entirely alone. Your neighbors will cajole you out of your house for the village festival to eat your portion of goat meat

Those are probably reasonable conclusions but what inspires me most about this this story is the series of simple, pragmatic choices this man made. He didn’t set off to “beat cancer”, or to find the elusive magical cure. No, what he did was chose, moment by moment, day by day, to live. He might have died in his bed within days of returning to Ikaria. He would have had the death he chose, if that were the case. But he was not at any point focused on trying to determine the detailed outcomes.

Here is what inspires me about this story – at each stage he was focused on how he would live today and at no point did he think how to escape death.

Read the whole article here.

Posted in from the consulting room, from the reading room, health, life | Tagged health, medicine | 2 Comments »

Health in healthcare training

November 20, 2012 by bobleckridge

I’ve long been bemused by the lack of reference to health in healthcare training. The standard clinical textbooks of Medicine not only have no chapters on health, books like Davidson, still a standard medical school text don’t even have an index entry for health.

Then the other day I stumbled on an old document from 1938 entitled “The Wheel of Health”, by G T Wrench MD. The content of the text is not what I want to mention today, but I’d like to share the following paragraphs from the author’s introduction.

Why was it that as students we were always presented with sick or convalescent people for our teaching and never with the ultrahealthy? Why were we only taught disease? Why was it presumed that we knew all about health in its fulness? The teaching was wholly one-sided. Moreover, the basis of our teaching upon disease was pathology, namely, the appearance of that which is dead from disease. We started from our knowledge of the dead, from which we interpreted the manifestations, slight or severe, of threatened death, which is disease. Through these various manifestations, which fattened our text-books, we approached health. By the time, however, we reached real health, like that of the keen times of public school, the studies were dropped. Their human representatives, the patients, were now well, and neither we nor our educators were any longer concerned with them. We made no studies of the healthy–only the sick.

1938! He could have written that today!

Does this not surprise you?

Posted in education, from the consulting room, from the reading room, health | 1 Comment »

Otagi Nenbutsu-ji

November 19, 2012 by bobleckridge

Just outside of Kyoto, up near Arashiyama, there is a little amazing temple – Otagi Nenbutsu-ji.
The most striking and unique thing about it is the 1200 or so rakan sculptures representing disciples of the Buddha.
Here are just a couple –

And here’s a short video I shot to give you an idea of the scale of this….

Do you remember the news story about the old lady in Spain tried to restore a fresco? (http://www.bbc.co.uk/news/world-europe-19349921), well I think she’s been to Japan too!