Feeds:
Posts
Comments

Vitamin N?

It’s what Richard Louv, author of “Last Child in the Woods”, and “The Nature Principle” , refers to as the therapeutic agent we call Nature. It’s a clever idea, as is his diagnosis of “Nature-deficit Disorder” which he claims is widespread in our urbanised societies.

He writes about how exposure to nature is healing and mentions that in Japan “Forest Medicine” and “Forest Bathing” are becoming recognised medical treatments.

He even has his own definition of nature – ” human beings exist in nature anywhere they experience meaningful kinship with other species”

A 2008 study published in American Journal of Preventive Medicine found that the greener the neighborhood, the lower the body mass index of children. “Our new study of over 3,800 inner-city children revealed that living in areas with green space has a long-term positive impact on children’s weight and thus health,” according to senior author Gilbert C. Liu, MD

And….

A study of 260 people in twenty-four sites across Japan found that among people who gazed on forest scenery for twenty minutes, the average concentration of salivary cortisol, a stress hormone, was 13.4 percent lower than that of people in urban settings.6 “Humans . . . lived in nature for 5 million years. We were made to fit a natural environment. . . . When we are exposed to nature, our bodies go back to how they should be,” explained Yoshifumi Miyazaki, who conducted the study that reported the salivary cortisol connection. Miyazaki is director of the Center for Environment Health and Field Sciences at Chiba University and Japan’s leading scholar on “forest medicine,” an accepted health care concept in Japan, where it is sometimes called “forest bathing.” In other research, Li Qing, a senior assistant professor of forest medicine at Nippon Medical School in Tokyo, found green exercise—physical movement in a natural setting—can increase the activity of natural killer (NK) cells. This effect can be maintained for as long as thirty days.7 “When NK activity increases, immune strength is enhanced, which boosts resistance against stress,”

I like these ideas – a lot! You can read more here and here.

Our hospital, the NHS Centre for Integrative Care at Glasgow Homeopathic Hospital, is built around a beautiful garden, and patients frequently comment about the increase in well-being they feel gazing out into, or wandering around in, the garden.

My recent trip up to Crarae Gardens gave me a similar experience. Don’t you feel better after spending some time in natural environments? Which ones are especially good for you?

Here are two questions which are in my mind during every consultation I have with a patient.

What kind of world does this person live in? and What coping strategies does this person use?

Of course like every doctor I will have a number of questions in mind during a consultation. The primary goal of undergraduate Medicine is to teach diagnosis (as best I conceive it, “diagnosis” is an “understanding” – an explanation for what the patient is experiencing). So that is likely to be one of the main goals of all consultations – what’s the diagnosis? Having achieved an understanding/explanation/diagnosis, the doctor then wants to answer the question “what am I going to do about this?” What the doctor does might be to further examine, investigate, or seek the opinion of a specialist. Or what the doctor does might be a therapeutic act – the most common being either the prescription of a drug, or the carrying out of a surgical procedure.

In other words, the same two questions are important for the doctor too. What kind of world does the doctor live in? And what are his or her coping strategies?  The world view frames the diagnosis, and the coping strategies determine the actions.

The current dominant practice of Medicine has emerged from a particular world view, and this world view is the basis of the actions chosen. So what is that world view? (I’m not going to try and nail down a label for the current Medical orthodoxy, but others have termed it “biomedicine”, “Western Medicine”, or even “scientific Medicine”. Whatever the label, I’m referring to the type of Medicine most commonly practised in the UK, and, yes, of course, you’ll see that is very similar to the commonest practices in many other countries too)

The world view from which the current orthodoxy emerges is based on certain postulates –

  1. There is only one reality.
  2. Reality can be “partialised”. It can be divided into parts which can be studied separately in order to know the whole.
  3. Knowledge can be acquired by an observer who is separate from, and stands apart from, reality.
  4. Observing has no influence on what is observed. (or the influence can be isolated or “controlled”)
  5. The observer’s values and meanings can be isolated and suspended.
  6. Two events related in time can be assumed to be causative – “A is the outcome of B”.
  7. Specifics can be generalised i.e. an explanation from one time and place can be applied to other times and places.
  8. Reality can be described in terms of “laws” and “norms”.

I don’t find these postulates either helpful or convincing. What are the postulates behind my world view as a doctor?

  1. There are multiple realities. No two individuals experience identical realities.
  2. The multiple realities are inextricably interconnected to create the whole. As such no single part can explain the whole.
  3. No-one is outside of reality.
  4. Every act of observation influences (creates even) what is observed.
  5. The observer’s values and meanings create their reality. They can’t be suspended. (Points 3 and 4 are connected to there being no object which can be known without the active involvement of a subject)
  6. Complexity and chaos theories show us that reality is non-linear. Causation can never actually be proven.
  7. Specifics always occur embedded in multiple contexts and as such are always unique. Generalisation involves ignoring the contexts.
  8. Laws and norms are cultural constructions to describe common patterns. Nature is diverse and natural phenomena are emergent (continually evolving and developing into different patterns)

How do you think these different world views affect firstly the diagnosis, and secondly the actions taken?

 

 

Well red

follow me through the red window…..

red arrow

red path

falling

washed up

red dipper

two hearts

symmetry

If you live as if Life is about trying to avoid death, inevitably, you’re going to lose.

If you live as if Life is about living, you win. Every day.

Mirror, mirror……who’s the fairest in the forest?

DSC00977

There’s an excellent article published in the BMJ this week highlighting the increasing problem of “over diagnosis” (defined as “when people without symptoms are diagnosed with a disease that ultimately will not cause them to experience symptoms or early death”)

Medicine’s much hailed ability to help the sick is fast being challenged by its propensity to harm the healthy. A burgeoning scientific literature is fuelling public concerns that too many people are being overdosed, overtreated, and overdiagnosed. Screening programmes are detecting early cancers that will never cause symptoms or death, sensitive diagnostic technologies identify “abnormalities” so tiny they will remain benign, while widening disease definitions mean people at ever lower risks receive permanent medical labels and lifelong treatments that will fail to benefit many of them. With estimates that more than $200bn (£128bn; €160bn) may be wasted on unnecessary treatment every year in the United States, the cumulative burden from overdiagnosis poses a significant threat to human health.

Where’s the problem coming from? The authors discuss a number of the factors, but they pretty much boil down to an overly reductionist view of illness, commercial and vested interests in technologies and drugs, and fears of under diagnosis.

Drivers of overdiagnosis

  • Technological changes detecting ever smaller “abnormalities”

  • Commercial and professional vested interests

  • Conflicted panels producing expanded disease definitions and writing guidelines

  • Legal incentives that punish underdiagnosis but not overdiagnosis

  • Health system incentives favouring more tests and treatments

  • Cultural beliefs that more is better; faith in early detection unmodified by its risks

You probably eat chocolate because you like it. I know I do! But here’s a study suggesting significant health benefits from eating 100g of dark chocolate (greater than 60% cocoa) every day for 10 years.

Results Daily consumption of dark chocolate (polyphenol content equivalent to 100 g of dark chocolate) can reduce cardiovascular events by 85 (95% confidence interval 60 to 105) per 10 000 population treated over 10 years. $A40 (£25; €31; $42) could be cost effectively spent per person per year on prevention strategies using dark chocolate. These results assume 100% compliance and represent a best case scenario.

Conclusions The blood pressure and cholesterol lowering effects of dark chocolate consumption are beneficial in the prevention of cardiovascular events in a population with metabolic syndrome. Daily dark chocolate consumption could be an effective cardiovascular preventive strategy in this population.

If you’re worried about the weight gain potential of 100g of chocolate a day, the researchers suggest “substituting chocolate for other snacks”! (what they mean is balance it out with other changes in your diet)

IMG_0912

Nature loves diversity. So should you.

We live in a complex, constantly changing, ever more amazing, astonishing world. One of the things which takes me aback every time I come across it is a claim to know something for certain, and, beyond that, the claim that this certain knowledge is the ONLY possible explanation or choice.

Margaret Thatcher once famously said “There is no alternative”. The moment she said that she revealed she was living in a state of delusion. In complex, interconnected phenomena (like Life, the environment, the economy…..) there are countless alternatives. What she really meant was she didn’t wish to consider anybody else’s opinions, views, or values.

We’re facing a similar situation in economics. The latest fashion is for “austerity” (which seems to mean protect the profit making potential of the finance sector by reducing everyone else’s standard of living). The advocates of this view, who are in the seats of power throughout Europe, are certain that this is the right policy to adopt. In fact they are so certain, (“there is no Plan B”), that they maintain there are no alternatives.

It’s the same in Medicine. I read a piece recently by a Pain Specialist (that’s someone who tries to reduce pain, not inflict it!), who used the phrase “the Ayatollahs of Evidence Based Medicine”. Health policy makers, claiming the certainties of science, cite “evidence bases” to support their choices based on their world view ie their values, prejudices and preferences. They are convinced they are right, that they know best, not just what is best for them, but what is best for you. If you think differently they will tell you you are wrong.

Yesterday, reading The Edge, I came across this statement by Carlo Rovelli.

 The very expression ‘scientifically proven’ is a contradiction in terms. There is nothing that is scientifically proven. The core of science is the deep awareness that we have wrong ideas, we have prejudices. We have ingrained prejudices

CARLO ROVELLI is a theoretical physicist, working on quantum gravity and on foundations of spacetime physics. He is professor of physics at the University of the Mediterranean in Marseille, France and member of the Intitut Universitaire de France. He is the author of The First Scientist: Anaximander and His Legacy; and Quantum Gravity.

It’s a good point, and one worth remembering……science is NOT about certainty, it’s about unceasing wonder and having the humility to know that you will never know everything.

I don’t trust those who claim there are no alternatives to their own “certain” one. There’s nothing appealing about the arrogance of conviction.

Mind the gap

Mind the gap

This caught my eye in the lane at the end of my street the other morning.
As I look at it again now, I love the pattern of the leaves, and how the foreground frames the background, and it makes me aware how multi-layered our reality is, and how nice it is to slide your awareness from the leaves, to the light, to the trees in the distance, to the colours and the shadows, and the plants behind the plants, and it just stops me again and I breathe out a long, slow breath and I think “how absolutely amazing it is to be alive”