Heroes Not Zombies

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!

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?

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?

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.

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.