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I find that people are all very different. One of my core values as a doctor is that there are no one-size-fits-all medicines or approaches. Because people are different, the ways in which they get better differ, and the treatments which work best for them are different. That’s why I have concerns about the more extreme “evidence based medicine” fanatics, who see only two classes of treatment – “proven” and “unproven” (as if you can be sure what’s going to work for an individual before you’ve even met them)

One of the significant differences I see between people is that some really need to talk. They want to talk, and encouraging them to talk about their traumatic experiences is a way of enabling them to cope and to improve. Others, however, are quite unlike that. Some, even if encouraged, really do not want to talk about past traumas. I think it’s important to understand these differences between people and to offer them the kind of help which is best for them.

Psychologists have studied the particular issue of talking about trauma post 9/11. Their work was reported today on the BBC news site. What I found very interesting was their discovery that contrary to popular opinion that it’s always better to talk about such things, they found a significant number of the people who did well after that event, had chosen not to talk about their feelings at that time.

So, it appears, it’s good talk……..sometimes, and for some people, but don’t apply that advice indiscriminately.

I had a letter published in the BMJ today. Here’s the text –

What exactly does it mean to say that a treatment produces a decline in “all cause mortality by 21%” in a group of patients aged 80 and over? How long did the treatment postpone deaths from “all causes?” A month? A year? Forever? Use of all cause mortality without a time frame stops researchers and readers asking what the treated group end up dying from. By focusing too narrowly we fail to clarify the true consequences of taking a particular treatment.

I wrote this in response to an Editorial about the treatment of elderly patients with high blood pressure. Somewhat astonishingly the article claimed a study had shown that treating over 80 year olds with antihypertensives not only reduced their chances of having a heart attack or a stroke but produced a reduction in mortality “from all causes” by 21%.

That just cannot be true……..not without qualification. And the qualification is the time period under study. The author of the editorial made no mention of the time period. Mortality remains 100%. Everybody, but everybody, dies. If we effectively reduce the chances of dying from one particular kind of disease, then before we make an informed choice to do what will achieve that, don’t we need to know what we’re MORE likely to die from instead? In fact, it’s not just a matter of death, it’s a matter of life. With an increasing emphasis from biomedical medicine to take drugs for life for a healthier life we desperately need some good whole of life research to show what the impact these interventions have on not just the kinds of deaths such people experience, but the kinds of lives they experience too.

There is a terrible tendency still in Medicine to think in too small pieces. We need the bigger picture.

As I flew over the coast recently shortly after taking off from Edinburgh airport, I snapped this shot.

Lothian coast

What strikes me here is the almost symmetry between the man-made shapes of the golf course, and the natural shapes in the sand created by the tides.

the spider and the flower

I was photographing this lovely yellow flower when suddenly I noticed a bit of it was moving…….then I saw the little spider!

Look at it! See how the yellow of its body so PERFECTLY matches the yellow of the flower! Goodness! How does that happen? Isn’t it astonishing!

One of my favourite philosophers is Deleuze. He emphasises not thinking of discrete objects. He rejects the typical “arboreal” system of thought where we set every organism into a specific branch in a taxonomic tree. Instead he suggests we think in terms of the connections and borders and interactions. He emphasises a “rhizome” model (like grass, which has no single centre, but is, instead more like a vast web). I’ve always found that idea appealing because it rejects labelling and putting things into boxes. Instead it emphasises dynamic change. That’s why I have the byline at the top of my blog – “becoming not being…..”

When you think in terms of becoming, not being, you focus on the interactions, the connections and the development of organisms. After all, can we really understand either this flower or that spider without considering how, together, they make a little functioning unit, a little ecosystem?

Seed

I was sitting sipping a coffee at an outside table in the cafe at the market the other day and I saw this seed lying on the table.

seed

I thought I’d capture it and share it with you.

Isn’t it amazing? If you look closely, there are two capture devices built into it! At the left end, there’s a tiny, wee hook-shaped hair for grabbing onto something and, at the other end is this delicate and exquisite brush of fine, fair hairs for carrying it far in the wind.

Seeds have always been a source of wonder to me. How can such a tiny object turn into a flower, or a bush, or a tree? I guess if you are knowledgeable about such things you’ll know what this seed might become – I’m afraid I don’t! One of the subjects which enthralled me at university was embryology. How on earth can a single, fertilised cell turn into all the diverse types of cell in the human body and grow in the right places?! Awesome!

Do you think this seed might become a great tree somewhere? Like these ones?

forest sky

I also went to a garden festival and one of the stalls sold seed pods. Look at their diversity!

seedpods
seedpods
seedpods

So, there’s two things that amaze me about Nature – creativity and diversity. These are such important features of human beings too, aren’t they? How little we guess about the potential of a baby! How little we know about his or her uniqueness! Amazes me every time I think about it!

If you were asked to say what is the essence of medicine, I wonder what you’d say?

Something about “evidence based” or “scientific” or “effective treatment”?

Well, David Sokol, a lecturer in Ethics and Law took this as his subject for an article in this week’s BMJ. He reports attending a clinical neurology class at his local medical school and witnessing a patient with Motor Neurone Disease becoming upset when asked what she had been told about her disease. He sees the neurologist comfort her by taking her hand, and he says this –

As I watched him comfort the patient, my thoughts returned to Selzer’s essay and his concluding words: “Out of the resonance between the sick man and the one who tends him there may spring that profound courtesy that the religious call Love.” As I read this, it occurred to me that Paracelsus in the 16th century and the late French haematologist Jean Bernard also claimed that medicine was grounded on love.

and this –

The words of Paracelsus, Bernard, and Selzer, which hours earlier sounded fuzzy, now rang out with a newfound clarity. I saw, for the first time, the very essence of medicine.

Impressive. Very impressive.

I’ve often said that if I am ever ill and need a doctor I want one who, frankly, gives a damn! I want him or her to care whether or not I am suffering and for that to be the basis of their choices.

Installation Art

installation

I saw this today in the Jardins d’Albertas in Aix en Provence. From the distance I could see these amazing billowing sheets. I don’t know what they are made of but they floated, danced and drifted constantly. Then as I got closer I noticed all the deck chairs scattered across the grass. I thought they were for people to sit on, but then realised they were part of the same art installation.
The whole set was totally engrossing. I stood here, transfixed, and somehow, those deck chairs seemed like the animals you see at the zoo and in a moment, suddenly, you think “They’re all looking at ME!”
Only once I’d uploaded the photo did I see all the shadows, and there’s one of the ways in which a photo can let you see something even more clearly. Why didn’t I notice the shadows at the time? Well, I’m glad I see them now!

I love a good art installation and I’m a big fan of Anthony Gormley, however, I’m afraid I couldn’t find any information at all about the artist responsible for this work.

Here are some more photos from other angles………
sheets
catch the sheets
rear view

Things aren’t things.

OK, that doesn’t make sense, does it? What I mean is that we tend to view the world as made up of objects, or entities. We do that by focusing our attention on parts of what we see, separating out the bits we want to collect together and name. This is one of our major ways of both making sense of, and managing, our world. A great model to help us to take a different view is that of a network or web. One of the most interesting books I’ve read in recent months is “Linked“, by Albert-Laszlo Barabasi.

Networks are made up of nodes and links. You can see anything you like that way. Let’s start with an object, like the chair you are probably sitting on right now. It’s made up of a number of materials which have been attached to each other……wood, or metal, or plastic, and maybe cloth, or leather or some other material. Take any one of these elements in your chair, say, one of the legs. It’s most likely made of wood, or metal (but maybe it’s plastic). Whatever substance it is, you’ll have the impression it’s pretty solid. Solid enough to stop you falling on the floor at least! But it’s made up of molecules which are connected to each other. And every single molecule is made from atoms which are connected to each other. And that was as far as we used to go. But since we smashed the atom open, we’ve discovered that even that is made from sub-atomic particles, like protons and electrons which are linked to each other. Does it stop there? Nope, even those tiniest of little particles are now known to be made of even smaller elements (quarks for example), all restlessly connected to each other. It seems no matter how far in we go, solid substance escapes us, and we find more and more networks of particles and links. Every particle being another network of particles and links.

Maybe it’s just my mind, but that’s where my thoughts went when I looked at this –
glorious seedhead

Then, a little further along the same embankment, I came across this –
seeds

Some of the seeds have already blown away and I thought about how each of these plants can’t be understood all by itself. They are all connected to other elements around them, and the wind comes and blows some of the seeds great distances, and the seeds fall on the ground, and if there is enough good soil, and water, and warmth, and sunlight, each seed bursts out through its capsule and becomes another of these plants. Vast, great, intricate ecosystems and biological networks.

But here’s another whole scale of connections too. Along comes me with my camera and I take this shot and I connect my camera up to my mac, and I upload it to flickr and copy the code into my wordpress blog and write these words and along comes YOU and you see it and now that seed has connected us to each other.

You know what? It blows my mind!

poppy field, originally uploaded by bobsee.

I took a lot of photos of this particular poppy field, then, for some reason, I crouched down and filled the foreground with one of the wide ribbons of poppies spreading right across the field and as I looked through the lens of my camera I noticed these two olive trees in the distance.
Amy, has written some fabulous guides to photography, and in one of them she talks how a camera can increase your awareness. I completely agree. But, on an occasion like this, it also changes your perspective. If I hadn’t had my camera with me I just wouldn’t have seen this. Crouching down, standing up, zooming in and out with a telephoto lens, moving to different parts of the same field…….not only does all that let you see what you’d miss if you just walked or drove by, but it let’s you see the world differently, let’s you see it as if for the first time.
Look at this field. Isn’t it an inspiration? Aren’t you drawn to the invisible gate between the olive trees? Don’t you wonder about the red carpet spread across the field?
You can spend a long time in a place like this

poppy field, originally uploaded by bobsee.

There are thousands of poppies in the fields in Provence just now. One thing that really strikes me about them is how, so often, they catch you by surprise and how you just can’t take your eyes off them.
As I was walking down the path to the front gate, this splash of red caught my eye. I turned and looked, a gap in the foliage at the side of the path having opened up, and it was as if looking through a window into another world. From another angle, it just doesn’t look like this, but from this spot, right here, it suddenly seemed magical, a gift, a moment to stand and wonder about just how amazing and beautiful the world can be.
It’s inviting, isn’t it? Don’t you want to clamber through and see what lies beyond?