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reflected tree

reflected tree, originally uploaded by bobsee.

There’s something about seeing the reflection of a tree in a puddle which always catches my eye.
Maybe it’s seeing part of the world upside down. I remember reading about a technique to learn how to draw which involved turning the image you are copying upside down then drawing it. Apparently it helps you see the shapes better.
Well, as I was walking to the station this particular puddle definitely caught my eye. I love the shape of the tree and the pinkish morning clouds are lovely too.

We all love simple solutions. Human beings have such strong urges to understand. We are driven to try and make sense of our experiences and our lives. It could be argued that this drive is a significant factor in human survival and development. It’s a good thing to try to understand. What’s not appreciated so much is the value of doubt. Whilst it’s good to understand, it’s the belief that we never completely understand anything that drives our continual growth. Without doubt, thought stops, reflection ceases and learning hits the buffers.

I’m not arguing for obfuscation. I do like clarity. But the reality is that we are complex creatures living complex lives. Health and illness cannot be reduced to simple formulae or single causal factors. It’s for these reasons that I find myself so impressed with the recent work from the Glasgow Centre for Population Health which has just published an interesting piece of research.

They have studied 20 European regions to make comparisons with the experience of the West of Scotland. The regions they studied were similar to the West of Scotland in terms of de-industrialisation, deprivation and poverty. What’s happened over the course of the second half of the twentieth century is that the West of Scotland has fallen behind all the other regions. Life expectancy figures and a whole bank of illness and health measures have shown all the other regions are improving faster than the West of Scotland.

There’s a common and fairly simplistic view that deprivation is the main cause of ill health, but deprivation cannot explain the differences between the West of Scotland and other similar regions. That’s the somewhat startling conclusion of this study. If deprivation cannot explain it, then what is the explanation? I’m impressed that the Centre for Population Studies has explored a number of possible explanations but hasn’t found any of them to be satisfactory. However, complex causes such as income inequality (it’s been repeatedly shown that the greater the income inequality within a community, the poorer the health experience at any discrete level of wealth), migration and the speed of change (de-industrialisation), are probably all significant, whilst, simple explanations such as absolute deprivation scores, cigarette and alcohol consumption, and so on, cannot explain the differences.

Health is a complex phenomenon and this kind of adult, intelligent research is just what we need.

I’ve just finished reading Michio Kaku‘s “Hyperspace” – it’s a book I’ve had on my shelves for years but didn’t get round to reading (I’ve got LOADS like that – but I’m still convinced I’ll read them ALL eventually!). It’s about multi-dimensional thinking in physics and maths, and I read it because of a dream I had. It’s a fabulous book, which really does make difficult concepts understandable. I highly recommend it.

In the last chapter of the book, Michio tackles the reductionism vs holism issue, because in Physics, apparently, there are two very different groups of adherents to each of these viewpoints. He has an interesting exposition of the more extreme forms of these two groups, referring to the reductionists as “Belligerent science” and holists and “Know-nothing science” – OK, I know, both extremely judgmental and controversial terms but read this paragraph where he describes them –

Belligerent science clubs the opposition with a heavy, rigid view of science tht alienates rather than persuades. Belligerent science seeks to win points in a debate, rather than win over the audience. Instead of appealing to the finer instincts of the lay audience by presenting itself as the defender of enlightened reason and sound experiment, it comes off as a new Spanish Inquisition. Belligerent science is science with a chip on its shoulder. Its scientists accuse the holists of being soft-headed, of getting their physics confused, of throwing pseudoscientific gibberish to cover their ignorance. Thus belligerent science may be winning the individual battles, but it is ultimately losing the war. In every one-to-one skirmish, belligerent science may trounce the opposition by parading out mountains of data and learned PhDs. However, in the long run arrogance and conceit may eventually backfire by alienating the very audience that it is trying to persuade.

Know-nothing science goes to the opposite extreme, rejecting experiment and embracing whatever faddish philosophy happens to come along. Know-nothing science sees unpleasant facts as mere details, and the overall philosophy as everything. If the facts do not seem to fit the philosophy then obviously something is wrong with the facts. Know-nothing science comes in with a preformed agenda, based on personal fulfillment rather than objective observation, and tries to fit in the science as an afterthought.

I recognise these attitudes clearly. I have been on the receiving end of classic “belligerent science” communications – some of it so offensive, I just delete it straight after reading it (and wish I’d never read it in the first place!) “Belligerent scientists” clearly don’t like homeopathy! In fact, the tone of some of the comments I have received to posts I put up concerning homeopathy, led me to create a “Commenting policy” which you can read at the bottom of the right hand sidebar of this blog. On the other hand, I’ve read plenty of comments from the other extreme end of this axis. I find this latter group to be a lot nicer than the belligerent crowd I must say, but often not any easier to have a discussion with.

I confess to having a strong affiliation to holistic perspectives on the world, but science has always been a fascination for me and it thrills me to understand how things work so I see a real value in reductionist thinking too.

How to reconcile these two viewpoints? Well, you could read Kaku’s final chapter, but essentially he argues for taking a higher perspective and seeing that both methods are appropriate in different circumstances.

One contemporary philosopher who has considered this issue is Mary Midgely.

She argues against reductionism or the attempt to impose any one approach to understanding the world as the only right way to see things. She suggests that there are “many maps, many windows” on reality and argues that “we need scientific pluralism – the recognition that there are many independent forms and sources of knowledge – rather than reductivism, the conviction that one fundamental form underlies them all and settles everything” and that it is helpful to think about the world as “a huge aquarium. We cannot see it as a whole from above, so we peer in at it through a number of small windows … We can eventually make quite a lot of sense of this habitat if we patiently put together the data from different angles. but if we insist that our own window is the only one worth looking through, we shall not get very far”

I like that. I like it a lot.

Here’s to an understanding of the value of different viewpoints, and different methods in diverse circumstances. I think we could advance the lot of humankind so much more if we attempted to engage with, and understand, each other, rather than bashing each other about the heads! In particular, less arrogance and conceit would be good!

The UK government has announced this week that it is to roll out a screening programme – “Health MOTs” – checking blood pressure, height, weight, age, current medication, family history and whether a patient smokes and include a simple blood test to check cholesterol and, in some cases, sugar.

Patients with abnormal results will be offered advice, blood pressure drugs and/or statins.

Announcing the plans, Alan Johnson, the Health Secretary, said screening could save 2,000 lives a year

This is an old but much peddled nonsense.

The mortality rate for human beings is 100%. Everybody dies. Reducing the numbers of people dying from one particular disease inevitably increases the numbers dying from something else – people don’t die healthy! But there is virtually no debate at all about this. I’ve never read a single piece of research which asks the question – if less people die from heart disease and strokes, what will they die from instead? Does anybody know? Does anybody care? Well, they should do.

Let me be clear. If there are effective interventions and treatments for any diseases, we should use them. I’m not saying it would be good NOT to reduce heart disease. However, I’d like to know two things – firstly, those who have been treated after a heart disease risk factor is picked up in screening…….what life experience do they have? What diseases are increased in this group? (do we see more cancer, more dementia, more degenerative diseases for example?) And, secondly, more specifically what is the life experience of this group who are put onto drugs for decades after screening? (lifestyle interventions are likely to have positive impacts on a wide range of diseases, but drugs for preventing specific diseases only, at best, impact on those particular diseases)

I think that we need to start thinking of health, not in the short term, but from what has been termed a “life course” perspective. Without that, we are barreling in, at best, semi-blind.

A rather disturbing report from the Healthcare Commission in England has found that less than half the staff in the NHS believe that patient care is top priority for the Trusts which provide NHS services.

That’s pretty shocking. Shouldn’t it be clear to everyone who works in health care that THE top priority should ALWAYS be patient care? There’s something going badly wrong if patient care is NOT the top priority. Health care is about people, and there are two groups of people who are very important in delivering health care – the patients and the carers (staff). This latter group, as far as the NHS is concerned, are not a happy group. The same report states that only one in four staff members feel valued by their bosses.

There’s been something going on in the NHS in recent years……a form of managerialism which has introduced management methods from industry and commerce which are not appropriate in health care. “Agenda for Change” has broken NHS staff morale, and is probably one of the key factors causing staff feelings of being undervalued. And targets based on throughput and so-called outcomes is producing a health service which has lost sight of its main purpose.

Health care should be about caring – caring for the people who use the service and those who provide it.

where the flowers grow, originally uploaded by bobsee.

This kind of thing constantly amazes me.
As the boat I was in sailed past this cliff, this little yellow flower caught my eye.
Isn’t it amazing how a seed can find the smallest amount of soil in which to grow and thrive? You’d almost think this tiny hollow was especially created just for this single flower.
Life is amazingly opportunistic and can make the most out of any chances which come its way

One of my patients today told me a terrible story of her experience undergoing surgery. I’m not going to recount any of that here of course, but she made such a good point to me I thought I’d share it with you. Maybe you agree?

She said, whenever a drug is prescribed, even if the doctor doesn’t go into a lot of detail about the possible benefits and potential harms, when you pick up the medicine from the pharmacy, the packaging contains a pretty comprehensive description of the product, including a list of the known, potential harms. This, she said, allows a person to make a fairly informed choice about whether or not to take the drug. However, there don’t seem to be any such leaflets available about surgical procedures.

Why not? she asked. There are “generic” potential harms – anaesthetic risks, infection risks and so on – which could easily be desribed, and then, surely there are known “specific” risks related to the intended procedure. Couldn’t the Royal College of Surgeons organise its members to develop comprehensive written information to be given to any patient before an intended procedure? Wouldn’t that allow a more properly informed consent?

I think this is SUCH a good idea. I’m not aware that such a thing exists at the moment. If it does, could you point me to it?

Thank you

Here’s an astonishing calculation. In England, in 2006, there were 16 million admissions to hospitals. That’s an astonishing number for a population of about 50 million!

As if that’s not astonishing enough, 6.5% of those admissions were for patients who were suffering from the bad effects of prescribed medicines. That works out at 1,040,000 patients!

At an average of £228 per day as the cost of a hospital stay and and an average of 8 days admission for each of these patients, the cost to the NHS in England in 2006 was £1,896,960,000.

Compass, the organisation which made this calculation concludes –

“Now is the time for a debate about costs and policies about which drugs the healthcare service can afford as people are paying infinitely higher prices – the drugs bill to the NHS now stands at £11bn – for increasingly marginal rewards and higher risk from adverse drug reactions.”

These figures are part of a trend. Every year the drugs bill gets higher and every year the cost of treating people for the adverse effects of prescribed drugs goes up. This isn’t a sustainable path. Is anybody thinking we need a re-think about health care?

daffodils

daffodils, originally uploaded by bobsee.

Walking to the railway station from home yesterday I stopped to capture these daffodils.
I love this outburst of yellow and cream which lines the main road into Stirling at this time of year

coffee
I recently posted about the claimed health benefits of tomatoes, and continuing in that vein………something else I really enjoy is my daily coffee.

Apart from enjoying it, can I add a little health-benefit smugness to my mug? Turns out I can! Recent research has shown that caffeine protects the “blood brain barrier” from the damaging effects of cholesterol. One of the many ill-effects of cholesterol is damage to the tissues which protect the brain from toxic substances circulating in the blood. The researchers believe this may explain the potential for a coffee a day to reduce the chances of getting Alzheimer’s Disease.

Like with the tomatoes, I don’t really need other reasons to enjoy coffee, but it’s good to know I can consider it part of my healthy lifestyle!