Heroes Not Zombies

Dry stane dyke

October 24, 2007 by bobleckridge

Dry stane dyke, originally uploaded by bobsee.

This is what we call a “dry stane dyke” in Scotland. It’s an ancient art and it’s the making of walls with the stones as they are. They aren’t shaped or machined to fit and the art lies in fitting them together without using any cement or mortar to bind them together.
I love their organic uniqueness. They are glorious!
And I love how with time the lichens and the moss soften many of the hard edges and bring the greens and golds and the silvers to the shades of grey.
I love how they weather and how they fit so perfectly well into the fields.

Posted in from the dark room, photography, Uncategorized | 4 Comments »

Drug company money paying for medical education. No problem. Nothing to see. Move along there.

October 24, 2007 by bobleckridge

JAMA (The Journal of the American Medical Association) has published a survey of the links between Medical Schools and the pharmaceutical industry in the US.

They found that 60% of departmental heads had a financial relationshipwith a drug company as a consultant, member of a scientificadvisory board, a paid speaker, an officer, a founder, or amember of the board of directors.

Two thirds of departments at medical schools and large teachinghospitals had relationships with industry that involved researchequipment, unrestricted funds, support for research seminars,residency and fellowship training, continuing medical educationprogrammes, discretionary funds to buy food and drink, supportfor professional meetings, subscriptions to professional journals,and intellectual property licensing.

Overall, they say, 80% of clinical departments and 43% of non-clinicaldepartments had at least one tie with industry.

Now, I don’t know about you, but that concerns me. That’s an awful lot of influence. What do you think the teachers think about it?

Despite these ties “more than two thirds of all chairs witha personal relationship with industry reported that their personalrelationships had no effect on the various types of departmentalfunctions. A similar percentage claimed that there was no effecton their personal financial status,” the authors say.

No problem. Nothing to see. Move along there………..

Posted in from the consulting room, from the reading room, health | 3 Comments »

How paper extends our minds

October 24, 2007 by bobleckridge

I read a couple of great posts about how people use paper. Across on 43folders. wood.tang’s post about the backs of envelopes was inspired by Merlin’s post entitled Making friends with paper. (really great little video embedded in that post by the way). Both these guys are making the point that they still use paper preferentially for certain tasks despite being keen on technological solutions. They make the point that there’s something different about interaction with paper. Read the comments from people to both these posts – they are also very interesting and inspiring.

This fits with a point being made in a book I’m reading at the moment – it’s Andy Clark’s Being There. He describes a concept of the extended mind. What he shows is how our physical interaction with the environment allows us to develop and use cognitive functions that our brains either just couldn’t do alone, or certainly couldn’t do so well. One simple example he gives is doing a jigsaw. We pick up the pieces, twirl them round in our fingers, hover them over different spaces and our brains, which are good at pattern-spotting, work with these movements and actions and our hands and brains then work seamlessly to solve the puzzle.

I know that since I started doing the morning pages about a year ago my own creativity and productivity has gone through the roof. This blog here is a good example of that. Interestingly, I find I almost never ever go back to read anything I’ve written in those daily notebooks. That’s not how they work. It’s the act of writing longhand in a nice notebook which works with the brain to produce the end result – ideas, solutions, decisions etc etc.

How about you? What’s your relationship with paper these days?

Posted in creativity, from the reading room, life, personal growth | 4 Comments »

Poetry and health

October 22, 2007 by bobleckridge

When I was recently on holiday on the Isle of Skye I popped in to An Tuireann for a look around, a bite of lunch (had fabulous home-made, thick chunky oatcakes and crab pate), and to log on to the net via their free wifi connection. While uploading photos to flickr, and writing a post or two for this blog, I got chatting to Mark Goodwin, the Literature Development Officer. A delightful and gentle man. He gave me a few postcards from the Poetry Box and I read the poems on them. They were so good! Here are some extracts I noted –

from At The Shrink, by Angela McSeveny –

I can hear the whisper of his pencil

Against the paper

As he jots down notes.

The point jerks like a seismograph

Measuring the impact of my answers.

I blurt out some startling truth

And watch, baffled,

When his right hand doesn’t move.

Well, I can tell you, that little segment got me re-thinking how I take notes! Amazingly, it had never occurred to me, until I read this, that the movement of my pen on the paper of the patient’s case record might be having an impact on the patient. But more than that, these lines also highlight for me how we all discriminate, categorise and judge what we see, hear, experience. A patient tells their story. I listen, hearing some parts more clearly than others, interrupting, or leading this way or that, according to my interest, and in the process create my version of their story…….which turns out, hopefully, to be similar, but, for sure, will be new, unique and different, co-authored by the pair of us.

from…Night Sister, by Elizabeth Jennings

How is it possible not to grow hard,

to build a shell around yourself when you

have to watch so much pain, and hear it too?

………..

You have a memory for everyone

None is anonymous and so you cure

what few with such compassion could endure

I never met a calling quite so pure.

Reading this again just now, made me think again about that study which measured doctors’ responses to others’ pain. But the last line is the one which really struck me – ‘I never met a calling quite so pure’. You don’t hear much about ‘calling’ any more. Sadly, the current ethos is one of reducing every health carer’s job to a list of tasks and competencies, then assuming that any person who can tick all the correct boxes will be able to carry out exactly the same job. It’s not like that. People matter. The personality, the values and the motivation of a health care worker will shine through, for good or for bad! The new way of selecting young doctors for training posts in the UK uses a computer-based questionnaire system and does not accept the submission of a cv for example, and the candidates for GP training are referred to only by their numbers (to prevent prejudice on the part of the selectors from the candidates’ surnames). How many have a ‘calling’, and would any selector rate such a claim?

And finally, from Elma Mitchell’s, ‘This Poem” –

……even the simplest poem

may destroy your immunity to human emotions

All poems must carry a government warning

Words can seriously affect your heart.

Oh, so true! How a word can sting, burn, wound, comfort, move, excite, quicken or slow the heart! One of my favourite writers is Raymond Carver. He can write both poetry and prose in a way that you can be moved to tears by a tiny handful of his words.

So, what do you think about the relationship between poetry and health? Have you any experiences you’d like to share?

Posted in creativity, from the consulting room, from the reading room, health, writing | 2 Comments »

Deaths from prescribed medication up 155% in 10 years

October 21, 2007 by bobleckridge

The Independent on Sunday today carried a special report on adverse drug reactions to prescribed medication in England.

Between 1996 and 2006 in England the number of prescriptions issued by doctors has risen 51%, from 498 million to 752 million. Over the same period the number of reported deaths from adverse reactions to these drugs has shot up 155%, from 382 to 973 (actually they estimate the number of deaths reported is only 10% of the real number – this would give 10,000 deaths a year!) Also over this period the number of serious reactions to drugs has increased 214%, from 5,022 to 15,760, resulting in the occupation of 5,600 beds by patients with these serious problems. This has an estimated cost to the NHS in England of £466 million a year. This is an astonishing sum of money. I can’t help but think about the arguments used against Tunbridge Wells Homeopathic Hospital claiming the cancellation of a contract with them would save about a quarter of a million pounds a year. They could save a lot more than that if drugs were prescribed less frequently and more carefully.

A British Medical Association spokesperson said –

The British Medical Association said last night that the figures amounted to a “wake-up call” and is calling for better training in the medical profession. Dr Peter Maguire, deputy chairman of the BMA Board of Science, said: “This big rise in fatal and serious adverse drug reactions should be a wake-up call to all doctors. We have a large number of new medications, but there are also fake drugs coming into the market, and more and more people are using herbal and over-the-counter drugs, as well as all the existing prescription drugs. On top of that, people are living longer and we have the situation of polypharmacy, where we treat people with several medications.

These figures are quite shocking aren’t they? The contemporary paradigm of medicine is to focus on the disease and try to treat either the pathology or the symptoms with drugs in the first instance. Despite the rise of Evidence Based Medicine, drug trials do not typically identify the adverse reactions to drugs. We have to wait until people in the real world start to experience them before we see the problems. We should be cautious about prescribing, and we need to put more effort into understanding and developing non-drug solutions to health problems (after all, four out of ten of the top reported drugs are prescribed for mental health problems). However, drugs can make a huge difference to peoples’ lives. They are often necessary. So we have to train doctors to be better prescribers. One of the main problems identified in this report is that patients often complained that a drug was causing them problems but the doctors didn’t pay heed to what the patient said. This is fundamental. Doctors should listen to their patients. Carefully. And should trust what they tell them.

Posted in from the consulting room, health | 11 Comments »

leaf

October 21, 2007 by bobleckridge

leaf, originally uploaded by bobsee.

Today in the UK, it’s Leaf Sunday. Apparently this is THE day when the leaves of autumn are supposed to look their most colourful. If you’d like a map of where in the UK to go ‘leaf peeping‘ then here’s one here.

This time of year always reminds me of a thing John Peel once told about on his radio show years and years ago. He suggested a nice thing to do at this time of year might be to go out and pick up a leaf that had fallen from the trees and write on the leaf the word “Hello” with black marker pen. Then someone walking along might see the leaf, pick it up and see the “Hello” and their day might be a better day. I know, sounds kinda ridiculous, doesn’t it? But go on, try it! And if you pick up any leaves with “Hello” on them, tell me about it, will you?

Posted in from the dark room, photography, Uncategorized | 2 Comments »

Following the connections

October 18, 2007 by bobleckridge

This headline caught my eye in today’s Guardian – ‘I was trapped into being alive’. It’s an interview with Robert Wyatt. Ah, Robert Wyatt…….now that takes me back to the late 60s, early 70s, when my friends and I were great Soft Machine fans. So I immediately start to think about that band and head off to youtube to see what I can find. Oh, delight, delight! In two vids there is a live recording of the Softs performing Out-bloody-rageous from the glorious Third album – now this might, or might not, be your cup of tea, but here’s the second part – with Robert Wyatt on drums, Elton Dean on sax, Hugh Hopper on bass and Mike Ratledge on the keyboards. I have this on vinyl (must get round to digitizing my three or four hundred albums!) but haven’t heard it for years!

I’ll leave you to explore more of you like, but this music was revolutionary in its time. It was fresh, exciting and innovative. It was real musicianship. Well, Robert Wyatt fell out of a window and broke his back paralysing him from the waist down for the rest of his life. In his solo career though, he has produced some of his greatest work. He has a most unusual singing voice. Here he is singing Elvis Costello’s Shipbuilding –

In the interview, he says that during his deepest depression in the 90s he was

quite unable to sleep. Couldn’t lie still, revolving in the bed all night, and Alfie had to go upstairs to sleep. Wheeling up and down the corridor at 20 miles an hour, I couldn’t stop. I couldn’t write. I lost my sight, I suddenly needed glasses. It felt like dying, but that would have been a release. Physically, as it turns out, I’m very resilient. I was trapped in having to be alive.

Wow! I think that’s an amazing statement. In fact, I meet quite a lot of people who have this kind of experience. Even in the midst of the most awful suffering they discover that they have some kind of life force, some determination to be alive, some resilience, which keeps them toe to toe with the struggle of living and denies them the escape of non-existence.

The final part of the interview really grabbed me too –

Wyatt says his work is instinctive. “A French journalist asked if my music was spiritual, and I said, ‘Only in the original sense of spirit meaning breath.’ I am a breathing animal. If anything, I get lower, not higher, in art to work things out, relying on animal instincts to guide me through what sounds right. Beyond that, it’s unknowable, verbally inaccessible.” He adds, with characteristic self-effacement: “That’s why I work with musicians.”

What a wonderful exploration of the concepts of spiritual versus animal instincts, weaving them together, blurring their distinctions, to focus on what he calls the “unknowable, verbally inaccessible”. Now, I love stories, and I love to write. I am a great fan of words and it delights me to hear my patients’ stories every day but one of the other bigger loves of my life is music. And I think dear, old Robert Wyatt has just hit the nail on the head and explained some of that to me. I know I’ve mentioned here a few times, Deleuze’s three ways of thinking, but this makes me realise that two of my most favourite ways of experiencing the world are through stories and through music.

So, from this little headline in the Guardian, I take a wander down memory lane, accessing almost forgotten parts of my being, find myself singing along to Shipbuilding, and musing about the totally bloody amazing thing it is to be a human being.

Posted in from the reading room, health, life, music, Uncategorized | 2 Comments »

Improving health by aiming at something else….

October 18, 2007 by bobleckridge

Now, here’s an interesting study. It’ll soon be published in the November issue of the American Journal of Public Health. There’s a way of considering the amount of health benefit from an intervention. It’s to assess the number quality-adjusted life-year gains per dollar invested. That is, not just benefits in terms of greater life expectancy, but also a measure of quality of life in those years. It’s a cost benefit analysis so the economic payoff is measured by assessing how much the intervention costs so you can work out how much it would cost to get the benefit of the better, longer lives. These researchers claim to have found an intervention which brings greater payoffs in these terms than most other interventions. What amazing new drug is this? Or is it a life-style change?

Nope.

You’re going to be surprised. It’s reducing class sizes at school!

The class size reduction was from 22 – 25 kids per class, down to 13 – 17. From kindergarten through to Grade 3. The better education, produced better educational outcomes leading to better, less hazardous jobs and the ability to move out of poorer housing etc. I won’t bother you with the details of the figures here (you can follow the link and read more yourself if you like). But what I think makes this study especially fascinating is thinking out of the box.

These days we hear endless claims for technological fixes – from wonder drugs, to vaccines, to new claims for possible genetic engineering. But, historically, the greatest improvements in the health of populations do not come from medical interventions, they come from things like improving water supplies, sanitation, reducing overcrowding and so on. There’s been an enormous movement towards looking at smaller and smaller parts over the last couple of hundred years – reductionism. In the future we’ll see the greatest health gains by focusing holistically, considering the environments and contexts in which individuals are embedded and studying what happens within these systems instead of exclusively studying what happens at molecular levels.

Posted in education, from the consulting room, from the living room, health, life, science, Uncategorized | 1 Comment »

Linked

October 17, 2007 by bobleckridge

Smart World starts by acknowledging the work of two others – Albert-Laszlo Barabasi and Andy Clark. I’ve just read Linked by Barabasi. (ISBN 0-452-28439-2) It’s a fascinating book about the rather young science of networks. I agree with the author, that understanding how networks are created and function is going to be absolutely key to our future direction in science.

A network, quite simply, is made up of nodes and links. One example is social networks. Think of a piece of paper with the names of several individuals on it and lines drawn between the names of people who know each other. It’s remarkable how quickly information can spread around such a network. Maybe you came across the movie “Six Degrees of Separation” – a story based on the premise that there are only an average of six links between any two human beings on the planet. Turns out that idea, which apparently came from a Hungarian short story, is pretty accurate. But there’s a twist…….sometimes the number of links is way less than six (even between people who don’t know each other). Other kinds of networks you are familiar with are the maps of flight routes you see published in airline magazines, the power grid, and, yes, our dear World Wide Web. In fact, everywhere you look, you’ll see networks. Everything is connected. Nothing exists in isolation.

To try and understand how networks develop and how they function, Barabasi takes you on a journey through the world of mathematicians, physicists, social scientists and engineers. It’s quite fascinating. In the process he describes a very clear evolution of this new science. Intially, complex networks were thought to be completely random. But randomly created networks produced by computer modeling turn out not look like real world networks. Real world networks don’t have random distribution of nodes. Some nodes are way more connected than others. Barabasi calls these hubs. Once you introduce the concept of hubs, the mathematical modeling of networks reveal what are known as “power laws” (this is a bit beyond me I’m afraid – maybe Phil can help explain these?) but, as I understand it, if you take a single quality or characteristic in nature, say, height of individual human beings, you’ll get a bell curve. Bell curves look symmetrical and they have steep sides ie there aren’t many “outliers”. Complex, natural networks however have node distributions which can’t be described by bell curves. Instead you get a small number of highly connected nodes (hubs) and a huge number of less connected ones. This characteristic produces incredibly resilient and fast networks.

Real life networks are highly resistant to damage and they adapt to change. You can take out lots of nodes and not make much difference to the functioning. To really damage them you have to go for the hubs. Take them out and you bring the system down catastrophically. So, the structure of networks provides both their greatest strength and their greatest weakness.

Barabasi gives masses of great examples, from epidemiological spread of viruses like HIV, to the functioning of international economic markets, to the spread of ideas throughout civilisations. But one of his most interesting analyses is his critique genetics.

How often do you read about “breakthroughs” in mapping the genetic “origins” of various diseases – all with the promise of predictive genetic tests and of treatments based on what is known as pharmacogenomics – finding which genetic precursors determine the responses to which particular drugs. He dismantles this reductionist view very effectively and promotes a network model instead – making what I find to be a convincing argument that the genetic bases of diseases won’t be found in mapping the genome but in mapping the networks of genes.

This shift in perspective is crucial. It drives us away from a reductionist consideration of elements and parts towards a holistic consideration of system function by understanding nodes and their connections. He even terms this “postgenomic biology”. I like it! However, it’s at this point that he suddenly disappoints. His chapter 13 is very odd. It’s entitled “Map of Life” and in it he takes this idea of postgenomic biology and applies it in a bizarrely reductionist way, predicting that the future of medicine will be in tests and highly individualised drugs based on eliciting these genetic maps. He thinks you won’t need consultations with doctors any more, just simple blood tests which will be computer analysed and targetted, tailored drugs will then be kind of published on demand and delivered to your door and, voila! you have your own special cure! I’m sorry, but I don’t buy this. I mean, I believe that if we could produce a new generation of highly specific drugs rather than the blunderbust ones we use now that would be great, but what happened to this idea of the science of networks, and how they would change our understanding of everything? Suddenly Barabasi leaps into a reductionist model of disease and healing which is predicated on the idea that each individual is indeed an island. Hasn’t he just spent the rest of the book showing us the importance of mapping connections? Isn’t every individual in fact massively connected not only to other individuals but to all kinds of environments. Isn’t it impossible to understand an individual as context-free?

However, don’t let chapter 13 put you off. He really is onto something extremely important here. Once you start to think this way you see networks everywhere and you begin to understand the inescapable importance of connections, and, interestingly, of hubs. We’re at the beginning of this science and I think it’s pretty exciting.

Those of you who have read other posts on this blog will be familiar with my references to Deleuze. His philosophy of networks – he preferred the model of the rhizome – predates this scientific development and has probably been one of the important nodes from which this area of study has grown. You’ll also be familiar with the concept of the Complex Adaptive System which I believe is the best model we have so far for understanding human health and illness.

Posted in from the reading room, health, life, science, Uncategorized | 23 Comments »