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Walking is good for you (but how can you be convinced?)

June 3, 2007 by bobleckridge

A BMJ-published study from the Scottish Physical Activity Research Collaboration has focussed not on the fact that walking 30 minutes every day will significantly reduce your chances of suffering from several diseases (potentially halving heart disease risk for example) but on how to motivate people to act on this advice.

What would it take for YOU to change your habits and walk for 30 minutes every day?  The answer is interesting –

Our findings are consistent with (but certainly not proof of) an assumption that different types of people may respond to different approaches, tailored to their psychological characteristics or life circumstances. In other words, one size may not fit all and various approaches should be offered: some people may respond best to personal advice from their doctor, others may prefer the private feedback from a device such as a pedometer, others (perhaps those in a more advantaged socioeconomic position) may benefit from interventions delivered through the internet, others may benefit from the social support of a walking group, and others may increase their walking in response to prompts about reducing their car use on environmental grounds.

In other words, what works for one person doesn’t work for another and if we want to help people we need to both actually communicate with them to find out a bit more about them, and then tailor our advice to best suit the individual.

This kind of study gives me hope. For too long Medicine has focussed on disease and then tried to treat every patient with the same disease in the same way, but we are beginning to see the glimmers of the New Medicine which focusses on the individual and tailors the treatments according to the individual’s uniqueness.

This is a move from Zombie Medicine (unthinking, treat everyone the same) to Hero Medicine (thinking, holistic and individualised)

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

“Novel” treatments?

June 3, 2007 by bobleckridge

A three year study of treatment for “acute promyelocytic leukemia” adding arsenic into the mix has shown that doing this can increase the survival rates significantly.
What really struck me in this story though was this comment by the Reuters journalist –

Arsenic has been used as a traditional therapy in China for more than 2,000 years, but its use in the United States is still rather novel.

Why is that? What is it about the tendency to certainty in Western thinking? I suppose we have a long history of believing we are right and that our ways are best. We live in a chaotic world where chance events change people’s lives forever every single day. When it comes down to the individual all the so-called certainty of our statistics-focussed view of the world is of little use. When I meet a patient with disease X, I have no way of telling whether or not they will CERTAINLY respond to the same treatment as other patients with the same disease, nor of knowing EXACTLY what will lie ahead for them. But as human beings we can’t cope with total chaos, and complete uncertainty. We need to have some idea of what’s happening in our lives and some idea of how things MAY turn out with particular choices we make. That’s just how we are. We need to juggle our knowledge of uncertainty and unpredictability of the particular with our knowledge of probability gained from the general. The problems arise once we turn those probabilities into certainties.
There was an interesting line of dialogue in CSI the other night – one character, a forensic scientist, said “I am confused”, and her boss replied “Good. That’s the best place for a scientist to be”. He was SO right. Well, not that scientists should always be confused but a scientist who stops doubting, stops looking and stops thinking.
Wouldn’t it be a good thing for us to look outside of our little boxes and see what phenomena are actually already well-observed (just by other people in other places – people who think differently from “us”)

I’m a homeopathic doctor and homeopathic arsenic was the very first remedy I had success with. Whether or not you believe in homeopathy, one thing a study of the subject brings is a greatly increased knowledge of substances used medicinally in different cultures over the centuries. It’s well known to homeopathic doctors that arsenic has traditionally been used to increase stamina and staying power (in fact, it was used to do just that in racing horses until it was made illegal!)  It’s also well known to us that arsenic is a commonly indicated homeopathic palliative treatment in cancer.

I wish we could replace the arrogant know-it-all and I-know-best in scientists and doctors with an attitude of lifelong curiosity and wonder.

What do you think? How would you change the education of scientists and doctors to increase open-mindedness, creative thinking and foster a spirit of humble, endless curiosity?

Posted in education, from the reading room, health, science | 2 Comments »

3 ways to think

May 27, 2007 by bobleckridge

According to the French philosopher, Gilles Deleuze, wrote that there are three ways to think. I know, you’re already wondering how you can think three ways with one brain! Well, you probably use the three ways all the time. In fact, Deleuze claimed it was important to know about the three ways so you could both see things more clearly and communicate more effectively. You’ve probably come across arguments where one person is saying “But what are the facts? Just give me the facts!” while another says “But what is your heart telling you here?” and a third wants to know “But what does this all mean?”. These three questions arise from three different ways of thinking and whilst they are all trying to get at THE TRUTH, they are all actually dealing with entirely different aspects of reality.

So here they are –

  1. Science – thinking about function. A scientific way of thinking takes a focus on how something works. Understanding how something works is very useful. It gives us the chance to try and make it work better, or at least to improve our experience by figuring out how the world works.
  2. Philosophy – thinking about concepts. Science uses concepts to design experiments and observational studies which will throw light on how the world works. Without the concepts though we wouldn’t know where to start. Many scientists unfortunately confuse concepts with facts, thinking that both are THE TRUTH which leads to closed minds and arrogance. This causes a kind of blindness – “my view is THE correct view, yours is WRONG”. We have to be able to think conceptually if we want to better understand our world.
  3. Art – thinking about percepts and affects. What do we perceive? And what feelings are associated with our perceptions? This is not about the how of perception or the how of feelings, it is about using conscious engagement with our perceptions and feelings to understand an aspect of reality which science and philosophy cannot achieve.

I really like this idea. When I meet a patient it’s important that I am aware of my perceptions and of the feelings that arise in me during a consultation. It’s important that I have a developing conception of illness and of health and it’s important for me to understand what isn’t functioning well in this person’s body-mind.

I also like this idea when it comes to teaching. We learn better when our learning experience engages our three different ways of thinking. We need education which shows us how things work, which teaches us to to conceptualise and which engages our feelings. Remember “Gradgrind” in Dickens’ Hard Times? His view of education was that children were empty vessels waiting to be filled with facts. Ring a bell? Oh, for more enlightened educators!

Posted in education, from the living room, life, perception, philosophy | 13 Comments »

Quasicrystals

May 24, 2007 by bobleckridge

You should never believe a scientist who claims to be certain about what is possible and what is not possible. For most of the 20th Century physicists believed that crystals could only have certain structures (based on their “rotational symmetry”). In fact, until 1982 they claimed that is would be impossible for a crystal to have a structure based on a five-fold pattern (like a pentagon). Then in 1982 somebody discovered the “impossible” – a crystal which had exactly that structure. As is often the case in science, once one had been discovered several others then turned up (you only see what you can see!). These structures were given a new name “quasicrystals”. Now, mathematicians are beginning to understand these strange materials –

“Mathematically speaking, quasicrystals fall into a middle ground between order and disorder,” Damanik said. “Over the past decade, it’s become increasingly clear that the mathematical tools that people have used for decades to predict the electronic properties of materials will not work in this middle ground.”

This is such an interesting comment – the “middle ground between order and disorder”. Finding patterns in apparent chaos is always somehow exciting. But for me, this story has another interesting element. There’s a kind of arrogance in many scientists which is the arrogance of certainty. Any scientists who stands up and declares that either all that can be known about a subject is already known, or that anything which does not fit our current understanding is just impossible, will, time and again, be proven wrong!

Posted in from the reading room, science | Leave a Comment »

Empathy-inducing technology

May 24, 2007 by bobleckridge

Janssen LP have created goggles and a headset that give the wearer the experience of having hallucinations. There are two scenarios to choose from – riding on a bus where people appear and disappear randomly and birds of prey claw at the windows, and going to pharmacy where the pharmacist gives you poison instead of pills and other customers stare at you in disgust.

They’ve used these goggles to train social workers, policemen and others who might have to deal with mentally ill people and have apparently shown that after the training the workers understand mental illness better – learning through virtual empathy!

Posted in from the consulting room, health, perception | Leave a Comment »

Humans beat the machines!

May 24, 2007 by bobleckridge

I was taught at medical school that the way to make a diagnosis (that is to understand what’s wrong with a patient) was to listen carefully to them (take a history) and examine them thoroughly. Only if the diagnosis remained obscure at this point would we subject the patient to any investigations. Sadly, there has been an increasing reliance on technology to the point where many doctors seem to be losing the ability to diagnose on the basis of listening and looking. A study from the University of Winsconin has shown another problem with this.

The researchers studied patients with acute appendicitis. They compared what happened to those who went straight to surgery after the diagnosis had been made clinically, and those who first went via a scanner room to have a CT investigation to make the diagnosis. Those who went via the scanner (two thirds of all the patients!) took longer to have their operation done than those who went direct to theatre (only a third of them). The scanner group had twice the rate of burst appendix (perforation) and twice the number of post-op complications.

Moral of the story? Don’t rely on machines as a routine way to make a diagnosis.

We need to make sure medical students and doctors know how to look and listen and make good diagnoses without relying on technology.

Posted in from the consulting room, health | Leave a Comment »

Becoming not being….

May 22, 2007 by bobleckridge

We have a real tendency to divide up our experience of the world, put the pieces into separate boxes and label them. Brian Broom talks about this in his excellent book, “Meaning-full Disease“. He says we discriminate, categorise and judge. It’s kind of how we make sense of the world. The human body is remarkable and is endowed with an incredible amount of sensory equipment to detect the world we live it – we sense light and colour, sounds, smells, textures and so on. In fact, our sensory systems are under constant bombardment. If we didn’t discriminate we wouldn’t be able to make sense of it all. We can only deal with so much at a time. We are pattern-seeking creatures, constantly trying to recognise and make sense of the sights, smells and sounds that surround us. Of course, we lose something in this process of discriminating. We ignore most of the signals coming our way and only pay attention to the ones that most interest us. As I said in an earlier post, “we are what we pay attention to“. If we want to grow, if we want to develop and change and not be stuck in deep ruts, then we need to shift our attention, to deliberately try to break our attention-habits and notice what else is in the world. I am a doctor specialising in homeopathic medicine. This is a method which is based on noticing difference. When a patient tells me their story, I don’t want to know just what symptoms they have in common with other patients I’ve known (so I can make a diagnosis), but I want to notice what is different, what makes this person unique. Picking out patterns is a good skill, but we just have to be wary that we don’t always only see the same old patterns. We also categorise everything. We love labels. Often a so-called diagnosis is nothing more than a label. I saw a little boy recently who had an itchy bottom. His mum said the paediatrician had diagnosed the problem as “pruritis ani”. That’s a latin label. You know what it means in English? Yep, “itchy bottom”. So how helpful is that label? Labels, categorising sadly tend to limit our vision. Once we place something in a box we tend to stop being aware of it, stop noticing how different it is from anything else in the same box. Finally, to judge those boxes, calling some “good” and some “bad”? I can’t remember who said it, but I remember once reading “Judgement stops thought”. How true. When we judge something and especially when we judge a person, we stop thinking, stop noticing and stop actually seeing.

Nothing stays the same. We are always constantly changing. We grow, we develop, we change. The processes of discriminating, categorising and judging create a false impression that the world is made up of fixed, separate things. It’s not true. Nothing exists except embedded in a web of connections, and nothing exists without changing. The world is not really so easy to pin down, and thank goodness for that. Life is dynamic. It flows, it moves and constantly changes. Too much pinning down, labelling and judging creates a false impression of a fixed, stagnant world. So, beware. Shift your attention, break your habits and try to see the connections between things, try to see how nothing just is anything, but instead how everything is in the process of developing and changing. Everything is becoming not being…….

Posted in creativity, from the living room, health, life | 2 Comments »

Where do you relax? Part 2

May 21, 2007 by bobleckridge


I think it’s good to know where you feel most relaxed, to know what helps you to feel good about life. We all need some time for ourselves. I often tell my patients that they should schedule into their busy diaries some time for themselves – not time to catch up on chores (well, you need that too probably!), not time to spend with your loved ones (yes, you DO need that too!), but time spent alone. It can be simply an hour one day a week (that’s better than no time at all) and it shouldn’t involve anything elaborate. A walk in the park, sitting watching the world go by for a wee while, listening to music, or reading, or just noticing your environment, really whatever works for you is good.

For each of us particular environments are most relaxing. Some of us prefer the seaside. For others, its a park.

This photo is taken in Princes Street Gardens, Edinburgh – plenty of seats there!

Go on, try it. Schedule some YOU time!

 

seats in park, originally uploaded by bobsee.

 

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

Where do you relax?

May 21, 2007 by bobleckridge

We are all different and we all find different ways to relax or wind down. One of my colleagues always asks her patients to tell her what’s their idea of a great holiday. The answer can reveal a lot about a person’s coping strategies. I think it’s important to know what makes you feel good, where you feel good, when you feel good. We often get fixated on our problems and one way to not get stuck with problems is to focus on possible solutions. The solutions come from what works for us, the places, times and situations that help us to feel good.

This boat (for many people a boat is a symbol of freedom) and the blue, blue sky, at the seaside represents a way of relaxing for many people.

Where do you go to relax?

What’s your favourite holiday?

 

boat and the sky, originally uploaded by bobsee.

 

Posted in from the dark room, health, life, photography | 1 Comment »

CCTV surveillance

May 21, 2007 by bobleckridge

 

There are 4 million CCTV surveillance cameras in the UK. But who is at the viewing end? This camera is at the Floral Clock in Princes Street Gardens, Edinburgh (no clock there! Long since gone! Just a patch of earth…)

This poor man looks like he’s bored stone rigid! No wonder, this camera’s video feed must be worse than watching paint dry!

But seriously, we live in a command and control society. Who’s in command? Who wants the control?

 

surveillance, originally uploaded by bobsee.

 

Posted in from the dark room, from the living room, life, photography | 1 Comment »

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