Treating the parts that real medicines cannot treat – a place for placebos

As a skeptic I have a shameful confession to make: I once had an imaginary condition miraculously cured by a placebo treatment.

Some conditions have symptons but not signs. Symptoms are felt and reported by patients, signs can be detected using some form of test. Headache and nausea are symptoms of migraine, vomiting and pallor are signs.

About 10 years ago I went through some high-stakes changes and made a career-move which required full-on keyboard use.  But I developed Repetitive Strain Injury which affected my hands to the extent that I experienced pain up to my shoulders.  Lawyers have a field day with RSI, because some repetitive strain injuries such as Carpel Tunnel Syndrome have signs, but others are just painful with no measurable physical changes. The long and the short of my story is that I bought a wrist magnet and strapped it on my right arm. Within half an hour my right arm was considerably less painful than my left and over the next few days the pains disappeared completely. I was able to take up my new job with no problem at all.  A miracle cure! For a condition my doctor had been powerless to treat! Woo hoo!

Doctors are often exasperated by patients who turn up with functional conditions (ie ones which have symptoms but not signs) because there is nothing concrete to treat and no objective way to measure outcomes. In the worst case, they consider the patient to be a malingerer and even in good cases trust between paient and doctor break down and create a space for kindly Alternative Medical practitioners to step into. Functional conditions are for Alt Med of course because the intervention needed isn’t medical. It’s in the realm that Terry Pratchett’s Granny Weatherwax calls “headology”. The wrist magnet really did cure my RSI.  It worked, not because it improved the flow of fluids in my body, but because I thought it improved the flow of fluids in my body.

Placebos are a side-effect free way to treat conditions which can’t be treated using evidence-based medicine. Let’s be clear here: these conditions are honestly experienced by people of integrity. Just because their minds and bodies are lying to them, doesn’t mean they are lying to the doctors. But there are no symptoms that can be measured and treated so the medical model and the patients’ experience simply don’t overlap. This creates a gap in the market which alt med happily and sometimes effectively fills. But not all alt med is innocent and all of it is expensive and based on false models and premises. We need medical science to admit there is something going on here that needs treating, rather than dismissing functional conditions as hysterical, imaginary or psychosomatic.

Unfortunately, medics who accept that placebos may indeed be appropriate for these conditions cannot bridge gap by prescribing them, even if they will work where “real” treatments fail. Doctors consider it unethical to lie to patients, and I think most patients would agree with them. So at the moment there is indeed a place for alt med in providing these interventions.  Alt Med has no place in treating pathological conditions of course (ie “real” ones): flower drops and sugar pills cannot treat cancer, and magnetic bracelets can’t cure Carpel Tunnel Syndrome.

Betjeman and the Medics

Come friendly bombs and fall on Slough!
It isn’t fit for humans now,
There isn’t grass to graze a cow.
Swarm over, Death!

It is astonishing that Betjeman’s poem was published in 1937. The world has slipped farther and farther down a neatly flagged path to hell in the intervening 70 years.

Come, bombs and blow to smithereens
Those air-conditioned, bright canteens,
Tinned fruit, tinned meat, tinned milk, tinned beans,
Tinned minds, tinned breath.

Tinned minds. Yep. I recognise that idea in my tiny tinny way. We may have better access to different people, different opinions, different world views, than ever before but too many of us retreat in terror from the total perspective vortex, closing our minds behind us, and slinking off to watch lowest common denominator tv.

Mess up the mess they call a town-
A house for ninety-seven down
And once a week a half a crown
For twenty years.

97 pounds, presumably, and 2/6 a week for twenty years would be another 125 pounds. Ach, the numbers are irrelevant, Betjeman is talking about the numbing effect of the mortgage. We are chivvied and coerced and badgered into shape by the mechanistic nature of the organisations we deal with. We sell our soul to the bank, putting our hopes and fears down in the neat little boxes on the form and sign on the line. But then it’s a Computer that says ‘No’.

The drive for efficiency, maximising core competencies and adhering to best practice has – through the ruthless forces of corporate darwinianism – produced standardised ways for organisations to deal with people. The average transaction gets increasingly easier. I can pay a bill with two or three mouse clicks and a dozen or so keystrokes, instead of spending my lunch hour two banks, one to draw out cash and one to pay it in. This is good. But in living memory in Cirencester the Bank Manager would go to the cattle market every Tuesday with a little book. If a farmer wanted to bid for a particular bull, for instance, the bank manager would authorise the appropriate overdraft there and then and note it down in his book. Personalised banking. Expensive, though, in time and money.

Cheap conveniences and cheap pleasures have dehumanised us.

And get that man with double chin
Who’ll always cheat and always win,
Who washes his repulsive skin
In women’s tears:

And smash his desk of polished oak
And smash his hands so used to stroke
And stop his boring dirty joke
And make him yell.

Young British doctors are being crushed by the Machine. I am an outsider to this situation and have not mastered the details, but it has been decided that it is too messy for doctors to apply in a disorderly ad hoc way for training jobs at the appropriate level in a hospital which is local to where they live. Oh no. You see we have too many young doctors and need to cull them. And the culling must be done fairly. So 20,000 of them are being fed into a giant grain hopper which is spitting the lucky ones out into hospitals around the country. The unlucky ones won’t get jobs.

But spare the bald young clerks who add
The profits of the stinking cad;
It’s not their fault that they are mad,
They’ve tasted Hell.

The junior doctors had to fill out a form with ten or twelve questions, 150 words to each answer, to summarise their skills, attitudes, ambitions and experiences. This is efficient, it’s auditable, and if everyone plays the game to the same standard it is even fair. But it is also demeaning, dehumanising and soul-destroying.

It’s not their fault they do not know
The birdsong from the radio,
It’s not their fault they often go
To Maidenhead

And talk of sport and makes of cars
In various bogus-Tudor bars
And daren’t look up and see the stars
But belch instead.

You can’t see the stars in Maidenhead any more, for the light pollution. The power-cuts in LA a couple of years ago brought phonecalls to the police and other services. “Hey, man, there’s aliens coming, see those lights in the sky, man!” There are people in Los Angelese who have never seen the stars. True story. Or so I’m told.

In labour-saving homes, with care
Their wives frizz out peroxide hair
And dry it in synthetic air
And paint their nails.

There is a narrowing definition of what is “normal” behaviour these days. Previously people could be odd, or unusual, or individual, or eccentric and still be normal. The world would adapt around them, around us, accepting people with greater or lesser tolerance as just being “like that” whatever “that” was. Now everyone is packaged and labeled and anyone at either end of the bell curve is identified as having a “syndrome” or a “disorder” or both. Oh, and given meds. Never forget the meds.

The slack has gone out of the world. There are no longer any spaces which can accommodate the unusual. People are no longer accepted in their own terms for who and what they – we – are. Anyone different is drugged into conformity. If we don’t caringly and kindly administer these drugs, the world becomes unbearable, so people who are a little rough around the edges become consumers of drugs that change their natures, distort their personalities, and – oh apotheosis of human ambition – make them normal.

But do you know what? No-one’s normal. We are all distorted by the pressure of others and of the systems that we interact with, like creatures trapped in an M C Escher drawing with no leeway to move, taking on whatever shape we can create for ourselves in the gaps left by our fellows and the computerised customer service systems that provide us with turkey twizzlers and dvds.

The land fit for heroes isn’t fit for people.

Come, friendly bombs and fall on Slough
To get it ready for the plough.
The cabbages are coming now;
The earth exhales.

Exercise and the placebo feel-good factor

I had an epiphany about exercise this morning. About length 16 it was. I spent the remaining 14 lengths, (or maybe the remaining 12 lengths – I tend to lose count around length 23), thinking about it.

My rather damp epiphany is that half the vaunted benefits of exercise are in fact just placebos and I am immune to them. This is the reason why lycra-clad gym-bunnies assume that I am being stupid, mad, stroppy or all three when I tell them that, no, exercise does not make me feel good.

I can only manage swimming for half an hour if I approach it as a meditation practice and concentrate on doing the perfect stroke. And then the next one. And then the next one. The mindfulness of swimming. Feel the water around your nostrils and on your upper lip. Etc.

• No. I don’t have more energy afterwards. Placebo.
• No. I don’t need less sleep. Placebo.
• No. It does not put me in a better mood. Placebo.
• No. I don’t enjoy it at the time. Placebo.
• No. I don’t enjoy it afterwards. Placebo.
• No. I have never ever found myself getting addicted to it. Placebo.
• Or even used to it, really.
• No, no, NO it is NOT – heaven spare us all – fun. Place-ee-frotting-BO. OK?

I swim with gritted teeth and go to the gym in a state of desperation crossed with Calvinist bloody-mindedness because you don’t see fat people in their 50s, because my mother disabled herself through sustained inactivity, because (and only because) it is Good For Me.

Migraines 2

I’d love to write a piece of prose-poetry about migraines, famous sufferers, early diagnoses, traditional cures, but d’you know? – I don’t really want to. I’ve spent too much of my adult life dodging migraines. It is like dodging bullets but you move considerably more slowly.

Triptanes. For me triptanes are where it’s at. They have been life transforming. Yeah, yeah, I know about eating feverfew and not eating chocolate, I know about avoiding triggers, I know about keeping a migraine diary, I know about cold pads and hot pads. So please don’t go there, ok. Really. These are my migraines not your migraines so please back off. (Isn’t that possessive interesting? Do you think I can be bothered to explore that idea right now?)

It would be easier if they started with auras. Oddly, although I sometimes get get visual disturbances in the form of bright zig-zag lines across my vision, they are unconnected with pain or nausea and pass in about 20 minutes or so. They make it impossible to read road-signs or menus or do any work, but they are otherwise pretty and harmless.

The pain is an entirely separate thing and it starts very gently; it strokes me softly above the eyebrow and touches me lightly down one side of my neck, like a nineteenth century despoiler of virgins. And then sounds become too loud, light becomes too bright, and – if I am lucky – I throw up and throw up and throw up. Bile is interesting stuff. No really.

Triptanes, it seems, work on a different model from other anti-migraine medications. They are symptomatic: no pain, no sono- or photophobia, no nausea, but apparently they don’t change the electrical disturbances in the brain which are the true triggers of migraine. In other words, you still have a migraine, you just don’t know you are having one. Which explains why I feel either washed out or knocked sideways afterwards.

Triptanes. Life transforming. Discuss them with your doctor or your pharmacist.

Needles, motes and beams – part 2

Monday’s post about Sir Isaac Newton prompted a comment on the subject of eye operations from the one who cares about these things.

You see, eye operations are usually performed with either local or regional anaesthetics. (“… which means that the recovery rate is umpty percent better, and the operations are dumpty percent cheaper so that dum-diddy thousand more are done each year…. “ … or so the one who cares about these things explained). However, with some eye surgery the patient sees the scalpel come towards the eye, the latex covered hand, the surgeon’s masked face.

Ikkk.

Ikketty ikkk. Ikketty ikketty IKKETTY IKKK!

Thankfully that is not something I’ve ever had to deal with, but I thought I’d share the following two images which are linked to the article in which they were originally published.

and

These show what a cataract operation looks like to the patient.

With a cataract, of course, you start with a lens which is translucent but not transparent, so you can see light and shade and little else. These two paintings were painted by artists following their eye operations. The full article is worth reading if only because of the slightly non-plussed tone of the thing.

I feel slightly non-plussed by them myself, but I thought they were oddly interesting, and worth sharing.

Right. That’s the last thing I have to say about sticking needles into your eyes, I promise. Well, unless there’s a next time.

Chillin’

Bloglily’s recent post in praise of sloth has made me re-examine what happened to me the day I bought my new phone. I’d got the day of an event wrong, and ended up with some completely unscheduled time.

Now for the scary bit: I had a much nicer time than I have had for ages on the free days when I plan my activities.

What….?

Why………?

What am I doing to myself?

My ‘to do list’ is looking pretty good at the moment: I did my two most pressing ‘must do’s yesterday and, other than standard chores, the rest is ‘would like to do’s.

But are they? Would I really like to do them, or would I prefer to do something entirely random instead? Perhaps I should make myself a gamer’s dice with some entirely pleasant and slothy activities on it, and throw it at least once a fortnight, or once a week, or every couple of days.

What would be good to have on it?

• Sit in bed, reading fiction and eating soft fruit
• Amble round the shops in the market town looking at tat and not buying it
• Take a walk through the valley
• Download a concert from Radio 3 and listen to it while knitting
• Go out and photograph things

… I find it rather sad that I can only think of five slothful and spirit-renewing things to do.

Note to self: Must do less.

Are noses being worn longer in New York this season?

Have you ever noticed how strong the generational influence is on portraiture?

If you look at photos from the 1920s all the girls seem to have tip-tilted noses, neat little chins and big round eyes.

It is hard to tell what any specific early 18th century woman looked like from her portrait, because they all painted to look the same: plump along the jawline, heavy-nosed and pop-eyed. Most of these portraits seem to be informed by the same ideal woman, though there is no way of knowing who the original beauty was. Likewise, 16th century portraits all feature people with long thin faces, long bony noses and sunken eyes. Since such a volta face is genetically impossible we are left with the only explanations being fashion or toadyism.

Now, more than ever before, women manage to achieve a consistent image of beauty. If you look at images of modern celebs and wannabes they are indistinguishable identi-girls; tall, skinny, broad-mouthed, with high round breasts and an expensive mane of hair-extensions. And they all have the same short little round-nostrilled nose, sometimes even a nez retroussez, though these days it is achieved with the knife rather than the brush.

But it seems that a tip-tilted nose is so last year, darling. Take a look at the noses on this lot and see what you think. (Poor Helen Shifter, she’s stuck with last season’s schnoz, and doesn’t it age her? She’s so brave about it, too).

I could draw conclusions, but you are an intelligent person and it’s late, so I’ll trust you to draw your own.

In the midst of life we are in death

We were called into a meeting room the other day – the whole team – at no notice. Solemn faces all round and the manager saying “there’s no easy way to say this, but for those of you who knew him….”

One of the young men had been found dead at the foot of his staircase the day before. He’d not turned up for work on Monday, HR had called his father, and it was his father who found him. He was 29.

I’d only exchanged a few words with him – he seemed like a nice lad and he was well-liked by those who worked with him.

What I found disturbing was the need for friends and colleagues to speculate: it seems his relationship had ended recently and there has been a lot of speculation that he committed suicide.

We all need an explanation, a justification, for young death. We look for an answer to the question “why?” We live in a state of secular denial, and so that answer has to be physical or psychological.

However, I’m shocked by how many people cannot accept the idea of an accident or natural causes. My family background, which includes medics and clergymen, means I know that there is no special age before which people do not die.

Shit does happen. Ulcers and appendixes burst. So do blood vessels in the head. People slip on stair-cases, fall through windows, electrocute themselves, choke on food, knock themselves out in the shower and drown.

This lack of acceptance of the brutal unfairness of fate is behind the desperate need of the Diana conspiracy theorists to believe that her mortality was a human betrayal, not a slip of the steering wheel. The idea that the universe could be that random, unfair and cruel is frightening. It could be you.

It is difficult to know what to hope for – to hope that he died of an accident is to hope that his life was stolen from him. To hope that he died of his own volition is to hope that he was so lost, lonely and desperate that he could not see how much the future can hold when you are 29.

Either way, my heart went out to his father, and I am glad that the person who has my spare key is not a member of my family.

Managing Cancer

I have two dear friends both of whom had operations last summer for cancer.

U had breast cancer. She chose to have a lumpectomy and to manage her post-operative care using homoeopathy. She’s a homoeopath herself but she is at least getting someone else to prescribe. S had ovarian cancer, probably a result of her genetic inheritance. She had an operation to remove the cancerous ovary, a course of chemo, a full hysterectomy, and she is about to start a second course of chemo.

I admire U’s integrity, though her personality is such that the decision to reject chemotherapy was barely a decision at all. She believes chemotherapy to be poison, western treatments for cancer to be based on false premises, and western medicine to be based on a faulty model. She could no more have accepted chemo than I could drink sulphuric acid. At the moment the decision looks good – she’s fit, she’s healthy, she’s working, she’s in a good relationship, the future’s exciting, she has the health and the energy to live life to the full.

I admire S’s fortitude. The chemo has made her very sick, she’s been unable to work during it, family members are struggling with the pressures of her illness, she’s dealing with it all because she has no choice. She’s also aware that you tend to catch her brand of ovarian cancer very late, and that even the hysterectomy didn’t manage to cut it all out.

So here we have U – apparently healthy but I fear that the tall hooded chap will tap her on the shoulder with a bony finger sooner than she expects, and S, who knows that the rattling noise behind her is the sound of his feet on the path.

I don’t know which of them is wiser. Such important decisions – how to live your life, how to face up to death – I worry that U will regret her integrity, and I worry that S will regret choosing weapons which make her so ill to fight the disease which is killing her.