Tag Archives: medicine

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.

Quacktitioners III – a little bit of ‘me’ time

Oh dear, this isn’t going to be popular. And the reason it isn’t going to be popular is because I’m suggesting that women go to alternative practitioners for the same reason that men go to sex workers – for rest and relaxation or, as the women’s magazines call it, “a little bit of ‘me’ time”. Hear me out before you dismiss me as salacious or simplistic: it’s a conclusion it’s taken me a couple of years to arrive at and it’s one I’d like to test in debate.

When we ask “what do alternative therapists offer that doctors don’t” the simplest answer is “45 minutes of undivided attention”. There are plenty of other answers the most worrying of which is “hope”, but this post is not about desperate searches for a reprieve from a death sentence, it’s about healthy people who go time and again to alternative practitioners. I know what they’re like. I’m one of them.

In my time I’ve spent thousands on alternative therapists.  I’ve had pins stuck in my flesh, candles balanced on my ears and my aura captured in photographs.  I’ve had my chackras re-aligned, the state of my gut diagnosed by the strength in my arms and been annointed with everything from marigolds to onions.  One osteopath refused to chant over me on the grounds that “it’s a bit too shamanic for Cheltenham” but he was willing to do it in Stroud. Make of that what you will.

It was all money fantastically well spent even though none of it cured anything, though the shamanic osteopath did free up a neck muscle which had gone into spasm. But I got a bargain every time, because what I was really buying was 45 minutes of uncritical attention.

Men go to sex workers for this, though in their case they want orgasms rather than attention, but then they’re from Mars. Vive la différence.

So here is my two pronged observation:

  • Firstly, that what pays alternative therapists’ rent and rates is a predominantly feminine need for someone else’s considered attention and non-threatening touch
  • And secondly that men tend to sexualise sensations, and women tend to de-sexualise them, and alternative therapists and beauty therapists offer some decidedly odd services in a women-friendly way

If you’re not sure about my second point, ask yourself why it is that if men want a massage or colonic irrigation or to be wrapped in cling-film or put in a sensory deprivation tank it’s sexual and they look around on the scene or go to a sex worker, but if women want any of those things it’s beauty treatment and they go to a health spa?

Please think about this for a while because it’s probably one of those things that you’ve taken for granted for so long that you’ve never realised just how strange it is. Yes, I know that health spas will happily take a man’s money and wrap him in mud and cling-film, but let’s face it, men who really want this sensation see it as a form of bondage (it’s called “mummification”) and find other fetishists or go to some highly specialised sex workers. And equally, if having your insides washed out with warm water is your thang, then women want Enya playing in the background and the gentle aromas of neroli and ylang ylang floating in the air and men, um, don’t.

But think how peculiar this is. Same physical sensation interpreted in very different ways. I don’t know about you, but I think that’s very odd and very interesting.

So, what do we do with this observation? I dunno, and there isn’t room here for my thoughts and speculations on the subject. But if the medical profession is serious about casting a harshly critical light on to alternative therapies, then it should consider what it is that people are buying, and if you ask me, it’s attention.

Personally, I think that the alternative practitioners are providing a service as necessary and helpful to society as the service provided by prostitutes, and while I’m certainly in favour of regulation, I don’t think banning either helps.

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!

SloughIt 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’.

Time Magazine - The Machine of the YearThe 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.

Pink Floyd - The Wall - Gerald Scarfe 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.

Cycle - MC EscherThe 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.

Migraines 3

You wouldn’t think lying in bed sleeping would be this exhausting.

I am not sure if it is the migraine itself, or if it is the triptane, which I took too late to be effective.

Either way, I have spent the last 36 hours dreaming great long complicated convoluted dreams, mostly about work. I guess it is a good sign that they are mostly about work, since it suggests that the rest of my ducks are in satisfactory rows. It’s odd when one dreams in Visiothough.

I wonder if Microsoft could sue me for running an unlicensed copy in my head?

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.

Visual experiences during cataract surgery under topical anaesthesia and Visual experiences during cataract surgery under topical anaesthesia

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.

Golden lads and lasses

I went to a couple of parties recently, both on the same day.

Some friends of my older sister have an annual bash, lunch in the garden (the weather has always been kind) with everyone kicked out at 6.00pm. They invite their cohort from university. They were an ambitious generation, maybe even a greedy one, at one of England’s two oldest universities so it’s a pretty smart cohort.

It used to be smarter. There are few creatures on the planet as sleek and enviable as ambitious, well educated professionals in their thirties when the education was Oxbridge or Ivy League, and the professions are politics, money, ‘business’ or the law. In those days an understated and very English competitiveness floated in the air like the smell of oil seed rape.

Now most of them have celebrated their 50th birthdays. The successful ones are looking back on their decision to retire early and feeling smug, and the less successful ones are aware that retirement is more likely than promotion. Mind you, none of them are what you would call unsuccessful. The fact that the cars are Volvos and Beemers rather than Jags and Mercs is a symptom of maturity, not poverty.

There are still flashes of the old competitiveness. They swap stories of when they were in Hong Kong, buying companies or closing them down or whatever, but it’s a much gentler group now than it was a while back. Interestingly, and to their credit, they all seemed to be with their original partners, their engagements celebrated almost 30 summers ago with champagne picnics while punting. The women were successful in jobs which are academically demanding and which may have some status but which are not excessively paid, they are neither social climbers nor professional leaders. The men have had more material success than the women, but then they have not had a glass-ceiling or motherhood to contend with.

The second party later that evening was a group of young medics, mainly junior doctors, some 25 years younger. Newer to each other, with less history and experience, looking at their ambitions from the blunt end, but still they were fabulous creatures: sexy, good looking, intelligent, talented, witty and hard-working.

However, one of the young men commented on the compulsion that the young women have to be brilliant AND physically fit AND beautiful AT ALL COSTS. They are indeed young goddesses, lovely and talented, but they seem much more driven than their mothers and aunts. The generation in between are smashing the glass ceiling, and these young amazons will be running the medical profession in twenty years time.

I don’t know. What do I know? Looking back myself, I see that my main ambition in life has been to avoid boredom. Most of the time I’ve achieved it.

 

Truth, stardust and comfort blankies

We should be able to do it now. We should be able rise above superstition, supposition and woolly thinking. We have arrived at the once-in-a-species chance to combine wisdom with knowledge and transcend both.

For the first time in our history we have the data. We really do know things. We have researchers and academics finding things out and publishing them as if their jobs depended on it.

We are also joining the gaps between these pieces of knowledge to some extent. Climatologists train as mathematicians and physicists first, but climatology also draws on the skills of botanists and archaeologists and palaeontologists and zoologists and lepidopterists and… well you get the idea. Not just climatology. Bristol University provides a taught Masters in Archaeology for the Screen Media. The list of connected specialities is huge.

And finally, we have methodologies. There were many seminal innovations in the 20th century: the internal combustion engine, flight, digital computing, penicillin, genocide, but the one without which none of the others would have had any effect is the development of methodologies. It was the development and application of manufacturing processes which enabled the Model T to roll out of the factories in Detroit in its hundreds of thousands. It was the development of a methodology for genocide which meant that six in every eight European Jews were killed in the 1940s.

The relevant methodologies though are the ones for generating information, for finding hard data and separating it out from theory, hypothesis and speculation. So, not only do we know stuff, we have reliable ways of sorting out true stuff and sifting out the plausible stuff, putative stuff, speculative stuff and down right wishful thing.

The ostrich-eye view

However we have not outgrown our comfort blankie. We prefer the warm cosiness of superstition and woolly thinking to the hard realities which face us and – and this is the really unforgivable thing – we tell ourselves we are looking at the evidence and drawing our own conclusions. We are doing nothing of the sort. We lie.

There are examples of this all the time. I once heard a taxi driver saying “75% of all cars on the road are red: if you think about it, it’s true”. The fact that he had failed to look through his windscreen and see that three in four cars are not in fact red was worrying enough. But the fact that he thought he had gone through a verification step pushed me off my mental cliff. What on earth did he think he was doing when he ‘thought about it’? What did ‘thinking about it’ mean to him?

This happens in commercial environments too. I recently distracted a meeting for five minutes by trying to understand if the statement “20% of balls are blue” meant “20 balls in every 100 are blue”, or if it meant “each ball is pie-bald and has a blue patch covering 20% of it”. Eventually the person I was asking the question of snarled “it’s just an expression” and I had to bite my tongue not to reply “no it’s not an expression, it’s a number”. I paraphrase, but I still say he was talking bollocks.

It is this intellectual laziness and moral cowardice that enables intelligent, educated and otherwise thoughtful people to believe in medieavalisms such as astrology or crystal healing or spiritualism or tarot cards. It’s incredibly simple to demonstrate astrology – just run the thing backwards. Collect data on people’s personalities and the events of their lives, and get an astrologer to tell you where the stars were when each person was born. You could limit them to a specific year if you felt generous. If astrology works, you should be able to run it backwards as well as forwards. You could take the same approach for tarot readings. If homoeopathy has more than just the placebo effect, then it should be demonstrable. It isn’t, and one has to conclude that it doesn’t.

Actually, homoeopathy is a case in point. The less a person engages with the methods and concepts of evidence based-medicine, or experimental and evidence-based science for that matter, the more likely they are to accept homoeopathy on trust. (Mind you, the only evidence I have for this is anecdotal and my argument is deductive – but this proves my point – we can now validate and categorise both the data we use and the conclusions we draw from it). What is worrying though is that the reasonably well-educated and predominantly middle class patients of homoeopaths believe that their faith in homoeopathy is worth as much or more than the evidence-based practice of medicine, despite the fact that medical science actually is curing more people year on year and this information is readily available. There’s none so blind as those who won’t see.

Stepping up to the line

By contrast, one of the most fascinating programmes on British radio at the moment is In our Time with Melvyn Bragg. Lord Bragg made his name in literature, humanities and the arts; he is nobody’s fool and no kind of intellectual slouch. However, he struggles with some pretty simple mathematical and scientific concepts whenever the subject is outside his own cultured fields. Fair play to him, he tackles the subjects and tackles them well. But it is astonishing to hear someone as polymathic as Bragg flounder in the midst of really very simple science. And then one realises just how innumerate and scientifically illiterate even the most educated and cultured of us are and – even more worryingly – that this is not seen as any kind of problem.

Almost half a century ago C P Snow argued that someone who does not understand the second law of thermodynamics is as uneducated and uncultured as someone who hasn’t read Shakespeare. He also says “if I had asked an even simpler question — such as, What do you mean by mass, or acceleration, which is the scientific equivalent of saying, Can you read? — not more than one in ten of the highly educated would have felt that I was speaking the same language.”

The madness of crowds

On top of that, we don’t get it. We all feel entitled to an opinion in this democratic age. Like the taxi driver, we do not realise that we cannot think. We all feel that our opinion on – for example – evolution is as valid as the next person, even if the next person is a geneticist or an anthropologist or a palaeontologist and we aren’t. In fairness, the failure is in our education system where people are encouraged to ‘think for themselves’ without being taught how to think critically or being given the basic tools of analysis. This is the downside of democracy. We dumb down to our lowest common denominator. I am not going to argue against democracy: as Amyarta Sen points out, it is the only demonstrable safeguard against famine for a start.

Looking further up the slippery pole, we glimpse our leaders, chosen by us mainly from graduates who studied humanities or social science or business or law. It is not just that they are ignorant. The thing that gives me the great big hairy heebee-jeebies is that they believe that they are ‘informed’ and that being intelligent is enough. They do not accept that some subjects are too technical, too specialised or just plain too hard for the lay person, no matter how intelligent, to grasp, and that some things simply cannot be paraphrased. We are being led by people who just don’t get it, and who don’t actually know that there is stuff to get.

However, I do believe that responsible government requires our winsome elected leaders take and act on the professional advice of specialists even if we don’t like it. Interestingly Thatcher was the political leader in the 1980s most alert to the challenges of climate change. She was a scientist and understood the methodology, even if it had been decades since she’d actually done any chemistry.

Our bad

We are failing the great moral test of our times and retreating into the comfort of a new mediaevalism, surrounding ourselves with ideology and doctrine and the warm and righteous certainties of fundamentalism. We have the chance to rise above all this, to step into reality and claim our inheritance as intelligent and wise children of the stars.

Instead we are sitting in the dust, looking for comfort by casting runes, and that will bring about the ruin us all.