Oh brave new world that has such doctors in it!

October 28, 2014 at 10:38 am | Posted in Uncategorized | Leave a comment
Tags: , , , ,

NHS-LogoI’m a writer, and like many writers I’ve got what a friend of mine calls “text hunger” – if it’s there, I’ll read it. One such recent encounter was with one of those little leaflets that come with medicines.

Two things struck me about this text. The first, of course, was the bizarre range of symptoms I’d risk by taking the pills. Medicines by Big Pharma, side-effects by Goya. As it happened, I didn’t lapse into unconsciousness, my skin did not peel off and my eyes remained resolutely un-yellowed. (It was only a sinus infection!)

The second thing that struck me was the way the leaflet’s writers kept exhorting me to contact my doctor if I had any problems. As one of the side-effects was coma I’m not sure how they envisaged that scenario; but that’s by the by. I was left with the strong impression that wherever the writers lived, it was somewhere with truly amazing healthcare services.

The same impression seeps like a miasma of optimism from Internet sites about health-related issues. Any queries? Go talk to your physician, they’ll sort it out. Got a headache? (It could be a brain tumour!) Ask your GP; they’ll calmly steer you through your anxieties. Afraid your fever might be Ebola, not flu? Just get an appointment and check.

As for the frequent media reports of wonderful medical advances, with their tales of current patients carefully examined and lengthily treated, and future patients whose medications will be personalised to their particular circumstances, they seem designed to raise unrealistic expectations.

Where is this fabulous land in which doctors sit, primed and eager, in their surgeries, with all the time in creation to soothe, heal and most of all listen? It isn’t here. Nor, I suspect, is it where you are (though I’d be delighted to learn otherwise). Unrealistic? It’s like reading the Narnia books, except I’d be less surprised if I met a talking animal.

How does anyone think we are going to find the time and money to do all this personalising of medicine? Here in the UK we can barely afford the current NHS. Despite swallowing vast quantities of funding and research time, problems like obesity, alcoholism and dementia aren’t about to be ticked off the healthcare agenda. Medics may be able to do astonishing things like helping the paralysed to walk, but there are still an awful lot of common conditions – from arthritis to Alzheimer’s, chronic fatigue to Crohn’s disease – which they struggle to manage successfully, let alone cure.

Now and again the media, presumably tired of simulating Dr Pangloss, flips into attack mode and screams about hospitals in special measures and patients expiring for lack of medical attention. We have those round here too: a ring of hospitals so poorly that we can only pray we never get sick enough to need them. But over-emphasising the negative is no more helpful than dishing out happy positives. When a friend of mine needed urgent care, it was given with quick and kind efficiency.

Plus or minus, public visions of the NHS seem worryingly detached from the reality. I heard a top doctor on the news the other day fretting about how paying doctors to diagnose dementia could affect the doctor-patient relationship. What relationship would that be? Every time I visit my surgery I see a different person. They are almost all kind and pleasant, but they have a demoralising aura of hurry and overwork, as if patients are not so much people as problems to be solved, with a pill if possible or a referral if not.

Our GPs are so busy that same-day appointments are a rare treat. This may be because they are currently overwhelmed by people panicking about Ebola, as a friend sourly suggested, but I doubt it. The NHS I know – the real one, not the media fable – has had these problems for years. All those siren voices encouraging people to book appointments may not have helped, but the problems run deeper than mere anxiety.

Moreover, not everyone panics. There are many patients who, like me, ruinously distort their nation’s health statistics by not going near a doctor unless they’re driven there by nagging friends and relatives. A cold or flu? Pile on the painkillers, whip up a honey-and-lemon. Lingering coughs and strange twinges? Wait a week or two and see if they get any worse. I had my sinus infection for months before I bothered the doctor with it, and that was only because I was getting so deaf it was making conversations difficult.

When I did finally approach the surgery, there wasn’t a hope of actually seeing a doctor that week. I managed to get a prescription purely by telephone, from a complete stranger whose scheduled morning call was three hours late. The consultation may have lasted as much as five minutes. And the pills didn’t work, so I had to go back again.

This is the real NHS: good people doing their best in near-impossible situations. They can fix many basics. There’s a huge amount they can’t fix, because medicine just isn’t that accomplished yet.

But it’s not just that. Patients and future patients ramp up the problems by smoking, overeating, drinking too much, sitting around all day and/or refusing to take responsibility for their own health. That’s you and me both, and the world and his wife or partner, egged on by the media, politicians and various industries whose business models depend on our laziness, greed, short-termism and anxiety.

Why is it so difficult for people in the public eye – politicians, doctors, media commentators – to say so? Why the polished pangloss or the exaggerated panic? The NHS has enough to deal with without these crazed swings from love to hate, from praise to vituperation. And those of us who see the NHS as a national treasure need to think clearly about its needs, which are our needs – especially with a general election looming.

How can we do that if no one will tell us the truth, unvarnished, untarnished and without obfuscation and propaganda? I know humankind cannot bear very much reality (Mr Eliot said that, so it must be true). But surely we could bear a little more than this.

Advertisements

Of shrinking brains and modern anxieties

September 12, 2014 at 12:22 pm | Posted in Uncategorized | Leave a comment
Tags: , , ,

A recent piece in Discover magazine highlights research on changes in brain size over the last 20 000 years. Contrary to what you might expect, the findings seem to point to decreasing size up until very recently (the last century or so, when better nutrition and public health measures became available). The article doesn’t mention gender differences (men typically have bigger brains than women) or health issues (some big brains can be a sign of big problems), but it suggests various hypotheses about why the changes may have happened, making for an entertaining read.

(Not as entertaining, however, as Kurt Vonnegut’s novel Galapagos, one of my ten books every scientist should at least know about, in which one of the hypotheses is delightfully explored. Vonnegut takes the idea that we’re dumbing down, living through the rise of the ‘idiocracy’, and extrapolates it far into the future.)

Rumour has it that IQ measures, those sure and certain guides to human ability, are also not soaring like they used to. (That’s debatable; a recent meta-analysis confirms the Flynn effect.) Shrinking brains, diminishing smarts: that’s the assumption. One researcher in the Discover piece argued that, “As complex societies emerged, the brain became smaller because people did not have to be as smart to stay alive.” (In other words: blame welfare.)

Cro-Magnon folk didn’t take WAIS tests, so it’s hard to assess this claim. And — here’s an unscientific argument! — it doesn’t fit with what I’m hearing from people I’ve talked to about this. If they feel they’re getting stupider, it’s because the world around them is getting so much more complicated than it used to be. If people have less ‘grey matter’ (and white matter, without which the famous grey stuff would be a splodge of useless gloop), they’re definitely doing more with it. Especially if they’re reading, watching or listening to the media.

Our modern anxieties may not be as severe as our Cro-Magnon ancestors’, but I find it hard to believe that those early humans had nearly as many of them. A modern person may not worry as much about survival (although too many still have to — a point it may be easier to overlook when you hail from the upper echelons of academia). But we moderns have huge fears about getting on, doing the right thing, keeping up with the neighbours, etc. etc.

Here’s a list of just a few of the modern anxieties we’re expected to concern ourselves with these days.

  • Computers — are they safe and secure? Are they destroying your health? What are all those updates actually doing to them? What are they doing, under those smooth bland surfaces? Can you trust online sites?
  • Privacy — do you have any left? If not, why aren’t you panicking? Go and read Paul Bernal.
  • Cars — should you feel guilty about damaging the planet? Or yourself? Cars are bad for the health.
  • Health — don’t even start. Driving’s the least of it: the list of what you should be doing, eating, drinking — or not — is endless.
  • Energy — almost all of it seems to be obtained in harmful or ethically dubious ways, except possibly the stuff you can’t afford.
  • Food — ditto. Are you eating meat? Eat less. Is your fish responsibly sourced? Are you sure? Are you a milk drinker or soya eater? Feel the guilt: you’re helping to ruin goodness knows how many environments.
  • Other goods — probably ditto. Why aren’t you taking the time to research who’s nice and who’s nasty in the corporate world?
  • International finance — any civilisation that thinks it’s a good idea to hand over its monetary systems to a gang of smart young computer buffs with less empathy than your average potato is surely doomed. We tried it; they gave us the Great Recession. Have we sent them to their bedrooms (or to jail) and cut their pocket money? Have we changed the system so they can’t do it again?
  • Careers — there’s someone on Twitter or Facebook who’s half your age and is bragging about doing twice as much. The sensible thing would be to pity them for having been brought up to be such a shameless vulgar narcissist, but chances are you’ll feel the social pressure and worry that you ought to be working even harder. (In all the spare time you aren’t using up pandering to all the other anxieties.)
  • International politics — it is highly likely that there is nothing you can do that will make any difference whatsoever to the multifarious stupid, nasty, disgusting and cruel human behaviours currently disgracing the planet. (I wrote a whole book about cruelty and what to do about it, and that didn’t make a difference that I know of. Odd, eh?). But you’re expected to know about them, worry about them, and maybe sign a petition or two. (It’s quicker than writing a book.)
  • Animals — I watched a TV programme about conservationists in Costa Rica trying to save a baby sloth. They failed. It was terribly sad. It was also one on a very long list of critters I’ve been told about and/or begged for cash to support.
  • People — even in one of the wealthiest nations on the planet, there seems to be a superabundance of poor/abused/wronged/sick adults and children to care about. And don’t forget concerns about immigration, people-trafficking, slavery and the like; there’s plenty more which could be added to that list.

With all that on his mind, I suspect that even the most brilliant Cro-Magnon genius might just curl up in a ball and start whimpering.

 

Forgotten sins: of fashion and morality

January 28, 2014 at 12:37 pm | Posted in Uncategorized | 1 Comment
Tags: , , , , , ,

We tend to think of morality as long-lasting. Think of the Ten Commandments, carved in stone, or the claims of evolutionary psychologists that moral sentiments have ancient origins. Morality is associated with permanence, certainty, and truth. So it’s odd how rapidly our moral opinions can change.

Each of us could plot our own moral profile, a graph showing how much we care about a range of topics, from the environment to immigration. Concern, however, doesn’t necessarily imply understanding of an issue. You can see why: there’s so much to know about nowadays that we have to outsource most of the knowing to others. Yet expressing moral judgements is a common form of social bonding, and there are many situations in which we’re expected to have an opinion about a topic – often by people as ignorant of it as we are.

In part, this might explain why morality can change so fast: as people learn more, they may revise their judgments. However, many moral opinions are driven by fashion and the media, the sources from whom we learn about stuff we can’t be bothered to learn about. These sources don’t exist to impart information, but to sell things – and moral outrage sells; so it is in their interests to foster judgmental fervour. The result is a lot of strong opinions with a shaky factual basis. New facts alone may not suffice to modify these beliefs, but a wider cultural shift, with its changing social, legal and financial incentives, can.

In the UK a few decades ago, many women – and even young teenage girls – ran a gauntlet of sexual comments and touches by men. It was part of life, however unwelcome. Now the culture has changed so much that ageing celebrities are being hauled through the courts, and the media, for acts committed years ago. Current stars, and the public, know it’s no longer acceptable to fondle fourteen-year-olds or force yourself on an unwilling female. They know they may lose their job or even go to prison. This doesn’t mean such acts no longer happen, but they now carry more social risk.

We’ve certainly noticed the moral change in this case; there’s been so much public comment on sexual abuse. Yet there are some features of morality which have slipped out of our culture almost unnoticed. These forgotten sins (and their opposites, since every vice has its complementary virtue) used to be common, but no more. Is it that we simply don’t have the mental capacity to think about the older sins because our heads are so full of new ones, in this world of cyberbullying and online grooming? Or is it that older sins have become unfashionable – partly through their link with previous generations, and partly because they’re too uncomfortable for us complacent moderns to think about?

If so, might it be worth taking another look at them? It’s very hard for someone immersed in a particular social situation – i.e. living as most humans do – to see that situation’s problems. This is why outsiders, though often unwelcome, are so useful. They add new perspectives, whether you’re an organisation thinking of employing more diverse staff or a nation debating some hot-button moral issue.

If you haven’t a helpful outsider handy, another approach is to look at what isn’t in the public conversation. Silences can sometimes speak louder than words, and if no one’s talking about certain kinds of bad behaviour, that may be because it suits today’s society to encourage that behaviour.

As an example, how about vanity? It’s generally considered a form of pride, and we think of it as pride especially concerned with physical appearance. A quick check with Google Books shows that, at least in written words, discussion of vanity is declining, and has been since early in the nineteenth century, as this graph from Google ngrams shows.

Decline in 'vanity' and 'vain', 1800-2000

Decline in usage of ‘vanity’ and ‘vain’, 1800-2000, in Google’s books database

Meanwhile, industries concerned with personal appearance are worth billions, and forecast to grow still further. Data from the American Society for Aesthetic Plastic Surgery show that in the decade-and-a-half between 1997 and 2012, surgical cosmetic procedures in the US grew by 75%, to nearly 1.7 million. Procedures not requiring the beautified to be cut open grew by 920%, to over 7.5 million. Apparently, in 2010 Americans spent $33.3 billion on ‘personal care’, which would be enough to reduce world poverty by half … if it had been spent on reducing world poverty.

It’s as if being ugly is now a worse moral flaw than being conceited. Which is peculiar, because we know from celebrities that where beauty leads, good behaviour doesn’t always follow. Nor are people with facial disfigurement incapable of the highest human virtues, whereas being conceited is associated with bad behaviour. Yet the beauty-is-good stereotype is so prevalent, it’s even featured in an fMRI experiment.

Perhaps that’s why we don’t talk so much about vanity these days. Maybe the moral principles which used to condemn it came up against the market’s demand for profit. Plus, technologies have turned what was once a matter of fate – personal appearance – into a matter of personal choice. (Providing you have the money, of course, but that takes us into yet another minefield, the morality of poverty, and this post has touched enough sore spots for the time being.)

The constant demand for economic growth, the new powers to change our appearance, and the earning potential of playing on human vanities – and anxieties – together make up a powerful set of forces to set against an elderly moral principle. With respect to vanity (and the vain demand a lot of respect), it seems that the clash between market and morals has been won by the market, at least in the West and for now.

Of course, vanity isn’t the only unfashionable vice. I wonder if the market’s winning on the others too.

“Revolutionary!” “Controversial!” What media talk about science really means

October 14, 2013 at 12:38 pm | Posted in Uncategorized | 1 Comment
Tags: , , , , , ,

Like science itself, mainstream media reporting of scientific findings can be confusing, not least because ordinary words are given specialised meanings. To help the perplexed, here’s a light-hearted gloss of some of the commonest terms used by media folk to talk about science and scientists.

–––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––-

“Expert” – knows more than we do.

“A leading …” – we’ve heard of this person (and we can barely spell their research discipline), so they must be important.

“Professor” – can mean either a) a professor or b) anyone with a doctorate.

“Scientists believe …” – the ones we asked said …

“X says [something controversial]” – and so they did, with a little judicious editing. Whaddya mean, out of context?

“New” – almost certainly not, but if even the researchers aren’t thorough about their literature searches, you can’t expect us media types to know about previous work. We can barely remember what happened yesterday.

“Extraordinary” – it sounded weird to us (but then, so does most of this science stuff).

“Important” – we can see how this might have something to do with the real world.

“Groundbreaking” – it’s in Nature, Science, or PNAS. Or, it’s female, disabled, or ethnic minority.

“Breakthrough” – something useful may possibly result from this at some point in the future.

“Landmark” – every scientist we asked, the press release, and the journal’s editorial all said this might make a difference.

“Revolutionary” – contradicts something said by somebody else.

“Controversial” – we suspect the only researchers who think this are the study’s authors, but hey, it’s eye-catching.

“A study suggests” – even we recognize that this one’s so provisional we need to say so.

“Abstract” – we haven’t a clue what this means, let alone if it’s any practical use.

“Theoretical” – see Abstract.

“Challenging” – we have no idea what they were banging on about.

“Developing” – we’re pretty sure they haven’t either.

“Theory” – anything more than a guess, put forward by a scientist.

“Hypothesis” – an irate scientist complained about how we misused the word theory.

“Anecdote” – a term of abuse used by scientists to complain about the media. We prefer to see anecdotes as baby datapoints.

“X causes Y” – X has been linked Y to by some statistical method. You don’t want to know the details, do you? Good.

“Correlated with” – a patient scientist explained to us that correlation is not causation, so now we can show off.

“X doubles the risk of Y (no baseline risk given)” – trust us, we’re headline-writers. And we’re not telling you what the original risk was because it’s so tiny that you’d realise this is a total non-story.

“X doubles the risk of Y (baseline given)” – we know you can’t make any sense of this statement without knowing what was doubled, so we’ve fed you the number. What we haven’t told you is that there are probably so many other factors causing Y that you don’t need to panic over X, at least until you’ve stopped smoking, changed your diet, done more exercise, moved to somewhere less polluted, and stopped worrying about all the crap in the media.

“A gene for X” – this gene produces a protein which may have some small influence on something in the body which eventually has something to do with X.

“Brain regions associated with X” – these brain regions seemed to be doing something when the few people tested in the study were X-ing, so they may have something to do with X. They’ve also been associated with lots of other things, but we like to keep the story clear and simple.

“Brain activity” – some complex statistical measure which some specialised research-folk think may be quite highly correlated with changes in brain cells, and a lot more less specialised folk think may have something to do with the mind, whatever the hell that is.

“Neurologist” – anyone who does anything related to actual brains (i.e. not a psychologist).

“Neuroscientist” – any person working on brains who’s explained to us that they’re not a neurologist.

“Remarkable” – a scientist who shows signs of being successful despite being a woman.

“Brilliant” – this guy’s a better self-publicist than most of his colleagues.

“Maverick” – weird even by scientific standards, and quite likely to be wrong.

“Confident” – probably a bully, and even more likely to be wrong.

“A lone voice” – the probability of wrongness is close to 1.

“Professor X could not be contacted …” – Professor X has had dealings with the media before.

“Fluent communicator” – wow, a scientist who doesn’t just stare at their feet!

“Engaging communicator” – this one smiles!

“Brilliant communicator” – this one can talk and they’re not bad-looking, for a geek.

“Difficult” – we suspect this one has autism.

“Dedicated” – you really chose to spend your career doing that?

“Committed” – it’s ridiculous how seriously you take this stuff.

 

Blog at WordPress.com.
Entries and comments feeds.

%d bloggers like this: