Can Medicine Be Cured by Seamus O’Mahony

I recently finished Seamus O’Mahony’s book Can Medicine Be Cured? He poses the title as a question and it is tempting to apply the principle that one should, as a matter of course, answer these kind of questions as ‘No’. And, indeed, O’Mahony offers little comfort that it can be answered positively. As a result, there may be some risk of despair in reading it.

Jane Rosamund Moore provided an excellent review for us at the BJGP.° O’Mahony takes a hammer to the medico-industrial machinery - the endless biomedical research and Human Genome Project, generally all regarded as A Good Thing, are all duly bashed. Like Moore I was particularly intrigued by O’Mahony’s account of the Mid-Staffs scandal and the contentious use of statistics.

In her review, Moore notes that O’Mahony comes across as a bit ranty. That feels like more of a problem in the back end of the book. For instance, I’m quite prepared to look critically at the evidence for bare-below-the-elbows infection control policies but there is a whiff of the old-school consultant when complaining about the abolition of white coats. The chapter on empathy and compassion wasn’t as compellingn and felt a little under-cooked. Worryingly, O’Mahony offers little in the way of solutions and we’re left with the end-of-career cry that it ‘was better in the old days’. Except O’Mahony wasn’t that impressed then either. How do we find another way? We get a few words at the end about readjusting our aims for people who are suffering but it’s cold comfort.

Overall, though, it’s an excellent book and one that challenges. And O’Mahony offers plenty of avenues for further exploration. We need contrarians. Perhaps one of the best in recent years is the redoubtable Richard Smith. Smith gets to a fundamental problem at the heart of the doctor-patient-system dynamic. O’Mahony writes:

Richard Smith, then editor of the British Medical Journal, wrote about the ‘bogus contract’ in 2001. This contract is based on patients believing that modern medicine can do remarkable things; the doctors can easily diagnose what is wrong, know everything it’s necessary to know, and can solve all problems, even social ones. Doctors know that these beliefs are childish, and that the contract is bogus.

1 November 2019 Scribbles

Memy: Learning poetry by heart

I’ve been making an effort to commit some poetry to memory. I wouldn’t describe myself as an avid poetry fan, I have a very modest collection of books, but I do get an enormous pleasure from being able to recite a few verses from memory. It is deeply satisfying and they make good company.

I recently discovered a rather brilliant app, Memy°, for the iPhone. So, with apologies to Android users, I thought I’d race through a quick review of its features.

You can adjust the text size - I’ve gone very small here so you can get a feel for the way the app works. The poem is a classic, Ozymandias, by Percy Bysshe Shelley. (We used to have a tortoise called Percy named after the poet - a play on the last name of course. Ahem.)

There are three different methods to help you memorise and the one shown is the most common. You read the poem a few times and then the fun starts. The app blocks, randomly, a word from each line. Read it again until you are confident you know the missing words. You click a button and it then blocks two words from each line. Read again. And, so on. Keep going and you will, eventually, have it memorised. A long press anywhere on the screen gives you a brief glimpse.

More features

Folders. It has folders for organising your poems. The folder system is a little basic with no drag-and-drop and no bulk edit or move options. That’s all good when you only have a dozen poems. I’m planning to build my repertoire up over the coming months and years and I’d like to think there will be scores of poems in due course. It could get a little clunky. For the moment it works just nicely. 

Importing and exporting. You can import and export back ups. This is handy for getting your poetry collection from one device to another. Actually, my preference is to save poems as txt files in Dropbox and the app allows you to import these (as well as rtf, html, and PDFs).

Not just poems. You can also use it to learn other stuff. Actors will find it helpful and there is the facility to remove some lines and sections from the memorising algorithms - handy, as you don’t need to learn everyone else’s lines in a script.

What have I learned so far?

I had a headstart with some of these as I had learned them years ago. But some of them are new to me as well. I’m also going to use it to learn some quotes and I have my eyes on some of the classic Shakespeare speeches. Here are five I’ve got solid again:

Ozymandias by Percy Bysshe Shelley°

Tomorrow, and tomorrow and tomorrow by Bill Shakespeare°(a Macbeth speech)

Invictus by William Ernest Henley°

Anthem for Doomed Youth by Wilfred Owen°

This Be The Verse by Philip Larkin°

31 October 2019 Scribbles

Richard Freeman: former Team Sky doctor

I read Richard Freeman’s book, The Line, last year when it came out. In July 2018 I sent an email to a magazine offering a review. I wondered if there were some serious professionalism concerns that had not yet been picked up. The jiffy bag story, the lost laptop, it all looked bad. I never wrote anything further and nothing was published. It wasn’t long after that the GMC eased in.

Sections of the book read like a long apologia - in the dictionary definition sense of being a statement of defence of one’s actions. It felt a lot like Freeman was already constructing a narrative of self-justification. And, I’m not particularly critical of that - it’s more-or-less nailed on human nature to do so. I wonder, given the revelations that are now emerging, whether the cognitive dissonance must have been off the scale and, more than anything, I feel sorry for Freeman. I’m inclined to believe he is, or at least was, what he said he was: a caring, person-oriented doctor. Given he has, by his own admission, lied then some bad decisions were made.

Reports are emerging° that Freeman has admitted he “told a lot of lies”. Obviously, the media are going to take an intense interest, particularly, if it offers any suggestion of impropriety on the part of Sky’s stellar cyclists. There’s a bit of me that worries that Freeman realises he was caught ‘bang to rights’ and is now coming clean to reduce his punishment, as can happen. A larger part of me hopes he is in a better place and had simply come to a policy of full disclosure as the best remedy for himself and others.

I’ve always been a little wary of doctors who get into sports medicine. It’s a discipline that has been obsessed for decades with the elites, the research is dominated by studies into young males, and there is very little to help the normal person in their life. It is also, I suspect, beguiling and many of the doctors enjoy that aspect. For me, and I love sport, it looks like an elaborate form of private medicine. Not my cup of chai. There is an intense culture around elite athletes and it’s one that I suspect could be all-enveloping. It would easy to get dragged into it. To make bad decisions. The GMC are alleging Freeman got some medication for the purposes of doping. We’ll see how it plays out. As per his sub-title, medicine and sport have certainly collided and he has been caught in the crash.

30 October 2019 Scribbles

Healthy diets and the planet

There is, as with society in general, increasing concern about planetary health amongst the medical profession. While clearly climate change can damage health it is not always immediately apparent how doctors themselves can help people make changes. Two main areas stand out: physical activity that reduces the use of vehicles; and a healthy diet that helps reduce the carbon cost of producing our food.

So, what is the evidence that a ‘healthy diet’ is better for the environment. All depends on how you define healthy of course. A new paper published in PNAS° has analysed it further, indeed, it’s described as the “most sophisticated analysis to date” in the Guardian but I’m guessing that’s reporting on the authors’ view in the press release.

They looked at 15 food groups, five major health outcomes, and five aspects of environment degradation. The food groups associated with the best health are all, with the exception of fish, the best for the environment. This lovely graphic from the Guardian° shows it best.

It’s easy to criticise journalists for their reporting of science - reducing complex research articles to short articles is always a bit fraught. And, to be fair to those who criticise, it is often done very badly indeed. The Guardian, while not completely immune from the siren call of clickbait, has to be commended for this graphic that rather brilliantly summarises the key findings. It reproduces one that is provided in the paper itself but it is good to see.

And one important point to make and I nearly missed myself - the y-axis is logarithmic. Those towards the top are orders of magnitude worse than those at the bottom.

The graphic also serves another function when it comes to giving dietary advice. The nature of evidence on diets doesn’t always sit well with the one-to-one consultation but encouraging people to consider pushing their diet towards that bottom left corner is a helpful message.

29 October 2019 Scribbles