Medicine

Changing our minds

Café Scientifique tonight in Oxford. I can't get to this ... and it looks pretty interesting — Dr Martin Westwell (Deputy Director of the Institute for the Future of the Mind, Oxford University) on 'Bending minds - how technology can change who you are':

Martin will talk about the mind, the brain and how pills to make you smarter, pills to make you forget, electrodes inserted into the brain, and devices to let you control computers just by thinking are all technologies that are with us now or are just around the corner. How do these technologies and the new experiences they bring transform and bend the human mind? How are we going to harness the new technologies to maximise the potential of individuals without sacrificing that individuality? What roles do scientists play in deciding how they are to be implemented?

And the Institute for the Future of the Mind?

In the 21st Century, technology will exert unprecedented influence indirectly and directly upon the brain and the critical issue is not whether, but how, such new experiences will transform the human mind. The Institute for the Future of the Mind, is one of 10 research institutes in the new James Martin 21st Century School made possible by a $100M benefaction to Oxford University, with the aim of finding solutions to the biggest problems facing humanity and identifying the key opportunities of the 21st century.

I'm interested in the brief profile there of Dr Westwell: 'Martin’s particular interest is in the way that young people form their minds and the influences of technology on this process in the future'.

Meanwhile, Peter Brunner, an American scientist, can be seen here, demonstrating a BCI — a brain-computer interface.

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MSF: AIDS

Many thanks to The Play Ethic for this link: a powerful video on the African AIDS catastrophe, by Médecins Sans Frontières (MSF). Peter Kane says:

Not only does it look like the missing link between Pixar animation and computer game machinima, but it's clearly inspired by the video game Katamari Damacy, where a little prince rebuilds his father's world by rolling a 'Katamari' round the landscape, which picks up every kind of object. Except in the MSF video, the ball starts with one African villager getting struck down by Aids, which rolls around picking up others... I'll let you watch the clip to experience the full impact.

In any case, with reference to my posts on the military-ludological complex below, this is at least an example of digital counter-culture at its best.


Patient Opinion

Ross:

I'm at Our Social World in Cambridge, UK today and taking notes here. But wanted to point out a really interesting Enterprise Social Software project that Headshift launched today:

Patient Opinion. Just under a year ago, my father died in hospital. My mother, an NHS nurse of many years and herself now hospitalised, was aghast at some of the lapses in care that my father experienced. She is sure (and I share her view) that his end was hastened by these failures — failures made all the more obvious by the contrast with the often very good care he received.

Happily, she is now in a different, and much better, NHS hospital. She'll be interested to hear of this new initiative and I am sure she will not need much encouragement to contribute her voice. (There will be many questions to be asked, of course, and the FAQ page is here.)

Who's behind it?

  • Paul Hodgkin is the director and founder of Patient Opinion. He is a Sheffield GP and has worked for the Department of Health, South Yorkshire Strategic Health Authority and The King's Fund.
  • Miriam Rivas-Aguilar is Operations and Services Manager for Patient Opinion.
  • James Munro is a consultant to Patient Opinion on IT and health services research issues. He is director of health services research at ScHARR at the University of Sheffield, and editor of healthmatters magazine

Pain, that cruel guest

I missed this last month: Robert McCrum, writing in The Observer, about 10 years of living with the aftermath of 'a devastating stroke (at 42) which left him paralysed down his left side. During his extended convalescence, he wrote a memoir. It was meant to close the door on his illness, but instead it opened another into a parallel world of other people's pain':

I have become a lightning conductor for a thunderstorm of physical calamity that is raging just over the horizon … my story is not unique. I am just a more visible representative of an army of sufferers across this country, and across the world. I have had letters from widows, orphans, hospital carers, parents. I try to answer these letters, but compared to the stories I'm hearing, my experience has been trifling - as more than one correspondent has pointed out. Sometimes, I feel ashamed to claim fellow citizenship with these sufferers, but there it is: they are writing to me and there's not a thing I can do about it. As well as looking through the eyes of someone who might have died, in these 10 years I have acquired a quite new view of the world. Of course, I recognise that people will want to communicate with those they feel are sympathetic to their plight, but now I have come to believe something different. It is this: that despite the stupendous journalism of feelings, there is still a vast unarticulated story out there that gets no publicity, a story of almost unendurable pain and desperation. Sure, I've been to hell and back, but these people are living in hell every day of their lives.

Oddly enough, the more everything is reported, analysed, expounded, categorised and explored in newspaper column after column, and the more people feel able to express whatever they think about virtually anything under the sun,the more deafening is the general silence that hangs over illness and ill health. There is a sea of horror lapping at the edges of the everyday world, and these messages in bottles are floating in on every tide. These are the messages from the world of pain, messages that describe the suffering of strangers.

From this, I have learned three things. First, that the world's frontline pain is the pain of Aids, cancer, heart disease and stroke (the big killers). Behind the line, there's the pain of despair, loneliness and loss. The aching void in the lives of the bereaved and the afflicted. Second, I now know that we are all, in some sense, in the doctor's waiting room. I used to be indifferent towards, and frightened of, illness. Now I recognise it as part of the human condition. Illness is OK. There's nothing wrong with infirmity. It's part of the way we are. In the famous words of Samuel Beckett's Worstward Ho: 'Ever tried. Ever failed. No matter. Try again. Fail again. Fail better.' Failing better is something every stroke sufferer knows about.

Finally, there's this recognition. Despite the extraordinary progress of medicine, despite all the safeguards we have built into the way we conduct our lives, we are still in the world of our ancestors, when life was characterised by the poets as a sparrow fluttering out of the storm into the brightly lit mead hall, circling through the laughter and the smoke for a moment, before disappearing once more into the dark. Sometimes, when I read these letters, I sense that dark just beyond the window. And I feel grateful to be still alive, in the warmth and the light of summer, out of the storm.

I remember Alphonse Daudet's La Doulou, translated by Julian Barnes in 2002 as In The Land of Pain, the history of his own terrible suffering with tabes dorsalis, a form of tertiary syphilis where the back, in effect, wastes away. I gave my copy away a couple of years ago, but I remember how the great Charcot prescribed the Seyre Suspension, the patient being suspended for several minutes at a time, sometimes just by the jaw. Daudet endured this treatment 13 times:

I am suspended in the air for four minutes, the last two solely by my jaw. Pain in the teeth. Then, as they let me down and unharness me, a terrible pain in my back and the nape of my neck, as if all the marrow was melting: it forces me to crouch down on all fours and then very slowly stand up again while — as it seems to me — the stretched marrow find its rightful place again.

Morphine as a relief:

Each injection stops the pain for three or four hours. Then comes "the wasps", the stinging and stabbing here, there and everywhere — followed by the Pain, that cruel guest.

Other fragments I recall from when I read and had a copy of the book — and have found again now, online:

Torture walking back from the baths via the Champs-Elysées.

I've passed the stage where illness brings any advantage or helps you understand things; also the stage where it sours your life, puts a harshness in your voice, makes every cogwheel shriek.

The hotel. The bell-board. The bath times. Solitude. Encroaching darkness.

My poor carcass is hollowed out, voided by anaemia. Pain echoes through it as a voice echoes in a house without furniture or curtains. There are days, long days, when the only part of me that's alive is my pain.

Finally, two things. First, this moment, as introduced by Julian Barnes himself in The Guardian:

His response, both personal and literary, to his condition was admirable. "Courage... means not scaring others," Larkin wrote. Numerous witnesses attest to Daudet's exemplary behaviour. His last secretary, André Ebner, remembered Daudet sitting with a friend one morning, eyes closed, barely able to speak, martyred by pain. The door-knob gently turned, but before Mme Daudet could enter, her husband was on his feet, the colour back in his cheeks, laughter in his eye, his voice filled with reassurance about his condition. When the door closed again Daudet collapsed back into his chair. "Suffering is nothing," he murmured. "It's all a matter of preventing those you love from suffering."

And then, this:

Daudet … recounted to Goncourt a dream he had once had, in which he was walking through a field of broom. All around him there was the soft background noise of seed-pods exploding. Our lives, he had concluded, amount to no more than this: just a quiet crackle of popping pods.


ICE

Back in April, a Cambridge-based paramedic launched a national campaign with Vodafone to encourage people to store emergency contact details in their mobile phones. Following the events in London yesterday, it might be timely to give this a little more publicity …

Bob Brotchie, a clinical team leader for the East Anglian Ambulance NHS Trust, hatched the plan last year after struggling to get contact details from shocked or injured patients. By entering the acronym ICE – for In Case of Emergency – into the mobile’s phone book, users can log the name and number of someone who should be contacted in an emergency. The idea follows research carried out by Vodafone that shows more than 75 per cent of people carry no details of who they would like telephoned following a serious accident. Bob, 41, who has been a paramedic for 13 years, said: “I was reflecting on some of the calls I’ve attended at the roadside where I had to look through the mobile phone contacts struggling for information on a shocked or injured person. It’s difficult to know who to call. Someone might have “mum” in their phone book but that doesn’t mean they’d want them contacted in an emergency. Almost everyone carries a mobile phone now, and with ICE we’d know immediately who to contact and what number to ring. The person may even know of their medical history.” East Anglian Ambulance NHS Trust

For more than one contact name: ICE1, ICE2, ICE3, etc.


Desolate places

I remember Dom David Knowles' book, Bare Ruined Choirs, a celebration for, and lament over, the empty, roofless monastic buildings of these islands. Now, Alex has set me looking at Abandoned, a site where Uryevich collects pictures of 'abandoned plants, unfinished buildings, industrial sites. Most of them situated near to Moscow' — haunting, silent, empty places that have a melancholy weight to them, as does this one, an unfinished and abandoned Moscow hospital:

Another of Alex's links was to an abandoned psychiatric facility in Whitby, Ontario. I suddenly remembered the psychiatric hospital where, as a schoolboy, I had sometimes made occasional visits, organised by my school, to chat to patients: Powick Hospital, Worcestershire. Formerly the 'Worcester County Pauper and Lunatic Asylum', it was shut down in the 1980s but is still talked about because of the experiments with LSD conducted there. (In 2002, the NHS settled the claims of 43 former patients out of court, at a level well below the expected.)

Even without reports now online about forgotten children, Powick lives on in my mind as somewhere unhappy and disorienting. I see there is a website, British Asylums ('looking at the era of the “Lunatic Asylum” system during the 19th and 20th centuries. The site largely focuses on the asylums themselves from their origins as providers of sanctuary and care through to their demise in the dying days of the 20th century'), and a Middlesex University index of English and Welsh lunatic asylums and mental hospitals (and a lot more information besides, including a Mental Health History Timeline).

I think of John Clare (1793–1864), committed in 1837 to a private asylum and then, in 1842, to the Northampton County Asylum for the remainder of his life.

I am — yet what I am, none cares or knows,
My friends forsake me like a memory lost:—
I am the self-consumer of my woes:—
They rise and vanish in oblivion's host,
Like shadows in love's frenzied stifled throes:—
And yet I am, and live — like vapors tost

Into the nothingness of scorn and noise:—
Into the living sea of waking dreams,
Where there is neither sense of life or joys,
But the vast shipwreck of my life's esteems;
Even the dearest, that I loved the best
Are strange — nay, rather stranger than the rest.

I long for scenes, where man has never trod
A place where woman never smiled or wept
There to abide with my Creator, God;
And sleep as I in childhood, sweetly slept,
Untroubling, and untroubled where I lie,
The grass below — above the vaulted sky.

The punctuation adopted here is based on that in Robinson's & Powell's 1984 Oxford Authors Series edition and aims to present 'I am' as Clare wrote it. (The poem was written in the Northmapton County Asylum when Clare was in his mid-fifties.)  Helen Vendler: '… because Clare was unschooled in standard grammar and punctuation, his manuscripts presented his publisher [Taylor] with the problem of "corrections." By himself, Taylor transcribed the cascade of almost illegible manuscripts (a scribe failed at the task), changing misspellings, inserting punctuation (Clare used almost none), rectifying Clare's dialect-grammar, and suggesting cuts. Clare reacted to the corrections sometimes with gratitude, sometimes with irritation. Increasingly, he wished to assert his independence; yet he depended on his publisher to see his works into print. He went so far as to try to leave Taylor and solicit subscriptions by himself for a volume that he could himself control, but he could not manage to collect enough subscribers.'


England, My England

In amidst much else that is gloomy (our probable lack of preparedness for the threat posed by avian flu) or, shall we say, arresting (the new powers of the Home Secretary to impose Control Orders), the Telegraph (may require registration) lightens our world with news of the death of its eccentric, erstwhile reporter, Harry Greenfield:

He joined The Sunday Telegraph in 1965 and soon became the defence correspondent. He was a genial man with a bushy beard and had a tweedy, shambolic air. He could never bring himself to open his post and the Ministry of Defence press releases piled up on his desk to form a barricade.

Once Sebastian Faulks, one of his colleagues at the time, pulled an envelope from near the bottom of the heap, opened it and said: "Ah Harry, I see Mafeking has been relieved."

He had two Jack Russell terriers, named Chindit and Sherpa. After the death of Sherpa, he often brought Chindit to the office where he would sit on Greenfield's lap as he worked. If anybody approached, Chindit would go for them. Chindit never had his owner's impeccable good manners and had Greenfield banned from most of the pubs in Clapham, south London.

Greenfield moved on to become a feature writer with a style much more elegant than his appearance and he covered many aspects of country life. He had a passion for fly fishing and he also wrote a memorable article about Chindit's success in a ratting contest.

After his departure from the newspaper, Greenfield became involved in paganism and his former colleagues heard tales of him dancing naked at stone circles. He was 65 before he had his first tattoos and he told a friend that the thing that most embarrassed him about his past was that he had worn a tie-pin.


Whence (? the modern phenomenon of) obesity?

Boing Boing links to this article in the Harvard Magazine: 'The Way We Eat Now — ancient bodies collide with modern technology to produce a flabby, disease-ridden populace'.

We are not adapted to handle fast-acting carbohydrates," Ludwig continues. "Glucose is the gold standard of energy metabolism. The brain is exquisitely dependent on having a continuous supply of glucose: too low a glucose level poses an immediate threat to survival. [But] too high a level causes damage to tissues, as with diabetes. The body is designed to keep blood glucose within a tight range, and it does this beautifully, even with extreme nutrient ratios: we can survive indefinitely on a diet of 60 percent carbohydrates and 20 percent fat, or 20 percent carbohydrates and 60 percent fat. But we never [before] had to assimilate a heavy dose of high-glycemic carbohydrates.

Laser-aided vision

A system that projects light beams directly into the eye could change the way we see the world. US firm Microvision has developed a system that projects lasers onto the retina, allowing users to view images on top of their normal field of vision. It could allow surgeons to get a bird's eye view of the innards of a patient, offer military units in the field a view of the entire battlefield and provide mechanics with a simulation of the inside of a car's engine.

The system uses tiny lasers, which scan their light onto the retina to produce the entire range of human vision, reported the journal of the Institute of the Electrical and Electronics Engineers, IEEE Spectrum. BBC News


Brain chips

Scientists are to implant tiny computer chips in the brains of paralysed patients which could 'read their thoughts'. US researchers from Cyberkinetics Inc are to be allowed to implant the chips underneath the skulls of patients. The chips will map the neural activity which occurs when someone thinks about moving a limb. Scientists will then translate those signals into computer code that could one day be fed into robotic limbs.

The company, based in Foxboro, Massachusetts, has been given Food and Drug Administration approval to begin the trials of the four-millimetre square chips. The 'Brain Gate' contains tiny spikes that will extend down about one millimetre into the brain after being implanted beneath the skull, monitoring the activity from a small group of neurons. The signals will be monitored through wires emerging from the skull, which presents some danger of infection. The company is working on a wireless version. BBC News