Silent as light

The Antiquary: “is preoccupied on every level by the relation between past and present.”

Mary Midgley: “These doctrines are often bizarrely over-confident and over-simple”

George Orwell in Why I Write: “… one can write nothing readable unless one constantly struggles to efface one’s own personality”

Raymond Tallis in Summers of Discontent “There are several things to be noted about emotions. The first is they fill the world with meaning”

Kenneth Calman in Makars and Mediciners:  “It is perhaps here that the role of literature and the arts generally can have an advantage, by the author exposing poor health choices and behaviour patterns, in ways which are more powerful and effective than that of the medical teacher or professor. The writer’s imagination and expression can change things. The word can be powerful.”

Nathan Filer in The Shock of the Fall: “I think that’s what I am doing now. I am writing myself into my own story and I am telling it from within”

Andrew Greig: “He knows fankle from bourach.”

Raymond Tallis in Defence of Wonder “When we are in love we see the ordinary things about another person for what they are: not in the slightest bit ordinary.”

Gilbert K. Chesterton: “The world will never starve for want of wonders; but only for want of wonder

“She makes sunlight dim” (Sian)

Thomas Tranströmer to his lifelong friend Robert Bly: “In this climate it`s all or nothing. Anybody not 100% for is “self-evidently” 100% against. Have I given you a little picture of the climate? All you can do is Follow your own crooked conscience, wait for the moment of truth and hope you won’t need to be ashamed one day of how you lived through these years.”

Raymond Tallis: [Philosophy is a return] into that nearest, which we invariably rush past, which surprises us anew each time we get sight of it”

Tomas Tranströmer: “Balansnummer is ‘balancing act.’ The poem is partly a protest-poem against the prevailing mood in Swedish intellectual life. What I say is that finding the truth, being honest etc. is a difficult individualistic act of balance, you have to put off the rhetoric, all slogans and moustaches and prejudices and . . .”

Stephen Bann, MIDWAY: Letters from Ian Hamilton Finlay: “I recall saying once to Finlay that the special feature of the letter as a literary genre was that one never went back on the first draft to produce a fair copy.”

Nathan Filer in The shock of the Fall: “I have approximately 7.4 x 1027 atoms in my body”

Ian Hamilton Finlay: “Sometimes my wee best seems just not good enough”

Richard Holloway in Leaving Alexandria: “The toughest lesson life teaches is the difference between who you wanted to be and who you actually are. And it can take a whole life to teach it”

Robert Louis Stevenson: “Letter to a young gentleman who proposes to embrace the career of Art”

A. S. Byatt in Possession: “He put little slips of paper in the entries that made up his fragile narrative or non-narrative”

Adam Nicolson in Sea Room: “I’m wedded to this plunging-off form of thought, and to the acceptance of muddle which it implies”

Mukul Kesavan in Looking Through Glass: “Like all chroniclers of the relatively recent past, history ran out against the present”

Julian Barnes in The Noise of Time: “He bought a large scrapbook and pasted ‘Muddle Instead of Music’ onto the first page.”

Ronald Ross: “Science is the differential calculus of the mind, Art is the integral calculus; they may be beautiful apart, but are great only when combined.”

Walter Scott in The Antiquary (in Oldbuck’s room) “Amid this medley, it was no easier to find one’s way”

Margaret McCartney in The Patient Paradox: “The conclusion that variability is bad is distant from the much simpler observation that patients are all different.”

Robert Crawford in Young Eliot: “Leafiness suited him”

Alexander McCall Smith in Chance Developments: “His one and only book, ‘The Future Lies in the Past’, eventually published”

Patrick Deeley in The Hurley Maker’s Son: “I sensed the sun, beaming from a place that was higher than the world”

Penelope Fitzgerald in The Bookshop: “The sky brightened from one horizon to the other”

Hanya Yanagihara in A Little Life: “You made art because it was the only thing you’d ever been good at, the only thing, really, you thought about between shorter bursts of thinking about the things everyone thought about.”

John Berger in Here is where we meet: “To find any sense in life it was pointless to search in the places where people were instructed to look.”

Edmund De Waal in The White Road: “He writes a letter about how things are made, but it is actually about compassion.”

Alice Hoffman in Faithful: “No one could count all the stars. There are far too many.”

Madeleine Thien in Do Not Say We Have Nothing: “So familiar to me, like an entire language, a world, I had forgotten”

John Steinbeck in Of Mice and Men: “Both men glanced up, for the rectangle of sunshine in the doorway was cut off”

Frailty – nothing about us without us

In September 2016, Professor Martin Vernon, National Clinical Director for Older People and Integrated Care at NHS England stated why diagnosing frailty is important:

In the same month Professor David Oliver had this Acute Perspective published in the British Medical Journal. It attracted over twenty responses many of which, but not all, were supportive.

I submitted this response as I was not convinced that “frailty” was inherently any less likely to stigmatise our older generation:

A year later, Dr Steve Parry, the Vice President of the British Geriatrics Society (BGS) had this perspective  published on the British Geriatrics Society Blog , asking “when does a well-meaning medical fashion become a potentially destructive fad?” This perspective also attracted over twenty responses.

A week later, the former President of the British Geriatrics Society, Professor David Oliver argued why he was “fine with Frailty”:

Dr Shibley Rahman, an Academic in Frailty and Dementia and has outlined why he is of the view that such a model, based on deficits only, if applied to our older generation could cause harm. This article also attracted many responses.

In a recent Acute Perspective Professor Oliver outlined his concern that the British public may not have realistic expectations when it comes to frailty and “progressive dwindling”:

My understanding is that the term “progressive dwindling” was first used by George J. Romanes in this 1893 book:

This is the context in which the term is used:

The dictionary definition of “inutility” is: uselessness or a useless thing or person.

Healthcare Improvement Scotland has been concentrating on frailty as one of its National Improvement initiatives. This first started in April 2012 and so has developed significantly in the five years that have followed. NHS Scotland staff have been reminded to “THINK FRAILTY”. Up until now the focus has been on deficits and how to “screen” for these with “toolkits”.

In a BBC Radio Scotland “Thought for the Day”, the broadcaster and writer Anna Magnusson recently considered the language that we use in relation to our older generation. I made this short film using her words and voice. I have shared it with Anna Magnusson and she wrote a kind personal response to me:

We are far more than our labels from omphalos

These words from an Edwin Morgan poem resonated with me as a description of the complexity of ageing:

The people best placed to assist in understanding the complexities of ageing and the language best used to describe it are surely the older generation themselves.

Delirium screening (some years later)

Over three years ago I wrote this summary of my concerns about mandatory delirium screening. The consequences for me in writing this were life changing: the reality of having the courage to care in NHS Scotland.

Time has moved on and we should consider recent statements on this subject:

6th June 2017: Dr Claire Copeland:
“Two heavyweights of the delirium world: Wes Daly takes on Professor Alasdair Maclullich: to screen or not to screen. Let the battle commence”

5th August 2017: Dr Sharon Inoyue:
“Very important. Studies show dramatic increase in antipsychotic treatment with mandatory delirium screening”

31st August 2017: Dr Dan Thomas:
“In the UK I would be very surprised if many with delirium in hospital left  on antipsychotics (which is good!)”. This is a speculative response to an article in the Journal of the American Geriatrics Society which had found that “most patients with delirium discharged  on a new antipsychotic had no instructions for discontinuation”

Footnote:
Whilst evidence cannot ever be complete there has been
consideration of antipsychotic use for delirium:

 

A child. An incredibly ancient child.

I recently read the novel ‘How to stop time’ by Matt Haig and in a brief passage of this he talked about an ancient tree that had outlived any sentient being:

For the last two years, in my greenhouse, a cutting of the Fortingall Yew has been growing. The Fortingall Yew is estimated to be between 2000 and 3000 years old.

I took six cuttings and potted them up but only one has survived. I have potted it up so that I can give it to Alexander McCall Smith in thanks for the kindness and support that he has given to me as an artist.

 

Raised by the people of Scotland

Crowd-funding is nothing new. The Martyrs’ monument was funded by public subscriptions to redress the events of 50 years previously when five Scots were transported for sedition. Their speaking up for the common people was judged by those in authority to be “wicked and felonious”.

The Foundation stone for the Martyrs’ Monument was laid on the 21st August 1844:

400 people attended the laying of the foundation stone. 183 years to the day later it happened to be five of us who gathered for a peaceful protest recognising the ongoing imbalance in power between those in high office and those in the general population.

Walter Humes, writing in Scottish Review, 21st September 2015:

President Obama put this in a slightly different way:

Our protest also happened to coincide with a solar eclipse. My particular experience with high office has related to my petition for a Sunshine Act for Scotland:

Surely one of the reasons that we commemorate the past is so that we can learn from it. The voices of the people really do matter.

‘The medical untouchables’

The following is a recent opinion piece by Dr Des Spence published in the British Journal of General Practice.

I had been lined up to do the media interviews on BBC Scotland in relation to petition PE1651. However, on the day, due to changed travel arrangements, I was not available. Dr Des Spence was interviewed instead and did a better job than I could have done.

As an NHS doctor and specialist, I fully support this petition (PE1651) which calls on the Scottish parliament “to urge the Scottish Government to take action to appropriately recognise and effectively support individuals affected and harmed by prescribed drug dependence and withdrawal.”

I have submitted my response.

I feel it would be helpful to hear the views of the Chief Medical Officer for Scotland and in particular, how this matter might be considered as part of Realistic Medicine.

Three recent posts by me demonstrate the scale of competing financial interests in medical education in the UK. If you have a moment, you should have a look. Perhaps you might then share the worry that I have about this matter:

I have previously raised my own petition, PE1493, which the Scottish Public has supported. This was a petition for a Sunshine Act for Scotland, to make it mandatory for all financial conflicts of interest to be declared by healthcare professionals and academics.

My petition, supported by the public, had no support from “Realistic Medicine”. The public has had no update from the Scottish Government on my petition in 18 months. My view is that this is a shocking failure of governance and would seem to demonstrate a lack of respect for democracy.

The Laird of Asloss and Sliddery Braes

A film about John Glen Parker of Asloss and Slidderybraes, Kilmarnock.

This Laird was able to be completely comfortable with who he was. He put others first.

His father was the first to recognise brilliance in Rabbie Burns.

    This film is for my mother Margaret and my daughter Rachel

The laird of Asloss and Slidderybraes from omphalos.

Unrealistic Medicine

This BMJ Editorial of the 30th June 2017 has had a number of responses:

The Editorial was a consideration of Academy of Medical Sciences report ‘Enhancing the use of scientific evidence to judge the potential harms and benefits of medicines’.

The President of the Academy of Medical Sciences and the Chair of the Report, Professor Sir John Tooke, has submitted this reply:

It is most welcome for Professor Sir John Tooke to set out his further thoughts but I found that what he said did not reassure me about the future of science and so submitted this response:

Unrealistic Medicine
Written by Peter, 15 July 2017
Submitted as BMJ Rapid Response.

The further thoughts of Professor Sir John Tooke, Chair of the Academy of Medical Sciences report ‘Enhancing the use of scientific evidence to judge the potential harms and benefits of medicines’ are most welcome.

Professor Sir John Tooke does not reassure me that an era of unrealistic medicine and the business of science will change anytime soon. Meantime the NHS is struggling across the United Kingdom and this may be in part due to the promotion of medical interventions whose evidence base lacks the objectivity that we all surely seek.

I would suggest that most of us fully understand the “reminder” from the Academy of Medical Sciences that potential conflicts of interest can come in all forms and not just financial. But like the public I share the view that we should start with potential financial conflicts of interest as evidence has determined that exposure to industry promotional activity can lead to doctors recommending worse treatments for patients  Godlee and Freer remind us that we expect this from our elected politicians and in other areas of public life.

The voluntary ABPI Register is not working. Its database is only a little more than half complete. This really does challenge the “E” in EBM.

The pharmaceutical Industry has, over the preceding year, increased payments to healthcare workers for “promotional activities” from £109 million to £116.5 million.  This is a major part of Industry budget. Furthermore, we do not know how much may be being paid by device makers and other forms of industry for promotion of their products.

It is welcome, but somewhat “after the bell has rung”, that Professor Sir John Tooke confirms that the Academy of Medical Sciences intends to “review” its approach to public transparency. But one wonders how many “houses” do we need to “get in order” to address this issue effectively? I find myself worrying that it could be like a game of Monopoly that never seems to end.

The most effective and cheapest way to address this matter would be Sunshine legislation. This would avoid multiple, overlapping and generally unsearchable databases of interests.

I would suggest that the reputation of science is at stake as is the balance between benefits and harms for us all

Roy Porter, who sadly died prematurely was considered as one of the United Kingdom’s finest historians of science and health. He ends “Madness: A Brief History “ with a teasing question: ‘Is folly jingling its bells again?’