I am confident this is the most memorable article ever from the British Journal of Urology

Full access here. This is certainly worth reading all the way to the end…. can’t help but wholeheartedly agree with the author’s conclusion.

How (not) to communicate new scientific information: a memoir of the famous brindley lecture

In 1983, at the Urodynamics Society meeting in Las Vegas, Professor G.S. Brindley first announced to the world his experiments on self‐injection with papaverine to induce a penile erection. This was the first time that an effective medical therapy for erectile dysfunction (ED) was described, and was a historic development in the management of ED. The way in which this information was first reported was completely unique and memorable, and provides an interesting context for the development of therapies for ED. I was present at this extraordinary lecture, and the details are worth sharing. Although this lecture was given more than 20 years ago, the details have remained fresh in my mind, for reasons which will become obvious.

The lecture, which had an innocuous title along the lines of ‘Vaso‐active therapy for erectile dysfunction’ was scheduled as an evening lecture of the Urodynamics Society in the hotel in which I was staying. I was a senior resident, hungry for knowledge, and at the AUA I went to every lecture that I could. About 15 min before the lecture I took the elevator to go to the lecture hall, and on the next floor a slight, elderly looking and bespectacled man, wearing a blue track suit and carrying a small cigar box, entered the elevator. He appeared quite nervous, and shuffled back and forth. He opened the box in the elevator, which became crowded, and started examining and ruffling through the 35 mm slides of micrographs inside. I was standing next to him, and could vaguely make out the content of the slides, which appeared to be a series of pictures of penile erection. I concluded that this was, indeed, Professor Brindley on his way to the lecture, although his dress seemed inappropriately casual.

The lecture was given in a large auditorium, with a raised lectern separated by some stairs from the seats. This was an evening programme, between the daytime sessions and an evening reception. It was relatively poorly attended, perhaps 80 people in all. Most attendees came with their partners, clearly on the way to the reception. I was sitting in the third row, and in front of me were about seven middle‐aged male urologists, and their partners in ‘full evening regalia’.

Professor Brindley, still in his blue track suit, was introduced as a psychiatrist with broad research interests. He began his lecture without aplomb. He had, he indicated, hypothesized that injection with vasoactive agents into the corporal bodies of the penis might induce an erection. Lacking ready access to an appropriate animal model, and cognisant of the long medical tradition of using oneself as a research subject, he began a series of experiments on self‐injection of his penis with various vasoactive agents, including papaverine, phentolamine, and several others. (While this is now commonplace, at the time it was unheard of). His slide‐based talk consisted of a large series of photographs of his penis in various states of tumescence after injection with a variety of doses of phentolamine and papaverine. After viewing about 30 of these slides, there was no doubt in my mind that, at least in Professor Brindley’s case, the therapy was effective. Of course, one could not exclude the possibility that erotic stimulation had played a role in acquiring these erections, and Professor Brindley acknowledged this.

The Professor wanted to make his case in the most convincing style possible. He indicated that, in his view, no normal person would find the experience of giving a lecture to a large audience to be erotically stimulating or erection‐inducing. He had, he said, therefore injected himself with papaverine in his hotel room before coming to give the lecture, and deliberately wore loose clothes (hence the track‐suit) to make it possible to exhibit the results. He stepped around the podium, and pulled his loose pants tight up around his genitalia in an attempt to demonstrate his erection.

At this point, I, and I believe everyone else in the room, was agog. I could scarcely believe what was occurring on stage. But Prof. Brindley was not satisfied. He looked down sceptically at his pants and shook his head with dismay. ‘Unfortunately, this doesn’t display the results clearly enough’. He then summarily dropped his trousers and shorts, revealing a long, thin, clearly erect penis. There was not a sound in the room. Everyone had stopped breathing.

But the mere public showing of his erection from the podium was not sufficient. He paused, and seemed to ponder his next move. The sense of drama in the room was palpable. He then said, with gravity, ‘I’d like to give some of the audience the opportunity to confirm the degree of tumescence’. With his pants at his knees, he waddled down the stairs, approaching (to their horror) the urologists and their partners in the front row. As he approached them, erection waggling before him, four or five of the women in the front rows threw their arms up in the air, seemingly in unison, and screamed loudly. The scientific merits of the presentation had been overwhelmed, for them, by the novel and unusual mode of demonstrating the results.

The screams seemed to shock Professor Brindley, who rapidly pulled up his trousers, returned to the podium, and terminated the lecture. The crowd dispersed in a state of flabbergasted disarray. I imagine that the urologists who attended with their partners had a lot of explaining to do. The rest is history. Prof Brindley’s single‐author paper reporting these results was published about 6 months later [1].

Professor Brindley made a huge contribution to the management of ED, for which he deserves tremendous gratitude. He was a true lateral thinker, and applied his unique mind to a variety of problems in medicine. These include over 100 publications that focus on the areas of visual neurophysiology and several other aspects of neurophysiology, including ejaculation and female sexual dysfunction. He also published one remarkable paper studying the effect of 17 different drugs used intracorporally to induce erection [2]. Seven of these (phenoxybenzamine, phentolamine, thymoxamine, imipramine, verapamil, papaverine, naftidrofury) induced an erection. It is not clear to what degree Brindley’s own penis served as the test subject for these studies.

This lecture was unique, dramatic, paradigm‐shifting, and unexpected. It is difficult to imagine that a similar scenario could ever take place again. Professor Brindley belongs in the pantheon of famous British eccentrics who have made spectacular contributions to science. The story of his lecture deserves a place in the urological history books.


The turtle menace – the peril of ICD-10 code W5922XD

Have you heard of the menace represented by ICD-10 code W5922XD?

If you don’t know what the hell I am on about, check it out here.

There’s also the menace of other species.

There’s fires in perhaps unexpected places.

Injuries can happen anywhere – such as here or here or here,

For those who may be offended by my tone, having survived multiple turtle and macaw attacks while being burnt while watersking in the prison pool en route to the library while singing arias, apologies.

At least you don’t have to face this. Repeatedly.

Don’t Take Notes With A Laptop – from @andymcnally


Original Scientific American article.

Far transfer through music? This longitudinal study suggests it works!

A post on the potential “far transfer” of music education – ie the longer term impact on cognitive ability. I like the way that Pedro restrains his enthusiasm here! “Far transfer” is tricky to study, but also is a factor in education that needs to be considered when subjects/disciplines are accused of lacking “relevance”

From experience to meaning...

I’m a musician as some of you might know and very much in favor of music and music lessons, but I’m a bit hesitant about this new study. It sounds like great news: cognitive skills developed from music lessons appear to transfer to unrelated subjects, leading to improved academic performance.

Why I’m not so sure? Well, this kind of far transfer is not something easy to achieve and I don’t want to get my hopes up too high. So, let’s have a look at the press release:

Structured music lessons significantly enhance children’s cognitive abilities — including language-based reasoning, short-term memory, planning and inhibition — which lead to improved academic performance. Published in Frontiers in Neuroscience, the research is the first large-scale, longitudinal study to be adapted into the regular school curriculum. Visual arts lessons were also found to significantly improve children’s visual and spatial memory.

Music education has…

View original post 835 more words

“They should teach that in school….”

One of the academic studies I haven’t had time to pursue (so only blog about) is a thematic analysis of editorials in medical journals – with a focus on the many many “musts”, “need to s”, “shoulds” and “have to s” imposed on doctors, “policymakers”, and so on.

Education is more prone to this, and from a wider group of people. Everyone has their idea of what “they” should teach, ascribing to schools magical powers to end social ills by simply putting something on the curriculum.

Much of this is very worthy and well-intentioned. People want their children to be prepared for life. That the things suggested may not lend themselves to “being on the curriculum” with any degree of effectiveness is rarely considered.
That curricula are pretty overloaded anyway is rarely considered.

Anyway, the UK Organisation “Parents and Teachers for Excellence” has been keeping track of these “X should be taught in schools calls” in 2018 so far.:

How often do you hear the phrase “Schools should teach…” in the media?
We’ve noticed that barely a week goes by without a well-meaning person or organisation insisting that something else is added to the curriculum, often without any consideration as to how it could be fitted into an already-squeezed school day. Obviously the curriculum needs to be updated and improved upon over time, and some of the topics proposed are incredibly important. However, there are only so many hours in the school week, and we believe that teachers and schools are the ones best placed to decide what their students need to know, and not have loads of additional things forced on them by government because of lobbying by others.

So far, as of today, this is the list:

So far this year we count 22 suggestions for what schools should do with pupils:
Why We Should Teach School Aged Children About Baby Loss
Make schools colder to improve learning
Schools ‘should help children with social media risk’
Pupils should stand or squat at their desks, celebrity GP says
MP’s call for national anthem teaching in schools to unite country
It’s up to us: heads and teachers must model principled, appropriate and ethical online behaviour
Primary school children need to learn about intellectual property, Government agency says
Call for more sarcasm at school is no joke
Schools should teach more ‘nuanced’ view of feminism, Girls’ School Association president says
Schools ‘should teach children about the dangers of online sexual content’
Schools should teach children resilience to help them in the workplace, new Education Secretary says
Government launches pack to teach pupils ‘importance of the Commonwealth’
Schools must not become like prisons in fight against knife crime, headteacher warns
Schools should teach all pupils first aid, MPs say
Call for agriculture GCSE to be introduced as UK prepares to leave the EU
Councils call for compulsory mental health counselling in all secondary schools
Set aside 15 minutes of dedicated reading time, secondary schools told
Pupils must be taught about architecture, says Gokay Deveci
A serious education on the consequences of obesity is needed for our most overweight generation

Teach girls how to get pregnant, say doctors
Start teaching children the real facts of life

I am confident there are a lot more out there PTE haven’t been linked with. From sarcasm to “how to get pregnant” to first aid to intellectual property to resilience.

I do wish someone would do my study on medical journals’ imperatives for me!

Critical thinking about critical thinking

At Aeon, an interesting piece on “critical thinking”, by Carl Hendrick:

Essentially, “critical thinking” as a skill detached from context is meaningless and illusory:

Of course, critical thinking is an essential part of a student’s mental equipment. However, it cannot be detached from context. Teaching students generic ‘thinking skills’ separate from the rest of their curriculum is meaningless and ineffective. As the American educationalist Daniel Willingham puts it:

[I]f you remind a student to ‘look at an issue from multiple perspectives’ often enough, he will learn that he ought to do so, but if he doesn’t know much about an issue, he can’t think about it from multiple perspectives … critical thinking (as well as scientific thinking and other domain-based thinking) is not a skill. There is not a set of critical thinking skills that can be acquired and deployed regardless of context.

This detachment of cognitive ideals from contextual knowledge is not confined to the learning of critical thinking. Some schools laud themselves for placing ‘21st-century learning skills’ at the heart of their mission. It’s even been suggested that some of these nebulous skills are now as important as literacy and should be afforded the same status. An example of this is brain-training games that claim to help kids become smarter, more alert and able to learn faster. However, recent research has shown that brain-training games are really only good for one thing – getting good at brain-training games.

Hendrick concludes:

Instead of teaching generic critical-thinking skills, we ought to focus on subject-specific critical-thinking skills that seek to broaden a student’s individual subject knowledge and unlock the unique, intricate mysteries of each subject. For example, if a student of literature knows that Mary Shelley’s mother died shortly after Mary was born and that Shelley herself lost a number of children in infancy, that student’s appreciation of Victor Frankenstein’s obsession with creating life from death, and the language used to describe it, is more enhanced than approaching the text without this knowledge. A physics student investigating why two planes behave differently in flight might know how to ‘think critically’ through the scientific method but, without solid knowledge of contingent factors such as outside air temperature and a bank of previous case studies to draw upon, the student will struggle to know which hypothesis to focus on and which variables to discount.

As Willingham writes: ‘Thought processes are intertwined with what is being thought about.’ Students need to be given real and significant things from the world to think with and about, if teachers want to influence how they do that thinking.

Medicine of course has had a vogue for “problem-based” learning for over half a century now. The premise of this is similar to that of critical thinking skills, and both have a laudable root of increasing learner engagement and showing the relevance of what they learn to “the real world.” Yet there are all sorts of assumptions, and wishful thinking involved.

“Working here makes us better humans”

A daily thought from Leandro Herrero:

I have had a brilliant two day meeting with a brilliant client. One aspect of my
work with organizations that I truly enjoy is to help craft the ‘Behavioural DNA’ that shapes the culture of the company. This is a set of actionable behaviours that must be universal, from the CEO to the MRO (Mail Room Officer). They also need to pass the ‘new hire test’: would you put that list in front of a prospect employee and say ‘This is us’?

There was one ‘aspirational’ sentence that I put to the test: ‘Working here makes us better human beings’.

It was met with scepticism by the large group in the meeting, initially mainly manifested through body language including the, difficult to describe, cynical smiles. The rationalists in the group jumped in hard to ‘corporatize’ the sentence. ‘Do you mean better professionals?’ The long discussion had started. Or, perhaps, ‘do you mean…’ – and here the full blown corporate Academy of Language – from anything to do with skills, talent management, empowerment to being better managers, being better leaders, and so on.

‘No, I mean better human beings. Period!’- I pushed back. Silence.

Next stage was the litany of adjectives coming form the collective mental thesaurus: fluffy, fuzzy, soft, vague…

I felt compelled to reframe the question: ‘OK, so who is against working in a place that makes you inhuman? Everybody. OK, ‘ So who is against working in a place that makes you more human? Nobody. But still the defensive smiling.

It went on for a while until the group, ‘organically’, by the collective hearing of pros and cons, turned 180 degrees until everybody agreed that ‘Working in a place that makes you a better human being’ was actually very neat. But – there was a but – ‘Our leadership team wont like it. They will say that its fluffy, fuzzy, soft etc… In the words of the group, it was not ‘them’ anymore who had a problem, it was the infamous ‘they’.

The “difficult to describe” cynical smiles are familiar…. indeed I am sure I have perpetrated such smiles more than once myself!

Medicine can be a dehumanising profession, sometimes literally. Dehumanising in both ways – patients, especially some categories of patient, colleagues, but also we ourselves. Of course, the rationalist part of us can pick apart what “better humans” means…