Circadian rhythms Nobel Prize for Medicine or Physiology 2017

When I was young, the Oscars had an air of naffness, and the likes of the Golden Globes or Emmys even more so. One of the many many ways internet culture has failed to live up to its utopian hype   is the glorification of these sort of jamborees into moments of Great Cultural Significance, endlessly teased over by scolding columnists determined to weed out wrong think even about a glorified trade awards ceremony.

The Nobel Prizes haven’t quite reached the same point – indeed, as I wrote here before, their cultural impact may be somewhat diminished – but nevertheless, they are also subject to a strained search for important messages. The Nobel Prize in Physiology or Medicine 2017 was awarded jointly to Jeffrey C. Hall, Michael Rosbash and Michael W. Young “for their discoveries of molecular mechanisms controlling the circadian rhythm”

The video illustrates nicely what Circadian Rhythms are. 

 

Here is Robash’s lecture (with 5250 YouTube views) which is a good place to start a consideration of circadian rhythms:

And here is Young’s, which ties it all back to human circadian rhythms (just over 4000 views):

Here is Hall’s Nobel lecture, I note he is wearing a Brawndo hat from the film “Idiocracy”. I also note this video has just over 6000 views on YouTube (the Brawndo ad linked to above has over 3 million) Then again, it is a little hard going – Hall is not as funny as he thinks he is… and while there is some interest in his anecdotal style of various prior Drosophilia researchers it is not that effective an entry into this world (so while it is the first lecture given and includes the overall introduction, I have left it to last):

Slides of Robash’s and Young’s lectures are available on the Nobel site. Rather endearingly, they are basic PowerPoint slides replete with credits for everyone in the lab.

So there you go. 3 Nobel lectures on a subject of direct relevance to all our lives have a grand total of less than 15000 views on YouTube. I could easily find some ephemeral/trashy/obscene video with several multiples, but what is the point?

In the New Yorker, Jerome Groopman identified the “real message” of the prize as a rebuke to those who ignore or underfund basic science (in fairness his piece is also a decent introduction to this research).  While there may be some merit to this, it strikes me as more likely that the Academy recognised scientific work of genuine merit and enduring relevance.

And Groopman’s piece was one of the only ones I could find online that discussed the science and the issues related in some context (even though it was one I found slightly suspect) – most of the others essentially recycled the press releases from the Nobel Foundation and the US National Science Foundation

In my post “Why isn’t William C Campbell more famous in Ireland?” I discussed an excellent piece by Declan Fahy on “the fragile culture of Irish science journalism”. One wonders if this fragility is perhaps not only an Irish phenomenon.

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“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!

“Mental health apps offer a head start on recovery” – Irish Times, 18/01/18

Here is a piece by Sylvia Thompson on a recent First Fortnight panel discussion I took part in on apps in mental health.

Dr Séamus Mac Suibhne, psychiatrist and member of the Health Service Executive research technology team says that while the task of vetting all apps for their clinical usefulness is virtually impossible, it would be helpful if the Cochrane Collaboration [a global independent network of researchers] had a specific e-health element so it could partner with internet companies to give a meaningful rubber stamp to specific mental health apps.

“There is potential for the use of mental health apps to engage people with diagnosed conditions – particularly younger patients who might stop going to their outpatients appointments,” says Dr Mac Suibhne. However, he cautions their use as a replacement to therapy. “A lot of apps claim to use a psychotherapeutic approach but psychotherapy is about a human encounter and an app can’t replace that,” he says.

Here are some other posts from this blog on these issues:

Here is a post on mental health apps and the military.

Here is a general piece on evidence, clinical credibilty and mental health apps.

Here is my rather sceptical take on a Financial Times piece on smartphones and healthcare.

Here is a piece on the dangers (and dynamics) of hype in health care tech

Here is a post on a paper on the quality of smartphone apps for panic disorder.

“a tendency to overhype fixes that later turn out to be complete turkeys”

An interesting passage on the contemporary dynamics of the quick fix, from “The Slow Fix: Solve Problems, Work Smarter and Live Better in a Fast World” by Carl Honore:

“The media add fuel to that fire. When anything goes wrong – in politics, business, a celebrity relationship – journalists pounce, dissecting the crisis with glee and demanding an instant remedy. When golfer Tiger Woods was outed as a serial philanderer, he vanished from the public eye for three months before finally breaking his silence to issue a mea culpa and announce he was in therapy for sex addiction. How did the media react to being made to wait that long? With fury and indignation. The worst sin for a public figure on the ropes is to fail to serve up an instant exit strategy.

“That impatience fuels a tendency to overhype fixes that later turn out to be complete turkeys. An engineer by training, Marco Petruzzi worked as a globetrotting management consultant for 15 years before abandoning the corporate world to build better schools for the poor in the United States. We will meet him again later in the book, but for now consider his attack on our culture of hot air. ‘In the past, hard-working entrepreneurs developed amazing stuff over time, and they did it, they didn’t just talk about it, they did it,’ he says. ‘We live in a world now where talk is cheap and bold ideas can create massive wealth without ever having to deliver. There are multi-billionaires out there who never did anything but capture the investment cycle and the spin cycle at the right moment, which just reinforces a culture where people don’t want to put in the time and effort to come up with real and lasting solutions to problems. Because if they play their cards right, and don’t worry about the future, they can get instant financial returns’

The world of Policy and the Salzburg Statement

With his recent elevation to Taoiseach, something Leo Varadkar (who was supposed to work with me when I did a locum in Tallaght in May 2007… but he was occupied with some election or other) said in the late 1990s got a fair bit of coverage. This was to the effect that as a doctor you can help a few people, but as Minister for Health you can help millions. While at first glance this seems like a truism, it has for some reason got under my skin. There are various reasons for this, not all of which I will get into. Perhaps I am jealous of a road not travelled! (I am pretty confident I am not)

In a way it sums up a particular seduction – the seduction of the World of Policy. Get interested in any field – from the natural world to technology to medicine indeed – and sooner or later the siren song of policy will be heard. Wouldn’t it be great to Make A Difference not just on the piecemeal, day-to-day way, but on a grander scale? Increasingly I think not. Clearly someone needs to formulate policy and to think about things on a broad scale – but they should do so without illusions and with a certain humility. People have a habit of behaving in a way that the enlightened policy makers don’t foresee.  The circuit of conferences and “networking” can become an echo chamber of self congratulation. Doing good, perhaps, is best done on a smaller scale.

These thoughts are occasioned by reading about the Salzburg Statement. This is something I heartily approve of – a call for action to ensure all children enjoy the right to play in a nature rich space within ten minutes of their home.  The statement is made up of eight key actions:

Eight actions to transform cities for children

  1. Ensure children of all ages, backgrounds, income, and abilities have equitable access to nature and play regularly and in meaningful ways to promote good health and wellbeing.

  2. Embed nature in everyday places used by children, such as schools, backyards, parks, playgrounds and city streets, to make the city into a natural outdoor classroom.

  3. Involve children in designing and planning natural spaces for recreation, education, inspiration and health, to give them ownership and pride in their local communities, schools and parks

  4. Build curiosity, wonder, and care for nature in children (for example by greening school grounds and involving children with community gardens).

  5. Protect natural features across cityscapes and create an equitably distributed network of accessible green and nature-rich spaces that all generations can reach on foot.

  6. Connect cities with the broader ecosystems in which they are embedded, creating corridors for people, plants and animals to move safely across the city and into its surroundings.

  7. Establish more urban conservation areas to increase access to nature and connect cities to the broader protected area network.

  8. Work together through cross sectoral and multi-level partnerships to build an inclusive culture of health in cities.

 

There’s nothing there I would disagree with, though as with all these kind of interventions I would like more robust dissection of what, say, Item 3 would mean in practice.

I am always a little wary of dressing up worthy activity in the mantle of Health. What Resting a case for nature on the vagaries of purported health benefits can be a dangerous and debunkable game – especially with the media. This visual  handily shows how media can seize on single studies to generate headlines:statins.png

One can easily imagine a Katie Hopkins-ish journalist seizing on the inevitable ambiguities of research to “debunk” the claims for health benefits of nature.

I should state very clearly I have no reason to think that the Salzburg Statement is a wonderful initiative I look forward to hearing more of. But I am a little wary of the siren call of the World of Policy.

Leandro Herrero – “The best contribution that Neurosciences can make to Management and Leadership is to leave the room”

A while back I reviewed I Know What You’re Thinking: Brain Imaging and Mental Privacy in the Irish Journal of Psychological Medicine, and discussed a couple of studies which illustrate the dangers of what could best be called neuro-fetishism:

In 2010, Dartmouth University neuroscientist Craig Bennett and his colleagues subjected an experimental subject to functional magnetic resonance imaging. The subject was shown ‘a series of photographs with human individuals in social situations with a specified emotional valence, either socially inclusive or socially exclusive’. The subject was asked to determine which emotion the individual in the photographs were experiencing. The subject was found to have engaged in perspective-taking at p<0.001 level of significance. This is perhaps surprising, as the subject was a dead salmon.

In 2007, Colorado State University’s McCabe and Castel published research indicating that undergraduates, presented with brief articles summarising fictional neuroscience research (and which made claims unsupported by the fictional evidence presented) rated articles that were illustrated by brain imaging as more scientifically credible than those illustrated by bar graphs, a topographical map of brain activation, or no image at all. Taken with the Bennett paper, this illustrates one of the perils of neuroimaging research, especially when it enters the wider media; the social credibility is high, despite the methodological challenges.

I am becoming quite addicted to Leandro Herrero’s Daily Thoughts and here is another. One could not accuse Herrero of pulling his punches here:

I have talked a lot in the past about the Neurobabble Fallacy. I know this makes many people uncomfortable. I have friends and family in the Neuro-something business. There is neuro-marketing, neuro-leadership and neuro-lots-of-things. Some of that stuff is legitimate. For example, understanding how cognitive systems react to signals and applying this to advertising. If you want to call that neuro-marketing, so be it. But beyond those prosaic aims, there is a whole industry of neuro-anything that aggressively attempts to legitimize itself by bringing in pop-neurosciences to dinner every day.

In case anyone doubts his credentials:

Do I have any qualifications to have an opinion on these bridges too far? In my previous professional life I was a clinical psychiatrist with special interest in psychopharmacology. I used to teach that stuff in the University. I then did a few years in R&D in pharmaceuticals. I then left those territories to run our Organizational Architecture company, The Chalfont Project. I have some ideas about brains, and some about leadership and organizations. I insist, let both sides have a good cup of tea together, but when the cup of tea is done, go back to work to your separate offices.

It is ironic that otherwise hard-headed sceptics tend to be transfixed by anything “neuro-” – and Leandro Herrero’s trenchant words are just what the world of neurobabble needs. In these days of occasionally blind celebration of trans-, multi- and poly- disciplinary approaches, the “separate offices” one is bracingly counter-cultural…

What practice which seems perfectly fine to us now will seem weird/unethical/laughable in fifty years?

On my other blog I posted a quote from James Jeremiah Sullivan’s essay  on the polymath Constantine Samuel Rafinesque:

That’s what’s so terrifying but also heroic in Rafinesque, to know he could see that far, function at that outer-orbital a level intellectually, yet still wind up viciously hobbled by the safe-seeming assumptions of his day. We do well to draw a lesson of humility from this. It’s the human condition to be confused. No other animal ever had an erroneous thought about nature. Who knows what our version of the six-thousand year old earth is. It’s hiding somewhere in plain sight. In five hundred years there’ll be two or three things we believed and went on about at great length, with perfect assurance that will seen hilarious to them.

One could cite many many examples of “safe seeming assumptions” in every sphere – moral, scientific, social, cultural – which as time went by became unsafe and then positively harmful, laughable or just plain weird.

There is a self-congratulatory tendency to exaggerate and outright distort how wrong people were in the past. This is a form of epochalism, the belief that we live in a time unique in human history  True in a trivial sense, but blind to the patterns of human life and what could be called the human condition. One of the recurrent themes on Stephen Pentz’s poetry blog First Known When Lost is that the modern belief that We Are Somehow Unique is an illusion. Other people, at other times, have struggled with mortality, the passing time, what is a good life, and in times in their own way as complex and baffling as our own.

Anyhow, the point of this post is really to post a question, and a question that is in principle unanswerable. What will the practices in medicine in healthcare that, in fifty years, will seem either weird or unethical or simply bad, that we take for granted today? The nature of this question that these are not things that, by and large, are objected to today, but seem a normal part of practice. One could put forward many obvious answers about eHealth or about health insurance, but of course values change over time and assuming our values now will be the normative values of fifty years is a fool’s game.