Sunday, 27 May 2007

More on IBS

I've mentioned Irritable Bowel Syndrome here before. This month an article has appeared in the British Medical Journal which claims that
The medical management of patients with irritable bowel syndrome is often unsatisfactory. Doctors are still taught that irritable bowel syndrome is a diagnosis of exclusion, and patients readily sense that they are being told that nothing is really wrong with them. Many people soon come to appreciate that the range of medical treatments available is limited in both scope and efficacy. The mood of negativity, once established, is difficult to dispel.
The BBC report on this article has one of the authors, Dr. Ian Forgas, saying
Patients with irritable bowel syndrome should be made aware of the existence of these treatments so that they can make informed choices.

Specifically, they should be made aware that using a psychological treatment does not mean that the disease is 'all in the mind'.
Nick Read, with whom I appeared at the Ilkley Literacy Festival, is quoted there:
There's now a lot of evidence that psychological therapies can be effective, but a lot of doctors remain sceptical, and carry on treating with drugs which have side-effects, and which basically don't work.

I work with patients with IBS trying to understand what, for each patient, lies behind the illness.
The BMJ report also quotes Hippocrates:
It is more important to know what sort of person has a disease than to know what sort of disease a person has.
Imagine taking that seriously!

Friday, 25 May 2007


Hooray! A permanent academic post at last. I'll be starting in the philosophy department in Canterbury, Kent in September.

Next week Darian and I are speaking about our book at the Hay-on-Wye literary Festival.

Tuesday, 22 May 2007

Meditating on health

A study finds that practicing yoga leads to an increase in the brain transmitter gamma-aminobutyric acid (GABA), associated with a feeling of relaxation and a lessening of anxiety.

In our book we mentioned work by Richard Davidson on the effects of mindfulness meditation on immune response to 'flu vaccine. After an 8 week course subjects were vaccinated and found to have a significantly stronger response than controls. Differences also showed up in brain activity, with greater left-sided anterior activation.

Davidson jointly edited a book Visions of Compassion, whose subtitle - Western Scientists and Tibetan Buddhists Examine Human Nature - explains its contents.

Wednesday, 16 May 2007

Broom review

I posted about Brian Broom's book Meaning-Full Disease a while ago. You can read a review of it at the Heroes Not Zombies blog.

Monday, 14 May 2007

The Biopsychosocial model

I'm a little busy at the moment preparing for an interview, so posts won't be so frequent for a few days. In the mean time, readers might like to take a look at this paper: Medically unexplained symptoms: the biopsychosocial model found wanting.

On the face of it, the biopsychosocial model might sound as though a way had been found to overcome mind-body dualism. Taking a systems theoretic stance, we can view the individual as a biological organism, with a personal psychology, participating in a society.

As the authors argue, however, the use of this model in practice reinforces dualistic thinking. If no biological pathology is found in a patient, the illness is taken to be psychologically or societally induced, and the patient brought to understand that they have misrepresented the system level relevant to their disorder.

On the authors' view,
Rather, clinicians have an important role as experts in the process of helping patients interpret and make sense of their pain as part of their legitimate experience of the world, and, as such, the interpretivist view provides a more satisfactory philosophical rationale for a patient-centred clinical method.

Wednesday, 9 May 2007

Alcohol abuse

There has been some debate as to whether those in the medical profession are more likely than the average population to abuse alcohol. This article in the Student BMJ suggests the evidence is inconclusive, but does note a culture of ritualised drinking games in certain medical student cohorts. Even if alcohol abuse were no higher than in other comparable professions, it would still represent worryingly high levels of consumption.

Now, perhaps medical professionals are better than most in not allowing their drinking to endanger others, in view of the obvious risks of malpractice. However, evidence from Spain shows that a higher proportion of medical professionals there are drink-driving.

In our chapter of the psychology of doctors, we discuss the question of whether medical training and practice puts an unusual strain on doctors. We suggest that the source of the problem lies earlier. This report comments on a study published in 1972 which agrees
that alcohol and drug use among physicians was related to life adjustment (e.g., unstable childhood) difficulties before medical school.
Unfortunately, this type of detailed study of the lives of a sector of the population are much rarer today.