Running up against orthodoxy

There is much food for thought in Brian Martin's Dissent and heresy in medicine: models, methods and strategies:

An orthodoxy that draws on the full range of resources, namely which exercises unified domination, is incredibly difficult to challenge. Many challengers subscribe to the myth of scientific medicine as being based on open-minded examination of evidence, and thus handicap themselves, since in practice they are ignored or attacked. In order to have a chance, they need to understand that science and medicine are systems of knowledge intertwined with power, and that if their alternative relies entirely on knowledge, without a power base, it is destined for oblivion.

Strategies for dissidents and heretics are offered, including this advice:

Although rejection of dissent and heresy is the standard mode of operation of science, the establishment normally trades on a belief that ideas are treated on their merits... If challengers can reveal the reality, for example by showing that defenders of orthodoxy use double standards, lie, unfairly block publications, harass opponents, destroy documents, withdraw grants or dismiss researchers, this can lend credibility to the challengers and attract support for fairer treatment.

Book News

Hanif Kureishi kindly chose our book as his best book of the year.

The American edition is now advertised at Amazon (May 2008) with the title Why People Get Sick, and a very different cover.

The cover of the paperback of the UK edition (Feb 2008) is also advertised.

Another psychosomatic book

Jean Benjamin Stora, psychoanalyst and psychosomatician, head of teaching for Integrative Psychosomatics at the Faculty of Medicine at La Pitié-Salpêtrière (Paris), has written When the Body Displaces the Mind: Stress, Trauma and Somatic Disease.

When the human being is overwhelmed by excitations, tensions and frustrations, and the psychic apparatus is no longer able to absorb them because of its fragility and its weaknesses, it is the body that takes over.

Stora updates Freud's economic model:

This new psychosomatic approach fosters the economic and energic dimension of psychic functioning and its role in somatisations. In formulating the economic principle, Sigmund Freud referred to Carnot's theory in order to justify his viewpoint scientifically. Now, as Carnot's theory applies only to closed mechanical systems, it is no longer appropriate today; this book proposes replacing Carnot's theory with the 'open dissipative energy systems' theory (Ilya Prigogine) adopted in medicine and adapted here to the economic principle of psychoanalysis.

Naturally, the pitfall of dividing 'real' organic diseases from psychosomatic ones has been avoided:

In the context of this new approach, it is no longer a question of psychosomatic diseases but the role that the psyche plays in all diseases without actually being their cause. The psyche participates in the defence of both the organism and the immune system and it must be examined in relation to the somatic functions and organs.

Should be worth reading.

It's not what it used to be

As a busy term comes to a close, I hope to find more time for this blog now.

A couple of weeks ago my PhD supervisor, Donald Gillies, came to speak to our Reasoning group about Popper and induction. Knowing my interest in psychosomatic medicine, he brought me the details of a paper which had interested him:

Hallee JT, Evans AS, Niederman JC, Brooks CM, Voegtly JH: Infectious mononucleosis at the United States Military Academy. A prospective study of a single class over four years. Yale J Biol Med 3:182-195, 1974.

This is not available online, but a follow up is:

Psychosocial Risk Factors in the Development of Infectious Mononucleosis, S. Kasl, A. Evans, J. Niederman

It concludes:

Psychosocial factors that significantly increased the risk of EBV [Epstein-Barr virus] infection being expressed as clinical IM were: 1) having fathers who were "overachievers" (occupational status exceeding own educational level, or wife's education, or her occupational status); 2) having a strong commitment to a military career; 3) ascribing strong values to various aspects of the training and of military career; 4) scoring poorly on indices of relative academic performance; 5) having strong motivation and doing relatively poorly academically.

I was just thinking how university students might be good subjects for a similar study. However, tangible sexual behaviour seems to be the sole focus of today's researchers. In

A cohort study among university students: identification of risk factors for Epstein-Barr virus seroconversion and infectious mononucleosis. Crawford D H et al., Clin Infect Dis. 2006, Aug 1;43(3):276-82,

The authors conclude:

Our findings suggest that acquisition of EBV is enhanced by penetrative sexual intercourse, although transmission could occur through related sexual behaviors, such as "deep kissing." We also found that EBV type 1 infection is significantly more likely to result in IM. Overall, the results suggest that a large EBV type 1 load acquired during sexual intercourse can rapidly colonize the B cell population and induce the exaggerated T cell response that causes IM. Thus, IM could, perhaps, be prevented with a vaccine that reduces the viral load without necessarily inducing sterile immunity.

One day I'll write a book on changes in medical research.