If a doctor expressed concern about a patient showing signs of addiction, Ms Panara was trained to counter those fears by educating them on so-called pseudo-addiction, she says. For example, an addict might turn up at the surgery requesting a fresh batch of pills before their 30-day supply should have run out, claiming they had lost the tablets or accidentally dropped them down the toilet. The advice that she was told to give the doctor was that the patient’s dosing was too low and should be increased, she says.

“The theory of pseudo-addiction was that a patient might exhibit these drug-seeking behaviours, but if their pain were adequately managed by giving a higher dose, then that drug-seeking behaviour would cease,” she says. “Thereby we were building their tolerance, building their physical dependence, and making them an addict.”

I still fail to see why we need drug representatives, nor why they are allowed.

How Purdue’s ‘one-two’ punch fuelled the market for opioids | Financial Times

 

The business model is the same as everything else that is booming, from iPhones to residential property: as long as it can be bought with debt, the price matters a lot less, and vendors, middlemen, creditors all make big margins.

FT

We need to demonstrate much more clearly that Universities (and their leaders) are listening and acting. Much of the criticism levelled at HE is legitimate so the sector needs to take action to transform both itself and in turn the opinion of some of the public. This can be achieved through greater transparency relating to fees, funding and value; an even more proactive approach to the big issues (diversity, mental health, social mobility, relationships with business) and a collective and authentic approach to sharing all that is great in UK HE.

Link

This is no solution, more a symptom of the sort of thinking that got us here.

Surprise Gift: Free Tuition for All N.Y.U. Medical Students – The New York Times

N.Y.U. said that it had raised more than $450 million of the $600 million that it anticipates will be necessary to finance the tuition plan. About $100 million of that has been contributed by Kenneth G. Langone, the founder of Home Depot, and his wife, Elaine, for whom the medical school is named.

To date, only a handful of institutions have tried to make medical education tuition-free, according to Julie Fresne, senior director of student financial services of the Association of American Medical Colleges, a nonprofit organization that represents medical schools.

Link

Opinion | How to Get the Most Out of College – The New York Times

“The more you regard college as a credentialing exercise, the less likely you are to get the benefits.”

For a baseline life expectancy of 80 years:

• Eating 12 hazelnuts daily (1 oz) would prolong life by 12 years (ie, 1 year per hazelnut)
• Drinking 3 cups of coffee daily would achieve a similar gain of 12 extra years
• Eating a single mandarin orange daily (80 g) would add 5 years of life.

Conversely:

• consuming 1 egg daily would reduce life expectancy by 6 years
• eating 2 slices of bacon (30 g) daily would shorten life by a decade (an effect worse than smoking).

Well these are all taken from John Ioannadis’ article in JAMA. He asks : “Could these results possibly be true?”

The great financial crash led to some (but not enough) soul-searching about the state of academic economics and, in turn, the academy. Whole swathes of the modern research university are geared to the production of unreliable knowledge.  There is money in it. Without wishing to understate in any way Ioannadis’ major contributions, we have known that there are fundamental methodological flaws in much of observational epidemiology for a long time (for instance see the late Alvan Feinstein’s article in Science). A must read. 

(The Challenge of Reforming Nutritional Epidemiologic Research John P. A. Ioannidis, AMA. Published online August 23, 2018. doi:10.1001/jama.2018.11025)

It is not only taxi drivers that are being “uberised” but radiologists, lawyers, contractors and accountants. All these services can now be accessed at cut rates via platforms.

FT

The NHS became such a platform, for good and bad. That is the real lesson here. The tech is an amplifier, but the fundamentals were always about power.

From an obituary of Paul Boyer.

“Paul Boyer was approaching the finish line of his career when he risked everything with a jaw-dropping proposal. He addressed one of the most important, as-then-unanswered questions in biochemistry”

“We were attending a UCLA seminar in 1972 when I noticed that he wasn’t paying attention to the speaker. Afterwards, Paul approached us in a very excited state. This was surprising because he was known for his calm demeanour. He confessed that he had spent the hour thinking about old unexplained data. He asked: “What would you say if I told you that it doesn’t take energy to make ATP at the catalytic site of ATP synthase,” (as was universally held at the time) “but rather that it takes energy to get ATP off the catalytic site?” This was a eureka moment.

As is often the case with transformational ideas, early reactions were negative. When the Journal of Biological Chemistry rejected our manuscript containing data supporting this concept, Boyer told me without animosity that he could see why they would do that — “It was a very striking claim.”

Well, I have never had an idea to compare with this. But sitting through talks that do not light my fire, I have always found conducive to thinking creatively about something else. Its similar to the way that some writers practice their craft better in a coffee shop than in a silent office. Intellectual white noise.

Remember: the best ideas are not in the literature. If they were…..

Those who rent seek on biomedical knowledge wish to seek to define the norms of what is foundational. What is foundational for the practice of medicine should be contested more. Anatomy for surgeons is an easy case to make. But for most non-surgeons, the case for much anatomy is far from simple.

In any historical account of the ascent of modern medicine, Versalius looms large. But this Nature article (Sex, religion and a towering treatise on anatomy) intrigues me for a not so obvious reason: the counterpoint between how such knowledge was represented and understood.

Even Vesalius realized that his images could be confusing, and devised an ingenious method to explain them. A letter or number was printed onto the image of each body part, with a separate key. Unfortunately, the characters were often too small to pick out against the swirling background….

Faced by such challenges, many medics might have given up on the images. Indeed, when we reconstructed what early modern readers and scholars found fascinating about the Fabrica, it was evidently the text. The clear majority of sixteenth- and seventeenth-century readers who annotated the book focused on that and left no traces of having engaged with the illustrations. Sixteenth-century reviews of the Fabrica confirm this impression, because they tended to discuss only the text.

This is no surprise. The Fabrica’s scholarly readership was trained in the traditions of Renaissance humanism, which put a strong emphasis on textual analysis. Even if they found it difficult to interpret visual information, medical practitioners were expert at making sense of long Latin texts.

June, July are the busiest time of year for. It is when I update all my teaching material, and I always underestimate how long it will take me. Here is a guide to some of it. But still I need to catch up with some more, as the new students have already started.

 

Navigating the online resources from jonathan rees on Vimeo.