are we missing the point? – Medical vs patient care

As society becomes more educated and technology advances, I think we’ve missed the original meaning of “patient care”.

This thought arose as I read “Shroud of a Nightingale” by P.D. James. The basis of patient care, was to make them feel better. While medical advancements have allowed more cures to be accessible, the element of “care” has been re-defined to what I perceive as incomprehensible. Coaxing isn’t a solution, but the desensitization towards pain today is a curious affair.

A patient is unwell. Let’s run ten over scans. It’ll include a bunch of blood tests, an MRI scan of the brain which you might not be able to do when you’re weak, CSF tests via a lumbar puncture and many others. Let’s go through everything that the textbook taught me to, because everyone that comes within the door is a “case” that can be encountered.

No, I am not medically-trained. Yes, I understand the importance of finding out the cause of a discomfort. Yet time and again, I see people close to me go through this routine only to receive an oddly sanguine response of “the tests are inconclusive”. But hey, doesn’t matter – more wouldn’t kill, so here’s a heap of antibiotics you can try to take to fix your undeterminable issue.

I wonder, sometimes, if it was all necessary. Could a better preliminary diagnosis have resulted in more accurate tests and hence a more effective treatment? That bunch of tests and medication – did it serve to build up or wear down the patient’s immunity? Does the patient’s mental health still matter? I’m not sure we realise that bland food, pain and agony doesn’t motivate anyone to get well. Gone are the days where nurses swallowed feeding tubes consciously, to learn what the patient would feel in the process. Everything is deemed “a simple procedure” and “minor discomfort” today. But – it is not JUST a procedure. Your equipment standards have increased; your emotional standards inversely proportionate.

Medical care is great; patient care isn’t. Here’s hoping that some day someone will look into it again.

appreciating the people of science and beyond

Almost half a year ago I was reading Better You Than Me: Scientists Sicken Mosquitoes To Stop Dengue and I recall dropping my Professor an email about it. Just a week ago, I happened to chance upon A Scientist’s 20-Year Quest To Defeat Dengue Fever again and wanted to write about it but a tight work schedule put this off until today.

A quick summary – an Australian scientist, Scott O’Neill has an idea to prevent the spread of dengue. The article tells us how despite the difficulties of injecting the Wolbachia bacteria into mosquito eggs, O’Neill persevered for the past 20 years and more to come, working out how to infect mosquitoes with this strain of unique bacteria such that they can no longer spread dengue. Of course more problems could develop when the mosquitoes develop resistance and so forth, but I’ll leave the details of this significant research for your own reading at the links above.

Without scientific expert opinion, I discuss this solely out of admiration for O’Neill’s persistence in creating a positive impact for the dengue communities, a prevalent problem for those living in tropical areas. This also brings to mind Robert Koch. After a series of studies on anthrax and tuberculosis, Koch’s attempt to prove that vibrio bacterium as a cause of cholera was fraught with challenges due to the miasma theory of disease. In short, the miasma theory postulated that disease proliferation was caused by a lethal form of “bad air” or “pollution”. This gave little credit to Koch’s work, which fundamentally supported the germ theory. I would time and again emphasize the importance of Professor Ferdinand Cohn, who had in all his brilliance as one of the first botanists in Europe teaching with living plant samples, recognised Koch’s humble request to meet for a presentation of his earlier findings.

I draw two main learning points from here.

1. I am thankful and inspired by the good people out there who are still doing research for the better of communities. With monetary incentives in place, I have heard of some black-sheep researchers squandering a good amount of resources on absolutely unhelpful equipment without valid reason. I do not imagine that scientific research yields results spontaneously – a good many number of years is definitely needed to translate an idea into a discovery for cure.

2. It sometimes takes a lot of luck and fate to have that “rare stranger” acknowledge your work. Koch, without academic credentials, was given the opportunity by Cohn to demonstrate revolutionary experiments before himself and Cohnheim. Koch later also received Professor Cohn’s encouragement for journal publications soon after. I quote a few lines from Thomas D. Brock (1988). Robert Koch: A Life in Medicine and Bacteriology. ASM Press, p. 48. “Koch’s success was not only through the elegance of his research, but also through the force of his personality. Cohn, an especially good judge of character, was charmed by Koch’s sympathetic personality … … Koch found in Cohn not only a fatherly figure but a valued advisor of immense integrity”.

I’m always thankful for the random people who show up in my life, somewhere out of the blue, who have recognised my abilities and guided me along in my career.
Have you met one of these brilliant people in life?
If you have been fortunate to, yet have not been in touch with your “rare stranger” for awhile, maybe it’s time to re-connect and share a word of thanks too. 🙂

if we could all make a difference with science & art…

I was recently introduced to interesting insights in molecular gastronomy. I learnt about Homaru Cantu, founder of MOTO restaurant and his ideas of ‘miracle fruit’ and a first step to saving world hunger, as well as how it extends our definition of ‘food’. I have my reservations, and I am no scientist or professional chef, but I drew a very positive lesson from Homaru Cantu’s great vision, I thought I’ll share this too.

We often think of things in their preset categories, we place things in silos and we assume exclusivity to many characteristics. We examine in-depth, but not widely. We find aerospace engineers and business gurus, experts in their specific field of studies, but no longer see the great thinkers like Socrates, Plato, Aristotle whose studies span various disciplines. Times have changed, I am well-aware, but I wonder if this change has done more good/harm to our understanding of the world.

I started to think about me – or us. My current job requires me to predict the future – meet consumers’ needs, second-guess what they desire, invent the next best technology that dominates product categories. Sometimes we try so hard to outpace ourselves, we imagine the future and neglect the past that holds the very answer we’re looking for. I recall my first encounter with the ‘History of Science’, or ‘History of Diseases & Medicine’, and realised how historians too, can contribute to scientific studies and technology. My studies of the History of Science showed me how much was known or conceived in the early years. 3D TVs aren’t a brand new thing – people wrote about highly-similar items in the past – in those days 3D TVs were probably classified as science-fiction? We mocked, laughed, and chucked it aside. Instead of re-imagining a brand new product, a close examination of past records could potentially give us new ideas which we could leverage upon. While the concept might have been impossible years back – today’s advanced technology gives us a chance to materialise it. Of course, innovation must precede invention, but science might be enhanced if history is given a chance in its playing field.

I thought about how a molecular gastronomist aimed to transform our understanding of ‘food’ with the help of ‘science’ to achieve a greater humanitarian goal. How many of us are really open to applying scientific knowledge to culinary activity? Yet how often have we associated cooking with artistic qualities? Is this an example of assumptions that may have sidelined greater potential? There are limits to what we can accept in the combinations of food and science, without a doubt – I am not entirely receptive towards ‘edible paper’ etc but sometimes opening our minds a little more can put us in a creative space which we have always strived to achieve.

Maybe, just maybe, I am not a one-dimensional office-bound individual. Maybe if I could apply some of my existing knowledge to other aspects of life, I might be able to make a difference too. I don’t purport that I can make a huge positive impact to the world but we can all start somewhere.

Try this – think about your skills or what you can do, apply it to a field/discipline that you thought was totally irrelevant – maybe you’ll come up with something interesting too! If I do, I’ll be sure to write an update here!

Cheers to the week ahead everyone!

unsolved mystery: the history of st vitus’ dance

I’ve been back to reading about the dancing plague and how we still don’t know too well about it. I’m not even sure how many people out there know about this, but I’ve been intrigued since I learnt about it.

Doing no justice to the phenomena and in brief, the dancing plague was a situation where groups of people danced uncontrollably down the streets, sometimes for days, likely in a trance of hallucinations or unconsciousness, and forms a social influence which results in larger throngs of people following suit. Apparently the dancing plague was later attributed to Sydenham chorea, or of mass hysteria.

I’m not quite sure what to make of this, and in no way am I challenging scientific reasoning; I merely wish to seek an explanation from anyone who might know more about this – if chorea does not spread by air, how did one’s suffering of it result in groups of people doing just the same?

One explanation was that music was played when an outbreak occurred and those unaffected would join the procession as per a usual dance. Possible, indeed… or some have suggested a stress-relieving process for the masses that danced, but which overdid it and resulted in hallucinations. I’m not so convinced with this, though. More scientifically, some have theorized ergotism, tarantism and more, causing mass hallucinations. Possible too…

I chanced upon the concept of dancing mania when I was reading about mass hysteria and it has caught my attention all this while. Confined to the earlier centuries, this form of epidemic hysteria may have passed over, but the very concept should be emphasized – the power of words, starting from idea generation, should not be underestimated. How words & ideas have shaped mindsets & identities, even spurred nations at war, this seemingly intangible epidemic should be given due attention nonetheless. Are we looking into all these plausible epidemics that we have neglected for centuries? Has our constant development resulted in our neglect of the basics?

We have been asking constantly how to move on, yet sometimes we lose sight of the what and whys of our persistent thirst for more…

We could keep going, with Tourette syndrome,  Tanganyika laughter epidemic, fainting epidemics, idea-seeding and more, but let’s just keep it to this for now.

regression? unknown.

This is a first post of diving back into the history of medicine. I had intended initially to start with Koch, due to my fascination of his perseverance, but had recently encountered George Huntington’s works on describing the disorder at age 22. I’m not sure how this is linked but each time I think of Huntington’s disease I get a tad affected, I think of the novel Flowers for Algernon and I find life very, very sad.

I cannot claim to know much about Huntington’s Disease, especially since I am only starting to research and learn about it. I find regression sad, in all cases, of which the most common being Alzheimer’s. It is so much a person learns from his Day 1 on earth, and with HD, you lose your physical dexterity to chorea, your mental capacity, and eventually you lose everything. Potentially, you lose the people around you who no longer understand, or choose not to understand, brushing off your anxieties and flaring up at your irritability. You forget, involuntarily, all that you have treasured, all that you have mastered, and it all falls into dementia.

I know people who suffer from dementia – some self-comforting individuals believe it may be better for sufferers to indulge in their own worlds, oblivious to the cruelty of reality. I beg to differ. While it may sound positive, I’m not sure anyone would appreciate being highly dependent on others for help all the time, even for things as simple as chewing, or having someone perpetually misunderstand you due to difficulties in speaking. What makes HD sadder is that even episodic memory fails, one step worse than Alzheimer’s.

I’m not sure hot it was related to Flowers for Algernon but I remember feeling terribly depressed after reading the book when I was a teen. It was the same regression that killed my emotions. I guess when Charlie (protagonist of the novel) was subject to a procedure that endowed him with astonishingly high IQ which he lost later due to the failed experiment, I saw how one could lose everything he had gained. Charlie’s high IQ allowed him to work differently, think differently, and when he lost this intelligence, he lost everyone around him – his new job, his new relations, everything. And this novel ended with him requesting someone to leave flowers on Algernon’s grave (the mouse who became Charlie’s friend from the same experiment).

There you go – all he had at the end, was a little mouse that suffered just his fate. Who could understand what he was suffering? Who could know, or remember, what he knew? So with his change in character following a regression, his sexual partner left him in fear of his transformation. The book states that Charlie remembers that he was once a genius, albeit reverting to his past form, with IQ of 68. He did not wish for anyone to take pity on him, hence moved away from the rest of the world he knew. The character lost his skills, knowing that it was an experiment.

Can anyone imagine, how a patient of HD or dementia, might feel about losing his skills and capabilities without understanding how or why it might have happened? And it just keeps happening, day after day, time after time, with no apparent way to salvage the situation… …