Trust Me I’m a Doctor reminds me of Tomorrow’s World

October 28, 2013

A new BBC series promises to debunk popular medical myths. Its approach reminds me of an earlier popular science approach, Tomorrow’s World

Another of the series, Trust Me I’m a Doctor [TMID] had its showing this week [October 24th 2014].

TMID is presented as helping the lay person to gain insights into medical advances. Tomorrow’s world [1965 -2003] attempted to do a similar educational service for scientific and technological discoveries.

There is much to admire in the intentions of the original scientific programme, and in this new ‘medicine for the masses’ effort. I had some serious concerns about the original, with its remorseless enthusiasm for the new and quirky. I have rather similar concerns over TMID.

The worship of the wow

Tomorrow’s World sought to popularize by bringing out the wow factor in scientific discoveries. TMIF has that familiar worship of the wow on medical matters. The slight hint of irony in the title may be significant.

The approach of TMID

The approach of TMID is to challenge conventional wisdom to reveal another hidden possibility. The BBC blurb put is like this

Going behind the headlines to give you the definitive answers to your health questions. Can you be fat and fit? Could you improve your health by staying in bed longer? Should we all be taking an Aspirin pill to help us live longer? Michael Mosley is joined by a team of doctors who use their expertise to get to the bottom all those health claims.

My concern with the approach

My concern with the approach is that it is too easy to start with a loosely framed generalization and arrive at a conclusion which itself is as dodgy as the conventional wisdom it challenges, backed up with ‘clinical evidence’. The definitive answers are not as definitive as might be hoped for. In the episode, the framing went as follows:

One is made of fruit. The other is caffeinated. So a smoothie is a healthier option than a coffee, right? Don’t be so sure, says Michael Mosley, as he weighs the evidence.
Which is healthier – coffee or smoothies? It seems obvious that the answer must be a smoothie. After all, drinking coffee is a necessary evil, while having a smoothie, made from fruit, is part of your five-a-day. But when you look into the scientific studies they reveal something much more surprising.

The dangers of the either-or

I suggest that something conceptually dodgy is going on when a complex issue is reduced to an either-or. Despite the ‘evidence’ from clinical trials, I was left unconvinced. If the original question is “what is healthier for me, as an individual, drinking coffee or smoothies?” I find no satisfactory answer. The clinical trials provided statistical evidence of factors associated with medical benefits and disbenefits [if that’s the right word] of smoothies and of coffees. I won’t be watching the unfolding series.

Is TMID good for your understanding of up-to-date medical knowledge?

Now there’s an interesting question… we are asking two doctors whom we trust to comment for a future post.


Glaxo takes hit in China, but these are global dilemmas for Big Pharma

August 6, 2013

Glaxo Smith Kline faces a serious scandal for its business practices in China. There are serious implications for the entire global pharmaceutical industry

Some years ago, I wrote of the dilemmas facing Glaxo as its then chief sought to address criticisms of the gap between corporate actions and its rhetoric of corporate social responsibility. The entire pharmaceutical industry has been a favourite target on the internet under the cover-all term Big Pharma, as long-term profits were threatened, and speed-to-market pressures increased. Various unpleasant and often illegal practices were revealed.

The $400 million scam

Glaxo Smith Kline [GSK] is currently [July 2013] the centre of another scandal through its operations in China. The company is accused of a $400 million scam involving bribing doctors. Eighteen Glaxo employees have been arrested in China. The Chinese authorities claim a network of 700 people has been involved.

The issues are those facing the global giants known collectively as Big Pharma. The current story has a depressingly familiar tone. Last year [2012] Glaxo Smith Kline was hit with a $3bn fine for mis-selling drugs in the US. To date, the city has taken a relaxed view on the affair. Analyst Nils Pratley disagrees, offering three reasons:

First, reputation matters to drug companies and to Glaxo chief Andrew Witty who has been on a clean-up campaign during his five years in charge. After [last year’s fine] Witty said he was dealing with “echoes of the past” and announced his determination that such events would never happen again.

Nobody should doubt his sincerity but the Chinese allegations, if they are proved, would represent a serious failure of management. As far one can tell, GSK put in audit controls that it thought were sufficient for China; it may have been bamboozled by a sophisticated internal scam that was hard to spot without access to private bank accounts and emails. But that would be an explanation of failure, and won’t help GSK on the image front. Witty the unwitting is poor branding when you are dealing with governments around the world.

Second, GSK will probably have to rethink its entire model of doing business in China and other “high risk” countries. That signals disruption ahead as internal compliance controls are overhauled yet again.

[Eventually] in China, GSK will have to arrive at a working arrangement with a central government that appears to have a twofold agenda of running an anti-corruption drive and getting more funding into its dysfunctional healthcare system. Greater opportunity for GSK could emerge from the mess [through lower costs but greater volumes of sale and a better-regulated market.} But, to judge by the current aggressive rhetoric in China, the road to that position could be very long indeed. The story is still developing, but the City looks to be underplaying it.

I have long argued that the ‘pipeline’ model of innovation long-accepted by Big Pharma is in need of rethinking. It is based on a belief that success requires a pipeline of massive proportions through which vast numbers of candidates proceed in a Darwinian series of tests. Commercial pressures have ramped up the size and speed of operations. The temptation to ignore corporate social responsibilities is strong, regardless of the rhetoric and the establishment of CSR departments. Sir Andrew faces a host of leadership dilemmas.

July 2014

China continues legal proceedings

See Feldman, S. (2013) Trouble in the middle, oxford: Routledge for a broader analysis. http://blogs.wsj.com/chinarealtime/2013/08/01/eight-questions-steven-feldman-trouble-in-the-middle/
Accessed, July 12th 2014

August 2014

China jails Peter Humphrey for illegal transactions

http://www.bbc.co.uk/news/world-asia-28712420


Sir John Gurdon’s Nobel Prize and his No hope School report

October 12, 2012

When John Gurdon shared the 2012 Nobel Prize for medicine for work on stem cells, one much reported story was of a school report which rated him very unlikely to succeed as a scientist. It becomes the latest in a line of predictions of future failure including those for the young Churchill, Einstein, and Edison

In October 2012, the news broke that Sir John Gurdon was to share the 2012 Nobel Prize for medicine, for work on stem cells. One part of the story revealed that a school report had rated him very unlikely to succeed as a scientist. It becomes the latest in a line of predictions of future failure including those for the young Churchill, Einstein, and Edison.

The ridiculous idea

According to the report from Eton College, his biology teacher wrote:

“I believe he has ideas about becoming a scientist. On his present showing this is quite ridiculous; if he can’t learn simple biological facts he would have no chance of doing the work of a specialist, and it would be a sheer waste of time, both on his part, and of those who have to teach him.”

Duffers who did well

An article in The Mail gave an excellent list of schoolboys and a few schoolgirls, mostly British, who were deemed duffers at School only to confound the expectations of their teachers. Among the names were Winston Churchill, Stephen Fry, Ian Fleming, John Lennon, and an excessive number of actors and actresses. In most cases the individuals were rebellious in the eyes of their teachers, although perhaps strong-minded might be another description of them.

What about Edison?

One name worth adding would have been that of Edison, who was sent home from school as someone who was inherently incapable of benefitting from education. The Independent compiled a similar list and mentioned Marcel Proust [“Pas intelligent” according to his Professor].

Discouragement or a valuable wake-up call?

The argument can be framed as one supporting the benefits of no-nonsense direct feedback. However, another perspective is that students of a strong enough self-image are able to achieve their potential despite ill-judged feedback.

A question of pedagogy

The Mail argued that there is too much euphemism and false positivity in feedback to school pupils. Perhaps a blunt ‘wake-up call’ had been good for the young Gurdon. It’s a popular and ancient argument still heard in discussions of leadership style. “Some people need an arm around their shoulders, others need a kick up the backside”. It’s a version of situational leadership.

Maybe the Mail has a point

Maybe the Mail has a point. Perhaps there has been a movement towards avoiding the more robust forms of direct feedback to students. However, there are a few nuances to consider.

Or maybe

There is also the possibility that such blanket assessments are hopelessly wrong. Teachers who dismiss some (many?) pupils as being inherently inferior and unlikely to amount to much, suffer from a blinkered view of potential. My suspicion is that wrongly diagnosed ‘failures’ such as Sir John survive such feedback , rather than succeed because of it.

The pupils who went on to achieve great things were those of strong self-image and less likely to be damaged by assessments which could be harmful to others of weaker ego strength.


The intoxication of power: From neurosciences to hubris in healthcare and public life

October 7, 2012

brain-scan-wikipedia

There is increasing interest in neurological examinations of leadership behaviours and pathologies. The Royal Society of Medicine examines current research ideas

On Tuesday 9 October 2012, The Royal Society of Medicine, in association with the Daedalus Trust set out to explore aspects of the pathology of leadership and decision making: how it may be understood and what may be done about it.

The meeting acknowledges the origins of the concept of the Hubris Syndrome as being postulated by Lord David Owen. Dr Owen who was listed as a participant on the day.

“Exciting developments in cognitive, affective and social neuroscience and constantly evolving systems of commissioning, business and governance in healthcare, together with relentlessly changing cultures in society make this a timely, even essential conference.

The aim of the conference will be to integrate emerging knowledge from neuroscience, social sciences and organisational governance to nourish benevolent leadership and create effective constraints to hubris and related conditions.

How can we contain hubris and nourish benevolent leadership?
How can we prevent collusion with hubris in groups and develop effective governance constraints?
How can we create cultures of cooperation, accountability, creativity and effectiveness in diverse institutions in society?”

Does social networking “rot the brain”?

An earlier LWD post [February 2009] asked whether social networking was causing neurological changes. The topic has prompted fierce debate about possible changes to neural connections through too much time spent on the computer.

The dark side of leadership

Leadership studies have increasingly identified a ‘dark side’ to the exercise of power. In particular, the charismatic leader stands accused of operating often through narcissistic personality characteristics. The new more clinical approach seems to offer more insights into this important avenue of research.


E Coli, Cucumbers and the Consequences of Modernity

May 30, 2011

Tudor Rickards

Update: The initial reports of the source of the E-Coli deaths in Germany last week [May 2011] were later revised pending more careful analysis. An excellent review from CTVNews provided an informed view of the outbreak

Tim Sly, an epidemiologist and professor of public health at Ryerson University in Toronto, notes that this epidemic appears to be due to a double whammy: salad vegetables that haven’t been cooked (which would normally kill off most E. coli bacteria) and the use of organic growing methods.

“Organic foods are by definition fertilized with animal droppings and that’s where E. coli exists,” Sly noted in an interview with CTV.ca.

“We’ve been prophesying for a long time that as people move into organic foods, we’re going to get more of these (outbreaks).”

He says E. coli tends to be a surface contaminant that can simply be washed off. But if someone doesn’t wash their vegetables thoroughly, there can be problems.

“If you’re going to be eating organic food and you’re going to be eating them raw, you do need to exercise much more sanitation and hygiene, with washing and peeling. Which is something that we should be doing anyways,” Sly notes.

Initial post

The BBC reported that cucumbers infected with the E-Coli bacterium had produced deaths around Europe. The infections may be seen as another dilemma of modernity and its consequences.

The death toll in Germany from an outbreak of E.coli caused by infected cucumbers has risen to at least 10. The cucumbers, believed to have been imported from Spain, were contaminated with E.coli which left people ill with hemolytic-uremic syndrome (HUS).

Modernity and its consequences

Modernity has given us drugs to combat disease. It has also given us diseases which combat drugs. It has given us protection from the environment, as well as inflicting grave insults to the environment.

Organic farming and its consequences

This week, we have been reminded of the principle of unintended consequences. The cucumbers were grown under conditions of organic farming. Intensive farming has its environmental insults. Organic farming too has its unintended consequences.


Creative Leadership: Where are the new IDEOs?

June 23, 2009
Prof Cheng-Hock Toh

Prof Cheng-Hock Toh

The design consultancy IDEO has been rightly praised for its innovative and creative work. But where are the new IDEOs? We identify one candidate within the British National Health Service

IDEO’s fame has spread through its high-profile image and the advocacy of such management gurus as Tom Peters and Bob Sutton. Its brand image was also helped by a TV special, showcasing its creative ‘deep diving’ approach applied to invention of a new supermarket trolley.

IDEO deserves attention not just for its award-winning product designs, but also for its creative approach to generating innovative products. A Business Week article noted

From its inception, IDEO has been a force in the world of design. It has designed hundreds of products and won more design awards over the past decade than any other firm. In the roaring ’90s, IDEO was best known for designing user-friendly computers, PDAs, and other high-tech products such as the Palm V, Polaroid’s I-Zone cameras, the Steelcase Leap Chair, and Zinio interactive magazine software.

By showing global corporations how to change their organizations to focus on the consumer, IDEO is becoming much more than a design company. Indeed, it is now a rival to the traditional purveyors of corporate advice: the management consulting companies such as McKinsey, Boston Consulting, and Bain. Management consultants tend to look at the corporate world through a business-school prism. By contrast, IDEO advises clients by teaching them about the consumer world through the eyes of anthropologists, graphic designers, engineers, and psychologists.

Where are the new IDEOs?

Where are the new IDEOs? They are out there, perhaps not yet as celebrated, but delivering creative and innovative results to their own ‘customers’.

This thought was prompted after an invitation I received to attend a Creative Leadership Forum meeting at MerseyCare, a National Health Service trust working out of the North West of England. The Trust had already drawn attention to its work, as reported in an earlier LWD post.

The Trust’s website demonstrates the pervasiveness of its innovative thinking applied to actions that make a difference.

The Creativity Forum

The Creative Leadership Forum describes itself as being designed for those interested in leadership, creativity and innovation, offering a range of stimulating, thought provoking and energising opportunities including:

Stories from leaders across a range of disciplines e.g. business, arts and science
Round table conversations on contemporary themes
Listening and contributing your own ideas
Creative events
Informal networking with colleagues.

The theme of the meeting [June 22nd 2009] was the relationship between arts and health.

The format was pretty much as described. The guest speaker was a soft-spoken and distinguished-looking gentleman who correctly conveyed the impression of being a senior medical consultant.

He was Professor Cheng-Hock Toh of Liverpool University, a pioneering researcher into intravascular coagulation (bleeding and clotting problems). This work led to the establishment of the Roald Dahl Haemostasis & Thrombosis Centre at the University’s medical school.

The Centre’s approach to comprehensive care was one focus of his talk. The other was the Centre’s engagement with the arts.
The apppropriately-named and successful New Blood exhibition captured the spirit of these ventures

It’s IDEO all over again

As I listened I was struck by the parallels with the philosophy of the IDEO organization, the that of the Creative Leadership Forum itself, and also that of such creative leaders as Professor Toh, who didn’t have to sell his ideas to implement them.

IDEO was among the first design organizations to hit on the idea of co-creation, heavy involvement of sponsors and product end-users in the creative design process. Nothing is totally new, and perhaps it is more accurate to say IDEO had re-applied some of the principles of the synectics invention approach introduced into ADL by George Prince and Bill Gordon decades earlier

No matter. The point is, that synectics, IDEO, and now networks such as Merseycare’s Creative Leadership forum, permit learning and changing work climates for innovative results.

As Proessor Yo put it when setting up his new Institute in 2001 “We just talked to people …then they wanted to help you”. The helpers included people from the Roald Dahl foundation, who listened and decided to do more than just provide their name among a list of sponsors.

Co-creation: In California and on Merseyside
Driving away I tried to remember what I had heard which was something else linked the IDEO approach. Professor Ho had talked about involving all his staff in creating a climate of care The Business Week article supplied the answer:

Kaiser Permanente, the largest health maintenance organization in the U.S., was developing a long-range growth plan in 2003 that would attract more patients and cut costs. Kaiser has hundreds of medical offices and hospitals and thought it might have to replace many of them with expensive next-generation buildings. It hired IDEO, the Palo Alto (Calif.) design firm, for help. Kaiser execs didn’t know it then, but they were about to go on a fascinating journey of self-discovery. That’s because of IDEO’s novel approach. For starters, Kaiser nurses, doctors, and facilities managers teamed up with IDEO’s social scientists, designers, architects, and engineers and observed patients as they made their way through their medical facilities. At times, they played the role of patient themselves

There are new IDEOs. You can find them in the most surprising places. I rest my case.