The naturalistic fallacy at work.

If you haven't come across the naturalistic fallacy before, it is the idea that anything natural is good. A moments thought will show that on that basis alone rattlesnakes must be awesome and should be cuddled. So off you go, tell me how that works out for you.
Today I have had two exampkes of the amount of phallus in that fallacy, from different directions.
Firstly as part of my normal life as an academic I am in South Kensington wanking for coins. Sorry mean lecturing. As many may have noticed it is hotter than a camels bum bag today, so hot that it has melted the few Sprungli truffles i was saving to revive myself.
However the torture pit in which i was teaching was air conditioned.
Trust me on that showing nature sucks.
I also had an interesting discussion with...well I was born in the 60s and grew up near Glastonbury. He wasnt a hippy but he was what people who don't know hippies think of when they say hippy.  Given that at coffee break i was in lotus trying to relax my back which is being a bastard today, and necking pills, the subject of my ailment came around.
Oh joy, he is a devotee of Bowen therapy, a mystic offshoot of chiropractic which combines nonsense with 70s gameshow hosts. Or something.
I was politely deflecting this when the old line about chemical analgesia being bad came up. What was interesting was that in his head analgesia = NSAID. Which sticks him in with a lot of GPs. So of course drugs rot your stomach etc.
I pointed out that opiates also exist, but the addiction limits use, rather stupidly imho.
He actually offered to source raw opium for me.
I have no need of this, as due to my gp being a rather cowed wreck of a man cowering under a desk I long ago opened the door to the land of poppy on the NHS. But it shows the level of idiocy we deal with. First drugs are bad mmmkay, lets rub your hand with my magic healing woo. But if that fails lets smoke smack! Its natchral!
I sometimes wonder if I am mad. But that would leave no word to describe the people i meet.

Lovely refit...now do it again.

I use London City Airport a good deal. Its not the kind of airport you go to for the shopping, it has always been pretty functional but it works and it is efficient, so in my book it wins.

But there is nothing so good that a marketing twat cannot mess it up.

I have recently been spending more of my time in a wheelchair. It comes as a shock to people when i get out and walk around but actually mkst people in a wheelchair can probably walk a bit. With me my condition means i cant walk for long and standing still hurts like crazy. So i have given up on walking in airports. This weekend I am using city in a chair for the first time.

City has just had an internal refit sponsored by Bloomberg. There are lots of plug sockets, audio links, usb charger sockets etc. Of course there are none of those for people in wheelchairs but everyone knows cripples cant think or use computers so thats alright.

There are pleasant sitting areas, with low tables to gather round and chat. All of these are walled off with a string of bar tables and bar stools set just far enough apart to exclude a wheelchair.  So if you want to rest your drink ln something it has to be at head height.  But at least it stops the deformed wheely mutants from bothering the normal folk when they are trying to relax.

One of the really good things about city airports lounge was the view over the runway. You could sit and sip coffee and watch the planes. Now you have a massive wall of bloomberg info blocking the view from half of the room, and the other half is accessed by passageways so tight that you fear to go down them with a wheelchair because you will not be able to turn and come back, and if anyone has left a bag there you are stuffed.

City are trying to maximise the customer experience, and lets be clear there is nothing wrong with anything they have done in principle.  But it is very clear that the designer gave no thought at all to anyone with mobility problems. And in fact they are trying to make sure they do not clutter up the place by coming back.

It has to be said the security staff and check in folk were very well trained, professional and lovely.  But it comes to something when the highpoint of an airport trip is the body search.

I hope someone from city or bloomberg reads this. They need to.

What have you got to be miserable about?

In some ways it is impossible to talk about an illness without indulging in what has been called, with some reason, disability top trumps.  How can one compare one disability with another after all?  Or one illness with another?  After all there was a huge fuss recently when, with the best intentions, a charity tried to compare one cancer to another.
To be honest its probably not worthwhile to even start.  After all what matters is that someone is in distress, not a sad, sick game of "Who's the gimpiest? ".  But we humans, or rather you humans and us horses, with our pack structures and our narrative imaginations seem, to need to rank everything.
On that basis my personal disability probably wouldn't make it into the top 100.  Don't get me wrong, i recently characterised it as:  (pardon the swears)

a pigfucking hyaenabitch arse elephant from hades with a cuntgiraffe chaser

but there are worse varieties even of Ehlers Danlos, and within my own variety I am one of the least afflicted. 
Why am i bothering about ranking systems?  Simply put, death.
I live in a country where euthanasia is technically legal.  But only in certain circumstances, the chief ones being that one has to have a terminal disease or a cancer, to qualify.  Now on one side I can see the point there, as probably those people are top of the list when it comes to suffering....or are they?  Seriously how does one gauge suffering?

I know that this is a touchy subject for many, and brings out a lot of make believe artists, but lets be clear here I am talking specifically about the right to die of people who can ask for it personally.  No coercion, no power of attorney.  I also emphatically do not want to promote the idea of topping oneself.  Its not a romantic statement.  It is a last resort.

But we live in a world where that last resort is effectively closed off to anyone who actually needs it.  I mean all due respect but if a cancer patient wants to kill themselves generally they should just substitute alternative medicine for the chemo and wait a year or two.  Some of us don't get off so lightly.

I do not understand, to be frank, why we do not allow anyone who asks for it a painless death.  Many people in chronic pain kill themselves, or try to.  Frankly they have a point.  Granted many suicides are irrational acts, carried out in the throes of great passion.  But some are rational choices.  Does anyone have the right to deny this exit?  My simple answer to that would be no.  Heck if I were in charge there would be combination drive-in suicide booths and pet food factories on industrial estates worldwide.

I may be a little liberal in my views there but it comes down to this for me...when life becomes an intolerable sentence do we really have the right to deny people parole?

On Science and Salesmanship

Today I had to sit through three seminar talks given by candidates for a post at my institution.  The audience reaction is quite important to the hiring process here and so it is a duty not a pleasure, which is what seminars normally are for me.


The thing with seminars is that they have changed over time, and not in a good way.  Originally seminars were a discussion- the talk kicked off the questions and the questions kicked off the debate.  In some places this has degraded so that the only questions asked tend to be toadying ones, or occasionally, horror of horrors, there are no questions at all.  Frankly if I ever presented work where it roused no questions I would retire.  But luckily, where I work the spirit of the original seminar is alive and well.  There is often a debate.

I am well known for asking questions.  I once took my wife to a conference, partly to prove to her that it was indeed work not fun.  She was waiting outside a lecture hall with a friend of mine when a group of pale sweating students wandered past clearly shaken up.  when she asked what the matter was she was informed that they had had questions from me and needed to recover.  So today i was expected to ask questions.

I struggled.  It wasn't the 3 hrs pain racked sleep.  It wasn't that I didn't understand the subject.  It was simply that the only question I could think of was "What the hell was that crap?".  Because what I saw was bullshit layered thick and hard.

The problem is the insidious presence of advertising in science.  Of people selling themselves.  And not in an honest, up front prostitution type way.  Each talk started off with a gush about the areas of application.  Each one was about environmental/green/natural fallacy stuff.  And each gush was TOTALLY UNRELATED TO THE RESEARCH.  I mean for the love of god I bullshit for a living.  If you are going to sell me a line at least make it plausible.

In one of the films where he plays God George Burns has some advice for an evangelist, and I would like to paraphrase it for scientists.  If you want to sell something sell shoes.  Don't try to sell a line of bollocks in science.  It degrades the subject and it degrades you.

Pimping my other place

Just to let you know that the more sickness related and personal stuff will be being posted at my other blog.
Please visit and look around the site.  The guys at Chronically Skeptical need some traffic

On pain, brains and drugs. And Vultures

Your standard GP struggles to treat pain.  I think it would be hard to find a GP who did not agree with that statement to some extent.  That's because pain isn't a thing.  It is lots of things.

For a start pain can be chronic or acute.  Or in some cases chronic acute.  The treatments for these are different, for complex reasons.

For another thing, pain is not what people think.  Or rather thinking plays a big part.  Because pain is not nociception.

Nociception is the nerve stimulus, the signal that tells the nervous system that Bad Thing Happen.  This is then processed into pain, which is the feeling.  Feeling is a good word for it because there is a strong emotional component there.  Now you may think that this is the same stuff, because the feeling arises from a signal.

Well no.  the same stimulus will give you different amounts of pain depending on mental state.  How you feel mentally affects how much pain you feel.  Bigtime.

Painkillers work in many different ways but they focus , for the most part, on the nociception end of pain.  Reducing the signal.  This is particularly true of the NSAIDS which don't do very much else.  It is also true of the opiates to a degree.  However some of the opiates have other effects which cross over into emotionsville, particularly Tramadol and Buprenorphine.  Tramadol has a lot of cross activity which makes it act very much like an SNRI antidepressant such as venlafaxine.  Buprenorphine plays with the kappa opioid receptor, which has effects on the emotional processing of pain.

Any drug based therapy for pain will have limitations because it is trying to fix a moving problem.  the same amount of stimulus feels different on different days, so the same amount of drug may not cope.  It may be fair to say that breakthrough pain is emotional in origin. So for long term use its best to have an emotional therapy as well as a pharmaceutical one. However despite limitations drug based therapies are probably the best we have, showing the strongest results.

Drugs do have limitations.  In the context here addiction is not one of them.  Dependence yes, addiction no.  Study after study has shown that when you are using the drugs for actual pain then addictive behaviour is unlikely.  Dependence and habituation are likely, and are difficulties with drug treatment.  Pain management programs can help a lot, but it depends who runs them and how they are run.  The intent should be to give the patient their life back by any means.  Anecdote alert but I have several friends whose experience of these programs is that all they are interested in is getting you off drugs.  never mind if you suffer, never mind if the result of this is that you have to spend all day every day thinking about your pain to manage it, drugs are bad mmkay.  This is what happens when ideology enters medicine.

A well run pain program should focus on reducing drugs where that can be doen without impacting quality of life.  Its main focus should be reduction of pain.

So we have an imperfect world, with no real answer to pain, just some strategies to make it a bit better.  Enter the vultures.

Its hard to talk about pain without someone bringing up some of the tired old bollocks beloved of the worried well.  You know, homeopathy, chiropractic, acupuncture, reiki, having your underpants chanted over, that sort of thing.  The people offering this are, in my honest opinion, either idiots or vultures.  Idiots in that in the face of all reliable evidence they believe this witchcraft works or vultures in that they know it doesn't but still prey on the desperate.  In the case of Ehlers Danlos even the support organisations have this stuff.  The HMSA in the UK has form here  where they say magnet plasters help some people.  Well yes, if your pain is being caused by iron filings, or by having geographically puzzled pigeons migrating into you.  But if its real this is just a distraction.  The Ehlers Danlos National Foundation in the US suggests in this tome that acupuncture or acupressure may help despite increasing evidence that its simply being in the room with someone who appears to care that reduces pain as acupuncture , sham acupuncture and placebo acupuncture ( synonyms) have the same effect.

Essentially selling hope to the hopeless makes you rich.  It also makes you pond slime.

To start with I am rather new to this so the blogging thing may take a while to get going.  Possibly it will fizzle.  But unless you try you never know.

So I am going to imagine I have an audience out there.  Hello *waves*

Why am I blogging?  because I like ranting about things.  And other bloggers don't rant correctly.

So for my first rant...pain.

EDS comes with pain as a standard feature.  EDS-HT has more pain than other types, even though it is generally the least serious variety.  I spend my life in pain, sometimes severe, often just a background ache.  One of the better ways I have heard this described is think of the day you get flu.  You don't have the fever yet or the cough but your joints ache all over and you are so-darned-tired.

That's EDS-HT on a good day.

Now this rant is not a cry for sympathy.  I wouldn't know what to do with that if i got it and it certainly wouldn't change anything.  This rant is about attitudes to pain and pain medication.  There may be a supplemental rant about Pain Vultures.

If you mention to anyone that you are on pain medication the first thing you will be asked is when you are coming off it.  That's my experience anyway.  If you take pain medication in front of people they become uncomfortable.  I have had people change seats on flights to get away from me because I have used my in-flight coke to wash down some tramadol.  Pain medication is seen as a short term thing, and it is also seen as a vice.

When pain medication is mentioned in the media it is frequently in a context such as this call to tackle addiction or this warning about secret addiction in fact addiction is often the stand-out word.  After all who wants an addict as a husband, teacher, lawyer?  But what do we mean by addict?  Most people will develope a physical dependency on opiates and opioids through long term legitimate usage.  Are they addicts?  Well many people would say yes.

Pain medication is only fine if you are dying.  It is almost synonymous with palliative care.  If you are living it is something that should be short term, rationed and shunned.  But what does this mean for people living with chronic pain?  Generally a choice between being shunned and being in pain.

Drugs can change you, and change your behavior.  But nowhere near as much as constant pain does.  Chronic pain is undertreated, ignored and even seen as something that refines ones spirit.  Of course it makes you four times more likely to commit suicide, and that, mark you is amongst the ones who get specialised pain treatment at a dedicated clinic.  Pain clinics in the UK are not widely available, and often have pressures put on them by ideologues so that their goals are redefined toward reduction of drug use rather than control of symptoms.

Pain is something we treat poorly, understand poorly and tolerate poorly.  In this background the pain vultures thrive.  You know who i mean, the osteopaths, acupuncturists, Hopi ear candle merchants etc.  Offering hope to the hopeless.  There is a special circle of hell reserved for these people.

But that's another rant.