Welcome to my blog

Hello. I am Sherlock and this is my diary. My job title is "osteopath", and my work is problem-solving. This involves detective work, hence my name. Detective work involves reason and science, but is not limited by them. It also involves the eye of experience, and "hunches". Thus, some would regard my activities as those of a quack, a title I assume here with irony. I am writing this blog because I like writing. I am quite opinionated, and perhaps I suffer from a repressed need for expression. I have no particular prior "agenda"; if I have any bees in my bonnet, no doubt they will make themselves apparent by their buzzing. All names and identifying details of any people featuring in these anecdotes have been changed. Thank you for reading.

Monday, 23 May 2016

The why game

You will have done it as a child, and may have had your own children do it to you. "Why?", they ask and you give them an answer and they say "Why?" again, and so it goes on and you quickly realise you could spend the rest of your life on this. All children become instinctively aware early on of the fallacy of the why-because game. And they are also aware that you cannot work it out. So your only recourse is to say, "Because." Or "Because I say so." To which of course they say, "Why?" The wisest thing to do then is to concede the last word stay silent. The fallacy of the why game is the fallacy of seeing the world in terms of single linear chains of connections between cause and effect. But the world doesn't work like that.

The world works not as simple chains of cause and effect, but as a network of mutually influential phenomena. Let me use an analogy. If you are out walking in unfamiliar terrain and you stray from the track and get lost, back-tracking and doggedly focussing on looking for the path is like asking "Why?" You might find it, but you will always be dependent on the beaten track. What if you can't find it or it peters out? You will have to cast your vision widely about to establish roughly, from a series of widely scattered landmarks, your position and the location of where you want to go. Now you are working with a network, which is more real and ultimately more useful.

The human body does not work in the why-because way, either. This is where conventional medical reasoning often falls down. As an osteopath, if you are my patient and you ask me "Why?" we both quickly find we cannot go very far along the chain. So I say, "There is this, and this, and this, and this...let us look at how they relate to your health."

Thursday, 19 May 2016

A sceptical eye cast on the biasis of "Skeptics"

I suspect I am not the only one to have long lost interest in the antics of the "Skeptics". But this piece is refreshing. Sceptical science journalist John Hogan takes a look at the blatant biasis of the organised "Skeptics", and asks them to examine their own views more sceptically...

http://blogs.scientificamerican.com/cross-check/dear-skeptics-bash-homeopathy-and-bigfoot-less-mammograms-and-war-more/

Monday, 9 May 2016

An interesting sensory experience in a salad bowl

Yesterday over lunch in a small village restaurant I went to sleep in the salad bowl, which seemed to cause some alarm among the people around me. I was heroically helped by well-meaning but misguided diners, and an ambulance was called. Before it arrived I ruined people's lunches by crouching on the floor on all fours retching up mostly spit and colourless mucous. I don't want to tell much about the ultimately banal reason for my falling into my food; I am more interested in my experience of it all.

SCENE 1. I am sitting eating and chatting quite happily with my wife and a friend. I omit to chew properly a bite of tough old lamb shoulder, and it goes down nearly whole. I feel it get stuck at the bottom of my gullet and discomfort builds up there. I take a swill of wine to wash it down. A bad move. The wine can't get past it and adds to the blockage. Discomfort turns into pain and I feel my diaphragm spasm up. I feel the blood draining from my face and I am a little faint. I try to take a deep breath (this has worked before), and... END OF SCENE 1.

SCENE 2. I am a rather pleasant, relaxed dream. I say "I am a dream" because actually there is no sense of a separate, individual me being "in" a dream. There is just the dream. It is the sort of dream where the images, sounds and spoken words which make coherent sense in the dream are incomprehensible nonsense if remembered later. Anyway, it is pleasant and peaceful there. I become dimly aware of voices to my right. They are a mild disturbance. The images in my dream have turned into a kaleidoscopic pattern of many colours rotating round and round in a clockwise direction. I realise some of the voices are saying my name. All the imagery is now in a mad swirl and a commotion is growing on my right. I feel movement and become aware of people asking "Are you all right? Are you all right?" Now I am becoming aware of myself as an individual person, but all is confusion. What is this? This is not normal. Why? What am I? Who am I? What is happening? I realise something is wrong but I don't know what it is. I can't move or speak. I realise something bad has happened to me. I am alarmed. What's happened? Am I dying? Will I be all right? I am being pulled back into the void, but my fright impels me to fight to regain consciousness. Gradually my normal awareness restores itself and I can raise my head. I realise it is my friend who has been shaking me and asking me if I am all right. One of the most prominent swirls of colour in my kaleidoscope has coalesced into his multi-coloured shirt. I sit up and breathe and say, "I'm all right", although I feel far from all right. "What happened?", my friend asks. "I don't know", I reply.

I did not know because of the absolute perceptual discontinuity between my sitting up chatting and the utter disassociation, perceptual distortion and cognitive confusion I experienced in the salad bowl.

The perceptual distortion interests me. It must be the same kind of experience of the world of a new born baby. The cognitive machinery for differentiating and classifying sensory input into preconceived taxonomies of class and meaning is not operating. What is perceived is chaos.

Saturday, 7 May 2016

The large intestine meridian is actually the diaphragm meridian

Traditional Chinese medicine holds that the shoulder, in particular the lateral deltoid and subacromial parts, are physiologically connected to the large intestine by a "meridian" or channel conveying vital energy (qi).

In my opinion this is wrong, or at least a misconception. I am not concerned with qi here, because I am not convinced of its physical existence. I am more concerned with evident relationships.

It is the diaphragm which bears a closer relationship to the shoulder. The sensory innervation of the diaphragm via the phrenic nerve derives from the third to the fifth cervical spinal levels. These are the same levels which supply most of the sensory nerves to the shoulder via the axillary, suprascapular and supraclavicular nerves. Pain deriving from the diaphragm can produce referred pain in the shoulder, particularly the deltoid area. I know this from personal experience as well as theory.

It is common clinical experience that radicular pain affects the upper extremity in a way that is much less well defined by dermatomal or myotomal arrangements than in the lower extremities. That is to say, there is a lot of "tomal" crossover. In the same way, referred pain from the diaphragm (via C3, 4, 5) does not have to stop at the shoulder, but will refer also down the arm through other "tomal" regions, especially on the lateral side, mirroring the supposed large intestine meridian.

The large intestine is in close anatomical relationship to the diaphragm at the flexures between its transverse and vertical parts. In fact it hangs from the diaphragm by fascial structures. Collections of gas in these flexures, or inflammation or swelling affecting them, can irritate the diaphragm. But so can disorders of other anatomically related structures: the liver, the spleen, the stomach. Hence the misconception.

Oh, and the small intestine meridian should be called the oesophagus meridian.

Just remember you read it here first, folks.

Monday, 21 March 2016

How to download any scientific article for free

A major bug for searchers of knowledge is the conflict of interest inherent in the relationship between the world of science and that of publishing: unhindered flow of information vs. the profit motive. I am not alone in thinking the current dynamic is weighed too heavily on the side of profits for large companies.

With the usual fee for journal access at €30 per article and upwards, without institutional access to a wide range of journals, your efforts as a student, independent researcher or author are severely or even terminally hampered.

So I hail researcher Alexandra Elbakyan from Kazakhstan, who has created a website that bypasses journal paywalls, providing immediate and free access to "nearly every scientific paper ever published". You can read more about it here.

I would just like to clarify a couple of points about how to use the site. It can be used in two different ways:

You can go to the site at http://sci-hub.io/ and enter the title of the article you want to see, its URL or its PMID or DOI identifier, then click "Open".

Or you can go to the URL of your article, then in the browser search bar insert ".sci-hub.io" (without quotation marks, and don't forget the initial full stop) in the URL immediately after the ".com", ".org", "net", (etc.) part and before all the rest of the URL. Then click go or press enter.

In both cases you will be taken to a page in Russian. Don't panic: it is a CAPTCHA challenge. Just type in the box the letters shown above it and click on the button below it. In a few seconds your article will be shown on the screen as a downloadable PDF.

Saturday, 19 March 2016

Should I take an anti-inflammatory?

This is a question patients suffering from pain frequently ask me.

First of all let me say here what I first tell everyone who asks this question. Whilst I can tell you what is my general attitude to anti-inflammatory and pain medication, and I can tell you what I would probably do in general terms if I were in your situation, I cannot give you specific advice about medical drugs: this does not form part of my professional competence or my role.

So, what is my general attitude to anti-inflammatory and pain medication? This derives from four simple facts:
  1.     It is a biological fact that the inflammatory response is a necessary healing mechanism for tissue damage.
  2.     However, it is a human fact that it can be very painful.
  3.     Moreover, uncontrolled chronic (long-term) inflammation can do more harm than good.
  4.     On the other hand, taking anti-inflammatory drugs long-term can produce serious side-effects and can also be absurdly counter-productive (some of them actually increase joint damage in the long-term).
Therefore, my general attitude is to avoid this kind of medication unless either the pain is unbearable, or it is affecting the body negatively in the long-term (e.g. mood, walking, sleeping). In these cases, if it were me I'd take the minimum dose necessary to reduce the pain to a tolerable level.*

Otherwise, why would I want to suppress a healing reaction?

This, in my opinion, is a major reason for recurrent ill-health: the masking of symptoms and the suppression of the body's own medicine chest have meant the original complaint did not heal normally or completely.

Far better to attempt to eliminate the underlying reasons for the inflammation and/or pain. That is what osteopathy is all about.


* There is no guarantee of course that anti-inflammatory or pain medication would have any effect. See here.

Friday, 4 March 2016

The power of procedures

Summary in simple language: If when I am treating a patient, I find and work on "abnormalities" that others do not see and no machine can detect, it does not matter. Those abnormalities fit into a personal scheme of things which I have learned about and learned to deal with over many years. In this context, actions have effective power.

When a doctor writes a prescription for a medical drug, the prescription has power - a certain power to heal - quite apart from the physiological changes brought about by the drug. This is usually regarded as a placebo effect, that is, an effect produced by the mind of the patient, triggered by his or her interaction with the doctor.

But could it be that the power of words and actions derives not only from the workings of the patient's mind? Could directed intelligence and concentrated intent be able to change things by actually acting directly on living matter? In the case of a doctor writing a prescription, any such power must be relatively weak, because there is usually not a great deal of concentration of intention in that act. Other modalities, like acupuncture and osteopathy, being procedure-rich, would have greater potency in this regard.

In osteopathy, each procedure requires focused attention and is carried out with intent. Each individual act of intent fits coherently into an encounter where the overarching intent is to heal. This is a context in which acts might acquire power - the power to act upon physiology in ways directed or influenced by the intent itself. Mind over matter, if you like, and if you think that is mumbo-jumbo, fair play to you. But it is a possibility I am advised by my experience to allow.

Much has been written recently of what are seen as weaknesses in the osteopathic model: the lack of statistical association between structural abnormalities and illness or symptoms, the lack of inter-rater reliability of diagnostic palpation, the non-existence in science of some of our constructs, the variability of method and approach used by different osteopaths. But if the ideas in the previous paragraphs were possible, none of this would matter very much.

These things are problems only if I believe that what I feel and what I work on should be taken as objectively verifiable phenomena; and that the plausibility of my working explanation should be supported by established science. They would cease to become problems if I believed the following:
  • Subjective phenomena are equally important as objective ones.
  • Phenomena specific to my interaction with my patient here and now are equally important as context-independent ones.
  • Focussed intent is a powerful therapeutic agent in its own right.
Well, I am at ease with subjectivity; I am at ease with the idea of patient-therapist as a time-limited, context-specific system; and I am happy to allow the possibility that the power of attention can change the attended-to.

In this regard, to the osteopath, intra-rater reliability - that one can reliably tell the difference between normality and abnormality within one's own frame of reference - is more important than inter-rater reliability. The rhetorical question will arise as to what use it is pick out, even with 100% reliability, "abnormalities" that do not exist (that cannot be detected objectively)! But in my mind it is probably an error of thought to equate "reality" (i.e. what "exists" and what does not) with objectivity.

So perhaps it is enough that what I do is coherent within my model and within my own perceptual and conceptual frame of reference. Each of my actions then could become a catalyst and a conduit for my focussed attention and my intention.

By the way, and importantly, I am by no means saying it is all like this. There is plenty that is easily observable by anybody, which we work on day by day.