Ramblings (and music) of a guitar-playing shrink
I would write something (witty, pithy, and snarky – all at once, even) pointing out the problems with Giles Fraser’s piece of tripe in the Guardian about depression and antidepressants … But I’m not going to bother, for two reasons. First, Glosswitch already did a great job of that in the New Statesman. Second, I’m just feeling too good to be snarky, because I took this picture of the Milky Way this evening.
I was thinking today. Dangerous thing to do, I know, but that’s me: living on the edge.
I was thinking about this article which describes how thoroughly Linus Pauling jumped the shark in his dive into not-medicine. That led me to think about not-medicine and its relationship to medicine, and my relationship to not-medicine, and to my patients who have fallen for the proponents of not-medicine.
To start with, why I am I writing "not-medicine" instead of "alternative medicine" – or more nastily, "woo" (as I always used to)? "Woo", because I have been somewhat swayed by the notion that a derisive approach (embodied by calling it all "woo" or similar) is aggressive and unhelpful. So I’ve (mostly, I think)) stopped that. "Alternative medicine" because that implies it’s a viable alternative, as though it’s simply a choice between two forms of medicine, when most clearly it is not. A number of wags (Dara O’Briain and Tim Minchin come to mind, though other non-comedians have also said similar, and I have no idea who was first) have said things along the lines of (I’ll quote the relevant bit of Tim Minchin’s beat poem "Storm")
By definition, I begin
Alternative Medicine, I continue
Has either not been proved to work,
Or been proved not to work.
You know what they call alternative medicine
That’s been proved to work?…
And that really is true. We (doctors) want it all, in a way. If something really does help, and doesn’t cause unacceptable harm, we want to use it. We want to help our patients get better with it. We – honestly – don’t hold to any ideologically-based notions on what sort of thing it must be.
But… we must be able to be sure that it really does help, and that it doesn’t cause unacceptable harm. We have to be as sure as we can be; not just have a good feeling about something because it seems pretty good. Or even if it seems really good. Example: S-Adenosyl methionine, or SAM-e is a purported treatment for depression, but one I wouldn’t use (currently) even were it available to me. Studies of parenteral SAM-e have shown rapid efficacy against treatment-resistant depression, and if I recall correctly, it appeared to be tolerated relatively well too. So why wouldn’t I use such a thing? Because I don’t have the data; not because I haven’t looked, but because the studies that have been done are of parenteral SAM-e, and the efficacy, safety, and tolerability of oral SAM-e have not been established. I’m not just splitting hairs here: it’s not sensible to simply assume we can extrapolate from one to the other.
Ok, if it were me at the other end, I’d probably be frustrated by my shrink’s reticence in such an instance, but the point is, I have to be that cautious and conservative. I can’t just be swayed by what sounds good. I can’t be swayed by anecdotes, or by a few case reports (which really, are just anecdotes that’ve been scrubbed up enough to be published); I have to be able to be confident that I know roughly that the thing I’m recommending is sufficiently likely to afford benefit, and sufficiently unlikely to cause serious harm, that it is worth my recommendation.
Otherwise people might just as well stop seeing doctors, and order what they want from online pharmacies.
I must admit the flipside: just because I don’t, or won’t recommend or endorse something, doesn’t mean it is ineffective or dangerous; it simply means that I lack, and can’t find, the data to let me be sure of the potential risks and benefits.
I’m rather pleased with myself today, as for the second weekend in a row I’ve done my longest run: 13 km last Sunday, and 15 today. It felt really, really good. I actually didn’t want to turn around, but thought I should probably start to head back. The trip home was slower as well, as it was not just uphill, but into a headwind. Rather a cold one too, so at least that was helpful, but at times I did feel as though I was being blown backwards. xP
I think also, that the distance recorded by my apps (Runmeter, Runner’s Log, and Micoach) must be as the crow flies. Why? Because on the return I came to a couple of downhills up which I had trudged wearily on the outward trip; being too tired, with feet too sore to consider trying to moderate my speed, a became gravity’s bitch, and accelerated mightily. Well, I like to think it was mighty. In any case, it was very definitely at least as fast as I have gone before, and that was about 3:30/km (for far less than a km, I hasten to add; that’s only a short sprint – a sprint for me, anyway). However, Runmeter told me at the end of that km that my fastest pace during that km was something like 4:15 or so. Bollocks to that, I say. So I thought perhaps it is a function of me running the hypotenuse, and Runmeter measuring one of the other sides.
So I ran along doing trigonometry in my head and came out with … I’m sitting here trying to work it out again, and am fascinated by how much more readily I could do it while running. O_õ
Right, laboriously thought it through again: say (for the maths) 100m as the crow flies; slope was 40-45 degrees I reckon, call it 45; square on the hypotenuse (where I ran) equal to sum of squares on other two sides; 10,000 + 10,000 = 20,000; square root of 20,000; square root of two and chop the zeroes; about 140m or so; 4:15 says Runmeter = 25 sec for 100m; about 6 2/3 x 140 for a km (ok I used 150 m to make the maths easier – I had run about 10km by this time, and was still running xP ); 6 2/3 x 25s = 2 min + 30s + 16s = 2:46 or near enough (2/3 x 24 for ease of maths xP ); probably less of a slope than I thought, so the distance wouldn’t be as much, so increase/round up; definitely still not going to be much more than 3 min/km.
So there. xP
Seriously though, I do find it utterly fascinating how much better my brain worked while running. I clearly need to spend more time running.