Tuesday, 27 January 2015

"Because There May Not Be Bugs On You"

This one is tricky.

Magical thinking is the attribution of causal connections to events which rational observation shows to be unconnected.  For instance, suppose someone is gambling in a casino and a passerby pauses to tie her shoelaces just as they get a big win.  That gambler might then want the passerby to stay and tie her shoelaces every time he places a bet.  Similarly, if someone prays and something positive and on-topic later occurs, it would be easy to conclude that prayer is powerful.  This is of course not how prayer works, but that's not what this is about.

We all have our taboos, and there are cultural taboos.  Suzette Haden Elgin, author of Mother Tongue and inventor of the women's language Laadan, once imagined a culture where presenting items in blue containers was so abhorrent that it would be like - sorry about this - us being given birthday presents in parcels smeared in excrement.  She then imagined that same culture retaliating by scuppering negotiations with us by insisting on sending female delegates, which we found unacceptable. The point being, of course, to illustrate that the taboos of the patriarchy are as illogical as not wanting things in blue boxes.  I should point out that the future human culture she imagines is of course highly sexist.

However, I did have to stick a note of apology in there before I even mentioned one of our own taboos, and you can imagine that a language spoken by a culture with that taboo would tend either to avoid using any words for "blue" or perhaps use a euphemism such as "sky-coloured" (this culture is of course not based in Britain or that would be a synonym for grey rather than blue).  This kind of thing has happened in Italic languages.  Latin avoided using the word mensis for Cynthia because of its association with menstruation and instead referred to her as Luna, a contraction of lumina - "the light", and that taboo has led to similar words being used today in, for instance, French.  English has no such history and still has the word "Moon", although of course it does tend to refer to those taboo subjects using Greek or Latin rather than English words, something which incidentally sounds very strange to German ears.  Likewise, Castilian Spanish refuses to use the word *siniestre, the expected word for "left", and instead uses izquierda, from the Basque ezker.

There are reasons for all of these things, and they have various connections to what we tend to agree is realistic.  For instance, it seems to make sense to have a taboo about excrement because of the risk of infection, and in fact this could explain the taboo about the hand used for wiping rather than eating (again, apologies for the association).  The latter taboo is of course historically exaggerated and now anachronistic.  That said, we do seem to have various things going on for us which stop us from risking our health, particularly from infections.  Among other things, aversion from skin lesions springs to mind, as well as the abhorrence we tend to have of unidentified brown matter as opposed to blue.  There is a whole load of stuff in the Bible, for example, about the diagnosis and quarantining of lepers, many of whom probably would have turned out not to have leprosy at all.  As a Christian, I feel obliged to bore you rigid by posting a slab of text from Leviticus:

Leviticus 13 King James Version (KJV)
13 And the Lord spake unto Moses and Aaron, saying,
2 When a man shall have in the skin of his flesh a rising, a scab, or bright spot, and it be in the skin of his flesh like the plague of leprosy; then he shall be brought unto Aaron the priest, or unto one of his sons the priests:
3 And the priest shall look on the plague in the skin of the flesh: and when the hair in the plague is turned white, and the plague in sight be deeper than the skin of his flesh, it is a plague of leprosy: and the priest shall look on him, and pronounce him unclean.
4 If the bright spot be white in the skin of his flesh, and in sight be not deeper than the skin, and the hair thereof be not turned white; then the priest shall shut up him that hath the plague seven days:
5 And the priest shall look on him the seventh day: and, behold, if the plague in his sight be at a stay, and the plague spread not in the skin; then the priest shall shut him up seven days more:
6 And the priest shall look on him again the seventh day: and, behold, if the plague be somewhat dark, and the plague spread not in the skin, the priest shall pronounce him clean: it is but a scab: and he shall wash his clothes, and be clean.
7 But if the scab spread much abroad in the skin, after that he hath been seen of the priest for his cleansing, he shall be seen of the priest again.
8 And if the priest see that, behold, the scab spreadeth in the skin, then the priest shall pronounce him unclean: it is a leprosy.
9 When the plague of leprosy is in a man, then he shall be brought unto the priest;
10 And the priest shall see him: and, behold, if the rising be white in the skin, and it have turned the hair white, and there be quick raw flesh in the rising;
11 It is an old leprosy in the skin of his flesh, and the priest shall pronounce him unclean, and shall not shut him up: for he is unclean.
12 And if a leprosy break out abroad in the skin, and the leprosy cover all the skin of him that hath the plague from his head even to his foot, wheresoever the priest looketh;
13 Then the priest shall consider: and, behold, if the leprosy have covered all his flesh, he shall pronounce him clean that hath the plague: it is all turned white: he is clean.
14 But when raw flesh appeareth in him, he shall be unclean.
15 And the priest shall see the raw flesh, and pronounce him to be unclean: for the raw flesh is unclean: it is a leprosy.
16 Or if the raw flesh turn again, and be changed unto white, he shall come unto the priest;
17 And the priest shall see him: and, behold, if the plague be turned into white; then the priest shall pronounce him clean that hath the plague: he is clean.
18 The flesh also, in which, even in the skin thereof, was a boil, and is healed,
19 And in the place of the boil there be a white rising, or a bright spot, white, and somewhat reddish, and it be shewed to the priest;
20 And if, when the priest seeth it, behold, it be in sight lower than the skin, and the hair thereof be turned white; the priest shall pronounce him unclean: it is a plague of leprosy broken out of the boil.
21 But if the priest look on it, and, behold, there be no white hairs therein, and if it be not lower than the skin, but be somewhat dark; then the priest shall shut him up seven days:
22 And if it spread much abroad in the skin, then the priest shall pronounce him unclean: it is a plague.
23 But if the bright spot stay in his place, and spread not, it is a burning boil; and the priest shall pronounce him clean.
24 Or if there be any flesh, in the skin whereof there is a hot burning, and the quick flesh that burneth have a white bright spot, somewhat reddish, or white;
25 Then the priest shall look upon it: and, behold, if the hair in the bright spot be turned white, and it be in sight deeper than the skin; it is a leprosy broken out of the burning: wherefore the priest shall pronounce him unclean: it is the plague of leprosy.
26 But if the priest look on it, and, behold, there be no white hair in the bright spot, and it be no lower than the other skin, but be somewhat dark; then the priest shall shut him up seven days:
27 And the priest shall look upon him the seventh day: and if it be spread much abroad in the skin, then the priest shall pronounce him unclean: it is the plague of leprosy.
28 And if the bright spot stay in his place, and spread not in the skin, but it be somewhat dark; it is a rising of the burning, and the priest shall pronounce him clean: for it is an inflammation of the burning.
29 If a man or woman have a plague upon the head or the beard;
30 Then the priest shall see the plague: and, behold, if it be in sight deeper than the skin; and there be in it a yellow thin hair; then the priest shall pronounce him unclean: it is a dry scall, even a leprosy upon the head or beard.
31 And if the priest look on the plague of the scall, and, behold, it be not in sight deeper than the skin, and that there is no black hair in it; then the priest shall shut up him that hath the plague of the scall seven days:
32 And in the seventh day the priest shall look on the plague: and, behold, if the scall spread not, and there be in it no yellow hair, and the scall be not in sight deeper than the skin;
33 He shall be shaven, but the scall shall he not shave; and the priest shall shut up him that hath the scall seven days more:
34 And in the seventh day the priest shall look on the scall: and, behold, if the scall be not spread in the skin, nor be in sight deeper than the skin; then the priest shall pronounce him clean: and he shall wash his clothes, and be clean.
35 But if the scall spread much in the skin after his cleansing;
36 Then the priest shall look on him: and, behold, if the scall be spread in the skin, the priest shall not seek for yellow hair; he is unclean.
37 But if the scall be in his sight at a stay, and that there is black hair grown up therein; the scall is healed, he is clean: and the priest shall pronounce him clean.
38 If a man also or a woman have in the skin of their flesh bright spots, even white bright spots;
39 Then the priest shall look: and, behold, if the bright spots in the skin of their flesh be darkish white; it is a freckled spot that groweth in the skin; he is clean.
40 And the man whose hair is fallen off his head, he is bald; yet is he clean.
41 And he that hath his hair fallen off from the part of his head toward his face, he is forehead bald: yet is he clean.
42 And if there be in the bald head, or bald forehead, a white reddish sore; it is a leprosy sprung up in his bald head, or his bald forehead.
43 Then the priest shall look upon it: and, behold, if the rising of the sore be white reddish in his bald head, or in his bald forehead, as the leprosy appeareth in the skin of the flesh;
44 He is a leprous man, he is unclean: the priest shall pronounce him utterly unclean; his plague is in his head.
45 And the leper in whom the plague is, his clothes shall be rent, and his head bare, and he shall put a covering upon his upper lip, and shall cry, Unclean, unclean.
46 All the days wherein the plague shall be in him he shall be defiled; he is unclean: he shall dwell alone; without the camp shall his habitation be.
47 The garment also that the plague of leprosy is in, whether it be a woollen garment, or a linen garment;
48 Whether it be in the warp, or woof; of linen, or of woollen; whether in a skin, or in any thing made of skin;
49 And if the plague be greenish or reddish in the garment, or in the skin, either in the warp, or in the woof, or in any thing of skin; it is a plague of leprosy, and shall be shewed unto the priest:
50 And the priest shall look upon the plague, and shut up it that hath the plague seven days:
51 And he shall look on the plague on the seventh day: if the plague be spread in the garment, either in the warp, or in the woof, or in a skin, or in any work that is made of skin; the plague is a fretting leprosy; it is unclean.
52 He shall therefore burn that garment, whether warp or woof, in woollen or in linen, or any thing of skin, wherein the plague is: for it is a fretting leprosy; it shall be burnt in the fire.
53 And if the priest shall look, and, behold, the plague be not spread in the garment, either in the warp, or in the woof, or in any thing of skin;
54 Then the priest shall command that they wash the thing wherein the plague is, and he shall shut it up seven days more:
55 And the priest shall look on the plague, after that it is washed: and, behold, if the plague have not changed his colour, and the plague be not spread; it is unclean; thou shalt burn it in the fire; it is fret inward, whether it be bare within or without.
56 And if the priest look, and, behold, the plague be somewhat dark after the washing of it; then he shall rend it out of the garment, or out of the skin, or out of the warp, or out of the woof:
57 And if it appear still in the garment, either in the warp, or in the woof, or in any thing of skin; it is a spreading plague: thou shalt burn that wherein the plague is with fire.
58 And the garment, either warp, or woof, or whatsoever thing of skin it be, which thou shalt wash, if the plague be departed from them, then it shall be washed the second time, and shall be clean.
59 This is the law of the plague of leprosy in a garment of woollen or linen, either in the warp, or woof, or any thing of skins, to pronounce it clean, or to pronounce it unclean.
 Lots of instructions, and clearly they have come from somewhere and my first impression is that they'd work quite well.  I imagine they ended up in the oral tradition preceding the Bible because the groups of people who didn't have them tended to come down with leprosy and were therefore more likely to be slaughtered by their enemies or not have so many offspring which survived childhood, so we get this handed down to us.  Nonetheless, I imagine a lot of people with psoriasis, impetigo or eczema ended up in leper colonies as a result and perhaps after a while they really did end up with leprosy, although apparently it's not very infectious.

Sometimes these taboos turn up in a medical context.  For instance, some people have germ phobias which are very disabling.  There is also the "matchbox sign" - patients turning up with matchboxes full of significant "parasites" which they believe are infesting their skin but which look to the practitioner to be mere flakes of skin or bits of lint.  This phenomenon was immortalised by Fox and Matt Groening thus:

(Copyright Fox, will be removed on request)

Unfortunately, whereas it may be amusing to some to point the finger and laugh in this way, there are two words in that sign which I want to emphasise:

Because there may, and particularly in days of yore there may have been.

Now the problem emerges of what a practitioner is supposed to do here, because clearly there are such things as parasites and pathogens, but it's very easy to slip into either seeing them everywhere or seeing them nowhere.   There are some CAM people who attribute problems to parasites and infestations very often, and there are others who do so very seldom.  I am in the camp that does so very seldom, not because I believe they're never there but because I believe the problem often precedes the infection or infestation.  Infections and infestations often result from problems like stagnation of fluid or weak barriers.  For instance, this is the position of the ethmoid bone:

...and this is the ethmoid bone itself:

(Sorry about the blur).  The ethmoid bone has to be riddled with holes because the olfactory nerves responsible for smell pass through it into the nasal cavity.  No holes, no sense of smell, bed catches on fire, you don't notice, you die.  So it's quite important.  However, that makes it quite fragile.  If it breaks, meningitis is more or less inevitable because it forms a barrier between the otherwise relatively harmless bacteria living in the nose and the linings of the brain.

This kind of thing happens to a less dramatic degree all the time in various ways.  Someone might eat a packet of crisps and damage the mucus membrane enough in their mouth to get an infection that way - probably quite a minor one of course.  However, if the person is healthy, which includes behaving healthily, they will be more protected against these problems.

So these things:

 "Ixodus ricinus 5x" by Richard Bartz - Own work. Licensed under CC BY-SA 2.5 via Wikimedia Commons - http://commons.wikimedia.org/wiki/File:Ixodus_ricinus_5x.jpg#mediaviewer/File:Ixodus_ricinus_5x.jpg

...of which we are so enamoured, we have to be wary about in two opposite ways.  On the one hand, we have to do sensible things like washing our hands after going to the toilet so we don't get the bottom ones, or avoiding walking through long grass so we don't get the top ones or, more importantly, their associated spirochaetes:

However, on the other hand we also have to be very careful not to see them everywhere.  We need balance, and we need strong barriers and flow.  Some of these barriers and flow are in or on our bodies, and some of them are in our minds.

We have magical thinking and taboos so we can protect ourselves, of course, and we also have rational thinking.  We can err on either side with both, but magical thinking exists for a reason and has brought us through the stone age and bronze age over many millenia to the start of the period during which rational thinking has become dominant.  Also, we may not always realise the reason for a taboo or particular way of thinking, and it's difficult to know when we're tinkering with something which should be left alone, and when we need to change something.

Monday, 26 January 2015

Suspecting And Suspected

A couple of days ago there were a couple of incidents which saddened and annoyed me. They happen to have been on Facebook and that does influence them of course, but they're more reflective of a sign of the times than the mere influence of social media. 

The first was that a friends' account was hacked. Before I go any further, I want to say that I don't approve of that usage of the word "hacked" and prefer "cracked", but I realise I'm fighting a losing battle there so for now I'll concede for the sake of clarity and use the hated H-word.  The hacker proceeded to do two things. One was to post porn videos to various people's walls.  This was probably just immature. More seriously, they also attempted to join various parenting groups, presumably to get access to pictures of small children. Now, it is of course possible that it was innocent but given the juxtaposition with pornography that seems quite unlikely.

The second incident was on a group devoted to other purposes where a sixteen year old girl posted a link to her YouTube channel, assuming that was up front. I proceeded to tell her that many people didn't like that being done as they saw it as tantamount to spam. She then asked me about my channel and I told her she'd probably find it boring but if she wanted homework help she'd find it there.  Someone else then intervened, saying I was behaving suspiciously, so I messaged her offering to send her my full contact details and explaining that part of the " day job" was doing science workshops with children. She was of course dubious because of my transness.

What links these two incidents is that I am suspecting in one case and suspected in the other. However, it's also linked by the impression of inappropriate contact between adults and children. Confusingly I am on opposite sides here, so either I'm being inconsistent or there's a bigger picture I have yet to see.

First of all, the earlier incident concerned someone who unexpectedly requested membership of a home ed group.  The person in question is single and in his forties, and male.  I immediately became suspicious and took a look at his wall to find it was covered in posts in Thai.  Links to porn videos were then posted to his friends' walls.  I came to the conclusion that it wasn't him doing this but that he had probably not taken care to keep his account from being hacked. so I unfriended and blocked him.  A couple of days later, I received a friendship request from a new account which I assumed was his, him having sorted his problem out.  I accepted the request and immediately a porn video was posted to my wall from the account in question, so I also unfriended and blocked that.

I want to analyse this process.  First of all, I have reason to be suspicious of this person.  However, the mere fact that he is close to my age, male, single and childless is not sufficient reason to be suspicious.  Although I might imagine that a male in his forties who has never parented children biologically and is single would be more likely to be an active paedophile, or at least a paedophile, it doesn't follow.  He may simply be asexual or gay, or even hetero and unlucky.  However, if he then attempts to join a group consisting only of parents and home educated children it does raise my suspicion.  Hence the booting, and I have to say that seems entirely fair and rational to me.

Second of all though, there was another incident where I fell under suspicion.  An adolescent posted a link to her YouTube channel on a Facebook group which had nothing to do with YouTube.  I responded by saying that it wasn't really the done thing but then we got talking and I reluctantly posted a link to my own channel because it contains homework help-type videos on it.  Another user then said she was suspicious of what I was doing, in particular because of my name, and this is where it gets complicated.

I'm involved with home ed children because I used to home educate myself.  As mentioned before, I deal with the problem of child safety by encouraging parents to stay with their children during sessions.  Clearly this wouldn't work if we were, as certain public authorities seem to suspect, all part of a conspiracy to abuse the children.  However, there comes a point where suspicion becomes pathological, assuming a medical model.  Without that idea, I suppose the most I can say is that the conclusion is far from warranted on rational grounds.
My intention was to help the child with her homework, which I have regularly done in the past with other children of my acquaintance. The suspicion this aroused, I think, illustrates two things about life today, and to be honest I don't know what to do about them.  There is the angle of transphobia, which may or may not be valid.  Someone on the internet sees what she perceives to be a man masquerading as a woman, and becomes suspicious because it seems deceptive.  It's also unfamiliar and may be associated with sexual deviation in her mind.  It then gets coupled with the concept of an unstoppable male sex drive and with possible paedophilia.  In fact, none of that is really there, and I can only speak for myself here but I doubt it exists in other transwomen's minds either.  So I get misgendered as a man and also associated with a misandric stereotype.  However, I may be wrong.  It could be that a 47-year old ciswoman posting a link to her homework help channel on YouTube to a sixteen year old girl would be treated with equal suspicion, but I suspect she wouldn't have been.  Mind you, that isn't to say that suspicion wouldn't be warranted, but I suspect that generally it isn't.  One of the most hateful things about being perceived as being male is that you are a constant object of fear and suspicion to strangers.  This is a major plus about transition for me - I want rid of that.  I want to be recognised as someone with nurturing and mentoring skills and decades of parenting experience.  Hence that incident is particularly galling to me.

The trans condition is of course quite rare and possibly not particularly good as a source of universals.  However, there is a second point which is important here.  Are children and adults nowadays to be expected not to interact at all unless they are in the same family or have a professional involvement with them?  If that's the case, what kind of a world are we making?  Even if it's one where there is less child abuse, the price paid is extremely high.  A generation of children is now reaching maturity which has been trained to suspect people's motives and in an environment where probably the majority of adults are afraid to interact with children at all.  There are many fantastic things about the younger generation of course, but they are also under a lot of pressure, probably more than my generation at the same age, and the last thing they need is an environment where adults are automatically regarded with suspicion and censor themselves constantly so that they get no tactile contact, very little informal conversation and don't even interact online.  Granted, there is a risk of grooming and child sexual abuse and that is a serious risk, but what other problems have we created by behaving in this way?  What kind of a world have we made?  Possibly one in which there is an epidemic of self-harm and suicide attempts, way bigger than the scale of stranger danger about which we were encouraged to be wary.


On the other hand, I cannot and even feel I should not remove my own distrust of the FB user I've just blocked.  His behaviour really is inappropriate.

So how am I supposed to resolve this problem?

Sunday, 25 January 2015

Cardboard Planets

I have to be a little careful here so I don't start trying to work out what a planet-sized piece of cardboard would be like.  On reflection I think it would contain a lot of diamonds, but now I must stop.

Feel free to peruse the following model:

This is a rather poorly constructed icosahedral "globe" of this planet.  It was made from this:

Now, I'd be the first to say that I'm not exactly the most dextrous trup on Yom, but at that point people would probably get annoyed and so instead I'll just say I'm not exactly the most practical person in the world, and consequently the icosahedral globe in the top picture is a bit of a mess.  However, there are other reasons for this.  One of them is that it's rather small and therefore fiddly.  Another is that if you look at the lower picture, it turns out that three of the faces are in bits, so they have to be stuck together and should lie flat but obviously won't. Also, the sea is exactly the wrong shade of pink, but this is because I've run out of printer ink (that almost rhymes!) and couldn't risk doing it in blue.

So, you may well ask why I'm making icosahedral globes of the planet.  If you are, I can only assume you haven't been involved in many role-playing games.  If you have, you're probably aware that an icosahedron  is a fairly good approximation to a sphere.  Mands will 'splain (hopefully not mansplain):

A map is an attempt to represent a curved surface on a flat one.  This is impossible to do perfectly because things will always be squashed or stretched out of shape or the directions between them will change.  In a small area this is less important, but at planetary level it becomes a major problem.  Therefore, the closer your shape is to a sphere the better as far as your map is concerned.

The map above is problematic because it's small and has broken faces.  It would be better if it consisted of ten pairs of triangles, each on an A4 sheet of card, which could be cut out and turned into a globe of sorts, which, being bigger, is less fiddly to put together.

I initially thought of doing this with dodecahedra as it would be slightly more accurate but have now decided that they're too fiddly.

I would call ten sheets of card each with two equilateral triangles on it a booklet.  I also now have the scale for the largest planet in the solar system with an easily accessible solid surface, or at least partly solid.  Another ten sheets would represent Venus to the same scale, another five Mars and another five Mercury.  Cynthia would probably only need three.  Then there are the largest asteroids, the four giant moons of Jupiter and ... well, you get the picture.

The smallest roughly spherical celestial body in the Solar System is Mimas, which has a diameter of I think 410 km.  A bit less.

So this is my plan:  make icosahedral flat scale models of every round celestial body in the Solar System, possibly some others in other shapes, print them on cards, one sided, A4, and make it into a book and sell it.  And then everyone will say it's marvellous and not bother to buy it, because that's how my life works.

Saturday, 24 January 2015

Liquid Joy

This post was originally going to be about giving up things you're addicted to by tapering doses.  Say you drink four cups of coffee a day and you aim to reduce that to one.  You start by drinking three instead of four a day, which is a 25% reduction, but if you then cut it by one again, that's a reduction of 33 1/3%, so it gets more and more severe, and whereas that may be fine with coffee, with other drugs it could be dangerous, so instead of that you do something like have three cups over a thirty hour period.

Then I realised that the example was silly because this:

is a liquid.  It's not like you're taking Pro Plus tablets and are going to end up shaving bits off them so you can carry on going down by a quarter, because fluids are practically speaking infinitely divisible in quantities of that size.  That's about three hundred millilitres of coffee in that picture.  If you want to reduce that by a quarter, you just drink 225 ml instead, assuming the strength is the same.

This illustrates one of the many advantages liquid medicines have over solid preparations, and to this extent this post isn't really about herbs at all so much as how drugs are delivered.  In a sense, they aren't drugs at all because the word "drug" means "dry", which is what liquids aren't.

Peruse the following pic if you will:

All of these are herbal preparations.  Many people, such as me once before I started training, imagined herbal remedies were normally in the form in the mortar at top left.  These are dried stinging nettle leaves. I always used to imagine that herbal remedies were usually in the form of teas, the herbs being dried and steeped in hot water for twenty minutes or so, strained and drunk.  Sometimes they are, of course.  Chamomile is probably best delivered this way and diuretics such as nettle leaves are also appropriately taken with water, so that makes sense.  Back in the day, a ridiculously large number of herbs were considered to be diuretics due to the simple fact that they were drunk as teas, in water, so technically they almost all were, but because of the water rather than the plants.  Water is of course a liquid, so it does mean that the dose can be adjusted very precisely.  Three hundred millilitres of nettle tea can be adjusted easily to well under 0.1% of the dose, which is so precise as to be completely unnecessary.

It does sometimes make sense to take simples - single herbs - in this way.  However, herbal prescriptions usually involve several remedies together, and if fairly large plant organs are involved, problems can emerge.  Chamomile flower heads, cinnamon cambium and ginger rhizomes, to give three examples, might need to be mixed together.  The chamomile is springy and light, so it will tend to rise to the top.  Ginger rhizomes are lumpier and denser, so they will sink.  Cinnamon cambium (the layer under the bark) will also tend to float but will also be in long quills.  This means that in that form, a bag of the three herbs given for whatever reason will tend to be uneven.  The patient is likely to get wildly different doses at different times.  Not is pulverisation the answer because this exposes the herbs to oxidation, light and fungal spores.

Therefore, for a Western herbalist the usual preference for most herbs is in the form at bottom left - tincture, in this case of Trifolium pratense.  This is the herbal remedy infused in a solvent of some kind, such as ethyl alcohol and water, polyethylene glycol, glycerol, diethyl ether or vinegar, for about a month, pressed and often mixed with other herbs, then taken in recently boiled water to drive off the solvent.  These can sometimes be incompatible or render each other ineffective, and so forth. I could go on and on at this point because there's a lot to this, but I won't.  Nevertheless they have a number of advantages over capsules and tablets, two of which currently spring to mind.  The first is that because they can be mixed, the patient can take a dose of every drug prescribed at once, meaning that concordance is greater.  Concordance is the degree to which a patient follows the advice given, also known as compliance and adherence, and is a hugely important factor in medicine which is frustratingly often ignored.  The other is that as mentioned above, the dose can be very precisely adjusted - dare I say "titrated"? - to an extent way beyond the degree to which tablets can be.  In fact this needn't even apply to herbs.  The same would apply to any medicine which can be taken in liquid form.  It's also easier to reduce the dose of a liquid gradually.  Actual tinctures themselves bring problems of their own, but titration and to a lesser extent concordance ain't two.  For some reason, liquid remedies in the dominant form of Western medicine are in the minority, usually given to particular sections of the population such as children, and, probably due to economies of scale, many times more expensive per dose than pills.  This is a great pity.

Wonderful though liquid solutions are, they're not always ideal.  This is illustrated in this picture by the jar of cream.  You don't usually expect to paint a tincture onto the skin and if you did that on its own, it wouldn't be very effective.  Instead, you may put it in a cream.  Creams are emulsions, that is, suspensions of oil in water or water in oil maintained by an emulsifier, which could in fact be a herb such as licorice or marigold if that's needed.  They are also intimidatingly hard to make, but a tiny ray of hope is offered by the phrase in the British Pharmacopoeia, "some creams have only a creamy appearance".  They block the evaporation of water from the skin, hydrating it and making it easier for the drugs in them to get into the body by enabling them to dissolve into and pass into the body fluids.

There are two other definite liquids in that picture.  Tea tree oil is at the top right.  Essential oils are usually liquids, with the exception of menthol and another one I've forgotten which is also, I seem to remember, explosive.  Essential oils are a whole subject in themselves so I don't want to go into them here except to say that the way I use them is rather unlike the way an aromatherapist would.

Finally, there are certain herbs which can't or shouldn't be made into tinctures because their physical properties either prevent that or are useful in themeselves.  That mug contains the legendary "gloop" which annoys Sarada so much.  It's fenugreek in infusion form and it's slimy and nasty because it's high in mucilage.  Mucilaginous herbs often have uses in addition to their gloopiness, but the gloopiness often provides a protective layer or soothes the surface it's applied to.  I of course am taking fenugreek because it's phytoestrogenic.

I've skimmed over the non-tincture elements of that picture on the whole, but you can probably see from this that when the option exists, drugs of any kind are probably best given in liquid form, and that was basically what I wanted to say today.  Bye for now!

Friday, 23 January 2015

Herbs And Mental Health

This title is a bit broad and clearly I won't be covering the entire topic of mental health and herbs in one fell swoop.  Nonetheless this was an issue which sometimes arises regarding clients.  Some quasi-sceptical people might in fact argue that a mental health problem is a sine qua non of going to see a herbalist as it would betray a flawed understanding of reality and a delusional perception of the efficacy of herbal remedies.  Cognitive dissonance of course assures that I do not share this opinion.

Even so, it is the case that a lot of my patients present having been diagnosed (see why this blog would be better in Latin?  Diagnosatae  says "having been diagnosed" in one word and indicates that they are plural and all female - obviously not all subsets of my patients are exclusively female) with mental health conditions and like many other patients are also taking medication prescribed by their GPs with which I don't interfere.  Sometimes they may be diagnosed during the time they're seeing me, obviously not by me but by someone else, and start taking, for example, anti-psychotics or anti-depressants.

For now I want to leave aside the thorny question of the nature of mental illness and just temporarily settle with the idea that there are people who are on medication which will change their behaviour, for instance make it less likely that they will kill themselves while not sedating them out of waking consciousness.  In particular with monoamine oxidase inhibitors (MAOIs), a class of antidepressant, there has been an issue that if someone takes something else at the same time, such as St John's Wort, there is a widely-perceived risk of danger to life from physically-based pathological processes.  This could also be turned round of course, and the insistence could be made that the risk is from the MAOIs rather than the Hypericum perforatum,

 so there is a bit of an issue there about what counts as the default, unmarked state and what counts as outside the norm, so to speak.  Another issue is like the one you find with this stuff:

Grapefruit juice of whatever colour, along with some other Citrus fruits and pomegranates, inhibits the activity of a liver enzyme called CYP3A4, which is part of what's known as the cytochrome P450 system, responsible for oxidising substances so that their properties change and they can be excreted more easily and safely.  The liver does a lot of this, and CYP3A4 is just one example.

"Trifolium pratense 0522" by 池田正樹 (talk)masaki ikeda - Own work. Licensed under CC BY-SA 3.0 via Wikimedia Commons - http://commons.wikimedia.org/wiki/File:Trifolium_pratense_0522.jpg#mediaviewer/File:Trifolium_pratense_0522.jpg

Trifolium pratense is substantially broken down by it, although since it's a herb rather than a purified drug that probably wouldn't apply to everything in it.  I am currently using this very fact to reduce the breakdown of trifoliol, an oestrogen from that plant, in my own body. It does have a lot of drug interactions, including some used for psychiatric conditions.  It will generally lead to an increase in the plasma levels of the compound concerned, so it is potentially risky, and this is the kind of possible interaction we should all be wary of, so it is sensible to take care.

A dead white male - Hippocrates in this instance

It is indeed.  It now gets rather complicated because of the following quote attributed to the Father of Medicine, Hippocrates:  "Let food be your medicine and medicine your food".  Food is also medicine.  It gets absorbed and processed, and its constituent parts broken down by the liver and eliminated just like medicine does, and so there can, as grapefruit indicates, be drug interactions just as much with food as there can between herbal remedies and purified drugs.  Two examples are the anticoagulant drug warfarin, which works because it looks to the body a bit like vitamin K but doesn't work like it, and antifolates, which are drugs used against cancer, malaria and some other conditions which again work by being mistaken for a vitamin but not being able to perform the same function in the body, this time folic acid.  Incidentally, it's not hugely surprising that the same drug can be used against cancer cells and malaria since malaria is an animal-like single-celled organism, so these are "cytotoxic" drugs.  If you have to attack cells, which with malaria you do because that's all it is, you can sometimes target part of the cell which doesn't exist in human cells but if it's more general, that attack might well also kill cancer cells.  That's a digression though.

Suppose a patient has been sectioned and is now in a mental health ward.  Certain aspects of their life and environment will of course be fairly tightly controlled.  For example, they probably won't be drinking alcoholic beverages.  That particular drug is out of the picture for them.  However, some of them will undoubtedly be consuming, for example, caffeine, a drug which has obvious effects on mental health, for instance generalised anxiety disorder and panic attacks, among other things.  Nicotine is another one.  Tobacco use has been seen as a form of self-medication.  It's no longer clear to me whether psychiatric in-patients are permitted to smoke, but as a former cleaner of mental hospital ceilings it's entirely clear to me that they used to do it in droves, and a common request of patients at that time (the mid-'80s) was for a cigarette.  Tobacco smoke contains MAOIs, so that raises some interest for a start.

Suppose, further, that this patient has a cough, possibly linked with their self-medication from tobacco.  I might offer them Glycyrrhiza glabra and Althaea officinalis, which are licorice and marsh mallow, both soothing expectorants, both used as sweets.  A member of staff might object to the use of these herbs because they perceive there to have been insufficient research on them, although that is not in fact so - I don't want to go into that here.  Having said that, I would be prepared to bet that at some point a patient on antidepressants, anxiolytics or antipsychotics has eaten copious quantities of licorice and marsh mallow without ill-effects.  Marsh mallow is less likely because of the perverse tendency of confectioners to use gelatin instead of marsh mallow itself to make it nowadays, but it has very probably taken place at some point.

(Thanks for the mug Emma).

There will also be psychoactive components in patients' diets, often in very large amounts, such as gluten.  This like other compounds will vary in psychoactivity according to the patient, often unpredictably.  It's inconsistent not to allow the use of prescribed herbal remedies of particular species - not all of course - and yet to allow the use of coffee, tea, tobacco, garlic, licorice and ginger, which I strongly suspect does take place.

The question also arises of how well the categories of psychoactive and physical even work for herbs.  Some herbs clearly do have a direct and very clear effect on the mind, such as Nicotiana (tobacco), Coffea (coffee) and Cannabis.  However, consider some other herbs.  Suppose you have an emotional element premenstrually and you use an oestrogenic herb such as Trifolium pratense (again!) to address that.  That will change your mood.  Suppose there is an element of iron-deficiency anaemia contributing to your depression.  In that case, herbs rich in iron such as Urtica (nettle) or Petroselinum (parsley) would be psychoactive because they will provide iron and might address anaemia and therefore depression.  Suppose I then bung a bitter in like Erythraea  and more of the iron is absorbed.  That would possibly address the depression more effectively.  Or, someone with an underactive thyroid due to iodine deficiency might also be depressed and Fucus, being high in iodine, could address that too. On the other hand, a particular herb might not suit someone or there might be no thyroid or iron-deficiency connection to the patient's depression.  More abstractly, someone who once took LSD once took Xanthoxylum from me, and the oddness of the experience of tasting it (it makes the tongue tingle) triggered an acid flashback.  Similar associations might exist between the taste of culinary herbs and spices and past experience - they could for instance induce a sense of well-being due to nostalgia about the time you had that curry your dad always used to make you when you were a child, or it might bring less happy memories.  In certain circumstances, almost any herbal remedy could be psychoactive.

The remedies I mentioned above for a sectioned patient with a cough are expectorants although licorice in particular has other marked actions.  They may or may not have interacted with the patient's medication, but that interaction is not confined to something which happens to be deliberately prescribed by a herbalist as a herbal remedy.  It also applies to other substances which even a sectioned patient will be exposed to.  Scores of such substances are ingested every day in such circumstances.  Moreover, everyone is an individual and has her own personal history.  Maybe she would remember that curry with fondness and that would improve her mood.  Given that, asking for remedies to be controlled in this way makes little sense.  It is of course sensible to be cautious about what something does to the liver.  Karela, also a popular South Asian vegetable, is bound to have a major effect there and will be found in some curries because of its bitterness, for example.  I am finding my own body exhibiting the bitter reaction while I am typing this, which is another factor as it means the trifoliol will now be declining more rapidly than previously.  Sectioned patients are at least as subject to this kind of process as I am and often probably more so.  Therefore it makes no sense to restrict the intake of certain herbal remedies in those circumstances unless there is a similar restriction of food and other ingredients, and that doesn't, on the whole, seem to happen.

Thursday, 22 January 2015

Southernwood And Yarrow

 "Artemisia abrotanum0" by Kurt Stüber [1] - caliban.mpiz-koeln.mpg.de/mavica/index.html part of www.biolib.de. Licensed under CC BY-SA 3.0 via Wikimedia Commons - http://commons.wikimedia.org/wiki/File:Artemisia_abrotanum0.jpg#mediaviewer/File:Artemisia_abrotanum0.jpg

Two stories that come to mind about herbalism are the "southernwood" story and the "yarrow" story.  I expect there to be other similar ones.

Southernwood is a kind of wormwood found in the Med and like wormwood it kills worms and "brings on periods" (that's a euphemism). I have used it but it's nothing special. It has a couple of uses and is an entirely prosaic, lacklustre remedy which in no way stands out from the crowd.

However, there is a story about southernwood and a particular herbalist. A certain practitioner used to do the usual kind of consultation, taking a full medical history, listening to the patient, performing the necessary physical exams and so on. Then he would give the patient southernwood and they would get better.  It didn't matter what the health problem was. It would happen anyway. Presumably he even gave the herb when he wasn't supposed to.

"Achillea millefolium vallee-de-grace-amiens 80 22062007 1" by O. Pichard - Own work. Licensed under CC BY-SA 3.0 via Wikimedia Commons - http://commons.wikimedia.org/wiki/File:Achillea_millefolium_vallee-de-grace-amiens_80_22062007_1.jpg#mediaviewer/File:Achillea_millefolium_vallee-de-grace-amiens_80_22062007_1.jpg

Then there's the yarrow story, which is easier to pin down. When Coffin brought western herbalism back to Britain in Victorian times (an interesting story in itself which I will get round to one day), he encountered an old herbalist who, whatever the patient had, would recommend giving her yarrow, soaking a hot brick in a yarrow tea and sending them to bed, and hey presto, the patient would get better. Now, yarrow is not like wormwood because it seems to have more actions than any other herb. It's antiinflammatory, astringent, promotes sweating, and allegedly has a great long list of things it can do, although that list seems to me to be a lot shorter than the ones I attach to chamomile and marigold, both of which are incidentally in the daisy family like yarrow.  Therefore this story is slightly different to the other one because it involves the use of a herb which is a lot more versatile.

The first story is more about the herbalist and the second more about the herb, although also about the herbalist. The idea is that someone's health is likely to improve when they see a herbalist and that it isn't really about the herbs. Of course, I do think it's substantially about the herbs but also the lifestyle changes are as important, and I am not a particularly charismatic individual so I'm not sure if I could pull something like that off.  My self-doubt in that area might of course make that self-fulfilling.  What it's saying is that the ritual of seeing a healthcare practitioner and getting the attention and care, perhaps the respect, is a huge part of the process of healing.

Now consider research into herbal remedies.  There are various problems with the ecological validity of these studies which are too involved to go into here although they include things like the solvents used, the use of standardised extracts rather than whole plant extracts and various questions of quality control.  One thing they almost always exclude is the herbalist herself.  A double-blind study on herbal remedies published in a major medical journal does not generally involve the use of remedies by a professional herbalist with the use of a placebo by a control group, but the action of a possibly very low quality "active ingredient" set at a particular level, extracted by methods not used by the herbal industry and not given in the context of a consultation.  This considerably reduces the value of such studies.

When I read such studies, I usually see something like the results being quoted as ineffective or barely noticeable.  This contradicts my clinical experience.  I am aware that when I give a consultation and measure something like peak expiratory flow, blood pressure or peristalsis, something which is easily quantifiable, and then prescribe and dispense herbal remedies, the quantity measured will almost always change in a positive direction.  I'm not able to reconcile these observable objective facts with the claims of research papers which reach negative conclusions about the efficacy of the same remedies, except to note that they are not being given in the same context as I give them.

Therefore, the question I pose myself is this:  is there something about the consultation itself which has a therapeutic effect?  I don't see myself as a magician or anything special, so it may just be that being simply listened to by almost anyone is therapeutic.  

This is also the effect which people miss out on when they buy herbal remedies without a consultation.  It's also considered unethical for a herbalist to do this.  However, it's also not clear what I should do when a patient is clearly confident about her assessment of her own health, and I don't feel I am in a position to judge that she isn't competent, so I don't.

Hence herbalism, and I think other kinds of therapy, seem to be about more than they seem to be on the surface.  Clearly you have to be doing something when you practice a therapy, or the session wouldn't exist, but what you're actually doing appears to be about something other than it does superficially.  I don't know why that is.

Wednesday, 21 January 2015

Sarada's Troll

"Do not feed the troll" is a common exhortation with a lot of sense in it.  Clearly to give much attention at all to someone who is behaving badly in order to get attention is a bad thing as it rewards that bad behaviour.  I have in fact been a little concerned that Sarada has been giving her troll as much attention as she has. Having said that, there are times when instead of you feeding the troll, the troll feeds you, and this is one of those.

I've started in the middle again, haven't I? OK.

There has been a persistent troll over on Sarada's main blog.  Judging by some of the things he has said, I'm pretty sure I know who he is, but we keep him around for amusement. I never get trolled here of course due to the very small readership, but over on YouTube I get plenty of that.  When I get trolled there, the first thing I do is to look at the troll's channel. I almost invariably find that they have no uploaded videos.  How to explain this?

Well, it could be that they maintain a channel just for trolling, or at least for making comments on videos, and in fact there's no obligation to upload videos just because you happen to be on YT.  If you don't though, it means the conversation is rather one-sided and misses the whole point of the site.  It becomes rather like watching the telly rather than having a proper nuanced conversation.  In any case, I very much doubt that's the real explanation for the absence of videos.

I think the  viddearth results from excessive self-criticism and low self-esteem.  If you don't make any videos yourself while freely criticising others, it may just be that your standards for what counts as good are so high that they stop you from even trying to make a contribution while encouraging you to pick holes in others' because like your own potential work they fail to meet your ionospherically high standards. Therefore contributors get to see your carping and nothing else.

I'm not sure it's fair to level such an accusation at Sarada's troll although I do also think this kind of mindset can contribute to a typically right wing approach to life and the world.  If you are blaming yourself for failure or thinking that "even little you" can achieve X in life, you might go on to judge others equally harshly, and that can add up to a rather conservative world view in the end which attributes responsibility very much to individuals and sees the power and therefore blame to be in their hands for removing themselves from, for example, a poverty trap.

This is where Sarada's troll comes in, because his welcome contributions to Sarada's blog then begin to make more sense.  His offensiveness to Sarada and myself is rather limited for the simple reason that his world view differs so much from ours that it can have little impact on us.  To draw a real-world analogy, the most hurtful forms of transphobia are passive and unintended, or come from the people closest to me.  Indifference is of course often worse than hatred, but at least he doesn't fall into that category.  However, one of the most hurtful things that can happen to me is to be called "sir" by a stranger aiming to show me respect.  What really doesn't have any, or at least the same kind of, impact on me is, for instance, an alcoholic in a park haranguing me about my gonads or a gang of transphobic young men blocking my path in the city centre and threatening me, because at that point I don't so much see them as people as mere physical hazards to my well-being such as freezing cold weather or a sudden gust of wind near a cliff.  They have failed to achieve the status of perceived sentience, although that's not to say that I wouldn't help one if he was to suffer a medical emergency or give him food if he was starving.  Sarada's troll's world view has placed him on that level for me, so I now see him as an interesting phenomenon, perhaps like a chatbot or a mild computer virus, rather than a person worthy of respect, although I'm sure he is in the real world.

Some examples of how he has managed to remove himself from respectworthiness follow.

In a possibly unpublished post, he has described a certain group of people as "half-wits".  This is an attempt to label people as of less worth because of an alleged disability, and if inaccurate is no better as it uses disability as a slur.  This means he's valuing someone as of less worth because of something which is not only beyond their control but also by no means a character flaw.  It happens to be false as well.  What it illustrates about him is that he has responded to an immediate impression of disgust or repellence at the Other by evaluating a person's unchangeable character in ethical terms.  There is no nuance or empathy here, but it's also interesting as it indicates a vice-virtue based view of ethics, which to be honest is quite interesting and has quite an attraction to me intellectually.  It might also serve as a warning to me of a danger with virtue-based ethics.

"So-called husband" and "wife" are two epithets applied to me, partly of course because he is attempting to get at Sarada rather than myself, and perhaps to hammer on a wedge between us.  Here he has a problem because by taking this approach he is actually not misgendering me, so it makes me feel better rather than worse.  However, it doesn't really work for me because now that he's used the word "half-wit", I can't take his views seriously.  It does give me a very slight warm glow though.  At least he isn't calling me "sir".  Quite the opposite.

Finally, and this is the most interesting thing, he says Sarada is talentless.  Since he comes from a right-wing perspective, he is likely to place trust in market forces as an accurate mechanism for determining value.  That means that his judgement of the quality of Sarada's work is inconsistent.  All that matters, according to his presumed value system, is the market value of her work, and she does actually get paid for it.  There is no come back from this unless he does not subscribe to the supremacy of the so-called free market.  His claim today, in fact, that he passes her blog content to his friends so they can all have a good laugh at her "expense" means, in fact, that her writing is of value to him and others, and since he may have rejected the notion of any other criterion of value than popularity and demand, the more he passes it on and the more people laugh at her stuff, the more thoroughly refuted his evaluation of her work becomes.

This, of course, is an example of the kind of contradiction inherent in the capitalist world view.  He paradoxically values her work as ridiculous while contradicting himself by attempting and failing to attribute a negative value to my beloved "urine-guzzling dyke in denial" (I wish!).  So I would like to thank Sarada's troll for once again corroborating Marxism as an accurate account of the nature of society and economics, if any were needed.