Thursday, December 30, 2010

Kodachrome: 1935-2010

Kodak stopped the production of Kodachrome® in 2009 and the last roll will be processed today in Kansas.

To many photographers, it remained the best colour film ever made. Even the best modern digital cameras cannot produce the same colour and saturation until you use Photoshop to process it. The quality of the slides may be related to the complex process of adding the dye during processing and for a long time only Kodak could process it. 

The 25 ASA film remained my favourite. 

Arches National Park on Kodachrome 25 ® 
©1987 Am Ang Zhang

The New York Times PARSONS, Kan. — An unlikely pilgrimage is under way to Dwayne’s Photo, a small family business that has through luck and persistence become the last processor in the world of Kodachrome, the first successful color film and still the most beloved.

That celebrated 75-year run from mainstream to niche photography is scheduled to come to an end on Thursday when the last processing machine is shut down here to be sold for scrap.

In the last weeks, dozens of visitors and thousands of overnight packages have raced here, transforming this small prairie-bound city not far from the Oklahoma border for a brief time into a centre of nostalgia for the days when photographs appeared not in the sterile frame of a computer screen or in a pack of flimsy prints from the local drugstore but in the warm glow of a projector pulling an image from a carousel of vivid slides.

In the span of minutes this week, two such visitors arrived. The first was a railroad worker who had driven from Arkansas to pick up 1,580 rolls of film that he had just paid $15,798 to develop. The second was an artist who had driven directly here after flying from London to Wichita, Kan., on her first trip to the United States to turn in three rolls of film and shoot five more before the processing deadline.

…… Among the recent visitors was Steve McCurry, a photographer whose work has appeared for decades in National Geographic including his well-known cover portrait, shot in Kodachrome, of a Afghan girl that highlights what he describes as the “sublime quality” of the film. When Kodak stopped producing the film last year, the company gave him the last roll, which he hand-delivered to Parsons. “I wasn’t going to take any chances,” he explained.

At the peak, there were about 25 labs worldwide that processed Kodachrome, but the last Kodak-run facility in the United States closed several years ago, then the one in Japan and then the one in Switzerland. Since then, all that was left has been Dwayne’s Photo. Last year, Kodak stopped producing the chemicals needed to develop the film, providing the business with enough to continue processing through the end of 2010. And last week, right on schedule, the lab opened up the last canister of blue dye.

The last Kodachrome picture: Steve McCurry’s Blog 
"Imagine leaving digital images in a hard drive and coming back 40 years later. Would anybody be able to read that data? That's the great thing about film. It's a self-contained object. You hold the picture up to the light and there it is."                          Steve McCurry: National Geographic

Read more>>>>

Howard Creech

Lens, New York Times

Paul Simon: Kodachrome.
"When I think back on all the crap I learned in high school, it's a wonder I can think at all."


The Cockroach Catcher on Amazon Kindle UKAmazon Kindle US

Wednesday, December 22, 2010

NHS-Kaiser Permanente: Integration?

Ray of hope from California?

 California©2007 Am Ang Zhang 
When all the talk is about trying to emulate Kaiser Permanente in the NHS reform up and down the country, my observation is that unless there is some radical rethink, the new NHS may end up as removed from Kaiser Permanente as imaginable.
Ownership and integration has undoubtedly been the hallmark of Kaiser Permanente and many observers believe that this is the main reason for its success, not so much the offering of choice to its members. Yes, members, as Kaiser Permanente is very much a Health Club, rather than an Insurer.  Also, a not so well known fact is that Kaiser doctors are not allowed to practise outside the system.
It is evident that the drive to offer so called choice in the NHS, and the ensuing cross-billing, has pushed up cost.  The setting up of poor quality ISTC (Independent Sector Treatment Centres) that are hardly used is a sheer wastage of resources.  When Hospital Trusts are squeezed, true choice is no longer there.  Kaiser Permanente members  in fact sacrifice choice for a better value health (and life style) programme.

The push for near 80% of GP commissioning is to lure the public into thinking that they are going to be better served.  In fact this is a very clever way to limit health spending and at the same time leave the rationing to the primary care doctors in a very un-integrated system.

So what about the specialist doctors that we call consultants in England?  Well, some are already offering their services in a private capacity to the GPs via PCTs, who are at liberty to buy those services. The NHS pay for hospital Consultants has now lagged behind that of GPs, and many consultants supplement their income by private work. Once you have had a taste of Porsche and Ferrari, are you going to go back to Rover?  A few major insurers are poised to buy up Foundation Hospitals and offer consultants a deal they cannot refuse.  This will lead us further away from the Kaiser Permanente ideal of an integrated system.

The most conservative estimate is that Consultant income will increase by 300% in the new private provider dominated specialist service. Has anyone not noticed that you buy private insurance to get your Specialist treatment? The gatekeeper is still your friendly GP.

The total income for all Private Health Insurers is currently estimated at around £6.5 billion, a quarter of which goes to the Specialists.

The NHS is already funding 20 to 25% of the Private sector.

By contrast, Kaiser Permanente is in part successful by doing away with the internal market and fees for service.

I know, the abolishment of internal market and cross charges will mean job losses for the accounting department, but we may then get more nurses and other clinical staff.

The conclusion?  There is an alternative: full integration via Foundation Trust Hospitals.

There is no reason why Foundation Trust Hospitals, once free of central control, cannot be responsible for training doctors (medical schools) and offer an integrated service from Primary to Secondary care.  A sort of “Free” Hospital (as in “Free” School) concept.  Ownership will be by us, the people.

This will be like the old NHS, more integrated!!! 

Yes, the old black is the new black.

NY Times: 

Sunday, December 19, 2010

NHS-Kaiser Permanente: The Good Bits!!!

We may not catch a cold!!! Or we NEED not catch THE cold!!!
 ©2010 Am Ang Zhang
It is amazing how planners often overlook the most important aspect of why an organisation such as Kaiser Permanente is a success. Having looked at some of their ways of saving money in my last post, I need now look at why Kaiser Permanente is such a success.       New York Times
What perhaps the NHS should not ignore is one very important but simple way to contain cost: salaries for doctors, not fees.
The current thinking of containing cost in the NHS by limits set to GP Commissioning will end up in many patients not getting the essential treatments they need and GPs being blamed for poor commissioning.
Foundation Trusts will be expected to balance books or make a profit. Instead of controlling unnecessary investigation and treatment Trusts would need to treat more patients. This is not the thinking behind Kaiser Permanente and is indeed the opposite to their philosophy. It may well be fine to make money from rich overseas patients, but there is a limit as to the availability of specialist time. Ultimately NHS patients will suffer. 

The side effect of the current drive of GP Commissioning is that it would no longer matter if Foundation Trusts are private or not. Before long most specialists would only offer their expert services via private organisations. Why else are the Private Health Organisations hovering around!!!
What can GP Commissioners do?

Do exactly what Kaiser Permanente is doing: integrate!!! Integrate primary and specialist care. Pay doctors at both levels salaries, not fees! In fact both the Mayo Clinic and the Cleveland Clinic pay their doctors salaries as well as the VA and a number of other hospitals including Johns Hopkins.
Yes, employ the specialists; buy up the hospitals and buy back pathology and other services.
Not big enough: join up with other commissioners.
What about very special services such as those provided by Royal Marsden, Queens Square, Papworth & GOS?
This can be similar to Kaiser’s arrangement with UC for kidney transplants.
But this is like the old days of Regional Health Authorities!!!
Right, did you not notice that the old black lace is back in fashion: the old black is the new black!!!
Merry Christmas.

Saturday, December 18, 2010

NHS-Kaiser Permanente: Which Bits?

For some years, successive governments have been verbal in hailing Kaiser Permanente as the model for a future NHS, and it is an open secret that Kaiser Permanente has been visited by many PCT and NHS Trust members.  Bearing in mind this trend, we need to look closely at Kaiser Permanente’s claims and indeed look at the lessons that can be learned, the “bits” that are applicable and the “bits” that are not.  The once progressive Royal College of Physicians in England seems to agree: David Lawrence, Kaiser's chief executive, gave a talk there entitled:
"Can the NHS Learn From the USA?"

So what indeed can we learn?
©2010 Am Ang Zhang

Importing the US model will undermine the health service

What the NHS can learn from the US is that its healthcare system is in crisis. The US healthcare industry is big business, but the 40 million poor, including 10 million children, have no insurance. Healthcare bills result in 40% of personal bankruptcies annually.

Health Insurers until now exclude pre-existing conditions. This means the sickest and especially the chronically ill will not get coverage. Additionally by a process called:


When a person is diagnosed with an expensive condition such as cancer, some insurance companies review his/her initial health status questionnaire. In most states’ individual insurance market, insurance companies can retroactively cancel the entire policy if any condition was missed – even if the medical condition is unrelated, and even if the person was not aware of the condition at the time. Coverage can also be revoked for all members of a family, even if only one family member failed to disclose a medical condition.

The government and Kaiser may well argue that its not-for-profit status engenders different behaviour. But in the US, the not-for-profits use the same tactics as the for-profits when the environment gets competitive. Kaiser actively seeks younger, healthier members and imposes different rates for employer groups based on their history and risk of healthcare.

Sometimes their competitive behaviour gets them into trouble. The California branch of Kaiser has had cumulative fines of $1.6m, 63% of all the fines levied by the Californian department of managed healthcare. The activities for which they have been fined include denial of care, use of unqualified staff and inadequate staff-patient ratios.

In Britain, the government argues that it does not matter who provides health services so long as they remain publicly funded. But the crisis-ridden US healthcare industry is also heavily dependent on government funding and there are striking similarities between its model of health maintenance organisations (of which Kaiser is one example) and Britain's primary care trusts, which replaced district health authorities in April and which will hold 70% of the NHS budget.
American health maintenance organisations integrate insurer (funding) and provider functions, rather like Bupa or PPP healthcare. This builds in an incentive to pass the risks and costs of care down to the patient. Primary care trusts also integrate funding and provider functions and are established as trading bodies or business units. Their statutory duties require them to break even and when there is insufficient funding they must find more income or pass risk back to patients.
There are four ways of doing this: excluding high-risk groups; limiting the range of services; redefining some NHS care as non-NHS care; and income generation through private healthcare. The first option is difficult since primary care trusts can't actively exclude high-risk and high-cost individuals, but they will have a strong incentive to restrict the services available to groups such as the mentally ill and those with chronic disease.

Primary care trusts may also seek to redefine NHS care as personal care by implementing Department of Health guidance issued last year which recommends limiting NHS care to a maximum of six weeks. Primary care trusts could use this to redefine elements of NHS care as personal care (rehabilitation after a stroke, say), which would then be subject to means testing and patient charges.
There is nothing to stop primary care trusts promoting the use of private insurance and sale of top-up services to NHS patients. A recent BMJ article which purported to show that Kaiser delivered cheaper healthcare at higher quality has been discredited. The NHS provides cover to all 60 million residents but Kaiser California covers fewer than 6.1 million of the 34 million in California and excludes the 20% uninsured. Even so, Kaiser's crude costs are more than 40% higher per capita than the NHS. Healthcare costs rise while access and quality fall when private providers come on the scene.

The government's modernisation plans for the NHS have all the hallmarks of the US model in which the government devolves the risks and costs of care to doctor and patient. The success of the NHS has been due to its dual role as universal payer and provider. If the government persists in uncoupling this by importing US models of care, they will import the US care crisis and all the inequities which follow.

The article was written by Allyson Pollock
The Guardian, Friday 21 June 2002 11.00 BST

Yes!!! 2002
Professor Allyson Pollock was then head of health policy at University College London. She has now moved to Scotland.    

Kaiser Permenente money saving tactics:

Mental & Chronic Illness:
In some plans Kaiser does not provide care for chronic serious mental illness, care of the elderly is variable, and some care, such as that for a chronic illness, ceases altogether after 100 days.

Patient dumping:
November 16, 2006
The Los Angeles city attorney's office has filed criminal charges against hospital giant Kaiser Permanente for endangering a former patient. The charges allege Kaiser dumped a homeless patient on the city's downtown Skid Row.

The charges stem from video captured by security cameras in March. The footage shows a 63-year-old patient from Kaiser Permanente's Bellflower hospital, dressed in a hospital gown and 

Union Rescue Mission                                      slippers, exiting a taxicab on Skid Row. She is later seen shuffling toward the Union Rescue Mission, the city's largest homeless shelter.

NPR   LA Times
At least she was near a homeless shelter, unlike others we know about in Mid Staffordshire.

Kidney transplant program violations lead to closure

In 2004 Northern California Kaiser Permanente initiated an in-house program for kidney transplantation. Prior to opening the transplant center, Northern California Kaiser patients would generally receive transplants at medical centers associated with the University of California. Upon opening the transplant center, Kaiser required that members who are transplant candidates in Northern California obtain services exclusively through its internal KP-owned transplant center.
On May 3, 2006, the Los Angeles Times published an investigative report which showed across-the-board mismanagement in the KP-run transplant program which resulted in delays for patients awaiting kidneys.[66] According to the report, Northern California Kaiser performed 56 transplants in 2005 and twice that many patients died waiting for a kidney. At other California transplant centers, more than twice as many people received kidneys than died during the same period. The practice of delaying these transplants resulted in considerable savings for KP.

Read more>>>>

Mandatory arbitration

In order to contain costs, Kaiser requires agreement by planholders to submit patient malpractice claims to arbitration rather than litigating through the court system. This has triggered some discussion and dissent. Some cases proceed to court and one argument is over whether the requirement to go through dispute resolution is enforceable.

Wilfredo Engalla is a notable case. In 1991, Engalla died of lung cancer nearly five months after submitting a written demand for arbitration. The California Supreme Court found that Kaiser had a financial incentive to wait until after Engalla died; his spouse could recover $500,000 from Kaiser if the case was arbitrated while he was alive, but only $250,000 after he died. The Foundation for Taxpayer & Consumer Rights contends that Kaiser continues to oppose HMO arbitration reform.

Read more>>>>
On January 1, 2014, health insurance carriers will no longer be able to deny coverage for pre-existing health conditions. However, for many with pre-existing health conditions this is simply too long to wait to get California health insurance coverage. Perhaps, they are unable to qualify for group insurance and they would be denied if they applied for an individual health insurance plan. Help is on the way. As of this September 23, 2010, health insurance carriers will no longer be able to deny coverage to minors ages 18 and under. Also, for those 19 and above, states will be offering Pre-Existing Condition Insurance Plans (PCIP) beginning this August, 2010.

Kaiser Permanente declined an invitation to join the Plan:

"To meet the law’s rapid deadlines, the state of California understandably opted to use a financial intermediary (third-party administrator) to make fee-for-service payments to healthcare providers," said Trish Doherty, a spokeswoman for Kaiser. "As a predominantly prepaid healthcare provider, Kaiser Permanente is not organized in a manner that allows us to easily participate in this new program."

Many other states had something similar. By 2014 no insurer will be allowed to exclude anyone. That was the Obama reform. We will have to wait and see what happens and perhaps it is why so many insurers are coming to England.

Ranking in California:
In 2003 the California Institute for Health Systems Performance published a consumer guide ranking the quality of care in 181 hospitals across California. The score was based on the recent hospital experiences of 35 000 patients, and included a survey of patients' experiences with respect to patient preferences, coordination of care, information and education, physical comfort, emotional support, involvement of family and friends, and transition to home. Kaiser accounted for 27 hospitals out of the 181 surveyed, and 11 of them were rated below average for quality of care, whereas the remainder were only rated average.

So which “bits” can NHS implement?!!!

NY Times:
HEALTH care systems in most industrialized countries are in crises of one form or another. But the American system is characterized by both feast and famine: it leads the world in delivering high-tech medical miracles but leaves 45 million people uninsured. The United States spends more on health care than any other country - $6,167 a person a year - yet it is a laggard among wealthy nations under basic health measures like life expectancy. In a nutshell, America's health care system, according to many experts, is a nonsystem. "It's like the worst market system you could devise, just a mess," said Neelam Sekhri, a health policy specialist at the World Health Organization in Geneva.
The Last words:

Prof Allyson Pollock and Sir Denis Pereira Gray:
“When the Lancet published a paper on MMR, which threatened to undermine public health programmes, the DH and other major medical journals lost no time in entering into the scientific debate. Now we have a paper being widely adopted by policy makers, the claims of which concerning Kaiser are not supported by the evidence.”

Guardian: Allyson Pollock
Additional material: Wikipedia

Monday, December 13, 2010

Snorkel to Resolution

Interesting to catch up on news after snorkeling:

©2010 Am Ang Zhang

The Independent:
By James Moore, Deputy Business Editor
Saturday, 16 October 2010

Resolution, the Guernsey-based company that wants to create a British "super-insurer", added another string to its bow yesterday with the purchase of Bupa's income protection, life assurance and critical illness cover business for £165m.

The firms are also looking at ways in which they can sell each other's offerings.
Bupa said the decision to sell the operation, which trades as Bupa Healthcare, was part of a decision to refocus strategically on healthcare products and services. As a provident association, Bupa is owned by its policyholders.

……Resolution was founded and is headed by Clive Cowdery, the entrepreneur who is a specialist in the field, although he has kept a relatively low profile recently with John Tiner, a former head of the Financial Services Authority, serving as the company's front man.

So I look up John Tiner:

The Independent:
By James Moore
Friday, 25 June 2010

So why's he in the news?
Well, since stepping down as chief executive of the Financial Services Authority he has been one of Clive Cowdery's bag carriers at Resolution, the Guernsey-based company that wants to create a UK super-insurer. Yesterday it pulled off its second deal and it will now be combining the UK business of French insurer AXA with Friends Provident, having bought the former for £2.75b.
When you say bag carrier...
Well yes, we're being a big rude there. Mr Tiner's actual title is chief executive of Resolution. That sounds impressive, but it's Mr Cowdery who runs the show. Mr Tiner has, however, been acting as the front man for some time now. He's always been a bit of a flash so-and-so, though, and it never hurts them to be brought down a peg or two.
Flash, an ex-regulator?
Yes, we know it might sound strange, but it's true. While running the Financial Services Authority Mr Tiner had a Porsche with the registration T1ner. And there was something of a rumpus when it emerged that his leaving do cost more than £20,000 when he quit the City watchdog.
Oh dear, is he that bad?
Well, he's hyper-confident, some would say over-confident. He's a Leeds United fan and his fondness for motoring has led him to come unstuck at least once – with a drink driving conviction. Mr Tiner styled himself as a crusader for the consumer at the FSA and is responsible for a shake-up in insurance regulation that still has much of the industry's great and good shaking their heads.
So a gamekeeper turned poacher?
Quite. MrTiner, who started out at the collapsed accountancy firm Arthur Anderson, was being very coy about a notable sting in the tail of yesterday's deal – the inevitable job losses.
Oh dear.
Oh dear indeed. There will be more to come. The Resolution team – who have a management contract that gives them 10 per cent of the upside from the deals they're busily doing – are not done yet. They've ambitions to nearly double the size of their insurance operations.

Arthur Anderson again? Remember Enron?

I think I will go back to snorkeling!
©2010 Am Ang Zhang


Saturday, December 11, 2010

Wagner: Tannhäuser, Wilde & Freud

Tannhäuser in the kingdom of the goddess Venus, by Henri Fantin-Latour. Photograph: akg-images

As Tannhäuser opens at the ROH, the Guardian had an interesting article:
Admired by Queen Victoria, Oscar Wilde and Freud, Tannhäuser contains one of the most extreme depictions of sex attempted in music.
Tim Ashley       Saturday 11 December 2010

In chapter 11 of The Picture of Dorian Gray, Oscar Wilde's hero goes to the opera. As transgression and excess begin to rot that famous portrait, the piece to which he becomes obsessively drawn is Wagner'sTannhäuser, the only named musical work in a passage widely viewed as a catalogue of the trappings of decadence. Wilde describes the "rapt pleasure" Dorian takes in "seeing in the prelude to that great work of art a presentation of the tragedy of his own soul".

Dorian was by no means alone, for it was in Tannhäuser, more than any of Wagner's other operas, that many in the late 19th century found a reflection of their moral and sexual concerns. Its admirers included Queen Victoria, Baudelaire and Freud. It inspired major works both of literature and pornography, and was interpreted as everything from a justification of normative values to a fierce celebration of counterculture extremes. It appealed above all to those who were – or felt – outlawed by their sexuality.

The opera's starting point is the dichotomy between flesh and spirit, as refracted through a variation on the medieval legend of the troubadour Tannhäuser, who strayed into the Venusberg, or kingdom of the goddess Venus, whose lover he became. Sexual satiety provoked his return to the world of men, where shame impelled him to seek salvation by undertaking a self-mortifying journey to Rome to beg absolution from the Pope. The latter, however, rejected his request: damnation awaits those who have enjoyed the pleasures of Venus; Tannhäuser has no more chance of achieving salvation than the Pope's staff has of beginning to flower. Yet after the troubadour left, the Pope's staff did, indeed, miraculously, begin to flower. But too late for Tannhäuser's soul: he had returned to Venus with whom he will remain until he is damned on judgment day.

Read all >>>>>

Overture: here>>>>.

For a different version at Bayreuth.

Tannhäuser is at the Royal Opera House, London, until 2 January. See you there perhaps on the 27th.
Other Opera Posts:

Tuesday, December 7, 2010

PISA: Education! Education! Education!

Despite another record rise in exam results in the UK, Britain has fallen behind many countries in the latest PISA scores.

The Programme for International Student Assessment (Pisa) is highly respected across the globe, and enables politicians and policy-makers to assess how different country's education systems compare.

It shows the UK's reputation as one of the world's best for education is at risk, and has tumbled several places since 2006.

The UK is ranked 25th for reading, 28th for maths and 16th for science. In 2006, when 57 countries were included in the study, it was placed 17th, 24th and 14th respectively. Poland has stretched ahead of the UK in maths, while Norway is now ranked higher in reading and maths.

Andreas Shleicher, head of the Pisa programme, said the picture for the UK was "stagnant at best". "Many other countries have seen quite significant improvement," he added.

The New York Times noted:

With China’s debut in international standardized testing, students in Shanghai have surprised experts by outscoring their counterparts in dozens of other countries, in reading as well as in math and science, according to the results of a respected exam.

Sunday, December 5, 2010

Mental Illness: Music, Art & Literature.

Are we ignoring music, art and literature to the detriment of our patients? Is the answer to psychiatric problems totally controlled by medication, medication and more medication? Or is it selfishness on our part as we may otherwise not see the great works in music, art and literature that some of us do not wish to over-medicate or to medicate at all.

I am grateful to the Frontier Psychiatrist for his:
December 2nd, 2010
“Sarah Wardle, poet and author of ‘A Knowable World’ recently came to speak at a conference I helped organise.  A Knowable World follow’s Sarah’s detainment in a Central London psychiatric hospital for over a year for manic episodes of bipolar disorder and it received positive reviews from both the British Journal of Psychiatry and the Guardian newspaper. I would also recommend it as her poems offer an eloquent glimpse of experiences that are relatively rarely documented.

“……Apart from a few at the beginning and end, written before and after, most poems were written on the wards, for example one that begins, ‘The consultant psychiatrist is on the ward./ In his proximity all is hope with the world’.  Others were responses to the daily round of fire alarms and PRN, to snow seen on Easter Sunday from a ward window, or to a fellow patient’s suicide.  The opening poem describes the MRI scan that prompted a previous psychiatrist, Professor Basant Puri, to take me off medication and put me on fish oil.  The closing poem describes walking up Ben Nevis and celebrates being out in the open again.  Writing was a lifeline for me and I was heartened to receive in hospital acceptances from journals, such as The Times Literary Supplement, for poems written on the ward…….”  Read more>>>>

From my blog post:

Wednesday, July 1, 2009

Madness and Modernity, Bobby Baker & The Peril of Diagnosis

Bobby Baker is a successful performance artist who had suffered acute psychiatric problems including self harming, which she captured over a period of 10 years in hundreds of 'diary drawings'. These paintings (158 drawings, selected from a total of 711) and commentaries demonstrated her anger with the mental health service and any viewer thinking of entering psychiatry might be put off forever.

Bobby was told by the first psychiatrist she saw that she suffered from borderline personality disorder. (Time article link)

As her story unfolded in her drawings, one gets an uncomfortable feeling about the state of our psychiatric service and wonders if we are even at the 50th step. She has triumphed over some of life’s most frightening experiences despite all. 
“As my ability to function improved, hell became more firmly encased in my skull. I’ve formed the opinion…..that psychosis is a metaphor for extreme suffering. My delusions led to paranoia that a network of professionals was constantly searching for evidence that I was wicked. …….Medication didn’t help – it just made me fatter and fatter.”           Bobby Baker     Wellcome Collection Exhibition pamphlet.


Tuesday, February 5, 2008

Sadness medicated to extinction

Her theory is that nowadays people uncomfortable with sadness that German romantic poets and the characters they wrote about would have been medicated out.

Yes, there is so much sadness and melancholy and suffering in the Goethe poems which Schubert set to song. It is of course a form of sublimation and in psychiatry most would agree it is also the best psychological defense mechanism.