Thursday, July 20, 2017

Proms: Finland & England.

The Proms has just started. And what a start. Sibelius will feature prominently. As the Cockroach Catcher started his listening career on Violin Concertos, it was doubly exciting to hear Lisa Batiashvili’s (1739 Guarneri del Gesu violin) exhilarating Sibelius Violin Concerto.

© 2012 Am Ang Zhang

From Finland:

March 13, 2015
Helsingin yliopisto (University of Helsinki)

Although listening to music is common in all societies, the biological determinants of listening to music are largely unknown. According to a new study, listening to classical music enhanced the activity of genes involved in dopamine secretion and transport, synaptic neurotransmission, learning and memory, and down-regulated the genes mediating neurodegeneration. Several of the up-regulated genes were known to be responsible for song learning and singing in songbirds, suggesting a common evolutionary background of sound perception across species.
Listening to music enhanced the activity of genes involved in dopamine secretion and transport, synaptic function, learning and memory. One of the most up-regulated genes, synuclein-alpha (SNCA) is a known risk gene for Parkinson's disease that is located in the strongest linkage region of musical aptitude. SNCA is also known to contribute to song learning in songbirds.
"The up-regulation of several genes that are known to be responsible for song learning and singing in songbirds suggest a shared evolutionary background of sound perception between vocalizing birds and humans," says Dr. Irma Järvelä, the leader of the study.

In contrast, listening to music down-regulated genes that are associated with neurodegeneration, referring to a neuroprotective role of music.
"The effect was only detectable in musically experienced participants, suggesting the importance of familiarity and experience in mediating music-induced effects," researchers remark.

The findings give new information about the molecular genetic background of music perception and evolution, and may give further insights about the molecular mechanisms underlying music therapy.


The Guardian:Why we are shutting children out of classical music.
April 2, 2009 Tom Service is a 33-year-old classical music critic. For 25 years of concert-going he found himself to be amongst the youngest in the audience.

But there is something else that is strange:

“I've noticed that bus and train stations now pipe canned classical music, day-in, day-out, through their speakers as a way of stopping young people hanging around. So toxic have the associations become, that this experiment actually works: there is evidence that playing Beethoven and Mahler has reduced antisocial behaviour on the transport network.”

He went on:

“An entire generation, aged between 10 and 30, seems radically disenfranchised from classical music. How, and when, did this happen?”
Then in Finland:

“A couple of years ago, I saw a class of seven-year-olds in Helsinki enthusiastically learning Finnish and maths by performing sophisticated little songs with astonishing tuning and rhythm. And this wasn't a music school - just a typical Finnish state primary. Finland only developed its curriculum in the postwar period, but it works: today, the Finns are classical music world-beaters, and their education system has produced more great instrumentalists, conductors and composers per capita than any other country on earth.”

Esa-Pekka Salonen is of course the Principal Conductor of the Los Angeles Philharmonic Orchestra and Finland’s most famous music export in recent times.
I was at a concert recently and a large numbers of players in the orchestra were Koreans. Well apart from steel and TV and cars, the Koreans are now into golf and music in a big way. The LPGA is certainly dominated by Koreans. Could it be that music gave them the edge in golf as well, not just the chopsticks?

Tom again:

“Here is a ready-made answer to the problems of renewing classical music's role in society. Make them statutory requirements for every local authority, and give them the responsibility for rebuilding the network of classical musical possibility that used to resound throughout the country.”
And perhaps throw in golf for good measure.

It was in 1990 that American troops played deafening pop and heavy metal music day and night outside the Vatican Mission to Panama City that Noriega surrendered.

In future, this strategy might have to be changed, Beethoven, Mahler and God forbid even Bach.

Tom Service’s last words:

“We've already lost one generation - we can't afford to lose another.”

Old and New: Multiple Sclerosis & Elgar
The Ring: Child Psychiatry & Human Behaviour
Nobel: Kandel and Lohengrin
Lohengrin: Speech Disability, Design & Hypertension
Easter Passion: Bach, Beethoven and Mahler
'The Knowledge' and the Brain

Monday, July 17, 2017

Portraiture: Rule Breaking!

© 1998 Am Ang Zhang
"You must never shoot up the nostrils!"

Strange I should win the Club's Portrait Competition!

Hasselblad/150mm lens.

Film: Kodax TMax 100

Printed on Record Rapid paper/ Selenium Toned

Selenium Toning is for archiving prints and imparts a lovely tone depending on concentration.

Link: Silverprint

Monday, July 10, 2017

Pre-Raphalites & GBM!

The Art Institute of Chicago has quite an interesting collection. What caught my eye the other afternoon was a Pre-Raphaelite, well one of three that Rossetti did and the original I believe was in the Tate, London.

Beata Beatrix, 1871/72
Art Institute Web Site

A founder of the Pre-Raphaelite Brotherhood, Dante Gabriel Rossetti was both a poet and a painter. In this picture, he portrayed the dying Beatrice from Dante Alighieri’s Vita nuova, a medieval tale of idealized love and loss that had personal meaning for Rossetti, who had lost his wife, the artist Elizabeth Siddal, in 1862. He began the first version of the work, now in the Tate Gallery, London, in 1864, after finding an unfinished oil sketch that he had made of Siddal. The Art Institute’s painting is one of two replicas of the Tate composition, but it is the only one with a predella, the small panel at bottom showing the final meeting of Dante and Beatrice in paradise.

Pre-Raphalites reminded me of our librarian.

She and her husband retired to Dorset and one year we decided to visit their new place and have a taste of the old England they have always raved about. They were from Sheffield but spent a lot of their live there before moving to Sussex. So it was a bit like returning home.
They proudly showed us the guest room because it was decorated with some of the last scrolls of William Morris wall paper that they happened by.

How charming.

After dinner the conversation somehow turned to the Pre-Raphaelites and our librarian promptly produced a book with an amazing painting on its cover.

In a chance encounter with Andrew Lloyd Webber, Josceline Dimbleby asked him bluntly if she could go and see the portrait he had of her great-aunt, Amy Gaskell.

“Ah, that wonderful dark picture,” Andrew said. “Yes, please come……Well, I think she looks rather like you......”

“Did you know that she died young?” Josceline asked Andrew.

“Of a broken heart.”

She told Andrew that she would try to find out more. This led her to start researching into the life of Amy, her mother May and the famous Pre-Raphaelite painter Edward Burne-Jones and the result was the book A Profound Secret[1].

I looked at the book cover and thought the portrait reminded me of the Picasso I used for my Anorexia Blog.

It is said that as a young man Picasso admired the pre-Raphaelites and Edward Burne-Jones so much that in 1900 he would have gone to London rather than Paris had he had the fare.

“There was a hint in the book that she might well have died of Anorexia!” My hostess said.

It was a fascinating book, like good family biographies are, as long as you accept that it is not going to be as organised as fiction. A good writer helps and Josceline Dimbleby is a well established food and travel writer.

For a psychiatrist, it is especially interesting as he is allowed glimpses into the various personalities, their psychiatric problems and the resulting family dynamics, without the interference of the usual psychiatric labelling or coding. Unfortunately self medicating with alcohol, opium and other fancy substances was rife in that era (and perhaps now too) and the result could often be tragic.

Indeed Josceline thought at one point in the book that Amy might have suffered from Anorexia although it was not a known condition at the time. She left it till the end of the book to let us into the final secret. You will have to find out for yourself.

Without the effect of drugs that would double the bodyweight, we have in the end one of the most beautiful portraits of the Pre-Raphaelites. Burne-Jones’ life is of course another psychiatric book: his mother died when he was six days old and many felt that all his life he was searching for the perfect mother he so missed. It is indeed ironical that the art world has been much enriched by what was essentially untreated bereavement.
Psychiatry may need to look again at what we have been doing, as we do not seem to have found another Burne-Jones.


Does having a good hunch make you a good doctor or are we all so tick-box trained that we have lost that art. Why is it then that House MD is so popular when the story line is around the “hunch” of Doctor House?

Fortunately for our librarian, her GP (family physician) has managed to keep that ability.

My friend was blessed with good health all her life.  She seldom sees her GP so just before last Christmas she turned up because she has been having this funny headache that the usual OTC pain killers would not shift.

She would not have gone to the doctor except the extended family was going on a skiing holiday.

She managed to get to the surgery before they close. The receptionist told her that the doctor was about to leave. She was about to get an appointment for after Christmas when her doctor came out and was surprised to see my friend.

I have always told my juniors to be on the look out for situations like this. Life is strange. Such last minute situations always seem to bring in surprises. One should always be on the look out for what patient reveal to you as a “perhaps it is not important”.

Also any patient that you have not seen for a long time deserves a thorough examination.

She was seen immediately.

So no quick prescription of a stronger pain killer and no “have a nice holiday” then.

She took a careful history and did a quick examination including a thorough neurological examination.


Then something strange happened. Looking back now, I did wonder if she had spent sometime at a Neurological Unit.

She asked my friend to count backwards from 100.

My friend could not manage at 67.

She was admitted to a regional neurological unit. A scan showed that she had a left parietal glioma. She still remembered being seen by the neurosurgeon after her scan at 11 at night:

“We are taking it out in the morning!”

The skiing was cancelled.               

Glioblastoma Multiformis (GBM)

In 2013, I came across an article in the Washington Post[1] about none other than a doctor that was diagnosed with the condition. But his story took a bit of a twist that my further research was to reveal.

When we met our librarian, she told me that the hospital neurosurgeon had also been diagnosed with GBM. He has now retired and is being treated at Queens Square where he trained.

Then another London doctor friend, a paediatric cardiologist has also been diagnosed with the condition. He decided to move back to Hong Kong to be treated, yes by his old Medical School.

Since it has been quite a few decades since I was at Queens Square, I was desperately searching for any information I could find.

Is it an infectious condition? Why all the people I know are linked to hospitals. Could we have a Dr House style brain storming. Is there any modern treatment as I vaguely remember it as one of the most vicious brain tumours.

OK,  Senator Kennedy has no hospital link, except for treatment there.

But lets see what our doctor/patient found:

Why me[2]?
Why did this tumor happen to me? I never smoked and had had no brain injuries, and there is no history of such tumors in my family. As a cardiologist, I had implanted close to 400 pacemakers in my life and during the procedure was exposed to ionizing radiation (X-rays). In the early days we used portable X-ray machines and gave ourselves some protection by using thin lead gowns. Nowadays, heavy lead gowns are worn, and doctors and technicians protect their thyroid and eyes with shields and glasses. We also use heavy sheets of radiation-protective glass that hang from the ceiling.

At some point in my research, I was surprised by an article by a Johns Hopkins-trained cardiologist who now practices in Israel. He had collected data on 23 invasive radiologists and cardiologists who had developed tumors, of which 17 were GBMs on the left side of the brain. I wrote to the author, who told me that he had learned of several more such cases since his article was published, and he added mine to his file.

Well, I think that is as far as we can go on the hospital link. What about others.

Sharp eyed readers reading Anderson’s article would have noticed that it opened with some detail that he did not quite link to his condition but further research revealed some interesting findings.

I have always maintained that in ancient times, there are very observant people that noticed links that few people would have noticed. In order to drive fear into people for their own protection, these observations were somehow incorporated into religious believes.

Yes: Pork[3].
I also had a blood test for cysticercosis, an infection that results from eating undercooked pork contaminated with Tenia solium. This common parasite produces cysts all over the body, including the brain. It is the most common reason for seizures in many countries, particularly in India, where children with seizures are first treated for this disease even before other studies are done. My blood test was strongly positive. I started a course of oral medicine to treat it. The test reassured me.

He obviously did not relate Tenia solium to GBM, but my further research showed something rather extraordinary.

There has indeed been case reports of neurocysticercosis[4] associated with GBM. This would now explain what Dr. Anderson reported as a by-line. There is even a case of both husband and wife “catching” GBM[5] and to me Tenia solium infection would be the natural explanation.

Then I discovered something quite shocking: Tenia infection can occur in Orthodox Jews[6]. No, I do not think they secretly eat pork, but apparently they can catch it from nannies from endemic countries.

But the main exciting part of Dr. Anderson’s article was his treatment when the traditional one failed.

It was the use of a modified Poliovirus Vaccine at Duke[7] that attracted his attention.

DURHAM, N.C. – An attack on glioblastoma brain tumor cells that uses a modified poliovirus is showing encouraging results in an early study to establish the proper dose level, researchers at Duke Cancer Institute report.

The treatment, developed at Duke and tested in an ongoing phase 1 study, capitalizes on the discovery that cancer cells have an abundance of receptors that work like magnets drawing the poliovirus, which then infects and kills the cells.

He decided to have the treatment and two years later he appeared on a CBS 60 minutes about the new treatment[8].

Part of the transcript:

Dr. Fritz Andersen showed us the results in another patient -- himself. He's a retired cardiologist and at age 70, he became the second person in the polio trial.

Dr. Fritz Andersen: This is a fairly sizeable temporal tumor, which means...

Scott Pelley: That we see right here.

On the left is his tumor before treatment, on the right a hairline scar where it used to be. Like Stephanie, that was nearly three years ago.

Dr. Fritz Andersen: So when they said that this thing is just a small scar, and we think it's possibly cured. I nearly fell off my chair. I said, "that's, that's, that's impossible." They said, "well, we don't know, but so far it looks fantastic."

Scott Pelley: Do you consider yourself cured? Or do you call it remission?

Dr. Fritz Andersen: I feel it is a cure, and I live my life that way.

Well, he has done well, both our Librarian and the Paediatrician that returned to Hong Kong did not make it.


[3] And the pig, because it has a cloven hoof that is completely split, but will not regurgitate its cud; it is unclean for you. You shall not eat of their flesh, and you shall not touch their carcasses; they are unclean for you.


Monday, July 3, 2017

PFI: Only £209bn!!!!

Please, do not cry!
PFI deals will ONLY cost taxpayers £209bn!!!!  Independent

©2012 Am Ang Zhang

Margaret Hodge, M.P. did not shy away from pointing out that:
“Every single one of you has failed to do proper due diligence about this and no one has been brought to account.

“There is an issue of negligence here and one that I have not felt with a health report to this committee before.”

Who were they that failed?

Dr. David Bennett (not a medical doctor and seemed less confident for someone from McKinsey)), Una O’Brien, permanent secretary for the Department of Health, who looked the most confident of the lot she did not know that Hospital Trust Boards are not to be trusted and of course the Trust CEO (well there has been 5) and Head of the Strategic Health Authority.

MPs were also outraged at the apparent failure of trust bosses, the health regulator Monitor and the Strategic Health Authority to take responsibility for the crisis.

The PFI Hospital:
This is about the 611-bed Peterborough City Hospital was opened in November 2010 at a cost of £289 million with the funding being provided through the government-backed PFI scheme.

The solution: millions again! Not on nurses or doctors!
MPs were also told that over the last few years, some £14 million has been spent on a range of consultants as well as five chief executives, to try and resolve the crisis.

A further £3 million is to be spent on setting up a new team of consultants, which was announced by Monitor today, and which will go into the hospital next year also in a bid find a solution to the trust’s woes.

Free advice from Bloggers etc: why not just buy the companies that own the PFI shares and if necessary by compulsory purchase?

Allyson Pollock:
How PFI is crippling the NHS

Last year the NHS underspent its budget by £900m, returning much of it to the Treasury. This raises serious questions about stewardship of public funds, at a time when hospitals with PFI-associated deficits, such as Hinchingbrooke, have been franchised out to companies such as Circle, and other PFI hospitals in south London and elsewhere are under "special measures". Before 1990 any hospital overspending would have been managed without recourse to closure, and failing hospitals were unheard of.

Failure is a product of successive governments' policies since 1990: Kenneth Clarke's introduction of capital charges and trusts, New Labour's PFI policy, foundation trusts and payment by results, and now Lansley's new funding regime and policies.

Since the policy was launched in 1992, report after report over almost two decades has shown how each wave of PFI has been associated with trust mergers, leading to 30% reductions in beds; staff lay-offs; and closures of hospitals, accident and emergency departments and an untold number of community services – all because of lack of affordability. PFI, once trumpeted as the largest hospital-building programme, was in fact the largest NHS hospital and bed closure programme.

Metronet calls in administrators: Cost to Taxpayers £410 million

Allyson Pollock again:

The debt is toxic.

However, the government will not allow hospitals to default on the debt (it would threaten all the other PFI schemes and result in the banks taking legal action). Moreover, PFI is a Treasury policy for the whole of the public sector and it is a policy that the Treasury is exporting abroad. The Treasury and health department signed off all the PFI deals in the full knowledge that affordability had been an issue from the very beginning. The Treasury stuck to the line that there was no alternative.

This is what the public needs to know and is not being told.

First, the high costs of PFI debt charges means that the NHS can only operate anything from a third to half as many services and staff as it would have done had the scheme been funded through conventional procurement. In other words, for every PFI hospital up and running, equity investors and bankers are charging as if for two. Edward Leigh, the chair of a Treasury committee report into PFI, called investor returns the unacceptable face of capitalism.

Second, we can still afford to pay for universal healthcare – but only if we stop using NHS funds to prop up banks and equity investors.

Third, it is PFI deficits that are driving service closures, not patient demand or an ageing population. Service closures have nothing to do with service redesign.

Fourth, the government has now embarked on a new path, bringing in an Act that effectively abolishes the NHS, and which allows hospitals both to enter into more joint ventures with industry and to raise up to half their income from private patients. Two monsters are now unleashed – PFI and Lansley's Health and Social Care Act 2012.

Colin Douglas
Here in The BMJ, he reviewed Allyson Pollock’s Book, NHS plc.
"Since it was Pollock's views on the PFI that so upset its proponents, it is worth summarising them briefly. Costs are now intrinsically higher, because of capital borrowing at higher rates than those available to government, because of cash hungry consultancies and the vast transactional and monitoring costs of countless contracts, and because—for the first time on a large scale in the NHS—commercial profits must be made. To accommodate all these new costs clinical services have been scaled down, while matching assumptions about increased efficiency are only variably delivered. All this, along with the rigidity of a trust based strategy for building hospitals and the locking in effect of contracts fixed for decades, seems to Pollock and many others at best a bad bargain, at worst a naive betrayal that opens the NHS to piecemeal destruction and the eventual abandonment of its founding principles. And all over the country PFIs—greedy, noisy, alien cuckoos in the NHS nest—gobble up its finances and will do so for the next 30 years.”
Next 30 years!

The private finance initiative was devised to get schools, hospitals and roads built without swelling the government's overdraft. Critics discerned a conjuring trick. Instead of the state borrowing, private consortiums did, and then the public paid – at a premium rate. It has often been likened to sticking a mortgage on a credit card; but Whitehall always resisted that charge.

It was just too important to flatter the books, especially to Gordon Brown. His twin obsessions were constructing temples to New Labour's social policies and establishing his prudence: PFI appeared to further both. But the trickery was too flagrant. Friendly thinktanks were tasked with devising a rationale couched in the language of public-private partnerships. It was said that City expertise would somehow foster efficiency. Henceforth PFI was all about improving the allocation of risk. Beautifying the books had nothing to do with it.     

PFI makes me particularly angry. It is a guaranteed loan to property investors, where high-rate mortgage payments are kept off-balance to reduce the country’s declared debt. In other words, it’s the Enron of the NHS. This is money the NHS has committed to leave frontline healthcare for the next 35 years.”