Archive for the ‘history’ Category

Stress, fighter pilots and medical students

August 31, 2010

In which Dr Aust offers, instead of bad science, a rather meandering anecdote.  Sorry.

En route back to Britain last week from our rather damp annual holiday, I couldn’t help noticing all the media coverage of the 70th anniversary of the Battle of Britain.

Like all children growing up in Britain in the 60s and 70s, I guess, I became familiar early on with the story of the Battle as it has passed into British folklore (or history).  I remember my mum taking my little brother and I to see the 1969 film version during a rainy holiday (another one!) on the Isle of Wight. At the time (the tail end of the 1960s) Winston Churchill was not long dead, and we children could all recite by heart his famous line about the Battle:

“Never, in the field of human conflict, was so much owed by so many to so few”

So the picture of young RAF fighter pilots pushing themselves to the limit to keep the Luftwaffe (the German air force) at bay in a knife-edge struggle against the odds was a very potent one in those days – and of course, there were many people still alive then who had been part of the battle. The struggle and the bravery of “The Few” seemed to embody what British people felt were “the British virtues”. Perhaps that is still true – though I was interested to find, reading the modern Wiki entry on the Battle, that the historians nowadays debate the version of it that I grew up with.

Anyway, the coverage this Summer reminded me of learning about the Battle of Britain some forty years ago – but also about another context in which I have come across the story being used.

Let me fill in this other context for you.

One of the things you get used to dealing with over the years, if you are a University teacher, is students who feel under pressure. Now, for people of my vintage there is a definite tendency, I think, to see University in hindsight as a right old lark. From the perspective of ten or twenty or thirty years spent earning a living, and dealing with all of life’s other vicissitudes, it is rather difficult to see the University years as a time of stress and pressure. Indeed, I think this view is common among most people looking back at their student years. When I learnt, rather late, to drive, I had a driving instructor who used to describe his one year at University before dropping out as “the best year’s state-sponsored drinking I ever had”. And I had a good laugh at this very funny David Mitchell piece from the Guardian last week.

Now, it is fair to say that things have changed in more recent years. The state in Britain is not sponsoring students nearly as much as it used to, and nothing like it was when I was young. Many of our students now have to have part-time jobs to help with their finances – though this seems to be far less common in “vocational” degrees, like medicine, that have more fixed time commitments during the week. We set a lot more formal assignments for students to do then when I was a student, and we set students exams far more often too. And many of our students are certainly worried about getting a degree results good enough to ensure they will be competitive in the employment market. So it is, I freely admit, not like it was when I was twenty years old.

Having said all of that, the first couple of years at University must still be, I think, one of the least stressful times work-wise in most people’s lives. In most UK Universities and courses, you merely need to pass the 1st year exams. You don’t have to get 80% – or even 60%.  In the 2nd year of UK science degree courses, the exams typically count in part towards the final degree grade (classification), but usually only a bit (often contributing something like 20-25% of the final mark). Meanwhile, in professional degrees, the 2nd year is another “you simply have to pass” deal. Depending on the particular degree, the pass mark for the year (or its component units) will typically vary between around 40 and 55%. There are sometimes “Distinction Points” for those who record the top marks, but mostly it is pass/fail.

Given all this, you would not think students in this part of their University course (the early years) would be that stressed.

Some of them, however, are.  Or they certainly feel, and tell us, that they are.

Medical students are a special example in some ways, partly for the following reason. People who reach medical school are typically those who have been used to being the top, or near the top, of the class throughout their years in the school system. Conversely, they are not used to failing things. But obviously, the step up from school to University is a significant one. And now you are in a group where everyone has been selected as being from the top echelon at school. Anyway, there is a top of the medical school class, and a bottom. And some people do fail medical school exams in the 1st year.

The good news for them is that they get another chance.

Further good news is that, if you are going to fail one set of exams in medical school, the best ones to fail are probably the first lot that you do. Everyone knows there may be an “adjustment”, both for academic or personal reasons, in the transition from school to University. Away from home for the first time, for instance. Busy socialising, for another. Getting used to working without teachers and parents prodding you along for a third. As a result of this, you typically get cut a little slack if you are a student having a few bumps. You have to pass the resit exam, but the initial failure does not get you written off as a no-hoper, or even a problem case.

But some students take any failure very personally. And each year, at least a couple of those that have failed the first Semester exams fetch up in the Faculty offices complaining that they are having problems with stress.

Now, views on how to approach discussing this with students differ. Back in the 1950s, in the era of the Dirk Bogarde Doctor movies, such a student would no doubt be told to “Pull your socks up, work harder and stop talking such utter nonsense.”

We don’t do that any more.

We are sympathetic. Really, we are.

Indeed, we in the University are rather more sympathetic than some in the medical profession itself might be. Hardliners in medicine (which might at times include Mrs Dr Aust, for instance if she has had a bad week in the medical trenches) have been known to offer the view that if a person can’t cope with failing their 1st year medical student exams and having to resit, then they are going to be about as much use as a junior doctor (a job that undoubtedly is stressful) as the proverbial udders on a bull.

So one take on the stressed 1st year student who failed their exams is that they perhaps benefit from being gently reminded that it is a minor setback that they can hopefully address and overcome, regroup and move forward, worse things happen at sea etc etc.

So, sympathy, but also a gentle steer that failing an exam isn’t the end of the world, or really that stressful in the greater scheme of things, and you need to get things in some perspective.

Which brings me back to where I started – with the Battle of Britain.

You will see why in a minute.

At a medical school where I worked, the person who for many years saw the students having “difficulties” (including those who were feeling stressed) was called the Senior Tutor for Students. The occupant of this role was a slightly crusty (but actually very wise) Yorkshireman, honed by many years of teaching gross anatomy whilst also working as a GP in a local health centre. By the time I met him, this chap, who was one of the best medical teachers I have ever come across, was in his 50s and already a legendary figure among generations of undergraduates.

One of his more celebrated routines for talking to 1st year students who were complaining of stress problems went something like the following.

————————————————————————————-

(Fixing student with deep hooded gaze over his glasses)

” Yes… well, How to look at this.”

A pause.

“Consider, if you will, A Battle of Britain fighter pilot in the Summer of 1940, fresh from training school. Solo flying hours on a Spitfire… perhaps a handful. Sleep in the last week… perhaps 20 hours in all. Chance of returning from the next day’s sorties against the German fighters, perhaps two out of three…”

Longer pause.

That (word very slightly emphasised) would be stress, I’m sure we could agree”

Another pause.

“Now…. you are a first year medical student…..”

————————————————————————–

Which is, I hope you will agree, the stuff of legends. I have certainly met doctors who could still remember, a dozen or more years later, themselves or their friends being on the receiving end of  this spiel.

And finally, with another teaching year at the University about to start, with all its inevitable minor vicissitudes – not to mention the uncertain economic future for the University sector –  I shall be taking my own advice.

I shall be doing my very, very best to keep it all in perspective.

Who should be voting on electoral reform?

May 13, 2010

In which Dr Aust lets another member of the family have the pulpit.

This will probably be the last UK election-related post – something I suspect some readers will be glad of – unless I write later about our new Minister for Universities and Science. However, as you have probably heard enough from me on politics, I thought I would let another member of the family have the last word on events last week.

As those who read my “Electoral Eve Wavering” post may remember, my dad, who is the real scientist in the family, was a Labour candidate for Parliament back in the 60s. Later, in the 80s, he was an early member of the now defunct Social Democratic Party (SDP).

As you will see from the letter below, which he wrote to send to one of the national newspapers, he is not a tremendous fan of our current voting system.

People with long memories may recall that the SDP allied itself with the Liberals for the general elections of 1983 and 1987. I will quote from the Wikipedia entry:

“The Alliance did well in the 1983 general election, winning 25% of the national vote, close behind Labour’s 28%. Because of the British “first-past-the-post” electoral system, only 23 Alliance MPs were elected.”

You might detect a pattern there.

Anyway, I will let my dad speak for himself.  He has chosen his own pseudonym.

———————————————————————————————————-

“In the 1966 General Election I failed to get elected to the House of Commons by a margin of considerably less than one thousand votes, running as a Labour candidate under the leadership of Harold Wilson. At the time I was sad about this; though those were the days of Wilson’s ‘White heat of scientific revolution’, I was the only working scientist who came even close to election in that Parliament.

About a year later, I received a letter out of the blue from the former Liberal candidate who had run against me and had gotten around 3,500 votes. He wrote that he thought that he and I were of a single mind about most things, and that he was sorry that by splitting the left-of-centre vote he had facilitated the election of the Conservative candidate.

On Election Day last week I voted tactically in Oxford West and Abingdon for the Liberal Democrat candidate, Dr Evan Harris, who had been a progressive Member of Parliament for our constituency since 1997 and is outstandingly supportive of the scientific community. Dr Harris was beaten by 176 votes after a recount, but there were 5,999 Labour votes in the constituency – 10.6 % of the turnout – and most of them, I feel sure, would have preferred Harris to the Conservative who was elected. Why did not more of them vote tactically, as I did? The answer must be that tribal loyalties run strong. That is fair enough; the result is not democracy by any sensible description, however.

In retrospect I am not sorry that I did not get elected in 1966: I am sure I have been a better scientist than I would ever have been a politician. For Dr Harris, though, and for many like him, the outcome is tragic and undemocratic. I was born in the latter days of the second Labour Government of Ramsay Macdonald – later reviled for leading a governing coalition in the national interest. I shall now probably die under a Tory Prime Minister. It saddens me that in the 80 years in between we have still not mastered the art of democratic electoral compromise that has served our German neighbours so well since 1949.

Nick Clegg and the Liberal Democrats had an historic opportunity early this week. They could have insisted on a free and binding vote in the new House of Commons on an Alternative Vote system for the next General Election as the price of their support for David Cameron’s government. The Liberal Democrat Party owed this opportunity to the country, and especially to their supporters, and Clegg certainly owed it personally to Evan Harris. There is, I believe, now a majority within the 2010 Parliament for this minimal first step in progressive change, as there was among the thinking electors who made up the left-of-centre majority vote on May 6th.

I am now sad that Mr Clegg has dissipated the opportunity. Though he did not actually renege (as Tony Blair did after the 1997 General Election) he has settled for a meaningless commitment to a referendum on electoral reform, with the precise question to be put not specified. It is a certainty that the Tories will fight furiously against this reform: time and again we have seen how ‘First Past the Post’ fosters their cause. It is the politicians, though, and not the populace, who must sort this matter out. Regrettably, most voters do not understand the subtleties of the system they use already,  so a referendum for change will almost certainly prove abortive.”

Pateraustis

Oxford, 12th May 2010

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PS  from Dr Aust: For those curious as to what the coalition parties actually agreed on electoral reform, here is the actual text:

“The parties will bring forward a Referendum Bill on electoral reform, which includes provision for the introduction of the Alternative Vote in the event of a positive result in the referendum, as well as for the creation of fewer and more equal sized constituencies. Both parties will whip their Parliamentary Parties in both Houses to support a simple majority referendum on the Alternative Vote, without prejudice to the positions parties will take during such a referendum.”

(Italics mine)

———————————————————————————————————-

PPS An interesting game for conoisseurs of British political “third party” trivia is to spot the former SDP members in the current cabinet. Interestingly, they are by no means all to be found among the Lib Dems. As best I can tell, the list is as follows (Cabinet Ministers in bold):

Ex-SDP Tories:

Andrew Lansley (Sec State, Health), Greg Clark (Minister, Decentralisation), Chris Grayling (Minister at Dept of Work & Pensions), Stephen O’Brien (Minister at Dept for Int’l Development).

And ex-SDP Lib Dems:

Vince Cable (Sec State, Business), Chris Huhne (Sec State, Energy & Climate Change), (Lord) Tom McNally (Minister of State, Ministry of Justice) Paul Burstow (Minister at Dept of Health)

More Twisted Führer Mash-Up Fun: Today Homeopathy, Tomorrow…

January 11, 2010

In which Dr Aust hails the work of the polymath Dr DeeTee

Dr Aust often wishes he could do several things at once. Sadly, experience has shown that he can only manage this by doing everything in an incompetently amateur-ish fashion.

Some other folk, however, manage to do several things with amazing competence, despite one wondering where they find the time and energy. Many of the medical bloggers I have got to know, largely virtually, seem to fall into this category (some examples can be found in the blog sidebar on the main page).

“DeeTee” (or just “dt”) is the “nom de blog” of a hospital consultant in infectious diseases in the UK. After many years as a regular on the Bad Science Forums, and sterling work defending vaccination in the thankless and invariably nutter-rich surroundings of the Guardian’s Comment is Free discussion threads (like this one), he is now to be found blogging from time to time over at The Lay Scientist.

However, he has also found the time, perhaps amid the Christmas and New Year lull in the swine flu cases (?) to devise a new Führer-Mash-Up. This was originally linked from the previous Mash-Up thread about Chiropractic, but clearly deserves a post of its own.

In this one the Führer is in a distressed state because he cannot get his homeopathic sugar pills.

Enjoy!

(To which the appropriate response is “Zu Befehl!” Heel-clicking optional)

Beware: strong language. Make sure you have captions turned on (arrow in bottom right corner of the video)

Notes:

1. If you think the homeopathic remedy “Berlin Wall 30cthat the Führer refers to in the video is a joke, then you are insufficiently familiar with the loonier fringes of homopathy – or, in other words, with homeopathy. The remedy does exist: you can buy it from Helios homeopathic pharmacy here, while for more about it, and a fascinating insight into the way homeopaths think (!), try here or here. Please, though, do not visit these latter pages if under the influence of any mind-altering substances, as a Psychic Embolism might ensue. Or you might die laughing.

2. The Bristol study is the notorious survey-masquerading-as-a-clinical-study also sometimes referred to as “the Spence et al. study.” The full reference is:

David S. Spence, Elizabeth A. Thompson, S.J. Barron. “Homeopathic Treatment for Chronic Disease: A 6-Year, University-Hospital Outpatient Observational Study” Journal of Alternative and Complementary Medicine. October 2005, 11(5): 793-798. doi:10.1089/acm.2005.11.793.

The “study” is distinguished (if that is the word) by having no control group, and by being about as utterly useless as a purported piece of science as is possible. David Colquhoun gives it a quick fisking here.

Notwithstanding its utter feebleness, the Spence et al study is routinely cited by homeopaths as “compelling evidence that homeopathy is a valuable intervention”, or some variant thereof. I seem to remember that when Dr Peter Fisher, the Queen’s homeopathic doctor, debated Ben Goldacre some years ago (video here), he showed at least one slide summarizing the results of the Spence et al. paper. One should also note the journal in which the study appeared, that legendarily credulous house organ of Unreality the  Journal of  Alternative and Complementary Medicine .

3. The question of Hitler’s possible medical conditions has its own fascinating Wikipedia entry, which includes some history of the discussion over whether Der Führer might have had syphilis. One of the arguments against his having the disease (and particularly its tertiary manifestations) is that a reasonably effective treatment for syphilis was available at the time; the arsenical drug Salvarsan (arsphenamine), discovered in Germany in 1908 by Sahachiro Hata and Paul Ehrlich.

4. The reference to “Quantum entanglement” will be instantly recognisable as indicating the Führer’s was aware of the seminal work of noted Quantum Homeopathic Unreality guru, Dr Lionel Milgrom. Some viewers may object that the Führer could not possibly be aware of Milgrom’s work, which has largely been published in last decade. However, in the Quantum Unreality Many-Unreal-Worlds Hypothesis, all states of time co-exist simultaneously in one of the infinite number of possible realities. So there. And if you don’t believe me, it’s in Michael Crichton’s novel Timeline, so it must be true.

5. The Fuhrer makes reference in the video to the German pharmaceutical companies Merck and Bayer. Both companies were around in the Nazi era, though Bayer was then subsumed into the notorious chemical conglomerate IG Farben. The German pharmaceutical and chemical industry, and particularly IG Farben, was intimately involved with the Nazi regime, as you can read in the company’s Wikipedia entry. This involvement is something that Herr Dr Med Matthias Rath makes much use of in his regular schtick that one might paraphrase as “Mass murderers of Big Pharma, then and now”. Less bonkers readers might feel that drawing comparisons between IG Farben’s use of slave labour and manufacture of Zyklon B, and the current manufacture and use of antiretroviral drugs to treat HIV, is the purest insane nonsense.

6. There is actually a fascinating history of homeopathy, and alternative medicine generally, connected with the Third Reich. I may add something about this later as I have time. Alternatively, you can find bits about it in many places around the Internet. Homeopathy was well-established in Germany in the 1930s, as were various other alternative therapies.  Among the senior Nazis there was a fair bit of enthusiasm for anything that could be identified as being a “folk” (völkisch) practice. The senior Nazi most renowned for his enthusiasm for homeopathy was Hitler’s deputy Rudolf Hess, later the prisoner of Spandau.

And since we’re doing homeopathy on video…

And finally, since we are celebrating homeopathy in cinematic form, I couldn’t resist finishing by adding yet another bit of Youtube magic, in this case the marvellous Mitchell and Webb “Homeopathic A&E” sketch. Even if you’ve seen it (and I’m sure most of you have) it is still funny on repeat viewing.

A moment’s pause

November 11, 2009

No bad science – just a small bit of family history.

Dr Aust, like many folk of a slightly pessimistic disposition, has to remind himself periodically that he is actually pretty lucky.

One of Dr Aust’s pieces of luck has been to live in an era where major wars have been absent, and compulsory military service ditto.

Dr Aust’s forebears were not so lucky. Or perhaps they were lucky in different ways, since both Dr Aust’s grandfathers survived military service and war, one in the Great War and the other in World War Two.

Dr Aust never met his paternal grandfather, who died a few years before Dr Aust was born, and who many years earlier in 1917 had fought at Passchendaele (the Third Battle of Ypres).  All that Dr Aust knows of his paternal grandad comes from Dr Aust’s father – himself later a national service conscript officer, though spared war service by the luck of being in a branch of the army (the engineers) who were not much in demand for the Korean War.

According to Dr Aust’s dad, the old man attributed his surviving WW1 to two things: first, being a decent shot with a Lewis gun (which meant that as a gunner he was always a fair few yards back from the advancing front line of his infantry platoon); and second, Bartonella quintana, (better known as trench fever), which got him “invalided out” of the line.

When I read the obituaries this Summer for Harry Patch, the last surviving British infantry soldier of WW1, I found that Patch had been a Lewis gunner at Passchendaele too, losing all the other members of his gun crew on one single day in September 1917. Dr Aust’s paternal grandfather, like so many others, lost his best friend, but at least he had the good fortune to make it home to his family.

Dr Aust’s maternal grandfather, the man I used to call Grandad when I was a kid, was the only professional soldier in the family, joining the army in the late 1930s and eventually rising to the rank of RSM (regimental sergeant major). He served through the WW2 North African campaign, and then in Burma, and after the war in the closing days of British India.

I was reminded of my maternal Grandad  a few months ago by a nice post of Dr Grumble’s which you can read here.

According to my mother, Grandad never spoke a word about the war to anyone in the family. Not a word in thirty years. I didn’t know until very recently that on the day before he died he made an exception, though probably an involuntary one. Having been hospitalised by the first stroke of a series that would quickly kill him, he suddenly wanted to tell his wife (my maternal grandmother) and his daughter (my mother) about the war. The memories had been buried deep for three decades or more, but not gone. I was reminded of something I read earlier this year about Britain’s last surviving veteran of the Western Front, Henry Allingham:

In November [2008], [Henry Allingham] took part in ceremonies to mark the 90th anniversary of the end of WWI.

Speaking before events began, Mr Allingham said he couldn’t forget the war even if he wanted to.

“I saw too many things I would like to forget but I never will forget them, I never can forget them,” he said.

Both Patch and Allingham long refused to talk about the war, but changed their minds late on in their lives, feeling that the memory of their lost friends, and the terrible cost of war, meant their recollections ought to be heard, especially by the young. I wonder sometimes whether Dr Aust’s grandparents would have felt the same if they had lived into their 80s or 90s. Anyway, read Dr Grumble’s post and see if you can work out why it brought back memories of his Grandad for Dr Aust.

Or read the obituaries for Henry Allingham here, and Harry Patch here and here.

And see why Dr Aust will be observing two minutes silence at 11 o’clock on the 11th.

Which brings me to something else. My Grandad, who liked to kick a football around with my brother and me, would put his medal ribbons on for Remembrance Day, but the only military badge he habitually wore was a rather odd one which he had on one of his overcoats, and which looked like this.

chindits-badge

Now I was curious, as children are, about Grandad’s badge, so I asked him what it was.  And he told me the name of the unit that wore the badge, and that his comrades had been “very brave men”.  So perhaps “never said a word” isn’t absolutely true.

Of course, these very brave men were not all stereotypical white Anglo-Saxon Protestants. Grandad himself was a Catholic Irishman, and many of the men he would have served with would have been Indian army troops, or Gurkhas. The expeditions included Burmese regiments, and West African soldiers too. Nothing new there for the British army, actually. When I was hunting about on Wikipedia and Youtube, I found that Indian Army professional soldiers were serving on the Western Front in 1914 at the first Battle of Ypres.

Which somehow reminded me of a bunch of people who have recently been trying to wrap themselves in the British flag, and the symbolism of Britain’s military history, including the World Wars. You can probably guess who I’m thinking of.

As an antidote to their opportunism and unpleasant message, you could try this, or this. Or possibly even this. And there is plenty more on Youtube for those with a taste for history.

Anyway, tomorrow at 11 I will be stopping to think of my two grandfathers – the one I knew and the one I didn’t. And also to spare a thought for all the others – whatever their race and nationality – who served, and especially those who weren’t as fortunate. And for the people they were connected to.

And I’ll try and remind myself, again, that I’m actually pretty lucky.


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