Genetic Medicine (pharmacogenomics)

by Evan in General Health

It seems that a day barely passes without the promise of genetic medicine being promoted. All this promotion has the effect of making me sceptical.

I wondered if I was just being cynical. Then I realised I had a friend who I could ask. My friend is David Wyatt who started one of the early bio-tech companies in Australia. Since then he has been involved in lecturing at university and various other start up ventures. David is fairly ‘green’ in his approach to life. He has been a candidate for the Australian Greens and also has a quite ecological understanding of life in general. In short he is knowledgeable but not just a booster for the industry. David is of course a very busy person. I sent an email asking him what his thoughts on the promise of genetic medicine were and he kindly replied with this email. I hope you find it informative.

I’m really stretched for time (& will be for a few months I expect) so I’ll quickly kick off some thoughts on this. It is an interesting question.

Human Genomics is a relatively new field that evolved out of the human genome project (HUGO). The idea of individualized therapy matched to an individuals genes is called pharmacogenomics.

The computational demands of the genetic analysis is so great that it resulted in an alliance between the IT industry and genomics and really stretched the IT industry….supercomputers etc. I was hired as a consultant by the Aus Govt a few years back to facilitate a joint biotech Science project between Australia and France. When I visited France I was struck by the extent that the big national genomics centers were dominated by computers. I became involved in similar bioinformatics projects in Australia.

I’m no longer up to date on this fast moving field and am a little skeptical.

The very nature of Big Pharma/capitalism will tend to ensure that these developments are only available to wealthy people. Unless there are major technological breakthroughs (which are possible), the cost of individualizing treatment genomically is likely to be very high initially. In theory, pharmacogenomics is meant to ensure that a therapy (usually drug) works well without any side effects and hence there would be no need to perform the large scale clinical trials. Clinical trials on large populations often fail as drugs work well on some individuals while causing major side effects on others. This could well have a genetic basis.

Already many old drugs that failed clinical trials have been resurrected and are being looked at again under pharmacogenomics.

As is often the case, initial promise of pharmacogenomics seems disappointing and may take a long time.

If the combination of genomics, IT and pharmacology is as powerful as hoped, it might be possible for the cost of such individual treatment to drop sharply over time. Initially only the wealthy would be treated and the diffusion to the masses uncertain. Without mass markets it might not even be affordable/viable for the wealthy.

If you have any thoughts on genetic medicine please let me know in the comments. Favourable, against and all points in between are welcome.

How to Respond to Frustration

by Evan in Psychological Health

Late last week the ADSL account I was using was cancelled. Since then I have been using dial-up. And it is S-L-O-W, I mean mind-numblingly, boringly, tediously SSSSLLLLOOOOWWWW.

This turn of events did not make me happy (you picked that up, no?). After a couple of days the penny dropped and I realised how frustrated I was.

At which point I started thinking about it. I realised that I still had an internet connection – I could still post to my blog, I wouldn’t just be taken down without people knowing what happened (this was done to me recently by the people who host my blog – what a 24 hours that was!). In short things weren’t great, but they could certainly be worse.

And there was other stuff that I could be doing. My whole life isn’t tied to online – even writing that I publish online can be written off line.

So I thought this was a good opportunity to write about what to do with frustration.

Fritz Perls: Frustration is the difference between here and there.

In other words our frustration is about desire. If we are content with what we have and where we are then we aren’t frustrated.

This insight leads to the advice: let go. With no expectations or desires we won’t be frustrated.

This is undoubtedly the case, but I’m not sure it’s desirable. Is it really desirable to shrug our shoulders at the appalling suffering in some parts of the world? To simply instruct those starving to death that they shouldn’t desire food? This advice can quickly become an excuse for callous indifference. (I don’t mean that this is the intention of those offering it.)

Compassion means some kind of desire to alleviate suffering. To remedy the distance between here and there. (This is quite different to the desire to my every whim met (and RIGHT NOW, dammit!) but desire and frustration still seem to me to be part of the story.

There is also the opposite approach to frustration. This approach thinks that, frustration is what life is about. You should desire things as intensely as possible – and direct all your attention to getting what you want. In this way of thinking people are little more than collections of desires dedicated to satisfying their longings. This way of doing things, in one sense, wants us as frustrated as it is possible to be.

This can be awfully crass – usually the desire seems to be as much money as possible. However there is no reason why it shouldn’t apply to other desires – even self-realisation or enlightenment.

The big problem I have with this way of thinking is that the intensity of desire is sometimes thought to do something on its own. It seems to me that usually our desire needs to lead to action, if we are to become satisfied.

Another problem is that it can be awfully self-interested, there is usually no room for intimacy.

There is another approach to frustration. To see that it is a kind of information. If we are frustrated, then we want something. It may well be worth knowing what that is.

A simple example is when we have something like a maths problem to solve. We know what we want (the answer) and know – if it has been done properly – that we should have enough information to figure it out. (Usually this is some kind of guessing game – what information has been left out. I have my doubts about this kind of guessing game, but that’s the subject of another post.) Usually the trick is to find out what type of problem it is and apply the standard procedures for this kind of problem. This means looking at the information given, trying out different things, finding the one that fits, applying the procedure, and obtaining the result. We are satisfied.

We categorise the situation (as the kind of problem it is) and then apply the standard procedure. This can be applied to relationship difficulties, building a popular blog, building a house . . . the possibilities are almost infinite.

In the world of human relationships this can be a good deal more complicated. We may realise that what we want is physical touch. We can get this through a massage, shaking hands, exchanging hugs and so on. We can try out all of these and find which is most satisfying.

We then have more information about what we want. A handshake may be all we want, or we may find that we long to be closer to people. In which case this might mean developing conversational and listening skills.

This approach of classifying the desire and finding a standard way of meeting it (eg. if we’re hungry making lunch) can work very well for most things.

The problem is when we want something new. We sense that we want something more or different to what we have. We can even have the sense that we will know it when we find out but can’t say what it is yet.

In this situation there are at least a couple of things we can do.

One is to try out different things, and then reflect on whether there were some that were more satisfying than others. If so, then we may at least have a sense of where to do more things.

We can also try out imagining what it is that would be ideal. We can imagine a perfect day (or week or year). One where we don’t have this frustration. We can then compare how this is different to our current situation. This may give us a clue to what the frustration is.

In summary my way of dealing with frustration is:
Let the frustration tell you what the need is.
Follow a standard approach for meeting this need.
If this isn’t possible: try out lots of different things and reflect on which of them is more satisfying.
Or, try imagining a life without the frustration.

And yet, there are some frustrations that seem constant. If we wish to end hunger in the world we are going to be frustrated (at least for the forseeable future, so far as I can tell) and this means to some extent embracing some suffering. I think that all we can do is be clear about this choice.

For me the resolution is to do what I can and find a way to rest content with this. Others, who are willing to embrace more suffering than me, may well see this as callousness on my part.
In this situation there is little we can do except find ways to be kind to ourselves while doing what we can (punishing ourselves when we have done what we can seems counter-productive to me).

One qualification. Some things that seem hopeless may not be. Ending world hunger is one thing, me finding a job I like is something else. They may both feel equally difficult to me (finding the job may even feel more difficult). But they probably aren’t (most of the time, for most of us, anyway). So the important qualification I think is: we don’t know for sure. So, we can adopt an exploratory, experimental attitude.

How big a part of your life is frustration? What ways do you have of responding to it. Let me know in the comments.

Authentic Blogging - A Great Post

by Evan in Uncategorized

Just a quick note to point you to a great post by Maria at Neverthesamerivertwice, who has done a guest post for me.

She has done a great post about what she wants to do with blogging and how to do blogging in a genuinely worthwhile way. She has called the post Authentic Blogging. A great post on what I think is an important topic.

Defensiveness Can Be Good

by Evan in Psychological Health

[My apologies. I am having internet problems at the moment and am reduced to dial-up. So no photos until I am back to a better connection speed. Evan]

I usually have difficulty when people get defensive. I feel surprised and not sure what to say. I know that I’ve offended or hurt them in some way, but I don’t know how. And it doesn’t usually occur to me at the time to stop and reflect about what we have just been talking about, so that I could figure it out. I just want to make it better and get back to the easy relationship we had only a few seconds before.
This is an uncomfortable place for me – the result being that it is easy for me to judge defensiveness harshly. To see it as a bad thing. (I feel bad so the other person’s behaviour must be bad.)
When I’m the one being defensive it is a different story. Someone has denigrated something important to me or crossed an important boundary. I am hurt and need to defend myself against what I experience as an attack.
This isn’t a nice experience. I feel hurt and so I defend myself. At these times it is easy to see defensiveness as a good thing.
These times of defensiveness are usually difficult for both people involved. So, I’d like to make some suggestions about living more easily with defensiveness.

Remembering when we have become defensive.
Something important was going on. What was the precious thing we felt the need to defend? We may find that this is something really important to us. We may find that we are surprised at what we feel to be important.

Remembering how we have responded to other’s defensiveness.
For me there is usually something like a very mild panic. This doesn’t make it easy to respond well. It is possible to understand our reaction – for me to understand that I feel like a child about to get into trouble. Gradually it is possible to let this childlike part of me know that I will look after them the best I can.

Spending an hour or so remembering these times can help us understand and respond less immediately. When we feel defensive we usually attack. This usually happens automatically.

It seems to me that this being our automatic response can be a problem. We forget that we may have other options – especially when we are responding as a child. This can just lead to difficulties that don’t get resolved, and our relationships suffer.
Having taken time out to reflect it may be possible to experiment with different behaviour.
When we become defensive.
It may be possible, if we can see that we are responding automatically, to do something different. One thing to try is saying why you are upset. You may not want to talk about your emotion but you may be able to identify what the issue is for you. You can disclose the issue without going into any details. In this way you can remain safe but give the other person information about how they have upset. This may help them respond better to you.
Another way is to say that we need time out. We don’t need to give an explanation, we may even offer some kind of apology, and then terminate the conversation for the moment.
If it is a relationship where you feel safe you may want to disclose your hurt feelings. Or you may say that you would like to talk about why you are upset later. If the other person is willing to listen this can help the relationship to deepen.
When someone else is defensive.
It may be possible, if we see we are responding automatically, to try something different. We may even want to try an automatic apology – as a way of giving a little time to think and find a way to address what is going on. (I don’t mean as a way of accepting blame but to convey that we didn’t set out to upse the other person.) An apology can be very disarming.
It is also possible to ask what we have done or said. This may not be easy for the other person to say (or even identify – they may not know why they are upset or what it was that we said or did).
It may be possible to keep listening. To reflect back to the person what they have said.

When we are defensiveness this is good information that something important to us has been violated in some way. When another person is defensive then we know that something important is going on for them. If we can learn to find the time and space to listen to defensiveness there is much valuable information – about ourselves and the others we are engaged with. Learning from our defensiveness we can deepen both our understanding of ourselves and our relationships.

I’ve Done a Guest Post

by Evan in Uncategorized

I’ve just done a guest post on great sex over on Smack Dab in the Middle.

It’s a bit more uncensored than how I write on this blog (I use the eff word for instance). But if you’d like to head over there and have a read please do. My idea is that great sex is about awareness and authenticity. The comments so far have been fun too. Evan

If Cornered - Reflect

by Evan in Relationships, Uncategorized

A couple talking at sunset
Image by Elsie esq.

This is a rule of thumb for counselors - “if all else fails; reflect”. That is if you are getting nowhere trying to help the other person, just let them know that you here what they are saying: reflect back to them what they are saying. The idea is, instead of making suggestions or giving advice to say something like, “So, you’re saying that . . . ” or “If I’m hearing you you’re feeling . . . right now”.

This can be very useful to those of us who aren’t counselors. There was an incident the other day that reminded me about how useful this rule of thumb can be, so I’ll re-tell it for you.

My friend, who we’ll call Ms. A, rang her sister-in-law who is separated from her husband and has the care of their two children, who we’ll call Jack (age 5) and Jill (age 8). The husband is not real supportive and only has the children part of each weekend. After talking to her sister-in-law Ms. A also spoke to the kids. The children had just spent part of the day at their father’s. Jack told Ms A that he didn’t like Daddy and that Daddy was mean. Jack had wanted a ham sandwich for lunch and Daddy had made him have a honey sandwich instead; even though there was ham in the fridge.

Ms A found herself in a difficult position. She didn’t want to buy into an argument. She didn’t want to criticise the father to the children - it wasn’t going to help her sister-in-law. And it wouldn’t help the children’s relationship with their father for Jack to perhaps say to his father, “Well Aunty A says you’re mean too!”.

What Ms A was very clever. She used reflection. She said something like, “Daddy didn’t give you what you wanted and now your sad and upset”. Jack said, “Yes, and . . .”, and talked about how he was feeling. This helped the relationship between Jack and Ms A and avoided her getting caught up in any relationship dramas with Jack’s father.

Reflection is a very useful option to remember in those times where we feel put on the spot. It can not only get us out of feeling cornered, it can do this in a way that moves the relationship deeper.

Are there times when you have used reflection? Are there times when you think it would be useful to use it? Let me know in the comments.

If you liked this post you might also like these posts:
Connecting with the Emotion
How to Listen to Someone

You can sign up for my free email course on health by leaving a comment on this post. The course is called Designing and Long and Healthy Life - it is 12 emails delivered over 6 weeks and covers all aspects of health (the physical, emotional, mental, spiritual and social).

Health is About Choice and Relationships

by Evan in General Health

Just a quick note.

Below is a link to a panel on the social determinants of health. It’s about 50 minutes - audio only so it shouldn’t take too much bandwidth.

The drawback is that the panel contains a couple of politicians. However, it also contains the brilliant Michael Marmot (who in my opinion has revolutionised our understanding of health) and the great David Korten (who is brilliant on the impact our social organisation has on individual’s health). It also has an Aboriginal Australian woman who has worked with Aboriginal people (who have the worst health status in Australia, third world health in a first world country: our treatment of our indigenous people is the great shame of Australia).

[One piece of background information. The Aboriginal woman on the panel helped do a study of the sexual abuse of children in indigenous communities. After this report where the indigenous people willing spoke about this horrendous issue the previous conservative government responded by sending in the troops and taking away many of the basic rights of indigenous people. The newly elected Labor government - the Democrats is the US equivalent - has maintained this policy. If you wanted any more fuel for your disgust and contempt for politicians this is enough.]

It’s a great panel and well worth a listen. Here’s the link.

The Wealth Healthy: Wellbeing’s Social Determinants