At Peace

My Lifetime Stories in blog

Sunday, July 30, 2017

Bread & Butter

After 7 years or so, i got to taste the toasted bread with butter and sugar again. I forgot how yummy it tastes like.
There was one particular house I remember well - Masri, Isma, Joe and Payen, they thought me that a welcoming house is truly a house that is available 24/7 for u - for a game of pro evo or two (or probably 100s), a constant supply of never-ending nasi and lauk, britney spears and boybands (that's probably only for Masri), and most importantly, how to enjoy a simple food like a toasted bread with butter and sugar.
I'll forever be greatful, and I may not know where some of you have been or how life has been treating you now, but I hope that we'll be able to enjoy a good bread, butter and sugar again in Jannah.

Sunday, July 02, 2017

Superstition in Medicine

It is a universal phenomenon that many people believe in or perform certain rituals that give them extra confidence in doing certain things. Scientifically, at least from the viewpoint of direct evidence, none is logical. In Ireland,often we hear people said and do - 'fingers crossed' or 'touch wood', when they hope for good luck. In Malaysia as well, we hear certain things being practiced, like - wearing red during on-call time will make you super busy (include anything red at all), cannot jinx things by saying things are awfully quiet as you will be super busy later. And these people who somehow develop this bad luck will be called 'Jonah'.
I probably would never know how the superstitious came into being - especially wearing red during call. Wikipedia mentioned 'crossed fingers' can be traced back to the early centuries of Christianity when some of them crossed their fingers as a sign of invoking power associated with Christ's cross for protection. It was also a secret sign when they were prosecuted by the Romans.
'Touch wood' originates from pagan belief that many spirits inhabited wood, trees, rivers etc. Or some believes it means the cross of Christ. So, by touching/knocking on wood, it's kinda of letting them know seek their blessing, or some people said, it is to mask the spirits' hearing from knowing, hence warding off the evil.
And there are many more interesting origin of many beliefs (superstitous or not), like number 13 etc.

SUPERSTITION AND BENEFIT
Do I believe in superstition? Previously, I tend to answer No, as it makes no sense. But to think about it, it really depends on the definition. Prayers can be considered by some as superstition, as there is no direct physical evidence that it may help. But I still do it as I do believe it can make a difference. Then it hit me, that things I believe in may not be shared by others - and I am in no position to judge, except for stating what I believe and what make sense to me.
Scientifically, studies have been performed to see if certain rituals improve performance. Consistently, it seems that certain rituals like crossing your fingers improve performance!! (Damisch L et al, 2010). Now, they did not say that the actual act of crossing your fingers made that different, but they talked about how it increases your confidence by changes in perceived self-efficacy. It was described like a 'boost'. It buffers against uncertainty and anxiety.
While I can say I understand if people continue to want to 'cross their fingers', (though I think from Islamic point of view, it is problematic) - I cannot understand this 'wearing red' thingy. I was told that certain doctors were asked to change their clothes if they go on-call wearing red!
Searching for evidence of whether wearing red may affect on your busy schedule failed to reveal satisfying evidence. Interestingly, some studies (though not consistent) suggested that women tend to wear red during ovulatory phase. They relate this finding to the natural changes that happens (like more attractive voices, faces and odour etc) to attract the opposite gender (Blake KR, 2017). But still, even if we agree with this finding, still it did not explain why men who wear red still attract patients (if you believe so)? In fact, men wearing red were viewed as aggressive (and may hinder patients)!
Another way to explain this phenomena is through cognitive bias. We have the natural ability to connect the dots, even when there is no real line there. The mother of all cognitive bias states that we, as human, tend to highlight the thing that conforms to our belief, and suppress things that don't. So, just may be, because of all this notion of wearing red makes you busy, we tend to remember the times when we are super busy while wearing red, but forgot the times we were super busy wearing other colours. Even if we tried once wearing red in order to shatter the superstition and we got really busy, that is still questionable finding, as being busy is subjective. We are the one wearing red and we analyse the finding? I sense some definitive bias there. Plus, the night can either be busy or not busy - so 50-50. I remember reading a study on this issue, but I failed to find it again. It must have been from Malaysia, as no other country seems to have similar belief.

JONAH
Personally, I dislike calling people Jonah. It may have become a term with no real meaning, but it originates from prophet 'Yunus'. Both scriptures (Bible & Quran) mentioned prophet Yunus/Jonah as a prophet who was sent to his people and he fled due to difficulty before Allah permits him to do so. While on the boat, they cast lots and he was condemned. Then he was swallowed by fish. From him, the Muslims learnt one of the most beautiful prayer that we recite during distress - Surah al-Anbiya 21:87
"... he cried through the depth of darkness, (saying): "There is no God but You, Glorified be to You! Truly I have been of the wrongdoers."
Hence, it gives me a bit of a jolt, when a prophet of God is being used to label a person with bad luck, in a joking/derogatory manner. We may still use it, but perhaps in an optimistic way, like "Don't worry, things will be better. Just like Jonah/Yunus." (Smiley face)
At the end, we decide what we want to believe. Some may be harmless, others may not.

Placebo Effect

One good thing being here is that, any talk that you listen to, most probably is being given by the world leader of such topic. Recently, I listen to a short talk on Placebo effect by Dr Ted Kaptchuk. He participated in a lot of interesting and 'weird' trials and also an expert in understanding traditional chinese medicine, especially in acupuncture.
Placebo is usually defined as a tablet that has no effect, given in a trial that mimic the investigated drug, in order to make the patients feel that they are not being left out. Not using placebo in studies opens up to a lot of potential biases, which may render the result not applicable to the general masses.
His understanding of placebo is slightly different. He believes that so-called inert tablet DO have effect. He proved this by showing few publications that compared active treatment, sham treatment and no treatment. In one elegant study on asthmatic patients, patients who has exacerbation of asthma were treated either with b2 agonist (proper treatment) or 'faked' B2 agonist or 'faked' acupuncture procedure or no treatment (literally just observation). From objective improvement of FEV1 viewpoint, only those patients treated with B2 agonist improved. But from symptoms/subjective improvement, all patients improve except for those who did not receive any treatment at all. (Wechsler, NEJM 2011)
In another example, he mentioned that patients who were given morphine by nurses 'face-to-face' has much more improvement in pain symptoms compared to those who were given in 'secrecy'.
Recent study using functional MRI suggested that genuine acupuncture and sham acupuncture triggered different region in the brain, but subsequently leads to symptoms improvement.
He is also actively doing study using 'augmented placebo' to see if irritable bowel syndrome can be improved. He believes that the effect of placebo is real, and partly can be explained by that interaction that medical practitioner has with patients - something that he called 'augmented' placebo in his trials.
How is this going to help me? Previously, there was some ethical dilemma (for me) in terms of prescribing certain medications like vitamins to patients in certain situations that I know there may not be much of benefit, but unlikely to cause harm either. Now, with this possible placebo effect in mind, it can actually make some difference.