Goosebumps from Skin at Wellcome

Human Skin. Credit: Ivor Mason, KCL. Wellcome Images

I finally got round to seeing the Skin exhibition at the Wellcome Collection, which runs until the end of the month. It may have been a mistake to see it at lunchtime, though – at least before I’d eaten.

I’m not particularly squeamish, but there is something about skin – especially detached from it’s living, breathing embodiment – that prompts discomfort, unease, even disgust.

The exhibition opens with a startling, larger-than-life photograph of a woman’s back, zipped down the spine with surgical stitching (Every One No. 14, by Sophie Ristelheuber). Frustratingly, there’s no explanation, although one assumes its an operation scar. But the black and white image is arresting, alarming even, suggesting  that the skin could be unzipped like a costume. It’s a thought that recurs through the exhibition.

Warning: loneliness may seriously damage your health

Tea for one

Of all the health stories I’ve written recently, one has stuck in my mind. It’s a thorough review of all the good-quality research there’s been into social connections and lifespan.

It’s more than 20 years since a study first found that, taking other factors into account, people who were socially isolated were more likely to die during the next few years than people who had plenty of social connections. And not from suicide, but from all types of causes.

The latest review shows that people who are socially isolated (measured by a range of factors, including living alone, taking part in social or sporting activities, and having close friends or confidants) are actually twice as likely to die over any given time period.

That’s a huge increase in risk, comparable those well-known health risks, smoking, obesity and alcoholism. Yet isolation, or its better-known cousin loneliness, are rarely taken seriously as health risks that can be addressed.

Most of us go through periods of loneliness in our lives, although it seems almost taboo to admit to it.  It’s a stigma, a sign of not belonging. Think of the classic description of the neighbourhood oddball who suddenly commits a horrible crime.  ’He was a bit of a loner,’ people say, ‘he kept himself to himself’.

I’m not planning on any horrible crimes, but I’ve certainly felt lonely at times in my life. Moving to a new town for a new job, where I found it hard to fit into the office clique, was one low point. I’d have given anything for someone to go for a drink with at the end of a difficult day – yet I’d have died rather than tell my colleagues how lonely I was.

And I was lucky, with sympathetic friends and family at the end of a telephone line. I dread to think how it must feel if this is your whole life.

So, although the study is startling in its conclusions, I’m not actually that surprised. Protracted periods of loneliness or isolation seem to sap the will to get on with life, to eat well and exercise, keep off the booze and cigarettes. It may be that illness itself is socially isolating (although the studies were in healthy people) or it may be that our social lives encourage healthy behaviour. It may just be that we deal better with the stresses and strains of life if we have the support of others.

Whatever the cause, keeping up friendships and getting involved with life is clearly the key. The research backs a cheering recent study that found people’s happiness in retirement was most closely related to their levels of social activity and numbers of friends. As one of the researchers was quoted as saying, people simply need to be surrounded by people, as fish are by water. We may not notice when all is going well, but we certainly do notice when they’re gone.

The risky business of life and death

Weighing it up

Calculating the probability of something happening – good or bad – is a task we all do hundreds of times a day. Is the road clear enough to cross? If I have another cup of tea, will I miss my train? Do I need an umbrella today, or sunglasses (or both)?

Mostly, we do it without a second thought. We take data – how long it takes to walk to the train station, the weather forecast – and make our decisions. But for some big decisions, the data is simply missing.

Two stories I wrote this week illustrate this. The first was about IVF. Success rates are something in the region of 1 in 5 for the first round of treatment. It’s an expensive and demanding business, both emotionally and physically. So if you are among the 4 in 5 couples who don’t have a baby first time, what are your chances of succeeding in a second round?

Until recently, you’d have little firm data to go on.

Lie-in for better teen health

Strange how things change. I naturally wake at around 6am these days, and enjoy getting into work early for an hour or so of quiet work before the hurly-burly begins.

But I can still just about remember my teenage years, when dragging myself from sleep and through the motions of getting dressed in time for the 8am bus was a miserable struggle with a head full of fuzz. Then, come the weekend, I’d pull the duvet over my head until midday at the earliest, no matter how sunny and bright the day, much to the disgust of my parents.

I was fascinated to learn that the teen shift to night-time waking and day-time sleeping has a physiological basis. Natural sleep onset shifts by about 2 hours, compared with ‘middle’ childhood, so that the onset of puberty means children who previously got sleepy at 8pm or 9pm can’t even think about sleep until 11pm. However, they still need around 9 hours of sleep, hence the difficulty with waking at 6 or 7am.

But long-term lack of sleep causes more than grumpiness in teenagers. There’s a growing body of research showing that lack of sleep links with health conditions like obesity and depression. And if our 15-year-olds are all dozing through class, what effect does that have on their learning?

So the story I wrote last week, about shifting school start times forward by half an hour, added to a growing heap of evidence. After 3 months of the later start time (8.30 compared to 8am), the adolescents taking part were happier, less likely to fall asleep in class, felt more energetic and were more likely to take part in after-school activities.

The study wasn’t perfect. It didn’t monitor school achievement, for example, and indeed there’s little consistent evidence that later school hours has any effect on grades. Also, there’s a limit to how much you can generalise to the majority of schoolkids, from a study of rich white children at a private Rhode Island boarding school.

But of all the things that feed into how we set school hours – parental convenience, road congestion, tradition – surely children’s health and happiness should be somewhere on the list?

Nanny NICE?

I’m a big fan of the work of the National Institute for Health and Clinical Excellence. Someone has to make the hard decisions about which treatments are sufficiently cost-effective to provide on the NHS. I’m glad the decisions are, by and large, made by committees of experts, after careful appraisal of the evidence.

You can hear the ‘but’ hanging in the air. A series of pronouncements in recent weeks has started the alarm bells ringing.

First up, a minimum price for alcohol, as part of a guideline to prevent hazardous and harmful drinking. Hmm, maybe. There’s evidence it would cut the amount the nation drinks at a population level, but it could be a pretty blunt tool to cut the amount imbibed by problem drinkers.

Next, pronouncements about how much salt and saturated fat we eat (too much, predictably). This guideline (on the prevention of cardiovascular disease) ranged widely in its recommendations, taking in the banning of takeaway outlets near schools, food labelling and advertising, catering guidelines for the public sector, and increasing physical activity. 

I began to be suspicious when I read the blithe announcement in the press release that ‘most consumers don’t even notice any difference in taste’ when salt is reduced. Hmm, then why do food companies use so much of it? And why does a GP friend hate telling people to switch to a low-salt diet, ‘because it makes them so bloody miserable.’

But the one that had me muttering into my (salt-free) porridge this morning was the recommendation (part of the guideline on quitting smoking in pregancy and after childbirth) that midwives should administer a carbon monoxide test to all pregnant women, to see whether they smoked or not.

Quacks, cures and the evidence

A medical practitioner administers leeches Credit: Wellcome Library, London.

One of the joys of the Wellcome Collection is the elan with which they throw together fun, silliness and high calibre intellectual entertainment, all in the same event.

Friday evening’s Quacks and Cures event was a good example. We met friends in the foyer, had a beer and a bite to eat at the cafe, listening to live music. Then we headed off to explore three floors of medical mystery.

We encountered live leeches in the exhibition hall, where we watched tiny comma-shaped leeches being hatched from their cocoons. We were invited to handle some meatier specimens, which we’re reliably informed are used as a handy form of anticoagulation in some hospitals, for example to keep blood vessels open when doctors want to reattach the end of a severed finger.

In the library, we were accosted by a couple of rather scary nurses, who ushered us in to watch a panel of doctors in the reading room, offering diagnoses from the 18th, 19th and 20th centuries based on visitors’ symptoms.

Upstairs, we lounged in the comfy seats to watch hilarious public information films from the 1960s and 1970s. I don’t think you’d get away with some of them nowadays, especially the somewhat forthright approach to childhood obesity.

Boost sex life forty percent in 5 minutes!

No, I haven’t started a side-line in selling  ’herbal viagra’. But I’ve written a sad little story that I would like to personally recount to every doctor who’s ever discharged anyone from hospital after a heart attack.

Having a heart attack is a huge shock and people take a while to get back to normal. For many people, ‘normal’ includes having sex, and quite right too. But studies show that less than half of women have restarted their sex life, a year after a heart attack. That compares to almost 70 percent of men.

Why? Of course, it may be personal choice, or changed personal circumstances. But a lot of people worry hugely about having sex after a heart attack.

Who’s mapping who? Magnificent Maps at the British Library

Diogo Homem, A Chart of the Mediterranean Sea, 1570 (British Library)

Maps stir up surprisingly strong emotions. That was my first thought, observing the suppressed, slightly obsessive air of excitement among the visitors to the British Library’s sumptous Magnificent Maps exhibition.

There’s the thrill of excitement when you grasp a familiar shape or recognise a place name that means something to you.

I found myself glued to a 17th century map of London, tracing familiar streets (Great Russell Street at the top, Tooley Street at the bottom, Fetter Lane in the centre) and marvelling at the changes (everything outside my Bloomsbury office window was once fields). This particular map was made in 1682, just 16 years after the Great Fire of London, while the city was in the process of being remade. Fascinatingly, it includes a representation of St Paul’s Cathedral quite unlike the version finally built. Clearly, they were expecting a dome, but beyond that the plans changed substantially between this representation and the finished product.

Then there’s the frustration when you simply can’t orientate yourself on a map – for example, the baffling medieval Mappa Mundi, with their monsters, devils, creative geography and mysterious Christian iconography.

When is a doorway not a doorway?

When your brain thinks it may be a brick wall.

Freezing of gait (FOG) is one of the most frustrating symptoms of Parkinson’s disease. Imagine finding you are suddenly unable to continue walking, or to begin walking, when you want to. To add insult to injury, it tends to happen when you’re under stress – running late, trying to get onto a train or into an escalator packed with other people. It sounds horribly similar to one of my recurrent nightmares (I’m late for something vital, on the platform, train about to leave, laden with luggage, legs refusing to move. Welcome to my world…).

Not everyone with Parkinson’s gets FOG, and the usual medication (variations on dopamine agonists) don’t help much. Why it happens is a bit of a mystery. The standard explanation was that dopamine deficiency stops messages from the brain (telling the leg muscles to get on with it) from getting down the nerves to where they’re needed. But more recent research has questioned whether that’s the only thing happening.

Feeding time at the Old Bailey

I took part in a little-known, rather extraordinary daily ritual yesterday. Every day when the Old Bailey is in session, the judges arrive at the chambers of the Sheriff of London for lunch. Assembled to meet them, rather charmingly, are a selection of guests chosen, presumably, for their potential to make diverting, non-judicial conversation.

The current Sheriff, Peter Cook, is an old friend of the family, which is how I found myself sipping champagne with men dressed in ermine robes, on the hottest day of the year. One of my fellow-guests was the actor John Hurt. The previous day had featured stars of the Royal Opera. I hope my lunch companions weren’t disappointed with a mere medical writer - they were certainly too charming to say so.

The whole thing is extraordinarily well-choreographed. At 12:30pm, guests arrive for drinks. The judges arrive about 12.45pm, and we sit down to dinner at 1pm sharp. Somehow, three courses including cheese and coffee are consumed before everyone gets up at 2pm to return to work.

The judges wear their wigs and gowns, and conversation stays mainly away from shop (although I heard one or two snippets about a most notorious current case). I learned exactly who can afford to live in the glorious big houses opposite the Dulwich Picture Gallery (Old Bailey judges) and why its a good idea for a judge to become a season-ticket holder for their local football club.

I may be giving away too many legal secrets already, so I’d better stop before I end up on the wrong side of the Old Bailey’s hospitality. It was a fascinating glimpse into a side of London life that I never knew existed. Many thanks to Peter Cook for letting me in (and out again).