On 24 April 2017, the Daily Mail published an article with the title statement “Going to the loo ‘just in case’? Don’t – it could wreck your bladder”. With a daily print circulation of 1.5 million (December 2016) and 100 million unique online visitors per month, the newspaper dispenses alarming and dangerous advice which may encourage people to hold in their urine, thereby risking urinary tract infections and renal impairment.
The article itself, apart from a number of lurid stock photos, is less sensationalist in tone than the headline. However, the focus is so scattershot (bouncing from the volume of urine that a bladder can hold, to a brief differential diagnosis of polyuria, the use of earplugs, men exercising their pelvic floor, and even David Cameron’s Brexit negotiations) that the only “take home message” risks being the first line for the newspaper’s readers. With an average reader age of 58, many of the Daily Mail’s readers will suffer from nocturia and take such advice to heart.
Dismissing tabloid medical journalism as beneath scrutiny is done at our peril, as many patients rely on newspapers to build their knowledge base and engagement can be significantly affected by what is understood to be true. When this message is dangerously incorrect, it should be confronted and disputed.
We don’t need the European Union, the National Health Service, or any other outdated monolithic organisation.
You see, Britain is special, and will ALWAYS remain so. It’s what makes us expats when we move overseas, whereas people who come here are foreigners. The respect that we have means that we will always be lucrative trading partners for Australia, New Zealand, Canada and all our former colonies. If Scotland and Northern Ireland don’t like it, then to hell with them. The union of England and Wales (Wangland) can form strong alliances with our friends overseas and we will once again rule the waves.
Happy Purim to all the Jewish people around the world, celebrating the day that Queen Esther saved the Jewish people by alerting King Xerxes to the Grand Vizier Haman’s evil plot.
Israel’s Prime Minister Benjamin Netanyahu referenced this whilst speaking to schoolchildren earlier this week:
“In Persia, they wanted to kill us but it didn’t work,” Netanyahu said. “Today, too, Persians are trying to destroy us, but today, too, it will not work.”
Bibi has spent much of the last week selling the lie that Iran’s ruler wanted to kill the Jews. Wrong! Haman was NOT the ruler. He was the vizier. He was an adviser. He was this guy:
Netanyahu’s rationale for amending history is logical: A persistent simmering frisson between Iran’s theocratic regime, which does not recognise Israel, and the hawkish Israeli prime minister consolidates the power of both parties. However, in making this statement, Netanyahu is crushing an important shared Jewish and Persian lore which has been mentioned in numerous historical manuscripts and holy books (The Torah, Bible and Quran).
Chief amongst this is Xerxes’ grandfather Cyrus The Great who liberated the Jewish people enslaved in Babylon, and announced an edict for the rebuilding of the Temple of Jerusalem.
This Persian ruler therefore ushered in a new epoch in the history of the Jewish people, culminating in the temple itself being completed during the reign of Darius II four generations later.
The Cyrus Cylinder, kept at the British Museum, describes how Cyrus allowed captives in Babylon to return to their native territories, which earned him an honoured place in the Jewish faith.
How about Xerxes, who was the grandson of Cyrus and the ruler during the events which are now celebrated in Purim? Does marrying a Jewish maiden, listening to her describe Haman’s plans and condemning the vizier to hang for his tricks mean that this was a ruler who wanted to “annihilate the Jews”. How about issuing a decree which authorized all Jews to defend themselves, and appointing Mordechai the first Jewish prime minister of the Persian Empire? These historical facts were, conveniently, rather missing from Netanyahu’s comments.
This contempt towards history is an insult to both Persian and Jewish History, two ancient cultures who have been intertwined for millenia despite the current challenges. This should be a time for celebrating cultures, and the deep bond which was cemented between Persia and the Jews following those events. Bonds which have persisted for many centuries, and still exist to this day, despite the rhetoric from Iran’s leaders, and perhaps the hawkish elements in Israel.
Abdol Hossein Sardari, known as the “Schindler of Iran” is an example. A diplomat who saved thousands of Iranian jews from deportation by the Nazi regime, he then began issuing hundreds of Iranian passports for non-Iranian jews to save them from persecution, dying in poverty two years after the Iranian Revolution in 1981. His actions do not fit into Netanyahu’s narrative either, but he exemplifies the courage and the principles of human rights that Cyrus the Great pronounced 25 centuries earlier.
Published on: https://iranwire.com/en/blogs/693/4344
In this guest blog, Dr Nima Ghadiri describes the harrowing experience of the end-of-life care his grandmother received in an Iranian hospital, and the betrayal of the principles of bioethics, which were first identified many centuries ago by Iranian polymaths, including Avicenna and Razi.
Avicenna (left) and Razi (right), Persian physicians and polymaths who helped define the principles of bioethics, used by healthcare professionals to this day
My beloved grandmother and closest friend Batool Sepassi died in an Iranian Hospital ICU (Intensive Care Unit) following a short illness.
During the course of a viral illness, she became increasingly short of breath and had to be admitted to a local private hospital. She had a chest infection and was taken to the intensive care unit accompanied by close family. At this point the family had separated to go to the payment desk, and my grandmother was taken to ICU, though no medical history was taken nor treatment started until payment was organized (the privilege of private healthcare).
There were some major flaws in treatment. Having been admitted with a chest problem, it took 30 hours for a chest consultant to see my grandmother, though not without a battle — we were told “this patient is not on my list” — and a serviceable X-ray was only taken the following day.
My family was only allowed an hour a day to visit my grandmother, which was extremely hard given that she thrived on closeness to family and friends. My close relatives stayed outside all day the ICU to be able to glance at my grandmother from a distance and hear her calling out for them. This was a traumatic experience, particularly when they heard the expressions “Saaket” or “Khafeh Sho” (“Shut up”) from my grandmother when she was undergoing procedures. My grandmother loved to communicate and form bonds with people, and appreciated having her close ones hold her hand during medical procedures. During all of her stay, her arm was outstretched to hold someone’s hand, but there was no one there and her hands were eventually fastened to the bed.
The course of the disease was unpredictable, and ultimately a poor prognosis was given, i.e. the chances of my grandmother’s survival diminished. During this period, interactions with nurses and doctors were punctuated by disregard and dismissal. For example, when one relative noticed that the nebulisers were inserted in my grandmother’s eyes rather than her nostrils (where they belong), this fact was dismissed with a “oh, her oxygen was high”. There were a few good doctors and nurses, but they were conspicuously outnumbered by the poor ones. When my cousin objected against intubation (insertion of a tube into the lungs) for the last few hours of life, instead of explaining the rationale, the doctor shouted at her “Do you want to kill your grandmother?” It took a lot of pressure to prevent the ICU team from doing a completely needless invasive procedure (kidney dialysis) with just a few hours of life remaining and kidney test results that had been unchanged for years.
Nevertheless, simple measures such as giving my grandmother something to drink were considered a luxury. When my grandmother was deteriorating, no provision was made to allow her to be close to loved ones. She and her family did not want her to be in an intensive care unit, and not only was she kept there against her will during the treatment phase, but she was kept there when she was about to die.
I asked my cousin to connect her to me by video call before her death during the one-hour visiting period. Her eyes were initially closed, but as soon as she heard my voice, they opened wide. Her mouth was entirely bandaged apart from a tube coming out of it, but I could see the outline of her lips moving briskly underneath all the bandages. She wanted to say something, and had never been stopped from talking to me before. She started vigorously shaking her tied arms in an attempt to communicate with me, but then realized her efforts were fruitless and her eyes started welling up with tears. In all my years of knowing her, I don’t remember her crying. She died just over an hour later, curtains drawn and no loved ones around her.
Nothing could have prepared me for this image, which remains traumatically imprinted in my mind. It will be a memory I will never forget. I keep wondering what she wanted to say – was she saying goodbye to me, or asking me to convey a message: to look after my mother, my brother, or help someone desperately in need? Finding the answer to this is a futile quest, but it is a rumination that will, sadly, remain.
Dying alone, with family not allowed to be with her is one thing, but my family were also denied the chance to see her after death. Only after begging were they able to get a brief glimpse of her in the corridor prior to entering the mortuary after challenging the comment, “She’s gone, why don’t you just go now”.
Passing away is an inevitable part of people’s existence, but the environment for this chapter of life is so important. As a doctor who works in the United Kingdom’s National Health Service, I have been well-versed in the importance of dignity in death. But in Iran, a country whose polymaths helped define the early principles of bioethics, it is unfathomable that core bioethical values were denied for such a sweet soul as my grandmother, and potentially for others. These principles include Non-Maleficence — not performing unnecessary procedures that serve just to prolong the patient’s life and often cause distress and pain to the patient — and Autonomy – respect for the desires and values of the patient, including how they want to be treated and how they want to die.
In my grandmother’s case this was with her family around her and without fruitless procedures. Denying someone’s spirit and character so manifestly in their final days and hours is criminal. These sentiments were shared by my family, and indeed being able to spend time with a loved one before and after their death to say goodbye should be a basic right, rather than just being able to observe this sorrowful moment from a distance. It should not be such as Sisyphean effort to spend time with a loved one and find out what happened during a hospital stay, hampered at all stages by a lack of sympathy and empathy alongside a degree of ageism against someone who is perceived as just a bed number rather than a human being.
A photo of Nima Ghadiri’s grandmother holding a pomegranate on Shab-e Yalda (An ancient Persian festival commemorating the Winter Solstice), three weeks before she died
I remain always indebted to my grandmother for looking after me as a child in the United Kingdom and being someone I could talk to and share my life with for so much of my existence. Even at her age, she had the spirit of someone many decades younger, was full of life and brought joy to so many. She shared all she had with charity and those less fortunate than herself. Strangers often commented on how sweet and bright she was and I used to talk to her about films, technology and current affairs. She remained a fountain of wisdom and I could not have dreamt of a better grandmother. Her grandchildren remain traumatized by the manner in which she has gone, and the suffering and abuse that she endured. Because she was such a positive and life-loving soul, I do not want the final page of her life to be negative. I am not sure how yet, but I know that I would be happy if the discussion arises for Iran, the country of Avicenna, Razi and numerous others, to re-discover what care, particularly at the end of life, means. Perhaps in the future, I will open a palliative care institute in her name.
Home Virtual Reality has seemingly been looming on the horizon for three decades, ever since VPL Research founder Jaron Lanier announced the EyePhone device which retailed for just short of $10,000. But motion sickness, and the astronomical price, pushed the technology into the wilderness.
The VPL EyePhone from 1989. Image: VPL Research https://vrwiki.wikispaces.com/
This year, home Virtual Reality re-entered mainstream consciousness with no less than five new devices under the Christmas tree, ranging from premium technology room-scale experiences like HTC Vive (think Star Trek’s Holodeck) to more accessible smartphone-based products such as Google Daydream and Samsung Gear, and a price range from £12 (Google Cardboard) to £689 (HTC Vive). Facebook founder Mark Zuckerberg calls it:
The next major computing platform that will come after mobile
The Oculus Rift headset with the Oculus Touch hand controllers. Image: Oculus VR https://www3.oculus.com/en-us/rift/
With these new devices, it will be interesting to observe which one finds most favour in 2017: Will Facebook-owned Oculus Rift make use of its technology and social media real-estate to market its pioneering product to the masses, or will Sony’s Playstation VR deliver the fun games to make VR a genuine prospect for a world of console gamers? Will people prefer affordability and portability with Samsung’s Gear over the need for a tricky room-based setup with the HTC Vive, arguably the most immersive and wow device of all?
At its core, Virtual Reality remains a gaming technology. However all of the various devices are equally adept at providing amazing storytelling experiences, 360° music videos, or plunging the user into historic galleries and exotic worlds. Entering a famous Vincent Van Gogh painting in Borrowed Light Studios’ “The Night Café” is, in equal measures, beautiful and surreal.
Borrowed Light Studios’ “The Night Café is a unique experience allowing you to walk around a Café inspired by the famous painting from Van Gogh. Image: Borrowed Light Studios http://www.borrowedlightvr.com/the-night-cafe/
As the user base is small, the market for “Triple A” gaming titles lasting hundreds of hours is minimal. The fortunate side-effect is a booming market for short experiences and quirkier games such as “Accounting” from the Crows Crows Crows Studio which are both enjoyable and affordable. But there is still the odd zombie shooter, and zombies jumping up on you in virtual reality is very, very frightening. Beyond slaughtering undead hordes, are there more constructive applications of virtual reality technology? Yes, and the possibilities are endless….
Education and Training
Virtual Reality has always been a prospect for training in professions where peoples’ lives and health are at stake. Simulators are already used to train pilots dealing with unexpected events, but the opportunity for more convenient home practice can only be a positive development.
Medical professionals can learn interventions for the operating room, emergency department or clinic, both challenging and more routine. The Miami Children’s Hospital, for example, is developing medical instructional software for basic procedures such as nasogastric tube insertion and starting an IV drip, with the aim of educating doctors as well as patients. Medical and nursing students can also learn their subject with more context than a book, for example by interacting with a “live” anatomical dissection table.
Organon VR Anatomy on the Oculus Rift makes learning anatomical structures more vivid and helps the understanding of spatial relationship between them. Image: Author’s Own http://www.3dorganon.com/site/
Over the past decade, there has been an explosion in the use of simulation medicine, particularly in cardiopulmonary resuscitation and life support where it provides a much more realistic way of portraying a scenario than a mannequin and actors, and where it provides more for assessment: Gestures, eye movements, metrics and real-time feedback are more useful assessors of these skills than a written examination.
For surgical training, VR is increasingly being proposed for the learning of minimally-invasive surgical procedures. It allows a realistic operating room environment, including interaction with colleagues, but in a safer environment where mistakes are not going to cause any harm. Bimanual tool handles and force feedback can mimic surgical tools – although it will take a while for this to be accurate enough to use at home, to the level of devices such as the NeuroTouch – a commercially available brain surgery simulator. New developments in tracking technologies such as Microsoft’s Handpose (which records complex hand movements) may add more intricacy to VR surgery training.
Virtual Reality is not limited to learning practical skills. Even attributes like empathy can be augmented through the headsets. Embodied Labs has designed a VR program called “We Are Alfred” which gives medical students, many of whom are in their twenties, an insight into experiencing the life of a 74 year-old man with audiological and visual problems. Providing the experience and learning the patient’s perspective can be invaluable in how the students develop as medical professionals.
Embodied Labs’ “We Are Alfred” allows students to experience the life of a 74 year-old with visual and audiological problems. Image: Embodied Labs http://www.embodiedlabs.com/
The complete audiovisual immersion provided by Virtual Reality can conjure or awaken emotions which users may not have been aware of. This has been used to good effect in journalism, such as The Guardian’s award-winning 6×9 experience of solitary confinement and film-maker Nonny de la Pena’s Project Syria which inserts the viewer into the plight of Syrian child refugees.
The founder of Oculus VR Palmer Luckey, affirms that this immersive power of Virtual Reality can be a medium for social change, through its ability to put you in places “in a much more real way”. Virtual reality campaigns following the 2015 Nepal Earthquake and The Dolphin Project (Both Huffington Post’s RYOT) have had a palpable impact on awareness. A recent AT&T campaign in the United States sees the user driving a car through residential neighbourhoods and ending up causing a tragedy whilst texting. The feedback following this emotive exercise showed that people who had the VR experience consciously removed their phones before driving.
New ways of working
Meetings and conferences are set to transform from the often vaguely distant videoconference to VR meetings. The social games and experiences on this years’ devices have highlighted how much more connected people feel when they are in a shared VR space than a 2-dimensional screen. Be it event/product marketing, site inspections, interviews or negotiations, the presence and interactivity afforded by Virtual Reality will see it slowly replace Skype as “the next best thing” to physical contact.
In the field of surgery, earlier this year, Dr Shafi Ahmed performed bowel surgery which was live-streamed for anyone to “jump into the operating theatre”. With improvements in haptic devices, performing remote surgery may become a reality sooner than we would have expected.
Surgery streamed in Virtual Reality. Image: Medical Realities http://www.medicalrealities.com/
Tests and Therapies
Diagnosis of illness lends itself to Virtual Reality, particular for conditions in which visual assessment is important such as Parkinson’s Disease and Multiple Sclerosis. A test developed by Tomsk Polytechnic and Siberian State Universities in Russia uses cheap headsets and Microsoft Kinect sensors to monitor people’s movements in virtual environments. Neurologists are then able to make earlier diagnoses and start rehabilitation. Indeed, the ability to see a doctor face-to-face from distance was one of the motivations for Facebook’s Mark Zuckerberg when he purchased the Oculus VR company.
Virtual Reality being used to diagnose Parkinson’s Disease. Image: Tomsk Polytechnic University http://tpu.ru/en/news-events/914/
Oculus founder Palmar Luckey first identified the potential of VR in rehabilitation whilst working with a team of therapists at the University of Southern California, helping military veterans who suffered from post-traumatic stress disorder by providing exposure therapy. This involved recreating battlefield episodes but allowing the guidance and support of a trained therapist to help identify and address the psychological trigger for illness. He said that this was when he first identified that virtual reality can be an important new therapy method:
It can make a significant difference in people’s lives
Virtual reality has been shown to be beneficial in rehabilitation after strokes, particularly in improving upper limb strength and in re-learning activities of daily living. There have also been potential benefits observed in helping motor learning in children with cerebral palsy. It can become a key weapon in the rehabilitation arsenal for physiotherapists and occupational therapists over the next decade, changing the face of rehabilitation for all kinds of diseases.
Virtual Reality is no longer in its infancy. It has hit the mainstream and is here to stay. Let’s use it to improve our world.