Friday, November 29, 2013

Love and Light Healing or Dark Arts of Sales?

I am angry again! It happens when you care about patients and healthcare and open your eyes.

I have just seen the blog describing a child dying from receiving 'herbal homeopathy' treatment instead of antibiotics for a streptococcal infection. And the parents are under investigation for child abuse - neglect leading to the death of their child. 

I am not sure about that one. Certainly it is taking the concept of child abuse literally, which means that parents have no rights, only responsibilities to the physical and psychological care of their child. By the same logic, we would be locking up all the parents of obese children. 

Perhaps this is just for public show and education and will go no further. Those parents have suffered enough. They are going to have to live with causing the death of their child for the rest of their lives. They have suffered enough.

I seriously believe that they are the naive victims of dark side sales strategies that are being used by the 'alternative healers', conspiracists and their media. They are the ones that should be held responsible and accountable for the death of this child.

I want to see the 'homeopath', who may not have been a trained homeopath at all but a complete amateur, in court. The author of any book in their house the influenced this decision should be prosecuted.

I am all for freedom of speech and it is time I had mine too. I want to see Government Mental and Physical Health Warnings splashed across every book and other piece of media that objectively and culturally threatens the mental and physical health of the reader or viewer. It is the right of every reader or viewer to know the whole of the truth.

I am very open minded, unusually so, to alternatives to modern medicine themselves. Evidence Based Medicine does support their occasional use There is a safe place to use them when a medical diagnosis or non-diagnosis has been made I applaud those alternative health systems that are rising to the challenge of meeting medicine on a level playing field and whole heartedly believe that sceptics are treating them unfairly.

What I object to is malicious and malevolant sales strategies being used to sell such therapies for personal and societal gain and profit, including the rubbishing of medical professionals and their effective therapies. 

I am deeply offended at their claims be holistic and that doctors are not. They claim to be working holistically with body and mind. 

What do they know about the body? Ask them where the kidneys or ovaries are. What is that muscle called? What does it actually do?

I am all in favour of physiotherapists, osteopaths and chiropracters as front line clinicians in their area because they actually know what they are talking about and what they are doing.

What do they know of the mind? Ask them what an emotion is. Ask them how they are learned and how they express themselves. They do not know.

Amateur counselling based on blind sympathy is liable to make the problem worse rather than better. But patient's like it.

You would hope that an 'energy worker' would at least know what this energy stuff is. Usually if you ask, you will get some glib, meaningless jargon like 'energy is vibrational frequency'. Press them and they don't know. They can give no usable definition relating to the real world or health, mental or physical.

This is the worst passive aggressive use of language as a weapon of intimidation to show the client's lowly position in the hierarchy of things. This is not the use of communication to share knowledge or understanding but belittle the recipient, disempower them and confirm who is the guru here that is some incomprehensibly knowledgeable that they must be trusted. Just don't question. Pay up.

Apparently, doing a couple of hours  in a Reiki 'workshop' is enough to demand more cash per hour than years of medical training in the UK. Anybody with a name in the healing world can charge more than a surgeon even in the US where the public would have it that doctors are profiteering. Somehow, their therapist is full of love and light and would never do such a thing.

They have disempowered the public from questioning, understanding or analysis of what they are up to by causing mass confusion. Then they gloss it over with image so nobody suspects.

'Energy' does have a meaning. I was taught it in psychology. It is the power to change internally, mentally, in order to adapt to the environment. Positive energy is pep talk that motivates the use of energy. Negative energy is the stress caused by resisting necessary internal and psychological change.

So when a cilent comes complaining of stress, their objective is to vampire their energy. Because the customer does not understand what 'energy' is, they can be told that the 'therapist' is giving them 'energy' when they are removing the necessity to change. Because nobody knows what 'personal' or 'spiritual' 'evolution' is, they can tell their clients that they are evolving. In fact, they are being regressed towards the animal and child stage.

They call it becoming conscious when they are advocating becoming subconscious, less than conscious.

Listen to your heart! I know a little bit about what that means when the sages of old and mystery schools used that pretty phrase. I know what it means to somebody who is informed about what 'the heart' is. It is the altrustic mindset above linear consciousness in the abstract hierarchy of the mind. In that philosophical hierarchy, which was even used by the likes of Galen, the linear mind, normal consciousness, is placed in the upper abdomen. Below it in this abstract, working model, lie the two parts of the subconscious mind, the passive aggressive subconscious mind.

If you know that, you know that this wonderful heart that they are talking about is ultra-objective due to its selflessness and lack of ego. You know that it is ultra-rational compared to linear consciousness. It fulfils the highest philosophical formal logic of consistency with the the entirety of the available evidence. It is more likely to be correct in practical situations than normal consciousness. It outperforms linear arguments that forget the context in real life. It really is worth listening to in real life.

In this way, the past masters of the clinical arts were truly clinicians of heart and soul. And they earned that the hard way, just as the ancient sages and mystery schools suggested. They learned it as a step by step process of elevating consciousness.

So what happens if you say this to a person who is not so informed about what the pretty words mean? The New Age, where unrealistic shortcuts are what sells, would have their blind followers believe that 'Follow your heart' means ignore the rational mind and listen to anything else instead. Listen to your subconscious. Thoughtlessly obey your emotions.

In fact, what they are selling is not 'listening to your heart'. They are telling people to follow the very lowest levels of the mind and to be subconscious, less than conscious. They are getting the to follow their genitals and rectums.

It is all about emotional control and preventing people from listening to the rational mind. This is the darkest art of sales psychology. It is to program the emotions and invalidate logic. It is to discredit objectivity and altruism.

The Noble Scientific Ethic of Objectivity is the exclusion of all emotion and personal interest. 

The strategy is simple. The emotions do not understand words. They cannot process words. They just judge them on whether they sound good or bad, nice or nasty. The subconscious cannot judge the rationality of what is told. It just believes what it is told and shown. It makes associations between what it is told and shown regardless of the rationality.

Co-dependency is called love if that is what the subconscious mind is told and shown. It is defenseless.

Oh, how that is abused by the love and lighters. You can sell any egotistical evil when you call it love.

Exactly the same happens with 'rights' and 'civil liberties'. We like rights and civil liberties. They sound good. You can even sell what is frankly child abuse under those headings and the subconscious mind will just doze through it without questioning. Physiological tranquilisation will even sent the conscious mind to sleep so it does not notice or analyse what is happening.

You can sell anything to the subconscious mind and the subconscious person through the incorrect use of meaningless words that sound pretty or sound nasty. That is how it is done. It is brainwashing and disempowering people from thinking for themselves. And the motivation is profit and ego.

So there is evil in this world. Do not believe in innate human goodness. Look at the evidence and distrust. See through the sales pitch and distrust. Look at their motives. They are pure egoism and profiteering.

The only way to combat the dark arts of sales that are being used against modern medicine for the profit and ego of the 'healers' is to add emotional tags to rational explanations. It is the use of good and bad words according to their true meaning. It is the opposite of using these good and bad emotional tags to confuse, irrationalise and sell deathly lies.

There is objective evil in this world. It is damaging others for personal gain and ego. There is honest evil that is openly evil and easy to detect. Worse still is evil that is sold as sugary goodness using the dark arts. That is deceptive evil. It is doubly evil. It is far more dangerous.

Such people cannot be effectively judged on their self image or their telling the world how good they are. It is just dark sales. They must be judged on their actions. They must be judged on the predictable and avoidable consequences and outcomes of those actions. 

No, they do not have good intentions. Ignorance is no excuse. If they did really have good intentions, they would find out what they are talking about before they opened their mouths. The problem is that if they found out what they were talking about, it would devastate thir self image. They would have to admit that they were doing evil through wanton neglect and wilful ignorance just to protect their self image.

In every conceivable way, these people are objectively evil. That must be explained openly. Their brainwashing must be resisted and undone at every possible opportunity.

In the end, one of the causes of death for this child was the cultural timidity of the medical profession in speaking this truth. They have been letting the most immoral practitioners of alternative 'health'  and the love and light brigade get away with their deceptive evil for far too long. It is costing lives. It is costing children's lives.

So why not a concerted campaign for those Goverment Health Warnings on any media that corrupts minds and objectively damages is health? And let us get the warning right so that it is effective in preventing more children from dying. Let it say that this product is only a dark sales pitch for the author's ego and profit and the author does not give a damn about the consequences they are causing. Let us make the debate over rationality a matter of morality.

Wednesday, November 27, 2013

Selling The Best Therapy (Part 2) The Light and Dark Arts of Sales Psychology

Selling The Best Therapy (Part 2) 

The Light and Dark Arts of Sales Psychology

Do you want better communicative, persuasive and educational skills as a doctor?

If you want to be the best, learn from the best. Learn from a sales psychologist. 

Get the right one and it will be the most worthwhile single course in all of your medical education. A really good corporate/sales psychologist carries enormous value in industry. I have been offered the equivalent of 3 months of medical salary to give a one day workshop on selling to the conscious and subconscious mind using the CBT model. I refused due to lack of control over who I was sharing this powerful knowledge with but that does not apply to doctors selling their services in service of the most precious comodity, human health.

Have no qualms. Sales technology or psychology covers a wide span. The knowledge base of sales technology knows how to sell anything and everything. 

The use of sales in medicine is often unpalatable because of the high profile of the dark side of sales. They can sell crap for their own profit which in no way enhances life to weakminded, or is even so worthless that even damages life. They can even cause so much desire for a life filled with such crap that the customer forgets rationality and the reality of their financial situation on credit until they get their home repossessed.

That is the dark side of the psychological arts of sales. It is passive aggressive sales, conning and bullying them into purchase or belief, often under the pretext of 'The customer is always right' when under the influence of the advertising campaign. These are the Win/Lose and Lose/Win strategies to convince the unwitting to buy inferior products that will be in the trash five minutes later whilst remaining on the credit card forever and putting cash into the pocket of the unscrupulous salesperson.

The only reason that the good doctor has to know about this side of sales is to know the strategies that are being used against them.

There is another side of sales despite a generally negative reputation. Sales technology covers all products not just the crap ones. Psychological technology has been developed to help sell the most wonderful, life enhancing products because nothing sells without sales. This Light Art of Sales tech is educating, informing and guiding customers to acquiring products at a fair price that will substantially improve and enhance their lives.

And one would hope that all doctors believe that their products fall into the life enhancing category! This is exactly the situation that the best outcome and evidence based therapies of medicine find themselves in. They are competing against inferior therapies being sold by sales psych black arts of passive aggressive Lose/Win and Win/Lose Dark Side Sales Strategies. DSSS need aggressive treatment to avoid a pandemic spread and serious health consequences.

This is Win/Win sales. Usually it is associated with the IT world and interbusiness relationships and dealings, in both cases to produce long term partnerships based on mutual respect and trust that produce mutual benefit for both parties. And although modern medical ethics, informed consent, patient participation and consultation dynamics are not usually called sales, this is exactly where they come from. They are absolutely classical Win/Win sales and the sales psychologist understands them much better than the best medical profession. It is there one and only job and their core knowledge.

The classic example used to present the concept of Win/Win sales is the purchase of a new computer....

Seller Wins - Customer Loses

The customer is cohersed, confused and bullied into buying the top of the range computer and everything else that they do not need for the salesperson to reach their targets and make as much short term profit as possible. The salesperson is selling what is most convenient to them at the highest price possible inlcuding out of date stock and stock that is about to go out of date. The use of impenetrable jargon is a typical tactic to ensure the seller's position in the hierarchy and intimidate the buyer into submission. The use of language as a weapon forces the customer into having to trust this 'expert' something that they will obviously never understand and cannot question.

The result is that the customer buys resentfully and sooner or later realises that they have been had. They tell everybody they know and the shop that was once so profitable has no customers. In the long term, it fails.

Seller Loses - Customer Wins

The customer gets exactly what they wanted. The customer is always right because the seller wants to massage their ego. And the customer gets what they want at the cheapest price possible. 

Well it works if you are selling useless trinkets based on personal taste or fashion where this year you have to buy a blue one and throw out the yellow one and next year you'll need pink. Well, it works until there is no employment and your economy collapses under the weight of foreign imports. 

It does not work for any product that has a practical purpose and has a technical specification
unless the customer is competent and knowledgeable in that field. This is why this does not work in IT except when selling to very well informed and rational customers. They buy things because they are pink or have lots of flashing lights and get home to discover that they are unfit for the purpose they were intended for. Eventually, the customer discovers that they bought something they will never use. It can do so much they get confused and never use it. At the very least, they have spent twice what they needed and probably got themselves into debt over it.

This is industry specific. Any industry that requires significant investment in R&D is cut past the bone by the customer's right to the lowest prices. They fall behind. Progress is unfunded. This is not industry specific. Quality falls to cheapen the product and it falls to pieces after a few weeks. 

Both Have Been and Are Practiced In Health

Traditional, the Win/Lose Aggressive Passive scenario is practiced in health including the the intimatation of the patient by using jargon as words rather than communicating to share knowledge. It still happens. It is being forced on the medical profession by limiting the amount of time that the doctor has to spend with the patient. The doctor wins when they get the resentful patient out of the door as quickly as possible with the correct medical treatment in their hand. The resentment affects treatment compliance. They seek another doctor. They trash the reputation of that doctor.

Or they become powerlessly dependent on the doctor and enter the sick role. Forget lifestyle improvements and patient responsibility.

In view of this tradition, the pendulum has swung the other way and patient are insisting on winning. The are demanding the Lose/Win, Passive Aggressive situation where the doctor shuts up and does as they are told. The patient decides what is wrong with them and what treatment they want. The doctor's medical training and clinical acumen are out of the window. They are a passive and pointless part of the consultation, rubber stamping whatever the patient wants with their license without making the individual risk benefit analysis that is the heart of their training.

Doctors feel disrespect and are malcontent. Treatment complaince is probably worse because the know-it-all patients do what they feel like without accepting the risks. Treatments fail. They get unnecessary side effect from unnecessary treatments and investigations. They tell everybody that doctor was stupid and no help at all. Medicine is dangerous.

And that is not counting the greater side effects such as multiresistant bacteria, loss of clinical skills, loss of clinicians and medical economics, driving up the costs of healthcare to the extent that they cripple entire nations whilst ensuring social injustice. The basic human right to healthcare can only be met for those that pay for it.

There is no half way house between the two. Society's solution of give and take does not work. There is no harmony, only a tense conflictual balance like a tug of war in which nobody is satisfied, distrustful and stressed.

The Win/Win Scenario

Sales psychology has gone beyond a bipolar model of two opposites. They have introduced a thrid opposite pole. It is opposite to Win/Lose and Lose/Win. It is even dyametrically opposed to the tense balance between the two. It is the polar opposite of the line between passive and aggressive. This is called assertivity.

Imagine going to buy a computer if you do not know too much about them. The salesperson greets you and asks what you are looking for. They get you to explain your present and future needs in your own terms. They stop to consider then explains the issues in accessible terms that you can understand. They communicate to share their knowledge and respect your ability to grasp it when it is explained accessibly rather than in jargon.

The salesman offers you a solution and explains that solution as the best individual option for you. It is a computer that is nothing like top of the range and half the price of the you were expecting to pay. The salesperson even wants to sell you a lead to your sound system instead of cheap and cheaper sounding speakers to the distort the music and videos you constantly listen to. 

Of course, you agree. The expertly guided decision becomes your decision too. You take ownership of that decision.

You are over the moon as the customer. Your needs have been listened to by somebody who cares. A solution has been found especially for you. What is more, you can certainly trust this salesperson. Their actions have proven that they want the best for you rather than acting in their own immediate interest of selling you the biggest and best.

The salesperson is happy too. They sold you what you needed at a fair price. They made their normal markup. Then they are really happy because the customer is so satisfied that they spend the budget that they saved on a printer or software that they had thought they could not afford or even a tablet. More to the point, they have earned and deserved a repeat customer, a customer for life.

And when your computer arrives, they come round after hours and personally deliver and install it. They even start it up and make sure that you are clear on the basics. They even leave you with an idiots' guide and the invitiation to pop round to the shop if you have any difficulties or problems. And if there is a major problem, it will not have to be sent back to the manufacturer.

Now you really are going to recommend this computer shop to all your friends. 

This Win/Win strategy is especially important in corporate relationships with suppliers in the fast moving high tech world where the final manufacturer is the customer for components. The old model of trying to drive prices down is a disaster in terms of quality and R&D for those components. Instead, companies now work together in 'strategic partnerships' that trust to components being sold at a fair price that allows R&D. They actually work together on product development rather than passive aggressively competing.

This is the sales psychology that doctors need to apply in each and every medical interaction. In fact, the highest morality and ideals of doctor patient interaction are built directly on this assertive, Win/Win model.

The Health Outcome Focused Pole of Consultation Dynamics

The medical profession appears to be far behind the sales psychologists in terms of interpersonal dynamics. I have still only heard of a bipolar system with Doctor Focused at one end of the line and Patient Focused at the other end. That system 'has' no Win/Win scenario. The system somehow squeezes all possibilities of consultation dynamics into it so Win/Win must be in there somewhere but it is not explained or clarified. 

Using the tripolar system of the sales psychologists, a triangle instead of a line, makes it all so clear. It is the Assertiveness Triangle with Assertiveness at the top and Aggressive and Passive at the two corners of the base.
The Assertive Win/Win Solution is the vertex and it is Health Outcome Focused. It is doing what has been proven to be the best for the patients' health. However, it is far more than following the therapy on the protocol. It is more complex than that. It includes many subjective events too, such as patient education in a manner that is accessible and relevant to the real world so that the patient can truly become a part of the decision making process. That is what assures the highly positive health outcome of treatment compliance and continuation. It also ensures long term satisfaction and mutual respect for both parties.

Next: Selling The Best Therapy Part 3: The Magic of Assertiveness

The Art of Communication: Selling The Best Therapy (Part 1)

Selling The Best Therapy
Part One - The Need to Fight Fire with Fire

I was sad but not at all surprised to see this blog, 

in which a surgeon does the right thing and recommends the gold standard treatment for a patient with cancer. The patient, quite reasonably, seeks a second opinion but that second doctor is so persuasive that the patient on only chooses a lesser therapy but comes back to complain about the surgeon's practices.

The surgeon involved and the commentators below believe that this was some sort of failing in communication on his part or unreasonable behaviour on the part of the patient's husband. I will agree that there was a lack of understanding by the surgeon about how the patients' minds would work and their decision making process. However, when it comes down to it, the surgeon was simply outsold by a better salesman.

This surgeon believed that his product was so good that it would sell itself. He was proven wrong. Products do not sell themselves. A great product unsold remains on the shelf whilst the inferior product competently sold takes over the market.

The customer rarely chooses the best product. They choose the product that was best sold.
Doctors may be the great receptive communicators (ie taking a history) because they are taught how to do that but many are lousy at the other side of communication, objective focused expressive communication. This is the realm of the salesperson and they are the experts.

And this is a question of morality. Modern medicine and individual doctors are playing straight down the line and by the rules. They are being honest and unmanipulative. They lay the simple facts on the table and ask the patient to choose without cohersion or pressure. They even give a fair hearing to the competitors and hope that hard statistical evidence will win them over. They really are playing fair.

There is a general rule. The morality of a person is consistent. Those moral enough to recommend the treatment with the best objective outcome are too moral to use sales psychology. The morality of those that recommend anything but the gold standard therapy in outcome terms must be questioned. The further they are from that evidence, the more their morality must be questioned. Selling your own therapy regardless of the evidence shows deep moral corruption and expect that immorality to come out in the use of sales strategies.

Were it not for the marketing departments of the pharmaceutical industry who are prepared to use psychological strategies, modern medicine would already have its back against the wall in the face of New Age healing and its marketing. Somehow, doctors are seen as money grabbing and profiteering despite having earned it the hard way by diligently learning and working for patient benefit. However, those that sell themselves as full of love and light claim to be beyond money can charge up to $1000 per hour for a consultation and make significantly more addressing a wider audience. 

The New Age can create millionaires by talking about religious beliefs detachment from material possessions. And nobody seems to notice! That is sales! That is brand image!

Of course, doctors would never criticise because they believe in permitting patients to make up their own minds on the evidence. They barely use their power. They barely defend themselves in case they offend somebody else's sensibilities, even those of the lowest morality. They think it is enough to have the truth of the evidence on their side. They just let them get away with it.

If you are trying to sell a product that has no hard evidence for effectiveness against products that do, you must have pretty low morality. That comes through in the immorality of their salespitch. They will do anything to sell. They are desperate. Their ego and life depends on it. 

Don't expect respect, even due respect from such people. Expect every underhand strategy including emotional manipulation. Expect them to know the worst tricks of the dark arts of sales psychology and to use them.

The darkest art of sales psychology is to make the customer decide subconsciously and emotionally rather than use their conscious mind to make a rational decision. The salesperson then maniplates the subconscious emotions until the customer is convinced.

The customer is defenseless in this process. All of their conscious rationality has been subverted and avoided. The subconscious has no rational process on which to analyse, process, judge or decide. It simply takes in what it has seen with a total lack of judgement.

These strategies are being used all of the time by those who care only about achieving their aim. Half the time they do not realise they are using them or defend them with pretty words like 'love', 'care' or 'heart'. They do not know what they are doing or how they are doing it. 

They are 'street-wise' and have learned in life that this is how they get their own way. It is effective and they do not care how it works or the morality of what they are doing, sabotaging the ability of the other to think for themselves or make a rational and objetive for their own good or the good of others.

Or they are learned by copying another successful salesperson or manipulator without understanding. Or it is learn as a ritual, from those that sell the lowest common denominator of sales psychology and techniques. Just do it like this and it will work. 

Do not try to understand what you are really doing. You really do not want to know that. It would sabotage your ego and self-image of sugary goodness. Just do it. Just keep telling the customer how wonderful you are and how much you care. Keep up that superficial smile.

It works. The customer is defenceless in this process. All of their conscious rationality has been subverted and avoided. The subconscious has no rational process on which to analyse, process, judge or decide. It simply takes in what it has seen with a total lack of judgement.

If you are up against somebody using this type of strategy and all that you are using is to educate them and try to lead them to a rational, conscious decision for their health benefit, you will lose. You stand no chance. They have sabotaged the very thing that you rely on, the patient's ability to think for themselves.

This is McDonalds vs the organic fruit and vegetable producer whose life's work is to honestly provide the healthiest possible food for the health and good of all. Happy meals. Let your kids decide. Make the association in the children's vulnerable mind between burgers and happiness.

The only error in this metaphor is that the doctor who recommends the best outcome therapy is blindfolded to the reality of the malicious strategies being used against them and gagged by their ethics not to whisper a word against the opposition. They are fighting against all odds with their hands tied behind their backs.

The very first stage of a doctor learning about sales psychology is 'Know Thy Enemy'. Know the strategies that are being used against recommendations of the gold standard therapy. Accept that those who do not have the ethics to support that gold standard therapy and who would instead sell their therapy for their own personal profit are not going to fight fair. 

This is not about communication. This is about subconscious manipulation.

The opposition is using it against you!

And do not expect those whose life and self-image depends on their ability to sell second rate or worse therapies using dark psychological arts. In fact, expect them to impose shackles on the best of the medical profession so that they cannot fight back. Expect them to paralyse anybody who gets in the way of their egos and profits by burdening them with inflexible ethics. That is exactly what they have succeeded in doing. 

To even start to gain a level playing field is to play dirty, just as dirty as the opposition. It is the one and only level playing field. Their strategies must be balanced out to assure fair play. It is to openly expose and sabotage their strategies as they would do to you. To win and get the patient to accept the best therapy for their health, you have to play the detractors at their own game.

If you don't play the game, you automatically lose.

Part Two: The Light and Dark Arts of Sales

Tuesday, November 26, 2013

The Challenges of Pain Clinic

Chronic pain clinic is incredibly challenging, stimulating and rewarding. It is perhaps the most complex of specialties, covering the cutting edge of all medical specialties because this is where patients come to when standard medicine has failed. Most are the exceptional cases. It also requires a crossdisciplinary approach, including as a minimum, medicine, physical therapy and clinical psychology. All this is compounded by its newness as a medical specialty. 

It is no empirical science. The all-important evidence is subjective. The theories as to what pain really is in scientific terms, are more hypothetical. Theoretically based medicine is somewhere between limiting and already failed. Everything that science knows how to do has already been tried in most patients before they get to pain clinic.

Psychology is of prime importance. It is the final path between hard trauma, pathology and physiology of the nervous sysstem and what the patient actually experiences. 'Pain is only in the mind' but only on a technicality. It is an incomplete statement that devalues the human experience and the need to take it seriously. It would be better to say that 'The word pain is defined as being the mind's perception and response to injury'.

Psychologically, patients appear to fall into two functional groups: pain fearers and pain haters. Fear always makes pain worse, whether it is fear of the pain itself or the implications of the presence of pain, fear of the diagnosis behind that pain. Pain fearers burn out and get depressed which always exacerbates the pain itself. Where pain and depression go hand in hand, both must be treated aggressively.

The pain hater has a fight or flight, adrenaline reaction to the pain. Adrenaline is rarely considered as an analgesic but it is innately so. The fight or flight response is an evolved system to maximize survival in violent situations, including ignoring injuries and pain to keep fighting or running for your life.

These two groups are of particular importance in musculo-skeletal pain. The pain fearer avoids pain if at all possible, resting the affected part. The muscles grow weaker and the joints grow stiffer. Pain and disability increase in the long term. This also relates to a cluster of other psychomedical problems, including dependency and the sick role.

The pain hater uses their hate to break through the pain barrier. They exercise and stretch the muscles  and joints without fear, innately knowing that this will maintain their mobility and ease the pain in the long run. They are basically doing their own physiotherapy.

Here, in pain clinical, every patient is a complex individual who has defied the odds in most unfortunate way. Few categorizations exist except neuropathic, musculo-skeletal and a few named conditions. Patient numbers are often small for quite unique problems. Positively proven Evidence Based Medicine is rare. The lack of evidence is only a lack of evidence.

These are the patients who have fallen through the net of EBM. What usually works did not work. EBM has failed them. TBM can't help them. All that is left is experience based and anecdotal medicine. All that is left is the clinician's inspiration and art. The only rule is 'Firstly, do not harm' or take minimal risks considering that the quality of the patient's life is being devastated and terrorized by pain.

And this is where the 'Positive EBM' of Europe, deaasigned by doctors for doctors and patient health, versus the 'Negative EBM' that has been inflicted on US style medicine can help. My experience of European Pain Clinics and rehabilitation is a very open minded approach to complementary medicine, especially acupuncture and anything that relaxes the body and mind. Anything is now worth a try especially when little or no harm will be done and in EBM, it does not matter if science does not currently understand how a therapy works. It does not matter even if these therapies are just regarded as placebos. They could be super-placebos enhanced by caring human contact and ritual.

The only objective in pain clinic is the reduction of the subjective experience of pain. It often becomes a matter of repeated trial and failure; failure not error because therapy is based on outsider chances rather than hot favourites. 

Neither doctors nor patients should give up just because the first therapy does not work. Just keep trying new things, so long as they are relatively safe. Only once one pain clinic expert has run out of options should another be seen. They might have another trick up their sleeve and find that magical ease for that individual patient.

This is about the art of the individual clinician as much as it is about the individuality of every case. This is a world of trying everything and open minded inspiration for therapies that may not work on average for 'average patients' (if there such a thing) and innovation for what has not been tried before.

I do hope that in the US, EBM is not being blindly imposed on pain clinic in ignorance of this context for the sake of cost cutting. In fact, pain clinic is relatively cheap. If the physician is denied the possibility of open minded inspiration and trying the unusual and novel, the patient will just keep presenting for the standard treatments that have not worked in the past. They will have more and more very expensive investigations and surgery instead of the relatively low tech approach of pain clinic.

Saturday, November 23, 2013

Have You Brushed Your Lashes? Daily Eye Care and Hygiene Routine


Why did nobody tell me about this!

It all could have been avoided with Daily Eye Hygiene Routine!

Daily Eye Hygiene is to opthalmologists as brushing your teeth is to a dentist. It is just one of those things that everybody should do every day in order to prevent serious problems in the future. And it is even simpler than brushing you teeth.

Take A New Cotton Bud

Dip In Clean Water

Close Eye

Scrub Gently At Base Of Upper Lashes For 20 Seconds

Now Do The Other Side

This is the enemy of your eye health. 
These are the microscopic, infected fragments that you are removing on a daily basis.

Early Warning Signs With The Naked Eye

  • 'Dandruff' or crusting in lashes
  • Small white swellings at lash base
  • Lash loss
  • Grey Lashes (lashes never naturally turn grey)


  • Irritable, watery 'dry' eyes
  • Minor discomfort in bright light
  • Slight redness

Can Lead To

  • Cysts 
  • Abscesses
  • Local infection spreading backwards into orbit
  • Corneal Ulceration
And all because nobody told us that a quick scrub of the lashes should be a part of everybody's daily personal hygiene routine along with brushing our teeth!

That is all that it takes to avoid these symptomatic irritations

Friday, November 22, 2013

Wiki EFT - Wiki's Most Vitriolicly Biased Entry?

I am sickened by the subjectivity and bias of the Wikipedia webpage on Emotional Freedom Technique. Where is their objectivity and neutrality?

This article is a trusted resource for the general public. When it discusses therapies, it is being used by the public to make therapeutic choices. It may even be used by health professionals to make therapeutic recommendations. As such, Wikipedia carries a responsibility to fairly represent this therapy in contrast to the alternatives.

Everything that is said, of course is true but for the sake of being unbiased, let us put that INTO PERSPECTIVE; not just a convenient fragment of the truth but the whole of the truth as demanded by any court of law.

CBT (including RET) is the only psychological therapy to meet the standards required. There are even questions as to whether pharmaceuticals meet those standards other than in terms of short term symptom relief, which is really bad Evidence Based Medicine. The quality of evidence for the original versions of other psychological therapies (before they started to borrow more from CBT) was generally low. The therapies themselves fail to show anything but customer satisfaction. Any positive, objective effects come down to the individual therapist client relationship.

The academic leaders of the EFT community are doing what they can to collect adequate, high quality evidence to make this an Evidence Based Therapy. They are obeying the scientific process. They are following the higher standards of clinical evidence that many scientific papers published in top journals do not live up to. Nor do many journals on 'counseling'. In fact, it is still accepted practice to publish second or third rate evidence in the best medical journals, including case reports.

Criticism over failure to meet the highest quality study design in Evidence Based Medicine must be put into this perspective. These standards are incredibly high and rarely achieved, especially in psychology. Clinical treatment decisions often have to be made by using moderate quality evidence as an indicator rather than demanding cast iron proof where high quality studies are not available.

It happens in real world medicine where the stakes are high. I remember the license being granted for the prevention of osteoporotic hip fractures to a drug with quite horrible side effects. It was made on the basis of a 5% p-value ( NB this article has been checked for objectivity) after 42 previous studies had failed to show statistical significance.

In contrast, I have never heard of an EFT side effect. Benefit - probable but not completely proven or defined. Risk - none identified as yet.

That is a really good equation for a first line treatment for non-life threatening conditions and symptom control.

Yes, CBT/RET has better evidence. It also cost more and is not necessarily available. There is more stigmatisation and seeing a clinical psychologist can be socially unacceptable for the patient, especially in milder states.

Teaching EFT as a psychological tool for self-help is not only empowering but is a really useful weapon in the therapist's armoury to discourage dependency and increase patient responsibility. The general culture of passive aggressive dependency is a major factor and root cause in many mental health issues.

In my experience, the EFT process can give the patient the power and self confidence to confront their underlying issues and enter into a state of self-analysis and deep catharsis.

In many ways, EFT can be seen as a CBT self help tool. It promotes the central concepts of CBT perfectly. It promotes the belief that we can control our emotions and moods rather than be their helpless victims. It confronts the dangerous societal belief that we should let our moods rule us rather than taking conscious control over our lives.

This means that EFT is culturally healthier than any of the other psychological therapies that have also failed to produce gold standard clinical evidence. Avoiding dependency is the major issue of psychoanalysis so it should be considered approximately neutral despite the fact that many patients attempt to create it. Generic counselling promotes emotional domination and all but encourages dependency. Pharmaceuticals certainly promote dependency. Used indiscriminately, they relieve the symptoms and allow the patient to resist the major internal and external life changes that CBT uses to such clinically proven effect in long term therapy.

So do you recommend the therapy that generally promotes the models of the gold standard psychological therapy, CBT, or those that sabotage its fundamentals?

As for this Wiki page's attitude towards a lack of scientific basis, I am truly appalled. This represents the worst of the now discredited culture of Theoretically Based Medicine that Evidence Based Medicine is trying to eradicate for its corrupt use in creating a pharmaceutical monopoly, the proven dangers of prioritising the use of therapies based on laboratory theories over real life evidence and the lost opportunities in health of discarding therapies which produce evidence that they do work in real life just because the Skeptic Society does not like them. It breaks the precious fundamentals under which science should be practiced by promoting theories, that are in fact nothing more than subjective opinions of how the evidence should be explained backed by subjective reputation, over the hard evidence. It is the subjective exclusion of evidence for emotions and vested interest when theories should be accepted or rejected on the basis of their performance in explaining the entirety of the available evidence. It is a corruption of the Noble Scientific Ethic of Objectivity.

The depth and scale of this problem cannot be overemphasised but nobody dare talk about it for fear of offending the emotions of the Skeptic Society. The get physiological fight or flight reactions when anything disagrees with their indoctrinated norms and fight it or flight it through over-criticism. This is how they react to anything new but anything old and accepted causes physiological relaxation. They doze off and anything passes them by without them even noticing. It is hardly the recipe for the inquiring mind that the mindset of science demands.

And watch them get emotionally offended at the very possibility.

If they had the emotional freedom that The Noble Scientific Ethic demands, they would take this warning about the well known but insidious effects of the subconscious mind and its emotions on rational, conscious thought very seriously. They would be proactive in erasing these emotional responses as a part of their sacred quest for objective truth about the universe that we live in.

I recommend EFT every time to improve academic objectivity.

When it comes to the mechanism for EFT, I do not care and Evidence Based Medicine does not care. I am objective enough to admit I do not know.

What we know for sure is that a part of the effectiveness of EFT does come from the fact that it mimics the CBT process but with greater independency. Quite what the tapping does, I do not care and nor does Evidence Based Medicine. We do not care if it is just a ritualistic ploy to motivate and give confidence for the patient to do their personal CBT work. It works. That is good enough for us.

I feel that EFT has been pushed into coming up with explanations of mechanisms that sound scientific. The word 'Energy' comes up for New Age acceptance. So everybody goes off looking for electrical mechanisms.

I am happy with the concept that the tapping and eye movements are some sort of mysterious communication with the subconscious mind that science does not yet understand.

Ask a sceptic what the mind is and how it speaks and hears words.

Ask a sceptic what consciousness is.

Ask a sceptic where the subconscious mind is.

The answers to those questions shows just how little empirical science knows about the subject and that they have no right to comment, let along dismiss EFT.

Thursday, November 21, 2013

Knowledge is The Food of Clinical Intuition (Part One)

What we seem to have forgotten as a profession is that the scientific knowledge of medical school and the academic science beyond that are not end in themselves. They are the means to a greater end. It is a necessary step along the way to becoming an exceptional human clinician who has applied scientific knowledge and understanding as a part of a greater human context for both doctor and patient.

Knowledge and evidence are fragments. Theories are the patterns that tie the individual pieces of knowledge and evidence together to make them predictive. However, theories are linear and generally only tie two strands of knowledge together to create a small section of a greater jigsaw puzzle.

That is what we learn in scientific medicine. We learn one system at a time, organ by organ. We also learn to think like that, to use the mindset of empirical, laboratory science. It is to form a foundation for what comes next. The physician on the path to greatness builds on this, adding to it and braodening their horizons and the amount of information can be added. The scale and complexity of their puzzle expands to encompass other realities such as the patient's psychology and social situation.

For the clinician, science is the kindergarden for thought. It is a safe environment in which to learn the basics. Simple answers can be checked and fed bacck upon before entering the complexities of the real clinical world. The importance and culture of objectivity can be learned under simple and safe conditions before being put under very serious pressure and challenges in everyday human health.

The ability to think clinically is ever more important with the mass of evidence that is available in the modern world. Often it is conflicting evidence from experts and studies approaching the same subject from a different point of view. The academics have the luxury of having a cozy little debate about it but clinicians somehow have to make sense of the conflicting evidence and make life and death decisions on that basis. The academic tradition is to make linear arguments that hold together by deprioritising or excluding the inconvenient evidence and basing their opinion on other learned opinion rather than the gold standard of consistency with the entirety of the evidence available. Doctors cannot safely do that.

The Arts of Clinical History and Clinical Examination are external, easily identified and taught in medical education and training. The third basic clinical art is clinical thinking, an invisible, internal process. Perhaps it is the most important of the three basic arts of medicine because it is this that takes all of the information from the first two arts, plus the technological results to produce the diagnosis. It deals with the evidence to put it into practice on a case by case basis and creates complex treatment plans. However, the art of clinical thinking is rarely discussed and never directly taught. It is a process of consciousness beyond scientific description. It is a subjective human experience.

All that we hear of from science is their occasional anecdotes of genius where massive conceptual breakthroughs are made. Einstein called this imagination. Watson is said to have dreamed the double helical structure of DNA and designed his experiments around that inspiration. Newton was meditating on the universe under a tree when struck from above by the metaphorical apple of knowledge.

Such great inspiration is a rare, unreproducible mystic event in academic science. Inspiration is so rare because it cannot and will not be taught. However, I have had the privilege to work for and with some absolute clinical geniuses. I can tell you that they live and work in this inspired state of mind where jigsaws of disconnected facts fall together into perfect harmony. They fall together into perfect consistency.

This state of mind can be described. What it feels like to think like this can be communicated. The path to attaining and living this higher level of clinical thought can be illuminated. It can be practiced and learned.

This thinking comes from a cleverer part of the mind. It is a higher part of the mind, what Freud called the Super Ego. We could even call it conscience, that higher part of the mind that sees the greater picture and rebukes us for egotistical and myopic decisions. It is there in everybody but it is silent. It is the quiet voice. It is the tranquil voice of the still mind.

This part of the mind from which inspiration and true intuition come is there and available to anybody, not just clinicians. What makes it inaudible is the constant chatter of the conscious mind and the rollercoaster of emotions from the subconscious. Inspiration in sifting through complex evidence, applying theory in practice and making difficult diagnoses with a mass of subjective observations that the linear consciousness just finds too confusing comes from the silent mind. It only comes to the silent mind.

Inspiration comes to the truly objective mind. The Noble Scientific Ethic of Objectivity is the exclusion of all subconscious emotion and vested interest. For better, hope and wishful thinking must be excluded. For worse, fearing the worst must be excluded. The clinician must be able to deeply trust themselves in this or they will not trust their inspiration. That only comes from accustomed living of that objectivity. It comes from living the medical ethic of always putting patients' health first and going beyond the call of duty regardless of how the clinician feels. That is what establishes new subconscious habits that can be trusted.

This is the habit of thinking first rather than letting emotions make decisions. If the emotion agrees with the decision, enjoy it. Use it as physiological motivation to drive that objective, rational and informed decision home.

Only once that habit has been established can a clinician innately trust the objectivity of their own mind. They no longer have to question it. They have no self-doubts because they know deeply that personal interest, including acting for patient popularity never enter their mind. They know that they intrinsically do the right thing and are uncompromising and uncompromised in putting the patient first and going beyond the call of duty.

It is in this silent, still mind that the evidence floats freely. When there is no pressure of inner words or emotions, the pieces of the puzzle twist freely. The evidence is certain. The interpretation is not. Suddenly, the hard evidence falls into place and it all makes sense whichever way you look at it.

True inspiration always makes rational sense. Its linear logic always works. It has just selected one of a variety of possible rational explanation for the evidence, even originally think a rational explanation that has not been considered or investigated before. It has selected the only linear explanation that is consistent with a wealth of other information. Perhaps more to the point, it always agrees with all scientific first principles.

Counter-intuitively, I will say don't take any piece of scientific knowledge too seriously. Take it light-heartedly whether you like it or not. Enthusiasm corrupts the process and subjectively prioritises it. Objectivity is being lost. Instead, think something neutral. Examine the study design and statistical process. Bore yourself so the new knowledge is unweighted.

The Super Ego is clever than the conscious mind. Trust it. It will all be in there. You will simply remember the most amazing details from years ago that you thought you had forgotten when they are needed so long as they are left floating freely. The higher parts of the mind will simply select them when necessary.

The more you know, the better the process works. It gives the hgier parts of the mind more pieces of the jigsaw to play with. It cannot be overloaded. Trust it. If you have once experienced its marvels, you will trust it.

Wednesday, November 20, 2013

The Alternative View of Evidence Based Medicine

In the US, Evidence Based Medicine has been stupidly and ignorantly introduced through the HMOs for simple cost cutting. What I always hear and read from American doctors is 'The HMO says No!' and that is the end of the conversation, leaving the doctor standing in front of the patient humiliated and disempowered. 

In other parts of the world, its introdruction has been driven and managed by the medical profession and things are very different. The answer is not a blunt 'No!'. The response is 'What is the problem? Well, this is the best treatment for that diagnosis on offer for the patient's short and long term health.' 

A highly ethical medical profession that cares about the health of their patients created and introduced this system. It comes from a system that traditionally fostered good patient health and pioneered preventative medicine and true healthcare. Doctors were not paid by the consultation. They were paid a salary for taking on a responsibility for a community whether working in hospital or family medicine. It was in their interests to keep patients healthy and prevent them from needing and seeking medical attention. The sicker their community was, the more work they did for the same amount of money. The ideal was to get and keep their patients as well as possible through lifestyle, self-care and education.

Some of the earliest and most profound results of Evidence Based Medicine were about lifestyle and exercise which the medical profession had largely been leaving to the patient's common sense. The big turn-around for common sense was the danger of bedrest and exercise avoidance.

A significant number of accepted therapies were reinvestigated to see if the evidence proved them as effective as doctors thought they were. There were surprises. Some drugs were being used on faith, tradition and wishful thinking focused around the shared expectation of the doctor and patient that the doctor must be able to do something. 

This came down to bad science, science that broke it founding principles. The Noble Scientific Ethic of Objectivity had been betrayed. Emotions and vested interests were getting in the way of truth. Scientific theories from the laboratory were being applied in the complexities of real life. Simple facts were being forgotten, most notably that the human body attempts to compensate for anything externally done to it. Sometimes it was enough to cancel out the effect of the drug entirely until unusably toxic levels were reached. (The Therapeutic Window)

Theories of science did not necessary work in real life. They were just being accepted by the doctors and patients because of a false belief in the certainty of science and technology. Theories were being built on theories, names and academic reputation and not evidence that the treatment actually worked in real life. Convoluted arguments were being constructed in theory that proved real life black to be white.

The reverse was also happening. Therapies that did produce real life benefit were being overlooked or even attacked because they had no scientific basis or mechanism behind them. They were being discredited by the medical profession and through it, scientific and technological medicine were gaining a monopoly and strangehold on health.

This earlier medical culture, called Theoretically Based Medicine, was open to conscious and unwitting abuse. It was not good for the health of the patients but great for the power, popularity and pockets of the medical profession.

Any of the criticisms against medicine, even by the conspiracy theorists, only applied to Theoretically Based Medicine. All ethical matters and criticisms have been systematically resolved in the new culture of Evidence Based Medicine. In fact, others in health and 'healing' have been left behind practicing just the way that doctors did before revitalising their ethical standards. 

The best of this new medical culture welcomes other therapies is its complex holistic treatment plans. They call such therapies complimentary therapies. It is the competitive 'healers' who aggressivelycall  themselves alternatives and few are prepared to work in any sort of team. Rather than trying to cooperate with the medical profession, many would prefer to decry and discredit it. They certainly will not work in teams with doctors for the sake of patient health in my experience.

Evidence Based Medicine has actually created a (nearly) fair playing field for modern medicine and its alternatives. They are assessed on an equal basis for their proven risk/benefit profile regardless of whether scientists understand or like their theoretical basis. Particularly when it comes to side-effect profiles, the alternative therapies often win for the first line therapy of non-life threatening conditions.

It is a theoretically fair playing field. Alternative medicine faces the costs and organisation to produce high quality clinical trials that are far from its individualist and competitive culture. Modern medicine has opened the door but the onus is on them to come in.

One of the first successes was the use of visualisation of the immune system fighting back in childhood leukaemia. Acupuncture, Eye Movement Disassociation and Retraining and Emotional Freedom Technique have all got their acts together and published in reputable medical and clincal psychology journals. They have been or are in the process of being accepted by mainstream medicine because they have accepted the olive branch and the compromise. If they want to be compared to western medicine, they must follow shared rules on the quality of clinical investigations so that they can be directly compared.

And we should remember that even the best evidence based clinical psychology such as Cognitive Behavioural Therapy and Rational Emotive Therapy is hardly science. There are scientific explanations for the Behavioural Therapy side but the Cogntive side is based on the knowledge and understanding of the relationship between the human conscious and subconscious, both of which are a meaningless mystery in empricial scientific terms. 

Just because something sound highly sensible and rational, like the mind is capable of changing its thoughts and moods, does not make it science. Culturally, science appear to be trying to cement the illusion of its rationality by allowing these rational subjects to call themselves sciences for the kudos but there are not physical scientific mechanisms behind them. They are based on abstract philosophical mechanisms proven to be functioning working models by the real world clinical evidence.

Physiotherapy and the closely related chiropracters and osteopaths are more like human mechanical engineering than pure science. Their concepts are common sense and proven rather than being built on theories of how or why they work. The most important thing is that they do work. This is the fundamental underlying principle of Evidence Based Medicine.

Despite their lack of true scientific basis, these therapies have been fully accepted because of the high equality evidence that they have produced.

Other therapies have tried and failed. They have failed to produce objective results better than the placebo that they must be compared with. Some therapies that had been accepted by the western medical profession fell victim to more rigorous standards in clinical evidence. When Psychoanalysis was compared, it failed against The Great Healer Time and three hours per week of untrained human time and attention. What had to be proven was that the years of professional training of the analyst statistically improved outcome. For a therapy like Reiki to be proven as clinically effective, it would require that average Reiki therapists outperform average untrained people who attempt to relax patients using their hands to relaxing music.

The offer is open to them if thy dare to take it but they are not allowed to make up the rules.