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ANTIBIOTICS IN RENAL FAILURE
50 I could medical
Even for psychologists who work in departments, who presumably are more attuned than most to medical thinking, it is sometimes difficult in planning a course in psychology to strike an easy balance between imparting useful information to the medical student and boring him with arid, if scientifically valid, facts about behaviour. I suspect that many academic psychologists in non-medical departments would find the task impossible. Curiously the Royal Commissioners themselves seem to have been aware of the dangers of a too-esoteric approach to behavioural science teaching, for they say in their report 1: not agree more.
" In psychology particularly, the approach of many academic teachers to their subject has offered little of the practical interest which is essential if it is to be attractive and useful to the medical student; in very many cases the teachers’ natural wish to arrive at scientifically verifiable facts has led them to focus their attention on laboratory processes rather than on the complexities of the human
being ". Their recommendations for the future
seem
all the
more
puzzling, therefore, and reflect a lack of awareness of how psychology itself is organised, both academically and as a profession. There seems, for example, to be a misconception that academic psychology has at its disposal a unified body of facts which can be made immediately relevant to the medical student’s needs, if only the teachers can be persuaded to do it. This is just not so. Where there are such facts they tend, if anything, to have been collected by psychologists who have applied their research skills to clinical problems, usually because they too are impatient with the sterile preoccupations of their colleagues in general departments of psychology. Compared with specialties like physiology and anatomy, medical psychology is a very new entrant into the field, but there is good cause to believe that, for reasons other than undergraduate teaching, it will continue to establish itself as an independent branch of behavioural science. Surely it would be a retrograde step to abandon it as the natural growing-point for such an important development in medical education. of Psychological Southern General Hospital, Glasgow S.W.1.
University Department
Medicine,
G. S. CLARIDGE.
SiR,—The interesting and valuable contribution to recasting medical education from Dr. Hooper and Mr. Humphrey prompts me to raise a fundamental issue early in the discussion of plans for including behaviour studies in medical education. It is important to realise at this stage that behaviour studies
themselves, as provided by experimental psychology, sociology, and indeed social anthropology, do not provide a coherent basis out of which an adequate course can be constructed (this is probably the underlying reason why the students commented on the inadequacy of the textbooks). The reasons for this are historical. The sciences of behaviour have grown up out of man’s traditional awareness of his own behaviour, as seen in religion, literature, and history, the concepts of which are an inappropriate basis for scientific thought. Yet on this conceptual foundation existing behavioural sciences are carrying out experiment and interpretation without having gone through the necessary phase involving the description of behaviour to establish what it is that is being investigated. For example, we are still without a complete description of the behaviour of the laboratory rat some quarter of a century after psychology began subjecting the rat’s behaviour to experimental studies. Ethology can correct this imbalance by introducing the technique of observation as the basis for establishing what the structure of behaviour is, and what therefore are the natural subdivisions of the subject. This knowledge would then provide us with the necessary foundations for a science of behaviour capable of integrating the disparate contemporary studies. We have successfully run a course on the ethological basis of 1.
Royal Commission H.M.
Stationery
Medical Education, 1965-1968: Report; p, 105. Office, 1968. See Lancet, 1968, i, 809. on
personality for third-year medical students, designed
to
illustrate the structure of social behaviour as the basis for understanding human personality. The course, which is experimental, is currently divided into five sessions, as follows: there is an introduction describing the place of observation in scientific method and the present state of behavioural science; this is followed by the levels of organisation in personality, the comparative morphology of social behaviour in mammals, growing up in sub-human primate societies, and human nonverbal repertoires of communication. Together these subjects constitute a core around which video-taped human clinical material is presented by various specialists. The key-note of the presentation is coherence, which enables an increasing participation by the audience as each session progresses. Since observation is not only the basis for a science of behaviour but also a method for acquiring first-hand knowledge of the patient, we have been teaching fourth-year medical students how to observe animal behaviour; some of the problems involved are set out in my joint papery entitled Medical Students’ Powers of Observation, which some of your readers may like to consult. Sub-Department of Ethology, University Department of Psychiatry, Medical School, M. R. A. CHANCE. Birmingham 15.
ANTIBIOTICS IN RENAL FAILURE SIR,-I should like to congratulate Dr. Kincaid-Smith and her colleagues (Dec. 28, p. 136) on their results with the use of anticoagulants in immunological, " irreversible ", acute renal failure: once again the application of experimental pathology in the clinical field has brought its reward. I would support their thesis that the immediate improvement produced by heparin can be due only to the prevention of fibrin deposition in glomerular capillaries in which immonological damage to the endothelium has removed the protective power of fibrinolysis. In support of this I should like to quote joint work which I have done here with Dr. Nicholas Wright in which we noted that inhibition of fibrinolysis in rats which had nephrosclerotic kidneys resulted in fibrin deposition confined to the damaged glomeruli. In other words I think it probable that, once a glomerulus is so damaged that fibrinolysis has gone, the glomerulus is doomed to obliteration by sclerosis. The haemoconcentration in the glomerulus must mean that there is an increase of viscosity (reflected at the efferent arteriole), which may explain a more than usual tendency for fibrin formation. Thus the kidney’s remarkable fibrinolytic potential is seen in a teleological role. Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP.
E. N. WARDLE.
COST OF TREATMENT OF ADDICTION SIR,-Apparently like Dr. Pierce James (Dec. 7, p. 1239), I resent that I should have to pay an extra four shillings on my already over-taxed bottle of whisky to pay for free heroin to heroin addicts. However, I almost equally resent Dr. Field’s
ungracious attack on psychiatrists (Dec. 21, p. 1350). Far from undertaking the burden of running " addiction units out of lack of humility ", we agreed to this with the utmost reluctance, and largely because we were told that failure to do so would be socially irresponsible, since there was an imminent danger of a Chicago-gangster-style black market developing if we did not. Many of us protested that that was a police responsibility. Many psychiatrists who feel obliged to take part in the scheme appreciate perfectly well that the idea of successfully treating " our present addict population is wildly unrealistic, especially with the resources available. "
"
"
West Middlesex Hospital, Isleworth, Middlesex. 1.
Chance, M.
R. A.,
F. P. HALDANE.
Humphries, D. A. Br. J. med. Educ. 1967, 1, no.
2.
Even for psychologists who work in departments, who presumably are more attuned than most to medical thinking, it is sometimes difficult in planning a course in psychology to strike an easy balance between imparting useful information to the medical student and boring him with arid, if scientifically valid, facts about behaviour. I suspect that many academic psychologists in non-medical departments would find the task impossible. Curiously the Royal Commissioners themselves seem to have been aware of the dangers of a too-esoteric approach to behavioural science teaching, for they say in their report 1: not agree more.
" In psychology particularly, the approach of many academic teachers to their subject has offered little of the practical interest which is essential if it is to be attractive and useful to the medical student; in very many cases the teachers’ natural wish to arrive at scientifically verifiable facts has led them to focus their attention on laboratory processes rather than on the complexities of the human
being ". Their recommendations for the future
seem
all the
more
puzzling, therefore, and reflect a lack of awareness of how psychology itself is organised, both academically and as a profession. There seems, for example, to be a misconception that academic psychology has at its disposal a unified body of facts which can be made immediately relevant to the medical student’s needs, if only the teachers can be persuaded to do it. This is just not so. Where there are such facts they tend, if anything, to have been collected by psychologists who have applied their research skills to clinical problems, usually because they too are impatient with the sterile preoccupations of their colleagues in general departments of psychology. Compared with specialties like physiology and anatomy, medical psychology is a very new entrant into the field, but there is good cause to believe that, for reasons other than undergraduate teaching, it will continue to establish itself as an independent branch of behavioural science. Surely it would be a retrograde step to abandon it as the natural growing-point for such an important development in medical education. of Psychological Southern General Hospital, Glasgow S.W.1.
University Department
Medicine,
G. S. CLARIDGE.
SiR,—The interesting and valuable contribution to recasting medical education from Dr. Hooper and Mr. Humphrey prompts me to raise a fundamental issue early in the discussion of plans for including behaviour studies in medical education. It is important to realise at this stage that behaviour studies
themselves, as provided by experimental psychology, sociology, and indeed social anthropology, do not provide a coherent basis out of which an adequate course can be constructed (this is probably the underlying reason why the students commented on the inadequacy of the textbooks). The reasons for this are historical. The sciences of behaviour have grown up out of man’s traditional awareness of his own behaviour, as seen in religion, literature, and history, the concepts of which are an inappropriate basis for scientific thought. Yet on this conceptual foundation existing behavioural sciences are carrying out experiment and interpretation without having gone through the necessary phase involving the description of behaviour to establish what it is that is being investigated. For example, we are still without a complete description of the behaviour of the laboratory rat some quarter of a century after psychology began subjecting the rat’s behaviour to experimental studies. Ethology can correct this imbalance by introducing the technique of observation as the basis for establishing what the structure of behaviour is, and what therefore are the natural subdivisions of the subject. This knowledge would then provide us with the necessary foundations for a science of behaviour capable of integrating the disparate contemporary studies. We have successfully run a course on the ethological basis of 1.
Royal Commission H.M.
Stationery
Medical Education, 1965-1968: Report; p, 105. Office, 1968. See Lancet, 1968, i, 809. on
personality for third-year medical students, designed
to
illustrate the structure of social behaviour as the basis for understanding human personality. The course, which is experimental, is currently divided into five sessions, as follows: there is an introduction describing the place of observation in scientific method and the present state of behavioural science; this is followed by the levels of organisation in personality, the comparative morphology of social behaviour in mammals, growing up in sub-human primate societies, and human nonverbal repertoires of communication. Together these subjects constitute a core around which video-taped human clinical material is presented by various specialists. The key-note of the presentation is coherence, which enables an increasing participation by the audience as each session progresses. Since observation is not only the basis for a science of behaviour but also a method for acquiring first-hand knowledge of the patient, we have been teaching fourth-year medical students how to observe animal behaviour; some of the problems involved are set out in my joint papery entitled Medical Students’ Powers of Observation, which some of your readers may like to consult. Sub-Department of Ethology, University Department of Psychiatry, Medical School, M. R. A. CHANCE. Birmingham 15.
ANTIBIOTICS IN RENAL FAILURE SIR,-I should like to congratulate Dr. Kincaid-Smith and her colleagues (Dec. 28, p. 136) on their results with the use of anticoagulants in immunological, " irreversible ", acute renal failure: once again the application of experimental pathology in the clinical field has brought its reward. I would support their thesis that the immediate improvement produced by heparin can be due only to the prevention of fibrin deposition in glomerular capillaries in which immonological damage to the endothelium has removed the protective power of fibrinolysis. In support of this I should like to quote joint work which I have done here with Dr. Nicholas Wright in which we noted that inhibition of fibrinolysis in rats which had nephrosclerotic kidneys resulted in fibrin deposition confined to the damaged glomeruli. In other words I think it probable that, once a glomerulus is so damaged that fibrinolysis has gone, the glomerulus is doomed to obliteration by sclerosis. The haemoconcentration in the glomerulus must mean that there is an increase of viscosity (reflected at the efferent arteriole), which may explain a more than usual tendency for fibrin formation. Thus the kidney’s remarkable fibrinolytic potential is seen in a teleological role. Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP.
E. N. WARDLE.
COST OF TREATMENT OF ADDICTION SIR,-Apparently like Dr. Pierce James (Dec. 7, p. 1239), I resent that I should have to pay an extra four shillings on my already over-taxed bottle of whisky to pay for free heroin to heroin addicts. However, I almost equally resent Dr. Field’s
ungracious attack on psychiatrists (Dec. 21, p. 1350). Far from undertaking the burden of running " addiction units out of lack of humility ", we agreed to this with the utmost reluctance, and largely because we were told that failure to do so would be socially irresponsible, since there was an imminent danger of a Chicago-gangster-style black market developing if we did not. Many of us protested that that was a police responsibility. Many psychiatrists who feel obliged to take part in the scheme appreciate perfectly well that the idea of successfully treating " our present addict population is wildly unrealistic, especially with the resources available. "
"
"
West Middlesex Hospital, Isleworth, Middlesex. 1.
Chance, M.
R. A.,
F. P. HALDANE.
Humphries, D. A. Br. J. med. Educ. 1967, 1, no.
2.