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Breast screening error: disaster or blessing in disguise?

The NHS computer error that has resulted in some 450,000 women aged around 70 not having received an appointment for a final breast screen is obviously, and understandably, deeply worrying for the women concerned. Predictably, the media have headlined the estimate that up to 270 of them may have developed cancers that are more advanced and difficult to treat than they would have been if diagnosed earlier. But this depends on a number of assumptions. Leaving aside the fact that this is the upper limit of an estimated 135-270 range (compare the "up to" speeds quoted by ISPs - how many customers achieve them?), the situation, as usual, is more complicated than the headlines imply.

New Scientlst has a good discussion of the question (Why breast screening error stories are getting death stats wrong). This article makes the important point that, for some women, the failure to notify them may have done them a favour. The current NHS estimate is that, for every 200 women in the 50-70 age range screened, one will be spared an early death but three will have unnecessary treatment for cancers that would not have been a problem in their lifetime.


... it means that up to 800 women may have been saved from harm by not sending them their final screening appointment letter, as they avoided possible reduction in their life expectancy through unnecessary treatment.


The New Scientist article makes the important point that the women who received unnecessary treatment would never know this and would presumably be forever grateful, believing that their lives had been saved by the 'harrowing treatment process'. So this is an 'invisible' harm that is difficult to quantify.

Book review: The Mind Is Flat, by Nick Chater

Sigmund Freud did not invent the notion of the unconscious—in one form or another it goes back to antiquity—but he undoubtedly popularised it. Thanks largely to him, many people today think of their minds in terms of the iceberg metaphor, which implies that much of what goes on in our minds is largely or completely unknown to us. The idea of the unconscious is deeply infused in art, literature, and many other aspects of our life; in fact, it is so widespread that it is practically impossible to escape.

But why has it remained so popular? Probably because it corresponds with how we think of ourselves intuitively. (At least, this is true for Westerners; whether the idea is so deeply ingrained in other cultures I'm not sure.) And yet some psychologists and philosophers have rejected the notion of an unconscious mind. This where Chater stands, although, as he tells us, he came to this view only after a long struggle. [Continue reading]

Book review: Casting Off, by Elizabeth Jane Howard

At the end of the third volume of the Cazalet Chronicles, Confusion, a lot of threads were left dangling. Here they are all tidied up pretty completely, against the background of life in post-war Britain, which still has plenty of hardships to be endured more or less stoically. Rationing of food, clothing, and fuel is still there or is even increasing under the Labour government, and there are the famous London smogs, one of which Howard describes vividly. [Continue reading]

Book review: The Stories of English, by David Crystal

There have been many histories of English but nearly all of them focus on what Crystal terms Standard English. His book, he claims, is different. Its title is "The Stories of English" and not "The Story of English", because it sets Standard English in the context of the numerous other varieties of the language that have existed and still exist today. All of these, Crystal believes, are equally valid and deserving of respect.

The book covers the whole history of English, starting with Old English and continuing up to the twenty-first century. At all stages on the way we meet a great number of variations, which are illustrated with often lengthy quotations (this is a long book). Continue reading

An interesting paper, possibly relevant to acupuncture

Structure and Distribution of an Unrecognized Interstitium in Human Tissues
doi:10.1038/s41598-018-23062-6

This paper is very interesting in its own right and I think may have relevance to acupuncture. Although the focus is mainly on internal organs the findings also relate to the skin and connective tissue generally. The authors describe a previously unknown but widespread system of fluid-carrying channels of potential clinical significance.


"We propose here a revision of the anatomical concepts of the submucosa, dermis, fascia, and vascular adventitia, suggesting that, rather than being densely-packed barrier-like walls of collagen, they are fluid-filled interstitial spaces. The presence of fluid has important implications for tissue function and pathology. Our data comparing rapidly-biopsied and frozen tissue with tissue fixed in a standard fashion suggest that the spaces we describe, supported and organized by a collagen lattice, are compressible and distensible and may thus serve as shock absorbers."


This mechanism is thought to occur in the skin under mechanical compression and in the musculosketal system during activity.


"In sum, while typical descriptions of the interstitium suggest spaces between cells, we describe macroscopically visible spaces within tissues – dynamically compressible and distensible sinuses through which interstitial fluid flows around the body. Our findings necessitate reconsideration of many of the normal functional activities of different organs and of disordered fluid dynamics in the setting of disease, including fibrosis and metastasis."



Whether this discovery will ultimately prove to have relevance for acupuncture remains to be seen, but it's certainly something we need to be aware of. For example, it may be an additional reason for rejecting skin pressure as a valid control in acupuncture trials. So watch this space (literally).