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Julian Sheather

Julian Sheather: Will the confluence of big data and the genomics revolution lead to a transformation in personalized healthcare?

9 Feb, 15 | by BMJ

julian_sheatherWill the confluence of big data and the genomics revolution lead to a transformation in personalized healthcare, or are the emperors’ clothes looking a little threadbare? This was the theme of the Astellas Innovation Debate for 2015, held in the Royal Institution’s lovely raking lecture theatre in Albermarle Street. George Freeman, Minister for Life Sciences, gave an upbeat, we’re clearly in the run-up-to the election, opener. This was visionary stuff. The i-Gene revolution had bought us to the threshold of a great leap forward. Precision healthcare, personalized to our individual genomes, will strip old health of its inefficiencies, side-effects, and randomness. Healthcare costs will plummet. Outcomes will go through the roof. The NHS will become the first publicly funded health system to offer genomics as routine treatment. Smartphones will become medical sensors, providing real time data about our health status, transforming self-care and bringing relief to an overstretched health system. Freeman summoned the ghosts of the great dead: Bevan, he told us, would have championed the i-Gene revolution. Nor does the good news end there. Access to all that rich data locked away in NHS databases—duly anonymized—will unleash the life science industries, giving fresh impetus to the UK’s economic recovery. The future is bright, the future is i-genetic. more…

Julian Sheather: Torture, medicine, and the need for an independent eye

26 Jun, 14 | by BMJ

julian_sheatherIn August 2012, Claudia was woken at 3:00 in the morning when soldiers burst into her home in Veracruz City, Mexico. They tied her hands and blindfolded her. They took her to the local naval base where they tortured her: they subjected her to repeated electric shocks, then they wrapped her in plastic, and beat her—the plastic was to disguise the marks. She was accused of being a gang member, something she vehemently denied.

The next day she was forced to sign a statement unread. In court a week later, she retracted it and testified to the abuse she had suffered. All but one of the charges against her were dropped, and the judge ordered the federal attorney general’s office to investigate. This was nearly two years ago. Nobody has yet been held to account, and in all that time she has received no specialist medical and psychological assessment. more…

Julian Sheather: The man whose mind exploded

13 Jun, 14 | by BMJ

julian_sheatherDrako Oho Zarhazar has anterograde amnesia, a rare brain disorder that has left him unable to form new memories. The distant past—episodes from before the traumas that disabled his mind: a motorcycle accident; his car crushed beneath the wheels of a monster truck—remains to some degree with him, but he can hold almost no memory of anything that came after. He lives in a more or less permanent present, moving in a single interval of time, ghosted by his own slowly withdrawing past.

A former dancer, bohemian, drug dealer, fetishist, and one time muse to Salvador Dali, Drako is in his seventies and, it’s fair to say, he is slightly more than unusual. He strides into his documentary, caped like a magi, walking with his staff down the pebbled foreshore of Brighton beach. He is bald, pierced, crazily (almost childishly) made up, his upper lip horned with a black waxed Dali-esque moustache. Naked on the beach, his nipples are pierced, and a rather lovely tattoo of an ithyphallic ram wraps around his back and leaps down his flank. more…

Julian Sheather: Public health and social power

29 May, 14 | by BMJ

julian_sheatherIt’s hard not to brood from time to time on some of the intractable public health problems that entangle us. Take obesity. Swimming with my boys over the weekend, I was again struck by how much the food that should sustain us is killing us. It’s hard as well not to wonder where change might come from. We know that obesity arises at the juncture between appetite and environment, between private choices and systems that constrain and encourage, between our evolved appetites, the supermarket shelves, and our all too wavering wills. We champion individual and commercial freedoms—freedoms to buy, freedoms to sell—but the private exercise of our liberties is everywhere undoing us.

We know that change will somehow have to address both the regulation of our desires, and also the great social playgrounds in which our desires roam. Partly it is a private issue—what I eat is my business—and partly it is a public one, as cumulative private choices can become big social problems. Although for thousands of years we approached the problem of appetites via the virtues, we now quail at any public suggestion of moralism, preferring the quaint and neutral fiction that we are all rational economic actors and that we can be entirely taxed into good health.


Julian Sheather: Time to debate the ethics of robot care?

17 Apr, 14 | by BMJ

We take it for granted that compassion is at the heart of good care. But what if the hand that reaches out to yours is a robot’s? What if the last face you see on earth is a facsimile? The use of robotics is well established in parts of medicine. Surgery involving remote manipulation of robotic arms is now commonplace. Some have even predicted that surgery will cease to leave a scar: introduced via orifices, robots will travel to the afflicted area, self-assemble and do their robotic thing. But by and large these remain an extension of ordinary human tools—just better. Fully-autonomous robots, our companions and servants—even our nemeses—have not made it far from the pages of science fiction. As an editorial in The Economist has it, set aside car manufacturing and vacuum cleaning, robots have been more successful at parsing our anxieties about technology than delivering real world promise.  But things might be changing. Scientists at Ohio State University have developed an algorithm that enables computers to read human emotions. Google and Amazon are both investing heavily in robots. Big data, cloud computing and the ever-growing crunching power of ever-shrinking processors suggest that robotics may be about to take an automated leap forward. more…

Julian Sheather: Ugandan anti-homosexuality legislation: bad law, bad science

25 Feb, 14 | by BMJ

For all the fanfare that headline science can generate, it is usually quiet science that arouses my sympathies. Carefully uncovered facts can settle like welcome oil, stilling the troubled waters of moral panic and vengeful politics. I am more drawn to the Victorian naturalists who posted songbirds to each other, carefully mapping variation, than to their bullish champions, the Huxleys, and, more latterly, the Dawkins’, who would batter the world’s opinions into quiescence. Disappointing morning then when I return from a week in Norfolk and find that President Yoweri Museveni of Uganda has signed into force draconian anti-homosexuality laws, attaching a life sentence to “aggravated homosexuality.” Even more disappointing to learn that he has done so on the basis of advice from fourteen Ugandan medical “experts.” The clincher, according to these “experts,” is that homosexuality is not genetic behaviour, but learned—not a “natural” occurrence, but a social pathology. more…

Julian Sheather: To see the world in a grain of wheat

14 Oct, 13 | by BMJ

Many years ago I was walking along Kilburn High Road with a sharp-eyed naturalist friend when he spotted an ear of domestic wheat growing in one of those squares of soil cut into the pavement for urban trees—forlorn scraps of earth that litter gets stuck in, cigarettes get put out in, and dogs (and the occasional drunk) like to defecate in. He practically whooped with joy, then spent a good five minutes crouched over it—much to the confusion of passers-by—while he lectured me, excitedly and at length, on the marvel of wheat and the natural history of our relationship with it. It was the first time I had ever really thought about just how dependent we are on a species of grass that was probably first domesticated over ten thousand years ago in what is now Turkey. For most of us urban dwellers, felt knowledge of our dependence on domesticated grass is rare, as rare as, well, finding an ear of wheat growing on Kilburn High Road. more…

Julian Sheather: Do younger doctors take more time off sick?

8 Jul, 13 | by BMJ

I’ve been doing some work recently with a GP trainer. I’m not a good judge of these things, but I would put him in his mid-fifties. He strikes me as the sort of committed, diligent, unassuming doctor who has helped form the backbone of post War British primary care. Committed to the NHS, possessed of a strong sense of social justice, he seems to combine intelligence, sensitivity, and a kind of wily strength or resilience. more…

Julian Sheather: On tweeting black medical humour

13 Jun, 13 | by BMJ

I was at a conference on doctors and social media recently, sharing a platform with the GMC. The organisers put up some darkly funny tweets by doctors at the ends of their tethers, usually fired off in the small hours. There were jokes at the expense of patients and juniors, managers and colleagues…The question for the GMC and me was, more or less, should doctors be posting this stuff? Is it ethical and, slightly more urgently, will the GMC be after them if they do?

Social media are powerful tools and in some form or other are probably here to stay. But among a great many things that are useful lurk a few hazards for the unwary doctor. One of these is the way social media can blur the distinction between our public and private lives. Reading those tweets at the conference—so much compressed spleen—was like watching the collective medical unconscious rear its head: a 4 am outpouring of rage, frustration, and plain disbelief. more…

Julian Sheather: Francis—the ethical challenge

30 Apr, 13 | by BMJ

Medical ethics has positioned itself as a decision making tool, a philosophical spanner if you like in the clinician’s toolbox. For understandable reasons it has concentrated on practical dilemmas: even those landmark legal decisions—the removal of treatment from Anthony Bland comes to mind—are buttressed by intense philosophical scrutiny. In the process medical ethics has attracted some good minds from academic philosophy, pleased no doubt to see some practical pay-off from their more abstract deliberations. more…

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