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Dr Nikesh Parekh: Film Review The Lunchbox- ‘Letters, chillies, and memories’

4 May, 14 | by Ayesha Ahmad

Set between an apartment block in suburban Mumbai and a modest office floor, The Lunchbox is a film of understated elegance exploring human emotions and connections. Ila (played by Nimrat Kaur) is a young, middle-class Indian woman who is desperately trying to rekindle a waning marriage by preparing her husband delicious lunches that are delivered by the ‘Dabbawala’ system that is widely acclaimed for its efficiency; Dabbawala is an Indian word for men who deliver vast numbers of lunchboxes hanging off the sides of their bicycle in Mumbai and some other cities in India.

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The Wolf of Dallas: Money, Stigma and HIV – Guest Review by Shehzad Kunwar

14 Feb, 14 | by BMJ

A Review of “Dallas Buyers Club” (USA 2013, directed by Jean-Marc Vallee). Released in the UK on Friday 7th February 2014

 

 

Say hello to Ron Woodroof, a ‘typical’ Texan. He loves the rodeo. He wears a white t-shirt, boots, a large belt buckle and, of course, a classic Stetson hat. He is a heterosexual aggressive man who loves drinking, drugs, gambling and women. Not the ‘typical’ person you envisage when you think someone with HIV/AIDS living in the 1980s. But after Ron is diagnosed with “HIV”, he becomes an “overnight champion” for human rights; in particular for the rights of those living with HIV to access unlicensed treatments. In an era where discrimination towards those living with HIV was rife, he is soon shunned by his friends and colleagues, gets evicted from his trailer and ends up in an apartment with a pre-op transsexual. His newest “enterprise” is selling FDA unapproved antiretroviral drugs to fellow end-of-lifers.

 

While acting in his new role pharmaceutical “drug dealer” Woodroof, played by Matthew McConaughey, discovers facts that elude health professionals: such as the significance of patients’ concerns and the value of achieving peace, rather than than prolonging life at all cost.

 

Based on the 1992, ‘Dallas Morning News’ article written by Bill Minutaglio, the script underwent multiple re-writes before funding was secured. With many actors competing for the role, it was McConaughey, who Woodroof’s sister said shared the same swagger and personality as her brother, who eventually secured the role.

 

Armed with a passport, and a strong sense of enterprise, Woodroof travels around the globe acquiring illegal drugs such as alpha-interferon. Ron creates his own pseudo-Big Pharma company in the form of a “Dallas Buyers Club” selling prescription-only drugs deemed illegal by the FDA

 

Moral ambiguity imbues the film, with the question of ethics as a recurrent theme. For example, in the representation of research, Woodroof and Big Pharma run clinical trials in parallel.  The numerous attempts made at shutting down Woodroof’s enterprise by the hospital and Internal Revenue Service, who he tries to bribe to keep his business going, is echoed by the pharmaceutical companies subsidizing the hospitals running the antiretroviral trials on their behalf.

 

Homophobia and ostracizing those who were ‘different’ are evident throughout the film. Director Jean-Marc Velee’s perspective of the deliberate targeting of HIV community groups, amongst the gay scene by Woodroof in selling his drugs, is paralleled by the pharmaceutical companies going straight to human trials of AZT, further exploiting and preying on the “desperate and dying”.

 

The character of Eve, played by Jennifer Garner, represents ethical medicine. She questions the pharmaceutical companies’ intentions in persevering with the clinical trials once the significant side effects of antiretroviral drugs became apparent. Her character also highlights the hierarchy that exists in medicine, then and now. As the film progresses, Eve’s voice as the younger, more empathetic doctor contrasts that of her boss Dr. Sevard. His desire to continue with the trial is directly juxtaposed with her disenfranchisement with it and continuing support for Woodroof’s work.

 

Much hype has surrounded Matthew McConaughey’s weight loss, but that is a small part of his meticulously researched performance. The subtleties and nuances of both his voice and expressions portraying a multi-dimensional figure earned him a well-deserved Oscar nomination.

 

In some aspects it seems that the film is made for the undiscerning viewer, in its stereotypes of corporate America and each characters role displayed clearly in their costume. As another variation of the classic David and Goliath story, nothing is ambiguous here and with the constant voice-overs, there is no doubting the identity of the protagonist. Velee’s perspective is that there is a direct comparison between Woodroof and Big Pharma, with Woodroof’s success in that battle epitomised in his prolonged life beyond the 30 days he was given by the medical profession.

 

This film is a timely way to revisit the HIV/AIDS crisis and continues the work of titles such as “Philadelphia” and “Angels in America”. But unlike Denzel Washington’s character, in Philadelphia, Woodroof’s personal change is guided by greed rather than compassion. Vellee, ensuring that the film’s take-home message is heard loud and clear, amplifies this journey for the mainstream viewer.

 

Dr Shehzad Kunwar (independent film maker, photographer and musician): shehzadkunwar@doctors.org.uk

To Have Been What I Always Am, So Changed From What I Was: Reflections on Altered States and Beckett

30 Jan, 14 | by Deborah Bowman

 

London is currently home to productions of four Samuel Beckett plays. A trilogy – Not I, Footfalls and Rockaby – performed by the extraordinary Lisa Dwan, is at the Royal Court Theatre in advance of a transfer to the Duchess Theatre. Across town, Juliet Stevenson takes on the role of Winnie in Happy Days at the Young Vic Theatre. Both productions are preoccupied with altered states. And, for anyone interested in the health humanities, the concept of the altered state is unavoidable and fascinating.

Not I, the first play in the Royal Court trilogy, plunges its audience into a darkness that is unremittingly absolute. Every glimmer of residual light is extinguished and the effect is devastating. There is nothing between us and ourselves. No distracting or reassuring visual clues that we have a place in the world. All that remains is the blackness. We wait until our eyes adapt – for surely they will adapt – isn’t that what eyes do? Isn’t adaptation the essence of humankind? But they don’t. We don’t. It is inescapable: our altered state.

And then, looming above us in a beam of light, is the mouth. We cannot help but focus. It commands our focus. This disembodied mouth. All that there is in the room is the darkness, the mouth and our thoughts. And so it begins. Words, sounds, glimpses of sentences tumble out of those bright red lips – a life pouring forth, demanding to be heard. At first we can’t make out the words. Some are familiar, but some a nonsense. Is it the speed? Is it the accent? We are concentrating so hard; why can’t we understand? And still the words cascade into the darkness and still we search for meaning. We revert to the comfort of clinical categorisation: this is logorrhea. But how pointless that seems – what is the value of naming but never knowing?

And still the mouth moves and the waves of sound wash over the auditorium. We sense damage. We intuit harm. We no longer need the details – we can feel it. In our altered state, all communication convention is overthrown and we discover it doesn’t matter. If we persist in attending to another, then we will make a connection.

In contrast to the claustrophobic darkness of Not I, the theatre in Happy Days is assaulted by light. It is brutal and unforgiving in its reach. Under the burning brightness, we find Winnie buried up to her breasts. As with the plays in the trilogy, we know nothing of how she came to be here. Beckett is not concerned with causality – it is enough simply to meet a person where and how they are. So, we encounter Winnie, trapped in the earth for reasons we will never understand nor need to understand.

Winnie’s altered state is physically, emotionally and metaphorically concerned with what lies beneath. The audience too, whilst looking only at the top half of her body in an unchanging set, begins to grapple with the unseen and the unexpressed. As Winnie digs deeper into the bag she treasures, her memories, hopes and identity emerge in the form of mundane, and practical objects. Her failed efforts to engage Willie – to share her altered state with another – require her to dig ever deeper into her self. The increasingly brittle humour with which she meets her predicament discomforts us – as altered states so often do.

When Act 2 opens, Winnie’s state is further altered and she is buried up to her neck. All that is visible now is her head. Her hair is disheveled and her teeth rotting. She is herself and yet, so crushingly and irrevocably altered. Her decline is physical and existential. She is in pain. She is unsure whether she is alone because she can no longer turn to see Willie. She can no longer dig deep – and what lies beneath is suffocating her.

As Willie painstakingly crawls his way across the earth, upwards towards Winnie and the gun that rests in front of her, the potential narratives flood our minds. His intentions are ambiguous to the last. But this is not a state that ends. The lights dim and the actors remain frozen on the verge of change. A change we can imagine, but cannot control. An uncertain, but unavoidable, change that mirrors the shifting and complex experiences and perceptions of those altered states that, in other contexts, we call ‘illness’.

Not I, Footfalls and Rockaby is at the Duchess Theatre from 3-15 February 2014

Happy Days is at The Young Vic Theatre until 8 March 2014

 

Guest Piece: Joseph Ting: “Medicine Now, at the Wellcome Collection London: Obesity, The Body, Malaria and Genomes”.

14 Jan, 14 | by Ayesha Ahmad

Medicine Now, a permanent exhibition at the Wellcome Collection in London, presents a range of ideas about science and medicine since Sir Henry Wellcome’s death in 1936. Designed to broaden engagement with medical science beyond the narrow confines of the laboratory or clinic, Medicine Now presents a cogent multidisciplinary view of four topics, Obesity, The Body, Malaria and Genomes. These are explored through the perspective of patients, doctors, scientists and artists.

 

Medicine Now ranges over contemporary art, the way medicine has been perceived, and has affected the human race, in the last eighty years. The intersection between art, science and medicine is made accessible to the lay audience and there are challenging displays for the specialist visitor.

 

Obesity

Dieting, weight consciousness, anxiety about body weight and shape and widespread hostilty to obesity are fundamental themes in contemporary life. There is tension between modern populations trying to control their weight amid unprecedented opportunities to let themselves go. [1]  John Isaacs’ two metre high “I can’t help the way I feel” (2003) comprise superhuman sized globules of cellulite perched on tiny legs (Fig 1).

 

This corporeal aggregate of multilobulated fat has submerged its own head, preserving its anonymity. This however has the unfair effect of diverting the viewer’s attention to the grotesquerie emanating from below the neck. A strategic overgrowth of fleshy apron over the thighs conceals the gender of the person portrayed by “I can’t help the way I feel.” Isaacs may be commenting on society’s fixation with the female form, despite obesity afflicting both sexes.

 

I can’t help the way I feel” could be considered the ugly embodiment of the obesity epidemic. The attention-grabbing dimpled thighs, soft bulges and doughy rolls of Isaacs’ sculpture reminds one of the difficulty the obese face in trying to not draw attention to themselves. The artist’s sympathetic contention that “the way in which the flesh grows, erupts and engulfs the body can be seen as a metaphor of the way in which we become incapacitated by the emotional landscape in which we live and over which we have little control” did little to temper my repulsion for “I can’t help the way I feel.” The impulse to ridicule, discriminate against, and publicly monitor the body shape of, the obese has its basis in the visible markers of fatness (wide hips, protruding belly, vast thighs) transgressing aesthetic standards and signalling pathology and disease. [1] My seeing fatness led to the negative reading of fat bodies. More than ever, judgements about our own and others’ worth is based on the morphological body as compared to the ideal.

 

The Body [Figure 1]

Anthony Gormley, a commentator for Modern Medicine, claims “the body (to be) the root of all our experience, a place where we all live and on which our consciousness depends.” The Body examines new techniques and ways of looking at our internal biological structures and function.

 

Medical imaging technologies play a crucial role in comtemporary medical care.  A century after Wilheim Rontgen discovered x rays, the human body is accessible to radiological techniques that enable doctors to peer inside the intact human body. To improve understanding of new technology, the visitor can sit on sound chairs to hear the views of a Professor of Medical Physics on CT scans and an ultrasonographer on antenatal ultrasound.

 

Anatomical objects-dissected bodies and constructed models-have aroused the interest and curiosity of lay audiences since the late fifteeth century. [2]I found the coronally-sectioned plastinated body of a standing human cadaver confronting. Michel Foucault’s vivid description of “externalising the internal” remains deeply disturbing when one imagines plastinated transparency forcing the total detachment of the body’s interior from an identifiable and skin-covered person. The sliced body brings to mind Gunther von Hagens’ Bodyworlds blockbuster that travelled the world and attracted millions of visitors. Then there was outcry protesting the moral ambiguity surrounding the display of artfully dissected human bodies for mass entertainment.  However it is hard to deny the educational value of Transparent Woman (1980), from the Stiflung Deutsches Hygiene-Museum, which allow the visitor to light up several human organs with a push button panel.

 

Moral objections are harder to pose with the Visible Human Project. Digitised anatomical bodies are developed from thin CT cross-sections of a standard adult male and female body, offering perpetual electronic cadavers that are able to be logged onto regardless of time or location, and facilitating the training of students and surgeons. Digital simulation comprise unmediated inscriptions of cadavers that have not been distorted by the pencil of the illustrator or the knife of the dissector. 2 However, unless the electronic form can be sculpted into a model by 3D bioprinting, tactile cues remain impossible.

 

The audio observations of a humanities academic seeing medical students performing anatomical dissection for the first time was most poignant as the heart was delivered into cupped hands. It brought back memories of my own tentative first encounter with our dissection group’s cadaver in the anatomy laboratory. However, The Body pays scant attention to human physiology. The finger sensor that was supposed to measure my pulse and cardiac rhythm and display this “biogram” on a touch screen failed to work. The pulse oximeter is not a new innovation, having been around for decades.

 

Malaria

The mosquitoes used by Alastair Mackie to outline the world’s coasts on a plain white board in Mosquito Coast (2002) come from the malaria research laboratory at the Division of Cell and Molecular Biology at Imperial College London (Fig 2). The fragility of thin borders formed by a delicately assembled line of single mosquitoes belies the difficulty humans have encountered since antiquity in trying to overcome malaria’s formidable defences and superb adaptation. Mosquito Coast testifies to an army of malaria-bearing mosquitos encircling land masses and islands to symbolically entrap the world.

 

At the dawn of the twenty-first century, Mackie’s map puts us on notice that the malarial mosquito loaded with its most feared pathogen still commands worldwide attention. Each year millions of people die from malaria. Over vast regions, human health continues to suffer and national economies fail. Although malaria is a potent threat only in the tropics, it remains a disease without borders, with sporadic cases occuring in returning travellers and immigrants in advanced nations. The absence of national boundaries in Mosquito Coast signify the porous permeability of malaria’s distribution. Where it had not been reported previously, de novo malaria now occurs ocassionally in northern Australia. [3]

 

Mosquito Coast  forces the recognition that malarial mosquitos remain a robust and ancient foe that continues to shape human history worldwide. Opportunities for malaria spread around the world occur with increasing international travel and trade. Mosquitoes survive transoceanic flights in aircraft cabins and baggage compartments and are brought to distant ports in shipping containers. [4]

 

Mosquito Coast stimulates thinking on the the role of global climate change, congested urbanisation and environmental degradation in expanding the habitat of malaria-armed mosquitoes. We are reminded of the disrupting effects of human activity on the ecology of pathogen carrying vectors. However it is not all bad news. Mackie’s world map reminded me of satellite-aided Geographical Information Systems that employ meterological data and malaria incidence tracking to better  deliver insecticides and antimalarial. The global reference implied in Mosquito Coast urges international research to control malaria and its mosquito vectors to be as collaborative as the tightly linked mosquitoes on show.

 

Genomes examines the scientific study of DNA as well as its social and cultural significance. The scale of the challenge faced by the Human Genome Project is mirrored in the formidable series of books containing the first printout of whole human genome, presented at reduced font to to able to accommodate 3.4 billion units of DNA code, and neatly arranged on high shelves. High tech gene sequencing is complemented by television documentaries dealing with the human suffering inflicted by a mysterious familial disease, the genetic mechanisms of which were not known then. Even when the diagnosis of a range of genetic diseases is now possible, the prospects of replacing defective genes with curative intent remains a distant dream.

 

Conclusion

 

Modern Medicine more than fulfills the Wellcome Collection’s modest aim to being a “free destination for the incurably curious.” The exhibition is capable of inciting public interest in the performance of medicine in its more recent incarnations. In exploring the connections between modern medicine, life and contemporary art, visitors can achieve intriguing insights that result from the intersections between past with present; professional and lay; science, art, and society. Obesity and Body is analogous  to “looking and being looked at [judging body weight and aesthetics], and looking through [medical imaging and anatomical models]” respectively. Genome and the (plastinated) Body displays pose difficult moral and ethical challenges.

 

Modern Medicine is cohesively curated;  the microscopic genetic imprint of life plays an influential role in determining body shape and size, and our susceptibility to diseases such as malaria. In embedding biomedicine within an rapidly evolving historical and cultural landscape, and undertaking to explore the future direction of biomedical science, the challenge Modern Medicine faces is to maintain its contemporaneity since opening in 2007.

Figure 1

 

 

Figure 2 

 

References:

1. Stearns PN. Fat history : bodies and beauty in the modern West.

New York: New York University Press: 1997.

2. van Dijck J. The transparent body : a cultural analysis of medical imaging. Seattle: University of Washington Press: 2005.

3. Hanna JN, Ritchie SA, Eisen DP et al. An outbreak of Plasmodium vivax malaria in Far North Queensland. Med J Aust 2002;180:24-28.

4. Spielman A, D’Antonio M. Mosquito : a natural history of our most persistent and deadly foe. London: Faber: 2001.

Written by Dr Joseph Ting; Adjunct Associate Professor, Faculty of Health and Social Work, Queensland University of Technology, Brisbane, and Senior Staff Specialist, Department of Emergency Medicine, Mater Health Services, Raymond Terrace, South Brisbane 4101. Email: jysting@uq.edu.au/ Joesph.Ting@mater.org.au 

Alam Anjum: Emotional Warfare: From Doctors to Patients

25 Nov, 13 | by Ayesha Ahmad

 

Whilst watching the film, “The Doctor”, released in the year 1991, I was struck by the same old question in my mind, whose answer I have been looking for several years that; to what extent does a doctor need to be attached or detached from their patients as persons?

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Khalid Ali: From lecture halls to cinema screens: learning about the psyche through films

11 Nov, 13 | by Ayesha Ahmad

Last year, the round-up of medical humanities-related films at the London Film Festival (LFF) centred on the theme of old age. This year, to synchronise with Mental Health Day (which fell on 10th October 2013, the second of the twelve days of the LFF), the mind and its mishaps serve as our cluster-point.

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Khalid Ali: Hidden crimes in stroke exposed through a camera lens A review of film “Abuse of weakness” directed by Catherine Breillat, France 2013

27 Oct, 13 | by Ayesha Ahmad

The impact of stroke on the lives of patients and their carers seen in the French film “Amour” directed by Michael Haneke was an eye opener to audience around the world, and justifying the film winning the Oscar for the best foreign film in 2012. As stroke organisations around the world celebrate the “World Stroke Day” on the 29th of October this year another French film “Abuse of weakness” tackles the trials and tribulations of life in the aftermath of a stroke.

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Event: Anatomy for Life

12 Jul, 13 | by Ayesha Ahmad

BMJ 1

Ayesha Ahmad: The Sky Surrendered Your Story, and I Held It.

9 Jul, 13 | by Ayesha Ahmad

Between the doctor and the patient, there is a void; a chasm of the unknown, territories of wild terrain, fertile for a relationship to grow, to nurture and become a healing.

The healing. The healing comes as an ending; a termination of the settlement of the pain identified by the bearer being recognised by the observer.

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Ayesha Ahmad: St. Panteleimon: Patron Saint of Physicians

25 May, 13 | by Ayesha Ahmad

A few weeks ago, in the city of Belgrade, I sat alongside some of the most eminent of ethicists in current biomedical debate, and discussed the morals of enhancing humans.

In light of our scientific and technological development of the means to cause our own final destruction, for our survival, it was argued, we need to enhance our morality, through therapeutic interventions that lead to morally-enhanced motives. Otherwise, we will just become what we become. By virtue of the nature of such therapeutic interventions, subsequently, there will no longer be any need for the reflections of whom we are.

So, too, will the narratives of our writers, our poets, our artists be executed and belong only to a death that cannot speak of our existential disclosures.

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