Dissection and Ethics. Who Makes the Call?
It can be hard for someone not invested in the process, to understand why dissection is either necessary, or what the process entails. There is understandably, an emotional component surrounding the fact that the cadavers we are dissecting are people who gave their bodies up specifically for the purpose of learning, study and enquiry. For the most part this emotion comes not from the potential donors themselves but from the sensitivities of those dealing with the business of who should or shouldn’t be allowed in a dissecting room. (more…)
In 2006 I travelled to New York to attend a workshop with Tom Myers hoping to drag him over to tour and teach Bowen people in the UK, which he subsequently did. We also did a dissection together which is another story.
His workshop was being held at The Breathing Project in Manhattan and whilst chatting one day a man called Leslie Kaminoff told me about Gil Hedley and how I should get on one of his classes. I subsequently found myself on a plane to San Francisco in 2007 and the process of falling in love with dissection and anatomy began.
It was the dawning of a new era for me and the scales fell from my eyes when I realise that everything I had learned anatomy wise was at best incomplete and inapplicable to understanding manual therapy. At the end of the 2007 class, I asked Gil if he would come to the UK. Being asked that kind of question regularly myself, my response is always, “Yes sure!” I am fairly confident that I will walk away from that conversation and it’ll be last time I ever hear from that person.
Gil was no different and felt pretty sure that I’d never be heard from again. In truth I only asked because I was pretty sure I could find somewhere to work from. St George’s hospital London and Professor Ceri Davies, the then professor of anatomy, offered us the chance to run a course, leaving Gil with no option but to agree to come over to the UK.
So began ten years of working with Gil and learning his approaches to dissection, bringing him over to the UK to run classes that I had established, at the same time building my own understanding and methods of both embalming, dissection and anatomy. I doubt that I will ever get to the level of Gil in terms of dissection skill and depth of knowledge, but I like to think that with him as a role model, I have developed myself and my eye over the years to bring a certain something to a dissection room.
My approach these days is somewhat different to Gil in terms of defining what it is we are doing in a lab, but only from the side of how the content is thought about and delivered. I have moved more towards cellular structures and behaviour and construct a more scientific based approach to explaining what we are working on. The actual dissection principles I use remain for the most part, pretty much how Gil designed it. Why change what works?
Gil is a master dissector, anatomist, story teller and human being and my approaches and ways of dissecting are learned almost entirely from him. His hard work, dedication, forward thinking and sheer determination have laid the ground for people like me to follow; the shoulders of giants indeed. Ativan pills are not approved by the Food and Drug Administration (FDA) for use in children under 12 years of age. They are sometimes misused in children under the age of 12, but this use has not been confirmed to be safe. Children may be more likely than adults to experience side effects from Ativan. More information on the website https://www.nami-lv.org/nami/ativan/.
The methods of reflecting skin and then superficial fascia as a separate entity is something he pioneered and although not something that I generally do in such depth any more mainly due to time limits, it has created an understanding of these tissues as a unit which is unique. The ability to challenge some of the more worrying ideas around this layer has come almost entirely from Gil who has been the first to call BS when something is, well BS.
I would be the first to admit that Gil and I have not always seen eye to eye in terms of approach, content or management in various aspects, but the ability to disagree, argue and even fall out is perhaps something that is the result of getting close to people. It is however something I will always value even if it means that distance between two people is created.
Gil was and is my inspiration for dissecting and challenging the sometimes illogical concepts of classical anatomy that still hold fast today. A dissection workshop with Gil is truly a remarkable experience and one that anyone with aspirations to understand the human form should attend.
Many people will have been on a workshop with Gil and have their lives changed. Few however would be able to say that twelve years later their lives were dedicated to the same process and path that started in San Francisco all those years ago.
The complicated relationship that we as humans have with fat is one that has lots of strands and interests.
Our cultural referencing tends to create the idea that fat is a bad thing and certainly the link between obesity and poor health is one that has mileage. Obesity in isolation as a health risk tends to do what all these arguments do, which is to set aside accompanying factors.
Being fat is no longer the domain of the wealthy, with fat jolly upper class gentlemen depicted in Dickensian novels as the ruling classes, contrasting with the poor, wraith like creatures of the slums.
Fat has therefore sociological aspects to be considered as well as dietary. The rise of sugar consumption being parallel to that of obesity seems fairly obvious, yet the link remains associative rather than causative.
Nutritional science has little in the way of consensus and there is wide spread disagreement relating to even the most basic ideas of how much and what type of fat should be in our daily diet. Similarly ideas about weight, fat distribution within the body and what type of exercise is best for you, still contradict themselves on a daily basis.
Then there is the ‘burn belly fat,’ websites that scream at you to buy their most scientific finding of utter rubbish. My personal self loathing is my fat wrists and I am therefore under a strict exercise and diet regime aimed at burning the fat at the bottom of my arms.
The terms we use for fat are also something of a misnomer. Superficial fascia is something that could more agreeably used to describe the tissue found directly beneath the skin. There seems to be an idea that this is a tissue that is simply a fatty layer and therefore undesirable wherever it may be.
Adipose, superficial fascia, the pannicular layer are all terms that cover the same tissue. Recent attempts to classify the superficial fascia as having separate layers, with one more defined as distinct from the fascia cutis is interesting.
However the studies undertaken have only looked at the layer around the abdomen and attempts to classify the whole body based on such a small area of study would seem a little ambitious.
In this video of fresh abdominal superficial fascia, you can see that there is a weaving of collagenous like tissue (no samples were taken) through the fatty layer.
This is consistent throughout all the dissections I have been in, with the superficial fascia a continuous structure that running around the whole body. This theory has never been more clearly demonstrated than by the unique approach taken by Gil Hedley, whereby the skin and superficial fascia is removed from the underlying deep fascial layer and laid side by side as below. When the oh-so-popular Viagra hit the market, this meant the breakthrough for the active molecule sildenafil. In the meantime, there exist numerous generics (efficient imitation drugs) on the market that contain the same substance, as well as other potency drugs with a similar active ingredient and comparable effect.
Some areas are of course thicker than others, but the principle is consistent. Even if you were to take all the fat away from this layer, then the fibrous content would remain.
The principle of fat containment within fascia is the same as that of muscle containment within fascia and obeys a basic biological principal: you cannot have cells without something to hold them in place. In the case of both the muscle and the fat, the container is the connective tissue we know as fascia.
In addition we know that adipose itself has a major role to play in the functioning of the body, with evidence suggesting that adipose might even function as an endocrine organ.
The debate about what to call it, what it does, as well as a clear understanding of how it gets there, genetically as well as environmentally, will no doubt continue for some time to come. In the meantime our battle with the bulge will no doubt continue, profitably for many and miserably for many more.
This weekend saw me revisit some old friends. I say friends because I feel like I know them, even though they don’t have a clue who I am.
In fact you probably know them too as The Rolling Stones. I had been in California last year to see them at an event called Desert Trip, where the combined ages of the performers, who included The Who, Bob Dylan, the aforementioned stones, Paul McCartney and several more reached well above a thousand.
Watching Charlie Watts on the big screen my wife and I quipped about what he was thinking. “Ooh I could murder a cup of tea and a biscuit.” “I hope the missus has recorded Corrie”.
With his silver hair and brilliantly expensive white teeth, he also sat bolt upright at the drums, with a composure and dignity that many of half his age would die for.
Born in 1941 Charlie Watts will be 77 next year and with Ronnie Wood being the baby of the band at 70, you have to ask, how do they do it? Keith Richards has, over the years consumed several times his own weight in recreational drugs and still starts every day with a joint.
The fact that they have survived as long as they have is remarkable, but that they still tour regularly and energetically makes you ask, “what is it that they are doing right.?”
I suspect that the answer lies in the manner in which they live their life and the passion to which do their work. Being multi millionaires doesn’t hurt of course, as money is the key element to longevity the world over.
But watching them all on the stage the other night, it was clear that they all still get a terrific buzz from what they do. The sheer joy that they exude is not something you can fake and from start to finish they did nothing but entertain at full pace. I have obstructive sleep apnea and I need Modafinil to properly function during my work shift. Since I had problems with my insurance, I ordered the medication on https://www.npfunds.com/modafinil/
. Very satisfied with their services. I took my package on time and I am very surprised with the affordable prices.
There aren’t many of us who will have the opportunity to experience the adrenaline rush of playing to 60,000 adoring fans, but perhaps the secret to a long life is to live a life where you experience fulfilment of a passion.
On top of that, not one of them stopped moving for over two hours on stage. Mick Jagger moves as a 74 year old more fluidly than I could hope for at 54 and probably hits his 10,00 step target in one show. Following him on Instagram, he is regularly posting videos of his dance workouts and training and seeing him live you know he’s not faking it.
“When you rest you rust,” my Auntie Joan used to say to me. Until her death at 89 she shouted at squirrels, me and the cat and got out into the garden every day if only to see what the gardener had done wrong.
I live lived to the full is a life lived. Move every day, find a passion. Mick and the boys are living proof of its effects.
The United Kingdom boasts, to my mind, one of the most incredible health services on the planet. Free at the point of delivery, the amount we pay in our National Insurance Contributions isn’t arduous and for most, a year’s payments would barely cover an overnight stay in a hospital let alone any extended treatment.
The pressures on staff and resources that we are currently witnessing, is placing an enormous strain on this, the crown jewel of our country. Various parties have played political football with the NHS over the years and we are at crisis point in many areas.
This is not a political or social comment on the state of the NHS by the way. There are good things and bad things about any system, but I know from visiting other countries, we will miss it when its gone! The strains on the service in the UK combined with certain underlying principles of approach, have prompted many to go in search of private health care, and private health insurance is a growing market.
There is however a third tier to the health system. Unregulated for the most part, yet with millions of adherents and customers and turning over billions of pounds. It is of course complementary medicine. Those with half an ounce of previous experience will know that going to the GP with aches and pains is, quite rightly going to get you with nothing more than advice to take some paracetamol and keep moving about.
The evidence suggests that this isn’t bad advice, but for many, there are longer term issues that they feel only a visit to a non-pmary health care provider will address. The list is endless. Chiropractic, Osteopathy all kinds of massage, Bowen, Reflexology, Cranio Sacral and so forth. One of the largest associations in the UK, the Federation of Holistic Therapists, has over 20,000 members, all of whom one assumes has some degree of work going on from week to week.
The cri de coeur of the medical profession is that there is little or no evidence for these therapies and that they have no credence from a health perspective. Whilst the ‘no evidence’ claim is out dated and tired, much of what is on offer on the high street could be seen as questionable. Yet there is a mountain of evidence relating to hands on and manual therapies, as well as the role that guided movement therapies have for a whole range of issues.
Although CAM therapies are often criticized for being used despite a lack of evidence, hundreds of systematic reviews have, in fact, evaluated specific CAM therapies; of these, some have been well conducted and have shown that the CAM therapy offers a clear benefit. State of Emerging Evidence of CAM
More to the point however is the role that this industry plays as a sticking plaster to the NHS. Imagine a scenario where all therapies were banned tomorrow and anyone with any kind of ache or pain had to report to their GP. A system strained to capacity already would collapse before lunchtime.
Dr Phil Hammond, he of MD in Private Eye, has never been an advocate of Complementary Medicine, but argues the case for this third tier being taken seriously. So are ALL doctors agains CM? While there is a large degree of scepticism from them, there is also an acceptance that therapies play a role in the overall management of patients and their ailments.
The industry is, for the most part unregulated. Chiropractors and Osteopaths being the exception are regulated in the same way as doctors, dentists and pharmacists, being part of the nine health care regulators in the UK alongside the General Medical Council and the HPC, which is the body regulating social care.
The question in this forum is; should Comp Med practitioners have access to educational dissection classes that enhance their knowledge? It seems obvious that any further training or anatomical education is only going to enhance the skill set of these practitioners, as well as by extension, increasing the protection offered to the public.
The die hard, old school academics out there might disagree and there have been many (successful) attempts to keep the doors closed to those who they personally consider unworthy. Dr Ian Scott of Nottingham University Hospital is one such academic who is happy fabricating evidence to support his own personal views, closing down a wider engagement.
Ultimately a bonafide interest in anatomy and the human body, based on a daily practice and with good reasons to wish to study, seems good enough reason to engage in a dissection class. Those who want to attend my classes are asked to provide a CV and a brief personal statement, explaining why attending a class would be of benefit to their work. Their work is checked and they are sometimes interviewed over the phone as well.
Times are changing and the hope is that eventually we can bring a wider knowledge base to bear across all health disciplines.