Regarding the generational changeover

31 Jan
Joan Escarrabill

The day before turning 65 last November, I climbed up the 238 steps of the Pyramid of the Sun in Teotihuacan (near FD Mexico). I did it with only a short break halfway up. At the top I had dyspnoea but I was able to hold a conversation without difficulty. I went down backwards holding onto the guide rope because my left knee didn’t allow me to go down in a conventional way, face forward, but I did get down. Human beings have the tendency of setting temporary goals arbitrarily. Establishing 18 as the legal age has nothing to do with the maturity of a person and nor does being 65 make you old. To understand the idea of “getting old” it might be more objective to remember, for example, “the first time that  …”

  • … a resident doctor or student speaks to you in a formal way.
  • … an unknown person, on the street, identifies you with a “sir”.
  • … a young person offers you their seat on the underground or bus.
  • … you come across a book in a second-hand bookshop and see that you have the same one, bought many years ago (and remember perfectly well where and when you bought it).
  • … you realise you are no longer able to run.
  • … you forget to hail your bus or don’t run down the stairs in an underground station to catch a train.
  • … you look for the banister to descend a staircase.
  • … you receive a letter from the Town Council saying that you are eligible for a “pink pass” (senior citizen’s transport pass)
  • … in a professional meeting you are asked directly how long you have before retirement.
  • … your presentation is appreciated because you know the history of the problem well.
  • … or comments are made saying that your beard puts years on you.

All this does not happen to you at 65. All this occurs little by little, in an irreversible manner. It is biology. And worse for those who don’t get there.

That is why retiring at 65 is no more than an illogical convention bereft of justification. There are people who anxiously wait for retirement to be able to “do the things they like”. I don’t understand this idea of retirement at all. Maybe it’s because I don’t understand retirement with a set date (like an expiry date). Whatever the case, I don’t see the need to retire to do other things because I really like what I do.

A very different thing is to reject retirement and to hold onto the monopoly of space, time and ideas. A generational change over is essential. With time, we all tend towards stability and Darwin showed us that the more stable a system, the less possibility it has for survival. A stable system has little variability and therefore little capacity to respond to new situations. The limited capacity of response impedes adaptation and therefore leads us to the same future as that of the dinosaurs.

It is much more important to talk about a generational changeover than retirement. Some key ideas in my opinion are:

  1. No generation has the right to stipulate how their successors should live. Each generation has the right (and obligation) to live as they see fit.
  2. No generation has the right to leave the space they have occupied in a way that impedes successive generations to design it the way they think best.
  3. No generation has the right to prevent successive generations from moving forward at their own chosen speed. Each one can move forward at the speed they desire but there comes a time when generations that have more past than future cannot monopolise the fast lane on the motorway.
  4. There is no need to consider retirement as a “set date” although it is imperative to be clearly aware that natural evolution will lead us to gradual invisibility.
  5. Experience DOES NOT generate knowledge. Experience is very useful to identify patterns more quickly, to increase the “bank of solutions” or to carry out repetitive tasks with greater precision (although it won’t be long before machines beat us at this). What generates knowledge is curiosity, critical thinking and hard work (very hard work), in other words, perseverance.
  6. Each generation has the duty to explain what they have done and why they did that. They need to put this forward for general consideration. This should not be done to gain recognition but to be questioned so as to help learn from mistakes and to avoid others committing unnecessary reiterations.
  7. Naturally, no generation has the right to define the agenda that a succeeding generation needs to follow. Giving an opinion with a critical spirit, yes, always, but stipulating the itinerary based on experience is doing a great disservice to the generational changeover.

All this is not a justification for paralysis. There are always challenges in this process. It is always possible to find “blue oceans” on which to sail. Joaquim Mª Puyal has returned to the radio. I have not listened to him at all but I have read some declarations in which he stated that “at my age, a challenge is a luxury”. We can (should) look for challenges at any given time, but with the rules of the game in mind.

A friend of mine, Josep Mª Monguet, told me that he went to visit a friend of his who was very ill. He said that the man, now ill, had always been very active. When he saw him, my friend, using a stereotype said to him: “What are you up to these days?” “I think up concepts”, he replied. After all, you are very fortunate if you can still “think up concepts”.

Post written by Joan Escarrabill (@jescarrabill)

Shall we go an extra mile? The IMIM and IDIBELL place the patient at the centre of research

24 Jan
Maite Solans Domènech

Research impact assessment studies show that to achieve more impact on society the participation of ‘people that can provide value’ is an important factor. What these studies show us is that making key actors participate in the long process of research can improve the efficacy of its application and its impact on society. In the conference which AQuAS organised on Participation in Research last April 4, Derek Stewart, very much involved in Patient and Public Involvement and Engagement at the NIHR Nottingham Biomedical Research Centre, told us that participation provides different perspectives to research. In addition, Derek Stewart explained that “while patients have the opportunity to configure the future and make sense of what is happening to them in their day to day, researchers have the opportunity to legitimate what they do and make their results visible.”

So what have we learnt from all this? Firstly, that there is diversity of participation in research with a wide range of ways of interaction that are inserted in the different levels of the research process. Secondly, that despite individual idiosyncrasies, a global and shared approach is needed to avoid contradictions and to take advantage of mutual learning. Thirdly, that a commitment is needed on the part of all the different institutions and the research community in order to favour participation in research and to have an impact on society. This is why a Work Group on Participation in Research has been created, (#SomRecerca). Under the initial coordination of AQuAS, different health research institutions have come together to promote actions, agents or strategies that facilitate participation and that foster more awareness of the research community. The principles that accompany this group are based on mutual support and the acceptance that diversity and different realities exist within each context.

The first step taken by this group has been to hold conferences in two institutions (IMIM and IDIBELL), last 22 and 23 of January, under the title Shall we go one step further? Placing the patient at the centre of research. These conferences have been a good opportunity to present experiences that were already on the go within the institution itself which place the patient at the centre of research.

The conferences have made the different experiences stemming from individual motivations worthwhile, of researchers or users themselves, and they have been inspirational as examples of where one can start. The patient has been placed at the centre of research in these experiences: to obtain resources, to generate ideas, to prioritise research or to be a part of the research team, among others.

And more specifically, actions have been proposed that help develop the participation of patients which provides value in research:

  • Informing patients of the research that is being carried out in institutions; that is, bringing research closer to citizens
  • Communicative skills of the researcher towards a non-scientific audience
  • Effective communication channels between patients and researchers, be they via an associative network or via other activities or means of communication such as conferences with patients, etc…
  • Support for all those involved in participation: of recruitment, of time, of resources, between researchers or with a guide.
  • Stable work groups that include the participation of different profiles (basic and clinical researchers, assistants, managers and patients) so as to identify needs, come up with ideas or make proposals, for example.

In short, the synergies between patients and researchers must be sought out in those cases where value can be provided. It is not always and easy path but one which makes a whole lot of sense.

Post written by Maite Solans Domènech.

Medical tourism

17 Jan
Joan MV Pons

Those who have seen the British movie “The Best Exotic Marigold Hotel” (2012) will remember that one of the protagonists, a cantankerous old lady who saves the hotel thanks to her bookkeeping skills, goes to India to get a quicker treatment for arthroplasty although I can’t remember whether it was for a hip or knee replacement. It serves as another example of what is known as medical tourism which consists of precisely that, travelling to another country to find a health service more quickly or cheaply.

Barcelona is a centre of attraction for health tourism and several clinics and hospitals in the city advertise their services through the Barcelona Medical Center and the Barcelona Medical Agency, in a mix of hotel interests and prestigious professionals. The Catalan Tourism Agency itself includes this as an asset for a country. Not long ago, when there were doubts about whether there would be enough antiviral treatments of direct action to treat all people infected with the hepatitis C virus, some astute countries like Egypt, where tourism had dropped sharply for different reasons that have not gone by unnoticed, announced that for 5,900€-8,000€ you could spend one week in the country, have a stroll around the pyramids and at the same time receive treatment. It is worth mentioning that Egypt, due to its high prevalence of hepatitis C, has great expertise in this and is an undeniable tourist destination, even more so if we throw in a cruise along the Nile to boot.

We are not saying anything new regarding health tourism because even in the times of ancient Greece some temples in Asclepi had more attraction than others. It is a phenomenon which has been on the rise for quite a few years now even though it has been affected by economic recessions, like other businesses. We are talking about a medical tourism which is sensitive to quality and another more sensitive to cost; the first predominant among the affluent and the second among the middle class. No country seems to be protectionist in this field. In fact, quite the contrary and it is a form of importation (people who come looking for a health service with a short stay but which can easily be extended in the long term to pensioners that come looking for sea and sun in the last years of their lives). It could almost be considered as a form of foreign investment.

There are countries which, following Adam Smith’s recommendations, have specialised in a particular type of health tourism. Barcelona is well-known for its eye clinics, digestive surgery, transplants and assisted reproduction. In terms of transplantation, everyone knows that the trade in human organs is banned but no one doubts that in some countries it is done. Regarding assisted reproduction, the greater or lesser attraction of a country is largely determined by the degree of permissiveness in its legislation and as with other types of health tourism, by its costs. This legal issue becomes particularly apparent in what is known as surrogate pregnancy or surrogacy. It is said that this “industry” specifically, where a difference can be made between gestational surrogacy (embryos generated in vitro) and traditional methods (only artificial insemination), generates up to 6 billion dollars annually and that India is one of the main destinations. Needless to say, there are considerable ethical issues regarding both assisted reproduction and transplantation.

Besides what has already been mentioned, one can find a wide range of services abroad: all sorts of heart, bariatric or plastic surgeries, and also the more traditional treatments in health spas in exclusive locations (who does not think of “The Magic Mountain” by Thomas Mann). For those who see the world as a potential source of business, medical tourism can be a great investment and if tendencies today are anything to go by, it will continue grow even more in the future. It is also a very competitive field of business, especially in terms of prices as an international comparison of costs show.

Post written by Joan MV Pons.

Blog AQuAS Awards 2018

10 Jan

Avui fem públic qui és el guanyador del Blog AQuAS Awards 2018 que reconeix el post amb més lectures de l’any.

En aquesta edició, el premi es debatia entre cinc posts finalistes de Ferran Barbé, Olga Martínez, Xavier Mora, Núria Radó, Angelina González, Dolores Ruiz i Dolors Benítez.

El guanyador ha estat Ferran Barbé amb el següent post:

Moltes felicitats, Ferran!

Let’s begin the year…

3 Jan

We begin the year by giving thanks to all the people that have collaborated in the blog AQuAS during 2018: Ferran Barbé, Olga Martínez, Xavier Mora, Cari Almazán, Gaietà Permanyer, Dolors Benítez, Clàudia Pardo, Francesca Moya, Iria Caamiña, Núria Radó Trilla, Núria Cuxart, Glòria Novel, Jordi Varela, Ernest Abadal, Marta Millaret, Núria Rodríguez-Valiente, Marc Fortes, Mercè Salvat, Anna García-Altés, Marcel Olivé Elias, Jean Patrick Mathieu, Enric Limon, Gonçalo de Carvalho, Alícia Avila, Elisa Poses Ferrer, Ion Arrizabalaga, Joan MV Pons, Joan Escarrabill, Felip Miralles, Montse Moharra, Lina Masana, Mireia Espallargues, Xavier Bonfill, Marta Gorgues, Gemma Cabré, Jorge Arias, Johanna Caro Mendivelso, Kayla Smith, Angelina González Viana, Dolores Ruiz Muñoz and Ramon Maspons.

Many thanks to everybody!