Please give me a Placebo

This morning an article was published on the BBC News website:  “Anti-depressants: Major study finds they work.”  Apparently there has been some debate about this.  “Scientists say they have settled one of medicine’s biggest debates after a huge study found that anti-depressants work.  The study, which analysed data from 522 trials involving 116,477 people, found 21 common anti-depressants were all more effective at reducing symptoms of acute depression than dummy pills.”


The BBC article came with a meaningless picture of pills, so here is my meaningless picture of pills.  They are multivitamins in case you are interested.

Well that would seem like good news.  Until that is you read a little deeper.  Then we find that “the study found they ranged from being a third more effective than a placebo to more than twice as effective.”

Just a minute.  If a drug is one third more effective than a placebo I think that means that in a trial where the placebo cures 3 people the drug cured 4 people.  So this means that for every extra person cured by the drug three other people are cured, but would have also been cured if they took a sugar pill, and would have suffered none of the side effects.

Even the most effective drug on the list of 21 studied was only “more than twice as effective.”  Given that they didn’t say “nearly three times as effective,” let’s assume that it was at best 2.5 times as effective.   That means that if 10 people could be cured by a placebo 25 people are cured by the drug.  In other words, nearly half the people taking the drug would have been better off without it.  And this is for the best drug available.

Now let’s be clear: depression is a terrible thing, and it blights the lives of some people, or even leads them to take their own life, and sometimes the lives of others too.  However, most of the data in the study came from trials covering just eight weeks of treatment.  If all of those people had been treated with a placebo for eight weeks a bunch of them would have become better with no side effects at all.  And if those that didn’t improve were then given the drug that would result in about the same number again getting better, albeit some weeks later.  Wouldn’t that be a great result?

For some reason giving people placebos is seen as unethical but I can’t quite work out why.  Sure, it’s important to address the needs of someone with suicidal thoughts as fast as possible.  We should trust the doctors to have some idea who those people might be.  Let’s also bear in mind that some anti-depressants have also been linked to increased risk of suicide and we trust the doctors to prescribe them appropriately.

All I can say is that if a drug is only twice as effective as a placebo, then for my own case, in a non-critical situation, I would much rather be prescribed a placebo in the first instance.

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Express Espresso

At the end of January David Leeper came to have a chat with me whilst I was stewarding at ArtSpring Gallery.  He explained that he has entered a coffee barista competition, and would love to have some coffee cups custom made by a local potter.  Well all that sounded lovely and he liked the sort of work I showed him.  The problem was that he needed them for 17th February.   Suddenly it’s starting to sound like one of those silly challenges on The Great Pottery Throwdown.


Freshly thrown

I was careful to be frank with David about the risks.  Even if I made the pots the next day they would then have to dry, the bases would have to be turned, they would have to dry completely before firing.  That wouldn’t be quick in February – a week if we’re lucky.  Then they have to be glazed, inside one day and outside the next because they have to dry again in between the two stages.  Then the final firing.  A quick flick through the diary app on our phones.  Hmm, they would be ready a few days before the competition.  And that assumes that I don’t mess up anywhere along the way.


Based turned

On the plus side I had made some espresso cups some years ago and they held exactly the 4 fl. oz. he was looking for.  What’s more I already had batches of the glazes he liked made up and I’d used them recently so the risk of the glaze not working was minimised.  I had the right clay in stock.

I scaled up the cup I had made before to allow for the shrinkage of the clay in drying and firing and did a test run that night to work out what weight of clay would be right.  (Because of course I hadn’t written it down when I made them!) I turned the bases the next day and measured them to check that the size would be OK.  I wasn’t convinced – they looked a bit big.  Nevertheless I ploughed on and made a run, including some spares.  After a few days they were all made, turned, and brought into the house to speed up the drying.


Glazed and ready to fire

The following week they were in the kiln for the first firing.  As soon as they emerged I lined one up next to the original and to my amazement it looked about right on size.  There is still a little shrinkage to go in the final, and highest temperature firing.  I glazed the inside with white and let them get touch dry before applying wax to the rim and the area of the side where the lip will rest.  The next day I sponged off any white below the wax line and let them finish drying.  The final process was to dip them in the grey glaze and wipe the base clean.


Opening The Kiln

The next morning I loaded them in the kiln and programmed the glaze firing for 1200 Celsius.  I go for a slowish ramp up a short soak at top temperature and then a controlled cooling for a couple of hours before the kiln switches off and cools naturally.  The next morning I was able to take a few out provided I used oven gloves.  I marched straight down to Tonbridge Old Fire Station, where David runs the coffee shop 65mm Coffee.

EspressoArrayWe were both really excited to see coffee in them for the first time.  He made me an excellent espresso, and then poured two with added foamed milk in a fancy pour pattern.  David was very happy with the cups, and I was relieved that I’d managed to produce what he wanted and not ruin his chances in the competition.

Good luck for Saturday David!


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Stuffing Balls


With my mother now living nearby, for the first time in about 20 years we celebrated Christmas at home.  We retrieved the tree from the loft and decorated it and by some miracle the fairy lights worked.  With just three of us for dinner we settled on a large chicken, but to make it more Christmassy we decided to make a stuffing.  I grabbed a recipe from the BBC Good Food website and it turned out rather well.  So well in fact that we thought we would enjoy the stuffing as a meal on its own.

I like to make our own sourdough bread and there is often the end of a loaf left over.  Not enough for lunch with soup, but rather too much to just throw away.  Occasionally we will use it in a topping for baked fish au gratin but a new recipe to use breadcrumbs would be useful.

Last night I made the stuffing balls again.  I made half of the original recipe, adapting it a bit to use dried parsley as the fresh isn’t growing in the pot on the patio and I’d used the last of that at Christmas.  I served it on a bed of curly kale, and topped it with a little sweet chilli sauce.


Serves 2

1 large onion, chopped very finely
25g butter or coconut oil
25g hazelnuts, roughly chopped
70g dried apricots, chopped into small pieces
100g fresh sourdough breadcrumbs – I used wholemeal
1 heaped teaspoon freeze dried parsley – you could add more
zest of half a lemon
1 egg
salt & pepper to taste
1 tablespoon extra virgin olive oil

Small saucepan crammed with chopped curly kale
squeeze of lemon juice
drizzle of good oil – I used flax seed oil, but extra virgin olive oil would be fine too.


Dice the onion really finely, melt the butter or coconut oil and slowly fry the onion until it starts to caramelise.  Meanwhile make the breadcrumbs, chop the nuts and apricots.  Mix all of these in a bowl with the parsley, lemon zest, salt and pepper.  Once the onions are ready add them in too.  Finally add the egg and mix it all together.  Form the mixture into about eight balls and place in a shallow dish.  Drizzle them with half a tablespoon of olive oil and place in the oven at 180C fan.

Now prepare the kale, chopping it into small pieces if it isn’t already and putting about 1cm of water in the bottom of the pan.  When the stuffing balls are starting to brown on the top (about 15 mins) put the pan of kale on the hob.  Remove the stuffing balls from the oven, turn them carefully and drizzle them with the remaining half tablespoon of oil. Return them to the oven for another 10 to 15 minutes.  This is about how long it will take the kale to reach boiling and cook.  Drain the kale and sprinkle with a couple of teaspoons of oil.  I used flax seed for the Omega-3 fatty acid content.  Squeeze in some lemon juice and stir it round.  Divide it between two warmed plates and top with the stuffing balls.  A little sweet chilli sauce, ketchup or relish sets it off nicely, but don’t smother it.



Posted in Food and Cooking | 5 Comments

Wat Day


The view as I opened my room door

This post has been delayed because, as I mentioned in the last one, I lost my phone on the way to the airport in Chiang Mai.  Once Song Kran festival was over and the post offices were re-opened the lovely BP and Lek at The Chiang Mai White House mailed it back to me.  It arrived a week or so ago but it’s taken me this long to get my act together, download the photos and write this post.


Wat Ban Ping


Every day as I set off to the massage school I was entranced by the sight of Wat Ban Ping glistening in the morning sunshine over the tree tops from the balcony.  I decided on my last day that I would visit.  It turns out that the wat (temple) is a relatively new building as the original was damaged by fire and rebuilding was completed in 2008.  It has been rebuilt with glass mirror mosaic on the fascias, hence the sparkle I saw each morning.  I sat in the meditation hall for a while.  Outside in the grounds it was quite busy as they were hosting a medical information event.



The Buddha statue in Wat Lok Molee

I then wandered on to a much older wat, which BP mentioned was his favourite.  Wat Lok Molee is just outside the old city wall to the north.  According to Wikipedia its exact age isn’t known, but it must have already been in existence in 1367 as it is mentioned in a charter from that year.  The current meditation hall was built in 1545 and it is mostly undecorated teak.  This wat was also busy as as the monks were attempting to run an event for lots and lots of mini-monks – young boys of, I would guess between 5 and 8 years old.  All in their orange robes they looked  the part, but their attention span was clearly that of young boys and they had to be constantly corralled by their teachers into a separate pavilion. It reminded me a lot of a Sunday school outing.

The chedi behind the meditation hall has a small Buddha set into an alcove.  There was a wire leading up to this and there is a ritual whereby one can pull a little scoop of water in the shape of a bird up the wire.  Provided you pull it slowly and carefully it will get to the top where it tips up and bathes the Buddha.  This may have bestowed blessings on the participant.  What it certainly did was provide enough water for a fine crop of weeds growing out of the brickwork.


The meditation hall and Chedi of Wat Lok Molee


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Thai English

The assumption of many Thais is that all Westerners will speak English and not Thai.  They are generally right, and many of those who do try to speak Thai mess it up spectacularly.  What the Thais very often don’t recognise though, is that although their English might be better than any foreigner’s Thai, they are not necessarily easy to understand.

In Thai there are a limited number of ways a syllable can end.  Any vowel sound is fine, but there are only a limited number of consonants that can come at the end.  Even though the word may be spelled with a letter that would normally make an S, or D sound, when in a final position the sound will be like T.  What’s more, although the T is formed with the mouth it isn’t actually spoken.  Such things happen regularly in French for example, but they are rare in English.  Nevertheless, the Thais think the same rules should apply so the ends of English words or syllables are often ignored.

For some reason Thais find the R sound hard to make.  Goodness knows why, it’s not that they don’t have lots of words with an R in them.  There are plenty and in theory the R should be rolled in the way the northern Scots do.  But even educated Thais, if they are not trying to make a good impression or reading the news on TV, will substitute an L sound or ignore it completely.

There are only a few consonants that can appear together in Thai.  GR is found, though it will generally be said GL given the above dislike of R.  But if the letter of S in Thai (of which there are four) and the letter for L appear together then they will automatically insert a short unwritten vowel.  So naturally enough they thing the same should apply in English.  So ‘slowly’ will be pronounced ‘sa-lowly’.

Today, as I was packing my bag in my room I got a call from reception.  “Execute me, when will be checking out of your loom?”  now the service wasn’t spectacular, but it wasn’t so bad I’d want to kill someone.   I walked to the local metro station, went a couple of stops and then joined the train to the airport.  The second train was quite busy and a few stops along the driver asked over the speakers “Please move in the train so passengers can get in.  Thank you for your copulation.”  I’m not sure the young chap with the his nose already in my armpit wanted to get that close.

Inside Bangkok’s Suvanabhumi Airport

I was typing this sitting at Bangkok’s Suvanabhumi airport. (An inspiring building as airports go.) A young Thai woman approached me asking if I had time to complete a survey for the Thai Tourist Board and I agreed.  Her first question was “Are you here on holiday?” and I said no, not really, it was a study trip.  “Ah, mean holiday?”  OK, here goes I thought, so I tried “mai chai krap, mah sip ha wahn laew rian nuat thai krap.”  Which was my attempt at saying that I’d been here 15 days to study Thai massage.  She thought I’d said neua (meat) rather than nuat (massage) but once that misunderstanding was corrected she looked at me blankly and walked away without saying anything else.  So much for Thailand being the land of smiles!  Maybe I accidentally thanked her for her copulation.

Two uneventful flights, another hasty dash across Muscat airport and some uninspiring airline food later and I’m home in Tonbridge with my bag mostly unpacked.  A great trip but if feels wonderful to be home with Lovely Husband again.

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A Day Out in Bangkok

I was planning on sharing details of my last day in Chiang Mai.  However I took photos on my phone to show, and then my phone came out of my pocket in the tuk-tuk on the way to the airport.  Thankfully the Chaing Mai White House called the tuk-tuk driver and he has returned it to them so I should have the photos to share eventually.

Meanwhile and uneventful flight to Bangkok and a pleasant afternoon sitting by the pool and drinking mango shakes.  I was planning to head out to dinner but the thunderstorm which looked as though it had passed let rip just as I was planning to leave so a sudden change of plans and I ate here.  I had stir-fried rice with seafood, but it was definitely de-spiced for the Western visitors.

Today after breakfast I decided to visit Wat Arun.  I remember seeing this spectacular prang  – a great spike which gleams in the sunshine – from the river when we first visited Bangkok in 2010.  I walked down to the central Sathorn pier, and caught the local ‘express’ river boat.  These are easy to recognise from their orange flag.  There is a tourist boat with a blue flag which is even more express, because it stops at fewer points.  However it costs a little more and you have to put up with a bad and loud commentary over the speakers.

The slightly disappointing thing is that Wat Arun is currently having it’s hair done.  The top part of the spire was covered in scaffold so that it could be cleaned.  Nevertheless it was interesting to get close-up to the surface which is painted white and inlaid with ceramic tiles.  It is possible to climb up a couple of levels of the spire.  The steps are impressively steep, especially when you remember that Thai people are generally short.

The first time we visited Bangkok our friends Dugan and Det took us to the end of the boat ride for lunch.  As I was done at the Wat it seemed like a good thing to repeat.  I continued up the river to the last stop at Nonthaburi. A 15 Baht fare (about 40p) gets you any distance.  The tourist boat doesn’t go this far.  Adjacent to the pier is a floating restaurant called Rimfang.  I was the only customer for lunch.   I had crispy fried catfish with basil leaves and it was not de-spiced, there were full-on slices of both red and green fresh chilli in there.  Perfect with a portion of rice and a glass of iced lemon tea.

Another 15 Baht fare took me all the way back to the central pier.  This really is a great way to get a feel for Bangkok. From there I caught the BTS Sky Train to Sala Deng and walked back to the hotel.

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Study at Thara Thai Massage

Today was my last day studying with Ajahn Suwat at Thara Thai Massage in Chiang Mai.  (Ajahn is a Thai title, meaning something like ‘master’.)  I’m very happy that I chose to study with Suwat, and grateful that he accepted me as a student.

Thara Thai Massage, Chiang Mai

My massage practice came about by accident really.  We were taking a trip to Australia to visit my sister and family and stopped over in Bangkok for a few days.  Friends from London showed us around and introduced us to a local friend who took me for my first massage.  I was so impressed by it that a year later I flew to Chiang Mai to take an beginners course.  This was just with the intention of learning more – but I so enjoyed it that I ended up studying more more deeply and people who had received massages in the UK encouraged me to do more.

As the benefits of the massage practice started to show more people came by recommendation, and often because they had a specific ache or pain that concerned them.  This was when I started looking for resources on how to handle specific conditions. I came across one of the Thara Massage videos on YouTube about a year ago and realised that this was the style of massage I was looking for.

Ajahn Suwat has taken his own study of massage in the Thai style, but then applied his deep knowledge of anatomy to it.  Through 15 years of research and observation he has noticed links of cause and effect in the human body. Because of the holistic approach of Thai medicine he has noticed things which might be missed by western medicine.  As a result his practice in Chiang Mai has become recognised as the place to go if you need physical therapy.

The two week course began with four students.  Two Thais, a Korean and me.  We learned a basic massage routine which covered the body in the Thara house style.  It is a very efficient style and could be used to give an overall general massage prior to focussing on specific needs.

Even though it would take some time to perfect this style as soon as we all had the basics Ajahn went on to cover specific ‘syndromes’.  This might either be a named medical condition such as ‘plantar fasciitis’ or it might be a set of aches and pains that could arise from tension in a specific muscle.  For example, who knew that tension in the Psoas (a muscle of the lower abdomen and hip) could show up as soreness in the ankle, the back of the knee, the ribs, and the front of the shoulder.?

The awarding of a certificate

The pattern for the remaining days was that Ajahn Suwat would teach about three different syndromes in the morning and we would then be left to practice in the afternoon.  He would pop in to see if we had any problems or answer questions.  If we were short of bodies to practice on his staff would often volunteer when they were not working.  If he was giving a massage himself in the afternoon he would sometimes call us in to see an example of something.  If we were not practising there was always the option to sit quietly in the treatment room and observe.

The second week started with me as the only student, which give me full-on attention and less time for note taking.  This was a real treat although it meant that there was less opportunity for practice.  Staff at the clinic were very kind in letting me practice both my massage and my Thai on them.  I felt rather poor at both.  On the last two days Alexandra from The Netherlands joined.

The low student numbers is normal at this time of year – it is just building to the hottest time and the air quality in Chiang Mai can be pretty poor due to the burning of the rice fields in the surrounding area and neighbouring Laos. Most overseas visitors come from Novembeer to February.  I consider myself to have been very lucky to have the attention of a true master of Thai massage.

So, what now?  I have a rough notebook which I intend to write up properly, which I hope will help me revise what I have learned in the process.  The next stage will be to incorporate what I have learned into my existing practice.  Meanwhile I have a day to get my things together, a flight to Bangkok and a day there to relax and do some sight seeing before returning home.

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