# Fly Fishing On Prescription

Watching the line whispering through the morning light and softly landing on the lake, balancing between hope and tension. Fly fishing is an art that creates its own poetry but what does it do for my health ?

Fly fishing is trying to trick a fish, normally trout or salmon, into taking something that is made to look like a fly. The skill is to place an artificial fly in front of a trout at the point where it is hungry enough to wrap its mouth around it. Sounds simple but after many years of trying to outwit one of the wildest animals on the planet they are still ahead on cunning.

After a days fishing I feel much better both physically and mentally. This feeling is supported by studies which have shown the benefits from standing in the fresh air are: a reduction in exposure to pollution, boosting the immune system, increase in energy and is a source of Vitamin D which increases the protection from bone problems, heart disease, diabetics etc. Also, because the trout usually are aware of what I am up to they quickly move away and I have to follow. All this walking has been shown to help fight dementia, cut the risk of dying from cancer, and helps improve heart muscles. Another benefit is from walking on rough and slippery surface on the edge of a lake where it has been shown that it aids balance and coordination . Then there is the cast and re-cast which is the balletic movement of the arm, rod and flick of the line out across the water which apart from keeping muscles strong gets the heart beating. And finally the wrestle with the fish when it pulls and tugs on the line after it has taken the fly, although it isn’t High Intensity Training my heart is usually beating hard against my ribs.

Apart from the physical benefits there are mental health benefits from fly fishing. Watching for movement of the fly, or just trying to spot a trout, requires lots of concentration, and although there are no studies about the effect of concentration on benefits for mental health, most fisherman that I chat to report that their worries are shut out by watching for the twitch of the fly. Another aspect is the reduction in stress. In a 2009 study by a team of researchers from the University of Southern Maine, the University of Utah, and the VA in Salt Lake City they found that combat veterans had significant reductions in stress and post-traumatic stress disorder symptoms and improvements in sleep quality after participating in fly fishing.

I would add to the list of benefits from fly fishing is the activity of learning. And there is lots to learn: understanding how fish live, the impact of weather on their feeding, casting technique, tying flies, etc. which is an ongoing process. Studies have shown that learning new skills can improves mental wellbeing in particular learning can boost self-confidence and self-esteem, build a sense of purpose, and help connect with other people.

On the surface there may appear to be many barriers to fly fishing. For example, the world of fly fishing may look like a totally male-dominated activity, however there is a long legacy of female anglers. Women have been involved in angling in one way or another for many centuries. Dame Juliana Verna wrote a book called Treatise on the Angle published in 1497. In recent times Joan Wulff who pioneered casting techniques is still fishing at 89. There are many more women revolutionising fly fishing as well as increasing numbers of women’s clubs for example Angling Clubs, fly fishing women, and a successful health initiative Casting for Recovery whose mission “is to enhance the quality of women with breast cancer through a unique retreat program that combines breast cancer education and peer support with the therapeutic sport of fly fishing.” Age is no barrier either, with initiatives such as Fishing for schools and The Prince Albert Angling Society Junior Section and at the other end of the age spectrum there are courses run my Age UK.

For many people contemplating fly fishing a big question looms - what do I do when I catch the fish ? do I have to kill it ? No. The vast majority of fish are returned to the water, and because of their experience of being caught, are even more aware of strange looking flies and more difficult to catch. Unhooking a fish must be one of the great experiences as you hold a wild animal for a few seconds before letting it go back into its own world.

Of course weather is an issue. On a bright spring morning standing on a lakeside it could be something straight out of a Constable painting. But it can be wet and windy. However with the proper clothing you can carry on fishing which makes the end of the day cup of tea and piece of cake even more delicious. Or you can do what I do which is shelter in below a tree and wait for the rain clouds to pass over; spending the time thinking about my next tactic to catch that trout!

Cost can be an issue but for a few hundred pound a rod, line and a box of flies can get you started. It is important to add to the list some form of glasses to protect your eyes from an erratic fly during casting and some head gear to protect from the sun, or in my case, a fly sticking in my head. However, there is one thing that is a must and that is proper training for casting. A few hours with an accredited trainer can make sure that bad habits are not adopted.

In summary there are lots of health benefits from fly fishing. Therefore my call to the medical professionals is that instead of reaching for a programme of drugs, or activities with strange sounding names, why not prescribe some fly fishing for long term health benefits?

# The Future Of Mathematics

Mathematics creates a dilemma: most people agree that it is an important skill to have for everyday living as well as the economic future of the country, but it is socially acceptable to be “absoulutely useless at maths”.

The state of mathematics in the UK bubbles to the top of the news headlines: Numeracy skills have got worse, not better and Asia tops biggest global school rankings. Experts opinion are sought on the state of mathematics; they give advice on what needs to be done. Journalists bounce the subject around: For Britain’s pupils, maths is even more pointless than Latin,and Maths isn’t the problem - the way it’s taught is. All of this is against a background of drip fed statistics: adult numeracy has dropped from 26% of the population in 2003 to 22% in 2011, and eight out of ten people don’t know what APR means let alone how to calculate it ( a sizeable minority of think it’s short for April ). Government ministers respond with tweaks to the mathematics curriculum fully expecting a swift implementation. But the topic sinks back down to the lower depths of the public consciousness. Until the next survey sparks another heated debate.

The problem with developing skills in mathematics is failing to recognise that it is a language. A language that uses numbers, not German or French. And like most languages it is a skill that has to be practiced regularly. The language of mathematics consists of activities that involve additions, subtractions, multiplication and divisions which are used to quantify the amount of money in our banks, search for the best deals on the web and and count the number of days left before our next holiday. Like any other language, our skill in its use is linked to how important it is in our lives. Even equations with their strange appearance of $x$ and $y$’s have an important role in our lives. When understood mathematical symbols can unlock a new set of skills that can have many applications, for example working out compound interest which is important in calculating the amount of money required for a happy retirement.

President Ronald Reagan once remarked “you persuade people through reason but motivate through emotion.” In the case of mathematics there are enough reasons to persuade people about its importance: managing household budgets, improved job opportunities, transferable skills, planning for the future, improved critical thinking and so on, but how can people be motivated to use mathematics ?

Like learning any language the earlier it is started the better. It builds confidence and reduces the anxiety that many experience in later life. The early stages of mathematics requires a lot of practice: counting, multiplying, dividing, measuring, and so on, but this can be done by applying those skills to problems that affect everyday life. For example, managing pocket money, writing software to monitor local wildlife, building models to predict the impact of waste on the local environment around the school etc.

Another area is the impact of mathematics on the world that we live in. Mathematicians, and those who use mathematics, need to communicate to as wide an audience as possible about the benefits that mathematics can bring rather than discussing the latest solution to an equation. Also, those with mathematical skills need to make connections to other areas of society ( rather than on-going areas of academia, industry or governments ) and make new links e.g. health, social problems, etc. Breaking into new areas will create a pioneering spirit which could motivate others to join in.

In the public domain more effort is required to raise the profile of mathematics. Mathematics institutes and organisations reinforce academic achievement when they should be analysing the level of mathematics skill in the population - why don’t they walk around supermarkets and ask shoppers about using mathematics rather holding another survey amongst themselves? And where is the popular face of mathematics? Where is mathematics Brian Cox? If there was a popularity vote between Brian Cox and Marcus du Sautoy ( the closest equivalent to Brian Cox ) then I feel the Professor Cox would win by a mile! Those involved in mathematics should ask why that would be and then take what can be learned and apply to promoting mathematics.

Therefore the challenge ( and plea ) to mathematics teachers, authors, experts, governments and industry is to develop an understanding of the emotional aspects of mathematics and then tap into it to motivate its greater use, rather than wasting time and money on another survey. Maybe the next time a celebrity proudly claims that they are ‘rubbish at maths’ then the web will crash with the volume of clicks as people unfollow or unfriend them !

# Career Advice From A Philosopher

Recently the paper shredder has been working overtime. It has been chewing its way through bills, bank statements and a few drawers worth of career documents: CVs, pay slips, bonus letters and redundancy notices. Stopping frequently to let it cool down, a thought emerged about my career and the path it had taken - had it been worth it ? Then I remembered the advice the philosopher Wittgenstein gave to Maurice Drury, one of his ex-students.

Wittgenstein met Maurice Drury in 1929 during his period as a philosophy lecturer at Cambridge University. He actively encouraged his students not to become professional philosophers, and in Drury’s case after graduating he became a psychiatrist. They met as often as circumstances allowed until Wittgenstein’s death in 1951.

During one visit they went for an evening walk when Drury, who was a newly trained doctor, doubted his career path, because of his “ignorance and clumsiness.” At the time Wittgenstein brushed off the conversation as Drury’s lack of experience. Later that evening he wrote him a letter giving advice about his choice of career. After a section where he admonished Drury for “thinking about himself” when he should be “thinking about others e.g. your patients”, he wrote:

“But not because being a doctor you may not go the wrong way, or go to the dogs, but because if you do, this has nothing to do with your choice of profession being a mistake. For what human being can say what would have been the right thing if this is the wrong one? You didn’t make a mistake because there was nothing at the time you knew or ought to have known that you overlooked.”

Wittgenstein’s approach to solving philosophical problems was to untangle the misuse of words. In particular, it is using words where they have lost their meaning that leads to philosophical problems for example: is truth the highest good?, are computers conscious? and can he can feel my pain? Wittgenstein’s solution was to show that the use of words such as “truth”, “good”, and “conscience” were being misused and once shown then the problems disappear.

In their conversation Wittgenstein picked up on Drury’s use of the word “mistake” and questioned if he had used it correctly. The word mistake is used in the context of knowing the action that should be taken. For example when I take a route to visit a friend and arrive late because I took a wrong turn I may say “Sorry I am late, but I made a mistake and turned left instead of right at the traffic lights”. I am using the word mistake correctly because I am describing where I went wrong. Therefore within the context of visiting my friend the word mistake is being correctly used and its meaning is clear to both of us. However, in the case of a career to use the word mistake correctly would mean that I would have known what the correct career route was, and nobody knows that because we can’t read into the future. Drury made the best decisions he could within the circumstances at that time.

Wittgenstein’s advice to Drury is not the standard career guidance that floods the book shops and web with ‘Ten Steps To Success’ type headings. Instead, he untangles the misuse of a word that leads to Drury’s frustration about his career choice. As the shredder grinds through the last staff appraisal, Wittgenstein’s career advice has questioned whether I was asking the right question!

# Moral Distance's Impact On Service

We live in a service economy but my experience is that the “service” part is sadly missing. Why is that ? Could it be that the ‘moral distance’ is far too long ?

Business leaders face a dilemma. As their business grows, or changes to meet the latest customer demands, then the moral distance will increase. The link between them and front line staff and their customers becomes extremely long. Can the moral distance be reduced ? Here are some thoughts. First, to assess the impact of any actions whether it is the implementation of a new sales system, procedures or training to manage customers, then the front line staff should always be involved. In my experience all front line staff are dedicated to their businesses, and they can provide some practical ways to make sure that the changes actually help customers.

Nothing is perfect in business when implementing change and it is critical that a ‘what-if’ analysis should be carried out e.g. what happens when we run out of stock? what happens when the helpline is busy? and so on. Also, check how the customer will be managed if something goes wrong. In my case I received no notification of a problem other than there was a ‘suspended’ message against the order which meant very little to me. A better word would have been “out of stock.”

Finally, business leaders should be visible, approachable and remain in contact with the frontline staff and their customers. This can be done in many ways, ranging from “Management by walking around” or regularly monitoring helplines, complaint systems or social media. In other words making it a priority that they are in contact with the frontline and customers.

It is clear that as the moral distance increases then the quality of service tends to reduce, not only for a business but for governments and other organisations. A reduction in the moral distance will put the “service” back into the service economy and next time I order a product it will arrive on time !

# Gambling On Prostate Cancer

Medical terminology is full of complicated terms. Words such as rhinorrhea ( runny nose), cerumen ( ear wax ) and epistaxis ( nosebleed ) map out a land where only a few can tread. But recently I have had to step into it when I came across the term 'false positive'.

I have reached an age where health is starting to dominate my thoughts; in particular my prostate has been painfully brought to my attention. My doctor summarised the situation “your days of peeing over the school yard wall are over!” Therefore to diagnose the problem I have had various tests and examinations including the Prostate Specific Antigen ( PSA ) test which is used to detect prostate cancer. When searching the web to find out more about the test I came across the phrase “false positive” which seems like a riddle posed by Yoda for ‘Young Skywalker’ in Star Wars. How can something be “false” and yet “positive” ?

Developing a medical test is subject to many constraints. For example, the test should ideally be non-invasive, easy to use, and low cost. Also, because of the complexity of the human body and the limited level of knowledge about how it works the results from a medical tests are rarely 100% accurate. Accuracy is important. For example if a test is 90% accurate then the results of 90 tests out of 100 will correctly show whether a person has the disease or not. But for the remaining 10 tests the results will be wrong.

To work out what false positive means with respect to myself and the PSA test I grabbed my pen and paper and settled down to work out the following example. First, there is a lot of controversy about the accuracy of the PSA test therefore it is very difficult to get a definitive number on its accuracy. However, for the purposes of this example I assumed that it is 33% accurate ( or 1 in 3 ). It is important to note that if the test result is positive it does not mean that there is a probability of 33% of having prostate cancer. What is usually missed is the baseline information, which is the information about the situation before any testing is carried out. Therefore, to work out the probability of actually having prostate cancer I needed an estimate of the number of men in a population who will have prostate cancer - the baseline information. For this example I have used an estimate of 1 in 33 as a guide to who will have prostate cancer ( the chances of prostate cancer increases with age ).

The following steps work towards answering question: if the result of a PSA test is positive what is the probability of having prostate cancer ? :

To keep the numbers simple I have kept the population size down to 100 therefore, the following diagram shows 3 in every 100 who will have prostate cancer - approximately 1 in 33 ( the baseline information ):

Population showing 3 in 100 with prostate cancer

The following diagram shows the results from applying the PSA test with an accuracy of 1 in 3 ( 1 in three tests it gives a correct diagnoses ) where the plus signs are positive results:

Population after the results of the PSA test

From the digram it can be seen that the test gives the correct result for one case of prostate cancer and gets the other two cases wrong. The two wrong cases are called false negatives ( when designing a medical test the number of false negatives are minimised to reduce the chances of missing the disease ). The test gives positive results for 64 cases when there is no prostate cancer - which are the false positives. In other words the test returns a positive result when there is no disease. Therefore the probability that I could have prostate cancer is 1 in 65, and not 1 in 3 - the odds of not having prostate cancer when the test is positive have improved !

A large number of false positive results indicates that there is a low probability of having the disease. When a test has a low accuracy then more medical tests have to be performed. For example following a positive result from a PSA test then further tests will be required, for example an ultrasounds scan or a biopsy before a diagnosis is reached.

The PSA test is quick and cheap, it can costs between £30 - £50 per test, but it can be unreliable, However, there are new medical tests being developed to improve the accuracy in detecting prostate cancer, for example: Imaging techniques uising MRI, improved blood test and urine test.

Next time I discuss further medical tests with my doctor to diagnose the problems with my prostate I will be asking about its false positive result. It may not put my mind to rest but it will reduce the terminology fog and then I can concentrate on managing the situation !

For more information about the PSA test see: Should I have a PSA ? and for a detailed description of the mathematics behind the example discussed in this post see: Mathematics of a False Positive Test.