A picture is worth a thousand words: comic books for medical and patient education

Patient communicationThe BMJ has just published an interesting feature about comics in medicine – the history, the approaches, and their use in medical and patient education.

The authors Michael J Green and Kimberly R Myers call such comics “graphic pathographies”: illness narratives in graphic form. “These graphic pathographies can be helpful to patients wanting to learn more about their illness and find a community of similarly affected people,” they say. “Graphic pathographies also provide doctors with new insights into the personal experience of illness and misconceptions about disease and treatment that could affect compliance and prognosis.”

Mom's cancerThe two examples they discuss are Marisa Acocella Marchetto’s Cancer Vixen, in which Marchetto describes her experiences as “a shoe-crazy, lipstick-obsessed, wine-swilling, pasta-slurping, fashion-fanatic big-city girl cartoonist” with breast cancer, and Brain Fies’ Mom’s Cancer, which documents Fies’ mother’s metastatic lung cancer. Both provide actually quite moving and at times subtle personal accounts of illness, and in a more succinct and engaging way than the same tale in prose form.

Medikidz diabetesMedical comics are proving particularly useful in patient education, both to promote public awareness and to help patients and their families understand what to expect from a disease. Apparently, combining pictures and text enhances understanding because reading and viewing activate different information processing systems within the brain. “This combination also fosters connections between new information and existing knowledge,” say the authors, “thereby increasing recall of health information, especially among those with low literacy.”

The series Medikidz is a prime example of the latter approach. Medikidz comics provide quite complex medical information for kids about a variety of different diseases, such as osteosarcoma, scoliosis, and type 1 diabetes.

The “Medikidz” are a group of five larger-than-life superheroes who journey around Mediland, a planet shaped like the human body. These heroes battle against villainous characters representing aspects of disease. For example, Chi is the Medikidz lungs specialist whose secret power is hypnotic relaxation, whereas her nemesis is Anna Phalaxis.

Comics can also be used to educate medical students and doctors. For example, personal patient stories in comic book form could reinforce to junior doctors that fact that healing a patient entails more than treating a body. Also, as the authors point out, “In keeping with research in medical education showing that visual art improves students’ diagnostic skills, reading graphic stories may likewise enhance students’ observational and interpretive abilities.”

I find these comic fun to read, and they certainly seem a novel and creative way to communicate patients experiences and information about diseases.

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Clinical research from the heart

Hot on the heels of Valentine’s day, the British Heart Foundation has announced the winners of their images competition “Reflections of Research,” in which UK scientists funded by the foundation were asked to submit the most striking still and video images of their research.

Winners of the video category are Dr Michael Markl of University of Freiburg, Germany, and Dr Philip Kilner of Imperial College London, and their video of blood flowing through the heart. Concentrate hard and you can see, in red/yellow, blood flowing through the left side of the heart, down the aorta, and into the body as the heart rotates. Blood flowing through the right side of the heart towards the lungs is shown in blue. According to the BBC, in the future doctors may be able to use this type of imaging to help simulate the blood flow in a patient’s heart.

looking-through-the-heartWinners of the picture category were Mathieu-Benoit Voisin and Doris Proebstl from London with their remarkable heart shaped cell stain.

The researchers are studying how white blood cells move from the blood into into damaged tissue to cause inflammation; for example, after a heart attack. They were using using fluorescent pigments to stain two key players in this inflammatory process – pericyte cells from the blood vessel wall (stained red and blue) and collagen (green) – when looking through the microscope they noticed that the cells had arranged themselves into a heart shape.

“Through better understanding of how white blood cells interact with the components of the vessel walls, we hope to identify new avenues to treat conditions that underlie heart and circulatory inflammatory diseases,” said Dr Voisin. “Our research is funded by the British Heart Foundation so we were really delighted to see this heart shaped arrangement of cells appear by chance through the microscope!”

I think my favourite image from the competition is this runner up picture of the muscle fibres in the left ventricle of the heart.

heart stringsThe image, from Dr Patrick Hales at University of Oxford, was generated using diffusion tensor imaging of the heart. This magnetic resonance imaging (MRI) technique tracks the movement of water molecules through the heart muscle, which reveals how the muscle cells are aligned.

“This technology allows us to model the structure of muscles in the heart in a non-invasive way, and how diseases can cause it to change,” said Dr Hales. “In the future, we hope that our research might be able to determine how the structure of the heart is damaged during a heart attack, and how the muscle fibres respond.

“We also hope that our computer models of individual hearts will one day be used as a tool for diagnosis, and could even provide patient-specific assessment of treatment options. Imagine your doctor trying out treatments on a ‘virtual’ version of you, before choosing the right prescription.”

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Wellcome Image Awards: shedding light on the microscopic world

This week medical charity the Wellcome Trust presented their annual image awards, which highlight the best new pictures acquired in the past 18 months by their free picture library.

The prizes are awarded to “the creators of the most informative, striking and technically excellent images” on the basis of “the ability of the picture to communicate the wonder and fascination of science.”

Dr Alice M Roberts, who presented the awards, emphasised not only the utility of images in science, but also their value as beautiful work of art.  “Imaging and imagery can help scientists in many ways: to understand structures that are too small to be seen by the naked eye, or perhaps to elucidate the relationship between structure and function,” she said. “But as well as deepening understanding, the art of science can also be – in its own right – beautiful and awe-inspiring.”

My favourite images are those created using microscope techniques like electron microscopy and multiphoton microscopy, which provide an extraordinary insight into the detail of human anatomy.

This first picture is of villi in the small intestine – finger-like structures that absorb nutrients from the food passing through the gut.  Paul Appleton, who produced this image using fluorescent imaging techniques, hopes that it might help researchers identify cancerous change in colon tissue, pointing out that “Scientists have to characterise normal tissue before they can look for changes in abnormal tissue.”

SI villi

Another of my favourites is this vivid picture of capillaries from a structure in the eye known as the ciliary body, which sits either side of the lens.  Capillaries measure 5-10 micrometres in diameter and are only one cell thick, so getting such a clear and informative image of these tiny vessels is quite an achievement.  The bright red colour is the result of a dye – likely to be carmine dye – that was injected into the artery that supplied the capillaries.


Number three is this picture of compact bone – the dense stuff that surrounds the bone marrow.  The structures that look like rings in a tree stump are called osteons, in which lamellae of bone tissue form around canals that house the blood and nerve vessels supplying the bone.  The black specks show osteocytes, the living cells that produce bone tissue.  The cells are lost during processing, however, leaving the holes within the bone that they once occupied.  Unlike the previous images, no false colour was added to this picture.  Your intestines aren’t blue and red like the image of villi above, but your bone definitely looks like this.

compact bone

Last is this image of in vitro fertilization.  The “blazing sun” object is the egg, the “rays” produced by cumulus cells that protect the egg.  This image shows the moment of conception, with a sperm wiggling its way in on one side.


These images and more are available to view on the Wellcome Trust Image Awards website.  They’re also on display until Spring 2010 in a free exhibition at the Wellcome Collection.

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“Fame? I want to be a scientist!”

diversityNot my words, but those of the choreographer for Britain’s Got Talent winners Diversity.

If you’ve been in the UK at all in the past month you can’t help but have read about the Britain’s Got Talent TV show.  In this nationwide talent contest, people from all walks of life with talents ranging from the bizarre to the extraordinary do their best to impress the cynical judges in a bid to win £100,000 and the chance to perform their act for Prince Charles at the Royal Variety Show.

Eleven-piece street dance troupe Diversity trumped the tabloid punchbag ‘hairy angel’ Susan Boyle, but group choreographer Ashley Banjo isn’t going to let fame go to his head.

Banjo wants to make time to study for his masters degree in physics and biology, he told the Daily Mail, as the career prospects for a scientist seem better to him than those of a nationally famous dancer.

“I’m not going to be spinning on my head when I’m 50, but as a qualified scientist I can always earn a living”, he told a press conference today.

What would you prefer, a UK tour or a career in science?  Given the limited success of previous Britain’s Got Talent winners, Ashley Banjo is probably making a smart choice…

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Every-body loves anatomy

I thought it was finally about time I wrote a post about the fantastic Street Anatomy blog.  Billing itself as ‘obsessively covering the use of human anatomy in medicine, art and design’, the site highlights tons of interesting uses of human anatomy in everything from fashion to advertising.

Although a lot of the art the blog features is amazing – photography, jewelery and album covers to name a few examples – I’m most intrigued by all the wacky products they pick out, the perfect present for any medically minded friend!

Med student cousin sweating about an anatomy exam?  Give him a sneaky solution by getting him the answers on a t-shirt!


Girlfriend stamped all over your heart? You can do the same to her, albeit a bit more literally, with these trainers.


Does your little sister want to be a doctor when she grows up? A anatomical My Little Pony will give her a headstart!


If it’s my birthday you’re shopping for though, I want some anatomical bed sheets.  Or one of these please.


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Music, memories and the mind

Yesterday I went down (no, make that up – up a very steep hill, on my bike) to Jackson’s Lane in Highgate for some neurology theatre – not of the surgical kind but a performance of the play Reminiscence.

Inspired by a case study published by the neurologist Oliver Sacks, the play tells the story of elderly Mrs O’Connor, who, following a stroke, experiences temporal lobe seizures accompanied vivid auditory hallucinations. Although she recognises the songs she hears, Mrs O’Connor can’t put her finger on where she knows the melodies from. Through these seemingly familiar “experiential hallucinations”, she re-lives events that she believes are buried memories from her distant past.

As far as I was concerned, a key aspect of the play was how Theatre DaCapo approached a dry medical case study and transformed it into an engaging piece of theatre. Instead of depicting the story of Mrs O’Connor through the objective view of the neurologist, the whole case study is portrayed from the perspective of the patient, bringing an altogether more human angle to the case study.

Thus, the onus was on the theatre group to represent effectively the subjective, difficult-to-quantify experiences of a neurology patient. In order to do this, the five-man group of actors used clever staging and a myriad of props and visuals.

In scenes such as the one shown here, actors popped out from between the folds of a giant white backdrop, portraying in this instance the characters Mrs O’Connor begins to see as her hallucinations gather more sensory components. In another scene, the actors, posing as doctors, appeared in the windows within the backdrop and bounced neurological terms off each other, depicting Mrs O’Connor’s disorientation at the mass of medical information she was being bombarded with.

Folk songs – reworked in a classical style and performed by the actors – and the pitching and swaying of the scenery indicated when Mrs O’Connor was experiencing a seizure.

I was also interested in how the play was going to depict the neurology that underlines the case study. In the scene shown here, a dish of jelly was used to represent the brain and the affected region scooped out with gusto to demonstrate how the seizures and hallucinations could be cured by surgical removal of the damaged part of the brain.

One of the issues raised by the play is whether the hallucinations Mrs O’Connor experiences actually reflect real memories, or are false and are in fact the result of Mrs O’Connor’s psychological motivation to come to terms with her past. This issue was one of many debated in a a panel discussion after the play in which the audience quizzed the director Michael Callahan, clinical psychologist and Mind Hacks blogger Dr Vaughan Bell, and actors Ian Harris and Katie Pattison. During the discussion, we touched on whether the verity or not of our memories is important – although they may be revised through telling at different points in our life, they still represent an important part of our identity.

It was a refreshing change to learn about a clinical case study through such an imaginative and well-realised play rather than from a journal paper.

  • Reminiscence will be performed at 8pm at Jackson’s Lane theatre until Saturday 20th September (matinee 2pm Wednesday 17th September). For tickets, contact the box office on 0208 341 4421 or buy online at jacksonslane.org.uk

(Thanks to Theatre-DaCapo.co.uk for the photos)

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