Getting under your skin

Originally published in December 2018 in the newsletter of the National Association of Sessional GPs.

Perspectives

under-your-skin

A visit to Body Worlds and the art of plastination.

As I was shepherded into a dimly-lit lift, I was expecting an exhibition designed to titillate and shock.

How do you react to seeing a man standing, flayed of his skin, his internal organs on view, his muscles brick red, his blue eyes staring out at you? Or what about the trio posed round a table playing poker? You may have seen them in the film Casino Royale. James Bond stays cool. His interest is not the plastinates but how the villain manipulates their chips.

There was no Daniel Craig the day I visited the exhibition, but a crowd of people, all intensely curious and fascinated. Body Worlds, the controversial exhibition of plastinated human bodies, isn’t voyeuristic. It isn’t the Chamber of Horrors. It turned out to be earnestly educational. And compelling.

The only plastinate I personally found disturbing was the man holding his flayed skin in his hands, but I had recently seen much the same in Jusepe de Ribera’s painting of Apollo flaying Marsyas. Ribera painted to disturb. Plastinates are made to intrigue and inform.
They are the brainchild of anatomist Dr Gunther von Hagens of Heidelberg. Looking for improved teaching aids for his students, he had the idea of impregnating anatomical specimens with plastic. Lay people were intrigued, so he created exhibitions for the general public. He worked out how to plastinate whole bodies, not just of humans – this exhibition includes a man on a rearing horse.

I was surprised that all the human bodies appeared so slim. But they have been stripped of their fat. Forty years ago most people were that lean. Since then we have become accustomed to a population with a thick padding of adipose tissue.

Doctors know how few patients understand the working of their own body. Body Worlds aims to change that. It seems to be succeeding, to judge from the rapt attention visitors bestowed, not just to whole bodies, but to specimens of individual organs. How many people know where their kidneys are and how they work? Or how black a smoker’s lungs are? The information content is serious and substantial, but leavened with videos, cartoons, interactive demonstrations and quotes from sages from Confucius to Kant. You can’t take photos in the exhibition so visitors really engage with what’s on show.

From start to finish the emphasis is on the damaging effects of modern life and what you can do to mitigate them. I did not expect to go to Body Worlds and find myself encouraged to take deep breaths to reduce stress. But I did – and some weeks later I still do.

Around 50 million people around the world have seen versions of Body Worlds, and the overwhelmingly positive comments on TripAdvisor justify Dr von Hagens' mission. As always, there are some who claim to have got nothing out of the experience. And some who complained about the cost. It isn’t cheap – £24 for a ticket bought online, £28 at the door, although curiously entry to the shows in continental Europe is less than €20.

Yes, I was made uneasy. But it wasn’t squeamishness that disturbed me. It was speculating about the provenance of the bodies. In China the lucrative market for kidney transplants was, and may still be, fed by ‘donations’ from executed prisoners. Suspicions have been voiced that Body Worlds’ bodies come from the same source. The trafficking of cadavers and the manufacture of plastinated bodies and body parts are big business in China, particularly in the city of Dalian. The general manager of Dalian’s biggest company was taught plastination by Dr von Hagens, who also seems to have been involved in the business.

So, were the bodies in Body Worlds obtained from what we would regard as an ethical source and with full voluntary consent? Voluntary donations, unclaimed bodies and judicial executions could not possibly supply sufficient fresh corpses for China’s plastination industry. So where do they come from? Many new prisons and a cadaver processing plant have been built near the plastination factories in Dalian. Falun Gong, the large spiritual movement which has become a focus of Chinese government oppression, claims that the size of the plastination programme parallels the persecution and disappearance of hundreds of its members.

No-one apart from the Chinese authorities knows the truth. However, Dr von Hagens has taken steps to distance himself from these murky waters. He stopped using Chinese bodies in 2007 and established a donation programme which apparently has more than 18,000 potential or actual donors on its list. Body Worlds’ website claims that nearly 80% of them are German, and all but 26 are European or American. Donors consent to the use of their bodies for public as well as medical education; some sign up because they see plastination as a more dignified and useful end to their corporeal existence than burning in a crematorium or rotting in the ground.

Donors are guaranteed anonymity, which makes it impossible to marry up specimens with consent forms, but a 2017 review by the Ethics Advisory Committee of the California Science Centre, an exhibition and educational establishment, assessed Body Worlds’ documentation on donors and was reassured that appropriate consent was being obtained. And the committee commended the project’s educational aims.

As you leave the exhibition, you pass six containers, each labelled with a health resolve. You drop in tokens to indicate whether you intend to stop smoking, cut down alcohol, exercise more . . .

As GPs we know that giving patients health advice is easy, but keeping them motivated is hard. So, do the good intentions expressed at the end of a visit to Body Worlds translate into changed behaviour? A review of visitors six months after their visit to Body Worlds in Vienna was cautiously encouraging. Most felt much better informed and up to 33% claimed to have modified their lifestyle.

If a third of visitors actually make long-term changes, a visit to Body Worlds is more effective than many interventions offered by the NHS. So how about a partnership with Body Worlds? What about subsidising tickets for whole families, including a year of repeat visits and follow-up questionnaires and incentives? Lifestyle changes are more effective if everyone in the household is involved. It might just work.

Judith Harvey

Judith Harvey has written regular articles for the Sessional GP, the newsletter of the National Association of Sessional GPs, for over twelve years. Her reflections range widely on practical, ethical and cultural aspects of health and medicine.

Judith was a research scientist, ran the VSO programme in Papua New Guinea and taught in a Liverpool comprehensive school before going to medical school. She has been a partner, a salaried GP and a locum, an LMC chair and a long-time supporter NASGP. For eight years her charity, Cuba Medical Link, enabled medical students to go to Cuba for their electives.

Judith has now published her previous articles from the NASGP website as a new book Perspectives: A GP reflects on medical practice and, well, just about everything…

SEE ALSO: Judith Harvey on NASGP