Category Archives: medical

medical, personal

Humanity Restored?

Bastard! One year I’ll learn not to put anything in my diary for at least two days after I have my ‘flu jab. Yep it always gets me, usually for only 24 hours.

This year it hit me hard. GOK why it should.

I had the injection about 9.30 on Friday morning. By 9.30 that evening I was huddled under the duvet feeling like death — the full ‘flu symptoms: fever, aching bones, crashing headache, don’t like bright lights, unable to stay awake but sleeping fitfully and just so depressed.

Saturday’s plans had to be abandoned. But heroically Noreen managed to mop up the couple of bits we couldn’t entirely avoid. Meanwhile I slept the day away. And although I felt rather better by the evening I then couldn’t sleep last night. That’s pretty normal for me when I’m ill: sleep well all day and badly at night.

Humanity is present again today, but only just. I’m still weary and aching; still depressed. Still not functioning properly in the brain department. (Yeah! OK!)

Hopefully normal service will be fully restored tomorrow; there’s too much to do for it not to be.

It’s true what they say about ‘flu, even the after-effects of the injection: it hits you fast and hard, and floors you. If the symptoms come on gradually and you can still function at all, then what you have isn’t ‘flu. If you get hit by a train and can’t function even if you need to, it is ‘flu.

Yes, I usually get some reaction to the injection. I never expect it! But it isn’t usually as bad as this. The only previous year I remember it as bad as this was two years ago when the inoculation contained swine ‘flu (or was it bird ‘flu?) vaccine. That knocked me out for a week! Clearly my body hadn’t seen that before.

What’s interesting though is that not everyone reacts the same. On Friday morning in the supermarket we met a couple who also go to our doctors and who had their jabs several weeks ago: they both said they had had no after-effects at all; not even a sore arm. And my mother says she never gets any after-effects. But I do, and I know several others who do.

Lesson: In future keep at least a couple of days clear after the ‘flu jab, and be prepared to be hit hard. I did neither this year and have only myself to blame. Even Noreen tried to warn me! But did I listen?

But the after-effects of the inoculation, however horrid, are way better than actually having ‘flu properly. One really doesn’t need that, especially if you’re at all immune-compromised (elderly or with a long term condition like diabetes, respiratory problems, etc.) or a carer because ‘flu can really knock you out, possibly even terminally.

So if you’re offered a ‘flu shot by your doctor, I’d say take it. Yes, it may make you feel rough for a day or so, but that’s better than the 1-2 weeks real ‘flu will last.

medical

Good Doctor, Bad Doctor

As some of you may know I’ve managed to get myself embroiled (at a local level and from a patient perspective) in some of the health service reforms which are now happening.

Partly as a result of this I’m reading Ben Goldacre’s latest book Bad Pharma: How drug companies mislead doctors and harm patients.

Even if only 25% of what Goldacre alleges in the first quarter of the book is true (and that seems conservatively low) there is a scary, systematic and unethical ethos pervading the whole of the pharmaceutical industry which emanates from both the drug companies and the regulators.

At the end of the first chapter [p.99], where Goldacre has discussed the problem of missing drug trial data, he issues this challenge:

If you have any ideas about how we can fix this [the missing drug trial data], and how we can force access to trial data — politically or technically — please write them up, post them online, and tell me where to find them.

What follows is my small response to Goldacre’s challenge.

— o O o —
As patients there is not a lot we can do to address these issues; they’re just too big for the man on the Chapham omnibus to be able to make, individually, a difference. Given that the drug industry, the academics, the medical professional bodies and the regulators have singularly failed to adequately address the issues, the major thrust of the resolution probably now has to come in the form of primary legislation across all territories — something for which sadly few politicians are likely to have the stomach and no government the priority. However that doesn’t mean we patients can (or should) do nothing. This is what I think we can do, at least in the UK.

  1. Through our doctor’s Patient Participation Groups (PPG), and through our local LINk/Healthwatch/Health & Wellbeing Boards, we should be putting pressure on the medical world and specifically the local Clinical Commissioning Groups (CCGs, replacements for the PCTs) to force GPs to act ethically and without bias.

    One way to do this would be for GPs to be given guidance on what patients expect of them. This is likely to be way beyond the minimum acceptable standards required by legislation and regulation. And indeed I’m involved at my local level in drafting just that. I can’t say more about it at present as the work is still in draft form, uncompleted by the authors, unapproved by the sponsoring group and of course not yet delivered to its expected recipients. (That it is being done is in the public domain as it is referenced in publicly accessible meeting minutes.) However we are committed to it being published, and publicly accessible, when completed. With luck this will be before the end of the year, so I hope to return to it in a later column.

    But such guidance could contain clauses like (all my wording will need tightening):

    • Clinicians are expected to behave in unbiased and ethical ways. They must declare annually and publicly on their practice’s website all benefits received (services, goods, money) worth over [[name some modest value like £50]] received from any pharmaceutical company or healthcare provider (public or private). They should demand the same transparency from those who they themselves consult or to whom they refer patients.
    • All clinical trials/research in which a clinician is involved must be publicly registered and defined prior to starting and be referenced by the practice’s website. All clinical trial data (including anonymised patient-level data) and results must be published within 12 months of study completion. Again clinicians should demand the same transparency from those who they themselves consult or to whom they refer patients.

  2. All members (medical and lay) of CCGs, Health & Wellbeing Boards, etc. must also make declarations as in 1 above.
  3. Is it possible to find an MP who is willing to put down an Early Day Motion (or Motions) in Parliament demanding legislation to:
    • require all clinical trial data and documents (including anonymised patient-level data) be made publicly accessible, without hindrance, within 12 months of the completion of the study, and within 3 months to the appropriate regulatory bodies.
    • make all clinical trial data, whoever performs the studies, funds or sponsors them, subject to Freedom of Information requests at no charge, and with no exceptions, worldwide and retrospectively.
    • make gagging and other “interference” contracts illegal?

    We should then be encouraging our MPs to support the motion.

  4. There doesn’t appear to be an e-petition to the government. What about it? The partition should require that the actions outlined in 3. above be passed into primary legislation during the lifetime of the present parliament. I guess this would need someone more skilled than I am at drafting to write the petition effectively and without allowing wriggle room.

    According to the government’s own rules 100,000 signatures on an e-petition should trigger a parliamentary debate. That ought to be achievable if everyone buying Goldacre’s book signs and gets another couple of signatures. Create a Facebook page and it could attract even more signatures.

No that isn’t actually a lot in terms of fixing a worldwide, pervasive problem with Big Pharma. But we have to start somewhere and it is probably as much as we patients can realistically do initially, at least initially. Items 1 and 2 should start a trickle up of activity. Hopefully 3 and 4 will start a hammer down.

Thoughts from anyone?

medical

Shaping a Healthier Future

There’s a big brouhaha going on in NW London at the moment over the proposals to reorganise the way our hospitals work.

Needless to say all the local agitators and pressure groups are out in force, mostly peddling totally inaccurate messages like “Save our hospitals”, “You won’t have A&E services”, “Major cuts to your health service”.

Needless to say most of this is totally fictional and they have not understood the actual proposals, which are contained in an 80 page consultation document. I even wonder if any of them have read it.

I have been to several public meetings recently. I am appalled at the inability of people to understand the proposals, the way in which everything is parochial, angry and internalised, and their inability to step aside from “it might be inconvenient for me” and see the bigger picture. People are being angry and frightened, because they dislike change and they cannot (or will not) make the effort to understand.

Nevertheless, and although my GP is one of the team responsible for the proposals, in fairness I have to say they have not been well presented, in clear and straightforward messages and in a way which Joe Public can understand. Joe Public does not listen to detailed arguments (he never did!) but needs sound bites and simple statements. The NWL NHS team may be excellent clinicians, but they have not got good PR/marketing/presentation skills — and it shows. I’m no expert but a lifetime in business (including training) has put me ahead of the pack.

As a working thinker I have therefore made it my business to get involved. Having read the consultation document a number of times I have now distilled it down into a 10 slide, simple presentation for my doctor’s surgery patients’ group. And I have tried to help the NHS team to hone their messages.

Here is a copy of my presentation slides, which are on Slideshare. If you are in NW London then please read the presentation.

[slideshare id=14342271&style=border:1px solid #CCC;border-width:1px 1px 0;margin-bottom:5px&sc=no]

NWL NHS Hospital Consultation, 2012 from Keith Marshall

The bottom line is that this is roughly a 10% change in what the patient will see. In other words for every 10 people who go to hospital, one may go to a different hospital. All these hospitals are within something like an 8 mile radius — it’s not like we have to travel 30, or even 60 miles to hospital as is the case in many other areas of the country.

Now I’m not pretending the proposals are flawless; of course they aren’t. There are currently some big gaps like the lack of appropriate public transport services — something he NHS team are well aware of and are already discussing with Transport for London. However ultimately we have to stand aside from our parochial feelings and do what we know is right. In my mind, and regardless of the business case, these proposals are clinically, logically and logistically the right ones and should have been done years ago.

If you can, please also read the Shaping a Healthier Future consultation document.

When you’ve done that please have your say on the proposals; there is an online questionnaire.

The consultation runs until 8 October.

medical

Kids Spread Germs

There’s an interesting short article in the October 2012 issue of Scientific American, which I was reading last night.

Under the banner Target the Super-Spreaders, Kathleen A Ryan proposes that the best way to tackle flu is not by vaccinating the elderly, the immuno-compromised and the pregnant. It is actually by vaccinating all schoolchildren between the ages of about 5 and 18.

The article doesn’t seem to be online, so here are a few key extracts:

[T]he most effective way to protect the elderly, and everyone else, is to target kids … Schools are virus exchange systems, and children are “super-spreaders” — they “shed” more of the virus for longer periods than adults.

Computer-modelling studies suggest that immunizing 20 percent of children in a community is more effective at protecting those older than 65 than immunizing 90 percent of the elderly. Another study suggests that immunizing 70 percent of schoolchildren may protect an entire community (including the elderly) from flu.

Perhaps the best example of the effectiveness of childhood vaccination comes from Japan. The 1957 flu pandemic prompted the Japanese to start a school-located childhood vaccination program. For at least 10 years vaccination against influenza was mandatory for all children. Excess deaths from influenza and pneumonia … fell by half … The study showed that for every 420 schoolchildren immunized, one life was saved, predominantly among the elderly. Once the program ended, immunization rates fell, and death rates rose dramatically over the next few years.

In Alachua County, Florida … a school-located influenza vaccination program has been in full operation since 2009. Implemented as a coalition of schools, health departments and community advocates … the program administers FluMist nasal spray, a live attenuated vaccine, free of charge to students, from pre-K to 12th grade, in public and private schools regardless of insurance status. Immunization rates of elementary students have reached 65 percent — enough to reduce the incidence of influenza in Alachua County during the past two flu seasons to nearly zero.

School-wide vaccinations would require a big conceptual change in immunization strategies, involving schools, communities, paediatricians and health departments. Who will fund and lead such an effort?

Well who’d have guessed it? Kids spread germs. Sounds a sensible strategy to me. But it needs a paradigm healthcare thinking. Just a little something else for the NHS to get its teeth into!

medical, science, thoughts

Sleeping with Your Partner

Just a quick follow up to my post of the other day about the keys to a robust relationship and especially the one about sharing a bed.

Quite serendipitously the same day I happened across a reference to an article in The Wall Street Journal reporting on research which shows that there really are benefits to sharing a bed. For instance:

While the science is in the early stages, one hypothesis suggests that by promoting feelings of safety and security, shared sleep in healthy relationships may lower levels of cortisol, a stress hormone. Sharing a bed may also reduce cytokines, involved in inflammation, and boost oxytocin, the so-called love hormone that is known to ease anxiety and is produced in the same part of the brain responsible for the sleep-wake cycle. So even though sharing a bed may make people move more, “the psychological benefits we get having closeness at night trump the objective costs of sleeping with a partner”.

It’s nice to have some scientific support for my thoughts. ☺

amusements, history, links, medical, science

Links What You May Have Missed

A pretty mixed bag of the curious and interesting which you may have missed in this instalment. Let’s start with the historical …

Archaeologists reckon they’ve located the exact site, and part of the structure of, the Curtain theatre in London’s Shoreditch area, which was used by Shakespeare prior to The Globe.

Meanwhile on the south coast some other archaeologists have discovered wall paintings of a dozen or so medieval ships in a Winchelsea cellar. That has to be worth a visit!

Elsewhere historians are puzzling over the possibility that the ancients were also visited by UFOs and flying saucers.

From ancient history to natural history … You always wanted to know about turtle sex, didn’t you? Well here’s a disquisition on the terrifying sex organs of male turtles. We’re promised girlie turtle anatomy to follow.

While on the subject of sex (well you just knew there’d be more, didn’t you!) back in 2006 an American Roman Catholic nun and theologian wrote a sensible book about sex and relationships. But now the Vatican has decided it doesn’t like the content and has banned it. What price Galileo?

Now, what will the medics come up with next? Oh, I know, fungi. After investigating the bacteria and viruses which reside in our guts they’ve now started to investigate similarly located fungi.

Scientists have also been investigating whether whether human farts are germ-laden, or merely malodorous. Turns out they are germ-laden, but only if you’re naked.

So now for something a little more appealing. Emily is getting married. (Well people will do it, y’know!) But what’s this? The latest wedding accessory appears to be … a birdcage! Her only question is “why?“!!

And finally while on the subject of nubiles, didn’t you always want to know what was inside Kylie’s knickers? Well now you can thanks to a surprisingly interesting collection of X-ray images of of everyday objects as art.

Toodle pip!

medical, science

Plastic Animals

Yesterday we took a trip to London’s Natural History Museum. I’ve not been inside the NHM for maybe 50 years although I go past fairly frequently. I left feeling strangely disappointed.

We went mainly to the the latest Gunther von Hagens exhibition, Animals Inside Out, which is a display of his plastination, anatomical and display skills. It is the animal equivalent of the blockbuster Bodyworlds, which I’ve still not managed to see.

Von Hagens’s skills are incredible. And the displays were interesting, revealing and illuminating. They varied from the tiny brain of a hare to a complete giraffe; from a scallop to a shark. The blockbuster pieces had to be the giraffe, an elephant and an entire bull. Oh and this camel which is outside the (paid) exhibition in the impressive Central Hall of NHM underneath the dinosaur’s tail!

Plastinated Camel Plastinated Camel

The actual display pieces were amazing. But having said that I was disappointed. We spent about 45 minutes in the exhibition. I would have liked to spend longer there, and would have done had there been any more to see. The expense of putting on an exhibition like this is immense; GOK how much it costs and how much time it takes to plastinate an ostrich, let alone a bull or a giraffe! But even so I felt the exhibition was a bit thin, both in the number and variety of exhibits and the information provided. I would have liked many more examples.

Especially I would have liked a lot more explanation of what I was looking at. My anatomy is pretty damn good for a non-medic/zoologist/vet. I know where a fish’s gill plates are but does Joey Schoolboy? But I don’t know the detail of how a sheep’s guts are arranged. And I wanted to be told, if only with some labelled diagrams. I felt the explanatory texts were much too terse. OK many people don’t want, and can’t take in, huge amounts of detail. So put that detail in separate panels which they can choose not to read.

Oh, you mean the detail is all in the book of the exhibition? But why do I have to buy the book? OK so it’s only £12.99, but I neither want nor need the book. I wanted to be told what I was looking at! But then the exhibition is only £9 (full price) which I thought very reasonably priced — I’d expected it to be more like £15 or even £20. So I suppose I shouldn’t complain.

After the exhibition we went to the main restaurant for coffee and cake (the NHM has something like four food outlets and as many shops!). This was another depressing experience. The restaurant system is so arcane (and unwelcoming) they have to employ someone full time to explain it to people. The décor was fairly dire. The only saving grace was that the chocolate fudge cake was fairly good.

Then after that I wanted to look at the fishes. What fishes?! The fish displays seem to consist of four wall displays tucked in a blind corridor at the back of nowhere. And totally uninteresting. This was old style museum display at its worst: a selection of almost random exhibits stuck in a case with nothing to make it at all interesting, no obvious variety of different biotypes (marine vs freshwater; tropical vs temperate). The marine invertebrate displays next door were exactly the same: a huge room with very boring displays in wall cases and nothing else.

After that, and looking at the plastinated camel and (over-hyped) dinosaur in the Central Hall my back was complaining so we didn’t investigate further. Maybe we should have done and maybe some of the other displays would have been better, but it didn’t look enticing. So we gave in and came home.

OK so what’s the bottom line?

If you’re interested in the broad ideas of how animals work then do go and see Animals Inside Out. It is worth the admission charge; just don’t expect too much. If you go expecting anatomical detail and explanation, as I did, you’ll be disappointed. And judging by our experience if you go on a mid-week early afternoon during school term the exhibition will be quiet.

As for the rest, frankly I won’t be going back in a hurry.

Sorry guys, but I much expect better of major world museum in this day and age.

medical, quotes, science, thoughts

Gardening the Mind

I came across the following quote from Jill Bolte Taylor’s Stroke of Insight on the interwebs the other day. It seems a good take on personal development and personal responsibility.

I view the garden in my mind as a sacred patch of cosmic real estate that the universe has entrusted me to tend over the years of my lifetime. As an independent agent, I and I alone, in conjunction with the molecular genius of my DNA and the environmental factors I am exposed to, will decorate this space within my cranium. In the early years, I may have minimal input into what circuits grow inside my brain because I am the product of the dirt and seeds I have inherited. But to our good fortune, the genius of our DNA is not a dictator, and thanks to our neurons’ plasticity, the power of thought, and the wonders of modern medicine, very few outcomes are absolute.

Regardless of the garden I have inherited, once I consciously take over the responsibility of tending my mind, I choose to nurture those circuits that I want to grow, and consciously prune back those circuits I prefer to live without.

Although it is easier for me to nip a weed when it is just a sprouting bud, with determination and perseverance even the gnarliest of vines, when deprived of fuel, will eventually lose its strength and fall to the side.

amusements, arts, links, medical, science

In Case You Missed …

The usual links to things which have amused me and which you may have missed …

First of all … politics. Never short of an Idiot, and interesting cynical take on James Murdoch vs David Cameron.

And secondly … politics. The politicians are about to remove some of the interest in our lives by having “a bonfire of dead wood statutes” and abolishing some 800 outdated and obsolete laws. Have they really nothing better to do? Oh, sorry, it’s their job to make our lives boring.

So to alleviate that boredom here are a few seriously amazing items …

How long would it take to travel to the moon at the speed of whale? One Minute Physics has the answer.

[Not safe for the faint-hearted!] Turning to biology, entomologists have recently found and described an enormous Warrior Wasp, aka. Waspzilla. Talk about awesome! Yes, I really would love to meet one.

Still on the biological, I discovered The Tiny Aviary, the website of illustrator Diana Sudyka. Gorgeous drawings like the one above.

And finally more stunning art, this time from Dalton Ghetti who carves sculptures in pencil lead. How you even start doing that makes my head hurt!

Enjoy!

current affairs, environment, medical, science

Fukushima Reprise

4 Comments

There’s so much going on at the moment that I should be writing about that I’m having a hard time keeping up! Anyway here’s the next piece.

There was an interesting, and I suggest important, “Opinion” article in last week’s New Scientist (dated 17 March 2012). In it Don Higson, a fellow of the Australasian Radiation Protection Society, argues for the total revision scale on which nuclear accidents are measured and points up the lack of true comparison between Fukushima and Chernobyl. Along the way he highlights the major differences between the two in health effects, adding some further important perspective on the situation.

The article itself is behind a paywall, so I hope I’ll be forgiven for reproducing some factual highlights here.

Everybody who gets cancer in Japan over the next 40 years will no doubt blame their misfortune on radiation from Fukushima Daiichi […] This would be entirely understandable but will have no basis in science […]

[T]here is no possibility that the physical health consequences of Fukushima Daiichi will be anywhere near as bad as those of Chernobyl.

As far as anyone knows, no member of the public received a significant dose of radiation attributable to the Fukushima Daiichi reactor emergency […]

Chernobyl was the worst that could happen. Safety and protection systems failed and there was a full core meltdown in a reactor that had no containment […]

237 Chernobyl workers were taken to hospital with suspected acute radiation sickness; 134 of these cases were confirmed; 28 were fatal; about 20 other workers have since died from illnesses considered to have been caused or aggravated by radiation exposure […]

On top of that, it has been estimated that about 4000 people will die […] from radiation-induced cancer […]

At Fukushima Daiichi, the reactors shut down safely when struck by the magnitude-9 Tohoku earthquake […] problems arose after they were inundated by a much larger tsunami than had been anticipated when the nuclear plant was designed […] The reactor containments were partially effective […]

There were no deaths attributable to radiation. Two workers received burns from beta radiation. They were discharged from hospital after two days. Two workers incurred high internal radiation exposure from inhaling iodine-131, which gives them a significant risk of developing thyroid cancer.

Doses incurred by about 100 other workers have been high enough to cause a small risk of developing cancer after 20 or more years […] About 25 per cent of the population dies from cancer whether accidentally exposed to radiation or not. This rate might be increased by an additional one or two per cent among the exposed workers […]

[T]here have been no radiation injuries to children or to other members of the public […]

[T]he amount of iodine-131 escaping from all the reactors at Fukushima Daiichi was less than 10 per cent of the amount released at Chernobyl, and the release of caesium-137, the next most important fission product, was less than 15 per cent of the Chernobyl total […]

As I’ve said before, we need to keep this in perspective.

While there are clearly many, many lessons to be learnt Fukushima should be looked on as a success story in terms of reactor design. Yes there were shortcomings in the design of the resilience, the fall-back ability, the processes and the communications. And there have been massive knock-on effects on the population and the environment — and indeed it has been argued the worst of the health effects will be the devastating mental stresses on the Japanese people (see, inter alia, this Guardian report).

But given that those reactors are 40-ish years old, and that even before March 2011 we knew a lot better how to design safe and secure reactors, this should be viewed as a (limited) success story.