Saturday 30 August 2014

"The Big Fat Surprise - Why butter, milk and cheese belong in a healthy diet."

                 I finally finished "The  Big Fat Surprise - Why butter, milk and cheese belong in a healthy diet." by Nina Teicholz.   An entertaining enough read that reviews most of the  major studies regarding diet and cardiovascular disease, all of which are open to interpretation and therefore none of which are definitive. So, apart from a little entertainment, what have I learned from this thick  volume about the influence of diet on health and longevity?  Not much that  I  didn't  know before.  There is really nothing new here but it is a good overview of the various controversies that continue to rage.

                 Ms Teicholz does an excellent job of describing and then taking each study  and  the research teams that generated them apart. She efficiently reviews their shortcomings and does seem to enjoy highlighting  the human frailties that,  naturally  enough, prejudices even the most honorable researchers in favour of their own conclusions and their tendency to massage the data to prove whatever point they are trying to make.  It could be that the offending component is any of the food groups or even subgroups (e.g. saturated v unsaturated fats)  She makes the point that as soon as there is a minimal amount of data and often not enough to come to any firm conclusion, the food industry start planning how to turn the greatest possible profit from it.  She describes well the "Fat and Oil Wars" and how Big FoodCo  spends vast sums politicizing the health issues and extravagantly entertaining all categories of health care professionals and researchers in an attempt to support theories that they believe will help to promote their products.  Various scientific meeting are hosted in exotic places so it is not difficult to get the world experts to attend meeting, debating the Mediterranean Diet in Greece or some other pleasant Mediterranean resort. 

                 If I was still practicing medicine this book would not change my management of overweight patients but then I never subscribed to any of the fads of the day.  Nor would I change my dietary approach to cardiac patients.      As my parents used to say, "moderation, in all things".  And they never even went to medical school!


Wednesday 27 August 2014

E-cigarette & The WHO.

       Has the WHO Gone crazy? They would like to put a ban on using E-cigarettes indoors.   Water vapour must have it's risks, but surely it isn't as dangerous as those plastic water bottles that everyone is drinking out of these days, when there is perfectly safe water in the tap.  What about all those chemicals leeching out of the plastic that they are drinking and feeding to their kids?  Especially after they have been cooking in the car on a hot summers day. (Unfortunately, sometimes the kids as well.)
      They have even expressed concerns about second hand watervapour!
     And does it not seem strange in an era when the inhalation of marijuana seems more acceptable than water vapour? 
       I don't think anyone would deny that cigarette smoking or marijuana smoking is much more damaging than sucking on an E-cigarette, some of which don't even have any nicotine in them.  
       The WHO must have more important things to do than nit pick and witch hunt over a group of adults who chose to try to give up smoking for a less harmful habit.  If not we are wasting an awful lot of money.  And since new smokers these days come from the ranks of teenagers perhaps they may be choosing a less harmful alternative.
       Life will never be risk free and while we must monitor what we ingest and inhale and try to prevent harmful substances from being disseminated, lets treat adults like adults.  A WHO police force is exactly what we don't need!

Tuesday 26 August 2014

The Doc and the Cops. IV

Flu Shot Day!
            When I arrived at the Post hospital that  morning at 8 a.m., Mike had already got things under way.
            “We’re going to be a bit busy today, Doc,” he informed me.
            “Oh, how is that?”  I asked, "I have to meet a patient in the Emergency Dept at eleven.
            “Oh don't worry, Doc, I'll get you there in time," he reassured me."  We have about 30 young fellows who need their flu shots this morning,” he answered.  “And then we have a young fellow I admitted during the night, with tonsillitis and there are about another eight wanting to be seen, and of course then there are others who come in during the clinic I’ll let them in until nine o’clock and then unless they look sick they’ll have to wait until tomorrow.”
            “That’s going to take quite a while Mike.  Thirty immunizations even before we start seeing the sick ones.”
            “I have all thirty of the men requiring the immunizations lined up, standing to attention, with their sleeves rolled up and waiting for their shots,” Mike said proudly, his military background surfacing. “I filled up thirty syringes with the required amount of the vaccine and I’ll wipe off their arms with the alcohol swab, while you inject the vaccine.  If we allow about a minute for each one we should be done in a half hour or so.”
            “Sounds good to me, Mike and if we keep up the momentum, I might just  make my appointment at the  Grey Nun’s hospital and grab a bite of lunch before my afternoon office.”
            Mike smiled, “don’t worry Doc; I’ll make sure you're in time.”
            As I followed Mike into the clinic, I found thirty young RCMP recruits standing to attention with their sleeves rolled up their shoulder.  On a mobile trolley nearby there were thirty alcohol swabs and thirty loaded syringes.  Without further ado Mike wheeled the trolley to the first candidate, wiped down the appropriate area of the left shoulder and waited for me to pick up a loaded syringe.  I gave the injection.  We were about halfway along the lines when we heard a crash as the recruit third in the line slid to the floor and not too silently.  I started to run towards him. 
            Mike said, “You just carry on Doc, you’ll have to wipe off the arms yourself with the alcohol swab, while I look after the poor lad.  It always amazes me that the biggest, strongest looking lads are the ones who faint at the sight of a needle, let alone a prick from one.”
            Just as he said there were always a couple of fainters.  Mike never seemed to worry about them getting hurt and so neither did I.  ‘They’re big strong lads, don’t worry about them’, was Mike’s retort when I expressed some concern.  Our failure to worry was well rewarded as nobody ever did get hurt and in those days there were not so many unemployed lawyers hanging around.

Friday 22 August 2014

Decapitation. Ultimate act of Savagery!

                         What sort of savage cuts a man's head off and is proud of it?  Is it some sort of mental illness?    Is the poor perpetrator unhinged, delusional, psychotic, crazed, unaware of what he's doing?   No. this is a diagnosis you won't find in the DSM5   It is called evil,  and we better learn to recognize it again and how to deal with it.  There are evil people and evil cultures.  Let not political correctness destroy us because it will if we let us.  Edmund Burke said, "There is, however, a limit at which forbearance ceases to be a virtue."   We need to need to keep  that in mind.  Burke also said," All that is necessary for the triumph of evil is that good men do nothing."
                          We need to remember that!

Monday 18 August 2014

Pot 'Heads"

            As a 'life member' of the  College of Family Physicians of Canada and of the Canadian Medical Association I was embarrassed to see that these organizations and the Royal College of Physicians and Surgeons of Canada all said they would decline Health Canada's invitation  to endorse a campaign on the dangers of marijuana use by young people!  Does that mean they don't think there are dangers to young people?  I can't believe they could be that stupid.  Assuming they are not stupid, does that mean they do not want it to be brought to the public attention?  No, of course not, that would be malpractice by my definition.
So why?  The only reason left is that lending their endorsement might just have political repercussions.  
             I am embarrassed that organizations that I have contributed time and effort to over the years (and a good deal of money, too) don't have the guts and integrity to support an effort to educate people on the dangers of marijuana.  They know only too well there are many risks involved.   They had no such reservations regarding speaking out against cigarette smoking, for instance.  My only explanation is that they  'don't want to get involved'!  Instead, they issue the following feckless statement: "the CFPC, CMA and Royal College will continue working to enhance public education  and increase awareness of the health risks of drug and alcohol consumption by Canada's young people."
             Shame on all three of you!
Hey folks, I want your comments on this!!

Saturday 16 August 2014

E-Cigarette - H20 V 2bacO

                  What's wrong with Public Health Administridiots and other Health Care Professionals when they are recommending banning E-Cigarettes, probably one of the greatest aids to cessation of tobacco smoking we have.  When these feckless milksops wag their fingers in warning against the possible dangers of inhaling water vapour and propylene glycol as against the very definite multiple risks of tobacco inhalation, about which they have  been rightfully screaming out against for years, I wonder if they have totally lost contact with reality.   Surely this is a 'no contest'!   H2OV2bacO.  Come on folks, let's not be dopey!
                     Yes, I can hear some of them say, but some of the compounds used have some nicotine added and to that I reply that nicotine is one of the least toxic components found in tobacco.
                       Considering that there is evidence to suggest  that smoking is on the increase, the arguments that e-cigs cold normalize the act of smoking or act as a gateway to smoking are particuarly weak, particularly in a society that is overwhelmingly approving of free accessibility of marijuana.
                       Concerns about the safety of the vapour itself is largely laid to rest by an article in BMC Health Journal which concluded that it poses virtually no risk to users.
                        As far as the Tobacco Industry is concerned, it is going to win either way as they already are in the e-cig business.
                         So to the Administridiots in the Department of Health, it is time to stop trying to organize a witch-hunt on E-Cigarettes and accept an aid to smoking cessation which may be the best we have to date.

Wednesday 13 August 2014

Ebola - The Bleeding Edge. II

Can You believe it?
                           With over a thousand deaths from this terrible disease, there is still some debate about making drugs such a Zmapp available to the afflicted.  Of course it is not clear how effective these drugs may be, if they are effective at all, nor what unexpected side effects may become apparent, but preliminary tests at least look promising and if desperately ill people prefer to take the risk as against no treatment,  there is no treatment other than supportive care, then that should be their choice.  (Always presuming there is sufficient vaccine to offer it.)   When penicillin became available clinical trials with endless equivocal statistical analysis to see if it was effective were not necessary.   The patients who were given the drug recovered rapidly while many of those who didn't get it died.  Simple. Nobody thought of legalities.  For God's sake, give  the patients the Zmapp (or whatever) if knowing the situation they request it.
                            Unfortunately, the medico-legal lottery and the goldmine the legal profession has tapped into has changed the face of medicine (or as it is called these days - The Health Care Industry.) forever..  Because of the greed of some of the public, encouraged by many in the legal profession, physicians and those associated with  the provision of health care have been forced to consider the legal implications of any action, no matter how well planned or how appropriate,should things not go as planned.  Drug companies likewise.    There is an expectation by the self-centred "ME" generation that everything better work out the way I want - or somebody is  going to pay.  An adversarial attitude has developed that I and most of the physicians of my era never experienced.  I was never sued or even threatened with a suit.  Perhaps that's because my patients thought I  cared about them - and I did.  We were on the same side.   Now physicians and other health care personnel are influenced in their approach to  help by the consequences of their efforts resulting in failure with potentially disastrous consequences.
                            Retirement, after fifty-five years is much easier to take than I anticipated .  And it ain't because I'm getting old and tired!!

Sunday 10 August 2014

Obesity and 'The Big Fat Surprise.'

           As a Family Doc with a special interest in nutrition and obesity for many years and a considerable amount  of experience in running an Obesity Clinic and treating patients on an individual basis for being overweight and/or obese, I viewed with interest the recent publication of a new book entitled
"The  Big Fat Surprise - Why butter, milk and cheese belong in a healthy diet." by Nina Teicholz.    
            There are literally dozens of  books on  the shelves full of magical  ways to lose weight,  the very plethora proving their lack of significant success.  The success that is achieved is largely due to  the only really valid equation in weight loss - take in more calories than  you burn and you gain weight, take in less and you lose weight.  Approximately 3,500 calories is equal to a pound of fat (although there is some dispute as to how accurate this figure actually is.).
            What is particularly unusual about this book (and I  have only read a review of it so far) is that it attributes weight gain to fruits, vegetables and other carbohydrates and recommends a diet rich  in meat animal fats and dairy products. It challenges the whole idea of animal fats being bad for you and indeed suggests that they are good for you,- at least better than plant or unsaturated ones.  It also seems to deny the entire lipid-heart disease association.  I have read many "magic bullet" books over the years and have found that they all work to a greater or lesser extent for weight loss, if rigidly adhered to, but that is almost certainly related to the fact that they  result in a lower calorie intake and encourage an exercise program.
            This certainly seems to open up a can of worms with regard to what a few years ago was regarded as settled.   The current scorn for experience in actually treating obese patients with some degree of success in unfortunate.   Success in  treating the obese, sedentary and sometimes  high risk patients in a general practice in  the field has a lot to do with motivation and the desire to maintain a healthy body weight and I think very little to do with the equivocal interpretation of the statistics of most of the esoteric studies Ms Teicholz's goes on at length about.  Enough said, I must read the book carefully before I say more.
             Perhaps we need a book entitled ' the commonsense approach to weight loss and good health' .  Unfortunately commonsense is so uncommon these days that it may not be possible to find enough of it to write a book! 
           Obesity, continues to be a major health risk so I will be visiting this topic on a regular basis in the future.

Wednesday 6 August 2014

Ebola! The Bleeding Edge.

            I can't help wondering why two American  health care workers were brought back to the U.S. for the supportive treatment that could have equally efficiently been arranged on site, even if it required sending out some further medical support.  It surprised  me that such a highly infective and lethal condition would be introduced to the U.S. for so little advantage to the patients. Despite the reassurances that there is "virtually no risk of it getting into the general population", such  things do happen for a variety of reasons even in the best treatment plans.  If such an event occurred the results could be so catastrophic that even a small risk seems untenable when the same treatment could  have been administered on site.  The antibody infusion could have more easily been transported to the patients than the other way around.
          One has to wonder how this decision was made and why?

What do you think?

Monday 4 August 2014

The doc and the Cops. Pt 3.

Part 3.
         My appointment as a Special Officer in  the RCMP  was a source of great amusement to my family and  friends until I threatened to arrest them by virtue of the powers vested in me!
         For the next several years every now and again I would get a call
 from the RCMP to request that I come out to the airport, or to the
 RCMP holding cells which were located below the main post office on
 S. Railway St in Regina, Saskatchewan.  For the most part it only took the
 appearance of the doctor at the scene to help resolve it.
              Such a request resulted in a visit to the airport one
 night when a small aircraft made an unscheduled landing at the Regina
 Flying Club, where I was greeted by several RCMP officers.  When I
 got to the airport the accused had already been questioned and denied
 any contraband items including drugs.  I was invited into the interrogation.
              "Let's go over this again," the RCMP officer said, "you
 are from Regina and you were down in Minot, North Dakota for a few
 days holiday, and you arrived here tonight without a flight plan and
 tried to land unnoticed at the Regina flying club right next to the airport?"
              "Yeah, that's about it."  The scruffy looking little pilot said.
              "And you brought nothing back with you?  You were just
 on holiday."
              "No sir,"
              "So why the late-night flight with no flight plan?"
 asked the officer.
              "I had to come back in a hurry.  I had a phone call that
 my wife was sick so I thought I'd better get home as soon as possible."
              "We got the doctor here to check you over," the officer said.
              The prisoner glanced over at my direction,"
              "Hi, Doc," he said as though delighted to see a friend.
              "Hi, I am Dr. Smith, I do some work for the RCMP, in
 fact I'm a special constable in the force and I want you to realize that."
              "I'm sure glad there's a doctor here, it makes me feel a
 lot safer," he grinned.
              You dumb bastard I thought, I've just told you I'm on
 the other side.  Aloud I reiterated, "You understand that I am an RCMP
 special constable as well as being the doctor and I want to make sure
 you understand that.  I'm not your family doctor."
              Judging from the way the grin faded from his face and
 was replaced by a look of anxiety I felt he was beginning to get the message.
              "I'm OK doc, I don't need no doctor," he bleated.
              "I'm here because you're under suspicion of smuggling
 drugs into the country," I responded.
              "They searched the plane, didn't find anything," he
 replied indignantly.
              "Yes, but to put it bluntly they think you may have
 swallowed the evidence or stuck it up your ass.  In either event,
 there's only one way it can come out and you know as well as I do
 what that is.  So the suggestion is that I do a rectal examination
 and if necessary a sigmoidoscopy."
              "What the hell is that?"  He asked anxiously.
              "It's sticking a tube up your bum and looking to see if
 there are any condoms up there that may be full of heroin or
 something like that," I explained.
              "There's no way I'm having anyone sticking a tube up my
 bum.  You can't make me."  He said challengingly.
              "No we can't," I admitted.
              The officer in charge intervened, "that's OK doc, if he
 won't consent to that, we'll just hold him here in one of our holding
 cells at the post office for a few days until all of his bowel
 contents are emptied right under our supervision and then scrutinized
 so carefully that a grain of sand couldn't pass through unnoticed."
              And that's exactly what happened, after an agonizing
 twenty-four hours the prisoner couldn't hold on any longer and passed
 a condom full of heroin.  Twelve hours later he passed another.
              Case solved!