Tuesday 19 September 2017

Of natural causes - George Michael left his legacy to spotify

Now that George Michael's post-mortem findings have come to light, our GP urges caution on Donald diagnosis

Former Wham! star George Michael died aged 53 on Christmas Day
Former Wham! star George Michael died aged 53 on Christmas Day
Dr Maurice Gueret

Maurice Gueret

His lover phoned the ambulance to say that he had gone blue. His former partner said that his body just gave up. His publicist said that he passed away peacefully. His Wham singing partner said that a supernova in a firmament of shining stars had been extinguished. His coroner said no inquest was required, as death was due to natural causes.

And there's nothing quite as natural in a 53-year-old singer as a non-alcoholic fatty liver, a dilated cardiomyopathy and myocarditis. Which, in everyman's language, is a flabby, inflamed and poorly pumping heart, twinned with a deep-fried lardy liver. We don't know the full medical history. We don't know the toxicology results. Now we won't hear witnesses on a court stand. And why should we? Georgios Kyriacos Panayiotou made his worthy contribution and left his legacy to Spotify.

The phrase 'death from natural causes' is widely used, but poorly understood. Excluded from the definition would be fatalities caused by hungry crocodiles, faulty parachutes and political assassins. Natural causes implies that the principal cause of death is a recognised illness or body malfunction. And it shouldn't be directly caused by something or somebody else. There are about 30,000 deaths in Ireland each year. It's the job of a county or city coroner to examine deaths that are sudden or unexplained. Coroners can be legal or medical people - often a longstanding local GP, or a well-regarded solicitor. If a deceased person has not been seen by a medical doctor in the calendar month before death, then it is mandatory for the coroner to get involved. All deaths where violence, misadventure or potential negligence is suspected must be reported. The coroner's job is to find out who died, where they died, when they died and how they died. Coroners have to be satisfied that there is nothing untoward about deaths before directing doctors to issue death certificates. They can decide to have post mortems completed, and if inconclusive, an inquest might follow. Coroners get involved in about 6,000 deaths a year. Of these, fewer than 1,000 will go to inquest.

* The USA medical establishment is in a tizzy about Trump. A letter to the New York Times signed by 35 psychiatrists and mental-health professionals suggested that the new President has "grave emotional instability" that leaves him incapable of serving his country safely. The letter also inferred that other doctors were afraid to speak out because of the American Psychiatric Association ruling that diagnosing mental illness from afar in public figures was unethical. The so-called Goldwater Rule urges psychiatrists to refrain from public comment on patients they have never examined and to get consent from anyone whose mental health is mentioned in public. Back in 1964, a magazine polled psychiatrists about whether Senator Barry Goldwater was a fit person to be President. The editor was sued for libel and Goldwater took him to the cleaners for what would be half a million dollars today. It's a funny old country that denies psychiatrists a platform to speak from their knowledge base, but lets an ignorant President freely insult Mexicans, Muslims and women that he has never met.

* I'm a sugar man myself. Just a half spoon in tea and a fussier quarter portion in coffee. It's not good for the figure, but the low dosage eases guilt. The real damage is done by dunked biscuits. I have never quite trusted the health profile of artificial sweeteners. Now I'm not certain I can trust the legions of people who take them. A new test is being used in Canada for the detection of urine in public pools. It measures the levels of an artificial sweetener that swimmers pass in their urine (the sweetener, acesulfame potassium (ACE), is commonly found in processed food and passes through the body unaltered). It would appear that the chemical sweetness-and-light brigade are clouding the waters for the rest of us. Renegades who are too cosy in their lanes to get out to go to the lavatory. Researchers spent three weeks at two pools, and, in testing for ACE, they found 75 litres of pee in the big one and 30 litres in the smaller one. I am afraid to bring you the results of their hotel jacuzzi testing lest you never go on holidays again. Faeces in a swimming pool does pose an infection risk. Urine is sterile, so it's really no more than an eye and airway irritant on its own. But it doesn't mix well with pool chemicals. The baddies here are DBPs: disinfection byproducts that result when pool cleaning chemicals meet human waste. Very toxic. I'll be watching out the next time the sugar bowl is passed to see who is on the artificial sweeteners.

* I'm in no particular hurry to finish writing a book called Doctor's Dublin. The research is so interesting that the writing of the book has lapsed. This month, I am looking at Soyer's Famine Soup Kitchen, which was set up in the Croppies' Acre field in 1847. Visitors to Collins Barracks on the quays will know the area well. Soyer was a French celebrity chef based in London who took his nation's penchant for bragging to new heights. He invented a thin beef and vegetable soup, fortified with lashings of salt and sugar, and made all sorts of claims for its famine-beating abilities. He was invited to Dublin, and his soup kitchen was installed to feed thousands of souls every day. The local nobility were charged a fee to come and watch the masses being fed. His critics said it was more a case of poor soup than soup for the poor. The kitchen didn't last long and was dismantled and moved to the Liberties. I'd love to know if anything remains of Soyer's soup kitchen and am all ears if you can help.

Dr Maurice Gueret is editor of the Irish Medical Directory

drmauricegueret.com

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