For reasons far from clear to this innocent doctor, purveyors of health pseudoscience particularly target the breakfast market with their wares. Today's comestibles are wrapped up in supermarket packets that read like patient information leaflets. Amongst the latest wheezes to assail my ears are oats for your heart, and breakfast vitamin mixes for your immune system.
The latter seems to fly in the face of recent advice from a paper in the reputable Annals of Internal Medicine, where the authors suggested that supplementing the diet of well-nourished adults with most mineral and vitamin supplements has no clear benefit in terms of chronic disease prevention, and might even be harmful. The big promotion of oats as a cardiology cereal began in America, where food claims tend to receive more critical attention than they do in Europe. One major oatmeal manufacturer claimed his product was so unique it went about 'actively finding' cholesterol and removing it from the body. A threat of a lawsuit from the Centre for Science in the Public Interest led to a climb-down. The man who threatened litigation agreed that "oatmeal is a healthy food, but that is no excuse to give people the impression that it will miraculously remove cholesterol from your arteries". And so say all of us. I am very partial to a nice bowl of porridge. For me, not my heart.
As a medical student, the first baby I delivered was in St James's Hospital. The lady was so grateful for my attentions that she called her son Maurice. I think Maurice was her eighth – in medical terms, she was a 'multigravida'. This was back in the days when St James's had its own tiny maternity unit, with, perhaps, just a birth or two each night. It was an oddity even then, because just a mile up the road was the high-tech Coombe Hospital. I liked obstetrics. Most days and nights ended with tears, but happy ones. But there were tragedies, too. Around this time, I read the comments of a well-known obstetrician, who said that at any one time there was hardly a consultant in this field who didn't have a lawsuit against him. The impression was that if you chose this career as your medical speciality, you would, unavoidably, spend time in court. I didn't deliver too many more Maurices after hearing that. There were good reasons for eventually closing the maternity unit at St James's. As, indeed, there are good reasons for closing down a heap of understaffed, small birthing units around the country. If international best practice people were called in, they would probably close half of them down tomorrow. Not enough births, not enough specialists, not enough critical-care facilities for the babies who struggle in the early hours of life. Closures in Dublin have always been easy. Hospital loyalties are thin on the ground when half the population goes private anyway, and there is little local media to fawn over Dublin's politicians. But recent revelations about wide variations in Caesarean-section rates hint at a major problem in Irish maternity care that isn't going away.
Pharmacists are hopping up and down again as they demand a greater role in our health services. Hardly a week goes by without another press onslaught claiming that pharmacists could reduce millions of unnecessary visits to hospitals and GPs. I think they fulfil that role very well already in their treatment of minor ailments, their careful monitoring of doctors' prescriptions, their extensive drug-interaction knowledge, and their provision of preventative measures, such as flu vaccination. But 20-minute delays in getting prescriptions filled could really escalate if they started to deliver babies, remove ingrown toenails, order CT scans and conduct fitness-to-work assessments on customers. I'd like to see more meat on their proposals for a greater clinical role. Playing doctors and nurses is all very well for children, but when adults take on these bedside roles, we need to point out that a medical-school training differs very markedly from a pharmacy one. If they plan on dangling a stethoscope perilously across their shoulders at the back of the shop, they should know that it took me six years to learn how to walk that way.
Ben has been in touch, with some lovely medical malapropisms. I was familiar with the old gastric favourite of Dublin patients, the 'bleedin' Ulster', but wasn't aware that many Dubs used to present with swellings of the lower leg that they called 'various veins'. He tells me that, many years ago, he had a very one-sided conversation with an elderly gentleman, who was at pains to tell him that he had lost a 'Len' and didn't know what to do about it. He wondered if there was a grant for his lost 'Len'. It took some time for the real meaning to dawn. The man had lost his contact lens and, in his own quaint way, believed that a len was the singular of lens! Do get in touch anytime with your malapropisms. They shorten the recession. I'm at firstname.lastname@example.org or by post at PO Box 5049, Dublin 6W.
Before Christmas, I wrote a piece on restless legs syndrome, and a Cork lady has been in touch with some advice. She had many of the symptoms,
but found that many sufferers are unwilling to talk about it in case doctors think it trivial. Her own symptoms were not particularly painful, but did keep her awake. She tried quinine, without success. Anyhow, she read an article about how calcium-rich foods can trigger muscle cramps and restless legs. She was already taking calcium tablets and, lo and behold, when the dosage was reduced, the suffering went away. This story reminded me of an old mnemonic we used in medical school to remember the signs of a high calcium level in the blood. It went 'Stones, Bones, Groans, Moans and Thrones', and referred to kidney stones, diseases of the bones, tummy pains, mental symptoms and urinary frequency or constipation.