Sunday 19 August 2018

Hot water science and reversal of medical policy

Wake up and smell the lukewarm non-carcinogenic coffee says Maurice Gueret, who is left cold by new science

Coffee was linked to bladder cancer at one point
Coffee was linked to bladder cancer at one point
Dr Maurice Gueret.

Maurice Gueret

I'm not one of those doctors given to pontificating about the goodness or badness of individual foods. There are risks and benefits to almost everything in life, and the only certainty, when we weigh them up, is that no two scales will ever register the same. 'Choose your genes wisely' and 'a little of what you fancy' are the mottoes on my wall.

When I started out in medicine a quarter of a century ago, links were being made between coffee and bladder cancer. The World Health Organisation's cancer-research arm declared coffee to be "possibly carcinogenic" and added it to its 2B category, alongside chloroform, bracken fern and other chemical nasties. But this summer their position was quietly reversed. Coffee is no  longer classified as  cancer-causing and, in fact, may actually reduce the risk of some cancers. A group of 23 scientists convened by the International Agency for Research on Cancer declared the evidence against coffee to be inadequate. Instead they now say that "very hot drinks", regardless of what's in them, can cause cancer. Very hot means above 65 degrees Celsius, which is how most people like their tea, coffee and hot toddies served. If it's as dangerous as they say, I might not be around for the next policy reversal in 25 years' time.

I was recently bemoaning the fact that doctors get no training in either basic accountancy or health economics. A stark omission, considering how much time Ireland spends wondering where its annual health budget has gone. Well, I was contacted by a medical student to tell me that things may be changing for the better. The curriculum is still the same, but the make-up of classes in our medical schools has radically shifted. In my day, 99pc of the intake were like me: spotty, 18-year-old Leaving Cert students. But my student friend tells me that in his fourth-year class today, there are five chartered accountants alongside five engineers, four lawyers and a healthy quota of scientists and teachers, too. Many of the young house doctors appearing soon in a hospital near you will have experience from other walks of life. This can only be to the advantage of an insular profession, no longer all cut from the same cloth.

My friend also made mention of a famous French doctor called Baron Guillaume Dupuytren. It's a little known fact among patients that the best-known and most vocal doctor in any jurisdiction can often be the least popular medic in his profession. Dupuytren didn't cut the mustard with his colleagues. "The greatest of surgeons and the smallest of human beings" was his well-deserved sobriquet. Though he proved his expertise in the treatment of burns, and went on to have the famous claw-hand syndrome named after him, his contemporaries saw him as arrogant and domineering. Nobody and nothing got in the way of his career. From an impoverished backround, Dupuytren went into medicine soon after the French Revolution wiped away the elitist entry criteria that would once have barred him from entry. He spurned surgery on his deathbed, saying he would rather have the hand of God on him than any surgical colleague. But he had his fans. When the funeral procession passed Paris's medical school, his clinical students paid the greatest respect to their master. They unhitched the horses and pulled the hearse themselves all the way to the Pere-Lachaise cemetery.

Peggy lives well outside the capital now, but she grew up in the north inner-city and wrote to tell me of the many familiar cures they had in 1940s and 1950s Dublin. Money was very tight at the time, and she recalls that a doctor's visit, at four shillings and sixpence, was reserved for real life-and-death emergencies. Doctors, with these high house-call charges, were out of the question for many families, and Peggy remembers a local neighbour and wise woman called Dolly Taplin being called in on many occasions. She tells me that Dolly was probably the forerunner of today's alternative-medicine practitioners. Her cures were both effective and affordable. Peggy remembers her mixing Lifebuoy soap and sugar to prepare poultices, sometimes hot and other times cold. She would take one look at a sick child and know whether she could help, or immediately advise borrowing the money and calling the doctor. I believe Dolly's maiden name was Kathleen Wilson, and she lived under the railway bridge at North Strand. Her parents were Scottish and her father was a jeweller in Dublin. Whether she had any qualifications, I am unsure, but I'd like to hear more of her care, if any readers can help.

I will never be wise enough to understand the machinations of the EU. What began for us as a kind of a giant car-boot sale for our milk, meat and mackerel, has morphed into a ticket-free jamboree. Five-hundred-and-eight-million people (ourselves included) now have the right to pitch a tent and reap whatever benefits we see in each other's gardens. Where could it all go wrong? Big business went east for cheaper labour. And millions of bright and mobile young folk came west on Ryanair for better wages. We are not allowed to say that the operation took place too quickly for the patient's good, or was carried out without informed consent. Britain is pulling its drawbridge up. Mark my words, they will keep their stall in the single market, divested of red tape with all future admissions by timed ticket only. And Ireland may discover too late that independent thought is just as important as independent rhetoric.

Dr Maurice Gueret is editor of the Irish Medical Directory

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