For generations now, governments have been swinging the lead when it came to removing industrial metals from our taps. Doctors had a week's advance warning this month that lead pipes and Irish Water were going to be in the news again.
Just days before Minister Kelly laid out his pipe dreams, the HSE wrote to everybody in Family Doctor-land. They filled us in on some background details, in case pesky patients with lead in their pencils came around plumbing for answers, or asking tricky questions. So what did they tell us? Well, basically that the World Health Organisation has declared a zero-tolerance approach to lead in water, where previously a blind eye was turned. Up to now, we medics had mainly confined our worries to lead in petrol, paint and industrial settings. Now that these sources have been tackled, focus is shifting to the family home.
Now, real lead poisoning is extremely rare in Ireland, with only two cases recorded in Irish hospitals in a recent four-year period. It usually occurs in an industrial setting, or through exposure to cosmetics, toys or paints that have escaped the regulation process. What is now at issue is long-term low-dose lead exposure, and the theory that subtle effects like high blood pressure in adults and lower intelligence in children may result from lead in your tap water. The public-health doctors also secretly hope that concern about lead in drinking water might encourage Irish women to stop being the worst breastfeeders in the world.
And before an entire nation of pre-1970s householders runs off to the nearest laboratory for blood tests, the HSE strongly warns against this. In very bold letters, they state that "screening of human lead levels is not routinely advised". They took test samples in Galway and Limerick, where raised lead levels were found in drinking water, and the results were within normal reference levels. They say blood tests are only needed if there is a real need to rule out lead as a source of unexplained chronic symptoms. My recollection of common lead-poisoning symptoms from my student days include tummy and toilet problems, headaches and an occasional lead taste in the mouth. Sniffing petrol in those days could also give you a nasty tremor, excitability, weak muscles, brain failure and sudden death. In the rare event that samples do need to be taken, lead-free needles are essential. These can be obtained by special request from the serology departments of local hospital laboratories. There's little point measuring minute amounts of lead in your blood when the needle used to siphon it off is full of the stuff. What is infinitely more important than a blood test is a lead test of your water supply. The magic number is now 10 micrograms per litre. If your water has not been tested, or has been tested and is over this level, you might visit the HSE website and do a search for the word 'Water'. Their good advice on water is free of charge. Unlike the leaden water in your taps.
Death of Professor Aidan Halligan
The untimely death of Professor Aidan Halligan continues to reverberate on these islands. Former colleagues have been saying fascinating things about this most charismatic of men. Aidan was the man who might have become the first leader of the Health Service Executive in Ireland, but got lucky. One colleague recalled what Aidan said when he took up any new job. He had three basic rules: "Don't tell me who to speak to, don't tell me where to go and don't stop me doing anything". It helps explain why he finally declined to work for the HSE. In his British Medical Journal obituary, another colleague said that Aidan was "a natural leader, not a natural bureaucrat" and "would have been wasted as chief executive". Alas, our politicians retain their greasy grasp of your healthcare, and we shall never know.
When does a long-term illness cease to become long-term illness? Well according to the Minister of State at the Department of Health, Kathleen Lynch, it's at the precise age of 17. I wrote here recently about a glaring anomaly in the Long Term Illness Scheme, which classifies juvenile mental illness as long term, but deliberately excludes mental illness in older teenagers and adults. The difference is hugely important, because the State will provide vital psychiatric treatment without charge to one group and refuse it to another. Independent TD Tom Fleming from Killarney has taken up the cudgel with a Dail question to the minister, who says she has no plans to amend the regulations. Mr Fleming has written to me to say he will pursue the matter further, and wonders if a test case might be taken to the Ombudsman. Sounds like an excellent idea.
Whooping cough cure
Speaking of Kerry, Helen has been in touch with a final whooping-cough cure for our collection. During the early 1970s, she was driving on holidays towards Tralee with a gasping two-year-old son. The child had not been vaccinated because of an allergic condition. Coughing was so severe on arrival that the hotel receptionist called a doctor. The GP had recently returned from the United States, and drawing on his experience there, suggested bringing the child to the top of Mount Brandon. He said the quality of the air up there would most definitely assist a cure. The following morning, an old lady in Tralee gave the exact same advice to the father of the boy, so they all trooped up together. Helen says the Mount Brandon air worked a treat and they were never so thankful.
Dr Maurice Gueret is editor of the 'Irish Medical Directory'