Friday 23 February 2018

Medication nation - 'an easy slogan and little else' says Dr Gueret

It's hardly fair to be raising red flags about the dangers of chemists, says Maurice Gueret, who is on the bus again

Dr Eva and Andrea Hayes - Medication Nation on RTE
Dr Eva and Andrea Hayes - Medication Nation on RTE

I was reading a journal interview with a well-known doctor this week. His career was spent mainly in the development of new drugs, and when he was asked what personal ambition he still had, he was quite clear. He wanted to help change the public perception of the pharmaceutical industry and give proper credit to the development of medicines that have brought benefit to so many patients.

Well, I was on the bus recently - not long after RTE had screened their Medication Nation documentary. Downstairs in the stairwell was a small advertisement for strawberry-flavoured ibuprofen, the sort of bottle you might use to ease fever or pain in a small child. Somebody had scrawled on it, "KEEP CHEMISTS AWAY FROM YOUR CHILDREN - AND FROM YOU!!!". It was a minor act of public dissent. But symptomatic perhaps of a growing wave of anti-science and anti-medicine rhetoric, particularly on social media.

One doctor with a Facebook page, a dangerous thing even for trendy medics, recently had a visitor who told followers that this particular GP promoted dangerous vaccines. I wasn't impressed with the scattergun approach adopted on Medication Nation. I don't believe that Irish people 'love their pills' more than any other race. They are too expensive here for that, and we have nothing like the addiction problem with major opiates that they have witnessed in the United States. We do have problems with over-the-counter codeine addiction and long-term prescription of sleeping tablets beyond safe limits. But the leap to Medication Nation makes for an easy slogan and little else. Balance is hard to find in a world fixed on volume.

* Irish nursing homes now rank among the best-inspected in the world. Hardly a week goes by without the results of more unannounced visitations being uploaded to the HIQA website. Scuff marks on the paintwork and soiling around the bins are diligently recorded by inspectors, and cross-checked on subsequent visits. Health-and-safety protocols abound and are checked frequently. Staff records are examined. Social activities are counted. There are medication, food and governance checks to beat the band. But I've never seen recorded how long the patients are actually living. I read recently that the mean survival time for new entrants to nursing homes in the UK is less than 15 months. Apparently the mean survival time in Iceland is double this. It's a very complicated subject, and one cannot jump to conclusions about individual care centres based on survival statistics alone. But it would be wise for HIQA to examine this data as closely as it examines moss on the paths or loose panels on the bath. And when they do, they might care to release it on a national or regional basis.

* The untimely death of former TD Peter Mathews was felt by many. He held a cornucopia of political views, and would speak at length on most of them from a sound knowledge base. It's becoming obvious to this observer that many of our best public representatives don't really fit in the paralytic mould of careerist-ridden political parties. Peter was that rare politician who was as well endowed with good manners as he was with fresh ideas. It was poignant that his funeral was held on Lollipop Day, when oesophageal cancer is highlighted on the Irish health calendar. It's a very challenging condition, with about 400 new cases here every year, two-thirds of them in men. The oesophagus (or gullet) is a very central part of the chest anatomy and invasion to neighbouring organs can be rapid. Difficulty swallowing is the most common symptom, but half of patients may also report chest or upper-abdominal pain. Unexplained hoarseness, weight loss or food regurgitation should also warrant a check up. It's good advice not to take over-the-counter heartburn remedies for more than a week or two, but to get ongoing digestive symptoms checked out early. It's not a common cancer, but early diagnosis can be missed by attributing symptoms to something else. When I was in medical school, just about one in 10 patients who had surgery were surviving five years. This figure has now improved to about one in five patients. Not great, but you gladly accept any improvement with oesophageal cancer.

* Mental health is all the rage these days, with half the world expert in it and the other half forced to listen to them. I find the best way to understand it all is not to go along with the populist flow of health promotion at every crossroads, but to spend more time delving into its history. Irish Academic Press has just published a new paperback edition of Asylums, Mental Health Care and the Irish, which gives a wonderful run through two centuries of not exactly putting the patient first. There is an excellent account of how a left-leaning teacher took command of the mental hospital in Monaghan in 1919, and raised a red communist flag over the building to signify that the ordinary staff had taken over. The matron and medical officer were kept prisoner so that any emergencies could be dealt with. The windows of the asylum were blacked out, and the occupying attendant staff changed clothes with patients so they would not be identified if police stormed the building. In fact, the only storming came from the local Catholic clergy, who were allowed through the barricade doors to hear confessions! I won't spoil a real life page-turner by telling you how it ends, but if you want to understand some truths about who really runs the asylum that is the Irish health service, this book is a must.

Dr Maurice Gueret is editor of the Irish Medical Directory

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