If you have ever wondered about the physical and mental health of famous historical figures then read on - but be aware, current political figures are off limits.

Perhaps the reason curious decisions were made and even more curious events took place will become a little clearer.

---

609
Is Rugby a Dangerous Sport ???
Apart  from the inevitable physical injuries which occur in  any contact sport there has always been some concern there may be long term cognitive effects from heads being in too many scrums and rucks in rugby.

There are no objective data supporting that concern, but there is some unscientific evidence taken from the cream of New Zealand rugby:

• I owe a lot to my parents ,especially my mother and father – Tana Umaga
• That kick was absolutely unique, except for the one before it which was identical – Tony Brown
• I’m going to graduate on time, no matter how long it takes – Rodney So’ialo
• Nobody in rugby should be called a genius. A genius is a guy like Norman Einstein – Jono Gibbs
• I’ve never had major knee surgery on any other part my body – Jerry Collins
• Well, either side could win it,or it could be a draw – Murray Mexted
• You guys pair up in groups of three, then line up in a circle – Hurricanes coach

  ---

Melatonin –the arguments continue !
Melatonin is a hormone produced by the Pineal Gland which is a very small gland situated deep in the brain and very inaccessible. Melatonin has an effect on the body clock with hormone production being affected by daylight and darkness.

Melatonin has been available for some years over the counter.

Efforts to have such a potentially dangerous drug restricted to a prescription-only status as with other hormones were unsuccessful as opponents to restriction successfully argued Melatonin was a “natural substance”.

Melatonin has been widely promoted and used as the solution to jet lag and to promote sleep. Other bizarre uses include being used as a “perpetual youth drug”.

A recent meta-analysis of published research, as opposed to hearsay and commercial promotion found Melatonin in reality did little to promote sleep or assist with sleep restriction as happens in jet lag. Most claimed effects can be attributed to placebo. In people with a sleep disorder from medical causes Melatonin did increase the time asleep by about 10 minutes in eight hours sleep.

Melatonin has been poorly researched to date for all sorts of technical reasons. As well the quality of commercially available products is often very suspect and the recommended dosage varies widely between commercial products and between stores selling the product. Be aware “natural” Melatonin may contain a virus.

Hormones are very potent body chemicals often with multiple target body organs eg the hormones oestrogen and thyroxine affect a wide range of  physiological functions.

Would I take a hormone such as Melatonin with largely unknown effects on the body for such a simple, self limiting problem as sleep deprivation?  No way !!

---

“Wrongful Life” and Legal Action
Recently there have been more legal cases suing for damages alleging “wrongful life”. It is an unusual concept but it has made a lot of money for lawyers.

The basis of the claim is a child born with severe disabilities should not have been allowed to live - the child should have been aborted. Consequently the parents of that disabled child can sue for damages.

This question recently seems to have been finally settled in Australia at least. The Australian High Court has ruled that children born with deformities which were not detected during pregnancy cannot sue for damages. This case involved a profoundly disabled child born to a mother who contracted German Measles during pregnancy.

The court decided it could not determine whether the alternative  of being aborted during pregnancy was a better or worse outcome for that child. The court further decided it was an impossible task to compare life with a disability with no life at all.

---

Youth and Driving Skills and Road Accidents
One of the most significant Public Health Issues is Road Traffic Accidents (RTA): World wide there are about 750,000 - 880,000 RTA deaths per year.

Asia contributes about 45% of those deaths.

During the annual week long “Water Festival” in Thailand there are about 700 deaths and 30,000 injuries from road traffic accidents. Most of these are alcohol and motor bike related accidents.

In West Australia drivers aged 17 -24 years  cause 30% of fatalities and 30% of  hospital admissions from road traffic accidents. Probationary drivers are involved in crashes at triple the rate of more experienced drivers.

Much more stringent restrictions on young drivers in Australia are coming in 2007.

---

The Cost of Medical Treatment
Some research claims up to one quarter of the entire government health budget is spent on hospital care during the last 18 months of life.  Much of this care is given in the absence of any real prospects of extending overall survival or quality of life.

The number of patients who need to be treated to save one life or prevent one serious event can be in the order of hundreds of thousands with sophisticated procedures such as some cardiac surgery, breast cancer screening and surgery for localised  prostate  cancer.

A claimed consequence of these enormous costs is between 20% - 45% of eligible people miss out on effective treatments for common and serious conditions such as cardiac problems and stroke.

The implication is a serious one. Rationing of medical treatment is on the way as no government can afford the cost of meeting patients’ over expectations of the value of modern technological medicine. An ageing population is very threatening to health services.

The real questions are how will  health care rationing be done and  who will be responsible for that rationing.

---

Is anybody reading your promotional material ???
The Australian Bureau of Statistics found almost half of the 15 -74 year group had “poor “ or “very poor” literacy skills. These people had difficulties with many of life’s daily literacy demands. 

A further 35% if those surveyed did not have a high level of literacy but were able to cope day to day.

Health literacy is defined as the ability to read, understand and act on health information. Clearly much Health Education material is simply not being understood and so is ineffective. Many patients are simply unable to understand treatment or the reason for tests and are unable to understand medication directions.

Almost certainly the same applies to company promotional material and other written company material such as instructions for use of a product. IT information and the design of many of the forms we have to fill out are significant culprits.

It also gives cause to wonder at the effectiveness of  the Australian Education system.

---

Obesity vs Starvation
We have all heard the dire predictions of the world not being able to produce enough food to feed an increasing population.

Well the opposite has happened:  World wide the number of overweight people now exceeds the number of starving people.

In fact the gap is widening as obesity continues to grow quickly and under –nutrition drops slowly.

---

508
Holidays and Long Haul Flights and DVT
It's that time of the year again when families head off to distant fields for the school vacations.

Long flights are often involved with the associated stress, sleep deprivation, irritation and challenges of airports, marveling at the speed and discomfort of modern planes and the frustrations of keeping young children confined for hours at a time.

It is also that time when the risks of Blood Clots (Deep Venous Thrombosis - DVT) forming usually in the legs of long distance travelers….sometimes called "Economy Class Syndrome"….concern holiday makers. The risk of DVT continues for about 2 weeks after the flight.

Remember a DVT can form during any form of travel eg car, bus ,train where you are sitting in a cramped position for some time.

DVTs most commonly occur in hospital patients, post surgery.

A DVT can affect anyone but risk Factors include:

• Age over 40 years
• Pregnancy
• People with or who have had cancer
• Anyone taking Oestrogen eg the contraceptive pill or HRT
• Smokers
• Obese people
• Dehydration
• Recovering from recent surgery
• Having an immobilised limb eg a leg in plaster

A DVT is potentially a very serious problem so take the following precautions when traveling to prevent DVT:

• Exercise as much as possible –follow the plane video instructions
• Walk around the cabin
• Drink plenty of water
• Avoid excess coffee and alcohol
• Elasticised stockings may help
• Taking Aspirin pre flight might help a little

The overall risk of DVT?  Not really known but perhaps 1:50,000 travelers or about one death per two million flights. Even lower risk with the above precautions.
>>return to top

---

Flying and Radiation Exposure
A seven hour flight will expose a passenger to about the same radiation as a standard Chest X –Ray (0.04 units).

Each year people living near Chernobyl Nuclear Reactor receive about 250 times the Chest X –Ray dose . . . . . with a consequent risk of developing cancer of about one in 1700.

An abdominal CT scan is equal to the radiation dose of about 400  Chest X –Rays.

The message is clear : Avoid unnecessary X-Rays.

Radiation is not a potential danger from Ultrasound which uses  sound waves and not X-Rays.

---

Traffic Problems and Heart Attack:
German researchers found the risk of Heart Attack in susceptible patients increased significantly one hour after they were exposed to traffic, whether they were traveling by car, bicycle, motorcycle or public transport.

A combination of stress, noise and traffic-related air pollution were blamed. All sound familiar?

You can probably can add Jakarta Road Rage to the above.

---

War and Disease
In the Napoleonic Wars eight times more men died from disease than battle injury.

Diarrhoeal disease is the biggest infection problem armies face and the biggest user of manpower. At El Alamein in WW II about 40 -50% of Italian and German troops had dysentery.  In the Korean War 55% of USA troops developed diarrhea within 6 weeks of arrival.

What about modern times? In the Gulf War there were 50-100 cases of diarrhoea per 1,000 personnel.

Anybody who has had severe diarrhea let alone dysentery would know just how easy it is to lose enthusiasm for anything, let alone marching to war.

---

Diet and Cancer
Unfortunately there is no evidence that dietary supplements or dietary  modification alters the clinical course of cancer or pre cancer.

The National Cancer Institute examined various diets and supplements including vitamins, anti oxidants, retinol and garlic and their effect on various cancers. The conclusion was no benefit was seen.  The study noted the large personal expenditure on supplements by some patients.

A healthy diet alone or in combination with dietary supplements, weight loss or exercise has no effect on all –cause mortality. Equally research showed no evidence of harm. A healthy diet is still strongly encouraged as many cancer patients live for many years and could die or be affected by other diet related illnesses.

Unfortunately this is another example of something like dietary supplements, vitamins, anti oxidants etc sounding as though it should be helpful treatment but it simply is not. >>return to top

---

Oral Rehydration as Good as IV Hydration
Diarrhoea in children is very common and can be a serious, life threatening infection. Dehydration is the very real danger especially in small children and babies.

Medical attention should always be sought except for very minor cases.

Rehydration is the basis of treatment and is crucial.
Evidence continues to support very strongly the use of Oral Rehydration Therapy (ORT). In fact ORT has been claimed by some to be one of the greatest medical advances of the last century.

Again recent research confirms ORT is as effective as Intravenous Therapy and does not have the cost, technical equipment and skill requirements needed for IV Therapy. Anybody can give ORT. No medical or nursing training is necessary.

It is worthwhile having a few packets of  ORT at home. Start using ORT immediately your child develops diarrhea or vomiting.

---

Well at least you still have one good leg ! !
"Just make sure they operate on the right bit !” Often spoken not only in jest.

In one USA  study over a 20 year period and about 2.8 million operations only 25 were in the wrong place! Only in one case was permanent significant injury caused.

Great care is obviously taken to make sure the correct part is operated on.

Sometimes it is partly a patient error: A Brazilian man who attended a clinic seeking to have his ear-ache treated ended up having a Vasectomy. The man entered the Vasectomy Room mistakenly thinking he had been called to the Ear Clinic.

The patient later explained he thought his ear-ache was caused by an infection which had spread to his testicles. The patient who had two children did not want the vasectomy reversed.

He later returned for his ear examination. True story.

---

What’s in a Word……
Most know the word “doctor” really means teacher. Originally it was a title of courtesy and respect bestowed on learned men (I liked that !). Only about 300 years ago did it come to mean a purveyor of medical knowledge.

Presumably that was an improvement on 1300 BC when the word "leech" was used to designate a doctor. >>return to top

---

607
Drugs and Professional Cycling
You will have seen reports of alleged drug use in Tour de France cyclists.
Unfortunately cycling is one of the sports with the worst drug use record.

One top cyclist said it was not possible to make the top 50 ranking without drug use. Some claim up to 90% performance drug usage in professional cyclists
.
One champion cyclist spoke of injecting himself 12 to 13 times per day and  taking a blood test to measure a certain blood parameter which indicates illegal drug use up to four times per day. He also took Growth hormone, Folic Acid, Iron, blood transfusions, aspirin to prevent clotting caused by the drugs and on some days injected cortisone and male hormones as well as a drug co-factor.

In one year recently four professional cyclists died from heart attacks. The youngest was 23 the oldest 35.
About 100 cyclists have died prematurely over the last 20 years. Amphetamine fuelled riders have fallen dead from their bikes in mid race.

The use of performance enhancing drugs is now very sophisticated and often well ahead of drug testing methods. The rewards are so high many cyclists are tempted. It is generally considered the problem is so large and profitable that control or elimination of drug use in cycling is unlikely.
 . . . and genetic performance enhancement has yet to become widespread …..and thought to be almost undetectable !

---

Nicotine is safe . . . .. . .what did you say ? ? ? ?

• Nicotine does not cause cancer.
• Nicotine does not cause respiratory disease.
• Nicotine is not directly responsible for tobacco – related diseases.  It is the other components of tobacco which cause all of the problems.

Nicotine only induces and maintains tobacco addiction.
That means Nicotine Replacement Therapy e.g. as Nicotine Patches used to stop smoking is safe and does not cause the health problems associated with tobacco.

Nicotine in these patches slowly reduces the nicotine addiction while the psychological addiction or ritual of reaching for a cigarette, lighting the cigarette, repetitive hand to mouth mouth etc is overcome. Psychological dependence is a very difficult habit to eradicate.

Just how addictive is smoking
Recent U.K. research showed smoking just one cigarette at age 11 doubles the risk of taking up the habit e.g.  after three years of non smoking those who had smoked just one cigarette at age 11 yrs were twice as likely to be smoking by age 14yrs than those who had never smoked.

Anything else ? ? ? ?  
Lots more about smoking !! ……….Try this:   Men who smoke more than a packet of cigarettes per day have a 40% greater chance of being impotent than non smokers.

---

>>return to top
I think . . therefore I am . . .(or something like that)
This world famous Philosopher died in August 1900.
Who was he ???? . . . . . .and what did he die from ???

At age 24 he became a Professor of Philosophy in Basle which was a remarkable achievement.  He later served in the Franco-Prussian war where it appears he contracted the disease which caused his disastrous medical problems and ultimately his death.

He returned to Basle University but in 1878 his health became worse and by 1889 he had a breakdown. He collapsed in a street in Turin, was half blind, in almost unrelenting pain and wrote crazy notes to his friends.

He spent the last 11 years in total mental darkness and was looked after first in an asylum and then under the care of his mother.

Imagine what ideas Friedrich Nietzsche might have produced had he not suffered from Tertiary Syphilitic Disease…………or ………..where some of his ideas produced because of the mental effects of Syphilis?

---

Did you hear about . . . . . . . . . .
Have you heard of Viagra, Celebrex or Xenical?  You have? ……….then you will realize just how effective the new technique of direct -to- consumer pharmaceutical marketing has become in NZ and USA where it is legal. It is not legal in Australia.

Prescription-only drugs were originally promoted through  medical literature and doctors only.

This new marketing technique influences patients to request prescription–only drugs by brand name during medical consultations ……..and they do !

Well is it effective marketing? NZ data show $US 2million on promotion contributes up to a 42% increase  in prescribing volume of that drug.

---

Are you overweight ?
How do I  check if I am overweight ?

Easy :             1. Look in the mirror after a shower
                       2. Measure your waist circumference.
Males:         A waist > 102cm – obese
                                   >94 cm – overweight
Females:      A waist > 88cm – probably obese
                               >80cm – probably overweight

These values are closely associated with an increased risk of heart disease and diabetes.

Incidentally US Researchers found people who  frequently attend a religious service are likely to be fatter than everyone else !
By contrast, little old ladies of European descent who only attended church once per week were more likely to be slim.
>>return to top

---

603
Management of AdrenoCortical Insufficiency during Surgery. . .Wott??
50 years ago an article with this topic appeared in a learned medical journal. A sharp eyes reader somehow put two and two together and was able to make avery significant revelation.
One of the three patients discussed was 37 years old and treated his Addison's Disease with daily oral cortisone as well as injections of cortisone every three months.

He suffered from severe back pain with subsequent bone fusions and a metal plate inserted. This back problem was a football injury aggravated by World War II service. He had a well known stooped posture.

Not surprisingly he also suffered from chronic lethargy and weakness typical of Addison’s Disease. These symptoms were of considerable public and political concern in 1960 and almost certainly affected his ability to work to his full potential. At least publicly his political career was not characterised by these symptoms.

He had a “Moon Face” from the cortisone. For pain relief he famously used a rocking chair, took hot baths and wore a very stiff corset.
It has been reasonable speculated that this corset held President John F Kennedy upright long enough for Lee Harvey Oswald’s third shot to strike President Kennedy with fatal consequences.

---

The day after the night before
The effects of a night of social drinking can linger long after the party is over.  The anecdotal guidelines of " eight hours from bottle to throttle" is not valid according to new data.
An evening of "normal" drinking adversely affects:

• memory
• fine motor control
• mental reaction times    
• physical reaction times
• psychomotor skills generally

These negative effects surprisingly continue the next day despite blood alcohol level having returned to zero !!
This has relevance to all workers and students but especially those in potentially dangerous jobs.

---

Blood donors
Czech blood authorities have boosted blood donations by promising patrons two beers in exchange for one blood donation.
WHO recently recommended the country do more to curb alcoholism.

>>return to top