How beauteous mankind is! O brave new world,

That has such people in’t!

(The Tempest Act 5 Scene 1)

Shakespeare’s irony did not escape the novelist Aldous Huxley. His 1932 novel, Brave New World, takes place around the year 2500. The people are oppressed by ruthless authorities, distracted by inane televisual ‘entertainment’, controlled by genetic and social engineering and numbed into conformity by a tranquilising drug called ‘soma’.

Brave New World (1932) preceded the more famous but similar  novel, 1984, written by George Orwell in 1949. The contemporary world seems to be approaching these novelists’ apocalyptic vision with alarming speed. As a doctor, I am most concerned by the exponential increase in the prescription of antidepressants and tranquilisers – especially during the present recession. The Guardian reports that the prescription of antidepressants has increased by 20% in just three years.

This is particularly outrageous because two years ago a major study warned that antidepressants were no better than placebo in mild and moderate depression (surely the majority of cases) as I mentioned in a post at the time. My point was that it was the height of hypocrisy to criticise NHS homeopathy (drug budget £10 million) when the budget for these less-than-evidence-based antidepressants was £232 million!

At the time, the medical profession vowed to ‘do something’ about it. What has been ‘done’ is that the prescription of antidepressants in the UK has – in the words of the Guardian – soared. The situation across the Atlantic in the USA which offers the best medicine money can buy – is even worse. The use of anti-depressants in the ‘home of the brave’ has in the words of USA Today ‘skyrocketed’ by 400% (sic!) since 1988.

The situation with highly addictive tranquilising drugs is another horror story that I’ll leave to somebody else to write about. Both sets of drugs have potentially dangerous side effects and patients really should be monitored carefully on them – if their doctors can find the time of course. But it seems nobody cares that much about these horrific statistics. After all should we really be knocking such a profitable industry during a recession? Much better to start a new organisation protesting against all that money wasted on treating naive patients who want NHS homeopathy. And don’t read Huxley’s Brave New World either – read his last novel, Island. It’s about a type of Utopia and much more optimistic than Brave New World.

Stay optimistic and banish your fears

Orwell was out by at least forty years.

(from Instructions for Androids)

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Professor David Nutt, the former UK chief drugs adviser thinks that he has statistical evidence that alcohol is more harmful to society than heroin or crack cocaine! Nutt’s politically outrageous (but annoyingly scientifically sound) views about the relative dangers of various drugs got him fired by former home secretary, Alan Johnson from the Governments Advisory Council on the Misuse of Drugs last year. Now Nutt has simply gone too far.

Its empirical formula is C2H60. It’s certainly a chemical but is it a ‘drug’? Surely not. Surely all you boozers, barflies, alkies, dipsos, dredge-heads, dronkies, shickers, waste cases, winos and international piss artists aren’t drug addicts?

How could any of you heavy hitters, gin-soaks, rumheads, brandy-shunters, hop-heads, old soakers, grog artists, toss pots, beerheads, barstool jockeys, brew hounds, ale-knights and other aristocrats of the bottle be considered to be addicted to anything?

How dare anyone suggest that you lovely lushes from bag ladies to queens of Scotch are addicted to a drug? This country – and many others besides – would have an even more serious ‘drug problem’ if it irrationally counted every harmless drunkard as part of the enemy in our ongoing war on drugs ?

Calling all drinking class people drug addicts is a politically incorrect insult. Your beverage of choice is legal, socially acceptable and generates huge revenue for hard-pressed governments all over the world.

What’s wrong with that?

Cheers!

Legal Disclaimer: This post has been written in the spirit of Provocative Therapy, the cutting edge in the use of reverse psychology and humour in psychotherapy. Thus nothing above should be taken ‘seriously’. As Oscar Wilde put it: ‘Life is far too important a thing ever to talk seriously about it’.

So remember to DRINK RESPONSIBLY

Now watch Liz & Ed discuss the issue of alcohol the non-drug.

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Comedians may be taking over American politics. Or so hopes John Avlon in The Daily Beast. And that does not mean that all USA politicians are clowns. Actually ‘I forgot to duck’ uttered by the shot Ronald Reagan were the last words of a President that made me laugh – but then again, according to Gore Vidal, Reagan was a professional actor ‘hired to impersonate a president’ so he doesn’t count. Avlon reckons that ‘laughter and satire is the only sane response to the sickening spin cycle we’re subjected to on a daily basis’ To which I say: ‘Congruence at last!’

Comedians and satirists have philanthropically been doing their best for humanity for centuries. Think Shakespeare, Swift, Mark Twain, Lenny Bruce, Bill Hicks and our very own Chris Morris and Howard Jacobson. However such comic prophets have been far outnumbered by the ludicrously rich, mind-numbing, ‘Have you ever noticed?’, socially irrelevant blabbermouth ‘funnymen’ who are irritatingly ubiquitous. Maybe this is about to change in America. Two men are leading the Comic Revolution, John Stewart and Stephen Colbert.

John Stewart,voted ‘most trusted man in news’ last year plans a pre-election ‘Rally to Restore Sanity’ in which he has advised people to wear banners saying “9/11 was an Outside Job” and “I disagree with you, but I’m pretty sure you’re not Hitler”.

My personal favourite Che Guevara of comedy is Stephen (“Keep your facts, I’m going with the truth”) Colbert who also plans a ‘Keep Fear Alive’ rally which as a Provocative Therapist, I might feel obliged to attend! Just watch him testify at a real Government Congressional Immigration Hearing which explains why the ‘audience’ only chuckled while I cried with laughter.

Comedy has the capacity to mirror truth in medicine as well a politics. Anyone want to invite me to testify to a select committee on Health in the House of Commons? Accept it dear readers, America is always going to be two steps ahead of us in everything.

Provocative Therapists know the power of satire in counselling. When patients get their Inner Joke (the joke of how they are preventing themselves from finding happiness) they change. And people can change. And America can change. And it wasn’t a comedian who said that, it was President Barack Obama.* Hear! Hear! and Ha! Ha!

* Well he was only a presidential candidate when he carved the word ‘change’ in stone but that’s not important as long as he doesn’t lose his sense of humo(u)r now.

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Giving diseases a national identity, an inanely xenophobic practice at best, is now regarded as politically incorrect. Referring to rubella as ‘German measles’ might still be considered merely naïve, but any mention of ‘mongolism’ (once a widely used synonym for Down’s Syndrome) is likely to be met with severe censure. The term ‘French letters’ has important medical connotations but is not a disease.

This week I read that rickets, the illness referred to in some European countries as ‘the English disease’ due to its prevalence among the poor on this island in the 19^th century – is making a comeback in England. Rickets, a disease which softens the bones of children causing fractures and skeletal deformity most noticeably bowing of the legs, is caused by a deficiency in Vitamin D. You can get it in foods like fish and egg yolks but this vitamin is unique in that it can be made by the body on one condition – that you get enough sunlight. Dark skinned people, who need more exposure to sunlight for this purpose may certainly be more prone to getting rickets but the authors of a paper on the increase in the incidence or rickets,published in the British Medical Journal point to another cause.

The men in white coats in Newcastle (a city which has 20 new cases of rickets a year), Profs Cheetham and Pearce suggest other possible causes. One is kids choosing to stay indoors and play computer games over getting some exposure to sunlight outside. Another is that parents, fearful of the harmful effects of the sun, overuse sun-blocking creams.

It’s not only our children that suffer from lack of Vitamin D. More than 50% (sic) of British adults lack Vitamin D in the sun-free seasons of winter and spring. My colleague in the New Medicine Group, Dr Damien Downing has been ranting about this for many years at our weekly clinical meetings and elsewhere. As he has relentlessly pointed out, Vit D deficiency is also responsible for a broad spectrum of illnesses including various cancers.

The fact that the return of rickets and Vit D deficiency to our shores isn’t headline news is a national disgrace. It is emetic that the media continues to host the  vengeful, vindictive, vituperative, vicious and disingenuous campaign against homeopathy while hardly mentioning the increase of an easily treatable vitamin deficiency affecting half the British public! (Sorry but I had to get that alliteration in somewhere)  Perhaps the return of rickets is simply not ‘sexy’ enough a topic to sell newspapers and television programmes?

Unlike most of the other bad news we read about every day, this is something we can easily do something about

1. Make hay when the sun shines. Without overdoing it, make sure your skin gets a little exposure to the sun. This is even more important if you have a dark skin.
2. Take a high quality Vitamin D supplement in the winter and spring and check with a doctor that you are taking the right dose.

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Just returned from holiday and glancing at the headlines saw this one warning all women to ‘Cut food and drink to avoid breast cancer’. The Daily Mail headline is explained further by the subheading ‘18,000 women a year could be saved by exercise and dieting’

Here’s the thing: Research by none other than the World Cancer Research Fund (WCRF) has shown that by keeping your Body Mass Index in the lower part of the normal range of 18 – 25, exercising 30 minutes a day (yes 30!) breastfeeding your babies and drinking no more than one small glass of wine a day, you can definitely decrease your chances of getting breast cancer.

Okay, okay I know that’s asking a lot so let’s see how girls who ‘just wanna have fun’ can still enjoy life.

Let’s look at some popular recreational activities enjoyed by women: smoking, recreational drugs, dancing, retail therapy and sex.

Smoking: Research has definitely shown that this is very bad for you. (And I’ve checked with my lawyers before saying this.)

Recreational drugs: Also bad for your health and even worse if you end up in jail for using them.

Retail Therapy: Yes, that’s okay. Oh, sorry I remember that nobody’s got any money these days.

So that leaves Sex and Dancing..

Sex: Yes, it’s still good for you as long as you keep it safe. Try hard to be  as active as possible so as to increase the exercise component (see above).

Dancing: It’s wonderful exercise, great fun and the best game in town for grown up boys and girls. Read this poem by the late Adrian Mitchell and then go out and dance, dance, dance…

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As a physician, I’m aware of the dangers of obesity to health of course. But never in my wildest dreams did I suspect that obesity could be the cause of the decline of Western civilisation? Did I even think that it could be a reason why we could lose the struggle in Afghanistan, a place from which even the lean machine of the USSR army was sent packing with its tail between its legs?

You cannot imagine my shock when I read this article in the Independent about how our soldiers are apparently ‘too fat to fight’. A spokesman for the British army, Major Brian Dupree apparently said in a leaked memo: “The numbers of personnel unable to deploy and concerns about obesity throughout the Army are clearly linked to current attitudes towards physical training.”

Allow me to explain: Apparently to be a fighting fit soldier you need to exercise a whole 2 HOURS a day! If you can’t/won’t/don’t do this and are fat – you will be punished for your obesity by not being deployed in Afghanistan! Does this mean you will remain in England training as a soldier (sans 2 hours exercise a day of course) while your thinner colleagues are privileged and honoured enough to be sent to fight in the desert for what is left of Western civilization? Surely this amounts to some form of politically incorrect discrimination?

Okay, I thought, but the British Army is surely not the main defender of the West. We depend on America, the land of the brave and home of the free and home too of non-obese heroes of mine such as Sylvester ‘Rambo’ Stallone and  Arnold ‘The Terminator’ Schwarzenneger.  Imagine my horror and distress to find out that America has the same problem as us with obese soldiers!  Oh, no – I lamented, the West is surely lost now.

And then like a phoenix from the ashes of a lost civilization, the image of a saviour of a man came to me! No it wasn’t the Chosen One, the non-obese, Barack Obama – it was a man who, if we would have let him have his way – would have prevented (yes prevented) Gulf War II ! Yes, ladies and gentleman, I’m talking about none other than the very last heroic American military leader of all time, Stormin’ Norman Schwarzkopf! To imagine what would have happened if he had been considered ‘too fat to fight’ is a thought too horrible to contemplate!

And slowly I began to see the light. Colour returned to my ashen face as I remembered other great military leaders (Patton, Churchill and many others came to mind) that would have also been considered too fat to fight.  It irks me to think of our enemies – if they have a sense of humour – enjoying these articles about obesity in the military of the West. A few jpgs.  sent their way of Stormin’ Norman and General Patton will surely spoil their party.

And as for obesity as a medical problem of the West – it’s simple to treat. Provocative Therapy is effective for civilians and soldiers alike. The only way not to lose weight is to not turn up for your sessions – or of course don’t consult a provocative therapist in the first place. However I refuse to ‘treat’ so called overweight military heroes such as Norman Schwarzkopf Jnr. Instead I call on him to speak out against the demoralizing nonsense being spoken about British and USA troops! Far from being a joke, the future of the West might depend on him doing this. Let ‘em have it Stormin’ Norman!

http://en.wikipedia

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In one of the most innovative and enterprising moves to stop the  obesity endemic in its tracks ever made by a nanny state, a prescient quango known as the Foods Standards Agency (FSA) has advised/warned chocolate manufacturers to keep the size of their chocolate bars down.

Hapless confectioners have been told that chocolate will be regulated as follows:

Chocolate ‘snacks’: (eg. Mars bar): At present, Slough’s main contribution to the universe, has a mass of 58g. Chocolate tycoons have been given a mere 3 years to reduce this to 50g.

Chocolate ‘bars’: (eg. Dairy Milk and Yorkie) These must be reduced to 40g or less.

It is to my deep regret that no restrictions on advertising chocolate have been suggested. As a doctor and psychotherapist, I have long been appalled by the blatant misuse of Freudian psychoanalytic theory to sell chocolate to the young by inundating them with pictures of attractive young models of either gender consuming both chocolate bars and chocolate snacks in none too subtle images of fellatio! With rampant hormones and their unconscious minds manipulated by evil chocolatiers promising sexual bliss but delivering obesity, what chance do our young have in this world?

Manufacturers of ‘fizzy drinks’ are to be hit even harder. Any drink containing sugar should be reduced from 330ml to 250 by as early as 2015! This should save at least 4739.6 lives over a 37 year period according to unofficial calculations.

It is rumoured that computers have calculated that these changes will reduce obesity by 19.29% thus saving 66755.34 lives over the next 50 years. Deaths due to  chocoholic smokers compensating on oral gratification by choosing to smoke more and eat less chocolate have apparently not been figured in to the FSA’s computations.

A spokesman for the hamburger industry, already hard hit by the ban on supersizing, said there is absolutely no truth in the rumour that a quarter pounder will need to be downsized to a three sixteenth pounder by the year 2016. He admitted however that the FSA has absolute power in such matters and that cattle ranchers in Brazil have been warned that the demand for meat in the coming decade could be reduced significantly. Meat prices are presently high but the noble FSA, with the best intentions for the public of course, could well put an abrupt halt to the present bull market in beef. Time to sell beef stocks then? Don’t ask me for financial advice. Doctors are well known for doing their boots on the stock market.

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I switched on the radio this morning and immediately heard extremely important news from America. Apparently the President had appointed a very FAT doctor to the most heavyweight medico-political job in the country – surgeon general. Across the  media and the blogosphere, self-righteous commentators were self-righteously condemning the Chosen One for sending out the ‘wrong message’  to the lardos of America.  So I dashed to my computer to get a picture of the prospective big shot of American medicine. What an anticlimax!  Maybe I’ve just seen too many pictures of fat people gorging on fast food in America. When you say a fat woman in America, I expect to see a VERY FAT WOMAN and certainly not a voluptuously endomorphic lady like Regina Benjamin. How dare journalists speak of her as the ‘elephant in the room’ of American medicine? Who do these hacks think they are?  I refuse to join their ranks. I applaud Barack Obama for this appointment. Let me explain:

I know I’ve campaigned for fat people to pay more for air travel, but that is only because I resent being penalized for being 1kg overweight on my luggage while someone twice my weight, but whose baggage (if not BMI) is within the norm, waddles  happily through. The plane uses more fuel to carry overweight people as well as overweight luggage. So it’s logical for you to be asked to step on to the scales next to your luggage and pay per kg, but I digress… This Dr. Benjamin looks like a GP with kindness and largesse and a body shape that is most desirable in certain parts of the world and was worshipped by artists such as Peter Paul Rubens.

If I were sick I’d be more than happy to have Dr. Benjamin  at my bedside  as would the poet W.H. Auden who expresses his partiality to plump doctors in Give me a doctor:

Give me a doctor partridge-plump,
Short in the leg and broad in the rump,
An endomorph with gentle hands
Who’ll never make absurd demands
That I abandon all my vices
Nor pull a long face in a crisis,
But with a twinkle in his eye
Will tell me that I have to die.

Auden, an Englishman, must have written this poem during his long sojourn in the USA!USA! because he rhymes ‘hands’ and ‘demands’. When I googled the poem (Google is marvellous for poetry) to make sure I had it word perfect, I came across a blog of another doctor who quotes a poem of a retired London GP by the name of Dr. Marie Campkin. Clearly a pastiche of the Auden poem of the same name, Dr. Campkin’s poem  accurately depicts the  state of British general practice today:

Give me a doctor underweight,
Computerised and up-to-date,
A businessman who understands
Accountancy and target bands.
Who demonstrates sincere devotion
To audit and to health promotion -
But when my outlook’s for the worse
Refers me to the practice nurse.

Dr. Campkin clearly understands what modern medicine is all about – money. I feel she loses her teeth in the last line because many patients would be happy to be referred to the nurse or any one else willing to help them. I’d prefer:

‘But when my outlook’s for the worse
Suggests that I phone for a hearse.’

In short I’m appalled that pc America has suddenly decided that Size Matters when it comes to choosing a leader of medicine or any other type of leader other than the CEO of Weight Watchers. Imagine we applied this sort of ‘ethics by example’ to Winston Churchill. What example would he be to the young binge drinkers of today? Whereas Hitler was a slim vegetarian. Need I say more?

I say ‘Give ‘em hell Regina! Live up to your name, O  Queen of American medicine! From across the Atlantic one doctor at least sends his unequivocal support!

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Red Alert!

Half of the planet’s people are at risk of a new epidemic  called ‘Cell Phone Elbow’ This is not a joke! We are talking about 3 billion people at risk of suffering from Cubital Tunnel Syndrome, the latest form of overuse injury which may be even worse than Blackberry Thumb.

This is how it works: When you talk on your mobile phone you bend your arm. This compresses your ulnar nerve which leads to pain in your little finger and on the outside of your ring finger.

News of this potential pandemic shocked the world yesterday and it was elegantly reported on CBS news. Watch Dr Jennifer Ashton (a thinking patient’s pinup of a doctor if ever there was one) beautifully explain how this disease threatens half the world’s population.

Treatment of the problem might require physiotherapy, osteopathy, chiropractic, ultrasound, injections of local anaesthetic and even years of psychotherapy for post-traumatic stress syndrome. As prevention is better than cure, all cell phone users are advised to use hands-free devices. My good friend Arnold Brown advises you to ignore fellow pedestrians who think that you are ‘psychiatrically challenged’ and inanely talking to yourself. They are the ones who are going to suffer from pain in the pinkie – not you!

Rumour has it that the British government is well aware of the problem and that health secretary Alan Johnson is even considering banning mobile phones in one last altruistic swan song of the nanny state. My personal opinion is that he should not be distracted by offers of poisoned chalices and petty politics at home when global health issues need his urgent attention.

Next week: A dangerous new syndrome is being reported internationally. It’s called Repetitive Overuse of Brain and Over-Thinking Syndrome (ROBOTS) Overusing your brain these days may cause you to suffer from unbearable existential angst. If you don’t know what that means you might be suffering from early ROBOTS already!

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In a strangely incoherent article in The Mail yesterday, the journalist, Daniel Martin, epitomises the current confusion about alternative medicine that reigns in the UK and its NHS. This time it’s acupuncture that gets it in the neck – or perhaps in the back as the article speaks a lot about back pain.

Calling acupuncture (a system of therapeutics in use for 5000 years) ‘mumbo jumbo’ medicine, Martin bemoans the fact that NICE, the government’s ‘rationing watchdog’ will tomorrow announce that patients will be allowed to ‘demand’ acupuncture and other apparently unproven treatments on the NHS. He goes on to quote the ubiquitous David Coquhoun: who uses the term ‘theatrical placebo’ by which he means that patients are duped into only thinking they are better. So a patient who feels that his back pain is gone or much better has been unfairly duped and a stop should be put to this obviously irrational way of helping people.

The article then becomes ugly when it begins to whinge about money that could be spent on Alzheimer’s treatment, being wasted on things like acupuncture. I think I’ve dealt quite adequately with this NHS finance issue here.

What the NICE report is actually admitting is refreshingly honest. Back pain is often a mystery, difficult to treat and a problem that costs the country millions every year in lost working hours. Bearing this in mind, NICE is recommending that patients be allowed to choose (a concept too horrible to contemplate for people like Colquhoun) a course of alternative medicine for back pain. This is what gets totally up the nose of authoritarian medical bullies such as Prof. David Colquhoun. They hate the idea of patient choice because patients may make choices abhorrent to them. In other words, although you pay for the NHS in your taxes, you are too ignorant to be allowed to choose among various recommended treatments for your back pain.  NICE may have been influenced by a Seattle study that showed acupuncture helped patients with back pain. Detractors point out that patients in the study who received ‘toothpicks’ rather than acupuncture needles also did well. So they say it’s obviously worthless. Fortunately NICE does not see it that way. Perhaps because they agree that the first duty of a doctor is to heal – not initally and primarily satisfy his/her own curiosity about how and why things happen in the human body – something that will never be fully understood.

There are more things in heaven and earth, Daniel Martin and David Coquhoun:
Than are dreamt of in your philosophy.

You choose what you want for yourself and families and let us (ignorant as we may be) choose for ours.

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