MacDoctor

An Australian forensic pathologist, Professor Roger Byard, wades into the herbal remedy debate with the dire warning Herbal remedies can kill. This is rather over the top, even for an aussie. Sure, there have been fatalities from herbal remedies, especially some of the Chinese ones that contain things that are suspiciously non-herbal. But you can kill yourself with paracetamol quite easily  and there isn’t a medication made that is 100% safe.

In the US alone at least 100,000 people die every year from the side effects of conventional medicine – around 10,000 from simple medication errors. Before the herbalists start gloating, though, I should point out that the vast majority of conventional medicines are considerably stronger in their effects than the herbal versions. Herbal medicines get their “safety” profile from the fact that most of them are considerably weaker and, usually, less effective – particularly in the types of doses recommended by the manufacturers.

Quite a number of deaths attributed to herbal remedies are, in fact, caused by the concomitant consumption of a conventional medicine. Prof Byard cites the classical example of this in the admixture of St John’s Wart (usually taken for depression or menopausal symptoms) and Warfarin. St. John’s Wort prolongs the action of Warfarin, making you more likely to bleed or have a haemorrhagic stroke (bleed on the brain). The problem here is not with the St John’s Wort, which is one of the more useful herbals, but with its use with Warfarin (it is also potentially dangerous with antidepressants such as Prozac). Note that taking St John’s Wort with Warfarin is not actually a problem – you just need to use a good quality brand of the herb (so that the dosage is fairly constant) and you need to take frequent blood tests until your clotting time (INR) settles to its new level. Typically, you will be taking less warfarin.

Likewise, most of the herbals can safely co-exist with conventional drugs, but it is essential your doctor knows that you are taking them. Doctors are notoriously bad at asking about herbals – we just don’t think about them. It is therefore important you volunteer the information. Some doctors will then attempt to get you off your herbal meds. I can’t advise you here as they may well be doing the right thing. However, if you are unhappy with your GP’s attitude, you always have the choice to find someone more sympathetic.

By far and away the biggest problem with herbal medicine is not their side effects or the dangers of taking them, it is the dangers of taking them in preference to conventional medicine. While St John’s wort appears to be effective in mild to moderate depression, a severely depressed person almost certainly requires conventional drugs and psychotherapy. While Saw Palmetto seems quite effective for benign prostate enlargement, it is utterly useless for prostate cancer. These remedies are not necessarily useless, just inadequate for the purpose. Taking them can lead to delays in diagnosis and treatment with sometimes fatal results.

Herbal remedies are no better or worse than conventional drugs in general. Just because something is “natural” does not mean it is safer, less harmful or better for you. Deadly Nightshade is a herbal drug, as is aconite (Wolfsbane), but you wouldn’t want to be taking either of them.

Not for long, anyway.

It is all so unpredictably zany…

Today in the News

Millions wasting their time trying to get fit, says study

Apparently exercise is a complete waste of time for about 20% of the population. Of course, that means for 80% of New Zealanders it is every bit as good for you as doctors have been making out. However, you can guarantee that everyone will now claim they are in that 20%…

But wait, there’s more…

Beer good for bones

And beer contains high amounts of silica which helps to prevent osteoporosis (thin bones). Peter Cresswell is predictably excited about this. I can just see some of my patients with cirrhotic livers and failing hearts telling me proudly how strong their bones are.

Sigh.

I think I’ll go and have a beer to drown my sorrows

And strengthen my bones.

Apparently, John Key gave a speech today in parliament.

Must have slept through it.

In what has to be the most bizarre over-reaction I have heard in a long time, the Herald reports that a 12-year-old girl was arrested for scrawling on her desk. That is: properly arrested in handcuffs and dragged off to the police station and given eight hours of community service as her sentence.

Wow.

I realise this young lady may, in fact, be a small demon in little girl disguise rather than an innocent angel. But that is a wildly disproportionate response even for the most unruly, dreadful child in the universe. And this was not a strange attempt to “scare” her, this was a proper arrest with a proper sentence.

“(Alexa) Gonzalez has been assigned eight hours of community service, a book report and an essay on what she’s learned from the experience. (emphasis mine)”

I would imagine her essay would run a little like this:

What I learned from my arrest.

I learned that those in authority over me can be vindictive, mean-spirited, petty tyrants. I learned that they don’t want my respect, only my fear.

I learned that those in charge of those in authority over me have no control over them, but only excuses for their inadequacies

I learned that the public don’t have servants, only masters.

I learned that the police are not your friends but your keepers. They do not serve justice but only the law.

I learned that discretion is not part of the police’s lexicon. While an individual policeman may turn a blind eye once in a while, as soon as someone invokes the law they lose all ability to use common sense.

I learned that judges are no wiser than their law enforcement bretheren.

I learned that might determines right and that force justifies even the most stupid of decisions and the pettiest of motives.

I learned that the only thing that counts is who has the gun.

There is still one thing I don’t understand, though.

Why are adults so shocked when we rampage through schools with weapons?

Apparently, Mr Obama would now like to talk to to Republicans about health care. The man is really a laugh riot. After trying to ram a highly divisive, partisan health bill through the senate and failing, Mr. Obama would like a televised bipartisan summit for half a day to break the impasse.

I suspect you are going to need more than half a day, Mr. President.

I also suspect that you should have held bipartisan talks right up front instead of using your majority to ram through a health bill that is clearly unpalatable to virtually all republicans. You might have come up with something most people could have lived with. Instead you have nothing except a plan for a bit more showmanship.

Unfortunately, Mr. Obama, life is somewhat more complex than television appearances, isn’t it?

The Herald is running this demented campaign at the moment to change the New Zealand flag. Clearly, anyone with a halfway-decent-functioning brain cell would realise that the best time to design a new flag would be if and when we decide to become a republic. Redesigning a flag at the moment is a meaningless exercise in mindless branding, as evidenced by the mostly appalling designs displayed in the Herald’s web site here and here.

MacDoctor has some observations on flag designs:

1. Black is not an appropriate background for a flag. The only flag to have an all-black background was the Jolly Roger. Go and play with the Somalis and leave us alone.
2. You are supposed to recognise the colours of a flag. Only a moron would put the name of the country or, worse still, the initials of it (OMG!), on a flag. Death is too good for you.
3. Those people who included a small cute icon of a kiwi should immediately throw themselves off the Auckland bridge as a warning to silly people the world over. The Heraldic Authority of New Zealand has already hired hit men to eliminate you, anyway. Your days are numbered.
4. Flags that incorporate dozens of elements look like one of those old TV test signals – dated. Mind you, it suits the high pitched whine some are making on this issue.
5. The biggest argument against using a silver fern is that John Key likes it. Not that I dislike the man, but, recall, he is an investment banker turned politician. Would you let your accountant design your logo? Telecom obviously did (both logos) and look where it got them. Do we really think that the only thing good about New Zealand is our rugby team (you know, the one that keeps losing the world cup)?
6. You know that white bar in the middle of tino rangatiratanga? That can represent the massive division that will be caused by suggesting a design based on it. Very symbolic. And stupid.
7. The “stars only” motifs will get us into a serious copyright war with Southern Cross insurance. This is not necessarily a bad thing. But do we really want to be the butt of endless “stars” jokes – dancing with the stars, stars in their eye, when you wish upon a star and, of course, endless coffee shops called “starlight express(o)”.
8. Swirly Maori motifs? Probably not a good plan for a country in which half of the people can’t even pronounce Aotearoa properly.

This is my thousandth blog post since starting in July 2008. Today also saw my 200,000th page view.

Goodness, you people are persistent.

Unfortunately, after a 1000 posts and 200,000 pageviews, I have decided I have had enough and I am going to quit blogging…

Additional:

…or not (but I had you going for a second, didn’t I?)

Fear not – the Mac will be back….

An HoS article on the sexual incontinence of famous men and the curerent trend towards “polyamorous relationships” (viz. Sleeping around) opens with the question “Are men naturally monogamous?”

This is a stupid question.

I am well aware that most of the males in animal kingdom do not mate with a single female for life, that they have multiple sexual partners and occasionally engage in homosexual sexual activity. Males of the species do not appear to be naturally monogamous. They also tend to kill the young of previous males, but I am not advancing that as an explanation of our child-murder statistics. The selective lifting of animal behaviours to justify our actions is a stupid argument that ignores the simple fact that we engage in unnatural behaviour all the time. Civilisation is, in fact, constructed on an artifice of completely unnatural acts. Even the very idea of a “swingers” party as outlned in the article is very unnatural. In the animal kingdom, if I wanted someone else’s mate, I would simply kill him and take her. A “mate swap” is not something that would readily occur to a lion or a baboon.

If men were to behave absolutely naturally, we would evacuate our bladder and bowels wherever we felt the urge, kill and steal from others with impunity and rape women whenever we felt randy. That we don’t is because we are civilised (well, some of us are civilised). In fact, when we want to show our disgust at someone’s behaviour, we call them an “animal”. It is, therefore, somewhat inconsistent to try and justify our bad behaviour by saying it is “natural”.

Marriage is a profoundly unnatural, civilised behaviour. The vast majority of the animal kingdom operates with short term relationships. Male fishes often don’t even meet the female, but just fertilise the eggs (I know some humans like this). But the price of this transience is that the infant mortality is massively high. Even in species where the birth rate is low (elephants and rhinoceroses for instance) the infant mortality is high. One of the primary benefits of society and civilisation is that our infant and child mortality is virtually non-existent compared to the animal kingdom. This is due to many factors but the stable nurturing of children in a long-term marriage is a principle part of it. The evolutionary value of civilisation and stable marriage is obvious. A large portion of human longevity and population growth is entirely due to increased infant survival. Our survival is dependent on our unnatural behaviour.

Religious and sexual preference reasons aside, long-term monogamous marriage or, at least, cohabitation, is essential for our long term survival as a species. Of course, this does not mean to suggest that sexual promiscuity will bring about the downfall of civilisation (though, historically, it has been a sign the civilisation is failing). But it does mean that the argument, that we should somehow take our behavioural cues from the animal kingdom, is seriously flawed.

“It’s only natural” is usually an excuse for stupid behaviour, not admirable action.

I would imagine that there is nothing scarier for a teacher than to be confronted by a child having a full-blown allergic reaction to something. It is pretty stressful for emergency-trained doctors and nurses so it must be doubly so for a non-medical person. Schools have the dilemma of wishing to reduce the risk of a child having an allergic reaction but not making the construction of a healthy lunchbox an impossibility. I was impressed by the practical nature of their efforts and the lack of knee-jerk banning in this article in today’s HoS. Unfortunately, the teachers have to contend with frightening misinformation:

““Some of these kids we’re told have only got a minute before they can have permanent brain damage,” said Pemberton. “It is increasing and it frightens some teachers – the responsibility is enormous.””

I assume this garbled information has been relayed from a parent. If you are injecting yourself with an EpiPen, you should do it within the first minute, otherwise you may become unconscious. Teachers should inject the EpiPen as soon as possible because it is more effective the earlier it is given. No child will be permanently brain damaged because you didn’t get the dosage into them in under a minute. On the other hand, keeping the EpiPens in a filing cabinet is probably not a good idea. A better plan would be to issue each teacher with one to carry around.

Avoiding the allergen (thing that causes the allergy) itself would be the best way of avoiding allergic reactions, but this is not easily done. Eggs and nuts are the commonest severe allergies and amongst the commonest, cheapest healthy foods. Banning eggs and nuts would merely make it difficult for parents to put good food into their children’s lunches.

Sensibly, most schools avoid an outright ban on food and merely ban swapping lunches. This measure meets with the approval of allergy experts:

“But Allergies New Zealand chief executive Penny Jorgensen said food bans made it harder for children to learn to manage the condition.”

I am immediately stuck by how applicable this argument is to the proposed re-banning of unhealthy foods in tuck shops. Surely it would be better to teach the kids which foods are unhealthy and allow them to chose to purchase healthy foods? While this will certainly not work with some children, it is, overall, a far better way of ensuring children learn that unhealthy foods are a treat, not a way of life. A food ban merely takes the unhealthy food out of schools – the one environment where establishing healthy eating practices has some chance of working. While it may temporarily reduce some childhood obesity (but the evidence to date indicates it won’t), it does not teach children to choose a healthy variety of food when surrounded by unhealthy ones. This is precisely the sort of self-reliance, and responsibility for themselves, that they need to learn if they are not to become obese, self-gratifying adults.

I have to say I am amused by the frenzied reaction to the story of the Chinese drug dealer who was drawing a sickness benefit and living in a state house. Does anyone actually think this is an abnormal situation? Judging by the reactions over on Kiwiblog, I would say the answer to that is yes. Even David Farrar himself wonders why this man is able-bodied enough to earn drug money yet unable to work in a legitimate career.

WINZ accept people on to a sickness benefit when they are given a valid medical certificate by a doctor. Unless there is some very obvious reason why this certificate can be called into question, WINZ has little choice but to accept this state of affairs. Typically, someone has to report the person to WINZ before they will investigate. So it is very unfair to blame WINZ for this situation.

It is also unfair to blame the doctor for issuing the certificate. Since it takes a great deal less physical strength and stamina to be a drug dealer than an minimum wage labourer, it is perfectly feasible that a doctor could issue a perfectly legitimate WINZ certificate without ever suspecting the beneficiary’s extracurricular activities.

In addition, a patient may have an illness that provides little or no physical signs to prove that the illness is genuine. The doctor in this case has no real option but to accept the patient’s word that he is genuinely incapacitated. Good examples of this would be chronic back pain, depression and chronic fatigue syndrome. None of these have easily obtainable objective signs or investigations that definitively verify the disease. It is relatively easy for a patient to become knowledgeable enough to fake his/her symptoms. As the majority of  patients with these sorts of illness are completely genuine, it would be both counterproductive and extremely unfair to expect them to provide some sort of “proof” of their illness. One has to take them at their word.

It is perfectly feasible that some people genuinely become incapacitated at a very physical occupation, go on to sickness benefit, then find that they can make a very decent living dealing in drugs. It is not very likely that they will then say to WINZ “thanks, but I don’t need a benefit any more because I’m a successful drug dealer”. I am certain that there are dozens of sickness beneficiaries who are exactly like Mr. Szeto – drawing a benefit becomes a form of cover for them (not a very good one when they buy expensive cars!).

And before anyone frenzies in the comments, the vast majority of sickness beneficiaries are just as honest as you and I. They have genuine illnesses which prevent them from working and they don’t deal in drugs. Of course, a fair number of long-term beneficiaries could retrain themselves into a new career more rapidly and with greater enthusiasm than they do, but that is an entirely different story. Very few beneficiaries are out and out crooks or even particularly lazy (the common right-wing meme). Most (of the long-term ones, at any rate) have absolutely appalling self-esteem which holds them where they are. For this we can thank our socialist-leaning friends in Labour who have convinced most long-term beneficiaries that they are helpless without welfare.