Inventing Disease

With the huge amount of research that surfaces each day, it is not surprising that the quality varies considerably. Sometimes, you actually have to wonder whether the researchers are having a joke at our expense. Dubious research coupled with the tendency to disease mongering and the creation of new conditions can lead to hilarious outcomes.

If this story had appeared on April first, it could easily be dismissed as an April fool joke. However, as it appeared at the end of June, it seems these researchers take themselves seriously. With straight faces, they warned that Australian teenagers are becoming text addicts and in turn, risk a “range of serious mental and physical disorders from depression to repetitive thumb syndrome”.

To help legitimize this nonsense, new terms have been created. “Textaphrenia” is defined as hearing texts arrive when they haven’t and constantly checking to see if a message has arrived. “Textity “is the anxiety felt when they haven’t received a text or are unable to send texts. Post traumatic text disorder are injuries that occur when texting such as walking into things and feeling depressed when people don’t contact them. Binge texting is sending lots of texts. One can only wonder who pays for this sort of research.

This sort of research can be easily dismissed as absolute nonsense. Clearly, texting, which is a relatively new phenomenon by human existence standards, can, like anything, can be taken to extremes by some individuals if they chose to do so. There is no disease entity involved in this. Unfortunately, creating terms like the ones above, allow people to make excuses for their behavior. One wonders if somebody crashes their car while texting will be able to claim that they were suffering from one of these text related conditions and offer that as an excuse.

Furthermore, it continues the trend to medicalise human behavior. Texting is a form of communication. In exactly the same way some people talk more than others, some people will send more texts than others. Some people have brown eyes and some have blue. None of these represent abnormalities or disease processes. Some people will over do activities be it texting, eating, drinking or any other form of human past time.

The solution to this is not to create fancy new medical terms and pseudo diseases. The answer will certainly not be in developing medications to control these non-existent diseases. The continued medicalisation of life is an invitation to people to not be responsible for their actions. The solution is in fact for people to take ownership of their behavior. If they send too many texts, then the simple solution is to send less. If you walk into walls while texting, then the solution is to look where you are going if you are not able to multitask.

Life can be actually fairly simple when researchers are not involved.

Spending On Disease Does Not have to Keep Rising

You would need to be living under a rock not to know that health (disease) care spending is continuing to increase. The total spending in the OECD is increasing faster than economic growth and inflation in the OECD.

The USA spends the most at around 16% of GDP nearly double the OECD average of 8.3%. This average has gone up from 7.3% in the 1990s . Governments are generally responsible for half or more of this spending. Virtually all the focus at a government level is on how are we going to pay for more disease care in the future.

A different question would be how can we keep healthy so as not to have to spend so much. There are two aspects to this. The first and (dare I say obvious) one is people actually being healthier. With three quarters of spending on “health” being spent on preventable lifestyle related conditions there is plenty of scope . For example 80% of cases of stroke come about in people who are overweight or eat poor diets, smoke or do not exercise. Strokes are extremely costly both in dollar and human terms

There is another aspect as well. One of the big costs in the system is pharmaceuticals particularly those which are “lifelong” treatments. You would think that there would be a interest in making sure that the money was well spent and that there was value, once again, both in dollar and human terms.

Statin drugs, which are used to lower cholesterol, generate billions of dollars in sales on the basis of reducing heart disease. Yet there has never actually been any evidence, which shows that cholesterol in the bloodstream is the problem.

Furthermore there has been a trend to place more and more people on these drugs as a form of “prevention”. Yet a major analysis has shown that for people without heart disease there is no decrease in mortality in those with risk factors who take a statin. Fully three quarters of the people taking these tablets are in this group.

Basically millions of people are taking an expensive drug, which is not actually doing them any good. Questions have also emerged about a study in 2008, which showed benefit from one statin in reducing heart disease given that nine other trials found no such benefit. These focus on the independence of the researchers.

Meanwhile an expensive diabetes drug (Avandia) is under question due to evidence that those taking it had higher rates of heart attacks and strokes than those not taking it. These two conditions are more common in diabetics and one of the aims of managing diabetes is to reduce these conditions. Again you would think that this would raise alarm bells in medical and government circles.

There are more and more examples of this emerging with long term drug use. Medications are trialed over short time periods and then used over long periods. Problems not apparent after two years might become apparent after ten years.

Our reliance on pills is costing us in both dollar and human terms. Every person taking a tablet they do not need is risking side effects for no benefit not to mention enduring cost to their hip pocket. Every time a use for a pharmaceutical is widened to capture more people being in a “risk” group the more this cost increases.

It is time we rejected unnecessary use of pharmaceuticals and were far more questioning of the cost benefit equation in the ones we do use.

Facebook and Bikinis

Facebook is an interesting beast. Over the last year or so I have grown to over 1000 friends some of whom I actually know, most of whom I do not know personally and some of whom I have actually got to know which has been great.

The other interesting thing as the number of friends grows is the invitations to events, causes, groups and pages. The range of these is incredibly diverse. In turn it got me thinking, what does publicly joining a group, cause or page say about the person. It may say a lot more than what is contained in the bio or even what appears on the wall.

Exactly how we get these invitations is not absolutely clear to me. The diversity of what I get invited to though is enormous. Recently I have been invited to like wrestling girls as well as peace in the Middle East. Both have their supporters and although they are poles apart obviously different people felt both might be of interest to me.

Sometimes I click through to have a look at the page in question before forming a view. Other times I “judge the book by its cover” in deciding whether to join, like or ignore. In some respects it is a click of the mouse. In another, it is a public announcement about my likes, interests and even beliefs.

This came home the other week when I “liked” a draw Mohamed page and drew the ire of someone. Now I am happy for people to follow the religion of their choice and absolutely respect their right to do so. However there is no reason why other people cannot have a laugh, be it about religion or anything else.

The interesting thing about offense is that it can actually only be taken not given. Whether or not a person takes offense is a choice they make. It is not a function of what is said or done as nothing causes equal “offense” to all people. Those who choose to take offence will generally blame the other party rather than accept ownership of their own feelings.

The other interesting phenomenon is that after the mouse is clicked that may be the last I see of the group or page. Whilst I can search and find groups I have joined unless I can remember what I am looking for it will be difficult to find.

So what am I do with the invitation, which got me thinking about this whole issue? It is an invitation to like the page “I love sexy bikinis”. It was sent by a friend and promotes a retail website selling, well, bikinis. To be honest they look pretty OK. If the page was “I love pretty landscapes” or “I love stunning architecture” would that be different?

All three are about something, which is visually appealing. If I like the architecture or landscapes no one would bat an eyelid. If I like the bikinis will there be a range of comments from the nudge nudge variety to the morally outraged?

In liking such a page what am I saying publicly? The answer of course is that I like the look of women in bikinis. This puts me in the company with 90% or so of the male population and a high percentage of women too. Serious swimmers do not wear bikinis. They are, of course, worn for appearance not functionality.

So do I publicly declare my like of bikinis or not? You will have to check my Facebook status to find out.

Collateral Damage In The War On Cancer

Since the war on cancer was declared by then president Nixon in 1971 much effort has been devoted to the war. So how are we doing? In 2007 there were 12 million new cases of cancer reported world wide and 7.5 million deaths.These numbers are projected to rise to 27 million new cases and 17.5 million deaths by 2050.

These figures do not suggest that what we are doing is working a s well as it might be. The other figure which, does not get quoted much is the collateral damage which is done in the war. Hang on a minute, what is collateral damage? Surely screening for and treating cancer is all good even if it doe not always work.

There is a view which is promoted in the media and by doctors(particularly those involved in cancer screening) that screening is all good and that early detection is important. There is no argument that early detection is better than late detection. There is also no doubt that some people have had their lives “saved” by early detection.

Do we know how many people are in this particular boat? Do we know how many people had unnecessary procedures including biopsies and surgery not to mention needless stress because screening tests picked up cancers that were not actually there? Do we know how many people have early cancers which f not found would not actually develop and lead to a reduction in life expectancy?

Figures are starting to emerge. The British Medical Journal published figures on mammography. The difference in deaths in women aged 40 to 55 that can be attributable to mammography screening is 0.06%. Looked at another way for every woman who would otherwise not have found the cancer and died, 1610 women need to have tests. In addition to this ten women will undergo surgery, which will provide no benefit to them, only potential complications.

With prostate screening the situation is even worse. For every cancer successfully detected and treated early, 48 men will have unnecessary surgery, which can lead to urinary incontinence and impotence in one third of cases. Another review suggested that screening led to no decrease in death rates. The inventor of the PSA test, which is used for screening(but was not developed for that use) described prostate testing as like flipping a coin.

The positioning of cancer screening as saintly leads to criticism of anyone who questions the current orthodoxy. Keep in mind that there are considerable vested interests invested in screening programs and those advocating screening may have a conflict of interest, which would not be acceptable in any other field.

Every person who has surgery or other unnecessary procedures is collateral damage in the war on cancer. Some will say this is a reasonable price to pay. Others may not see it this way. The key point is that you can only make a decision on how you want to proceed if you know all the facts.

A Week Used To Be A Long Time

It is an old adage that a week is a long time in politics. With the world speeding up it seems like a day is now a long time. It is highly unlikely that Wednesday morning that many Australians would have thought there would be a new prime minister within 24 hours.

The fall of Kevin Rudd is quite remarkable. Twelve months ago he was riding high in the polls and at one point enjoyed record high approval. This is a first term government, which came to power after over 11 years in opposition.

Certainly the popularity of politicians goes up and down. Polls, which seem to dominate all thinking these days are necessarily done on small numbers of people and the results extrapolated. Often they are close to the mark but as all the politicians know there is only one poll that really counts.

Clearly the labour party formed the view that they were likely to lose those years election with Rudd in charge and replaced him with his …deputy.

This raises the real question of style versus substance. Were people turning “against” the prime minister because of the policies of his government or him personally? It is worth remembering that as his deputy, new Prime Minister Julia Gillard was involved in policy making. So it is not likely that a new face will bring about huge change in policy. One of the key issues has been the mining profits tax and I wrote about the connections between wealth and health previously.

So is the issue the message or the delivery of the message. Are the governments’ approval ratings falling because people do not like what they are doing or is it simply that what they are doing has not been “sold” in the right way.

Julia Gillard will, like all new leaders, have a honeymoon period. Many will like to see her succeed because she is the first woman to be Australian Prime Minister and this will in itself provide a boost in the polls and an air of goodwill, which will color people’s opinions and also media coverage.

Ultimately the problem though facing many countries is that there is a focus on personality rather than policy and a fixation on polls and the 24-hour news cycle. To grow an apple tree you need to pant the seed and tend it over many years before it grows and provides fruit. Expecting fruit after three months and declaring the tree a failure (and ripping it out) if that doesn’t happen would be ridiculous.

Equally with government policies, which have, long-term effects, judging policy success in a short time frame and then acting on that may make as much sense as ripping out the tree. Of course bad policies should be dropped as would trees, which are not growing be removed from the orchard.

With an election due within nine months it will be interesting to see whether we see changes in policy (particularly the unpopular mining tax) or simply a change in selling the message or perhaps a bit of both.

Most interesting will be the response of the people.

Relationships Do Not Have To Be Complicated

Relationships form one of the pillars of DIY Health. There are many different relationships that we have and over the last week we have seen examples of how the way we conduct these this impacts on people, for better or worse.

There are two separate events, which caught my eye; resignation of the CEO of David Jones department store after allegations of sexual harassment, and the furor over allegedly racist comments by a former footballer. Both say something about our relationships.

Firstly were the comments made at a private function by a former footballer Mal Brown who allegedly made references to Aboriginals and cannibals in jest. Not surprisingly this made the news for a few days and led to the usual screaming from those with a vested interest in doing so.

Now I was not at the function, so do not know the context of the comments. However following media reports millions of people became aware of the comments of one person instead of the small number in the room. More interesting are the claims that one person’s remarks are widened out to suggest it represents “systemic racism” either in football or society in general.

Of greater significance is that the man who made the comments has a long track record of playing and coaching Aboriginal footballers and has probably done much more to help their advancement than many of those now screaming out in “horror”. A sign of maturity in race relations will be when jokes whether bad or good are seen as jokes rather than put into a political context. Laughter is one thing we all have in common as humans.

The resignation of David Jones CEO Mark McInnes again highlights how traits, which serve people well, can lead to their downfall. There is a long long history of leaders be it in business or government having multiple affairs, relationships, mistresses or whatever term was popular at the time. This goes back to the days of Caesar and continued through to Bill Clinton. “Leaders” in other fields have a similar track record.

In this particular case the man has resigned and is forgoing something in the order of $16 million in lost entitlements compared to seeing out his contract. There is no way a fine of that magnitude would be imposed by a court. Furthermore nobody is disputing he was extremely good at his job.

None of this excuses behavior, which is unacceptable and he has paid a high price. Equally one can also wonder if the behavior is shaped by the fact that other women may well have warmly received or even sought his attention. It is likely that some did. It is also likely others did not but were not prepared to speak out. There will undoubtedly be more stories emerge over the next week or two

The problem is that often the exact same drive and personality traits which led to success and rising up the power ladder can send you right back down again. A football coach who calls a spade a spade may go far on the playing field but come unstuck at after dinner functions. A CEO who charms women does well in running a retailer but comes unstuck from his private dealings with people if he does not learn where to draw the line.

Relationships are often made more complicated then they need to be. They are never helped when people who are in no way affected jump in with opinions or interpret behaviors through their own biases or worldview.

The old golden rule of do onto others as you would have them do onto you does not even quite work in the politically correct age. You need to do onto others, as they would have you do onto them. For that to occur we need to be honest and open in our dealings with people. We can not expect others to be mind readers. We need to tell them what we do and do not accept and we need to act on that accordingly.

Maybe relationships are not that difficult after all.

Be Questioning

A survey of Australians shows that church attendance has fallen about one third over the last 16 years. A number of other “religion” parameters such as belief in heaven and god have also fallen although running in parallel with this is an increasing interest in spirituality, separate from religion.

This trend is part of a broader trend in society away from “authority” figures and institutions in general and to a greater desire to find ones own way rather than be told which way to go. We see this in declining church attendance but also declining regard for judges, police politicians (of course) and dare I say even doctors.

Ultimately the problem we have is that people have used authority badly and come to feel that it is the position they have which confers importance upon them rather than position being recognition of what they bring to it. In other words putting a robe on me does not give me moral authority if I do not have it without a robe. If a person is corrupt, putting them in a police uniform does not change who they are. Yet we see time and again the excuse of position being offered when people are caught out.

There is no doubt in my mind that the response to child sexual abuse by the church has contributed to its loss of credibility. There has been more energy expended trying to defend people and position than trying to resolve the issues.

In other fields similar problems emerge. Reports of two undercover policemen arresting and charging a skimpy barmaid for showing too much buttock will leave many wondering why the police are not spending their time investigating murders and robbery. A similar thought goes through my mind every time I cruise by two policemen under a shady tree holding a speed radar.

The medical profession is not immune to this trend and is also guilty of undermining public trust by its own actions. Reports of researchers and doctors being paid by pharmaceutical companies for research which invariably is favorable to the sponsors does not help credibility. Neither does beat ups like swine flu.

Despite overwhelming evidence that this is not a major threat, health authorities are at it again with claims of chaos and horror to come. This is after a vaccine, which was not needed, was rushed to market and then withdrawn from use in children under five following an unexplained death. Official pronouncements of safety do not sound good in these circumstances. Little wonder that peoples confidence is shaken.

Meanwhile we are constantly told that the whole reason for vaccination is that people are protected against the illness they are vaccinated against. This flies in the face of the actions of the WA health department after a case of measles was found. A frantic search was done to find all possible contacts. If the herd immunity principle works, then why the panic? Interestingly one of the three cases was a paramedic who you would assume was vaccinated.

A two page circular to doctors gives “useful “advice like conducting an examination in a room which can be left vacant for two hours and avoid “suspects” using the waiting room. And who are these suspects? People with a fever ,cough and sore throat. The average doctor would of course not see many of them in winter would they? Apparently people born before 1966 are automatically immune!

Now measles is not a pleasant illness and vaccination has contributed to its decline. However generations survived it in much lesser circumstances than we enjoy today. If the whole purpose of mass vaccinations is called into question when one case is found is it any wonder that people become questioning.