Monthly Archives: November 2012

As Life Expectancy Increases Will the Elderly Become a Greater ‘Burden on Society’?

Of all the pieces Dalrymple writes, none get more comments than the medical ones. I’m sure Dalrymple would say that fact is indicative of the modern obsession with health and the drive for immortality. In his latest piece at Pajamas Media, he writes about an increasingly important medical issue:

At dinner the other night, a cardiologist spoke of the economic burden on modern society of the elderly. This, he said, could only increase as life expectancy improved.

I was not sure that he was right, and not merely because I am now fast approaching old age and do not like to consider myself (yet) a burden on or to society. A very large percentage of a person’s lifetime medical costs arise in the last six years of his life; and, after all, a person only dies once. Besides, and more importantly, it is clear that active old age is much more common than it once was. Eighty really is the new seventy, seventy the new sixty, and so forth. It is far from clear that the number of years of disabled or dependent life are increasing just because life expectancy is increasing…

Read the rest here

Burning up

Talk about bad research projects…
The subject of spontaneous human combustion was of sufficient importance for Alfred Swaine Taylor to devote to it one of 12 sections in his exhaustive The Principles and Practice of Medical Jurisprudence of 1865… “In many experiments made on different organs and on different bodies, I have not observed that different parts of the same body or the parts of different bodies have varied in their degree of combustibility.”
The imagined vision of this rather dour individual (according to all portraits of him) doggedly comparing the flammability of organs and bodies by trying to set fire to them, in order to establish his point, is one not without a certain ghoulish satisfaction.

An Unfamiliar Season of the Year

Contrary to the explanation put forth by a bureaucrat, Dalrymple explains the real reason that only 15 percent of eligible voters turned out in the recent elections for local police commissioners:

The reason for the low turn-out during this election was that the British people can still recognise a pseudo- or para-reform when they see one. What the British people want from their criminal justice system, of which the police form a part, is safe streets and protection from crime: the one thing against which they know that the political and intellectual class has set its face. Popular indifference is caused by an awareness that our political class will move mountains to produce trifles, and produce trifles to move mountains.

Aunty BBC gibbers

On his Salisbury Review blog, Dalrymple has fun with this quote from former BBC director general George Entwistle:

I made inquiries as to find out why what had happened on Twitter had happened because it seemed to me that the events surrounding the film in terms of what happened on Twitter were an important part in understanding how this thing had achieved a scale and created a noise around potential identification that was clearly surprising.

(H/t Teddy M.)

The nature of hypertension

I wasn’t previously aware of this mid-20th-Century medical dispute (subscription required):

Among the most famous controversies in 20th century medicine was the momentous one between Sir George Pickering (1904-80) and Sir Robert Platt (1900-78) over the nature of hypertension: whether high blood pressure was merely one end of a normal distribution, or whether there was a bimodal population, one part of which suffered from the discrete disease called hypertension. The dispute rumbled on for years. It is generally thought that it was Pickering who triumphed in the end, in the process overturning what until then had been the orthodox view. It is not given to mortals, even to doctors, to live without orthodoxies.

Dalrymple praises Pickering’s writing, and one can see why:

The hypothesis [of a continuum in blood pressure and the gradation in risk that it poses] has been greeted by medical scientists “as a glimpse into the obvious,” and by physicians as “dangerous nonsense because it is against established teaching.” It is apparently difficult for doctors to understand because it is a departure from the ordinary process of binary thought to which they are brought up. Is it normal or abnormal, physiological or pathological, health or disease, good or bad? Quantity is not an idea that is as yet allowed to intrude. Medicine in its present state can count up to two but not beyond.

The scourge of ulcers

This BMJ piece (subscription required) offers another reason to be thankful for living in the modern era:

In the middle of the last century there was a genre of books (I will not dignify it with the name of literature) with titles such as How to Live with Your Ulcer and How I Cured My Duodenal Ulcer. The lettering on the spine of the latter work, by John Parr, was in silver, except for the word “cured,” which was in diabolic red for emphasis. A cure for ulcer then was regarded as of almost supernatural occurrence.

Parr, who wrote the book in 1951, had an ulcer from 1919 until 1946, which gives him a kind of authority. We find it now as difficult to remember the miserable chronicity of peptic ulceration as to remember life before the internet. With a little effort, however, I can remember the household smell of ulceration—namely, that of boiled fish, peppermint water added to aluminium hydroxide, and various extracts of liquorice; a combination that was, aesthetically if not therapeutically, unpleasing.

Should Doctors Lie to Their Patients About Their Survival Chances?

Dalrymple writes at Pajamas Media on a new study on cancer patients in the New England Journal of Medicine:

The authors found that those patients with the least accurate estimate of the chances of cure (that is to say who were the most falsely optimistic) rated their doctors the highest for their communication skills. In other words it is possible that doctors who give an optimistic message are those that patients think have told them the most, in the best and clearest way; but it is also possible that optimistic patients view their doctors in a benevolent light. What doctors tell patients, and what patients hear their doctors tell them, may be very different as every doctor is, or ought to be, aware.

What should the doctor do? Give the patient false hope or tell them the truth?

A whistleblower’s tale

On Ibsen, the difficulty of accepting difficult truths, and the germ theory of disease, in the British Medical Journal (subscription required):

Parents are inclined to believe that a child’s failure in exams condemns him or her to a life of poverty and frustration. They might console themselves with the case of Henrik Ibsen (1828-1906), the great Norwegian playwright. He took the entrance exams to medical school while working as an apothecary’s apprentice—but failed them. Would we have heard of him had he passed? This is the very question that is often asked of Hitler and the Viennese art academy.

This comparative assessment of two famous playwrights will interest some:

One of Ibsen’s first champions in Britain, George Bernard Shaw, who wrote the book The Quintessence of Ibsenism in 1891, took the same view of the germ theory of disease as Dr Stockmann’s father in law until his dying day, but then he was also a much lesser playwright than Ibsen.