Monthly Archives: August 2013

Men: Need Another Excuse to Put Off That Prostate Exam?

Dalrymple discusses a disappointing anti-cancer drug, and his own avoidance of doctors, at Pajamas Media:

Of course, it might be argued that the avoidance of death, important as it undoubtedly is, cannot be the sole purpose of life in general or of medicine in particular. We do not visit the doctor only that he might prevent us from dying. And it might well be that the avoidance of a diagnosis of prostate cancer brings with it immense benefits from the point of view of quality of life: for if you are diagnosed with a cancer, however benign it is supposed to be, your anxiety is likely to be raised and you will be subjected to medical procedures that may themselves be unpleasant or even hazardous…So finasteride might do some good even if it does not save life.

On the other hand, like all drugs, finasteride has its side effects. And one has to remember to take it to obtain even its muted benefits, which is a bit of a nuisance. All in all, the paper is not encouraging: except to me, of course, who wants desperately to have to do nothing for the sake of my health. This paper provides me with a partial justification for my inaction. I’ll wait for my symptoms to develop, and then we’ll see.

Our Fool of a Prime Minister

According to the British Medical Journal, David Cameron recently asked a healthcare advisor how the NHS could “move to ‘zero harm’ in the wake of [the Mid Staffordshire scandal]”. Dalrymple is not amused by this utopianism:

If this is an accurate representation of what the Prime Minister asked of Dr Berwick, he should resign at once from public life and never return to it. For if he meant by ‘zero harm’ what it appears to mean, namely that a system that treats millions of patients, conducts millions of examinations, performs millions of operations, every year, should harm no one, then it is so stupid and ignorant that anyone who could think such a thought and believe it worthy of expression is not what in managerialese is called ‘fit for purpose.’

If, on the other hand, he meant something else by it, something more sensible, he is an unscrupulous demagogue playing to a gallery that he believes can be courted and won over by sentimental claptrap such as the possibility of human existence in which nothing untoward ever happens (actually, such a life would be intolerable, like a permanent Sunday afternoon from the time when everything was shut on Sundays). And the second possibility, while intellectually better than the above, is, from the point of view of his character, even worse. In neither case is he fit to govern.

Does Too Much Sugar Increase the Risk of Dementia?

Arguing that “[n]ot all that appears in the world’s most distinguished medical journals is distinguished. Laborious hackwork exists in all fields of human endeavour…”, Dalrymple critiques a paper in the New England Journal of Medicine that claims to find an important causative relationship:

…some of the data given by the authors do not fit with their hypothesis and indeed are mysterious and inexplicable. According to a graph in the paper, the blood glucose level among diabetics does not correlate in a linear fashion with the chance of developing dementia. Instead, the graph is a flattish, j-shaped one, in which, over a third of it, higher levels of blood glucose correlate with a lower chance of developing dementia. The increased risk of someone developing dementia with a blood glucose level of 150 compared with someone with a blood level of 170 was actually higher than that quoted for non-diabetics with levels of 115 and 100 respectively.

This is absurd. Since diabetes is defined simply by the level of glucose in the blood, there is no reason why the relationship between blood glucose levels and the development of dementia should take the form described in this paper. Elephantine labour has thus given birth to a scientific mouse.

Souk or Supermarket?

Dalrymple explains one of his preferences here:

Two photographs in the newspapers moved me more than any others. They were not those of corpses strewn across the rubble, and other such sights to which we have now grown accustomed as we eat our morning toast. No; they were photos of the souk in Aleppo before and after bombardment.

How attractive, architecturally and socially, the souk was before it was reduced to rubble! In a word, how civilised! I have always preferred souks to supermarkets, whatever the vaunted advantages of the latter. Even if it were true that supermarkets offered more choice (I am not sure that it is, I think it likely that they offer more choice of what should not be chosen), as human institutions souks are preferable.

The Medical in Shakespeare’s Julius Caesar

We do not know what Shakespeare really believed, save that he liked money and feared the mob: for he was a stern creditor, and whenever a mob appeared in his plays it was sure to be foolish, fickle and stinking, at the mercy of the last orator it heard. So it is in Julius Caesar: the mob first believes Brutus, then Mark Antony, and tears the old poet Cinna limb from limb simply because he bears the same name as one of the conspirators against Caesar, a different Cinna. Thus Shakespeare recognised that people in crowds may do what they would not do as individuals.

But did Shakespeare really believe that joining a political plot could cure the ague, presumably (considering the proximity of the action to the Pontine Marshes) malaria? In Act 2, scene I, Brutus successfully persuades Caius Ligarius, who is sick of the ague, to join the conspiracy against Caesar. Ligarius says:

By all the gods that Romans bow before,
I here discard my sickness.

And he does.

Likewise, did Shakespeare really think that plague (a disease rampant in London while he was writing the play) was truly the reward of morally reprehensible behaviour? Reproaching members of the mob for welcoming Caesar into Rome after his defeat of Pompey, whereas shortly before they had welcomed Pompey, Marullus says:

Run to your houses, fall upon your knees,
Pray to the gods to intermit the plague
That needs must light upon this ingratitude.

We do not know whether Shakespeare thought that epidemics really were divine vengeance upon men’s wickedness, or whether he simply used the trope because it would have been highly plausible to his audience.

Brutus opposes Caesar, though he is Caesar’s close friend and acknowledges his virtues, because he fears that he will soon turn into a tyrant; the other conspirators in the plot to kill him are more self-interested. Cassius decries Caesar for a weakling by describing his behaviour while ill in Spain:

He had a fever when he was in Spain,
And when the fit was on him, I did mark
How he did shake; ’tis true, this god did shake;
His coward lips did from their colour fly,
And that same eye whose bend doth awe the world
Did lose his lustre; I did hear him groan;
Ay, and that tongue of his that bade the Romans
Mark him and write his speeches in their books,
“Alas!” it cried “Give me some drink, Titinius,”
As a sick girl.

This is authentically callous and patently unfair; but Shakespeare intends it to be.

Caesar, of course, ‘hath the falling sickness,’ but it is a manifestation of Shakespeare’s clinical acumen that he should make Caesar have a fit, fall unconscious and foam at the mouth precisely at a moment of high emotion, when – unwillingly – he turns down the crown offered him for the third time.

Perhaps the strangest medical incident in the play is the suicide of Portia, Brutus’s wife. Missing her husband, and fearing that he will be killed by Octavius and Mark Antony in their struggle for power:

… with this she fell distract.
And her attendants absent, swallowed fire.

North’s translation of Plutarch, from which Shakespeare took his plot, has this to say:

She, determining to kill herself, took hot burning coals and cast them into her mouth, and kept her mouth so close that she choked herself.

As for her friends, they were negligent; knowing her to be sick, ‘they would not help her, but suffered her to kill herself.’

Negligence is nothing new.

Copyright 2013 Anthony Daniels

On the Pleasures of Humanitarian Anger

Dalrymple has a new piece for the Library of Law and Liberty that provides a deeper analysis of a human type he has written about before and which we all know well: the unjustifiably and self-righteously enraged.

Anger allegedly felt on behalf of vast numbers of people who are believed to suffer because of a single characteristic that they have in common is deeply satisfying to those who feel it because it assures them that they are, at heart, generous and open-minded people, capable of empathizing with a large proportion of suffering mankind (the larger the better), despite their own personal good fortune.

But why should they require such assurance in the first place? Because they know in their hearts that they do not care half as much for humanity as they think they ought, and therefore compensate for the coldness of their love by the warmth of their wrath. They are angry that they are not as good as they would like to appear in a world in which a person’s goodness is often measured by the strength of feeling he expresses on behalf of others. Hence the shrillness of anger; this also explains the oft-noted paradox that those who love humanity or some very large portion thereof seldom love individual humans, to whom indeed they are frequently outright hostile, while those who make no claims to love humanity en masse are kind and considerate in their personal relations.

Architectural Bedsores

Visiting Norway, Dalrymple notices that the new architecture there is no better than that of his native Britain, though Norway is a richer country:

It must be admitted, however, that architecture is past its Corbusian nadir, that it can now construct buildings of a cold and glassy elegance to which, however, the heart will never warm, and which age will never improve. They are the cold-blooded reptiles of architecture; and while snakes can be elegant and even, in a way, beautiful, one does not clutch them to one’s heart.

The Hilarious Pessimist

Can Living With Chickens Protect Against Face-Eating Bacteria?

A strange question, to be sure, but one that may prove important to children in Africa suffering from noma, or cancrum oris. I quote, however, from the opening lines of Dalrymple’s piece at Pajamas Media:

When doctors knew nothing and could do even less (if actively harming patients with their treatment counts as doing less than nothing), they hid their ignorance and therapeutic impotence by the use of impressive-sounding Latin terminology. Even when they spoke in the vernacular they did their best to be incomprehensible, and generally succeeded. Portentousness was then a substitute for prowess.

Doctors are still inclined to use impressive-sounding words for the same purpose: or at any rate, so their critics say. Idiopathic is a learned way of saying that the cause of a disease is unknown; and when a disease is said to be multifactorial in causation, it is an implicit avowal of ignorance: for diseases should at least have necessary causes if doctors can claim to understand them.

Read the rest here

Should an Alcoholic Be Allowed to Get a Second Liver Transplant?

At Pajamas Media, Dalrymple writes of a past dilemma brought on by his status as a doctor and writer:

A newspaper in England asked me to write an article, for what for me was a considerable sum of money, to opine that a certain very famous soccer player, who had turned severely to drink after his retirement, should not be given a second liver transplant, the first having failed because of his continued drinking. The player in question was not admirable, but he did say one memorable thing. Impoverished by his habits, an interviewer asked him where all his money had gone. “Wine, women and song,” he replied. “The rest I wasted.”

I told the newspaper that, as a practising doctor, I could not possibly write an article saying that a named person should be left to die without potentially life-saving treatment.

He goes on to say he didn’t actually believe the patient’s second transplant should be prioritized over someone else’s. “But doctors treat diseases, not the deserts of their patients.”

Update: Sorry, I forgot the link. Included above. Thanks for the reminders.