On Charity and Criticism of the #CEOSleepOutZA

This post wast authored by Simon Shear (@axaxaxasimon on Twitter). Amongst all of the opinions expressed around the CEO Sleep Out it is by far the most eloquent and appropriate, which is why I have chosen to share it on my blog (with permission).

The CEO Sleep Out is like Henry Kissinger winning the Nobel Peace Prize while calling North Korea the Democratic People’s Republic: self-parody that needs no further exposition. But it may be useful to investigate the allegations made by the critics of the critics (aka ‘haters’) of this ultrapremium sympathy fest.

But first some preliminary remarks

1. Charity

– Charity is elective. It’s an act of largesse. Taxes are not charity. Charity confers some prestige on the giver. It is, inevitably, an act of power.

– The burden of taxation often feels onerous. The burden of charity usually doesn’t. The normal charitable giver will tend to choose the level of giving that she feels will sufficiently burnish her moral self-worth but doesn’t hit the pocket too deeply. Finding that sweet spot is an art. There is nothing wrong with this. People who give to charity doing a good thing and are, to that extent, better people than those of us who don’t.

– Charity is not justice. It can make the community more just, but it has built in limits. Compare the benefits to the poorest of the welfare state, funded by highly burdensome taxation, to discretionary charity. Compare also the benefit of the welfare state to the most highly taxed: i.e. not being lynched in their mansions. The latter point may be contested, but I hope it is still plausible that justice may sometimes demand principles that go against one’s immediate interests.

– Sometimes the state of affairs is so bad that ordinary charity is not enough. Something must be done. This may mean fundamental reform, or it may mean a pantomime, an enactment of a radical gesture, that forecloses systemic change. No doubt there’s a neat Lacanian-Zizekian term for this.

2. Empathy

– If you need a camping trip to learn that sleeping in a non-branded* cardboard box during a Highveld winter without K-Way thermal underwear or hot chocolate with marshmallows (with the metro police present to ensure you have a safe night’s sleep, rather than harass, assault and displace you) then you are an idiot.

– Our CEOs are not idiots, so the exercise could not possibly have been undertaken as an investigation into the conditions of being homeless. (And if it were, it would have failed, given the additional provisions and protections mentioned above.)

– Furthermore, if the country’s financial elite wanted to learn about being poor, there are plenty of experiences they may have only a vague understanding of, but about which at least something can be learned through exposure. What is it like for their poorest employees (do outsourced cleaning staff count as employees? I guess the CEO of the cleaner outsourcing firm will have to take one for the team) to wake up at 5am in a low cost house or shack and walk (unprotected by armed response) to catch a succession of unsafe, overcrowded taxis to get to work on time? An unglamorous but interesting way to learn more about people poorer than you is to take public transport for a few days.

– ‘But the events are about raising awareness’. What does this even mean? Does is mean that CEOs are real humans whose suffering matters, whereas the authentically homeless are statistical abstractions, or apparitions glimpsed briefly through the window as the Uber speeds through Doornfontein on the way to Maboneng? Not consciously, it doesn’t. It means that social issues need to be sold to us like deodorant or Big Macs. It means that how, when and in what degree to alleviate suffering is a consumer choice and advertising is the key to social change.

– Consumer choices are driven by desire. Your hunger for power or acceptance or pizza. What we now think of as empathy is the affective result of socially conscious advertising. You are not a good person unless you feel deeply. You must be sad for the suffering. The misery of the destitute is all about is.

– But why address suffering in this way? Why emulate, in however watered down a fashion, the conditions we seek to relieve? Because charity, advertising and empathy are symptoms of the same malady.

– What will the homeless think of our parlour game? Who cares, it’s not for them. Why listen to the homeless people directly, why let their voices be heard, when we can inhabit their sprit ourselves and make our own, more rational, policy decisions?

– What’s wrong with imagining the conditions of others? Nothing. That is what not being a psychopath is. And there exist ways of gesturing towards an approximation of the experiences of others. One could imagine – and I think these actually exist – experiences held in total darkness to get a sense of the way blind people navigate the world, which is maybe not wholly unproblematic (sic) but at least is not obviously condescending – this is about imagining different ways of being in the world, not cloaking yourself in a fancy dress of other people’s misery – and invoke the mystery of human experience as such, and of the particular ways of experiencing the world of the unsighted.

On the critics of the haters

Some very obvious points that nonetheless need to be made:

“At least these people are out in the freezing raising money, while you sit in your warm bed trolling on your iPhone.” I don’t wish to be ungracious, but the CEOs were hardly suffering. This was a high prestige social event and, I bet, a lot of fun. But that’s a secondary point. Yes, it took effort and initiative to go out there and make this thing happen. We should be impressed and, yes, our criticisms shouldn’t be gratuitous or personal. But that doesn’t invalidate those criticisms. We could imagine people working very hard and suffering greatly (early colonial missionaries, say) and doing work that is condemnable. We should be sympathetic to these people, even praise their good intentions and hard work and lament our own laziness and moral ineptitude. But that does not exclude strong criticism.

(Note, by the way, that running a marathon is also a source of suffering, but it is a privilege to choose to suffer like that and the beneficiary is yourself.)

“I see debate on Twitter streets about #CEOSleepOutZA. R25m for our destitute kids looks good to me. If you think it’s flawed, do it better!” This is an actual Lindiwe Mazibuko quote. The point is not trivial and impeccably Harvardian. A good sum of money was raised by the event that will directly benefit people. But do we truly think raising an adequate amount of money (where do we set that bar?) renders something beyond criticism? How about a charity ball where the guests come in blackface to increase awareness of racism? Or a party where we take ketamine and pretend to have muscular dystrophy to raise fund for medical research? How about every time I kick a homeless man, you donate R100 to charity? Is that too low? R200? R5 000? At what price does it become ok?

“Can the haters present a R25 million cheque to aid the homeless?!” Yeah, sure. No problem. Just nobody try cash it.

“Also, to all the haters saying the #CEOSleepOutZA is offensive and ‘poverty porn’ what have you done lately to help those less fortunate?” Pretty much nothing. I gave a guy at the robots some coins. Is this the end of the conversation? Is the event not patronising because I’m selfish? Can we patronise the less fortunate because others, who are more fortunate, haven’t done anything constructive either?

Hating is sometimes *the most constructive* thing you can do. Not often, but sometimes. And never singly, but together. It is much easier for journalists, who are dependent on their corporate employers, to condemn government than to hold business to task.

We need to do the hating on their behalf.

P.S. If you are an important business person who took part in this event and we happen to enter some sort of scenario that involves money flowing from your business to my bank account, I’d like to make it clear that this is all a joke, hahaha, and you guys are the best.

* The CEOs slept in boxes with the sponsor’s logo emblazoned on the side. This is not a joke.

There’s No Debating Noakes

In a short period of time the Noakes/Banting/Paleo diet has become the power bracelet of our decade. Short on logic, lacking in scientific reasoning, and completely oblivious to established fact, the fad charges on under the misguided leadership of its supreme leader.

Back when I wouldn’t have given much credence to what I now believe will result in the next few million cardiac stents to be sold by the lovely folk over at big Pharma, I jokingly tweeted that I should have considered refrigerating Noakes because after day 5 of the diet he was starting to go off.

Well, never a truer word said in jest and over 2 years later the sponsored book selling professor really has left a bad taste in my mouth. Of course I take full responsibility for goading the man (yes he is just a man) and reminding him on several occasions why much of what he says and promotes is bad science. His vitriolic followers have joined in the mudslinging with only the best defamation one can find in the social media space and the occasional threat of violence.

Naturally those who have the least relevant evidence, anecdotes, and are staunch supporters of the LCHF way of life often remind me how much older, more experienced, and simply more intelligent Noakes is than I. Even the great professor himself has attempted to ridicule my opinions based on my qualifications and research profile. This in spite of the fact that Noakes acknowledged knowing ‘nothing or, at best, very little about nutrition’ prior to December 2010.

It therefore came as a surprise when in late June Noakes challenged me to a debate on the topic of ‘Why Noakes is a quack harming SA Health’. This soon expanded into the title of ‘Why Noakes is a quack and a danger to the health of all South Africans’. It is important to point out that both of these topics were suggested and formulated by Prof. Noakes himself, with no intervention on my part. In fact he was so keen to debate this topic that he suggested the debate take place a mere 4 weeks later. This was not to be due to work commitments on my part and so began the back channel communication to confirm the details and the date of the debate.

IMG_2489

Initially I considered a change in title but as time went on and no suggestion of this was made I began planning my argument based on proving Noakes to be a quack and a danger to the health of our citizens. Something I believe to be true. I should point out that I do not make a living promoting any diet nor have I ever earned a cent from this type of work. Therefore constructing my argument was considerably time consuming given that this was a first for me but a likely fifth or even tenth for UCT’s most controversial staff member.

Following more than 3 weeks of back and forth it was finalised that the debate would take place at the Charlotte Maxeke Johannesburg Academic Hospital Auditorium, adjacent to Wits Medical School, on the 23rd of October between 5 and 8pm. We agreed that tickets would be sold for R50 per person and despite my initial suggestion that all proceeds should go to charity this was the proposed fee structure by Noakes’ people:

 Fee Structure

All seemed well until last Friday when I received a mail notifying me that Prof Noakes feels the title he suggested is unacceptable and is demanding a change to ‘The Tim Noakes (Banting) Diet is a dangerous fad that will kill many South Africans’.

Change of Title

When I took to Twitter to notify my followers and challenge Noakes over this movement of the goalposts he first responded with ignorance and when this failed he attempted arrogance.

Following this I received an e-mail on Saturday night urging me to either change the title or to withdraw from the debate.

Change or Withdraw

There are multiple problems with Noakes’ new proposed title besides for his inconsistency and inability to stick to his guns. Not least of this is the repositioning of his argument into an advantageous position prior to the debate. Some, including the Prof., have argued that the original topic is too focused on Noakes and not the diet, but this is nonsense given that only one man has endeavoured to make himself the face of the Banting diet in this country. If you want to play the LCHF ball you have no choice but to play the LCHF man.

I will debate Noakes but it will be on the original topic or nothing – and therefore nothing it is. The truth is that the leader of the ‘Real Meal Revolution’ doesn’t want a fair or honest debate. He wants another marketing opportunity to sell more cookbooks and peddle a potentially dangerous lifestyle to people who don’t know better and desperately want to trust the formerly respected scientist.

I apologise to those who are disappointed on both sides of the argument and leave you with these two comments which in a few sentences probably prove far more about the dangerous beliefs of Professor Tim Noakes than 3 hours of debate ever could.

IMG_2107

IMG_2497

Tagged , , ,

Lies, Damned Lies, and Marie Claire

From an early age most children will be told that drugs are bad. This will be reinforced again and again, usually by a recovering crack addict, who for some reason gets to preach to school assemblies about how to live one’s life. But I digress.

The usual culprits we’re all urged to avoid are substances like heroin, cocaine and methamphetamines. Now imagine if I told you there was a drug which millions of people take legally every day which can cause nausea, vomiting, stomach ulceration, severe bleeding and even death without warning. In fairness I’m lying about the warning part because the drug in question is Aspirin and the above information is available in the package insert and from any suitably qualified healthcare provider. The fact that the overwhelming majority of people who take Aspirin, often on a daily basis, will never suffer from any of these side effects is obviously of little comfort to those who take to making mountains out of mole hills using nothing but their stupidity and Facebook accounts.

This brings me to an article published by Australian Marie Claire in April of 2013 which has recently gone viral on social media networks across South Africa. The offending piece from the overrated penal colony claims that your oral contraception is a ticking time bomb which could go off at any moment rendering you anything from depressed to paralysed or even dead. As I’ve already illustrated with Aspirin, every single drug ever created has potential side effects. The important word here is ‘potential’ and the even more relevant concept is ‘risk versus benefit’. The use of any medicine should always be carefully considered for the risk it may pose to a particular patient and the benefit which they may gain from taking it. Some drugs which reduce blood pressure can cause kidney failure, but their benefit in preventing cardiovascular disease due to to high blood pressure most often outweighs the very small risk of causing kidney problems in a subset of patients which we can usually identify.

There are several issues with the Marie Claire article which raises most of its concerns with Yasmin and Yaz, third generation oral contraceptives taken daily by millions of women worldwide. The article selectively chooses to publish evidence about the number of adverse events and even law suits related to these drosperinone containing contraceptives. At no time does it provide any meaningful figures choosing instead to manipulate data so as to make the drug sound far more dangerous than it actually is.

For example if the occurrence of an adverse event in the normal population is 1 in 1 000 000 and in a population taking a drug this increases to 2 in 1 000 000, the best way to report this for effect would be to say that the drug causes a 100% increase in the adverse event. The fact that this is still very unlikely to happen is completely lost and is a common method used by those who wish to distort data to make their point (see Wikipedia for the definition of news media).

We, the medical fraternity, are acutely aware of the risks oral contraceptives. They’re banged into us, excuse the pun, from early on in our training. These include an increase in risk of venous thromboembolism (VTE) or ‘clots’, emotional lability and weight gain, amongst others. It is however important to remember that risk is the chance that something may happen but not a guarantee that it will.

In the case of oral contraceptives the increased incidence of VTE is 3 to 10 events per 10 000 life years on such an agent versus 1 to 5 events per 10 000 life years not taking the drug. Indeed that is as many as 10 times more events but in the overall scheme of things not actually significant enough to flush your pill down the toilet tomorrow morning (this is a euphemism, please don’t poison all of us and the fish with your birth control). Further studies analyzing the increase in relative risk show similar findings with an obviously increased risk of VTE of as much as 4 times in those on oral birth control, however this should be placed in context because pregnancy in itself increases the risk of VTE by up to 20 times and it is still a relatively rare occurrence.

That said it is for this reason that such drugs are only available on prescription from your doctor, who should inform you of the potential risks and complicating factors. I am baffled as to how Professor Kerryn Phelps, who claims to have taken Yasmin at the age of 46 and suffered a complication, could not have known that women over the age of 35 are at considerably higher risk of VTE. The risk in such patients usually outweighs any potential benefits and those of us with a non Australian medical education know this.

Lastly, and perhaps most importantly, is that all patients should be aware of changes to their mental and physical well-being which may be caused by the initiation or cessation of a drug. Such changes should not be ignored as several of the anecdotal case examples in the Marie Claire article seem to indicate. With that said if you’re choosing to get your health advice from any periodical they sell in the queue at your grocery store then you may have more mental health issues than any kind of contraceptive will cause. If you still disagree based on such anecdotal evidence then please find another suitable contraceptive because it’d probably be best for all of us if you didn’t breed.

(For more on interpreting erroneously reported scientific data please read this.)

Tagged , , ,

The Science of Cancer

The only politician you should trust is a dead one. Thus when politicians take to giving health advice you’d be well advised to ignore them and their pearls of wisdom. Last week member of Parliament Mario Oriani-Ambrosini wrote an article which was meant to discuss his journey with Cancer but instead took a cheap shot at the entire medical fraternity.

Ambrosini believes that he did so in the name of name of ‘hundreds of millions’ of cancer patients worldwide whom he quite obviously feels have been mistreated. The simple fact that none of the evidence supports such a view is clearly lost on the honourable member. Allow me to take you on a journey through the reality that is Cancer in 2013.

There is no doubt that cancer remains and will continue to be a major health problem facing all of humanity for the foreseeable future. The argument that science does not know what causes cancer is completely without foundation. The most basic definition of cancer is that it is the uncontrolled division of cells anywhere in the body. Simply put, this happens because of mutations in proto-oncogenes and tumour suppressor genes which are intended to prevent such cell behavior.

Proto-oncogenes provide the genetic information required for cells to grow and become parts of functioning organs. The mutation of these genes results in oncogenes which can then lead to the proliferation of cancer cells. Tumour suppressor genes, as the name implies, are part of the biological mechanism which defends the body against cancer by destroying cells which are damaged or function improperly. Mutations in these genes potentially result in the inability to prevent the aforementioned uncontrolled cell division. This is an incredibly simplistic and only partially complete explanation of the very complex mechanisms behind cancer, but it is just a glimpse of the volume of knowledge science possesses about one of our greatest enemies.

Patient autonomy, a fundamental of Bioethics, means that Ambrosini is entitled to choose his doctors and his treatment. Tullio Simonici is however not a doctor. He may have once qualified at a medical school but has since been stripped of his medical registration and was in 2006 convicted of fraud and wrongful death. Indeed he has in my opinion lost the right to use the title ‘Dr’. My opinion does not however prevent Simonici from selling the bogus cancer treatment which Ambrosini bought into. The notion that a fungal infection, vaginal thrush for those of you without science training, causes cancer or has any role in the development of the disease is without basis. The additional claim that Sodium Bicarbonate (cooking/baking soda) has any effect on cancer cells or fungus is equally without evidence. The further assertion that a gene (CYP1B1) which encodes for an enzyme acts as a self destruct mechanism for cancer is completely spurious.

According to US figures from the American Cancer Society, where Ambrosini claims 550 000 die each year despite treatment, 67% of people diagnosed with cancer now survive at least 5 years after receiving the bad news. The 5 year survival rates for localised breast cancer are 99% and an even better 100% for regional prostate cancer. It is true that more advanced disease translates to a lower chance of survival regardless of the interventions offered by medical science or the obligatory snake oil peddlers. In the case of Mr Ambrosini lung cancer with spread has relatively poor 5 year survival rates at a meager 4%. The general consensus is that metastatic mesothelioma confers a life expectancy of less than 2 years post diagnosis.

The potential cures for cancer which Ambrosini speaks of will not come from the Dalai Lama nor will they come from discredited medical practitioners trying to make a quick buck on the Internet. Cures will come from science and like them or not “Big Pharma”. The advances we have seen in the treatment and cure of several diseases including certain cancers are directly as a result of the massive investment by doctors, biologists, pharmacists, academic institutions, corporates and governments worldwide.

Cancer is not ‘science’s greatest failure’ but rather an ongoing success story for which the conclusion will sadly come too late for people like Mario Oriani-Ambrosini. It is understandable for terminal patients to clutch at even the smallest chance of survival regardless of any realistic expectation of success. That said muddying the waters with misinformation which only serves to endanger the lives of others is no way to end ones existence, not even for a politician.

Tagged ,

Simple Facts

The Daily Maverick recently published an article written by Mandy de Waal entitled ‘Baragwanath’s shame: a good man dies’. Sadly there are only two shames here and neither is that of a hospital or its staff. Firstly it is terrible that a man lost his life and even more unfortunate that by all accounts he seemed to be a caring and community focused individual. Secondly it is particularly appalling that the death of someone has been used to benefit a journalist and malign healthcare providers who do the very best for their patients in exceptionally difficult circumstances.

Essentially the exposé is about Godfrey Tenehi who passed away due to burns he sustained as a result of a fire in his shack. This is where the truth of the article begins and ends. The poor research and multitude of errors are quite frankly astonishing.

The article claims that an Advanced Life Support (ALS) Nurse was on the scene with the patient yet there is no such qualification. A nurse may have additional Trauma or even ICU qualifications but at no point are they specifically referred to as ALS, as is the case with Paramedics who can achieve this level of qualification. A simple search of the South African Nursing Council’s website would have revealed this simple fact.

One of the more junior Paramedics treating the patient says that ‘burn wounds are the worst because they are so painful’. While burns can be exceptionally painful this is entirely dependent on the extent and the depth of the burn wound. As it turns out the most severe burns, full thickness or what is also known as third degree burns, are painless because the nerves are destroyed. Since the journalist in this case emphasised the severity of both patients’ injuries, and having dealt with several shack fire victims, it stands to reason that the burns sustained here were mostly full thickness. A quick search of burns on Wikipedia would have revealed this simple fact.

Mandy goes on to describe Baragwanath Hospital as having one of the best burn units on the continent. This is not the case. Chris Hani Baragwanath Academic Hospital (CHBAH) has one of the best burn units in the world. It also has one of the largest most able trauma units as well as a very busy Intensive Care Unit. However CHBAH also serves an estimated population of six million people which means that resources are scarce. These include but are not limited to ICU beds, ventilators, heart monitors, stretchers and staff. On occasion the hospital becomes full and may not be able to cope with any further patients. This is the ‘divert’ as described in the article and had the Paramedic followed the protocol and taken the patients to Charlotte Maxeke Johannesburg Academic Hospital, an eleven minute journey with lights and sirens not 30 minutes as stated, both patients may have been better served on that particular night. A short conversation with any senior emergency service personnel would have revealed this simple fact.

After Godfrey was admitted to the hospital his brother, Ted Tenehi, claims that he was not seen by a doctor and was simply sent to a ward with ‘just a pipe in his mouth’. Ted also claims that despite being told that Godfrey was in the trauma ward this could not be the case because ‘there [were] people there who [were] sitting eating…and walking around’. Mr Tenehi’s ignorance can be forgiven, he is a layperson who is grieving a great loss. This does not excuse the failure of de Waal to explore the truth that no patient can be admitted to a ward without an admitting doctor; that no patient ends up with an endotracheal tube to maintain and protect their airway without a doctor; that no patient with burns is admitted to a hospital without large volumes of pain drugs (usually intravenous Morphine); that a trauma ward is one which has a spectrum of patients some of whom may be very ill and others who are/have recovered. A quick telephone call to any one of the thousands of doctors listed in the phone book would have revealed this simple fact.

The answer to Ted Tenehi’s question of ‘why his brother’s girlfriend was taken to ICU and his brother was taken to an open ward’ is much like many of the other facts in this case, very simple. The greater the percentage of burns the less chance a person has of surviving and the higher the mortality rate. Essentially any patient with more than 60% body surface area burns has a low chance of survival with that chance decreasing exponentially with each increasing point closer to 100%. Given the limited resources in all hospitals patients with a very poor prognosis are not considered candidates for ventilators or ICU beds. These are saved for those we know based on evidence have a fair chance of survival. This is not a South African phenomenon as all healthcare systems need to allocate resources effectively. Much can be said about public healthcare, but none should be without an appropriate amount of understanding of what is involved. When reporting on anything medical or otherwise a little bit of research goes a long way. Perhaps a first year journalism textbook would have revealed this simple fact.

Fabrice Muamba

Given the lack of luck the Irish have with the game of soccer (football if you’re one of those imperialist pigs) St Patrick’s Day was never going to be a good omen. Tragedy first struck when Kaizer Chiefs left a bucket of KFC behind their goal, giving Bennie McCarthy the impetus to score twice. Of course the second tragedy of the day occurred in the league in which Bennie used to be good enough to play.

In the 41st minute of the Tottenham – Bolton game Fabrice Muamba collapsed on the field. According to media reports the first medical responder turned him onto his side after which he was reassessed and then resuscitated. The details are quite sketchy and the TV footage is ‘respectful’ so it’s difficult to say what exactly was done, but it appears as if CPR (Cardio Pulmonary Resuscitation) was performed along with Defibrillation (that ‘cool’ shock thing House does every chance he gets).

The media have largely reported that Mr Muamba suffered a heart attack although some of them later changed this to say that he had suffered cardiac arrest. This is perhaps less informative than telling you that the sky is blue or that Lady Gaga is psychotic. While not impossible it is highly unlikely that a 23 year old fit athlete would suffer a heart attack, kind of like Superman suffering from impotence.

In general an athlete’s heart is stronger and more powerful than that of the average person.  Simple examples of this exist with people like Lance Armstrong and Miguel Indurain, who reportedly had resting heart rates of below 30 at their peak fitness (normal is 60 to 100).

Of course a heart attack is still a possibility if anyone exercises when sick, but given the environment of the Premier League it’s unlikely Fabrice would have been let out of his cotton wool had he been suffering with a cold, or even an ingrown toenail. One, or a top flight club, does not simply take chances with multi-million dollar investments.

So if not a heart attack then what explains cardiac arrest, which literally means ‘heart stop’, in a young healthy athlete?

There are several possibilities and no doubt those who want to take umbrage with this article will find some obscure congenital defect that may have caused the problem. However any good doctor will tell you that common things occur commonly. In this case the likely cause is what’s termed an Arrhythmia. The simple explanation is that your heartbeat, and the electrical impulse that governs it, is as well organized as a North Korean military parade. It is sharp, precise, and repetitive.

If for some reason this rhythm becomes interrupted it will change and become an Arrhythmia. The degree of change depends on a number of factors, and the ability to return to normal depends on several physiological inputs. However the more disorganized the rhythm becomes the less blood your heart pumps out, potentially making it a useless piece of hardware and causing you to fall unconscious and possibly die.

Over the past number of years there has been a lot of research around Sudden Cardiac Arrest (SCA) amongst athletes. In the run up to the 2010 FIFA World Cup (apologies for using the F word) several articles were published in relation to this topic and it was brought to the forefront of discussions in the emergency medicine community.

While the research remains ongoing there are several hypotheses as to why athletes seem to be at risk for SCA. A well established hypothesis is that certain individuals have what is known as channelopathies. Effectively this means that electrolytes (salts like Sodium and Potassium) are not transported as efficiently as they should be into and out of cells. This predisposes a person to abnormal and potentially deadly heart rhythms (Arrhythmia). In these cases genetic testing has been shown to be useful in families where there is a history of SCA, especially among young family members. Often several people in a family are affected, but once this is known a Cardiologist can offer treatment options.

As a rule making a diagnosis becomes more and more difficult the further away one is from a patient. That said based on current evidence it seems possible that Fabrice Muamba may have an undiagnosed channelopathy which then caused an abnormal heart rhythm and ultimately cardiac arrest. It should be noted that Muamba is still alive because he received CPR and Defibrillation very soon after collapsing. These are skills which are proven to save lives and can be performed by people who are not medically qualified but have been on a straightforward 4 hour course.

The message here is to know how to spot these ‘tragedies’, know how to provide the necessary emergency assistance, and to pretty much ignore any diagnosis made by the news media.

Imagine

Imagine being China.

Imagine being able to celebrate a new year with more fireworks than Pearl Harbor whilst not having to worry about scaring any pet dogs.

Imagine being able to have internet policies so opposite to the mantra of ‘Do No Evil’ that Google refuses to do business in your country.

Imagine being able to side with fascists in Iran, North Korea, Myanmar (Burma) and Sudan with absolute impunity.

Imagine being able to use child labour because iPhone users and LED Television viewers are prepared to ignore this fact as long as they have fancy consumer electronics.

Imagine being able to recolonise Africa by bribing high ranking government officials so that when all is said and done you own the majority of the world’s mineral resources.

Imagine being able to execute more people yearly than all other nations combined, especially the pesky political opposition to your regime.

Imagine if this New Year China resolved to be a better country. They won’t, but it’s nice to imagine.

Take One For The Team

When I was a medical student I was told on several occasions by different surgeons that ‘if I didn’t stick my finger in it (the rectum), I was bound to stick my foot in it’. I’ve always assumed (and hoped) that they were only speaking literally about the first part, although admittedly there are some odd doctors out there.

I mention this rather strange anecdote because November marks the beginning of Movember, a campaign promoting male health and more specifically awareness around Prostate Cancer. To show your support for the cause one should grow a moustache throughout the month. Naturally this movement has been taken on with much zeal by the same kind of men who think lifting weights and grunting loudly at gym is cool. In fact Movember is the kind of activity often done by groups of males who want to bow to peer pressure but feel that smoking or taking steroids is just too much effort.

Indeed most of the people who actively partake in the campaign, and even the Portuguese women who become involved by mistake, believe that they are doing good. After all Prostate Cancer is the most common cancer in South African men, it kills more than 2500 of us per year, and will affect 80% of men who reach the age of 80. Movember one could argue promotes an important aspect of health, and nails the message home because it is even endorsed by CANSA.

However there is a massive problem with this ingenious marketing concept despised by Gillete executives the world over. Besides the considerable funding raised for the various worthy organizations, the Movember campaign is a failure. This is because the best health advice any doctor could ever give you is that prevention is always better than cure. This is not just a saying but how all healthcare should be run and how every single human being should approach their health and well-being.

Instead of growing a moustache some marketing gurus should apply their minds to convincing billions of terrified men to go for a digital rectal exam. If this is too impossible a task, then even compelling men to make simple lifestyle changes which decrease their risk of developing Prostate and other Cancers would help. The truth is that cultivating facial hair will do absolutely nothing for your health, other than perhaps raising some money so that when you are dying of Cancer at least some caring NGO can sponsor the Morphine for your last few painful days, weeks or months on Earth.

Rather man up and take one for the gender team, then come home and tell your partner that regular ejaculation is proven to lower the risk of developing Prostate Cancer – you can thank me later.

My Personality Begs to Differ

I’m no Orthopaedic Surgeon but I have a bone to pick with Ndumiso Ngcobo. This past Sunday the teacher turned blogger turned Times columnist focused his attention on some of his best friends, doctors.

In essence Ngcobo asserts that doctors have no personality. That we are as bland as rice cakes or the people who write Sunday columns for the slow dying print media. Some colleagues have assured me that Ndumiso is merely being tongue in cheek, call it professional disagreement but my diagnosis is head up arse.

In his article, which you can find here, Ngcobo descbribes how his mother would have liked him to become a medical practitioner, a feat prevented only by his own laziness. Then again life can pass you by while in a comfy armchair from which you criticize the world.  Failing to discover a medical career Ndumiso is now forced to suffer being surrounded by several doctors clamouring for his attention whilst making bad jokes and worse dinner conversation.

Mr Ngcobo’s assertion is that “one can either choose to have a charming personality or get a medical degree. Not both”. He goes on to say that we can’t be funny and aren’t good looking. Someone please let Riaad Moosa and Michael Mol know of this revelation. I will concede that when doctors get together the conversation is often medical. Just like whenever there’s a doctor at the table everyone without medical training forgets their boundaries and thinks it’s acceptable to ask about their genital discharge.

Then again I really shouldn’t be offended. Not only is Ndumiso Ngcobo’s theory as flawed as the plot in a Twilight film, but his best work from this past week will be in a bin by Tuesday. My best work, and that of my colleagues, gets to celebrate another birthday.

iPerspective

Pancreatic Cancer is the 8th leading cause of Cancer death in the world. This past week the media reported on two men who died from the disease. Barring alien abduction there is very little chance anyone reading this does not know about one of the men who succumbed to the disease. Of course I am referring to Steve Jobs, but you knew that already.

Since word of his death first broke news and social networks have been packed with nothing else. At the peak of the postings an estimated 10 000 tweets were being sent per second. This breaks the previous record set by the earth shatteringly important announcement of Beyoncé’s pregnancy. At last count more than 2.8 million tweets had been sent relating to the death of the digital mogul with up to 5.9% of all tweets sent on Thursday containing the word ‘Apple’.

Since there are already an estimated 500 000 articles eulogising Mr. Jobs I’ll refrain from telling you all about the man who made it possible to keep an entire music library in your pocket, or to study ornithology by launching birds at three little pigs. Indeed Steve was many of the wonderful things people are saying about him. He was a visionary. He was a pioneer. He was the leader of the most profitable computer company in history.

It is true that the iPod, iPhone and iPad have had a massive impact on the way we use electronic devices and how we interact with the world on a daily basis. Some have said that Jobs changed the world, as if we wouldn’t have digital music players, smart phones and tablet computers without him. Perhaps the form of certain gadgets would be different but there is little doubt that most of the technology which exists today would still have been invented, with or without one man.

Regardless of whether you believe that Steve Jobs succeeded at Apple solely to make you happy in your skinny jeans or simply to make shareholders very rich, there is something very wrong with the way in which society has reacted to his death compared to that of the other man who died of Pancreatic Cancer.

Ralph Steinman, winner of this year’s Nobel Prize in Medicine, passed away largely unnoticed mere days before being awarded the honour. Steinman discovered and named ‘dendritic cells’ which form part of the innate immune system and are integral in identifying antigens. Effectively these cells recognise markers of a foreign substance in the body, from bacteria to viruses to poisons, and act as a biological trumpeter ensuring mobilisation of a cellular military force.

Much of the research Professor Steinman conducted aimed to understand and even manipulate the way the body’s immune system attacked foreign invaders. He researched HIV/AIDS this way and even treated his own Cancer ultimately prolonging his life. His discoveries will be instrumental for centuries and perhaps millennia because they form a building block on which the fight and cure of any disease is based.

In times past society made heroes out of people who stepped on the moon, transplanted hearts and surmised theories on relativity. Today our heroes are pregnant singers and Forbes Billionaires. The untimely death of Jobs and Steinman should give us one final gift from two talented people – perspective.