by Dr. Iain Corness
Update September 23, 2017
Hear today – gone tomorrow
I used that
headline a few years ago now, but it seems nobody listened! Should I
have shouted it a little louder? But jokes aside, deafness is an
increasing problem in Thailand, a fact which is being acknowledged by
the various noise abatement bodies in this country (and yes, amazingly
there are some).
For some reason,
noise seems to have become part of the local ‘culture’. How many times
have you heard people screaming into their telephones? At volumes so
loud they really don’t need the phone at all. Go into shopping centers
and be physically assaulted by noise levels so great they approach the
threshold of pain. I personally experienced one promotion for children
that had passers-by holding their hands over their ears, whilst two
screaming and amplified emcees exhorted the children to crowd around the
stage (and its boom boxes). The damage to the hearing of young ears
could be horrendous! Even walking down the street your ears are
assaulted by not just motorcycles but slow moving promotional vehicles
with mobile boom boxes to tell you all about the newest shopping center,
where you can shop in comfort, other than unrestricted noise!
What does not seem
to be understood by the public at large, however, is that hearing, like
eyesight, deteriorates over time. However, damage the hearing early in
life and when the hearing loss through aging is added to the hearing
loss from noise exposure, you are guaranteed of increasing deafness as
you get older.
What is not
understood is that “noise” is not just measured by intensity, but it is
volume multiplied by time of exposure. If the industrial noise level
exceeds 90 decibels (dB) for a 40 hour week, this is known as a ‘noise
dose’ of 1.0. If the noise level experienced by the unprotected ear was
over 120 dB, then the ‘safe’ exposure was measured in minutes. And as an
example of 120 dB, that is the level reached by an ambulance siren – or
a rock concert. Other examples are the hammer drill that you use to
drill holes in concrete which operates at 114 dB or a headset for
personal listening at full volume, so the ‘safe’ level here is 15
minutes a day. Even a hand drill operates at 98 dB, so the unprotected
ear should not be exposed to this level for more than two hours.
The noise induced
deafness characteristically affects the hearing at 4 kHz first, and that
is towards the upper musical ranges, and it goes on from there. If this
noise induced hearing loss begins early in life, then the chances of the
person ending up clinically deaf by the time he or she is 50 years old
is very high.
So what can be
done? Various research papers from around the world have managed to
quantify the risk, and others have managed to show that the risk is
perceived by older children and young adults, but they are not likely to
do much about it. In some ways I can agree with them. Why bother going
to a rock concert if you have to sit quietly to hear the music?
Journal of Public Health looked at this problem and reported that 74
percent of rock concert attendees thought it was likely or very likely
that noise levels at music concerts could damage their hearing, but only
three percent wore hearing protection.
Dr. Jeannie H.
Chung and co-workers from the Harvard Medical School found a few years
ago that only eight percent of young adults thought hearing loss was a
very big problem and yet most respondents had experienced tinnitus or
hearing impairment after attending concerts (61 percent) and clubs (43
So we know the
problem exists. We know the relative ‘safe’ levels of noise exposure,
but is wearing ear protection the answer? Quite frankly, this is a
classic example of the ambulance at the bottom of the cliff, rather than
the fence at the top of the cliff. Preventive action needs to be done at
the noise source. It is time for us to start shouting at the regulatory
authorities! And keep your children away from noisy shopping center
Update September 16, 2017
The ‘reality’ show
The ‘real’ danger? The
thought that immunizing your child makes it more likely that he or she will
develop Autism should have been put to rest years ago. Unfortunately this
has not been the case, despite reams of scientific reports.
Right at the outset,
please take on board the simple fact that MMR vaccine does not produce
Autism. I am only going to bore you this once on the subject, but there is
plenty of evidence, so please read.
For example, “Although
the Wakefield et al. (1998) case reports suggested that the MMR vaccine may
be associated with autism, recent epidemiological research has provided
strong evidence against any such connection. Kaye et al. (2001) conducted a
time trend analysis on data taken from the UK general practice research
database. As discussed earlier, they found that the yearly incidence of
diagnosed autism increased dramatically over the last decade (0.3 per 10,000
persons in 1988 to 2.1 per 10,000 persons in 1999). However, the prevalence
of MMR vaccination among children remained virtually constant during the
analyzed time period (97% of the sample). If the MMR vaccine were the major
cause of the increased reported incidence of autism, then the risk of being
diagnosed with autism would be expected to stop rising shortly after the
vaccine was instated at its current usage. However, this was clearly not the
case in the Kaye study, and therefore no time correlation existed between
MMR vaccination and the incidence of autism in each birth order cohort from
1998 to 1993.”
That was the UK. In the
US it was a similar story. “Most recently, the U.S. governments Institute of
Medicine, in a comprehensive report cosponsored by the National Institutes
of Health and the Centers for Disease Control and Prevention, recently
concluded that there exists no good evidence linking the MMR vaccine and
autism (Stratton, Gable, Shetty, & McCormick, 2001).”
And finally, in 2004,
the Institute of Medicine (IOM) Immunization Safety Review Committee, an
independent body of experts who have no conflict of interest with
pharmaceutical companies or organizations that make vaccine recommendations,
studied a possible MMR-autism link and found no evidence supporting such a
connection. A panel of experts brought together by the AAP reached the same
‘dangerous’? Despite claims from some sections of the world’s more vocal
communities, I was not at all worried when I took my children to have their
“shots”. Sure, I know there are ‘risks’, but all medical interventions have
a certain degree of risk attached to them. And when you stop to think about
it – just “living” has inherent risks.
I came across some
interesting Australian statistics when my son asked how dangerous was it to
surf Down-Under. Prepare yourself for some chilling data!
Last year, two surfers
were killed by sharks. So that means I’m never going in the water again.
However, 300 Aussies drowned, 1,200 had accidental deaths, 2,700 died of
cancer and 19,000 died from the results of smoking cigarettes. How are the
relative ‘risks’ now? I will chance the water again, though my pool is
probably the safest.
I shudder to think
about the risks of crossing the road on foot, forget the zebra crossings, as
we don’t have zebras in Pattaya, and let’s not talk about the road toll!
Yes, the second highest road toll per capita in the world.
With immunization you
have to consider the benefit versus risk, and for me, it really is a
‘no-brainer’. I did not want my children to get measles, a much more
dangerous illness than most people imagine, for example. The benefit of
immunization outweighs risk by far.
The following figures
came from the US comparing the results of immunization, versus the situation
before immunization campaigns. The first column shows reported diseases and
the last column shows the reduction from immunization.
Those figures tell you that
immunization is effective, and for me, the risks are almost negligible
compared to the benefits.
Please consider immunization as a high
priority for your children too!
BSE and it’s not Creutzfeldt-Jakob disease
I had an interesting discussion
with a colleague the other day regarding Breast Self Examination (BSE).
Is BSE worthwhile? What advances are there?
It made me think back to the words of Dr Michael
Moreton, previously the International Medical Coordinator at the Bangkok
Hospital Medical Center. I have taken the liberty (with his prior
permission) to reprint his letter.
“I was a specialist in Women’s
Health care for many years and the techniques used to screen for Breast
Cancer are of special interest to me.
“I agree wholeheartedly that Breast
Self Examination (BSE) is a useful method of monitoring the breasts.
Every woman’s breasts are different in texture and the patient becomes
an expert in her own breasts and can recognize changes that a doctor
might miss. I suggest to patients that a good time is in the shower or
while waiting for the water temperature to stabilize before getting into
“It is important to know the
correct technique. You should press the breast tissue between the chest
wall and the flat pads of your fingers, do not use the tips of the
fingers. When you have your next physical exam ask your doctor to
demonstrate how to do this. Every doctor has had the experience of a
woman coming to see them and telling them that they have a breast lump
and it is only with the woman’s instructions that the doctor can feel
the lump. It’s a good technique; we both recommend that you do this
“The debate about Mammography
swings one way and another. The modern machines are now using a digital
technique. This has several advantages. With the older machines there
was a worry that repeated mammograms might even cause cancer due to
radiation. There is no chance of that now. With the computer we can also
zoom in to worrying areas and get more information. Digital also has the
advantage that the pictures can be sent electronically for a second
opinion or put on a disk so that you can keep the pictures and show a
doctor in another country if that is your wish.
“Ultrasound, can also be useful in
certain situations. In order to perform mammography the breast has to be
compressed between two plates and X-rayed, in women with small breasts
this can be difficult and U/S may be a better method for these women.
Similarly women with breast implants may be additionally assessed with
this method. If I am particularly interested in one area of the breast I
will ask the technician to look carefully at the area. The U/S can be
angled in from different directions and this can be useful in examining
a worrisome area of the breast. Most modern U/S machines also have a
Doppler ability and they can identify areas of the breast with a
particularly rich blood supply, which can be a sign of trouble.
“The most exciting thing is the use
of genetic studies in assessing the chances of cancer in any one
patient. We know that there are two genes BRCA1 and BRCA2 which can be
inherited and will increase the chances of cancer developing. When this
blood test is perfected any woman will be able to have a blood test to
see if she has a high risk or a low risk of getting breast cancer. Then
different screening programs can be arranged.
“A few dietary steps can be taken
which may help to reduce the chances of cancer. A diet full of fat is
thought to be dangerous; one more reason to avoid them. One positive
step that mothers should take is to breast feed their babies as it is
found that this activity is protective.”
Thank you Dr Moreton, your thoughts
from a few years ago are just as relevant today. The genetic studies
have to be thought of as “risks” not an absolute diagnosis. Newer
technology now has three-dimensional mammography (also called digital
breast tomosynthesis, digital tomosynthesis, or just tomosynthesis)
creating a three-dimensional picture of the breast. A conventional
mammogram only creates a two-dimensional image of the breast from two
digital images of each breast.
And while the boffins develop even
better techniques, it still needs you ladies to go looking too.
There are many
supplements including Vitamin B 12, that have been touted as “the answer”
for everything from old age and Alzheimer’s to heart disease, breast cancer,
high cholesterol, and sickle cell disease. However, the results have been
inconclusive. Studies are also suggesting that vitamin B-12 does not help
with stroke risk or lung cancer. Nor will it take strokes off your golf
However, there is some
evidence to suggest that some supplements can enhance health in different
ways. The most popular nutrient supplements are multivitamins, calcium and
vitamins B, C and D. Calcium supports bone health, and vitamin D helps the
body absorb calcium. Vitamins C and E are antioxidants - molecules that
prevent cell damage and help to maintain health.
One trend is to take
daily doses of antioxidants such as beta carotene, vitamin A and C or
selenium to protect yourself against cancer, heart disease or signs of
premature ageing. There is some scientific evidence that people who have a
high level of antioxidants in their diet have a lower risk of heart disease
and certain cancers. That is why the nutritionists say we should eat at
least five portions of fruit and vegetables a day. However, other studies
also suggest that taking those same antioxidants in pill form may not have
the same effect and may even be harmful. Who do you believe!
Here’s where we start
to have a ‘belief’ problem. Is Big Pharma blocking the sale of health giving
supplements because Big Pharma doesn’t “own” them? One problem in the
supplements studies is the fact that supplements are not as rigidly tested
as are front-line treatments, so the supplements you want to take, may in
fact be useless. Or worse, downright dangerous.
When Big Pharma
develops something new it then takes several years before this new wonder
drug hits the market, after expenditure of millions of dollars. And remember
that if Big Pharma can’t make money from new drugs, then all research will
halt. The drug to cure cancer will not be found. It is not being held back
by Big Pharm, let me assure you. The pill to stop cancer will make the
owners of the patent gazillions, not just billions.
But I sidestepped
myself. We are all living longer, so what can we do to get our hands on the
elixir of youth? If you believe folklore, the answer to aging is again
multivitamins. Peddling mega-vitamins is a megabuck industry, credited with
improving your health, your love life and fixing everything from falling
chins to falling arches.
still conflicting evidence about whether taking certain vitamin supplements
can affect a person’s risk of cancer,” says Dr Alison Ross, at Cancer
Research UK. “These products don’t seem to give the same benefits as
vitamins that naturally occur in our food.”
chief dietitian at St George’s Hospital in London says, “The whole idea that
you must meet some vitamin and mineral target every day of your life is a
marketing myth. You can eat lots of fruit and veg one day and not much the
next but over a week you will still get the right amount of nutrients. There
is very little scientific evidence that there is any benefit whatsoever in
taking a daily multivitamin - even in old people. You cannot exist on a poor
diet then shore yourself up with a multivitamin. The idea that taking high
quantities of vitamins will give you a health boost - like putting premium
petrol in your car - is complete nonsense.”
Dr Toni Steer,
nutritionist with the British Medical Research Council’s Human Nutrition
Research in Cambridge, states supplements cannot compete with real food
because when we eat fruits and vegetables the vitamins and nutrients
interact with other chemicals to produce positive effects on the body. “If
these same vitamins are pulled out and isolated in pill form, there is no
guarantee at all that they will have the same effect.”
A study in the journal
of the American Medical Association found that people who took antioxidant
vitamin tablets (particularly vitamins A and E, and beta-carotene) were more
likely to die earlier than those who did not. Oops! What next?