Biting on a bullet!
Surgeons can be the
‘prima donnas’ of medicine, if you like. It is the surgeons who get the
headlines in the newspapers. It is the surgeons who are the stars in movies
and TV. Who can remember the irascible surgeon Sir Lancelot Spratt (Dr. In
The House, 1954) or the young surgeon Dr. Kildare (1961)? Slightly more
recent, the American surgeons in M*A*S*H?
However, surgeons have been around for
many centuries and have their own Royal College. The origins of the first
Royal College of Surgeons go back to the fourteenth century with the
foundation of the ‘Guild of Surgeons Within the City of London’. There was
dispute between the surgeons and barber surgeons until an agreement was
signed between them in 1493, giving the fellowship of surgeons the power of
incorporation. In 1745 the surgeons broke away from the barbers to form the
Company of Surgeons. In 1800 the Company was granted a Royal Charter to
become the Royal College of Surgeons in London. A further charter in 1843
granted it the present title of the Royal College of Surgeons of England (of
which I proudly say I am a member).
We marvel at the surgical advances in
the past century, but while I take my hat off to the surgeons, the real
praise goes to the anesthetists. Without the advances in anesthetics, brawny
assistants would still be holding patients down while surgeons attacked with
scalpels and saws and the patient lay there biting on a bullet.
The first anesthetic agent was ether,
dribbled on to a mask to knock the patient out and allow the surgeon to take
his time and become meticulous in his approach. The first public
demonstration of ether anesthesia took place on 16 October 1846, at
Massachusetts General Hospital in Boston. The anesthetist was William Morton
and the surgeon was John Warren; and the operation was the removal of a lump
under the jaw of a Gilbert Abbott.
While there have been enormous advances
since then, I can remember being a medical student and assisting at an
operation in outback Australia in 1964. The anesthetic was ether, dribbled
on to the patient’s gauze mask by the matron of the public hospital, and it
was a Caesarian section for twins. There was no air-conditioning and it was
43 degrees in the theatre, where the fumes were making us all woozy.
Amazingly everyone survived the ordeal, mother, twin sons, the local doctor,
the matron and me.
Despite outback Australia, anesthesia
progressed in the rest of the world. Chloroform was introduced by James
Simpson, the Professor of Obstetrics in Edinburgh, in November 1847. This
was a more potent agent but it had more severe side effects, including
sudden death. However, it worked well and was easier to use than ether and
so, despite its drawbacks, became very popular.
The next major advance was the
introduction of local anesthesia – cocaine – in 1877. Things definitely did
go better with ‘coke’! Then came local infiltration, nerve blocks and then
spinal and epidural anesthesia, which in the 1900s allowed surgery in a
relaxed abdomen, and is still used today, especially in obstetric
anesthesia, where the mother can be anaesthetized without the baby being
affected as well.
The next important innovation was the
control of the airways with the use of tubes placed into the trachea. This
permitted control of breathing and techniques introduced in the 1910s were
perfected in the late 1920s and early 1930s. Then came the introduction of
intravenous induction agents. These were barbiturates which enabled the
patient to go off to sleep quickly, smoothly and pleasantly and therefore
avoided any unpleasant inhalational agents. Then in the 1940s and early
1950s, there came the introduction of muscle relaxants, firstly with curare
(the South American Indian poison, but not administered by native blowpipe)
and then agents less dangerous.
Anesthesia is now very safe, with
mortality of less than 1 in 250,000 directly related to anesthesia.
Nevertheless, with today’s sophisticated monitoring systems and a greater
understanding of bodily functions, the anesthetic profession will continue
to strive for improvement over the next 150 years.”
On behalf of all patients requiring
surgery in the future I thank the anesthetists. No longer do they have to
bite on this bullet!
Influenza and the WHO
I am no great lover of the World
Health Organization (WHO). I have to query the decision to make
Zimbabwe’s despot the ambassador? I do also believe that the WHO “needs”
epidemics to generate funding, to keep going. But then, I may be an old
Here are some of the WHO “killer” epidemics. We
should not forget the panic with the Swine flu (also H1N1) a few years
ago. Bulletins from the WHO every day added to the panic. The word
“pandemic” instills fear and even hysteria.
Where WHO let itself and us down was the fact that
WHO did not tell the media that the immediate danger of viral infections
has two requirements – how easily it passes from one host to another and
how lethal is the ensuing infection.
The ‘pandemic level 6’ only referred to the
contagious nature of the virus and H1N1 is certainly highly contagious.
However, with only around 4000 deaths in the world from that 2009 Swine
Flu virus, just how lethal was it, when the seasonal flu kills 36,000
people each year just in the US alone, and 200-300 people in Thailand?
Read those numbers again – 200-300 people from the seasonal flu in
Thailand! That’s from the “nothing out of the ordinary” flu!
Right, what can you do about avoiding a full-blown
influenza infection this year? Quite simply, flu vaccination can keep
you from getting sick from flu. Protecting yourself from flu also
protects the people around you who are more vulnerable to serious flu
illness. That’s the contagious nature again.
Flu vaccination can help protect people who are at
greater risk of getting seriously ill from flu, like older adults,
people with chronic health conditions and young children.
Flu vaccination may also make your illness milder
if you do fall ill.
Flu vaccination can reduce the risk of more serious
flu outcomes, like hospitalizations and deaths.
A recent study showed that flu vaccine reduced
children’s risk of flu-related pediatric intensive care unit (PICU)
admission by 74 percent during flu seasons from 2010-2012. Yes, a 74
One study showed that flu vaccination was
associated with a 71 percent reduction in flu-related hospitalizations
among adults of all ages and a 77 percent reduction among adults 50
years of age and older during the 2011-2012 flu season.
Flu vaccination is an important preventive tool for
people with chronic health conditions. Vaccination was associated with
lower rates of some cardiac events among people with heart disease,
especially among those who had had a cardiac event in the past year. Flu
vaccination also has been shown to be associated with reduced
hospitalizations among people with diabetes (79 percent) and chronic
lung disease (52 percent).
Vaccination helps protect pregnant women and their
babies for up to 6 months after they are born. One study showed that
giving flu vaccine to pregnant women was 92 percent effective in
preventing hospitalization of infants for flu.
Other studies have shown that vaccination can
reduce the risk of flu-related hospitalizations in older adults. A study
that looked at flu vaccine effectiveness over the course of three flu
seasons estimated that flu vaccination lowered the risk of
hospitalizations by 61 percent in people 50 years of age and older.
There are special vaccination instructions for
children aged 6 months through to eight years of age as some children
require two doses of influenza vaccine. Children in this age group who
are getting vaccinated for the first time, as well as some who have been
vaccinated previously, will need two doses. Your child’s health care
provider can tell you whether two doses are recommended for your child.
A complicating factor comes with the annual make-up
of the actual vaccine itself. Since the viral strains dominant in any
particular year can change, this does mean you should top up your immune
status with an annual jab.
In some quarters there is still resistance to
influenza immunization as well as the childhood vaccinations, but to be
honest, I cannot understand why. Sure, there are risks involved with
immunization, but those risks are very, very small compared to the risks
in getting the flu.
News of the latest earth-shattering
breakthrough crossed my desk last week, complete with the promise that this
new treatment will stave off Alzheimer’s and Parkinson’s disease and will
help me live to be 120.
Now, that makes me think about whether I actually want
to live to be 120. Watching the natural progression of aging in myself, I
have this feeling that 100 will be enough. I could do without the
Alzheimer’s and Parkinson’s though.
The new pill is actually an old pill called Metformin
which is used in the treatment of diabetes, and the first trials on
metformin will be next year in the hope it may return what is considered to
be very promising. If successful, it would mean that a person in their 70’s
could have the same biological age as a healthy 50 year old. Projecting that
further, it might mean that at 120 the person will be like a spritely 100
Professor Gordon Lithgow of the Buck Institute for
Research on Aging in California, who will lead the study, said, “If you
target an aging process and you slow down aging then you slow down all the
diseases and pathology of ageing as well. I have been doing research into
aging for 25 years and the idea that we would be talking about clinical
trial in humans for an anti-aging drug would have been thought
inconceivable. But there is every reason to believe it’s possible. The
future is taking the biology that we’ve developed and applying it to
According to the research people, they have already
conducted tests on animals which show it significantly extends their lives.
Belgian researchers tested metformin on a species of
roundworm and found that they not only aged more slowly, but also stayed
healthier for longer.
Now that may be so, but also stretches research into
incredulity. Animal experiments are generally done on species that have
something in common with humans, hence beagles, laboratory rats and mice and
the odd chimpanzee. But roundworms? Come on!
However, the Food and Drug Administration, the American
regulator, has given the go-ahead for the same trials in humans, so if you
find someone crawling along on their belly on your lawn, you’ve just spotted
a 120 year old volunteer.
Scientists believe that metformin could hold the key to
anti-aging because it boosts the number of oxygen molecules released into a
cell. This appears to boost their strength and ability to survive for a
longer period of time.
The trial, known as Targeting Aging With Metformin, or
TAME, is due to begin in the US next winter.
Scientists from various universities and organizations
are raising funds and attempting to recruit 3,000 adults aged 70 to 80 who
have or are at risk of cancer, heart disease or dementia.
This is where the whole thing becomes more than
somewhat silly. Everyone aged 70-80 is more at risk of cancer, heart disease
or dementia than anyone younger. This easily proved.
And here is more evidence that academia can fiddle the
figures when required. Cardiff University uncovered anecdotal evidence that
patients given metformin for diabetes lived longer. Oh yes? This was despite
the fact that those with the illness tend to have shorter life expectancies
because they are more prone to heart attacks, strokes and kidney damage.
University researchers with “anecdotal evidence.” May I
remind them that “evidence” requires hard facts, not anecdotes! And remind
myself to steer clear of Welsh universities.
Never forget that what keeps scientific research going
is “money”. When you have a research laboratory, you need money to keep it
going. And the best way to raise money is to promise breakthroughs,
especially cancer and anti-aging. Nobody wants cancer and nobody wants to
die. As I write this, there are people scouring the globe looking for a
“cure” for their cancer, and for many, there isn’t one, but they are
prepared to clutch at straws. Wouldn’t you? Wouldn’t I? (No I wouldn’t.)
So should all the diabetics I know start celebrating
while waiting for their expected century? No, is the answer, and that
statement was all done without fancy titled “research” trials.