Thursday, July 21, 2016

Korea & Sunshine: Suicide!, Diabetes & Autism!

©Am Ang Zhang 2015

As Vitamin D is hitting the news, I am reprinting my blog that touches on the Korea phenomenon. We are of course talking about the Samsung Korea which has over the last 50 plus years adopted Western Science, Sports and Culture in a very big way.

South Korea has topped the world in Suicide rates (24.7/100,000) and now they found that Diabetes rate is as high as the US without the obesity that is normally associated with it. Could Sunshine/Vitamin D be part of the answer?

South Korea has enjoyed its link to the west and has embraced advances in modern technology that has helped to establish itself as a major force in Steel and Car production. It is not backward in embracing modern electronic technology and is a major player in Computers, Cell Phones and of course Television.

They have a culture of taking things seriously and that shows in their attention to technical details in advance production. Why else do you think much of Apple’s iPhone component is made by its rival, Samsung.

South Korean children were brought up to play golf and western music instruments. South Korea supplies western orchestras with a large number of musicians.

South Koreans embrace western idea of medical advance as well. Could this be the cause of one of its problems?

The Independent:
Saturday, 14 May 2011
A population-wide study of South Korean children has shown autism rates much higher than in the United States, suggesting more people worldwide may have the disorder than previously thought.

By examining 55,000 children age 7-12, even those not enrolled in special education programs, researchers found that one in 38 children had some form of autism, including the more mild social disorder known as Asperger's Syndrome.
In the United States, the autism prevalence rate is believed to be one in 110.
1: 38?
In my recent cruise of Central America crossing the Panama Canal, it is not difficult to spot the South Koreans. They were dressed to be protected from the sun.
Despite temperatures reaching the mid 90s F, long sleeves, long slacks and hats with near complete surround was the order of the day; and Golf gloves as well, for both hands. And that is just for walking around town.
I have no idea how much Sunscreen they use, but that would be 50 SPF minimum.

You stay indoors with music instruments!
So lets look at their golfers:

Very little sun tan!!!

In an earlier post:
April 1,2009
Confirming the fears of Somali immigrants in Minneapolis, the Minnesota Health Department agreed Tuesday that young Somali children there appeared to have higher-than-usual rates of autism.

"Though health officials emphasized that their report was based on very limited data, they concluded that young Somali children appeared to be two to seven times as likely as other children to be in classes for autistic pupils.”
Could sunshine or the relative lack of it be the culprit here. Sunshine and Vitamin D3 is the new black. 

In the history of Medicine, we sometimes ignore the most obvious. Just like mosquitoes in diseases in Panama.
Autism posts:

Wednesday, July 20, 2016

Bipolar Disorder: Lithium & Neuro-protectiveness!

Australian Trilogy:

Bipolar Disorder: Lithium-The Aspirin of Psychiatry?


Fremantle: Medical Heresy & Nobel


Tasmania & SIDS: The wasted years!

©Am Ang Zhang 2013

Cade, John Frederick Joseph (1912 - 1980)
Taking lithium himself with no ill effect, John Cade then used it to treat ten patients with chronic or recurrent mania, on whom he found it to have a pronounced calming effect. Cade's remarkably successful results were detailed in his paper, 'Lithium salts in the treatment of psychotic excitement', published in the Medical Journal of Australia (1949). He subsequently found that lithium was also of some value in assisting depressives. His discovery of the efficacy of a cheap, naturally occurring and widely available element in dealing with manic-depressive disorders provided an alternative to the existing therapies of shock treatment or prolonged hospitalization.

In 1985 the American National Institute of Mental Health estimated that Cade's discovery of the efficacy of lithium in the treatment of manic depression had saved the world at least $US 17.5 billion in medical costs.

And many lives too!

I have just received a query from a reader of this blog about Lithium, and I thought it worth me reiterating my views here.      It is no secret that I am a traditionalist who believes that lithium is the drug of choice for Bipolar disorders.

The following is an extract from The Cockroach Catcher:
“Get him to the hospital. Whatever it is he is not ours, not this time. But wait. Has he overdosed  on the Lithium?”

“No. my wife is very careful and she puts it out every morning, and the rest is in her bag.” 

Phew, at least I warned them of the danger. It gave me perpetual nightmare to put so many of my Bipolars on Lithium         jjjjj          but from my experience it was otherwise the best.

“Get him admitted and I shall talk to the doctor there.”

He was in fact delirious by the time they got him into hospital and he was admitted to the local Neurological hospital. He was unconscious for at least ten days but no, his lithium level was within therapeutic range.

He had one of the worst encephalitis     they had seen in recent times and they were surprised he survived.

Then I asked the Neurologist who was new, as my good friend had retired by then, if the lithium had in fact protected him. He said he was glad I asked as he was just reading some article on the neuroprotectiveness of lithium.

Well, you never know. One does get lucky sometimes. What lithium might do to Masud in the years to come would be another matter.

I found that people from the Indian subcontinent were very loyal once they realised they had a good doctor – loyalty taking the form of doing exactly what you told them, like keeping medicine safe; and also insisting that they saw only you, not one of your juniors even if they were from their own country. It must have been hard when I retired.

Some parents question the wisdom of using a toxic drug for a condition where suicide risk is high. My answer can only be that lithium seems inherently able to reduce that desire to kill oneself, more than the other mood stabilizers, as the latest Harvardresearch shows.
Lithium has its problems – toxic at a high level and useless at a low one, although the last point is debatable as younger people seem to do well at below the lower limit of therapeutic range.
Many doctors no longer have the experience of its use and may lose heart as the patient slowly builds up the level of lithium at the cellular level. The blood level is a safeguard against toxicity and anyone starting on lithium will have to wait at least three to four weeks for its effect to kick in. In fact the effect does not kick in, but just fades in if you get the drift.
Long term problems are mainly those of the thyroid and thyroid functions must be monitored closely more so if there is a family history of thyroid problems. Kidney dysfunction seldom occurs with the Child Psychiatrist’s age group but is a well known long term risk.
Also if there is any condition that causes electrolyte upset, such as diarrhea, vomiting and severe dehydration, the doctor must be alerted to the fact that the patient is on Lithium.
Could Lithium be the Aspirin of Psychiatry? Only time will tell!
Related Posts:

Chile: Salar de Atacama & Bipolar Disorder.

The Cockroach Catcher
Review on Amazon

The Cockroach Catcher on Amazon Kindle UKAmazon Kindle US

Monday, July 18, 2016

Sleeping on Duty: Bed 1 & The Moon!

Recent Junior Doctor discussions on sleeping on duty brought back memories for this retired Child Psychiatrist. When I did my first House Job (residency) in Internal Medicine I was on for two nights out of three and three weekends out of four as it is busier weekends and more of us would be needed. 

We have three Internal Medicine Units and I am in Medical C for want of a creative name or a rich donor. We need to be on after acute take as these were our patients. It provided for continuity and training. Then we are off for one night when, if we do go to the cinema, it would be a waste of money as we fell asleep within minutes. We have 36 beds and bed 1 is with bed 36 behind the nurse station. Nurses tried not to use bed 36 so that the Houseman could catch some sleep. I once fell asleep on one of the those rare nights when everything went quiet at about 2 am. I was catching up with history from a wife at the nurse station. The wife stood across the highish station and the next I knew was that an hour or so went by. I fell asleep holding my pen. 

The wife of the patient just said: You must be tired, doctor. 

No complaints and she did not walk off either. I was so grateful. Medicine the way it should be. In Hong Kong.

©2013 Am Ang Zhang

Then I remember my Bed 1 patient: 

The Cockroach Catcher  Chapter 47  Going To The Moon

 ime and again I have been asked why I decided to pursue child psychiatry as my career. This question was often posed by my juniors who were at the point of their life when they had to choose their career path. It would have been dishonest of me to tell them that I knew exactly why. In life certain events seem to just happen and hopefully they gel together well enough so that one does not have to say at the end of one’s working life that a wrong decision was made.
         After passing my finals, I did my internship in Internal Medicine and Obstetrics and Gynaecology.
         In our final year the first reports came through of cures in Leukaemia.  People’s hopes were rekindled and Medicine moved into a new era.
         Needless to say cancer touches every family in more ways than one can imagine and especially when it hits at one’s prime in life it is a highly emotive thing. In other words, no one is immune, not even if you are a doctor. At the time of my internship we had to deal with all those over the age of twelve and a number of inpatients were young Oncology cases. One of the boys I can remember was having the full VAMP treatment. Someone had a dry sense of humour to borrow from the word Vampire and with good reasons. Blood samples had to be drawn often and it was years later that I appreciated the work of some psychiatrists who recommend the limiting of daily blood drawing to before 10 A.M. every morning. This simple enforceable rule greatly reduced the emotional stress of the children involved. Patients were by and large compliant and they knew that the blood drawing was important.  When they were able to work out that it would not happen after 10 A.M. they had at least a good ten hours of relative peace.
         I had this highly intelligent boy on the ward with Leukaemia on treatment. He was barely thirteen and looked nine-ish. He was my most helpful assistant and would follow me on the lab trolley when I was doing my blood sample rounds. He would fill in the forms and match the numbers on the sample bottles. He never made a single mistake as far as I can remember.  Most of my contemporaries had some pet patient like that. How else could we have got through the day’s work? Most sisters and matrons turned a blind eye and the consultants and professors had been there so they did not mind either. Considering that we were then spending the major part of our waking life on the ward, we got closer to these patients than to anyone else in our life at that point.
         This boy was beginning to show the effect of steroids and he had some of the most frightening nightmares when he would scream in the middle of the night and nothing much would comfort him. He would sit up and say something about going to the moon and that was probably the only thing of which anyone could make some sense. The regular night nurse who had children of his age was most fond of him and would give me detailed reports of the timing of such occurrences. At other times I could see her playing her mother rather than nurse role and just holding him while he sobbed.
         He had the Number 1 bed which was right by the nurse’s station and it was a rather cosy one as the bed opposite was generally the last one to be used. If I had not been on call, he would give me a quick run down on who was new and who was unconscious and who had insecticide poisoning from suicidal ingestion. In any case, one could smell the insecticide as one walked in as these survivors breathed it out.
         We all so hoped that the cure would extend to him and he would certainly make a good doctor or a good nurse.
         One day when I returned from weekend leave – the one in four weekend that we got to catch up with our sleep, our romance and our family – I could smell something but it was not Malathion[1]. Something was wrong. All his things were gone and the bed was now stripped bare. Night nurse was still around, waiting for me to turn up.
         “He has gone to the moon,” she said.
         Oh no. He had a massive bleed in the brain and passed away during the weekend. His last words were: I am going to the moon.
         I more or less decided at that moment that although we were brought up on the first day of Medical School to confront death, this just might be too much for me. Dealing with the death of a good friend’s father following a cerebral haemorrhage was hard enough but the passing of a young thirteen year old was going to leave its mark and I did not want too many of those.

The Cockroach Catcher
Review on Amazon

The Cockroach Catcher on Amazon Kindle UKAmazon Kindle US

Can it be that it was all so simple then
Or has time rewritten every line
If we had the chance to do it all again
Tell me - Would we? Could we?
                                                                      The Way We Were


A Chapter on Anorexia Nervosa,  

Anne of Green Gables

[1] Malathion – an insecticide often ingested in attempted suicides at the time.

Sunday, July 17, 2016

Shoe, Hunt and Simon: Elite! Elite!

Just watched the film version of The Big Short:

I think there is something fundamentally scary about our democracy…. Because I think people have a sense that the system is rigged, and it’s hard to argue that it isn’t.

                            Michael Lewis: The Big Short

So smart and well-shoed PM convinced Hunt to stay on to finish his plot or has she no choice but to keep him on for the final kill, only time will tell. No doubt the future is bright for private health insurers as they have no obligation to look after the already ill people or if you somehow catch psychosis. They can legally dump you. Even for Anorexia Nervosa. Or theycan pay you a small fee to go back to NHS ( well the few bits still left). Either way, doctors are no match and doctors with hearts? don't even think about it. Punters will queue up at A&E but Simon had a plan: persuade you to use community hospitals and UCCs and then later close Community Hospitals. When we have someone who gave up millions at UnitedHealth looking after us: the future looks bright but only for some.

Jeremy Hunt:

So there’s Jeremy newly installed as Health Secretary after just seven short years as an MP. This is a summary of his meteoric rise:

He made a fortune at the taxpayers’ expense as monopoly supplier to a notorious quango where, by happy coincidence, his cousin sat on the Board. He became MP for SW Surrey where, by happy coincidence, his cousin had been MP previously. He became Minister in charge of Media & Culture where, by happy coincidence, he wound up steering his pals at Newscorp in the right direction. And he became Health Secretary partly because, by happy coincidence, his cousin is a lobbyist for the private health sector.

Virginia Bottomley: Secretary of State for Health 1992-95   now with BUPA. Cousin  of  Jeremy Hunt.

Andrew  Lansley
The former Health Secretary Andrew Lansley blocked an attempt to hold a Parliamentary debate into the influence of an NHS lobbyist who he has admitted to knowing “over many years”.
Today The Independent revealed that NHS bosses allowed a lobbying company run by John Murray to write a draft report which could help shape future health policy.
But attempts to get the report’s origins debated in Parliament were blocked by Mr Lansley, who is now Leader of the House of Commons and in charge of scheduling legislation and debates.
The issue was raised by the Liberal Democrat MP Tessa Munt last month.
But Mr Lansley rejected her request replying: “I know John Murray, I know him over many years to be, in personal terms, someone very expert in relation to specialised healthcare issues. The responsibility lies I think with NHS England and it is their job to exercise a dispassionate and impartial approach to the making of policy.”

David Miliband

Like his mentors Tony Blair and Peter Mandelson, Mr Miliband is one of that unappetising breed of modern politician that has chosen to profiteer out of public service. It is a pity that the BBC did not ask him whether his sudden decision to abandon his constituents was not informed by a desire to keep his huge earnings out of the public eye.
During his short, undistinguished career, Mr Miliband has done grave damage to British politics. He is part of the new governing elite which is sucking the heart out of our representative democracy while enriching itself in the process. He may be mourned in the BBC and in north London, but the rest of us are entitled to form a more realistic view. David Miliband has belittled our politics and he will not be missed.
Money? Really?
The House of Commons register reveals that he has earned an incredible sum – nearly £1 million – from outside interests since losing the party leadership to his brother, including £125,000 for 15 days’ work as a director of Sunderland, a constituency-based football club owned by a super-rich businessman with interests in private equity. Approximately £60,000 has come his way from the UAE, a gulf state with an unappetising human rights record, and another hefty chunk from St James’s Place, a company that advises very rich people how to invest their money.
It looks as though these people are everywhere! The Shadow Elite.

Are you ready to read it? 


It is scary!!!

"The new breed of players," writes Wedel, "who operate at the nexus of official and private power, cannot only co-opt public policy agendas, crafting policy with their own purposes in mind. They test the time-honored principles of both the canons of accountability of the modern state and the codes of competition of the free market. In so doing, they reorganize relations between bureaucracy and business to their advantage, and challenge the walls erected to separate them. As these walls erode, players are better able to use official power and resources without public oversight."
"That's a spot-on description of what happened with health care -- as well as a spot-on description of the totally-lacking-in-transparency bailout of the financial system. Remember how the bailout was supposed to take care of not just Wall Street but Main Street? Well, the former ended up with record profits and bonuses while the latter is looking at double-digit unemployment -- and millions of foreclosures and bankruptcies -- for the rest of the year."

Perhaps the decade!
                                            Janinie R. Wedel is an anthropologist.

"We Are Wall Street" that circulated this spring, directed at Main Street America

: "We eat what we kill, and when the only thing left to eat is on your dinner plates, we'll eat that."

The 21st century power brokers -- less stable, less visible, more peripatetic, and more global in reach than their elite forebears -- are potentially more insidious and dangerous to democracy. Their manoeuvrings are largely beyond the reach of traditional monitors. Unlike the rest of us, these players are virtually immune to accountability to voters or government or corporate overseers, because the full range of their activities and their true agendas are more difficult to detect.                                      
   Janinie R. Wedel

Looks like they are here and targeting our much loved NHS.

“Interestingly, former health ministers have done particularly well. The ex-health secretary Patricia Hewitt earns more than £100,000 as a consultant for Alliance Boots and Cinven, a private equity group that bought 25 private hospitals from Bupa. After leaving the department, her predecessor, Alan Milburn, worked for Bridgepoint Capital, which successfully bid for NHS contracts, and now boasts a striking portfolio of jobs with private health companies.”

Alan Milburn

Following his resignation as Secretary of State for Health (to spend more time with his family, his partner is a hospital doctor), Milburn took a post for £30,000 a year as an advisor to Bridgepoint Capital, a venture capital firm heavily involved in financing private health care firms moving into the NHS, including Alliance Medical, Match Group, Medica and the Robinia Care Group. He has been Member of Advisory Board of Pepsico since April 2007. Wikipedia

 Alan Milburn now also holds a place on the board of PepsiCo as an advisor.        Wikipedia

Patricia Hewitt

In January 2008, it was announced that Hewitt had been appointed "special consultant" to the world's largest chemists, Alliance Boots. Such an appointment was controversial given Hewitt's former role as Health Minister, resulting in objections to her appointment by members of a Parliamentary committee. Hewitt will also become the "special adviser" to private equity company Cinven, which paid £1.4 billion for Bupa's UK hospitals.

In March 2008, it was announced that Hewitt will join the BT Group board as a non-executive director.[40] She joined the group on 24 March 2008. In July 2009, Patricia Hewitt joined the UK India Business Council as its Chair.

In May 2009 The Daily Telegraph reported that Hewitt claimed £920 in legal fees when she moved out of a flat in her constituency, stayed in hotels and then rented another flat inLeicester. Claimed for furniture including £194 for blinds delivered to her London home. In June 2009 Hewitt announced that she will be stepping down from the House of Commons. She said she was leaving the Commons for personal reasons as she wanted to spend more time with her family.   Wikipedia
David Bennett is the current head of Monitor (a sort of health FSA!) He is not a medical doctor.
David was a Director at McKinsey & Co. In his 18 years with McKinsey he served a wide range of companies in most industry sectors, but with a particular focus on regulated, technology-intensive industries.

Ex-Blair: Patricia Hewitt: now with Cinven (Bupa Hospitals)

NHS & Monitor: Eggs & Enron.

Councils blamed over Iceland savings