Lithium Bipolar and Nanking

Nanking Poster: THINKFilm

On July 2, 1996, the anniversary of Ernest Hemingway’s own suicide, Margaux Louise Hemingway, his grand daughter was found dead in her studio apartment in Santa Monica, California at age 41.

On November 9, 2004, Iris Chang (張純如), who was propelled into the limelight by her 1997 best-selling account of the Nanking Massacre “The Rape of Nanking: The Forgotten Holocaust of World War II”, committed suicide. Earlier she had a nervous breakdown and was said to be at the risk of developing Bipolar illness. She was on the mood stabilizer divalproex and Risperidone, an antipsychotic drug commonly used to control mania. There was a detailed report in San Francisco Chronicle.

My sentiments about the treatment of bipolar illness are expressed in The Cockroach Catcher:

“I am a traditionalist who believes that Lithium is still the drug of choice for Bipolar disorder. Tara’s mother was well for ten years. She was taking only Lithium and no other medication.”

The anti-suicidal effect of lithium has been confirmed by a number of recent studies in both the U.S. and in Europe.

According to the results of a population-based study published in the 2003 Sept. 17 issue of The Journal of the American Medical Association (JAMA. 2003;290:1467-1473, 1517-1519), Lithium reduced suicide rates of patients with bipolar disorder but divalproex did not. Risk of suicide death was about 2.5-fold higher with divalproex than with lithium.

Another paper published in 2005 (Arch Suicide Res. 2005;9(3):307-19) reviewed the existing evidence.

“The article reviews the existing evidence and the concept of the anti-suicidal effect of lithium long-term treatment in bipolar patients. The core studies supporting the concept of a suicide preventive effect of lithium in bipolar patients come from the international research group IGSLI, from Sweden, Italy, and recently also from the U.S. Patients on lithium possess an eight- time lower suicide risk than those off lithium. The anti-suicidal effect is not necessarily coupled to lithium's episode suppressing efficacy. The great number of lives potentially saved by lithium adds to the remarkable benefits of lithium in economical terms. The evidence that lithium can effectively reduce suicide risk has been integrated into modern algorithms in order to select the optimal maintenance therapy for an individual patient.”

The JAMA paper highlighted the declining use of lithium by psychiatrists in the United States and observed that:

"Many psychiatric residents have no or limited experience prescribing lithium, largely a reflection of the enormous focus on the newer drugs in educational programs supported by the pharmaceutical industry."

One might ask why there has been such a shift from Lithium.

Could it be the simplicity of the salt that is causing problems for the younger generation of psychiatrists brought up on various neuro-transmitters?

Could it be the fact that Lithium was discovered in Australia? Look at the time it took for Helicobacter pylori to be accepted.

Some felt it has to do with how little money is to be made from Lithium.

My questions are: Will the new generation of psychiatrists come round to Lithium again? How many talented individuals could have been saved by lithium?

Now back to the Japanese atrocities in the Nanking Massacre in 1937, one of history’s worst but relegated to obscurity. The impact of Iris’ book and her tragic death was such on Ted Leonsis, Vice Chairman of AOL, that he went on to produce a film on the subject. The film, Nanking, premiered in Sundance Festival last year, was shortlisted in the documentary feature category of the Academy Awards, and won the Humanitarian award for documentary in the Hong Kong International Film Festival.

Mariel Hemingway, younger sister of Margaux, read the words of Minnie Vautrin in the film. Minnie Vautrin was an American missionary renowned for saving the lives of many women at the Ginling Girls College in Nanking, China during the Nanjing Massacre. In 1941, Minnie Vautrin committed suicide.

In July, 2007 the film premiered in Beijing. The BBC said:

“It is doubtful, though, it will ever be shown in Japan, where historians claim the massacre has been exaggerated.”

Experts estimate the Japanese killed 150,000 to 200,000 people and raped more than 20,000 women and children, but a group of MPs from Japan's governing party recently said no more than 20,000 were killed.

Abuse Abuse Abuse

All is not well in this beautiful part of the OLD WORLD that is Austria.

Salzburg, Austria

Last weekend, Josef Fritzl, an engineer in his seventies was found to have kept his 42-year-old daughter locked in his cellar since she was 19. The woman, who bore her father seven children during her captivity, was discovered only after one of the children she had with her father fell into a coma in hospital.

Austria does not have the monopoly of family abuse.

The following are all extracts from The Cockroach Catcher:

Dr Am Ang Zhang experienced this in Hong Kong:

“……But the crunch really came when I had to deliver the baby of an eleven year old mother. Yes, eleven. It was a smooth event but the complex case situation of the uncle abusing her and so on probably sowed some seeds for my eventual move into child psychiatry……”

In Australia, Sara’s mother made a brave attempt to save her:
“That her husband only served three months of a three year sentence for abusing his own daughter meant that she felt totally unsafe as soon as he was released. On top of that her belief in herself was totally destroyed or at least her belief in her own ability to judge character. He started stalking her and despite an injunction she did not feel safe and in desperation went to a refuge. Eventually she was advised to return to England.”

In England, Amanda could paint like Magritte:

“……Amanda was by then fourteen but her father had been abusing her since she was about eleven. Her mother worked night shifts and father would come to her bed room to tuck her in. This had been going on for as long as she could remember.
…… She was bleeding quite badly and told her mother, who told her that was what happened to girls when they grew up. She knew what menstrual period was but she said this was different; but mum did not want to know and gave her a box of sanitary pads. Then her period started and she started to worry about becoming pregnant. Her father said it was not a problem and asked ……”

Chris’ mother had breast implants paid for by her father:

“……She had been abused by her father from about the age of twelve and the awful thing for her was that she actually enjoyed the sexual side of things. It was an abuse she found hard to come to terms with. She could not hate her father because when she came out of hospital after her Anorexia, she had no breasts to speak of. Her father paid for implants, twice……”

Laura’s mother found it too much to bear

“……She had just taken a massive overdose of Paracetamol and her liver was thought to be too far gone to survive. She died a rather painful death and we were all deeply saddened.
Could we have done any better? Was the truth too much for her to bear? Would she still be alive if we had not discovered the sex abuse? We would never know. We might have rescued Laura from sex abuse but now she had lost her mother……”

I can only quote from Shakespeare:

And your experience makes you sad:
I had rather have a fool to make me merry
than experience to make me sad…..
(from: As You Like It - Act II, Scene 7)

Adoption Adoption Adoption

In yesterday’s paper:

“Judges attack council over baby adoption”

“Senior judges have made an unprecedented attack on the "disgraceful" actions of a local council for rushing through the adoption of a child against the wishes of her father.

Lord Justice Thorpe said that East Sussex county council appeared more concerned with meeting a quota than the best interests of the family.”

Many will say that such adoption is of course in the best interest of the child. After over thirty years dealing with children and their emotional problems, I am never too sure if there is any foolproof way of placing children when such important matter such as parenting is involved. Some adoptive parents are extremely wealthy and well known world wide. Others are educated and in positions of influence and power. Do they make good adoptive parents?


We only need to look at one recent case in Hong Kong that hit World news:

“Diplomat 'dumped his adopted child because she did not fit in'”

“Jade, a seven-year-old of South Korean origin, is the focus of an escalating dispute across two continents. At the age of four months she was adopted by a Dutch consular officer based in Hong Kong, Raymond Poeteray, and his wife Meta. But the couple have now surrendered Jade to the Hong Kong social welfare department for readoption, reportedly because the child could not adapt to Dutch culture.

The revelation has sparked protests amid claims that the couple were treating the child as if she were an unwanted present. She had been discarded like “a piece of household rubbish”, said the Dutch daily De Telegraaf.

The South Korean Consulate in Hong Kong said that Mr and Mrs Poeteray had complained that Jade was not adapting to Dutch culture or food. “That is the reason they gave for why they want to discontinue the relationship,” a South Korean official said.

This was met with incredulity. “They adopted her when she was a baby,” said Law Chi-kwong, a professor at the department of social work at Hong Kong University. “They are responsible for shaping the child’s mind and culture. How can you say that the child cannot adapt to the culture in which she was raised?”

Hopefully the child Lord Justice Thorpe talked about will fare better.

Adoption can go terribly wrong in other ways too. In Newsweek in December 2007 an article highlighted the problem of an adoptive mother serving a 19-year sentence for second-degree murder in a Virginia maximum-security prison.

“Her story is awful—and rare—but sadly it is not unique. Adopting a child from another country is usually a positive, enriching experience for both the child and the parent. Over the last 20 years, foreign adoption has become more popular, and Americans now adopt about 20,000 children from Guatemala, China, Russia and other nations each year.

…… Since the early 1990s, the deaths of 14 Russian children killed by their adoptive parents have been documented.”

Russia has now stopped international adoptions.

But what was the reason for the rush in the UK case quoted earlier. Could money be the driving force?

It was reported that:

“Tony Blair set a goal in 2000 for a 50 per cent increase in adoptions, to reduce the time children spent in foster care. In the last round of targets, councils were offered bonuses totalling £36 million for increasing the number and speed of adoptions.”

I decided to look again at the UNICEF Convention on the Rights of the Child

Article 3
2. States Parties undertake to ensure the child such protection and care as is necessary for his or her well-being, taking into account the rights and duties of his or her parents, legal guardians, or other individuals legally responsible for him or her, and, to this end, shall take all appropriate legislative and administrative measures.
……………….
Article 9
1. States Parties shall ensure that a child shall not be separated from his or her parents against their will…… Such determination may be necessary in a particular case such as one involving abuse or neglect of the child by the parents, or one where the parents are living separately and a decision must be made as to the child's place of residence.
2. In any proceedings pursuant to paragraph 1 of the present article, all interested parties shall be given an opportunity to participate in the proceedings and make their views known.
3. States Parties shall respect the right of the child who is separated from one or both parents to maintain personal relations and direct contact with both parents on a regular basis, except if it is contrary to the child's best interests.

In the East Sussex case:

“The adoption proceedings began while the father was in hospital after a heart attack, but as soon as he was fit he instructed a solicitor to write to the council and ask that he be allowed to care for his daughter. The council reacted by placing the baby girl with prospective adopters the day before a court hearing at which her father intended to challenge the adoption.
Lord Justice Thorpe said: The council's failure to answer that letter and subsequent placement on the eve of the hearing give rise to the clearest inference that the council was out to gain its ends by means more foul than fair.”

Strong words indeed. However, the April 7 blog of Dr Crippen warned that such intelligent and educated judges might not be around for much longer:

“Successive Labour governments have destroyed the English secondary education system. They are in the process of destroying the university education system by compelling the universities to admit under qualified students from sink comprehensives. They are destroying the NHS by undermining the medical profession so that they can be replaced with poorly trained but cheaper HCPs. It is only right and fair, therefore, that they should also destroy the English legal system.
English judges have traditionally been highly intelligent and have been educated at leading Universities. New Labour does not like that. So they are proposing to allow judges to be appointed from the Crown Prosecution Service, that well known bastion of legal mediocrity.”

Enron, South Africa and Carbon Trading

From the Cockroach Catcher:

“……Without a proper job, my father, who managed an airport in China before fleeing to Hong Kong, decided he would like to try his hand at poultry farming – ducks, pigeons, chicken and turkey. The farm was right by the river and so it was convenient for us children to be engaged in fishing or exploring the nearby ponds. At the time I had no idea that my school friends in the city did not have such activities and more importantly such fun
……The farm was to be closed rather unexpectedly. There was nothing wrong with the running of it; and business was good. But “Bird Flu” struck and it struck bad, literally wiping out our whole stock. No farm along the river was spared. The sight of dead poultry was horrible. I do not know how they were cleared, but cleared they were, probably by the government.
Thus my father’s little entrepreneurial venture came to an abrupt end. I do not think he really ever recovered from that as he never went into another business venture and became very cautious……”

How times have changed and if Kyoto Protocol existed then, things would have been so different. The farm would have generated money not just from the poultry but from the methane generated by the poultry manure.

This is how it works:
36 industrial countries that signed the Kyoto Protocol agreed to reduce greenhouse gas emissions by financing “clean development” projects in the third world. So those companies who need them can offer to buy carbon credits (technically called Certified Emissions Reduction, or CER) from the likes of my father’s poultry farm, which say generates 3000 CERs per year @ €5 per CER, totally €15,000, until Kyoto expires in 2012. The farm owner then installs methane digesters. In doing so he generates electricity and can reduce his utility bill substantially by selling the surplus into the national grid. Also, he can still sell his poultry but now has a less smelly farm. But here is the fun bit. The one who pays €5 per CER can now sell the carbon credits say to a European Bank for €20. The bank might hold on to it as an investment as its price will most likely go up.

Of course the small farm owner only benefits in a small way. The ones who really benefit from the Kyoto Protocol and carbon trading are again the “big boys”.

So what has Enron got to do with all of this, you may ask.

Well, this is what I gleaned from the latest copy of Fortune Magazine:

“For two centuries rum, molasses, and sugar were bought and sold at London's West India shipping docks. Today the gleaming office complex that towers over the docks, Canary Wharf, is the global nerve center of carbon finance. Barclays, Citibank, Credit Suisse, HSBC, Lehman Brothers, and Morgan Stanley all have trading desks here, and so here is where you find a pair of investment bankers - both 35, both alumni of Enron, both brainy and self-assured - who have emerged as two of the world's top carbon traders.

Louis Redshaw of Barclays Capital and Imtiaz Ahmad of Morgan Stanley (MS, Fortune 500) have risen above the crowd for several reasons. First, they were early movers: Redshaw started the desk at Barclays in 2004, before EU trading began, and Ahmad traded emissions credits for BHP Billiton, the giant mining company, before joining Morgan Stanley in 2005. Second, their banks have relationships with utilities and industrials whose emissions are regulated by the EU. Third, they can navigate a market that is opaque and highly regulated, and offer insight into where prices are going.”

In the meantime I read that a new technology called “coal gasification” provides a way to generate clean electricity with coal, which is plentiful. The gasification plant is cheaper to run, and it makes it easier to capture the carbon dioxide and inject it into a geological reservoir (sequestration), or even an oil well to help push the oil out of the wells. Oil produced from underground coal in this manner can cost as little as $55 per barrel compared to the OPEC oil price of $120. The only trouble is that if there is a big scale move to do that, OPEC will reduce the price to below $55.

South Africa during the sanction years managed to produce oil from coal, thank you very much.

Table Mountain, Cape Town, South Africa ©2004 Am Ang Zhang

“SECUNDA, South Africa -- Every day, conveyor belts haul about 120,000 metric tons of coal into an industrial complex here two hours east of Johannesburg.
The facility -- resembling a nuclear power plant, with concrete silos looming over nearby potato farms -- superheats the coal to more than 2,000 degrees Fahrenheit. It adds steam and oxygen, cranks up the pressure, and pushes the coal through a series of chemical reactions.

Then it spits out something extraordinary: 160,000 barrels of oil a day.”

The other benefits are that sulphur and mercury will not be released into the environment and we may one day be able to eat tuna and other seafood without mercury contamination and of course reduction of acid rain that destroys forests.

Unless we the people understand the science and of course the politics, we cannot win.

One thing is for sure: oil will run out; and it is time we support good clean alternatives.

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Vacation in the Evergreen State

From The Cockroach Catcher:

“……I know how lucky I was to have the opportunity at an early age to be exposed to a world still very much in its raw state. It set up for me a life long interest in living things and the environment in which we live……”

Perhaps it would not surprise anyone that whenever we can, we try to get as close as possible to this kind of world on vacation. Yet we have to be realistic. Much of nature has to be managed as men have now “invaded” every possible corner of the earth. There is management and there is management. A sound scientific knowledge is required not only of the people who manage but also of the public, who must be informed and be able to assess the way nature is being managed.

One thing we cannot manage is the weather.

We left England one April morning when it snowed heavily. We were heading to North Western United States to see the glorious apple and cherry blossoms. There we were met with more snow, and some lakes were still frozen.

Frozen Lake, Washington State

©2008 Am Ang Zhang

Earlier in the year there was record snowfall in the area. In February in a short two-week period there was nearly 15 feet of snow, a record for 30 years. The late frost after the fruit trees blossomed could mean a ten percent drop in fruit production this year.

All kinds of gadgets were installed to minimise damage by such late frosts including powerful fans. Temperatures in late April could still be as low as 20°, Fahrenheit.

Special Fan installed in orchard to minimize frost damage

©2008 Am Ang Zhang

The blossoms were beautiful, especially against the backdrop of the snow clad North Cascades.

©2008 Am Ang Zhang

©2008 Am Ang Zhang

©2008 Am Ang Zhang

©2008 Am Ang Zhang

Then there is fishing.

That too has to be heavily managed. The rule book is huge and there are detailed regulations on what can and cannot be done. There are some lakes that are opened throughout the whole year and then there are those that only open on the last Saturday of April. 500,000 or so fishermen were expected on that first day alone at the Washington lakes. Even at the regulation five trouts per fisherman, that would be a whopping 2.5 million trouts. (There are rare local trouts that one is not supposed to keep.) The fish went well with the local wild asparagus that was just coming into season.

Native Rainbow Trout from Wapato Lake

©2008 Am Ang Zhang

I then read an article in the local paper on how Yellowstone National Park struggled since 1990 to bring back the native cutthroat trout population. I well remember our first visit there in the early eighties when it was the tourist thing to hire a boat and rods and go fishing for cutthroats on Yellowstone Lake. Even a novice like me caught one legal sized fish.

Away on Vacation

You might have guessed that I am away on vacation, until 1^st May in fact. In the meantime, perhaps you would like to catch up with some of my past postings: 57 in total since I ventured into the Blogosphere; or even read my book: The Cockroach Catcher.


If I may, I would like to share some of the reviews and feedback I have received so far:

From the LULU.com website, where you can preview the chapter Seven Minute Cure and if you so wish, order a copy of the book (after creating your own account):

Fascinating! What a great read. Just reading the one chapter made me want to read the whole book. Thank you!

A beautiful opening! A piece written with of all that wit, intelligence and sarcasm! The author has managed to illustrate a boring NHS subject in the most interesting of ways. He has convinced me to read on. The NHS should urgently seek help and advice from this doctor!

Thank goodness for doctors like these!! If the rest of the book is as good as the preview chapter then it will be a fantastic resource for practitioners and the public.

Fascinating preview chapter. I can't wait to read more.

Horrah for the doctor. Chapter 1: The Seven Minute Cure. The doctor overcame the obstacles faced from the establishment and freed a young child from her prison. Great read.

Other reviews and feedback:

Absolutely riveting! Brings me back to working (in NHS psychiatry) when work was really interesting! The tone is quite conversational; it is like hearing you telling stories. I ordered more copies for my family and friends.

I knew it would be very special and it sure is. To us your trainees it is like going back on the rotation to have the joy of working with you again. The difference is that l can now learn at leisure from this book. Congratulations.

The book is very well written and makes very easy and interesting reading even for the laymen. You learn a lot about the Health System, a lot about child psychiatry and a lot about the growing up and development of the author.

Fascinating account of child psychiatry cases, including some creative yet effective treatments. Anyone who is a parent or around children or really anyone at all actually will find the book surprising, entertaining, thought-provoking, funny and moving.

The book makes me realize the difficult decisions with which a doctor is so often faced, the need for him to have faith in himself and, coupled with that, the need for continued idealism and enthusiasm. These don't, of course, apply only to doctors but are particularly important for them.

Great book. I have bought one to give to my son on his birthday.

(Note: both father and son are doctors.)

I was in Special Education for many years. I just love the way you dealt with the girl who was bullied, and the boy with Behaviour Disorder. I am buying two more copies, one for my friend who is a psychologist and one for a colleague in Special Education.

I wish I had read your book when I was headmistress. I would have had so much more insight into why some of the pupils behaved the way they did.

I have been a school counsellor for 15 years and we have had regular recommendations on books to read. None of them taught us as much as your book, which would have been very useful for our weekly screening meeting discussions.

Reading the book and his blog, you cannot help admiring the author's width and depth of knowledge, the light-heartedness, the humility, the humane and the human side of people.

You learn a lot about the Health System, a lot about child psychiatry and a lot about the growing up and development of the author.

What a book! I cried a little. I laughed a little. I know I should not.

Your stories are amazing. I really enjoy reading it.

My wife cannot put your book down and I shall not be able to get my hands on it until she has finished.

I was horrified by some of the gruesome cases and agonised at the suffering of some of your patients. But there are moments of laughter and smile at Dr Zhang's wit in handling the cases and patients.

Am Ang, thank you for a wonderful book. You know I could not put it down. My husband is now reading it and he said it is such an easy read as he thought it was all going to be heavy and clinical.

You have such a way with the little ones. What about the 12 year old pretending to be three and a half! My goodness.

Just the village life can fill a book. (Seriously an in-depth version will be much welcome!) Book two can be Life at HKU. And so on... Fascinating!

Having grown up in farming country, I love the Chapter on The Village. I know it is different but so much about village life just clicked with me. Makes me wants to go home to have a look. I would like you to write more about yourself. Just all the little details you are so good with.

I wish I had your book when I was bringing up my kids. I am giving each of my two children a copy. I decided to put down Pillars of The Earth for a while and start your book on a flight. I could not put it down to go to sleep. Wow: it makes so much sense.

I did expect the cover photo to be one of yours – after all, the creative mind needs full exposure, artistic and otherwise. I was just recommending it to some friends.

I never imagine I can have so much fun and gain so much knowledge by reading a book of this sort by, of course, an author with a sense of humour and a deep understanding of human nature. I really enjoyed reading it. Life could be so much easier if we had the chance to do what we like, to let our thoughts be shared by someone we trust, to make sugar pills of nasty encounters and so on and so forth for bearing more positive thinking. Just by a mere short conversation, which hit exactly at the 'dead pit' of the hiccup boy, the hiccup was over. Human nature is just like that. After reading the author's accounts of his cases, I wish I could also be endowed with such wit and wisdom, not so much for curing others, but to let my own body and soul remain healthy and sound always.

Love it. I read it in three days flat. Not only should parents read it; I think all those in the medical profession should read it. There is so much common sense. I am recommending it to my book club. Will you come and talk to them about it?

Wine, Media and The Mind

It is amazing how easy it is to influence modern day consumers with nothing other than a well made film. As far as wine is concerned the film Sideways has more or less changed the wine landscape of California if not elsewhere. This is because of two simple lines from the film. The wine snob character Miles tells friend Jack before a double-date dinner:

“If anyone orders Merlot, I'm leaving. I am not drinking any……Merlot.”

All of a sudden, it is no longer cool to order Merlot, and Pinot Noir becomes the new Merlot.

The fact that the same snob Miles’ most treasured wine Cheval Blanc is 45% Merlot is lost to the vast majority. In fact if Petrus had not refused permission, Miles would have drunk Petrus in the film, and that, one of the most expensive wines in the world, is 95% Merlot.

In the animated hit Ratatouille, feared critic Anton Ego visits Gusteau's, the restaurant in which the movie is set, and orders a bottle of 1947 Château Cheval Blanc to go with his meal. The '47 Cheval is probably the most celebrated wine of the 20th century. However, there has been no rush to buy cases of this as you are unlikely to find them except in top merchants and private cellars.

I have my own suspicion about some lesser known films that may have influenced wine drinking habits in the Far East.

In 1985 the film Tampopo came out of Japan. This comedy features a truck driver who helps a young widow named Tampopo improve her noodle restaurant, and draws attention to the power of food.

There is a beautiful wine tasting scene, by a group of hobos following the lead of a professor. The professor realises that life as a hobo is much freer, with no one above him telling him what he should do, no targets to meet, and no paperwork.

The wine tasting is not at a winery or a restaurant. It is in a park by the back door of a restaurant. The wine is that little bit left at the bottom of a bottle. There is not enough to go round; so the hobos allow the professor to do the tasting and are content to just listen to his analysis. (In the Cockroach Catcher, I wrote that a blind case presentation at Queen Square was a bit like wine tasting.)

It is one of the most enjoyable scenes for wine lovers and if you are not a wine lover you will become one.

The wine?

“Chateau Pichon Longueville Comtesse de Lalande,” announced the professor in perfect French.

This wine has since become a favourite of the Far East.

Chateau Pichon Lalande is not as expensive as the First Growths but is fast catching up. Fortnum and Mason of London used to have a house Pauillac made by Chateau Pichon Lalande. I was tipped off to get the last few bottles some years ago. Now the supplier of their house Pauillac is Chateau Haut Bages Averous, a vineyard next to the new rising star of Bordeaux: Chateaux Lynch-Bages.

The best year in recent vintages has to be 1989, a great year for most of Bordeaux and rumour has it that it will become drinkable in 2009. Hurrah. The 2000 is superb too but recent vintages have all been great and if you can store them buy them now.

The biggest wine influence worldwide came from a documentary. In 1991, after the airing of 60 Minutes on CBS, wine sales went up 44% in the next four weeks in the U.S. It was about the French Paradox: the incidence of coronary heart disease in France being 40% percent lower than in the U.S.

Health sells.

Once upon a time in Hong Kong, when people made money they drank the most expensive Cognac and Scotch, with Hennesy XO and Dimple being the “Gold Standards”, partly because of their highly recognisable bottles. To have such a bottle on your dining table was a sure sign that you had arrived. Now, the status symbol is the most expensive red wine, and it is often taken with just about any dish that is served.

But then the French perhaps always knew; including its own most famous psychoanalyst Jean Laplanche (born 1924). His book The Language of Psychoanalysis was first published in 1967 and translated into English in 1973. All of us training at the Tavistock had a copy and it is to this day one of the best reference books on the subject. He has co-authored a number of other books in psychoanalysis.

What is not so widely known is that Laplanche was for many years the owner of Chateau de Pommard, a Burgundy vineyard, and actively involved with the wine-making processes. He sold the vineyard in 2003 but continues to live on the estate with his wife and to act in the capacity of a consultant to the new owners on wine making matters.

Free Drugs For All!

On C.N.N. today:

Prescription drugs found in drinking water across U.S.

“(AP) – A vast array of pharmaceuticals – including antibiotics, anti-convulsants, mood stabilizers and sex hormones – have been found in the drinking water supplies of at least 41 million Americans, an Associated Press investigation shows.

In the course of a five-month inquiry, the AP discovered that drugs have been detected in the drinking water supplies of 24 major metropolitan areas -- from Southern California to Northern New Jersey, from Detroit, Michigan, to Louisville, Kentucky….

The situation is undoubtedly worse than suggested by the positive test results in the major population centers documented by the AP.”

Here are some of the key test results obtained by the AP:

• Philadelphia, Pennsylvania – 56 pharmaceuticals in treated drinking water (63 in watersheds), including medicines for pain, infection, high cholesterol, asthma, epilepsy, mental illness and heart problems.

• Southern California (18.5 million people) – anti-epileptic and anti-anxiety medications in a portion of the treated drinking water.

• Northern New Jersey (850,000 people ) – metabolized angina medicine and the mood-stabilizing carbamazepine in drinking water.

• San Francisco, California – a sex hormone was detected in the drinking water

• Washington, D.C., and surrounding areas – drinking water tested positive for six pharmaceuticals.

The Washington Post headline reads:

Drugs in Water Hurt Fish and Wildlife:

According to the report, the affected species include: fish, prawns, oysters, mussels, vultures, snails, antelope etc.

“Pharmaceuticals in the water are being blamed for severe reproductive problems in many types of fish: The endangered razorback sucker and male fathead minnow have been found with lower sperm counts and damaged sperm; some walleyes and male carp have become what are called feminized fish, producing egg yolk proteins typically made only by females.

Meanwhile, female fish have developed male genital organs. Also, there are skewed sex ratios in some aquatic populations, and sexually abnormal bass that produce cells for both sperm and eggs.

There are problems with other wildlife as well: kidney failure in vultures, impaired reproduction in mussels, inhibited growth in algae.”

Victoria Falls—not tested!

Are we just looking at the excesses of the Americans? Apparently not. The same article reports:

“Elsewhere in the world: from the icy streams of England to the wild game reserves of South Africa; snails, fish, even antelope, are showing signs of possible pharmaceutical contamination. For example, fish and prawn in China exposed to treated wastewater had shortened life spans, Pacific oysters off the coast of Singapore had inhibited growth, and in Norway, Atlantic salmon exposed to levels of estrogen similar to those found in the North Sea had severe reproductive problems.

… Freshwater mussels exposed to tiny amounts of an antidepressant's active ingredient released premature larvae, giving the next generation lower odds of survival; in a separate lab study, the antidepressant also stunted reproduction in tiny fresh water mud snails….

In Pakistan, the entire population of a common vulture virtually disappeared after the birds began eating carcasses of cows that had been treated with an anti-inflammatory drug.”

Have the locals in Barbados been right all along? They have always claimed to have the best coral filtered drinking water! Was that one of the reasons why they have the second highest number of centenarians per capita in the world?

You may ask: What about bottled water? Antimony, a chemical used in the making of polyethylene terephthalate (PET) bottles, used by most mineral-water sellers, can be detected in bottled water, according to Prof. Shotyk at the University of Heidelberg:

“Bottled water had an average 160 ppt of antimony when opened immediately after bottling. But ground water stored in a PET plastic bottle had 630 ppt of antimony when opened six months later.

Prof. Shotyk no longer drinks water from PET bottles.”

Volvic was in trouble in 2006: two bottles had naphthalene in it. So was Evian: in 2007, China seized 118 tons of Evian water because of excessive amounts of bacteria.

Also, don’t forget that some bottlers simply repackage tap water. According to the industry's main trade group, they do not typically treat or test for pharmaceuticals.

I think I will start my own distillation plant for water, like they do in Aruba.

Or else just drink wine.

Passion and Easter

Passiflora alata

In the early 1600s, a Jesuit priest came across a Passion flower in South America and was taken by its complexity and beauty. That night he had a vision, so the story went, that the flower's trio of stigma resembled the three nails used in the crucifixion; the stamens represented the wounds; the spiky purple crown above the petals, the crown of thorns; and the tendrils of the plant were the scourges. The name was a direct reference to the Passion of Christ. I find it peculiar that the plant has been found in the wild in every continent except Europe and Antarctica.

In England the Victorians loved it and then fell out of love with it. Now it is making a comeback possibly due to the fruits’ popularity in modern gourmet cooking.

There are many varieties and some are edible. Of the edible kind there are two big groups, the one with the dark skin one and the one with the yellow skin.

The plant itself, from the stem to the leaves and the flowers, have been used by South American natives for various medicinal purposes, none currently approved by the F.D.A.

The fruit has some of the most concentrated fragrance of any fruit species. The charm is in its acidity which enhances the intense flavour and natural sweetness. With fine vanilla ice-cream it is a delight. It can be used as a topping for many desserts and famously for Pavlova. It is made into soft drinks and is often used in tropical cocktails. The golden variety is best eaten fresh and the dark skin ones can be left to mature as the flavour intensifies further.

With the golden to near blood red seeds, the fruit qualifies as a colourful non-green fruit, with all the necessary anti-oxidants. To me it is just flavoursome.

The other passion of course is Bach’s St Matthew’s Passion, appropriate for this time of the year. The biologist Lewis Thomas when asked what message he would send to aliens famously said: “……Bach, all of Bach……”. Richard Dawkins picked it as one of his eight desert island discs. Now you know.

On the Easter music note, it is perhaps appropriate to mention Mahler’s Second Symphony: The Resurrection. The text of the music made no biblical reference and it was Mahler’s very personal view of life and his life was full of tragedies and suffering, with the premature deaths of his siblings and daughter, and his own heart disease. There has not been a greater composer to emerge since his death.

Alaska, Good Friday Earthquake and Zyprexa

On March 27, 1964 at 5:36 p.m. an earthquake of the magnitude of 9.2 was recorded in Alaska with an epicenter 80 mile east of Anchorage. Of the 131 deaths recorded, 119 were caused by the tsunami triggered by the quake that devastated Valdez and severely damaged the coastal towns of Seward and Kodiak. It is still the most powerful earthquake recorded in U.S. history. On the first day alone, eleven aftershocks were recorded with magnitudes greater than 6.0.

Alaska is the largest state of the whole of U.S. It was bought from the Russians on March 30^th, 1867, and represented one of the all time best buys given the discovery of gold in 1872 and later oil. One should never sell the family silver.

The most important gold town of Juneau was named after one of the miners.

The most impressive modern day engineering achievement has to be the Oil Pipeline:

“The 800-mile-long Trans Alaska Pipeline System (TAPS) is one of the largest pipeline systems in the world. It stretches from Prudhoe Bay ……to Valdez, the northernmost ice-free port in North America. Since pipeline startup in 1977, Alyeska Pipeline Service Company, the operator of TAPS, has successfully transported over 15 billion barrels of oil.”

On March 24, 1989 the Exxon Valdez got into trouble in Prince William Sound when it hit Bligh Reef, splitting its side open and releasing oil and leaving an eight-mile (1.61km) slick. It is one of the worst environmental disasters of modern times and 19 years on the U.S. Supreme Court is still deliberating whether to uphold the $2.5 billion punitive-damages award levied against Exxon Mobil for the spill.

Alaska recovering after Exxon Valdez

In the meantime there is a different kind of earthquake in Anchorage.

March 6, 2008, Anchorage Daily News:

State claims drug maker hid data

“Drug maker Eli Lilly knew from the start that its schizophrenia drug Zyprexa was linked to health problems in patients but hid that information because it wanted a big moneymaker, a lawyer for the state told jurors in Anchorage Superior Court on Wednesday.”

Zyprexa is the trade name of Olanzapine.

In The Cockroach Catcher, Dr Am Ang Zhang inherited a patient who had been put on Olanzapine:

“ The biggest girl was asking for her third helping. She could not help it. It was the Olanzapine she was on. Now she looked nothing like the slim girl she once was, having put on as much as her original body weight.

But her symptoms had disappeared.

She needed three helpings of cereals and six slices of toast complete with thick layers of jam and butter – butter that was from the EEC and only for hospital use by patients, all part of the huge mountain that even the might of the Vatican could not consume.”