Hokum Locum

Liquor still quicker

There is little doubt there are criminals who are prepared to drug women in order to sexually assault them. History records the commonest drug used was chloral hydrate in an alcoholic drink (Mickey Finn). The modern equivalent is rohypnol, a drug discontinued in New Zealand owing to its abuse potential. However, as Ogden Nash observed “liquor is quicker” and alcohol remains the most likely cause of incapacity leading to unwanted sexual activity.

There has been recent publicity alleging ‘drink spiking’ but a remarkable dearth of evidence to support these allegations. Invoking the law of parsimony, if women drink a lot of alcohol it is more likely that they were drunk rather than drugged by some additional chemical. This has been my experience in clinical practice. I was working in a hospital emergency department and a woman brought in her daughter who alleged she had been drugged during an evening out. They requested a blood test. I ordered a drug screen as well as an alcohol level. The time was 3pm the day after her night out. The drug screen was negative; however, the young woman’s blood alcohol was still 112 mg/100ml blood. The legal limit for driving is 80mg/100ml blood. I leave it to readers to do the maths but I suggest she must have been seriously intoxicated the night before!

The current hysteria about ‘date rape’ is a smoke screen to cover up serious alcohol abuse by many young people.

From the Journals

Bromelain, an aqueous extract of the pineapple plant, is widely sold as a natural organic anti-inflammatory agent. The results of a randomised controlled trial cast doubt on claims that it is an effective treatment for osteoarthritis. Although the trial was too small to be definitive, there was no benefit over placebo (Quarterly Journal of Medicine 2006, 99: 841-50).

High blood pressure features in a randomised controlled trial of acupuncture appropriately named SHARP (Stop Hypertension with the Acupuncture Research Program). Despite the promise suggested by case reports and small observational studies, active acupuncture was no better than invasive sham acupuncture at reducing systolic or diastolic blood pressure in 192 patients with untreated blood pressure (Hypertension 2006, 48: 838-45).

A New Zealand doctor has been given a grant of $5000 to continue her research into the treatment of autism. Her alternative methods involve dietary manipulations. In one case, “within a week of having colours and preservatives removed from his diet”, Dr Gullible (not her real name) claimed the subject had a vocabulary of 200 words. Well then, within a few more months he will have conquered the Concise Oxford Dictionary! Dietary manipulations involve a change in management and attention and it is this which is responsible for any observed improvements. These are placebo interventions (NZ Doctor, 15 November 2005).

Fat Lazy Teenagers

Claims have been made that overweight adolescents should have surgery. Some of these fatties have weighed in at 150-200kg. They can be seen in any shopping mall, usually eating a bag of chips and clutching a bottle of soft drink. The parents, usually the mother, are also obese and the situation is not a disease but one of child abuse. The standard of reporting and medical insight is pitiful. A report in the Christchurch Press (23-24 December, 2006) claimed that a possible cause of obesity was hyperinsulinaemia, an excessive production of insulin. Obese people who develop diabetes do have hyperinsulinaemia but this is caused by their obesity, not the other way round. The obesity causes an insulin resistance at the cellular level and the pancreas responds by cranking up its production of insulin.

After surgery, one teenager lost 80kg and is now training to be a chef! I think there needs to be a great deal more informed debate before the health system starts funding this sort of surgery.

Occupational Health-Disease of the month

The history of occupational medicine is full of examples of absurd complaints being linked to the workplace. For example, pain syndromes in women who are only typing a few words per minute (refer Dr Yolande Lucire’s book: RSI Belief and Desire).

The latest medical construct is ‘acoustic shock’ seen in call centre workers. Seven hundred employees have reached out-of-court settlements in the UK with a payout of three million pounds. A further 300 cases are pending. It pays to have an employer with deep pockets. An article in the Guardian Weekly (24 November, 2006) advises that “acoustic shock is caused by exposure to a sudden increase in noise, but people who are already anxious or under stress appear to be particularly prone to it.”

Note the careful wording. The ‘disease’ is not created in normal people but in those who are naturally “anxious or under stress”. These words are designed to obscure the fact that this is not an occupational disease but an attempt to attribute personal angst to the workplace.

Although not given to crystal ball gazing, I predict that this condition will next appear in Australia closely followed by New Zealand. Furthermore, I predict that the condition will remain unheard of in India, the origin of most call centre calls, since there is no compensation available.

The next time you are disturbed by a call centre while eating dinner, yell loudly down the phone and tell the caller to make a claim for ‘acoustic shock’.

Sickie Busters

Fraudulent absenteeism is just as common across the Tasman as it is here. Absenteeism costs Australian industries an estimated $7 billion dollars per year. Rates are around 3.5 percent but this figure can double with-you guessed it-call centres! These must be the people who are away from work while consulting their advisors about their claim for ‘acoustic shock’.

Some savvy people have set up a business (Direct Health Solutions) and they check up on people taking a sickie. Client absenteeism has been reduced by one third and for every dollar spent there have been gains of $12 saved in terms of productivity.

A DHS Nurse reports “you can always tell people throwing a sickie, because very often they haven’t decided what’s wrong with them”.

Sunday Telegraph Australia, 12 November 2006

Selenium Poisoning

A 75-year-old man had a blood test which showed an elevated prostate specific antigen (PSA). He became concerned about prostate cancer. The article does not say whether there was a suspicion of prostate cancer or whether the PSA test was done as a ‘check’. Prostate cancer is certainly common in males of this age, being found incidentally at autopsy in 40 percent of those over the age of 75 years. A screening ‘check’ of PSA cannot be defended in this case because a male diagnosed with prostate cancer at the age of 75 years is more likely to die from some other cause (ie with the disease rather than from it).

The patient visited one of “287,000 sites discussing the use of selenium in prevention and treatment of prostate cancer” and “was able to purchase 200g of sodium selenite powder without adequate instructions.” Three to four hours after ingesting 10g of the powder he presented to an emergency department, acutely unwell, and subsequently died of acute selenium toxicity.

The authors comment: “This case highlights the risks associated with failure to critically evaluate Internet material and exposed the myth that natural therapies are inherently safe”.

Medical Journal of Australia 2006, 185 (7): 388-389