Mass psychogenic illness and the war on terror

In Vancouver there has been a strange incident on a bus. A bus driver, and several other people, became violently ill after a man asked the driver how his day was going. When the driver said fine, the man replied it wouldn't be for long.

Some brown pellets were found on the bus containing "thyme, mud and a pine substance." One epidemiologist is discounting the illness as mass hysteria:

"Nausea, vomiting, all of those kinds of things are associated with this," he says. "Somebody starts to get sick and then it rapidly spreads to other people. (It's) quite a classic presentation for this sort of thing."

Others argue that as the paramedics treating the driver were also effected that mass hysteria is not a likely cause. Mass hysteria can have rather shocking effects.

In Jordan in 1998, eight hundred children suffered side effects from a vaccination, with 122 being admitted to hospital, in the space of a day and a half. The cause was found to be a mass psychogenic illness - there was nothing wrong with the vaccine. As this WHO bulletin records, there is a considerable body of evidence behind mass psychogenic illness, and it has been linked to various triggering fears.

It is possible that this Canadian Bus incident may be the first mass psychogenic illness related to the War on Terror.

Become an information master

Michigan State University have a rather nice web-based course anyone can undertake at home in their own time on Information Mastery, Evidence-Based Medicine (EBP), and critical appraisal of the medical literature. That should keep you busy. It includes the important advice "Feel good about not knowing everything". Knowledge may be power, but it is easy to be electrocuted with the amount of information available to us.

Drugs and testamentary capacity

A book chapter I have written about prescribed drugs and testamentary capacity, with two colleagues, has passed the final hurdle on its way to publication. It will appear later this year in the Encyclopedia of Forensic and Legal Medicine. Our chapter is about this sort of situation

Blog suspended

Blogging is suspended until further notice.

BBC terror watch

The BBC screened a simulated terrorist attack this week; some fools took it far too seriously.

Later in the week the BBC organised a terrorist shootout under the flight path to Heathrow airport, not unsurprisingly this was taken seriously by the police who sent an armed response team and grounded jets for 20 minutes.

Great Water Cooler Discussions No 2344

On the film Troy:

"It look quite good, but I've heard it isn't very accurate."

"Which bit?"

"The Troy bloke, they have supposedly changed his character quite a lot."

Nazi medicine and eugenics

In the so-so film Extreme Measures a doctor, played by Hugh Grant (in a thriller?), uncovers a sinister plot by disabled people and their relatives. They use tramps and allsorted vagabonds from the streets for research in order to help them walk again. The evil disabled people are defeated, but one central moral question seems to arise and then be immediatly missed at the very end of the film. The wife of the doctor who was running the unethical research project (killed in the denouement of the film) passes his research notes to Grant's character suggesting he would have wanted him to have them. He accepts them and is apparently touched by this gesture from beyond the grave.

But is it ethical to use data obtained in such a way, or should the good doctor toss the notes away? Is it unethical not to use the results if it may benefit another? That might even make a more interesting film.

The more well-known example of this moral dilemma is the extremely horrific work carried out by Nazi physicians. For example they carried out research into the effects of extremes of temperature and high altitude, should that research be ignored, given its sickening provenance? One writer puts the issue in stark terms:

One cannot fully confront the dilemma of using the results of Nazi experiments without sensitizing one's self to the images of the frozen, the injected, the inseminated, and the sterilized. The issue of whether to use the Nazi data is a smokescreen from the reality of human suffering. Instead of the word "data," I suggest that we replace it with an Auschwitz bar of soap. This horrible bar of soap is the remains of murdered Jews. The image sensitizes and personalizes our dilemma. Imagine the extreme feeling of discomfort, and the mortified look of horror upon discovering that one just showered with the remains of murdered Jews. The ghastly thought of the Nazis melting human beings (and perhaps even one's close relatives) together for a bar of soap precludes any consideration of its use. How could any civilized person divorce the horror from the carnage without numbing one's self to the screams of the tortured and ravaged faces of the Holocaust? Indeed, it is only with this enhanced sensitivity to the suffering that one can accurately deal with the Nazi "data."

Holocaust survivor Susan Vigorito found the use of the word "data" a sterile term. She was 3½ when she and her twin sister, Hannah, arrived at Auschwitz. They were housed for an entire year in Mengele's private lab in a wooden cage a yard and a half wide. Without anesthetic, Mengele would repeatedly scrape at the bone tissue of one of her legs. Her sister died from repeated injections to her spinal column. She claims that she is the real data, the living data of Dr. Mengele.

On a similar theme, The Lancet this week carries a review of an exhibition in Washington called Deadly Medicine: Creating the Master Race which charts the involvement of physicians, geneticists, psychiatrists, and anthropologists in the evolution of a horrific "public health" campaign in "the name of national regeneration".:

Murder soon replaced sterilisation as the public policy of choice for those who could not contribute healthy children or economic productivity to the state as killing multiplied in the insane asylums and in the notorious T4 programme that targeted the demented elderly. The slaughter then accelerated to unimaginable proportions as racism was added to the public-health drive to rid the Reich of the "threats" posed to its health and genetic purity by Jews, gypsies, homosexuals, and Slavs.

A must see, if you can get to Washington.

An accompanying piece gives a distilled history of Eugenics from its appearance in 1883 in a book by Charles Darwin's cousin, Galton, through its uptake in Nordic countries as "racial hygiene" , to the Holocaust. The word will continue to be used.

As a theory, however, eugenics has persisted. Compulsory sterilisation laws remained on the statute books in Scandinavia and in some US states until the 1970s and, in the past two decades, the word has begun to reappear in the popular press in discussions of the ethical implications of the Human Genome Project. Galton's word is (it seems) here to stay, whether we like it or not.

The deadly perils of Bertie Bassett

Bertie Bassett may be harmful to your health in large quantities. A lady in Yorkshire has overdosed on liquorice:

The woman from Yorkshire went into muscle failure, a potentially fatal condition, after eating too much Pontefract cake.

Writing in the Postgraduate Medical Journal, doctors said she had been eating the liquorice sweets to relieve chronic constipation.

"She had been eating a packet of sweets a day, about 200mg," said Dr Raja Hussain of Pontefract General Infirmary.

Bertie Bassett was unavailable for comment, but interesting facts abound on his website. Liquorice Allsorts were invented by accident when different samples of sweets were dropped on a wholesaler's counter, and Jelly Babies were originally issued to celebrate the end of World War I and called "Peace Babies". Production was suspended during World War II, so there were no "War Babies".

Limericks along the lines of "There was a young lady from Yorkshire..." may be left in the comments box.

MMR in Universities

MMR vaccine is to be offered to students in universities, following a case of mumps at an international student sports event in Spain.

Meanwhile, in The Lancet, Wakefield has been accused of selectively interpreting and quoting another person's work to bolster his argument. There's a surprise.

HIV: Good news from South Africa

Good news in South Africa, after the previous denial of the problem by Mbeki, where HIV treatment is rolling out and making a big difference to people's lives:

a short distance away from the chaotic triage centre, is a quiet, tastefully decorated haven that dispenses antiretroviral drugs to a small but growing number of AIDS patients. The clinic, which opened last December thanks to a grant from the Nelson Mandela Foundation and the South African Medical Association, is currently treating about more than 90 phase IV patients and accepts new admissions by the week.

"This really was the hospital where people used to come to die; it was like a hospice", senior registar Kevin Rebe told The Lancet. "But now 85% will leave alive. We now see patients coming in who are severely unwell and they get better."

OTC statins

The Lancet is not impressed...

In the absence of evidence of the overall mortality benefits of OTC simvastatin, it is difficult to avoid concluding that the motive behind the Government's decision is saving money. Statins are currently prescribed to about 1·8 million people in the UK, costing the NHS £700 million a year. With the NHS bill for statins predicted to be more than £2 billion a year by 2010, transferring costs to patients might seem timely. But privatising the prevention of heart disease will increase inequalities, with many unable to afford the likely £10-15 per month longterm. For the manufacturer, of course, the motive is clear. With simvastatin now off patent, creation of a new market (perhaps 8 million more people in the UK) will please shareholders.

Parochial blogging.

I'm moderately active in the internal professional politics of the Royal Pharmaceutical Society of Great Britain, which is undergoing a process of modernisation, as are all health care regulators like the General Medical Council for example. However there is a difference. The RPSGB holds two roles, both regulating and representing the profession of pharmacy. The process of modernisation has put severe internal pressures on the politics of the RSPGB, which can be every bit as vindictive as the politics of Westminister at times.

The current plan of modernising the RPSGB has been seen by many as undemocratic. The rules of the Society dictate that any change in the Royal charter requires membership approval at a special general meeting and this was denied, leading to a SGM called for by the membership (which was ignored) and an expensive court case.

The opposition has come from a grassroots campaign called Save Our Society, who incidently run a blog. They do not wish to sacrifice the representative role of the Society.

It has just been announced that they have won all the available seats on the Council of the RPSGB and taken 60% of the total vote, This completely changes the balance of power and will mean an end to the destructive process the Society is currently engaged in.

It may seem a small parochial interest, but for many pharmacists, who have been banging their head against a brick wall for the past few years, this is the equivalent of a Velvet Revolution.

Anyway, you can see some of my "political" activity in The Pharmaceutical Journal here and here.

Root causes of infertility

Norman Geras highlights a possibly underdiagnosed cause of "infertility":

A German couple who went to a fertility clinic after eight years of marriage have found out why they are still childless - they weren't having sex... Doctors subjected them to a series of examinations and found they were both apparently fertile, and should have had no trouble conceiving.

A clinic spokesman said: "When we asked them how often they had had sex, they looked blank, and said: "What do you mean?"

This reminds me of a case I was told of some years ago, when after lots of investigations, eventually it was realised that the couple needed to be told that it was not possible to conceive a child via the belly button.

The colour purple

Following today's news I wondered about suitable soundtracks...

Purple Rain
Purple Haze
Purple People Eater

Although the it seems that Fathers 4 Justice were behind the attack on Blair, purple is allegedly the international colour of equality*, I think this guy may be the real brains behind the operation.

*A quick Google for the International colour/color of equality seems to show that the only people who have ever stated this are Fathers for Justice, unless of course you know otherwise.

MMR not linked to autism

Hiatus broken to break news of important report from the Institute of Medicine concerning autism and vaccines:

Based on a thorough review of clinical and epidemiological studies, neither the mercury-based vaccine preservative thimerosal nor the measles-mumps-rubella (MMR) vaccine are associated with autism, says a new report from the Institute of Medicine of the National Academies. Furthermore, the hypotheses regarding how the MMR vaccine and thimerosal could trigger autism lack supporting evidence and are theoretical only. Further research to find the cause of autism should be directed toward other lines of inquiry that are supported by current knowledge and evidence and offer more promise for providing an answer, said the committee that wrote the report.

and in the New York Times:

The Immunization Safety Review Committee at the Institute of Medicine, which is affiliated with the National Academy of Sciences, was formed three years ago to examine those issues. The group, composed of expert physicians and scientists with no connections to the pharmaceutical industry, met nine times to gather evidence on the claims.

The committee emphasized that it carried out its mandate from a neutral position: the weight of evidence would indicate only whether it was possible to favor or reject a link between vaccines and autism. "You can never really prove a negative," Dr. McCormick said.

Of course this will make no difference to "true believers" in the link, who are unhindered by the need to have evidence for their claim.

Hiatus

Various pressures force a break. Those wishing to keep up to date with drug issues in the UK should read DrugInfoZone and UKMIcentral.

In the meantime, enjoy this picture of Christopher Wren's St Paul's Cathedral in London, taken moments before an amazingly ferocious hailstorm on the 4th of May.

Smoking Dog

If you haven't seen the smoking dog, then do so (large file 2mb)

Heart failure and socioeconomic status

Some evidence that deprived patients are more likely to develop heart failure, and are less likely to be seen by their GP. However, the rate of prescribing suitable treatments is not different between the affluent and the poor.

HRT - risk benefit

Those scared off HRT, are willing to return to it and accept the slightly increased risk in return for the benefits of symptom control.

Web worries

It appears that the public may use the internet sensibly when it comes to health issues.

The researchers, from the department of social policy and social work, suggest that parents of children with chronic diseases use the internet as an extra information source and continue to have confidence in health professionals and in prescribed treatments. Sarah Nettleton, who led the research, commented: “Our findings suggest that people are sensible about what they find online and there is not necessarily a need for an extensive system of kite marks to guarantee the quality of e-health information. Having said this, we also found that people appreciated having websites recommended by health professionals.”

Pfine

Reuters reports that Pfizer Inc has agreed to pay $430 million and plead guilty to criminal charges for illegally marketing an epilepsy drug for unapproved uses, such as migraines and pain. The allegations were made in a lawsuit filed in late 1996 by whistle-blower David Franklin, who had worked for the maker of epilepsy drug gabapentin (Neurontin™), Warner-Lambert, before Pfizer acquired it in 2000.

Via DrugInfoZone

Seven steps to patient safety

According to Eddie Cochran there were Three Steps to Heaven, according to the National Patient Safety Agency in the UK, there are 7 steps to safety (which presumably lead you away from the 3 steps to heaven)

Statin news

Statins (used to reduce cholesterol) are to be sold over the counter without precription in the UK, while Astra Zeneca have written to health practitioners to warn of the risk of rhabdomyolysis from rosuvastatin (Crestor®).

Knackered?

The Knacker Factor helps you predict when you'll need to stick pins in your hand to stay awake and gives you an individualised graph of when you will feel tired during the day.

Useful for students, brain surgeons, and nuclear powerplant technicians alike, but be aware that it is sponsored by the manufacturers of a caffeine tablet. Personally, I'd go for a nice fresh ground cup of coffee...

This does remind me of an unusual, and sadly successful, suicide attempt with caffeine.

Beckham may effect your health

Bill Shankly famously said "People Say football is a matter of life and death" , " I believe it is much more important than that".

As we approach Portugal 2004, I thought this scientific paper entitled Health system goals: life, death and . . . football [PDF} might be of interest:

Objectives: Both the World Health Organization (WHO) and the Federation Internationale de Football Association (FIFA) have developed sophisticated ways of defining and aggregating performance to produce overall, single number indices. These are used to illustrate some of the problems of measuring, comparing and improving health system performance.

Methods: Possible associations between FIFA football rankings for international ‘A’ sides for 176 countries and rankings on the WHO overall health system performance index were explored using econometric techniques.

Results: There is a significant relationship between a country’s FIFA ranking and its ranking by the WHO. Taken at face value, the statistical analysis suggests that, if the national football team does well, the WHO score improves.

Which might explain this...

Modern exam tips

For many exams are approaching. The University of Wales Institute's exam tips seem fairly sensible. I liked this one:

Don't bother talking to people who only want to discuss what you haven't revised. Freak them out by pretending you watched the StarWars trilogy last night. (Don't actually do this).

And this is something I didn't have to think about when I was a student:

Turn your mobile off. All those exciting messages will be waiting for you when you finish.

Coyote physics

Beep, Beep. PooterGeek has found a set of rules for the actions of Coyote and the Road Runner drawn up by the creator of the series. My own favourite rule:

No outside force can harm the Coyote---only his own ineptitude or the failure of the Acme products.

Of course, he sued.

COYOTE V. ACME

In The United States District Court, Southwestern District,
Tempe, Arizona
Case No. B19293, Judge Bartholamew Simpson, Presiding
Wile E. Coyote, Plaintiff -vs.- ACME Company, Defendant
...
Mr. Coyote states that on occasions too numerous to list in this document he has suffered mishaps with explosives purchased of Defendant: the ACME "Little Giant" Firecracker, the ACME Self-Guided Aerial Bomb, etc. (For a full listing, see the ACME Mail Order Explosives Catalogue and attached deposition, entered in evidence as Exhibit C.) Indeed, it is safe to say that not once has an explosive purchased of Defendant by Mr. Coyote performed in an expected manner. To cite just one example: At the expense of much time and personal effort, Mr. Coyote constructed around the outer rim of a butte a wooden trough beginning at the top of the butte and spiralling downward around it to some few feet above a black X painted on the desert floor. The trough was designed in such a way that a spherical explosive of the type sold by Defendant would roll easily and swiftly down to the point of detonation indicated by the X. Mr. Coyote placed a generous pile of birdseed directly on the X, and then, carrying the spherical ACME Bomb (Catalogue #78-832), climbed to the top of the butte. Mr. Coyote`s prey, seeing the birdseed, approached, and Mr. Coyote proceeded to light the fuse. In an instant, the fuse burned down to the stem, causeing the bomb to detonate. In addition to reducing all Mr. Coyote`s careful preparations to naught, the premature detonation of Defendant`s product resulted in the following disfigurements to Mr. Coyote:

1. Severe singeing of the hair on the head, neck, and muzzle.
2. Sooty discoloration.
3. Fracture of the left ear at the stem, causing the ear to dangle in the aftershock with a creaking noise.
4. Full or partial combustion of whiskers, producing kinking, frazzling, and ashy disintegration.
5. Radical widening of the eyes, due to brow and lid charring.

Computing in prescribing

An interesting evaluation of General Practitioners prescribing systems ability to prevent prescribing errors is published in the BMJ. The results show some deficiencies:

The safety features of computing systems currently in use in about three quarters of UK general practices have clinically important deficiencies. All may fail to warn in a situation when a warning is expected, thus potentially creating a health hazard to patients.

Dr Robin Ferner in an associated commentary says:

No human activity is error-free, and we have recognised belatedly that prescribing is complex and prone to error. We need to make it safer—which means increasing the chances that important errors will be avoided or caught by checks before they are translated into harm. We can and should ensure that prescribers—who now include nurses and pharmacists—learn to use medicines safely. Practical examinations in the core skills of therapeutics should help. That will still leave patients vulnerable to prescribers' human failings. Computers can improve communications by generating a legible and complete prescription. But Fernando and colleagues show that several widely used systems fail to detect known prescribing errors. Those who walk the therapeutic tightrope in general practice will want the assurance of a safety net that will catch important errors before they harm patients, an assurance that current systems cannot provide.

Libya update

France has declared it will intervene in the case of the Bulgarian healthworkers who have been given a death sentence in Libya. It is alleged that they deliberately attempted to infect children. [Background information here].

France is no stranger to HIV infection scandals itself, with government ministers taking the blame. Similar problems have also occurred in Japan, Canada, Italy, Iran and Portugal.

Tip for French action. No Pasaran!