Rethink Health - February 2011

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Blaming the Victim

I have never been to India but am told that the culture shock is serious. "Slum Dog Millionaire" certainly pulled no punches. I was left marvelling at the tough resilience of surviving slum children all over the world. Many more succumb, of course.

More marvellous still, however, is the idiocy of the public health response. We were told a few weeks ago that "no child should die of diarrhoea. With rotavirus vaccine, they don't have to." This is a slogan of a partnership involving the WHO and the US Centers of Disease Control who are jointly campaigning for worldwide vaccination against rotavirus. The chances are it will be added eventually to the list of must-have infant vaccines, even in Britain.

Why the accent on rotavirus? The availability of a newish vaccine, still in patent, must have a lot to do with this. But its performance in no way justifies the slogan I quoted. In the most prominent clinical trial of this vaccine in several African countries, it could only reduce the occurrence of severe rotavirus diarrhoea by under 40%. And in the real world, rotavirus is only one of myriad risks presented by sewage-contaminated drinking water.

Nothing beats decent sewerage, with drains laid below aquifers and water mains to reduce the risk of contamination. Such a simple precaution! The victims are powerless in this, which is where national authorities and the WHO should be investing. 

Victims can help themselves a lot, though. We should all dry cookware and cutlery carefully, after cleaning it as well as we can. We should store them in a dry, airy place, food side down, - in sunlight if possible. Since being told that for my expedition to Aswan in 1965, I have never heard it repeated. Yet germs cannot multiply without moisture, and keeping the total number of germs as low as possible is the best way to minimise disease. To banish germs altogether, or be vaccinated against every possible risk, is complete pie in the sky. 

If money could be made out of washing up and careful drying, we'd hear more about it! Here is what you really need to know - free of charge.

"Smoking and Alcohol"

I keep hearing reports that some disease or other is down to our social vices. I don't condone over-indulgence of any kind, but I simply don't accept this  blanket condemnation. Tobacco and alcohol have been blamed for the rise in breast cancer, higher male death rate and pandemic obesity - to name but a few. Whilst they may easily be implicated in undermining health generally, more specific blame for diseases outside the lungs and liver is not credible.

The truth is probably simpler. Researchers are briefed to ask these questions "is it smoking?" - "is it drinking?" because these habits have become official public enemies. Our civil servants want us, not them, to bear the blame for our misfortunes. And in my experience if we ask silly questions, we get silly answers.

Meanwhile pollution of food, air and water with chemistry and radiation are never questioned, out of deference to the manufacturers and authorities who put them there. More important still is the degree to which we allow foods to be degraded, refined and counterfeited, pandering to what is profitable. We simply have no idea what a good public health policy could and should deliver, because we have never had one since our mains and drains were engineered - during Victoria's reign!

Anyone who hits the bottle hard enough to get loud, foolish, forgetful and ill - even occasionally - has a serious problem. Distilled spirits behave like a negative meal, since you need food from elsewhere to make them safe. But vine fruits go some way to repair the mineral deficiency of most foods now, and well-made wine makes that benefit available around the year. I cannot condemn moderate regular consumption of good wine, which is on a different scale altogether from the Friday night binge. Just take a couple of days off occasionally, to make sure you still can.

There is nothing at all to be said for smoking, from the health point of view. Yet the smell of burning tobacco is undeniably attractive, and some people enjoy inhaling the smoke sufficiently to run the well-known risks of doing so. Even they are protected in large degree by eating properly, with the vitamin C and anti-oxidants conveyed by abundant fresh vegetation helping to limit the damage. 

They would, of course, fair better still if they stopped smoking but kept up these eating habits! Substitution of nicotine patches stops lung damage. Making each last longer than the last,  is a painless way to dry out.