Fortified food

Give us this day our folic acid, is a prayer the United Kingdom will recite before Ireland, writes Maurice Gueret, as he opens a can of worms with no expiry date

Daily bread

It’s over two decades since Irish doctors called for fortification of the nation’s flour with folic acid. Ireland still has too high a number of babies born with spina bifida and anencephaly. Yet evidence is incontrovertible that taking folic acid before conception and during the early months of pregnancy substantially reduces the number of cases. For 25 years the State’s policy has been to encourage all women of child-bearing age to take folic acid supplements. But the campaign is half-hearted, and just over one-third of women now attain the required folate level to prevent neural-tube defects. In October it was announced that the UK is to make it mandatory for folic acid to be added to flour. Much of the research and clinical work on the role and dosage of folic acid in reducing neural-tube defects was done in Ireland. So it’s more the pity that our neighbours beat us to the finish line. Doubtless we’ll copycat them down the road, as we so often do.

Blow out

A loyal reader has been in touch with a story his mother used to tell about her doctor in the 1930s. One day she joined a fairly long queue outside his surgery. The GP had been delayed and, when he arrived, he raced towards the clinic’s door. As he did so, he broke wind extremely loudly and everyone in the queue burst out laughing. He turned to face them and they stopped in their tracks. “Listen, if half of youse could do that, youse wouldn’t be standing here!” he roared.

Can of worms

Patients often ask about the expiry date on medicines, what it means, and if it can ever be ignored. This is a can-of-worms issue and I defer individual product queries to the pharmacist, who is more expert in the formulation and shelf life of particular drugs. Though it was interesting that in a recent shortage of epipen allergy injectors, authorities said patients could use some devices beyond the expiry date. Drugs have expiry dates because the manufacturers are obliged to have them. The potency and safety profile of medicines cannot be guaranteed beyond their expiry date. This is especially true for antibiotic syrups, eye drops, nitroglycerine heart treatments and insulins for diabetes. However, work conducted on stockpiled medicines owned by the US military over many years suggests that many medicines do survive intact for a good few years. Then a Californian study examined eight unopened medicines with 14 different ingredients that were up to 40 years after the expiry date. They had been found in the rear of a retail pharmacy. Twelve of the 14 ingredients were found to be present near enough to the original potency on the label. Our throwaway society is only now getting to grips with food waste. I suspect medicine waste may not be far behind.

End of life

Ireland has dealt with a lot of big issues in recent times, with bans on gay marriage and abortion cast aside in our more outward-looking state. I expect the euthanasia debate to rekindle soon, though it would appear that doctor-assisted deaths may not be new to all families in the state. The late Dr Paddy Leahy said that he assisted many deaths by injection, but principally in the UK, where he worked during the war years and into the 1950s. Dr Paddy also admitted to giving a lethal jab to a personal friend, who requested one after a large stroke. There are family stories the length and breadth of Ireland of doctors being called to assist those dying in discomfort. One such case happened on Christmas Day many years ago. A man lay dying at home and in extreme pain. The local doctor came out promptly at the request of the son, who asked if something could be done to relieve his father’s distress. The doctor opened his bag, filled a syringe, and said to the son, “Now, you know what this means.” The son nodded and the doctor gave the injection. The wife and daughters were in the kitchen at the time and were never told by the son in his lifetime what had happened. As he packed his case to leave, the doctor told the son that his father may come around a bit an hour later, and be like his old self, but he wouldn’t be, really. The doctor left and what took place was exactly as he predicted. The father passed away peacefully that Christmas Day. Those days of mutual trust and confidence in doing the humane thing are still omnipresent in veterinary medicine, but have vanished from human practice, perhaps to its cost.