Rude Health
Maurice Gueret checks out the draft programme for government
Cycling breeds
Thank goodness library and bookshop doors are ajar again. And MoLI is re-opening in a fortnight. Good writing is appreciated all the more after 137 pages of a draft programme for government. I read it through and wished for a policy of my own: a strict national limit on how often the words ‘vibrant’ and ‘sustainable’ are used in one place. It’s a good programme for anybody in the bicycle trade. Cities and cycle pathways look set to get much of the money that used to be spent on rural roads. Biodiversity is mentioned 48 times; potholes aren’t mentioned once. I oiled up my old bicycle some time back and took to the roads around Dublin. But the experiment came to a jolting end. I had lost my nerve. I found car drivers respectful enough. It was a new generation of urban cyclists who scared the wits out of me. There are two breeds on bikes. Those who ride them as they do in the pedestrianised towns of Holland. And those who ride them as if competing for the yellow jersey in the
Tour de France. I fear that the investment we are about to make in our saddled-up Republic is for speed merchants in goggles and Lycra. Those of us with black bikes, bicycle clips and baskets in the shed may end up keeping them there.
Bismarck Care
I’m puzzled by what a new government is going to do about health. The stated mission in their programme is universal healthcare, but it was abandoned by Leo Varadkar years back. Slaintecare is not universal healthcare. It’s an attempt to drive an ideological wedge between public and private healthcare, when the real aim should be to bring them together to work for everyone. Covid-19 should have taught us one lesson. Germans do healthcare a lot better than the free-for-all British service and the forprofit-only American one.
Otto von Bismarck designed the socialised German system and gave it to his country as a Christmas gift in 1884. There is mandatory insurance for everyone, with an annual premium from all citizens and employers, proportionate to income. A not-for-profit insurance pot pays hospitals and health professionals for the work they do. Busybodies, clipboard folk and layered bureaucracy are minimised. Patients are central, and everyone is incentivised to see them as soon as they can. With the 50th anniversary of Ireland joining the European Union approaching, any new government should ask our new best friends to help us out in installing an old system that actually works.
Compound E
Dexamethasone is big news this summer. Last month, we learned that the UK had ringfenced supplies when trials of the 70-year-old steroid appeared to reduce hospital deaths in Covid-19 patients. It was the first bit of good news in ages for Boris Johnson, who has been under pressure to explain why the NHS suffered greater mortality in the first pandemic wave than any other health system in Europe. Steroids last made headlines just after World War II. In 1949, physician Philip Hench, of the famous Mayo Clinic, told colleagues about a new drug, then known as compound E, that was allowing patients with severe rheumatoid arthritis to walk again. He showed them a ‘before and after’ film of his patients and received a standing ovation. Compound E was cortisone, and doctors came to know it, and its descendants, as medicines that helped the body to heal itself. A variant called dexamethasone was created in 1957, and became a licensed treatment here in the 1960s. Decadron was the first trade name for the tablets, which were yellow or pale blue, depending on the dose. There was also an injectable form that could be used to treat swelling of the brain, severe croup and joint flare-ups. It may not be a panacea for this pandemic. But dexamethasone is a very good start.
Video script
I read that the United States FDA has given approval to the first video game on prescription to treat a medical condition. It’s called EndeavorRx and the tagline is ‘Play Your Medicine’. It will be used in conjunction with standard treatment, not instead of it. The treatment group is eight-to-12-year-olds with attention deficit hyperactivity disorder (ADHD). It looks like a bog-standard whizzaround video game to me, but apparently it stimulates neural pathways that are important in increasing the attention span. Competition, perhaps, for a subscription to Minecraft and Animal Crossing.
Dr Maurice Gueret is editor of the ‘Irish Medical Directory’ drmauricegueret.com