Dis­turb­ing noises!

Malta Independent - - DEBATE & ANALYSIS -


He made his protest af­ter a fu­tile re­quest to the author­i­ties and the po­lice to do some­thing about it. Noise as a source of pol­lu­tion is a dif­fi­cult sub­ject to tackle be­cause ir­ri­tat­ing noise lev­els are so sub­jec­tive but, make no mis­take, it can pro­duce very dis­turb­ing health pat­terns in hu­man be­ings caus­ing in­som­nia, anx­i­ety and de­pres­sion if it is repet­i­tive and loud, es­pe­cially in those who are ill and the el­derly.

It is also some­thing that we in Malta have not even started to tackle as an en­vi­ron­men­tal is­sue. Traf­fic, en­ter­tain­ment ar­eas, petards, dis­cos and build­ing sites all cre­ate noise which may be repet­i­tive, loud and dis­turb­ing, mak­ing life for those liv­ing nearby – and even the work­ers in­volved them­selves – dif­fi­cult or un­bear­able. We even have mo­tor cy­cles and cars re­mov­ing their si­lencers to sound more pow­er­ful to the detri­ment of peo­ple liv­ing in the roads they pass through.

I think that Dean raised an im­por­tant is­sue in Malta that is not be­ing tack­led at all and needs to be. My first ad­vice to him is to keep this ef­fort up and my other ad­vice is for him to choose care­fully the tools he uses for his mis­sion. Bat­tles on the en­vi­ron­ment are usu­ally pro­longed in na­ture.

I par­tic­u­larly have in mind the true story of Erin Brock­ovich, who had to labour for sev­eral years against the poi­son­ing of the wa­ter sup­plies of the neigh­bour­hood in which she lived. Sev­eral hours, days or years spent fight­ing for a par­tic­u­lar cause means Dean will need en­ergy and per­se­ver­ance and it means that he has to pre­serve his health so that he can live to fight an­other day. So I do not sug­gest hunger strikes as a method of grab­bing at­ten­tion as they usu­ally fin­ish in a dead end. I do, how­ever, sug­gest for­ti­tude and seek­ing ac­tive sol­i­dar­ity as some of the tools he should use. In­volve more peo­ple and make more ‘noise’ on the is­sue. An en­vi­ron­men­tal lobby should be strong and per­sis­tent lead­ing those re­spon­si­ble to po­lit­i­cal ac­tion! So good luck in your quest and per­sist.

The sec­ond se­ries of dis­turb­ing noises this week were from the chair­man of the Medicines Author­ity, Prof. An­thony Ser­ra­cino In­glott who, con­trary to the ad­vice of the Med­i­cal Coun­cil, sug­gested that the morningafter pill should be avail­able over the counter (OTC) with­out a doc­tor’s pre­scrip­tion. The Med­i­cal Coun­cil, a coun­cil elected by its doc­tor mem­bers and hav­ing statu­tory pow­ers at law, sug­gested that cau­tion had to be fol­lowed in dis­pens­ing the morn­ing-af­ter pill due to un­cer­tainty, but also stated that if the author­i­ties should go ahead with mak­ing it avail­able, it should be avail­able only on a pre­scrip­tion ba­sis by a med­i­cal prac­ti­tioner.

Prof. An­thony Ser­ra­cino In­glott goes on to say that phar­ma­cists have the nec­es­sary train­ing as to whether or not it should be pre­scribed, and should only con­sult a doc­tor (re­gard­ing a pa­tient) when the phar­ma­cists have doubts. He goes on as re­ported as say­ing that this is not only about the morn­ing-af­ter pill, it is with every other med­i­ca­tion as it is stan­dard prac­tice! Now I do not know where he has got this from, as ev­ery­body knows that un­less one has a pre­scrip­tion for drugs, one can­not get them over the counter, al­though there are a few OTC prepa­ra­tions.

If any­thing, af­ter the an­tibi­otic de­ba­cle as a re­sult of which most an­tibi­otics are now use­less be­cause they were avail­able OTC for a long time, the Health Depart­ment is go­ing in the op­po­site di­rec­tion, where it is in­creas­ing pre­scrip­tion items and re­duc­ing OTC items! This makes much sense be­cause of­ten the his­tory of a pa­tient is needed – as is a fam­ily his­tory and an ex­am­i­na­tion – be­fore the cor­rectly dosed item is pre­scribed for the nec­es­sary num­ber of days!

The of­fi­cial SPC of one of th­ese emer­gency con­tra­cep­tive prod­ucts is full of con­tra-in­di­ca­tions, pre­cau­tions and in­ter­ac­tion warn­ings. How are th­ese things to be as­cer­tained over the counter? Who will be re­spon­si­ble if things do not go well with the pa­tient, to put it mildly? What if, for ex­am­ple, the pa­tient has liver prob­lems, Crohn’s Dis­ease, ul­cer­a­tive col­i­tis, galac­tose in­tol­er­ance, al­ready has an ec­topic preg­nancy, is on pheny­toin, phe­no­bar­bi­tone, car­ba­mazepine, sev­eral an­tibi­otics, herbal prepa­ra­tions, war­farin or has had in­testi­nal surgery? Who will be re­spon­si­ble for what hap­pens then when things go wrong?

There is also an­other se­ri­ous is­sue here and it is a pub­lic health one. In pub­lic health we teach the pub­lic the ABC of safe sex. First Ab­stain, if not BE Care­ful who to have re­la­tions with and if not, a very dis­tant thirdly, use reg­u­lar meth­ods of Con­tra­cep­tion to pro­tect against ill­nesses and un­con­sid­ered preg­nan­cies. Emer­gency con­tra­cep­tion, on the other hand, is an oc­ca­sional method. It should in no in­stance re­place a reg­u­lar con­tra­cep­tive method! Emer­gency con­tra­cep­tion does not pre­vent a preg­nancy in every in­stance. If a woman has had un­pro­tected in­ter­course ear­lier in the cy­cle, con­cep­tion and even im­plan­ta­tion may have al­ready oc­curred!

What rot­ten med­i­cal ad­vice is this, to have the morn­ing-af­ter pill avail­able over the counter when the reg­u­lar con­tra­cep­tive pill is cur­rently avail­able only on a doc­tor’s pre­scrip­tion be­cause of the dan­ger­ous med­i­cal is­sues in­volved like ve­nous and ar­te­rial throm­boses and smok­ing? Is not this telling the woman to dis­pense with reg­u­lar con­tra­cep­tion and only use the morn­ing af­ter pill which is use­less af­ter im­plan­ta­tion has oc­curred apart from all the other eth­i­cal is­sues con­cerned with its use?

If it is de­cided to al­low the use of the morn­ing-af­ter pill, this should be only on a doc­tor’s pre­scrip­tion, al­low­ing the pre­scrib­ing doc­tor and the dis­pens­ing phar­ma­cist to look at the med­i­cal – as well as eth­i­cal – is­sues in­volved. All med­i­cal pro­fes­sion­als have the right to ob­ject if they iden­tify a dan­ger to the pa­tient’s life, just as they have the right to con­sci­en­tious ob­jec­tion on eth­i­cal grounds if they feel it ap­pro­pri­ate. Pro­fes­sion­als should not be con­sid­ered as pup­pets in the hands of the state or of ill-ad­vised pa­tients’ re­quests.

I can­not un­der­stand how this is­sue is be­ing pi­loted by Civil Rights Min­is­ter He­lena Dalli, who is not a physi­cian, and not the Health Min­istry. I can­not un­der­stand how the Med­i­cal Coun­cil and sev­eral other health pro­fes­sion­als give ad­vice against cer­tain prac­tices and one has to only con­sider the sin­gu­lar ad­vice by the Chair­man of the Medicines Author­ity? What about the Bioethics Com­mit­tee set up by gov­ern­ment? Are they asleep or have they been switched off by their Min­istry?

I sug­gest that if the gov­ern­ment goes along with Prof. Ser­ra­cino In­glott’s sin­gu­lar ad­vice on this is­sue, then civil in­dem­ni­ties for health dam­ages caused should also be laid at the feet of the peo­ple in­volved, his feet and at the feet of the Min­is­ter tak­ing his ad­vice!

Dean Camil­leri

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