A pickled onion could be the cure...
There is no chance of good that does not carry the risk of ill,” noted the Scottish philosopher David Hume – hence the requirement for doctors to obtain their patients’ informed consent that they appreciate both the good and ill of any proposed treatment. This is scarcely necessary when commending antibiotics for a nasty chest infection, as the “chance of good” is so self-evident.
It should, however, be mandatory for those preventive drugs to lower blood pressure, cholesterol and glucose for reasons illustrated by the misfortune that befell a man in his mid-80s: fit and healthy for his age but taking medication for type-2 diabetes and raised blood pressure.
He acquired a new doctor who, finding that both his HbA1c and blood pressure were marginally above the recommended guideline targets (8.5 per cent versus 8 per cent, 154/92 versus 140/80), switched him to insulin and doubled the dose of his antihypertensive drugs. Three weeks later, he was admitted to hospital with a fractured hip and found to be both hypoglycaemic and hypotensive (i.e both his sugar and blood pressure levels were too low). Once recovered, he could no longer live independently and required residential care.
Now, the presumption of adhering to guidelines and intensifying treatment to achieve them (with all the potential hazards, as here, of over-treatment) is that it will be to the patient’s advantage – but by how much? Professor John Yudkin, writing in the British
Medical Journal, calculates that for this unfortunate man, the increase in his life expectancy from switching to insulin and doubling the dose of his antihypertensives would have been in the region of just five weeks.
The financially incentivised requirement for doctors to “treat to guidelines” lets them off the hook of making this type of calculation, and the very modest gains that may result. They need to be encouraged to do so – best achieved, Professor Yudkin’s suggests, by the public insisting on the principal of informed consent based on an appreciation of the “chance of good and risk of ill” of any proposed treatment.
Hair-raising
This week’s medical query comes courtesy of Mr O W from Bristol, in his early sixties and “hopefully in good health”. For the last several months, his body hair on the lower abdomen and pubic region has become dry and coarse – irritating his skin and causing “not inconsiderable discomfort”. Could this, he wonder, signify he is lacking in some essential nutrient, or might there be a hair-softening agent he could apply?
Pass the vinegar
Finally, the last word on the tribulations with the acidsuppressant Omeprazole (and other ‘‘azoles’’) in predisposing to disturbances of heart rhythm (from suppressing magnesium levels) and inflammation of the bowel (microscopic colitis). It would appear that many cardiologists and gut specialists are unaware of the connection, and subject their patients to intrusive and inconclusive investigations, whereas discontinuing the drug is curative. Those whose heartburn recurs can switch to Gaviscon or Ranitidine.
Two further points merit clarification. The stomach secretes acid to aid digestion – that is its natural state – and while reducing the volume of acid with medication will alleviate heartburn the acid per se, is not itself the cause. The culprit rather is incompetence of the lower oesophageal sphincter, the valve that permits its reflux upwards. For those on the plump side, the valve’s competence can be restored by losing weight, while nocturnal heartburn can be prevented by elevating the head of the bed with a couple of bricks.
Next, several readers commend the benefits of cider vinegar (two teaspoons before meals in eight ounces of water) and picked onions which, being acidic, one might imagine, should compound rather than relieve heartburn. This highlights the paradoxical and important phenomenon that, for some, heartburn is due to their stomach producing insufficient acid due to an age-related decline in the number of acid-secreting glands. It is suggested that this hypochlorhydria, as it is known, predisposes to reflux by causing the valve to relax – a process that is reversed by cider vinegar and pickled onions.
Email medical questions confidentially to Dr James Le Fanu at drjames@telegraph.co.uk. Answers will be published on the Telegraph website every Friday, at telegraph.co.uk/ wellbeing/health-advice