Maurice Gueret on health

Irish people and drink

Top tipplers

The latest booze charts were published this month in The

Lancet, and they reward us with interesting insights into drinking patterns and abstinence rates in nearly 200 countries worldwide. Ireland holds fifth place in the high-drinking stakes for the most recent year studied. It doesn’t quite qualify us for the final of the Champions League (that’s Moldova vs Lithuania), but we are firmly in a high league position of world tipplers, consuming just over 13 litres of pure alcohol each per year. The study authors forecast that we may fall down the tables in years to come. Not because of any wave of national abstemiousness. But because other far-flung parts of the globe, especially in Asia and Africa, are expected to consume more. Thirteen litres mightn’t sound a lot. But that’s pure alcohol we are talking about. I have done the sums, and it’s 133 bottles of a medium-bodied wine a year. Moldovans and Lithuanians are consuming the equivalent of 145 bottles of the same plonk. Figures worth bearing in mind if you are becoming a bit well-known at the bottle bank.

Pioneers no more

Last year, the same medical journal published a stark statement saying that the safest level of alcohol drinking is none at all. Alcohol is cited in almost 3 million deaths a year. Life assurance actuaries will tell you that it is the biggest risk factor for deaths and disability in the under-50 age bracket. Influence of the total abstinence movement in Ireland has certainly waned, alongside its sponsoring church. This new study tells us that the number of Irish teetotalers has fallen to less than 10pc in the last 30 years. When you consider that in the 1950s, the Pioneer Total Abstinence Association claimed that one in three Irish adults were members, that’s a very sobering fall from grace. Predictions in this new study are that by 2030, just 1 in 20 Irish adults won’t be touching a drop. We will have taken our place among the nations of this Earth where alcohol has replaced tea as the daily medicine of popular choice.

Turf toe

I don’t learn much medicine with my subscription to Sky Sports, but was thankful to a recent Sunday-night golf commentator for introducing me to an ailment they call turf toe. I had never heard of the condition, or at least not with that name. The English golfer Paul Casey, pictured right, suffered from turf toe, and it badly affected his game some time back. It’s an American term for what we call a sprained MTP — the metatarsophalangeal joint. You have five of these joints in the front of each foot. The phalanges are the small wiggly bones in your toes, while the metatarsals are five longer ones hidden beneath the skin of your forefoot. Americans reserve the term turf toe for a sprain of the big toe. The condition came to prominence when they started building a lot of artificial pitches for American football teams. Most sports that moved from softer grass to harder artificial turf noticed an increase in these injuries. The sprain happens when the toe becomes hyperextended. If you are running and somebody or something heavy lands on your calf, it doesn’t take a lot to overbend the big toe. In Casey’s situation, not being in a contact sport, it took some time to get a diagnosis. Possibilities considered for his swollen painful toe were chipped bone, arthritis, insect bite, infection and gout. Relief and treatment followed only when the correct diagnosis of turf toe was made. He is playing well again on Sky Sports, and the limp is gone.

Cause of death

It can be a morbid preoccupation of doctors to scan daily death columns looking for proof of diagnosis or confirmation of failure. Irish death columns are quite tame and respectful in their content. You may sometimes guess the diagnosis from the place of death, age, manner of passing, or where donations are encouraged to go. In contrast, the weekly British Medical

Journal actually records the diseases that doctors die from in their weekly obituary column. It’s a tradition, built, I suppose, on the premise that the first question doctors ask in the wake of a death, especially of a colleague, is what the diagnosis was. As I write, this week’s collection includes the effects of old age, organ failure from a yellow fever vaccination, a bad fall, ruptured aortic aneurysm, brain tumour, and complications of an intestinal pseudo-obstruction. When my earthly time is up, I have no objection to publishing cause of death. If it’s a trip, so be it. Just don’t say it was on the way to the bottle bank!