A green planet is a healthier world

We doctors were always taught about the various diseases as if they were separate, individual afflictions, with little interaction.
The fact that a multitude of other factors, including environmental ones, also strongly influence disease was rarely discussed.
If we have been a bit slow on the uptake, those heading the campaign on climate change certainly haven't.
Frustrated by the slow response from many of us to their pleas to make "green" changes to our lifestyles, they have sought new ways to bribe us into submission - and come up with the impact that climate change could have on our health as a topic that hopefully will get us listening.
Health Secretary Andy Burnham has declared that health should now be at the centre of our fight against climate change and has called upon ministers and professionals across the world to recognise the danger that climate change poses to public health.
Wherever we live in the world the climate has powerful impacts on human life. We are brilliantly designed to live in many environments but there are limits.
Extremes of heat and cold can cause potentially fatal illnesses and research has shown that they can increase death rates from heart and respiratory diseases.
It's already happening. Heatwaves across Europe cause thousands of deaths and the recent flooding in Cumbria disrupted many lives, significantly increasing the risk of disease.
The majority of people rely on safe drinking water, sufficient food, secure shelter and good social conditions to ensure their health.
A changing climate is likely to adversely affect all of these conditions.
It's clear to see how changing ecological systems may affect the prevalence and range of infectious diseases.
Vector-borne diseases such as malaria, dengue fever, yellow fever and encephalitis are currently among the largest global killers.
It has been predicted that the global population at risk from malaria will increase by between 220 million and 400 million in the next century.
While it is unlikely that climate change would cause malaria to become re-established in somewhere like London, the overall effects of a rapidly changing climate on health are likely to be overwhelmingly negative, particularly in the poorest communities - which ironically have contributed least to greenhouse gas emissions.
One reason we in the West have done so little about it is that most of these climate-related disasters occur in developing countries.
Perhaps if we started to suffer from them saving the environment would become more of a priority.
There are added benefits to getting greener. Cutting down on red meat consumption means livestock numbers can be reduced, lowering methane emissions but also improving our diets, particularly our saturated fat intake.
As is so often the case it's the elderly, the very young, the homeless and the poor who are especially vulnerable to increase risk of disease.
Darwin would certainly have something to say on this but only the fittest being able to survive is no longer acceptable.

Stress has many causes and symptoms

We all need a certain amount of pressure in our lives to make our work satisfying and help us meet our deadlines.
But too much pressure without having the chance to let off steam causes stress. Of course, what is stressful for one person may not be stressful for another. Some thrive on it while others crumble.
If you feel that you are always rushing about, trying to be in too many places at once, missing meal breaks, for ever taking work home with you, and never seem to have enough time for exercise, relaxation or spending time with your family, then you may well be at risk of developing stress-related problems.
Stress is caused by a wide variety of different situations, and so can also have a wide range of symptoms. I tend to divide these into physiological, psychological and behavioural symptoms.
Physiological symptoms caused by stress include headaches, migraines, stomach disorders, raised blood pressure, changing sleep patterns, muscle spasms, back/shoulder/neck pain, general malaise and an unwillingness to work.
Psychological symptoms can cause you to grow resentful towards your work, making it a place of anxiety, tension and the cause of irritability, low self-esteem and forgetfulness. It can even lower your sex drive.
Finally, behavioural symptoms can cause sufferers to becoming irritable, aggressive and withdrawn, and to stop communicating.
An affected person may show signs of changes in eating and sleeping patterns; they may drink and smoke more, and even start excessively self-medicating.
Of course, these will also affect home life, making them more “difficult” outside work, less able to cope with their family and maybe even neglecting their hygiene and personal appearance.
There is rarely any one single cause of work-related stress.
While sudden, unexpected pressures can trigger it, it is often the result of a range of stressful factors that build up over time. If they are left undetected and untreated, they can reach boiling point and cause a full mental breakdown.

Why sport is a vital goal for women

A local school in Lambeth, near to where I walk my dog, is the venue Sport England has chosen to announce the launch today of its new £10 million campaign targeted at getting women from disadvantaged communities to play more sport.
Even Gordon Brown is urging a cultural change that allows girls to see sport and physical activity as aspirational - something that is most definitely not the case now.
Many girls enjoy games such as netball and hockey at school but as soon as they leave often all sporting activities stop. This is a shame.
The statistics show that campaigns of this sort really are needed.
There has been almost no change in the level of women's physical activity in the UK for the past 20 years, with 80 per cent of women doing too little exercise to benefit their health.
Twice as many men play competitive sports as women and six out of 10 women prefer exercising alone to team sports. Is this because sporty athletic girls are seen as unfeminine and female team sports a little too sweaty and "butch"?
I suspect that early experiences at school (don't we all have memories of terrifyingly masculine PE teachers hurling medicine balls at us?) have a greater impact on how girls perceive sport, and this is backed up by some evidence.
Research has shown that nearly a quarter of women say that PE at school put them off sport, two in five girls felt selfconscious about their bodies in PE lessons and a quarter of women hate the way they look when exercising or playing sport.
I remember having to play in "skins" (meaning top off) as one team colour as opposed to "shirts" (top on) and absolutely hating it, feeling terribly self-conscious, but I suspect getting small boys to run around with their tops off is forbidden now. I did go to a public school, after all.
This has got me thinking about the way we doctors sell the idea of exercise to our patients. I tend to say "join a gym" as an automatic response when discussing weight loss, as this is the London thing to do.
Talking to my colleagues has confirmed that this seems to be the standard advice that most of them give. But is the gym quite the same, and does it have the same benefits as a team sport? I favour the mindless gym as my own choice of training.
I work out admittedly a little excessively and go about five times a week, which means I like to think I am pretty fit. But I suspect my speed, agility, balance and endurance are actually very poor.
I lift weights in the main which will make me strong but that's about it.
Playing sport would certainly redress this imbalance. So this idea has struck me as rather a good one, and perhaps something we should be suggesting more - and gym membership a little less.
The benefits of sport go far beyond simple weight loss.
We know that women who play sports do better academically; they have improved learning, memory, and concentration, giving active women an advantage.
Sport teaches teamwork and goal-setting skills; important in business where teaming up with others to meet goals can be the key to success.
Some benefits of sports are immediately obvious - such as improving fitness and maintaining a healthy weight, but women who play sports are less likely to smoke and have reduced chances of getting breast cancer and osteoporosis later in life.
We also know that women involved in athletics feel better about themselves, both physically and socially, and playing sports can help deal with stress and fight depression. I don't know why I didn't think of it before.

Stop being so selfish and get the swine flu vaccine

The swine flu vaccine has finally been developed and approved and is about to be rolled out across the UK amid a flurry of controversy.Should pregnant women get it? Do I really need it if I'm young, fit and healthy? Should I get the seasonal flu vaccine, too?
The anti-vaccine lobby suggest we are using claims of an impending emergency to rush medical products through the usually tight controls to the detriment of their safety.
They state that the swine flu jab hasn't been properly tested or put through the normal process of long-term safety testing that the public expects.
They also argue that because the fatality rate from swine flu is remarkably low, in fact no higher than seasonal flu, there is no real need for a vaccine at all.
Most other non-live vaccines and previous flu vaccines are safe for pregnant women to be given, and as they are more likely to be hospitalised if they catch the flu it seems sensible they are vaccinated.
The European Medicines Agency has given a clear recommendation that the GlaxoSmithKline vaccine can be given safely to pregnant women and side-effects will be monitored closely during the initial campaign.
The Department of Health has issued a dramatic statement claiming that the risk of swine flu is so great that patients' health will be put at risk and the NHS left understaffed through illness if the majority of its workers are not vaccinated.
Many NHS nurses see the jab as unnecessary and potentially unsafe.
To add to the mêlée, some very up-to-date reports of Canadian research suggest the possibility that having the seasonal flu jab could double your risk of developing swine flu.
No wonder NHS Direct is already swamped with calls.
This is an unfortunate example of the medical establishment's attempts at reassurance and calls for calm backfiring on them.
The repeated reminders of the benign nature of swine flu, and the recent claim that the UK is "tantalisingly close" to beating the virus, is making many believe that vaccination is neither important nor necessary.
My view is that frontline staff should strongly consider the vaccine, especially those working with very ill patients.
As was proved in round one of the swine flu attack, most of us who got it were relatively mildly ill for a short time but it did kill those with pre-existing conditions.
I will be getting vaccinated because, as a London doctor, I am almost certainly going to be exposed to the virus by my patients.
I often see the elderly and the frail and those with serious immune diseases so I need to be sure that I will not be passing this potentially life-threatening virus on to them.
Flu can kill the vulnerable. Nor do I want to give it to my grandmother on a Christmas visit.
Perhaps we need to start thinking about this issue a little more altruistically?

Dr Christian wears Hawes & Curtis

Traditional shirtmakers from Jermyn Street have been coordinating my outfits for Embarassing Bodies & Supersize vs Superskinny. The vibrant colours combined with elegant, subtle tailoring paired with an impressive array of bold stripes and checks have been my choice since series one.

After so many enquiries about the shirts I wear on TV I have decided to write in here where I get them from.

I often wear Hawes & Curtis off screen too in clinic as they are always very smart and definitely not boring.

Jacko's Death Highlights abuse of prescription drugs

Another death and so another issue becomes ‘hot’ this week. This time it’s misuse or abuse of prescription drugs following the death of Michael Jackson. I’m not sure the issues are quite the same in the UK. Patients here don’t have doctors at their beck and call in quite the same way as they do in, say, the US. There, the very nature of the way doctors are paid means that they have a greater need to keep their patients happy and coming back to them, which dare, I say it, means providing them more readily with the prescriptions they ask for (I now ready myself for indignant letters from American medics...) It is now claimed that the abuse and trafficking of prescription drugs, including painkillers and stimulants, has overtaken the use of nearly all illegal drugs.
If you think about it from the addicts point of view this shouldn’t really be that surprising: medications containing narcotic drugs or psychotropic substances can provide a high comparable to practically every illicitly manufactured drug when taken in appropriate (or perhaps that should be inappropriate) quantities, but without the risk of them being ‘cut’ with various noxious substances by the dealer. Fentanyl, a painkilling drug is thought to be around 80 times more potent than heroin and is pure. Why would you ever go back to heroin?
The two most commonly abused drug groups are opioids and benzodiazepines. They are usually prescribed for short-term use but they may also be prescribed for chronic pain or generalized anxiety and this is where the problem starts.
The body becomes tolerant to their effects and so larger doses of the drugs are needed to achieve the same effect. Doses get gradually higher until patients are taking huge quantities and become completely dependent.
Addiction is different. Addicts tend to be reliant on the regular use of a drug to satisfy physical, emotional, and psychological needs so that the drug begins to take over their lives and becomes more important than anything else. There are many housewives who are unidentified addicts. Started on antidepressants during a bad patch a year or so ago they become convinced that they now cannot function without their tablets. They depend on them emotionally and getting them off them will be a Herculean task.The elderly are particularly at risk. It’s estimated that as many as 17% of adults 60 and over abuse prescription drugs.
This is because there is less likelihood that an elderly person will comply with directions. We docs give advice like ‘always take with food’, ‘don’t drink alcohol with these pills’, ‘finish the course’, or even, in the case of addictive drugs, ‘only take for a short time and don’t sell your pills to dodgy looking blokes down the pub’, but this advice is rarely stuck to. Doctors are also much more likely to prescribe addictive medications to elderly patients than to younger ones.
But possibly a more acute problem in the UK is the effect that the pressures of looking good seem to be having on our fitness fanatics. A survey of male and female gym users last year found that 10 % used diuretics, 10% had used thyroxine, 14% insulin, 22% tamoxifen, 24% growth hormone and 44% had used ephedrine to boost their fitness.
And the issue of body dysmorphia is increasing in young men so that steroids remain the most abused drug, and even 7% of women admit to taking them. This is still abuse of medications, even if it’s not the addictive ones. I’m not sure that as a nation we are all hooked on painkillers, but we clearly have plenty of demons to fight.

It's not the doctor's fault that recession breeds depression

The powers that be, or in this case the powers that want to be; the Lib Dems, have reported that we docs are prescribing too many antidepressants. Their new report claims an increase of 2.1 million scripts for the drugs in 2008. Apparently we need to tackle this issue and reduce our prescribing. But are they really all completely unnecessary prescriptions, or are there simply more depressed people around? Or is there an absence of other treatment options easily available for doctors to access?

It’s considered very bad management to have a patient commit suicide on you, especially if he has been in the week before to make clear his unhappy mind, and so doctors naturally feel some sort of positive intervention must be made quickly.

A 10 minute appointment is really only long enough to write out a prescription.I have found myself asking why we are even setting targets to reduce the growth in prescribing of anti-depressants. Why are they seen as a bad thing? They are an evidence-based treatment that is appropriate to the particular malady and they allow patients who previously would have been disabled by their mental health condition to return to a normal life and give them the confidence to tackle their once insurmountable problems.

We should really be asking why there are so many depressed people around.The truth is that the recession (and I know this has now become the excuse for everything) is doubtlessly affecting the mental health of the nation. GPs are offering drug treatments because most do not have many other options. Access to therapists, psychiatrists and counsellors is limited and waiting lists are long. Mrs Creak with her achy hip can safely wait a few months to see an orthopaedic surgeon, Mr Gloom with his black mood and suicidal ideation cannot. Antidepressants may not remove the cause of the problem it is true. Popping pills wont resolve a failing business or an impending redundancy, but they at least help the patient to better ride out the storm.

Norman Lamb, the Liberal Democrats' health spokesman says "The increase in the number of people being prescribed antidepressants is deeply disturbing.” Yes Mr Lamb, it is. It implies the nation is not coping, not that GPs are overzealously handing out happy pills. We do need more alternative therapies to help counter the increasing reliance on antidepressants, but they are just not available. The government has already committed millions to plug gaps in mental health provision and has promised to train thousands more therapists and hundreds more specialist nurses. But that is for the future.

They are not here now. I think an effective solution would be to recommend good financial and debt management advisors to those caving in under the economic uncertainties. They would be able to come up with far more useful advice, and they will have longer than 10 minutes to do it in.

Men’s Health Week

Men’s Health Week has just come and gone. I know it’s confusing given we already have prostate week, erectile dysfunction week, testicular cancer week, male menopause week, testosterone week and many others. What bits could be left to cover?

Looking at the statistics of GP attendances in the UK for last year and also at the top 10 causes of death that’s easy to answer: men actually taking any notice of their general health whatsoever would be a good start. Can I just point out here that grunting away on a pec dec at it’s heaviest setting once a week and occasionally slapping on some high-tech-packaged moisturiser doesn’t count as health care. It’s vanitiy.

It may well help us to find a mate which could in time allow us to pass on our genes, arguably our primary role in life, but it’s not ging to do much to make us healthy. Men are notoriously bad at going to their GPs when they are ill, and alarmingly good at ignoring problems. In fact research shows that women are 100% more likely than men to seek preventative health care. It’s a male pride thing you see, a machismo deeply ingrained by evolution. Illness is weakness, and it would never do to admit to being weak.

It’s also to do with background access to healthcare in general. Women realise from a young age that it’s ok to talk about their bodies; their periods start and they talk about that. Then come family planning issues, with an ensuing visit to the GP’s in many cases, then babies, smear tests, mammograms, more babies and finally menopause and HRT. She is often at the GP or having some sort of medical consultation.

For man it’s a different story with most presenting to their GP’s for the first time when they hit 50 because the prostate is starting to play up. And having to talk to another bloke about his undercarriage is a mortifying new experience for which life so far has left him totally unprepared. It’s unfortunate for men that so often the bits that seem to go wrong first are the really embarrassing ones: testicles and lumps thereon, prostates with their sexual and urinary sequelae, erection probs, man boobs. Our smugness at not having to go through the hell of ‘women’s problems’ is now making us look foolish as we now die at higher rates than women from the top 10 causes of death.

We also die six years earlier than women on average. In the current economic climate men are experiencing high levels of stress, longer working hours and for many a less secure home life. This will inevitably lead to increased anxiety, depression, hypertension and heart disease. They are all treatable, as are many cases of male cancers, but only if we catch them early enough. To do that men need to start taking an interest in their long-term health, recognise and respond to health warnings and seek help when they need it.

They need to get more in touch with their feminine side when it comes to their health and take as much pride in going for a check up at their GP’s as they do in their grooming and appearance.

Acupuncture helps, but so does a back rub.

New guidelines tell GPs that they should now offer acupuncture to their patients with chronic back pain. This is the first time an alternative therapy has been backed in this way and smacks of desperation. What worries me most is their reasoning. The guidance says anyone whose pain persists for more than six weeks should be given a choice of several treatments, because the evidence about which works best is so uncertain. Translated for you into plain English it says ‘we have no idea so might as well try them all and hope one works.’ And this is supposed to have come from the National Institute of Clinical Excellence. Makes you think.

Results showing the ineffectiveness of most alternative remedies continue to pour out and so, in what I have to admit is a quite brilliant move, the peddlers of this snake oil have had a change of semantics. Instead of ‘alternative’ the treatments are now known as ‘complimentary’ i.e. they are now supposed to be used alongside traditional medical treatments. If that doesn’t sound like an admission of their uselessness I don’t know what is. (If I sound a little closed to other ways of treating illness then forgive me. I am not. What I am utterly opposed to is the dressing up of unsubstantiated mumbo jumbo witchery as science, coupled with a very selective reading of the ‘evidence’.

The truth is that back pain is difficult to treat and rarely has an easily identifiable cause. It one on a list of many heart-sink complaints that GPs dread hearing, like ‘I’m tired all the time, doctor’ or ‘I don’t feel right in myself.’ For many doctors this decision will come as mana from heaven -finally something to help get the patients out of the consulting room door on time AND they feel like we have actually been helpful. Doctor happy, patient happy, but commonsense, logic and 200 years of medical science have just been shat upon. Trials looking at the efficacy of acupuncture have shown that it helps a bit, for some people, but so does sham acupuncture (sticking needles anywhere) and so does jabbing the skin with toothpicks. And come to think of it so does a cup of green tea, a good chat with a friendly looking therapist and a back rub. And perhaps that is the key: time and a sympathetic ear, certainly lacking from many GP consultations today. If time and money were spent on improving access to GPs and the amount of time they can spend with their patients I’m certain that many chronic conditions would improve, without the need to fool and insult patients with sham quackery.

Welcome to my very first post

In here I would like to write about things I am so often asked but for some reason have not yet found the time or space to answer.

Thank you all for the lovely emails to my website and messages on my Facebook profile, they really made me realize how keen you are to find out more about getting fully fit, healthy eating, wellbeing and other such stuff. I'm also going to write in general about things that interest me, and hopefully they might interest you too.

This week has been very very busy, filming in Southend on Sea today for my new Channel Four show about cosmetic surgery -The Ugly Face of Beauty. It's going to be a cracking show and I hope will make people realise the crying need for more regulation and control over the cosmetic surgery industry. And we filmed some amazing surgeries too.

Londoners need a trendy sex clinic

Despite decades of pleading from doctors to take the nation's sexual health more seriously, the Government is only just getting round to addressing the issue.
Its answer, as is so often the case, is to throw money at the problem, and so bring on a shiny new walk-in centre in Soho, complete with designer wallpaper and wi-fi access.

The glossy brochure looks like an advert for a new Grouchoesque members' club and its pages boast that "the colours, finishes and quality of materials and furnishings have created an inviting, comfortable, reassuring and stylish environment".

My gut reaction was to groan at the vast sums of taxpayers' money wasted on hardwood flooring and Cole & Son's wallpaper instead of medical supplies but the great difference between sexual medicine and most other specialities is that its success relies on getting people through the door and screened, not on expensive drugs or high-tech equipment.

Many STIs do not cause any symptoms and so people need to volunteer themselves for regular screening if we are to get on top of the problem.

Most NHS clinics I've worked in were around the back of the main hospital building, seedy, dirty, badly lit and certainly not places you wanted to be seen coming out of. Even the discipline itself, ungraciously called veneriology, was part of the dermatologist's remit. It's now a glorious speciality in its own right.
This new clinic offers exactly the same services as most other GUM clinics but the big difference is that it is trendy and welcoming, even, dare I say it, "cool".

Here's hoping that the bright young things agree with me and don't mind being seen coming out, for then our battle is half won.