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Issue 87

A free publication for Doctors and Patients

Knife crime - an emerging public health issue Report by Dr. Tom Fitzgerald According to a recent study, published by the Centre for Crime and Justice Studies, recorded muggings involving the use of knives have increased from 25,500 in 2004-5 to 64,000 in the year to April 2007. This reflects 175 victims every day, compared to just 69 in 2004-5. Every day, between 1997 and 2005, 13 people required hospital admission for treatment following stab injuries. Knife-related injuries are a major public health issue and treating victims of knife crime places a massive strain on our already overstretched NHS. Injuries caused by knives can have a devastating effect on victims and their loved ones. According to Home Office figures, between 1995-200, 37.9% of homicide victims were the victims of stabbings-the commonest cause of death. A similar study in Scotland revealed an even more alarming picture, with the homicide rate for stabbing-related assaults increasing 164% between 1981 and 2003.

An audit of forensic knife injuries at one East London hospital revealed 309 injuries over a 2 year period, of which 259 victims required admission, 184 required surgery and 8 died of their injuries. This audit suggested that the injuries were becoming more serious. In an editorial in the BMJ in 2005, a team of emergency physicians called for a ban on pointedtip kitchen knives of the dagger variety, which anecdotally are thought to be used in a significant proportion of forensic knife injuries. There are no reliable statistics on the incidence of knife carrying. With the rise in gang culture, many young people carry knives because of peer pressure or for protection against assailants. This creates a vicious cycle and evidence suggests that young people carrying knives are themselves more likely to be victims of knife-inflicted injuries. Evidence from the British Crime Survey 2005-6 suggests that young men, those from minority ethnic communities and the poor are most likely to be victims of violent crime.

Tackling the rise in knife crime will require an integrated approach, involving a number of government departments and other agencies. This must include action to address the root causes of violent crime as well as robust measures to deter young people from carrying knives. Further research will be required to evaluate various interventions to reduce knife-inflicted injuries. Steps need to be taken to reduce poverty, unemployment and social deprivation-all factors known to predispose young people to commit violent acts. Young people need positive role models, together with training opportunities if they are to turn their backs on the sub-culture of violence and knife carrying. Educational strategies will be required to provide young people with information about the consequences of knife injuries. High profile knife amnesties, such as the 2006 amnesty which saw 90,000 knives surrendered, are only part of the solution. The Violent Crime Reduction Act 2006 gave teachers tough powers to search pupils, suspected of carrying weapons. The Act also raises the age at which young people are allowed to purchase knives from 16 to 18. Currently, those prosecuted for carrying knives illegally may be imprisoned for up to 2 years, yet custodial sentences are rarely handed down. This is an ineffective deterrent and tougher penalties, together with robust enforcement have a vital role in preventing the increase in knife crime.

Inside... Page 2 - Insomnia - How to overcome it Page 3 - The ethics of cosmetic surgery Page 4 - The Cult called A.A.

Insomnia affects sleep quality How to overcome it Report by Laura Ng We all know sleep is important because our bodies’ systems undergo repair and maintenance during our sleep. But during our lives, we will experience some sleepless nights which are considered normal. But for some people, poor quality sleep is a recurring or even a lifelong problem. When your sleep quality is affected, the end results could well be feelings of fatigue during the day, irritability, poor memory, loss of productivity and loss of interest in family and social life. Therefore, achieving quality sleep is very important to your physical and emotional health. The quality of sleep is associated with number of sleeping hours. Doctors normally recommend that adults should need 7 to 10 hours of sleep daily and children would require more hours. But it varies among individuals. What matters is, for the duration you sleep, are you achieving the right quality of sleep? Insomnia, or the inability to sleep well, is a common problem which could affect anyone at one time or another. A person with insomnia may have difficulty falling asleep or staying asleep, wake up frequently during the night, or wake up earlier than desired the next morning. Insomnia generally falls into two categories, acute insomnia and chronic insomnia. Acute insomnia, which can last from one night up to several weeks, may be caused by a single stressful event; a period of emotional stress or illness; temporary pain or discomfort; disturbances in the sleeping environment such as noise, light or sleeping in a different bed and; a change in the normal sleep pattern, caused by jet lag or working in a late shift. This kind of insomnia usually doesn’t last


long once the root cause(s) is resolved. But it could be dangerous during the healing period as lack of sleep over a reasonable period could affect your concentration, leading to serious consequences such as accidents while driving or at work. Chronic insomnia is more serious as it can last for months or even years. The likely causes are mental or emotional conditions, such as depression or anxiety, or stress; poor sleep habits, such as watching television programmes in bed or going to bed at different times; too much stimulants intake such as coffee or cigarettes.; excessive drinking; lack of regular exercise; existing medical health problems such as breathing or heart problems, hormonal or digestive disorder, or chronic pain; side effects of certain drugs or different sleep disorders such as sleep apnea. Before we go on, a little more explanation is required here for sleep apnea. It is a condition whereby a person regularly stops breathing, or has slowed breathing during sleep for 10 seconds or longer. Depending on the frequency the breathing stops (apnea) or slows (hypopnea), we classify the condition as mild, moderate or severe. A person suffering from sleep apnea may snore loudly, and have restless sleep with difficulty breathing. As a result, he may wake up with a headache and tiredness which last the whole day. However, sleep apnea may improve with changes in sleeping habits. Sometimes, doctors may suggest use of devices to help easier breathing during sleep or even surgery. Insomnia can be cured as long as the victim develops a regular sleeping habit. Here are some remedies to help you ease or eliminate your sleeping disorder: 1. Reserve your bedroom for sleeping and sex only i.e. avoid eating, working, computers, TV, video or loud music in the bedroom 2. Create a clean and comfy environment for sleeping – soft lights, good ventilation, appropriate room temperature, good support pillows, sufficient comforters 3. Avoid caffeine drinks such as coffee, tea, soft drinks or chocolate drink and/

or cigarettes after 7pm in the evening. Also avoid snacking before bedtime. 4. Improve your diet by reducing meat intake and eating more fruits and vegetables especially kiwi, berries, green leafy vegetables, whole grains and cereals. 5. Switch off your mobile phones, blackberries, MSN or Yahoo! Messenger, ICQ etc after a certain time at night. 6. Drink a glass of warm drink such as soymilk or herbal tea before going to bed. But remember to visit the bathroom right before bed to reduce the chances of needing to get up later to do it. 7. If you find you can’t sleep after half an hour in bed, get up and read a book or listen to some soothing music. Use warm tungsten reading lamp instead of florescent lamp and don’t read books which are stimulating. Avoid watching TV, VCDs or DVDs as the light from these devices are bright and will affect the body’s biological clock, worsening your sleeplessness condition. You can return to bed as soon as you feel sleepy. 8. Exercise regularly does help to release tension, aiding sleep. But note not to do it late at night as this can result in insomnia. 9. Train your body to sleep and wake up at the same time every day regardless of whether it is a weekend or public holiday. The ideal time to get into bed is between 9 to 11pm so as to achieve the desired 8 hours of sleep. 10. If you need to nap during the day, try to keep it within 45 minutes which is sufficient to rejuvenate you. Napping too long may result in groggier mind and adversely affect your nocturnal sleep. 11. If you’re working at home, stop work at least two hours before bedtime to allow your mind to unwind and relax. With all these measures, doctors sometimes still need to prescribe hypnotics for sleep as treatment for insomnia But these medications are meant for short term only while patients try to find solutions to their various acute stressful problems.

The ethics of Cosmetics Surgery Report by Dr. Tom Fitzgerald Advances in plastic and reconstructive surgery have revolutionised the management of patients suffering from disfiguring congenital abnormalities, burns and skin cancers. Aesthetic (or cosmetic) surgery refers to plastic surgery performed

respect for autonomy, beneficience, nonmaleficience and justice. Whilst these principles were developed to guide physicians treating those suffering ill health, they provide the ethical framework which underpins modern surgical practice.

independent sector. No surgeon would ever proceed with an operation merely for personal pecuniary gain.

to improve physical appearance in the absence of pathology.

In general, competent adults have the right to decide whether they wish to undergo a surgical procedure. Providing they are given sufficient information, on which to make an informed decision, patients’ wishes must be respected. Information must include the risks of surgery together with alternative options. These principles still apply to aesthetic surgery where patients are not suffering from an “illness”.

Equitable access to healthcare is regarded as a basic human right. However, resources are limited and it is not possible for the National Health Service to provide aesthetic surgery for all those who would like it.

The demand for aesthetic surgery has increased in recent years as our culture has become more concerned with image and appearance. Many regard aesthetic surgery as a panacea for their personal and relationship difficulties. This may reflect modern imageobsessed popular culture, but it can be due to deep-rooted insecurities. Body Dysmorphic Disorder (BDB) is a psychiatric syndrome, characterised by a pre-occupation with a non-existent or minimal cosmetic defect associated with persistent attempts to have the defect surgically corrected. BDB is increasingly recognised, and may be becoming more prevalent. In the National Health Service (NHS), finite resources limit the availability of aesthetic surgery to those who suffer significant psychological distress due to their appearance. In 1979, Beauchamp and Childress published Principles of Biomedical Ethics, in which they presented four principles that have since been adopted as the ethical basis for contemporary UK medical practice. They argued that these principles “bridged” high-level moral theory and what they described as “low-level common morality”. These principles included:

This principle requires medical practitioners to act in patients “best interests”. Undertaking surgery to improve a patients self-image and esteem is acceptable. However, defining patients best interests can be very difficult. Many people experience real pain, discomfort, social handicap and suffering because they are self-conscious about their appearance. This group benefit from aesthetic surgery. This principle ensures that doctors never act against patients’ best interests or in a way that may harm a patient. Consultant plastic surgeons may decline to operate on patients if they do not believe that surgery is in patients’ interests. Surgeons are reluctant to operate on those with unrealistic expectations, as the risks of surgery may outweigh any benefits. Patients with serious health problems are at increased risk of suffering complications under general anaesthesia, and again the risks may outweigh the benefits. All such assessments need to be made on an individual basis. In the past, there has been a perception that surgeons have a potential conflict of interest in the

This principle requires doctors to ensure that medical care to available to all.

Rationing takes place on the basis of clinical need. Inevitably, this introduces subjective judgments about whose need is greater. In the private sector, those who can afford to pay can undergo surgery. Consultant surgeons and consultant anaesthetists treating patients, undergoing cosmetic procedures, should be on the General Medical Councils’ Specialist Register. Surgery should only be undertaken in premises that are fullyequipped, with resuscitation facilities and staff trained in advanced life support. Clinics and hospitals providing aesthetic surgery should be registered with the Healthcare Commission.

For further information: The British Association of Aesthetic Plastic Surgeons


The Cult called A.A. Report by Paul Roasberry When we think of cults, we usually think of bizarre religious sects, armed compounds, mind control and eccentric leaders. Most of us do not think of Alcoholics Anonymous (A.A.) as a cult, but I do. Three years ago, I was in the grips of a serious drinking problem. Like most alcoholics, I rationalised my drinking, citing the many terrible circumstances in my life. Then, almost three years ago, I stopped drinking. Oh, I attended a half dozen or so A.A. meetings at the time, upon the advice of someone recommended by a friend. The woman who suggested A.A. to me was a licensed psychologist. She was very active in A.A. What I found at the meetings was a weird mixture of the deplorable and the laughable. It didn’t take long to notice that something was not quite level with this organisation. I was tipped off to A.A.’s strong cult qualities when the lady psychologist made a somewhat curious remark during the first week or two of my sobriety. I had an uncle then who had been an alcoholic prior to 1960. Uncle Ralph consumed, by his own subsequent admission, about a quart of whiskey a day. He stopped drinking without the assistance of A.A. when he met my aunt. It was a condition of their marriage that he stop drinking, and he did.

Ralph, knew positively nothing about his character and yet claimed to be able to diagnose him as a “dry drunk” strictly on the information that he hadn’t progressed through the A.A.’s widely touted “twelve step program.”

At A.A. meetings, everyone sits around in a big circle. There are readings from ‘the Big Book’, a not-very-well-written compendium of home-spun philosophy and anecdote authored by Bill W and his colleagues some decades ago.

Of course, all cults have this in common: they reject and label as untouchables any who do not embrace their particular version of ‘truth’. To Alcoholics Anonymous members, anyone who stops drinking without chanting the mantras of cult founder Bill W are ‘dry drunks’.

Members start talking about themselves and their alcoholism, and oddly, this sounds more like self-criticism under Mao’s cultural revolution than anything therapeutic.

Don’t get me wrong. I do not advocate suppressing A.A. or any other cult. I simply want you to know, in case you are a problem drinker and are toying around with the idea of quitting, that it’s O.K. to develop your own solution to your own problem. The whole A.A. program hinges upon the alcoholic’s acceptance of what A.A. calls a “higher power.” This blatant renunciation of the concept of free will is also a characteristic of every single other cult I can think of - the individual counts for nothing, while the non-existent is all. Self-respecting, proud, analytical achievers do not make good cult members. A cult follower must be stripped of his sense of individual worth in many sects, he is humiliated sexually, deprived of sensory stimuli, sequestered from the larger community, or otherwise manipulated to look upon himself as degraded and worthless. In A.A., you are pressured to place your entire destiny in the hands of some “higher power.” When I began to ask hard questions about the nature of this “higher power,” I learned (no kidding!) that one member even had his motorcycle represent his “higher power.”

If you begin to question this program of A.A.’s, the talk gets tough. You are told that you can never recover on your own; you are doomed to lapse over and over again into drinking binges, or at best, become a dry drunk. The more you try to trot out examples of persons who have transformed their own lives under their own steam, the more the party line is thrown back: you are powerless against drink. Any examples of alcoholics who quit drinking without the twelve steps are in reality only examples of dry drunks. When I left A.A., I made the comment that if I were powerless, I might as well commit suicide, because a life without any control over destiny would be pointless and absurd. I went about my recovery in the most sensible way I could imagine. I removed alcohol from my home, found some healthy pastimes to pursue and, in the whirlwind breakup of my marriage, I devoted myself to staying afloat financially, making my new company prosper and seeking out some like-minded companionship - that was when I re-joined Mensa. So, if you are determined to quit drinking, try the one-step program, instead: just stop drinking. Believe me: you can do it. I did.

I remember my Uncle Ralph as a sweet, generous man during the thirty-odd years he was married to my aunt. He was not abusive or cruel, he worked hard, and made an excellent stepfather to my three girl cousins. When I mentioned Uncle Ralph to the lady psychologist, stating that he’d quit drinking on his own, she immediately dismissed my observation with, “Oh, well, he’s just a dry drunk.” She of course had never met my uncle


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Medical Matrix : Issue 87  

A free newspaper publication for doctors and patients

Medical Matrix : Issue 87  

A free newspaper publication for doctors and patients