Monday, November 11, 2013 C7
HEALTH FROM THE EXPERTS
Why knowledge is a good thing
................................................ Dr K. Ganapathy firstname.lastname@example.org The father is an electrician in Dubai; the mother a housemaid in Dhaka. Their 19-month-old girl had a critically located, malignant brain tumour which had produced gross hydrocephalus (retention of fluid). The fluid was diverted into the abdomen through a shunt in the girl. The shunt had worked too well, resulting in the brain shrinking. That produced a large clot between the brain and its coverings. The chubby child was happily playing, totally oblivious to the discussions taking place between her parents and the doctor. Twenty-five minutes were spent elaborating on the various treatment options available – ranging from complex microsurgery for the tumour, removal of the shunt which had produced the blood clot, ligating the shunt, and even a period of observation while waiting for new clinical signs to develop. Also possible was a combination of the above options at different times. Benefits, limitations of different types of radiotherapy, chemotherapy, looking for tumour markers in spinal fluid in lieu of biopsy, the natural history, mortality, morbidity with multimodality therapy, were discussed. It was evidencebased medicine at its best. The discussion, based on 38 years of knowledge and “wisdom”, would have elicited kudos in any postgraduate examination. It even took into account socioeconomic factors, parents’ wants and desires, quality of life, and so on. To expect the mother to digest and critically evaluate the information provided, and to choose an optimal treatment option, is wishful thinking. Would prior knowledge have assisted her in participating in the decision making? Not necessarily. But in the banal world of health care, health literacy is perhaps more important than antibiotics, access to diagnostics or state-of-the-art therapy in altering health outcomes. But unfortunately, the uninformed patient is a universal phenomenon. For millennia, doctors have been on a lofty pedestal often taking a “holier than thou” attitude. Some doctors could even view proactive methods to empower patients as a step in a backward direction. In this information age of DIY, is it not the responsibility of government and society to
Veteran golfer Gary Player has just turned 78 and still follows a strict fitness regimen. He tells Mark Graham why it’s so important to look after yourself
1,000 The number of press-ups or sit-ups Gary Player does every day
erely listening to veteran golfer Gary Player recite his daily fitness regimen is enough to induce feelings of weariness and breathlessness, not to mention awe and admiration. Player, who turned 78 this month, does about 1,000 pressups or sit-ups almost every single day and often puts in a round of golf at one of the 300 courses he has designed in different parts of the world – including Kau Sai Chau, off Sai Kung, in Hong Kong. The lean and lithe South African sporting legend, the most successful international golfer of all time, has been a fitness advocate for more than half a century. It has given him the physical stamina and mental sharpness to continue playing, and working, into old age. He has a formidable annual schedule which involves zigzagging across the globe, often by private jet, from his two home bases: a vast estate in South Africa or the golf-oriented Jupiter Island in Florida. Last week, he was in Shanghai hosting the annual Gary Player International. Yet, when he first joined the international golf circuit, his devotion to a strict daily routine was considered extreme, even eccentric. “When I first started on the golf circuit I used to go the YMCA and work out there – I was ridiculed and called a nut in those days; nobody did weights. Now [golfers] have a travelling gymnasium,” says Player. “I look at people my age on the tour and they can’t travel like I do. They don’t have the energy, their quality of life is diminishing, whereas mine is getting stronger.” The results of his gym work are obvious: he walks vigorously, thinks quickly and talks eloquently and passionately, particularly when it comes to his two pet topics, health and environmental degradation. “Very few 30 year olds would beat me in a fitness contest,” says Player, matter-of-factly.
“Exercise is so important. I complete my fitness regimen four times a week, unless I am in one place, in which case it is every day. “I always say it’s thin to win; fat and you end up on the mat. When I was nine years old, my brother went to war and he made me promise that I would exercise while he was away.” Player is a virtual teetotaler – only a glass of whisky once a month – and follows a strictly modulated diet, avoiding fatty or sweet foods wherever possible and eating meat sparingly. Beijing-based consultant Justin Downes, who runs Axis Leisure Management, has worked with Player on several
The way we are going, the world is becoming desperately sick GARY PLAYER (RIGHT)
golf projects in China. He is in awe of the golfer’s stamina and uncompromising attitude to fitness. “I might do 1,000 sit ups in a five-year span, and he can do that in a day. He is an inspiration. His passion and energy far surpass that of someone a fraction of his age. His enthusiasm never changes no matter how hard he works,” says Downes. “He is not ready to retire. His body and mind are not at the point where he wants to sit and sip a pina colada and watch the sunset; that is just not him. He will be the same until he just physically cannot do it any more.” Over the past three decades, the Player Foundation has raised about US$50 million, which is helping educate destitute
children around the world. Money raised at last week’s invitational in Shanghai will be used to assist HIV/Aids-afflicted orphans in Yunnan province. Player is a huge admirer of China’s economic success, but disapproves of the growing fast-food culture and the rising levels of obesity and diabetes. He is also cynical of the contemporary habit of quickly blaming ailments on stress. “You have to find ways to combat it. Unfortunately, they don’t teach people in schools how to eat properly, exercise and prepare themselves for life. They should be saying to them, ‘You will have stress in your life. Here is a way to combat it’,” he says. “I don’t know anybody in the world that doesn’t live with stress, it is a matter of teaching yourself how to handle it. I think the best way is by eating well, exercising, sleeping well and no smoking or drinking.” Player, who has six children and 22 grandchildren, is an advocate of governments providing financial incentives for people who keep in good shape, thereby making them, in theory, less likely to use public medical facilities. “Obesity is the tsunami of the world,” he says. “The way we are going, the world is becoming desperately sick and governments will not be able to afford it. The human being is going to have to be rewarded for looking after himself. “We have to do more incentives for people who are looking after their health – which cost countries less – like a tax deduction if you can do ‘x’ amount of push-ups, or can run a certain distance, or have low sugar count, or low cholesterol,” he says. email@example.com
ensure health literacy? Health literacy has been defined as the ability to read, understand and act on health care information, to be able to judge, sift and use reliable information in the context of one’s own health. If a patient does not understand the full implications of the diagnosis, and importance of prevention and treatment plans, an untoward event may occur. Health illiteracy is often the reason for health disparities. In the past eight months, I have initiated a knowledge empowerment programme using multi-point videoconferencing. Using the internet-enabled Village Resource Centres of the MS Swaminathan Research Foundation in rural Tamil Nadu (mssrf.org), consultants from Apollo Hospitals Chennai (telemedecineindia.com) have interacted with more than 4,500 villagers from 13 villages. Using multiple-choice questions, knowledge levels were measured before and after the talks. A modest increase of 20 per cent was attributed to unfamiliarity with the questionnaire model; in fact, some scored less after the talk.
An informed, questioning patient will ensure better health care Feedback revealed that the villagers were delighted to listen to authenticated information on common health issues in a language they understood. More importantly, the attendees had discussions with those who were unable to come. Preliminary studies indicate that such empowerment could alter health outcomes. An informed questioning patient will ensure better doctors and better health care. As Sir Muir Gray, the former chief knowledge officer of Britain’s National Health Service, once said: “In health care, knowledge is as important as antibiotics.” Medicine is not black or white, but shades of grey. Knowledge of one’s health condition and involvement in the decision-making process is crucial. It is the prerogative of every citizen to know what works for whom, when, where, why and at what cost. The author is a past president of the Telemedicine Society of India and the Neurological Society of India. drganapathy@ apollohospitals.com
Photo: AFP Patients should be informed enough to ask doctors about the advantages and disadvantages of various treatments. Photo: Corbis
HITS AND MYTHS
Check the label before you zap that plastic ................................................ Sasha Gonzales firstname.lastname@example.org Q: Is it unsafe to microwave food in some plastic containers? The straight answer: yes The facts: unless you are using a microwave-safe variety, it is not safe to microwave your food in regular plastic containers and wraps. Dr Alex Ching, a radiologist at Matilda International Hospital, says plastic containers may be safe to hold foods at room temperature, but advises against using them in microwave ovens. Typically made from high-density polyethylene, these
containers should be avoided for heating up foods with a high fat and sugar content. Such foods may reach temperatures exceeding 100 degrees Celsius in the microwave, and the high temperature can cause the plastic chemicals to break down and leach out, thereby contaminating the food in the container. Microwaveable or microwave-safe containers are commonly made from polypropylene and crystalline polyethylene terephthalate (CPET). These materials have high melting points (above 200 degrees) and are therefore safe, says Ching.
Recognising the potential for chemicals in plastic to migrate, the Food and Environmental Hygiene Department closely regulates the production of plastic containers and materials that come into contact with food. There are stringent rules that
Avoid using containers such as those used for takeaways in the microwave
the manufacturers of food packaging must comply with. Before issuing its “microwave safe” stamp of approval, the department estimates the ratio of plastic surface area to food, how long the container is likely to be in the microwave, how often a person is likely to eat from the container, and how the food is expected to cook while microwaving. The scientists then measure the chemicals that leach out and the extent to which they migrate to foods. Manufacturers have to
undertake a toxicological evaluation to show that those levels are safe. In this context, the term “safe” means that the material has to pass a test that shows it will not cause cancer or genetic damage, or have an impact on reproduction or development. Only containers that pass this test can display the words “microwavable”, “microwave-safe”, or their equivalents, adds Ching. Such containers are typically
tested for up to 240 hours in the microwave. “Therefore, if you were to buy a reusable, microwave-safe plastic container and use it to microwave your food, you should feel quite confident about using it, as long as you follow the instructions.” Avoid microwaving plastic containers such as those used for takeaways, or those used to hold margarine or yogurt. Ching also warns not to microwave plastic storage bags or any other plastic containers that have been designated for other purposes. If you are concerned, just transfer the food to a microwave-friendly glass or ceramic container.