by Dr. Iain Corness
September 22, 2018 - September 28, 2018
Your intelligence is in your jeans? (Sorry, in your genes)
Nature or Nurture?
What shapes us? In many published studies of human beings, their
development and their frailties, it often comes down to a discussion of
Nature or Nurture. My doctor son, for example; does he get his academic
brilliance from me and his reluctance to fight bureaucracy from being
raised by his mother? Nature versus Nurture again. Or how deep is the
One area which
always interests prospective parents is their likelihood of getting
intelligent children or drones. Much has been written about the inherent
dangers to the unborn child while it sits, waiting in the wings, so to
speak, for that awfully long drawn out 9 months of gestation. Mind you,
it could be worse - we could be elephants and have to wait three years
to see how a brief encounter in the bush turned out!
Many factors can
influence the unborn child in utero, as we doctors like to call that
“bun in the oven” stage. Most of these developmental influences are not
good influences and may produce children that are smaller than the
average - smoking by Mum-to-be being a prime example.
Some clever chaps
in Norway sat down and followed around 700 kids from birth to age five.
Around half of these children were of low birth weight, and the other
half “normal”. So at age five they assessed the children for Verbal
Intelligence Quotient (IQ) and Non-verbal IQ.
The results were
interesting. While the smaller babies did have a very slight lowering in
the two IQ scales measured, it was not much. However, the factors that
did alter the results were Mum’s non-verbal problem solving abilities
and child rearing style. In percentage terms, this accounted for between
20-30% of the variance in the observed children, while birth weight
accounted for 1-2% only.
Now before you rush
out thinking that it is all genetic and wonder what you have to do to
increase the depth of the family gene pool, did you notice that not only
were there genetic factors at work (Mum’s non-verbal abilities) but also
child rearing style, which is not genetic, but a learned response from
her mother. Definitely “nurture”.
To my mind, this
shows there is almost certainly a predominance of effect on children by
their mothers. Both genetic and nurturing. I’m sorry, Dad. It might take
two to tango, but Mum is the all-important one - especially in the first
few years of a child’s life.
Now at the risk of
being sent hate mail by the lady liberationists out there, I do believe
that this demonstrates a very “normal” behavioral pattern. The male of
the species Homo sapiens was the hunter-gatherer, while the female
stayed at home to cook sabre tooth tiger burgers and raise the
offspring. Of course the mother has a greater influence on the
preschoolers mind (and the abilities of that mind).
So in answer to the
vexed question of how to get intelligent kids, it’s easy. Simply find an
intelligent healthy woman, who wants to stay home and raise your brood
of geniuses. The harder part is finding one that wants you for her mate!
September 15, 2018 - September 21, 2018
How to get the best value from your doctor’s appointment
The most common complaint that patients
have about their doctor is that they didn’t understand half of what the
doctor was telling them!
That is not just in Thailand where
there can be language problems, but can happen in the UK where the British
patient is in consultation with a British doctor, or in Australia with the
Aussie patient and the “Aussie” Indian GP.
Whose fault is this? Sometimes it is
the patient and other times it is the doctor. Hopefully after this week we
will have made your life as a patient more smooth and satisfying.
The first problem occurs when the
patient does not relate his or her symptoms, but tells the doctor what the
condition is and will sometimes produce reams of computer print-outs with
passages from “Dr” Google highlighted.
Don’t get me wrong, Google is
completely accurate if you give it the correct diagnosis, but if the
diagnosis is in doubt, then Google will give doubtful results.
Where all this falls down is when the
patient gives the doctor the diagnosis (instead of the symptoms) and then
expects the medication suggested by Google to be given to them by the
doctor. “Just give me the tablets Doctor and I’ll get out of your hair.”
This is where the consultation really
falls apart. The patient has suppositions based on incomplete data. The
doctor does not know whether to directly challenge the patient’s Google
diagnosis, or to try and sway the patient’s thinking away from the computer
print-outs. This is often done by suggesting a test which might convince the
patient if it is negative (and the doctor knew all along it would be).
Much of this is an unnecessary cost and
waste of time.
So much from the patient’s point of
view, what is the consultation from the doctor’s view point? The doctor
makes his or her diagnosis by getting a history (“When did the pain come
on?” or, “Does anything make it worse?” for example) then listening to the
symptoms, and then carrying out a physical examination. Finally, there is
something called ‘clinical acumen’, a gut feeling that the doctor has after
seeing hundreds of these types of condition. The young doctors have to start
somewhere, but they don’t have clinical acumen until they have a few years
of clinical experience. Note that at no time does the doctor factor in the
patient’s Google diagnosis.
All that above is in the ideal
situation, but there is another problem often found in the patient-doctor
relationship. Verbal communication.
It stands to reason that if either the
patient or the doctor has to converse in a ‘foreign’ language there is a
very strong likelihood of miscommunication. Fortunately, the Bangkok
Hospital Pattaya has a team of interpreters covering the major languages and
you should request one if you are unsure of your own command of English.
However if your native language is Kituba or something from the tropical
jungles of Africa and only discovered last year, be prepared to emulate
Marcel Marceau the mime artist.
The doctor has to also use language
that the patient understands, and not scientific medical terminology. “How
is your urination?” is not the way a patient usually describes the bodily
So, to get the maximum benefit, tell
the doctor your symptoms, not the diagnosis, get assistance with English if
necessary, and don’t be afraid to ask the doctor to explain something
further if needed. It is for everyone’s advantage that you leave the
consulting room confident in your knowledge about your body and what the
doctor is doing to get you fit and well once more.
September 8, 2018 - September 14, 2018
Biting on a bullet!
Surgeons can be the ‘prima donnas’
of medicine, if you like. It is the surgeons who get the headlines in
the newspapers. It is the surgeons who are the stars in movies and TV.
Who can remember the irascible surgeon Sir Lancelot Spratt (Dr. In The
House, 1954) or the young surgeon Dr. Kildare (1961)? Slightly more
recent, the American surgeons in M*A*S*H?
However, surgeons have been around
for many centuries and have their own Royal College. The origins of the
first Royal College of Surgeons go back to the fourteenth century with
the foundation of the 'Guild of Surgeons Within the City of London'.
There was dispute between the surgeons and barber surgeons until an
agreement was signed between them in 1493, giving the fellowship of
surgeons the power of incorporation. In 1745 the surgeons broke away
from the barbers to form the Company of Surgeons. In 1800 the Company
was granted a Royal Charter to become the Royal College of Surgeons in
London. A further charter in 1843 granted it the present title of the
Royal College of Surgeons of England (of which I proudly say I am a
We marvel at the surgical advances
in the past century, but while I take my hat off to the surgeons, the
real praise goes to the anesthetists. Without the advances in
anesthetics, brawny assistants would still be holding patients down
while surgeons attacked with scalpels and saws and the patient lay there
biting on a bullet.
The first anesthetic agent was
ether, dribbled on to a mask to knock the patient out and allow the
surgeon to take his time and become meticulous in his approach. The
first public demonstration of ether anesthesia took place on 16 October
1846, at Massachusetts General Hospital in Boston. The anesthetist was
William Morton and the surgeon was John Warren; and the operation was
the removal of a lump under the jaw of a Gilbert Abbott.
While there have been enormous
advances since then, I can remember being a medical student and
assisting at an operation in outback Australia in 1964. The anesthetic
was ether, dribbled on to the patient’s gauze mask by the matron of the
public hospital, and it was a Caesarian section for twins. There was no
air-conditioning and it was 43 degrees in the theatre, where the fumes
were making us all woozy. Amazingly everyone survived the ordeal,
mother, twin sons, the local doctor, the matron and me.
Despite outback Australia,
anesthesia progressed in the rest of the world. Chloroform was
introduced by James Simpson, the Professor of Obstetrics in Edinburgh,
in November 1847. This was a more potent agent but it had more severe
side effects, including sudden death. However, it worked well and was
easier to use than ether and so, despite its drawbacks, became very
The next major advance was the
introduction of local anesthesia – cocaine – in 1877. Things definitely
did go better with ‘coke’! Then came local infiltration, nerve blocks
and then spinal and epidural anesthesia, which in the 1900s allowed
surgery in a relaxed abdomen, and is still used today, especially in
obstetric anesthesia, where the mother can be anaesthetized without the
baby being affected as well.
The next important innovation was
the control of the airways with the use of tubes placed into the
trachea. This permitted control of breathing and techniques introduced
in the 1910s were perfected in the late 1920s and early 1930s. Then came
the introduction of intravenous induction agents. These were
barbiturates which enabled the patient to go off to sleep quickly,
smoothly and pleasantly and therefore avoided any unpleasant
inhalational agents. Then in the 1940s and early 1950s, there came the
introduction of muscle relaxants, firstly with curare (the South
American Indian poison, but not administered by native blowpipe) and
then agents less dangerous.
Anesthesia is now very safe, with
mortality of less than 1 in 250,000 directly related to anesthesia.
Nevertheless, with today’s sophisticated monitoring systems and a
greater understanding of bodily functions, the anesthetic profession
will continue to strive for improvement over the next 150 years.”
On behalf of all patients requiring
surgery in the future I thank the anesthetists. No longer do they have
to bite on this bullet!
Update September 1, 2018 - September 7, 2018
Blood group differences – Thai and Farang
A couple of weeks ago,
a call went out to the farang population in Thailand for some Rh negative
blood. This happens around three times a year, and each time this stimulates
some of our more public spirited foreigners to ask why there is a shortage,
and what can be done about it?
The basic problem does
come down to some of the many differences between Caucasian races and Asian
races, and I’m not talking about cultural differences here. Just as there is
a difference in hair types and skin types, there are differences in blood
types as well.
The question is often
asked as to why the blood collection agencies just don’t stock up on the
rarer groups, so there is always some to call upon. Unfortunately it isn’t
that easy, as the ‘shelf life’ of blood is only around 30 days.
Blood transfusions and
blood banks only came about in the 1930’s with Sergei Yudin of Russia
organizing the world’s first blood bank at the Nikolay Sklifosovskiy
Institute, which set an example for the establishment of further blood banks
in different regions of the Soviet Union and in other countries. By the
mid-1930s the Soviet Union had set up a system of at least sixty five large
blood centers and more than 500 subsidiary ones, all storing blood and
shipping it to all corners of the country.
News of the Soviet
experience traveled to the United States, where in 1937 Bernard Fantus,
director of therapeutics at the Cook County Hospital in Chicago, established
the first hospital blood bank in America. In creating a hospital laboratory
that preserved and stored donor blood, Fantus coined the term ‘Blood Bank’.
Within a few years, hospital and community blood banks were established
across the United States and in 1940 Willem Johan Kolff organized the first
blood bank in Europe.
With the discovery of
blood groups, generally classified by the ABO system (so we are generally
either A, B, O or AB) it was soon apparent that there were differences in
their distribution in the world. There are many reasons for this, including
susceptibility to disease of various blood groups, population drifts,
inter-marriage and others. However, the end result is that simplistically
the Asian population has a different distribution of ABO groups from the
Caucasian population. For example, blood group B is far more predominant in
the East than in the West.
When you look at one of
the other blood typing systems, the Rhesus grouping into Positive or
Negative, even greater disparities become apparent. The Asian population has
very little Rhesus Negative (0.3 percent), compared to the Caucasians (15
percent). For interest, 50 percent of Basques are Rhesus Negative, one of
the highest in the world.
Recently there has been
the discovery of another blood type called the Bombay group. This is a
version of O +ve, that was not compatible with the usual O +ve blood. First
identified in Mumbai, from which the group derives its name, so far there
have been just 179 such cases reported in India. However, even in India,
there have been cases where doctors could not find a donor for transfusion
of the Bombay group blood that would have been necessary. Even though it has
first been identified in Mumbai, the city is now believed to have just 35-40
people with the group.
Consequently, you can
see that when there is a need for blood for a number of injured Caucasians
in an Asian country, the chances of there being sufficient blood stocks are
If you are a farang
resident in Thailand, please have your blood grouped and if you are Rhesus
Negative, go on a register at the local Red Cross, or even the nearest large
hospital, so that you can be called upon in emergencies. The Central Blood
Register can be contacted at 02 259 7305.
disaster (or ‘between disasters’) there is no desperate shortage, but since
blood does not keep ‘forever’ there will be times in the future when we will
need Rhesus Negative blood, so don’t spill it in the streets, spill it at
the Red Cross!