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Update December, 2014

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Doctor's Consultation  by Dr. Iain Corness


Is it all in your genes? Jeans?

Ever since we managed to crack the genetic code and write down all the genetic sequences, many people think we have got disease licked. Take a peek into your genetic make-up and your (medical) future will be revealed.
After all, look at Angelina Jolie who had a bilateral mastectomy because she has the “breast cancer gene” in her genetic sequencing. Ms Jolie didn’t wait to see if breast cancer was just around the corner, she had an elective mastectomy instead. Was that wise? Or was it a knee-jerk reaction?
One factor that has stopped the majority of people interested in looking at their genetic make-up has been the cost. To do a sequencing cost many thousands of dollars (not baht), but like many items, the costs are going down.
A personal DNA testing kit that gives users an insight into their genetic make-up has gone on sale in the UK. Called the 23andMe Personal Genome Service (PGS) costs around THB 9,000 and claims to offer access to more than 100 pieces of information about a person’s health, ancestry and family traits.
Users spit in a tube, seal it and send it off to be analyzed in a laboratory. After four to six weeks they can log in online to see a detailed report of their results. The kit, which has been part-funded by Google, said the tool is not “diagnostic” but includes results of tests for genes associated with inherited conditions such as cystic fibrosis or sickle cell anemia thalassemia).
It also tests for genes that may reveal risk factors for diseases or conditions such as blood clotting, Alzheimer’s or Parkinson’s.
In addition to findings about their health, the firm says users can explore the genetics behind why they may be a more frequent smoker, how they metabolize caffeine and their body’s response to diet and exercise. They can see information about the genetic basis of traits such as hair color, freckling, height and hair loss.
The service also includes a “full genetic ancestry report” allowing people to trace their family's genetic roots and “potentially discover and communicate with new relatives”, according to 23andMe.
The firm says on its website that it is “committed to maintaining the security and confidentiality of your personal information” and has put in place security measures to help protect against the “loss, misuse or alteration of information under our control”. About 10,000 UK-based customers have already paid extra to have the kit delivered from the US.
Is this then a “good thing”? Should we all be lining up to spit in the tube, and the future will be revealed quicker and more accurately than Gypsy Petulengro?
I advocate caution here, because some people who want to know, may actually be the worst custodians of their own selves. You see, just having the Diabetes gene, for example, does not mean that you will definitely get Diabetes. It is better to accept this as having a “tendency” towards Diabetes. So what should you do with this advance knowledge? Regular medical checks and blood sugar testing is called for here.
Now let’s look at the ramifications of the “full genetic ancestry report”. Can you live with the knowledge that your father, whom you look up to and love so dearly may not be your father? And how does this knowledge impinge on your relationship with your mother? In your hunger for knowledge, you might bite off more than you can chew!
Regular readers will know that I support the notion of regular check-ups. I promote these as giving you a heads up on what’s ahead medically. You can plot the rise of blood sugar or cholesterol. You can see annual rises in blood pressure, which can end up as a stroke. You can see changes in serum creatinine, as a measure of kidney function, and evaluate the liver enzymes for early signs of damage. You can look at serum uric acid as a precursor of that painful condition called gout.
A check-up will show you in real time, what is happening, while DNA testing is still a “perhaps” situation.
Turn out the pockets of your jeans, rather than those in your genes.

Doctor will be with you in a moment!

For someone lying on a stretcher, that “moment” could feel like hours. I know I wasn’t prepared to wait many “moments” when I broke my heel bone (called the ‘Os Calcis’ for those who want this column to be precise and correct).
Now imagine what it is like to wait 35 hours to be seen. All I hope is that someone gave the poor devil some anesthetic during that day and a half wait. That figure of 35 hours was revealed at an investigation into a hospital in Kent in the UK.
British Health watchdogs are about to issue a damning report warning of major failings by Medway NHS foundation trust, in Kent - now branded the worst hospital in the country - as it admitted to repeated cases of patients waiting more than 24 hours in Accident and Emergency (EMS in Thailand).
In recent weeks, at least nine hospitals in Britain have closed their A&E units to only the most urgent cases. The pressures came as hundreds of thousands of NHS workers went on a four hour strike, in protest over their pay. Having worked in the UK hospital system myself, albeit many years ago now, it would, however, seem as if the same old problems of public hospitals overcrowding, under-staffed, under-paid and generally just not up to the job, has continued.
Inspectors have said that the Kent hospital is in a “state of crisis” with patients “stacked” waiting to be treated, including children left without assessment, and patients with potentially dangerous heart conditions left unmonitored.
It follows national statistics showing a doubling in the number of patients forced to endure long trolley waits since last year, which triggered warnings that the NHS is entering a crisis, even before the expected increases during the cold season.
The hospital’s death rates were 17 percent higher than would be expected in 2013/14.
The new report follows a catalogue of failings, which in September was responsible for almost one quarter of England’s long trolley waits.
In the same month, five patients suffered from “serious incidents,” trust documents reveal, including a patient left with a needle in them for two months after undergoing surgery.
Such lapses are so basic they are defined by the NHS as “never events”.
In another case, a female patient placed in a side-room without a call bell, broke her hip after falling when she was unable to get help to go to the toilet.
The nursing side gets the flak in these sorts of situations, but I can assure you that the nurses are not slacking. When questioned, staff were saying they felt “under siege” as 16 ambulances queued outside. These kinds of work loads just cannot be endured.
But the patients are also suffering, as well as waiting in silence, one presumes. Like all enterprises there are targets to be met. Try this one for size - Latest figures show the Kent hospital is also missing national targets to treat urgent referrals for suspected cancer within two weeks.
So just what can be done? The government approach has always been the same - throw money at it, but even though figures of around an extra 1.5bn in funding are being mooted, it will be nowhere near enough.
A most senior doctor in the UK has urged patients to turn to pharmacies, to relieve strain on the country’s A&E units.
The simple truth is that the socialist health care model just does not work financially. In saying that, you have to compare it with the private hospital system. While it may sound like I am just blowing a horn for my hospital’s healthcare system, you will never hear of patients left on stretchers for 35 hours at any private hospital in Thailand.
The times between referral and being seen for cancer patients can be measured in hours, not weeks!
The majority of your blood test results are available in 45 minutes, though some can take an hour.
The time between having your X-Ray and it being reviewed by the referring doctor is measured in seconds.
So you pay for it, but if you are from the UK, you never had it so good!

HEADLINES [click on headline to view story]

Is it all in your genes? Jeans?

Doctor will be with you in a moment!



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