With the public sector bracing itself for the cuts one interesting way balancing the books came to  light recently when a newly elected tory MP spilled the beans on her former employers, Kensington and Chelsea primary care trust, who had hired out a hospital  ward for a porn film.  Rather than taking credit for such ‘blue sky’ thinking  the spokesman for the hospital managers was keen to distance them from it.

Sorry I don’t have a link to the film , so if you want a bit of medical titillation you will have to be satisfied with the X-ray pin up calendar.

With tax rises, spending cuts and deficits the new government would seem to have far more immediate concerns than reforming the libel law there is an increasingly strong  lobby that reform is vital if we are have an open and democratic society. English libel law is expensive, complex and very difficult to defend against.

Recent cases have brought the issue closer to home for me.  In 2007 Dr Henrik Thomsen, a Danish radiologist, raised concerns about the safety of a drug used in MR scanning at a conference in Oxford.  Rather than entering a scientific debate over the matter the manufacturer, General Electric, brought a libel case against him.  This is far from unique, a more widely publicised case arose in 2008 when Simon Singh of the Guardian  was sued by the British Chiropractic Association when he attacked claims to treat colic, ear infections and asthma in children with spinal manipulations.  

Though both cases have been dropped  libel law threatens to stifle scientific debate

Dr and Mrs Bob are proud to announce the arrival of a potential new member.  8lb 8oz on the 7th of April.    We are particularly grateful to the midwifery and medical staff who whisked him relucantly into the world by emergency caesarian section.

He is long and is already growing at an astonishing rate.- nearly 1lb over the last week so small wiry frame that appears to be the optimum of the fell runner may not be his!

One of the hazards of endurance events that does not receive all the attention it should is driving home.

Sir Ranulph Fiennes having completed Saturdays High Peak Marathon in a respectable 12hours 22 minutes, which would have seen him back in Edale about 12pm, was involved in an accident about 2 hours later at 2pm  when, according to news reports, he crossed to the opposite side of the road colliding with two other cars.  Thankfully there were no serious injuries.

For such a natural activity, that has sustained man’s hunting and migration for millions of years, modern running seems to generate a lot of injuries.  There is a growing movement of  ‘barefoot runners’ who believe that the problem lies with shoes.  A recent  study demonstrated that greater forces are put through ankles, knees and hips when shoes are worn.  This is counter intuitive given the barrage of marketing claims of the ‘cushioning’ of modern running shoes, but the explanation would appear to lie in the heel striking before the forefoot. 

Barefoot running isn’t always an option for soft feet on rough terrain and this has led to thin soled flexible light weight shoes- now where have I heard that before?  Methinks a man from Bolton has beaten them to it!

Like many of you Dr Bob is fed up with the electronic drivel filling his inbox but every now and again there is one that catches his eye and raises a smile.  ‘Evidence of the use of pandemic flu to depopulate USA’ was one such email.  Circulated by someone in Sheffield Teaching Hospitals from the operating theatres, who may have been sniffing something they shouldn’t, and circulated to every email user group, for some bizarre reason starting with ‘All Nursery Nurses’. It contains a link to a delightful conspiracy to the effect that the World Health Organisation (WHO), the UN and for some strange reason the US government are going to decimate the population of America with a toxic flu vaccine.  What they seem to be most concerned about were emergency powers that allow the confiscation of property and guns.

I remember meeting a previous Director of WHO, a most amiable Finnish man who helped me with my bags at St Polten railway station on the way to a conference.  That must have been a stonker of a hangover.

But a Dark Peak member has sent me some press reminders of more relevant threats to our health.  I will leave the burning genitals, hippo swallowing, buzzing undies, deck chair hazards and leave you with something that touches the deepest masculine fears:

Do you take nonsteroidal anti inflammatory drugs (NSAIDs) like ibuprofen regularly before competition to avoid pain?  Dr Bob doesn’t -although you might argue he doesn’t compete as such- but according to the British Journal of Sports Medicine this is very common amongst athletes in a variety of sports.  A quarter of world cup players took these drugs before 2 /3 of matches and one in ten before every game.

But why is this undesirable?  NSAIDs block enzymes that are involved in blood vessels ,leading to more heart attacks and strokes, and the kidney, reducing renal function.  They also reduce healing of soft tissue and bone injuries. The is also evidence that NSAIDs impair development of collagen in muscles, tendons and ligaments as a result of training and so may lead to more injuries.

Dr Bob knows though that fell runners are made of sterner stuff and unlike footballers  don’t live in fear of a tumble.

But don’t despair the big guns of medical research are being turned on that great question of our time; why do we get fluff in our belly buttons? What is it made of? And why is it usually found in men.

According to a paper in the Journal Medical Hypotheses (2009 volume 72 pages 623-5) written by a Dr George Steinhauser from the Vienna University of Technology it is made of textile fibres and collects in men’s navels due to the hair that traps it.

Unlike physiotherapists and sports medicine practitioners Dr Steinhauser had large numbers of subjects (503 pieces of fluff) and a long 3 year follow up period.  The average quality of navel fluff was 1.82mg.

A recent article got me thinking about the subject of that bane of many runners Achilles tendonitis and why there is so little good quality research into its causes and treatment.   There is a huge variety of treatments, including injections of all sorts of compounds into and around the tendon, blasting it with ultrasound, striping it from the surrounding tissues, scooping the centre out and making cuts in the tendon to name a few.  Most of these have no rationale behind them and little or no evidence.  What passes for research is usually very poor quality with  small numbers of subjects, short follow up and lack of randomisation, there is reasonable evidence, at least in motivated individuals with tendonitis affecting the mid position of the Achilles tendon, a series of exercises when the tendon is stretched under tension (eccentric exercise) is effective.  There is little evidence of how it might work but it seems to lengthen the tendon muscle unit, increases the tendon stiffness and increases the quantity of type 1 collagen.

The controversy over safety on warts and other runs had me thinking of the famous telegram from Arthur Ransome’s ‘Swallows and Amazons’:

Better drowned than duffers if not duffers won’t drown.’

Commander Walker these days might be expected to have replied by text or email to his wife when asked if his children could sail on the lake something along the lines of:

‘have you done a risk assessment?’. 

While the  traditional Dark Peak ethos that ‘ everyone is responsible for their own safety’ may seem harsh to some it is crystal clear and what might start with apparently harmless measures like carrying a little survival  equipment might lead us to some very unsavoury interference with natural selection- not too mention our sport!

For those who are interested to see evolution in action – or as they put it ‘chlorinating the gene pool’ -see http://www.darwinawards.com/