- Email: [email protected]
Citizen Copito
DISSECTING ROOM
Doctoring the risk society Food fads
Citizen Copito
Scottish salmon is the latest casualty in the health food wars. Last month, it was top of the health promotionists’ menu as a high-concentration source of the essential fatty acids thought to protect against coronary heart disease. This month, after the discovery that it contains traces of 14 toxins—including dioxin and polychlorinated biphenyls (PCBs)— implicated in cancer and birth defects, it joins salt and sugar, burgers and chips, fizzy drinks and crisps, Pot Noodle and Sunny Delight, on the lengthening list of condemned food and drinks. Milk too has joined this list. Provided free to post-war schoolchildren (until stopped by the then Secretary of State Mrs Thatcher, the “milk-snatcher”, in 1971) milk was regarded as a symbol of goodness as well as a source of protein, minerals, and other nutrients. According to a recent newspaper article, milk must now be recognised as a highly toxic substance, which causes anaemia, diabetes, heart disease, rheumatoid arthritis, asthma, multiple sclerosis, lymphoma, and cancers of the ovary and prostate (Guardian, December 13). It is a safe bet that, before the year is out, somebody will have discovered that fruit and vegetables, currently being stuffed into the nation’s children at the government-approved rate of “five-a-day”, are a potent cause of some terrible disease. Perhaps by then everybody will have forgotten about mad cow disease and we can all return to roast beef, long believed to be the source of national vitality. When patients raise questions about food, I make two observations. The first is that human beings have thrived for millennia— and continue to thrive—on a great diversity of diets. This fact suggests that it is very unlikely that any commonly consumed food makes much difference, one way or the other, to life expectancy. The second is that doctors only talk about diet when they have no effective treatment. For decades, patients with peptic ulcers endured an array of exotic— and useless—diets. Once drugs that worked against stomach acid were developed in the 1970s, in the form of H2 blockers, all talk of dietary measures ceased. The lesson of history is that when doctors start telling patients what they should and should not eat, patients would be well advised to ignore them.
Mike Fitzpatrick e-mail: [email protected]
338
uesday, November 25, was one of the saddest days of 2003 for Barcelona, Spain. An illustrious citizen, loved by almost everyone in the city and beyond, was lost forever to cancer at 0640 h. But the news of his death, solemnly announced by the city’s Mayor during a special press conference, was not wholly unexpected. City authorities had been sensitive enough to warn citizens beforehand that “Copito might miss Christmas”. The pain was also eased when the Mayor, in gratitude for services to Barcelona, called the deceased “Citizen” Copito—an honorary title reserved for a select few—and promised a sculpture and a street bearing his name. Yet I was surprised that the funeral was so simple. I was hoping for a burial ceremony with leaders saluting the deceased. Instead, Copito’s ashes along with a seed of a tropical tree will be put some day in a biodegradable case, then buried somewhere in what was his home for nearly 40 years so that a new life sprouts out. Maybe that was Citizen Copito’s will before dying. There was another unusual event surrounding Copito’s death. For the first time, a Spanish citizen had received an official mercy killing. As the Mayor explained, Copito was in pain, and so the professionals in charge of his health practised euthanasia to save him from further agony. I assumed that perhaps Copito himself or a relative had given some sort of consent; certainly nobody protested against this decision. Besides enjoying a fantastic quality of life, Citizen Copito had received superb medical attention since he came to Barcelona in 1966. I remember a Sunday morning in the early 1970s when the medical director of a famous hospital in Barcelona was urged to immediately open and prepare the operating theatre as the privileged citizen had an apparent appendicitis. In 2001, Copito was diagnosed with cutaneous squamous-cell carcinoma. Although the lesion was initially successfully removed,
T
it relapsed later and eventually became metastatic. Prominent dermatologists, oncologists, and plastic surgeons at city hospitals offered their advice. An ophthalmologist from a renowned centre was added to the interdisciplinary team when, by chance during the second operation on the tumour, a cataract was detected in the right eye. Surprisingly, a daily medical newspaper reported that some doctors took the opportunity to have their photograph taken beside the anaesthetised patient. Citizen Copito’s end-of-life care included treatment with antidepressants, ibuprofen, and low-dose methotrexate. Moreover, in a bid to keep him absentminded and entertained, city authorities encouraged people to go to his home to say their last goodbyes. I wish that I had been able to say goodbye. But in addition to being too busy, I must admit that I had felt disappointment when I first met Citizen Copito in the 1970s. As a child, I was greatly excited at the possibility of meeting a celebrity who I had seen only on television and in newspapers. But a grouchy Copito turned his back on me, jumped up in the air, and hung from a branch while I vainly attempted to gain his attention. At the time, I could not understand why such a bad-mannered and spoiled personage was so revered. But now I realise that Copito de Nieve (Snowflake), the world’s only known albino gorilla, the emblematic animal so closely associated with Barcelona for the past 37 years, had become a true symbol for a city which was trying to recover its identity. An identity—the essence of Catalan—which had been almost obliterated by Franco’s dictatorship and repression. And although I think that the child was right in his naive interpretation, I like to participate in the collective process of building absurd symbols. Because I love my city. And I loved Copito de Nieve. Xavier Bosch
THE LANCET • Vol 363 • January 24, 2004 • www.thelancet.com
For personal use. Only reproduce with permission from The Lancet publishing Group.
Doctoring the risk society Food fads
Citizen Copito
Scottish salmon is the latest casualty in the health food wars. Last month, it was top of the health promotionists’ menu as a high-concentration source of the essential fatty acids thought to protect against coronary heart disease. This month, after the discovery that it contains traces of 14 toxins—including dioxin and polychlorinated biphenyls (PCBs)— implicated in cancer and birth defects, it joins salt and sugar, burgers and chips, fizzy drinks and crisps, Pot Noodle and Sunny Delight, on the lengthening list of condemned food and drinks. Milk too has joined this list. Provided free to post-war schoolchildren (until stopped by the then Secretary of State Mrs Thatcher, the “milk-snatcher”, in 1971) milk was regarded as a symbol of goodness as well as a source of protein, minerals, and other nutrients. According to a recent newspaper article, milk must now be recognised as a highly toxic substance, which causes anaemia, diabetes, heart disease, rheumatoid arthritis, asthma, multiple sclerosis, lymphoma, and cancers of the ovary and prostate (Guardian, December 13). It is a safe bet that, before the year is out, somebody will have discovered that fruit and vegetables, currently being stuffed into the nation’s children at the government-approved rate of “five-a-day”, are a potent cause of some terrible disease. Perhaps by then everybody will have forgotten about mad cow disease and we can all return to roast beef, long believed to be the source of national vitality. When patients raise questions about food, I make two observations. The first is that human beings have thrived for millennia— and continue to thrive—on a great diversity of diets. This fact suggests that it is very unlikely that any commonly consumed food makes much difference, one way or the other, to life expectancy. The second is that doctors only talk about diet when they have no effective treatment. For decades, patients with peptic ulcers endured an array of exotic— and useless—diets. Once drugs that worked against stomach acid were developed in the 1970s, in the form of H2 blockers, all talk of dietary measures ceased. The lesson of history is that when doctors start telling patients what they should and should not eat, patients would be well advised to ignore them.
Mike Fitzpatrick e-mail: [email protected]
338
uesday, November 25, was one of the saddest days of 2003 for Barcelona, Spain. An illustrious citizen, loved by almost everyone in the city and beyond, was lost forever to cancer at 0640 h. But the news of his death, solemnly announced by the city’s Mayor during a special press conference, was not wholly unexpected. City authorities had been sensitive enough to warn citizens beforehand that “Copito might miss Christmas”. The pain was also eased when the Mayor, in gratitude for services to Barcelona, called the deceased “Citizen” Copito—an honorary title reserved for a select few—and promised a sculpture and a street bearing his name. Yet I was surprised that the funeral was so simple. I was hoping for a burial ceremony with leaders saluting the deceased. Instead, Copito’s ashes along with a seed of a tropical tree will be put some day in a biodegradable case, then buried somewhere in what was his home for nearly 40 years so that a new life sprouts out. Maybe that was Citizen Copito’s will before dying. There was another unusual event surrounding Copito’s death. For the first time, a Spanish citizen had received an official mercy killing. As the Mayor explained, Copito was in pain, and so the professionals in charge of his health practised euthanasia to save him from further agony. I assumed that perhaps Copito himself or a relative had given some sort of consent; certainly nobody protested against this decision. Besides enjoying a fantastic quality of life, Citizen Copito had received superb medical attention since he came to Barcelona in 1966. I remember a Sunday morning in the early 1970s when the medical director of a famous hospital in Barcelona was urged to immediately open and prepare the operating theatre as the privileged citizen had an apparent appendicitis. In 2001, Copito was diagnosed with cutaneous squamous-cell carcinoma. Although the lesion was initially successfully removed,
T
it relapsed later and eventually became metastatic. Prominent dermatologists, oncologists, and plastic surgeons at city hospitals offered their advice. An ophthalmologist from a renowned centre was added to the interdisciplinary team when, by chance during the second operation on the tumour, a cataract was detected in the right eye. Surprisingly, a daily medical newspaper reported that some doctors took the opportunity to have their photograph taken beside the anaesthetised patient. Citizen Copito’s end-of-life care included treatment with antidepressants, ibuprofen, and low-dose methotrexate. Moreover, in a bid to keep him absentminded and entertained, city authorities encouraged people to go to his home to say their last goodbyes. I wish that I had been able to say goodbye. But in addition to being too busy, I must admit that I had felt disappointment when I first met Citizen Copito in the 1970s. As a child, I was greatly excited at the possibility of meeting a celebrity who I had seen only on television and in newspapers. But a grouchy Copito turned his back on me, jumped up in the air, and hung from a branch while I vainly attempted to gain his attention. At the time, I could not understand why such a bad-mannered and spoiled personage was so revered. But now I realise that Copito de Nieve (Snowflake), the world’s only known albino gorilla, the emblematic animal so closely associated with Barcelona for the past 37 years, had become a true symbol for a city which was trying to recover its identity. An identity—the essence of Catalan—which had been almost obliterated by Franco’s dictatorship and repression. And although I think that the child was right in his naive interpretation, I like to participate in the collective process of building absurd symbols. Because I love my city. And I loved Copito de Nieve. Xavier Bosch
THE LANCET • Vol 363 • January 24, 2004 • www.thelancet.com
For personal use. Only reproduce with permission from The Lancet publishing Group.