T + 380. Good morphine starshine, the earth says hellooooo

06/03/2014

and helloooo there to you - you bunch of special lovers - as you may be able to judge I am now in a position to heartily recommend starting the day on a 10ml shot of morphine - works a treat at blunting the edges of all but the most severe colitis/gastritis gut pangs - so I give a jolly two thumbs up for good old prescription opiates.

As of midnight I was started on nil-by-mouth  so it looks like I'll be getting the endoscopy/colonoscopy? - the one that goes down your throat, later today - hopefully this morning.  This will give the team a good look at the extent of the GVHD/ulceration that has re-emerged to hopefully inform and direct the next stage of treatment.

All my prescriptions from home have now been duplicated by the pharmacy here so Meds are distributed by the nursing staff rather than me having to use the daily/weekly personal dispenser that I brought in with me.   There's been a bit of dosage juggling going on - the principal immuno-suppressant Ciclosporin has been bumped up to 175mg twice a day, the drug treating my oral GVHD mouth ulcers Mycophenalate has been dropped to 150mg twice a day (half of the dose from a few weeks back) and of course there's the lovely 3 hourly painkilling jabs which have given me back a degree of sanity. Speaking of which the rest of this blog entry goes a little off piste as regards MDS, GVHD and my hospital stay. The morphine appears to have made me feel the need to express a view on the obesity epidemic we are brewing in this country and the interlinkedness of loads of other stuff to it.

Later...

Before I let loose with the morphine rant, here's an update on the rest of the day's events for 06/03/2014. I had the CT scan done today and also the endoscope where a camera is passed down through the mouth into the stomach. Having had this procedure a couple of times before, I was expecting to be semi-conscious and to feel a degree of discomfort ie gagging as the tube is fed into you, but the anaesthetist was pretty much bang on as I felt nothing between the time that the facemask was hooked on until I gently came to in the recovery room. Good job and well done to all involved. I was a bit surprised to find that I needed a top up on my platelets before they would go ahead with the endoscopy - the count was down to 26 which is a bit low, but if I'm honest not entirely unexpected given the quantity of different immuno-suppressants I've been prescribed.

Seeing all my boxes of meds piled up made me think of that (health?) show on E4 - Supersize vs Superskinny, where the obese UK dieter is shipped across to the USA to meet someone who is maybe 10 years and most often at least 10 stone heavier than the UK counterpart. There is usually a section of the show where the American participant produces a huge black bin sack of meds and starts laying out the beta blockers, diabetes meds and all the varied pharma designed to keep them alive.

The more I think about the situation in America, the more I come to conclude that although these people assume the majority of the responsibility for the neglect they have inflicted on their bodies and health, there also comes a point at which they have become trapped. A few years ago my tack would have been definitely less empathic and very different, more along the lines of stop whinging so much, then stop eating so much and try changing seats more than once a day you disgusting corpulent disgrace. But once you start to consider the external factors influencing the emergence of a new obese demographic in the US and UK populations it should come as no surprise that as usual it's fuelled by money baby - pure bright shiny toothed corporate greed.

The Fast Food Corps coin the cash initially by ushering people gently into the junk food lifestyle -  emphasising the positive elements; good deal or your family/ togetherness/ shared bonding experience / part of a balanced diet because we also pop a bit of salad on top etc. Then the Pharmaceutical and Health Insurance Industries coin it at the other end of the process by selling treatment and drugs that keep the ulcerated, diabetes ridden hulks just alive enough to carry on consuming.

Principal financial beneficiaries of this in the US would be the health insurance and health delivery companies - as I have mentioned in previous blog entries I am more grateful than I can ever truly express that I was born to a country that provides universal healthcare free at point of delivery to its citizens. My inside expert (wife - Pharma Industry Sales and Marketing) tells me that the government in the UK have taken pretty stringent steps to curb the kind of excesses that used to occur in the Pharmaceutical Industry in the 80s and 90s which were apparently 'the good old days' of money making for all involved, but this appears to be far from the case Stateside -I'm guessing that the sheer scale of revenue involved gets the Health Industry lobbyists a seat at the top table along with the banks and defence contractors. Jeannette and I stayed in New York for a week in 2007 and I can still remember my surprise at seeing what in this country would be considered prescription drugs for diabetes, impotence and blood pressure being advertised on the TV - still not sure if its a good or bad thing - mind you I saw an ad for stiffy pills on ITV just the other day...so this country is very much mirroring the US where corporate/governmental congruity permits.

It has been explained to me that contrary to how it sometimes appears from 'scandal' pieces in the UK press, the NHS keeps a pretty tight rein (some would say too tight) on Pharma companies activites and pricing by prohibiting or severely limiting the kinds of inducements that sales forces would have used of old to secure orders. Wining and dining is out of the window as are 'training' days at premier UK events, you know Ascot, Chelsea Flower Show etc - all these things have been firmly left behind in the mid nineties under guidelines issued by the ABPI (Association of British Pharmaceutical Industry), which can limit the % of profit that a company can make over the course of a tender and in some cases get 'cashback' from the companies entering into the contract.

All fair enough and more power to the bright sparks who for once you may say are seeking to ensure that not every government contract needs to end with the tax payer taking another shafting from the predatory private sector. But apparently this sort of thing cuts both ways - now that the accountants and middle managers are in the ascendant in the NHS, drugs and medicine acquisition contracts have taken on similar profiles to other government departments. I can remember a phrase used in tender document packs - something along the lines of  'we do not undertake to accept the lowest or any tendered contract price..' except that they always do and it's invariably the cheapest. People in the know (my wife being one) say the downside of this is that a lot of  'dirty' drugs make it onto the hospital pharmacy shelves for prescription purely due to pricing. By 'dirty' I don't mean toxic as such, its more like if there is the option of two drugs that accomplish almost identical treatment outcomes with one priced lower due to slightly unfavourable side effects and maybe the other is marginally more expensive due to faster action in treating the condition - well I'll let you take a stab in the dark as to which one the quill sucker at NICE is going to plump for and place on the NHS formulary.

Next have to be the food and fast food industries, when I was in the US I wandered round their supermarkets slack jawed at the range of choice and variety on offer - but not necessarily in a good way - Choco-nut slurple berry maple syrup pancakes with pork cop sprinkles. Equally I was shocked at the way that pretty much any food type you can imagine will be mixed with corn syrup or fructose (therefore not labelled as sugar) and then combined with any other number of foods, resulting in avalanches of high carb, high sugar comfort food - the UK is not so far behind here- people unwittingly becoming hooked on stealth sugar in everyday innocuous looking foods. Supermarkets pile the stuff high because it's habit forming and therefore profitable - not because of its health benefits - and yet, -  and yet like smoking there is always the element of free will. Big Food Corp is not forcing this stuff into your sausage-like grip and jamming it down your throat - it's you doing that.

The resultant boom is big money with diabetes, high blood pressure and all the associated illnesses (and support services) required to treat the ever increasing bariatric population. Given that diabetes tends to exhibit as a chronic rather than acute illness, the Pharma companies have an enduring bedrock of bread and butter cash flow. The course of inaction on which this country is currently set can only grow the problem - even if the observations were based solely on what I see around me in a small slice of coastal south east England it would be bad enough but when you upscale this from a local population of maybe 200k  to a nationwide population of >60m, the numbers start to look very scary and headed only one way unless people in food industry, government, health care and indeed the public at large can be persuaded of the universal benefits of getting food right.

It is  pretty much to be accepted that fast, convenient food is a cultural mainstay in this country and as a democracy people have the absolute and individual right to decide what it is that they do or do not put in their faces (unless its a crack-pipe, handgun or maybe a flamethrower) - but what if the choices with which we are presented are tainted from the off? I'm from the generation that remembers freshly prepared and home cooked food as a kid - although I would wolf down crap food just as eagerly as the next kid given the opportunity, but I've also in recent years come to know the satisfaction and enjoyment of preparing home meals from scratch.

This is a model that no longer exists as the norm in millions of households across the UK.

In its overarching bid to provide time poor people  with access to quick quality cuisine or to simply sell plain old fashioned junk food to the less well off, Big Food Corps have created a very real fracture in the food chain. Fewer people cook for themselves any more and have therefore abdicated responsibility for the content of their foodstuffs - leaving it to the manufacturers (who just might not always have your best interests at heart) to stand as the arbiters of what goes into your food.

If I choose to produce a reduced sugar or low salt recipe I can tweak the ingredients to suit my taste or dietary needs while prepping it at home. Ready meals now form a major section of market share and take this facility entirely out of the hands of the consumer (unless you want to add more sugar or salt) and I heard a jarring example of this recently...

Again referring to Radio 4  - I was cocking half an ear to a show covering Health Care and Support Services and the impact that cuts are having on small scale local projects across the country. One item featured a health worker in the North West of England talking about a scheme she was having to close which taught mothers the further stages of feeding after their baby is weaned and starting on semi solids.

At this point I think I was probably rolling my eyes theatrically and muttering some distinctly non Radio 4 language about making busy work for interfering arseholes whilst suggesting she make a swift trip to leave a deposit at the 'Bank of the Fucking Obvious'. But what I heard next was a revelation. Firstly, many of the clients attending the clinic were primarily young parents who had coped with the early stages either through the use of breast or formula feeding or a combination of the two. Where they were coming unstuck was in moving up to the next level of nutrition. I suppose the clue is in the age group, what do teenagers like to eat most? yay- nutritional garbage. Before the health worker arrived on the scene and started working with this particular group of parents it had been common practise amongst this peer group for them to liquidise their usual fast food diet in a blender, render it down to a semi solid paste and feed the goop to their babies - not as a rare naughty but nice treat that you might give to a 4 or 5 year old after a trip to the cinema, but as a primary component of a semi-weaned infant's regular diet.

We've all I've seen baby goop and its all the same green or brown slop anyway - right?  Wrong.  So a meal would consist individually of either a kebab, chicken nuggets, cheese burger or even pizza - rendered to a paste - all of it containing the full unhealthy adult levels of salt, sugar and sat fats. This rocked me back on my heels - where else is it happening? - and what chance in hell do these kids have if the parents have no conception that what they're doing is wrong?

Whilst I don't wish in anyway to draw a comparison between possible addiction to sugar in food and nicotine addiction from smoking, I would however like to suggest the following scenario. What if we are now at a point akin to that reached in the 70s/80s where a ground swell of opinion and medical evidence was finally gaining sufficient head of steam to alert people to the fact that cigarettes weren't actually a jolly good work out for the lungs and that smoking could actually kill you.

In the intervening forty years smoking numbers in this country have decreased from 40% to around 20% of the overall smoke eligible population - even more importantly, the aura and perception around smoking has undergone a retrograde makeover, from being cool, sexy and rebellious to being dirty, anti-social, marginalised and most of all - deadly. The Big Tobacco Companies were never going to go bust, they just rejigged and diversified their money across different businesses and countries, judiciously paid people off when legally cornered and looked further afield for new markets where in turn they have probably bought at least another 40 years or so before these new markets (I'd hazard Africa, India, China) start to come to terms with smoking as a health hazard rather than a wacky hobby and, -  thinking along the speed at which things get done in such regions I'd call 40 years fast-tracking.

The scale and speed of change in the first world have been glacial - Big Tobacco has fought (and are still fighting) a stubborn rear guard action which slowed but never halted the campaign to depopularise smoking. The important strand is that change was initiated, refreshed and sustained through consistent year on year pressure and education. Freedom of choice is the same as it ever was, people can decide whether to smoke or not, but now the deck isn't loaded - there is no obfuscation or diversion as it is universally acknowledged by all but the dimmest of 40w thinkers (or lobbyists) that smoking will wreck your health and then it will kill you.

So seeing that the Big Food Corps are as entrenched now as Big Tobacco was then, why shouldn't the battle for healthier food proceed in the same way? -  After all the tobacco war is almost at tipping point in Western Europe and the majority of the English speaking world - if the only way is the hard slow way of joining up the dots of many minute victories to eventually secure a medium sized one  - well have at it. Any realist will tell you that there is far too much money at stake for there ever to be any meaningful change based on voluntary codes of conduct or self policing strategies introduced by the companies themselves. Nothing will move unless the droves of opposing legal chappies for each side are assembled and troughing it up on their client's behalf for all they're worth.

A UK Minister was recently questioned on Radio 4 about on the subject of guideline proposals issued by the Swedish Government recommending that Sweden's food producers work toward reducing (by about 30%) the amount of sugar (fructose, glucose, corn syrup etc) added to food and encouraging lower carb diets - not silly Atkins type levels, but a bit more sensible than is currently in place. When asked if something like that should be considered for this country (anticipating the looming BMI tsunami) the proposals were  instantly dismissed out of hand by this Minister I wish I could remember the bugger's name,- quashed as impossible to implement. Why is this such a monumental task as to be too huge to even consider? It seems to me to be very much in parallel to the tobacco scenario outlined above, so surely (although I imagine not in my lifetime) a series of incremental agreements and laws could be implemented to 'sensibilise' the content of mass produced food.

Although normally I welcome EU interference in our country's laws and policies just about as much as any Island Brit, I am still perfectly able to concede here that an EU ruling or law on this issue would be  suitable and fit for purpose - if ever there was a common interest for a common market this has to be it.

I suppose the next question should be 'Why should we wait for so damn long? People are eating themselves to death now - what about the current generation?' The jaded, but I imagine, entirely unblinkered view is that Big Food Corps would much rather spend less money and kill time fighting in the courts to maintain the status quo, current dividend levels and profit margins rather than embark on the changes needed - if only to buy themselves breathing space to develop new markets for their existing stuff before being strong armed into producing better quality stuff for the rest of in the first world.

The corporate reward structure is very much geared to the here and now - I think only Government/EU money can provide the basis to seed or kick start the kind of massive changes needed and only direct legislation rather than cosy self imposed guidelines would exert pressure sufficient to bear down on the range of industries that does not even acknowledge that a malaise exists let alone that there may be a medicine out there needed to treat it.

There you go then rant over - I'm not quite sure where it came from but there was obviously something that had been bothering the back of my head for a while. I would be most interested to hear any views on the above or even confirmation that someone actually managed to grind through it all the way to the end.