I was reminded last week of a gravestone inscription in Honley Churchyard somewhere in England by my close friend Jackie's emergency surgery whilst on holiday in Palma, Majorca: 'Where ere you be, let your wind blow free, for it is the wind, that killeth thee.' She had been complaining of constipation and the pain of trapped wind to which I, a sad expert in these matters, gave her the usual – unprintable – advice. Only it wasn't trapped flatulence, but a ruptured appendix.
Following successful emergency surgery in Spain within two hours of admission, we were reminded of the efficacy of the civilised European Health Insurance Card which Jackie flashed at reception, but which will be soon withdrawn by the Brexit barbarians. Anyhow, post-surgery, she was repeatedly asked if she was passing wind on a regular basis. Much was hilariously lost in translation. But this is an important health issue, and the last taboo. Female flatulence is rarely excused in mixed company. Digging around on this issue, I discovered that a friend of my daughter – a teenage lad – didn't know women passed wind until he met me. Two married women of my close acquaintance would never dream of passing in the company of their husbands. Many women have never heard their mothers pass intestinal gas – ever.
So, without further ado, here are the health benefits of passing wind (taken from Remedy Daily): reduces bloating, relieves abdominal pain, prevents damage to the colon, can be part of early diagnosis since the odour can be an early warning sign of unbalanced diet and even food allergies. Finally, inhaling small amounts of hydrogen sulphide gas is good for you. I'll leave it there… Let's encourage our daughters to be natural on a regular basis.
While travelling up from London last week, I came across Michael Blastland's 'The dark side of early diagnosis' in Prospect magazine. Early diagnosis is an issue close to my heart, and I've always been keen on that my friends get themselves 'checked out.' But lately I have been reading that health experts are re-evaluating the drive for ever more extensive pre-symptom screening for a wider range of conditions, mostly cancers.
To the cynical among us, this new thinking does not appear to be motivated simply by a desire to save money. And to be absolutely clear, those with a family history of a particular illness, and those actually displaying symptoms – a lump, say – should still avail themselves of the earliest possible diagnoses. That advice has not changed. But what is
being suggested in Blastland's piece is that if you do not fit either of these categories then perhaps you should think twice before having yourself screened. Why?
Early diagnosis is often pointless, if not positively harmful. If there is no treatment for a particular condition, then an early diagnosis will not add a day to your life. Instead, you get to know you are ill for longer, and maybe undergo unpleasant treatment for longer, with all sorts of ramifications for you and your family. Moreover, if you are screened when yet to display any symptoms (so there are no obvious indicators of a medical condition) it is much easier for the medical team to misdiagnose, and to believe you are ill when you aren't. Then, on the basis of a 'false positive,' doctors will, in good faith, suggest a course of treatment which in fact you don't really need and which might even be harmful. And who would risk forgoing treatment under those conditions? After all, isn't the point of the early screening to find out if you require treatment?
All this really hangs on differing attitudes to risk. The risk adverse are likely to want early screening, thinking it will increase one's chances of survival. The more cavalier, or those with their heads in the sand (at times it's hard to tell the difference) are more likely to pass up the offer of sending, say, a stool sample through the mail following their 50th birthday. But we are terrible at risk assessment generally.
Risk and statistics fascinates and bewilders me in equal measure as I struggle to get my head round the mathematical and counter-intuitive complexities: 'Statistics as Applied Risk Management' should be a mandatory course in high school. Our intuitions of risk are notoriously poor, for example the oft-cited behaviour we blithely follow, taking to the road in a metal vehicle with a shrug; but a fear of flying, by far the safest form of transport, has people holding up the bar at 7am before boarding a flight to Palma. And compare the levels of concern about the health implications of GM foods, say, or vaping, in the absence of any evidence that either is harmful, while continuing to drink alcohol excessively, smoke, putting off that planned exercise regime and the rest of it. Humans are rarely rational.
The trouble appears to lie in our evolutionary past. We are quite good at judging intuitively the risk posed by a snake or a dinofelis, but not so good at the risks of modernity (cars, excessive sugar and alcohol) that were not present in the Pleistocene. Hence the need for statistics. Want to know the real risks? Look to the statisticians. Where would the casinos and the insurance industry be without them? We can't allow these plunderers of our rationality and money a monopoly on this esoteric skill.
I'll use myself as an example. I've always been a bit of a gambler. Sometimes it pays off, sometimes not so much. In 2011, I endured a course of chemotherapy for breast cancer. I have a vague memory of having the list of possible side-effects and dangers read to me by my oncologist and the percentage risks attached. I had a one in a thousand 'chance' of getting leukaemia. Ach, I'll take it. Now, if I had been given the same odds for winning the national lottery half my pension would be gambled on a regular basis. Perhaps I should have listened to my inner gambler, because I did indeed develop leukaemia from chemotherapy treatment. A known unknown.
One last point: If it had been a known known I wouldn't have taken the course of chemotherapy, and as a result possibly died of breast cancer. With risk, sometimes – as many gamblers ruefully report – you just can't win.