The Pharmaceutical Journal
Vol 268 No 7182 p114
26 January 2002

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Strange syndrome [more]
Reek of profit [more]
Civilisation and the showcase [more]
The reason why [more]

Strange syndrome

Considerable doubt has been expressed, particularly outside the United States, as to whether the so-called chronic fatigue syndrome really exists or is imaginary. The dismissal of it has raised the question of how patients who might be said to be suffering from it should be treated, if at all. To dismiss reports from patients of disturbing symptoms which some clinicians regard as imaginary leads to an unsatisfactory situation where help may be denied. As is related in The Lancet for 12 January, a new report now published from a working group offers hope for a strange condition known as myalgic encephalomyelitis or myalgic encephalopathy as well chronic fatigue syndrome.

The range of symptoms concerned includes headaches, sleep disturbances, difficulty in concentration and muscle pain. Children and adults present the same picture of overall physical and mental fatigue.

An earlier paper in the Journal of the American Medical Association for 19 September 2001 last year pointed out that there is no standard approach to treatment. The use of agents including immunoglobulin, alpha-interferon, magnesium supplements, fludrocortisone, galanthamine, aciclovir and antidepressants has provoked side effects severe enough to necessitate withdrawal.

Current advice is that patients need positive early diagnosis and appropriate management and advice. Graded exercise therapy and cognitive behavioural therapy are judged the best available. More understanding is essential between doctors and patients, and "there are still too many reports from the field of patients being treated with disrespect or disbelief, and not being true collaborators in treatment".

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Reek of profit

On one of my rambles the other day, round a magnificent bay enclosed by high cliffs, I came across a strange building, closely resembling an ancient monastic establishment. In fact, despite its architectural granitic aspect, it had been a fish cellar, designed to accommodate pilchards in the days when those were the poor man's standby. In its cloister-like galleries the pilchards would be stacked, compressed, and then distributed. The most intriguing aspect of the place was a fine granite entrance arch, over which was engraved the motto "Dulcis lucri odor" — "Profit smells sweet."

This is a really modern aspect of trade, and strikes me as being antagonistic to the far more ancient motto "Pecunia non olet" which means "money does not reek". This old expression is attributed to the emperor Vespasian in the first century. According to Suetonius in his 'Lives of the Caesars', Vespasian imposed a revenue tax on public lavatories. When Titus raised an objection, Vespasian held a coin to Titus's nose and asked him to sniff it. When he remarked that it did not smell, the emperor commented "Atque e lotio est", meaning that the money was derived from urine. The implication was obvious, and would delight modern economists.

It is intriguing to reflect that the naturalist John Ray in his 'English proverbs' of 1670 records the popular saying "Muck and money go together", a remark which we associate with the eager industrial profit-makers of the Midlands and North. Ray in turn probably derived his information from Francis Bacon, who in 1625 pronounced that "Money is like muck, not good except it be spread." Verily, the capital ethic reaches well into our past.

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Civilisation and the showcase

In an essay published in Science for 7 December 2001 by a group of museum workers from the Chicago Field Museum, the authors argue the case for making bigger efforts to preserve the world's repositories of natural treasures. Their comments are timely when pharmacists are worried over the future of a museum in which they have a stake.

Collections of specimens, it is claimed, provide invaluable data that document the diversity of life on earth, and enable visitors and students to gain a glimpse of the richness of our culture over the years. A lack of scientific information has been blamed by makers of public policy for their failure to set priorities for conservation.

Moreover, museums stimulate and maintain active programmes of research by social scientists. Anthropologists have long depended upon them for studying the relationships between populations and their special environment. Human artefacts, no less than natural specimens, reflect cultures in the sight of keen observers and analysts. The collections in a museum of any size promote an interdisciplinary approach to methods and equipment, as well as providing the data for more circumscribed studies that might appeal to a highly motivated student.

Natural history museums in particular, comment the authors of the essay, are essential for sustaining biological and cultural diversity. They must raise their public profile and seek more adequate funding to support the capital investment, technology and human resources necessary for the continuance of their function in society.

What arguments apply to a natural history museum apply equally to any other type. Any museum must remind us of the evolution of techniques and equipment, whether it be in a professional activity or in the wider cultural setting.

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The reason why

Rudyard Kipling, in 'The elephant's child' (1902), wrote: "I keep six honest serving men; they taught me all I knew / Their names are What and Why and When, and How and Where and Who."

The most problematic of this assembly of teachers must surely be Why. It is the most difficult task in the world to answer the question of why people do things, their motives, their aspirations and their sense of social responsibility.

Consider those public figures Josef Stalin, Adolf Hitler, and a host of others who seem to have multiplied in the recent annals of sheer bestiality. It is possible to look into the lives of some of them and find traces of insanity or fanaticism. Yet do we ever discover the incontrovertible truth of their motives?

One fundamental question we have to ask ourselves when we try to understand the complex issues within human society and its cultures is "What is so-and-so trying to achieve, and why?" When you apply this test to our politicians, probably those of all persuasions in the political arena, it is charitable to come up with the answer: "He (she) is doing this in order to bring comfort to his (her) sense of self-esteem." The alternative, uncharitable, answer is unavoidable: "To fill his (her) pocket and achieve power over others." There is considerable evidence that the great delusion of power, which has prodded so many individuals in their careers, offers the answer to the question Why?

Yet surely it cannot be the complete answer. In the last resort, humans are inscrutable, are they not? They are never content with modest achievements and the calm and happiness they bring.

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