The Pharmaceutical Journal
Vol 272 No 7284 p132
31 January 2004

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Stonehenge lichen puzzle more
Professional priorities examined more
Strengthening health systems for the future more
Useless wit more

Stonehenge lichen puzzle

Lichens are fascinating plants, once you start to look into their habits. For one thing, they show a wide distribution of habitats, being classified as arboreal, terricolous, saxicolous and omnicolous, according to whether they thrive on trees, earth, rocks or all of these. Most of them, too, have astonishing powers of survival as communities, possibly because they involve a symbiosis between a fungus and an alga, and have unusual resistance against the elements, with one exception: they suffer from smoke contamination.

Lichens also pose interesting questions during their protracted existence. In the British Lichen Society Bulletin for winter 2003 the problem of the lichen population of Stonehenge is raised. Experts examining the enormous sarsens of this prehistoric monument during the summer of 2003 discovered lichens typical of those inhabiting sea cliffs. At least nine species had maritime affinities. They included the prominent Ramalina siliquosa in abundant large shaggy clumps. Yet the stones are 50km from the nearest coastline.

The presence of Ramalina in quantities in such situations as the Lizard peninsula and Land’s End is understandable, but that it should survive and flourish so far inland prompts questions. A dramatic, though unlikely explanation is that the stones were colonised by seaside lichens when they were transported by sea from the Prescelly Mountains in Pembrokeshire centuries ago. The well known longevity of the plant makes this hypothesis possible.

A more likely explanation is that in stormy weather salt spray may have been carried some 200km inland from the Atlantic coast. The salty deposit, building up on vertical and overhanging surfaces of the stones, may have encouraged the growth of Ramalina, which has also been detected in church towers well inland. Bird droppings may have contributed to the continued growth of the lichen.

What puzzles the lichenologists is that other, more common, seaside lichen species are not present as well. However, past attempts to clean the stones may have eliminated these other lichens and left the highly resistant Ramalina. The conundrum remains to be solved to everyone’s satisfaction.

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Professional priorities examined

In Oscar Wilde’s play Lady Windermere’s Fan (1892) Lord Darlington comments that “A cynic is a man who knows the price of everything and the value of nothing.” And in a more savage mood, Ambrose Bierce (The Devil’s Dictionary, 1911) defines a cynic as “A blackguard whose faulty vision sees things as they are, not as they ought to be.”

It is easy enough to become cynical in a strange world where what politicians say is not what they mean, and what they mean is not what they say. And it is easy enough to become cynical in a world where the practice of business is aimed at making a handsome profit for a few people and overlooking the call to provide an efficient service to society, even when that is the pretended objective of the business. It is time — especially when we pretend to make resolutions to improve affairs — to think hard about price and value, about what we are prepared to spend on providing such essentials as health care services and how we manage such services in an ethical and moral manner to the best of our ability.

One of the established principles of pharmacy practice is that all contact with the public should be carried out observing the highest technical and ethical standards. The financial rewards, although essential for continued practice, come second in rank when we consider priorities.

Pharmacists have long recognised the need to maintain professional competence, and have been ready to devote time to keeping their knowledge up to date. The fact that their governmental paymasters fail to recognise the cost that this entails does not remove responsibility from professional shoulders.

We see many public services — transport, health, education, policing and support services for bewildered citizens — failing to meet their professed targets because the powers-that-be cannot face the financial strain. At the same time, they adopt all manner of wasteful procedures that are far from beneficial to society at large.

We might be forgiven for allowing cynicism to creep in, blackguardly though it may be.

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Strengthening health systems for the future

The 2003 report from the World Health Organization indicates a change of emphasis from previous reports, and is the subject of an editorial article by Gill Walt, professor of international health policy at the London School of Hygiene and Tropical Medicine, published in the BMJ for 3 January.

The message in this report is that health systems must be strengthened to meet a growing array of health inequalities throughout the world. There is great injustice in the situation wherein some parts of the world offer expectations of longer and more comfortable lives whereas in others there is failure to control disease although the means to do so exist. Improvement has to be based on primary health care systems. Access to care should be universal, and tailored to meet treatment at the time of need. There must be health equity, community participation, and collaboration between the various health sectors. The WHO is no longer the sole organisation responsible and it must collaborate with others with similar aims.

An integrated approach to improving health everywhere is called for. In particular, the havoc caused by the HIV/AIDS pandemic and eradication of poliomyelitis need immediate attention. The recent SARS epidemic has revealed weaknesses in health systems, especially in infection control practices.

Other determinants of public health, such as tobacco control policies, reduction of road traffic injuries and attention to cardiovascular disease factors, demand integrated action. Steps are called for to establish health care systems that are responsive to the needs of populations. At the same time, there is a crisis in the global health workforce available to deal with the problems. Without adequate human resources there can be no health system.

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Useless wit

“Overmuch quickness of wit, either given by nature or sharpened by study, doth not commonly bring forth either greatest learning, best manners, or happiest life at the end.”
— Roger Ascham: The schoolmaster (1570).
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