The Pharmaceutical Journal
Vol 278 No 7456 p714
16 June 2007

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Health services in Iraq are on a downward slope more
The bird that thinks its two notes are a song more
Dealing with a stupid and unhealthy habit more
Roguish pleasure more

Health services in Iraq are on a downward slope

An editorial in the 2 June issue of The Lancet paints a grim picture of the health situation in Iraq today. Deterioration is proceeding at almost every level of the health service.

Insulin is unavailable in Iraq because it is not safe to distribute it. Cases of cholera were reported last month. The head of residential doctors in Samarra General Hospital has described how power facilities have prevented the use of all medical appliances there.

A recent report states that 54 per cent of Iraqis are now living on the equivalent of less than one US dollar a day. It also estimates that half of the children are malnourished.

Since 2003 some 12,000 of the country’s 24,000 doctors have left Iraq. One positive development is that 3.6 million children have now been immunised against measles, mumps and rubella, and last week UNICEF initiated a six-month action plan to address the specific needs of Iraqi children.

The Iraqi National Centre for Drug Control and Research is to analyse the quality of pharmaceutical products imported into the country. Accessibility is more important than availability since it is pointless having high quality if the drugs cannot safely be distributed.

People must have access to the drugs they need and not be prevented by restrictive curfews and checkpoints. It is imperative to look to future planning and take account of what is happening on the ground.

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The bird that thinks its two notes are a song

It is emphatically cuckoo time once again, although this year it strikes me as later than ever before. As Thomas Gray put it in 1748, “the untaught harmony of spring” is sounding.

In Britain we have the common cuckoo sounding his familiar major interval, usually a minor third, sometimes a second, and occasionally a very wobbly compromise.

The great spotted cuckoo is a rare visitor to Britain, not normally found nearer than Spain, Portugal and the south coast of France. It is parasitic on various corvids. It has conspicuous cream underparts, short legs and a long tail. It is a little smaller than a magpie and is noisy. It has a swoop flight like that of its humbler cousin.

Cuckoos have many strange associations. Many plants have been given derived names such as cuckoo flower (lady’s smock), cuckoo’s joy (marsh marigold), cuckoo pint (lords and ladies) and cuckoo bread (wood sorrel).

Cherry trees also have an association, since it is said that cuckoos must eat three meals of cherries before they can cease singing.

Folklore says that the number of repeats of the bird’s call forecasts the years of a life to come. Alternatively, it may indicate the number of years before matrimony.

To hear a cuckoo from the right is lucky, from the left unlucky. To hear it while standing on grass is good, but on shingle or mould is bad. If you have money in your pocket at the time it will multiply; otherwise you will lose.

In some areas in the 19th century it was customary to stop work at the sound of the first cuckoo call and take the rest of the day off to feast.

Cuckoos were associated with stupidity. Cloudcuckooland, according to Aristophanes in his play ‘The birds’, was built by birds in mid-air to separate gods from humans.

Gilbert White of Selborne in 1790 was brought a fledgling cuckoo from a water wagtail’s nest, and another from that of a pair of hedge sparrows. He saw young cuckoos fed by sparrows and more found in a rock cavity in a robin’s nest. White also heard of an old clergyman in Sussex who reared a cuckoo in a cage for four years. It made jarring noises but never cuckooed. As late as September it was skimming over ponds and catching dragonflies in the air.

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Dealing with a stupid and unhealthy habit

An editorial in the 5 May issue of The Lancet offers support for the recent recommendation by the National Institute for Health and Clinical Excellence that employers should provide smoking cessation support for their employees.

The editorial points out that in many parts of the world smoking is the main cause of preventable disease and early death. Moreover, it is expensive not only for the smoker but also for employers, since it has a considerable adverse effect on productivity. Non-smoking employees have to compensate for smokers who take smoking breaks or who are absent through illness caused by smoking. And it has been estimated that exposure to second-hand smoke in the workplace causes the deaths of two non-smokers every working day in the UK.

On smoking cessation methods, the NICE report says that five- to 10-minute interventions by health care providers are effective, whether they just offer advice or also provide nicotine-replacement therapy or bupropion. And longer or more frequent periods of counselling increase the quit rate. But, according to the Lancet editorial, doctors are often reluctant to make interventions. They may see smoking cessation counselling as an inefficient use of their valuable time. They may be unhappy at the lack (or, more importantly, a perceived lack) of funding for such work. And they may have an unfounded pessimism about the likelihood of success.

However, doctors are, of course, not the only health care providers who can offer smoking cessation interventions. The NICE report says that employers should let their employees know where they can go to receive interventions and also offer on-site support where possible. If doctors are reluctant to help, then other health care professionals, including pharmacists, should take the opportunity to offer their services to local employers, as already suggested in a Journal editorial (PJ, 28 April, p474).

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And I quote…

Roguish pleasure
“By God’s deins, I marle [marvel] what pleasure or felicity they have in taking this roguish tobacco; it’s good for nothing but to choke a man, and fill him full of smoke and embers. … By the stocks, an [if] there were no wiser men than I, I’d have it present death, man or woman, that should but deal with a tobacco pipe; why, it will stifle them all in the end as many as use it; it’s little better than rat’s-bane.”
— Ben Jonson, English dramatist (1573–1637): ‘Every man in his humour’, III.5.