The Round Medicine Quiz
How would you get from dirt to asthma to the Berlin Wall to homeopathy to vaccination to West Africa to asthma (again) to death to pounds 2,340 to struck off patients to autism to 1976?
I've no idea.
Well then, have a go.
Why should I?
Because this is a half-hour quiz and we've only managed to fill 30 seconds of it.
That's not my problem
Look, we've got you all the way down from Doncaster, fed you, wined you and given you the chance to shine on national television.
Virgin trains to soggy falafel to Blue Nun UK Living...
Look, my career depends on this - I can't afford another failure or I'll be back in the surgery looking at verrucas 24 hours a day. So either you grow up and do the quiz or...
Or I stick this bloody great needle straight in your eye.
Fair enough. Dirt to asthma was in the papers.
And what's the link?
I've just said. They were both in the paper in the same story. Are you deaf?
No, but what was the story?
I dunno. The headline said "dirt-asthma link" but I didn't read the article.
Have a guess then.
Dirty children who never wash get lots of asthma
No, quite the reverse in fact. A study by the Institute of Child Health at Bristol University found that children who bath every day and wash their hands more than 5 times a day are 25 per cent more likely to get asthma than their peers.
Presumably that's because the kids need to experience a few germs to get their immune systems primed properly so they don't over-react to allergens when they get older.
For yes. How did you...
And when the Berlin wall came down, it was expected that asthma rates would be much higher in the dirty, polluted East than the squeaky clean West, but in fact cities in West Germany had asthma rates of two and a half times those in the East.
Why was that then?
Because East German kids come from larger families, get more childhood infections and use fewer antibiotics. So once again, their immune systems get properly primed. Pollution can trigger asthma attacks but isn't a primary cause - did you know asthma is just as common on the Isle of Sky as in inner London? No. Have a bonus mark.
Thank you. Now, has extract of Berlin Wall been used as a homeopathic remedy?
Yes for ...
No, let me guess. To reunify a patient's symptoms or psychological state...
And vaccination is there, I presume, because like homeopathy it works on the principle of treating like with like ...
Yes, only homeopathy doesn't work. Ha ha ha.
I disagree. There's an increasing body of evidence to suggest it may have an effect in conditions such as hay fever.
A point off for being a smart arse.
Now West Africa and vaccination. Wasn't there a study that children who were vaccinated against measles were twice as likely to develop asthma in later childhood than those who had measles infection.
So was the immunisation programme stopped?
No, because children who weren't vaccinated were much more likely to die from measles, especially if they were poorly nourished or chronically ill.
And what about the UK?
Between 1970 and 1988, uptake of the vaccine was patchy and there were on average 13 deaths per year from measles and over 20 children with permanent brain damage. Since 1989, most GPs have immunised 90 per cent of eligible children and deaths have fallen to less than two a year.
And what made GPs increase their immunisation rates?
Money. Currently GPs get pounds 2,340 for hitting the 90 per cent target. This has helped reduce deaths not just from measles but from diphtheria, haemophilus meningitis, polio, whooping cough, congenital rubella and tetanus. On the downside, some parents don't feel they get an informed choice when their doctor has a pecuniary incentive to jab the kids and a few have been struck off the list for refusing (and hence jeopardising the target payment).
So what about autism?
I've no idea if it's linked to the MMR vaccine - but given the media scare it would be even more unreasonable to strike a family off who didn't want it. At present I'm unconvinced by the evidence and will continue to have my kids immunised but I know GPs who've stopped.
Exactly. There was a scare about whooping cough vaccine and brain damage, and although a later study found that lasting damage was so rare as to be unquantifiable, vaccination rates dropped to 30 per cent over 300,000 children went down with whooping cough and at least 70 died.