Wednesday, 25 August 2010

Middle Age Spread

Once again, there are stories in the press about the rise of Sexually Transmitted Infections (STIs) in young people (under 24), with half a million new cases in the UK in the last year, a rise of 3% from the 2008 figures. There's an excellent analysis of the data and the media response by Dr Petra Boynton who also deals adeptly with an ill-informed response to the data by a Tory MP.

Although the problem is much more serious with the under 24s, they are not the only group at risk from not using condoms and from poor sex education. As Dr Boynton points out in her blog: 'Sexual health messaging - particularly through education and public health campaigns often overemphasises morality discourses of 'risk' or 'responsibility'... Such an approach also assumes older adults act in different (and more 'appropriate) ways than younger people, which is neither fair nor true'.

The Family Planning Association (FPA) has collected data showing that STIs are also on the increase in the 45-64 age group.

Statistics vary according to different sources. The Royal College of Nursing has noted a 93% increase in gonorrhea between 1999 and 2008 in this age group. A survey done in the West Midlands found that the most commonly diagnosed infection among the over 45s was genital warts – accounting for almost half (45 per cent) of the diagnoses – while herpes was the next most common (19 per cent). Cases of chlamydia, herpes, warts, gonorrhoea and syphilis all rose sharply between 1996 and 2003.

To go back to the actual numbers rather than percentages, according to the HPA's data, Table 4e(ii) shows that chlamydia increased from 1091 cases in 2002 to 2638 cases in 2008. Their data also shows an increase in herpes cases from 1613 to 2903 in the same age group over the same period. These are huge increases in percentage terms but still a small incidence in the population as a whole. So if you see shock headlines about huge increases in grannies with STIs, check the baseline figures.

However, whichever stats you look at, there is an undeniable increase.

One cause is heterosexual couples of that generation splitting up and starting to have casual sex again. For some of them, the thought of dating again is daunting enough, let alone the idea of buying and using condoms. Some people may never have used them. Women who have been through the menopause are mostly of a generation whose main concern was avoiding pregnancy; being on the Pill was considered enough protection and greatly superior to using condoms. The Pill was also seen as empowering women as they didn't have to rely on the man to provide contraception. In addition, the powerful HIV/AIDS adverts of the 80s are now a distant memory and may have come from a time when they thought the campaign didn't relate to them in their steady relationships (which they assumed/hoped were faithful).

A poll by the Royal Pharmaceutical Society of Great Britain found that almost 20% of the 45-54 age group admitted to having unprotected sex in the last five years with someone other than a long-term partner. And a Saga survey of around 8000 people found one in ten not using condoms even though they don't know the sexual history of their partner. Again, a sharp rise from a small number to a slightly larger number is a trend but not a crisis although it is a trend that needs addressing.

While some middle aged people had excellent sex education from schools or parents, many didn't. STIs were often seen as something only the promiscuous got. They may not know, for example, how STIs can be transmitted through non-penetrative sex or that they are at risk at all. And while some people may have plenty of experience, both in having sex and talking about it, not everyone does.

Part of the problem is that sex is often portrayed by the media as something for younger people; the thought of older people having sex or expressing any kind of sexuality can be a bit of a joke or cause (younger) people to wrinkle their noses.

There is a gender bias too, just as there is with younger people where boys are portrayed as predators and girls as victims or 'morally loose'. Older men who are still active are admired (see how many Hollywood stars are still getting the girl in movies well into their sixties) while active older women are a bit distasteful. The alleged Cougar phenomenon in the media is really about women in their forties - maybe early fifties - who look much younger, not grannies. The most explicit portrayal you're likely to see on TV is an advert for a denture product with an older couple kissing (no tongues). None of this helps some older people feel confident in talking about sex openly or seeking advice.

It's encouraging to anyone approaching this age group that the fun doesn't have to stop. But while some are happily embracing their new sexual activity, some older people who grew up in a time when sex was less openly discussed may also find it harder to talk to GPs and health professionals about sex-related matters, especially if they are much younger. They may not even want to admit they are having sex again.

The current government coalition is doing little in the way of public health campaigning for sexual health services for any age group but the Family Planning Association is trying to address the problem for older people with a Sexual Health Week from 13-19 September specifically aimed at people over 50.

So far there has been no media hype or hysteria about older sex as there has been once again with young people, laden with high-handed moral judgements and shock horror headlines. This may change once the campaign launches.

The facts are that there is a small but significant upward trend that is indicative of poor education and campaigning. Just as teenagers need to be equipped to have responsible sex in a factual, non-moralising way, so do older people. The week in September is a good start but without a sustained campaign, it could just come and go without making much of an impact. So, there is not a huge new phenomenon, the very fabric of our society is not at risk from feckless pensioners and irresponsible baby boomers but the government is failing both young and old

Wednesday, 11 August 2010

Food Allergies - Fact, Fiction and Fad

There are two common responses when the subject of food allergies comes up. The first, mostly but not entirely from older people, is "Stuff and nonsense. They didn't exist when I was young, we ate whatever was put in front of us. You don't see starving people in the third world with allergies". The second is: "I feel much better and have lost lots of weight since I stopped eating wheat. I know I'm allergic/intolerant because I sent my poo/blood/hair away to be analyzed".

According to one source, 25% of adults think they have a food allergy although studies show that only about 2% really do. Which means that at least nine out of ten are making a big fat fuss about nothing. Recent news said that up to 8% of children now have allergies although a spokesperson from Allergy UK said: "Parents often look for alternative ways to diagnose their children, using tests which aren't scientific at all. Parents tend to think it's an allergy without taking proper medical advice".

It's mostly middle class people with a bit of spare cash who have latched onto food allergies and intolerances (the two are often used interchangeably). Not the life-threatening A&E kind of allergy but the feeling a bit bloaty and tired, self-dramatizing kind which are not allergies at all. Some people will happily say they're 'a bit allergic' to something without any medical evidence whereas they would never say 'I'm a bit diabetic' and not bother going to the doctor. One reason people might well feel better and lose weight by giving up wheat is that by not eating bread, pasta, pastry and pizza they are also cutting back on the high fat, high salt ingredients that go with them - cheese, highly salted meats, mayo, creamy sauces and so on. Or maybe they really are lactose intolerant and have accidentally cut most dairy out of their diet by giving up these foods. That's the trouble with self-diagnosis.

Saying 'I'm allergic to dairy' or 'I'm gluten intolerant' has become a bit of a middle-class mantra, not that different from telling people your star sign in some circles, as if that makes you more interesting and special. People are more than happy to discuss the details of their alleged intolerances in company where they wouldn't dream of mentioning an ingrown toenail or dandruff - two equally unpleasant but minor complaints. I've heard lengthy conversations about how cutting something out of a diet has changed someone's life, usually followed by a discussion of how they found out they had an allergy/intolerance. Inevitably, this does not involve a visit to the doctor. It involves posting some bodily fluid or excresence off for analysis. There are often endless conversations sharing the love and comparing notes on what foods they can't eat and how they got 'diagnosed'. While eating dinner. Of course, the host/ess has been thoughtfully supplied in advance with a list of all the things the guests can't eat.

A food allergy is an adverse immune response to a food protein. The body identifies a protein as something threatening, the immune system thinks it's under attack and triggers an allergic reaction which can range from mildly unpleasant to life-threatening.

In answer to the people who think that allergies are a modern fad - they're not. In the olden days, anyone with a serious allergy wouldn't make it through childhood and in days before the NHS and proper testing, the cause of death mostly went undiagnosed. The same still goes for parts of the third world. These people are often heard saying things like a certain food doesn't agree with them or 'I like it but it doesn't like me' without thinking that this could be a mild allergy. But going on and on about them is a modern fad, part of a more general obsession with food in our over-stocked culture. It's what used to be called being a fussy eater, perhaps followed by a smack on the bottie that quickly put paid to that bit of wilfulness.

An intolerance doesn't involve an immune reaction. It happens when the body is unable to deal with a certain type of food, usually because it doesn't produce enough of the chemical or enzyme needed to digest it. For example, a shortage of the enzyme lactase causes problems breaking down milk sugar (lactose) into simpler forms that can be absorbed into the bloodstream. There's a strong genetic pattern to food intolerances. Lactose intolerance is less common among northern and western Europeans (10 to 15 per cent are affected) than in Asian, African, native American and Mediterranean populations (70 to 90 per cent are affected). Symptoms include nausea, bloating, abdominal pain and diarrhoea, hours or days after. Which are pretty unpleasant. But those nasty squitty, pukey symptoms don't tend to get mentioned in dinner party conversations, which are more likely to involve weight loss and the person's skin improving. If you have regular cramping and throwing up, you'd probably hightail it to the doctor.

There are plenty of ways to get diagnosed. One involves getting medical advice. The rest don't. Some of these are pretty expensive, often hundreds of pounds. NICE has issued draft guidelines for doctors on diagnosis and treatment of allergies, which contain the advice 'Do not use the following alternative diagnostic tests in the diagnosis of food allergy: vega testing, applied kinesiology, hair analysis'. The guidelines also say that 'it was reported that many people with allergies practice self-care, using alternative sources of support rather than NHS services (for example, complementary services with non-validated tests and treatments)'.

Briefly, kinesiology uses 'energy* fields' in the body to diagnose allergy and intolerance, vega testing involves measuring electromagnetic conductivity in the body using a Wheatstone bridge galvanometer - the same device Scientologists use outside their centres to 'test' passers-by. Hair analysis tests for heavy metals that allegedly cause allergies or involves dowsing - swinging a pendulum over the hair; an allergy is diagnosed if an altered swing is noticed. And then there are the poo samples. Post your poo off to a lab in the UK or US and find out how many different foods you're allergic or intolerant to. As one UK hospital states, samples more than 8 hours old will not be processed as they have degraded too much, so sending poo through the UK postal service to another city, let alone to the States, is hardly going to ensure it arrives in prime condition. And I really don't want to think about what collecting your own poo sample involves. Or what postal workers might make of poorly wrapped packages.

There are some excellent analyses of why all these alternative testing methods are nonsense on stilts on Quackwatch and Holford Watch.

If you really are allergic or seriously intolerant, it can be very unpleasant indeed. If you think you might be or that your child is, see a doctor. Otherwise, kindly shut the fuck up. Or am I being intolerant?

* As soon as you hear 'energy fields', you know you're in quackland.