How’s your musculo-skeletal health?

October 25, 2016

You can get a scan if you’re worried about your bone density but there’s an easier way to test your musculo-skeletal health:

One in three women and one in five men will suffer a fracture as a consequence of low bone density.

But a challenge has been launched for World Osteoporosis Day to help gauge our resilience against osteoporosis.

It’s a simple test to count how many times you can sit and stand in 30 seconds without using your hands.

It measures overall musculo-skeletal health, that researchers say is vital to preventing osteoporosis.

You start seated in a chair, then count how many times you can stand and sit, with arms folded, in half a minute.  It’s important to fully stand and fully sit at each repetition to get a good measure.

A healthy person with average fitness under 40 should be able to achieve a score of more than 19.

If you are over 40, you should be able to score 1-2 less than this for every decade beyond 40.

If you struggle, you may want to consult a health professional.

Fonterra Principal Research Scientist Linda Schollum says the challenge is not in a formal research setting, but launched as a fun and engaging way to raise awareness.

“The test is a bit of fun and anyone in reasonable health can do it. It’s really valuable to test how well your body is faring.” . . 

I managed 25.

366 days of gratitude

October 9, 2016

It started with a slightly sore throat.

That was followed by a blocked nose and then a cough.

The throat is okay again and the nose has unblocked but the cough is persisting.

Tonight I’m grateful for cough mixture.

Mending beats measuring

October 4, 2016

Prime Minister John Key said the government was committed to reducing the number of children in poverty but didn’t want to put a figure on it.

Asked why the government could set goals to make the country predator-free but not measure the number of children in poverty, Mr Key said it was a complicated area, and the advice the government had been given was it was difficult to have one particular figure.

He said it was more binary in terms of whether there was a rat or stoat or possum there, whereas there were a range of different ways of measuring poverty.

It was better to focus on factors that contributed to deprivation rather than the exact numbers, Mr Key said.

“Isn’t it better for the government to say, ‘Rheumatic fever’s an issue, potentially prevalent with high levels of deprivation and therefore let’s focus on that rather than worry too much about the individual measure of poverty?'” . . 

There is no one definition for poverty which makes it impossible to get an accurate count on how many children suffer from it.

But there is no argument over children in severe deprivation being at risk of rheumatic fever.

Focusing on that will make a positive difference to the lives of those affected by and at risk of this very serious illness where counting won’t.

Mending beats measuring.


366 days of gratitude

September 6, 2016

A text arrived from my GP’s surgery – I was due for a hepatitis A vaccine booster.

Injections aren’t something most people welcome and I wouldn’t say I enjoyed the experience today.

But I am grateful for medical science which means I’m protected from a disease which although not usually serious in most people can be fatal.

Nikki Kaye fighting cancer

September 5, 2016

Prime Minister John Key has announced that Nikki Kaye will be taking leave from her Ministerial portfolios after being diagnosed with breast cancer on Friday.

“I have spoken with Nikki and assured her she has the full support of her colleagues and I as she deals with this difficult diagnosis,” Mr Key said.

“Her medical team is working hard to ensure a full recovery. Nikki will be dedicating her energy towards getting well, and I wish her all the best.

“I appointed Acting Ministers to Nikki’s portfolios on Friday and this will continue until she is able to return to her role.”

Gerry Brownlee will act as Minister of Civil Defence. Nathan Guy will act as Minister for ACC. Anne Tolley will act as Minister for Youth. Ms Kaye’s Associate Education responsibilities will be taken by Hekia Parata.

I first met Nikki before she was elected, when she was campaigning to win the Auckland Central seat – which she did. I wasn’t surprised when the promise she showed then was rewarded with promotion to cabinet.

She is fit – she runs marathons – and determined and those will help her as she undergoes treatment and recovery.

Small failures

September 1, 2016

Hawke’s Bay District Health Board expects investigations will show a combination of small failures led to the gastroenteritis outbreak in Havelock North.

. . . The DHB’s chief executive, Kevin Snee, said he expected the government’s inquiry would show that there were small problems in the systems and processes used by the DHB, and by the district and regional councils.

He expected this to show that, when aligned, the problems allowed the water supply to become contaminated and people to get sick. . . 

This is so often the case, lots of small things add up to cause a big problem.

Earlier tests pointed to a ruminant animal as the cause of the outbreak.

Even before that was announced the usual suspects were blaming intensive dairy farming, in spite of there being none near the bore supplying the town.

. . . Federated Farmers president William Rolleston said the area near the aquifer was mostly lifestyle blocks and orchards.

He said people needed to take a step back from the speculation.

“We all contribute to bacteria in the environment, birds do, humans do and so do farm animals.

“Last week we saw a crescendo of finger pointing at agriculture, we heard that this was because of intensive dairy farms and the closest dairy farm we can find is 40 kilometres away.”

Mr Rolleston said while the indications did point to a four-legged animal as the source of contamination, that didn’t mean intensive agriculture was to blame.

He said the aquifer in question was a shallow aquifer, which had a greater risk of having its seals breached.

“We’re not saying that agriculture doesn’t create a risk, but those are the risks that the council needs to actually take cognisance of and mitigate.”

Last week the Green Party said any inquiry into the Havelock North water contamination should look at the role of intensive agriculture.

Mr Rolleston admitted agriculture was a risk for water.

“We’re not denying that and farmers have been up to the task. We’ve spent a billion dollars in the last decade fencing rivers and we’re playing our part.” . . 

Environment Minister Nick Smith also says speculation is unhelpful:

Questions have been asked about the culpability of cattle and chicken farmers, as well as a nearby mushroom farm, but Dr Smith says sometimes even the most basic failures could be to blame.

The campylobacter outbreak in Havelock North struck down 5100 people with gastro, closed schools and businesses and has left residents still boiling their drinking water weeks later.

It is a reminder of the E. coli contamination in Nelson where upstream farmers, birds and waterfowl were blamed before testing confirmed the true cause, Dr Smith says.

“It was embarrassingly found that most of the problem was toilets from the council’s library having been wrongly plumbed into the stormwater rather than the sewerage system,” he told crowds at a Lincoln University environment lecture in Christchurch on Tuesday night.

He said the lesson was to be cautious of jumping to conclusions too soon. . . 

He also addressed concerns about measuring water quality, limits on water takes and proposed strengthening of swimming requirements.

Dr Smith warned a goal of making all waterways swimmable, rather than wadeable, were “unworkable” and “impossible” without a massive bird cull.

But the Green Party has criticised that view as baseless.

“He knows, as we all do, that the real and lasting damage to our rivers is from stock in waterways, farm run-off, sewage and intensified dairy farms among others – he just won’t admit it,” Green Party water spokeswoman Catherine Delahunty said. . . 

Tests above and below a dam on our farm confirmed birds were at the bottom of poor water quality.

The Otago Regional Council also proved seagulls were to blame for high levels of E.coli in the Kakanui River.

Up until recently, ORC staff and local farmers alike had been baffled about the cause of such high concentrations in the upper Kakanui, particularly during summer.

ORC staff have been concerned about the concentration of the bacteria, as high levels indicate a risk of people swimming becoming ill. The council enlisted the help of local farmers, who provided access to their properties and the nearby river for inspection.

ORC scientists went into the gorge to investigate by helicopter when this inspection failed to identify the source of the bacteria. The culprits − a large colony of nesting gulls − were found in rugged terrain, about 5km above the Clifton Falls bridge. Water quality samples were taken immediately above and below the colony, with divergent results.

Upstream of the colony, the bacteria concentrations were 214 E.coli/100ml, whereas immediately downstream, the concentration was far greater at 1300 E.coli/100ml.

The levels peaked on January 3, at 2400 parts per 100ml of water. ORC manager of resource science Matt Hickey said that according to Government water quality guidelines for recreational swimming areas, those with less than 260 E.coli/100ml should be safe, whereas water with more than 550 E.coli/100ml could pose a health-risk.

Mr Hickey said six colonies of gulls were found in total, on steep rocky faces, where they clearly favoured the habitat for nesting. While they had gone undetected up until now due to their inaccessibility, it was likely the gulls returned each year to breed.

“Unfortunately, these nesting gull colonies are likely to continue to cause high E.coli concentrations in the upper Kakanui River, particularly during the breeding season,” Mr Hickey said.

These are only two examples which show Delahunty is wrong to say birds aren’t a problem.

That doesn’t mean farming, especially when it’s intensive, is blameless.

There are many causes for poor water quality but many have happened over time and it will take time to get the improvements we all seek.

That is much more likely with the collaborative approach the Minister seeks:

New Zealand had a habit of turning environmental issues into a battle ground with winners and losers where farmers are seen as environmental vandals and environmentalists as economic imbeciles, Dr Smith said.

“I have been trying to lead a culture change at both a national and local level where different water users and interest groups work together on finding solutions that will work for the environment and the economy,” he said.

It doesn’t have to be either a healthy environment or a growing economy.

A collaborative approach, based on science, can achieve both.

Science must also be applied to the cause, and response to, Havelock North’s problems to ensure that a series of small failures doesn’t lead to large-scale gastroenteritis again.

What about the doctors?

August 30, 2016

Proponents of euthanasia argue that people have autonomy over themselves which includes the right to die.

They rarely look at the debate from the point of view of doctors who would prescribe lethal doses of medication or administer them.

At The Spinoff, Medical Association chair Stephen Child gives that perspective:

For many, the key discussion point is whether it is possible to write and administer perfect legislation that permits someone autonomy at the end of life without the secondary negative consequences of:

  • inappropriate deaths
  • reduction in quality of palliative care
  • normalisation of suicide.

Both sides of this debate will emphasise anecdotes, surveys or “research” demonstrating cases of potential intolerable human suffering, or cases of coercion/inappropriate decision making, resulting in potentially unnecessary death. . . 

The ethical standards of a profession often go beyond public opinion, the law and market demands, and may also differ from the personal values held by some individuals within that profession. The role of professional ethics, however, is not only to prevent harm and exploitation of the patient but also to protect the integrity of the profession as a whole. This often requires the professional body to fulfil a leadership role to ensure clarity and provide direction.

The NZMA, along with the World Medical Association and 53 national medical associations, holds the following positions on voluntary euthanasia and assisted dying:

  • We recognise the rights of patient autonomy, so we recognise the right for society to have this discussion. We also acknowledge that people currently have the right to end their own life and that this legislation focuses on third-party assistance with this act.
  • We recognise the rights of patients to refuse treatment or for the removal of lifesaving treatment, and that the natural consequences of an illness may progress to death.
  • We recognise the rights of patients to have good access to high quality palliative care services and we passionately advocate for improved resources, education, workforce and facilities to achieve this goal. We strongly oppose the current necessity for our major hospice facilities in New Zealand to have to raise half their funds themselves.
  • We recognise the patient’s right to have administered analgesia and sedation to relieve pain and suffering – even if a secondary consequence of this is the shortening of life. Morphine is not an agent of euthanasia, and will not by and of itself reliably end the life of a patient. These agents are administered to relieve suffering, applying a risk/benefit analysis similar to all treatments, with a shared understanding of the potential risks in their prescription.

It might look like dancing on the head of a pin but there is a difference between giving something to alleviate pain and suffering in the knowledge it could hasten death and giving to deliberately kill.

. . .  Many people, however, still find confusing the difference between the concept of administering terminal analgesia/sedation to a dying patient, and that of administering voluntary euthanasia to a patient with concurrently stable physiology. The difference between palliative care and assisted dying is well documented and clear. The World Health Organisation definition of palliative care includes the statement that palliative care “intends to neither hasten nor postpone death”.

In jurisdictions where euthanasia and assisted laws exist, concern is growing about the impact on palliative care, where those seeking euthanasia are referred first to palliative care for assessment. This has led to confusion in patients as to the role of palliative care and – in some instances – patients who are opposed to euthanasia declining palliative care services.

The profession as a whole has also echoed concerns about the accuracy of diagnosis and prognosis, as well as the lack of certainty around measuring the capacity of patients facing terminal illness, who often also have reactive depression, altered brain physiology from medications or metastases, as well as potential external coercion factors.

For the profession, as well as ethical considerations, physician-assisted dying raises issues of:

  • potential impacts on palliative care delivery
  • potential changes to a doctor-patient relationship
  • difficulties with adequate training, assessment and regulation of the profession
  • potential negative impact on health providers participating in such acts.

Principles of autonomy and self-determination are, of course, central to this debate. The NZMA respects and supports patient autonomy but is concerned about relying on these principles to enact euthanasia or assisted suicide. Principles of autonomy demand full knowledge of risks and alternatives, and consent must be free of coercion, duress or undue influence.

An absolute guarantee that those who choose assisted dying are doing it voluntarily would be extremely difficult to establish in legislation and ensure in practice. Doctors are often not in a position to detect subtle coercion – as is also the case when trying to identify signs of emotional or financial abuse of elders more generally. Coercion also extends to assumptions of being a burden, giving rise to a sense of an “obligation” to die.

Given the gravity of the risk involved for individuals where autonomy is claimed but cannot be guaranteed, the belief that autonomy should trump all should be viewed with caution. . . 


I gave doctors permission not to keep trying to save the life of our first son and seven years later asked them not to call the crash team when our second son stopped breathing.

Both had degenerative brain disorders and any treatment would have only prolonged their suffering and postponed their inevitable deaths.

If I faced the same decisions in the same circumstances I’d do the same thing.

That isn’t euthanasia though.

It’s also very different from an adult in full control of their minds who requests the right to die and I understand how the fear of  what might be ahead could lead someone to that decision.

But legalising euthanasia isn’t only about fully competent individuals who want the right to control their lives and deaths.

It’s also about others who might feel pressured to choose a premature end or who might forgo high quality palliative care for fear euthanasia will be an inevitable consequence.

And it’s about medical professionals and what it asks of them too.

In abridging the article from which I’ve quoted, I missed a paragraph on surveys carried out in Canada, New Zealand and the United Kingdom. Each survey showed while roughly 30% of doctors agree “in principle” with the concept of assisted dying only 10% would feel comfortable in participating.

That’s what is often missed in the debate. It’s not just about the right to die and the patients, it’s also about the right to kill and the doctors.


There’s an assisted suicide table-talk in Auckland tonight:

Broadcaster and comedian Jeremy Elwood hosts the current affairs cabaret, Table Talk, on the subject of Assisted Suicide. Join panelists David Seymour MP, promoter of the End-of-Life Choice Bill; Dr Jan Crosthwaite, University of Auckland Proctor and formerly Department of Philosophy; and Dr Stephen Child, Chair of the NZ Medical Association for a free-ranging discussion of a topic that defies politics.

Enjoy the full & delicious Ika menu, join a table or book for a group. Doors open and bar and dinner service from 5.30 pm, the discussion will start at 7.30 pm.

Follow the discussion on the

August 30, 2016 at 5:30pm – 10:30pm


Ika Seafood Bar and Grill
3 Mt Eden Rd
Auckland 1023

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