Is it me or am I in a supermarket checkout time loop?

Headline from yesterday’s Guardian:

“Removing sweets from checkouts could help tackle obesity – study”

Every dental professional who ever lived will probably shake their head and roll their eyes, (not a good look), when they read this, and mutter, “Isn’t that what we have been trying to achieve for years, or is it decades?”

Back to Google:

The Sybil Fawlty award this time goes to the research published in PLOS (Public Library of Science) journal. I apologise to the good and diligent researchers who have shown again that putting sweets and snacks in close proximity to people means that those people will buy them – or pester a parent to buy them; and that removing them is good for our health by leading us not in to temptation but delivering us snack free at the exit.

BUT

Removing them reduces the risk of the supermarket making sales and therefore risks their profit margins.

We know all this. We all know this.

We know what causes/contributes to tooth decay, obesity, diabetes etc

We know that avoiding snacking is good for us….and have done for decades.

We know that checkout snacks are tempting and not a good thing.

So what will happen? Cognitive dissonance is a wonderful / dreadful thing.

 

Merry Christmas from ASDA (has this stuff got relatively cheaper over the years?):

 

 

 

 

 

HPV vaccination (yet) again

July 2018: The Words:

UK Government advisers have recommended extending funding for human papillomavirus (HPV) vaccines to boys.

The HPV vaccine was previously offered to girls aged 12 to 13, with the new recommendation meaning 400,000 boys will also benefit every year.

All UK Governments took on board the Joint Committee on Vaccination and Immunsation’s (JCVI’s) advice.

‘The JCVI’s advice that boys should be vaccinated is very welcome news for boys and their parents,’ HPV Action campaign director, Peter Baker, said.

‘It will also benefit those girls who, for whatever reason, have not been vaccinated against HPV.”

December 2018: The Reality:

Steve Brine MP has said there will be no catch-up HPV vaccine programme for boys.

In a letter to the shadow public health minister Sharon Hodgson, he argues boys will benefit from ‘herd protection’.

However, the BDA believes up to 2 million boys will remain unprotected from HPV without a catch-up vaccine programme.

‘The latest data on vaccinations among girls illustrates precisely why we’ve needed a gender-neutral approach, Mick Armstrong, chair of the British Dental Association (BDA), said.

‘It also shows why penny pinching on a catch-up programme will leave many school-aged boys unprotected.

‘There can be no guarantees of “herd protection” when nearly one in five girls are missing out on the vaccine.

‘A catch-up programme remains the best way to protect all our children from this cancer-causing virus.’

….and many still believe that this bunch will come up with a fairer NHS Dental Contract.

Yerkes-Dodson is still relevant – if you want to enjoy your clinical career

Why should a “law” described first in 1908 be relevant to everyday Dentistry (and more)?

Robert Yerkes and John Dillingham Dodson described their tests with rats that could be encouraged to complete a maze when stimulated with slight electrical shocks. When the strength of the shocks was increased however the rats just ran about looking for an escape. They concluded that arousal levels helped to focus attention and motivation on the task at hand but only up to an optimum point and after that point fatigue appeared and performance declined.

Research has found that different tasks require different levels of arousal for optimal performance. For example, difficult or intellectually demanding tasks may require a lower level of arousal (to facilitate concentration), whereas tasks demanding stamina or persistence may be performed better with higher levels of arousal (to increase motivation).

The first image shows the classic inverted ‘U’ shape of a difficult task (placing implants, molar endo, treating some children are examples that come to mind). It also shows a continuation without decline of more simple tasks which can be maintained for longer without reaching a point influenced by fatigue (examinations, routine restorations on well adjusted patients).

 

 

The second image shows the typical “stress curve” where performance takes a while to peak if we are under too little stress, then goes through a short period of optimum stress before reaching too much and heading down through exhaustion to burn out.

The reason that I have written about this is that we need to look at the time periods that these curves represent from the short (an hour say) to long (months or even years). There are different challenges that dentists face with differing solutions.

Firstly of course there is the fatigue that comes from trying to do too much challenging work in a short period of time. This results in high stress levels and possibly poor performance on a daily basis. Often there are time management issues where we are obliged to match our performance to the patients availability. This can see a clinician “coasting” by dealing with the relatively straightforward whilst at their peak in terms of readiness and responsiveness but then having to find reserves of energy when the patient “demands” treatment at later times in the day. I have never understood why dentists are reluctant to tell the patient exactly when and why they would like to see them. My own experience in a practice with large numbers of children was to insist on seeing under 11s for any treatment (examinations excepted) first thing in the morning. For the most part when people have reasons explained to them and can understand that it is for their benefit then they will comply with your wishes.

Also to consider are the long term problems of fatigue that arise from the day after day, just doing it without time off. Even in the best time managed (at a relatively micro level) practice if there is often not enough time spent away to unwind, recharge the batteries and recover, then burn out will creep up on you. The prodromal signs are a lack of efficiency and, more importantly, effectiveness.

Dentistry is still a macho occupation for many who seem to get a perverse enjoyment from overwork. It’s sad but true that for many there is an opportunity to build the life they want but put obstacles in their own way as if frightened of taking control.

Time management on both micro and macro levels is hugely important, ignore it at your peril. Get help if you need it.

Our society is being highjacked

Thanks to Cal Newport for pointing me towards this site in his latest Study Hacks blogpost, “Beyond Digital Ethics”.

He talks about the work of Tristan Harris and The Centre for Humane Technology from whose website I have taken a page.

What began as a race to monetize our attention is now eroding the pillars of our society: mental healthdemocracysocial relationships, and our children.

What we feel as addiction is part of something much bigger.

There’s an invisible problem that’s affecting all of society.

Facebook, Twitter, Instagram, and Google have produced amazing products that have benefited the world enormously. But these companies are also caught in a zero-sum race for our finite attention, which they need to make money. Constantly forced to outperform their competitors, they must use increasingly persuasive techniques to keep us glued. They point AI-driven news feeds, content, and notifications at our minds, continually learning how to hook us more deeply—from our own behavior.

Unfortunately, what’s best for capturing our attention isn’t best for our well-being:

  • Snapchat turns conversations into streaks, redefining how our children measure friendship.
  • Instagram glorifies the picture-perfect life, eroding our self worth.
  • Facebook segregates us into echo chambers, fragmenting our communities.
  • YouTube autoplays the next video within seconds, even if it eats into our sleep.

These are not neutral products.
They are part of a system designed to addict us.

Take a look here.

 

 

Should you lie in the sun?

I periodically share information gleaned from a well know dermatologist.

This time there’s also a video where, to celebrate an auspicious birthday, my little brother shows the results of his experiments in cloning.

It is well worth a watch, or two.

The Weekend Read – This is Going to Hurt by Adam Kay

Very few, if any, books have made me weep with laughter and cry with upset in the space of a couple of pages but Adam Kay’s memoir of his years as a junior hospital doctor managed it. The final chapter left me in bits for many reasons.

I ordered the book thinking it would be a 21st century continuation of Richard Gordon’s, “Doctor in the House” or Colin Douglas’s “The Houseman’s Tale”. In one sense it is; the language is not entirely medical, Adam refers to Obs & Gynae, his chosen speciality, as “brats and twats” and there is plenty of normal hospital human behaviour. Clearly the author was able to tolerate the life of a junior doctor even though, “The hours are terrible, the pay is terrible . . . But there’s no better job in the world”, until something happened.

The significant difference is that whilst the idealism, the diseases, the people and their mistakes have remained much the same, the political interference and attitude to professionals has fundamentally changed. Doctor in the House was written in the idealism of the immediate post-Bevan years (1952) and The Houseman’s Tale just pre-Thatcher (1978) when I was just starting my spell as a hospital resident. This is set in am era dominated by Jeremy Hunt’s predecessors and their ilk, (the author includes an open letter to The Secretary of State for Health) where there has been a slow strangulation of health care in spite of the best efforts of those working within it the system. These diaries were written during the years 2006-10, sadly things have not improved.

Essential reading for anyone who works in or is a recipient of healthcare in the UK – perhaps not if you and your partner are expecting your first child.

Available from The Book Depository HERE

 

 

The rising north–south divide in health in the UK

This doesn’t make great reading.

….in the past 20 years, age- and sex-adjusted excess mortality has increased by as much as 46 percentage points in people aged 35–44 years in the north of England compared with the south, and by 27 percentage points in people aged 25–34 years…

….One cause of this higher mortality is an increase in suicide in young people since the 2008 recession, mostly in the north of England. This has been linked to increases in unemployment, associated with poverty, inferior social welfare, educational attainment, and poorer health outcomes. Rates of drinking, smoking, and obesity are also comparatively higher in the north and are at least partly driven by more fast food shops on northern high streets….

The Lancet

%d bloggers like this: