Charles Flynn

Pomposity and Bishops

Both too much and too little sleep linked to disease and death Mortality increases are associated with both too much and too little sleep, a new analysis of the Whitehall II study data among civil servants has revealed. Researchers at the University of Warwick and UCL found they could identify effects on mortality and disease resulting from sleep patterns many years before, even when other factors such as age, alcohol consumption, smoking and so on were taken into account. Results from the study were revealed at the British Sleep Society conference this week, and will be published shortly in the journal Sleep. Analysis of the Whitehall II data showed those who cut their sleep from seven to five hours faced a 1.7-fold increase in mortality from all causes. Those who slept more than eight hours, however, were also at increased risk of death, mostly from cardiovascular causes. The findings suggest that consistently sleeping around seven hours each night is optimal for health. http://tinyurl.com/2dhzyb

From US/Eastern News of August 12th 2007 comes a story of a most innovative and excellent form of recycling that could save our authorities a fortune, save our shorelines and our marine ecosystem and overcome the problem of glass disposal to boot. That this would also place cohesive granular material back on our beaches that would help arrest the sand draw down on our steepening and non-cohesive shores is yet a further advantage. http://cbs4.com/consumer/local_story_234142623.html Broward's Sand Shortage May Be Solved With Glass Picture a beautiful beach spanning miles of coastline, gently lapped by aqua-colored water, but sprinkled with glass? You'd think it might hurt but think again. It's actually sugary soft with sparkling granules that feel like, well, sand. And that's the point. Faced with the constant challenge of keeping sand on Florida's beaches, Broward County officials are exploring an innovative option to use pulverized glass to control erosion. The recycled glass would be crushed into tiny grains and mixed with regular sand to patch erosion problems on the county's beaches before they wash away. And it's only natural, officials say, since glass is made from melted sand. "Basically, what we're doing is taking the material and returning it back to its natural state," said Phil Bresee, Broward's recycling manager. The county would become the first in the country to use the process to dispose of recycled glass, bolster sand reserves and intentionally spread it on beaches, Bresee said. Sand is a commodity in South Florida, where beach-related business generates more than $1 billion a year for Broward alone. It has traditionally been dredged from the ocean a mile offshore and piped onto beaches, about 13 million tons of it since 1970 in Broward. That's enough sand to fill the entire Empire State Building more than 12 times over. But with the county's reef system restricting future dredge sites, available sand is becoming scarce and pricey as construction and fuel costs rise and dredge operations are pushed farther offshore. In 2005, a dredge operation brought in about 2.6 million tons of sand at a cost of $45 million. By comparison, a 1991 dredge operation brought in about 1.3 million tons of sand for $9 million. The recycled glass market also is lagging from low value, Bresee said. "The goal of this project is to spearhead a synergistic approach to the glass recycling challenges as well as beach nourishment ... We're certainly blazing the trail," he added. "It's unclear how much the project would cost the county, whether it would be cheaper to just sell the glass or even if the project is feasible as Broward doesn't have its own plant to process the glass. The state and county have so far spent about $600,000 on tests and engineering". "And while the glass sand project wouldn't solve the county's problem of limited sand supply, it would create a reserve to plug beach "hot spots" like pot holes before they become critically eroded", Bresee said. A typical large dredge project brings in about 2.6 million tons of offshore sand. The county would create just 15,600 tons of the glass material each year. Most of Broward County's 24 miles of beaches are considered critically eroded, in largely because of coastal development and offshore channelizing. Statewide, more than a quarter of Florida's 1,350-mile coastline falls into the same category. About $80 million is spent annually restoring Florida's beaches, but it's a constant challenge as storms sweep away sand and coastal development continues. "The sand that is still there is just getting harder to get," said Paden Woodruff of the state Department of Environmental Protection. Woodruff said the glass sand project would have multiple benefits. "You reduce waste stream that goes to our landfills and you generate materials that could be available for our beaches," he said. The idea grew from the unintentional consequences of an ocean dump site off Northern California near Fort Bragg. In 1949, officials began dumping garbage over a cliff into the ocean -- everything from old cars to refrigerators and glass, said Charles Finkl, a marine geologist with Boca Raton-based Coastal Planning and Engineering. Finkl said that while organic material degraded over the years, the glass broke apart and became smooth in the surf. The area is now known locally as Glass Beach. Another accidental glass dump site in Hawaii produced similar results, Finkl said. "You talk about glass beach and people have images of sharp glass shards but it's not that way at all," he said. "Mineralogically, its the same as natural sand." While Broward's plan would first crush the glass into sand-sized grains before spreading it on the beach, the California and Hawaii sites show it's not just a pipe dream, Finkl said. A similar technique has been used to create sandy beaches using glass along Lake Hood in New Zealand and on the Dutch Caribbean island of Curacao. Broward County tested a small patch of the glass sand on Hollywood's beach last year, using sensors to measure humidity and heat. Scientists have also conducted laboratory tests that show organisms and wildlife can live and thrive in the glass material just like natural sand, they said. The county is now awaiting a permit to place the glass sand in the surf zone to see how it reacts in the waves. But the science is simply too new to truly know of any long-term consequences, said Dennis Heinemann, a senior scientist with the Ocean Conservancy. "There's no way that you can predict all the environmental consequences of an action like this," Heinemann said. "There always will be unforeseen consequences." The state and Broward County are currently spending millions to remove some 700,000 old tires from the ocean floor off Fort Lauderdale that were dumped there in the 1970s with the good intentions of creating an artificial reef. It didn't work, and now the tires are scouring the ocean floor and wedging against the natural reef, killing coral. A lesson learned the hard way. Stephen Higgins, Broward's beach erosion administrator, said disastrous side effects from the glass sand are highly unlikely. "If we were going to construct an entire beach out of glass, I would be a little more concerned," Higgins said. "But our test results show there were no discernible differences between the glass-sand blends and the 100 percent natural beach sand."

Walking even a short distance a few times a week can yield dramatic improvements in health. On a relaxing stroll, a walker can burn 200 to 300 calories an hour, shedding pounds with minimal exertion. With a little more effort, the pounds fall away. Walking helps develop stamina, forces oxygen-rich blood into tissues, and improves circulation, and all without the trauma to the knees, hips, and ankles that running and jogging can produce. The benefits of walking, however, go well beyond the purely physical. More than any other activity, walking is a sure way to jump-start the brain, to set thoughts in motion and calm our troubles. Prompted by our modest exertions, the body begins to produce endorphins just a few minutes into a walk, chemical compounds that reduce pain and stress, enhance memory and judgment, and increase feelings of well-being as they course into the brain. Along with endorphins, walking produces increased levels of serotonin, an important neurotransmitter that further serves to reduce stress, for which reason doctors increasingly recommend walking as a treatment for mild depression and anxiety. So over the hills with you. A more relaxed, slimmer you will result and you will be around longer than if you sit in your car aiming to go the mile or so to work an extra few seconds faster.

Sherlock Holmes and Doctor Watson went on a camping trip. In the middle of the night Holmes awoke and nudged his faithful friend. “Watson, look up at the sky and tell me what you see.” Watson looked up at the night’s sky, and a vista of God’s creation was spread out before him. Watson replied, “I see millions and millions of stars.” “What does that tell you Watson?” “Well…astronomically, it tells me that there are millions of galaxies and potentially billions of planets. Horologically, I deduce that the time is approximately a quarter past three. Meteorologically, I suspect that we will have a beautiful day tomorrow. Why, what does it tell you?” Holmes was silent for a moment, and then spoke… “Watson, someone has stolen our tent.”

The term "eco-driving" is starting to appear. It saves money, ensures that driving is safer and not only saves lives and injuries but helps to save the planet. Average CO2 emissions from new cars in the UK in 2006 were 167.2g/km. This can be substantially reduced by "Eco-driving" i.e. driving a vehicle in such a way that it has as little impact on the environment as possible. This can include, for example: adhering to speed limits accelerating gently, keeping speed constant and changing gear at the optimal time limiting air conditioning (estimated to add 10-14% to fuel consumption) driving with windows closed and roof racks removed to reduce drag avoiding idling the engine not warming the engine up before starting off filling tyres to the optimum pressure keeping a safe distance from the car in front as sharp braking wastes fuel In addition the UK Government with their Smarter Choices programme aims to encourage use of less carbon intensive alternatives to the car for passenger travel. These can include: destination-based measures to reduce car use (e.g. workplace or school travel plans); changing access to cars, e.g. car clubs and car-sharing schemes; action to increase individual awareness of alternatives to the car (e.g. public transport information and marketing, travel awareness campaigns and personalised marketing); and measures to reduce the need to travel (e.g. teleworking or home shopping). However if you do drive, drive intelligently. You don't have to pay out £18,000 for a hybrid car. You can reduce your energy and petrol consumption without having to buy a whole new vehicle by being a careful driver. To sum up and reiterate some of the salient points: Combine trips: As much as you can, combine your errands to reduce the amount of driving you're doing overall. Also drive the shortest route between point A and point B. Car share: The fewer cars on the road, the better. See if you can share a car with people that work with you, or even people that work around you. You'll be saving on petrol and reducing pollution at the same time. Use your own body for transport: When you're just running out to the shop for a few items, try taking your bike or walking. You can carry a large string or cloth sack, or a backpack, to put your groceries in to carry them back home. You'll also be doing something good for your body! Take the bus: Check the time-table and see if there's a bus stop by you, and if it goes to work, school, etc. Paying a bus fare is a lot cheaper than a gallon of petrol. We need to take positive action by slowing down - tranquil driving or avoiding excessive car use saves lives - yours and other living creatures on the planet as well.

Bowel Cancer Gene Location Could Save Thousands of Lives. Scientists at The Institute of Cancer Research have identified a common genetic variant that can increase a person's risk of developing bowel cancer. Their findings appear in a paper published in Nature Genetics. Several genes are already known to contribute to bowel cancer risk. However, these are extremely rare among the population – only around one person in every 2,500 carries any of the known bowel cancer genes and they account for less than five per cent of bowel cancer cases arising annually. Around 35,000 new cases of bowel cancer are diagnosed in the UK each year. It is estimated that genetic risk contributes to around a third of cases. Professor Richard Houlston and colleagues studied the genetic make-up of more than 30,000 people in a hunt for genes that make up the rest of this risk. Around half of the participants were bowel cancer patients and half were healthy people. Approximately half the population has the genetic variation that increases the chance of developing bowel cancer by 20%. Lifetime risk of the disease rises from about one in 20 for those without the faulty copy of the gene to one in sixteen for people who do. Emma Mowat, of Bowel Cancer UK, said: “Overnight, this discovery potentially doubles the number of people we can identify as being most at risk from the disease - 10% of people diagnosed because of family history and 10% because of this gene. A ‘whole genome search’ was carried out which pinpointed a gene that is faulty more often amongst bowel cancer patients than in individuals without the disease. The gene's location was narrowed down within the genome to a region called 8q24. Scientists recently found that men who have the same genetic variant are at an increased risk of developing prostate cancer. It is hoped that the use of emerging technologies in searching for cancer genes could lead to improvements in diagnosis and treatment of the disease and save thousands of lives. Moreover leading an active life with a good green diet will assist many of those at risk.

Research at the University of Michigan suggests creating “Teflon” versions of natural antibiotics found in frog skin can make potential drugs better at thwarting bacterial defences leading possibly to a better antibiotic. It is all down to antimicrobial peptides (AMPs). These are produced by most animals and they are the immune system’s early line of defence against microbes trying to penetrate skin, mucous membranes and other surfaces. Injured or infected frog skin as well as the linings of the human respiratory and gastrointestinal tracts responds to invading pathogens by producing large quantities of AMPs. As well as fighting bacteria, AMPs attack viruses, fungi and even cancer cells, so drugs designed to mimic them could have widespread medical applications. The natural antibiotics AMPs were discovered in the 1980’s but they have some limitations. They are easily broken down by protein-degrading proteases secreted by bacteria. Increasing the concentration of AMPs to solve that problem can cause toxic side effects, such as the destruction of red blood cells. It appears to happen because sticky parts of the AMP molecule interact with the cell membrane in a harmful way. A research team, led by biological chemist E.Neil Marsh, replaced sticky parts of the AMP molecule with non-stick analogs. His inspiration came from the kitchen as much as the chemistry lab: non-stick cookware is coated with fluorinated polymers, plastic-like compounds composed of chains of carbon atoms surrounded by fluorine atoms. The fluorine not only makes Teflon slippery, it also makes the coating inert to almost every known chemical. When Marsh and co-workers swapped sticky parts of their AMP molecule with non-stick, fluorinated versions, the molecules became much more resistant to proteases. The non-fluorinated AMPs were all degraded within 30 minutes. Under the same conditions, the fluorinated AMP was intact after 10 hours. This should make them more effective. More experiments are planned in order to learn whether Teflon AMPs are also less toxic than their stickier equivalents. If they are, and if further studies continue to point to their promise, eventually producing large enough quantities of fluorinated AMPs for clinical trials should be quite feasible.

Chocolate Medicine The cocoa tree (Theobroma cacao) has great potential to benefit the public health and many of the countries where it is grown. There are some 150 different chemicals in its leaves, fruits, seeds and bark. The medicinal use of the cocoa plant goes back into antiquity to the Olmec, Mayan and Aztec civilisations. According to leading research scientists flavanol - rich foods such as specific cocoas could provide health benefits in the management of cardiovascular disease and cancer. A study of two populations of Kuna Indians living on islands near Panama who drank large quantities of a homemade, flavanol-rich cocoa each day compared to Kuna Indians living in Panama City who drank little cocoa and when they did it was the commercially produced variety relatively low in flavanols showed that the Kuna Indians still living on the islands had much lower deaths from heart disease and cancer. Other studies have shown that as well as significantly higher concentrations of flavanols in their bloodstream, the island-dwelling Kuna Indians had higher levels of nitric oxide metabolites - a marker for normal blood vessel function and healthy blood flow. It was found that a specific nutrient in cocoa, the flavanol (-) epicatechin could help to improve blood vessel relaxation. This nutrient is also found in in certain fruit and vegetables, such as apples and grapes. It was clear that the benefits of cocoa consumption are not exclusively linked to anti- oxidant activity. Certain cocoa flavanols potentially inhibit biochemical pathways that can cause inflammation, which can lead to the development of several health problems including cardiovascular disease. It is expected that there will be co-operation between major confectioners and pharmaceutical companies to develop preparations based on flavanols. One of these may be developed to create natural supplements to ease the symptoms of diarrhoea.

Doctors aren’t bovver’d! The July edition of the International Journal of Clinical Practice reports on research carried out at Birmingham University and Lund University in Sweden. 750 doctors from Belgium, Brazil, Denmark, Finland, France, Mexico, Portugal, Singapore, South Korea and the U.K. took part in a 'From the Heart' study. 61% of doctors felt it was acceptable for only 47% of their patients reaching their cholesterol goals. “Although doctors appear to appreciate the risks associated with cardiovascular disease - which they identified as a greater cause of death than cancer - the importance of lowering cholesterol does not appear to be widely endorsed” says co-author Professor Richard Hobbs from Birmingham University. I wonder in any fact whether some of the literature, which speaks of the possible links of statins with liver cancer and with memory loss, have struck a cord with doctors, and so they are not totally convinced of BigPharma’s marketing extolling the remarkable safety of statins. The findings of the survey included: - Doctors in South Korea (80%) were most likely to be happy with the 47% patient success rate statistic, while doctors in Finland were least happy (48%) - Prescribing statins and recommending lifestyle changes was recommended by 46% of doctors. This was followed by lifestyle changes alone (43%) and statin therapy alone (10%). Only 1.5% recommended no course of action. -Doctors in South Korea (66%) and Portugal (61.5%) were most likely to recommend a combination of statins and lifestyle changes, with doctors in South Korea (23%) and Portugal (29%) least likely to recommend them. -Statins alone were most likely to be prescribed by doctors in Brazil (15%) and the UK, France and Mexico (11%) and least likely by doctors in South Korea (2.5%) and Denmark (6%). - The percentage of doctors using national, European or local guidelines to set cholesterol lowering goals averaged 81% and was highest in South Korea (100%) and Brazil (93%) and lowest in the UK (45%) and Singapore (52%). Doctors reported that cancer was feared far more than cardiovascular disease and patients indicated that they were more aware that smoking and obesity were the main risk factors rather than high cholesterol. There appears to be great scope for for health professionals to inform the public of the value of lifestyle changes - more greens, losing weight, exercise etc as well as following the recommended guidelines for taking statins in conjunction with medical advice on risk such as it may be.

Imhotep “Father of Medicine” (2980 B.C.) We have been misled to believe that ancient Greeks, particularly Hippocrates, were the fathers of medicine . A research team from the KNH Centre for Biomedical Egyptology at Manchester University now say from evidence in medical papyri written in 1,500 BC - some 1,000 years before Hippocrates was born, that Imhotep is the true Father of Medicine. Imhotep lived during the Third Dynasty at the court of King Djoser. He was a scribe, chief lector, priest, architect, poet, philosopher, astronomer and magician (medicine and magic were used together (then as now!). He was worshipped as a god and healer from approximately 2850 BC to 525 BC, and as a full deity from 525 BC to 550 AD. In the ‘Turin Papyri’, he is described as the son of Ptah, chief god of Memphis in recognition of his role as a wise councillor. Early Christians worshipped him as the “Prince of Peace.” He was worshipped even in Greece where he was identified with their god of medicine, Aslepius. Homer (c.800 BC) remarked in the Odyssey: “In Egypt, the men are more skilled in medicine than any of human kind” and “the Egyptians were skilled in medicine more than any other art”. Prof Rosalie David, Director of the KNH Centre, said: “The ancient Egyptians were practising a credible form of pharmacy long before the Greeks. They can be thanked for the introduction of a structured medical and pharmacological system that continues to the present day.” Sir William Osler is quoted as saying that Imhotep is “The first figure of a physician to stand out clearly from the mists of antiquity”. He diagnosed and treated over 200 diseases, 15 diseases of the abdomen, 11 of the bladder, 10 of the rectum, 29 of the eyes, and 18 of the skin, hair, nails and tongue. Imhotep treated tuberculosis, gallstones, appendicitis, gout, and arthritis. He also performed surgery and practised some dentistry. He extracted medicine from plants. He also knew the position and function of the vital organs and circulation of the blood system. Medical documents first discovered in the mid 19th century show that ancient Egyptian physicians treated wounds with honey, resins and metals known to be antimicrobial. Piles and rectal prolapse were treated by medication, suppositories, laxatives and enemas. For burns, 'a mixture of milk of a woman who has borne a male child, gum and ram’s hair was applied'. Before surgery, patients were sedated with opiates. Local anaesthesia was known, where water was mixed with vinegar over Memphite stone, which resulted in the formation of carbon dioxide with its analgesic effect. Cough was treated by inhalation of honey, cream, milk, carob, colocynth and date kernels. If any of you want to create a stir in your local community you may consider (or not) this diarrhoea remedy “Green onions 1/8, freshly cooked Gruel 1/8, oil and honey ¼, wax 1/16, water 1/3, cook and take for four days”.

As statins are commonly prescribed and are useful in preventing strokes, heart attacks I thought this recent review published in the Lancet would be of interest. Any problems of course should be referred to your doctor as soon as possible. Other measures apart from statin use should be pursued including life style changes - more exercise, dietary changes, cutting down alcohol consumption, reducing weight are normally recommended either before considering statin treatment or as well as statin use. However, this recent review of the safety of statins has concluded that these drugs are well tolerated, with their main adverse effects — myopathy and rhabdomyolysis — occurring very rarely at standard doses. "With a few caveats and while awaiting good quality randomized data for the newer drugs, statins seem to be a remarkably safe group of drugs when used at their usual doses," the author, Dr Jane Armitage (University of Oxford, UK), concludes. The review, published online in The Lancet on June 7, includes all papers published between 1985 and 2006 on the safety, efficacy, and side effects of statins. Armitage notes that since statins were first approved in 1987, their ability to reduce the risks of vascular death, non-fatal MI, stroke, and the need for arterial revascularization has been shown by several large, high-quality randomized trials. But she adds that hopes that statins might protect against fractures, dementia and macular degeneration have not been supported by evidence from randomized trials. Myopathy Armitage says the only well-documented, consistent adverse effects associated with statins are muscle toxicity, including myopathy and rhabdomyolysis, and effects on liver enzymes. She states that all statins occasionally cause myopathy which could progress to rhabdomyolysis but she estimates that myopathy occurs in fewer than one in 10,000 patients at standard doses of statins; and while the risk increases with higher statin doses, it remains very low with atorvastatin 80 mg. Myopathy or rhabdomyolysis are usually reported in association with concomitant use of interacting drugs (especially fibrates), the review notes, adding that this side-effect is most likely to occur within a few months of starting statin treatment, or of increasing the dose, although some cases have been reported even after some years of apparently stable statin treatment, usually as the result of starting an interacting drug. Armitage points out that muscle pain is common in middle-aged patients (and often believed to be due to the drug because of product warnings), but is, nevertheless, unlikely to be due to statin treatment. Measurement of creatine kinase in such patients can exclude myopathy and allow safe continuation of treatment, she says. Importantly, any risks of myopathy and rhabdomyolysis can be kept to a minimum by knowledge of potential drug interactions and the vulnerability of particular groups of patients, she adds. Transaminase Increases The review reports that a small percentage of patients taking statins experience an increase in liver enzymes (in particular, alanine and aspartate transaminases), generally seen in the first 6 months of treatment. These are asymptomatic, are reversible on stopping the statin treatment or with dose reduction, and there is no convincing evidence from the statin trials that increases in either transaminase are associated with liver damage, Armitage writes. She adds that the effect on transaminases seems to be dose dependent, and effects on other liver enzymes and bilirubin also emerge with higher doses, but unlike with myopathy, the effects might be because of a greater fall in LDL cholesterol. But even at high doses, these liver enzyme increases have not been associated with hepatitis or liver failure. She notes that routine monitoring of liver function after starting statin treatment is no longer recommended for simvastatin, pravastatin, or lovastatin up to 40 mg daily, but remains recommended for the other statins and higher doses. If transaminases are more than three times the upper limit of normal in an asymptomatic patient with no other liver abnormalities, the enzymes should be checked within a week and statin treatment stopped temporarily if alanine transaminase is still at this level. Increases to between two to three times the upper limit of normal in an asymptomatic patient necessitate monitoring, but will often resolve while on treatment. The review also examines the safety of statins in several vulnerable groups. It says that no adjustment of dosage is needed for the elderly, since people aged up to 80 years were recruited in the various trials, but that the very elderly may be at increased risk of myopathy. It also reports that there is no evidence to suggest people consuming excess alcohol are at greater risk of side effects from statin use, although many such people were excluded from statin trials. Warfarin users may need to adjust the amount of the anticoagulant when statin treatment begins and again when it ends, it adds. Lancet. Published online June 7, 2007. The complete contents of Heartwire, a professional news service of WebMD, can be found at www.theheart.org, a Web site for cardiovascular healthcare professionals. Clinical Context The statins are widely used to lower cholesterol levels via inhibition of 3-hydroxy-3-methylglutaryl coenzyme A reductase. Several large randomized controlled trials have shown that statins reduce the risks for vascular death, nonfatal myocardial infarction, stroke, and the need for arterial revascularization procedures, all in relation to lowering of low-density lipoprotein (LDL) cholesterol levels. Because cholesterol lowering is now recommended for a wide range of people at cardiovascular risk, including those with average and below-average lipid levels, statin safety is of paramount importance. Six statins are available worldwide: lovastatin, simvastatin, pravastatin, fluvastatin, atorvastatin, and rosuvastatin; pitavastatin is available only in Japan and India. This review highlights the safety of achieving and maintaining low levels of total and LDL cholesterol as well as the specific safety of the available statins at different doses. Study Highlights The authors reviewed safety information from randomized trials of specific statins, including reports of spontaneous adverse effects and other sources of safety data. "Standard doses," or the commonly prescribed daily doses that typically reduce LDL cholesterol levels by 30% to 45%, are 10 to 20 mg for atorvastatin, 40 to 80 mg for fluvastatin, 40 mg for lovastatin, 40 mg for pravastatin, 10 mg for rosuvastatin, and 20 to 40 mg for simvastatin. Statins have qualitatively similar effects on lipid levels but varying efficacy in lowering LDL cholesterol levels. Statins are safe and well tolerated by most people, and they have been extensively studied. Their widespread use may globally affect the burden of cardiovascular disease. Statins are metabolized in the liver. Those that are metabolized primarily by the cytochrome P-450 system can interact with other commonly prescribed drugs (itraconazole, ketoconazole, miconazole, gemfibrozil, bezafibrate, fenofibrate, ciprofibrate, erythromycin, clarithromycin, telithromycin, nefazodone, verapamil, amiodarone, and HIV protease inhibitors) and regular ingestion of grapefruit juice. Although the adverse effects on muscle and on liver enzymes generally apply to all statins, other aspects of safety should not automatically be extrapolated from 1 statin to another, because each statin has a different risk for adverse effects and for drug interactions. Muscle pain is common in middle-aged patients using statins and is often thought to be related to statin use because of product warnings. However, muscle pain is actually unlikely to be caused by statin treatment, and adverse effects on muscle are rare at standard doses. Myopathy, or muscle pain or weakness with blood creatine kinase (CK) levels more than 10 times the upper limit of normal, typically occurs in fewer than 1 in 10,000 patients receiving standard statin doses, but this risk varies between statins and increases with use of higher doses and interacting drugs. Measurement of CK levels in patients with muscle pain can rule out myopathy and allow safe continuation of treatment. Rhabdomyolysis is a rarer and more severe form of myopathy with myoglobin release into the circulation, CK levels more than 40 times the upper limit of normal, and risk for renal failure. Both of these adverse effects on muscle occur more often with higher statin doses and are reversed by stopping statin use, usually leading to full recovery. All statins can cause myopathy and rhabdomyolysis, with varying risk for different statins that is not clearly related to the LDL cholesterol–lowering efficacy. For example, cerivastatin is not particularly effective but is much more likely to cause rhabdomyolysis vs other statins. Other cholesterol-lowering agents, especially fibrates, can also rarely cause myopathy, but combining statins with some fibrates, particularly gemfibrozil, increases the risk. Gemfibrozil also increases plasma concentrations of some statins by inhibiting their glucuronidation. The risk for myopathy with all statins is affected by drug interactions that are sometimes related to the metabolism of particular statins via the cytochrome P-450 system. However, other mechanisms may also be involved. Patients with renal impairment, hypothyroidism, or a seriously debilitated state or who are older than 80 years are more susceptible than others to myopathy. Adverse effects on the liver are rare at standard statin doses. All statins are associated with asymptomatic increases in concentrations of liver transaminases but not clearly associated with increased risk for liver disease. Pearls for Practice Statins are typically safe and well tolerated at standard doses and are metabolized in the liver. Those that are metabolized primarily by the cytochrome P-450 system can interact with other commonly prescribed drugs (itraconazole, ketoconazole, miconazole, gemfibrozil, bezafibrate, fenofibrate, ciprofibrate, erythromycin, clarithromycin, telithromycin, nefazodone, verapamil, amiodarone, and HIV protease inhibitors) and regular ingestion of grapefruit juice. Myopathy typically occurs in fewer than 1 in 10,000 patients receiving standard statin doses, but this risk varies between statins and increases with use of higher doses and interacting drugs. Measurement of CK levels in patients with muscle pain can rule out myopathy and allow safe continuation of treatment. Both myopathy and rhabdomyolysis occur more often with higher statin doses and are reversed by stopping statin use, usually leading to full recovery. Medscape Medical News 2007. ©2007 Medscape

Research shows that however green we are in the home, most of us leave our eco-habits behind when we clock in for the nine to five. For those of you who can see what needs to be done in your office, but don't know how to go about doing it, here's an eight-point guide put together by the Low Carbon Innovation Network. Step 1: From tiny acorns... If staff are pretty good at switching off lights but always leave their computers on, just focus on changing one issue at a time. 'One noteworthy method that has proved to be successful in the past is an office review of all electrical equipment to look at what’s been left on after all the staff have gone home,' said a spokesman from Legal & General. Step 2: Get the board on board If a company really wants to pick up the pace in reducing their carbon emissions, the backing of the senior management is a necessity. Even if the initiatives do not require investment, any scheme has a much better chance of succeeding with strong leaders on board. Step 3: First, find your problem The key is finding the right initiative for your organisation. If the necessary preparation has been made as to which area needs improvement, then the decision over which initiative to proceed with becomes a lot easier. Examples include: staff awareness days, pledge schemes – where staff pledge to act in the office as they would at home in relation to energy efficiency or encouraging staff to give up parking permits using cash incentives. Step 4: Carbon capers and eco excitement There are many ways to make schemes more entertaining, ranging from using comic stickers to bringing in a healthy element of competition in the office. A member of the Low Carbon Innovation network said, 'Launch the initiative company- or facility-wide on a memorable date or week. This could be linked to a national campaign, such as Energy Efficiency Week in October. Alternatively link it to an important company date and/or celebration, such as an anniversary or building construction date.' Step 5: Sing from the same songsheet It’s important to ensure that everyone in your organisation is on the same page. Presentations can be particularly useful to check everyone is clear in what they have to do and what the general aim of the scheme is. Other methods include using the staff intranet and newsletters; providing as much information as possible is vital to making the initiative successful. Step 6: Croissants for cereal cyclists One NHS trust manager told us, 'if you’re trying to get someone to do something for you, you need to give them feedback, higher recognition and just a thank you. An example of this was seen when we looked at transport, free breakfasts for cyclists have proved effective in promoting our ‘Cycle to Work’ scheme.' John Neame, Managing Director of the Low Carbon Innovation Network said: 'Motivating employees to sustain their level of commitment to energy saving initiatives seems to be a really tough challenge, so staff incentives can really help. Company bikes look like being the next big thing!' Step 7: Keep it up! Sustainability is the key piece of the puzzle. In order to make your new green achieve last, the manager or team in charge of it need to keep on top of the situation by monitoring how staff implement the scheme. After the novelty has worn off, staff can become more lax in their quest for energy efficiency. Step 8: Learn from your mistakes You can learn what worked and what didn’t from past initiatives; discovering what type of approach is the most effective gives you something to work from in the future. Feedback is fundamental in introducing new and improved schemes, whether they relate to carbon reduction or something completely different.

Anita Roddick has pointed me to this website - World on Fire: www.worldonfire.ca where singer/songwriter Sarah McLachlan compares the the production costs of making a music video to the needs of global poverty. It’s worth a visit.

If you are like me in that your night vision is not as good as it should be, you may be interested in recent American research which suggests chlorophyll derivate chlorine e6 enhances eye sensitivity to red light. So eating your greens rather than carrots could be the key to good night-time vision. In sight, light activates a visual pigment that sends an electrical signal to the brain. This process happens in the retina in cone and rod cells. Rod cells are insensitive to colour and the cone cells are mainly responsible for our colour vision. However, in dim light the cone cells cannot function and we largely perceive the world in black and white. This also means we are dependent on rod cells to see in the dark. Since these cells are particularly insensitive at the red end of the visible spectrum, America scientist Ilyas Washington asked: 'How might one enhance red light night-time vision?' "It is possible that taking a chlorophyll derivative supplement could improve night vision" - Ilyas Washington Prompted by research suggesting that deep-sea dragonfish see using chlorophyll, the scientists gave mice a chlorophyll derivative, chlorin e6, to see if their red vision was improved. Using a technique called electroretinography, which measures retinal cell responses to a flash of light, the researchers found that the treated mice showed almost double the response to red light when compared to non-treated mice. The group also showed that the chlorin e6 was localised in the retina and conclude that the increased visual sensitivity is a result of light absorption by the chlorophyll derivative. Washington is currently performing similar research in people. It is possible that taking a chlorophyll derivative supplement could improve night vision.

Scratch no more: Gene for itch sensation discovered: Itching for a better anti-itch remedy? Your wish may soon be granted now that scientists at Washington University School of Medicine in St. Louis have identified the first gene for the itch sensation in the central nervous system. The discovery could rapidly lead to new treatments directly targeting itchiness and providing relief for chronic and severe itching. The "itch gene" is GRPR (gastrin-releasing peptide receptor), which codes for a receptor found in a very small population of spinal cord nerve cells where pain and itch signals are transmitted from the skin to the brain. The researchers, led by Zhou-Feng Chen, found that laboratory mice that lacked this gene scratched much less than their normal cage-mates when given itchy stimuli. The laboratory experiments confirmed the connection between GRPR and itching, offering the first evidence of a receptor specific for the itch sensation in the central nervous system. Chronic itching is a widespread problem. It can be caused by skin disorders like eczema, or it can stem from a deeper problem such as kidney failure or liver disease. It can be a serious side effect of cancer therapies or powerful painkillers like morphine. For some people, chronic itching can be very disruptive, interfering with sleep or giving rise to scratching that leads to scarring. Effective treatment options for itchy patients are limited. Historically, scientists regarded itch as just a less intense version of the pain sensation. As a result, research on itching has been somewhat neglected. "Many genes have been identified in the pain pathway," says Chen, associate professor of anesthesiology, psychiatry and molecular biology and pharmacology. "But itch research has lived in the shadow of pain research, and no one knew which gene was responsible for itching in the brain or in the spinal cord until now."

You may think that poverty means you have a poorer diet and this in turn causes obesity. This view is challenged. A recent study from the Food Standards Agency seems to contradict the commonly held view that poor diet and poor health generally are caused by poverty (see for example a 2005 report from the Faculty of Public Health, Food Poverty and Health). Both studies in reality paint a more complex picture. For example, the FSA say that whilst there may be no evidence of a link between nutrition and income, there is evidence of a link between nutrition and level of education and some aspects of diet among those on low incomes are worse. Similarly, the FPH study recognises that a range of factors influences poor nutrition, including unemployment, disability and old age, as well as poverty. The idea that poverty alone may not be the cause of poor nutrition and poor health also gains support from a new study from the Institute for Child Health at UCL, reported in the International Journal of Obesity, 2007, pp 1-9, which suggests that obesity in children may be influenced more by whether or not mothers work and what hours. Children from more affluent families with working mothers may therefore be more at risk of obesity than those from poorer families. So once again there is evidence that modern society necessitating both parents working affects their kids.

As there is a fair amount of interst in evolution on this Forum I thought I would look into some of the recent research. As a pharmacist, the chemical processes interest me. Some of the most pioneering research is being carried out in California. This is one current report explaining that before life emerged on earth, either a primitive kind of metabolism or an RNA-like duplicating machinery must have set the stage. But what preceded these pre-life steps? A pair of University of California -San Francisco scientists has developed a model explaining how simple chemical and physical processes may have laid the foundation for life. Like all useful models, theirs can be tested, and they describe how this can be done. Their model is based on simple, well-known chemical and physical laws. The work appears online this week in “The Proceedings of the National Academy of Sciences.” ( http://www.pnas.org/cgi/content/abstract/0703522104v1) The basic idea is that simple principles of chemical interactions allow for a kind of natural selection on a micro scale: enzymes can cooperate and compete with each other in simple ways, leading to arrangements that can become stable, or “locked in,” says Ken Dill, PhD, senior author of the paper and professor of pharmaceutical chemistry at UCSF. The scientists compare this chemical process of “search, selection, and memory” to another well-studied process: different rates of neuron firing in the brain lead to new connections between neurons and ultimately to the mature wiring pattern of the brain. Similarly, social ants first search randomly, then discover food, and finally build a short-term memory for the entire colony using chemical trails. They also compare the chemical steps to Darwin’s principles of evolution: random selection of traits in different organisms, selection of the most adaptive traits, and then the inheritance of the traits best suited to the environment (and presumably the disappearance of those with less adaptive traits). Like these more obvious processes, the chemical interactions in the model involve competition, cooperation, innovation and a preference for consistency, they say. The model focuses on enzymes that function as catalysts – compounds that greatly speed up a reaction without themselves being changed in the process. Catalysts are very common in living systems as well as industrial processes. Many researchers believe the first primitive catalysts on earth were nothing more complicated than the surfaces of clays or other minerals. In its simplest form, the model shows how two catalysts in a solution, A and B, each acting to catalyze a different reaction, could end up forming what the scientists call a complex, AB. The deciding factor is the relative concentration of their desired partners. The process could go like this: Catalyst A produces a chemical that catalyst B uses. Now, since B normally seeks out this chemical, sometimes B will be attracted to A -- if its desired chemical is not otherwise available nearby. As a result, A and B will come into proximity, forming a complex. The word “complex” is key because it shows how simple chemical interactions, with few players, and following basic chemical laws, can lead to a novel combination of molecules of greater complexity. The emergence of complexity – whether in neuronal systems, social systems, or the evolution of life, or of the entire universe -- has long been a major puzzle, particularly in efforts to determine how life emerged. Dill calls the chemical interactions “stochastic innovation” – suggesting that it involves both random (stochastic) interactions and the emergence of novel arrangements. “A major question about life’s origins is how chemicals, which have no self-interest, became ‘biological’ -- driven to evolve by natural selection,” he says. “This simple model shows a plausible route to this type of complexity.”

For those of you who wonder what the meaning of some of the directions may be on your prescription I thought I would help. This is not comprehensive but I hope it is illuminating for some of those obscure acronyms of Latin origin. p.o. - per os - taken by mouth i.p. - intraperitoneal - injected into the peritoneal cavity i.v. - intravenous - injected in a vein. s.c. -sub-cutaneously - injected under/into the skin i.m. - intramuscular q.i.d. - quad in diem - four times a day q.d. - quad diem - everyday b.i.d. - bis in die - twice a day t.i.d. - ter un die - three times a day

If you think that the idea of a morning person or an evening person is nonsense, then postgraduate student Martin Sale and his colleagues from the University of Adelaide have news for you. They have found that the time of day influences your brain's ability to learn - and the human brain learns more effectively in the evening. And by identifying at what point in the day the brain is best able to operate, rehabilitation therapy can be targeted to that time, when recovery is maximised. "Our research has several future applications," Mr Sale says. "If the brains of stroke patients can be artificially stimulated to improve learning, they may be able to recover better and faster." The researchers used a magnetic coil over the head to stimulate nerve activity in the brain, and linked it to an electrical stimulus of the hand. Mr Sale, from the School of Molecular and Biomedical Science at the University of Adelaide, discovered that the brain's capacity to control hand movements is influenced by the time of day. His study found that larger changes are induced when the experiments are performed in the evening, as compared with mornings. "Such time-of-day variations in function are not unusual. Organisms are adapted to the continual change in light and dark during a 24 hour period to avoid predators and to reproduce faster," he says. "For example, the petals of many flowers only open during the day, while some organisms only reproduce at night. In humans, these rhythms are governed by a variety of hormones that control many bodily functions."

There are news reports stating that Africa, with 70 per cent of the world reserve of medicinal plants, has no share in the more than $70 billion (about N9 trillion) global herbal medicine business. The Director of Pax Herbal Clinic, Rev. Fr. Anselm Adodo, made the assertion at a workshop in Lagos organised by the clinic for journalists. Adodo said: “Africa is surrounded by wealth, yet live in poverty,” adding that the workshop just for herbal medicine alone but for poverty alleviation especially poverty of the mind. He called for the protection of indigenous knowledge by re-understanding, re-interpreting, re-examining and re-expressing it in the light of modern science. Adodo, popularly known as “native doctor” said it was important to set up international efforts with the objective of protecting and preserving indigenous knowledge. He added: “With every old person that dies in our villages, a whole library of books is being lost”. He said one of the main objectives of workshop and the publication of the centres journal, herbal doctor” was to store, protect and preserve the African knowledge of medicinal herbs. The catholic priest said knowledge, one of humanity’s great assets, was grossly under-used in Africa. According to him, the number of knowledge workers who are unemployed, under-employed or mis-employed particularly among university graduates is reportedly between 25 and 40 per cent in Africa. Adodo said practices such as ancestor worshiping, veneration, cult, voodoo and sorcery were signs of knowledge twisted toward the past instead of toward the future and thus, not efficient for the current forward-looking world. “It is knowledge that is detrimental to the transformation of African medicine into globally acceptable venture, thus keeping about a quarter of Africa constantly looking backward,” he said. Dr Bunmi Omoseyindemi, the Chairman of the Traditional Medicine Board, said there was a need to properly develop herbal and traditional medicine to create employment because unemployment was also a health problem. He told newsmen that “Nigeria has the highest rate of maternal and child health problem in the world and we must find a way to reduce it because it is part or our strategy to reduce poverty.” He added that orthodox and traditional medicine practitioners need to work in concert for the common goal of saving lives. Journalists drawn from various parts of the country took part in the workshop tagged Medicine Reporters Forum, organised by PAXHERBALS, a Catholic Centre for scientific cultivation, development and promotion of African medicine. According to the organisers, the forum is to ensure that journalists are well informed about happenings in the Nigerian herbal medicine sector. It is also meant to show them the huge potential of African medicine in transforming the continent and to encourage dialogue toward the development of the African medicine. According to the organisers, the forum is to ensure that journalists are well informed about happenings in the Nigerian herbal medicine sector. It is also meant to show them the huge potential of African medicine in transforming the continent and to encourage dialogue toward the development of the African medicine.

A report in the British Medical Journal warns GPs to curb antibiotic prescribing Experts have again called on GPs to reduce antibiotic prescribing because of the danger of resistance. The call came from the authors of a study published this week on BMJ Online First that showed prescribing amoxicillin to a child in general practice doubles the risk of beta-lactam resistant bacteria two weeks later. The authors said current levels of antibiotic prescribing could be enough to sustain resistance. Last week a report published by the Journal of Antimicrobial Chemotherapy warned that many GPs were risking adding to resistance by continuing to prescribe antibiotics for 80 per cent of patients who consulted with upper respiratory tract infections. Led by Professor David Mant of the University of Oxford Department of Primary Healthcare, the authors of the new study concluded that substantial and sustained changes in prescribing were required. www.bmj.com So if you have a common cold do not ask for antibiotics!

I came across an instructive essay by Chris Hedges about how the war in Iraq is "Beyond Disaster." Here's a quote: Saddam Hussein, like the more benign dictator Josip Broz Tito in the former Yugoslavia, understood that the glue that held the country together was the secret police. Iraq, however, is different from Yugoslavia. Iraq has oil-lots of it. It also has water in a part of the world that is running out of water. And the dismemberment of Iraq will unleash a mad scramble for dwindling resources that will include the involvement of neighboring states. The Kurds, like the Shiites and the Sunnis, know that if they do not get their hands on water resources and oil they cannot survive. But Turkey, Syria and Iran have no intention of allowing the Kurds to create a viable enclave. A functioning Kurdistan in northern Iraq means rebellion by the repressed Kurdish minorities in these countries. The Kurds, orphans of the 20th century who have been repeatedly sold out by every ally they ever had, including the United States, will be crushed. The possibility that Iraq will become a Shiite state, run by clerics allied with Iran, terrifies the Arab world. Turkey, as well as Saudi Arabia, the United States and Israel, would most likely keep the conflict going by arming Sunni militias. This anarchy could end with foreign forces, including Iran and Turkey, carving up the battered carcass of Iraq. No matter what happens, many, many Iraqis are going to die. And it is our fault. Is he right?

GreenMann Directory Launched Date Submitted: 06/08/2007 16:13:14 Source: Frank Schuengel -------------------------------------------------------------------------------- Island 21, the sustainability thinktank, is today officially launching the new GreenMann Directory, the Isle of Man’s guide for low-impact living. The 52 page strong guide can now be downloaded from www.greenmann.org and contains a wealth of information – from local businesses and organisations connected with environmental matters, over important and helpful websites, to helplines and ways to contact relevant government departments. Frank Schuengel, Secretary of Island 21, commented: “We felt that a lot of people would like to do something for the environment or live in an environmentally friendly way, but weren’t always sure how to do this best or where to look. That is why we believe the launch of the GreenMann Directory is an important step forward towards directly addressing the lack of information on environmental matters on the Island. We feel the information contained within the directory will be of great assistance to the island's residents, especially as we have also included many bits of interesting information about the environment and what we can do to preserve its good health.”. Charles Flynn, Chairman of Island 21, added: “The GreenMann Directory is a wonderful resource put together by so many people who care for our environment. Our team have been absolutely fantastic in completing this major work. We invite everyone to access and download their own free copy under www.greenmann.org and hope that as many people as possible will make good use of it.” The GreenMann Directory aims to provide information on ways to improve our environmental impact on our planet and was produced with the help of Island 21, the Department of Local Government and the Environment, the Royal Society for the Encouragement of Arts, Manufacture and Commerce, the Manx Co-operative Society, Bridson & Horrox, and many volunteers from around the island. A printed version of the guide, which will be distributed to every household on the island, is also planned and will go ahead as soon as funding has been secured. Ends

Ten Reasons to Love Your Pharmacist. Some brief notes and thoughts for an article I am compiling for a writer I have been asked to help by the Royal Pharmaceutical Society of Great Britain: 1. Pharmacists are experts in medicines. Nowadays they have studied for 5 years - 4 years at University to obtain an M.Pharm plus one year pre-registration in community, hospital etc to obtain practical experience followed by an exam before being able to register with the Royal Pharmaceutical Society of Great Britain and use the protected title “pharmacist”. The aspiring pharmacist has studied pharmacology, chemistry, pharmaceutical chemistry, pharmacy practice, pharmaceutics, pharmacy law, pharmacology, anatomy, biochemistry, kinetics, business practice etc. He/she has studied drug use, chemical effects, composition, and the biological and physical effects of drugs. The job has changed over the years with far more sophisticated medicines now available. We used to give plenty of over the counter advice but the range of treatment has extended greatly. No longer, do you get the corked polished bottle containing the medicine made in the pharmacy wrapped in white demy and sealed with wax but now most preparations are made by the manufacturer under strictly controlled conditions and handed out in a paper dispensing bag with specific written instructions on how to treat your medicines. Years ago I had to make the medicine from scratch including suppositories, ointments etc. There is now more emphasis on expert knowledge and drug information. We used to write our labels out - now of course they are printed on a computer with things like the expiry date. When I qualified, drug addiction was in its infancy. I had one patient to supervise at the All night pharmacy of Boots in Manchester. Now there are hundreds! 2. I believe the responsibility to be a professional pharmacist has improved substantially and pharmacists are now far more integrated into the primary care team and respected by other healthcare professionals such as nurses, dentists, dieticians etc as such. The influence of the tyrannical domineering doctor has been reduced and pharmacists are on an equal footing than they have ever been. Pharmacist’s main concern is to ensure treatment is safe and effective. In the dispensary medicine on prescription are reviewed (in fact an increasing number of pharmacists are getting qualified as supplementary prescribers), to ensure the medicine is appropriate, the dosage is correct and that side effects are minimal. It is the pharmacist’s responsibility to ensure patient information is communicated effectively in everyday language appropriate to the individual customer. 3. Pharmacists are easily accessible. Pharmacies are open at least six days a week with a pharmacist available for advice. I remember doing a seven day week during the holiday season, being on duty for much of that time from 9 a.m. until 10 p.m. but those days are gone! I never did find another pharmacist to share the hours. It is surprising how many visitors to the Isle of Man forgot their prescription medicines - asthma, heart tablets etc and needed emergency supplies. 4. It is important to perhaps patronise the one pharmacy to ensure all your healthcare information, which is stored confidentially on the pharmacy computer, is available. Being on first name terms with the pharmacist can be very beneficial for good advice, preventative health care, and drug information. Pharmacists are trusted professionals and if used properly play a significant role in disease prevention and health promotion 5. There has been a great shift over the years in that the profession has been feminised. Women have brought their own special gifts to the pharmacy and do concentrate on professional matters. Men appear to be more entrepreneurial. Both men and women pharmacists must be good listeners and caring. 6. Many pharmacies provide a home delivery service to elderly patients and to nursing/residential homes. Of course, nowadays many medicines can be purchased over the internet and provided these e-pharmacies are approved by the RPSGB, there is no reason why they cannot complement the traditional pharmacy. 7. Pharmacies are a great resource. Ask your pharmacist about self-help groups for particular health conditions. Ask about local services such as osteopaths, chiropody, continence nursing, disability aids, child resistant containers, easy to open containers, storage of medicines, the meaning of expiry dates etc. Even matters such as sexual health, pregnancy testing, drug syringe schemes for perhaps a family member. 8 Pharmacy is not just about drugs. It is about caring - putting something back into the community. Pharmacists go into nursing and residential homes giving advice to the elderly on retirement, nutrition, fitness. I, in fact, as a Licensed Lay Reader in the Church of England conduct church services in residential homes and provide pastoral care and health advice over coffee to those whom I have got to know over the years. I find this vocationally very rewarding. 9. Pharmacists provide advice not only on prescription medicines but also over the counter medicines. This advice can be on a whole range of everyday products - slimming aids, men’s health, health and beauty, sexual health, holiday medicines, vaccinations, foreign travel, allergies, skin care, winter remedies,, photography, diet, stress, alcohol abuse, home health care etc. 10. The pharmacist’ advice is cost effective. Diagnostic testing can take place confidentially for diabetes, cholesterol, high blood pressure. Ask the pharmacist for a consultation in a special quiet area/room in the pharmacy. p.s. And if you don't love your pharmacist....... A nice, calm and respectable lady went into the pharmacy, right up to the pharmacist, looked straight into his eyes, and said, "I would like to buy some cyanide." The pharmacist asked, Why in the world do you need cyanide?" The lady replied, "I need it to poison my husband." The pharmacist's eyes got big and he exclaimed, "Lord have mercy! I can't give you cyanide to kill your husband! That's against the law! I'll lose my licence! They'll throw both of us in jail! All kinds of bad things will happen. Absolutely not! You CANNOT have any cyanide!" The lady reached into her purse and pulled out a picture of her husband in bed with the pharmacist's wife. The pharmacist looked at the picture and replied, "Well now. That's different. You didn't tell me you had a prescription."