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EVIDENCE-BASED-HEALTH  December 1998

EVIDENCE-BASED-HEALTH December 1998

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Subject:

Fw: Sheep dip

From:

"Jon Wilcox" <[log in to unmask]>

Reply-To:

Jon Wilcox

Date:

Sat, 5 Dec 1998 15:19:44 +1300

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (223 lines)

Whoops, just tardily discovered I sent this to the wrong Mailserver (GP-UK),
should've gone to EBH....

Dr Jon Wilcox
General Medicine, Paediatrics and Obstetrics,
Glenfield Medical Centre,
452 Glenfield Road,
Auckland 1310, New Zealand
Phone or Fax +649-444-7656
e-mail   [log in to unmask]
-----Original Message-----
From: Jon Wilcox <[log in to unmask]>
To: [log in to unmask] <[log in to unmask]>
Date: Wednesday, December 02, 1998 10:52
Subject: Re: Sheep dip


>Following a proven (positive EBV PCR) post-viral myelitis in my own child
>recently I have witnessed a bizarre "epidemic" of mild, subacute and acute
>myeloradiculitis in my own patient clientele in our local area over the
last
>3 weeks, ranging from infant to veterans. This coincides with an outbreak
of
>glandular fever in many schools in the area, and also a peak in the
Campylobacter >season (Campylobacter is also associated with post-infectious
polyneuritis).

>Most cases fortunately are self-limiting, but can be very difficult to
differentiate from >acute Guillain Barre polyneuritis. Fortunately we now
have excellent tools such as
>DNA amplification to assess these conditions better than we did previously,
>to avoid such cases being misdiagnosed as, fort example, pesticide
toxicity.


>Most of the signs and symptoms of most of the pesticide "poisonings" are
>frequently unable to be differentiated from mild or subacute post-viral
>myelitis. We must avoid the danger of jumping on non-evidence based
>bandwagons or we pose the risk of treating patients inappropiately.
>Judicious and timely use of antivirals for conditions such as
>post-herpetic/zoster/EBV myelitis can be crucial. I would doubt that much
of
>the witchcraft which is employed in treating "pesticide poisoning" here in
>New Zealand would be at all likely to reduce the neurological damage by
>viral infections of the CNS. I presume the same witchcraft is employed also
>in the UK.
>JW
>
>Dr Jon Wilcox
>General Medicine, Paediatrics and Obstetrics,
>Glenfield Medical Centre,
>452 Glenfield Road,
>Auckland 1310, New Zealand
>Phone or Fax +649-444-7656
>e-mail   [log in to unmask]
>-----Original Message-----
>From: Chris Salter <[log in to unmask]>
>To: [log in to unmask] <[log in to unmask]>
>Date: Wednesday, December 02, 1998 03:20
>Subject: Re: Sheep dip
>
>
>>In article <00ff01be1d84$8cd042e0$3802bcc3@eleanor-tom>, dated Tue, 1
>>Dec 1998 at 23:31:20, John Caldwell <[log in to unmask]> writes
>>>Is anyone on the list aware of any evidence for such a connection, and if
>so
>>>could you pass on the details?
>>
>>Further to my original reply I only just remembered to check BBC News
>>Online.
>>
>>Wednesday, November 11, 1998 Published at 11:27 GMT
>>
>>Doctors warn on sheep dip
>>
>>http://news.bbc.co.uk/hi/english/sci/tech/newsid%5F211000/211513.stm
>>
>>By Environment Correspondent Alex Kirby
>>
>>People exposed to organophosphate (OP) sheep dips can suffer "genuine
>>and often very severe symptoms", according to new research.
>>
>>A report by the Royal Colleges of Physicians and Psychiatrists says
>>sufferers must be taken seriously and treated sympathetically by
>>doctors.
>>
>>The report follows the establishment of a working party early last year
>>at the request of the then Chief Medical Officer.
>>
>>It set its own terms of reference: to advise on the clinical management
>>of patients with the symptoms of chronic OP exposure, and to review any
>>new evidence about them.
>>
>>The group heard about symptoms including excessive tiredness, headaches,
>>limb pains, disturbed sleep, poor concentration, mood changes, and
>>thoughts of suicide.
>>
>>It was also told that patients felt strongly they had not been looked
>>after properly by hospitals and doctors.
>>
>>Cause still unknown
>>
>>Crucially, though, it did not look at the way that OPs do their damage,
>>saying only that "further studies will be needed to understand the cause
>>of these symptoms".
>>
>>OPs are ferociously strong pesticides, derived from the nerve gases used
>>by the Nazis in the World War II.
>>
>>>From 1976 until 1992, sheep farmers were obliged by law to use them to
>>eradicate pests from their animals.
>>
>>Even those who took the precautions recommended (such as wearing
>>protective clothing) say they were often ill after dipping.
>>
>>The report criticises the care available to sufferers with the
>>conclusion: "Existing clinical services do not, in the main, provide
>>satisfactory management."
>>
>>It urges doctors to take patients seriously and to be open-minded.
>>
>>GPs should usually be responsible for sufferers, according to the
>>report, and it may be helpful to set up groups of specialists to form
>>"centres of excellence".
>>
>>Professor John Newsom-Davis, chairman of the joint working party, said:
>>"I hope that this report will result in greatly improved medical care
>>for those unfortunate sufferers from OP sheep dip exposure and that it
>>will prompt further research."
>>
>>Committee member Professor David London said: "We found there was a
>>large group of people who were getting symptoms having been exposed to
>>organophosphate sheep dip and the management of these people was really
>>not very satisfactory."
>>
>>Chief medical officer Professor Liam Donaldson said: "The working
>>party's recommendations will be of considerable interest to a number of
>>government departments."
>>
>>He said the report would now be studied carefully by the Committee of
>>Toxicity's Working Group on Organophosphates, and would be sent to
>>relevant expert committees for further consideration
>>
>>Professor Donaldson said he had also asked the Department of Health to
>>open immediate discussions with the directors of the National Poisons
>>Information Service on the report's recommendations that specialist
>>advice should be set up in areas where it currently does not exist.
>>
>>Improved support for GPs who have patients sufferng from related
>>illnesses should be discussed, Professor Donaldson added.
>>
>>"Government funded research is already under way to establish
>>scientifically whether there is a link between prolonged low-level
>>exposure to OP sheep dips and ill health," he said.
>>
>>Critics see flaws
>>
>>The OP Information Network is in touch with almost 700 sufferers. It
>>sent material to the working party, but decided not to give oral
>>evidence.
>>
>>OPIN's Liz Sigmund said: "We are unhappy with this report, because it
>>did not look at how the symptoms are caused.
>>
>>"Nor does it address the problem that many GPs just do not know the
>>symptoms of chronic OP poisoning.
>>
>>"And some of our contacts know that several of its recommendations -
>>like using antidepressants above a very low dosage and techniques to
>>improve memory and speech - are not just useless. They can be positively
>>harmful."
>>
>>OPIN is also "very concerned" that the working party did not look at
>>reported cases of problems among children of farming families. It knows
>>of 22 such children.
>>
>>Ms Sigmund said: "They have severe cognitive and behavioural problems.
>>They could have been caused by direct exposure to OPs.
>>
>>"Or they might be the consequence of damage in the womb, or even of
>>genetic damage to the father. We just do not know".
>>
>>OPs are no longer compulsory for dipping sheep. But they are used in
>>other products such as some flypapers, flea collars for animals, and
>>anti-lice shampoos for use on children's heads.
>>
>>OPIN says it knows of at least one sufferer from OP poisoning who was
>>prescribed eyedrops containing OPs, to treat suspected glaucoma.
>>
>>Dr Bob Davies, a consultant psychiatrist practising in Somerset, has
>>seen many OP sufferers over the last five years.
>>
>>Dr Davies, himself a member of the Royal College of Psychiatrists, says
>>the report is "not bad, but weak".
>>
>>"They held their hearings behind closed doors and they did not look at
>>how the damage is caused. That is a fundamental weakness.
>>
>>"The key to understanding OPs is to know how they hit the brain at the
>>most basic level".
>>
>>"It is not a psychiatric problem. It is a chemical one."
>>
>>Although some farmers are calling for a blanket ban on OPs, Larry Cooke
>>of the National Farmers Union said this would not be practical unless
>>something else was available to eradicate pests from sheep flocks.
>>
>>He said that if pests were allowed to proliferate it would have dire
>>consequences for sheep farmers and result in animals having to be put
>>down.
>>--
>>Chris Salter (Vice Chairman)             Lincolnshire Post-Polio Network
>>                    Registered Charity No. 1064177
>>          <URL:http://www.zynet.co.uk/ott/polio/lincolnshire/>
>>     Web Site & Vice Chairman Email: [log in to unmask]
>>           Honorary Secretary Email: [log in to unmask]
>>        Member of the British Healthcare Internet Association
>>
>



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