The Vasectomy Doctor (24 page)

During the twenty-five years that I served in it, general practice underwent some massive changes. It became a speciality in its own right requiring aspirants to undertake a three-year post-graduate course ending with a membership examination. We are all members
of the Irish College of General Practitioners, and sport MICGP after
our names. In addition to this general practitioners these days tend to practise within group practices and single-handed practices have now become the exception. This is the very opposite to the way
that things were when I set up practice in Kildare on my return from
Canada in 1974. Then, single-handed practices were the norm, co-operation among GPs was at best very poor and competition for private patients quite fierce.

Now it is all sweetness and light. Every county has its own GP co-op – an arrangement whereby doctors in any given area cover for each other at nights and weekends. This should add enormously to the quality of general practitioners' personal lives because they can now go to bed at night and know that they are going to get a decent night's sleep. They can go away at weekends or take their children to the beach or climb a mountain and do all these things without the worry that one of their patients may need medical attention in their absence. They are no longer nailed to their practices as we were ten or fifteen years ago. In the bad old days I would be dragged out of my warm winter bed night after night to attend to an asthmatic child or to an old lady who had fallen out of bed or to a couple who had decided to have a good old domestic barney with lots of drink on board too, of course. And the next day I was expected to be fresh and well and all smiles and sympathy throughout a busy day's surgery. And this might go on week in week out for anything up to six months without a break.

That style of general practice is dead and buried and good riddance to it. I say the new order of things, the co-ops, the group practice, the absence of any real competition for private patients, should add enormously to the quality of a GP's personal life. But somehow or other this does not seem to have happened. Other extraneous changes have taken place in the meantime that have negated the internal improvements made in the organisation of community general practices.

The first five years of the new millennium have witnessed quite extraordinary growth and development in the Irish economy and infrastructure. We now have full employment but house prices and mortgages are so high that both parents have to work in order to pay for their lifestyles. They put their infants into crèches and feel guilty about it. They bring their babies to the doctor, not because there is anything wrong with their baby but because they want to assuage their guilt for leaving him or her in a crèche all week. They are assertive, stressed, rude, litigious and computer-literate. People who have done a full internet search before coming to see their GP offer a new challenge. The doctor–patient relationship has changed for all time. The authority of, and respect for, medicine have both gone out the window. Now doctors are on their guard all the time and practising defensive medicine, doing unnecessary laboratory tests just to cover them in the event of litigation. And on top of all that the health services are in such a shambles that it is extremely difficult to get the genuinely sick and urgent cases seen to within a chaotic hospital system.

Such are the stresses and strains and lack of job satisfaction within general practice these days that new recruits to the discipline are hard to find, general practitioners are retiring earlier and there is now a manpower crisis looming in general practice. This is reflected in the fact that many practices have a two or three-day waiting list of patients for non-urgent cases. In my day we didn't even have an appointment system never mind a waiting list of people wanting to come and see you. Changed times indeed from when not so long ago general practitioners would be fighting with each other for stealing ‘my patients away from me'!

Clane General Hospital, now in its twentieth year of existence, goes from strength to strength. Even the long-suffering shareholders are happy campers these days because they are in receipt of modest but real annual dividends. A four-million euro extension has just been added to house an MRI and CT scanner along with the many new medical and surgical consultants who have joined us in the recent past. We have an assisted-fertility clinic or IVF unit that is one of the busiest in the country and knee and hip joint replacement surgery has now also been introduced. This is for us a quantum leap forward and brings the whole profile of Clane Hospital up several notches. The place is now vibrant, complete and self-sufficient and I am very proud to have been part of it all through the years. For me at any rate it has gone from a dream, when I first conceived the idea, to a nightmare when we struggled so painfully to survive those dreadful early years wondering where our next penny might come from and how long would it be before the banks foreclosed on us. Then it went back to a dream again when we turned the corner
and the whole concept became sustainable, cheerful and even profit
able.

* * *

I have taken a keen interest in the subject of ‘andropause' or more properly the testosterone deficiency syndrome. All men as they grow older lose their high youthful testosterone levels at a rate of about one per cent per annum. This steady age-related decline in testosterone levels means that by the time a man reaches the age of say seventy or seventy-five he can expect that his testosterone levels will have fallen to less than half of what they were when he was a
young man of twenty-one. The question then is this: does this steady
natural age-related decline in male hormone levels have any adverse effects on the ageing man and, if it has, is it safe and effective to treat this decline with testosterone replacement therapy? The medical profession is divided on these questions. At the moment there are at least three schools of thought and more research will need to be undertaken before definitive answers can be reached.

The conservative doctors will say that by and large there are no ill effects to this decline in male hormones and even if there were it would be most unsafe to treat them. The majority of medics would I think acknowledge that falling testosterone levels is accompanied by some symptomatology but that this was not worth treating or the potential risks of treating with HRT were such as to make this treatment unwise. And then of course there are the more liberal of us who say that in a minority of men this decline in testosterone levels
can produce quality-of-life-reducing symptoms and that in these cases
hormone replacement therapy for men is not only justifiable but may also indeed be good medical practice. Opinion is as diverse as that. It has more to do with belief systems than with hard medical facts.

In the meantime however, because I deal with them on a daily basis, I am strongly of the opinion that at least some men do suffer from the consequences of age-related falling testosterone levels and that some of these adverse effects may be reversed by the application of testosterone replacement therapy. Symptoms most commonly encountered are:

• Loss of libido or sex drive

• Erectile dysfunction or impotence

• Increased belly fat and loss of muscle mass and strength

• Lethargy and mild depression

• Osteoporosis and easily fractured bones

• Senile dementia and arteriosclerosis – coronary artery disease.

Before a man can be considered as a candidate for hormone replacement it is essential that his prostate gland be checked for early cancer. This is best done by a blood test known as PSA. Once this is in order it is safe to give him a trial of testosterone replacement. These days this is best given as an intermusclear long-acting injection called Nebido and given every twelve weeks. If after say three of these the man notices no difference at all then therapy should be discontinued. If, as is more likely the case, the man feels better all round then therapy may be continued while keeping an eye on his PSA.

* * *

I am taking a legal action against the state for deliberately poisoning my drinking water. Ever since 1965, when the Health (Fluoridation of Water Supplies) Act 1960 came into law, all public drinking water supplies in Ireland have been fluoridated at a rate of one
part per million of fluoride to water. Every county council right across
the country is duty bound to add in this fluoride at source, that is at their water treatment plants. They are statutory-bound to do this whether they like it or not and a recent survey indicated that many of them do not like it one little bit and, given the option, they would prefer to discontinue the practice. But they have no option; the law says that they must add in the fluoride to the nation's drinking water supply.

Another statutory body called the Irish Medicines Board defines a medicine as ‘any product given to treat, or prevent or diagnose a disease'. Fluoride is given to the Irish population to supposedly prevent or reduce the incidence of a disease called dental caries or tooth decay. Therefore, according to the Irish Medicines Board's own definition of a medicinal product, fluoride is a medicine. Since another duty of the board is to regulate the granting of product authorisation for medicinal products and since fluoride carries no such product authorisation, fluoride is therefore not only a medicine but also, worse still, it is an unlicensed medicine.

By the Department of Health putting this fluoride into Irish drinking water supplies, the population is being mass medicated with an unlicensed medicine. Since we all need our tap water to make a cup of tea or coffee or to water our whiskey then we cannot escape this mass medication and must consume it whether we like it or not. My objection to this practice is not that fluoride probably has no effect on dental caries. I really do not care whether it works or not. Nor am I objecting to it on the basis that this fluoride may be doing me some harm. That doesn't matter all that much either. My objection to this odious practice is that it strips me of my God-given right to make a choice in this aspect of my personal health and is a clear violation of human rights.

Under article 40.3 of the Irish constitution you and I are given a right to bodily integrity. It is my contention, and this may be the linchpin of my upcoming action against the state, that through the non-consensual incursion by the state of a substance into my body, a violation of my constitutional right to bodily integrity has occurred and therefore the Health (Fluoridation of Water Supplies) Act 1960 is unconstitutional and must be struck out.

I know that this has been tried before and failed. The problem, if you like, with our having certain constitutional rights is that the scope and extent of these rights is open to interpretation by our judiciary. That interpretation and analysis may therefore be clouded or rendered biased depending on the prejudices of the individual judge making it. For example back in 1963 a brave young Dublin mother, Gladys Ryan, tried to stop the government from introducing the Health (Fluoridation of Water) Act 1960 by claiming that it would be a violation of her constitutional rights to bodily integrity and to privacy among other things. In other words she took the self same action as I am now undertaking. The Kenny judgement in the Gladys Ryan case interpreted her right to ‘bodily integrity' as meaning her right not to undergo any mutilation against her will of body or limb. Or in other words Justice Kenny took an exceedingly narrow and extreme view as to the meaning of bodily integrity – mutilation. Why he took this view may have had something to do with his unwillingness to face down the government of the day. I simply do not know.

Be that as it may however, in the forty-two intervening years things have moved on quite a bit. For example we now have the government's own definition of a medicinal product and fluoridated water would seem to come within that definition. In addition to this, constitutional right to bodily integrity has now been extended by judicial precedent to mean, for example, a right not to have physical contact to which one has not consented. I am not a lawyer of course but it would seem to me that if bodily integrity now extends to physical contact without consent, it should also surely extend to no non-consensual incursion of a substance into the body – no enforced medication against a citizen's will.

In addition to this, in the ward's right to die case in 1996, the Supreme Court ruled that our constitutional right to privacy meant that we had a right to refuse medical treatment even if such a refusal should lead to our death. If it can be shown therefore that fluoridated drinking water is a medicinal product – an inescapable truism in my view, then we already have Irish Supreme Court precedence as to the unconstitutionality of a practice where the right to refuse such medication is denied.

But should my legal challenge to the Irish Health (Fluoridation of Water Supplies) Act 1960 fail in both the Irish High Court and in our Supreme Courts then it should be possible to seek a remedy through the European Court of Human Rights who have a very similar definition to ‘medicinal products' as we have in Ireland. Article 5 of the European Convention for the Protection of Human Rights makes it very clear that: ‘No one may in principle be forced to undergo an intervention without his or her consent.' In the text of the convention ‘intervention' is understood in its widest sense and covers all medical acts including the act of medicating. One way or the other it is my intention to take this matter all the way because otherwise, judging by such government posturing as the recently concluded forum on Fluoridation, paid for by the taxpayer of course, there will never be any change to the status quo. As a blow for civil liberty and human rights this may well be my swan song.

CHAPTER 12

When the gunman left, having fired six times at me at close range and only managing to hit me once, he crossed the road from the surgery and sat down in the middle of a field surrounded by cattle looking at him with his still loaded rifle held across his knees. And the garda brought him out a pint of Guinness. Years later the publican who gave the garda that pint laughingly told me that he is still waiting to be paid for it. And hundreds of people who would have been on their way home from work stopped and got out of their cars to have a look at the scene being played out before them. At this stage I was in an ambulance. Ambulances generally drive too fast and make far too much noise. As a medical insider I can tell you that most of that blue light flashing and sirens blowing is exaggerating the degree of emergency being carried along within. I know it was so in my case. There was a bullet in my right hip joint for God's sake, that's not an emergency.