The three questions that every patient should ask their doctor | Ranjana Srivastava

An unimpressed nurse summons the oncology fellow to the chemotherapy chair. “I am not prepared to treat him with chemo. He can barely stay awake.”

“But his oncologist wants to push on,” the fellow responds.

“The patient doesn’t seem to understand how sick he is or how chemotherapy is doing harm. You’ll need to sort this out, I am afraid.”

The fellow sighs, caught on the horns of a dilemma.

Elsewhere, an elderly woman has taken warfarin, a blood thinner, for some time, and now presents with a massive cerebral bleed. She was going to the kitchen one moment and unconscious the next; she is expected to die shortly. As I console her stricken son, it emerges that she had sustained 50 falls that year leading up to the fatal one. There had been many doctor visits but no one had asked specifically about falls.

At the desk, as I solemnly write a note, I overhear the same exchange that’s going on in my head.

“Fifty falls!” one dismayed resident says. “Why would you put her on warfarin?”

“Because someone wanted to reduce stroke risk and someone else watched her heart disease but no one thought of the whole patient.”

“What were they thinking?”

If you listen to doctors and nurses, this is one of the most common questions you will find them grappling with and grumbling about. It reflects part genuine puzzlement and part exasperation that what one doctor has recommended seems ill-advised or even inappropriate to another.

The Grattan Institute estimates the cost of wasted healthcare dollars to be in the order of a billion dollars and the figure stings clinicians but as a disillusioned young doctor sighed, in the age of super-specialisation, it seems expedient to let every doctor manage “their own organ”. Except the practice harms patients who are after all, more than a collection of organs.

If highly trained doctors don’t understand their colleagues’ intentions it stands to reason that most patients feel even more hapless, caught in an endless tangle of tests and explanations but the knowledge and power asymmetry is such that it’s impossible to question the doctor, who must surely know better (if not best).

Physicians overestimated the effect of some interventions on life expectancy by as much as 30%

Unnecessary and expensive medicine is at an all-time high and the usual reasons given are patient expectations, financial incentives, therapeutic uncertainty, medico-legal fears and the sustenance of hope. Now a new study in JAMA Internal Medicine authored by two Australians points out that when it comes to unsound medicine, there is another element at play. It turns out that when prescribing a drug or ordering a procedure doctors are actually quite bad at estimating the benefit and harm associated with it.

In a systematic review of 48 studies performed in 17 countries and involving more than 13,000 clinicians, they found that doctors rarely had accurate expectations of benefits or harms. The inaccuracies were in both directions but more often, harm was underestimated and benefit overestimated.

No group of doctors fared well. As a result, children with acute ear infections may be overprescribed antibiotics and women with troublesome postmenopausal symptoms may be deprived of hormone replacement therapy. Obstetricians and neurologists underestimated the risk of birth defects from antiepileptic drugs and GPs overestimated the benefit of prostate cancer screening and underestimated the benefit of warfarin for atrial fibrillation, a common heart condition. Transplant surgeons were biased towards an inaccurately low estimate of graft failure and all types of doctors were unaware of the risk of radiation exposure from imaging.

Physicians overestimated the effect of some interventions on life expectancy by as much as 30% and for elective but by no means inconsequential surgery on the thyroid, lung, prostate and uterus, there were clinicians who believed that complications “never occurred or had a rate of zero”. Dermatologists couldn’t agree on psoriasis treatment and psychiatrists differed on the risk of harm from long-term antipsychotics. There was a reluctance to convey a numerical estimate of benefit and worryingly, clinicians “overwhelmingly recommend the interventions they provide”.

This study is a wake-up call for doctors because it speaks to our collective failure to appreciate that in prescribing more for our patients we don’t always help, and indeed, commonly inflict harm. The goal of good medicine is not only to avoid harm but also to provide actual benefit, a distinction that’s commonly blurred, including in oncology. Chemotherapy at the end of life improves neither quantity nor quality of life. It leads to more invasive procedures and greater likelihood of dying in an intensive care unit but patients continue to receive it.

In the reign of evidence-based medicine it is discomfiting news that doctors may not understand the data in the form of hundreds of thousands of studies poured upon us.

First, as any patient knows, the art of medicine matters as much as its science. Evidence applied without tact, consideration, empathy and an understanding of the patient’s perspective can be as harmful as evidence not applied at all. Doctors are increasingly exhorted to provide collaborative care and practice shared decision-making. The catch is that both art and science suffer when we don’t know the facts or struggle to convey them.

Part of the problem is the sheer volume of publications. Entwined in increasing bureaucratic demands many doctors lack the time and also the confidence to interpret academic research so we turn to (commonly paid) expert opinion, “peer influencers” and biased pharmaceutical advertising.

Medical schools run the obligatory statistics course but don’t ingrain in doctors that their interpretation of a journal article or more commonly, an “advertorial”, and their participation in marketing disguised as “literature” peddled by pharmaceutical representatives has a direct impact on patient experience, the cost of care and wasted healthcare dollars. Hospitals who should care even more about such education virtually ignore it and when it’s volume, not quality of care that’s rewarded, it all but extinguishes the desire to do better.

Meanwhile, what should patients do? The JAMA study suggests that doctors frequently don’t know and certainly, don’t know best. This is vexing but not all doom and gloom because doctors now have at their disposal an unprecedented number of sound guidelines, robust protocols and genuinely plain-language information for patients, not to mention easy web-based access to experts. When it comes to doctors seeking advice the world really is a global village. In a world of rapidly evolving information, patients should be prepared for a doctor to say, “I don’t know” provided this is followed by, “but I’ll find out.”

Here are three questions that every patient should ask of every new proposed drug or intervention:

• What are my options?


• What are the specific benefits and harms to me?


• What happens if I do nothing?

If patients asked these questions more often and doctors took it upon themselves to answer faithfully, medicine might yet experience a new dawn.

The three questions that every patient should ask their doctor | Ranjana Srivastava

Taxing questions about the NHS | Letters

Steve Richards’ proposal for a referendum on whether to tax more to invest in the NHS (Opinion, 3 January) is interesting. But his first “drawback” – that “the Treasury hates any form of earmarked taxation” – is not quite right. What the Treasury objects to (stating awkward facts, as usual) is that hypothecating an existing tax to a particular programme will put an unacknowledged extra burden on other programmes (actually or potentially). The problem with this proposal, as with any referendum, is that a “vote for change” lands the government with the further question: what change? In this case, what new tax? Indirect tax (VAT) is regressive. A straight proportionate increase in income tax looks unfair to low earners and harms incentives to work; but a steep increase in direct tax on rich individuals, or companies, will drive them to base their money, or themselves, abroad. This leaves a progressive tax on the value of fixed assets (land and buildings) – for example a reformed council tax; but how much would a government dare to tax “ordinary” property owners when house prices are already so high?
Alan Bailey
London

• As this winter is indisputably showing, the NHS is slowly dying, and no doctor or nurse can save it. The cure can only be ministered by the British people. As the year turns they must decide whether or not they believe, as they did in 1948, that “illness is neither an indulgence for which people have to pay, nor an offence for which they should be penalised, but a misfortune, the cost of which should be shared by the community” (Aneurin Bevan). If they do, they should indicate through their elected representatives that they are willing to open their wallets and pay the cost through increased taxation. If they do not, they should accept that our health system, the envy of the world, will perish, leaving behind the country’s poorest and most vulnerable. 
Dr Nicolas Suarez
Bristol

• At 2pm on New Year’s Eve I phoned Shropdoc, the out-of-hours GP service in Shropshire. I was staying near Clun and my grandson had a severe cold and agonising ear ache. I was told to expect a call from a GP within three hours. In fact they didn’t call until nearly midnight – far too late for anything to be done. Compared with how it once was, the GP service is frighteningly inaccessible and unreliable. The government’s seven-day proposals are completely unachievable without the appointment of thousands of GPs, but these are needed right now to make the current service effective.
Chris Hardy
London

• Join the debate – email guardian.letters@theguardian.com

• Read more Guardian letters – click here to visit gu.com/letters

Taxing questions about the NHS | Letters

Stacey Gregg: restless writer whose scripts fizz with tricky questions

“I find it hard to switch off,” admits Stacey Gregg. “The great thing about writing is that you are free to write about anything, to grapple with what’s happening in the world.” For the Belfast-born playwright, that might be issues of science, law, ethics and much more. Her monologue Scorch, inspired by real-life cases of “gender fraud”, is out on tour. The 2013 play Override, in which she explored an alternative near future, has just been given a sharp new production at the Tiger Dublin fringe festival. And Gregg is one of seven playwrights responding to issues around conception and birth in an upcoming international festival at the Royal Exchange in Manchester.

At 33, Gregg has already written six plays, and is under commission from the Royal Court, Clean Break and the Abbey theatre. Our Skype conversation is interrupted by bursts of laughter as she talks at speed, emanating the restless energy that has enabled her to alternate between writing plays, film and TV scripts, with acting stints in between.

Scorch, which won a Fringe First award at the Edinburgh festival last month, was written in response to recent court cases in the UK. “These were cases taken by women who had been deceived into thinking they were having a sexual relationship with a man, but discovered that their partner was a woman or, in one case, a trans man. The accusations were of ‘gender fraud’, which for me is a contested term. I thought that the media coverage sensationalised these cases, and this drove me to try to communicate the questions they raised in a more complex way.”

Amy McAllister in Scorch at the Edinburgh festival. Photograph: Murdo Macleod for the Guardian

Initially envisaging it as a TV script, Gregg reworked Scorch as a stage play, which she performed herself, before handing it over to the Northern Irish company Prime Cut. Directed by Emma Jordan, it was produced as part of the Outburst Queer Arts festival in Belfast last autumn. Poignantly performed by Amy McAllister, the solo piece captures the confusion of a teenage girl called Kes who wants to be a boy, and begins an online relationship with a young woman who assumes that Kes is male. The virtual world seems perfect to Kes, allowing her the freedom to present herself as she wants to be.

“It’s about the limitations of language, and of access to language. Kes doesn’t have words for her feelings,” she says. “I’m interested in responses to the play, its interpretation as a trans piece, because that seems to ignore aspects of lesbian sexuality. It is as if butch lesbians have gone away – they haven’t – and now we can only talk about this in terms of a medicalised idea of transition from one gender to another.”

Override examines what happens to relationships when people use technology to enhance or augment their bodies. It fizzes with ideas about biohacking, prosthetic envy and robotics. Its central questions are philosophical, to do with human perfectibility and utopianism. “All of that, and how to be authentic,” Gregg says, “and the continuum we are on when we introduce wearable technology. And our online and offline selves – the difference between me, born analogue, and those 10 years younger than me, digital natives. I’m a bit obsessed with all this.”

‘How to be authentic’ … Matti Houghton in Override at Watford Palace. Photograph: Manuel Harlan

Medical interventions into conception and birth and questions about access to reproductive technology are among the themes of a season of performances and debates at Manchester’s Royal Exchange next month. Gregg is one of seven female playwrights from around the world who have been commissioned to respond to the theme in the Birth festival. The plays will subsequently tour. Her solo piece, Choice, interweaves two stories – one of a British woman who is trying to conceive by IVF and one of an Irish woman travelling to England for an abortion. The piece will be performed by Gregg herself. “It’s difficult to describe the form it’s taking, but it is developed from workshops and research, and will be lo-fi. What’s emerging from all of the writers is the global inequality relating to women’s experience of birth.”

Gregg is the representative writer from the UK in this international programme. Moving between Dublin, Belfast and London, she enjoys what she calls her dual citizenship. “Dublin has been good to me. Rough Magic Theatre Company’s Seeds programme was the start, and then the Abbey theatre gave me my first break, for which I’m really grateful.” Her first full-length play, Perve – a prescient work tackling the sexualisation of children and the pervasiveness of pornography – was produced by the Abbey in 2011, followed last year by Shibboleth, which took a chaotically satirical view of Belfast’s peace walls.

Having grown up in Belfast in the aftermath of the Troubles, Gregg left the city to study English at Cambridge, where she narrowly avoided being sent down and was acutely aware of her working-class roots. This was followed by an MA in documentary film-making in London. She is increasingly drawn to writing about Northern Ireland, with a number of her plays set there – Ismene, Huzzies, Shibboleth – as well as two feature films in the pipeline. Her impulse is not only towards her native place, but also to her family background, captured in the class tensions of Huzzies, her comic play for Tinderbox Theatre in 2012 about a no-hoper Belfast rock band.

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Stacey Gregg on her play for Birth

Currently developing a new play with the performance artist Deborah Pearson for Clean Break, the theatre company that works with women in the criminal justice system, she says: “I want to write about the working poor and women in prison in a way that is not voyeuristic, but empowering.” Breaking new ground, experimenting with dramatic forms, Gregg is racing ahead, her antennae leading her towards performance art. “I’m more and more interested in live art, visual art – people like Kathy Acker or the Gob Squad, artists who combine philosophy and a kind of punk aesthetic, these attract me. I’m learning all the time – it’s hard, and it might involve failure. But I’d much rather see a mess than something that is well finished but has nothing to say, no ideas.”

Stacey Gregg: restless writer whose scripts fizz with tricky questions

Technology And Video Games Make Children Believe In a different way About Old Questions

It is well-liked to compose about how the internet is shifting the way we consider. Education and parenting journalists like to speculate about what new engineering is performing to our young children.

Men and women create both adverse and constructive versions. The adverse versions complain that we are raising a generation of kids that are sucked into screens, disconnected from the corporeal planet, wirelessly removed from something that ties us to area. The optimistic versions celebrate the potential network of connectedness, predicting a generation with an enhanced sense of sharing and neighborhood.

Of course, these two narratives have been close to for a lengthy time. They have absolutely nothing to do with the net, technologies, or video games. We just really like to fret about our youngsters although celebrating our progress. These stories have accompanied just about each era, every time with language distinct to the dominant technology. In essence, the narrative stays the same. It is just the principal human dilemma: we are concurrently instinctual individualistic predators and sophisticated intelligent creatures capable of civilization.

When vehicles have been nonetheless the dominant technological innovation, Freud addressed this paradox making use of ‘drive’ theory. In Civilization And Its Discontents he writes, “A excellent part of the struggles of mankind centre all around the single task of finding an expedient accommodation–one, that is, that will deliver happiness–between this declare of the individual and the cultural claims of the group and one of the troubles that touches the fate of humanity is whether such an accommodation can be reached by indicates of some certain type of civilization or whether or not this conflict is irreconcilable.”

Freud was writing about humanity in basic, but his observations have distinct ramifications for today’s parents. Our kids are more sophisticated than we think, they comprehend what’s going on in the adult globe and they emulate it as they develop up. They will understand to deal with vital human conflicts in the exact same ways as their mothers and fathers. They will design technologies, social methods, and financial versions that mirror the methods their parents choose to be in the planet.

In the present world, the web is one of the technologies we use to accommodate this conflict among individuality and community. We seek out out algorithmic solutions.

For illustration, on-line retailers bombard us with targeted promoting: direct electronic mail, suggestions, and ads strategically inserted into our social media timelines. Residing with us inside the ubiquitous temple of consumption, our children view us satiate our need for increasingly nuanced identity markers–the vestments and talismans of individuality–with shockingly precise personalization. Meanwhile, we’re comforted by the invisible and seemingly immortal hand of totally free market place economics, which guarantees to continuously intervene in buy to ensure that our self curiosity also positive aspects culture and community. This is the new iteration of a faith-primarily based narrative that we pass on to our youngsters.

In fact, it is a amazing solution to the primordial paradox that Freud so eloquently described. The world wide web mediates the conflict with ‘connected individualism.’ Each and every one of us imagines we are distinctive in the way we connect with other people. On the world wide web, every thing public is customized. All of the media 1 consumes is so nicely tailored to the individual that I’d have to work to see some thing that does not fuel my sense of self.

Numerous writers have observed the irony that in spite of the fact that we have a lot more information accessible than ever just before, we are exposed to significantly less diversity. We seldom see things we really do not want to see. Definitely, we nonetheless read through issues we disagree with, but these things usually serve to fortify our opposing place.

What’s curious to me about the planet of customized algorithmic curation is how a lot faith we have in it. How a lot of people have posted standing updates expressing their confusion about the ads that appear beside their timelines? “What tends to make Facebook believe I’m THAT variety of person?” When Pandora plays a song that we really don’t like, we wonder why. We’re puzzled to uncover specified categories that Netflix presumes we’ll appreciate.

It is bizarre to me that when the selection seems wrong, we nonetheless insist on an explanation, that we want to realize the logic of the predictive algorithm. I believe it signifies a misplaced faith in the electrical power of data. We doubt our own opinions, assuming automated curation must be more exact. If there is anything at all about new engineering that worries me, it is that we are beginning to have more faith in quantified measures of our subjective aesthetic taste than we do in our capability to really feel and judge in the second. This is a way of getting in the world that I do not want to pass on to my kids.

Think about Minecraft. Like most kids these days, mine play it all the time. I’ve written about the good issues my youngsters learn by enjoying. I enjoy the cost-free sandbox creativity. I believe it strengthens a sense of methods considering. But I’m also anxious that so several little ones develop an practically obsessive romantic relationship to the game. They could be studying to privilege a quantified data metaphor via which to make sense of reality–one the place every thing is divided into blocks, pixels, and units of resources.

Dividing factors into extractable monads is surely a helpful way to technique the world, but not the only one particular. We know now, as we enter the submit-industrial era, that adopting this kind of an method in isolation is eventually unsustainable. We want to mix our capacity for ratio based thinking–ratio-nal thinking–with other modes of currently being. It is preferable at times to be emotional, introspective, spiritual, intuitive, irrationally passionate, etc.

Consequently, I devote a lot of time producing sure my youngsters really don’t get too heavily absorbed in any one particular way of perceiving. I do this by paying out adequate interest to what games my little ones are enjoying that I can request them to switch video games. That’s correct, not all video games are the identical. Every single one particular has special narrative properties. Each and every a single has specific mechanics that inadvertently teach a specific way of producing meaning of the world. Gaming is not a singular way of currently being. Parenting gamer-kids is not just about monitoring the on/off switch.

In truth, I never limit my kids’ screen time. I do, even so, need reading time, outdoor play time, and bodily toy time. The variation in between limiting screen time and requiring non-screen time is subtle, but considerable. It emphasizes the positive benefit of other activities rather than the scolding the display.

The display is here to stay. We need to have to equip our youngsters with the capacity to use it as a much more meaningful way of mediating the important paradoxes of the human encounter than we at present do.

Jordan Shapiro is writer of FREEPLAY: A Video Game Manual to Greatest Euphoric Bliss, and MindShift’s Manual To Games And Learning For details on Jordan’s approaching books and events click right here.

Technology And Video Games Make Children Believe In a different way About Old Questions

Your questions about female genital mutilation and the campaign to finish it

Jaha Dukureh’s story of FGM survival: ‘I’m not going to let concern deter me from undertaking anything now.’ Video by Mae Ryan

Jaha Dukureh, who is leading the campaign to finish female genital mutilation in the US, and the head of the joint UNFPA/UNICEF task to end FGM Nafissatou Diop will be answering your inquiries about FGM between 12-2 ET Tuesday twenty Could.

Jaha’s petition on Alter.org and backed by congressman Joe Crowley, UN secretary common Ban Ki-Moon, and the Guardian has reached in excess of 48,000 signatures.The petition is calling for a new examine to uncover out just how many ladies and girls are impacted by FGM in the US, as the very first stage to forming a national action prepare to tackle the practice. The amount of American females and girls impacted or at threat is believed to have grown by 35 per cent to at least 228,000 in between 1997 and 2000.

Jaha has said she is determined to keep fighting until finally FGM is recognised as a true chance for American girls and policies are place in area to protect them. “I really don’t want to be poster youngster. I want each lady who has been through this to be able to speak out,” she says.

What do you want to know? Inquire your query by posting a comment in the thread under. Jaha Dukureh and Nafissatou Diop will answer them in between 12 – 1 ET Tuesday twenty May possibly.

What is female genital mutilation? Find out a lot more

Your questions about female genital mutilation and the campaign to finish it

Lancet Editors Increase More Questions About Prominent Harvard Stem Cell Researcher

There is more difficulty for Piero Anversa, the prominent and controversial stem cell researcher.

Right now the Lancet issued an expression of concern about an influential, a lot-cited stem cell paper. As very first reported by Retraction Watch, an investigation at Harvard Medical College and Brigham and Women’s Hospital has raised worries about the integrity of data coming from Piero Anversa’s laboratory at the Brigham contained in the 2011 SCIPIO research published in the Lancet.

Here is the total Expression of Concern issued by the Lancet:

On March 25, 2014, Gretchen Brodnicki, Harvard Health care School’s Dean for Faculty and Investigation Integrity, wrote to The Lancet to inform us that “Harvard Medical School (HMS) and Brigham and Women’s Hospital (BWH) are reviewing considerations about the integrity of certain information generated in a laboratory at BWH and incorporated in the following published paper…[the] 2011 Lancet SCIPIO paper”. The emphasis of this investigation is on two supplemental figures published on the internet (figures 2A and three). As far as we are mindful, the investigation is confined to the perform finished at BWH. Gretchen Brodnicki continues, “Because evaluation of this paper is ongoing, we cannot supply additional specifics at this time.” In even more discussions with Harvard Health care College, we have been told that the present investigation into this element of the work reported in the SCIPIO trial is likely to take numerous months. As quickly as The Lancet receives further details, we will inform readers accordingly.

In accordance to experienced sources, the Harvard letter requested a total retraction of the article by the Lancet. But without having much more details about the issues raised by the Harvard investigation the editors believed an expression of concern was the most they could justify.

As I reported in 2011, SCIPIO was the subject of considerable hype at the time of its unique publication. ABC News, CBS News and other media outlets utilised phrases like “medical breakthrough” and “heart failure remedy.” ABC News correspondent Richard Besser was so enthusiastic that anchor Diane Sawyer commented that she had by no means noticed him “so fired up.” The very first author of SCIPIO, Roberto Bolli, said the function could represent “the greatest advance in cardiology in my lifetime.”

Earlier this week, as a consequence of the same Brigham and Harvard investigation, a 2012 paper published in Circulation was retracted. Anversa was the senior author on that paper. The retraction was especially impressive because a single of the co-authors was Joseph Loscalzo, the editor-in-chief of Circulation and the chairman of the division of medication at the Brigham.

A single Harvard researcher who has long been familiar with Anversa’s perform mentioned that numerous men and women at Harvard are not amazed by these developments. “If something it’s surprising how prolonged it is taken for these inquiries to surface.”

Lancet Editors Increase More Questions About Prominent Harvard Stem Cell Researcher

From moonlight to the microwave: your science questions answered

Q How does the moon shine what triggers the reflection and how? asks Manish Kunwar

A As Professor Manuel Grande from Aberystwyth University explains, the moon isn’t basically a silvery mirror. “It is very challenging to get a surface which is both entirely white or entirely black,” he says. “Really the moon is fairly black. In noticeable light it reflects about twelve%. But there is an awful great deal of sunlight falling on it, so it seems to be quite brilliant.”

And the reflections can lead to troubles. “When we built our X-ray spectrometer for Sensible-one, the very first European moon mission, we actually had a whole lot of difficulty trying to keep this reflected sunlight out of the instrument.” In truth, he says: “In reduced moon orbit, the amount of light is not so diverse to what you see from a plane on Earth if you’re flying over a desert.”

But what is the moon really created of? “Most of the surface is created of either anorthosite (a variety of feldspar) – the light, silver-coloured materials you see towards the edges of the disk – or else basalt [which kinds] the dark regions: seas or maria. The ilmenite (titanium-wealthy) locations are notably black,” he says.

Q Why did the salt articles of the oceans continue to be almost consistent above hundreds of thousands of many years in spite of the reality that rivers carry enormous quantities of salt into the sea? asks Thoralf Schubert

A Levels of rainfall, evaporation and melting sea ice all have an effect on the salinity of seawater by incorporating or getting rid of water, but the complete amount of salt in the ocean remains pretty significantly continuous. When rain (which is somewhat acidic) falls, it washes over land, weathering and eroding rocks and carrying off salts, chiefly calcium carbonate and silicates, into streams which wend their way to the seas. Chloride ions are not a significant part of river water it is imagined that they ended up in the oceans as a end result of volcanic processes which occurred in the early background of the planet.

At 1st glance, it looks like a one particular-way street. Nonetheless, the salt content material of the oceans is not continuously rising. Instead, a “steady-state issue” exists, meaning that the input of salts into the oceans rather much balances the output.

These depend on the sort of salt. Calcium and carbonate ions, for illustration, are employed by marine creatures such as crustaceans to make their shells. Soon after they die, the shells type sediments on the ocean floor and sooner or later outcome in the formation of limestone.

Salts can also be locked up in clays at the bottom of the ocean, while regions around hydrothermal vents on the ocean floor can both spew salts into the water and remove them.

Though calcium and carbonate ions are portion of a fairly quick cycle, sodium and chloride ions hang about in the oceans for hundreds of thousands of years, but can kind sound deposits (normally in enclosed seas) if sufficient water is evaporated.

In addition, when seawater crashes in excess of coasts (which has happened a great deal this yr), some of it settles on the land, leaving salt residues.

Q Does taking a scorching bath impact male fertility? asks Chris Davies

A Taking a prolonged soak in a sizzling bath might seem heavenly, but as Dr Allan Pacey from the University of Sheffield factors out, the body is meticulously created to hold specific locations cool. “The sperm manufacturing approach needs testicles to be a couple of degrees cooler than body temperature. This is why they hang outside the physique,” he says. “So theoretically, anything that increases the temperature of the testicles for any length of time may hinder sperm production and therefore decrease male fertility.”

But it is not only the hot tub that has been suspected of causing troubles: “Previous reviews have advised that investing also prolonged in a bath or saunas or utilizing a doing work laptop on your lap might increase testicular temperature sufficiently to do this. Nevertheless, undertaking definitive research is tough since guys frequently undertake a selection of actions that might affect their testicles.”

One such factor is a chap’s choice of trousers. “In a recent multicentre review, researchers at the universities of Sheffield and Manchester found that sporting loose pants was linked with greater sperm good quality,” says Pacey. “Consequently, it may possibly be concluded that wearing restrictive underwear or paying as well lengthy in a sizzling bath might harm sperm manufacturing. But that precise research has never ever been accomplished.”

Q How does a microwave oven operate? And is it secure to stand close to it? asks mathsdude

A A microwave oven utilizes electromagnetic radiation (essentially high frequency radio waves) to heat up food. These microwaves are produced by a nifty gadget known as a magnetron, which includes a metal filament that heats up and emits electrons. The electrons are spun about by a magnet and in the procedure result in the radiation of microwaves, which are then directed towards the cooking chamber. When the oven is turned on, the foods within heats up.

But, you will notice, only the food gets sizzling – the dish it sits on stays cold. This is due to the fact the microwaves energise only water molecules and your foods is packed with water. Why water? Properly, a water molecule is polar it has a positively charged region and a negatively charged region, meaning that it can interact with an electric discipline.

To comprehend how this works, 1st think of a man or woman holding the finish of a rope that is attached to a wall and waggling it up and down. You’d see that the rope flips among peaks and troughs at distinct spots even though other points in the rope will not seem to move at all. This is referred to as a “standing wave”.

Within the microwave oven, the metal walls reflect the electromagnetic radiation and, like the rope-wagglers, develop standing waves. Inside of the cooking chamber, the peaks and troughs of the electrical and magnetic fields are flipping more than two billion occasions a 2nd. The polar water molecules interact with the electrical discipline and, as it flips, they rotate to adjust their orientation. This generates friction and consequently heat and it is this heat that cooks the meals.

A turntable is essential to make sure that the meals is heated evenly, otherwise the standing waves would result in hot spots at the peaks and troughs of the electrical area and cold spots at the factors midway among. One bonus of employing a microwave oven is that microwaves penetrate into the food, which means your meal is rapidly heated correct the way by means of. Contrast this to heating your dinner up on the hob there, heat is transferred via a laborious game of pass-the-parcel from the outdoors to the centre.

And there is no want to dread a microwave oven. The door is manufactured of glass with a mesh that reflects the microwaves back into the chamber and prevents the radiation escaping.

Hold the queries coming by emailing science.questions@observer.co.united kingdom. Please incorporate your full title and the place you dwell

From moonlight to the microwave: your science questions answered

20 questions with Allan Lamb

And now you’re about to cycle 109km (67.7 miles) in the Cape Argus charity cycle race. Why?

I have constantly followed the Tour de France closely and in the latter portion of my cricket profession, I commenced cycling as a great way to preserve fit and function my calf and hamstring muscles when they started taking part in up. I have also had numerous close friends with prostate cancer, so I am attempting to raise £500,000 forProstate Cancer Study.

Telegraph writer Joe Shute is racing towards you. How do you rate your chances?

I’m going to make sure he sets the speed but I’ll keep correct behind him for most of the way. He’ll be below stress – I’m not going to enable him to shoot away from me. Then just as we come up to the end I’m going to make sure he’s exhausted and I’ll fly previous him. I’m a established guy and I want to come in at underneath 4 hours. It is going to be stiff, but I’m education really hard at the minute and after I put my head down I’ll make positive I full my target.

When did you very first expand a moustache?

When I was 18.

What have been the perks of currently being a young cricket player for England in the ‘80s?

Enjoying cricket for a residing is superb. There weren’t a lot of perks when I was younger simply because there wasn’t a lot of funds in people days, nothing at all like there is now. The massive bonus was getting to see all the different nations – I wasn’t one to sit within viewing Television all day when we weren’t in matches. In New Zealand and Australia we employed to really like going out and exploring the wine farms.

Cricketing and consuming goes hand in hand, doesn’t it?

We played it challenging on the area, and we loved the game afterwards. We most likely did not have as much strain from journalists as cricketers do these days. We constantly employed to have cricket reporters coming on tour with us and we had a great rapport with them and would all go out for drinks together, but that stopped simply because editors started out to want stories about what took place off the field as nicely as on it. So it all changed – a bit sad that, genuinely.

What’s the craziest story you’ve read through about yourself?

When I was captain of the England staff throughout the 1990-1991 Ashes tour I was out in Australia with [fellow cricketers] Tony Greig and David Gower. I was not-out overnight, and even though I had to bat early following morning someone asked whether we wished to come and meet Kerry Packer [the Australia media baron]. Kerry invited us for a meal down on the Gold Coast, which was about a 45-minute drive away, and though I informed him it wasn’t actually for me, I received persuaded to go.

Our wives were with us and we ended up going for the meal but leaving very early to go to a casino simply because Kerry hadn’t been content with the support in the restaurant. At the casino, Kerry gave the ladies $ 1,000 (£540) and explained that they had to go and wander elsewhere even though we played. We had been properly up by about midnight and were going to split the winnings, but I said, “Seem boys, I’ve acquired to go, I’m batting and I’m England captain.” They all needed to preserve enjoying although, and inside half an hour we’d misplaced all the winnings – I’m talking shut to half a million dollars (£271,280). It was all Kerry’s income that we’d been going to share, but we lost the good deal.

Anyway I acquired back to my hotel with my wife at about one.15am, and the following day I received out and we lost the test match. However, the headlines in the paper had been, ‘‘Allan Lamb observed leaving a casino with a female at 6 in the morning.’’ Of program, it became the front web page of every paper and it wasn’t accurate. But then again, I probably shouldn’t have been out late that evening with Kerry Packer.

What have been your initial impressions of your friend and fellow cricketer Ian Botham?

I played towards Ian in 1979 in some county cricket matches, but it was only when I joined the England crew that we struck up our huge friendship. He was an outstanding guy to have all around simply because he had so a lot self-assurance: he didn’t feel in failure. He usually felt that he was greater than anybody else.

Any Beefy-on-tour pranks you’d like to share?

He was a shocker with the pranks. If he’d had an early night the night ahead of and was bored, he’d go into your dressing room, draw a big circle on your back and compose, “Please aim here.” Or he’d get hold of your cricket whites and tie a knot at the bottom so you couldn’t get them on.

Worst stage of your career?

The hardest moments were touring in the West Indies, when we just stored obtaining beaten. Because of the apartheid regime in South Africa, the West Indies said we weren’t allowed to perform in their main grounds so that made touring really difficult. We were struggling to get the amenities to practice in and then we had been receiving a bloody very good hammering on the discipline.

And the very best?

Beating the West Indies in the early ’90s in Jamaica after taking part in about 25 check matches against them. That was the only victory I ever had against the West Indies in check matches. Winning matches in Australia in 1986 and ’87 was also fantastic. We had been branded the worst England group to leave the British shores and the headlines study: ”They cannot bat, they can’t bowl, and they can’t field”, so winning was a excellent motivator.

What do you see as your private legacy to cricket?

I utilized to say to the guys, “If you are not satisfied and you are not enjoying what you do, you might as well pack up.’’ I feel that was my important thing: get out there and take pleasure in it and if you fail, you have acquired another chance. Some of the gamers now have a concern of failure – I believe that’s a bit of an English trait. When you’re scared of failure you are not going to succeed.

Why is English cricket currently in this kind of a dark place?

We need to have had a wake-up contact last summertime. Ok, we beat the Australians 3:, but it could have been a great deal closer. I really don’t consider we have been mentally hard adequate to face the Australians, who’d completed a lot of homework on us. We produced a handful of mistakes with choices also. Their strike bowler, Mitchell Johnson, was a large issue as well – he’s a yard faster than something they’ve placed just before. The rest of the globe hasn’t witnessed the like of Johnson since the West Indies were close to.

Must Kevin Pietersen ever play for England once again?

Effectively, he’s gone now. What Pietersen need to have done is stored his head down and scored runs for England and forgotten about what was happening behind the scenes. England is to blame as effectively for not managing him correctly – I feel they must have received him far more concerned in the staff and that might have assisted.

You’ve been married to your wife Lindsay for 35 years. What’s the secret to a content marriage?

You’ve acquired to continue to be quite great buddies and you’ve received to have enjoyable, that’s a large thing. You have to try out and enjoy what the other man or woman enjoys – I’ve not too long ago received Lindsay into fishing, though I was extremely angry when I took her up on the River Spey last 12 months to practise because she entirely out-fished me. It’s the pheromones or one thing from a female that the bloody salmon get attracted to.

Can you cook?

I adore cooking but I make a hell of a mess. I’ve done Prepared Steady Cook against Ian Botham but he managed to cheat. I consider Heston Blumenthal’s design of cooking has altered everything, and I enjoy viewing foods programmes on telly and all that. I’m a massive foodie, put it that way.

Favourite meal?

Truffles with pasta is just fantastic. Coming from Africa I also love a excellent previous steak on the barbecue.

What irritates you?

When I’m strolling down the streets in London and individuals quit or stroll and get in your way.

Who’s the funniest individual on Twitter?

Outdated Darren Gough [@DGoughie]– some of his stuff is extremely good. He will take the mickey all the time.

And ultimately, if you had been an animal, what would you be?

I would adore to be a cheetah since I’d be the quickest – no 1 could catch me and I could catch anything.

Allan is cycling the Cape Argus Cycle Tour on March 9 to raise funds for the Prostate Cancer Analysis Centre. He welcomes any donations at www.justgiving.com/Allan-Lamb1

20 questions with Allan Lamb