How George Bernard Shaw brought the drama of health care to the stage

This week in 1927, the curtain fell on a Broadway creation of George Bernard Shaw’s medical drama, “The Doctor’s Predicament.” Shaw – who is most well known for writing “Pygmalion” – was an Irishman by birth, a socialist by challenging expertise and a firmly dedicated Londoner. He wrote the engage in in 1905, while peeved at his individual physicians and the professional medical occupation in basic.

“The Doctor’s Dilemma” advocates for a socialized technique of wellbeing care shipping and a removing of the gain motive from health care observe. The engage in dramatizes a predicament professional by posh medical doctor Sir Colenso Ridgeon, who has a one dose of a curative elixir and two clients who could gain from it. On the a person hand is a gifted artist named Louis Dubedat who grifts income from his acquaintances and cheats on his loving wife Jennifer on the other, a devoted but poor medical doctor who serves the underprivileged irrespective of their capability to pay out. To make ethical matters even worse, Colenso falls hopelessly in like with Jennifer.

Shaw pulls out all the stops with a comic condition that poses a considerably further problem: How does one particular quantify the value of yet another person’s lifestyle and who is even skilled to do so reasonably and justly?

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“The Doctor’s Dilemma” first hit the boards at the Royal Court Theatre in London’s storied West End on Nov. 20, 1906. The engage in ran for only 50 performances, at a time when a Shaw byline did not however guarantee very long strains of ticket-consumers.

How George Bernard Shaw brought the drama of health care to the stage

Two German actors in “The Doctor’s Dilemma” in 1938. Photo by Imagno/ Getty Visuals

Just 21 many years afterwards, when saying the 1927-28 revival, The New York Situations opined: “One should bear in mind that Mr. Shaw then was not rated as he is now. His status has grown with the gradual whitening of his nice crimson beard his fame in equally England and The usa is now so wonderful that any enjoy of his is just about confirmed a run. It was not usually as a result.”

When Shaw complained about the commodification of wellness care, he was crafting about cottage industries of incompetent and impotent non-public practitioners who did far better monetarily by offering ineffective nostrums and incompetent theories. Today we see commodification in all the strategies that health care is run by large industries.

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Cautious of doctors of all stripes, Shaw was a strict vegetarian and vociferous wellbeing nut. Coming out of the fog of the most substantial and highly-priced pandemic of our lifetimes, we might ponder how Shaw predicted the value of globalizing community well being, combating infectious ailments, and educating men and women to dwell much healthier lives, including far better more sustainable, calorie-helpful, tobacco-, liquor-, toxin- and drug-cost-free eating plans. However, even he was not immune to the entice of a famous medical professional promoting his possess wellness merchandise.

When on a voyage around the environment in 1936, Shaw manufactured a unique end to Dr. John Harvey Kellogg’s sanitarium in Miami Springs, Florida. The two gentlemen — a single famous for producing a healthier way of living he called “biologic living” and co-creator of Corn Flakes, and the other the world’s most renowned living playwright — sat down for lunch, followed by a lengthy consultation and health-related assessment. Amid the flashes of photographers’ cameras, the two men sipped freshly squeezed orange juice.

The next day, Kellogg described that he was involved about the playwright’s lower purple blood mobile count (40 percent significantly less than regular, at 3,000,000) and hemoglobin (30 percent deficient at 71 mg/dl).

Kellogg And Shaw

Dr. John Harvey Kellogg in dialogue with IGeorge Bernard Shaw in Miami in 1936. Photo by Archive Pics/ Getty Images

These conclusions were being the result of Shaw’s diet program excluding red meat (and, that’s why, ample iron) in his diet plan. Even though an improve in iron-prosperous, environmentally friendly, leafy veggies, these as spinach, would without doubt assist Shaw reach a usual blood stability and truly feel superior, the medical professional suggested a different, marginally shady, way to obtain people finishes.

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He prescribed his newest foodstuff invention, a product he identified as “Food Ferrin,” which was a concentrated extract of spinach that supplied a day’s worthy of of iron in a teaspoonful or two. The option would be to ingest a pound of spinach each day. “I am sending you a bottle of this,” Kellogg wrote Shaw, “and if you think worthwhile to make use of it, I will gladly see that you have a larger offer.”

The check out — and the plug for Food items Ferrin — was broadly described in publications ranging from the Miami Herald to The New York Occasions and the Literary Digest. The medical professional stroked Shaw’s moi with a prediction that he would very easily dwell to be 100 (Shaw died in 1950 at the age of 94).

Kellogg further more pontificated to the reporters recording his each individual word that he sincerely hoped that “my tips may possibly establish of some company to the most distinguished of living Englishmen,” hence presenting a new doctor’s predicament: the most marketable health practitioner in America giving free samples of his latest foray into fortified foods to the profession’s finest critic.

Seaweed, sardines and sauerkraut: the best diet for your brain at every stage of life | Nutrition

While the foundations of brain structure and function are laid during pregnancy and early life, the brain is constantly being fuelled and shaped by the food and drink we consume daily. We should be thinking of brain health like a pension plan; it is best to start as early as possible so that you have more to draw from when you need it. That said, it is never too late to invest in your brain health. Here is how to use nutrition to aid the brain at each stage of life.

Pregnancy

Most people know that you need to take folic acid to support a healthy pregnancy, but there is another lesser-known nutrient that is critical to brain development. Iodine is a trace mineral that is essential for the production of thyroid hormones. We know that thyroid hormones play a role in metabolism but they also determine the growth and development of the foetal brain during pregnancy.

Consequently, the World Health Organization describes iodine deficiency as “the single most important preventable cause of brain damage” worldwide. A lack of iodine impairs thyroid hormone production during pregnancy, meaning a baby’s brain development will be unavoidably affected, with studies linking low maternal iodine with sub-optimal scores for verbal IQ at age eight.

A good source of iodine … laver bread.
A good source of iodine … laver bread. Photograph: neiljohn/Alamy

Because adequate thyroid hormone is required from the moment of conception, women need to ensure sufficient iodine intake for several months before conceiving. This can typically be achieved by eating a balanced diet that includes a variety of dairy, fish and seafood. However, those who do not eat animal foods may need to consult a health professional about taking an iodine supplement. Too much can be a problem too, with an excess causing iodine poisoning or hyperthyroidism, so it is important to get the balance right. The NHS suggests that a supplemental dose of 0.5mg or less per day is unlikely to cause harm.

Good things to eat now
Fish and cooked seafood – seek out smaller, sustainable species, such as MSC certified sardines, salmon and mussels
Eggs
Seaweed is a concentrated source of iodine. The British Dietetic Association recommends not eating brown seaweed more than once a week, especially during pregnancy.

Childhood

The brain continues its rapid growth and development during infancy and childhood. Omega-3 fatty acids, particularly one called DHA, make up a significant proportion of the membrane of brain cells. DHA is considered irreplaceable for brain development and evidence shows it may be especially important to ensure that children are getting sufficient amounts through regularly eating oily fish. A recent survey found that less than 5{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f} of UK children are meeting the fish consumption recommendations.

On the other hand, children in the UK are eating more than the recommended levels of added sugar. The UK government advises that free sugars – sugars added to food or drinks and found naturally in honey, syrups and unsweetened fruit and vegetable juices, smoothies and purees – should not make up more than 5{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f} of the energy (calories) you get from food and drink each day.

Children are eating, on average, eight sugar cube equivalents over the advised limit, largely in the form of sugar-sweetened beverages, and prepackaged cakes and biscuits, often eating over 11g of sugar at breakfast alone.

Brain food … sardines.
Oily fish … sardines. Photograph: Denis Zubchenko/Alamy

Not only is added sugar a risk to teeth, the energy in sugar is easy to overconsume, increasing the risk of Type 2 diabetes. In turn, diabetes significantly increases the risk of cognitive decline and dementia, and the longer someone has the condition the greater the risk, so it is very worrying that rates of diagnosis in childhood are on the rise.

Good things to eat now
Oily fish (salmon, mackerel, sardines, trout, anchovies, kippers) or a supplement
Fresh fruit or cheese with oat crackers for snacks
Low- or no-sugar drinks

Adulthood

Ultra-processed foods (UPFs) make up 55{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f} of the UK adult diet, the highest in Europe. UPFs are foods that are sold ready-to-eat or ready-to-heat and produced using ingredients or processes for which there is no domestic equivalent. To improve palatability and shelf-life, these foods tend to be higher in added sugar, fat and salt, and contain less fibre than their homemade equivalents. So how might having a large proportion of these foods in our diets be affecting our brains?

Well, firstly, research indicates that it is causing us to miss out on brain-healthy nutrition. A Mexican study of 10,000 people found that the higher the consumption of UPFs, the lower the intake of vitamins B, C and E and minerals. A 2015 Brazilian study that assessed the diets of over 32,898 people found similar results; the consumption of UPFs was inversely correlated to the intake of vitamins B3, B6, B12, D and E, magnesium, selenium and zinc, all known to be important for brain function.

Cognitive coffee … in moderate amounts.
Cognitive coffee … in moderate amounts. Photograph: Alex Fung/Getty Images/EyeEm

Longitudinal research has shown a correlation between diet quality and size of the hippocampus (the brain’s memory centre). The greater the proportion of UPFs in the diet, the smaller this brain area – this is a concern because loss of brain volume is linked to poorer function. Indeed, a recent study found that just a few days on a high UPF diet caused damage to the hippocampus that tracked with impairments in learning and memory. Though we are still in the early days of this research, evidence is showing that higher consumption of UPFs is linked to increased risk of depression and harmful changes in the regions of the brain linked to learning and memory.

There is, though, good news for coffee drinkers. Moderate coffee consumption (two to four cups per day) has been linked to better brain health and reduced risk of cognitive decline, in part because caffeine regulates a neuroprotective brain enzyme.

Good things to eat now
A daily serving of leafy green vegetables (spinach, watercress, rocket, kale)
Beans, legumes and wholegrains
Coffee, tea (just watch the sugar and cream)

Later life

That dementia is currently the leading cause of death in the UK is not simply an artefact of longer life expectancy, because we know that other, longer-lived nations, such as Japan and Italy, have lower dementia rates. Revealingly, one study found that the Japanese Alzheimer’s disease rate had increased from 1{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f} in 1985 to 8{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f} in 2008 and cited the increased consumption of a western-style diet as the cause.

Help reduce dementia risk … sauerkraut.
Help reduce dementia risk … sauerkraut. Photograph: Yulia Naumenko/Getty Images

What low-dementia rate nations have in common is moderate fish and seafood consumption, plenty of vegetables and beans, fermented foods eaten regularly, and tea and coffee.

Good things to eat now
Oily fish
Kimchi, sauerkraut, kefir, live yogurt
Berries (strawberries, raspberries, blueberries, blackcurrants, blackberries, cooked elderberries).

Kimberley Wilson is a psychologist with an MSc in nutrition and author of Unprocessed: How the Food We Eat is Fuelling Our Mental Health Crisis, published by WH Allen