Too much of any good thing is bad

We are all familiar with the saying ‘too much of a good thing is bad’, despite which we give in to the temptation to indulge…

We are all familiar with the saying ‘too much of a good thing is bad’, despite which we give in to the temptation to indulge in what are perceived as being good things. Another saying – ‘spare the rod and spoil the child’ – can also be considered a variant of the preceding one. Children who are doted upon by their parents not uncommonly turn out to be spoilt brats, demand more and more and may misbehave with the parents if their expectations are not met, or may go on to dilapidate heritage and leave the parents in the lurch too. In the same line come kindness or generosity – which can be abused of and can spoil relations as well as leave much hurt.

There are many examples of other good things that can turn out to be harmful if used in excess or inappropriately. A prime example comes from medicine – it is public knowledge that the serendipitous discovery of penicillin by Sir Alexander Fleming in 1928 revolutionised the treatment of killer infections. Medicine itself was transformed, as this initial success led to the discovery of further, more powerful antibiotics to deal with ever more infections, either to prevent or to cure them.

However, it was not long before the beneficial side of antibiotics started to give way to the obverse of the coin: antibiotic resistance. Nowadays it has reached alarming proportions, to the extent that some years ago the World Health Organisation felt it necessary to issue a formal advisory – a warning in fact – that unless the use of antibiotics was properly regulated, we would soon reach a stage where there would be none left to treat patients because all microbes would have become resistant. One shudders at the prospect of this potential scenario.

Before we consider further the medical use of antibiotics, we ought to remember that they have also been used in animal feed to promote faster growth, and this practice is to a large extent responsible for antibiotic resistance, as antibiotics in animal tissue moved into the food chain, eventually reaching humans also. So the agro-business sector also must assume its responsibilities in the matter and take the measures that are needed to stem this problem.

Doctors of course are the main prescribers of antibiotics for their patients, and their education and training prepare them to make safe and responsible use of antibiotics. However, the situation is more complex than that. Every year thousands of patients die because of antibiotic resistance, even in the advanced countries. They have had to devise guidelines for appropriate use of antibiotics by health professionals, in spite of which default occurs. In a recent article in ‘The Conversation’ titled ‘Drug resistance: how we keep track of whether antibiotics are being used responsibly’, authors Kirsty Buising and Karin Thursky of the University of Melbourne referred to the National Antimicrobial Prescribing Survey (NAPS) which ‘looks at whether prescriptions were compliant with clinical practice guidelines (including drug choice and dose), and whether the overall drug use was appropriate and safe’.

It may come as a surprise to us that a survey in 2013-14 found that ‘22% of antibiotic use in hospitals was inappropriate’, deemed to be non-compliant with prescribing guidelines, either incorrect duration, or incorrect dose and frequency. Now imagine the situation in countries, such as Mauritius, where no such surveys exist. Add to this unethical practices like giving over the counter antibiotics in pharmacies, more often than not for incorrect duration, compounded by the habit of patients to stop taking the antibiotic on their own when they start to feel better, and we can get an idea of how much harm such patients are doing not only to themselves, but to the population as a whole, because resistant microbes get transmitted to others.

What may surprise is that even water can be too much of a good thing! There is a syndrome known as water intoxication, also known as water poisoning or hyperhydration, which is a ‘potentially fatal disturbance in brain functions that results when the normal balance of electrolytes in the body is pushed outside safe limits by overhydration (excessive water intake)’. Admittedly it is a rare condition, occurring in some medical conditions, but more commonly it is associated with endurance sports, such as running marathons, and medical personnel at marathon events are trained to suspect water intoxication immediately when runners collapse or show signs of confusion. It can also occur due to overexertion and heat stress in any activity or situation that promotes heavy sweating, when water is consumed to replace lost fluids. Therefore persons working under such conditions for long periods must seek medical advice so as to take care to drink and eat in ways that help to maintain electrolyte balance.

Another liquid which must surely find mention is alcohol. Oh, but is alcohol a good thing? One may not say it loudly, but used in moderation it has been shown both in experiments and in clinical trials to have beneficial effects on the heart and circulation, and there are complex reasons why this is so which we need not go into here. Besides, there is the social benefit of conviviality that alcohol enhances. But again, the operative word is moderation – amounts advised by medical professionals. Crossing these limits can lead to disaster for the individual, his family and society. Of course in certain societies it is taboo – but not for the rulers and leaders! It would be better to shed the hypocrisy and abide by good practice, though I admit that this is more easily said than done.

Perhaps less well-known are some facts about exercise: we know that one of the pillars of a sound lifestyle to prevent the development of what are known as the non-communicable diseases is exercise – at least 30 minutes five times a week, so is it said. But this has varied and other studies have shown equal benefit from lesser amounts. Nevertheless, let me say that some amount of regular exercise is definitely a good thing.

But there is also such a thing as overdoing, Surely if one hour of exercise is good for the body, the brain and the mind, two hours – or more – are better? Well no. Studies have shown that there is a law of diminishing returns for exercise as well; further, there may even be a reversal of some benefits if one exaggerates. As far as I am concerned, a good bracing walk (almost) every day for about an hour, at one’s pace, is more than good enough. There are enough septuagenarians and octogenarians that I come across at Trou-O-Cerfs daily to prove the point.

Extreme exercise can kill in some cases, and there are cases of sudden death that have occurred in young people taking part in sports. The latest that I read about what are called these ‘unexplained’ death is that at some critical point there is a breakdown of the glucose processing mechanism in the brain cells, and this occurs in perfectly healthy persons. Unfortunately it is unpredictable, for there are no indicators nor any characteristic profile that have been identified.

Last but not least of course is the bane of our current post-industrial society: technology in the form of sophisticated platforms, social media and the rest. Gone berserk, from hacking to harassment. We have come full circle. Where this will end – if at all – is anybody’s guess. We can only hope for the best, for we cannot even anticipate the form that the worst will take!

 

*  Published in print edition on 6 October 2017

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