Physicians have been talking about smoking for many years and to individual recidivists on numerous occasions. I try to vary my pitch to get their attention. Emphysema as altitude sickness at sea level was an early theme. Recently I made a surprisingly strong impression on a smoker I have cared for since shortly after WW II. She doesn’t even have emphysema, but I have long ago suffered a shortage of new pitches to help her stop smoking. When I told her the following, she said, “You should write that up. They will do a double-take and read it again.” Here goes:
In colonial times the British sent prisoners to Australia to serve their sentences. No return passage to England was provided, so most of them stayed on as colonists. Now how to arrange a similar normal life for emphysema patients who are prisoners of their disease if only because of their need for supplementary oxygen. The Mediterranean Sea is 15,900 feet deep. There is more evaporation from its surface than the combined flow of all the rivers entering it. The Straits of Gibraltar are only 700 feet deep. The world’s highest dam is 950 feet high. Do you begin to perceive my program?—Dam the Straits of Gibraltar to exclude Atlantic Ocean water which is replacing the excess evaporation. (Incidentally, the Mediterranean Sea is only a little bit saltier than the Atlantic Ocean because in the depths of the strait there is a westward flow of dense salt water which drops by gravity toward the bottom of the Atlantic).
Now wait for the evaporation. Four or five giant salt seas like the Great Salt Lake will form leaving ample area for settlement. The Dutch with their tradition of dike building will be jealous. I have already suggested a foreign aid project for the Dutch in Bangladesh: making polders (this is what the Dutch call new districts reclaimed from the North Sea) in the Bay of Bengal to create arable land and protect from storm surges onto the extensive existing lowlands. Emphysema patients can be resettled in these low areas of the newly emptied Mediterranean basin where atmospheric pressure will be nearly double that of sea level, giving the ambient 21% oxygen the partial pressure of nearly 40% oxygen at sea level. Most of them won’t need any supplementary oxygen—no need to argue with them about sleeping with oxygen to get continuous relief from pulmonary hypertension. Nature has arranged for limitation of blood flow to a region of the lung affected by lack of oxygen in order to limit dilution of systemic arterial blood by poorly oxygenated blood passing through that part of the lung as in pneumonia or a collapsed lung. Involving this mechanism for whole lung anoxia is a limit to nature’s wisdom and results in pulmonary hypertension in both emphysema patients and exposure of normal people to high altitude. Compare with increased iron absorption in the presence of any anemia even if the anemia was not caused by iron deficiency. Still another limit to nature’s wisdom is excess hunger in diabetes out of control as if to compensate for the loss of food as sugar in the urine.
I have checked the technical facts, which do support the foregoing. Geology tells us that continental drift has closed the Straits of Gibraltar millions of years ago. The sea did evaporate leaving a salt lake. Engineers have built dams comparable to the requirement. The partial pressure of oxygen would increase. Social and political obstacles would be insuperable even if the displaced Mediterranean water didn’t raise sea level by the calculated 34 feet. So this whole discussion has been facetious even without getting into climate change in the surrounding continents.
My patient was correct in that this has been a new angle in getting constructive attention from smokers.
I hope it is obvious that this article is whimsical. But actually it has helped in getting the attention of a few smokers, a worthy goal for conscientious physicians. More subtly, I think the article illustrates that a plan which is technically feasible should not necessarily be carried out. An unintended consequence I didn’t directly mention is that the straits of Gibraltar are in a tectonically unstable area, so a dam there would be especially vulnerable to failure, the worst flood since Noah! So please regard this as the first April Fools’ health column that you ever read. April first, any year.
John A. Frantz, M.D. August 7, 2002
The following was written in response to an item in The Sunday Magazine of The Wisconsin State Journal on July 17 2001.
Your article “Size Matters” about cosmetic breast surgery in today’s paper was interesting and informative. The point about reluctance to recommend augmentation surgery in youth was well taken. The fact that this surgery seriously compromises breast feeding was not mentioned.
Human brain growth is quite incomplete at birth. Although the newborn infant can manufacture all of the special material for this growth, the extra quantities required for optimum development are supplied by human milk uniquely. Formulas for bottle feeding make only some corrections, which do not include these special brain forming lipids. A study in Cambridge, England, of breast fed premature babies showed an eight point IQ advantage compared to similar bottle fed babies.
This type of consideration is unlikely to be made by the young candidate for breast implants. Do the surgeons all discuss the consequences of implants for breast feeding with these young patients and their parents? If not, this letter may help.
John A. Frantz, M.D.
August 7, 2002