Ann Intern Med 16 Jan 2007

87 The story of HIV infection over the last 25 years has shed light on every aspect of medicine and its political context in our time. For most Africans and Indians it is still a death sentence: for Danes aged 25 and without hepatitis C virus, it reduces life expectancy (statistically) from 51 years to 39 years.

One of the burdens of being an ageing GP practising in one place for decades is an increasing clientele of elderly patients who can’t stop taking the benzodiazepines you’ve kindly supplied to them for years. They are supposed to be at increased risk of cognitive impairment, falls and hip fractures, but when you put this to them, they generally opt for a good night’s sleep. This observational study from New York finds that elderly patients who manage to give up their benzos don’t actually have fewer hip fractures, but keep on trying.

Nobody really welcomes old age, but we have to accept it because we don’t like the alternative. The earliest great literary narrative is the gift of Sin-liqe-un-inni from the middle of the second millennium BCE, who collated the Sumerian stories of Gilgamesh into an immensely wise and popular account of the hero’s coming to terms with grief, ageing and death. Gilgamesh meets the only couple who have escaped death: they live on an island and are rather bored, but show him the plant which can restore youth. He goes for a swim and loses it. Growth hormone is the modern American equivalent, apparently: lots of people use it illegally to postpone old age, but according to this systematic review, it doesn’t. You’d be better off going for a swim.

The role of opioids in chronic pain has always been controversial. The man who might have become our greatest philosopher-poet, Samuel Taylor Coleridge, famously declined after becoming addicted to opium as a result of taking it for recurrent rheumatic fever. At the moment my bedtime reading is Coleridge and the Doctors by Neil Vickers (OUP 2004). I can’t say that I have followed every minute twist and turn of eighteenth century opinion on the matter, but it is clear that although the addictive potential of opium had already been well described, it did not fit into any current philosophical framework. As a result, wine and opium were widely prescribed as “stimulants