Illness QI

APPLAUSE

Good evening, good evening, good evening, good evening, good evening, good evening!

And welcome to QI and my breeziest and most patronising bedside manner

for a show that's all about illness, infection and injury.

Joining me in Casualty are the slightly indisposed

-Andy Hamilton.

-APPLAUSE

Thank you, thank you.

-The disturbingly insidious Ben Goldacre...

-APPLAUSE

The seriously infectious Jo Brand...

APPLAUSE

And the terminally ill-informed Alan Davies.

-APPLAUSE

-Thank you.

And, to tell you the truth, their buzzers don't sound so hot either. Andy goes...

COUGHING

-Ben goes...

-A-CHOO!

-Jo goes...

-AMBULANCE SIREN

-And Alan goes...

-THE DEATH MARCH

-LAUGHTER

-Oh, dear!

And don't forget, of course, that you have your Nobody Knows Jokers.

TRUMPET BLAST Nobody knows!

In this series there may well be a question to which the real answer is nobody knows,

and if you can guess which question that is, you get extra points for playing your Nobody Knows Jokers.

Now, why would you swallow a pill made of a poisonous metalloid?

-AMBULANCE SIREN

-Yes?

Would it be because you got really pissed one night,

and then you woke up the next morning and realised you were next to Michael Winner in bed?

Well, oddly enough, until you got to that last point,

one of the uses of that poisonous metalloid was as a morning-after pill.

But its other use was for the other end of the body.

A metalloid called antimony, and it's a poison.

But it was popular in the Middle Ages as a pill because it was very good for constipation.

The weird thing about it is you would make a pill of antimony, it would pass through the body...

You would then rummage through your leavings and wash it and use it again.

"Rummage through your leavings"!

-I wasn't quite sure how to put it.

-I'm certainly going to use that again!

-I like that one a lot.

-And this would get handed on from father to son through generations.

-And they'd use the same one?

-Because it's a rare...

A father's leavings and his father's leavings...

This ball has been up your great-grandfather!

-And that's the earliest example of a repeat prescription.

-Yes!

-Very good.

-600 years!

Absolutely. The other use of it was an antimony cup where you would pour wine into it overnight,

when you'd had a large evening,

and in the morning you'd take the wine that had been soaked in this antimony cup, as it were,

and it would make you vomit instantly, so it was used as an emetic.

-So what is it? It's a naturally occurring thing?

-Yes, it's an element.

And it's an irritant, presumably?

There's a mnemonic for remembering laxatives

which is they're bulkers, lubricants, irritants, softeners and explosives.

And explosives would work like cholera.

You would stick them up your bum. Technical.

Or suppositories, as we comedians say.

-So that's for a really serious case of being stuffed up?

-Yeah.

-A proper phosphate enema, rocket fuel.

-Wow!

On a skateboard.

In Ancient Egypt, there was a doctor whose specialised function was to administer enemas to the pharaoh.

He was known as the "neru phuyt", which literally translates as "shepherd of the anus".

-LAUGHTER

-An official job.

-With the crook, you mean?

Obviously not a natural thing. Animals don't pump warm water up their arses, do they?

I mean, it doesn't seem to happen in nature in way that we know of.

-How did it come about?

-They are very popular with quacks.

I think there's something quite attractive about how transgressive it is

to squirt a lot of something up your bum

that makes pretend doctors feel like real doctors.

-But there was a guy, John Harvey Kellogg, the man behind Corn Flakes...

-The Road To Wellville.

Yeah, yeah. He had this big kind of quack clinic that he ran

where the moment that you arrived you had to make a visit to a man called the Rear Admiral who would...

bend you over and fill you with fresh yogurt and then you would poo that out,

-and then you'd be ready to quack on with your detox.

-And they would deal with your thrush at the same time.

What time's this show going out? LAUGHTER

Will people be eating?

Well, I mean, almost the most kind of basic fact about us all is that we poo.

And also that we are, as we age supposedly, we get more obsessed by it.

It's all you've got left, really. isn't it?

And there are stories of nurses who get sent stools by grateful patients. You've heard those?

They're not necessarily grateful.

Weirdly, I've no idea why, but that habit has followed me through into my comedy career as well!

There was a chap recently who tried to kill somebody by... He packed his anus with explosives,

and it was a Middle East prince, I can't remember which one, but he showed up...

His plan was shake the guy by the hand and then trigger it,

but, unfortunately, the body is very good at absorbing explosives.

That's why you have heroic acts with people jumping on to hand grenades and stuff.

So all that happened was he shook this prince by the hand

and the bomb went off and he just bumped up in the air slightly and then fell on to his knees,

and the prince, like any sort of royal, just went, "Very good!"

Oh, dear, oh, dear! Well, that's antimony.

As I said, antimony pills were quite literally passed down through the family.

Now, placebos. Placebos are often administered in the shape of sugar pills.

The question is how do they work?

-Very good!

-TRUMPET BLAST Nobody knows!

Now, you might want to question this, Ben.

APPLAUSE

-Well, they do work, but nobody quite knows why.

-What's extraordinary is not only do they work,

they work even when you tell someone it's a placebo.

-I mean, you obviously have studied the placebo effect more than most.

-Mm-hm. It's amazing.

I think the magic ingredient of the sugar pills is... it's belief and expectation.

So, for example, we know that four sugar pills a day are a more effective treatment

-than two sugar pills a day.

-Yes.

-And we know that a saltwater injection is a more effective treatment

than taking a sugar pill, not because the saltwater injection or a sugar pill does anything

physically to your body, but just because an injection feels like a much more dramatic...

Is it something to do with you just feel you're being taken care of?

-Some part of your body yields to the authority of an injection, even more than to a pill?

-Yeah...

-you know, pacemakers start working before they've been switched on.

-Yes.

I've heard this. Or knee surgery as well. They've cut people's knees open and then sewn them up,

and they've said they feel better even though they've not actually done anything.

That's kind of why it's important to do proper trials.

Otherwise you'd be running around thinking that it was worth cutting people open

and messing around with their heart, and actually it wasn't, it was just...

The intervention, the almost priest-like nature of the doctor, the faith that is reposed in them,

obviously that goes some way, I suppose, to explaining homeopathy,

because a homeopathic pill is as inert as a sugar pill, in fact.

But as Andy rightly said nobody really knows quite how the placebos work, but work they jolly well do!

What kind of condition that astronauts suffer from is measured by the Garn scale?

Garn is what Steptoe used to say a lot! "Go orn!"

Eilza Doolittle says "garn" as well, doesn't she? Yeah...it's named after Senator Garn who was...

a senator who became an astronaut.

-He suffered very particularly from what most astronauts suffer from.

-Depression?

No, seasickness, or at least travel sickness.

It's really, really bad up there, apparently.

There's a lot of vomming.

-Which is not nice in weightlessness.

-Drifting around the cabin!

-Oh!

-In fact...

They can't do that, they've got a helmet on. It'd have to be...

Yeah.

47% of all the medication used by the shuttle astronauts were seasickness tablets.

The sickest was Jake Garn in '85, and so after him they used the Garn scale.

A score of 1 Garn means you are completely incapacitated by sickness up there.

-It's the right word, cos it sounds like someone chucking up.

-Garn!

-It does.

Do you know what causes seasickness, for example?

Is it going up and down on the sea?

Yes...

that's the condition in which it happens.

-Oh, you mean physically causes it?

-Why does it make one sick?

Sometimes I've felt unwell on a ship just from the throbbing of the engines,

not even the boat moving about much.

Some sensation that's making this constant movement, it starts to make things come up.

-It's a disconnect between the visual information and the sort of balance information, isn't it?

-That's right.

-I'm at half a Garn at the moment.

-Are you? Just from looking at that...?

-I know!

-It is!

-Watch the horizon!

-Why don't birds get it when they're bobbing about on the surface?

-They never throw up.

-How do you know they don't?

-That's true.

Or of course maybe they've just evolved not to.

The bad things to do are going below deck for a long time, reading a book, looking at a compass,

doing detailed work or staring at one point.

It's helpful to stay in the fresh air, drink plenty of water, avoid fatty and spicy foods...

They say that for everything! Everything!

You can't move for advice now. You turn on 5 Live and someone's always telling you,

"Well, we've got an expert in because it's sunny today. What do you think we should do?"

"Well, you want to watch out because you can get sunburn.

"Apply a cream or wear a hat." Are they seriously saying this on the radio?

-What are you doing?

-And do avoid fatty and spicy foods!

-Don't jump out of the window if you're on the tenth floor.

-Absolutely.

-That must be from the film The Perfect Storm.

-It looks like a film.

That would be an exceptionally good photograph from another boat!

That's such a good point!

How did you hold that so still?

Anyway, yeah, that's the Garn scale. Almost half of all astronauts suffer from space sickness, it seems.

What is intelligent falling?

-AMBULANCE SIREN

-Jo Brand.

Is it when you see Michael Winner coming towards you...

and you deliberately trip so you can avoid him?

That would be intelligent falling!

-APPLAUSE

-Very good!

-You've really got it in for the Winster, haven't you?

-I have.

-Yeah.

Is it cos he's not returning your calls, is that what it is?

He won't take me out to dinner!

Is intelligent falling what Ronaldo does in the penalty area? Is that it?

No, it's a kind of way of trying to demonstrate what scientists mean by theory.

Because, as you probably know, they have in America this idea

that it's equivalent to teach intelligent design as it is to teach the theory of evolution,

because they say, "Well, the theory of evolution is only a theory,

"so why can't we suggest our theory?" which is a misunderstanding of what a scientist means by theory.

-You've lost me.

-Yeah, well, you've heard of the theory of evolution?

-Yeah.

-And you've heard of intelligent design?

-No.

-Ah! Well, in America,

religious people who decide that evolution is contrary to what the Bible says about the Creation,

they want children to believe that all creation was made by an intelligent being, ie, God.

And designed by some something.

-And their name for it, rather than just saying, "Just believe the Bible," is intelligent design.

-OK.

"It's a theory of evolution, so why can't we have a theory of intelligent design?"

And they can both be taught in the same way.

All I'm getting at is that theory has a rather specific meaning in science. It's not the same as guess.

It's not even the same as hypothesis.

This is what the OED calls a theory.

"A statement of what are held to be general laws, principles or causes of something known or observed",

ie, that's not a guess.

The theory of evolution, as far as any biologist or zoologist would say, is true.

-I mean, it is supported by facts.

-So what is intelligent falling?

Intelligent falling is saying, "Well, Newton had a theory of gravity,

"but it was overturned by Einstein's theory of gravity, so why can't we suggest our theory?"

-which is intelligent falling.

-Isn't the point partly

that different theories are supported by different amounts of evidence?

For example, David Icke has a theory that the Royal Family are all seven-foot green lizards

in six-foot human skin suits, and he doesn't have a lot of evidence for that theory.

-He doesn't, does he?

-Whereas evolution is supported by a lot of evidence.

And if you want to question a theory then you should do so by challenging its evidence,

-rather than by...

-Exactly.

-Intelligent design believers in America,

-what do they think they put in their cars?

-It is a problem. It's a hard position to be a fundamentalist.

On the one hand you have to forgive people, on the other you have to take their eye out...

Bit difficult to know which one you're supposed to do at any one moment.

-Well, if Michael Winner's around...

-Yes.

..I should make a decision!

I've got this fantasy of Michael Winner sitting down, saying, "Oh, it's Friday!

"What shall I do? I know! I'll watch QI. Jo Brand's on. She's my favourite!"

-And his disappointment when he sees you being so...

-He won't be disappointed.

-No, perhaps he won't.

So there we are. The fact is, evolution and gravity may be theories,

but they work perfectly well in practice. Who was the last British monarch to be deliberately killed?

Was it one of the ones who got beheaded?

Er...no.

LAUGHTER Worth trying.

-You avoided saying Charles I whom most people think...

-I couldn't bloody remember him!

-It happened in Norfolk, so where would that likely be if it was a monarch?

-Sandringham.

-Sandringham.

-It was the Queen's dad.

-No, not the Queen's dad, the Queen's grandfather.

This is King George V who was the grandfather of our current monarch.

There he is, looking spookily like his cousin Nicholas Tsar Alexander.

It's an attested story by the man who did it. It's extraordinary that it isn't better known, really.

In 1936, he was at Sandringham, feeling unwell.

On 15 January he retired to his bedroom.

By the 20th, he was comatose and clearly dying, but still clinging to life.

This presented his doctor, a man called Lord Dawson, with a bit of a problem.

In Dawson's opinion, the world at large would be better served by hearing of the King's death

in the morning papers,

rather than by him lingering on a little bit longer

and it being in what he sniffily referred to as "the evening journals".

So he decided to force the issue.

He wrote a very famous bulletin on the back of a menu card which was telephoned to the BBC.

"The life of the King is moving peacefully to its close."

He then went up to the bedroom, and this, according to his own diary, is what he did.

"I therefore decided to determine the end

"and injected morphia, three-quarters of a grain,

"and shortly afterwards cocaine, 1 grain..."

-Lucky old King!

-"..Into the distended jugular vein.

"I did it myself because it was obvious that Sister B, the King's nurse,

"was disturbed by the procedure."

LAUGHTER

"So I injected Sister B as well."

Essentially, isn't that what a speedball is? He's basically gone the same way as John Belushi!

It's... He gave him a speedball of morphia and cocaine.

-And he told the family, did he?

-Well, he wrote it in his diary and this was reve4aled in 1986.

-Treason?

-Well, it was quite extraordinary.

And the weird thing is, being a Lord, he was in the House of Lords,

not long afterwards he voted against euthanasia in a euthanasia debate.

He said, "I'm not opposed to euthanasia per se..." Having just killed the King, not surprising.

"I just felt it should be left to the discretion of doctors...

-"not anybody else." There we are.

-Or a doctor.

-"Or myself."

Now for a bizarre illness. What would you call a man who eats literally everything?

AMBULANCE SIREN

Winner.

HOOTER

Gotcha!

Oh, no!

-Everything? Like pens and paperclips and lifebelts...?

-Yes, basically. Polyphagism, also known as pica.

"An excessive appetite, often for non-nutritious substances,

"coal, clay, chalk, nuts, bolts, batteries, soil and so on".

It's a very exaggerated version of what can sometimes happen in pregnancy.

Did you get any weird appetites when you were pregnant?

Yeah, I ate a bit less.

Some animals suffer from it.

In horses, it's called depraved appetite,

but the most extreme example we could come across was a man called Tarrare,

a Frenchman in the late-18th century, he only lived a shortish life.

He was abandoned by his family as a child because they couldn't afford the food that he ate.

After working as a street entertainer swallowing stones and live animals,

be became a soldier, and they decided to test his appetite, and he obliged,

and he ate a meal intended for 15 people in a single sitting.

He tore apart and ate, without chewing, live cats, snakes, lizards and puppies...

and so they thought maybe he'd be a useful spy so they gave him things to swallow to go behind enemy...

-They were at war with Prussia. But he was caught first time...

-"He'd be a good spy"?

-He'd rather draw attention to himself!

-Well, no...

-Eating everything!

They thought he could just swallow some box with military secrets in it, basically.

So when he was searched he would have nothing. That was their theory.

So he was then put on a diet in a military hospital and he would scavenge offal in gutters,

he would escape from the hospital, in rubbish heaps outside butcher's...

-Did they put offal in gutters?

-Yes, and outside butcher's shops.

-Oh, I see.

-Bits of guts.

-Someone went "I don't like the look of that liver," and chucked it away.

-Exactly.

And he attempted to drink the blood of other patients and eat the corpses in the hospital morgue.

You know who's like that, don't you?

LAUGHTER I don't even need to say it any more, do I?

Anyway, he was eventually ejected from the hospital under suspicion of having eaten a toddler.

-And then he died...

-Eating a what?

-A toddler, a little baby, a child, an infant, yes...

which is against the law in France.

Yeah, they're picky, the French, with their laws, aren't they?

They had to draw the line somewhere.

They did an autopsy. He had a belly so loose, he could wrap the loose folds of skin around his waist.

He sweated constantly and stank to such a degree

that he could not be endured within a distance of 20 paces.

At table his eyes would become bloodshot and a visible vapour...

I'm becoming increasingly attracted to him.

..A visible vapour would rise from his body when he ate.

-Bloody marvellous!

-Surely somebody's got to make a film about this man!

He didn't gain weight or vomit and he seemed perfectly sane.

-He didn't gain weight?

-No.

-On the eat-everything diet, he didn't gain weight?

If you've got a whole cat and a dog inside, they probably eat everything else.

-Yes, that's true, like the little old lady who swallowed the fly.

-There was a diet pill like that

-where people would eat...

-The tapeworm.

-The tapeworm egg, and wait until they got to their ideal weight

and then they'd take the Helminticide that would kill the tapeworm, and poo out the worm,

-and then get on nicely slim.

-I wish they still made that.

His autopsy, you'll be pleased to know, also revealed an enlarged liver and gall bladder,

an enormous stomach covered in ulcers and oozing puss.

So that's nice!

So now drop your trousers, it's time for a dose of general ignorance! Fingers on beepers, please!

Why shouldn't you sleep with a dog?

COUGHING

He won't respect you in the morning, will he?

It's against the law, isn't it?

I don't know, I don't mean sleep with it in the sexual sense, I mean share a bed with.

I'm afraid it's really terribly unhealthy.

Quite a lot of plague, amazingly, good old bubonic plague,

-especially in the Southern states of America...

-Not in this country, surely?

-Not at the moment.

-We seem to be OK in this country.

-Where dogs are wearing those anti-plague hats!

Can I just say a propos of nothing, what hideous pillowcases!

They are, aren't they?

Is it a book from the '70s that picture?

I bet they're that kind of brushed nylon where you can catch your fingernails on it!

Actually, the diseases you get off animals are often worse than the diseases you get off people,

because diseases that live in humans can't kill you off instantly and universally,

cos otherwise the disease would die out and they need you to carry on

going to work and sneezing on the bus

and scratching your arse and preparing food and all the other things you do to transmit stuff.

But something that lives on a dog, it doesn't care if it kills off a dead-end host like a human.

-That's not what it's bred to... It's not part of its normal life cycle.

-That's not how it gets around.

Anyway, letting dogs and cats share your bed can cause all manner of problems,

so now I'm having a panic attack... What do you recommend?

AMBULANCE SIREN

-Yes?

-A paper bag...

HOOTER

Yes...good old paper bag.

-No, no longer.

-Is that not recommended any more?

-No, it isn't. No.

-Nor indeed the other standby, take a deep breath. Both of those are now...

-Pull yourself together.

Pull yourself together's probably OK. I think we could manage that.

-"Doctor, I think I'm a pair of curtains."

-"Slap her, she's hysterical."

-That's a fine one. She had, I think...

-She had good reason to be hysterical.

-Yes, she did.

Jack was not behaving normally, was he? He was being a little odd.

No, there's a new treatment called capnometry-assisted respiratory training, or CART,

which encourages people to take shallow breaths rather than deep breaths.

You want to avoid blowing off too much carbon dioxide, don't you?

Yeah, that's the thing. It's because you're hyperventilating, apparently,

you're getting rid of too much CO2, and the idea was...

that if you do it in the bag, you're breathing back in the CO2,

but apparently this is now not considered a very good idea, it's dangerous and should be retired,

-is current medical opinion.

-Quite hard to find a paper bag, isn't it?

-I'm going to try it on Winner!

And avoid, if you can, fatty and spicy foods.

So, now...if you want to wash the bacteria off your hands, what temperature should the water be?

For killing bacteria... it would need to be 30...40...

Well, the point is, in order to kill the bacteria, the water would have to be too hot for you to bear it.

-Too hot to touch.

-It would have to be about 80 degrees centigrade.

It's nothing to do with the temperature, it is to do with... you would know as a doctor...

-it's actually the vigourness of the scrubbing action.

-Actually, for proper infection control,

-we should all be naked below the elbow.

-Oh, really? Short sleeves is the answer?

-Yeah, yeah.

-Which you do see now with some doctors, I've noticed that.

-Mmm.

-Is that now the norm?

-Well, it's...

-That's interesting.

-I like those taps they have, you know, the elbow taps.

-Yes, that's it.

I'd like to get them for at home.

Do above all avoid fatty and spicy foods. Now...

how many portions of fruit and veg should you eat each day?

Now, in Japan, they say nine...

-I think...

-It's different all over the world, it seems.

The five has been chosen in Britain

basically because they think that's the most they can persuade the British to eat!

-We are most reluctant to eat anything...

-There's no way they'll eat anything green.

It tastes repulsive to us.

Denmark says six, France ten, Canada, it's between five and ten...

-Somebody just went, "Eurgh!"

-Oh, really, the idea!

In Scotland, it's one.

I know.

-And supposedly it's seven for women...

-It depends what counts.

-Exactly, Haribos count in Scotland.

Wine gums, things like that.

That's a vegetable! Starmix, Haribos...

-SCOTTISH ACCENT:

-I had a bag of Dolly Mixtures!

And lastly here's something every teenaged boy should know.

What is that burns when you set fire to your farts?

You want someone to say methane, don't you?

I'll say it! Methane! COUGHING

-Thank you, Andy!

-HOOTER

Everybody thinks it's methane. No, most human beings do not produce methane in their extrusions.

-It seems that we produce about three pints of wind a day...

-Pints?

-Yes, pints, it's measured in pints.

..Released in 10-15 individual "episodes".

You can get the boxed set as well!

The best...

Or you can have a feature-length version!

So pyro flatulence is the practice of igniting these episodes.

It can lead to serious burns, so don't try it at home, everybody.

But methane in the body results from microbes called methanogens,

but only about a third of humans have methanogens among their gut flora,

so no-one knows exactly why. It seems to be genetically determined.

A 2009 study by Arizona State University showed that methane producers

are more efficient at converting their undigested food into fat reserves,

which, bluntly put, means fat people fart more.

The major components of flatus...

The major components are all odourless.

The distinctive aroma is caused by skatole, indole and hydrogen sulphide.

During the Great Plague of London, doctors recommended patients store their farts in a jar

and then, when they were feeling unwell, smell them, and apparently this would help.

-Anyway, it's usually hydrogen in fact that's lit.

-As I always say, better out than in!

-Definitely!

A bit like Simon Cowell in a lifeboat! Er...

APPLAUSE

And now the complications set in as we look at the final scores.

It's very exciting,

because in first place with a very positive

and a very thrillingly impressive 8 points is Andy Hamilton!

APPLAUSE Oh...that's not happened before!

And in...

in second place with 5 points is Dr Ben Goldacre!

APPLAUSE

But by no means the sickest patient on the ward with only minus 7

-is Alan Davies!

-Oh, no! APPLAUSE

I'm afraid...

it's get the mortuary trolley ready, at minus 24, it's Jo Brand!

APPLAUSE

Well, that's all from us tonight. So it's good night from Ben, Andy, Jo, Alan and me.

And I leave you with this heart-warming tale from America.

In 1981, the Mayor of Springfield, Illinois, suffered a heart attack during a council meeting.

The council voted to wish him a speedy recovery by a margin of 19 votes to 18. Good night.

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