Mean what you say!

There are a lot of people who know the price of everything and the value of nothing.

Lady’s Windemere’s Fan.

Oscar Wilde. 1892–1900. Irish playwright.

Lost in translation, wrong interpretation, wrong meaning, change of meaning, all can contribute to confusion. I don’t know about you but I have seen more medical mistakes from inaccurate “handover” than tiredness. When I was an “attending” I often stopped residents in their tracks during handover. I would say: “pretend I’m blind. Give me a brief, relevant summary of the patient’s problem so that if I meet him/her I will know exactly what the problem is”. This usually prevented them from becoming prolix and made the handover shorter and more informative. We have talked about precision medicine [1] but precision in language in certain situations, like handover, is far more important.

There is a fashion now to replace the word “died” with “passed away” or even “passed” which I find particularly irritating. The concept of death is well known to doctors and the verb “to die” has served us well for many years. Why change it now with a euphemism? Is this a politically correct way of dealing with reality?

In the practice of medicine mistakes are made which frequently can be minimized by the use of accurate descriptions and precise terms. Accurate notetaking is part of medical practice. A consulting doctor should immediately be able to assess the patient’s problem by reading the notes. In many jurisdictions patients have a right to peruse their notes. This undoubtedly stems from the desire to make medicine more transparent. However, the downside of this is that doctors may be reluctant to express their views in writing which they do not want to share with the patient. In some countries a consultant is forbidden to see a patient unless that patient gives permission. Although this is not normally a problem there are situations where the doctor may not wish his/her differential to be known to the patient.

Some doctors, and certainly many journalists, describe illness in militaristic terms. How often have you read that he/she lost his/her ‘battle’ with cancer? This, I think, stems from the idea that the patient’s attitude in some way influences the progression of the disease. In almost 30 years of treating patients with malignant hematological disorders I have never been persuaded that the patient’s attitude to their disease has had any bearing on the outcome. Although it must be said that a patient with a positive outlook is certainly easier to treat/manage.

What then about an accurate description of wine? As we all know, it is incredibly difficult to describe a taste, and some of the writings about wine which contain bizarre allusions, are quite frankly laughable. Taste and smell are intrinsically interrelated. Ask anybody with a severe “head cold” and stuffy nose and they will tell you they can’t taste anything. In December 2019 I wrote an editorial in which I described the “tongue map”. As pointed out in that editorial many people now accept that all areas of the tongue can taste all basic tastes but some areas are more sensitive to certain tastes than others. The one thing we can all agree on is that a wine can be sweet or dry and most people can detect contamination of wine with TCA (2,4,6-Trichloroanisole) [2]. Although wine bottles are supposed to contain information about the wine, notably its grape variety, I must say that this basic information is not present on many of the wines I consume.

When talking about wine, there are two words which continue to cause some anxiety, in me, and they are “organic” and “biodynamic”. Are these terms explicit? Let’s have a closer look. One thing is certain; both terms are highly contentious. In my naivety, some years ago, I was under the impression that ‘organic’ salmon was wild, Fig. 1a, b. Not so. The only real difference is that “organic” salmon is stocked in open net cages at a lower density than so-called farmed salmon. What about “organic” wine? According to John Wilson, writing in the Irish Times [3], maximum levels of sulphur are lower compared with “normal” wine, but it is still permitted. Copper spray is limited to 4 kg per hectare every year. Organic producers can still add yeasts, diammonium phosphate, tannins and oak chips, and to acidify, de-acidify, and add (organic) sugar. If you clarify with egg whites, or gelatin, these should be organic. Who is going to enforce these rules and can you taste the difference between “organic” wine and wine without the “organic” label? One thing is definite; you’ll pay more for “organic” wine.

Fig. 1: Farmed/Wild salmon.

a Salmon farm. Salmon farm in Finland. Wikipedia. b Wild salmon. 8 kg salmon caught on a fly rod on River Shannon, Ireland. Photograph by S McCann.

The term ‘biodynamic’ is difficult to define when talking or writing about wine. Is biodynamic wine different from organic wine? The term is the brainchild of the Austrian social reformer Rudolf Steiner Fig. 2. The process that Steiner initiated in 1924, and his characterization of “the farm as an organism”, led to the development of “biodynamic agriculture”, and, more generally to “organic farming”. Steiner also said: “In the course of this materialistic age of ours, we’ve lost the knowledge of what it takes to continue to care for the natural world” [4, 5]. The official definition of biodynamic farming according to the Biodynamic Farming and Gardening Association is “a spiritual-ethical-ecological approach to agriculture, gardens, food production and nutrition.” If you know what that means, please let me know. Smith and Barquín writing in the Skeptical Inquirer quote Jancis Robinson as saying: To start with, what exactly is biodynamics? It is a method of organic agriculture admixed with some odd extras. These additional methods include taking into account cycles of the moon and relative positions of the zodiacal constellations when farming, as well as applying different sorts of homeopathic or esoteric “preparations” to the vineyard soil. These and other similar pretensions are set against a complex background cosmogony that makes the whole process not unlike a quasi-religious movement. According to Vicki Denig, some biodynamic winemakers use cow horns stuffed with manure, buried in the ground during the winter and then spread on the vineyard soil Fig. 3 ref. [6]. Whether the phases of the moon or the day of the week when the vines are planted really influence the taste of wine is a moot point.

Fig. 2: Rudolf Steiner.

Rudolf Joseph Lorenz Steiner (1861–1925), Austrian social reformer. Public domain. Wikipedia.

Fig. 3: Cow horn.

Cow horn stuffed with manure and spread in the vineyard. Denig V. 2017. VinePair.

Like “organic” wine you’ll probably pay more for the biodynamic label on the bottle, but in the meantime, I’ll drink wine made by reputable winemakers.