April 14, 2013 § Leave a comment
Sucking at relationships has an advantage. You get to know more people.
Late last Friday night my mobile unexpectedly rang. The display just said: “private number”. I knew my sons were home but I answered anyway. A frightened young voice started blurting out something about strange men in her house. I hoped it was a wrong number.
The caller turned out to be one of my very favourite people on the planet. Now 13-years-old, she had—with her mother and older sister—lived with me for several of her formative years.
Training trumped temperament. I flicked into emergency doctor mode to get the important information.
She was at home and unhurt. Her mum and sister were at a late movie. A couple of men had broken into the house but ran off when disturbed. Her mum’s mobile was off so she’d called me. She didn’t want to bother the police.
I told her to bother the police and that I’d be there in five minutes.
I arrived within the allotted time and didn’t find any intruders. The police appeared a few minutes later.
Assorted bits and pieces had been stolen but the biggest nuisance was the missing spare car key. The police said the thieves were likely to return to collect the rest of the car.
I generally avoid such issues by not owning cars that anyone would want to steal.
A couple of lifetimes ago, my then-partner and I returned at night to her car. A man was sitting in the driver’s seat. The car lacked certain refinements, for instance, a working inside handle on the driver’s door. After we appeared, the thief got panicky because he was trapped inside. He couldn’t open the door to escape.
Then-Partner took pity and let him out. He responded by giving her a peck on the cheek and saying, “Thanks Sis, next time I’ll steal a V8”. He’d destroyed the ignition switch but obligingly showed us how to hot-wire the car so we could drive home.
We drove off but—not surprisingly in view of the tangled spaghetti wiring dangling beneath the dash—the headlights died. This happened just as a police car passed. They stopped but weren’t interested in our story and quickly left. We were just instructed not to drive without headlights.
Funnily enough, years later I got the opposite advice from an NRMA roadside mechanic. My alternator died one night, so he charged the battery and suggested I drive home at high speed with no headlights.
My cars also break down during the day. On one occasion, I returned late at night to try to get it going again. There was a surprise inside. A corpse lay stiffly across the front floor, its pale face frozen in a ghastly grimace.
One’s thoughts during moments of high stress can be telling. Mine was, “Dang! I’m working in the morning and now I’ll be up all night waiting for the forensics team.”
I was therefore relieved when the corpse moved. It climbed out of the car whilst explaining that he’d been frozen wide-eyed with terror because he thought I was a cop. The Corpse was apologetic, said “God, I’m a bastard” and insisted on shaking my hand. He didn’t seem to have time to help get the car going but he did want to be friends.
Sucking at car maintenance has an advantage. You get to know more people.
March 1, 2013 § Leave a comment
Australian Doctor 1 March 2013
‘It could kill you,” I said. My patient struggled to speak. His eyes bulged as he rasped: “I couldn’t care less.” After catching a couple of quick breaths, he continued: “They’re all dickheads. The lot of ’em.”
He was referring to the hospital doctors who’d stopped his quinine. He wanted it for leg cramps.
In Through the Looking-Glass, Lewis Carroll invented the word “chortle”. It’s a combination of a chuckle and a snort.
My patient started chortling. And I started prescribing. We can at least allow people to control their lives even if we’re not supposed to allow them to control their deaths.
If asked, I’d have also explained what quantities and combinations of drugs might be hazardous. But that subject never arose.
My patient was short and barrel-chested, with a white beard.
A cartoonist would draw him as Grumpy, the dwarf from Snow White.
Confucius said wisdom could be gained in three ways: reflection (the noblest), imitation (the easiest) and experience (the bitterest).
Grumpy the dwarf gained wisdom from experience. In the re-imagined fairytale TV series Once Upon a Time, he told Snow White: “I don’t want my pain erased. As wretched as it is, I need my pain. It makes me who I am. It makes me Grumpy.”
Grumpy the non-dwarf also gained wisdom from experience.
He wound up an elderly pensioner in Brisbane’s poorest suburb, clinging to life for years, slowly dying from lung cancer and emphysema.
Maybe he was hanging around to see if things got better. I wish they had. The day after I watched a zombie movie, Grumpy shuffled grey-faced into my consulting room. I suddenly realised it takes phenomenal willpower to be the walking dead.
I last saw him a couple of weeks ago. He’d recently started treatment for brain secondaries.
People often act like their life’s dramas are some sort of real-life drama. Grumpy didn’t. It was impressive.
Last week, in a rare triumph of modern medicine, I received timely news from a hospital. Grumpy had died.
Two receptionists were teary. I’d have also shed a tear if my lacrimal sacs weren’t shy.
All my patients die. Eventually.
I miss most funerals but rescheduled patients for Grumpy’s. I arrived to an empty car park. It seemed nobody was even interested in checking he was really dead.
The folks at the cemetery office said they were running no funerals that day.
They were, however, aware of a separate Muslim group gathered down the hill organising their own service.
Grumpy started chortling in my ear: “Less use than a body snatcher late for a cremation.”
I rang the clinic receptionist. Yes, Grumpy’s widow had given her the same funeral details that I’d been told. And no, Grumpy wasn’t a Muslim.
“Are you sure?” I ventured hopefully. “He’s got a beard… ”
The receptionist made an odd noise. It wasn’t quite a groan or a snort. Maybe it was a grort?
As I drove off, my phone rang. It was the receptionist. She’d called Grumpy’s widow but she was out. Somewhere. Probably a funeral.
I was also told that an elderly patient had just fallen heavily at home. His wife had said his blood pressure was low and she’d wondered if I’d do a home visit.
I agreed to drop in before returning to the surgery but felt anxious driving there.
Should I have called an ambulance? And if things didn’t go well, how would I find his funeral?
December 6, 2012 § Leave a comment
“Faced with the choice between changing one’s mind and proving that there is no need to do so, almost everyone gets busy on the proof.” — JK Galbraith
Galbraith is also credited with modernising the old expression “when the soup hits the fan”.
Let’s hope the fan is turned off as the heat hits the permafrost, because the environment determines human health. The scary thing about global warming isn’t tropical diseases or storms — it’s our need to grow food for 7 billion people. If the climate is screwed, so are crops.
Everyone needs a hobby. Mine is reading climate change deniers’ internet commentary.
Trends are noticeable. In days of yore, they would literally deny the climate was changing.
Research has killed this meme countless times, yet it still staggers zombie-like in the wilderness, eating people’s brains.
Now it is often admitted that the climate is changing but not that humans might cause this; or admitted that there is human-caused climate change but, reassuringly, this won’t be “catastrophic”.
Until 2010, CAGW stood for Citizens Against Government Waste, not Catastrophic Anthropogenic Global Warming.
The technique is reminiscent of Sir Humphrey Appleby’s four-stage strategy in Yes, Prime Minister.
First, say nothing will happen. Second, say something might happen but we should do nothing. Third, say maybe we should act but that’s impossible. Fourth, say maybe we could have acted but anyway it’s now too late.
Deniers do, of course, deny they’re deniers. Better to be a sceptic than a denier of the bleedin’ obvious. Anyway, deniers typically have a specific belief system: they are Climate Stability Believers.
Of necessity, climate stability believers believe that 97% of climate scientists are corrupt liars; the world’s national science academies are run by fools; and that a two-decade conspiracy explains why only 24 of 13,950 peer-reviewed climate change papers argue against human-induced global warming.
Climate stability believers also believe they are fighting a power-grab by the gubmint, lefty-greenies, the UN, the Illuminati, Jewish bankers or elephants with trunks that look like uncircumcised penises. And no, I’m not making it up. Not all of it.
A recent study found rejection of climate science was associated with belief the moon landing was faked and so on. Outraged climate stability believers now accuse the Australian researchers of conspiring to paint them as conspirational.
The strongest association found with rejection of climate science was, however, belief in extreme free market economics. It seems creating a social wasteland isn’t sufficient.
Other research has found “hierarchical individualist” personalities tend to reject climate science whereas “egalitarian communitarians” accept it. Ideological battles are cute but you’re only entitled to your own opinions, not your own facts. Or physics.
The psychological studies explain why for six absurd years a climate stability believer chaired our nation’s Future Fund. Tony (“It’s complete crap”) Abbott has admitted his error but David Murray might never do so. It’s said old theories don’t die but their adherents do.
Of course, if it actually is climate scientists — not mining and oil tycoons — who are partying tonight with the cash, stripper factory and beer volcano then there’s only one rational conclusion.
I did the wrong uni degree.
(Australian Doctor 7 December, 2012 http://www.australiandoctor.com.au/opinions/guest-view/climate-stability-believers )
August 19, 2012 § Leave a comment
Okay, somewhat surprisingly I’ve finally found the time and inclination to trawl Australian Doctor for assorted articles hidden behind their you.must.be.a.doctor.wall.
It’s probably bad form to post 13 blogs on the same day, but I figure if nobody reads them then nobody cares.
So here they come …
17 August 2012 The Psychopathocene Age
13 Jul 2012 Sick and spotty (which the sub editor should have called “Sick and Spotted”, for reasons which might be apparent)
26 Apr 2012 Diagnosing Dr Google
3 Feb 2012 Perverse incentives
6 Jan 2012 Life’s random route
28 Oct 2011 Lifting the veil of ignorance
7 Oct 2011 Evidence in practice
24 Jun 2011 Dying to go
4 Feb 2011 Un-Australians of the Year
18 Jan 2011 A view from the waters
3 Dec 2010 Our risky business
8 Oct 2010 A matter of choice
17 Jun 2010 Dead write
… cool, I just discovered the date posted can be edited — let’s now pretend I uploaded them when they were originally published.
August 17, 2012 § Leave a comment
“We’re all going to die.” My new patient had a fine goatee and looked agitated. Her words lingered in the air as she sat down. I cast a wary eye at her and said: “Of course.”
She bristled. “No, I don’t mean it like that! I mean I’ll be dead, you’ll be dead, lots of people will be dead within a week.”
She was desperate to communicate but her eyes were maelstroms of anguish. I didn’t want to be sucked into the vortex and couldn’t hold her gaze for more than a few seconds.
We talked. Even before the tears started it became obvious she was mad, not bad; psychotic, not psychopathic.
Perhaps she’d have done better if she was a psychopath.
My employee number at one workplace is 007. James Bond is emotionally defective; as are many of humanity’s leaders, heroes and zeroes.
Most psychopaths aren’t powerful but perhaps most powerful people have a psychopathic spectrum disorder (a spectrum disorder that, to my surprise, garners only three hits on Google; or now maybe four). How else could politicians and industrial leaders risk an unliveable planet from climate change for pathetic short-term aggrandisement? Geologically we might live in the Psychopathocene, not the Anthropocene, Age.
A study last year suggested 4% of CEOs are psychopathic. The true percentage has got to be higher. Intelligent psychopaths don’t give themselves away by honestly answering questionnaires.
A current Parliamentary committee has heard one in four Australians have experienced or seen workplace bullying. This figure also seems remarkably conservative.
Large institutions such as hospitals — and, for that matter, parliaments — are surely the natural home of bullies and psychopaths. Most doctors have probably encountered assorted narcissistic surgeons, patient-abusing psychiatrists, nurse-savaging physicians, vicious control-freak midwives who make obstetricians look normal, weird women-hating gynaecologists (not all with testosterone encephalopathy) and administrators who get emotional about numbers and not people.
I’ve been there, done that. Worked with them all.
Of course, not every renowned paediatrician gets charged with waterboarding their 11-year-old daughter; and many a life is saved by psychopathic surgeons. There are indeed circumstances where I’d prefer to entrust my mangled body to a heartless technician rather than a sensitive soul. But there are no circumstances where I’d prefer the emotionally stunted technicians to control the health system.
I recall working as night resident in Campbelltown Hospital in the aftermath of the 1980s NSW doctors’ strike. The hospital still had no orthopaedic cover and none of the 17 or so other public hospitals I rang that night had an orthopaedic bed. I had a patient with a nasty compound leg fracture who had spent hours trapped in a car before being rescued. He then spent many more hours in casualty while I tried to find an orthopod to treat him.
Are you already better off than almost everyone on the planet yet self-righteously prepared to hurt people to get more? Let’s hope not.
But enough nostalgia.
I should see my psychotic patient again this afternoon. That is, if we are both still alive.
July 13, 2012 § Leave a comment
In 1932 Bertrand Russell wrote the essay In Praise of Idleness. He proposed a four-hour working day and optimistically hoped that “Medical men will have the time to learn about the progress of medicine”.
Russell also supported sick leave for all workers, not just more asylum time for Nietzsche.
Taking days off is a dilemma. I can recall a patient who probably died because I took a sick day.
Mind you, other patients might have survived because I haven’t worked.
I saw a medical student with a cold this morning. He wanted to know if he should keep seeing hospital patients. I explained that seeing patients would be no problem; however, touching and breathing on them might be.
Last week, I wasn’t well either. On Wednesday night I developed a feral illness with high fever, piercing headache, vomiting and photophobia.
I didn’t think to check for neck stiffness — but my neck did feature a purpuric rash.
A day earlier, before I got sick, clinic nurses had seen these skin haemorrhages and laughed that they were stigmata of passion. In reality, the marks were a bizarre injury inflicted by an agitated friend stammering: “How much can a Koala Bear?”
But enough of that, and more about idleness.
A lazy day at home revealed an unexpected insight: the headache was worse lying down.
I got a second opinion on viral meningitis from Dr Google (yes, he’s my doctor too) who wanted to check my blood pressure.
The automatic cuff wouldn’t inflate. The batteries were flat, as was every battery in the house. I got frustrated and started softly singing “Spot it”.
“Spot it” is sung to the tune of the Spot the Dog cartoon theme. The words are simplified for the sick and tone deaf.
In fact, “Spot it” has just two words, one being “it”. The other isn’t “spot” but it does have four letters and is commonly used when frustrated.
I noticed a flutter in the corner of my eye. It was the Ethereal Angel, one of my chronologically adult sons, making a rare daytime outing from his bedroom. His gossamer wings were hanging limply. He was not yet fully awake, so his body was translucent against the furniture as if he were on a Windows 7 desktop.
“Are you okay?” he asked. He knew his Dad sings only on special occasions.
“Sure,” I muttered. He floated off.
I used a manual cuff. Spot it, only 120 systolic. My head throbbed with disappointment at the normal reading. I hate wasted effort.
I returned to work the next day. The headache was bearable until the fire alarms went off. Once the cacophony settled, a patient sat down and happily exclaimed: “The ringing’s gone!”
I started talking about alarms but she looked slightly puzzled. Her notes revealed I’d seen her a week earlier complaining about tinnitus. Spot it. Another little error.
One day I might give away this game. It is, however, unlikely to be for the same reason Russell said he gave up philosophy: “Because I discovered spotting.”
April 26, 2012 § Leave a comment
It’s a weird world. As a child, I expected things would in time become explicable. Instead, I now do more eye-rolling and head-shaking than a Pentecostal patient with antipsychotic-induced dyskinesia.
Earlier this week, Google News featured a flurry of articles about the misdiagnosis of personal health problems by ‘Dr Google’.
That’s the Dr Google defined by the Urban Dictionary as “a person medically qualified by Google’s search engine to diagnose symptoms of sickness”, not the somewhat amusing Dr Google website at fffff.at/dr-google
Osler believed that a physician who treats himself has a fool for a patient. Presumably all self-diagnosis by Google is therefore the act of a fool.
Our planet no longer hosts Western black rhinoceroses or Zanzibar leopards. Investigative journalists are going the same way. This means health-related news is largely rehashed media releases interspersed with — when the reporter gets lucky — entertaining comments from arguing experts. The articles about ‘Dr Google’ fitted the template but the press release catalysing the stories wasn’t immediately apparent.
I felt this aspect of the ‘Dr Google’ story should be investigated without using Google. A quick search on Bing led me to a highly ranked and widely linked list of the best engines and resources to use during different types of searches. I scanned down the page and happened to notice its number one suggestion as a credible source of “facts about places”. It was the CIA’s website.
I abandoned this approach and returned to Google. A few seconds later, I discovered that the press release that sparked all the stories was from a UK firm selling treatment for bacterial vaginosis. They must have been thrilled at the response.
Apparently women have been self-diagnosing their genital discharges online and reaching erroneous conclusions. To add insult to injury, other firms’ products are then purchased.
Surprisingly, it seems women leap to the often correct diagnosis of thrush. This is despite anti-viral makers educating women that their self-diagnosed thrush might actually be herpes.
Fortunately, the supplier of bacterial vaginosis gel now has an online self-diagnosis tool. To check its impact, I tried googling, “what is my vaginal discharge?” The company’s website was nowhere to be seen in the results. Media coverage helps but search engine optimisation still rules.
The AMA’s response in the ‘Dr Google’ stories included appropriate warnings that many websites are designed for “lightening your pocket”. Online comments noted that many medical associations are also designed for lightening your pocket.
Other online comments complained that their doctors just used Google during consultations. Ouch! I often use Google with patients.
Last week I saw a toddler who had been sick for several days and was now breaking out in a rash. I use online information and pictures to educate patients about their conditions, so I googled “sixth disease”. (If you’re unfamiliar with sixth disease, Google it. Roseola infantum and exanthem subitum are harder to spell).
To my surprise and relief, Dad immediately chirped in that my online search was not required. The consultation was minutes shorter because he was just there to get a second opinion. To his own.
Thank you, Dr Google. You must be no fool.
February 3, 2012 § Leave a comment
Tony Webber is a former Director of the Professional Services Review. He’s also a clueless bureaucrat. At least, I thought that a few years ago while he was flailing around to avoid defining long consultations under Medicare.
I wrote at the time that, regardless of the PSR’s views, I would keep billing a long consult item for any professional attendance that hurt my brain and lasted more that 20 minutes. This included consults using phone interpreters for Kirundi-speaking refugees who turned out to have simple viral URTIs.
My opinion of the man has changed. AMA hacks are whining that Dr Webber is a doctor-basher but I liked his article ‘What is wrong with Medicare?’ in the latest Medical Journal of Australia.
Most of Dr Webber’s points were cogent and cautious. Comments like, “Australians are fortunate that, in the main, we do have a motivated and ethical health workforce”, shouldn’t generate much rancour — but if a buck is involved, emotions rise.
Most GPs have experienced the cases in which they are unable to write a care plan and organise referrals because the relevant Medicare items have already been claimed. Popping into a corporate surgery out-of-hours with a minor illness can, for some reason, lead to the use of Extended Primary Care items. Actually, the reason is obvious. It’s the payment of $250 for fifteen minutes’ work.
Why not allow everyone the occasional bulk-billed visit to allied health professionals without bizarre bureaucratic hoops and the perverse, if not outright perverted, temptation of a large rebate?
I often refer homeless youth to psychologists at a youth service. Many patients are incredulous to learn that a mental health care plan (MHCP) has been claimed by another doctor before they come to see me. They often have no idea of who did it. I’d hoped the recent slashing of the rebate would completely stop this but it hasn’t yet.
I often find myself thinking: “WTF? Why did some idiot claim a MHCP? Don’t they know the rebate isn’t $160 anymore?” But an immediate psychology referral for a very distressed patient still gets stymied as a result.
The only problem I had with Dr Webber’s piece was his failure to recognise that utterly stupid General Practice Management Plans and Team Care Arrangements are now often essential to the management and arrangement of a normal GP’s income. In one of my workplaces, they’re also essential to employing much-needed nursing staff.
It seems to be a law of human activity that the most useful work is the lowest paid. Garbage collectors are more important to the community’s health than health professionals but they get paid less. GPs are more important to community wellbeing than sub-specialists but they get paid less. And don’t get me started on why large companies pay millions to employ psychopaths as CEOs.
I’d like to see garbos paid more. Bulk-billing GPs’ incomes should also be supported. Pushing the oncoming flood of medical students into private sub-specialty practice because primary care is the poor doctor’s option won’t help the health budget or the community.
Politicians might one day realise this. Just don’t hold your breath.
January 6, 2012 § Leave a comment
A couple of days ago, I drove interstate to visit a friend. She’s in her 50s and has disseminated cancer. Luckily, a head scarf suits her.
She doesn’t want to know about her outlook and this seems reasonable to me. Our culture insanely underrates the most fabulous of defence mechanisms. Woohoo for denial!
My sick friend is currently thinking very positively. Positive thinking clearly can’t cure cancer (you can’t be more positive than to be loving life before the diagnosis); but it certainly adds value to our limited time on this beautiful space rock.
For some reason, her situation brought to mind NNT’s book, “The Black Swan”. That’s NNT as in Nassim Nicholas Taleb, not Number Needed to Treat.
One of Taleb’s arguments is that knowledge breeds confidence, and confidence breeds error. Beware of experts. They make the greatest mistakes. At some point in our lives, we might need to let go of experts and allow nature take its course.
On the drive home, my musical accompaniment was a song called, “Where is my mind?” It was stuck on repeat. Maybe that’s why the route taken was random.
I didn’t find my mind. I did however find Granny’s Farm in Nimbin and booked in overnight as Mr Juice Smith.
My alter ego might sound dodgy but I didn’t do drugs inside Nimbin. In fact, I don’t do drugs outside Nimbin either. I don’t need to.
Just between you and me, I’ve noticed sleep deprivation and anxiety prompt experiences unmentionable within earshot of psychiatrists. Or health registration boards.
Not that anyone should care. For instance, many studies put the lifetime incidence of derealisation and depersonalisation at over 50%. It’s abnormal not to have the occasional freaky experience.
My little psychotic moments make me feel like normal perceptions aren’t real. This could be hellish but it’s always accompanied by a deeply calming sensation that everything that’s happening is inevitable and cannot happen any other way.
Feel free to prove me in need of psychiatric care but try to keep the mathematics simple. Complex equations send me tripping.
Anyway, where is my mind…? Oh yes! Nimbin. Granny’s Farm.
The toilet door had this scratched in it: “Live each day like it’s your last.”
I liked the sentiment but this adage shouldn’t be taken literally. The best things in life truly are free; but many worthwhile things need more than a day to prepare.
I resisted the temptation to modify the graffiti. “Live each decade like it’s your last”, is better advice but I wouldn’t vandalise a toilet door in Nimbin–not when a hundred police in bullet proof vests occasionally burst through the town looking for dreadlocks to lock up.
With luck, we get a few hundred thousand hours to experience life. It isn’t long. Every hour is too precious to be wasted. You certainly don’t want to spend them in prison cells, psychiatric units or, at some indeterminate point near curtain fall, hospitals.
Happy New Year, I hope you all have a wonderful 2012.
And good luck to my friend, Siwwy.
October 28, 2011 § Leave a comment
This morning I saw a strange dark tonsillar lump. I wanted a photo but couldn’t fathom the practice camera. Neither could the receptionist. A co-worker blamed her blond hair.
My household is currently full of women; six perhaps — it’s hard to keep track. But I do know that none are blondes — mainly because I overhear the occasional comment like “Two blondes walked into a bar. You’d think the second one would have seen it”.
Stupidity does, however, have advantages. For instance, consider that stunningly stupid language called English.
Inane multiple meanings for words like “bar” create humour. Germans, with their more precise language, miss out on this but are compensated by wonderful words. Like Schadenfreude.
According to studies using functional MRI scans, schadenfreude — satisfaction derived from the misfortune of others — is especially seen in males with low self-esteem. The transposition, freudenshade, has been invented in English. It means sorrow at another’s success.
Maybe that’s the problem with the guy who wanders around Wall Street with a one-word placard saying ‘Jump’. Then again, maybe it’s not.
This economic crisis hasn’t seen many bankers jumping. The Western world’s governments, long criticised for incompetency, have been brilliant at privatising profits and socialising losses.
I therefore sympathise with the Occupy <Insert Place Here> movement. Last weekend, I watched videos of events in Melbourne when a violent gang infiltrated the protesters. Luckily they soon left with their weapons, horses and bloodied prisoners.
I dropped in to my local OccupyBrisbane protest the following day. I was signing a petition about excessive resource allocation to the richest 1% when a woman walked up behind me.
She asked the young guy organising the petition what it was about. There was a chilly hostility in her voice and I saw the petition guy flinch. I guess everyone had been nice to him until that point. The protest was a hippy party of love and peace.
I routinely interrupt The Anti-Christ for his signature on a Medicare form, so I decided to handle it. “It’s about inequality,” I said.
This seemed like a good place to start and, surprisingly, she softened. Many people belittle these protests but 99% of the population really will get shafted by the breakdown of global capitalism. John Rawls’ veil of ignorance is being lifted and most of us will be poor.
I wandered into a nearby shop for lunch. In many cities, reduced business for local merchants is cited as the reason for removing demonstrators. I therefore told the shopkeeper my business was due to the demo. Unfortunately she didn’t speak English.
The only time I’ve tried listening to a financial adviser, my ears bled and a kitten died — but failure to heed the experts has thus far served me well. Economists mainly research tomorrow why yesterday’s predictions didn’t happen today.
However, economists are creating better tools. For instance, and I jest not, the current crisis has catalysed development of the Hair Dye Index. Apparently there exists an inverse correlation between economic activity and hair dye use. Especially blond.