Helicobacter Pylori (HP or H. Pylori) is a bacteria that has been classified as a carcinogen for stomach cancer by the World Health Organization (WHO). Long term infection by H. Pylori can lead to the development of stomach cancer. As many as 80% of gastric cancers outside of the cardia (the part of the stomach near its junction with the swallowing tube, oesophagus) are associated with H. Pylori infection.  In 2007, an Asian-Pacific consensus conference concluded that population-based screening and antibiotic treatment of H. Pylori in high-risk populations is now recommended (J Gastroenterol Hepatol 2008; 23: 351 – 358). In patients with gastric cancer and H. Pylori, would eradication of H. Pylori after surgery prevent recurrence of gastric cancer? In 2004, a large double-blind randomized study showed that gastric cancer still occurred after successful eradication of H. Pylori. In addition eradication did not lead to a significant decrease in the gastric cancer incidence (JAMA 2004; 291: 187 – 194). In a meta-analysis of 4 randomised intervention studies on the influence of H. Pylori eradication on pre-neoplastic gastric lesions with gastric cancer incidence as a secondary outcome, the analysis showed that H. Pylori eradication did not significantly reduce the incidence (Aliment Pharmacol Ther 2007; 25: 133 – 141). So, should we eradicate H. Pylori to prevent gastric cancer recurrence?

A Japanese study from the Japan Gast Study Group involved 544 patients with early gastric cancer. All patients had H. Pylori infection at the time of cancer diagnosis and the cancer was removed endoscopically. Then half the patients were treated to eradicate the H. Pylori infection while the other half did not receive treatment (Lancet 2008; 372: 392 – 397). All patients then underwent endoscopy at 6, 12, 24 and 36 months. H. Pylori was eradicated in 75% of the intervention group while only 5% of the non-treated group lost the H.Pylori infection. After 3 years, 9 of 272 patients in the eradication group developed another gastric cancer at another site in the stomach (metachronous gastric cancer). However, in the non-eradicated group, 24 of 272 patients developed a metachronous gastric cancer. Putting it another way, the risk for subsequent cancer in the patients who had H. Pylori eradication decreased from 4 in 100 every year to 1.4 in 1,000 every year.

While the result of this study is significant, many would call for larger randomized study / studies to confirm or refute the finding of this study. To perform these large studies will take much time and expense. Hence, some would argue that in populations at high risk for gastric cancers, H.Pylori eradication should be practiced without waiting for further large scale studies. While the one week course of 3 medicines (commonly known as triple therapy) does not guarantee eradication of H. Pylori in 100% of cases, it is effective in a large proportion of cases. Given that the triple therapy is associated with minimal side-effects, one would be tempted to just take the medication in order to reduce the incidence of gastric cancer. If you were among the high-risk population, what would you do?

Have you ever been bumped into by someone who was writing a text message on a mobile phone and walking at the same time? No doubt you must have seen drivers of motor vehicle talking on their mobile phone or writing a text message while driving too. Most of these drivers will think that they ‘can handle it’ without endangering themselves or other road users. Those who use blue tooth technology to allow them to be hands free while talking on their mobile phone are likely to feel ‘more in control’ of their driving. However, is this multi-tasking behaviour really safe and will its use not affect one’s driving or other task efficiency?

An Australian study interviewed 1347 licensed drivers living in New South Wales and Western Australia about their mobile phone use (hand-held, hands-free and text messaging) while driving over a 17 days period and documented any adverse events as a result of use (MJA 2006; 185: 630 – 634). About 60% of drivers had used the phone and 12.4% of them had written text while driving. Three quarters of these drivers reported at least one adverse effect on their driving resulting from the most recent phone use. The effects included taking eyes off the road (55.9%), slowing down (38.7%), lack of concentration (38.2%), failing to indicate (5.0%), drifting between lanes (3.8%), sudden braking (2.8%), missing a turn-off (2.1%) and near misses (0.7%). One quarter of all drivers could recall having to take evasive action to avoid a collision in the previous 12 months because another driver was using a mobile phone. In a Danish study of predominantly male, heavy vehicle drivers, 0.5% of the drivers had crashed as a result of phone use and 6% had experienced dangerous situations on account of their phone use within the previous year. Two thirds of them had been in dangerous situations in the previous year because of phone use by other road users (Accid Anal Prev 2006; 38: 105 – 111).

We, especially the younger ones, like to think that we can execute several tasks at one time without any drop in our efficiency of execution. In reality that is not the case. In almost all instances, I see very little need for one to text or phone while driving. It is very seldom that you have to text someone or take the call right there and then.

To those who think or say ‘Like it or not, the age of multi-tasking is upon us. You are way behind time!’, I would only ask you to consider one question of mine.  Do you think you would be at ease if your surgeon were taking all calls on his mobile phone and your anaesthetist were text messaging and making calls on his mobile phone while you were having surgery?

Like it or not, in some situation, if you want to perform a task safe and well, you can only focus on one task at a time. In executing the mundane tasks of walking, driving and cycling, I advocate no text and no calls.