Scared of Doctors, or just you being you?

[margaretcarnes]

Well Man clinics are very profitable.

They're also very cheap for us here in Thailand, the grade A check-up at one of the top hospitals in Bangkok works out around 50 Baht per week for those undertaking them every 5 years.

...while many tests included in commercial "well-man" and "well-woman" services have great diagnostic value for people with symptoms, they are clinically irrelevant for those who are well.

To me this is the most pertinent part of that article. That these wellness checks are clinically irrelevant to those who are well is stating the obvious, but ofcourse we do not actually know for sure we are well or whether we have a silent killer developing inside of us. Just because you have no symptoms and feel as fit as a fiddle, does not neccessarily mean you do not have developing health problems.

We all know early detection can save lives, and we all know that having no symptoms does not mean we are neccessarily healthy. That's why some of us choose to have various checks and tests carried out, those who do not want them do not have to.

SJ

Couldn't agree more SJ. 3 years ago I felt as fit as a lop, but 2 months later started to get twinges from what was already a well developed ovarian cyst. I don't thing garlic would have prevented it either!

[MrPlum]

3 years ago I felt as fit as a lop, but 2 months later started to get twinges from what was already a well developed ovarian cyst.

Understandable point of view under the circumstances. I don't see a test for Ovarian cysts on the list for either Samitivej or Bumrungrad. Was the cyst picked up during a 'well woman' screening?

I've had a health MOT myself at Bumrungrad. Very slick and cheap but I knew I was healthy so basically was paying for reassurance.

Well Man clinics are very profitable.

They're also very cheap for us here in Thailand...

Until you find yourself on long term medication or undergoing unnecessary surgical procedures.

That these wellness checks are clinically irrelevant to those who are well is stating the obvious

If it's obvious to you, then it's obvious to them. The 'Royal College of Pathologists and the 'other respected medical and scientific groups' (not named in the article) have taken into account 'whether we have a silent killer developing inside of us' since they specifically mention cancer and heart disease. It didn't alter their conclusions... (odd irony this, me defending the orthodoxy against their biggest fans! ).

'Healthy people have nothing to gain from spending hundreds of pounds on blood tests and scans that purport to give an early warning of medical problems such as heart disease or cancer, the experts said.'

This is where I think the problems lie. 'Purport'. The RCP wouldn't use the word 'purport' if they had 100% confidence in these tests. When you are aware of the controversy surrounding PSA tests for prostate cancer, just as one example, you can understand why they are raising this as an issue.

A number of these tests either produce a high level of false positives or are of little clinical significance. You can find that you have a false positive, are offered more tests, (for which you pay), then you find you are clear. The Hospital is happy. You are delighted. You then start to work for their PR department. But what just happened? You've simply had confirmation there was nothing wrong with you, when there was nothing wrong with you anyway. Do they really deserve credit or have they just bamboozled you with a little medical sleight of hand? Guidelines state these tests 'should only be used when other symptoms suggest the possibility of cancer'. So if you've got no symptoms, the tests...
'... often cause needless concern or false reassurance, and can lead to unnecessary procedures that can be invasive, painful and risky.'

'needless concern', 'false reassurance' ('No need to give up the fags, folks. I passed my health MOT.'), 'unnecessary', 'invasive', 'painful', 'risky'. How come I never read any of that in the brochure?

The media are creating an army of the 'worried well' through various distorted messages. An example of how they do it is with the difference between 'relative risk' and 'absolute risk'. The media will quite often give you the 'relative risk'. e.g. 'New wonder drug cuts risk of heart disease by 50%!!' But if the risk was only 2 in 100 in the first place and taking the drug reduces it to 1 in 100 and the headline instead said "Heart Disease Risk falls from 2 in 100 to 1 in 100!", you'd probably yawn and go back to sleep. Instead you are lining up for pills.

Are you aware there are different standards between hospitals and testing labs? One hospital might flag your cholesterol level as too high and put you on an expensive long term drug regimen, such as Statins, while another may give you a clean bill of health. If Bumrungrad and Samitivej adopt the lowest possible trigger points, you may be taking expensive pills for what are only 'risk factors' or markers which actually need other symptoms before being 'clinically relevant' and for which the benefits of medication are negligible. Does anyone know by how much statins actually reduce your risk of heart disease or heart events? It's surprisingly small.

The pharma sector are reluctant to do comparative studies because they know their products will fare badly. A study published in the American Journal Of Clinical Nutrition in 2006 found that plant sterols, found in beans, nuts and seeds, lowered cholesterol more effectively than statins.

So what's with this airy dismissal of garlic by Brits who wouldn't know a healthy diet if it bit them! Garlic has a long and glorious history in many countries. It's well known the Mediterranean Diet (Garlic, Olive Oil, lemon juice, red wine) is far healthier than the British.

The NIH is according to their own blurb 'one of the world's foremost medical research centers.' So when it says 'Numerous case-control/population-based studies 'suggest' (nicely understated) that regular consumption of garlic (particularly unprocessed garlic) may reduce the risk of developing several types of cancer, including gastric and colorectal malignancies.' it might be something worth considering. Which is why I said 'consider'. If you don't want to, then don't. I simply present the information.

The University of North Carolina at Chapel Hill in 2000 conducted a meta-study. i.e. a study of studies conducted, around the world, on garlic's protective effects against cancer. http://www.scienceagogo.com/news/200009 ... _sys.shtml

The study shows that 'people who consume raw or cooked garlic regularly face about half the risk of stomach cancer and two-thirds the risk of colorectal cancer as people who eat little or none.'

Diagnosis is another cause for concern. Between 25% and 75% of diagnoses are wrong, depending on the condition. Accurate diagnosis is dependent not just on one off tests but your clinical history and tests taken over time. i.e. You compare the test you had today with previous tests to see if there is any progression. Do these hospitals do this? I don't have my medical history in Thailand. Do you?

There is a danger that you can come to believe that screening is a panacea, a way of warding off disease and staying healthy. It's not.

[Super Joe]

I don't see a test for Ovarian cysts on the list for either Samitivej or Bumrungrad.

I know Samitivej women's wellness centre carries out pelvic tests, and just searched Bumrungrad and found 'PAP smear and Pelvic exam'.

The 'Royal College of Pathologists and the 'other respected medical and scientific groups' (not named in the article) have taken into account 'whether we have a silent killer developing inside of us' since they specifically mention cancer and heart disease.

They also specifically mention ... "while many tests included in commercial "well-man" and "well-woman" services have great diagnostic value for people with symptoms."


Just a couple examples of silent killers that wellness checks can detect:
1) Cancers: can develop without early symptoms, by the time warning signs show it can be at an advanced stage. Early detection is essential and can save lives.
Wellness Checks: Can detect various types of cancers. Other screening methods can be used for other types. The risks associated with screening varies greatly, depending on the source.

2) High Cholesterol: no early symptoms, can cause build up and hardening of arteries, arteries become narrowed and blood flow to the heart is slowed or blocked. Results in serious risk of heart disease and heart attacks. Early detection is essential and can save lives.
Wellness Checks: Provide specific testing of total cholesterol, HDL, LDL and Triglycerides. Results are recorded and provided to you for comparison with future tests.

3) High Blood Pressure: no symptoms at early stage, you can have it for years without knowing while it can cause damage to the blood vessels, kidneys and lead to strokes and heart disease. Early detection is essential and can save lives.
Wellness Checks: Tests blood pressure while resting and at various stages of a stress test. The results are recorded and provided to you for comparison with future tests. Early detection is essential, and can save lives.

That's why I see the advantage of these check-up's. We all have a choice.

SJ

Edited: Off-topic and unneccesary comment removed, SJ

[Super Joe]

This Times article from last year suggests there are few benefits to those who don't actually have any symptoms...
'Health ‘MoT’ tests are misleading and can be harmful, experts say'
http://www.timesonline.co.uk/tol/life_a ... 524821.ece
''Healthy people have nothing to gain from spending hundreds of pounds on blood tests and scans that purport to give an early warning of medical problems such as heart disease or cancer, the experts said.'

Hold on hold on, now I've read the article in full I've spotted some very relevant small print, the report is based on the following criteria, quote:
"The phrase 'worried-well' is commonly used to describe people who are healthy yet concerned about possible diseases. In this document we use healthy people to mean people who are asymptomatic (with no symptoms of illness) and who are at low risk of developing a particular disease."
So all you lucky folk out there who know for sure you are at low risk of developing 'x, y or z', it's worth a read. And can I borrow your crystal ball please


The report is prodominantly aimed at people using home DIY test kits or private clinics with inadequately trained staff (quite rightly so). It does have positive things to say about screening/testing for early detection by qualified medical professionals in hospitals, like those of us in Thailand who may use Bumrungrad, Samitivej and the like, quote:
"Of course, tests are also used in GPs' surgeries and in hospitals. Here tests play a vital role in diagnosing conditions .... But tests offered by many online and private laboratories do not have to ensure that the quality of investigation is reliable and the provider does not have to be accountable for dealing with the results."


The medical organisations who produced the report also make references to money being lost by their section of the industry, quote:
"Along the way, we've also heard how the market in health and well-being tests for at-home use, now worth £99 million a year, is forecast to be a top ten trend of 2008; and we've noted serious policy concerns about how tests are evaluated and regulated and about the cost to the NHS"
"The NHS and other healthcare providers could also be missing out. Because of the lack of regulation, many providers of new tests put their money into marketing to consumers"
Don't let them suck you in Mr.P


When you read the report in full it has a very different perspective than that given by the Times' sensationalistic overview

SJ

[MrPlum]

Are you scaremongering, SJ? Lol. You keep saying 'silent killers'. Guaranteed to drive them through the hospital doors! If this is really such a risk then mandatory testing for the whole population should be undertaken in every country with modern facilities.

I think it is absolutely a matter of choice. An educated choice, made with the full knowledge of the risks.

Do you wish to suffer the possibility of false positives, additional costs and investigative procedures when you do not have any symptoms to start with? There may very well be 'silent killers' but which of the tests being used show you have any of them WITHOUT any other symptoms? This I think is the concern.

In the NHS it is recommended that the tests follow symptoms. In the Private sector tests are preceding symptoms. Since the RCP are guardians of good clinical practice, they are saying 'hang on a minute' this practice goes against guidelines and their concern is it is being done for purposes of profit. Whether the testing is coming from large or small labs the charge remains, that the tests being offered are of little clinical value without the accompanying symptoms.

Yes, you might flag a 'silent KILLER' (fear, fear, fear) but has the actual absolute risk been quantified? If the odds are say 1 in 1000 or 1 in 10,000 that one person may have an underlying condition and 100 in 1000 are put through unnecessary anxiety, invasive procedures, additional cost, etc... to be given the all clear, is this acceptable? This risk of testing isn't mentioned by the provider, yet it exists.

Of course it is worthwhile identifying any underlying disease. Especially to the individual. The question for the educated consumer is to decide whether, if they are asymptomatic, the risk is worth the reward. How will you feel if you actually test positive for AIDS? Some people go through the doors totally blase then nearly have a heart attack when they fail a test. This shouldn't be dismissed so lightly. It's very stressful.

If you are one of those that worship at the feet of the medical high priests then you will line up, totally trusting that the 'Best Hospitals in Thailand' only have your interests at heart yet we know this is not true. Come on now. Any hospital that has 'McDonalds' on its premises is 'avin' a larf'.

From time to time we hear of those who have had unnecessary operations and who invariably walk out the door with a shopping trolley full of drugs. Pushed on them because Doctors are compelled to do so.

I have a lot of praise for the facilities and the ambience in the hospitals. It's a far cry from the NHS but just like Tesco, which has a glittering smorgasbord of chemicals, fake foods and waxed dead fruit, one shouldn't be bamboozled by style over substance.

Here's an example of the controversy surrounding just one test, the PSA test for prostate cancer, published in the British Medical Journal, which gives plenty of succour to both sides, especially the 'shooting the messenger' faction.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1122361/

[sargeant]

Lindos i am going to actualy agree with MrP I eat raw garlic every day and have loads of it in my food as well
One of my favorite ways of having raw garlic is a cheese onion and raw garlic sandwhich
i have posted i believe that it was raw garlic and borehole PURE water which stopped the symptoms of my detected prostate cancer
whilst it has NOT cured it it has made it managable to a point i hardly notice it
not very scientific i agree but i believe it
If it starts up again i will however consult a doctor toot sweet

[sargeant]

Just to add to my last post i prefer the little onion type garlic with a bit of a kick in its taste its from the north and slightly more expensive but worth it

Another thing i take is an older coconut and mondays and thursdays i eat a piece it is a natural laxative

again not scientific but as its an addition to my normal meds and doesnt interfere with them i feel better

[Super Joe]

In the NHS it is recommended that the tests follow symptoms. In the Private sector tests are preceding symptoms.

Nonsense, the NHS has a screening and testing program that is not dependant upon symptoms.

Are you scaremongering, SJ? Lol. You keep saying 'silent killers'. Guaranteed to drive them through the hospital doors!

Allow me to unravel your spin .....
The NCBI YOU linked to in this thread has articles on 'silent killers'
The Times Online YOU linked to in this thread has articles on 'silent killers'
The BMJ YOU linked to in this thread has articles on 'silent killers'
The Scienceagogo site YOU linked to in this thread, has articles and advertises products for 'silent killers'
The University of North Carolina YOU referred to in this thread has articles 'silent killers'
The National Institute of Health YOU linked to in this thread has articles on 'silent killers'
The Science Daily site YOU linked to in this thread has articles 'silent killers'
The Medicine Plus site YOU linked to in this thread has articles 'silent killers'
The Foundation for Genomics & Population YOU referred to in this thread has articles on 'silent killers'

"I've had a health MOT myself at Bumrungrad"
"I'm in favour of testing where it increases awareness, education and PREVENTION"

You're CAPITAL letter use for emphasis, not mine. Oh the irony


Other contributors to this thread ....

I have always used Bangkok Pattaya Hospital for my annual medical check ups which I have every five or so years

Of course there are the silent killers

One of the silent killers that you need to have checked out

Had a colonoscopy at the Bumrungrad 5 years ago

Same with me and many other men I know concerning the 5+ years.

I had one (colonoscopy) when I turned 50

I had my first 2 years ago

medical checks are good. I had high cholesterol detected, took pills and diet advice problem cured

Some cancers at the early stages have no symptom by the time he symptom show it is to late

3 years ago I felt as fit as a lop, but 2 months later started to get twinges from what was already a well developed ovarian cyst

Your hypocrisy, double-standards and inconsistencies displayed in this thread, are similar to those I see in the other section IMO.
This thread has some helpful and useful advice, I feel it's now becoming 'polluted' by your self-confessed bias (you wrote "Yes, I am biased against the mainstream medical model"), and I don't want to be party to turning it into a 20 page saga of link and counter link, article and counter article blah blah blah.

So I'll leave it there

SJ

[MrPlum]

[Minor edit for clarity]

Your hypocrisy, double-standards and inconsistencies displayed in this thread, are similar to those I see in the other section IMO.
This thread has some helpful and useful advice, I feel it's now becoming 'polluted' by your self-confessed bias (you wrote "Yes, I am biased against the mainstream medical model"), so I'll leave it there.



SJ

Cheers to you too.

SJ. You have CLEARLY 'polluted' this thread with YOUR bias FOR testing. Posting 8x to my 3. You know our exchanges will never get anywhere. While you have a high level of confidence and satisfaction in the orthodox health system, I have quite the reverse. This is based on different experiences. Everyone gets this by now. It isn't necessary for you or others to continue to act as first responders to challenge my 'dangerous' heresy. Who assigned you this role? Even in a court of law, evidence is allowed from BOTH sides. Insults and smears don't cut it and never will.

The 'silent killer' point was gentle joshing. It's not that it's not an important factor. Obviously it is. Only you kept repeating it as if that was the only issue that matters. While I understand exactly what you are saying and about the Times article, your response DIDN'T answer the questions I raised.

What you seem to be missing in my posts is that the concerns about the appropriateness of tests are exactly about ME. Healthy, no symptoms, low risk, yet coughing up my cash for tests due to anxiety created by a fearmongering media and the medicalization of life itself. I said quite clearly that I undertook the test for reassurance, not because there was anything actually wrong with me.

Why don't you simply ask me to clarify my 'hypocrisy, double-standards and inconsistencies'? A simple request is all it takes.

I had my health MOT in 2006 and like you was happy to do so. However, since then questions have been raised in my mind about the quality and suitability of testing. As the GP in the article says... "If you don’t have symptoms, then very few tests are worthwhile, and those that are can be had through your doctor.”

I've also had a colonoscopy and for exactly the same reasons I would question the value of having another one. It was only in the course of researching this topic that I found that polyps weren't all they were cracked up to be. If you wish to spin this as double standards or inconsistency, better stop any kind of ongoing researching and learning.

Yes I said I'm in favour of testing and still am. I'm all for members taking the 'Ability to hear opposing or controversial views without popping a rib' Test. But questions have arisen about the value of SOME tests, within the context of an health MOT. Tests are not PREVENTION if the tests are no damned good. Nor are they PREVENTION if someone is already healthy. Nor are they PREVENTION if no-one changes their lifestyle due to over-reliance on testing.

With regard to the 95% of 'natural' medicine being 'crap'. This is more wishful thinking from the knackered knockers club. There is a distinction between the value of alternative and OTC medicine, which I have questioned, and 'natural' or 'traditional' systems, endorsed by the WHO.

As to the questions raised by the OP. Until these concerns are laid to rest I shall not be attending any more 'Well Man' checks. Should I develop any symptoms, I might see a Doctor but only if I think he can cure me rather than simply treat me. Otherwise I'll try and cure myself.

C'mon, SJ. Fess up. It was the McDonalds post, wasn't it? Big Mac followed by a Triglycerides test. Smashing!

[margaretcarnes]

Sarge - your little onion like garlic is now available in the UK under the name 'Chinese Solo' garlic. Much better I agree, and costs very little more expensive here than the regular stuff. (Less waste too.)
I also get through plenty of garlic on a regular basis, and don't doubt its' properties - along with many other herbs/plants - certainly can't do any harm, and all the better if you include these things naturally in your diet.
What I'm not so convinced of is using herbal remedies in place of manufactered drugs for a specific diagnosed problem. However - would be interested in more info from Mr P on types of seeds etc. known to reduce cholesterol?
A friend has just started on statins after a year of trying to reduce her cholesterol level by diet alone. Doesn't like having to take the statins, but all else seems to have failed. Doc says it's genetic - runs in the family - dish out the pills.
Just to answer Mr P's earlier Q though - no my cyst wasn't detected during a routine check. By the time I felt any pain it was the size of a 16/18 week foetus. I doubt the routine PAP smears would pick up something like that?

[PeteC]

..Just to answer Mr P's earlier Q though - no my cyst wasn't detected during a routine check. By the time I felt any pain it was the size of a 16/18 week foetus. I doubt the routine PAP smears would pick up something like that?

PAP smears here Mags, didn't pick up stage 2A cervical cancer in my wife here. Oncologist said she had 3 smears over 18 months and not detected in any of them.

She was lucky and after a few ops and a lot removed she's now cancer free a year after. Ovaries and tubes still there given her age to avoid menopause. Cervix, uterus, lymph nodes and 1/3 vagina gone. She's doing great but will have bladder problems forever it appears.

To this day I have no answers as to: 1) GYN screwed up administering/interpreting the tests. 2) Lab was slipshod. 3) PAP tests are not as reliable as is advertised. My thinking at present is 3-1-2 in that order. Pete

[MrPlum]

would be interested in more info from Mr P on types of seeds etc. known to reduce cholesterol?
A friend has just started on statins after a year of trying to reduce her cholesterol level by diet alone. Doesn't like having to take the statins, but all else seems to have failed. Doc says it's genetic - runs in the family - dish out the pills.

Oh bugger. You're asking ME? Don't you know how 'DANGEROUS' I am? Tell your friend to stay away from the Apple Chutney. hehehehehe....


Ok. Ok. Composing myself for a moment... You know my stance. Dietary improvements are good. Cleansing/fasting + Diet + Exercise + Stress reduction + Proper breathing + Adequate clean water + resolving emotional causes + proper elimination is better. Adopting one is great, two, better and all of them, ideal, removing the necessity, in the most part, for diagnosis. i.e. It doesn't matter what ails you, adopting these steps will, according to practitioners and those who have actually applied it, bring the body back into balance. Naturopaths believe if the body is not clean then success in the other areas can take longer to achieve.

There are some inspirational teachers and great books out there if you are struggling to drag yourself off the sofa. The 'Braggs' books have been going for many years. Jack Lalanne http://en.wikipedia.org/wiki/Jack_LaLanne was inspired by them and became an inspiration to millions of others. If the American enthusiasm isn't to your liking, then seek out alternatives.

If you don't wish to make dramatic changes, there have been success stories on here where one food item alone has resolved some issues for people. Apple Cider Vinegar for one. Your friend could investigate that as an option. One or two tablespoons per day in warm water for 21-30 days and see how they get on. It can be sweetened with blackstrap molasses or honey or taken with half a teaspoon of bicarbonate of soda. The ACV needs to be cold-pressed organic with 'The Mother'. You'll understand when you see it.

You can also get him or her to use only Sesame Oil for cooking for the next 21-30 days. From Black sesame seeds is best but any will do as long as it is cold-pressed and organic. Totally exclude all industrially-refined oils and trans fats. If your friend's BP is also high, they may find that has reduced as well. A teaspoon per day is sufficient.

The final element is raw garlic. If you take ACV+Sesame Oil+Garlic and remove refined fats/oils, I think you are off to the races.

This is just a personal opinion, so please treat it as such.

[sargeant]

Hi mags Missy had a full checkup with her UK doctor 2 days before flying out here for 8 days while here she was checked by a doctor in the St Pauli they both found nothing
The day she got home rushed to Hospital 1.5 pints of fluid removed from lung and as she calls it a trip through the doughnut showed up an 8cm ball of cancer. Other than feeling tired no symptoms until she got of the plane at swampy. Would a trip through the doughnut before have picked it up I don’t know but it sure as hell wouldn’t have done any harm

Mags you hit the nail on the head

What I'm not so convinced of is using herbal remedies in place of manufactered drugs for a specific diagnosed problem.

There are people that have done just that to there detriment
The ******* that advise it cover their back by saying "consult your doctor first" and if the person carries on and gets ill "its is his own fault he was told to consult his doctor" that is the classical dictionary description of the word hypocrisy

Just a couple of extra things I do
1----I eat porridge every third day supposed to lower cholesterol (i am hoping that my cholestoral levels will fall and my DOCTOR can cut my statins)
2----I have it with HONEY an ancient medicine
3----I eat 2 blocks of dark chocolate before bed every night supposedly good for my heart and means I don’t need enemas combined with the coconut
4----I smoke deliberatey to lower my stress levels And although Mrs Sarge is no longer raising them ??????????

Other than the porridge (a few months) all of the others plus garlic coconut and pure borehole water I have been doing since I came to LOS
Thats 12 years and i have still had 3 heart atacks
I do not recommend any of them if you want to try them feel free

BUT DO NOT GIVE UP ANY MEDICATIONS WITHOUT CONSULTING YOUR DOCTOR

[Super Joe]

[Minor edit for clarity]

'for clarity' hey?, this is what you added ....

C'mon, SJ. Fess up. It was the McDonalds post, wasn't it?

At least your 'use' of the Edit facility is consistent


SJ

[MrPlum]

4----I smoke deliberatey to lower my stress levels

Groan.... It's not just the stupidity but the predictability is what gets me.

Let me see if I have this message right...

I took garlic for 20 years but still had 3 heart attacks. Therefore, Garlic is crap!

I drank vinegar for 15 years but still drank like a fish. Therefore vinegar is a scam!

I've been eating oatmeal but don't exercise. Therefore oatmeal is useless!

I eat a pie and a pint washed down with a spoon of honey. Honey is rubbish!

I KNOW some members have had success trying these simple remedies but I'm going to ignore that because I know better than anyone else!

Ingredients of Apple Chutney are dangerous!

Anyone offering simple time-tested advice supported by studies is a CHARLATAN with an AGENDA!

I know it's none of my damn business but I'm gonna tell you how it is anyway and I'm right because I've been on this earth XX number of years. No-one puts one past old sarge.

A legal requirement to provide a disclaimer is being used as an excuse to kill people!

The FAILURE to provide a disclaimer is going to kill people!

I shall save everyone because they aren't capable of thinking or taking responsibility for themselves!

While I'm taking a bow for my 'in the nick of time' good works, due to my inflated ego I shall miss the fact that my hysterical distortions are unwelcome to those who specifically asked for advice!

The idea that you can still smoke and yet expect ANY approach to help you is not 'common sense and logic'. It's LUNACY. If anyone came to me and asked me for advice about natural OR orthodox ways to regain health and was STILL SMOKING I'd tell them there and then to p**s off and stop wasting everyone's time!

IDIOT!

http://stopsmokingnow.org.uk/smoking-di ... rt-disease