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Living with high blood pressure

July 7, 2020

Diagnosis

Back before COVID 19 rendered most GP’s appointments video or email, I went to visit my doctor about a pain in my thumb (it turns out I’d broken it, but that’s not the subject of this story). My doctor said, “Since we haven’t seen you for four years, let’s check you over.”

So she took my blood pressure:     215/125.

That’s high. That’s really really high. It should be no more than 140/90 and ideally 120/80. So mine was approaching double normal. Anyway she smiled, made an appointment for me to see her the following week, and suggested that if, over the weekend, I had the chance to take my blood pressure I should do so.

As it happens it was that weekend that my Danish niece was moving to the UK to attend Canterbury Christchurch University, and we spent some of Saturday trying to find a bank that would open an account for her. We finally succeeded at Barclays (thank you Barclays).

Anyway, the Stroke Association had a stall in the branch and were taking blood pressure measurements. So I got mine taken. Eventually.

They’d been using their blood pressure machines all day so the batteries weren’t fully charged; trying to inflate the cuff to stop my blood flow exhausted the batteries on three of their machines. The fourth worked. On the form they give you, there are four boxes, and they tick one of them:

  • Blood Pressure’s fine
  • Blood Pressure’s slightly raised, make an appointment with your GP to follow up
  • Blood Pressure’s significantly raised, consult your GP urgently
  • Go to A&E IMMEDIATELY!

As you might guess, my form had the bottom one ticked. I declined the visit to A&E as I had the appointment for the following week.

Medication

My GP took blood samples and performed lots of tests. My weight (BMI slightly over 25, but she was happy with that), diet, blood samples, cholesterol, electrolytes, lung capacity and lots of other measures were all perfectly fine. I simply had exceptionally high blood pressure.

So we began “titration” otherwise known as adjusting the dose.

To maintain my blood pressure at a normal level I take three different drugs:

  • Amlodipine – a calcium channel blocker – vasodilator
  • Candesartan – an angiotensin II receptor blocker
  • Bendroflumethiazide – a diuretic (water tablet – makes me pee a lot)

I will probably have to take these for the rest of my life. Luckily I live in the UK, and under our health system, since I’m over 60 years old, I get all of this medication free of charge. My GP explained these work well in combination, are effective, inexpensive and have few side effects (apart from the peeing).

I also check my blood pressure regularly.

She explained the best way to do that is to use a machine with an arm cuff and sit at rest, on an upright chair, such as a dining chair, with my feet on the floor and my legs uncrossed. I shouldn’t take the measurement if I need to pee as this may give a raised reading. I should then take three readings, discard the first one and average the other two.

bp

Arm cuff blood pressure meter

She suggested that wrist blood pressure meters can be inaccurate.

Side effects

I was taking all my medication each morning, then sometimes finding myself light-headed in the evening when I stood up. I mentioned this to my GP who suggested that I split the medication, so I now take Candesartan and the diuretic in the morning, and Amlodipine at night. That solved the problem.

Adherence

Adherence is the medical term for how well I stick to taking my prescribed medication each day. I’m pretty good. I rarely fail to take the medication.

However on days when I’ll be travelling for much of the day (not that often any more), I deliberately skip the diuretic. My pharmacist went apoplectic when I told him this, but I reckon that since my body was used to my blood pressure at 215/125, if it’s now normal but slightly raised for 24 hours I’m not going to come to any harm. And it avoids either my spending the whole journey looking for a loo, or having to carry extra clothes in case of an embarrassing accident.

Also, on the advice of a retired GP friend, I don’t take my morning medication before going for a morning cycle ride – his view was you want as high blood pressure as you can get when you’re vigorously exercising – I take it when I finish. Also I’ve discovered that my blood pressure can drop significantly when I finish exercise, particularly if the weather is very warm, and I don’t want it so low that I pass out.

Other medication

It’s a good idea to be aware how your medication works. The effect of the calcium channel blocker is to expand the blood vessels (vasodilation), this increases the volume of your blood vessels and, assuming the volume of blood they contain remains the same, reduce blood pressure.

There are some common anti-inflammatory medications, including Ibuprofen and Naproxen, which work by constricting the blood vessels. This reverses the effect of the vasodilator and so can increase blood pressure. I take them only very occasionally, and only when absolutely necessary. Again my pharmacist gets very agitated about this, but I think I know what I’m doing – it’s my body after all.

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I don’t pay road tax

June 18, 2020

…but then nor do you.

I continue to see claims that cyclists should not be on the road because they don’t pay “road tax” such as this one yesterday which seems to have been subsequently removed:

So let’s get some things straight:

There’s no such thing as “road tax”

There used to be. But it was abolished by Winston Churchill in 1937 and replaced by Vehicle Excise Duty (VED) – a tax that goes straight into the exchequer – it doesn’t directly pay for roads – it wouldn’t be anywhere near enough anyway. The excellent, and ironically named, website I Pay Road Tax, run by transport journalist Carlton Reid, is campaigning for it to be referred to as “car tax” which is effectively what it is.

Roads are funded from general taxation

Anyone who pays VED, income tax, VAT, inheritance tax or a myriad of other taxes is helping to pay for the roads. Roads are a resource legally available to everyone – motorists, delivery drivers, emergency services, the military, motor cyclists, cyclists, pedestrians and soon, probably, e-scooterists (although at the time of writing e-scooters are defined as vehicles and are not legal to use in the UK either on the road or on the pavement – this may soon change).

Update: As of 4th July 2020 it’s legal for hired e-scooters to be used in the UK on roads, cycle lanes and cycle tracks (NOT pavements). Privately owned scooters are still not legal in a public place. You have to be at least 16, hold at least a provisional driving license and are limited to 15.5mph. Helmets are advised but not mandatory.

Bicycles are not liable for VED

VED is a tax based on a vehicle’s emissions. A bike isn’t a vehicle (according to the Road Traffic Act) and it has no emissions. So it’s exempt.

Other exemptions include disabled drivers, electric vehicles, military vehicles and police cars. And pedestrians. Next time Ryan is stopped by the police I suggest he tries telling them they have no right to use the road because they don’t pay “road tax” and see how far he gets.

Also many cyclists also own a motor vehicle, on which they pay VED. And if they’re cycling then their vehicle isn’t clogging up the road, so when you’re driving and you next see a cyclist, don’t think “they don’t pay road tax” think “they’ve left their car at home which leaves more space for me”.

Many cyclists do have insurance

Members of Cycling UK (about 68,400 members) and the London Cycling Campaign (about 11,000) are covered by third-party insurance as a benefit of  their membership. I’m a member of the LCC, so I am covered by third-party insurance when I ride my bike. Many home insurance contents policies also include third-party liability and will therefore cover claims against the policy-holder or members of their household while cycling.

There are some badly-behaved cyclists

I stop at red traffic lights and at pedestrian crossings, but not all cyclists do. Then again not all motorists do. When I cycle commuted across London the vehicles I saw jump red lights most often were buses, taxis and white vans. The police, quite rightly, enforce the law for everyone, however, as Superintendent Andy Cox of the Metropolitan police explains, the police target their resource to maximise road safety:

If you consider countries where cycling is ubiquitous such as Denmark or the Netherlands, there are many fewer instances of badly-behaved cyclists. This is generally because the infrastructure is better suited to cycling. When you’re cycling, stopping and restarting requires a lot of effort, so cyclists will try to avoid this. Some do this by cycling through pedestrians on a crossing or failing to stop at traffic lights. Not a good idea. But better infrastructure which separates bikes from other traffic, and from pedestrians, enables cyclists to keep going. Cycle lanes are good, but those which require the cyclist to give way at every side road (there’s one like that near me between Marlow and Bourne End) and which mixes cyclists and pedestrians are simply not going to get used.

There are other reasons. In Denmark there’s a law of “presumed liability” which means, unless there is clear evidence to the contrary, the more vulnerable road user is considered the victim in an accident. So in a cyclist vs pedestrian collision the cyclist is at fault, and in a cyclist vs car, the motorist is at fault. This encourages more considerate behaviour. Also in Denmark if a cyclist is convicted of an offence they can get points on their car driving license, or even lose it. Maybe we should consider some changes to the law like that in the UK?

And finally, some reading…

The previously-mentioned Carlton Reid has written a fascinating book: Roads Were Not Built For Cars – How Cyclists Were the First to Push for Good Roads & Became the Pioneers of Motoring available at your local bookshop, Hive or, if you must, Amazon.

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Protect your email with a strong, unique password

April 24, 2020

Some of my friends have asked me recently about computer security, passwords, scams and malware. One thought he had a virus infection on his computer, another had been reposting hoaxes about WhatsApp messages while yet another had received one of these “we’ve got all your details, we’ve videoed you with your own webcam doing embarrassing things; if you don’t pay us money we’ll send the footage to all your contacts” emails. The reason he was particularly concerned was the email included one of his own passwords.

Of course it was a scam; it turned out the scammers had probably got his email and password from the LinkedIn security breach. So I confirmed with him that this wasn’t his email password and then reassured him it was a scam. He changed his email password just to be on the safe side.

Keep your email secure

Before anything like this happens to you, the most important piece of advice I would offer is: make sure your email password is UNIQUE (i.e. you’ve not used it for any other account, anywhere else, ever) and strong (8 or more characters and a mix of at least uppercase letters, lowercase letters and numbers). If it’s not. Then I suggest you change it as soon as you can.

Computer with chains and a lock

It’s unwise to use your children’s names and dates of birth. Don’t use “password” “qwerty” or “1234567890” (which are some of the most commonly used passwords).

Why your email?

Because email is the way you reset every other password. If someone hacks into your email account they can change that password, then access every other account you have by going to the website and clicking the “I’ve forgotten my password” link. The site then emails them a reset link. Worse, they could log into your email and automatically forward your emails to themselves, so you don’t know anything’s wrong, but they receive a copy of any email sent to you.

So your email password is, perhaps after your bank, the most important password you use. And it doesn’t require your email provider to be hacked. If a major website is compromised (recent security breaches in the UK include Tesco.com and Carphone Warehouse) the first thing the hackers will do is try each password on the email account associated with it… and if you’ve used the same password for both, then the hackers have access to your email.

How to make a password strong but memorable

My preferred technique is to pick the title of a favourite book, album or song and use that as the key. Let’s consider, for example:

All I Want for Christmas is You by Mariah Carey.

(I don’t use this, nor should you, it’s just an example)

Take the initial letters capitalised as in a normal sentence:

AIwfCiy

Substitute some of the letters. For example you could change the “C” of Christmas to X for Xmas, “for” to 4 and “you” to u:

AIw4Xiu

It’s still too short, so add the initials of the artist – MC:

AIw4XiuMC

There you have a pretty strong, apparently random, 9-character password, but because you know the passphrase, you can remember it every time. No one will guess it, nor will it fall to a brute-force “dictionary” attack where hackers try every word in the dictionary.

Some sites require your password to include a special character, if that’s the case you can insert a %, & or @ between the song and the artist:

AIw4Xiu%MC

There you go, the almost perfect password.

Could I make it even more secure?

Yes, you could use what’s known as “Two Factor Authentication” or 2FA. Your online bank already uses this so you’re probably familiar with the concept. When you login you need to provide a second password, or a code texted to your phone. Maybe your bank’s sent you a special authentication device such as the Barclays PINsentry below, or you use an “Authenticator” app which generates a one-time random code. There are several authentication apps. Microsoft includes one in Office 365 (now Microsoft 365)Google has one, and Authy is one of the independent ones.

Sites including PayPal, Twitter and Amazon support the use of Authentication apps for 2FA. Many sites offer a 2FA capability and it’s a good idea to enable it if it’s available.

Barclays PINsentry security device

Barclays PINsentry for two-factor authentication

How to remember all those passwords

Ideally every password you use should be strong and unique, but that’s hard, especially as our memories fade with age. Writing them down, while not a great idea, is better than using the same password everywhere. Use a little notebook and keep it somewhere safe at home – that’s far more secure than re-using passwords. Someone would have to break into your house to get it, and if they do that they’re much more likely to steal the telly! Whatever you do don’t write your passwords on a sticky note on your computer!

Better still, use a Password Manager such as LastPass (there’s a free version for web, PC, Mac, iPhone and Android) or 1Password (small annual fee) which can securely store all your passwords, generate new unique random ones and fill them in on your phone or computer as you need them. They have extensions for your favourite browser, and you can also access them securely from anywhere when you’re away from home (unlike the notebook under your bed). With a Password Manager you don’t need to remember, or even know, any password other than the master password for the app. Whatever you do, make that strong, unique and don’t forget it!

Should I change my passwords regularly?

It’s fair to say that the IT security industry is divided on this. Provided your password remains strong and unique then there’s benefit in doing so, and some systems require you to do so periodically. The problem is that many of us have lots of accounts, and trying to think of multiple memorable, unique, strong passwords regularly is hard. So many people, when forced to change their password, just use the same set over and over again, or they use the same password but include a number in it and increment the number each time. So being forced to change your password regularly may actually reduce rather than improve your security. Use a Password Manager and you can change your password regularly – in fact some of them will do it for you automatically!

What happens if the Password Manager site is breached?

Yeah, it has happened. Password Managers are, like antivirus software, a prime target for hackers. But it wasn’t a problem because the way Password Managers work is your passwords are securely encrypted with your master password as a key before being stored in the (yet further encrypted) Password Manager database, and are only ever decrypted, as you need them, on the device you’re using. Even the Password Manager doesn’t know your Master Password. So if the Password Manager site is compromised, all the hackers are likely to get is a list of encrypted records, none of which are any use to them.

They must know my password, how else do I log in?

When you first set up your password, the site does something called salting and hashing. Salting adds a string of characters (which may be very long and is usually unique to your user account) to your password before it’s hashed – a type of strong one-way encryption*. The resulting string can’t be reversed, so it’s impossible to work out your password from the salted & hashed string.

All this processing is done on your computer before the result is stored, so your password is never transmitted over the Internet. When you log in, your computer repeats the process and transmits the result which is compared with the stored version. If they match, you’ve entered the correct password and you’re allowed in. If they don’t, you’ve got it wrong. But at no point is your password known to, or stored by the system.

Even if a hacker managed to get hold of your unique salt and the hashing algorithms (as some are reported to have done in the LastPass breach) they’d still wouldn’t have your Master Password, so they’d have to guess it and try salting & hashing it to gain access to your passwords – which is why its still important to make sure your Master Password is strong and unique.

Clever eh? This salting and hashing system used by many major Internet sites, not just Password Managers. I suspect Tesco and Carphone Warehouse are using it now.

So keep your passwords, especially your email password, unique and strong, and use a Password Manager, then you can just ignore those scammers!

 

 

* For the purists, yes I know it’s not the same as encryption, but this isn’t the place to go into the details of the difference between encryption and hashing.

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Is Britain really panic buying and hoarding?

March 22, 2020

Undoubtedly, as the Coronavirus pandemic bites, some people are panic buying and hoarding. And some are bulk buying with the intention of selling goods on at a profit.

But I suspect the shortages in supermarkets are mostly down to something else.

Over the past 15 years, with the increase in the numbers of supermarkets, the growth in cooked-chilled and convenience foods, and the rise of Just Eat and Deliveroo, most people in the UK have been buying tonight’s meal that day, or ordering in. There’s evidence for this. In 2015 Waitrose published a study, reported in the Guardian, that identified exactly this trend.

Over time the supermarkets have adjusted their supply chains to replenish this little-and-often shopping style. Then suddenly we’re all faced with the possibility of being stuck at home for first seven, then 14 days and today, according to the Sunday Times (£) some of us will be told to stay at home for 12 weeks for our own good. Just imagine what happens when we all start to buy seven or fourteen times what we normally buy each day. Plus while take aways are still available, all those people who would eat in pubs and restaurants now can’t. So they’ve also gone food shopping.

I’m old enough to remember the “weekly shop” when we used to go to the supermarket on the way home on a Friday night and buy enough to make meals and have other products for the entire week. But for most families this is a thing of the past.

As a result the demand on the supermarkets’ supply chains has suddenly and massively increased.

Helen Dickinson, chief executive of the British Retail Consortium, said there was “plenty of food” in the supply chain and that the industry was experiencing “a peak in demand “like Christmas . . . without the four-month build-up period”.

Sunday Times, March 22nd 2020

Then the mass media, and social media, haven’t been shy about publishing photos of empty shelves, encouraging those of us sanguine enough to buy what we need for a few days, to rush out and buy more, just in case it’s not available when we need it. They need to publish more of these:

bargain_1894744b-1

A well stocked aisle in a UK supermarket

I’m sure it’ll return to normal, eventually. When either we’ve run out of room at home to store food, or we run out of spare cash or hit the limit on our credit cards. Helen Dickinson (quoted above) estimates there’s £1Bn more food in our homes than there was three weeks ago. Surely we can’t store much more without it going off and being thrown away?

And the cost of food will rise, not only because wholesalers sense an opportunity, and because of shortage, but because the BOGOF* and multi-buy offers normally offered by the supermarkets will be stopped for the time being.

I also suspect (but I have no evidence) that given the logistical constraints on distribution, priority is being given to food products in preference to non-food items such as washing powder. So those items will run short too due to both stocking up and reduced distribution. I’ll leave the last word to former Sainsbury’s chief executive Justin King:

“Britain’s food supply chain is under short-term stress, not structural stress,” he said, “Probably 50% of customers are buying twice their usual shop and supermarkets can’t cope with that.”

I hope it all settles down soon, but in the meantime I’ve bought some vegetable seeds which I’ll be planting out over the next few days – well I have lots of time and I’m not supposed to go out unless it’s vital…

*Buy One Get One Free

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Football on UK TV at 3pm? Never!

February 15, 2020

It seems perverse to me that in today’s technology and media landscape, with multi-billion pound fees paid for the rights to broadcast live football (soccer, for my transatlantic readers), it’s impossible to watch a live football match on a Saturday at 3pm in the UK unless you’re actually there in the ground, or have privileged access to a TV studio.

Why is there no live football on TV on Saturday afternoons?

The reason is that in the 1960s then Burnley FC chairman Bob Lord convinced other Football League clubs that if live football were available on TV at 3pm on a Saturday – the kick-off time of most football matches at that time – then their fans would stay at home and watch a higher league team on the telly rather than go to the live game. So a law was enacted that prevented the broadcast of any live match between 2:45 and 5:15 on a Saturday. This law is still in place and still observed, even for games being played outside the UK. Pubs in the UK are also unable to stream live matches between those times.

What’s the impact?

This is the reason so many matches are played on Sunday, Monday nights, Tuesday nights, Friday nights and why one Premier League match each Saturday kicks off at 12:30 (currently broadcast live on BT Sport) and another after the blackout at 5:30 (live on Sky Sports).

It’s also the reason that both the BBC and Sky have prime-time TV slots on a Saturday afternoon broadcasting a studio of football pundits all actually watching the live streams of the matches and then recounting to us mortals, who aren’t allowed to see the live action, what’s going on.

BBC football pundits on Final Score

I believe the one thing it does achieve is a substantial audience for the BBC’s Premier League highlights show, Match of the Day, and to a lesser extent the English Football League (EFL) highlights show currently on Quest.

Could it be fixed?

Of course it could. A simple change of the law to repeal this ludicrous rule would enable broadcasters to carry live football on a Saturday afternoon. Would it do what Bob Lord originally suggested and massively reduce attendance at lower league clubs? I don’t believe so, after all when lower league clubs get their matches broadcast live as part of FA Cup coverage, people still go to the games.

Perhaps we could try it as an experiment and revert if Bob Lord’s apocalyptic prediction comes true? But we’ll never know if we don’t try, because this has never been allowed in the UK – the home of football.

Perverse or what?

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A new type of telephone scam

November 12, 2018

My landline phone rang showing the number 0345 203040 (which I found out afterwards is Halifax’s customer service number). The lady on the phone with a strong Scottish accent said her name was Angela and that she was calling from Visa about some suspicious transactions on my bank Visa Debit card.

Would I confirm they were mine, and then they’d release them for payment? I asked how I knew she was from Visa. She said she wouldn’t ask me for any account details but didn’t give me any further verification.

She said one transaction was for £400 with Argos, and the other was £700 with Tesco. No, they weren’t mine. I wanted to find out which bank’s card this was (I have several with different banks). She wouldn’t tell me which bank, but asked me to list the banks. Which I did. She picked one and said it was that one.

She was very clever and credible. She knew my name and address. She asked what else I’d used that card for recently, if I’d put it into a cashpoint where it might have been compromised. (Possible but unlikely, I generally use it for contactless transactions). Did I actually have the card? Yes. Had it been damaged? No. What was the current balance? Hmm, I was dubious but I did tell her approximately.

Then she raised my suspicions further by saying she’d now like three pieces of security information, the first being my mobile phone number. I said I’d give her the last four digits, but she wanted the whole number. She said this was to demonstrate their security – she’d call my mobile and the number displayed would match the customer service number on the back of my debit card.

When I pointed out that it’s very easy to spoof any phone number you like on a phone call she hung up.

I presume if I’d been convinced by the phone number spoofing, she’d have gone on to ask for other details like my account number, sort code and so on.

I did call my bank afterwards who confirmed there were no such transactions, and that even in the event of a suspicious transaction on my card it would be them that contacted me, not Visa.

This is a new one on me – so watch out for Angela, or whatever name she uses next time!

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Black Friday – let’s leave it to the US

December 1, 2017

So it seems “Black Friday” has come and gone in the UK without it really stirring anything very much. The Daily Telegraph reports that Currys PC World in Oxford Street opened its doors especially early to let in the rampaging hoardes looking for a bargain – and there was one bloke outside who’d dropped by to pick up his pre-ordered laptop!

It’s no surprise to me. In fact I’m rather pleased that this particular US import isn’t getting much traction over here.

And nor should it.

Picture from The Sun of shoppers fighting over a flat-screen TV

The reason for “black Friday” is that this is how it was referred to by US retailers. The day in question is the Friday after Thanksgiving – which always falls on the last Thursday in November. For many of my American friends Thanksgiving, or “turkey day” as it’s colloquially known, is a much bigger family event than Christmas. The problem for US retailers was that after a day of scoffing Turkey and convivial drinking with their loved ones, most folks booked the Friday as vacation and slept in the next morning. So retailers didn’t sell very much on that particular Friday morning.

Hence it became known as “Black Friday”. Then some bright spark thought of the idea of having a discount sale, but one that ended at midday. So to get the great prices you had to get out of bed and go buy that TV, bike, carpet or whatever else, before lunchtime. I’ve been there on that day (in Boston, MA), and done it. And it’s quite fun, but a lot of people end up buying a lot of stuff they didn’t really want or need just because it was cheap, and the offer was time-limited.

That was it. And of course the UK doesn’t celebrate Thanksgiving, we didn’t have the dip in retail sales on that day, and “black Friday” meant nothing to us.

But the world’s moved on. We can now shop on the internet, so Americans can still sleep in and snap up those bargains without even getting out of bed. And, of course, anyone else in the world with an internet connection can shop from those US retailers. And, with US retailers owning UK chains (IIRC it was Asda, which is owned by WalMart, which originally introduced the concept of Black Friday to the UK some years ago) Black Friday has metamorphosed from a once-a-year, Friday-morning only sale in the USA, to a whole week of discount offers across half the globe.

I’m delighted to see that Marks & Spencer, Fat Face and several other major UK retailers are spurning the Black Friday farce – I believe they’re right when they say all it does is bring higher-price sales during December forward, and reduces the margin on them. It also encourages people to buy stuff they don’t really need. Time magazine suggests that in the US return rate of goods bought on Black Friday is significantly higher than for goods bought at other times of the year. It’s especially so for technology purchases. So the admin and restocking cost for the retailer is higher.

Please Britain, remember Thanksgiving isn’t something we celebrate, so let’s abandon this unnecessary US import.

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Whoops, no head-up display!

September 2, 2017

In an idle moment recently (I don’t get many of those at the moment) I was scrolling through Honest John’s car advice in the Daily Telegraph. I found this one:

This struck a chord with me, because I’ve just bought a pair of Polarised sunglasses to eliminate reflected glare from the inside of my car windscreen – which can be a major problem if the sun’s in front of me and shining directly onto the top of the dashboard.

So, some basic physics. When light is reflected off a surface, most of the light that’s vibrating parallel to the surface is reflected, while most of the light that’s vibrating at other angles is absorbed or diffused. This means the reflected light is mostly vibrating in one direction – this is what “polarised” light means. Reflections from the inside of a car windscreen will be horizontally polarised.

Polarised glasses are designed to eliminate horizontally polarised light because it’s horizontally polarised light which reflects from surfaces such as roads, puddles and lakes, tables and so on. That’s why I bought my new glasses – to eliminate the reflection from the inside of the windscreen when driving towards the sun.

Head-up displays work by projecting the display upwards so that it reflects off the inside of the windscreen – as shown above.

If you wear Polarised glasses, these will cut out any light reflected from the inside of the windscreen, however it got there, so you will not be able to see a head-up display. Reactolite glasses aren’t polarised, they just darken the lenses, so the display will still be visible.

Obvious really, Honest John!

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It’s about branding, stupid. (In defence of Nurofen.)

July 25, 2017

This is a post I wrote a while ago about branding and ibuprofen. For some reason I didn’t post it. But having just written a post about migraines, and mentioned ibuprofen lysine, I thought this was appropriate, so I’m posting it now.

The press in the UK prominently featured a judicial ruling in Australia against Reckitt Benckiser (one example) – the UK-based manufacturer of Nurofen. Nurofen’s a brand name for ibuprofen – an anti-inflammatory drug generally known as a NSAID.

Generic ibuprofen is available in the UK for as little as 16p a pack of 200mg tablets (1p per tablet).

However branded Nurofen is more expensive. That’s known as “branding” by marketers. Branding is a normal way of trying to maintain a price premium in a commodity market. And Nurofen has (or had) a very good brand reputation in the UK – but if what you want is generic ibuprofen, you can buy that more cheaply.

But generic ibuprofen, the active ingredient in standard Nurofen, isn’t very soluble, so it takes a little while to work its way into the bloodstream. There is a compound of ibuprofen that will provide faster pain relief: ibuprofen lysine. It’s highly soluble and therefore enters the bloodstream very quickly. It’s marketed by Boots (for example) as Rapid Ibuprofen. Reckitt Benckiser markets it as Nurofen Express which is more expensive than the Boots’ version, but it’s the same stuff. It’s NOT the same as generic ibuprofen – it contains an equivalent dose, but it starts to work more quickly.

ibuprofenlysineSo what’s everyone getting upset about?

First, much of the press – including the Daily Mail linked to above – is confusing generic ibuprofen and ibuprofen lysine. Although they contain equivalent doses, they are different and you would normally expect there to be a price differential. If you don’t care how long the drugs take to work – for example you’re using this drug to reduce swelling and don’t need immediate relief, then buy the cheapest generic. If you have a migraine and want your pain relief as fast as possible then you can pay more for a faster acting version of the drug.

nurofen_migraine_pain_342mg_-_12_capletsBut beyond this, the marketing guys at Reckitt Benckiser have been creating different packages for Nurofen Express and branding it as Nurofen Migraine Pain, Nurofen Period Pain and other variants. The press is getting excited because these are all the same drug in different guises. It’s true that the packaging conveys the impression that the contents are formulated to specifically target different types of pain. However if you read the details and compare the packages to one another it’s clear that each of them contains the same dose of ibuprofen lysine.

So are they trying to fool the public? I don’t think so. Let me try to explain.

In my past I’ve done some work in retail marketing. Retail packaging is all designed to sell your product, so there are three things you design your packaging to do:

  1. Be more attractive to potential customers than the competition – target your market segment
  2. Occupy more shelf space than the competition
  3. Describe the product (complying with relevant legislation)

So by labelling a package “Migraine Pain”, for example, the vendor makes it more attractive to someone suffering with a migraine who’s looking for fast relief from the pain. If they’ve got an excruciating headache they’re unlikely to read the packaging, or the leaflet inside, to see if something generically labelled as “Ibuprofen Express” is actually useful for migraine pain. They’ll simply pick up the one with “Migraine” in big letters on the package. This means Nurofen Migraine Pain is likely to sell in greater quantities to migraine sufferers than Nurofen Express even though it’s the same stuff.

Secondly, if the vendor manufactures multiple packages each for a different market segment (migraine sufferers, period pain sufferers and tennis elbow sufferers, for example) and each of those packages occupies a slot on the retail shelf then they’re denying that space to their competition – so increasing their sales and reducing those of their competitors.

This is an entirely normal retail sales strategy and you see it everywhere. Remember there were different covers printed for the Harry Potter novels – one aimed at adults and a different one at children? Same strategy – segment the market, take up more retail space, increase sales volume.

Is this a problem for the customer?

I don’t think so. Be an informed customer. If you want to know what’s in the packet, read the blurb on the back before you make your buying decision. Buying Nurofen Migraine Pain rather than Ibuprofen Express is no different from buying your electricity without checking to see if there’s a better deal from another supplier, or complaining that the adult version of Harry Potter and the Goblet of Fire is the same as the children’s version.

As a nation we’re getting a bit more savvy about knowing what we’re buying, both in retail and online, but we can still be influenced by imaginative marketing.

Read the packet!

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The weirdest migraine

July 25, 2017

I’ve been suffering from the occasional migraine for some years. My migraines are very consistent and are known as ocular migraines, or migraines with aura. They start with a spot in the centre of my vision. As soon as this happens I know I’m going to get a migraine and I know that the pain will follow in about 20 minutes. (I found this page from the Mayo Clinic informative.)

Either my wife or I generally carry ibuprofen lysine (aka Ibuprofen Express), which is a more soluble, and therefore quicker-acting form of ibuprofen than the regular medication. If I take this immediately the aura starts then I can generally avoid, or at least massively reduce, the pain of the subsequent headache.

When this happens I generally take myself off to bed, or a darkened room.

ocular-migranie-images-300x153The progress is always the same, the spot expands, it becomes a jagged bright diagonal line and I lose up to half my visual field. Which side I lose depends on which side I’m getting the migraine, so if my right visual field disappears then it’s a left-sided migraine and that’s where the pain occurs. The image above is very similar to my experience. This is from a website on Ocular Migraines. Very occasionally I get the same effect on the other side.

After about 30 minutes my vision returns (the jagged line slowly rises up my visual field and out of view) and if I haven’t taken the pain killers, that’s when I get the pain, for a couple of hours. Following that, and for as much as the next two days, my head feels bruised – as if someone’s hit me on the back of the head with something hard.

There’s no particular food, drink or activity that I’ve noticed that triggers one of my migraines. It could happen at home in front of the television, or travelling, or sitting reading. I am aware that a bright polarised light such as sunlight reflected off a shiny surface such as a wet road, a table or a body of water can bring one on though. I try to avoid those situations.

Yesterday was different though.

We were in the car on our way to supper with some close friends when I noticed the first visual disturbance. We stopped and I took the ibuprofen. We contemplated turning back, but ultimately decided to press on. By the time we arrived, I’d lost the right-hand half of my visual field. We explained the situation to our friends, reassured them I’d be ok in a while, and I had a cold (non-alcoholic) drink.

Never before have I tried taking part in a normal conversation during a migraine attack. It was quite bizarre. I’d lost much of my vocabulary, and actually found speaking very hard. When I did speak, I wasn’t making any sense (either to me, or to anyone else). I knew what I wanted to say, but not only could I not find the right words, I wasn’t pronouncing the words I could find properly or in the right order! This isn’t something I’d ever noticed before, but the websites about ocular migraines mention that speech may be disturbed.

After an hour or so, during the lovely meal, I became more coherent. I carefully avoided the classic migraine foods of cheese, coffee, chocolate and alcohol. By the time we left for home I was feeling much more like myself. Just a little bruised and fragile. And because I was the one who hadn’t drunk anything, I drove.

Life returned to (relatively) normal. A most unusual experience. (And yes, I have consulted my doctor in the past, I’ve had an MRI scan of my head, and we’ve ruled out strokes, TIAs and other possible serious causes, so I just have to live with the migraines and keep taking the ibuprofen lysine.)