Make no bones about it

Rory Hafford sits down with the straight-talking Prof Moira O’Brien to discuss bone health, the teaching of medicine and the lure of the Olympics

Talking to Prof Moira O’Brien is a bit like being caught in a wind tunnel! In fact, ideas and words can come hurtling towards you like a runaway train, or bang into you with the force of tiny meteors. She certainly makes you think: about how medicine is practised here in Ireland; about how medicine is taught in this country; and about the treatment options employed in the specialty with which she is mainly associated — osteoporosis.
Operations
When I caught up with her, she was recouping from the ‘mild inconvenience’ of a leg operation; her second in recent years. Dangerous ground, because you get the distinct impression that this woman is well used to cranking out regular 14-hour days and addressing assemblies numbering in the hundreds. Being cooped up in a hospital ward, in a room on her own, results in a lot of free time to think. Consequently, I got both barrels.
“They have made a mess of teaching anatomy in the colleges…
“The way the diagnosis and treatment of osteoporosis is handled in this country leaves a lot to be desired…
“Awareness is key. We need to be putting resources into getting the message out that this is a preventable disease… if managed properly.”
The professor’s words carry weight. When she talks, people listen. You can’t but. Behind the words is a world of real and relevant experience, not least of all her 25 years teaching at the Royal College of Surgeons, followed by another 25 years in Trinity College, where she still plies her trade. Allied to this, her enthusiasm is infectious. She is animated in her delivery, powerful in her pronunciation (50 years of teaching will do that to you) and passionate about medicine. She describes herself as a ‘people person’. And it shows.
She embraces change and pushes back boundaries. She was the first person to introduce a DEXA machine to this country, back in 1990; she set up the first student Sports Medicine body in Trinity College in 1985; she was one of the pioneers in the advancement of osteoporosis treatment in Ireland.
In some respects, her life reads like something out of an action/adventure novel. She was born in Malaysia, where both her parents worked as doctors. She was then shipped off with the family to Australia at the age of eight, earning the status of ‘refugee’. Shortly afterwards, her father became a prisoner of war, courtesy of the Japanese.
The life aquatic
Fast forward a number of years and Moira O’Brien, who by this time had qualified in Medicine, was moving to Sheffield, England, with her new husband, who had just landed a medical post with the Coal Board. But she didn’t like Sheffield. All her life she had lived near water: Sheffield was nowhere near water.
She applied for a number of jobs in Ireland and, in her own words, took the one with “the shortest hours and the longest holidays”.
Her love of sports was one of the main factors leading to her taking up a post with the Irish Olympic team, a role with which she is today well identified. “I swam, played hockey and ran. I loved sports,” she says.
Olympic physician
Working as the Olympic physician was where she was first exposed to the problems of osteoporosis. “When the girls overtrained they lost their periods; when the guys overtrained they lost testosterone. The fractures began to mount up and I knew we had to do something to address the problem at source.”
She certainly loved her time working with the Olympians. “I suppose I rubbed a few people up the wrong way because I really enjoyed what I was doing – and I did it in the days when you didn’t get paid for it. You did it because it excited you and because you could make a difference to the performance of the athletes.”
It’s the same, it could be argued, with osteoporosis. She has long been one of the main drivers behind the Irish Osteoporosis Society, attempting to damn up the tsunami of fractured and brittle bones that threatens to leave the health system awash with collateral damage.
She puts the problem into stark focus: “Osteoporosis is the commonest bone disease worldwide. One in two women and one in five men over the age of 50 will go on to develop an osteoporotic fracture. I see an awful lot of anorexic people and stressed people who are suffering with compromised bond structure as a result. The economic climate that we are currently faced with is also a causative factor. Think about it; if you lose your job, your stress levels kick up and your hormones are affected. This, in turn, has a knock-on effect on your bones.”
She is a big believer in going back to source and trying to head the problem off at the pass, as it were. Let’s take the sun, for instance.
Sun exposure
“We looked at 200 patients in the last year who have low bone densities and, of those, a large proportion have low vitamin D levels (below 50 n/mls per litre). With this in mind, here’s what we are advocating… ten minutes in the sun without sunblock to help absorption. I know this could be seen as a bit controversial in some circles, but ten minutes is not going to cause any burn damage.
“We have to remember that 70 per cent of the vitamin D you get is through the skin and we need to encourage this. What is happening now, apart from sunblock, are moisturisers and make-up which are also carrying sunblock. If I’m controversial in this it’s because I want to get to the source of the problem; I want to treat the cause. Osteoporosis is a condition that is wholly preventable, provided we act in time.”
She says that one of the commonest causes of this condition in Ireland is steroids.
“People are being given steroids for asthma and fibromyalgia and cancer… You need to treat the cause and, if you are putting somebody on a medication that can exacerbate the problem, then you need to do something about that.
“If your patient has two or more risk factors [for osteoporosis] then they need to have a DEXA scan. It’s as simple as that. Why wait? Why wait until they fracture? It doesn’t make sense.”
She pauses for a beat, perhaps to let the point sink in… and then continues: “I suppose I belong to the old school, where the patient always came first.”
I’m almost afraid to ask how she feels the condition is treated in the community. But I do.
“There are some excellent GPs, who are genuinely interested in this condition. But there are also others who are slightly dismissive towards it, saying it’s an old ladies’ disease, or a condition that was developed by some elements in the pharmaceutical industry. This is rubbish. It is totally preventable. But we have to be vigilant towards it early on.
“Between the ages of eight and twenty are the most important years, when bone is laid down. When we were kids we had PE every day. Nowadays kids aren’t encouraged to do weight-bearing exercises. We need to be encouraging the proper supplements and oily fish and super milk. These little things could make all the difference.”
Anatomy
She likes things done properly. And simply. Take the teaching of anatomy, for instance. “I really feel they have destroyed the way anatomy is taught. The big issue, in my opinion, is the problem-based learning approach. Look at it this way: they give you a problem and tell you to go solve it. But you can’t build a house unless you have the basic building bricks to do so and, if you haven’t been taught the basics [in anatomy], you can’t solve the problem. If you don’t know what is normal, you can’t tell what is abnormal.
“The basic principles need to be explained simply. The way they are doing it now is wrong,” she stressed.
There’s a theme emerging with Prof O’Brien: go back to basics; approach things simply; and keep the patient front and centre. And make no bones about it!