Health: Second Opinion

PEOPLE whose hands sweat a lot get little sympathy, but the condition is far from trivial. The popular perception is that a damp handshake means nervousness and wimpishness. There may be some basis for this belief - terror may cause the palms to sweat - but in most cases the dampness or dryness of the handshake tells us nothing about the personality. Excess sweating of the hands often goes with excess sweating under the arms, which may cause unsightly staining on clothes and problems with body odour.

Excess sweating is a cause of misery for its victims, but all too often doctors are unsympathetic. The standard treatment with a lotion of aluminium chloride may help a bit but rarely solves the problem. A new hi-tech surgical treatment is now feasible, but the chances of patients being offered it through the NHS seem increasingly small.

As long ago as 1920, a cure was available for those prepared to submit to a major surgical operation. Destruction of the sympathetic nerve centres in the upper chest leads to an immediate reduction of sweating in the arms and hands. At that time, however, both sides of the chest had to be opened to gain access and few patients or surgeons were prepared to undertake such a procedure for a condition that was not life-threatening.

The picture has changed with the development of minimally invasive surgery. An endoscope may now be inserted through a small opening in each side of the chest and the crucial nerve centres identified and cauterised within 20 minutes. The patient can go home the next day. A recent review in the Lancet says that the procedure is of proven effectiveness but is as yet being used in only a handful of European centres.

Sadly, few people in Britain are likely to get this treatment through the NHS: indeed it is a clear example of the problems facing health service decision-makers.

Whenever the NHS is criticised, Government ministers trot out statistics to show that ever more money is being spent on health care and ever more patients treated. The underlying reasons for the growth in health expenditure are well known if not well publicised: the population is growing and so is the proportion of old people (the greatest consumers of health care). More important, every year sees new treatments for common complaints: within the past 20 years replacement joints, heart pacemakers and plastic lenses for cataracts have become commonplace. The introduction of endoscopic video cameras into surgery has made it possible to carry out many common operations such as removal of the gall bladder or appendix without a major incision. It is such innovations - rather than administrative 'reforms' - that have led to the increased productivity in the NHS in the past five years.

The political decision has been taken to limit health spending and this means that instead of these innovations being used to shorten waiting lists they are used to close beds. Non-urgent operations such as cosmetic surgery are given very low priority; surgery for excess sweating will come into that category. Should the NHS pay? Or should relief of a socially embarrassing and distressing condition be available only to people who can afford to pay the costs themselves?