JASGBI Article: Surgical Trainees - Having a wine

Surgical Trainees: Having a wine

Ed Fitzgerald, General Surgery Registrar

Twitter @Diathermy 

Published in the Journal of the Association of Surgeons of Great Britian and Ireland,
Number 36, March 2012 (Full print article can be down loaded here)

Whilst many readers will be used to trainees having a whine, I would wager far fewer will be used to trainees having a good wine. Having read Professor Alderson’s excellent recent article on his secret wine life [1] I felt the need (after a glass of wine) to add a few further comments.

There is certainly a lot of pretentious tosh spoken about wine, and a straight talking Geordie approach is as good a way of cutting through that! Nonetheless wine is very subjective, and the need for ‘wine talk’ to describe it is important. There are as many different opinions on a bottle of wine as there are people drinking it, a situation not a million miles away from some clinical encounters I have experienced. The “mumbo-jumbo” of wine tasting talk (think Jilly Goolden’s infamous” sweaty saddles” comments) is not always helpful. Nonetheless I would argue that wine tasting has evolved its own technical language through the need to give physical descriptions to subjective sensations or appearances in the same way that our own medical language originally evolved for similar purposes [2]. These days we take for granted the whimsical Greek tradition of likening anatomical structures to musical instruments, plants and animals  - perhaps Jilly Goolden’s elaborate wine tasting descriptors may have fared better in an earlier era.

Wine tasting itself isn't a magic art, although it sometimes appears so. It’s as much about experience as confidence; experience in having tasted enough wines to make judgements, and confidence to accept and interpret what your senses are telling you. Translating a physical sensation like smell or taste into words is difficult, but it does get easier with practice.

"Tasting is completely subjective. We each inhabit a unique sensory universe, formed by memories and experiences. There are no rules, just opinions. However, some are more informed than others". im Atkin, wine writer

Wine tasting is a contact sport, and the more you make that contact the sharper you are and more knowledgeable you become. Reading books can only get you so far. Like having a good mentor in surgical training, to really explore wine you need a good coach to guide you. Finding a good wine merchant or knowledgeable friend is every bit as important in life as having a good GP (probably more so in fact, and certainly better for your health). But to really understand a wine you have to go and visit where it comes from – no hardship given these happen to be some of the most beautiful corners of the world. Explore the land, meet the makers, and eat the region’s cusine. Only then can you really get under the (grape-) skin of what makes a great wine. This is as much about people, history and culture as it is about ripeness, tannins and vine canopy management.

I am pleased to have sipped some of the outstanding wines recommended in Professor Alderson’s article, including Moss Wood, Grant Burge, and Vasse Felix’s finest – but only when the boss is paying (hence rarely!) A great deal of my personal pleasure over the years has come from exploring far-flung or unfashionable wine regions in order to find the undiscovered, great value heroes of the wine world. This has only been partly successful, in that some of the wines I fell in love with 10 years ago have now been ‘discovered’ and I can no longer afford to purchase them! But for fellow junior doctors on our meagre salary, it is worth spending a little time digging around off-the-beaten track.

"Compromises are for relationships, not wine."
Sir Robert Scott Caywood  

Nonetheless, getting good value from wine is not just about looking for under-valued wine regions or grapes. Currency fluctuation plays a part, with South Africa and South America currently offering better value than Australia and North America. Also important are the actul cash-values of what you’re prepared to pay. Cheap wine is a false economy, yet in the UK the average price point for a bottle of wine is only £4.85. Duty and VAT already account for half of this, and when the retailer, shipper and fixed costs (bottle, label, cork, etc) are taken into account very little is left over the wine itself.

The following figures are a little out of date now (VAT is 20%, duty now £1.81/bottle, and you’d be lucky to find any bottle worth drinking at £3.99) but they do show how spending a little extra on a bottle gives a return on the wine inside out-of-proportion to your extra spend [3]:

Retail price	£3.99	£5.99	£7.99
Bottling and packaging	18%	12%	10%
Transport, storage, distribution	7%	4%	3%
Excise duty	29%	20%	15%
VAT	17.5%	17.5%	17.5%
The wine itself (inc all margins)	28.5%	46.5%	54.5%

"Wine is a food, a medicine and a poison - it's just a question of dose".

Paracelus, 16th century Swiss physician

Wine and the medical profession make good bedfellows for several reasons. Undoubtedly there are some historical medicinal links, now being evidence-based by current research into the anti-oxidant Resveratrol (3,4',5-trihydroxystilbene) [4] and other polyphenols found in grape juice and grape skins. This alone can’t explain the fascination and passion that many doctors hold for wine. Personally, I enjoy reflecting on a number of similarities between the art and science of wine and medicine. Both topics involve an element of uncertainty. Some consumers will be uncomfortable and even baffled by the many variations in wine: what it will taste like, how it will develop with time, how it accompanies food, and whether two bottles of the same wine will even taste and age in the same way. Despite many years of playing this game, I still find myself scratching my head sometimes as to how the same wine can taste so different seemingly just because it’s not a sunny day outside!

For doctors, who spend a career trying to rationalise uncertainties, these unpredictable facets are perhaps less troubling and indeed add to the fascination. Without doubt there is also an endless academic pleasure in learning about wine too, and like constantly progressing medical knowledge every new vintage will add to the wealth of wines, wine makers and wine regions waiting to be discovered. The medical nerd is well catered for in the wine-world, with point-scores to memorise and vintage charts to recite. Similarly, those of a more romantic or philosophical disposition can wonder at how the science of ‘terroir’ - the geology, geography and climate of a vineyard – translate into the art of making and enjoying a wine every bit as individual as its unique vineyard site. Good wines – and not the industrial scale, chemistry set wines too often seen these days – are much more than a liquid commodity. Every one of these has a story to tell, but many branded wines have now lost contact with the place that the grapes were grown and the people that made them.

“I was convinced forty years ago--and the conviction remains to this day--that in wine tasting and wine-talk there is an enormous amount of humbug” Thomas George Shaw

It strikes me there is scope for more wine-related articles in the JASGBI. The ‘Surgeons News’ magazine from the RCSEd runs a regular column [5] and I hope the JASGBI will consider introducing something similar. Perhaps even a wine tasting at the ASGBI Congress? As a shared interest, there can be few other non-clinical topics that bring so many colleagues together for such a sociable activity. As one of the founding principles of ASGBI was “…the promotion of friendship amongst surgeons” what better lubricant to facilitate this that than a good glass of wine?

Ed Fitzgerald had the hepatocyte-challenging role of President of his University Wine Society, and is a previous winner of the Australian Wine Bureau’s  “University Wine Challenge” blind tasting competition. He still embarrasses himself by maintaining a small wine blog of tasting notes and musings.

References

1. Alderson, D. The Secret Life of … On the subject of wine. JASGBI 2011 35:24-25.
2. Wulff HR. The language of medicine. J R Soc Med. 2004 April; 97(4): 187–188.
3. Robinson J. Why cheap wine is a false economy in the UK, and the US:  http://www.jancisrobinson.com/articles/inside051113.html
4. Smoliga, J. M., Baur, J. A. and Hausenblas, H. A, Resveratrol and health – A comprehensive review of human clinical trials. Mol. Nutr. Food Res 2011, 55: 1129–1141. doi: 10.1002/mnfr.201100143
5. Surgeons News: http://www.surgeonsnews.com/spectrum/wine