The MMR Vaccine

I was thinking of posting about this issue, but anything i would say is done here, and in a far superior way to anything I would write

Iraq

I supported the war in 2003 and I still do. Imagine if we did not go to war in 2003 and two years later Saddam decided to gas 10,000 people somewhere in Kurdistan in 2006? What if we had known he was going to do it in 2005 and did nothing? Would that have been right?

At the end of the day Saddam Hussein was a nasty piece of work who wanted to develop weapons of mass distruction and would have tried to do some if we had left him alone.

No matter what the Chilcott inquiry finds people have already made there minds up with regards to the war with Iraq. Unfortunately I dont think that Iraw as an issue will settle down. Whats more important is to concentrate on the worsening situation in Afganistan

Tennis and Books

Tommorow I am going home and coming back to university life on sunday. This means I shall be able to see the parents, revise in the kitchen with copious amounts of tea, coffee, hot chocolate, biscuits, sandwiches etc. I will be able to go to karate on the Friday night (am very rusty, but still find it fun).

On the train I will get some quiet time and finish off the book I'm reading and hopefully start on Bill Bryson.

And Sunday morning will be spent watching Andy Murray (hopefully) win the Australian Open

Tip Top

The day after antibiotics stop working

Just had a lecture on resistance to antibiotics. This photo was taken from the 1930s and shows how TB was treated back then (without antibiotics). Basically if you had TB you were treated with plenty of fresh air and then you had to hope for the best.

Hopefully the situation shown in this photo wont be repeated. Not over using antibiotics and other precautions are useful and necesarry but what we could do with really are some brand spanking new antibiotics.

When antibiotics were first discovered there was a sudden explosion in the number of antibiotics being found or made(usually a slight modification of an old one). This then tailed of to zero until the late 1990s when the oxazolididones were produced. More new classes of antibiotics from Big Pharma would be much appreciated.

The market though does not give a good incentive for companies to produce new antibiotics, for reasons given

1)Antibiotics are taken for 7-14 days, drugs for diabetes or hypertension are taken for years
2)Big Pharma makes a new antibiotic that then becomes obsolete within five - ten years due to resistance
3)Drug companies make a wonderful new antibiotic, this drug is loved by everyone. So Health Authorities decide to keep it for later and restict the use of it to try and stave off resistance developing. Therefore companies makes no money off it

I am a little scared that when/if I qualify as a doctor I am going to be facing infections that the generation before me could have treated but that I wont

Bugger

Ethics, how to think it all through

Medical students are (hopefully) taught to think logically and in a systematic way. This is useful, consider chest pain and its causes. Thinking in the way described above allows us to break down the problem - Is it a cardiovascular, respiratory or musculoskeletal cause?

This also applies to ethics. Potential medics are often faced with an "ethics" question at interview. A classic is whether or not Patient A or Patient B should get a liver transplant. The decision is made more complicated for the student when the interviewer drops into conversation that patient A is an alcoholic and has been for the last five years. Then student then says patient B should get the transplant. The other interviewer then chirps in and says patient B is unlikely to survive the operation due to a previous illnesses.

Thankfully ethical decision making is made a little easier when students are taught the four ethical principles. These were thought out to help ethical decision making in a more secular world. They are as followed

1)Autonomy - Patients should be allowed to make there own decisions
2) Non-maleficience - Doc should do no harm
3)Beneficience - Do whats best for the patients
4) Justice - How does your decision impact on the wider world? (a very rough definition)

At an ethics OSCE station i was given the following senario

A patient was diagnosed by his GP as having a viral cold. The patients was worried about an upcoming exam and wanted antibiotics (his friend had told him he should be on antibiotics). The GP reassured the patient that it was probably due to a virus, would hopefully disappear within a few days and antibiotics would be useless. Despite protests from the patient his GP refused to prescribe any antibiotics

I was asked "Using the ethical principles explain why the GP did not respect the patients right to autonomy"

Books

I have a few days off before I start working again, which means I have been able to go into town and buy some books. Having read several bill Bryson books (Notes from a small country, a walk in a woods) I brought two more – one about his travels to Australia, the other to Europe. I also purchase More Blood, More Sweat and another cup of tea by Tom Reynolds, a book describing life as an ambulance driver in London.

Despite only being 100 odd pages into the book I am a bit depressed at how nasty some people can be. Already people have put graffiti on an ambulance and stolen another’s sat nav. Other depressing bits mentioned how much time is wasted due to idiots consuming to much alcohol.

Its a good book and it does have some funny and heart-warming bits in. Although I will be happier when I’ve finished it and can move on to Bill Bryson, simply because it’s an easier read and it’ll be more relaxing.

Buses, Taxis and the NHS

Medical School Interviews are inevitably scary; one common question is to ask about the makeup of the NHS, which sometimes lead to a discussion about the future of the NHS and the involvement of the private sector. This can be tricky for people, you need to weigh up the pros and cons of the private sector in medicine and avoid pissing off the consultant who is interviewing you - they might get a significant portion of their income via private patients.



One analogy to start with is the bus and taxi scenario. Queues of people are waiting for a bus, but there are too many people for the bus pending. A few people in the queue get together and pay for a taxi. Everybody wins! The people who get the taxi get to their destination on time and the rest of the people in the queue get to travel by bus. Except the bus driver then decided to go and work as a taxi driver

It seems that patients who need the NHS are becoming like the people waiting for a bus, where the driver has gone over and become a taxi driver. At the moment the private sector is getting the better deal over the NHS

Now it seems medical students may need to learn the pros and cons of franchises. Hinchingbrooke hospital is being lined up to be run by one of five private companies. The aim of a private company is to make a profit to give to shareholders etc. The bottom line when talking about the private sector is that any money a private company does not have to be spent on patients is seen as a good thing, whereas in the NHS any money left over can be used to improve treatment or pay for more nurses etc (or at least in theory)

Calor, Dolor, Rubor, Tumor

These are the signs of acute inflammation as described by A C Celsus about 2000 years ago. He is best known for the medical work De Medicina. Some of the the titles for the different parts include history of medicine, general pathology (modern pathology textbooks are commonly slit into general and systematic pathology), parts of the body, pharmacology etc.

One thing that strikes me is the blurring between the amateur and the professional when it comes to practicing medicine. Celus is credited with being the father of pathology, but you can argue either way whether he was a "professional." You can argue he must be due to the amount of knowledge shown means he must be, but others argue bits are a little superficial. Also most household heads would know some medicine (it was easy to pick up the relevant knowledge being an educated lay person), as it would be useful when running a large family with copious amounts of slaves etc

Also thanks to celsus we use the term cancer today. He translated it from the greek carcionos. Both terms mean crab and apparently refer to the fact that dissected malignant tumours were perceived to have pincer like growths into other tissues.

Tea and Mars Bars

In one part of the hospital that I am based at, one obscure little cafe, based in the researchy ara of the hospital, provides a cup of tea for 40p and a mars bar for 35p. At the front entrance to this hospital, where all the patients walk in and out (its also next to the main reception), another cafe owned by a big company provides a cup of tea for £1 and a mars bar for 55p.

Bit unfair dont you think?

Diet and the Big Brother State

This graph shows how much money is spent by the government telling us what to eat when compared to the food industry.

Not that we're influenced in anyway by advertisement when it comes to deciding what to eat. As responsible people we just use it all to come to an informed decision

Anyway I am pleased to annouce that afert a week of 2010 I have still stuck to my resolution of eating five (or more) portions of fruit and veg and a day. And have ignored the chip shop that is a five minute walk from my house

Nothing to get your hopes up about

Medical students are taught to be rather sceptical when evaluating new treatments (or anything else for that matter). This has served me well, especially when I am "Home, Home" and I glance the Daily Mail as read so by my parents. Apparently Alzheimers disease can be prevented and reversed by using mobile phones.



This was based on just one study on 96 mice, to me this signifies nothing, except maybe as an indicator as to where future research should be directed.



A quick google search will find this article, that didn't seem to worry or affect us then

Cricket

England have got to get 466 to win and clinch the test series in South Africa, with 140 odd overs to do it in, so all we have to do is rattle along at 3.5 an over and its in the bag. What could possibly go wrong?

She/He fought the cancer bravely and thats what helped her through it. I remember my mum said something like this when discussing a family friend who had a brush with cancer. I was reminded of this when I saw this article

http://www.guardian.co.uk/lifeandstyle/2010/jan/02/cancer-positive-thinking-barbara-ehrenreich

Although my mums comment was a harmless one, she was grateful the person in question was ok, the sentiments mentioned in the above article are actually quite insidious.

"She fought the cancer bravely." is a common phrase. What does this mean? Its horrible, because it implies that those people who died because of cancer did not fight hard enough. That they didn't really want to live, its there own fault it took there lives. It ignores the fact that cancer is still a deadly disease, the mechanisms of which we barely understand

Keeping a positive attitude can be helpful, not because it will help you fight the disease but it can help people deal the disease and come to terms with it

Is there a Journal of Negative Results?

One of the best forms of evidence that can be used in determining treatment is a meta analysis. Without going into to much detail this is basically where you sum up with statistics the results of all the Randomised Controlled Trials that has been performed. Unfortunately Scientific Journals are more likely to publicise RCTs that show a treatment is succesful as opposed to ones that aren,t. This means that meta analysis may show that a treatment is more useful then what it actually is

Journals are less likely to publice any research that gives a negative result, so a scientist may look at the literature and see that no work has been published on a particular gene. They then may spend a considerable time scanning it for mutations etc. However there is a good chance that this work has already been done a few years earlier by someone else who could not get there work published due to journals not being interested

A Journal of negative results would solve all of this

Evolution and Medicine

http://news.bbc.co.uk/1/hi/health/8435320.stm

This is an interesting story about prions and how natural selection can act to select the more aggressive ones. I apologise for another geeky type science post but I thought I would share a few more examples of how evolution can help doctors understand a disease

I have an interest in cancer pathology and applying Darwinian evolution to cancer cells is a neat way of understanding it. It can explain why cancers can become resistant to chemotherapy. Say chemotherapy is used to kill 99% of cancer cells, the remainding 1% is resistant - it then exapands (pathologists use the term clonal expansion) giving a tumour that no longer responds to treatment.

The best known example of evolution in medicine is the selection of bacteria that are resistant to antibiotics. This is why GPs are constantly being told not to prescirbe antibiotics unless its necessary and why patients are told to make sure they finish the course - to minimse the chance of further resistance to anitbiotics developing. In one lecture we were shown a picture of rows of children suffering from TB; this was before antibiotics. Nothing really could be done for them. Hopefully we will design a bunch of brand spanking new antibiotics quickly so this situation does not arise again.

Huntingtons disease is a gentic disorder that laregly escapes natural selection, as the disease generally presents after a person has reproduced, this can explain why early-onset Huntingtons is very rare.

I love the theory of evolution, i think it is an elegant explanation of how life came about and how it became as diverse as it is today. Evolution underpins biology and biology underpins medicine. All the examples above make more sense when explained by the theory of evolution, which is why I think its important that medical students have at least an appreciation of its power