Book Review: When Breath Becomes Air – Paul Kalanithi

This book is undeniably honest, highlighting the realities of being a doctor, a patient, and dying. I am not embarrassed to say that I ended this book in tears, not only is it impeccably written but one of the most unique and useful books I have ever read.

“As a resident, my highest ideal was not saving lives – everyone dies eventually – but guiding a patient or family to an understanding of death or illness.”
― Paul KalanithiWhen Breath Becomes Air

Becoming a doctor should not be viewed through rose tinted glasses, something I know I have previously written about (a phrase which has certainly stuck with me). The stresses, long hours and innumerable tasks which are encumbered within medicine are written about in ‘When Breath Becomes Air’, and most importantly the realisms of just wanting to get work done. Through reading this book, I learnt how easy it is to slip into monotony, to just ticking patients off a list, however, that is not what being a surgeon, let alone a doctor, is all about.

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This has helped me realise that every patient who walks into a hospital is different, and that as a doctor you frequently meet people at their most vulnerable, most scared or most weak. How you approach a situation or initiate a conversation can impact hugely on how someone remembers their hospital experience or views hospitals for the rest of their life, and what can easily become just another patient in your day is a huge moment in a persons life. The humanity of being a doctor is truly emphasised within ‘When Breath Becomes Air’, with the personal stresses, commitment needed and responsibility felt being accentuated.

“The physician’s duty is not to stave off death or return patients to their old lives, but to take into our arms a patient and family whose lives have disintegrated and work until they can stand back up and face, and make sense of, their own existence.” 
― Paul KalanithiWhen Breath Becomes Air

Besides this, the second chapter of the book is as close to an account of death as possible. Dr Paul Kalanithi himself realised how as a doctor you deal with patients every day, but rarely do you experience what it is like, or the close proximity of death. I have not dealt with many loses in my life, and I think reading this book I got as close as possible to experiencing just a tiny part of what dealing with cancer can be like.

For me, being a doctor is a commitment to putting your patients first, and I believe that in many cases this is about making them feel comfortable, aware of what is happening but also recognising when not to bombard a patient with information. ‘When Breath Becomes Air’ is both phenomenally written and a just balance between science, patient care and first hand experience. I would recommend it to anyone, as it is a huge insight into what life is like as a neurosurgeon, but also death and how hospitals can influence lives.

‘People often ask if it is a calling, and my answer is yes. You can’t see it as a job, because if it’s a job, its the worst one there is’
― Paul KalanithiWhen Breath Becomes Air

Here is the amazon link for ‘When Breath Becomes AIr’

https://www.amazon.co.uk/When-Breath-Becomes-Paul-Kalanithi/dp/1847923674

 

RSM Medical Careers Day

Last week, I alongside many other aspiring medics spent the day at Oakham School, for a ‘medicine day’ offered by the Royal Society of Medicine. It was an incredibly interesting day, and shed light on the application process and specialisms. Being a doctor is an incredibly varied role, and I love the potential that there is to choose a career which definitely suits you. However, it is easy for anyone to find out about the application process, course structures and entry grades, so I wanted to take some time to reflect on the medical professionals who gave their time to speak to us about their careers during the day. Two of which were presentations which particularly stuck with me, and another a comforting realisation.

The Trainee Years – Dr Brinda Christopher 

Dr Brinda Christopher is the president of the Sports and Exercise Medicine section of the RSM, and currently works for Tottenham football club. Admittedly, I have never particularly considered the role of doctors in this environment – thinking that the players would always turn to a physiotherapist. However, I found it explained to be an interesting field of medicine – and an uplifting one. Dr Christopher mentioned that a part of her choice of specialism was due to the unlikelihood of encountering death, as she herself finds it difficult to deal with. This has opened up my eyes to other aspects of medicine, where I have previously thought that dealing with death is something with is inevitably common as a Doctor. This shows that medicine can really be chosen to suit you, and hugely warped around your personality and what you want to do.

The road to being a doctor, is undoubtedly a long and winding long. Five or six years at med school, two foundation years, specialist training and a LOT of exams. However, I have no concern about whether or not it is worth it – it is an incredibly interesting, rewarding and important career, and the process is fitting considering as a doctor, you never stop learning. I learnt a lot from this talk about the stresses associated with being a Doctor, that many of these come from dealing with a huge system and not particularly the patients themselves. There are always quotas and deadlines to meet, making a hospital environment a fast moving one. It was emphasised during this talk, that being a doctor is not a career, but a lifestyle choice. While this is something I have witnessed first hand, it was not something which, before now, I had considered. Perhaps because I have taken it in my stride as an expected part of the job, but something I thought well worth mentioning.

Dr Christopher’s talk opened my eyes up to a field of medicine I was not previously aware of, and has encouraged me to take a look into what other specialisms which I am unaware of, are available. However, it was also an honest talk, the pros of being a doctor were equally weighted with the cons – moving around a lot, dealing with death, bullying in medicine and the stresses of the job. This appealed to be as I did not feel like I was looking onto the profession through rose-tinted glasses, and that some of the realities of being a doctor were brought to my attention.

So You Want to Be a GP – Dr Mohammed Saqib Anwar 

I had never even considered a career as a GP before this talk, I was convinced there would be little variety and an extortionate amount of time-wasting patients. However, this talk proved to me how a GP is often the first point of contact of the NHS. The first time a patient brings their potential illness to the attention of a medical professional, and that it is not only physical illnesses GP’s have to worry about it. Any doctor has a duty of care, and this extends far beyond diagnosis – it is incredibly hard for a patient to confide in you, if you are not approachable or have not build a rapport with them. Working in the medical profession is not about preventing death, it is about improving quality of life and providing standardised care to everyone. Those who repeatedly ‘waste time’ through appointments are not actually wasting time, as they are concerned about their health – the one time you turn them away, they may actually have fallen ill.

Being a General Practitioner is not a boring job, variety is encountered through clinics everyday. Although, the opportunity for other roles was highlighted to me throughout this day. Dr Saqib Anwar has a huge roles in media management, is faculty chair at the Royal College of General Practitioners and a primary care adviser for Care Quality Commission. When giving us a run through of his last two days, it included press releases, meetings and clinics – showing the life of a GP to be much more interesting than I initially thought. These two speakers were incredible, and gave a thoughtful insight into life as a doctor is two very different roles. My eyes have certainly been opened up to the prospect of different specialisms – even though it is years away.

The last speaker I would like to mention however, is a F2 student. Medicine is competitive, and not everyone gets in first time around, however this speech demonstrated to me that if it is truly what you want to do, there is more than one pathway into life as a doctor. This junior doctor was one of those people, and went on to do a biomedical sciences degree. After these three years, he gained a place on a graduates course – and from what I could see, hasn’t looked back since. So as a final message, don’t give up. Getting into med school is tough and challenging and just because you don’t achieve it first time around, doesn’t mean that you won’t make an excellent doctor.

This was only a small aspect of the day, but these talks definitely opened my eyes up to the endless possibilities within medicine. The day itself, was another affirmation that this is what I want to do, and worth the hard work. I learnt not only about the variety of life as a doctor, but left with some negatives to consider and a yearning for the next eighteen months to hurry up, so hopefully I can start med school!

Sources: RSM Medical Careers Day [23.03.17]

Rat Dissection

This week, as part of our biology AS I dissected a rat. As someone who is vegan, this was morally quite difficult for me, however once I had overcome my initial emotions, I learnt a lot from the practical – both about anatomy and ethics.

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I found it incredibly interesting to look at the ratio of the length of the rat and its small intestine, which was easily 2 if not 3 times longer than the rat itself. We focused initially on the digestive system, locating the stomach, ileum and large intestine. This was incredibly useful in realising what we have learnt about the surface area and ‘coiling’ of the small intestine, and how this helps absorption. What was also particularly apparent was how large the liver of a rat is, while not surprising due to its vast number of functions such as deamination, it was by far the largest organ inside the rat.

I then went on to dissect the chest cavity of the rat, removing its ribs using sharp scissors and a blunt nosed seeker. I was surprised with the positioning of the lobed lungs, as I found a particularly large right lung but a  considerably smaller left lung. However, this makes a lot of sense as the heart is slightly angled towards the left hand side of the rat, and the left side of the heart is larger than the right – therefore a smaller lung compensates for the larger side of the heart.

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I drew a scientific drawing of the chest cavity of my rat (left), representing what I could see in the clearest way possible. This was a good opportunity to practice this skill, however the dissection skills I learnt were of much more importance. The significance of making a clean incision and angling your scissors up, to keep the insides intact, but as I progressed through the dissection I also found I was picking up the right tools more frequently – those which would do the least damage to the organs.

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While I can’t say I’m an aspiring surgeon, this was an incredibly interesting experience and a huge personal achievement. I do believe that I would find operating on a human, who could consent, much less morally conflicting, than on an animal bred for dissection. Although, this experience has allowed me to partake in something I may find hard to agree with, it has taught me to put my feelings aside to do what is important (in this case, for my learning). This is something which applies easily to a medical professional, and a realisation I will take with me into my future career.

(I hope no-one is offended by these photos, and if you’d rather me take them down please don’t hesitate to leave a comment)

Marie Curie

Recently, as I’ve walked through my town and through London, I’ve seen several people selling yellow daffodils – a symbol for the Marie Curie charity. I thought I’d take a look at what it is they do, the support they provide and how such a phenomenal charity has influenced lives.

The Marie Curie charity logo.
The Marie Curie charity logo.

Marie Curie is a charity which is committed to providing care to everyone based on need, without taking into account their diagnosis [1]. They pride themselves in helping terminally ill people stay at home until the end of their lives, making the process more comfortable for many. They work with hospices, charities and the NHS, reducing the need for emergency hospitalisation and while most importantly benefitting people, they also help to cut hospital costs [1].

The research which Marie Curie undertakes focuses on finding the best ways possible of caring for terminally ill people, and improving their quality of life. This is a goal proven to be increasingly achieved as 99% of patients rated their overall experience as good or very good and 96% said they were involved by the staff as much as they wanted in decisions about their care [1].

Charities such as Marie Curie are so important in caring for terminally ill people, and relieving the NHS of some demand. When one of my best friends mum was being treated for cancer, she had a Macmillan nurse and I know that she supported them all through the process. It is integral to remember that these charities run on donations, and the care they can provide depends on the money donated. Without these funds they cannot function, so it is not enough to just admire a charities work, but important to support it too. They are great for offering help to everyone possible, regardless of age, income, or any other factor. While before I have realised how important these charities are in providing care for many terminally ill people, I did not previously consider the benefits provided to our healthcare system. Next time you see a donation box, please be sure to spare your loose change.

[1] https://www.mariecurie.org.uk/who/our-history [accessed on 12/03/17]

Making applying to Med School a little less daunting…

I thought I would do something a little different and more relaxed this week, and share with you what I’m doing towards application to medical school, and where I’m currently at with it. Suddenly, UCAS has been sprung on us at school, with lessons on how to use ‘Unifrog’ – a website which helps categorise universities and helps you see what each university can offer,  the booking of open days and study skills lessons about how to avoid plagiarism. It has taken me a while to realise how I think is best for me to progress with my application, and I thought I would share it in the hope it will at least help somebody consider their own!

Something I have been doing for a while, and would recommend to everyone, is keeping a word document with prospective ideas of what to include in my personal statement. Any interesting thoughts, articles or books I’ve read and found fascinating, alongside events I’ve attended I have kept a record of here. Just incase I forget about how interested I was, or exactly how many things I have been dong related to medicine. However most importantly, I have kept a log of my work experience, and for each day written a little on how I found it, what I thought and learnt from it, and then what I want to take away with me, and perhaps apply to future situations. For me, this has been crucial, as each time I add to this document I reread what I have previously written, and it reminds me of everything I have forgotten I’d learnt.

Similarly, it is never too early to be taking a look at University websites and league tables, and booking for open days are also now (mostly) available. I know that at the moment, I’m not entirely sure where I want to end up, and am incredibly keen to ‘feel’ a university and city as opposed to scroll through a website. I live surrounded by fields and farms, and I know that potentially moving to a city will be a big change for me, one which I’m excited for, but I definitely feel like I want to end up living and working somewhere I’m comfortable. Consequently, I think visiting universities is important, and am more than happy to miss a few days of school in June/July to ensure that I am happy with my choices! Having said that, I don’t think my Dad is too keen on all the petrol…

Another thing I think is important to mention, is that you don’t have to know. Everyone is new to this process so take your time getting to grips with new lingo, the application process and being confident in your decisions. Personally I would rather take longer over a decision and make sure I feel its the right one for me, than rush into something because all my friends are doing it. Take your time and read around – starting early means that you’re in no rush to make important decisions.

Please don’t take this blog post as gospel, and don’t suddenly panic if you haven’t started thinking about  applications. This is just what I’m doing and what I feel is working for me, and I have shared it only in the hope that it may help other people. I am not ready to apply for medical school by any means, just merely dipping my toe in the water to see what exactly the process I have to undertake in the future is. I want to wish everyone good luck with their future applications and with their journeys towards becoming a doctor. 🙂

 

Nature’s Medicine Cabinet – from Root to Remedy lecture

At the Cambridge Medicine Masterclass earlier this month, I listened to a lecture led by Sonja Dunbar, and was truly intrigued. If I’m honest, it was the lecture I thought I would be least interested in, as I expected it to focus on herbal remedies and the likes, yet it was much more medicine focused.

66% of all drugs have their origins in nature, and infant 80% of people in underdeveloped countries rely on traditional remedies from plants. Thus, their used simply cannot be ignored. Yet, what was a really interesting proposition was why are so many compounds in plants beneficial to humans? It is absurd to think that plants exist for our benefit, there are abundant defences to stop us using them. Spikes, thorns, bristles and chemical poisons all with the intention of helping the plant live longer, and protect the plants form those who are likely to eat it. A key example of this is the classic stinging nettle. These contain histamine, responsible for the itching felt after a sting and acetylcholine, a neurotransmitter. These are contained in a trichome, a specialised ‘hair’ in plants which is very similar to a hollow needle. Alongside this, stinging nettles contain Leukotriene, which promotes information and causes blood plasma to leak out of the membrane and lysosomes to swell, and serotonin. All of these chemicals are pumped in you your body when you are stung by a nettle.

Holly

This leads us to the scarcity-accessibility hypothesis, where a plant in an environment where it is more likely to be eaten, for example when other plants are scarce is likely to have the most defences. Examples of such plants  are Holly and cacti, both of which have visible mechanical defences – holly with its spiked leaves, and cacti with their needle-

cacti-needles_3cc3cf1c0f513010like spikes.

An interesting example of a plant which attempts to deter you form eating it, is the chilli. Chill is detected by TRPVI, the same receptor as vanilla, and vanillin and capsaicin are in fact structurally very similar. However, vanillin cannot get through the cell membrane, yet capsaicin can, and therefore binds to the receptor and tigers the brain into thinking you’ve eaten something hot. For most humans, this would not be a pleasurable experience and would put you off eating a chilli again. However, it gets better. Chilli’s receive no benefit from being eaten by mammals, as we grind and crunch seeds up due to our molars. Their seeds are therefore broken apart and cannot germinate to produce more plants. Although, birds eat chilli’s and don’t seem to find them hot. Why? Because birds don’t crush or grind the seeds, simply pass them through their digestive system and disperse them. They can travel great distances in a short space of time meaning that very little competition between the plants remains, and so birds do not find chilli’s hot, as the plant benefits from being consumed.

So, what are some examples of plants used in medicine? Foxgloves, contain digitoxin which helps to controlyour heart rate. It is a cardiac glycoside which interferes with sodium-potassium pumps, calcium ions and polarisation. In a high dose, it causes irregular heart rates, yet in a low does, it is very useful. Thus, from digitoxdigoxinstructurein digoxin has been developed, with less side affects and thus less associated dangers than the ‘pure’ substance, but with a very similar chemical structure.

Similarly, Aloe Vera contains 98.5% water, mannose-6-phosphate sugars and a collagen triple helix. It can be used in the treatment of thermal and radiation burns. It has been known to reduce swelling, stimulate faster tissue synthesis and help keep the wound clean and hydrated due to the high water content. Thus, it is used in many suncreams, after suns and in a gel to help prevent wounds from infection.

The lecture also spoke about the 2015 Nobel Prize in physiology or medicine. In 2013 there were 198 million cases of malaria, and is a disease which can easily escape detection due to the life cycle of the parasite. Theparasite enters liver cells where it can replicate for 2 weeks without detection. Eventually, the liver cells rupture and release the parasite, which consequently goes on to infect red blood cells. Here, the parasite escapes detection by wrapping itself in the cell membranes of cells from the organism – which will not be recognised as something harmful by the immune system. Cinchona  is an example of an early malaria remedy, which was so heavily sought after the plant nearly went extinct. Artemisinin also treats the fever of malaria, and with cold extraction, reduces 100% of the parasite load in monkeys and mice – incredible. Consequently, the death toll form malaria in the past 15 years has declined by 50%, and it is great to see the Nobel Prize being awarded for a medicine being developed for disease in underdeveloped/developing countries. This is because it takes around 12 years and £1.2 billion to take a drug to market, not something which is affordable to such counties, but malaria is a disease which takes millions of lives, and so any advancements could save countless lives.

What I learnt from this lecture is that biodiversity mattersin the hunt for new drugs. There are still plants we don’t know exist, and plants we do know exist but don’t yet recognise their uses. In destroying the biodiversity of our world, for example by deforestation, we could potentially be destroying cures for diseases. The ecology of the world we life in is important to allow us to survive, and while plants don’t exist for out benefit, they are incredibly useful.

(Source: Sonja Dunbar, Nature’s Medicine Cabinet Lecture, Cambridge University)

A Pharmaceutical Lecture by Gwenan White

Hello!! A couple of days ago I attended a pharmaceutical based lecture at my school, spoken by a woman who works for the company AbbVie, a comparatively small company specialising in virology, immunology, neuroscience and oncology. It was far more interesting and relevant to me than I initially thought it might be, and I took away some key lessons which I thought I would share with you.

It typically takes around 12 years to bring a medicine to life – over a decade of isolating compounds and mixing constituents and clinical trials. What interested me within this process was the use of animal testing. Animal rights are something I feel strongly about and if I’m honest, I’ve always been opposed to their use in science. However, recently I attended a lecture on the ‘naked mole rat’ (hopefully a blog post to follow!) and then this lecture, which has made me consider the benefits and boundaries of using animals in science. While I won’t dwell on the use of the naked mole rat too much as it is something I’d like to write about later, it was a talk which demonstrated to me a clear ethical and moral use of animals in research. In the pharmaceutical industry however, it is not always clear how these animals may react to the drugs within their systems. Although, it was emphasised to me that as few a animals as possible are used with the most effecting but least affective (in terms of side affects) treatment option primarily. Or surrogate models can be used preventing the need for animals. This showed me the diverse range of steps needed to take a medicine to market, and that medicines must not only be effective and ethical but also cost effective.

The ethos of the AbbVie  in the talk was that they aim to combine the expertise and stability of traditional pharma with the focus, culture and innovative spirit of biotech. This really summed up the state of modern science and medicine for me, we are in a stage where we a gradually moving away from the reliable treatments and options for those which may be slightly more risky but give patients better quality of life post treatment. For instance, when watching the BBC documentary ‘Hospital’ last week I was captivated by the innovative treatment of a 98 year old man. He first, had a compressed heart valve inserted into his heart through a blood vessel in his leg, which was then synchronised with the contraction of his heart using a screen. However, the incredible surgical techniques didn’t stop there, he later had a wire mesh inserted into an artery which led to his brain to remove a clot causing him a stroke and possible brain damage. This being a thrombectomy, which if carried out within 6 hours of a stroke results in full blood flow and a reduced risk of brain damage. Similarly, in the same documentary a new treatment method was used to treat an 18 year old girl with Sickle Cell disease, where her immune system was depleted using chemotherapy and radiotherapy allowing her to engraft bone marrow with a match of only 50%. This is an incredible feat. Linking this back to the lecture, it is through combining new ideas and treatment methods with the stability of old ones which medicine can and is advancing.

Like much of the news these days, the talk did also mention that out current healthcare system is not sustainable – we have an ageing population and more than 1/4 of people in the UK have a chronic illness. All of which need treatment and all of which costs money. A statistic which was raised is that every 36 hours 1,000,000 people pass through the NHS, and we do not have a healthcare system which can deal with that demand. What we do have however, is new means of empowering patients to look after themselves – who hasn’t seen an advert for an online GP? Or advice from the NHS website? What is crucial is that doctors need recognise the role of the patient in their own treatment – diet and lifestyle choice can hugely influence what treatment a person may later need, but also knowing when and when not to see a doctor of GP is crucial. The NHS does not, essentially, have time to waste. Having said that, there should be no ‘fear of finding out’ what the doctor has to say, and people should not avoid the GP Surgery because they are scared they are ill – they should act quickly and potentially save their own live, or give themselves years. If not, at least just peace of mind.

So these are some of the key ideas I took from a pharmaceutical lecture I thought would just be about the development of drugs, which was actually much more patient focused for an industry which is not allowed direct patient contact – charities and organisations on patient’s behalf must be used instead. Therefore, I would encourage everyone to attend some science or medicine based lectures, and not to be afraid to take notes. Taking notes is what I’ve found has really allowed me to write up and reflect on what I’ve learnt, and that’s definitely worth more than a few snide comments. I hope you’ve found this interesting and hopefully I will write more reflections on lectures in the future.

Delays in the NHS

Today, I read a rather shocking article by the BBC, entitled ‘The 10 Longest Hospital delays exposed’. The NHS is obviously a system which needs revamping, reorganising and millions of pounds invested in it to help it run. However, I found this article a very negative approach to what is happening. While yes, there is a chronic bed shortage and hospitals are overrun, there are still millions of people being treated each day.

The article does however, highlight again what I became aware of after watching the BBC documentary ‘Hospital’. This being, that many patients are occupying a bed in a hospital when waiting for a place in a care home, cottage hospital or specialised clinic. Consequently hospitals are ‘filling up’ as patients keep being admitted each day, but few being discharged. The links between these healthcare services are shown to be fractured, as sometimes communication between clinics, hospitals and care homes is not as frequent as necessary.

Aside from this however, the article does present key issues in the NHS. The greatest rise reported being 449 in a mid Yorkshire hospital. The graph clearly shows that the number of patients who see themselves as ‘stranded’ in hospital with nowhere to go for care when discharged, is on the rise, as has been clearly on the rise since 2014, and doubling the number of patients delayed in 2016 compared to that 2010.

For me, this highlights that many older patients who require access to care packages, including nursing home places and help in the home for daily tasks, such as washing and dressing, aren’t receiving this help. Quite possibly in the time that it takes for these links to be made, lives could be saved if other patients had access to these beds. The article also states that ‘Over the past four years, the number of older people getting help from councils has fallen by quarter, while the NHS district nursing workforce has shrunk by 29% in the past five years.’ To me, this screams lack of funding, and is an example of how cutting funding of the NHS has caused a cut in services, which has hindered the functioning of not only hospitals.   Aside from this, its is incredibly important to remember that these elderly people should also have dignity, and lives as independent and healthy as possible – this is not just being confined to a bed in hospital, unstimulated.

Restoring faith however, the article does mention that councils will be spending £16 billion this year on social care. This should help to reinstate the links between the services provided and provide those who should not be in hospital with adequate care elsewhere, and those who need hospital care access to that. Initially, this article sparked my anger, because I believe that the NHS is an incredible service which saves millions of lives, and to pick out the negatives is not necessarily representative. However, I am not naive enough to think that it is without its problems, but a system which deser

ves saving. Thank you for reading 🙂

This is the link to the BBC article…

http://www.bbc.co.uk/news/health-38896155

Medicine Masterclass – Cambridge

For me, yesterday was a truly inspiring day. I attended the Cambridge masterclass for Chemistry (natural sciences) in November, and can honestly say while an interesting day it proved that Chemistry is definitely not what I want to pursue. The recent medicine day however contributed greatly to my desire to be a doctor, with 3 medicine based lectures. It was entirely useful as it gave a quick taster of the ‘science’ aspect of medicine, what information lectures may contain and even how to approach studying medicine.

Lecture 1: How blood goes around the body (Dr Dunecan Massey)

Lecture 2: Nature’s medicine cabinet: from root to remedy (Sonja Dunbar)

Lecture 3: Pain and lessons from the naked mole rat (Dr Ewan St. John Smith)

We experienced 3 scientific lectures and an admissions lecture. While the day was a little daunting as I went alone, it was easy to meet likeminded individuals and learn about why they want to study medicine, alongside what they thought of their work experience. I also found the Q&A sessions with students useful in asking the ‘real’ questions and hearing the honest answers from people with first hand experience of the process. What did I learn from the day? While a lot about naked mole rats and intestines and the interesting aspects of botany, these were not the most significant aspects. It confirmed that I will happily walk into a day of lectures on medicine, and that it is truly a career I am interested in. Not only because of the people I will meet but because of the science behind it. Having the knowledge to be able to improve and save lives is an incredible opportunity and one I’m certain that as a future doctor, I will cherish.

I recommend the Cambridge Masterclasses to any student considering medicine or Cambridge, as they are an incredible opportunity to experience both the course and the city. I think the University has an incredible and unique teaching style, and it is definitely one I would to to consider further in the future. I am hoping to decipher the notes I made in the lectures and blog them in the future, so keep a look out!

Travel and Disease

This blog post is mainly allowing me to put together ideas and research I have found, and to make sure I understand the concepts I will be talking about tomorrow at my schools Biology Discussion Group (BDG) however I thought it was an interesting topic. The biology discussion group from my school meets fortnightly to discuss scientific and ethical topics. In preparation for our session tomorrow, I have been reading up on ‘travel and disease’ which is this weeks topic. I can’t say it’s something I had given much thought to before trying to find some articles to read for this weeks discussion, however, the way epidemics are now predicted is somewhat fascinating.

I always believed that diseases spread from country to country through an infected person jumping on an aeroplane, train or bus to go on holiday. Thus, I thought that if you wanted to predict the spread of a disease, you would look at how many people from one country travelled to another, and how many of those individuals were likely to be infected. Take the Zika Virus, if lots of people were to travel to Rio for the olympics, I would have thought it would spread quickly as each athlete or spectator returned home potentially carrying the disease. I have found however, that it is much more than this.

How quickly a disease can spread depends on two factors – population distribution and human-mobility networks [1]. Thus in a sense, I guess my initial theories were half right. How easy it is for a person to move from place to place is a factor. Consequently, it is not if one person travels from one country to another, but how many people they meet along the way. If an infected person walks into a shop, you then have to consider how busy the shop is likely to be at that time, and how many people the shopkeeper is likely to encounter between the time of infection and the time at which they are potentially unable to work anymore (say at diagnosis). Similarly, if an infected person sneezes on a £10 note and that therefore becomes infected, how many people are likely to encounter that note until it is no longer infectious? The contact goes on and on.

Here are some key points to consider when modelling epidemics:

  • Modern pandemics spread more quickly and less uniformly than those in the past e.g. The Plague. Why? Due to the global air transportation network and and the complex, integrated nature of much of our society.
  • To model the spread of an infectious disease, you must take into account the biological and physical principles alongside social and behavioural factors.

Therefore, what the spread of disease comes down to is actually very minimally air time, but in fact human behaviour. If you know what a population is likely to do, i.e. how many different people may encounter another in a day, the spread of disease is much easier to predict. The more research into human behaviour there is, the more likely it is that we are able to predict the spread of disease accurately [1].

Similarly, a disease is not going to spread across the entire world or even Europe, at the same rate. It may spread between certain cities or countries quickly due to large amounts of human mobility networks and an interactive society. Yet for others, there may be very little contact between two cities and very few people may move from one to the other, meaning that disease would likely spread at a very slow rate.  So, this theory doesn’t work unless we move from analysing small social groups in individual towns or cities, to analysing social aggregate states made up of millions of people [1] – in order to gain a mean activity.

The problems we face with this is that people’s lives are essentially non-conformal. Not everyone does the same thing every day, and each person has their own agenda. As a result of this, standard deviations (the spread of data) are typically extremely large, and there are no typical values for many of the quantities – e.g. the amount of times a person eats out a week.

Consequently, predicting epidemics is no easy feat. There are so many factors to include that it is very rare we will be able to pinpoint the exact spread of a disease. Having said that, techniques allowed scientists to predict the peak in the swine flu pandemic in the USA between late October and November 2009. Whats to learn from this? That the spread of disease is largely due to human behaviour, and that in understanding more of human behaviour we could open many doors to new methods of predicting pandemics and epidemics.

[1] The Flu Fighters – Physics World  – as of February 2010

I will link the podcast to this BDG session here once it has been edited 🙂

http://wgsbdg.podbean.com/e/travel-infectious-disease/