Monthly Archives: April 2017

PrEP – preventing HIV?

A couple of weeks ago, I read an interesting, if not startling, BBC article surrounding the Scottish NHS. This lead me to research more into the treatment which the NHS in Scotland has recently approved to fund and routinely offer to its people. This treatment is known as ‘PrEP’, and it has been proven that a daily dose can protect those at risk of contracting the virus [1].

How does PrEP work?

PrEP is an anti-retroviral drug, fitting with the nature of HIV as a retrovirus. This means that HIV is composed on RNA, and contain reverse transcriptase, which is an enzyme. This allows the viral RNA to be transcribed into DBA after entering a host cell. This DNA can consequently be integrated into the DNA of the host cell and expressed – one of the key problems with treating HIV is that it is a retrovirus. [2]

PrEP therefore, prevents the virus from multiplying if it enters the body [1] without major side affects [4] . Therefore, it is a preventative treatment as opposed to a ‘cure’ for HIV. Taking the pill consistently each day has been shown to reduced the risk of HIV infection by 86% alone [4] – a staggering number, however with other preventative methods such as the use of condoms, this number increases [3].

What are the benefits?

What is remarkable about this drug however, is that it is estimated 1900 Scottish people could benefit from the drug, and the huge amount of money (around £450 a month per person) which the Scottish NHS is investing, [1], but also saving. For each person who does not become HIV positive due to the use of PrEP, the NHS in Scotland with save £360,000 in lifetime treatment costs [1] – prevention is better than cure, they say.

I think this is huge step in the right direction, when fighting an incredibly stigmatised disease. The treatment has the potential to help improve quality of life, save money and to reduce the numbers of those suffering with HIV in the future. I can only help that our NHS follows in the steps of NHS Scotland

[1] http://www.bbc.co.uk/news/uk-scotland-39552641

[2] http://www.medicinenet.com/script/main/art.asp?articlekey=5344

[3] https://www.cdc.gov/hiv/basics/prep.html

[4] http://www.tht.org.uk/sexual-health/About-HIV/Pre-exposure-Prophylaxis

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