A Right to Die

This post is inspired by an article I read on the BBC health page about a man – Noel Conway – suffering from motor neurone disease; he had recently lost a case at the High Court, meaning he has been refused the right to an assisted death. I found this a very moving article, as I came to understand the reasoning behind Noel’s decision to challenge the law (which currently states that a person who assists someone in taking their own life could face up to 14 years in prison).

I have had numerous debates with many different people surrounding the topic of assisted suicide, and whether it should be both legally and morally acceptable, yet I still struggle to decide what I believe is right. Watching Terry Pratchett’s documentary ‘Choosing to Die’ enabled me to appreciate why assisted suicide could become so desirable for someone, especially if they are terminally ill. However, it also forced me to reflect on the implications and impact that death has on the family and friends of the deceased.

I have chosen to write about this topic because I feel it is one of the most controversial debates, especially for those considering a career in medicine. I would like to point out that the arguments and opinions expressed in this post are not my own; I am merely outlining the main arguments for and against assisted suicide.

For assisted suicide

  • Forcing a person to live a painful and uncomfortable life, in which their state of health may only worsen, is unethical
  • Terminally ill patients are going to die anyway; it is kinder to both the patient and their family to die when they choose to. This allows them to say a proper goodbye to their family and friends, enables them to set their affairs in order and means their family do not have to witness their loved one die a painful and undignified death
  • Assisted suicide allows a patient to die with dignity
  • Every person has a right to die, as they have a right to live, how they choose
  • Hospital resources are stretched to the absolute limit; the longer a terminally ill patient lives in hospital / with palliative care before they die, the more money and resources they use up. Allowing this terminally ill patient assisted suicide means these resources are free to help other patients

Against assisted suicide

  • Death of a loved one is very difficult to deal with, especially if they did not ‘have’ to die
  • What if the patient recovered from their illness – their death (and the pain caused to their family) would have been unnecessary
  • Vulnerable people may avoid seeking medical help for fear that euthanasia may be recommended
  • Vulnerable people may be exploited – forced to die to save money for example
  • Human life is priceless – it would be unethical for someone to die to save hospital money and resources
  • Religious argument – (I believe that) all religions consider life a gift from God, and that to take life away is to act as God, which humans do not have the right to do

As I said before, these arguments are not my own opinions; these are just some of the most compelling points I found whilst researching this topic – it is up to each individual to decide what they believe is morally and ethically right.

Thank you for reading!

The Suffering of the NHS

As I said in my previous post on the shortage of beds in NHS hospitals, it is no secret that our healthcare system is struggling, and with the winter fast approaching, it seems that the situation is only going to worsen. Despite the Department of Health insisting that “the NHS has prepared for winter more this year than ever before”, hospital chiefs are still warning that the worst is yet to come, and are calling for an extra £200-350 million of funding to be made immediately available. This is necessary, they say, to pay for extra staff and beds to cover the expected strain on the NHS over the winter.

In addition to this, Professor Ted Baker, the recently appointed new chief inspector of hospitals in England has stated that the NHS is not fit for 21st Century England. He pointed out that there has been a major shift in the population structure of the country since the 1960s and 70s, yet the same model of care is still being implemented over 50 years later. Almost ironically, despite being founded on a profession which is constantly evolving, the NHS itself has failed to change and adapt to keep up with the rest of the country. Prof Baker believes that the initial mistake was a lack of historical investment; money was coming in 15-20 years ago, but it was not spent on the right things, such as transformation of the model of care.

With concerns about both the short term and long term future of the NHS, Prof Baker has said “capacity is being squeezed all the time […] there comes a point at which the capacity isn’t there”. NHS Providers have agreed that without an emergency cash bailout, the NHS is going to face the worst winter in its history.

As an aspiring doctor, I find it very worrying that the NHS is in decline; it has been considered by many to be the greatest healthcare system in the world, offering healthcare to all, free at the point of delivery, yet it seems like this may not be the case for much longer. Sadly, privatisation and charging for treatment may become much more common in the future, although this is likely to only result in greater fragmentation of the service.

Thanks for reading!

Super malaria

It has recently been announced that the world is now facing a threat from the so-called ‘super malaria’ bug – a strain of malaria which is resistant to the main drug – artemisinin – used to treat malaria. Concerns are not only being raised because of the high resistance of the strain, but also as a result of the speed with which ‘super malaria’ has spread; it initially emerged in Cambodia, but has since spread to southern Vietnam, Laos and Thailand. If a new treatment is not quickly discovered, all forms of malaria could soon become resistant to artemisinin, which could have catastrophic effects, especially in Africa, where 92% of all malaria cases occur.

Currently, over 210 million are infected with malaria each year, but experts are concerned that with malaria potentially soon to become untreatable, the 770 000 people that die annually from malaria may well rise to millions of people. For the moment, all that can be done is to ensure that all areas where malaria has been eradicated remain this way, to prevent the spread of the ‘super malaria’ any further.

This is one example of the much greater problem of superbugs, commonly caused by the unnecessary, improper or overuse of antibiotics to treat illnesses – when a course of antibiotics is prescribed when it is not needed, or when the course of antibiotics is not finished, this allows for bacteria with resistant mutations to survive and reproduce. This then means resistant genes are passed on to future generations of bacteria, and consequently, the bacteria cause more problems, as they continue to infect people, but there is no longer an effective treatment.

At the moment, it seems there is not much that can be done to prevent the spread of ‘super malaria’, except contain it in as small an area as possible, and hope that an effective treatment is soon discovered.

Thanks for reading!

Supermarket health checks

Over 200,000 people suffer a heart attack each year in the UK, but with new proposed health checks, at least 9,000 heart attacks may be prevented. NHS England and Public Health England are encouraging crucial health checks to be carried out in supermarkets, football stadiums and by firefighters doing home checks, as it is believed that only half of those eligible for regular health checks end up having them.

These checks look out for signs such as high blood cholesterol levels or abnormal blood pressure which may be indicative of a more serious underlying health problem; most commonly cardiovascular diseases. Therefore, as part of an initiative to prevent thousands of unnecessary deaths caused by stokes, heart attacks and coronary artery disease, NHS is asking local authorities to step up and carry out simple health checks out in public, as opposed to the more traditional GP practice. Already, in Cheshire, firefighters have received funding to promote the idea of getting these checks done, and referring people onto services which can help should there be cause for medical concern.

Personally, I believe these checks to be a fantastic idea; I think that, often, people get caught out by their health because they simply don’t entertain the idea that they could be at risk of high blood pressure (for example). By encouraging health checks to be performed in places where the majority of the general public will likely come across in their day-to-day lives, not only could it help prevent many people from suffering illnesses and even fatalities, but also raise awareness, potentially causing people to rethink their lifestyles and perhaps trying to be more active or eat healthily.

Thanks for reading!

“The Immortal Life of Henrietta Lacks” – Rebecca Skloot

Henrietta Lacks was an ordinary woman who grew up in rural Virginia, America in the first half of the 20th century, and like many other black Americans at the time, lived a fairly simple life. She sadly died from cervical cancer on 4th October 1951, leaving behind her husband and cousin David ‘Day’ Lacks, and her five children. What happened next changed the history of medicine forever, but no one in her family would find out until much later, in 1975.

I first heard about Henrietta Lacks when discussing some of the ethical issues revolving around diagnosing and treating patients, and decided to read the book ‘The Immortal Life of Henrietta Lacks’ to find out a bit more. Before I began, all I knew of Henrietta was that she was a poor black woman, from whom someone had taken some cells – now known as HeLa cells – which had been used all over the world for all kinds of research, from developing a polio vaccine, to being exposed to nuclear radiation to see how this would affect human cells. Incredibly, Henrietta’s cells have lived and continue to live for far longer outside of her body than they ever did inside her body whilst she was alive, and can now be purchased by almost any who requires them.

As I mentioned before, Henrietta eventually died from cervical cancer, but before she did, a man named George Gey took a sample of cells from her tumour and cultured them, and it was there that the cell line known as HeLa was born. However, neither Henrietta nor any of her family members were aware (and consequently had not given any consent) that this had occurred, or even that she had had cells taken from her at all. Before I read this book, I had struggled to understand why this was such a controversial topic –  I couldn’t see what difference the consent of the patient would have ultimately made, given that she died so soon after, and her cells were only being used for research purposes – nothing wrong with that… or is there?

As Skloot makes clear in her book, there are a number of reasons as to why Henrietta’s cells have caused so much controversy; firstly, when Henrietta’s family eventually did find out that their mother’s cells were still very much alive years after her death, it caused them great deal of worry, especially for her daughter Deborah. Having struggled at school as a result of being near-deaf, Deborah understood very little about what the existence of her mother’s cells actually meant – she worried that her mother was still alive and and being researched on to test possible new drugs and vaccines, and that all this time she was being caused pain; consequently becoming very ill as a result – she developed depression and anxiety, and even suffered a stoke as a result of high blood pressure caused from the stress of learning about her mother’s cells. As well as this, Deborah’s brothers Sonny, Lawrence and Zakariyya Lacks were especially annoyed to learn that their mother’s cells had been sold all around the world and had raised billions of dollars, yet they never saw a single penny of it. Whilst they were perhaps not so worried about the cells as Deborah was, they thought it ironic that their mother had contributed so much to medicine yet they were unable to afford basic medical insurance.

Additionally, in the 1980s, several years after it was made publicly known that HeLa cells had come from a  woman called Henrietta Lacks, Henrietta’s medical records were released to the public, again without the consent of her family members, completely breaching the idea of patients having a right to medical confidentiality. Much more recently, in March 2013, HeLa cells had their entire DNA genome sequenced and published, which was then withheld by the researchers after objections were raised by the Lacks family.

Aside from the controversy, what this book also highlighted for me is the fact that these cells really did come from a living person, who had a life and a family. I think this is very important to recognise because so often in science it is easy to distance ourselves from the actual human or other organism which we are studying, and perhaps can cause us to act potentially less ethically or morally correct than we ought to – I hope to remember this in years to come when treating patients – that people are so much more than just their illness, and we have to allow for the fact that people have lives, families and beliefs they wish to uphold, and we need to respect these as much as we try to respect the patient.

I can highly recommend ‘The Immortal Life of Henrietta Lacks’ – it is not only very educational and gives you a lot to think about but is also very entertaining and a good read for anyone interested in science.

Thanks for reading!

Elephants – how have they beaten cancer?

As the constant struggle to find a cure for cancer goes on  in the medical world, it’s no surprise that scientists have been studying organisms across the animal kingdom hoping to find some inspiration, and therefore it wasn’t long before the phenomenon of Peto’s paradox was discovered.

Cancer is caused by damage to the DNA of a cell or cells in an organism, which causes disruption to the cell cycle, and constantly causes the abnormal, uncontrolled growth of a mass of cells which we know as a tumour. Given that cancer can arise from any cell, it would follow that organisms with a larger number of cells would experience cancer at an increased rate, yet it seems this is not the case. Whilst one in four people with cancer will die from it, only around one in twenty five elephants who have cancer will die, and the occurrence of cancer in elephants is significantly lower than in humans, so what is their secret, as surely an organism with 100x the number of cells should experience cancer 100x more frequently.

So what is their secret, decreased exposure to carcinogens? Skin better at preventing harmful UV light penetrating and damaging their skin? No, it all comes down to the tumour suppressor gene, p53, of which humans have 2 copies, and some elephants have as many as 40. The function of the p53 gene is to activate a protein which either stops cell division and repairs corrupted DNA, or induces the process of apoptosis – cell suicide. It also has the ability to limit blood flow to tumours to halt growth and can alert nearby immune cells to attack the tumour. Because elephants have so many copies of this gene, it appears that they are very good at tackling tumours and consequently cancer caused deaths are very much a rarity for elephants.

Thanks for reading!

The so-called ‘smart’ bandages

Work conducted at Swansea University’s Institute of Life Science is aiming to produce a bandage which can detect how wounds are healing and convey this information to doctors.

Through a combination of 5G nano-technology, which can sense the state of the wound at any given time, and the use of smart phones, to relay information about where the patient is and how active they are, this concept will provide doctors with a vast amount of information they never previously were able to have, and could help identify not only when a wound has healed fully, but also if there are early signs of infection, which may delay healing. Consequently, if the infection is treated with antibiotics before it becomes a problem, then it would speed up healing the for the patient, mean the wound is less likely to cause potential problems in the future, and save the NHS money in caring for the patient.

This is a very exciting idea, as it would allow clinicians to tailor treatment to the wound and individual person. In addition, if trials of the bandage are successful, it could also pave the way for bandages which are able to treat patients (for example, bandages with gel could react to environment surrounding wound and detect whether more gel needs to be released to hydrate wound more, or if gel needs to be reduced).

Such bandages could be produced by 3D printers to reduce costs, which again would benefit the NHS massively.

Thanks for reading!

Mass production of rare blood types

A team at Bristol University and NHS Blood and Transplant have managed to develop a method which allows them to produce an unlimited supply of red blood cells. Whilst it was previously possible to produce red blood cells in a laboratory, the cells died after producing around 50,000 cells (on average, adults have between 20 and 30 trillion red blood cells at any given time).

The new technique involves ‘trapping’ stem cells in an early stage, at which point they can grow and multiply indefinitely – essentially the stem cells have been made immortal. After a suitable quantity of cells has been produced, researchers trigger them to differentiate and become specialised as red blood cells.

Whilst there are no plans to stop using donated blood, such a technique could help when it comes to providing blood transfusions for people with a very rare blood type, as it is often very difficult to source rare blood types in such large quantities. One example of this is people from ethnic minorities, in which it can be almost impossible to match blood types. It also removes the risk of passing on diseases transmitted in the blood, such as HIV, malaria and septicaemia (although this isn’t really a problem).

However, there is a great cost associated with the production of these cells, and so it is unlikely that, at least for the time being, that these cells will be used on anything other than patients with very rare blood types.

Thanks for reading!

The Tsimane People

Recently, it was suggested that researchers have found a population with the healthiest cardiovascular system in the world, and it’s in the Amazon Rainforest – Bolivia, to be precise.

The Tsimane are a group of people who live, hunt and fish in the Bolivian lowlands of the Amazon Rainforest, and after extensive research, scientists have concluded that these people have the healthiest hearts in the world. So what is the secret: genetic protection? natural selection? medicine that offers immunity against CVD? No, its none of these things. The secret of the Tsimane people is that the hunter-gatherer lifestyle they lead is very healthy, and whilst it may not be practical for us in the UK to adopt this lifestyle, we can definitely learn some things from them.

Let’s look at their diet; they have a very high calorie intake from carbohydrates – almost 3/4 of their energy comes from rice, maize and a vegetable called manioc, which is similar to sweet potato. Then, some of their calories come from fat (14%) and the rest from protein. Secondly, they are far more physically active, with each person in the tribe averaging 16,500 steps a day, whilst here in the UK, the average person would achieve just under 10,000. Finally, and unsurprisingly, they some significantly less, meaning their bodies are not exposed to the huge number of chemicals found in cigarettes.

So can we learn from them? What has been concluded from this research is that the good diet and the lack of smoking places the Tsimane in good stead, but the exercise is believed to be what makes the biggest difference between their hearts and the hearts of people in the UK; whilst we may train intensely at the gym three times a week, and then sit down for six hours straight at work, the Tsimane are almost constantly on the move, so scientists suggest introducing exercise into smaller aspect of life, such as walking / cycling to work everyday, or simply using the stairs instead of an escalator.

Thanks for reading!

Stem cells – what are they, and how can they help us?

After my most recent post on multiple sclerosis in which I discovered that stem cells have the ability to prevent the MS from progressing any further, I decided to look into stem cells a bit more in order to gain a better understanding of what they are, and how they can benefit medicine in the future.

What are stem cells?

Stem cells are found in multicellular organisms, and they have the ability to differentiate and become specialised. In addition, they can also undergo mitosis to produce more stem cells. There are two main types: embryonic and adult (somatic) stem cells.

Where do they come from?

Embryonic stem cells – these cells come from the embryo when it is only 4-5 days old, meaning it contains only 100-150 cells at this point. At this stage, the embryo is known as a blastocyst, and consists of an outer layer of cells (trophectoderm), and an inner mass of cells which are undifferentiated.

Adult stem cells – such cells can be found throughout the body, and will remain in a quiescent (inactive) state until activated by disease or damage to tissue. Whilst most commonly found in the bone marrow, these stem cells can also be found in tissues such as the brain, the blood, the skin and the liver.

Uses

Stem cells now have a huge number of uses, given that scientists have figured out how to successfully remove them and encourage them to differentiate into all kinds of cells to treat all kinds of diseases and illness through growing new tissues or even entirely new organs (for example a trachea to replace one that had been blocked by a tumour).

Multiple sclerosis – multiple sclerosis is a degenerative disease caused by a fault in the immune system which causes it to attack nerve cells, damaging or destroying the myelin that coats them. However, scientists have managed to create a therapy which can prevent the MS from progressing any further (although it is unable to reverse damage already done). It is known as autologous haematopoietic stem cell transplant, and involves using chemotherapy to destroy the old immune system, and then using the patient’s own stem cells to produce a new one.

Whilst this remains a relatively new therapy, so far it has been a great success, and extensive research has shown that there are no long term effects and that MS does not return.

Treating burns victims – patients who have suffered extensive burning may be able to improve healing of the wound, reduce the formation of scarring and potentially even restore sense of touch in skin through use of stem cells. There is a large source of stem cells located just below the skin, which can be taken from a healthy area on the body and grafted on to the damaged area to engineer new skin tissue. The severity of the burn and how deep down the cells affected are depends on how much function of the skin can be restored.

Cancer – given that cancer is caused by the abnormal division and cell differentiation of cells, studying stem cells will give a better understanding of what causes a cell to differentiate and the signals it receives a releases during this process. In the future, this could allow scientists to learn what triggers tumours to form, how to stop them, and potentially how to identify cells which could cause tumours in the future.

Stem cells are also being used to treat cancers such as leukaemia, in which high doses of chemotherapy may destroy not only a cancerous tumour but also the healthy stem cells in the bone marrow. Doctors can harvest healthy stem cells from the patient or a donor and then put into a vein after a high dose treatment to replace the ones lost.

Ethics

Whilst the use of adult or somatic stem cells is generally considered to be ethically acceptable, there remains a great deal of controversy over the use of embryonic stem cells. This is because it involves creating multiple embryos to then destroy them, and many people are against this because they view it as killing an unborn child. However, others argue that because the embryo cannot feel anything and is not truly a child yet, that it is morally acceptable to use stem cells taken from an embryo.

There is an additional argument similar to the concept of ‘lesser of two evils’, in which people argue that whilst it may kill an embryo, it could save the life of someone who already has been born, although this is also a controversial argument in itself, as some say that it is immoral to value the life of one person over another.

In Japan, 2006, scientists managed to create their own embryonic stem cells, called induced pluripotent stem cells or iPCS and this could solve the ethical problem as no embryo loses its life in their creation. Despite this however, some scientists argue that iPCS are not quite the same as embryonic stem cells, and consequently, cannot yet be used in place of embryonic stem cells.

 

Thanks for reading!