Battling the Leader of Death

There are many illnesses, diseases and ailments in this world that we might all be subjected to. However, sometimes a treatment from your doctor isn’t the best way forward. Diseases and conditions are split into mainly 2 categories: communicable and non-communicable. A communicable disease is one which can be spread to another person through contact, for example, HIV/AIDS, polio, Tuberculosis, malaria, hepatitis and influenza. On the other hand, a non-communicable disease (NCD) is one which cannot be passed on from one person to another. It is non-infectious.  Currently, around the world today, NCDs are by far the leading cause of death in the world as roughly 63% of annual deaths are caused by them [1].

NCDs are split up into 4 categories: cardiovascular diseases (like heart attacks or strokes), cancer, chronic respiratory diseases (such as chronic obstructed pulmonary disease) and diabetes [1]. If we think about it, while these conditions are very different, they still have one thing in common: for most people, these problems could be solved with simple lifestyle changes, which is where public health plays a role.

Public health is the area in medicine which focuses on public health in terms of maintaining hygiene, studying epidemiology and disease prevention. It considers a population rather than a single patient and focuses a lot on holistic care (focusing on the whole spectrum of well-being rather than just the condition that might be affecting someone) [2]

Public health aims to influence larger populations into living a healthier lifestyle, and I believe that the best way to summarise it is ‘prevention is better than cure’. When trying to raise awareness about the conditions, public health campaigns are very effective to emphasise the ‘prevention’. Some examples of public health campaigns include:

  • Stoptober: this is a public health campaign which aims to encourage smokers to make an attempt to quit smoking [3]. If we refer to the 4 main types of NCDs, this would improve the situation of almost all of them! You would be less likely to develop a cardiovascular disease because smoking damages the lining of your arteries, leading to a build-up in fatty material which narrows the artery: this could lead to angina, a heart attack or stroke [4]. You would be less likely to develop cancers such as lung cancer or mouth cancer. You would be less likely to develop COPD as smoking damages the lining of your lungs [5]. Lastly, you would be 30-40% less likely to develop Type 2 diabetes. [6]
  • Change 4 Life: this is a campaign which aims to tackle obesity and encourages families to ‘eat well, move more, live longer’. [7] Today, we have an obesity crisis, especially with children. In England during 2016/17, 1 in 5 children in year 6 and 1 in 10 children in reception were classified as obese. [8] This has been linked to the fact that now, nearly 7,000 young children and young adults have been diagnosed with Type 2 diabetes, which is almost 10 times the previously reported amount. [9] Having this campaign would significantly reduce someone’s risk of developing a cardiovascular disease. People who exercise regularly (‘move more’) have a significantly lower risk of having a heart attack, and the most physical people have a disease rate 50% lower than those who live a sedentary lifestyle. [10] Furthermore, having a healthy diet (‘eat well’) means that someone is more likely to have better control over their weight, thus reducing the chances of being negatively affected by the knock-on effects of being overweight.

There are many other things which aim to prevent conditions before cure is needed. For example, recently, the Mayor of London has called to ban fast food advertisements off the tube. Also, the labels of ‘smoking kills’ on cigarette packets are also put there with the aim to put people off an unhealthy lifestyle and push them towards a healthier standard of living.

It is up to us now to decide how effective we want to make public health

By Muskaan Jonathan

  1. http://www.who.int/features/factfiles/noncommunicable_diseases/en/
  2. http://www.euro.who.int/en/health-topics/Health-systems/public-health-services
  3. https://campaignresources.phe.gov.uk/resources/campaigns/6-stoptober
  4. https://www.bhf.org.uk/informationsupport/risk-factors/smoking
  5. https://medlineplus.gov/ency/patientinstructions/000696.htm
  6. https://www.cdc.gov/tobacco/campaign/tips/diseases/diabetes.html
  7. https://campaignresources.phe.gov.uk/resources/campaigns/17-change4life
  8. https://digital.nhs.uk/data-and-information/publications/statistical/statistics-on-obesity-physical-activity-and-diet/statistics-on-obesity-physical-activity-and-diet-england-2018
  9. https://www.bbc.co.uk/news/health-46290849
  10. https://www.healthline.com/health/heart-disease/exercise#2

Does Euthanasia Have a Place in Modern Medicine?

Euthanasia is the practice of intentionally ending a person’s life in order to relieve their pain and suffering. [1] Euthanasia comes from the Greek words, Eu (good) and Thanatosis (death) and it means “Good Death”, but is it really all that good? [2]

There are different types of euthanasia:

  • Active euthanasia – a person directly and deliberately causes a patient’s death.
  • Passive euthanasia – death is brought about by an omission – i.e. when someone lets the person die. This can be by withdrawing or withholding treatment.
  • Voluntary euthanasia – a person makes a conscious decision to die and asks for help to do so.
  • Non-voluntary euthanasia – a person is unconscious or otherwise unable (for example, a young baby or a person of extremely low intelligence) to make a meaningful choice between living and dying, and another person takes the decision on their behalf.
  • Assisted suicide – where the person who is going to die needs help to kill themselves and asks for it.
  • Involuntary euthanasia – a person wants to live but is killed anyway.
  • Indirect euthanasia – providing treatment (usually to reduce pain) that has the side effect of speeding the patient’s death. The doctrine of double effect can be used to justify this type of euthanasia. This doctrine says that if doing something morally good has a morally bad side-effect, it is ethical to do it, providing the bad side-effect was not intended. This can be true even if the bad side-effect was anticipated. [3][4]

When considering the different ethical principles,”the practice of euthanasia, under some circumstances, is morally required by the two most widely regarded principals that guide medical practice: respect for patient autonomy and promoting patient’s best interests”. [5] Essentially, a patient has the ultimate say when decisions are being made about their treatment, and if a patient is in tremendous pain, it may be the most ethical thing to kill them in order to alleviate their suffering. However, these principles can be seen to contradict another ethical principle – non-maleficence – which states that a medical practitioner has a duty to do no harm or allow harm to be caused to a patient through neglect. [6] By committing euthanasia, a medical practitioner can be considered to be committing the greatest harm of all – to take away a life. Although in some circumstances, euthanasia can be considered to be the lesser evil and that there is more harm in letting a person live in insufferable pain.

Different countries have different laws on euthanasia. In the UK, active euthanasia and assisted suicide are illegal, whilst passive euthanasia is not illegal, after the Bland ruling of 1993. [7] In most countries, any type of euthanasia is illegal. There are only a few countries in which assisted suicide is legal: Belgium, Holland, Luxembourg, Germany, Switzerland and a few US states but there are variations in the legality of assisted suicide in these countries. [8]

Euthanasia has always been and will continue to be, a controversial topic. I personally believe that it is difficult for euthanasia to be a part of modern medicine. When euthanasia is accepted, the lives of people who are thought to be undesirable can be seen to be less than others. What would stop the involuntary euthanasia of disabled young babies who are considered ‘imperfect’?  Also, euthanasia may not be in the patient’s best interest, even if they have consented. For example, due to mental illnesses such as depression, which may leave a patient believing their life is worthless and that they are better off dead. In this case, euthanasia would not be the correct form of treatment. However, I do understand that euthanasia can be the most compassionate form of treatment for a patient who is in insufferable pain. In order for euthanasia to have a place in modern medicine, very strict rules and regulations would have to be implemented to ensure that no life is wrongfully taken away.

By Bernice Mangundu.

References:

  1. https://en.wikipedia.org/wiki/Euthanasia
  2. http://www.life.org.nz/euthanasia/abouteuthanasia/history-euthanasia1
  3. https://www.nhs.uk/conditions/euthanasia-and-assisted-suicide/
  4. http://www.bbc.co.uk/ethics/euthanasia/overview/forms.shtml
  5. Medical Ethics: A Very Short Introduction by Tony Hope
  6. https://www.themedicportal.com/medical-ethics-explained-non-maleficence/
  7. http://www.politics.co.uk/reference/euthanasia
  8. https://www.itv.com/news/2015-08-14/what-are-the-current-laws-on-assisted-suicide-in-the-uk/

Vaccines – How do they work and are they safe?

Hey guys! It’s Joerel again! Welcome everyone to a new segment of MedicineOnMyMind called Scientific Saturdays where I will be discussing either biological or biochemical processes inside or outside of humans or other organisms. This will be a once a month blog post, but there may be guest speakers whom will write about their own Scientific Saturdays blogs. In any case, we should start off with this first post.

Assuming you have read the title, today’s topic would be vaccines. We’ll be discussing what a vaccine is, how and why a vaccine works, and any dangers in having a vaccine. (‘Dangers’ is in bold because of the stigmas people associate with vaccines.)

What are vaccines?

Vaccines are dead or weak pathogens (which is done caused by chemicals – we’ll be talking about this later) and forces an immune response in your body. This is known as artificial active immunity; you do not physically the disease, but you do become immune to a specific disease by getting a weaker or dead version of the pathogen.

How does a vaccine work?

When a vaccine is injected into your body, there is an immune response to destroy the foreign pathogen. Essentially, a vaccine causes an immune response in our immune system in order to produce T and B Memory cells for that specific disease (or diseases if you have a three in one like the MMR vaccine). By doing so, this causes a quicker immunological response than if the ‘real’ pathogen (which is not weaker or dead) ever enters our body therefore we do not get sick at all and the symptoms are not expressed. The secondary immune response is so fast, if ever the real pathogen enters our body, the immune system would have the antibodies for the specific disease(s) due to the B and T memory cells present in our body.

Okay, but how does the immune system work on vaccines?

Well, when a pathogen first enters your body, your body is not aware that it is there. That is because the pathogen is miniscule compared to the other cells in the body. Nonetheless, a vaccine gives out several dead and weak strains of a certain virus or bacteria. Your immune system tends to use the phagocytes and phagocytosis to get rid of the pathogens. Macrophages, a type of phagocyte, is the first line of defence. A single macrophage can engulf and digest approximately one hundred pathogens. This process is called phagocytosis. What happens is the macrophage engulfs the pathogen via endocytosis, in which the pathogen is trapped in a vesicle called a phagosome. A phagosome would pair up with some lysosomes to form a phagolysosome, where the pathogen is digested but the antigens are not. The antigens are presented on the cell surface membrane of the phagocyte, which turns the phagocyte into an antigen presenting complex (or APC for short).

Another significant APC is your dendritic cells. These cells oversee choosing and picking of T and B virgin cells that reside in the lymph node. Your dendritic cells are important because these cells decide what type of immunological response you have during an infection. Dendritic cells become APCs by taking a sample of the pathogen via phagocytosis. When this happens, the dendritic cell then travels to the nearest lymph node, where it picks out a T virgin cell that has a complementary receptor on its cell surface membrane. When this happens, the T virgin cells become T-Helper cells, which rapid divide through the process of mitosis (proliferation / clonal expansion). These T-helper cells tend to divide into either killer cells that kill off pathogens, more helper cells that produce cytokines and interleukins for the stimulation of phagocytosis in phagocytes, the clonal expansion of B-cells or the stimulation of plasma cells to produce antibodies. Your T-helper cell then travels to the centre of the lymph node, in which they choose a virgin B-cell which has the similar receptor to the T-helper cell. How this happens is the activated T-helper cell signals to the virgin B-cells that has the same receptors to the T-helper cells. (This is a complicated process, so I’ll link to how this process works below, from the National Institution of Health.)[2] Either way, after the correct virgin B-cell has been chosen, the B-cells become activated B-Cells. The activated B-cell can either become plasma cells or the B-cells become B-memory cells, which remembers the specific pathogen that the plasma cells created antibodies for.

In the end, the antibodies produced by the plasma cells help the phagocytes engulf, digest and destroy the pathogen. But what is important is that the vaccine injected caused an immune response to produce T and B memory cells. This means you are immune (for a long while) for the specific disease and will never contract the disease(s) (for a long time or unless the pathogen mutates, so the whole process above must be repeated).

Dangers of vaccines:

Does anyone think vaccines are one hundred percent safe? Let’s talk about that.

You must remember that most vaccines must somehow either weaken the pathogen first, which means there are several chemicals that are used to do so. It would be wise prior to a vaccination to ask what is in the vaccine or to look up some of the ingredients used to make a vaccine. For example, you wouldn’t take a vaccine that had, for a weird example to highlight my point, nuts when you know you have an allergic reaction to nuts.

Most of the time, vaccines have certain chemicals which either prevents the reproduction of the pathogen when it is injected into you body or encourages your immune system to have a stronger response, so you are immune to the disease at a faster rate.

Most common chemicals used in vaccines are:[3]

  • Thimerosal (Ethylmercury) – This is safe, as this is broken down quickly in the body and is different from the ethylmercury found in fishes. Currently, there is no scientific link that this has any harmful effects, and this is ONLY added for the flu influenza.
  • Formaldehyde – While this may dangerous in large doses, a vaccine only contains a small amount of this chemical (0.02mg) and even then, formaldehyde is diluted into smaller amount during the manufacturing process.
  • Aluminium – After six decades of using aluminium, there has been no evidence that this causes any harmful effects on humans.
  • Antibiotics – This is most likely what causes a bad reaction in your body but manufactures of the vaccines ensure a strong antibiotic is NOT used and most of the time, they are reduced so there are negligible amounts in the vaccine.
  • Gelatin – While this is a major cause in causing allergic reactions, the incident rate is significantly small. If you think you or your child would have a severe allergic reaction (meaning if they do suffer from severe allergic reactions) then it is probably wise to choose an alternative method of immunity. Most of the time, this is relatively safe due to a small amount of Gelatin in a vaccine.
  • Monosodium Glutamate (MSG) – While there has been a small minority of short-term reactions, there are no long-term reactions link to MSG. The Food and Drug Administration, The World Health Organisation and the United Nations deemed MSG safe to use. (besides you guys eat some of this as a flavour enhancer in some foods so…)

Now you may think, even after hearing about what happens in your immune system and how relatively safe the vaccines are, that vaccines are completely dangerous, and you don’t want to put yourself or your child in that situation. But you have to ask yourself, am I really protecting me or my child by not having a vaccine? The answer is no.

Do you really think having natural immunity to diseases will somehow be safer than being exposed to a weaker strain or even dead version of a pathogen? Let’s take an example of measles.[4] Measles target your immune system, leaving you vulnerable to a secondary infection. You have the measles spots and pretty much can lead you to death and even if you do survive, your immune system is weak because of the measles virus that destroyed your immune system, so you’re still weak from the initial attack. Contrast that to taking an MMR vaccine, where you do not suffer from that attack and instead become immune without suffering any severe consequences like possible death. (To read up on possible effects, there’s a link on the citation which will lead you to the World Health Organisation’s information of people suffering from mild to severe effects. There is also one for the CDC’s review on vaccines. The numbers are low, but better to see it for yourself).[5] [6]

By not vaccinating, you are risking yourself and everyone else around you. The effect of herd immunity, where much of the population is vaccinated so the disease cannot infect many people to survive and ultimately leading to the extinction of the disease, decreases by not being vaccinated.

Vaccination is a good thing and a right to have. Don’t wait until it’s too late. If you’re travelling to a country where there’s a specific disease that’s prevalent in your area, ensure you get vaccinated for that disease before you travel, so you do get sick during your travels. It is better to be safe than sorry.

Thanks for reading, and I’ll see you next month for another Scientific Saturday.

 

SOURCES:

[1] https://www.youtube.com/watch?v=zQGOcOUBi6s&list=PLFs4vir_WsTyY31efyHdmtp9l7DpR0Wvi&index=3

[2] https://www.ncbi.nlm.nih.gov/books/NBK27142/

[3] https://www.publichealth.org/public-awareness/understanding-vaccines/goes-vaccine/

[4] https://www.youtube.com/watch?v=y0opgc1WoS4&index=1&list=PLFs4vir_WsTyY31efyHdmtp9l7DpR0Wvi

[5] http://www.who.int/vaccine_safety/initiative/tools/vaccinfosheets/en/

[6] https://www.cdc.gov/vaccines/vac-gen/side-effects.htm

The Power of Stem Cells

The research area of stem cells in medicine is moving fast and there are endless possibilities of uses for stem cells in many different aspects of medical science.

What are stem cells?

Stem cells are unspecialised and undifferentiated cells, meaning they’re not adapted to any particular function. Therefore, they have the potential to differentiate into any range of cell types in the organism.

This means that they are extremely useful and valuable in scientific research and in looking for future treatments, as the stem cells can be transplanted to different parts of the body to replace damaged cells.

Stem cells are already being used in various areas, such as in drug trials; before being tested on animals or humans, potential new drugs can be tested on cultures of stem cells. As well as that, stem cells grown on biodegradable mesh can produce new skin for burns patients, which is quicker than a skin graft.

They’re also being used to treat patients with leukaemia. Stem cells found in the bone marrow are transplanted into the leukaemia patients to generate new blood cells.

Stem cells can also be used to grow new cells in a laboratory to replace damaged tissues or organs.

Several weeks ago, I saw an article with the title ‘Scientists have discovered a new stem cell that could heal brain damage’. Called the “G2 quiescent stem cell” it’s one of several ‘sleeping’ stem cells in the brain. However, this particular stem cell is ‘showing a higher regeneration potential than others have [1].’ This newly discovered stem cell could help brains repair themselves from brain injury, or even neurodegenerative diseases such as Alzheimer’s disease and Huntington’s. In Alzheimer’s disease, brain cells (neurons) are destroyed because of the accumulation of abnormal proteins. When these dormant stem cells are awake, they can start producing neurons, which could potentially be used as a treatment.

This is based on a study of the small fruit fly, which shares many DNA similarities with humans. [1]

Despite the good signs, scientists are still unsure on how to ‘wake up’ these dormant cells, meaning actual treatments are still a significant way off. However, progress is being made all the time.

Other medical conditions that may potentially be treated with embryonic stem cells include:

  • traumatic spinal cord injury
  • stroke
  • severe burns
  • rheumatoid arthritis
  • heart disease
  • hearing loss
  • retinal disease

Stem cell research controversy

In recent years, there has been some controversy over how human embryonic stem cells are obtained. In order to obtain the stem cells, a human embryo must be destroyed. This induces ethical concerns for some people, as they believe that an embryo accounts for a human being and should not be destroyed in the name of scientific research.

Opponents of this argument believe that embryos are not yet human beings, and that the benefits of the research outweigh the issues surrounding the way that the stem cells are obtained.

[1] https://www.sciencealert.com/new-brain-stem-cell-could-fight-injury-or-disease

By Jenna Philpott

‘Why Weed?’

‘Oh wow, it smells so bad in that shop…’

‘You mean like the mary jane?’

‘Yes, like the mary jane.’

‘Imagine in Canada, it’s legal there!’

Just the other  day, my mum and I went to a corner shop near our house just to buy some chocolate for the icing of our chocolate cake. With such innocent intentions (and excitement to eat some chocolate cake), the smell of burnt rubber mixed with skunks and body odour surprised me much more than it should have. Living where I do, the smell of weed surrounds me often, it’s not very pleasant, and it’s something I can never get used to. On the contrary, this time, the foul odour sparked a very interesting conversation between my mum and I in the car!

‘Well, I don’t know, alcohol and smoking is legal too, and they have even worse effects’

‘What are you talking about? Marijuana will mess with your brain! You’ll hallucinate and get addicted’

‘I understand that! But that’s the same for alcohol! And think of how much more physical damage comes with smoking tobacco smoke!’

It is common knowledge for us that the legal recreational drugs (for us who live in the UK) are alcohol and tobacco smoke. Legal highs include ‘substances with stimulant or mood-altering properties whose sale or use is not banned by current legislation regarding the misuse of drugs’[1] such as solvents like deodorant and glue! That’s right, glue can get you high too. Here’s an article about solvent abuse:

https://www.themix.org.uk/drink-and-drugs/drugs-a-z/solvent-abuse-9613.html

Anyway, all I’m trying to get at is that drugs like alcohol and tobacco smoke are legal, but cannabis is not. Why?

There are many types of drugs[2], but the ones that I will be talking about are depressants and stimulants:

Stimulants are best described as the ones that make things speed up. They impact the central nervous system in a way that your heart rate increases, blood pressure increases, reflexes increases. Doctors will prescribe stimulants to people who have asthma as it increases breathing levels by opening up breathing passages. It can also be used to aid in weight loss as they can decrease appetite or help you perform better in sports and exercise. Stimulants include things such as caffeine, all the way to cocaine. If stimulants are overused, then it can lead to symptoms such as paranoia, psychosis, high body temperature, all the way to heart failure.

Depressants are basically the opposite. They also impact the central nervous system, but they do it in a way in which heart rate decreases, blood pressure decreases, and reflexes decrease too. Doctors will prescribe depressants to treat anxiety, insomnia, OCD – mostly medical and mental issues which stops a person from relaxing. If depressants are overused, it can lead to symptoms such as delirium, diabetes, impaired memory, hallucinations all the way to intense addiction leading to death from withdrawal.

Now that we know that, let’s get to comparing alcohol, tobacco smoke and marijuana.

Let’s start with alcohol. Alcohol is classified as a depressant. It’s short term effects include ‘slurred speech, unsteady movement, disturbed perceptions and inability to react quickly’[3]. In spite of this, many people will drink alcohol for its stimulant effects – alcohol will only ever start to have depressant effects when too much is drank. An alcohol overdose leads to a higher pain tolerance, toxicity to the point of vomiting, unconsciousness, even to the point of a coma from severe toxic overdose. After long-term uses of alcohol, there is damage to the liver and the brain – the liver is in charge of removing alcohol from the blood stream because, as I have covered, it is a toxic substance; inevitably, the liver will get damaged – this is cirrhosis[4]. However, in moderation, could alcohol possibly have health benefits?[5] The School of Public Health at Harvard University found that alcohol raises levels of lipoproteins – this is ‘good’ cholesterol associated with greater protection against heart disease. As well as this, the Catholic University of Campobasso reported drinking less than four or two, for men and women respectively, could lengthen your life for reason I don’t understand. Other benefits of alcohol consumption include reducing the chances of developing dementia, prevention from the common cold and lowering the chances of diabetes.

Tobacco contains many different harmful substances, the three worst and most important ones are nicotine, carbon monoxide and tar[6]. Nicotine is highly addictive, it is a stimulant and increases heart rate. Carbon monoxide combines with haemoglobin in red blood cells so they cannot carry as much oxygen so the heart has to beat faster and harder leading to heart disease and potentially stroke. Tar is a carcinogen, tar deposits get stuck in the lung so it cannot perform in the way that it should. We know that tobacco smoke leads to lung cancer due to the carcinogenic tar. So why do people smoke? Nicotine in cigarettes affects the brain so that it becomes reliant and you become addicted – within 10 seconds, the nicotine reaches your brain and makes it release adrenaline creating a buzz of energy. This rush of adrenaline only lasts for a short burst of time and thus the user will want to use it again. This makes it very hard to stop using it and in fact, if one tried to, it would lead to horrible withdrawal symptoms such as depression, insomnia, slower heart rate and more[7]. And this part will be mind-boggling, and I don’t even want to write it, but it needs to be done to make a clear, fair comparison: what are the health benefits of smoking?[8] Smoking decreases the risk of arthritis (according to the study from the university of Adelaide in Australia). Specifically, in the knees; this is due to the fact that arthritis occurs most commonly among the obese and people who regularly exercise – smokers do not tend to fit into these categories as smoking leads to a decreased appetite and people who smoke are less likely to be active due to lung problems. Numerous studies have also identified that smoking lowers the risk of Parkinson’s disease – the reason: unknown! Harvard researchers found that it came after smokers quit. What do you guys think? Could this just be a spurious correlation? Other benefits of smoking include lowering the risk of obesity.

Finally, let’s talk about weed. THC (tetrahydrocannabinol) is the chemical in charge of most of cannabis’ psychological effects[9]. Here’s how it works: when one smokes marijuana, THC passes from the lungs into the bloodstream; the blood carries the chemical to the brain and other organs so they absorb the THC. The THC acts on specific brain cell receptors and over activates parts of the brain that contain the highest number of these receptors leading to the short term effects of altered senses, mood change, impaired movement as well as impaired memory. In higher doses, marijuana causes hallucinations and psychosis[10]. The receptors that THC bind to play a role in normal brain development and function, consequently, if marijuana is used from a younger age(teenage years), it can cause impaired thinking, memory, and learning functions – at the moment, scientists are still studying if these effects are permanent. In addition to this, marijuana usage can lead to breathing problems, increased heart rate, problems with child development, intense nausea and vomiting, as well as hallucinations and paranoia. Simultaneously, it is not a secret that marijuana has many health benefits including treating chronic pain, depression and anxiety, as well as alleviating symptoms of cancer and chemotherapy as a result of cannabinoids slowing down the growth or even killing some types of cancer (they are a safe but not yet completely reliable treatment) [11]. In fact, it is prescribed by doctors around the world to treat conditions such as multiple sclerosis, spinal cord disease, arthritis and so many more![12] Basically, marijuana is used as an alternative to opioid painkillers – why? The quality of life of a patient is a priority for doctors. With chronic pain comes relatively little hope for a cure, but hope for effective management of symptoms that still allow them to live their lives to the fullest. Medical cannabis is chosen as opioids tend to cause drowsiness, lethargy and other symptoms that stop the patient from doing different activities.[13] Not only this, but marijuana is shown to be much safer than opioids, this is due to the fact that cannabis has a much lower risk of overdose and addiction in comparison to opioids, this is because the peak plasma concentration of THC (the amount your body can physically hold) is 100-200ng/ml and it would take a lot of weed to get to that point, you would have to have 80kg in an hour. When THC binds to receptors, there is also a release of a hormone which weakens the THC’s action on the receptors, so overall a negative feedback loop is created [14]

In my opinion, alcohol and tobacco smoke are much worse than marijuana. Doctors will actually prescribe marijuana to help people overcome drug addiction and alcoholism – if marijuana was worse, why would they prescribe it as medication? You don’t see a doctor prescribing alcohol to a person addicted to heroin or a person with chronic pain. So why is alcohol and tobacco smoke legal, but weed isn’t? I think that legalising and allowing more drugs which cause impairment and other bad symptoms is just unnecessary. Alcohol and tobacco smoke already has large, major companies and they were discovered first. This might be a bad analogy, but it’s like guns in America. It’s got more bad effects than good ones, but to just get rid of them completely will be so difficult as there is already many companies for guns etc. but legalising the use of poison bombs because the poison chemical has less potential to kill and some potential to have some benefits to plants or something will not solve the problem of guns! I think that the usage of marijuana as an opioid alternative is fine and would be good if legalised, but marijuana should only be used in an enclosed section of the hospital so as not to pose a threat to illegal recreational use as well as others in the hospital who could potentially be negatively affected (patients with asthma or schizophrenia). However, the biggest reason why I think marijuana is not legal, is because it is still being studied – there needs to be more solid research and evidence with explanation as to why marijuana is beneficial in the way that it is.

What do you guys think?

By Antonia Marie Jayme

Butterflies in my tummy: I clicked send

This week was a very busy week. I had a test, a bunch of homework, but what caused me the most stress was my dreaded UCAS application for medical school. I have enjoyed the last 2 years of my life attending conferences about medicine, studying for the grades and doing things that would enhance my application for medical school, but all of a sudden, it all seemed too real. All of that hard work for an online form. I have spent the last 5 months agonising over my personal statement. It is a torturous process, and whenever I had to delete something, it was like taking a knife to my soul. Then my choice of medical school: that was another long conversation. For a while, it seemed like it was all that my family and I could talk about! All of the Saturdays given to open days, all of the complaints from my sister when she was informed that she would have to wake up at 6 am at the weekend so that we could go to some odd corner of the country to visit a university: all of these thoughts were jumbled up in my head. But amongst the chaos during the week, and the chaos inside my head, there were a number of recurring questions I kept having: What if I get no interviews? Even if I get an interview, what if I don’t get any offers? Even if I get an offer, what if I don’t make the grades? Even if I make the grades, what if I hate my university? What if I hate being a medical student? What kind of a doctor would that make me if I hate my job from day 1? The butterflies in my tummy were causing a ruckus when I finally just closed my eyes and clicked the red send button.

Butterflies in the stomach is a sensation you will probably also be familiar with: when we feel anxious, or nervous it feels like a tingling sensation in your tummy. You may even feel nauseated. Well, it turns out that science has an explanation for these butterflies too! Our mood is very much dependent on our stomach, as our digestive system is closely linked to our central nervous system [1]. Stomach butterflies actually form part of our instinctive fight-or-flight response: a defensive cascade of events that our brain sets off when it detects a threat to our survival. This cascade of events may include an increase in heart rate, blood pressure and breathing rate (which is often also why people with panic disorder begin to hyperventilate during a panic attack) [2]. The nervous system simultaneously sends signals to the adrenal gland so it can secrete the hormones adrenaline and cortisol, which causes the body to become tense and sweaty. The muscle tension caused by the spike in cortisol [3] leads to extra sensitivity in the smooth muscles of the stomach. This added sensitivity is believed to be partly responsible for the sensation of butterflies.

The brain and stomach are in fact so closely related that some researchers refer to the stomach as a ‘second brain’ due to the discovery of the fact that the stomach contains a whopping 100 million neurons linking it to the Brain (which is known as the ‘brain-gut axis’) [4]. Nausea caused by butterflies happens because the adrenaline rush temporarily causes digestion to stop. This is part of the fight-or-flight response because blood leaves the places the brain thinks it is not needed: blood will leave the stomach and go to the legs and arms so it can provide the power for you to run away from the threat. [5] [6]

The fight-or-flight response was very prominent when our ancestors (cavemen and the like) were living in the age where they would get hunted by tigers and bears etc. Today, we get this sensation of butterflies in many different situations. Most commonly, it is in times when we feel nervous e.g. before a presentation or an interview. However, you might also have heard (or felt) butterflies in the stomach when you are in love or talking to a crush! Each of these different scenarios can elicit a fight-or-flight response which is slightly altered to another because different neurochemicals and hormones are being released. It’s kind of funny to think that in the past, my fight-or-flight response would have been activated by me being chased down by a literal tiger, but today it was activated when I saw a computer screen with UCAS’s logo on it!

These butterflies cause all the problems. They flutter around and distract me from remembering the things I need to remember. In this case, they distracted me from remembering how much fun I have actually had during this whole application process. All the friends I have made and the knowledge I have gained. I have genuinely enjoyed all of the conferences I attended, and even if I don’t get into medicine this time round, I can confidently say that I have at least grown as a person—which will only make me better prepared for the next application round!

[1] https://www.naturopathiccurrents.com/articles/probiotics-gut-brain-axis

[2] https://www.verywellmind.com/the-fight-or-flight-theory-of-panic-disorder-2583916

[3] http://www.stresshack.com/cortisol-and-stress.html

[4] https://psychscenehub.com/psychinsights/the-simplified-guide-to-the-gut-brain-axis/

[5] https://greatist.com/happiness/why-do-i-get-butterflies-my-stomach

[6] https://www.nytimes.com/1996/01/23/science/complex-and-hidden-brain-in-gut-makes-stomachaches-and-butterflies.html?pagewanted=all&src=pm

By Muskaan Jonathan

Relationship between Mood and Gut Bacteria

Humans: Same but Different

As individuals of the same species, we all have the same general features,
such as two arms, two legs, a head, and a torso. However, due to variation within a
species, ours being Homo sapiens, we are not identical copies of each other. Some
of these variations can cause beneficial, harmful or neutral characteristics.
Anatomical variations change the way that the human body forms, most being
relatively harmless to the person. Textbooks of anatomy usually describe the most
common form of structured found in the body, yet there are many examples of
variations from the textbook example that are frequently encountered.

During the Renaissance period in the 15th century, artists become increasingly
interested in the accurate representation of the human body. Famous artists, such as
Michelangelo and Leonardo da Vinci used dissection in order to portray the human
body accurately. Da Vinci excelled in the study of muscles and he produced many
remarkable and detailed diagrams showing actions and movement.
Textbooks of anatomy usually describe the most common form of structured
found in the body, yet there are many examples of variations from the textbook
example that are frequently encountered.

Examples of anatomical variations are the palmaris longus in the forearm
which is absent in about 14% of humans on one or both arms, and the plantaris in
the leg, which is absent is 6%. Another rare variation (1 in 7,000) is situs inversus,
which is a complete reversal of asymmetry in all the organs, usually with normal
physiology. For example, one part of this is dextrocardia, meaning that the heart is
on the right side of the torso, rather than the left. Human variations such as these
provide insight into developmental anatomy.

Double-jointedness, more accurately known as persistent generalised joint
hypermobility, occurs in about 5% of people. This means that the knees and elbows
can be extended beyond 180 degrees (hyperextended) and the hands and feet can
attain unusual positions. Hypermobile joints are not necessarily unstable, as
demonstrated by in performances of acrobats and gymnasts, but they are associated
with a tendency to have reoccurring dislocations of the patella or shoulder.
The human body is a complex machine, with different systems working in
harmony, with the points above being a few of the most interesting ones. Each
human body is different, but one of the same kind.

https://news.softpedia.com/news/The-10-Most-Common-Human-Mutations-57223.shtml

By Karis

Brexit and our NHS

We have all heard the word ‘Brexit’ many times. It is often associated with the economy, trading and businesses failing but have you ever thought about the impact it can have on OUR healthcare system?

For those not aware of what Brexit means let me give you a very brief explanation. It is the idea of leaving the EU (which we have been a part of since the 1990’s). A referendum was held in June 2016 in which 52% of the British population decided to leave the EU [1]. Britain is scheduled to leave the EU in March next year.

The main issue that may arise within the health and social care sector is staffing. Many of the staff and professionals currently working in the NHS come from other EU countries. The figure equates to roughly 130,000 staff of the 1.3 million working in the NHS. It is important to realise that even before we have left the EU the NHS has been struggling due to staff shortages [4].

The Royal College of Nursing has said that there has been a 92% drop in the number of registrations that they received from the EU (March 2017). This may be because people are uncertain about the security of a career in the UK in the future [2]. It is worrying to think what may happen AFTER we leave the EU. One of the reasons why providers recruit the NHS staff from outside the EU is because there are not enough resident workers to fill up the available vacancies. Article 50 only provides protection for those already working in the NHS and not for possible future employees [2]. However, in June 2018, the government did announce that they were ‘relaxing immigration rules’ so that more doctors/ nurses coming from outside the EU were still able to work in the UK [3]. Despite this reassurance, many of the NHS staff could decide to work in other countries. The question here is: If doctors go to work in other countries will that result in the doctors staying having to work extra hours (above the 48-hour limit)? Will that mean that pay will have to increase? And if so where will all the funding come from?

The next potential issue that may come with Brexit is the ability to access treatment in the UK and abroad. Currently, all EU citizens are allowed to have a European Health Insurance Card (EHIC). Holders of this card are able to access the necessary medical health care during their stay in a European Economic Area (EEA). The cost of these treatments can also be reclaimed. Also, EU nationals who currently live in the UK (and vice versa) can access health care the same way all the nationals of that country can access it. If, after Brexit, this can no longer take place then pensioners of UK nationality may decide to come back to the UK and this can have its own negative impact on the system. [4]

Funding and finance. The UK government pays a fee of £350 million A WEEK for membership of the EU. When we leave, we will have billions of pounds to spend on other things such as the NHS. Well, that is what has been promised! The funding of the NHS is dependent on the British economy and the treasury doesn’t seem so satisfied with how Brexit will affect it. The HM Treasury has said: leaving the EU will cause ‘an immediate and profound economic shock creating instability and uncertainty’.

 If the government decides to protect the health service budget and NOT the social care budget this can still affect the NHS indirectly. This is because, in 2016, the lack of social care funding resulted in approximately 400,000 fewer people receiving the social care that they require.[4]. If the £350 million is still not enough where will the government get extra funding from? Will they need to increase tax or will we be required to pay for our healthcare?

Brexit could also have an impact on cancer research.  The EU and UK have worked well together for cancer research and the teamwork is very strong. Leaving the EU can impact the level of research carried out and affect the patients. Fewer patients will be able to access treatments and there may be delays in new trials beginning. Another point to add is that once the UK has left we will have less of an impact in medicine and clinical sciences.  Limited cooperation could result in the UK being deprived of the top researchers that the EU has to offer. [5]

It is clear that the majority of the scientists and healthcare staff are against Brexit. These people can see how Brexit will impact their field of work and society as a whole. As we have already voted to leave the EU only time will tell whether this was an advantageous or a damaging decision.

By Kashaf Imran

Bibliography:

https://www.vox.com/2016/6/25/12029962/why-did-britain-leave-the-eu [1]

http://ukandeu.ac.uk/the-impact-of-brexit-on-nhs-staff/ [2]

https://www.bbc.co.uk/news/uk-wales-politics-44703552 [3]

https://www.kingsfund.org.uk/publications/articles/brexit-and-nhs [4]

https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(16)30025-0/fulltext [5]

‘It’s Not Just Pain. Period’

Periods are a part of many women’s lives, and with them can come cramps, headaches and pain. However, for many women, the pain that comes with their periods is excruciating and can prevent them from living their lives normally. If you are one of these women, experiencing such painful periods, you may have endometriosis.

Endometriosis is a condition where the tissue that lines the womb (endometrium) is found outside the womb, such as in the ovaries and fallopian tubes, where it induces a chronic inflammatory reaction that may result in scar tissue. [1] It is a fairly common condition, affecting approximately 176 million women around the world. [2]

Normally, as part of the menstrual cycle, estrogen causes the lining of the uterus to grow and thicken, preparing the uterus to receive a fertilised egg. If an egg doesn’t get fertilised, the lining of the uterus breaks down. This lining then leaves the body as menstrual blood. However, in endometriosis, the endometrial tissue that would normally line the uterus is found outside it. This tissue will thicken, break down and bleed with your menstrual cycle, but this tissue and blood have no way of leaving the body. This can lead to pain, swelling and scarring. [3]

The symptoms of endometriosis include: pain in the lower tummy or back (pelvic pain), painful periods that prevent you from doing normal activities, painful ovulation, infertility (due to the changes in structure and functions of the reproductive organs),  pain during or after sexual intercourse, pain when urinating or pooing during your period,  heavy bleeding, fatigue, nausea, constipation, diarrhea or blood in your pee during your period. Endometriosis can have a huge impact on general physical health and social well being, as it makes it hard to do many things. It can also have an impact on your mental health and can lead to feelings of depression which could be due to the mental strain of coping with symptoms. [1][2][3]

If you have symptoms of endometriosis, you should see your doctor. It can be difficult to diagnose endometriosis because the symptoms can vary considerably, and many other conditions can cause similar symptoms. You will be asked about your symptoms, and an examination may be completed on your tummy and vagina, to be able to recommend the best treatment for you. If these don’t help, your doctor may refer you to a gynaecologist for some further tests, such as an ultrasound scan or laparoscopy. A laparoscopy is where a surgeon makes a tiny incision in the skin and passes a thin tube through so they can see any patches of endometriosis tissue. This is the only way to be certain you have endometriosis. A laparoscopy can provide information about the location, extent and size of the endometrial implants (abnormal growth of endometrial outside of the uterus) to help determine the best treatment options.  [1][4][5]

Currently, there is no cure for endometriosis, but there are a number of treatments that can help to manage symptoms. Treatments include:

  • painkillers – such as ibuprofen and paracetamol.
  • hormone medicines and contraceptives – including the combined pill, the contraceptive patch, and medicines called gonadotrophin-releasing hormone (GnRH) agonists and antagonists.
  • aromatase inhibitors – a class of medicines that reduce the amount of estrogen in the body.
  • progestin therapy – can halt menstrual periods and the growth of endometrial implants, which may relieve endometriosis signs and symptoms.
  • surgery to cut away patches of endometriosis tissue
  • an operation to remove part or all of the organs affected by endometriosis – such as surgery to remove the womb (hysterectomy) [1][4]

It is not yet known what causes endometriosis to occur but there are lots of theories and ideas about how it develop, including: genetics, a problem with the immune system, endometrium cells spreading through the body in the bloodstream and retrograde menstruation (when some of the womb lining flows up through the fallopian tubes and embeds itself on the organs of the pelvis, rather than leaving the body as a period). It is likely that endometriosis is caused by a combination of various factors. [1]

By Bernice Mangundu.

References:

  1. https://www.nhs.uk/conditions/endometriosis/
  2. http://endometriosis.org/resources/articles/facts-about-endometriosis/
  3. https://www.bupa.co.uk/health-information/womens-health/endometriosis
  4. https://www.mayoclinic.org/diseases-conditions/endometriosis/diagnosis-treatment/drc-20354661
  5. https://www.medicinenet.com/endometriosis/article.htm

 

 

 

Gaming Disorder – Are Video Games Playing You?

Hey guys, it’s Joerel again and today I’m going to be talking – more like arguing actually – about the whole “gaming disorder” which the World Health Organisation (WHO) has officially recognised as a disorder around June of this year. This is going to be a doozy. In any case, let’s go for it.

So, you might be wondering, why did the World Health Organisation consider this as a disorder? Well, on their website, they see gaming disorder as (and I quote straight off the page) “a pattern of gaming behavior (“digital-gaming” or “video-gaming”) characterized by impaired control over gaming, increasing priority given to gaming over other activities to the extent that gaming takes precedence over other interests and daily activities, and continuation or escalation of gaming despite the occurrence of negative consequences.”[1] Okay, that does not sound so bad, does it? I personally believe that whatever the addiction is, whether it be something as hardcore as drugs and alcoholism or smoking, it should be taken seriously and should be treated as much as possible to return them back into a generally better state than they were before. Gaming can be addictive, and while gaming is quite relaxing and entertaining, too much of anything can kill. Everything should be kept at a reasonable limit (depending on what it is of course – drugs do not count for this), but not limiting the enjoyment one gets from such said pleasure. I know I like to play games on my laptop and on my Nintendo DS, but I know when I had too much. Overall, well played for keeping up with technology.

But, my argument is what they say next: “For gaming disorder to be diagnosed, the behaviour pattern must be of sufficient severity to result in significant impairment in personal, family, social, educational, occupational or other important areas of functioning and would normally have been evident for at least 12 months.”[1] That seems a bit too vague, kind of like YouTube’s ad revenue policies. To see someone being engulfed in gaming is within perspective. One doctor or psychologist might be able to see one person as a gaming addict while another might not see the same person as addicted to gaming. It is relatively new, because of the recent surge of gaming and so no-one can truly understand who a gaming addict is and who is not. While it may be seen in the near future, it is currently not possible and if it is possible, many may cause misdiagnosis. Dr. Vladimir Poznyak, a member of WHO’s Department of Mental Health and Substance Abuse, which proposed the new diagnosis to WHO’s decision-making body, the World Health Assembly states: “And let me emphasize that this is a clinical condition, and clinical diagnosis can be made only by health professionals which are properly trained to do that.”[2] Like I said previously, that is completely subjective. Also, it irritates me to not know what their training is. What is it? Like, would it not be obvious if someone has a gaming disorder? How would it work? Though there is some opposition from other professionals. For example, Dr. Richard Graham, lead technology addiction specialist at the Nightingale Hospital in London, said: “it is significant because it creates the opportunity for more specialised services. It puts it on the map as something to take seriously.” Though he argues that “it could lead to confused parents whose children are just enthusiastic gamers.”[3] highlighting the main issue when classifying this as an International classification of disease (ICD).

Also, you must consider some other factors. For example, has anyone is the WHO ever considered E-Sports at all when it came to this conclusion? E-Sports is professional gaming and there are stories out there which counter the point of having gaming disorder as a thing. Take example SKT Faker. SKT Faker, a professional League of Legends player, when he was only a teenager, he decided to drop out of high school to continue his love of gaming. He was scouted to be a part of SKT Telecom K and he played ever since for the organisation.[4] Guess what happened to him? He became known as one of the best players in League of Legends (LoL) as well as winning consecutive world titles in the game. The prize money is absurd when it comes to E-Sports. In 2016, the prize pool was $5,070,000 and last year’s being $4,946,969.[8] Faker, his team, and his organisation got both of those prize pool money because they won both years. E-Sports is not a joke. He threw away his education to win even more money than he would have if he continued his education – just by playing games that he was amazing at! While it is not implying people should leave school for a pursuit of professional gaming, if people see potential then they should go for it otherwise it would have been a wasted opportunity. Another example would be TSM Reginald, the owner of Team SoloMid. He placed his faith in LoL and focused on gaming rather than school or university and see him now.[7] Reginald owns one of the most successful franchises in E-Sports. Currently, TSM has investors such as Stephen Curry supporting his team.[9] Even actual athletes are recognising the potential in E-sports because it is as competitive as actual sports. 100 Thieves, a gaming organisation, has a partnership with the unstoppable NBA team Cleveland Cavaliers[6] and the Golden Guardians, another E-sports team, is supported by the Golden States Warriors.[5]

In my opinion, I think that gaming disorder as a classification should be reconsidered or at least put on hold for now. You must think of other factors, ones you don’t even know or think about, and while I commend WHO for trying to adapt to the new technological advances, I believe that they need further research. There are plenty of uprising professional gamers on the rise and the next thing we need is someone saying another person cannot pursue their career because of ‘gaming disorder’. While it is a good thing to consider, I believe personally, more research and proper training (in years, not months or days) should be done to properly assess this issue before they can officially press it as a disorder.

SOURCES:

[1] http://www.who.int/features/qa/gaming-disorder/en/

[2] https://edition.cnn.com/2018/06/18/health/video-game-disorder-who/index.html

[3] https://www.bbc.co.uk/news/technology-42541404

[4] https://www.youtube.com/watch?v=hNQC5GyumQ4 [The Story of SKT Faker]

[5] https://lol.gamepedia.com/Golden_Guardians

[6] https://www.100thieves.com/partners/

[7] https://www.youtube.com/watch?v=zbQsmHQh2gI [The Story of TSM Reginald]

[8] https://www.esportsearnings.com/leagues/190-lol-world-championship

[9] https://www.forbes.com/consent/?toURL=https://www.forbes.com/sites/mattperez/2018/07/24/tsm-raises-37-million-investors-include-stephen-curry-jerry-yang/#282742827f8a

By Joerel Gestopa

Cuts to NHS Procedures

To acknowledge its 70th birthday the NHS cut a total of 17 procedures from its service which have been deemed as unnecessary. Among this list of abolished or highly restricted procedures include snoring surgery, breast reduction, tonsillectomy, and hysterectomy for heavy menstrual bleeding.

It is estimated that this will stop approximately 100,000 operations, saving the NHS £200m. The medical director of NHS England, Steve Powis, insisted to the Times that ‘there is more to be done’ and this is just ‘the first stage’ of discontinuing unmerited and needless treatments.

Personally, I can definitely see reason for these cuts as the £200m saved could contribute towards offering more essential procedures. For example, I am a strong advocate for the introduction of brain scans for patients with migraines. I think that evaluating the effectiveness of each individual treatment provided is of paramount importance so it is ensured that taxpayers’ money is not wasted, but is spent only on evidence-based and necessary treatments.

Despite this, I can sympathise with those who will be affected by these cuts who will either have to turn to alternative or privatised treatments, or they will be forced to live (and potentially suffer with) the ailments for which they pursued a remedy. For example, women who have heavy menstruation will not be provided with hysterectomy (unless circumstances are extreme and fulfill certain restricted conditions). Hysterectomy is a surgical procedure where the cervix and womb are removed, hence stopping menstruation. This would restore confidence in women with heavy menstruation as they no longer have to worry about leakage, pain or feeling uncomfortable. An added bonus of this procedure is the eliminated risk of cervical cancer and hence the abolished necessity of cervical smears. However, this is a major surgery requiring general anaesthetic, so is associated with risks such as postoperative infection. Moreover, the procedure can cause premature menopause, cannot be reversed and may be less suitable than other treatments, for example, hormone therapy. Therefore, there is a strong argument to regard hysterectomy for heavy menstruation as an unnecessary risk with little benefit.

To conclude, I would propose that the cuts made were justified and that further cuts should be made in the future. Nevertheless, I maintain that each case should be considered deeply with an emphasis on ensuring patient care is of the highest possible standard.

By Sophie Maddock