My Week of Work Experience

A couple of weeks ago, I attended a work experience week at a local hospital which was designed for prospective medical students. I thought that it would be a good idea to reflect upon and share some of the events of the week.

The first day involved mainly talking to staff in a lecture hall, finding out what becoming a doctor involved, and some of the challenges that doctors face. I know that being a doctor isn’t a 9-5 job, and many of the people I spoke to emphasised the fact that the NHS runs on the goodwill of its staff. As a junior doctor in particular, your life has to revolve around your job, rather than the other way round like it is for most people. It’s a lifestyle. Hospitals can’t stop; so neither can their staff. I learned about the huge range of staff within the NHS- who are all absolutely fundamental. The system is like clockwork. If one piece is removed, the system breaks. Everyone relies on each other in order to achieve the best patient care possible, which is why teamwork within hospitals is so important. As well as this, each member must respect the others, which permits them to achieve the best dynamic possible, which, in turn, will help co-ordination, thus improving patient care. There was one surgeon who compared the operating theatre to a formula 1 tyre change- everyone knows their role, so they act as a unit to complete the task at hand with maximum efficiency.

We spoke to an F1 doctor who talked a bit about applying to medicine, having completed her course at Cambridge, as well as the time that she’d had as an F1 doctor. One very important thing that I learnt was that you can never know everything, and you shouldn’t try to know everything. There will always be someone who knows something that you don’t; but it’s important to find your own limits. Medicine is so competitive and I think that’s partly down to the nature of the people who undertake the course. Everyone who succeeds must be resilient. This F1 doctor described how she had been in a group of 5 friends, of whom 2 graduated. 1 decided that she didn’t want to do medicine, and the other 2 became ill, partly due to being overworked. This is why I think it’s so important to be sensible when studying for medicine. Work will always need to be done, but down time is so important to ensure our own health. Bearing this in mind, I believe that a doctor can never provide the best care to patients if they themselves are not at their best. I discovered that being an F1 doctor isn’t easy- you’re thrown right into the deep end, with new people, in a new environment, but most importantly, it’s what you’ve worked for. Despite the basic jobs which you have to do, the dreaded night shifts, the placement rotations and the moving round hospitals, it’s crucial to remember that you’re now a doctor, and unless you really do something stupid, nobody is going to take that away from you.

We then heard from a radiologist, who advertised a more relaxed life compared to what we had been told by the junior and F1 doctors. No ward rounds or clinics to attend, but very limited patient contact- something which doesn’t really appeal to me. I learnt a bit about the different types of scans used, and the differences between them. As well as this, we got shown some real scans of patients, including an MRI and various x-rays. CT and x-ray scans both work by looking at density of various tissue, whereas MRI uses chemical composition of tissue to create its images. More MRI and ultrasound scans are used in paediatrics compared to CT and x-ray, because they don’t give off harmful radiation. One problem with MRI however, is that it takes a long time to scan, which can means that patients have to stay still for a very long time- a potential issue when working with children, or anyone in a lot of pain. There’s also nuclear medicine, which involves injecting a radioactive isotope, and then tracking its movement through the body. The radiologist emphasised his dislike for nuclear medicine, stating that in 50 years time, he doubts it will still be used. It did seem rather counterintuitive to inject someone that you’re trying to make better with a radioactive isotope, which could potentially cause then to develop a cancer. PET scans involve injecting these radioactive isotopes, as well as taking a CT scan at the same time, in order to trace the movement of the chemical. Another method for diagnosis is a biopsy, which can involve needles or even surgery, as tissue or fluid is removed for examination. The radiologist let us play with some stents for a bit, used in interventional radiology, which is increasingly used in modern medicine. It allows for wires to be used under x-ray guidance, and stents to be put in, in order to widen blood vessels. The reason that it has become so popular is that it decreases the need for surgery, which takes longer, can involve a longer recovery period, and generally tends to scare patients more. Within radiology, there’s a wide variety of patients, as all sorts of patients in the hospital need scans. I think that this is definitely a benefit, as it allows you to work with a diverse group of people, so that each day won’t be as repetitive.

After this talk, we heard from an anaesthetist, who talked to us about sepsis. Again, anaesthetists are found all over the hospital, as well as outside hospitals- they’re involved in trauma teams, ambulances, helicopters, pain rounds, surgeries amongst many other things. This doctor spoke about the importance of diagnosing of sepsis, as the effects when untreated are lethal. 4 million people in the UK die each year form sepsis, yet despite this, only around 50% of the population have ever even heard of it. If a doctor suspects that a patient has sepsis, the most important thing is to start the treatment fast, and get them on antibiotics. Even if it isn’t a full diagnosis, starting medication early could save their life. The rapid progression of sepsis can mean that someone is feeling a little grubby at the start of the day, but is then dead within 24 hours. This is why the first hour is known as the ‘golden first hour’, as it can determine someone’s survival. It’s one of the biggest killers, but also has very little funding and research compared to other diseases like cancer or diabetes for example. The doctor also described to us the various problems that he faces when treating sepsis. There are only 15 ITU beds in this specific hospital, which all cost the NHS £2000 per night, compared to an average ward bed, which is £400. Sepsis uses a huge amount of resources, straining funding as well as staff. People with sepsis are often in and out of consciousness, hallucinating, and losing the rhythm of their day and night cycle. Frequently, if the patient survives treatment, they develop PTSD due to the trauma that they experienced in ITU, which appeared to them as torturous at the time. This means that they then need to be followed up by psychiatrists, with studies showing that after having had sepsis, 10% of patients lose their jobs, and 20% of patient’s personalities change drastically. I personally found this shocking, as I wouldn’t have ever associated sepsis with any kind of mental health problem. The main point that was made was that, for a doctor, if you suspect sepsis, treat it like sepsis. If the right precautions are taken, then lives can be saved, but otherwise, a patient ca rapidly decline. This doctor told us that it’s not all about science. Especially with sepsis- often they start treatment based on an ‘educated hunch’. He told us that it’s crucial to look at the patient as a whole, not just the numbers and readings which have been taken from them.

The next morning, I went to A&E. I’ve always wanted to get into an A&E ward, having seen 24hours in A&E many times before. I now realise the differences between how Channel4 portray A&E, and how A&E actually is. Yes, the doctors are always busy, there are always patients waiting, but there aren’t traumas happening every minute, or people suddenly having cardiac arrests. It does happen obviously, but nowhere near as frequently as the media portray it to. In A&E, you have to be a people person. There’s such a diverse range of patients who arrive, and you’ve got to be prepared for whatever comes- whether that’s a minor injury, a drug overdose, or anything else. One member of staff gave us a short presentation, talking about life in A&E- both the advantages and disadvantages. He said that you often get frequent flyers, who will come in often- these are usually drug addicts, alcoholics, people with chronic pain or people with mental health problems. Other than that however, one of the main drawbacks of A&E is that you don’t get to follow up your patients. There’s very little continuity from day to day. I guess that could also be a good thing though, as it’s very unlikely that you have repetitive days. We got told about the 4 hour target, which is the target time to have all patients seen and treated within before they leave the hospital. However we obviously can’t apply this to every patient, as some will be admitted onto wards for longer care. The main problem that hospitals face at the moment in A&E is bed blocking. One of the issues is that the department have patients unnecessarily filling beds, as their waiting for a place elsewhere, such as in a community bed, or a bed on a surgical ward. Despite this, often they can’t discharge the patient until another place becomes available elsewhere, hence patients have to wait longer to get a bed and see a doctor. It has a knock on effect. As well as this, many patients use A&E inappropriately, wanting a second opinion after seeing their GP, or to treat their chronic problems. This again can clog up the system. The doctor explained to us how they prioritise patients- using a triage system. When a patient comes in, they have their history taken and are perhaps given some pain killers whilst they wait, before being categorised. Each is given a colour: red, orange, yellow, green or blue. Based on this, a list is formed, so the most urgent patients will be seen by the doctor first. Some patients won’t even need to see a doctor, and will simply be treated by specialised A&E nurses. We got told about the specialist paediatric equipment that they have, which can improve efficiency when treating paediatric trauma cases. An example of this is the rainbow mat, which a child will lie on. It has colour gradations along it, and depending where the child comes up to on the mat, in terms of height, the doctor immediately look at the recommended amount of drugs needed and the equipment size which should be used for this particular sized child. I thought that this was a great idea, although doses may differ between weight as well as height, so this also needs to be considered.

After having this talk, I got to shadow an A&E doctor for an hour, which was really interesting.The doctor was treating a patient who had overdosed on a drug called speed. Her heart rate was abnormally fast, she had high lactic acid, low electrolytes, shortness of breath, back pain and arm numbness. Blood was taken from the patient, although she was petrified of needles. I found it incredible how well the doctor dealt with this. He told her that everything would be ok because he was smiling, so throughout the procedure, to reassure her, he continued smiling and chatted generally as a form of distraction. It seemed to work, as the patient didn’t make a fuss about having her blood taken. The doctor was checking her renal function as well as doing general tests. He showed me the toxicology database, which doctors use in order to find out which tests should be done on each blood sample. After sending the bloods off to the lab, I was told that it would be about an hour before the results came. During this time, the patient was waiting in the bed, taking up valuable space. One important thing that I observed was that the doctor didn’t know everything. He had a book of emergency medicine in his pocket, which he often referred to, and at one point he used his phone to look up how speed is taken. I think that in A&E, it’s so important to be on the ball. You can’t know everything, but you must know what you’re doing, and what to do to help the patient.

In the afternoon, I went to orthopaedic theatre for a bit. It was great to see surgery again, although the cases were relatively minor. Before the surgery, all the equipment was counted, and written on a whiteboard, to ensure that at the end of the procedure, all the tools could be recounted again. Everything had been sterilised, in special blue packets, which we were told to avoid touching at all costs. The first patient had carpal tunnel syndrome, and was having surgery to release one of the nerves in her wrist. I believe this to be called a decompression. Before making an incision, the surgeon reassured the patient, telling her what he was doing, and making sure that she couldn’t feel anything. There was a sheet of tissue put between the patient and her arm, to prevent her watching the surgery, which is important to avoid unnecessary distress. There was a nurse at her other side, who talked to her throughout the surgery, which again was very important to act as a distractor and to reassure the patient. The patient had a tournaquay around her arm to restrict blood flow, which would make the surgery easier, and less messy when making the initial incision. The surgeon was wearing special magnifying glasses, and was being extremely careful when cutting into the patient. To me, it seemed like a very delicate form of art. He told us that the patient had a very tight ligament in her wrist, and he showed us which was the median nerve. I found it amazing to watch such an intricate procedure. The next operation was someone who had broken two bones in his hand, and had surgery a while back to implant some wires deep into the bones so that he could get his hand moving again more quickly. They were removing the wires today. I asked about the healing times, with the doctors telling me that bone takes roughly four weeks to heal, but that it takes longer in smokers. The bars which had been implanted were made of stainless steel, and would be surrounded by scar tissue. The surgeon was telling us about the different sutures that they used in theatre, and the benefits of them. There are non-absorbable sutures, which are smooth and made of nylon, and need to be removed after surgery. On the other hand, you have absorbable sutures, which don’t need to be removed, as they simply dissolve. There are also braided sutures which can be tied easily and have ‘memory’, as they retain their shape. However there are gaps in the material in which bacteria can grown, so braided sutures aren’t always used. The third surgery that I saw was of a patient who had broken their scaphoid bone. I was told that this doesn’t heal well due to the blood supply being at the other end. The surgeons were doing a graft by taking some bone from the main bone in the arm and putting a screw into the scaphoid. There was a lot of x-raying in the procedure, to avoid mistakenly damaging the joints of the wrist, so I was sent in and out, to avoid unnecessary radiation exposure. They took out the fibrous scar tissue between the bones so that when the graft was put in, the would heal. When taking the bone from the arm, they made a ‘trapdoor’ shape and scooped out bone from the inside. This would then heal over time, but there would still be a risk of fracture after the surgery, due to the removal of bone, so the patient would have to be careful with it. The bone was grafted because it has various growth factors and cells which would stimulate the healing of the bone in the affected area. The surgeons packed in as much bone as they could before putting the excess bone graft back inside the ‘trapdoor’ which they had made. Unfortunately I didn’t get to see the end of the surgery, but I enjoyed watching those three operations.

The following day, I met three psychiatrists, and got shown round some psychiatry wards. Unlike A&E, there is commonly a great deal of continuity with patients, who you get to see at their worst and their best. This makes the doctor-patient relationship all the more important, and it can often be rather intimate, as you get to know your patients well over time. Another key quality to have as a psychiatrist is empathy, as discussions with the patient have to take place frequently. This shouldn’t be muddled with sympathy, because all doctors need to be emotionally resilient in order to detach themselves from the situation and provide the best care that they possibly can. Again, the team is very holistic, as you have a whole team of people around each patient, including nursing staff, community staff, OTs, psychologists and social workers. This makes teamwork crucial. The work-life balance is difficult, as you can have intense periods of being on-call, but you don’t necessarily need to be in work for all your on-calls, which could make it potentially more manageable compared to a surgeon who is on call, for example, who needs to be in work. I got told that the patient backgrounds are one of the most interesting parts of being a psychiatrist, as you can learn so much about an individual in this way. It gives a sense of humanity to the profession I think. With psychiatry, you look at many different disciplines, including neurology, consciousness and clinical things too. Nowadays, people are much more aware of mental health problems, which means that more and more people are seeking help. Of course this is a good thing, however in terms of the NHS budget; the country is struggling. There’s such a variety of mental health problems which a patient can have, and this adds diversity to the job. A psychiatrist isn’t limited to psychiatry wards though, as their often present in the general hospitals, where patients may have a mental health problem as well as a physical problem, or if someone, from A&E for example, has been found to have a mental health problem. It’s not like being a GP- although you see many patients; you can’t simply diagnose them based on a 10 minute appointment. Often, discussions are longer and much more in-depth. Therefore, as a psychiatrist, it’s crucial to be a people person; someone who can talk to others.The psychiatrists also talked about general life being a doctor- getting used to bad smells, working in a team, experiencing suffering and talking to patients. They said that despite all this, the most important thing is to be caring, and to want to help your patients. I couldn’t agree more.

After a lengthy chat with the psychiatrists, we walked over to the wards. A patient can be sectioned under the mental health act, against their will, when they are so unwell that they are deemed unable to see things clearly and judge things sensibly for themselves. They are at risk of either harming themselves or someone else. In order to do this however, three members of qualified staff must agree that this is the appropriate action to take. Patients who had been sectioned were on a separate ward from others, as this allowed for more intensive supervision, although in the main ward, there were still a few people who were on 24 hour supervision. They had a carer within a meter of them at all times. Although I know that this is necessary for the patients well-being, I couldn’t help but think how invasive this must be for the individual. Because of the surge of patients being admitted to these wards, the psychiatrist explained that they try and keep people on the wards for the minimum amount of time possible, ideally only 1-2 weeks. The lady explained that this never used to be the case, as people were admitted for months. The reality is that we simple can’t do that anymore due to the strains that the NHS is being put under. Whenever you introduce a new system, people will want to use it and take advantage of it. We were told about a bed crises which had happened, on the ward recently, where they ended up with people sleeping on mattresses in the corridors of the wards. Apart from this however, the patients all had their own personal space, bedrooms and social area. Most people had much more freedom than I had expected, although many of them seemed very phased out. I guessed that this was due to the drugs that they were being given. I found it interesting to learn about the roles of a psychiatrist, although I’m not sure that it’s a speciality that I would like to take on in the future.

The next day we went to a hospice which is linked to the hospital. We were told again about the importance of teamwork within the patient care that they provide. The multidisciplinary teams consist of doctors, OTs, physiotherapists, chaplains, secretaries, drivers, maintenance staff, caterers, volunteers, as well as many others. They all work together to provide specialist palliative care, supporting families in a caring environment. Hospices aren’t there to cure patients. They provide symptom control and emotional support, to help a person who is close to the end of their life. The centre that I visited was very diverse, with a huge range of specialist equipment and activities to help a range of patients and families. This included art and music therapy rooms, a specialist swimming pool for hydrotherapy, a beautiful garden, fitness equipment and other rooms for visitors too. All the patients have their own privacy, as the bays were all individual, on top of a large living area with kitchens, bedrooms, living rooms, a chapel and a conservatory. On my work experience week, the hospice was the least clinical environment that I visited. It seemed like residential housing rather than a healthcare environment. This is important with concern to the type of care provided, as families and patients need comforting during hard times. They also provide bereavement support, which can be quite intimate. Despite this very real and human side of medicine, it’s still important for doctors to know their boundaries, not seeing patients as their ‘friends’ or being invasive in any form. One thing that was brought up was the difficulty to measure success in a hospice. You can’t simply tick off patients, and it’s unlikely that they will be cured whilst staying in a hospice. Instead, the goals of treatment are focused primarily upon the patient’s own wishes in order to achieve a high satisfaction rating. Despite this, it can be difficult to manage certain expectations, and although hope is important; reality is too. Bad news has to be broken, but patients aren’t forced to accept the reality of their disease. The key thing to acknowledge is the shift in focus from normal medicine; from length of life to quality of life.

To contrast this very human side of medicine, in the afternoon, we got shown around the pathology lab for a bit. Here, they deal with medical microbiology, cellular pathology and haematology. We were told that around 80-90% of all hospital admissions will involve a pathological investigation, making the centre very busy, meaning that efficiency is important. The average turn around for a set of results would be 2 hours, but if it’s urgent, then the sample is usually processed within 30 minutes. The hospital functions every hour of every day; so the path lab must too. Even though there’s a need for efficiency, quality is crucial. A patient’s treatment is dependent on their results, so the readings taken must be accurate, in order to assure that the patient receives the correct care. When people don’t work to the same standards, different centres will show different results, which could drastically change treatment plans. This speciality is very science based, and although I do love science, I don’t think that I would enjoy the limited patient contact, as it seems as though your almost detached from the actual patients, solely looking at their samples rather than themselves as humans.

Overall, I enjoyed experiencing a range of specialities. It’s given me a more in-depth insight into the array of choices which you can take as a doctor. Although I’m still unsure as to what exactly I want to do, I know that I want to be a doctor; and I can’t wait for it.

I hope that you’ve enjoyed reading.

 

 

The Immortal Life of Henrietta Lacks- Review

Hello readers! Sorry for not posting in a while- I was busy with UKCAT and school exams. Thankfully they’re all over now though! Thought I would post some book reviews, as I’ve been reading quite a lot lately. The first one I would like to write about is ‘The Immortal Life of Henrietta Lacks’ by Rebecca Skloot. I thoroughly enjoyed this book, especially the issues that were raised with regards to medical ethics.

I thought I’d post the basic storyline and background information first, so that you can understand my viewpoint on the book. So, in 1951, a black lady in America called Henrietta Lacks was in hospital due to a diagnosis of cervical cancer. At this time, Henrietta had 5 children, and the family were quite poor. As part of a biopsy, Henrietta’s cells were taken, but without her knowing, they were passed onto a scientist called George Gey, who had been researching cell culture for some time. He wanted to culture cells for a longer period of time, without them dying- something that humans hadn’t yet achieved. He had been experimenting with culture medium, and at the time was using a solution composed of chicken blood, amongst other things. An additional problem that had been encountered was the contamination of cultures.

After growing the small sample of Henrietta’s cancer cells, Gey found that they were ‘immortal’. He was able to successfully culture human tissue in the lab for the first time. This was a huge step for science, as previous progress with this, such as the work done by the French surgeon Carell, had been faked. Gey was thrilled, and started sending his samples to scientists who requested them. The cell line had been named HeLa, but the identity of Henrietta had not been linked with the cells. Gey appeared on TV shows, and all over the media, as he was hailed for the revolutionary discovery. The cells started to be cultured by factories across the globe, and were being shipped everywhere for research. HeLa cells have allowed for many great achievements in science, such as the development of a polio vaccine, as well as numerous other drugs. It’s very easy to say that these cells did indeed revolutionise science. However there is a more human side to the story which much be considered.

After Gey found that Henrietta’s cells were of benefit to his research; he requested more. Henrietta had gone through radiation therapy, leaving a huge black mark on her abdomen, and she was in immense pain. George Gey visited, but failed to tell her about the discovery of her immortal cells. After her death, Gey requested an autopsy, in order to obtain as many HeLa cells as he could. However, to do this, he needed the family’s permission. Initially, her husband say no. The doctors requested again, realising the importance of these cells, telling Day (Henrietta’s husband) that by doing an autopsy, it would allow them to asses the risk of the children developing cancer, and could potentially help them. Day agreed to the autopsy, and Gey acquired more HeLa cells.

As HeLa cells were used over the years, the family remained unaware, until 1973. There had been articles published about HeLa cells before this, however the cells had been said to come from Helen Lane. Scientists weren’t sure whether to reveal Henrietta’s identity, so had given journalists a false name. However, this changed when Howard Jones published an article in April 1973, revealing the true person behind the HeLa cells. It wasn’t long before the family found out that Henrietta’s cells were still alive. Many of the family were confused at first, not fully understanding what this actually meant. This caused outrage. For them, they understood that cells had been taken without permission, and were now being used all over the world for various scientific experiments. Nobody explained anything to them, and they were left worrying that Henrietta was being exploited, being put in pain and experimented on. They were constantly hassled by the media, as well as scientists, who wanted interviews and cell samples from the rest of the family. For Deborah Lacks, one of Henrietta’s daughters, this lead to her becoming isolated and depressed.

As Skloot worked with Deborah to research and write the book, the family learned about the significance of HeLa cells, and what they had allowed science to achieve. The initial anger faded, but they were still unhappy that consent hadn’t been taken. There were scientists making millions using HeLa cells, but the family remained unable to even afford health insurance. To me, this doesn’t seem just.

I absolutely loved this book. It was the perfect combination between a science book and a story. I learned so much about medical ethics as well as interesting experiments and scientific advancements which have occurred over the past years. I found it incredible how much progress has been made with HeLa cells, such as chemotherapy, cloning, gene mapping, IVF, amongst many other things.

It provoked many questions for me too. Would Henrietta have been treated differently if she was white? I think this is an interesting question to ask, as in 1950’s America, the racial divide between white and black was still apparent. Henrietta attended John Hopkin’s hospital, which was specifically for black people, and was treated by white doctors. Did the doctors take advantage of her; not seeking permission because she was black? It’s debatable, but I personally don’t think that she would have been treated any differently if she was white, as it was her cells that scientists were interested in. Although I do think that doctors took advantage of Day’s vulnerability and lack of education when requesting and autopsy. The book also gave some background into some racist scientific studies which had taken place, such as the Tuskegee Syphilis Study and the Mississippi Appendectomies. I thought these were pretty horrendous to be honest, but it definitely shows the equality changes that society have made since these times.

Additionally, found it interesting to look at how the doctor patient relationship is different to that which we have in the UK at the moment. During this time, doctors were seen as knowing best, and there was little discussion with regards to treatment, which was decided by the doctor. It seems as though doctors saw their patients as being inferior, and less knowledgeable than themselves, so failed to explain patient’s conditions or treatment properly, which was particularly apparent between white doctors and black patients. This is hugely different to current day relationships, which depend hugely upon the opinions of the patient, as doctors increasingly try to involve the in the own medical decisions if it’s appropriate to do so. Only the other day, I was speaking to a GP who had a patient diagnose themselves with a rare genetic condition which they had researched online. The GP had never heard of the condition before, but went and researched it with the patient, and then agreed on the patient’s own diagnosis. The GP said to me ‘I wouldn’t have thought of that myself’. I think it shows just how important the patient’s own decisions and interpretations are becoming in modern day medicine.

Obviously the issue of patient privacy is key to this book, as Henrietta’s cells were taken without consent, and her name was then published as linked to these cells, again without consent. Although Gey managed to keep Henrietta’s true name secret until 1973, I think that it was mainly the pressure from the media which caused a name to be associated with HeLa cells. The newspapers had wanted a ‘personal story’ to publish, meaning that they wanted a name. I don’t think that it was right to claim that the cells were from Helen Lane, as it doesn’t necessarily give Henrietta the credit that she deserved for her impact on science. Despite this however, I don’t think that it was fair to publish her name in 1973, especially as the family had no idea that HeLa cells even existed.

One thing that I don’t really agree with, was the unethical uses of HeLa cells. The books discusses how the cancerous HeLa cells were injected into prisoners in order to develop new potential cancer treatments. These prisoners developed tumours with the injections, which they became more immune to with each injection. It showed the potential for our own bodies ability to fight off cancer cells. This study was voluntary, however I’m not sure whether the prisoners were of mental capacity to understand the risks of the treatment. I watched a documentary following this book, called ‘The Way Is All Flesh’ which shows some of the prisoners receiving the injections, claiming that they opted into the study in order to do some good for society to balance their wrongdoings. The scientist who was conducting the experiment didn’t properly inform his subjects of what he was actually doing to them, which was illegal, and putting them in danger. On top of all this, some of the patients died from cancer after receiving the injections. Would Henrietta have wanted her cells to be used in this way? This is another ethical dilemma which raises questions with regards to the suffering of few for the benefit of many. It’s a similar argument with the HeLa cells- was it ok to abuse one patient’s rights in order to benefit many others? I guess that a utilitarian would agree; but personally I’m not so sure. It seems that if we use this philosophy, we could go down a slippery slope, and the lines between what is acceptable and what isn’t would blur. The study was conducted by Chester Southam if you want to look into it.

Another problem that HeLa caused science was in the 1960s, which has been named ‘The HeLa Bomb’. Essentially, HeLa cells, because of their wide use, had contaminated many cultures, which had led scientists to believe that they were culturing a specific cell line, when in fact, they had simply cultured HeLa. This is because HeLa was more ‘aggressive’ than other cells lines, and would outcompete them in culture. This wasn’t realised for some time, until specific markers on cells were looked into, which were different for black and white people. Scientists had found that cells, supposedly from white people which they had been culturing, had these markers which were only present on cells from black people. This lead to the discovery of the HeLa contamination problem, rendering many recent discoveries inaccurate. This was a huge drawback for scientists at the time. I think this was important in the long run, because it showed the importance of aseptic techniques when culturing any cells line. Since this event, science has improved on culturing technique to allow for us to know exactly what we’re culturing in each dish.

Other cases which relate to patient privacy which were looked at, include that of John Moore, where his own doctor patented his cell line without informing him. Again, there was a lack of patient protection. It raises the question- who owns our cells? Moore sued his doctor, Golde, for stealing his cells. Can we claim our cells though? I think that one of the issues with patenting cell lines and claiming ownership of cells is that it can inhibit scientific research and discovery. For me, I think that to some extent, the public have a responsibility to aid scientific research, as essentially, they are the ones who benefit from science. At the same time however, science has a responsibility to the public, to keep them informed and not to exploit them. I’m not sure where this line is drawn though, as the balance s very difficult.

To conclude, although the case of Henrietta Lacks is extremely controversial, I think that doctors at the time were doing what was in the best interest of the public. Although the issue of patient consent is often raised with regards to this case, at the time the cells were taken, there weren’t any laws or rules which the scientists and doctors were actually breaking. Technically, they weren’t doing anything ‘wrong’. I don’t think that we can apply modern laws to Henrietta’s case, as although patient consent is fundamental to modern day medicine, it never used to be this way. In hindsight, perhaps some think that doctors should have acted differently, but I think that it’s crucial to understand that everything is much clearer in hindsight.

I hope that you have enjoyed reading my review. Let me know what you think in the comments. Perhaps read the book yourself. I would definitely recommend it!

A Brief Post On Skin Cancer

Cancer is never an easy thing to talk about with a patient, and it seems to be a common taboo in our society. I think that cancer is a very interesting disease, not only on a molecular level, but also from an ethical point of view. Should we treat everyone? What if the drug is too expensive? Who should be eligible for treatment? Although these questions may apply to a wide array of medical scenarios, I think that they seem to be more and more important in the field of cancer, especially with the ageing population. I wanted to dedicate a post to melanoma, and summarise some of the key mechanisms of the disease.

As in the case of many cancers, melanoma occurs through a disruption in specific cell signals which are responsible for cell proliferation and migration. Migrations is essential for bodily function, as it’s needed for not only wound repair, but also for embryo development, where specialised cells must move to the correct location so that they can form the body part that they were intended to grow into. For this to happen, certain genes are switched on and translated into proteins, hence triggering a cellular signalling pathway, which controls cells migration.

Melanomas occur originally in melanocytes, which produce melanin, darkening our skin to protect it against UV radiation. These cells express a gene called BRAF, which has a crucial role, as it codes for a protein that helps to relay stimuli from the outside to the inside of a cell. The external signal goes to RAS, before BRAF, which then can activate the MEK/ERK pathway, so that cells can respond to their environment, as these signals stimulate proliferation and migration. However, if this pathway isn’t regulated, a cancer can occur. One way that this happens is through mutation. In the case of melanoma, many patients have a specific mutation whereby thymine is replaced by adenine, which then causes valine to be replaced by glutamic acid, changing the shape of the kinase domain, which is a particular region on the BRAF protein. This part of the protein is needed to trigger MEK and ERK proteins, which are essential for cell proliferation and migration. The mutation causes the protein to malfunction, hence it tells the target cells to divide, regardless of whether it has had the signal to do so or not. This allows for uncontrolled cell division, meaning that a melanoma can form. As well as this, the mutated BRAF protein activates certain pathways which are involved in cell migration, meaning that these cells can become malignant, leaving their site of origin and entering either the blood circulation or the lymphatic system. These migrating cells can move to other sites in the body, forming secondary tumours. This is known as metastasis, and is the principal cause of cancer deaths.

The problem with treating cancers is that cancer cells are the patient’s own cells, hence it’s difficult to design a drug that will specifically target the cancer, and not healthy body cells. I recently read about a drug called Vemurafenib, which is specially manufactured to target the over active BRAF protein in certain melanomas. One of the problems with this, however, is that not all patients with melanoma will have this mutation. This means that DNA sequences must be taken, which can be very expensive, but is becoming more common in modern medicine. Vemurafenib blocks the BRAF protein, hence preventing the MEK/ERK signalling pathways which were responsible for the growth of the cancer. Trials of this drug so far have been successful, allowing patients to live for longer than originally expected.

Although these new drugs are great; they are costly. I think that at the moment, the most important thing that we can focus on is prevention rather than treatment. Persistent exposure to the sun causes an accumulation of DNA damage in skin cells, which can influence the cell signalling pathways which I mentioned earlier, increasing the likelihood of a harmful mutation. Although it’s not the only factor in skin cancer development, UV exposure is certainly one which we can control, and is particularly important for fair-skinned people. Sun cream can block UV light from harming our melanocytes, hence decreasing our risk of skin cancer. Another way in which we can reduce risk of skin cancers is by monitoring any moles, especially those which may look irregular. When checking moles it’s advised to look at : asymmetry, borders, colour, diameter and evolution. If there are any changed in these features of moles, it may be an idea to get a GP appointment.

Stay safe in the sun this summer!

Experience with Elderly Patients

I regularly do volunteering at my local hospital, and I wanted to speak about some of the experiences that I had yesterday.

On the vascular ward that I help out on, the majority of patients are elderly, which can cause certain problems, that may not arise on other wards. Yesterday, I overheard the nurses talking about an old man who had been bothering them. They were speaking of him in a very rude way, and I was wondering why this would be, and what trouble an old man could be causing. As I was doing the tea round, I soon found out. This chap was repeating over and over ‘Nurse can you help me?’. He wouldn’t stay in his bed, and kept trying to get out of the hospital. He said that all he wanted was ‘help to get out of this place’. This chap came up to me and asked if I could help him. I told him that I wasn’t a nurse, but I would happily make him a cup of tea or coffee if he wanted one. The response was rather harsh, as I was told that I was nasty, and didn’t know how it felt to be trapped like him. Although the nurses told me to ignore it, this comment really made me think about this man’s experience in hospital. Clearly he was confused, yet it didn’t seem as though any of the health-care staff had tried to explain why he was in hospital. Personally, I don’t think that this is acceptable, as it lead this poor guy to feeling like he was being imprisoned for no reason. The nurses were annoyed and frustrated, constantly having to put him back to bed, using rather bitter language towards him, and I can imagine this giving him the impression that he wasn’t even wanted in this place that he had been locked up. I know that patients like this can be difficult, especially when there are so many other people to look after, and other jobs to keep up with, but I don’t believe that any patient should be treated in such a way. I soon found out that he was soon to be transferred elsewhere to somewhere in which he could receive more care. I think that a better strategy could have been devised to help the patient, rather than arguing with him about staying in bed. Although I’m by no means an expert in elderly care, I think that a supportive conversation with this man, explaining clearly what was going on, would have been beneficial to him. I also believe that distraction techniques like TV, books or colouring can be a good way to tackle problematic patients.

Another problem that arises with elderly patients is loneliness. Yesterday, there was a lovely old lady on the ward who looked rather upset. After making her a cup of tea, I sat down with her for a bit of a chat. It turned into a half-hour conversation of varying topics. She was telling me all about her travels across the Greek Islands, Australia, and where she still wanted to visit. I soon found out that her daughter had moved to Australia, leaving her mother, and only visited once or twice a year. Again, I couldn’t help but feel sorry for this lady, who clearly didn’t have anyone to regularly speak to. I stayed with her for a while, finding out about her past experiences, and what her daughter did for a living. Clearly she was a proud mother, who supported her daughter’s work, despite living such a long distance away. This patient told me about her daughter’s chemistry degree, and how she worked for a beauty company, developing natural lavender skin care products. I listened as this lady spoke, getting in a few words now again, but mainly sitting silently. It was so interesting to find out about what this lady had done with her life, but more importantly, I think that she benefitted from sharing this. With patients who don’t get a lot of company, I know that it’s essential to speak to them, to prevent them becoming lonely and perhaps depressed. When I left this lady at the end of our conversation, she was beaming, and it made me think how simple things like a chat can be so helpful to some people. The only problem is that in hospitals, doctors and nurses probably won’t have a spare half an hour to chat to patients like that, even though this could play a crucial part in patient recovery. After seeing the change in this lady, I think that over the course of my volunteering, I will definitely take more time to simply chat to patients, to try to bring up their spirits.

Although elderly care in hospitals can be difficult, I think that with time and effort, there are ways to tackle it. Thank you for reading. Please share your own opinions and experiences in the comments below.

My Experience at The McWhirter Conference Cambridge

On the 29th of March I took the long journey down to Cambridge, unsure what to expect from a bioethics conference. It’s fair to say that over the course of the two days I learnt so much about not only ethical issues, but also about myself. I had never really engaged in any proper form of debating before, and I really enjoyed throwing around opinions and arguing my case, without the fear of being judged. My confidence has increased hugely and I feel much more at ease with meeting new people. I cannot express my thanks to the McWhirter Foundation for helping me with this self discovery.

In the first lecture, by Dr Van Campen, we looked at some basic principles of bioethics, and how companies go about making bioethical decisions across the world. It was specifically looking at the ethical issues of conducting multinational clinical research- whether we should conduct it, and if so, then how? In trials undertaken in developing countries, for example, the problem is that often the participants will not have access a drug once it has been marketed, particularly if it is a Western company who is conducting the trial. Some view this as exploitation, but there is a flip side to the argument, as these people wouldn’t otherwise have access to these experimental drugs which could save them. Also, these trials have the potential to speed up the research, while keeping costs low, which would be important for drug developing countries. Personally, I think that there are practical issues as well as ethical issues that come with this kind of research, as if an American or British company, for example, intends to market a drug that they have tested in India or elsewhere, we can’t be sure of the transferability of the data, as there are so many other factors which affect  trial, such as diet, exercise and lifestyle. These massively differ between developing countries and Western countries, so I think that the data which is taken from these trials should be looked at with caution before deciding to market the drug in the West. We discussed this quite deeply in our syndicate discussion following the lecture. In the lecture, we were also told about four key principles of bioethics: autonomy, justice, benefice and non-maleficence, and how pharmaceutical companies and doctors try to stick to these. Although drug companies must stick to certain reguations, I believe that money is what is really driving their business, rather than the desire to make people better. If these companies only wanted to help, then we would have a vaccine for malaria in third world countries. The sad fact is that we don’t make these drugs, because the people who are affected by malaria wouldn’t have the money to buy them, meaning that there would be little profit for the business, despite it having the potential to save so many lives. I asked the lecturer whether the same bioethical principles apply to children, and how these would differ, as a child may not be deemed to have the same mental capacity as an adult. She kind of avoided the question, simply stating that principles do differ, but she didn’t say how. This is something that I would like to look into a bit further, and has lead me to question whether it’s fair that adults rule over decisions for a younger person’s life. I think that it would probably differ between cases. For me, this is why it’s so important to consider each case individually, on a personal level, rather than setting fixed or inflexible rules to follow.

The evening of the conference was great fun. Not only we were treated to a formal three course meal, but also an incredible rising band called Outlya. I hadn’t heard of them before, but their music was great and apparently they have toured with James Bay. For me, they were definitely one of the highlights of the day. Afterwards, there was lots of time to socialise and chat with the band too.

The next day, we had a lecture by Lucy Van Der Wiel, which was called Dish Life. It was about the bioethics of using stem cells for research purposes, and where we should source these stem cells from- if it was ethical to take them from embryos. We got shown a video which was perhaps aimed at younger ages, but was entertaining nevertheless. It used the analogy of children being stem cells, with scientists looking after them and nurturing them in the lab. Afterwards,the syndicate discussion got quite heated, debating the moral value of embryos, whether they have consciousness, who owns the embryos, and whether we have the right to research on them. In my opinion, I think that we should continue to obtain embryos for stem cell research, as I believe that they have a huge potential to help cure many diseases, and the research that we carry out on them is extremely valuable to science now and science in the future. Many embryos that are created for IVF are unused, and may otherwise be thrown away, so I think that it is more ethical to make a use of these developing beings, rather than discarding them. However, saying this, it is important to take into account the opinion of the parents, as if they don’t wish for their embryos to be used, then we must respect that decision. The speaker also briefly talked about the case of Henrietta Lacks, whose cancer cells were used without her permission in thousands of studies around the world. These cells helped many new discoveries in cancer medication, but does this justify the compromising of her rights? This was another very interesting topic to debate about.

The final lecture, by Nichola Rumsey, was about body image. I found this very interesting, looking at how the current society is affecting the mentality of children, teenagers and adults around the world. We also looked into the unregulated business of cosmetics, and the problems that it poses to individuals and to the government too. Celebrities, toys, advertising, social media, magazines and models were all put to shame during this talk by a leading phycologist, who said that these all negatively impact how we feel about ourselves, as we strive to be perfect. In our discussion, everyone was pretty much in agreement that these developments in society aren’t good for the mental health of vulnerable people. However I challenged this. From a medical perspective, if a patient is obese for example, you can’t avoid the problem; too concerned about their mental health to directly tell them that they need to lose weight. The obesity is impacting their health, yet we need to achieve a balance which allows us to help a patient both mentally and physically to become healthy. This, for me, is a problem. Although body positivity is definitely a good thing, I am not in favour of brands promoting ‘curve’ ranges for larger women, or men for that matter. I think that it normalises being overweight, which is something that can severely affect global health, given the current statistics of people who are becoming obese. Again, I think that the balance we need to achieve is extremely difficult, as different people have different bodies, and may need to alter their diets in different ways. The problem is that media is accessible to everyone. This means that we can’t control who sees what, and how it will mentally affect them. This dilemma made a great debate, as many people weren’t in agreement with me on this issue.

After our final lecture we had a panel discussion, where one member from each discussion group was asked questions by the other groups. This was great fun, and a great way to end the conference. I was sad to leave Cambridge, but really valued everything I learnt whilst attending the event. I will never forget this experience, and hope to extend my knowledge on the topic of medical ethics in the future. Let me know what your opinions are on some of the topics that I have mentioned! Also if anyone knows any good books about medical ethics then please share! Thank you for reading.

The Impact of Air Pollution

We may all try to live a healthy lifestyle, choosing to eat well, stay fit and not smoke, but what if we were increasing our risk of cancer, simply by living next to a busy road?

An article in The Times recently suggested that living next to a main road could be as bad for your health as passively smoking 10 cigarettes a day. Scientists have claimed that this is affecting many people living in large cities, with children and pregnant women being particularly vulnerable, since air pollution has been shown to lead to roughly 4,500 premature births each year in this country. This is due to pollution caused by road vehicles, especially diesel engines, as they emit a significantly larger amount of harmful fumes than petrol vehicles. The problem with pollution is that you can’t necessarily see it, so many people don’t believe that it could be a problem, when, in fact, it’s thought that air pollution kills up to 40,000 people per year. If a new disease was to arise and cause this many deaths, surely the health service would be eager to do something about it, yet since air pollution isn’t perhaps as obvious to us, nobody is taking the necessary action.

There are currently activist groups who are pressuring the government and Theresa May to ban diesel engines which are accelerating pollution in cities. This may seem radicle and perhaps unrealistic at the moment, but already the government are discussing a potential diesel tax for drivers, in order to discourage the use of these vehicles. This would potentially reduce the amount of diesel drivers, hence decreasing pollution levels.

Although the risks from air pollution are greatly lower than that of smoking, they have similar risks to passive smoking, which drove the governments towards banning smoking in public places completely. Some of the health risks include: a declination in lung capacity, premature birth, diabetes, increased risk of dementia, heart attacks, stroke, and lung cancer. Children in densely pollute areas are more prone to developing asthma, wheezing, high blood pressure, leukaemia and high insulin resistance, which could lead to diabetes. Despite this, we cannot ban pollution in public places, as it isn’t something we can directly control. The only feasible action plan would be to try to limit the pollution emitted; but this is harder than it sounds, and even so, people are reluctant to change.

To decrease pollution, we need to reduce the use of cars and other transport which may give off harmful chemicals. One of the problems with this, is that as a society, we have become dependent on polluting vehicles, and limitations on such transport would be bound to cause problems throughout the UK. However, if everyone made small changes, such as lift sharing, taking a bus, bike or even an Uber taxi, the effect on pollution levels would soon become evident.

Personally, I think the issue that we need to address is educating people on the dangers of air pollution, and the health impact which it is having on our population. Many people, even those who lead healthy lifestyles, are unaware that pollution has similar risks to passively smoking. Perhaps these people would be more inclined to reduce their pollution emissions from daily transport methods, if they understood that air pollution could be undermining their efforts to keep themselves fit and well. Knowledge is power in this situation.

Using CRISPR to lower cholestrol

Recently I read an article that discussed the possibility of using CRISPR, to edit genes in order to lower someone’s cholesterol levels.

The technology is based on recent research that is focused on a protein known as PCSK9, which plays a role in cholesterol levels circulating in the blood. PCSK9 is known to degenerate another protein, which is located on the outer area of blood vessels. This second protein is responsible for removing low-density lipoprotein (LDL) cholesterol, also known as ‘bad’ cholesterol, from the blood. Therefore, if you have a higher level of PCSK9 protein, more of this protein will be degraded, and less cholesterol will be removed from the blood.

It has been discovered that some lucky people have been born with an advantageous mutation, meaning that they do not possess the PCSK9 protein, and therefore have naturally lower cholesterol levels in their blood. This is beneficial, as these people have a much lower likelihood of developing heart disease, stroke and peripheral artery disease, due to plaque build up in the arteries. Current statistics have shown that 25% of people living in rich nations are killed by strokes and heart attacks, yet this new technology has the possibility to allow people to lower their risks of these conditions, and lead longer and healthier lives. Although statins are widely available for these illnesses, the side effects of such drugs have been criticized, with doctors seeking treatment that doesn’t provide these symptoms. This is why this new therapy has stirred up excitement in the world of medicine.

Two innovative methods have utilized this information to come up with novel solutions to lower cholesterol.

The first of these methods has created antibodies, which take out the PCSK9 protein from the blood. In this study, this treatment was shown to be highly effective in humans in terms of lowering cholesterol, with no major side effects.  The results as to whether this lowers the chance of heart disease haven’t been released yet, but the data is expected sometime in March. Although this method may seem promising, the antibody drugs are extremely expensive, and patients would have to undergo routine injections of antibody roughly every 2 to 4 weeks. Due to the price, this method will not be available widely, so perhaps isn’t the way forwards in terms of lowering the population’s cholesterol levels.

The latest scientific developments in this field have made use of the CRISPR gene editing technology, which has recently become accessible to scientists.  So far a team known as AstraZeneca have successfully managed to de-activate the PCSK9 protein derived from humans, which was inserted into mice. The CRISPR Cas9 protein was injected into these animals and a specific RNA sequence was also guided within, aiding the Cas9 protein to bind to the correct section of DNA in the appropriate gene. After this, the special protein slices the gene at the specific point, meaning that when the cell repairs this break in DNA, mistakes which function to disable the gene are likely to occur. The experiment showed that mice given the CRISPR treatment had a greater drop in cholesterol levels in comparison to the mice, which were injected with the antibodies.

The CRISPR technique is seen as a better way of resolving this issue, as it disables the protein completely and doesn’t require regular injections unlike the antibody method. It’s simply a one-off injection, which can permanently alter the target DNA. Although this treatment may sound promising, there are many dangers associated with it, since if the protein was to incidentally alter the wrong gene, then it could cause unwanted mutation, with the threat of developing cancerous cells. Despite this, the researchers have said that they have tested ‘off-target’ effects of this therapy in 26 types of tissues in mice. The results of this are to be released soon, but the scientists have claimed that it’s “very promising in terms of safety”. On top of this, as CRISPR is still new to humans, it is constantly being re-evaluated and improved, meaning that the technology may be a viable treatment in the near-future, although some skeptics say that we’re t least 10 years away from human trials.

I think that this technique could save many lives if it becomes widely available, however research and practical costs seem hefty, and with the current financial situation of our country’s health sector, it seems unlikely that this could be available to the majority of our population. Thank you for reading. Let me know your own opinions on this.

 

 

Somnox

In Friday’s paper, I read an article about a new sleeping aid called Somnox. Essentially it is a robot which is designed especially to aid insomnia.

Somnox claims to be the first non-medical solution to sleep problems. The product itself is a huggable, peanut shaped pillow, which has multiple sensors to help asses sleep patterns and behaviour. The data which it gathers from the user are then plugged into a specific algorithm, which then designs a treatment suitable for the individual user.

One feature is it’s ability to optimise your breathing patterns for sleep. Breathing is a crucial element of drifting off, as it affects both heartbeat and metabolism, which also impact quality of sleep. As your heart rate drops to a level suitable for sleep, your body winds down and relaxes in response. This robot pillow mimics human breathing, in a specific rhythm, tailored to the user. Naturally, our bodies are influenced by breathing patterns of those around us, meaning that the robot can aid us in finding the correct breathing pace needed for our sleep. As your sleep state changes, the product is able to sense this, stimulating an alteration of breathing pattern, to maintain the ‘perfect’ rate of breath.

Beside this, Somnox has inbuilt bluetooth speaker which can play sleep songs and bedtime stories to you, helping the user to drift off into a peaceful sleep. The smart sound system has the ability to stop playing once you have fallen asleep, so as not to wake or disturb you during the night. On top of this, the speakers can also be set to act as a morning alarm clock, containing a database filled with a wide range of sounds to stimulate your awakening.

Another feature of this sleep device is the Smart Light system which has been programmed into the bot. If you prefer not to wake up to an annoying alarm, Somnox can wake you up gradually, by slowly increasing the light levels that it emits. This allows for a more natural start to the morning, as it imitates a sun rise.

This device could significantly improve the health of an individual, since sleep plays such an important role in physical wellbeing. With the rise in work stress and pressure, many people find it harder and harder to get to sleep at night, as problems play on their minds. The potential to improve sleep can aid performance during the day, since your body will be properly rested and energised for the upcoming day’s challenges. It can also improve happiness, since it has been shown moodiness and being easily aggravated are a direct side affect of sleep deprivation.

Although this is only in prototype stages at the minute, engineers from Somnox have started a Kickstarter campaign which aims to crowd fund the development of the sleep bot and hopefully allow for its release onto the market in the near future. This promising technology has already won the developers of the product several prizes, including the Robotdalen Innovation Award 2017 and the James Dyson award for best soft robotic invention.

I think that this could significantly improve wellbeing across the globe, and help to improve people’s general state of health. However, I suspect that when first released, the product won’t come cheap, due to the vast amount of technology which has been input into the robot’s system. Hopefully in the future, this sort of product will be available to everyone. What are your opinions on this? Please let me know what you think! Thank you for reading.

Misophonia

Last week, neurologists claimed that the hatred of specific sounds, can actually be a sign of a neurological disorder called misophonia, also known as selective sound sensitivity syndrome. Although recent research has caused interest in this condition, the term misophonia was first used back in 2000 by audiologists Pawel and Magaret Jastreboff, when writing an audiology paper.

Studies by Dr Sukhbinder Kumar have shown that common triggers include eating, breathing, pen clicking and chewing noises. The noises can provoke severe anxiety, or an extremely negative reaction, in those suffering from the disorder. In 2012, Kumar and his team published a study in the Journal of Neuroscience which investigated affects of harsh sounds on brain activity. Following this, they then looked into the effect of other noises such as chewing, on people with misophonia. It was discovered that specific noises were being perceived in a different way to others, hence these trigger noises stimulated a ‘fight or flight’ response in patients. The study also revealed that symptoms usually surface between the ages of 9 and 13, being more common in females than males. Further research showed that this anxiety was caused by abnormal connections in the brain, between the frontal lobe and the anterior insular cortex, meaning that certain noises are significantly amplified in both of these brain regions. The overactivity of the anterior insular cortex, means that people with the condition are significantly more sensitive to specific noises, as their emotions are more strongly linked to their senses in comparison to a ‘normal’ person. With brain imaging technology at Newcastle University, scientists were able to see changes in brain activity when specific sounds were interpreted, causing sufferer’s brains to go into overdrive, due to these abnormalities within emotional control mechanisms of the brain. This can then cause symptoms such as sweating and increased heart rate, hence increasing anxiety. Memories associated with specific noises were also shown to cause adverse reactions in people with misophonia, showing that the condition isn’t just a case of finding certain sounds annoying.

MRI scans compared reactions to a wide range of noises in people with and without the condition. It was hence discovered that trigger noises evoked a different type of response in people who suffer from misophonia. The subjects were played noises including neutral, white noise, unpleasant and sharp noises, as well as trigger noises. The dominating emotion present in misophoniacs after hearing trigger noises was anger as well as fear, rather than disgust, which was displayed in response to the unpleasant noises. In the most of cases, when trigger noises were interpreted, misophoniacs felt the need to flee the room in order to escape their feared sounds.

The only current solution for misophoniacs is self-medication, involving using headphones, ear plugs or music players to try to avoid trigger noises. Some medical professionals believe that CBT and exposure therapy can help patints, however, due to the lack of in-depth knowledge of the condition, there aren’t yet any medical treatments, meaning that misophonia can severely impact someone’s life, as they constantly try to avoid noises that cause anxiety and panic attacks. Quality of life is compromised, depending on the extent of the condition, as often victims who are gravely affected have to quit their jobs and miss out on social opportunities, in fear of encountering trigger noises. This can therefore lead to a life of isolation and loneliness. Online groups have been set up in order to support people with this condition, to help manage symptoms and share coping strategies.

Although this condition is relatively new to the world of medicine, research is being undertaken into solutions for people with misophonia. Some researchers believe that passing a minor level of electricity through the patients head, could alter brain activity, potentially curing their condition. Scientists Newcastle University are further looking into this as a prospective treatment.

Despite the abundance of research carried out by Kumar and his team, many remain skeptical of its validity, thinking that some people just find certain sounds ‘annoying’. What do you think of this condition? Leave comments below.

Bio-glass

Recent research has seen the development of bio-glass: a material able to imitate cartilage, possibly stimulating its regrowth. It has opened up the world of grafting to new possibilities. Grafting materials need to have certain properties, including biocompatibility, bioresorbability, and it must be osteogenic too, meaning that it is composed of bone-forming tissue. Materials that are biocompatible have been long sought after throughout the history of medicine, as early studies found that many metallic substances corroded in the body, being targeted by certain bodily fluids. Doctors therefore started searching for materials which could hold off the body’s chemical defences. It was thought that hydroxyapatite, being the body’s natural ceramic mineral, could be synthesised for medical uses inside the body.bioglass

Autogenous bone grafts, which are harvested from the patient’s own body, usually don’t provide enough tissue needed for suitable repair, so alloplastic grafts have started to be used. These often are made from hydroxyapatite, which is the most commonly occurring mineral in bone. Other materials that can be used include: calcium carbonate, some microporous grades of PMMA, polyhydroxylethylmethacrylate and other acrylates. These are commonly coated with calcium hydroxide which aids its adhesion. Bio-glass, on the other hand, includes silica, calcium oxide, sodium oxide and phosphorus pentoxide, to create a flexible yet durable material. It can stimulate the growth of new bone, and has been labelled, along with hydroxyapatite, as a bioactive ceramic. However, bio-glass has shown to possess certain advantages over hydroxyapatite, as it can bind to hard and soft tissues, whilst hydroxyapatite is only capable of binding to hard tissues, thus needing an exterior covering to hold the implant in place.

This material, which has been studied intensely at both Imperial College and the University of Milano-Bicocca, has been claimed to have some shock-absorbing and weight bearing properties similar to living cartilage. Another benefit of this material is that it can be manufactured into 3D printer ink, meaning that it can be printed into particular shapes which mimic certain human structures. It can be remodelled into many different forms including: pellets, powder, mesh and cones. It was found that as the proportions of the mineral components of bio-glass are altered, the properties of the material are changed, which can cause the bio-glass to become bioinert, bioresorbable or bioregenerative. This therefore opens up a wider range of uses of bio-glass, as the bioregeneration process stimulates self-healing characteristics, thus making it a reliable implant substance. Research has found that this material is capable of activating specific genes which control osteogenesis and growth factor production to produce bone, which is almost identical to natural bone. When implanted into bone tissue it was discovered that the bio-glass withstood attempted removal from the particular area, hence the phrasing ‘bioactive glass’. It stimulates a biological interaction of itself with the original tissue, thus creating a particular bond between them. The surface of the implant is able to alter its form, when exposed to liquids, to form a gel layer, with the capability to mineralise in just a few hours to create a hydroxycarbonate. The layer which forms imitates the hydroxyapatite matrix, meaning that osteoblasts form, and new bone is put in place.BioGlass_BioactiveGlassSurfaceReaction_WEB

With further investigation, these researchers hope to create implants to replace damaged cartilage discs, due to cartilage degeneration, which lie between spinal vertebrae, causing intense pain for the patient. The only treatment at the moment relies on fusing the patient’s vertebrae together, thus severely decrease a patient’s mobility. Scientists have the hope of engineering this bio-glass to mimic the properties of real cartilage for cartilage disc implants, instead of the devices which are currently used; made of metal or plastic.

Cartilage plays a key role in cushioning our bones, which is why bio-glass must include shock-absorbing properties. The scientists came to the further conclusion that this material could help to stimulate regrowth of cartilage, particularly in the knees. Currently, a tissue similar to scar tissue can be manufactured to repair the impaired cartilage, however the majority of patients have to undergo joint replacements, which again can hinder mobility.

The research group have the vision to create biodegradable scaffolding, for tissue growth, manufactured from 3D printed bio-glass. The microscopic pores within the material are able to stimulate the regeneration of cartilage, hence aiding recovery. The structure would then degenerate, leaving behind new cartilage which would be almost identical to the original tissue.

Various other studies have looked into the use of bio-glass for endosseous implants, as a remineralizing agent, as an antibacterial agent, in the use of drug delivery, for bone tissue engineering and as a graft material.

bioglass (1)The actual bio-glass material has been said to have been first used in the 1960s in Vietnam, but the recent flexible version which scientists have created is the only substance of its kind which can imitate the function of cartilage. This material aims to relieve excruciating pain that often follows cartilage degeneration, particularly in joints, which can severely reduce both mobility and therefore independence of a patient. The prospect of reducing stiff joint problems, without using stiff metal fittings, has brought about a new wave in medical though. A way of actually inserting these bio-glass implants is yet to be devised, and methods of 3D printing need further refinement. Additionally, the method still needs to pass essential regulations before being put into a clinical setting. There are also limitations with regards to the capability of bio-glass, as some studies have shown that it has a low fracture toughness, and mechanically, it isn’t always reliable. Therefore, one of the current aims is to develop a tougher bio-glass for scaffolds, in order for increase weight bearing ability. A patent for this idea has been secured, however it’s likely to be another ten years or so before this technology appears for patient use. Despite this, scientists have expressed their excitement for this ‘new generation’ of biomaterial, which could be a revelation for current treatment.

Thank you for reading. I hope that you have enjoyed reading about the recent innovation. Let me know what you think in the comments below.