Paediatrics, Hormones and Murder...

Today I attended a lecture given by Dr Tim Cheetham from Newcastle University who spoke to a small group of us about his life in paediatrics and mostly about hormones. I found his talk extremely interesting, especially because he gave us a detailed incite into the life as a paediatrician.
He opened his talk by posing the question 'Why do children get ill?'
We came to the conclusion that there were six main causes of illness among youth. These were;

• Single gene defects, such as PKU (phenylketonuria) or cystic fibrosis
• Multiple gene defects, such as type one diabetes
• Environmental insults, such as foetal alcohol syndrome
• Diseases we understand, such as meningitis
• Diseases we don't understand, such as congenital hypothyroidism
• Injury

We discussed the first point at length. He used the idea that hormones and glands worked using a switch system. The hormone is the mechanism which turns the switch on, with the gland being the switch. He used the concept that a defect is caused by the switch either being constantly switched on or the hormones having no effect on the switch meaning that it cannot be turned on at all. I found this extremely interesting, especially when the concept was put so simply.

Leptin

One example he used was a cause of obesity, which is of course a very relevant point to think about in this day and age. He told us about his time at Cambridge university where he met Professor Sir Stephen O'Rahilly, who conducted an experiment on a pair of mice, one of which was leptin deficient causing it to be obese. In the experiment he connected the two mice by their blood vessels, and the blood of the mouse producing leptin was transferred to the obese mouse, which reacted to the leptin and lost a considerable amount of weight. This got me thinking about the hormone leptin. Leptin is produced by fat tissue (adipose tissue) and is the 'full hormone' which informs the brain of the nutritional state of the body. It basically tells your brain when you have eaten enough. If your body is resistant to this, it obviously causes you to feel hungry and for you brain to feel as though you need to eat more. This is a cause of obesity. I then began to wonder if we could use the injected or consumption of leptin as a treatment for obesity and Dr Cheetham quickly answered my question. He spoke about the use of the drug Rimonabant. This is an inverse agonist for a cannabinoid receptor. This very basically means that it has the reverse effect of cannabis, which causes a feeling of elation and an increased appetite (or so I've heard.) So a loss of appetite is the required effect, and this effect is gained. The drug blocks the 'cannabis switch', which causes a block of the hunger switch as well. This, of course, however has the desired affect to reduce the calorific intake of the patient. However, Dr Cheetham proceeded to tell us about another side effect of the drug, which was actually rather easy to predict once we heard about it. It also had a depressive affect, which seems sensible when we look at the effect cannabis has which are being 'blocked' by the medication. It also blocks the feelings of happiness experienced when cannabis is consumed. The medication was taken off the market.

Environmental insults

The main environmental condition which Dr Cheetham spoke about to catch my attention was foetal alcohol syndrome. This can cause some very serious conditions and is a lot more prevalent than it should be, especially considering the level of knowledge we have about the dangers. This caught my eye particularly because it made me wonder why there was so little being done about it. We often see antismoking adverts on the television warning of the health problems which can follow from smoking but we very rarely see anything about this. It is widely known that drinking while pregnant is bad for the health of the baby, but I do not feel that the extent of the damage which can be caused is heavily publicised enough. An example of this is septo-optic dysplasia which is often seen in children whose parents have consumed alcohol during pregnancy or have used recreational drugs. It is a mutation affecting a particular gene. This causes failure of the pituitary glands which are extremely important. A child with this could present as hypoglycaemic because of a lack in growth hormones and cortisol levels or they could present with problems in their eyes due to lack of development of the optic nerve. It can also cause excessive urination and thirst due to the irregular production of ADH, or they could present as hypernatraemic. My main question after having heard about this was simply, why is nothing being done about this? Women are falling pregnant and damaging the lives of children and I feel as though more needs to be done to prevent this. The first step to this, in my opinion would be to educate pregnant women more about the dangers because of course people know it is dangerous but often women are unaware of the exact danger it can cause. This is especially important when it is a child's quality of life which is in play. 

Changes to the system

He also asked us to think about the changes in the medical system recently. We came to the conclusion that the two main changes to the cases seen in paediatrics were due to vaccinations and better knowledge of risk factors of common problems such as cot death. The vaccination and screening programmes have not only reduced the levels of child deaths due to diseases such as meningitis but also allows us to place preventative measure in place if certain genetic disorders are identified, such as congenital hypothyroidism, which we are all now screened for as infants. This would present as an abnormally high level of TSH due to the under active thyroid which is not being 'switched on' by the hormone. Screening for this began in 1984 and this has allowed for the administration of thyroxin in order to combat this condition. 

The best bits of the job

Dr Cheetham did a great job of selling a career in medicine without even really trying to. He showed us that the job requires a lot of problem solving and, by showing us several case studies, he showed us how one must piece together all of the information we are given about a case to come to a conclusion and treat a patient. This is such an exciting concept because it demonstrates that the day to day life of a doctor is ever changing and that each day presents a new problem to solve. He also displayed the importance of working as a team in the medical profession by combining knowledge and skill to help to find the best cure for a condition. He demonstrated that when this teamwork is not achieved, the system can fail using the examples of Harold Shipman, Dr Death, who killed elderly patients and Nurse Allit, who murdered babies in Grantham. As upsetting as this is, it teaches us a lot about the way in which we should work in hospitals to ensure that this cannot happen. It highlights the importance of teamwork and the continuous education of medical staff, and I personally cannot wait to be involved in such a system.