Impulse by Dr David Lewis

I recently read Impulse and thoroughly enjoyed it. Upon primary examination, while trying to choose a book to hand in for my school’s speech day as a prize, I was interested by the concept of the book; looking at why we do things without knowing why we do them. At first, it seemed as though it was mostly based on general psychology and so I did not expect to read much hardcore medicine related science, but was still interested nevertheless. I was pleasantly surprised to find that in fact the book was heavily science based and had plenty for me to get my teeth stuck into!

I read it while away on a trekking and volunteering expedition in the Atlas mountains in Morocco with a group, and managed to get them all interested in certain aspects of the book, such as how the length of index finger in comparison to ring finger can be used to find a ratio which is then used to determine the likelihood of the individual partaking in risky behaviour.

Another aspect of the book that I found particularly interesting was the section that discussed how animals can use a subconscious sense of smell to avoid inbreeding within their species. This caused me to do some further reading and I found that this occurs largely in birds, such as penguins. This also helps them to find their mates after a long period of foraging, and allows them to find their habitats after days at sea. The same principle applies with mice. They use the their sense of smell to detect which other mice are closely related to them, due to the genes relating to smell being on the same part of the genome as the genes related to the way the immune system identifies its cells. This produces the concept that if you smell similar, you are likely to be closely related. An experiment was done claiming that mice avoid inbreeding in this way, where a mouse was placed into a cage with its brother. When forced and with no other option, the mice would breed. However, if another, non-related male was introduced, the female would mate with the other male over the brother. Interestingly, if the second male was introduced after the female had fallen pregnant, the female would abort her current pregnancy to mate with the new male; a good mechanism to avoid inbreeding. Dr David Lewis claimed that this concept could be transferred and was proven to be in use among humans, in that we subconsciously find people with similar smells to our own less attractive, which is nature’s of way of preventing incest, using MHC (major histocompatibility complex) genes.

The overall message of the book is that a lot of what we do, or at least think we do, consciously, is in fact down to our genes or factors that we cannot control. This introduces the idea that ‘free will in an illusion.’ This is a dangerous concept, as highlighted in the final chapter of the book, due to the fact that it removes all personal responsibility and makes punishment of criminals significantly more difficult, particularly if it were to be widely recognised that free will is in fact a grand illusion. We would no longer be able to send murderers or psychopaths to prison because they could quite easily blame their subconscious (system I) brain and claim they were not in control of themselves; a dangerous and scary concept in my opinion.

The life of a clinical researcher

This evening I attended a lecture given by Dr Desa Lilic at Newcastle University about her life in clinical research. The talk was organised by Newcastle AMS, and I was lucky enough to be able to go along and listen. (Perhaps partly due to the fact that somewhere along the line in the organisation my friends and I were mistaken for undergraduate students at Durham Medical School as opposed to just Durham School!) 
Dr Desa Lilic opened her lecture by telling us how provocative she intended to be and that her aim was to make us think about the role of a clinician, and she stayed true to her word. She told us that in fact clinicians are not scientists. A clinician does not acquire the knowledge, but instead simply applies it. This concept was new to me because of course I had always been under the impression that clinicians really were scientists, in their labs, with their crazy hair and white lab coats. Well, maybe not quite like that, but I definitely thought they fell into the category of 'scientists.' 
However, once I started to think about it, I remembered why I want to be a doctor and not a scientists. Scientists acquire the knowledge and make the ground breaking discoveries, whereas doctors and clinicians use this knowledge to solve the problems faced by real people, and this of course requires interaction and application. This is the thing about medicine which really excites me! 
Next, we asked ourselves why people carry out research. My initial reaction would be to move forward in a way of thinking. When I don't understand something, or would like to know more about something, the first thing I will do is look more into it. Dr Lilic said that she had asked her colleagues what they thought and they all gave various answers such as better understanding of a disease, to help patients etc. The one which struck me, however, was for rewards and recognition. It had never really crossed my mind that going into medicine could make someone famous, and of course that is never anyone's intention in becoming a medical professional. However, Dr Lilic proceeded to illustrate that doing clinical research for fame or fortune is not sensible at all, using examples such as Watson and Crick. Of course they were not the only people responsible for the discovery of the molecular structure of DNA, and at least two of the main contributors were completely ignored in the papers they published. Notably, they used the research of Rosalind Franklin, who died prematurely, (possibly as a result of her exposure to radiation in her research) without her consent and she therefore received virtually no recognition at all for her efforts and for providing crucial information, without which Watson and Crick would not have been able to make the discoveries they did. Another example she used was in the discovery of myelomas which are used to produce monoclonal antibodies by fusing with B cells to form hybridomas. The discovery of the crucial deficient myeloma cell should have been credited to Michael Potter, but instead was credited to Milstein and Kohler. This was due to the fact that Milstein and Kohler applied the knowledge acquired by Potter and put it into a translational format. 
This led me to wonder whether science was in fact led by the researchers or by the market. Can scientists carry out good research without it having to directly lead to a new drug for example? Can scientists receive funding for research which will not lead to a development where there is a gap in the market? No, I really don't think they can. It seems that science has become market led and that all research must be applicable, which I think is a great shame. Dr Lilic made the point that all knowledge is useful knowledge and I would agree with this statement because although the research may not be directly applicable, it may be extremely useful in the future. For example, when Potter made the first myeloma deficient cell, he did have the use for it straight away, but without that research, we might not have had monoclonal antibodies. This shows that not all research must be directly applicable to be useful in science. I would like to end with a quote Dr Lilic included in her powerpoint. 'We don't choose our passions, they choose us', so the research should be based on the scientists' interests and the passions of the researchers, not the market. 

Audioprosthology work experience

A few weeks ago I was lucky enough to be able to follow an audioprosthologist for a few hours and see what the job involved. I must admit that I wasn't really sure what to expect from the morning but was still looking forward to it. It was so good to be able to go and learn about a field that I didn't already know very much about. Again, it had to be in french but it didn't bother me too much because I was counting it as my revision for my french mock which was coming up!! 

When I arrived I was greeted by a lovely lady called Murial Renard, who was kind enough to show me around the clinic she works in. Her job involves fitting hearing aids to children and I was able to watch this happen several times. I have to say I hadn't really considered working with children before because it hadn't appealed to me but after today it is definitely something I would like to think about. It was really amazing to watch the look on the children's faces when they could hear again and it was equally as wonderful to see how happy the parents were to see a change in their children. I felt privileged to be able to watch something like this happening so I can only imagine how incredibly satisfying it must be to be able to cause this. Even though it isn't a field I had considered, I feel as though it really showed me how much satisfaction there is in being a medical professional of this kind. It was also clear to me that the qualities I saw in all of the doctors in surgery were quite easily transferable to this profession. A sense of humour, good people skills and patience were all very important in the consultations I saw. I can't wait to be able to put these qualities to use myself and start helping people. 

Could viruses act as a replacement for antibiotics?

In one of my biology lessons today my teacher was talking about a microbiology course he had been on where he had been looking at the growth of bacteria in different conditions. He told my class about an experiment the people on the course with him had conducted involving viruses which attack bacteria called bacteriophages. I was extremely interested in this because straight away it got me thinking about the uses it could have,including as an antibiotic. This is especially important due to the thousands of antibiotic resistant strains of bacteria emerging, making it more difficult to treat patients suffering from diseases such as MRSA. He showed us an agar plate with his bacteria colonies beginning to grow with a wall down the middle. On one side of the wall was just the bacteria (E.coli)and on the other was the bacteria mixed with the bacteriophage. This interested me so much that I decided to do a little bit of research into bacteriophages. 

I discovered that phages, in the environment in general, work by producing enzymes called lysins which destroy the bacteria and therefore release hundreds more of the phages which had been held by the bacteria into the rest of the colony to attack more bacteria cells. 

Bacteriophages can therefore be used as an alternative to antibiotics due to their ability to perform the exact same function; destroying bacteria. This development of bacteriophages into medication as a treatment for bacterial infection would result in huge developments in the medical world. I found some information about an experiment conducted by the laboratory of William Smith which investigated the use of phages of the treatment of E.coli in mice. They wrote a paper which stated that a single dose of a certain E.coli phage was able to greatly reduce the number of that strain of E.coli in the alimentary tract of animals with a diarrhoea causing strain. This resulted in less fluid loss meaning that all of the animals treated with the phage survived. 

J'ai fait un stage

Due to the fact that my family are living in France and I'm attending boarding school in England, it's very difficult to do any work experience in the UK, despite my best efforts, but I did manage to find some to do in France. The obvious downside to this is that of course all of the doctors I was able to follow were speaking in french. Although at times this was frustrating for me because I was unable to ask some of the more technical questions I had, I am happy to say that I was able to understand the majority of the things the doctors were telling me in french. The anaesthetist who I was shadowing, Frederic, was extremely helpful and allowed me to see a wide range of things and also allowed me to get scrubbed up and sit in on 4 surgeries! 

I was so so excited to put my scrubs on and be able to watch all of the amazing things the doctors were doing. To start with, I followed around another anaesthetist, Carine, who showed me how they put up the fluid to put the patient to sleep. It was interesting to see the fact that some of the drugs had the exact same names, such as morphine, ketamine and adrenaline. I was able to talk to this lady about the surgery I was about to watch and she told me that it was to be on a man who's chin was too large and so they were going to perform a reduction. I was looking forward to this but was obviously a little bit nervous because it would be the first time I had watched a human surgery, and despite the fact that I was not phased by the surgeries on animals I'd watched, I still didn't know how I would feel. 

However, right before the op was about to start, I was ushered out by Fred who took me into another operating theatre, because apparently this operation was quicker and would allow me to see a larger variety of surgery. I arrived while the patient was still lying awake and so was able to observe the interaction between the doctors and the nervous patient. There were a lot of jokes made and the atmosphere was really light and fun despite the fact that this guy knew he was about to be cut into! I hadn't yet been told the operation that was going to take place but the interactions before the anaesthetic was administered illustrated to me how important good people skills really are in this type of career even if the majority of the time your patient will be asleep. 

Fred injected the drugs in the order Carine had previously told me about and the patient fell asleep. He allowed the patient to fall into a deep sleep and then explained to me that when the patient is under, they would stop breathing if the tubes were not placed into their trachea. He used a laryngoscope to open the trachea sufficiently to show me the vocal cords and explained that the tube is placed in between the vocal cords. Once all attached to the correct places, the screen began to beep, and Frederic explained what each number meant and I was then able to watch the different numbers change as the patient became ready for the operation to begin. 

I had not yet been told what this operation would be so obviously I was fairly shocked, being a 17 year old girl, when his genitals were revealed. I'm sure I must have blushed but luckily my mask should've covered that up! So all was revealed and it was very evident that there was a problem, because the scrotum was severely enlarged due to a build up of water. This was carefully removed by using an electrically charged instrument which burned away the tissue attaching the sac of fluid to the testicle.

I think it's fair to say that I was thrown in at the deep end and I wish I could say the next operation I was able to watch was slightly more pleasant (if operations can be pleasant to watch) but unfortunately it was probably equally as intense. I was watching a swollen prostate effectively be scooped out using an endoscope. The thing which I found really interesting about this was that there was a fluid pumped into the cavity of the prostate leading up to the bladder despite the fact that the instruments being used were electric. The doctor controlling the endoscope asked me if I had any questions, so I managed to ask how the fluid wasn't electrocuting the man and he told me they used a fluid which was non conducting. 

Next, Fred took me for a walk around several of the operating theatres. He showed me two theatres where heart surgery was taking place but unfortunately I was unable to see anything due to the fact that there were so many surgeons around the patient. Luckily though, there was also a lung operation taking place, and I was able to see this through a glass screen on a television connected to an endoscope. Frederic explained to me that this patient was a smoker and this was very evident by the black deposits on his lungs. I watched a section of his lungs be chopped off and removed through the tube. I was so fascinated by the fact that a part of lung tissue can simply be cut off and removed so easily, even if it was damaged or dead. 

Finally, I sat in on a surgery on a lady who's bladder was sitting too low down in her abdomen. Again this used and endoscope and the doctors simply made a hole just below her bellybutton and pumped air into her stomach to inflate it so that they had room to work. They then proceeded to use surgical thread the attach her bladder to the inside of her abdomen in a better area. The doctors showed me the various organs which were visible and after a rather funny conversation which involved me trying to explain the female reproductive system in english words for them, the operation finished and my crazy day in the hospital was over. 

I had had an amazing time watching all of the fascinating things the doctors were doing, and this definitely just made me more excited to start my application! I could see the various qualities required to carry out this job correctly, one of which, surprisingly, is most definitely a sense of humour! Everyone was always laughing and smiling and despite how serious the environment should have been, it was still a really fun day. 

Should we legalise cannabis?

The legalisation of cannabis is a heavily discussed topic for several reasons. I would say that these reasons fit into three main categories; economic reasons, democratic reasons and of course health reasons. I attended a heretics society lecture on this topic and it really got me thinking. What would the outcome be if we were to legalise cannabis and how could this affect my peers and I? I decided before I come to any conclusions, I need to fully weigh up all of the reasons for and against. 

Economic reasons

Of course, currently the price of marijuana is hugely higher than the production costs of the drug, but this is based on the fact that the supply is fairly low. People will often say that if the government were to legalise marijuana, they could profit massively from the taxation of the drug. However, I would argue that when the drug became legal, entrepreneurs would see the opportunity to profit from the ridiculously high street prices by driving them down and creating a competitive market while also increasing the level of availability which of course will drive the price down. I would argue that the government would benefit a lot less than the majority of people currently assume due to these factors. Of course the substance would be highly taxed due to the adverse effects it has but with the lower prices, the taxation is not likely to bring in the huge sum of money that could be expected. The government would be unable to set the tax levels too high because this could quite easily cause growers to sell on the black market where demand will be much higher if the legal product is too highly priced. This limits the economic benefits massively. So overall, I would say that the economic reasons are not enough alone to argue that cannabis should be legalised. 

Democratic reasons

The person who spoke at the heretics society claimed that we all have the right to make a silly decision which endangers our own health according to our civil rights and that democratically this therefore gives us the right to smoke marijuana. He compared this to the fact that we are allowed to drink and smoke tobacco despite the fact that it is not healthy. He was making the point that we cannot simply maintain that marijuana is illegal for health reasons. I definitely agree with this. There is not evidence of anyone overdosing on cannabis as opposed to the thousands of people who overdose on alcohol every year. It is fair to say that in a free society, it is unfair for the government to regulate substances based on anything other than the effect to the person and that there is a lack of consistency in the law today which allows a substance responsible for several thousand deaths per year to be legal and a substance which is yet to cause a death due to overdose to be illegal. 

Heath reasons

Obviously this is the most interesting to me, being interested in a career in medicine and taking an interest in the health of the population which I hope to one day be responsible for looking after. The stats which were discussed made me think a lot about the fact that we allow so many harmful, addictive substances to be acceptable in society. Obviously alcohol is the main example of this. Alcohol abuse costs the government over £21bn per year in healthcare and crime. This is absolutely ridiculous and in my opinion is a complete waste of resources. In 2011 there were almost 9000 deaths down to alcohol alone. On average 36 young people (under the age of 18) are admitted to hospital every day with conditions directly related to alcohol abuse. There are an estimated 1.6 million people dependant on alcohol in the UK. To me, it seems unbelievable that a substance like this is still legal. There is no evidence whatsoever to suggest that cannabis has lead to a death by overdose and also is much less addictive than both tobacco and alcohol. This begs the question, why is this illegal and other substances are not? Well one answer to this would be that previous prohibition of alcohol has failed and is therefore likely to fail again, making it very difficult to attempt to ban it as a drug. However, I would argue that the prohibition of cannabis is not working. It is still fairly easily available and a lot of young people are using it. The worrying thing about this for me is that young people have easy access to cannabis on the streets and mostly that, due to the fact that it is illegal, no standards can be placed on the substance. My view is that if we were to legalise cannabis we would be able to impose laws about the quality which is allowed to be sold and we would most definitely be able to better control the standards of the drugs people are taking, which in theory should make it more safe to take. In terms of addiction to cannabis, the drug is less addictive than drugs such as alcohol and tobacco which are legal. Frankly, I  disagree with all harmful substances because as someone wanting to enter the healthcare system, my main concern is the health of people who are at risk of becoming addicted to these substances, and these people are usually already suffering from other conditions, such as depression or other mental health issues. However, I also believe that we should have some consistency in the systems we have in place and the fact that the legality of the substance, which is already not incredibly harmful in comparison with other legal drugs, could in fact make it less dangerous means that to me, it seems almost sensible to legalise it for the health of its users. I also believe that its legality may in fact decrease its popularity among young people because it is no longer taboo. It could be seen as less 'cool' to use it because it is no longer illegal, making it less of a thrill. A question which was posed to the society, which I found particularly thought provoking was regarding the types of people who could potentially use this drug if it were to be legalised. Someone asked if we would be happy for primary school teachers to be smoking cannabis, and I have to say, it seemed ridiculous to even think about at first. However, after thinking about it, I asked the question, what is the difference between smoking cannabis and drinking alcohol as a primary school teacher. I don't see a difference. Of course it is not acceptable to smoke cannabis when you are teacher or to turn up to teach a lesson under the influence of the drug in the same way that it is not acceptable to drink while you are teaching or to come to work drunk. 

Overall, I feel that the reasons for legalising cannabis outweigh those for it to remain illegal due to the factors outlined above. I feel as though its legality would make it safer and would mean that its use could be controlled. 

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.