MEDISCOPE | ISSUE 1 | 04 NOVEMBER 2020

MEDISCOPE | ISSUE 1 | 04 NOVEMBER 2020
- MENTAL HEALTH
- EPILEPSY
- CANCER
- ETHICS
- MOVEMBER
- BMAT
Logo Design: Sethujah Gangatharan
Photo credits: https://cdn.pixabay.com/photo/2020/02/09/16/23/coronavirus-4833754_1280.jpg

Dear All,
WELCOME!
One of the main things that these last few months have emphasised, is the
importance of healthcare. Since the outbreak of Covid-19, medicine has been
at the forefront of our world, helping to keep society up and running. The
current situation is inevitable, especially since our knowledge on this disease
is limited.
WELCOME
Covid-19 has caused a lot of us to change and reflect on our lifestyle and way
of thinking, especially in regards to our health. We’ve adapted to wearing face
masks in places like school and incorporated more frequent hand washing to
stay safe. As well as cleanliness, these unprecedented times have forced us to
incorporate thinking about our impact on public health and the NHS. Since we
are trying to minimise the transmission of the virus, staff, parents and
students of various year groups cannot meet up in real life to discuss
medicine. We felt that a more safe way to confer about healthcare and
connect us all as a community, was by starting a journal where articles
written by students themselves are featured; and this is why we created
Mediscope. We want to make people more aware about current affairs, spark
debates about medical issues and discuss medicine’s everyday impact more.
This first issue includes topics about the main themes in November, i.e. mental
health, epilepsy and cancer. To get you debating we have decided to
incorporate articles about medical ethics as well. For aspiring healthcare
professionals, we have included tips about the BMAT along with a section 3
essay competition which year 10s and above can take part in. Don’t worry –
there are other quizzes and puzzles for all students, parents and staff to take
part in too!
- Sethujah Gangatharan
A special thanks to my co-editor Amy Booth (12S) - we both hope you enjoy
reading the journal and we’re sure it will give you an insight into something
new!
1
We would also like to say thank you to Dr Navneet Singh Kandhari for reviewing
the journal and to Mr Blount, Ms Harvey & Mr Bournat for all their help and
support!

CONTENTS
Mental Health:
- The impact of Covid-19 on mental health
by Sethujah Gangatharan 12S ......................................................................... 3
- Advice for coping with stress during exam season
by Zhiyun Xia 10F .................................................................................................. 4
- The effects of COPD on mental health
by Atharvaa Pangare 12N ................................................................................. 5
Epilepsy:
- Epilepsy in our pets
by Alice Edwards 12N ......................................................................................... 6
Cancer:
- Movember
by Amy Booth 12S ................................................................................................. 7
- What is Peto’s paradox and can we resolve it?
by Oscar Houghton-Boyle 12S ........................................................................ 8
Ethics:
- 'The physician should not treat the disease but the patient who is
suffering from it'
by Tanya Singh 13.2 ............................................................................................. 9
- How should patients with both Alzheimer's and cancer be treated?
by Amy Booth 12S ................................................................................................ 11
- The case of Steve Biko
by Sethujah Gangatharan 12S ........................................................................ 12
CONTENTS
Other:
- November's Recommendations ................................................................... 13
- Medical Dates in November ........................................................................... 14
- Quiz .......................................................................................................................... 15
- Puzzles ................................................................................................................... 16
- Photography Competition ............................................................................... 17
- BMAT ....................................................................................................................... 18
2

MENTAL HEALTH AND COVID-19
3
THE IMPACT OF COVID-19 ON MENTAL
HEALTH
By Sethujah Gangatharan 12S
SARS-CoV-2 is an infectious disease caused by a
virus that is part of the family of Coronoviridae
1
viruses. It is more commonly known as ‘Covid-19’
and those infected with it tend to experience
respiratory problems. Most of the population
infected don’t need treatment and recover with mild
symptoms but the older population or those with
underlying medical problems tend to develop more
serious illnesses as a consequence of it. One of the
main ways in which Covid-19 has affected people, is
by impacting their mental health.
For some people it has led to neurological
complications like delirium, i.e. mental confusion
and emotional disruption, agitation (a state of
2
anxiety) and stroke. A stroke is a life-threatening
condition in which blood supply to a part of the brain
is cut off. This can cause long lasting physical
problems such as paralysis and psychological
problems such as depression and anxiety.
However, those that haven’t tested positive for the
virus have also be affected mentally. For example,
lockdown and self-isolation has meant that people
cannot leave their houses for social interaction –
this restriction has had a greater negative impact for
those living alone. Bereavement and the fear due to
loss of income are also factors that have triggered
mental health conditions and worsened existing
ones.
3
Korean MERS-CoV was the outbreak of Middle East
Respiratory syndrome in South Korea in 2015. This
virus was also a part of the Coronovirdae viruses.
Tests done at the time showed that those
undergoing dialysis as part of their treatment in
4
isolation had increased levels of ccf-gDNA
(circulating cell-free genomic DNA) and ccf-mtDNA
(circulating cell-free mitochondria DNA). Parameters
for stress include ccf-gDNA and ccf-mtDNA and this
suggests that isolation caused high levels of stress.
It was also confirmed that these levels of ccf-gDNA
and cc-mtDNA increased for medical staff and
unfortunately, they then went on to show PTSD
symptoms as well. Another time in which healthcare
workers showed severe PTSD symptoms was during
the 2003 SARS-CoV outbreak in Singapore.
Healthcare workers are dealing with high risks of
contamination whilst having inadequate PPE, and
this itself has led to anxiety. The previous cases of
coronavirus in 2003 and 2015 suggest that this
pandemic could have a long-lasting effect on
healthcare workers’ well-being and perhaps could
cause PTSD. Mental health problems affect factors
like the capacity to make decisions and be attentive
in emergency situations. Due to a domino effect, this
could affect how well patients are treated and delay
the fight against Covid-19.
In order to improve the mental wellbeing of staff
and patients, mental health services should be
5
readily available. A survey carried out by the World
Health Organisation revealed that most countries’
mental, neurological and substance use services
(MNS) have not been readily available due to
reasons like the facilities being used as quarantine
or treatment facilities. A rise in the misuse of
substances like alcohol has clearly portrayed the
negative impacts that the closure of MNS has had.
6
NHS England has recently stated that it will invest
an extra £15 million to care for the mental health of
healthcare workers like doctors, nurses, paramedics
and therapists. The NHS National Mental Health
Director Claire Murdoch has said,
“Frontline workers are the backbone of the NHS,
from porters and cleaners to nurses, doctors and
therapists, and this funding will ensure they are
properly supported while they continue to care for
the thousands of patients who rely on the NHS.”
The money invested will be spent on things like:
Specialist bereavement support
An app for BAME (Black and Minority Ethnic)
colleagues which will hopefully help manage
anxiety & stress
And benefits like free car parking and free tea
and coffee in specific hospitals
Good mental health is fundamental for a good
physical health and vice versa. Covid-19 has had
many psychosocial consequences on healthcare
workers and the public so hopefully, the mental
health services provided by NHS England will help to
better improve the mental health of everyone.

ADVICE FOR COPING WITH STRESS
DURING EXAM SEASON
Mental health problems are one of the most
prevalent issues we are facing in the 21st century in
the UK. The rate of young people in the UK being
diagnosed with mental illness have risen rapidly,
with an estimated 10% of children between 5-16
years bearing the burden of a clinically diagnosable
1
mental disorder. One of the main causes of
deteriorating mental health amongst young people
are exams, which add stress and anxiety - an
already delicate balancing act in itself - to the
already precarious tower of school work, homework
and our daily worries. In 2015, ChildLine and the
NSPCC reported that over the past 5 years, the
number of students who raised concerns about
exam stress increased by 200%.
Although it is likely that anyone preparing for and
taking exams will experience some stress and
anxiety, scientific research has suggested that more
than 17% of GCSE students fall into the category of
being ‘highly test anxious’ ever since the new GCSE
system was put in place in 2018. This demonstrates
that while some individuals, such as former
Education Secretary Michael Gove, believe that
putting an emphasis on exams is a positive, many
recent studies actually show that exams are having
a detrimental effect on students’ mental, emotional
and even physical wellbeing as being healthy is not
just about how you look, it's also how you feel.
In response to a growing awareness of exam stress,
many articles have been published giving tips and
advice on how to manage and cope with exam
stress:
https://www.studentminds.org.uk/examstress.
html
https://www.nhs.uk/conditions/stressanxiety-depression/coping-with-exam-stress/
https://www.nhs.uk/conditions/stressanxiety-depression/coping-with-exam-stress/
https://www.ucl.ac.uk/news/2017/apr/7-tipshelp-you-cope-exam-stress
https://youngminds.org.uk/find-help/feelingsand-symptoms/exam-stress/
By Zhiyun Xia 10F
and more - I have summarised them all for you into
five (long) sentences:
1. Be honest and open up to the people you trust, you
will feel more relaxed letting all your stress out to
your friends and family.
2.Eat a balanced diet as well as sticking to your
sleeping schedule, exercising regularly and trying to
drink plenty of water to help you feel more
energised for longer, as this all helps more oxygen
flow to your brain and helps enlarges your
hippocampus, the part of the brain that all
information must enter/exit through
3.You have probably heard this one before; while
revising, take regular breaks and do not try to cram
revision the day before as none of that will go into
your brain anyways, why stress yourself out to no
avail?
4.Don't be too hard on yourself, think positively,
such as saying ' I can' instead of 'I can't' and try to
place yourself into a friends shoes, what would they
tell you?
5.Do not compare yourself to others, you will not
feel your best and motivated all the time, it may
sound cliché but it is okay not to be okay!
These tips will also help you in your daily routine as
well as becoming more organised and pro-active!
4
MENTAL HEATH AND STRESS

MENTAL HEALTH AND COPD
5
THE EFFECTS OF COPD ON MENTAL
Chronic Obstructive Pulmonary Disease describes a
group of lung conditions that make breathing
increasingly difficult. It develops over many years
and some people may not even be aware they have
1
it. Main symptoms include: increasing
breathlessness, productive chesty cough, frequent
chest infections and persistent wheezing. Less
common symptoms of COPD include weight loss,
tiredness, oedema, and in extreme cases, lung
cancer. COPD is one of the most common diseases in
middle-aged and old people, and has become the
third leading cause of death globally. Depression
2
and Anxiety are progressively becoming common in
patients with COPD. This is often linked to the poor
physical function, worse quality of life, increased
mortality, and damaged health status that patients
with COPD have to cope with.
There is currently no cure for COPD but there are
treatments available that can slow its progression
and control the symptoms. Approximately 85 to 90
percent of COPD cases are caused by smoking , so
after diagnosis patients are strongly advised to stop
3
smoking. Although any damage already done
cannot be reversed, it can prevent further damage.
When patients quit smoking, the withdrawal
symptoms have an extremely negative impact on
their mental health. These symptoms are caused by
nicotine receptors in the brain which are increased
due to previous nicotine use. These symptoms
include headaches, difficulty sleeping, increased
appetite and weight gain and can create a domino
effect leading to depression. Steroid inhalers are
also commonly prescribed; steroid medicines may
aggravate depression and other severe forms of
mental health, such as psychosis, may be triggered.
A study executed in the Affiliated Hospital of Zunyi
Medical University, Guizhou, China in June 2020
observed previously diagnosed COPD patients
admitted with acute exacerbations, patients with
anxiety or depression and healthy volunteers.
Patients were assessed using the Hamilton
depression rating scale, and baseline data and
clinical measurements - complete blood count test,
spirometry and arterial blood gas analysis was
collected to assess patients on the COPD evaluation
test. The independent variable was the COPD
evaluation test score, and as this score increased
HEALTH
By Atharvaa Pangare 12N
(higher scores denoting a more severe impact of
COPD on a patient’s life) the frequency of the patient
having AECOPD (Acute Exacerbations of COPD), as
well as a higher score on the Hamilton scale
increased. RDW (red cell distribution width) was
associated with AECOPD patients with depression
and/or anxiety. Red cell distribution width is a
parameter that measures variation in red blood cell
size or red blood cell volume. A normal RDW is
4
11.6% to 14.6% - a higher RDW means that the red
blood cells vary a lot in size. In 2016, researchers
from the Intermountain Medical Centre Heart
Institute found that patients with a RDW higher than
12.9% had an increased risk for depression. A study
in 2013 found that the higher the RDW, the greater
the risk for patients. The study looked at 43,226
patients and studied them for around 5.3 years -
examining their RDW levels at the time of diagnosis
and comparing them to a follow-up diagnosis of
depression. The results suggested that physicians
should be more aware and attentive in screening for
depression in COPD patients and treating it
accordingly. Dr May concluded by saying “Additional
studies will be needed to determine if the
association is causal, wherein depression is a result
of abnormal red cell size, anaemia or some other
co-morbidity.”
Despite the increasingly high frequency of mental
disorders in COPD patients, the evidence about the
optimal treatment is insufficient. Future studies
should focus on how pulmonary rehabilitation can
be improved to help mental health alongside
physical while determining the best treatment for
specific COPD groups – depending on factors such
as sex, severity of COPD, frequency of exacerbations
and severity of mental health problems.

EPILEPSY IN OUR PETS
By Alice Edwards 12N
As well as being crowned the most common neurological
issue found in felines and canines, epilepsy is known for
its crippling side-effects in a huge abundance of species.
This condition is characterized by seizures, which are the
manifestation of uncontrolled and hyper-synchronous
electrical signals of the brain normally resulting in sharp
and rapid muscle contractions, often alongside the loss of
consciousness. But what else do we know?
The large number of breakthroughs in the last century
have brought with them a deeper understanding of human
and animal medicine which has exposed the truth about
many conditions, including epilepsy. We are now able to
distinguish between different types of seizures 1 in our
pets: generalized seizure, i.e. the loss of consciousness,
involuntary repetitive movements, defecation and
salvation; and partial seizures - when more specific areas
of the brain are responsible, appearing as muscle tremors
or hallucinations. Although this is undeniably a harrowing
list of symptoms for worried owners, it is important to be
reassured that although disorientating, seizures do not
directly cause your pets any pain.
Next, it is important to confront the causes of epilepsy. Of
course, being such a diverse condition characterized only
by its seizures, it is not surprising that there are multiple
causes. The first of which is the most common, called
idiopathic epilepsy. This diagnosis dictates that the
condition has been passed down from parent to offspring
although it is still difficult to identify the exact
2
characteristic that is inherited and responsible. It may also
be defined as poly-genic if many gene mutations are
involved. Other causes include a variety of different
underlying health conditions such as brain tumours, liver
disease or kidney disease. Due to scientists’ limited
understanding in this field it’s impossible to breed animals
that will not be at any risk of epilepsy because those
previously born from generations of healthy litters have
still tested positive. Yet, we can identify those who are
most at risk, labelling them as breeds with higher
‘familial’ risk of this condition.
Despite the extent of extreme and periodic symptoms, the
prognosis for epilepsy in animals is a good one. However,
it is important to recognise, and act accordingly, to the
progressiveness of this disease. Although it is possible for
vets to prescribe many human drugs to animals, it is
important to recognize the side effects that may
accompany their use in different species, typically due to
an animal’s higher metabolic rate. The two drugs most
commonly used to treat epilepsy are Phenobarbital and
Imepitoin. In addition to these, potassium bromide may be
prescribed to help control seizures in canines. These are
known under the title of AEDs (anti-epileptic drugs).
Besides staying on top of medication, an owner needs to
keep a high level of vigilance around their animal,
recording their seizures and educating themselves about
when the intervention of medical help is necessary, for
example if the animal is seizing for more than 2 minutes.
It is important to recognise that it is possible an animal
4
can slip into Status epilepticus (SE) at any time. This
medical term is defined as continuous seizure activity that
lasts longer than 5 minutes or alternatively, one discrete
seizure which does not lead to the regaining of a full level
of consciousness during the recovery process. This is
considered to be a medical emergency, especially in small
animals, requiring immediate medical treatment from
professionals. The initial 30 minutes of SE is called the
compensatory phase in which the animal seeks to fulfil
their bodies increased oxygen demand. One way to do this
is by increasing blood supply to the cerebral regulatory
mechanisms. The activated sympathetic nervous system
can result in a rise in body temperature, salivation and
bronchial secretions (all of which an owner should be on
alert for). If aid is not offered within these 30 minutes, the
animal will slip into the decompensatory phase which
results in decreasing blood flow to the brain, ultimately
leading to neuronal cell death. After another 60 minutes, a
build up of intracranial pressure (pressure around the
brain) can lead to organ failures, with the patient's death
often following.
EPILEPSY
The next issue that this condition brings is the difficulty
for diagnosis in veterinary practice. Known as ‘diagnosis
of exclusion’, this process is a long one which entails an
immense amount of examinations and tests. To simplify
this, vets often divide the tests into two parts. Firstly,
they exclude any diseases that may have seizures as a
side effect and then they look in the brain itself to identify
any problems . Some of the tests that may be performed
3
include magnetic resonance imaging (MRI) and
cerebrospinal fluid analysis. This second procedure,
known as a 'lumbar puncture' in humans, warrants the
insertion of a long needle into the animal’s spine to gain
access to cerebrospinal fluid found in the subarachnoid
space.
A medics first action when faced with this situation should
be to stop the seizure as promptly as possible to limit any
further damage. This is normally through the use of a drug
called Intravenous diazepam (DZ).These are lipid soluble
and therefore can penetrate the CNS very quickly 5 which is
vital to limit the consequences of the ongoing seizure.
Once the seizure has finished a vets duty is to look into the
potential damage that it has caused and to deal with them
appropriately. This may include checking their airways,
blood pressure ECG’s and preferably blood gas values if
accessible.
Owners also need to be aware of the personal risk that
may occur if they attempt to restrain their seizing animal.
If these guidelines are adhered to, epilepsy should have
little interference with an animal's life-span or lifestyle.
6

MOVEMBER
By Amy Booth 12S
MOVEMBER
Movember is a an event that takes place in November every year.
Men around the world grow moustaches to raise awareness and
fundraise for men’s health; specifically suicide prevention, prostate
cancer and testicular cancer. Another way to get involved in
Movember is by running or walking 60km over November for the 60
men who we lose to suicide every hour or by raising awareness your
own way.
SUICIDE IS THE SINGLE MOST COMMON CAUSE OF
DEATH IN MEN UNDER 35.
1 IN 8 MEN WILL GET PROSTATE CANCER AT SOME
POINT IN THEIR LIVES
A MAN WILL DIE FROM PROSTATE CANCER EVERY
HOUR - OVER 10,000 MEN DIE OF THE DISEASE EACH
YEAR IN THE UK
To find out more about Movember and take part in fundraising,
please visit:
https://prostatecanceruk.org/about-us/movember
https://uk.movember.com/?home
https://www.huffingtonpost.co.uk/2013/10/24/movember
7

WHAT IS PETO’S PARADOX AND CAN WE
RESOLVE IT?
By Oscar Houghton-Boyle 12S
1
“Why don’t all whales have cancer?” At first this
may seem like a simple question but when looking
at research into cancer within multiple species we
find that the principles behind it remain unanswered
or confirmed to this day. Without observing other
organisms, one might expect that the probability of
developing cancer (ignoring carcinogenic
environments) would be dependent on the number
of cells that could possibly turn cancerous and the
organism’s total lifetime cell divisions. This
statement is true within humans, a longer life
allows more time to accumulate genetic damage or
2
mutations that cause cancer, but using this
principle an adult blue whale weighing on average
100 tonnes should be 1000 times more likely to
develop cancer than a human. However, observation
and evidence suggests this is not the case and even
research suggests there is no correlation between
body mass (and therefore number of cells) and
length of life affecting rates of cancer across
different species at all. Even domesticated animals
such as in zoos which usually live longer do not
show an increase in cancer cases compared to wild
members of the same species. Evidence shows that
humans and mice share a similar probability of
developing cancer despite us living on average 50
times longer and having 1000 times more cells than
mice.
3This observation is known as Peto’s Paradox.
Peto’s paradox simply put is the lack of a logical
correlation between the number of cell divisions and
probability of cancer but our question of ‘why’
remains unanswered. Despite being unable to
conclude the reason why large organisms are so
resistant to cancer many useful theories and studies
have arisen. In this article I am going to discuss the
two of the leading theories: evolution and genetics,
and hypertumors.
The fact that there is correlation between body
mass and cancer within species (in fact a 3-4 mm
increase in leg length above the average in
4
humans increases the risk of non-smoking
“related cancer by 80%) but not across species,
leads some researchers to believe that oncogenic
or tumour suppressor mechanisms are positively
selected above a given threshold in body mass.
This form of natural selection means that species
that have evolved to be larger have had to evolve
protection from the environment and the
increased risk of cancer that smaller species
simply did not need. Attributes such as a greater
redundancy of tumour suppressor genes, slower
cell turn over and more efficient immune systems
were positively selected and members of larger
species that did not have genetic mutations that
lead to greater numbers of mechanisms such as
these simply died off.
The second leading theory is the strange concept of
hypertumors, the term comes from organisms
known as hyperparasites (the parasites that live on
parasites). Ultimately, this is what hypertumors are.
Tumour cells contain certain advantageous
characteristics such as the ability to direct blood
vessels to the tumour giving it a constant supply of
bodily resources and therefore starve the body of
nutrients, space and energy which is sometimes
fatal. However due to the unstable nature of
cancerous cells there is another way in which Peto’s
paradox can be resolved. Cancer cells can mutate
multiple times even to the extent that they become
cancerous to the original tumours and also steal
nutrients and energy from the tumours blood supply
so both the tumours then compete with each other
for the body’s resources and never ever grow big
enough for the large organism to notice.
This resolves the paradox as it suggests that larger
organisms may be more susceptible to cancer; this
nature of tumour cells means that they can never
reach a fatal mass. Despite our question being
officially unresolved, research is happening
continuously and hopefully understanding why
some animals are less affected by cancer could one
day lead to effective treatments in humans.
8
CANCER AND ETHICS

“THE PHYSICIAN SHOULD NOT TREAT
THE DISEASE BUT THE PATIENT WHO IS
SUFFERING FROM IT”
By Tanya Singh 13.2
ETHICS
9
Despite the long-established tradition of the
Hippocratic Oath, where physicians swear upon the
healing gods to ‘not treat the fever chart’ ‘but a sick
1
human being’, a biomedical focus towards
treatment has prevailed throughout much of
2
history. The focus is restricted to measurable and
methodical processes where the sole aim lies in the
correction of biological abnormalities; it does not
acknowledge the patient’s complex individuality as
well as the fact that not all diseases can be
biologically treated. The truth is that diseases have
the capability to reshape the patient, posing a
plethora of interdisciplinary challenges that can
cause an accelerated deterioration in their quality of
life. Given this and the revolutionised understanding
of disease, it seems almost inadequate for sound
clinical care to be defined purely by the treatment of
disease.
From the concept’s origin, in the late 1980s, patientcentred
care has evolved to become a central goal
for optimal medical practice. 3 It involves the
physician being respectful and responsive to
individual patient priorities rather than exercising
the cookie-cutter approach of disease
standardisation. No two patients are ever the same
4
and so given their unique and somewhat
unpredictable manifestations of disease, it seems
impossible for the physician to treat disease
uniformly. An example of this involves an
adolescent who had previously experienced a single,
transient episode of diplopia and upon investigation
was found to have multiple sclerosis. The most
common medication given to ease this disease’s
symptoms is methylprednisolone but given the case
at hand, may do more harm than good; alongside
being given intravenously and its associated risks,
this corticosteroid can, paradoxically, cause the
patient to experience rare yet severe side effects.
These include potentially life-threatening
anaphylaxis with Kounis syndrome, i.e acute
coronary syndromes caused by allergic reactions. ,
osteoporosis and stunted growth - which could be
detrimental to the young patient's functioning and
development, especially as they mature into
adulthood. Given this, the route of treatment
appears to be groundless. Physicians should,
therefore, treat by evaluating whether their
patient’s quality of life is being compromised by the
illness as well as assessing the treatment’s benefits
to the patient’s current condition versus its risks.
This allows for the amelioration or preservation of
individual patient lifestyles, whereby (as suggested
by Dr Roger Neighbour) the right patient receives
the right treatment at the right time.
At a time when medical information is as easily
accessible as never before, it comes as no surprise
that many patients use online platforms as a source
of clinical advice and direction. The information,
which may at times be largely unregulated, can
cause patients to conceptualise certain beliefs and
preconceptions relating to their disease. Based on
the specific patient's understanding, these may
range from being idealistic desires to more
predictive notions and can influence the
development, course and prognosis of the illness
through either placebo or nocebo effects. Thus, the
physician should address the patient holistically by
focusing on the role of patient perspective. They
should help in modifying subjective perceptions to
better fit the reality of the patient’s condition, which
could, if not clarified, be at odds with clinical
evidence and interfere with the therapeutic capacity
of treatment. If treated only in view of biological
disease, patients may also develop a false
understanding of their disease, causing them to feel
detached from their treatment plan which could
potentially lead to inappropriate self-care. Instead, a
clarified understanding allows for a heuristic
approach towards treatment whereby the patient is
equipped with the knowledge and skills to adopt an
appropriate level of self-responsibility in relation to
their health. By listening, explaining and making the
patient part of the planning of their treatment, the
physician can provide beneficent patient-orientated
care whilst still respecting the patient’s autonomy,
5
obeying the core principles of medical ethics.
Moreover, through holistic patient management,
physicians can better fathom the reason for each
consultation. These can range from being less
pathological such as the want for being heard to
more biomedical, like pain relief. Through
establishing the reason, doctors can understand and
address individual patient needs and expectations
more accurately - the first NHS constitution in

England stated that ‘NHS services must reflect the
needs and preferences of patients’. This highlights
the physician’s responsibility as a doctor to treat
individual patients by understanding what is
important to them. For example, the symptom of
knee pain appears more significant for an athlete
compared to those in less physically demanding
professions. As a result, this would potentially
generate higher management expectations from the
athlete to suit their higher functional needs and
livelihoods. The physician should, therefore,
formulate treatment plans more aligned to helping
individual patients in restoring their individual
functionalities. Doing so promotes a shared
understanding where patients' needs, expectations
and interests are well addressed through mutually
agreed solutions, leading to better patient
satisfaction and outcome than if the physician was
to only treat the objective disease.
A substantial amount of a patient’s experience with
disease occurs outside of the medical setting.
Alongside biological problems, diseases can induce
wider psychological and social issues where
patients tend to seek explanations and emotional
support; it is not exclusively one of these problems
but rather their interaction which causes the state
of ill-health. An example of distress caused by
disease includes the social and psychological effects
of immobility in a disabled patient. In such scenarios,
the physician must treat the patient through the
means of supportive discussion and the developing
care networks in order to implement strategies to
mitigate both the somatic and mental distress of the
patient. It would be unethical to leave the patient
anxious about their condition if the physician was to
dismiss consequential issues as not being part of
the presentation of the disease - it could lead to a
lack of engagement and therefore an impaired
patient-physician relation only exacerbating the
patient’s psychosocial manifestations. As a result,
physicians should tailor consultations to treat each
patient’s varying degree of clinical, social and
physiological problems, much similar to the triaxial
6
Calgary-Cambridge model of consultation.
Elevated CRP results and incidental pulmonary
nodule detection are both examples of objective
indications of more sinister pathology including
cancer. Often at the early stages of this progressive
disease, the patient remains asymptomatic with no
decline in life quality and so, the physician should
need to treat the biological determinants of disease
rather than the patient’s unchanged wellbeing.
However, despite the apparent focus on disease,
patients will present with a wide variability of host
responses meaning that treatment still needs to be
customised to individuals to maximise its benefits.
For example, pharmacodynamics and
pharmacogenomics will differ between patients.
7
Polymorphic diversity in genes coding for
metabolising enzymes results in varied drug
metabolism; the same drug under the same dose,
could lead to overdose toxicity in some, whilst in
others, it could lack efficacy. An example of one such
anti-cancer drug includes docetaxel where ethnic
variability in its response has been suggested -
Asian patients have shown to have increased
toxicities and response rates. Such differences in
drug disposition mean that physicians should
acknowledge their patient’s unique genetic (and
environmental) make-up, allowing for precision in
treatment which overcomes many challenges
presented in conventional medicine, namely
treatment non-responses and increased disease
and resource costs.
The dynamism in technology has meant that
artificial intelligence and digital-style guidelines
have become an increasingly familiar part of the
current and futuristic vision for medicine. Although
they seem promising in building a more productive
and structured healthcare system, such
mechanisms process individual patients, reducing
them to algorithmic decisions and binary numbers.
Perhaps the proliferation of these systems is
leading to a more disease-centered approach to
8
treatment, where patient rights are in pursuit of
more efficient medical practices rather than the best
possible ones. On the whole, the systems are rigid,
insensitive to patient priorities and lack necessary
human bedside manners and altruism.
ETHICS
The triaxial Calgary-Cambridge model of consultation
Yet despite the need to treat the patient as a human
being and not a diagnosis, at times a more diseasecentred
approach may seem to be more appropriate.
Contrary to machines, physicians should take into
account patient fears, desires and circumstances,
applying the humane art of medical science. This
promotes a patient-centered approach towards
treatment which inculcates self-belief, positivity
and empowerment in patients which, enhanced by
the physician’s medical expertise and digital
advances is the best possible prescription for the
best possible patient outcomes. Thus, the physician
should not treat the disease but the patient who is
suffering from it as this has and will continue to
define sound clinical care.
10

ETHICS, ALZHEIMER’S AND CANCER
HOW SHOULD PATIENTS WITH BOTH
ALZHEIMER’S AND CANCER BE TREATED?
Alzheimer’s is a degenerative brain disease that is the
most common type of dementia. It is caused by cell
damage that leads to complex brain changes. There is
1
no cure or prevention or way to slow Alzheimer’s; as
it advances, symptoms get more severe and include
disorientation, difficulty planning or making
decisions, personality and behaviour changes,
confusion and eventually lead to speaking,
swallowing and walking difficulties. Alzheimer’s
disease is most common in people over the age of 65
as your risk of developing the disease increases with
age. The disease affects around 1 in 14 people over
2
the age of 65 and 1 in 6 people over the age of 80.
There are many studies that show that cancer
patients are less likely to get Alzheimer’s and
patients with Alzheimer’s disease are less likely to
3
develop cancer, however it is not uncommon to see
4
patients develop both. But when they strike together
it can be difficult for patients with memory and
decision-making problems to fully understand and
decide about their cancer treatment, it can also be a
difficult call for doctors to make about whether an
Alzheimer’s patient is fully understanding the risks
and benefits of a treatment.
Consent is a legal requirement for medical treatment,
and for consent to be valid the patient giving the
consent must have capacity. For someone to have
capacity they must be able to understand all the
information they are given and be able to make an
informed decision. However, for someone with
5
Alzheimer’s, their capacity can be affected, so they
cannot give valid consent so how can they choose
whether to revive cancer treatment or not?
One way to solve this ethical issue is for the patient
to have planned ahead when they could still
understand information and make decisions. The
Mental Capacity Act provides steps that people with
Alzheimer’s can follow to have control over decision
6
making in the future. Advanced care planning means
that the patient can write down how and where they
would like to be treated if they become unwell so
7
their wishes can still be carried out. For example,
they may wish to be cared in a hospice instead of at
home, a decision that would have been otherwise
unknown unless they planned ahead. Another
important aspect of care to plan is writing down what
treatments they do not want to have.
11
By Amy Booth 12S
This is called an advance decision to refuse treatment
(ADRT) in England and Wales and it means that
legally everyone knows what treatments they want
to refuse if their capacity becomes affected. As well,
writing down whether they want to donate their body
to medical research or teaching means that their
wishes can still be carried out. Another way to plan
ahead is by legally appointing someone to make
decisions on their behalf by a power of attorney. This
means a family member, friend or just someone they
trust can give consent for treatment and medication
when they are no longer able to make decisions for
themselves.
If patients do not get a chance to plan ahead or simply
don’t, health professionals can still give treatment if
they think it is in the persons best interests. But they
must try to get advice about what the person would
want through their family members or friends. Many
people with Alzheimer’s will also have carers, a
family member or a personal welfare deputy
appointed by the court, and those carers can help
make decisions about their treatment. It can still be
8
difficult for family members, carers or doctors to
make decisions for someone else so talking to
dementia specialists and other people that know the
patient well will help to make a decision that is as
close to what the patient would have wanted as
possible.
Even though there are still questions about
Alzheimer’s patients autonomy such as, what if they
might have changed their mind about treatment?, or
what if they are offered a new treatment after their
capacity becomes affected?, how can other people
truly know what the person would have wanted?, as
mentioned above there are ways that make sure they
are treated as close to what they would have wanted
as possible. But a decision will never be what the
patient wants unless it comes from the patient
themselves.

THE CASE OF STEVE BIKO
By Sethujah Gangatharan 12S
Imagine being killed for the colour of your skin. It’s
2020, so in fact, we don’t need to imagine that. With
the Black Lives Matter movement, 2020 has clearly
highlighted the racism and discrimination that has
been going on for decades. Hundreds and thousands
of innocent black people have died fighting for
equality and justice, and one of these people is Steve
1
Biko.
naked, chained up and unconscious across the
whole of the country. Since Tucker didn’t provide a
medical report, when Biko arrived there, he was
given no treatment and unfortunately died a few
hours later. The South African government covered
up the real cause of Biko’s death and claimed that he
was a ‘dangerous terrorist whose death was of little
4
concern to him and left him cold’.
In 1966, Steve Biko began studying medicine at the
University of Natal where he joined the National
2
Union of South African Students (NUSAS). The main
aim of this union was to end apartheid, i.e. racial
segregation, however this union was mainly
dominated by white liberals rather than the black
students. In Biko’s opinion, they failed to understand
the discrimination that the black people
experienced, and this is why he set up the black
consciousness movement. In Biko’s own words, this
movement was
‘for the black man to elevate his own position by
positively looking at those value systems that make
him distinctively a man in society’.
The government falsely blamed him of hating white
people and being a sexist but all that Biko was trying
3
to do was fight for equality. Despite the numerous
banning orders that were placed on him to try and
restrict his activities, Biko remained politically
active. On the 18th of August, he was arrested at a
roadblock and was then incarcerated in a South
African Prison. 25 days later, on the 12th of
September 1977, he died at just the age of 30. Five
days before he died, two doctors - Benjamin Tucker
and Ivor Lang - were called into examine Biko.
However, since these two doctors were so blinded
by society's racist views, they didn't examine him in
a fair manner - they didn’t even take a history or
carry out simple tests to check Biko’s mental state.
His numerous face and chest injuries were looked
past, along with his slurred speech and lack of
muscle control. Although the other examinations
that were carried out revealed things like blood in
the cerebrospinal fluid, Lang falsely wrote in his
notes that there was 'no change in condition'.
A few days later, Biko was found collapsed and
frothing at the mouth and this was when Tucker
suggested that he should be sent to hospital. The
police objected to him being admitted to a local
hospital and thus sent him to a prison hospital 750
miles away with no supervision. He was driven
Although many doctors were appalled by the fact
that the Medical and Dental had dismissed Biko’s
case and forgiven the two doctors for their
malpractice, only a small group of them (Frances
Ames, Edward Barker, Trefor Jenkins, Leslie
Robertson, and Phillip Tobias) were willing to take
this case to supreme court. Eventually, after a long
six years, Tucker was found guilty of improper and
disgraceful conduct, and his licence to practice
medicine was removed.
'I have come to realise that a medical practitioner’s
primary consideration is the wellbeing of his patient,
and that a medical practitioner cannot subordinate
his patient’s interest to extraneous considerations.'
This part of Tucker’s confession has highlighted that
a doctor’s commitment to their patient shouldn’t
change depending on the patient’s ethnic group. The
patient could be a prisoner or a princess and they
should still be treated the same. Lang and Tucker let
the irrational thoughts and views of a bigoted
society shape them as doctors, and this is why they
failed as doctors. Patients must be able to trust and
confide in a doctor and in order for them to be able
to do this, the doctor must be honest and unbiased.
The case of Biko is one of the many cases that has
5
shaped the GMC guidelines into what it is today. The
current guidelines state rules like:
'You must treat patients fairly and with respect
whatever their life choices and beliefs'
Biko's affair has emphasised the importance of
equality within healthcare. His case reminds doctors
of the qualities and values they should hold and
reinforces the fact that to be successful healthcare
professionals, they must abide by the Hippocratic
oath.
12
ETHICS

NOVEMBER’S RECOMMENDATIONS
Book of the Month:
RECOMMENDATIONS
When Breath Becomes Air by Paul Kalanithi
When Breath Becomes Air’ is a worldwide bestseller written by Paul
Kalanithi. His story is about his life and how he transitions from being a
doctor to a patient within a matter of days. He was an incredibly
hardworking person, pursuing neurosurgery as his medical speciality.
During his time at Yale, he met his wife Lucy, who he then married three
years later. In May 2013, he was diagnosed with stage-4 non-small-cell
EGFR-positive lung cancer, which was unfortunately inoperable. His story
explores the struggles of a cancer patient; the immense emotional toll it
had on his relationships; and the difficult decisions he had to make
throughout his journey. He also talks about the happiness his newborn
daughter brought into his world, and the meaning of life while in the face
of death.
I would recommend this book to anyone – even if you are not particularly into medicine. It made me
realise that time never stops for anyone. Paul Kalanithi was diagnosed with cancer even though he
did not smoke or take part in activities that are usually associated with it. Despite his story being
upsetting, he demonstrates how to seek out the positives in a turmoil of negatives. His patience and
acceptance of his situation helped me to realise that you cannot always control every aspect of your
life, hence why you should embrace every moment you live through. I thoroughly enjoyed this book
and I hope you will too!
By Keerthika Raguraj 12S
Podcasts of the Month:
You, Me & the Big C - BBC Radio 5:
This podcast is about life with, treatment of and other topics relating to the topic of cancer.
Inside Health - BBC Radio 4:
This is a series that demystifies health issues, separating fact from fiction and bringing clarity to
conflicting health advice.
No Such Thing As A Fish:
In this podcast, the writers of the game show 'QI', discuss the best facts that they have learnt each
week.
Documentary of the Month:
The Diagnosis Detectives - BBC iPlayer
Michael Mosley challenges 12 of the UK’s leading medical experts to diagnose patients whose
debilitating symptoms have baffled other doctors. Each expert specialises in a different field and
has their own ideas about what might be wrong. By combining their knowledge and using cuttingedge
technology to test their theories, they try to give these patients the answers they desperately
need.
13

NOVEMBER MEDICAL DATES
November is:
Movember - Men’s Health Awareness Month
Mouth Cancer Action Month
Lung Cancer Awareness Month
.
National Stomach Cancer Awareness Month
Pancreatic Cancer Awareness Month
Medical Weeks in November:
National Pathology Week - 2nd-8th
Alcohol Awareness Week - 16th-22nd
World Antimicrobial Awareness Week - 18th-
24th
Medical Days in November:
National Stress Awareness Day (NSAD) - 4th
World Radiography Day - 8th
World Diabetes Day - 14th
Prematurity Awareness Day - 17th
World Chronic Obstructive Pulmonary Disease
(COPD) Awareness Day - 21st
KEY MEDICAL DATES
14

QUIZ
To check you’ve been reading so far...
1) How could Coronavirus impact doctors' mental health in the future?
2) What is one tip about how to cope with exam stress?
A Compare yourself to others
B Eat a balanced diet
C Get 3 hours of sleep a night
D Cram!
3) What causes smoking withdrawal symptoms?
4) What are the two types of seizures in pets?
QUIZ
5) What is Peto’s Paradox?
6) What does patient centred care involve?
7) How did Biko's case shape the GMC?
8) Which act provides steps that people with Alzheimer’s can follow to
have control over decision among in the future?
9) What is the name of the broken bone in this photo?
10) What is the name of this muscle?
15
ANSWERS TO THE QUIZ WILL BE FEATURED IN THE NEXT JOURNAL

WORDSEARCH - CANCER
Benign
Biopsy
Cancer
Cells
Chemotherapy
Diagnostic Imaging
Kidney
Lymphoma
Macmillan
Malignant
Melanoma
Movember
Mutation
Oncology
Radiationtherapy
Tumour
PUZZLES
A biopsy is a small procedure in which a small sample of tissue is
taken from the body. This process can be used to detect cancer in
the body. The image on the left shows a duodenal biopsy.
16

PHOTOGRAPHY COMPETITION
PHOTOGRAPHY COMPETITION
This month's photography competition winners are:
Chioma Okeke
17
7S
Notable mentions:
Lola Houghton-Boyle
12S
These two photos
show Newton's
cradle, a device
that demonstrates
conservation of
momentum and
energy using a
series of swinging
spheres!
Tanvi Ambat
12N

BMAT
By Sethujah Gangatharan 12S
The BioMedical Admissions Test (BMAT) is the test that a small number of medical schools use to assess and
select prospective medical students.
The universities that require the BMAT for undergraduate entries are:
Brighton and Sussex Medical School,
Lancaster University
Imperial College London
University College London
University of Cambridge
University of Oxford: A100 Medicine
University of Leeds (required for dentistry as well)
The BMAT is split into three sections and each section tests a range of skills:
Section 1: 32 multiple choice questions in 60 minutes - this can be split into:
Relevant Section - tests the ability to understand arguments and select the most useful information in
a text
Finding Procedures - tests problem solving abilities using basic mathematical skills (no calculator
allowed!)
Identifying similarity - tests ability to analyse and interpret data
Section 2: 27 multiple choice questions in 30 minutes
Tests the ability to apply GCSE level scientific and mathematical knowledge, i.e. biology, chemistry,
physics and maths
Section 3: 1 essay question in 30 minutes
Tests the ability to develop ideas and communicate them in writing
Three essay questions, usually there is one on healthcare, one on science more broadly and one that
doesn't relate to medicine at all (for example, this can be about nature or politics)
Tips for the BMAT:
Read various articles: Section 1 tests the ability to identify relevent information from texts. By reading
various newspaper articles and journals, you can boost your skills for this section!
Read the BMAT specification: Don't assume that you know all the information needed for section 2 of the
BMAT - although the section is based on GCSE knowledge, the depth in which you may have covered the
topics could be different so reading the BMAT specification could help!
Normalise debating about various topics: Section 3 tests the ability to argue from various viewpoints so by
talking about current affairs, healthcare issues and politics, you will train yourself to naturally think from
both sides of an argument.
BMAT
ESSAY COMPETITION
This month's competition is a BMAT Section 3 essay competition which students in years 10 and above can take
part in. The question is:
'Treating the condition is the most important goal in medicine. Discuss what this statement means and explain
an argument in support of and in opposition to this statement.'
All essays will be read by Gayathri Thivyaa Gangatharan - a 3rd year Imperial College London medical student
and Newstead alumni! The winner of the competition will not only have their essay featured in the next issue of
the journal, but will also receive the opportunity to have a 30 minute 1 to 1 Q&A with her! We look forward to
receiving your essays!
Note: The essays should be maximum 1 side of A4 (font 11) and should be sent to nwsgmedicjournal@gmail.com
with 'BMAT essay competition' and your name and form as the subject.
18

WE HOPE YOU ENJOYED
READING OUR JOURNAL!
THANK YOU TO EVERYONE
THAT CONTRIBUTED TO IT -
DON'T FORGET TO KEEP
SENDING IN PHOTOS AND
ARTICLES!
For any queries and suggestions, you can contact us via email:
nwsgmedicjournal@gmail.com