MEDISCOPE | ISSUE 2 | 02 DECEMBER 2020

MEDISCOPE | ISSUE 2 | 02 DECEMBER 2020

- NUTRITION AND OBESITY

- CARDIOLOGY

- ANTIBIOTIC RESISTANCE

- PSYCHIATRY

- GENETIC DISORDERS

FEATURING AN ARTICLE

FROM:

Dr Hannah Bellsham-Revell

A Consultant Paediatric

Cardiologist & Newstead

Alumnus!

- ETHICS

- CHRISTMAS

- DECEMBEARD

- MDV INTERVIEWS

Logo Design: Sethujah Gangatharan

Photo credits: https://pixabay.com/illustrations/bacteria-medical-biology-health-3662695/

WELCOME!

WELCOME

2020 has been a very strange year that none of us saw coming. Even

though we all wish the current situation was over we all know it isn’t going

to just come to an end at the stroke of midnight on 31st December. This

strange year has taught us a lot though, about ourselves and life in general.

We have learnt that there are so many things we can do more efficiently

online whether it be meetings, a Q and A session or a conference. Virtual

communication soared through lockdown and still continues to be at a high.

The medical world has evolved so quickly to incorporate more online

aspects and we have definitely all changed our views on public health and

especially the NHS.

We created this journal so we can still communicate about medicine and

discuss relevant medical topics. Even though we cannot debate or talk

about these matters face to face we still hope we have created and will

continue to create a place to share knowledge and opinions safely.

This issue is packed with medical topics and includes articles about

cardiology, nutrition and obesity, genetic disorders, ethics and much more.

There is also a very special day in the life article by Dr Hannah Bellsham-

Revell who is an ex-Newstead student. There are puzzles and a quiz to keep

the journal interactive and we have included a PBL case and tips about MDV

interviews.

- Amy Booth

A special thanks to co-editor Sethujah Gangatharan (12S) - we both hope

you enjoy reading the journal and we’re sure it will give you an insight into

something new!

We would also like to say thank you to Dr Hannah Bellsham-Revell for

writing an article for this issue and to Mr Blount, Mr Bournat and Ms Harvey

for their continued support with the journal.

Thank you to everyone who read our very first issue. Thank you for all your

lovely feedback, we are delighted that so many people enjoyed reading it.

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CONTENTS

Nutrition and Obesity:

- Nutrition and Obesity In Animals

by Alice Edwards 12N ........................................................................................................................................................ 3

Cardiology:

- Myocarditis

by Jessica James Pallickamyalil 12S .............................................................................................................................. 4

- A Day in the Life of a Consultant Paediatric Cardiologist

by Dr Hannah Bellsham-Revell ....................................................................................................................................... 5

Antibiotic Resistance:

- The Rise of Resistance

by Myah Darkwah 12N ........................................................................................................................................................ 7

- Antibiotic Resistance in Farming - Does Agriculture need to change?

by Oscar Houghton-Boyle 12S ......................................................................................................................................... 9

Psychiatry:

- The Angel of Death

by Phoebe Yan Chun Po 12P ............................................................................................................................................ 10

- Narcissists and Sociopaths

by Rania Abou-Auda, Glynnis Agyapong, Sristi Kandel, Imaan Khan, Renee Kumar -Year 10 ............ 12

Genetic Disorders:

- Hutchinson Gilford Progeria Syndrome

by Atharvaa Pangare 12N .............................................................................................................................................. 13

Ethics:

- Utilitarianism

by Oluchi Ijeh 12S ................................................................................................................................................................ 14

- Abortion

by Sethujah Gangatharan 12S ....................................................................................................................................... 15

- Why are Peanuts and Nuts still Served on Planes

by Amy Booth 12S ................................................................................................................................................................ 17

Christmas:

- 12 Ailments of Christmas

by Amy Booth 12S ............................................................................................................................................................... 19

.

Other:

- December's Recommendations ................................................................................................................................... 21

- Medical Dates in December .......................................................................................................................................... 22

- Quiz ......................................................................................................................................................................................... 23

- The Case of Mr Reid - PBL Case

by Sethujah Gangatharan 12S ...................................................................................................................................... 24

- Puzzles:

- Wordsearch .................................................................................................................................................................. 25

- Crossword ..................................................................................................................................................................... 26

- Medoku ............................................................................................................................................................................ 27

- Issue 1 Quiz + Puzzle Answers .................................................................................................................................... 28

- MDV Interviews ................................................................................................................................................................. 29

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CONTENTS

NUTRITION AND OBESITY IN ANIMALS

NUTRITION AND OBESITY

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By Alice Edwards 12N

Ever since humans started viewing animals as

subordinate creatures and keeping them as pets, we

have taken on the additional work load of ensuring our

animal maintain a high quality of life. This of course

means the animals must be kept healthy. The nutritional

needs of animals are undeniably one of the most

important parts of animal care. However, because many

lack an inbuilt ability to moderate their own nutritional

intake it is incumbent on owners to take on this

responsibility, otherwise detrimental outcomes will

result. This article details why these kinds of actions can

cause long term problems and why obesity in animals is

an increasing problem.

Animal obesity is diagnosed when their body weight

exceeds 20% above recommended level. Of course, as

with humans, obesity in animals can bring with it an

abundance of potential risks, with a study on Labrador

retrievers revealing that an obese dog's life expectancy

may be 2 years shorter than that of its leaner

counterparts. In the past scientists were led to believe

that fat was a relatively inactive tissue whose presence

merely increased an animal's energy and calorie store.

However, since then, medicine has progressed and we

are now able to understand that fat tissue is biologically

active, creating oxidative stress (an imbalance of

radicals and antioxidants) and secreting inflammatory

hormones. This brings with it pain and distress for the

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animal.

A key point to remember is that different species require

different nutrition, which is reflected by their varying

digestive systems. Take rabbits as an example. These

creatures are herbivores, consuming a large amount of

fibrous matter. Their digestive system is adapted to deal

with this by carrying out hindgut fermentation. This

process involves passing chyme (partially digested

food) from the small intestine into the colon and then

the cecum where cellulose is digested with the aid of

bacteria. This is crucial as the plant matter rabbits

consume cannot be broken down fully by the initial

stages of digestion. In stark contrast is the monogastric

digestive system of carnivores where the digestive tract

is short and simple because meat is comparatively easy

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to digest. With the idea of nutritional needs in mind, why

does obesity occur?

A recent study carried out by Eleanor Raffan, a

veterinarian and geneticist at the University of

Cambridge, has discovered that a quarter of Labrador

retrievers, a breed renowned for being overweight,

possess a genetic mutation in a gene called POMC, with

every copy of this mutation coinciding with a 2KG

increase in the dog's weight. It is believed that this

mutation disrupts the brain’s leptin-melanocortin

pathway which is responsible for regulating the dog's

energy expenditure and consumption. This mutation

prevents the dog's hunger craving being fully satisfied

so it is in a permanent state of hunger. This encourages

owners to over-feed their pets, unaware this will have

no impact on their hunger and simply result in weight

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gain.

It is also important to address another key issue; some

humans have a misplaced belief that obesity enhances

the attractiveness of our canine companions. Promoted

by the kennel club, this corrupt aesthetic brings with it

detrimental costs to the animal. Breeds of dogs such as

Bulldogs and Pugs are forced to carry around extra fat to

create ‘rolls’ which many dog owners sadly find

appealing. This widely acquired view is reflected in the

astonishing 53% of adult dogs and 55% of cats believed

to be overweight or obese in America alone (statistics

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from the Association for Pet Obesity Levels). This is a

horrendously dangerous path to go down as humans

begin to prioritise their own wishes for ‘cuteness’ over

that of the animal's health. If this continues, we will see

a reduction in pet life expectancy not to mention their

quality of life.

However, obesity does not only rear its head in domestic

animals but also agricultural ones. A key example of this

in animal husbandry is farmers’ use of antibiotics to

increase the rate at which pigs, cows and turkeys gain

weight to increase profits. It is believed that these

antibiotics lead to changes in the gut microbiota which in

turn impacts metabolic rate leading to live stock gaining

weight at an unnatural and unhealthy rate. It is thought

this could be contributing to our own antibiotic

resistance, as it passes down the food chain when we

consume this meat. It is also believed that some farmers

feed their animals anabolic steroids which can be

categorized into two groups; natural steroids

(oestradiol, testosterone, and progesterone) and

synthetic hormones (the oestrogen compound zeranol,

the androgen trenbolone acetate, and progestin

melengestrol acetate). These steroids force animals to

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gain weight very quickly. This puts a huge amount of

strain upon their musculoskeletal system, with extra

weight causing the cartilage at the end of their bones to

become damaged. This extra weight gain can also make

bursae (fluid filled sacks found near the majority of

major joints) become irritated, resulting in joint stiffness

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and pain.

Many scientists also believe that it was famers’ use of

poorly developed food pellets which resulted in the

spread of the new variant CJD, colloquially know as mad

cow disease, in the late 1980’s. This led to 178 human

fatalities and 2000 others likely carrying this disease.

These above examples show the impacts of humans

abandoning their responsibility to maintain a good

nutritional standard for their animals. This must not be

allowed to continue for both their sake and ours.

MYOCARDITIS

Myocarditis is the name of a viral heart condition

that causes inflammation of the myocardium (the

heart muscle). Myocarditis can reduce the heart’s

ability to pump blood around the body, due to

damage to the muscle and/or the heart’s

electrical system. The damage caused to the

heart causes arrhythmias which can cause

complications and lead to permanent damage to

the heart muscle. This can then lead to heart

failure due to the clots in the ventricles or arteries

that lead to the brain, heart attacks or stroke as

the heart can no longer pump enough blood

around the body and in the most severe cases,

sudden cardiac arrest.

This heart condition is usually caused by a viral

infection and hence cannot be treated using

antibiotics. A reaction to an illegal drug, radiation,

bacterial infection, parasites, fungi or another

inflammatory condition, could also cause

myocarditis.

Unlike most cardiovascular conditions,

myocarditis is not just common in the elderly but

it can affect anyone and it affects males twice as

often as females. In addition to this, it is the third

leading cause of sudden death in teenagers and

children.

1

The most frequent symptoms include:

Arrhythmias

Fatigue and shortness of breath

Chest pain

Body Aches and headaches

Joint pain or inflammation

Fever

Fainting

Breathing difficulties or rapid breathing

By Jessica James Pallickamyalil 12S

In order to diagnose this condition, an

electrocardiogram, a chest X-ray, an

echocardiogram or a MRI scan can be used. The

electrocardiogram can detect the heart’s

electrical activity using electrodes that are taped

to the patient’s chest. A chest X-ray shows any

changes in the structure of the lungs or heart and

helps a physician to diagnose a patient with

myocarditis. An echocardiogram uses sound

waves to make an image of the heart or analyse

2

the blood flow in the heart. In more serious

conditions, a MRI scan is taken to diagnose a

patient with myocarditis. Drugs to reduce the risk

of blood clotting or to eliminate excess fluid in the

body, are usually prescribed to patients that

suffer from myocarditis. This reduces the

workload of the heart and also reduces the risk of

heart attacks or stroke. Some examples of the

medication include:

Enalapril, captopril, lisinopril (these are

angiotensin - converting enzyme inhibitors) -

they help the blood flow more easily by

relaxing the blood vessels in the heart.

Losartan and valsartan are receptor blockers

that also relax the blood 5 vessels to ease the

blood flow around the body.

Metoprolol, bisoprolol and carvedilol are Beta

blockers that treat heart failure and help to

control arrhythmias in the heart. This type of

medication is taken for a few months to aid

the heart’s recovery.

For more severe cases intravenous

medications (IV) could be used to support the

heart to pump blood around the body.

Ventricular assist devices (VADs) are

mechanical pumps that can support the

ventricles when pumping blood around the

body. VADs are commonly used when a

patient is waiting for a heart transplant.

If it seems like the patient’s heart is too weak

and it will be difficult for the patient to fully

recover, then the patient may be eligible to

receive a heart transplant and even then they

could be on medication for the rest of their

life.

Image showing the myocardium, i.e. the

muscle tissue that forms the walls of the

heart

4

CARDIOLOGY - MYOCARDITIS

A DAY IN THE LIFE OF A CARDIOLOGIST

5

A DAY IN THE LIFE OF A CONSULTANT

PAEDIATRIC CARDIOLOGIST

By Dr Hannah Bellsham-Revell

When I agreed to write this article, I forgot to take

into account the fact I haven’t written anything

other than research papers and clinic letters for

around twenty years!

Let me begin with a bit of background: I left

Newstead (Wren house) in 1999 and studied

medicine at St George’s Hospital Medical School in

Tooting. I spent my pre-registration year at St

George’s with four months of medicine, surgery

and GP before getting a two year paediatric

rotation at West Suffolk Hospital and

Addenbrooke’s. Then ‘Modernising Medical

Careers’ came in despite great protests, and I

started a paediatric run-through number, doing

six months neonates in Brighton and then seven

months at Evelina London (ELCH) in paediatric

cardiology. And effectively I have never left! I took

time out from training (out of programme for

research, OOPR) and completed an MD(res)

looking at imaging in patients with hypoplastic

left heart syndrome. During this time, I did locum

registrar on-calls in paediatric cardiology, then

completed six months on paediatric intensive care

(PICU) before leaving my paediatric training

number for a paediatric cardiology training

number. I completed my five years training (four

at ELCH, one at Great Ormond Street) in 2017 and

started as a locum consultant, getting a

substantive consultant post in 2018. So, all in all a

fairly long time in training, including a lot of shift

work (weeks of nights) and much juggling,

simultaneously trying to finish off my dissertation

whilst doing clinical work.

As a consultant I have a degree of flexibility; as a

trainee there is often much less flexibility and you

are tied to the rota. My current rota means

working 6 service weeks a year, where we are on

call from 8am on Friday morning to 5pm on

Monday evening, and then covering the ward

during daylight hours from Tuesday to Thursday.

Other than those weekends, we usually have two

to three other on calls in a month (‘day job’ 8am-

5pm, on-call 5pm to 8am, then ‘day job’ again 8am

to 5pm). We are lucky that we tend to have senior

trainees, so usually we are only called, or have to

come in out of hours, if there is an emergency. I

have one general paediatric cardiology clinic a

week, one Home Monitoring Clinic (for the most

vulnerable patients) a week and, once or twice a

month, I do an outreach clinic in Woolwich. My

other duties include intraoperative imaging,

where we perform echocardiograms in theatre to

assess the adequacy of the operation and MRI

lists. We also have a weekly multi-disciplinary

team meeting where we discuss all patients

requiring surgery, and review their imaging to

decide on the best procedure. There is of course a

huge amount of paperwork and administration, as

well as ongoing efforts to complete research.

As an example of a typical day (my Monday): I get

to work around 7am to do admin and sometimes

pop and see patients on the paediatric intensive

care unit (PICU) - I probably get in earlier than

most, mainly because I prefer doing admin in the

morning so I can get home more promptly. At

8am we have PICU handover, where we hear

about the progress of their cardiac patients.

Simultaneous to this is a teaching programme, so

some days I will be teaching. At 8.30am there is

the echo meeting to review the previous day’s,

current day’s and next day’s surgeries, as well as

any other scans. If I am on for intraoperative

imaging, I will then go to theatre to do an

echocardiogram at the beginning of the operation,

then do some admin until we are called to

perform a scan at the end of the procedure. I will

then usually try and get some lunch (I always

bring it in as there’s no guarantee I will have time

to buy any!) before clinic, which runs from 1.30pm

to 5pm. After clinic I will tidy up admin and head

home. We also have our trust laptops, which

means I can then do further admin at home, have

dinner and, finally, go to bed!

The COVID pandemic has been challenging for all,

but we have seen some positive changes which

will likely remain in place. To start with it was

rather surreal - I work with several Italian

colleagues who were shocked by the lack of

action in the UK, especially as some lost medical

colleagues. When lockdown happened, all

elective procedures and clinics were cancelled,

and we were encouraged to work from home

where possible. We went to a skeleton rota with

just one consultant covering the wards and one

covering an emergency clinic which ran all day

every day. I was working from home as I am

asthmatic (we now know that isn’t as great a risk

factor, but at the time a colleague who was

asthmatic had ended up ventilated with COVID, so

I was being very cautious). We had to triage all

our patients; they were divided into those who

had to be seen face to face (e.g., they needed an

echocardiogram or were fragile), those that could

be deferred by three to six months, and those that

could have a telephone consultation. As well as

triaging all the patients already known to us, we

had to triage all new referrals, as well as all new

incoming referrals. Our emergency clinics were

fully booked very quickly! Additionally, we had to

field numerous calls about shielding as letters

were being sent to patients, many of whom did

not need to shield. Furthermore, many families

were too anxious to come to appointments, which

meant a lot of reassurance was necessary if we

really needed to see the child.

The other significant change was that the Royal

Brompton Hospital (RBH) became a COVID

hospital, and all their paediatric cardiac surgical

patients were operated on at ELCH, with one of

their surgeons coming to operate. We had been

due to open a new cardiology ward and PICU on

level 6, but there had been numerous delays.

However, during COVID (around the time Boris

Johnson was admitted to St Thomas’), PICU

moved to the new floor to give their second floor

PICU ward to adults. Though this created some

logistical challenges, everyone successfully

pulled together and we were able to continue

operating on all children that required surgery

from both RBH and ELCH catchment areas.

We were beginning to feel a little happier – some

of our congenital patients had had COVID and not

been significantly unwell, and internationally this

is what the data had also suggested – but then, a

few weeks after the ‘adult’ peak, we started

seeing children presenting with a

hyperinflammatory syndrome (PIMS-TS, testing

negative but positive on antibodies). A call was

put out in London, then nationally and

internationally, and it became apparent that this

was being seen worldwide, with the same

ethnicities disproportionately affected. These

children were often coming to us desperately

unwell, with some even needing life support.

With an international multi-disciplinary strategy,

treatments were implemented, and the majority

of children made a good recovery, although they

will need ongoing follow-up as there is potential

for longer term effects on the heart and blood

vessels. At the height of this, we had to double

our team, having one cardiology team for the

PIMS-TS patients and one for the congenital heart

disease patients. We are currently waiting to see

whether we get a further influx now as cases are

increasing again.

An unexpected advantage of this unprecedented

situation has been the opportunity to review our

entire outpatient strategy. As a result, we have

realised that for many families a telephone

consultation would be appropriate (even as a

screening in the initial situation), and, for some,

follow-up would be better and more conveniently

done by telephone. This is a change that will

definitely be continued post-COVID. The COVID

pandemic and the health inequity it has revealed,

alongside the Black Lives Matter movement, has

also made us realise we all need to do better, and

has spurred on very constructive and important

conversations about race and inequity. I am eager

to work with the whole multidisciplinary team as

well as families, to improve access and outcomes

for all people, regardless of their ethnicity or

socio-economic status.

A picture of Dr Hannah Bellsham-Revell - a

Consultant Paediatric Cardiologist and

former Newstead student

6

A DAY IN THE LIFE OF A CARDIOLOGIST

ANTIBIOTIC RESISTANCE

THE RISE OF RESISTANCE

The war between bacteria and humans has been

going on for millennia. Bacteria being the cause of

many medical catastrophes such as cholera,

plague, and tuberculosis. But the discovery of

antibiotics ended this brutal conflict. Or so we

thought.

The Plague

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The Black Death was the worst pandemic of all

time. It was caused by a species of bacteria called

Yersinia Pestis carried by infected fleas on black

rats. It caused three diseases: bubonic plague,

septicaemic plague (reproduction in blood), and

pneumonic plague (reproduction in lungs).

Approximately 75 to 200 million people died

across Eurasia and North Africa. Public health

services and sanitation were incredibly poor in

the 14th century. However, the black death did

introduce the “quarantine”: a forty-day period of

isolation, which became a quintessential method

in controlling outbreaks.

Cholera

2

Cholera is a bacterial disease caused by the

bacterium vibrio cholerae. There were four major

cholera outbreaks in London during the 19th

century. London was a cramped, dirty city without

a good sewage system. The 1854 Broad Street

3

outbreak occurred in Soho and killed 616 people.

The Board of Health attributed cholera

transmission to “bad air” a theory called miasma.

But physician John Snow had a different idea:

germ theory. He believed an unknown germ was

transmitted by people ingesting infected water.

He researched the water companies providing

water to London and found that the

neighbourhoods dying from cholera received

water from companies that used the

contaminated Thames water. He mapped

contaminated water sources and the areas that

had outbreaks. He also researched the pump on

Broad Street and found that it was contaminated

and was the cause of deaths in the area.

John Snow laid the foundation for germ theory

and is known as the first epidemiologist and a

spearhead of the improvement of public health

and sanitation in London. The change in health

By Myah Darkwah 12N

and sanitation caused a great decrease in

infectious diseases.

Antibiotics

The biggest breakthrough in the fight against

bacteria has been antibiotics. Sir Alexander

Fleming discovered penicillin in September 1928.

He observed that a petri dish containing

staphylococcus culture had been contaminated

by a mould and the staphylococci in close

proximity to the mould had died (inhibition zone).

He extracted a sample of the mould and found it

to be from the penicillium genus and the mould

“juice” that was secreted, he called penicillin.

But how do antibiotics work?

Antibiotics kill bacteria or slow their growth by

attacking the cell wall or covering; interfering

with reproduction; or blocking protein production.

There are two types of bacteria: gram-positive

4

and gram-negative. Gram-positive bacteria can

be destroyed by penicillin because they have a

large amount of peptidoglycan (glycoprotein) in

their cell walls. Penicillin interferes with the

synthesis of peptidoglycan. However gramnegative

bacteria have a slime covering or

capsule that is hard for antibiotics like penicillin

to penetrate. There are five main groups of

5

antibiotics. Carbapenems, such as penicillin and

meropenem, are commonly used for severe or

high-risk infections such as meningitis. Then

there are fluoroquinolones, such as Ciprofloxin,

which are used to treat common infections

including respiratory and urinary tract infections.

Polymyxins are antibiotics that are effective

against Gram-negative bacteria like E. coli. There

are also aminoglycosides for very serious

illnesses, so they are only used in hospitals. They

have drastic side effects such as hearing loss and

kidney damage. The last group is tetracyclines;

these are used against sexually transmitted

infections and Lyme’s disease which is actually a

non-bacterial infection.

Resistance

Antibiotic resistance is a type of antimicrobial

resistance (when microbes become resistant to

antimicrobials) and it means that bacteria evolve

7

to survive exposure to the antibiotics that kill

them. Mutations in the genome of bacteria may

cause resistance and are passed on to offspring.

Resistant genes may be in plasmids which can be

transferred to offspring, or they may be directly

inserted into the circular DNA as pathogenicity

islands.

What does antibiotic resistance mean for public

health services?

Antibiotic resistance has become an increasingly

prevalent problem, and by 2050 superbugs could

kill more people than cancer. In the United States

more than 23 000 people die from resistant

bacteria each year.

MRSA is now commonly associated with hospitals.

The over sterile conditions provide the perfect

place for staphylococcus aureus to be exposed to

antibiotics and become resistant to them.

According to the annual epidemiological report by

Public Health England, the all-case rate of MRSA

dropped from 2007/08 to 2018/19 by 7.2 per

100,000 however recently this decline has

stopped: the average rate of MRSA cases has

6

remained stable from 2015 to 2019. The same

observation can be made in the United States. The

CDC saw the rate of MRSA cases decrease by 17.1%

each year from 2005 to 2012. However from 2013

7

to 2016 no significant change was detected.

For public health services antibiotic resistance is a

very significant threat. Many treatments require

the use of antibiotics so that the patient does not

suffer from bacterial infections that could worsen

their condition. For example, those undergoing

chemotherapy are more vulnerable to infection

and require antibiotics. Additionally, the second

major cause of death of those on dialysis

treatment is infection, which makes antibiotics

vital for the patient’s survival. Furthermore those

receiving organ transplants have to take immunosuppressant

drugs which also increase the risk of

infection.

How do we tackle resistant bacteria?

Microbiologists have been using genome

sequencing technology to map the genome of

species of bacteria. This means a mutant resistant

strain can be compared with the existing sequence

of the normal bacteria genome to see exactly

which genes are causing the resistance.

There are also ways of slowing the spread of

antibiotic resistance. The overuse of antibiotics is

one of the major causes of antibiotic resistance.

Therefore healthcare professionals should only

prescribe antibiotics in cases of severe bacterial

infection. Patients should be cautious and finish

the antibiotic course exactly as specified so that

the stronger bacteria do not remain and duplicate.

Viral infections such as influenza do not require

antibiotics.

However there are some causes of antibiotic

resistance that individuals cannot directly control.

For example, in some countries, antibiotics used in

livestock are not regulated and many animals

involved in meat production are overfed

antibiotics. This overuse provides the opportunity

for bacteria to become resistant. However the EU

did introduce regulations in 2006 to stop this

misuse in Europe but there are still many countries

that do not impose laws on this issue.

Bacteriophages

There are one group of non-living organisms that

can destroy bacteria: bacteriophages. They are

viruses that specialise to kill specific types of

bacteria. Up to 40% of bacteria in the ocean are

killed by bacteriophages. They work by inserting

their genetic material into them and releasing an

enzyme called endolysin that punctures a hole in

the bacterium. The pressure builds and the

bacterium bursts releasing many more

bacteriophages.

Bacteriophages are not harmful to humans and as

bacteria evolve, bacteriophages do also. The good

news for humanity is that in order for bacteria to

become resistant to bacteriophages they would

have to give up their resistance to antibiotics.

The Future

Unfortunately, bacteriophage treatment is still

experimental and pharmaceutical companies are

reluctant to invest in a treatment without

approval. A worldwide pioneer clinical trial of

phage therapy was conducted between 2013 and

8

2017 and produced informative results. Hopefully

more research will be conducted into

bacteriophages because we do need a solution to

antibiotic resistance. We need one quickly.

A Bacterium

8


ANTIBIOTIC RESISTANCE IN FARMING -


DOES AGRICULTURE NEED TO CHANGE?

Antibiotic usage in agriculture is increasing rapidly.

This is partly due to the increased consumption and

demand of growing populations and a relative

increase in wealth from economic development.

However, not only has the agricultural industry been

a huge contributor to greenhouse gas emissions and

water pollution, the threat of antibiotic resistance

has been rising steadily for years. These

development factors will continue to accelerate us

to a widespread crisis unless the misuse of

antibiotics is slowed. Evidence suggests that the

number of antimicrobial drugs used in food

production is the same and in someplace higher

than for human use. In the US more than 70% of

antibiotics that are medically valuable to humans

1

are used in meat production.

Throughout history, antibiotic use has been

revolutionary in farming and has been essential for

treating infections in animals and providing safe

food to eat, however, currently in some locations

inappropriate use of antimicrobial drugs is an

increasing problem. Usage of these drugs is

particularly prevalent in intensive farms where

animals are kept in squalid conditions and confined

spaces. The poor and unsanitary condition of animal

living space increases the change of infections and

sometimes dangerous disease to spread; as a result

these farmed animals are often given a large

amount of antibiotics to prevent infection and to

promote growth. This misuse of antibiotics is largely

been shown to lead to antibiotic resistance. In a

report described by the NHS it is stated that 72% of

the 139 academic papers used in a literature review

found evidence to link antibiotic usage in agriculture

to an increase in antibiotic resistance and only 5%

argued that there was no link at all. This has been

said to “provide enough justification for policy

makers to aim to reduce the global use of antibiotics

1

in food production”.

A large risk is posed when drug resistant strains are

passed on through direct contact between humans

and animals or from human preparation of meat.

There is also concern that pollution from these

farms and from antimicrobial drug manufacturing

companies can further spread resistant microbes

into the environment/water sources. Many last

resort antibiotics that treat human conditions are

9

By Oscar Houghton-Boyle 12S

widely used in meat production and no other

replacements currently known. This unsustainable

approach to tackle the problem of food production

is likely to lead to the emergence of dangerous

resistant strains of microbes. The report described

by the NHS suggests three recommendations on

how we could tackle the problem, however there is

no current agreed solution and stopping the use of

antibiotic usage in meat production all together will

have a significant detrimental effect on the ability to

produce food for many.

With this in mind the first of the recommendations

suggest the idea of creating a global target to

reduce antibiotic use in food production to an

agreed level in livestock and fish, along with

restrictions on the use of antibiotics in these

animals that are important for humans. Secondly it

would be important to implement a rapid

development of minimum standards to reduce

antimicrobial manufacturing and agriculture waste

being released directly/unprocessed into the

environment. And finally, improved surveillance to

monitor to problems of antibiotic resistance and

these suggestions in order to maintain progress and

to ensure global targets have been met is essential.

This increasingly important role often falls on policy

makers within government bodies and particularly

vets who work within policy making positions who

maintain animal standards and safety for humans in

agriculture. As many countries' populations and

economic development have boomed it has become

increasingly obvious that we need to ensure the

health of ourselves, the welfare of animals and

particularly the protection of the environment. In

order to reduce the risk posed by antibiotic misuse

current methods of agriculture need to change.

Change like many problems we face today will

require collaboration and further research into the

rise antibiotic resistance but hopefully one day this

problem will no longer pose a threat to human or

animal health.

THE ANGEL OF DEATH

By Phoebe Yan Chun Po 12P

The role of a doctor is to apply principles and

procedures of medicine to prevent, diagnose and

care for patients, helping save lives and making lives

better to the best of their ability. But have you ever

heard about Dr Death and his 200 patients? An

English general practitioner and serial killer who

intentionally murdered at least 200 of his patients.

Doctor Harold Frederick Shipman was born on the

14th January 1946 in Nottingham. He was born into a

working-class family, and he was the favourite child

of his mother, Vera, who subsequently raised her

child into having a sense of superiority above others.

As a teenager, his mother was diagnosed with

terminal lung cancer, to which he willingly oversaw

her care. When looking after his mother, he was

fascinated by the positive effect of morphine

administrated to his mother, as the morphine gave

his mother a euphoric personality when the drug

was administered, which helped her suffering until

1

she succumbed to her disease on June 21st 1963.

Morphine is a strong painkiller, and is used to treat

severe pain, and is often used when weaker

painkillers no longer work; working by blocking pain

signals from travelling from the nerves to the brain,

however certain doses can kill patients and can also

5

cause addiction to the drug. After the death of his

mother, he was determined to go to medical school,

and was admitted to Leeds University. Supposedly,

his determination to go to medical school stemmed

2

from the death of his mother, however there are

many theories to why we wanted to enter the

healthcare sector; such as the theory, due to his

sense of superiority his mother nurtured him to

have, led him to believe he could ‘play God’.

By 1974, Shipman was a father of two and had joined

a medical practice in Yorkshire, where he thrived as

a family practitioner. However, during this time he

developed an addiction to the painkiller Pethidine,

which is a common injection of medicine used in

6

labour. He forged large amounts of the drug,

through prescriptions, which is very illegal; he was

forced to leave the practice when caught by a

colleague in 1975. Before, being caught about his

drug addiction he supposedly had epilepsy (which

was not true), as Shipman would occasionally

blackout during working hours, which was the side

effect of the drug, as the drug pethidine can leave

2

patients dizzy. At this time he entered a drug

rehabilitation program, though he only received a

small fine (£600) and a conviction of forgery. At this

current time, doctors who become addicts to drugs

usually receive a suspension of their license to

7

practice medicine, yet Doctor Harold Shipman was

still able to work as a general practitioner and his

records of drug addiction were not relayed to the

next medical centre he moved to, Donneybrook

Medical Centre in Hyde. During an interview with the

medical centre, Shipman himself mentioned his

previous addiction, though the centre had no

4

records of this. The centre must have thought him

admitting his drug addiction and his rehabilitation

was enough for him to continue to work as a general

practitioner?

During his time at Donneybrook Medical Centre, he

built his reputation as a hardworking doctor, gaining

the trust of many patients and colleagues, however

he had a reputation of arrogance amongst the junior

staff members. During his time here he killed about

3

70 of his patients. In 1993, he established his own

surgery, becoming a very well respected member of

the community. At his surgery, Shipman had a long

list of patients who awaited his care, due to the

amount of respect the community had towards him;

he often gave home visits to his elderly patients, to

which the majority of his patients were those of the

elderly age group. Due to his ‘love’ for giving home

visits, it meant the majority of elderly patients were

referred to Shipman, this further reputing his stance

of a patient and saintly doctor.

But how did this well respected doctor kill?

What he would do is that he’d visit, usually elderly

women, either because of check ups or to conduct

surveys (for research or about the general care at

the surgery), the majority of the time Shipman had

the intent to ‘take blood’ as samples for either

testing or research, yet what he was doing is

injecting these elderly patients with lethal doses of

morphine. After injecting the patients with the

morphine, he’d leave, and later that day would be

found dead. Then relatives or friends, who would

find the body, would call up Doctor Harold Shipman

to ask what had happened, but Shipman would say

the patient died of old age, or had heart problems

etc. And for his ‘determination of death’ to be

proven, he would then alter the medical records of

the patients, to line up with the cause of death. In

many cases, after death, relatives of the deceased

are able to have the option to do an autopsy, yet due

to the reverence doctor Shipman had in the

community he persuaded families not to conduct

PSYCHIATRY

10

PSYCHIATRY

autopsies, and for the deceased to be cremated

rather than buried, so later, if investigations were to

be conducted post mortem, the morphine could not

be traced. He continued to do this for 12 years, with

the majority of his victims being healthy and still had

plenty more years to live.

At Shipman’s surgery, he gained many terminally ill

patients on his roster, which was done as practices

that have many terminally ill patients are granted

large supplies of morphine, and suppliers are not as

strict to how many dosages are given, since with

many terminally ill patients, the dosages may vary

2

from patient to patient.

The first suspicion of Shipman’s crimes, was

through a patient who was misdiagnosed with

cancer. This patient under a previous doctor was

misdiagnosed with cancer, and underwent

chemotherapy; due to him ‘still having cancer’ he

went to Doctor Shipman for treatment, although the

previous doctor once realising the misdiagnosis of

the patient, called Shipman numerous times to say

the patient didn’t have cancer, but Shipman still was

treating the patient as if he did have cancer. During a

home visit to this patient’s home, he gave an

injection to the patient’s father, supposedly Shipman

needed to check if the father’s blood matched with

the son’s. After the visit, his father later died of ‘old

age’. The family had suspicions against Doctor

Shipman, yet they didn’t bring this to court since

Shipman was extremely respected within the

community, and they thought it would have been

4

difficult to gain justice.

However, the majority of the suspicions came from

the local morgues, as when the deceased usually

get cremated, the doctor usually who treated the

patients has to sign off for the cremation to happen.

The local morgues received abundant amounts of

deceased patients under Doctor Harold Shipman,

who were almost all being elderly women who were

fully clothed. Usually elderly who die of ‘old age’, the

majority of the time die in their sleep, so wouldn’t be

fully dressed which was suspicious; as usually when

morgues receive deceased elderly they’d be in their

night gowns but very rarely dressed in their

‘Sundays Best’. They decided to have another doctor

investigate Shipman, and what he came across was

that Shipman’s death rate of patients was higher

than almost all doctors within the area (comparing

Shipman with doctor who treated the elderly, and

not paediatric and other doctors). Police then got

involved by investigating Doctor Shipman, but had to

investigate without Shipman’s knowledge and

couldn’t question patients, just in case it got back to

Doctor Shipman. After checking the medical records

11

of the deceased patients, the police concluded there

was no foul play (as doctor Shipman altered those

1

records).

Shipman was finally caught when he murdered a

former mayoress, Kathleen Grundy. Kathleen

Grundy’s body was discovered by her daughter,

where she laid dead in her arm chair. Grundy in the

community was known to be very active for her age;

when her daughter called up Shipman about her

mother’s death, he said that she died of ‘old age’ and

tried to persuade the family to cremate the

deceased Kathleen Grundy. However, the family

didn’t, and chose to bury her. After her death, a

forged will was found to give the majority of her

estate, to her doctor. Kathleen’s daughter was an

attorney so concluded the document was forged

and brought it to police, who then questioned

Shipman. On searching Doctor Shipman, police

found a large amount of stolen jewellery from

patients, so concluded Shipman murdered those

patients, and investigated further (though money

was not his motive).

Post mortem, they did an excavation of Kathleen

Grundy’s and other, recently deceased bodies and

found lethal amounts of morphine found in their

systems. His overall M.O was to visit patients to take

blood samples, where he would inject them with

lethal amount of morphine. He would then leave, but

sometimes would come back to the crime scene a

couple of hours later, where he would ‘discover’ the

body. He would then persuade family members to

cremate patients and not do any post mortem

autopsies. After death, he would alter records which

he very much enjoyed doing, he would even do it as

a planning method to which of his patients would

die next. This was ironic as police later when going

through the records, used this as evidence against

Shipman in court.

Why did Dr Shipman do this though?

During Kathleen Grundy’s case hearing, the theory is

that he murdered and stole from Kathleen Grundy as

a form of retirement. And in trial Shipman showed

an extreme lack of remorse, acting very arrogant

when the judge questioned to why he murdered over

200 patients (pleading he was innocent the whole

time). The three theories to why Shipman murdered

in this way is, 1 - he had psychopathic tendencies, 2 -

him doing this was his way of fulfilling the

superiority he had over others, or 3 - (which I believe

is the reason), was his way of recreating his

mother’s death over and over again. However, we

will never know as in 2004, he hung himself in his

prison cell.

NARCISSISTS AND SOCIOPATHS

By Rania Abou-Auda, Glynnis Agyapong, Sristi Kandel,

Imaan Khan, Renee Kumar - Year 10

There are 10 specific personality disorders, and

they can be are arranged into three clusters, A, B

and C. Narcissistic personality disorder (NPD) and

anti-social personality disorder (ASPD), also

referred to as sociopathy or psychopathy, are

1

categorised into cluster B personality disorders .

Cluster B disorders are typical of having dramatic,

emotional or unpredictable thinking or behaviour.

Narcissistic personality disorder is a mental

condition in which people have an inflated sense

of self-importance, a deep need for excessive

admiration and attention. Narcissists have trouble

forming relationships and their friendships are

2

mostly superficial. They also – to a certain extent

- lack empathy. Narcissism is linked to

environment, genetically inherited personality

traits and neurobiology (the connection between

brain, behaviour and thinking). Although it’s exact

causes are still unknown, it is thought to origin in

childhood and a common cause can be

overprotective or neglectful parenting.

1

There are

two main types of narcissists: oblivious and

hypervigilant. Oblivious narcissists are unaware

of the impact they have on others. Hypervigilant

narcissists are acutely aware of other’s and their

actions; they can use this to their advantage and

3

are usually quite charming. Some symptoms are

that they require excessive admiration, cannot

handle criticism, are short-tempered and

impatient, have trouble adapting to change,

cannot deal with stress and have secret feelings

of insecurity, shame, vulnerability and

humiliation.

Narcissistic people are normally known for their

being scheming behaviour although they are

easily guidable and are naive due to their

ignorance. Normally you will find narcissistic

people have relationship difficulties and problems

with work or school. They also have poor physical

and mental health.

They often lack empathy and can't tolerate

4

boredom. Deceit and manipulation are central

features and, people with this disorder are also

more likely to smoke and commit substance

abuse. They also often have features that meet

the criteria for other personality disorders, such

5

as bipolar disorder. Some people with this

disorder arrogantly self-appraise, for example,

they may feel mundane work is beneath them or,

they may show a lack of concern of their current

1

problems or of their future.

Anti-social personality disorder has many

negative effects on not only the individual with

the condition, but also on their family, friends and

6

on society in general. People with this personality

disorder are more likely to have problems holding

1

down a job or maintaining healthy relationships .

7

They may struggle with acquiring jobs as studies

have shown that they are less likely to have a

university degree or experience than others. Antisocial

personality disorder can cause the

individual to not as much talk to or feel close to

relatives outside their immediate family and

friends compared with people without the

disorder. This could result in the individual

eventually alienating themselves. Although the

person with the disorder may not directly harm

others, the stress of living with and/or caring can

6

be very high.

In comparison to each other, both narcissists and

sociopaths show disregard for other’s emotions

and often fail to make lasting bonds with those

around them. They often take advantage of those

around them. While they both find it hard to

empathise, a narcissist is characterised by a high

self-esteem while a sociopath’s most discerning

trait is that of lack of empathy, remorse and guilt.

Whereas narcissists do feel shame, guilt and

remorse to some extent, which is due to the

opinion of others.

PSYCHIATRY

Antisocial personality disorder is a disorder that

begins in early childhood. People with this

disorder normally have a common pattern of

disregard and violation of the rights of others.

Because of this, they find it difficult to become

close or have a healthy relationship with anyone.

12

HUTCHINSON-GILFORD PROGERIA

SYNDROME

GENETIC DISORDERS

By Atharvaa Pangare 12N

Hutchinson-Gilford Progeria is a rare and fatal

genetic disorder causing children to age rapidly

starting in the first two years off their life,

affecting reportedly 1 in 4 million new-borns

worldwide. Children with progeria appear normal

during infancy, however at around 9 -24 months

1

of age they start showing symptoms such as

growth delays – leading to them being

underweight. A distinguishable facial appearance

also develops- in which the head appears larger,

compared to the disproportionately small face,

along with micrognathia (underdeveloped jaw),

malformation of teeth, prominent eyes and a faint

blue tinge surrounding the mouth. In the second

year, due to alopecia, the hair on the scalp,

eyelashes and eyebrows are lost and are

sometimes replaced by short white or blonde

hairs, as well as prominent veins across the scalp.

Other symptoms include atherosclerosis,

cardiovascular disease, hip dislocations, joint

stiffness and loss of layer of fat beneath the skin.

On average, children with progeria die of heart

disease at the age 13, ranging from 8 – 21 years.

Like other heart disease patients, children with

progeria suffer from high blood pressure, angina

and other conditions associated with old age.

Progeria is caused by mutations in the LMNA

2

gene, which provides instructions for making

several different proteins called Lamins. The

Lamin-A protein is the scaffolding (a mesh-like

layer of intermediate filaments) attached to the

inner membrane of the nuclear envelope that

holds the nucleus of a cell together. Researchers

believe the defective Lamin-A protein, called

Progerin, makes the nucleus unstable.

Progeria is not usually a hereditary disease, and

the new gene change shown in that family has

3

occurred by chance. However, it is dominant as

only one copy of the gene needs to be changed to

have the syndrome. Mosaicism is where a parent

has the genetic mutation for progeria in a small

proportion of their cells but does not have

progeria. Due to mosaicism, parents who have

never had a child with progeria have a 1 in 4-8

million chance of having a child with progeria. On

the other hand, if they do already have a child

with progeria, the chance of them having another

child with progeria is 2-3%

The specific cause of the accelerated aging

associated with HGPS is not known yet but many

researchers suggest that the abnormal aging

process takes place because of the increasing

cellular damage caused by chemical metabolic

processes. These reactions produce a compound

4

called free radicals. Free radicals are formed

when oxygen in the body splits into single atoms

with unpaired electrons, because electrons like to

be in pairs free radicals hunt the body to seek out

other electrons and this leads to damage of cells,

proteins and DNA.

A cure for HGPS has not been found yet, however

some studies have shows that Progerin is

produced at much lower levels by healthy

individuals and its build up in coronary arteries

overtime as people age is normal. This suggests

that Progerin is a contributor to the risk of

atherosclerosis in the general population and is

potentially a new trait that can be used to help

predict the risk of heart disease. Researchers have

confirmed that this link between normal aging,

heart disease and progeria means if a cure for

HGPS is found it can also be used to treat people

who suffer from aging-related conditions such as

heart attacks and strokes.

A child with Hutchinson-Gilford

Progeria Syndrome

13

Utilitarianism is a consequentialist ethical theory that

advocates only for actions that produce the most

1

happiness and least amount of suffering possible.

Peter Vardy’s book ‘The Puzzle of Ethics’ says that the

theory can be best summed up by the phrase: “the

2

greatest happiness for the greatest number.” The

choice or action that produces the most happiness is

the right done. For example, the UK government’s

decision to enforce a lockdown near to the end of

March was influenced by data modelling produced by

Imperial College London which suggested that a

lockdown would suppress the virus and mitigate

deaths thus aiming to prolong the greatest amount of

3

human life and happiness possible.

Australian philosopher Peter Singer said in 2017 that

utilitarianism “often does give us the right answers”

despite it sometimes clashing with our “moral

intuitions”. Many people would argue that

utilitarianism is the “default setting” to ethical

reasoning and this is clearly shown with the trolley

problem. Imagine you are standing near some tram

tracks. You can see a trolley rapidly going down the

tracks towards five helpless workers who will

inevitably be crushed. You see a lever connected to the

tracks and realise that if you pull it, the tram will be

diverted onto another set of tracks away from the five

workers. However, on these second set of tacks, is one

worker. Would you pull the lever to kill one life but save

five? Some people would arguing that less people

would be killed whereas others would not arguing that

they did not play an active role in killing anyone which

highlights the clashes this theory can have with our

4

intuitions.

British philosopher Jeremy Bentham published a long

defence of utilitarianism and was ahead of his time

because he was an early defender of women and

animal rights. John Stuart Mill was another British

philosopher who was an early defender of

utilitarianism and animal rights who succeeded

Bentham. Utilitarianism is made up of value theory and

the theory of right action. Furthermore, there are two

5

versions of utilitarianism: act and rule utilitarianism.

The former states that utilitarian methods should first

arrive at specific actions which are either moral or

immoral and the general rules can be concluded. The

latter says that utilitarianism should first frame

general principles or rules and these rules can then

derive specific acts that are not allowed.

Utilitarianism is one of the most reason-based

approaches that enables people to determine right

from wrong as well as help them produce the greatest

6

good and least amount of suffering with their actions.

It is, to some extent, a valuable ethical theory because

UTILITARIANISM

By Oluchi Ijeh 12S

it allows us to primarily focus on happiness in society

and our lives. It is an easy ethical theory that we can

carry out in our lives because it only requires us to

focus on the tasks and actions that give us the greatest

happiness and this can help us make the best decisions

7

for ourselves. Furthermore, utilitarianism emphasises

a need for neutrality where you must consider

everyone and everything equally and try to have a

neutral perspective. For example, if you had to decide

whether or not to release your government approved

pharmaceutical drug with side effects but a potential

to heal many people, you would choose to release the

drug on the basis that it will be the best decision for

everyone that is involved. On the contrary,

utilitarianism is flawed because everyone has their

own definition of what makes them happy since no one

8

is the same. Whilst skateboarding may be seen as

more enjoyable than reading for some, the exact

opposite can also be true for others showing how not

all utilitarian decisions will make everyone happy. It is

not always easy to come to arrive at the right decisions

because you cannot always seamlessly predict the

consequences of your actions and then determine

which action you will carry out.

There are also always scenarios in life where people

are in high pressure situations and are therefore urged

9

to make difficult decisions in a matter of seconds. For

example, after spending hours considering all the

patients, it would be less daunting for a doctor to

decide which critical patient they would try to save. But

if we reverse the scenario in such a way that the doctor

is in a chaotic paediatric ward filled with infantile

screams and hardly any time, the doctor may not come

to the same decision about which patient they would

try to save. When it comes to the idea of neutrality,

utilitarianism diminishes the value of the close

relationships that we many have with certain people

and in some circumstances, utilitarianism would

require us to disregard our loved ones such as taking

the utilitarian approach and deciding to save 5 lives at

the expense of your own son or daughter dying.

To conclude, even though it is very difficult to

implement into every aspect of daily life, utilitarianism

can be a somewhat valuable ethical theory in the sense

that it promotes egalitarianism so that the happiness

or pain of one person is equal to the happiness or pain

of another person. It is also universal which means that

it can be applied in any situation with the unwavering

aim of maximising happiness and minimising pain.

14

ETHICS - UTILITARIANISM

ABORTION

By Sethujah Gangatharan 12S

ETHICS - ABORTION

Abortion is the termination of pregnancy by

the removal of the fetus or embryo. Due to

the Abortion Act, abortion is legal in the UK at

upto 24 weeks however in countries like El

Salvador and Poland, it is illegal. There are

two main types of movement arguing for and

against abortion and these are pro-choice

and pro-life.

Pro-choice emphasises that women have the

right to make a decision about their

pregnancy since it’s their body. Pregnancy

will have a major impact on their health,

education, wealth and practically, it will

change their lives completely. Banning

women from the right to their own bodies

suggests that women are simply just

containers that carry fetuses rather than

people and this view is simply inhumane.

Pro-life on the other hand prioritises the

fetus’ life and its right to be born. However,

although a fetus is a human being, does it

have the characteristics of an actual

1

individual? A person is defined as a human

being with life and the capability of conscious

thoughts but it is impossible to classify

fetuses as people when we aren’t sure when

exactly life starts. Some believe that life

starts at conception and others believe that

life starts at birth. Whether fetuses have the

capability of conscious thoughts or not is

hard to tell so we can look at other aspects of

what makes human beings people. People

have the ability to feel emotions and

sensations such as pain so can fetuses feel

pain?

Many argue that fetuses do not feel pain

since their CNS, particularly their anterior

cingulate cortex, have not fully developed

2

yet. In the past studies have been carried out

on patients with bilateral lesions in the pain

matrix, i.e. damage to places like insula,

amygdala and anterior cingulate in the brain,

Their experience of pain was observed in

15

various trials such as sudden hot and cold

hand immersions. Despite excessive damage

to the regions which have been known to

process pain, patients’ experiences of pain

were normal and similar to a person with no

damage to the brain. This suggests that

perhaps these parts of the brain aren’t

needed to have fully developed for a fetus to

experience pain.

In fact, what is pain? Pain could be classified

3

as a signal which stimulates neurons to carry

out actions in response to various stimuli.

However, it is also subjective, i.e. one only

knows what ‘pain’ is through their own past

experiences and feelings of fear and nausea.

One may feel that a sensation is painful but

another person may not regard that

sensation as anything at all. Especially since

fetuses would have had such little ‘life’

experiences, if they do experience pain in the

womb, it would probably be quite short and

shallow. Whether fetuses actually experience

pain or not hasn’t been proven so one thing

that can be considered is the provision of

fetal analgesia to relieve fetus’ pain.

Analgesia and anaesthetics are provided in

fetal procedures like open heart surgery so

perhaps they can be given to fetuses in

abortion too.

One of the reasons why women abort their

fetuses is after finding out that they have a

genetic disorder such as Down’s Syndrome or

Noonan’s Syndrome. Down’s Syndrome is

when babies are born with an extra

chromosome and this can potentially lead to

learning disabilities and other health

problems. Most people believe that Down’s

syndrome is a disease in which people are ill

and suffering. However, each person with this

condition has a good quality of life, is unique

and brings a new light into their families. A

couple of years ago, the NHS started

providing women the opportunity to screen

for Down’s Syndrome. The new test

was claimed to be ‘more accurate than ever’

4

but what exactly are they testing for?

Fundamentally they are screening for

whether the fetus has a ‘correct’ number of

chromosomes or not but in fact, this starts to

imply that to be a ‘normal’ human being, you

have to have 46 chromosomes. In one of the

leaflets that the NHS hands out to mothers

after screening, a list of complications such

as ‘heart problems, gut problems, hearing

problems, vision problems, thyroid problems

5

and dementia’ are listed. Simply listing these

complications makes the condition sound

very severe however these are complications

that any fetus could have. Anyone can grow

up to have ‘heart problems, gut problems,

etc’. In the past, when people have received

phone calls confirming a positive test for

Down’s, healthcare workers have said things

like ‘I’m ever so sorry but I have really bad

6

news’. Why is it bad news?

After receiving a positive result for Down's

Syndrome, 90% of women in the UK abort

7

their babies. In Iceland, this is worse - 10/10

women abort their babies. There is generally

a negative outlook about conditions like this

and eradicating the Down’s Syndrome

community implies that society views people

with this condition to be ‘imperfect’. This

therefore suggests that those without the

condition are completely ‘perfect’. In fact,

what is perfect?

We all know that ‘perfect’ is indefinable. In

this day and age, it has become accepted to

abort babies with Down’s Syndrome and

other genetic conditions. Although I am prochoice

and believe that women should have

the ability to choose what they want, I also

feel that this is completely ruthless. I have a

sister with Down’s Syndrome and in all

honesty, although she has a few learning

difficulties and other conditions, she is no

different from me or you. She has her own

hobbies, dreams and passion and radiates

such positive energy that I honestly could not

survive without her! The negative view on

people with genetic conditions like Down’s

has to be changed. Perhaps doctors and

healthcare professionals need to stop listing

‘all the things that could go wrong’ and start

talking about what could go right. They need

to start talking about how those with Down's

Syndrome are people filled with individuality,

emotions and life!

Many religions state that abortion should

only be allowed if the woman has an illness

since that could harm both the mother and

the fetus. Some also argue that abortion

should only be allowed in instances like rape

or incest but this suggests that for a woman

to have a right for her own body, someone

has to violate it first. In conclusion, I believe

that abortion should be legal in all countries

since equality is important and women

should be given the right to choose what’s

best for themselves and for their bodies.

Although providing analgesia will not resolve

the issue of a fetus’ right to life, it could

potentially solve the issue of fetal pain and

make sure that fetus’ die somewhat

‘peacefully’.

However, I do also believe that the outlook on

abortion due to genetic conditions should be

changed since aborting babies since they are

genetically different to a ‘normal’ human is

irrational.

A child with Down's Syndrome

ETHICS - ABORTION

16

WHY ARE PEANUTS AND NUTS STILL

SERVED ON PLANES?

By Amy Booth 12S

ETHICS - ALLERGIES

Allergies affect around 1/3 of people in the

1

UK and half of under 18s have an allergy.

Allergy is the most common chronic disease

in Europe and in children, with 6-8% of

children under 3 affected by food allergies.

It is estimated that 1 in 1333 of the English

population have experienced anaphylaxis at

2

some point in their lives.

Anaphylaxis is a life threatening,

hypersensitivity reaction which is triggered

by antigens, such as a type of food or an

3

insect sting. During anaphylaxis, the body

releases histamine which causes blood

vessels to dilate which can cause a

4

dangerous drop in blood pressure, loss of

consciousness, airways narrowing which

can prevent you from breathing properly

and sometimes the blood vessels can leak

5

which causes oedema. Any food

glycoprotein can cause anaphylaxis but the

most common foods that cause this

reaction are peanuts, tree nuts, fish, milk,

eggs and shellfish. Some people have

airborne allergies which means anaphylaxis

can be caused from just inhaling particles of

6

their trigger food. One of the main

treatments for anaphylaxis is epinephrine

also known as adrenaline. Epinephrine is

classed in a group of medications called

7

alpha and beta adrenergic agonists. People

with anaphylaxis risk are prescribed

epinephrine syringes to use from the onset

8

of severe allergic reaction symptoms.

Epinephrine binds to different cell receptors

to relax the muscles blocking the airway

and increase blood flow by narrowing blood

vessels. It also binds to receptors on

immune cells to prevent any more

9

histamine being produced. Anaphylaxis can

cause death within minutes, the most

common causes of death from anaphylaxis

are cardiovascular collapse, where the

heart cannot provide sufficient oxygen to

the body and laryngeal oedema, where the

throat swells up, preventing the person

10

from breathing in enough oxygen to survive.

Peanut allergy is the second most common

food allergy in children and affects around 1

in 50 children and 1 in 200 adults. Peanut is

the most likely food to cause anaphylaxis

11

and death. Peanuts started being served on

planes in the 1930s but weren’t sold alone

until the 1970s by Southwest Airlines as a

marketing move, “You fly for peanuts”, so

12

you get to eat peanuts. Peanuts are small

and easily served, they aren’t expensive and

have a good shelf life so other airlines

13

started to serve only peanuts as well. But

with the rise in food allergies and peanut

allergies being so lethal why are peanuts

still served on planes today?

It’s no wonder that flying for people with

allergies can be very nerve racking, a survey

by Allergy UK found that more than a third

of people with allergies have had bad

14

experiences when flying. There are

numerous stories of people having allergic

reactions on planes to people eating

peanuts and flight staff not being prepared

for how to deal with these medical

emergencies. Allergic reactions account for

2-4% of medical issues on airlines. Many

airlines stop serving peanuts on a flight if

they are told someone boarding has a nut

allergy and can make announcements to

passengers asking them not to eat nuts;

however there have been cases where

other passengers refuse to stop eating their

own peanut snacks and stories where

airlines continue to serve peanuts even

though they have reassured allergic

17

15

passengers they will not . Having an allergic

reaction on a plane can increase the

severity of a reaction. The oxygen pressure

in the plane when cruising is 25-30% lower

than when on ground which causes oxygen

blood saturation to decrease to 92-95%.

This can increase the chance of anaphylaxis

16

occurring. As well, with flights ranging

from 1 to 20 hours, having an allergic

reaction mid-air and not being able to be

rushed to hospital can be fatal. Many

planes get diverted when a passenger goes

into anaphylactic shock but having to wait

till landing with little medical equipment

can be extremely terrifying for the allergic

passenger. In cases where allergy sufferers

have been reassured by their flight

attendants that they will not serve nuts but

still continue to, the allergic passenger may

not have taken enough medication with

them in case of an emergency, because

they were told no nuts would be served.

Not having the necessary treatment

available can make a reaction more serious

and can make the allergic passenger more

anxious.

An example of a terrifying flight experience

was Tricia Powell, who has multiple severe

allergies, when she came back from a

holiday in Disney World. She had previously

been told that no nuts would be served on

her flight but was horrified when a flight

attendant started offering passengers

mixed nuts. Tricia went into anaphylactic

shock and her airways started to close, she

was given oxygen and the plane was

diverted. Because of her anaphylactic

reaction and another medical condition

Tricia had she underwent major surgery.

Her 5 year old daughter was traumatised by

watching her mums allergic reaction and

was left with PTSD and severe separation

anxiety and Tricia herself was left with

17

PTSD as well.

anaphylactic shock after eating a sesame

baguette from Pret A Manger that failed to

list all the ingredients. She collapsed during

a flight from London to Nice. Her father

administered two EpiPens during the threehour

flight, but her condition did not

improve. She was taken to hospital in

18

France but later died. Although this case

didn’t involve peanuts on a plane, the

conditions of the plane could have

contributed to her reaction.

There are multiple examples of flight

attendants not taking allergies seriously,

one involving singer Dua Lipa and her sister

who is severely allergic to nuts. Dua told a

flight attendant about her sister’s allergy

and the attendant shockingly replied saying

the airline is not nut free so her sister may

have to use her EpiPen and that nuts would

19

still be served.

There are many other examples of stories

like this and still there is a stigma against

allergies and how life threatening they can

be. Surely it is not that hard for people to

refrain from eating nuts for a flight to save

someone’s life, there are plenty of other

snacks available, so why are nuts still

served on planes when they cause so many

people fear and life threatening reactions?

If easyJet can stop serving nuts on all

20

flights then why can’t all airlines?

ETHICS - ALLERGIES

Another more well known case is Natasha

Ednan-Laperouse who died from an

18

12 AILMENTS OF CHRISTMAS

By Amy Booth 12S

CHRISTMAS

1 - Common cold and flu

Common cold and flu viruses can enter our

bodies through our noses. However, our noses

are constantly secreting mucus which traps

viruses. The mucus is moved by cilia that line our

nasal passages and then we swallow it, and our

stomach acids neutralise the virus. However,

cold air cools the nasal passage, slowing down

mucus clearance. Our immune system also

prevents viruses attacking our body through

phagocytes engulfing and digesting viruses.

However, researchers have also linked cold air to

a decrease in this activity, meaning in cold

weather viruses are a lot more likely to enter our

bodies. As well, in winter we spend more time

indoors because of the colder temperature. This

can lead to: crowded spaces - meaning it’s easier

to spread virus droplets from person to person,

and an increase in central heating usage -

causing a decrease in air humidity which can dry

out the nasal mucus and has been linked to a rise

1

in flu infections.

2 - Food poisoning

According to the Food Safety Promotion Board,

people are more at risk from food poisoning in

their homes at Christmas than at any other time

of the year. It’s suggested this is because people

buy more food than usual, fridges are overfilled,

raw meat is more likely to contaminate ready-toeat

foods due to packed trolleys and fridges,

food is left out in warm rooms for too long and

meats are not defrosted enough before cooking

and more effort is put into entertain family and

friends meaning many people don’t pay attention

2

to the risks of undercooked meat and poultry.

Turkey and other raw meats may contain

bacteria such as salmonella or campylobacter

which can cause abdominal pain, diarrhoea,

3 4

fever, headache, nausea, and vomiting.

3 - SAD

Seasonal affective disorder (SAD) is a type of

depression that comes and goes in a seasonal

5

pattern.

SAD is sometimes known as winter depression

because the symptoms are usually more

apparent and more severe during the winter

because of the darker, shorter days. SAD can be

felt as a lack of energy, reduced enjoyment in

19

activities and a need for more sleep than normal.

The exact cause of SAD is not fully known, but it

is suggested to be caused by the reduced

exposure to sunlight. It’s thought that a lack of

sunlight may prevent the hypothalamus, a part

of the brain, from working properly, which may

affect:

• Melatonin production – melatonin is a hormone

that makes you feel tired. The body may produce

more than normal in people with SAD.

• Serotonin production – serotonin is a hormone

that affects sleep, mood, appetites and

depression

• Circadian rhythm – the body uses sunlight to

time different important functions including

when you wake up, so during the winter when

light levels are lower, the body clock may be

7

disrupted leading to symptoms of SAD.

4 - Norovirus

Norovirus is a stomach bug that causes vomiting

and diarrhoea. It is also called the winter

vomiting bug because it is most common in

8

winter. This may be because people are indoors

more often with the heating on and windows

closed meaning fresh air is limited, as mentioned

earlier this makes it easier for the virus to

spread. As well, viruses like norovirus that are

spread through contact may survive longer

outside the body during winter. The lower

temperatures and levels of sunlight mean

viruses break down more slowly on surfaces like

door handles and taps increasing the chance of

9

spread.

5 - Christmas tree syndrome

Christmas tree syndrome is a seasonal illness

which is caused by your Christmas tree. People

with this allergy experience symptoms similar to

hay fever. The allergic condition is caused by the

presence of a Christmas tree in an enclosed

indoor space and the mould growth and pollen

on the Christmas tree. The fact that Christmas

trees stay in most houses for about a month only

10

makes symptoms worse. The syndrome can be

mild to severe, but is particularly dangerous if

11

you already have allergies or asthma.

6 - Hypothermia

Hypothermia is a medical emergency that

6

happens when your body temperature drops

12

below 35°C, it needs to be treated in hospital . It

happens when your body loses heat faster than

it can produce it. When your body temperature

drops, your heart and other organs cannot work

properly, because of this if left untreated,

hypothermia can lead to complete organ failure

and death.

The most common causes of hypothermia are

exposure to cold-weather conditions or cold

water, however, being in any environment that is

colder than your body for too long can cause

hypothermia if you aren't dressed appropriately

or can't control the conditions.

Some examples of conditions that can lead to

hypothermia include:

- Wearing clothes that aren't warm enough for

the weather

- Staying out in the cold for too long

13

- Not being able to get out of wet clothes

7 - Stress

Some people can feel overwhelmed by the

expectations of Christmas, the lack of time and

money and the pressure of gift giving which can

14

cause them to feel incredibly stressed. As well

with the planning fallacy (a phenomenon where

we misjudge how much time and effort tasks will

take even though we have experienced them

before) people expect a fun, relaxing Christmas

and end up with a chaotic, stressful one. With

social media we can now see how everyone

else’s Christmas seasons are going which can

add even more pressure and stress to make your

15

Christmas better.

8 - Asthma

For some people, asthma is harder to control

during winter months as cold air is a major

trigger of asthma symptoms. The cold, dry air

can irritate your airways which can cause the

muscles inside to spasm. Also on cold days, air

pollution can sometimes be worse which is

16

another trigger of asthma symptoms. As well,

there’s a lot of cold and flu viruses going around

17

which can also exacerbate asthma symptoms.

18

blue. Raynaud's mainly affects your fingers and

toes, but it can also affect other areas of your

19

body, such as your nose, lips and ears.

10 - Dry skin

Dry skin is often worse during the winter, when

20

environmental humidity is low and there are

frequent sudden changes in temperature. Going

from the cold outdoors to a centrally heated

21

house can bring on an flare up of eczema.

11 - Arthritis

For people with Arthritis, joints can get more

painful in winter. This may be because when the

atmospheric pressure and temperature drops,

the pressure inside people’s joints that pushes on

the nerves increases which causes pain. As well

the colder weather can make people’s pain

receptors a lot more sensitive which means they

22

will feel more arthritis pain.

12- Heart attack

Studies have shown that cold weather may

increase your risk of a heart attack. This may be

because the cold weather increases your blood

pressure as your blood vessels constrict and

blood flow speeds up to keep your body warm.

The heart also has to work a lot harder in winter

to maintain body heat. Cold weather can also

increase cholesterol levels and can make blood

more likely to clot. As well, blood levels of

immune system compounds increase in winter

which can prevent your body getting infections

but research has shown that this can also

23

increase the amount of plaque in artery walls.

CHRISTMAS

9 - Raynaud disease

Raynaud's disease causes parts of your body to

feel cold and numb due to cold temperatures or

stress. Small arteries that supply blood to the

skin narrow which limits blood flow. The affected

areas of skin usually turn white and then turn

20

DECEMBER’S RECOMMENDATIONS

Book of the Month:

RECOMMENDATIONS

Stiff – The Curious Lives of Human Cadavers by Mary Roach

As an aspiring medic, death isn’t something you usually focus on. After

all, isn’t the principal duty of a doctor to keep people alive, to cure their

diseases and ailments? We expect to spend years laboriously studying

the thirteen thousand ways the human body can fail, and everything we

can do to prevent, lessen or solve these problems. But what happens

when situations escalate beyond our capabilities? What happens to

bodies after they’re pronounced dead?

This book opened my eyes to the multitude of ways cadavers can

contribute to science and play a huge role in innovation even after they

have passed away. Roach doesn’t tiptoe around the delicacy of death –

rather she explores it head on, investigating how bodies decay, the rather

gruesome history of grave-robbing and the many industries in which corpses are used, that

otherwise would never have occurred to me. She explores the mental struggles of clinicians as they

face the notion of ‘clinical remove’ (desensitizing one’s work with bodies in order to cope) and

recounts her experiences with many learned professionals about their work with cadavers. We read

about the social dilemmas surrounding the value and importance of life in relation to economics,

morals and ethics. Roach presented ideas that made me question the integrity of scientific research,

and how I could contribute positively myself.

I would recommend this to anyone with an interest in science, and particularly those considering

pursuing a career in medicine. Its ideas stray from the conventional memoirs of doctors and provide

an alternate insight into an area of science that I’m sure many of us aren’t very well-versed on. The

mixture of heavy, societal and mental explorations with light-hearted humor makes this a very

enjoyable read.

By Sayedah Ali 12B

Podcasts of the Month:

Bedside Rounds:

This podcast discusses various wonderful, weird, and intensely human stories that have shaped

modern medicine

The Geeky Medics:

This podcast aims to inspire and inform through discussions with some of the most fascinating

individuals in the world of healthcare and education.

Documentary of the Month:

Surgeons at the Edge of Life - BBC iPlayer:

At two hospitals in Cambridge, some of the most renowned surgeons undertake some of the most

complex operations in the world, where technical skill is vital because even the smallest slip of the

scalpel would result in catastrophe.

21

MEDICAL DATES IN DECEMBER

December is:

Decembeard - Men’s Health Awareness Month

Medical Weeks in December:

.

Crohn's Disease and Colitis Awareness Week - 1st-

7th

National Grief Awareness Week - 2nd-8th

Medical Days in December:

World AIDS Day - 1st

International Day of Persons with Disabilities -3rd

DECEMBEARD

Every year over 42,000 people are diagnosed with colorectal cancer.

Also known as bowel cancer, this type of cancer is the 3rd most

common cause of cancer death in both males and female.

Decembeard is an event which raises awareness and supports this

type of cancer. Especially due to these unprecedented times, many

people are having their treatment pushed back and so donations

are needed more than ever. Decembeard is similar to Movember in

the way that men grow beards or die their beards different colours

to raise money and support bowel cancer patients.

MEDICAL DATES

To take part in Decembeard or find out more about it, visit:

Bowel Cancer UK

Cancer Reseach UK - Bowel Cancer Statistics

Cancer Research UK - Cancer mortality for common cancers

22

1. When is animal obesity diagnosed?

QUIZ

To check you’ve been reading so far...

DECEMBER'S QUIZ

2. What is myocarditis?

3. What medical school did Dr Hannah Bellsham-Revell go to?

4. How do antibiotics work?

5. In the US what percentage of antibiotics that are medically valuable to

humans are also used in meat production?

A - Less than 20%

B - 30-40%

C - 50-60%

D - More than 70%

6. What is one theory that suggests why Shipman murdered his patients?

7. What are the two main types of narcissists?

8. What is progeria caused by?

9. What is utilitarianism?

10. Which part of the brain is thought to be necessary to feel pain?

11. What effect does histamine have on the body during anaphylaxis?

12. Why does your risk of a heart attack increase in cold weather?

13. Which part of the brain is highlighted in the MRI shown below?

23

ANSWERS TO THE QUIZ WILL BE FEATURED IN THE NEXT ISSUE OF THE JOURNAL

THE CASE OF MR REID - PBL CASE


Mr Thomas Reid is a 66-year-old male who lives with his wife, Eleanor. Both his two children are going

through difficult divorces and so this has been causing him a lot of stress over the past few months. He

has been experiencing a feeling of breathlessness, a pounding in his chest and both these symptoms get

worse when he goes up the stairs. He found that he had to rest for a few minutes to catch his breath

after each step and often felt lightheaded. Eleanor became concerned after he nearly fainted one

morning, and took him to the hospital the next day for a check-up.

There, the doctors ran an ECG and took blood and urine samples. His serum creatinine was higher than

normal, and his urine was low in volume and very dark. His liver function and troponin levels were

normal however. Thomas had a raised BMI and his capillary refill time was more than 5 seconds. His

mouth and mucus membranes were very dry, and his legs were slightly swollen. His blood pressure was

80/50. His heart sounds were: I + II + 0 and there were fine crackles at the base of each lung.

The doctors decided to put Thomas on Warfarin and other medications to control his heart rate and

heart rhythm. He was given plenty of fluids and kept in hospital for monitoring. He started to feel better

however a few days later, as he was reaching for a glass of water on the table next to him, he realised

that he couldn’t move his right arm properly and he accidentally knocked the glass over onto the floor.

He also experienced tingling and numbness in his right hand and said that he felt as though he was

drunk, even though he had not had consumed any alcohol recently. He said to his doctors ‘I can’t see

much - I can’t see anything on the sides, top or bottom. I only see what’s exactly in front of me.’ The

doctors were alerted immediately, and Jack was taken for a CT scan of his head.

RESEARCH TASK:

1) Research what Serum Creatinine is and what it could help to diagnose.

2) Suggest why Jack’s liver function and serum creatinine had been checked and why his serum

creatinine was raised.

3) Thomas’ urine volume and colour showed that he was dehydrated. What could have been the cause of

this?

4) Find out the condition that Thomas describes when he says, ‘I can’t see much - I can’t see anything on

the sides, top or bottom. I only see what’s exactly in front of me.’

5) Research what his symptoms, i.e. the inability to move his right arm; tingling and numbness in right

hand; and a lack of clear, good vision could have been a result of.

6) Shown below are two MRI scans. The MRI on the left shows a healthy brain and an MRI on the right is

similar to Thomas’ MRI (note: it is not entirely accurate or exact). What do you think the MRI on the right

shows and thus what do you think happened to Thomas?

PBL CASE

7) Discuss the positives and negatives of a CT scan. Why was it used in this case?

8) Thomas was given thrombolytic therapy. Research what this therapy is used for and now rethink

question six - has your view on what could have happened to Thomas changed?

9) What are the impacts of chronic stress on health and wellbeing?

10) What other treatments and help could have been given to Thomas to help him manage his stress and

wellbeing?

THE ANSWERS TO THE PBL CASE WILL BE FEATURED IN THE NEXT ISSUE OF THE JOURNAL HOWEVER WE ARE

EAGER TO SEE EACH AND EVERY ONE OF YOUR ANSWERS SO PLEASE DO EMAIL THEM TO US!

24

WORDSEARCH

PUZZLES

ALLERGIES

ARTHRITIS

ASTHMA

BRONCHITIS

EAR INFECTION

FOOD POISONING

FROSTBITE

HYPOTHERMIA

INFLUENZA

MIGRAINE

NOROVIRUS

OBESITY

PNEUMONIA

STRESS

25

CROSSWORD

PUZZLES

Across

3. Antibiotic (12)

5. Needed right now (7)

6. Common winter illness (3)

7. Most frequently used analgesic (11)

8. Temperature, pulse, blood pressure, oxygen

saturation, respiration rate and consciousness (6)

9. Skin condition (6)

10. Inflammation (4)

14. Doctors instrument to listen (11)

15. Occurs below 35°C (11)

16. Tube for IV (6)

17. Bone (5)

18. Pink eye (14)

19. Sign of disease (7)

Down

1. Above 140/90 mmHg (12)

2. Respiratory system specialist (13)

4. Care that treats the whole person

(8,4)

6. Broken bone (8)

11. Unable to respond (11)

12. Common lung condition (6)

13. Last year closed 1,1 hospital beds

(9)

26

MEDOKU

PUZZLES

As you would do in a sudoku, fill in the 9x9 grid so that each row, each

column and each 3x3 box contains all the symbols below!

27

ISSUE 1 QUIZ + PUZZLE ANSWERS

Quiz

1) Coronovirus could cause healthcare workers to develop PTSD or other mental health issues in the

future, like the 2015 Korean MERS-Cov outbreak and 2003 SARS-Cov outbreak did. However, more

money is being spent on mental health services within the NHS so hopefully, all healthcare workers

will receive the help and support that they need.

2) B

3) Nicotine receptors in the brain which are increased due to previous nicotine use

4) Generalized seizures and partial seizures

5) The lack of a logical correlation between the number of cell divisions and probability of cancer

6) The physician being respectful and responsive to individual patient priorities

7) Biko's case brought new rules to the GMC about treating patients fairly and respecting their life

choices and beliefs. It has also caused many doctors to reflect on the Hippocratic Oath and on how

they themselves treat individuals.

8) The Mental Capacity Act

9) Ulna

10) Tricep

Wordsearch

Apologies there

was a publishing

error in the

wordsearch in

November’s

issue, here is the

corrected version

with the

answers. As you

would have seen

a new format has

been used for

this months

wordsearch so

there should be

no more

problems.

ISSUE 1 QUIZ + PUZZLE ANSWERS

28

MDV INTERVIEWS


The second stage of the admissions process for medical school is interviews. Interviews are used to test the

applicant’s understanding of the career and assess their qualities and motivation.

MDV INTERVIEWS

There are two main types of interviews:

Multiple Mini Interviews (MMI): as stated by the name, this type of interview is split into roughly ten

different stations which are usually 10 minutes long. Before each interview, you are presented with the

scenario and given a few minutes to prepare so overall, the interviews last approximately two hours long.

MMIs include elements such as:

Role play

Discussions about ethical scenarios

Group discussions and tasks with other applicants

Data Analysis

Often, there are also traditional interview style stations in which you could be asked about your work

experience, motivation to study medicine or current affairs.

Panel Interviews: this type of interview is more question focused rather than task based. For roughly 20 to

30 minutes, a panel of usually four to five interviewers take it in turns to ask questions about your

application to medicine. They could ask you about work experience, your personal statement, EPQ, etc.

Another type of interview is Oxbridge interviews - Oxford and Cambridge are both panel interviews however

they assess academic potential more than other qualities due to the fact that they follow a traditional

university course.

Which interview style is better?

Both interview styles have their advantages and disadvantages. The advantage of an MMI is that even if one

station doesn’t go well, the next station is a fresh start since the interviewers and scenarios will be different.

However, MMI interviews aren’t as in depth as panel interviews since they are much shorter. Since panel

interviews are longer, they give you more time to think about and elaborate on your answers, allowing you to

form an actual conversation with the interviewer.

Interview Reading list:

It is recommended that you research on a few of the following potential interview topics before your

interviews! It is mainly for medicine but some of these topics are relevant to dentistry and veterinary too:

General Medical/Dental Council guidelines

NHS

Structure of the NHS

NHS long term plan

Core values of the NHS

NHS Dental contract

The four pillars of medical ethics

Relevant cases such as:

Charlie Gard

Dr Bawa Garba

Dr Harold Shipman

Alfie Evans

Equality Act 2010 and its application in healthcare

The Human Rights Act

Hot Topics Such as:

Covid-19

Brexit and its impact on the NHS

Organ Donation - opt out system

The importance of IT in healthcare and issues with data protection

29

Categorised below are some example interview questions and tips!

General Questions (application to MDV, current affairs, hot topics etc.):

Why have you chosen this profession?

This career can be very stressful at time - especially with the Covid-19 pandemic, how have you managed

to cope with stress?

What do you think are the biggest issues within healthcare right now?

If you were given £1 million to spend within healthcare, what would you spend it on and why?

Should the NHS be privatised?

Out of the following qualities, which one is the most fundamental attribute for a doctor and why:

Commitment

Determination

Resilience

Intelligence

Is IVF treatment an affordable luxury?

What is the most important organ of the body?

What is your biggest weakness?

Role Play:

You have just received the news that your best friend’s mum has died but your friend doesn’t know yet. How

would you break the news to them?

Tips:

You could start off by preparing the other person for the bad news that they’re going to hear - for

example, ‘I know this may be difficult for you to hear but…’

Maintain empathy throughout the scenario - the other person could respond with a wide range of

emotions from sorrow to anger but it is important that you stay compassionate

Reassure them that you are there to support them

Ethical Scenario:

Teamwork

Professionalism

Organisational skills

Curiosity

A patient with Down’s syndrome became pregnant. Her mother wants the patient to have an abortion but the

patient themselves wants to keep the child. What should you do as a GP?

Ask the interviewer for more information about how old the patient is, whether they are married, etc.

Begin with a good introduction, summarising the main question behind this scenario

Talk through the case, arguing for and against whilst referring to each of the four pillars of medical ethics

Conclude by summarising your personal opinion on what should be done

Data Analysis:

Describe and explain what the graph on the right shows.

The main tip for this question is to literally describe what you see! Describe

the overall trends whilst referring to the units and don't overthink it - it is just

like a 2-3 mark science GCSE question!

General Tips:

Dress smartly for the interview!

Whilst talking about the attributes of a doctor, demonstrate that you have these skills as well by referring

back to your own personal experiences and reflecting upon them

The interviewers may discuss your section 3 BMAT essay, EPQ or personal statement so make sure you

know everything you wrote inside and out!

MDV

INTERVIEWS

Free Resources:

The Medic Portal

6med

The MSAG

Blackstone Tutors

The Aspiring Medics

30

WE HOPE YOU ENJOYED READING THE

JOURNAL! THANK YOU TO EVERYONE

THAT CONTRIBUTED TO IT - DON'T

FORGET TO KEEP SENDING IN PHOTOS

AND ARTICLES!

WE ALSO HOPE YOU HAVE A VERY

MERRY CHRISTMAS AND A HAPPY

NEW YEAR! HAPPY HOLIDAYS TO YOU

ALL, STAY SAFE.

For any queries and suggestions, you can contact us via email:

nwsgmedicjournal@gmail.com

MEDISCOPE | ISSUE 2 | 02 DECEMBER 2020

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