MEDISCOPE | ISSUE 2 | 02 DECEMBER 2020
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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.
1
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
2
CONTENTS
NUTRITION AND OBESITY IN ANIMALS
NUTRITION AND OBESITY
3
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
1
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
2
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
3
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
4
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
5
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
6
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
1
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
ANTIBIOTIC RESISTANCE IN FARMING -
ANTIBIOTIC RESISTANCE
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
By Sethujah Gangatharan 12S
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
By Sethujah Gangatharan 12S
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
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WE HOPE YOU ENJOYED READING THE
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AND ARTICLES!
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MERRY CHRISTMAS AND A HAPPY
NEW YEAR! HAPPY HOLIDAYS TO YOU
ALL, STAY SAFE.
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