RUMS Review Vol. VIII Issue I - January 2023

JANUARY 2023

RUMS

VOL. VIII ISSUE 1

REVIEW

UCL MEDICAL SCHOOL STUDENT MAGAZINE

The Team

EDITOR'S

WELCOME

Editor-in-Chief

Henry Spencer

Deputy Editor-in-

Chief

YG Woo

Medical School Reporting

Team

Editor: Daivi Shah

Dhanyata Narendra

Harini Somasekar

Niamh O'Connor

Polina Zabelina

Summayah Imran

Journalism Team

Editor: Anna Baker

Aisha Goplani

Amman Ahmed

Emil Lecointe

Zara Ahmad

Nilay Sah

Daivi Shah

Eeshaan Ghanekar

Eric Zhong

Isha Elahi

Saujanya Kesavan

Zoya Gul

Zahra Malik

George Ponodath

Ayman Asaria

Ulliana Savitskaya

Lakshmi Kowdley Hemanth

Elizabeth Kallumpuram

Sustainability Team

Editor: Maya Banerjee

Welcome to this edition of the

RUMS Review Magazine!

This year we have decided

to abandon our usual

themed magazines, and

rather break free to give

our writers the

opportunity to explore a

topic they are interested

in and share this interest

with you, our readers. As

always we have

maintained our usual

‘Medical School Reporting’

section to share the

achievements of RUMS

sports, societies and

volunteering groups as

well as explore projects in

and around UCL Medical

School. I am pleased to

say that we have also

continued

our

sustainability section this

year, highlighting the

effects of the climate

crisis on medical practice.

Highlights of the magazine

include a thoughtprovoking

exploration of

the government's sugartax

policy, by Nilay Sah,

an interview with

Professor Kate Ward and

an examination of how

climate change has

affected

zoonotic

infections. Additionally, I

am very grateful to Kate

Griffin, who has shared

her vast patient

experience of medicine

and doctors in our guest

feature of this magazine,

which can be found at the

back of the magazine.

I would like to thank all

the members of my RUMS

Review team who have

worked tirelessly to write,

edit and design the

magazine you are about to

read. In particular, I would

like to extend my thanks

to my deputy editor, YG,

and our sub-team leads,

Daivi, Anna, Maya and

Harini, without whom I

would not have been able

to put this magazine

together. And finally, I

would like to thank our

sponsors for their support

which has made the

production of this

magazine possible.

I hope you enjoy taking a

break from your day to

read the magazine which

follows (perhaps with a

cup of tea and a couple of

biscuits!).

Henry Spencer

Editor-in-Chief

Emil Lecointe

Isha Elahi

Design Team

Team Lead: Harini Somasekar

Amy Hickman Illustrations by:

Amman Ahmed Aishani Dass

English Team

Zoya Gul Elizabeth Kallumpuram

YG Woo

Chloe A. Yu

1

5

UPDATES

Director's Update

The Royal Free Association Update

RUMS President's Update

12

RUMS Committee Updates

MEDICAL NEWS

18

MEDICAL SCHOOL REPORTING

19

Reviews

25

Features

Polio & Juliet - The MDs

Comedy Revue

Medical Education and

the Arts

20

Sports and

Societies

The Athena Swan

Charter

Freshers' Advice

RUMS Tennis

RUMS Music

31

iBSc Explainer

Medical Anthropology

Women in Surgery

Spectrum

UCL Marrow

33

Out of Hours

An Interview with Professor

Kate Ward

UCL Student Hospital Fun Team

Target Medicine

3

CONTENTS

34

SUSTAINABILITY

Under the Weather - The Threat of Zoonotic Viruses

40

41

51

63

'Why are we learning about this?'

Climate Education at RUMS

JOURNALISM

Features

Can you pay my bills? The effect of

the cost-of-living crisis on medical

students

Experiments, Espionage &

Exploitation

The Medicatisation of Pregnancy

The Flip Side of Psychopathy

Research

Why we need to talk more about

Miscarriages

Can Recreational Drugs be Used to

Treat Psychiatric Disorders?

BACK PAGES

Guest Feature

Doubt, Uncertainty and U-Turns

in Medicine

54

57

59

63 65

66

Perspectives

Sugar Tax a Triumph - It's

Time we Sweeten the Deal

Careers

Soaring Horizons - A Career as

an RAF Medical Officer

Interviews

Professor Anthony Costello -

The Lancet Countdown

The Perks and Perils of Private

Practice

Alumni Feature

A Case Study of Medial

Orbital Wall Fracture

Crossword

4

DIRECTOR'S

UPDATE

A warm hello and

happy New Year

from the Medical

School,

we hope you enjoyed a restful

festive break. Well done to our

latest intake of students who

have completed their first term

with us. I hope you are settling in

well, making lots of new friends

and enjoying the start of your

journey as future UCL Doctors.

The campus seems busier than

ever before, and I think I am

finally getting my head around

the new traffic system on Gower

Street!

At the other end of their journey,

last summer saw the graduation

of over 300 new UCL Doctors,

with our first in-person ceremony

for three years. We were

delighted that a UCL medical

student, Lara Rossi, won the

University of London Gold Medal

(our second victorious year in a

row) with UCL hosting the annual,

pan-London competition for topperforming

finalists.

It is a very special year for us

ahead as 2023 marks the 15th

anniversary of UCL Medical

School, in its current form, and

the 25th anniversary of RUMS.

Our founding schools have, of

course, been around a lot longer,

with the Middlesex our oldest

‘grandparent’, established in

1746. We and RUMS will celebrate

these birthdays later in the year

so look out for updates from our

teams.

Another anniversary has just

taken place: it has been 35 years

since the opening of the first

ward in the UK dedicated to the

treatment of people affected by

HIV and AIDS — the Broderip

Ward at the Middlesex Hospital.

This was opened by Princess

Diana in 1987 and Professor Rob

Miller (Associate Professor of

Clinical Infection, UCL Institute

for Global Health) has spoken to

Metro about the visit. His

memories of the visit have helped

inform a play— ‘Moment of

Grace’—which tells the story from

the viewpoint of a patient, a

nurse, and a father estranged

from his son. We are incredibly

proud of the role the Middlesex

and our other founding hospitals

played in patient care at this

time. Many staff and students will

remember this well, including the

stigma associated with HIV and

AIDS. Gideon Mendel’s photos

from the Broderip and Charles

Bell wards of the Middlesex are

also particularly moving.

Recent times have meant

financial struggles for many

across the country, with medical

students impacted as much as

anyone, plus the

potential repercussions on

wellbeing and mental health. If

you are finding things difficult,

please do ask for help — our

Student Support team can offer

advice on many issues, as well

as signposting to further

support. You can also apply for

one of our many bursaries on

Moodle, or by speaking to one of

the team. We have recently

worked on making processes

simpler and more user-friendly,

so please do get in touch.

Wishing you a wonderful start to

2023, enjoy reading the rest of

the Review and a huge well done

to Henry and the team for

another excellent issue.

Professor Faye

Gishen

Director, UCL

Medical School

5

THE ROYAL FREE

ASSOCIATION UPDATE

Our alumni association, formally

called The Royal Free Hospital

School of Medicine Old Students

Association, was formed in 1999

when our medical school

amalgamated with UCLMS and

The Middlesex School of

Medicine. However, it originally

dates back to the 1920s. We have

about 1500 active members.

Our medical school was originally

called The London School of

Medicine for Women. The first

male students were admitted in

the late 1940s. One of our aims is

to preserve the history of our

medical school. The late

Professor of Medicine at The

Royal Free, Neil McIntyre, wrote a

book called “How British Women

Became Doctors”. If you are

interested in medical history, it is

certainly well worth a read.

We support students in financial

difficulties. Last year we gave

almost £18,000. Full details of our

bursaries are available to view on

your Moodle platform which also

explains how to apply for them.

As well as four hardship and four

graduate awards, we have funds

available this financial year to

support four students

undertaking overseas electives in

developing countries, with an

emphasis on those that include

infectious disease study.

Ankith Mannath, this year’s RUMS

President, and Niccolo Doe from

2021/2022, attended our formal

dinner on 16th November at The

RAF Club in Piccadilly together

with Prof Faye Gishen, your

medical school director. Both

Faye and Ankith spoke at our

annual meeting the following day

and gave our 40 or so alumni that

attended an update on events at

UCLMS. In the evening, I invited

Ankith, your Sports and Societies

VP (Andrew Morrish), Captains

from Rugby (Chistopher Savvas),

Hockey ( Jessica Holmes and

Nikhil Bashir), Rowing (Felix von

Spreckleson) and the Tennis

club's Treasurer (Nafisa Barma)

to an informal dinner at The

Freemasons Arms in Hampstead.

We were able to show them a

selection of sporting trophies

that the LSMW and the RFHSM

won over the years including

some dating back to the 1920s.

I’m pretty sure they all enjoyed

the meal and liquid

refreshments!!

I wish you all well and look

forward to meeting some of you

next year.

All the best

Peter

Dr Peter Howden,

Honorary

Secretary and

Treasurer,

The Royal Free

Association.

6

It has been an

extremely busy

term at RUMS and

even though we’re

rolling into the

new year, it feels

as if we’ve only

just begun.

Being one of the largest student

bodies at UCL, our Operations

and Finance team led by our

Treasurer Dana Nitzani has been

working tirelessly since early in

the summer to secure

sponsorships, stash, social

media engagements, etc. Dana

herself has been instrumental in

the planning of every single

event, programme and social

media post, often bridging the

gap between the several

branches of the SU, each of our

VPs, and our Networks while

managing our finances and

keeping RUMS alive. We’ve got

several surprises brewing so

keep an eye out for a load of

fresh drip next term!

After a very busy summer, we

kicked off the term with a

massive return to a Freshers’

Fortnight led by our Events VP

Tom Jenkins. Obviously, freshers

were exposed to some of the

RUMS classics: including the

Freshers’ Boat Ball, Pub Crawl

and Survivors’ Ball. Following the

explosive freshers-focused start

to the term, Tom spiced up our

events calendar with two

completely new events: the

RUMS Beach Party and, in

collaboration with RUMS Music,

the Jam @ Mully’s which was

open to all of UCL – a huge

success and a very well attended

event fraught with talent and

tunes. As we wind down a term

full of events we’ve already

thrown up the plans for a very

happening Term 2 and words

can’t express how excited we are!

On the Welfare wing of RUMS,

Khadeejah has been working

closely with UCLMS on

restructuring student support,

providing feedback and inputs at

every turn. We have also updated

the RUMS Disclosures Framework

which has been uploaded on our

social media channels to guide

students to the channels where

they can make reports and find

help. Looking back at Freshers’

Fortnight, Khadeejah led the

Welfare initiatives on the RUMS

Mums and Dads event while

collaborating with the Events and

RAG subcommittees on the Medic

Family Tournament and the mixer

events for international and

postgraduate students. The

Welfare subcommittee has also

collaborated with the

Medics4Medics Network to

organise programmes such as the

Peer Navigator Day Training and

journaling sessions. Going into

Term 2, we will be bringing back

the RUMS Welfare Week so keep

an eye out for details, freebies

and sponsors!

The RAG division of RUMS led by

Shahyr Shezad has also been

busy with their involvement in the

Freshers’ Fortnight, organising

the RUMS at Regents event on

day 1 of term, working with

Events and Welfare on the Medics

Family Tournament and

organising a book collection from

students, alumni and doctors at

each of the three teaching sites.

They have been working with the

medical school to help them

achieve their environmental

sustainability targets and will be

taking this work further in the

student community by organising

a kilo sale later in the year.

Towards the end of term 1 they

will also be organising a Karaoke

Sportsnight following our weekly

circles. Unfortunately, we were

unable to hold the promised

Winter Ball due to last-minute

contractual issues with the

venue but fret not, there still

exists the possibility of a postexams

summer blow-out!

The academic representation

space hasn’t been far from the

action. With Arya Toletti and

George Khalil leading student

representation, we have seen the

introduction and UCLMS-initiated

roll-out of the new Learning

Surveys – a shorter, more

succinct way of obtaining

feedback from a wider range of

students. Having identified a

shortfall in student

representation this year and

concerns that the student voice

is not sufficiently heard despite

the huge amount of behind-thescenes

work by the medical

school, we have launched a

RUMS Academics Instagram page

aimed at bridging the gap

between student feedback,

reception by the medical school

and implementation of changes.

All of this has been done to

prove that your voice as

students not only matters but is

also invaluable – our numerous

meetings and sessions with the

medical school are testimony of

this!

With the massive increase in

fresher recruitment amongst our

Clubs and Societies led by our

Sports and Societies VP Andy

Morrish, we’ve managed to

establish the largest yet RUMS

Clubs and Societies cohort

despite the soon-to-be-reversed

decision to disaffiliate the RUMS

Badminton club. We are currently

working with the RUMS

Badminton President-Treasurer

duo and the SU Activities

Officer, Mary McHarg, to reverse

this decision and promptly

reaffiliate RUMS Badminton so

they may rise to their former

glory. Despite these difficulties,

7

RUMS PRESIDENT'S

UPDATE

they have managed to widen

their membership base under the

temporary moniker of the RUMS

Society Social Badminton Club.

This unfortunate hiccup

highlighted our already urgent

need to rehash the SU policy

that has thus far barred the reaffiliation

and affiliation of RUMS

Clubs and Societies. Over the

summer, Andy put forward a

policy change proposal at the SU

Activities Zone, pushing for the

reversal of this 24 year-old

policy which was debated on the

31st of October 2022 at the

Activities Zone Meeting.

Unfortunately, most student

representatives at this Zone

were not very open to the idea

of the affiliation of new RUMS

Clubs and Societies (including

our amazing RUMS Networks).

However, we were assured that

the Zone and the wider SU has

no intention of letting RUMS

shrink in any way. As this article

is being written, we have

arranged to present an edited

policy proposal at the Activities

Zone Meeting to be held on the

6th of December 2022. This

policy would allow for current

RUMS clubs and societies to

reaffiliate in accordance with the

SU’s reaffiliation policies

(currently applicable to all other

UCL Clubs and Societies). For

the next publication of the RUMS

Review, I sincerely hope that I

will be sharing good news on

this front. Fingers crossed!

and wish them luck! As Gabriele

takes over from George, we’d

also like to thank him for all the

work he has done as part of the

RUMS committee for the last

three and a half years. May your

final year treat you well!

Finally, thank you for sticking

around to the end of this ramble.

Thank you for your kindness and

interest in holding RUMS close to

your heart. Most of all, thank you

for being part of the RUMS

community. See you next term!

Ankith Mannath,

RUMS President

2022-23

As we draw to the close of a

term, I’d like to congratulate and

introduce our most recently

elected VP and officers: Clinical

Education VP Gabriele Kurpyte,

General Secretary Mathura

Kathirgamanathan and Equity

Officer Suchita Rana. We’re very

excited to have them on board

8

RUMS COMMITTEE

UPDATES

Danna Nitzani

Treasurer

Term 1 started off in an incredibly

busy way with Freshers’ Fortnight,

and my role has stayed eventful

and engaging ever since. The main

areas I have been involved with in

RUMS so far have been managing

the main RUMS social media

platforms (including advertising a

lot of shoutouts for the other

medical societies!), arranging

sponsorships, overseeing finances

and completing administrative

talks (with Ankith’s help).

Alongside Andy and Ankith, I

assisted in organising Freshers’

Fair by contacting sponsors who

were keen to attend, negotiating

contracts and communicating

about the logistics of the fair.

With the invaluable help of my

Operations & Finance

Subcommittee, we are revamping

the RUMS Website to make it more

user friendly and practical for

students so it is no longer

outdated. The website will be

released soon, so keep an eye out!

When campaigning for my position,

one of the aims in my manifesto

was to maintain consistent

communication with sponsors to

build a partnership. This is

something I have been incredibly

passionate about in term 1 and will

continue to maintain for the rest of

the academic year. Through many

coffee meetings with

representatives from our

sponsors, we are in the dynamic

process of narrowing down what

would be beneficial to the

individual sponsor, how RUMS can

best be supported and how we can

combine our common interests

into an opportunity for

collaboration. Towards the end of

term 1, the representatives and I

discussed potential participation

in upcoming events such as Sports

Ball and Welfare Week (with the

help of the other VPs), and I am

looking forward to seeing these

plans come to fruition in term 2!

9

It’s been a busy first term for

Sports and Societies. It all kicked

off with our RUMS Freshers Fair,

which saw a huge number of first

years returning to the Royal Free

Recreation Centre for the first

time post-pandemic. We had over

50 clubs and societies showcasing

a wide range of extracurricular

activities and sign-ups were huge!

Sport has returned on Wednesday

afternoons - starting with our trial

periods, most seasons are now

fully underway. Our Sportsnights

have continued in fine form from

last year (despite the change to

Mully’s furniture) and UH

Sportsnight supporting ‘Right to

Play’ was a huge success.

Movember is in full flow for the

Men’s clubs, and we saw a

successful pink themed

Wednesday night for Breast

Cancer UK run by RUMS Women’s

Hockey. Look out for further

partnership between RUMS Clubs

and UCL Marrow, pioneered by

RUMS Men’s Hockey, which will be

happening soon.

Furthermore, the MDs Christmas

show, Polio and Juliet, was a

massive success. On top of this,

RUMS Music presented their

annual Christmas Concert,

showcasing four ensembles.

At the end of term, teams enjoyed

their Christmas Sportsnights as

well as the Bill Smiths Charity Cup

for Cardiac Risk in the Young,

hosted by RUMS Rugby. And of

course, we had a number of

viewings for England World Cup

matches at Mully’s.

Next term, we are hoping to

introduce a number of charity

Sportsnights, including a revisit to

Karaoke Sportsnight. Varsity, UH

and BUCS Cups are all up for

grabs, as well as more shows from

RUMS Music and the MDs. We will

also host our annual ‘Come Dine

with Me’ and, of course, Sports

Ball - I’ve already started sweating

about this one!

Andrew Morrish

Sports & Societies

Tommy Jenkins

Events

Hey everyone, I’m Tommy, your

RUMS Events VP! A healthy worklife

balance is an essential

ingredient to succeeding in

medical school and beyond; this

role requires me to ensure that all

RUMS medics have access to an

exciting social calendar that

encourages them to close the Anki

decks for a while to catch up with

friends and hopefully meet some

new people too! RUMS Events

have genuinely been a highlight of

my time at UCLMS, which is why I

was so keen to take on this key

organisational role. I’ve come a

long way from the fresher who

thought RUMS Events were rumdrinking

socials to planning a full

fortnight of events for the new

generation of RUMS! Organising

and running this year’s Freshers

Fortnight was simultaneously one

of the hardest and most fun roles I

have ever taken on. I was

responsible for ensuring that the

Class of 2028 had the best

possible start to their six years at

their dream medical school - no

pressure! It also showed me just

how much four years of medical

school ages you. Going out every

night for two weeks as a twentyone

year old results in much more

painful mornings than I had ever

experienced at eighteen! But, I’m

proud to say that every event was

a night to remember for me, the

RUMS committee and all of our

new freshers.

While still recovering from

freshers, I have been working

hard with my subcommittee on

planning some exciting events for

next term! My fellow fourth years

have already been asking me

when our Halfway Ball is (soon, I

promise!), and I’m also super

excited to hopefully see the return

of a couple of old classics from

the days before c*vid (did

someone say Take Me Out?). I’m

super excited to see what next

term will bring and I hope you are

too.

Hey RUMS! I’m Arya, your

Preclinical Academic VP. It has

been an absolute pleasure to work

alongside the committee this year

to better the community, and,

importantly, streamline the

education of years 1-3.

After a long time being cooped up

inside, there are few sights more

delightful than seeing the lecture

halls packed and the corridors

bustling with eager students. This

term has seen the freshers

produce some excellent formative

results, and the year twos

confidently sailing into NSB. Some

students have even gone above

and beyond, involving themselves

in external research projects like

the prestigious Rani Rawji

studentship, as well as UCLfunded

changemaker initiatives

geared towards undergraduate

mentorship schemes for medical

students.

On the RUMS front, the superstar

academic rep team have been

working on a centralised tutorial

resource where students can

easily find relevant, upcoming

tutorials across all societies.

We’ve also been working behind

the scenes with the Assessment

and Feedback Unit to establish a

better way of providing exam

feedback (with a potential

changemaker project on the way!).

I am personally excited to

announce our new RUMS

Academics Instagram account,

where we’ll be posting tutorial

info, tips, and important updates

from the medical school. We’re

also looking to overhaul the trove

to make it bigger, more up-todate,

and even more accessible.

This term has certainly been

exciting, but there is a lot more to

expect going into the new year

and I am looking forward to being

there every step of the way to

ensure RUMS remains as good as

can be in every way – not just

academically!

Arya Toleti

Education Years 1-3

10

Khadeejah

Hullemuth

Welfare

Hey everyone! I’m Khadeejah, the

RUMS Welfare VP.

This term has been super exciting,

setting up a solid foundation for

the year ahead. The year started

with a bang with our incredibly

successful RUMS Mums&Dads

event – it was so lovely seeing

those family bonds at Mully’s and

IOE, continuing with the RUMS

tradition! We then, for the first

time, had our Medic Family

Tournament, which saw Govinder

and Zahra’s beautiful, growing

family take the win.

We’ve also introduced Kakes with

Khadeejah (a very popular

favourite) and regular Wellbeing

Wednesday stories. On top of that,

behind the scenes have been

working with staff from faculty to

look at things like providing and

improving support in Anatomy lab

rooms, smoothing the transition to

clinical years, and helping staff act

on student feedback.

We really wanted to do a family

Xmas quiz, but with the craziness

of term and the busy calendars it

wasn’t possible. BUT, we’d love to

do one in the new year! Also,

watch out for WELFARE WEEK -

from January 16th! No spoilers,

but expect the annual joys of

smoothies, paintings and lots of

little furry animals!

11

News in Brief

By Nilay Sah

Lecanemab heralds new dawn for

Alzheimer Drug Research

Promising results from a

trial testing Lecanemab

have marked a turning point

in Alzheimer drug

development – a field that

has been riddled for 30

years with disappointment.

Nurses vote to strike for first

time in UK History

100,000 nursing staff are

set to strike with over 40

NHS trusts in favour of

walkouts. The Royal College

of Nursing are calling for a

China lifts tight Zero-

Covid measures

China’s three yearlong set

of stringent ‘dynamic’ zerocovid

strategy has finally

been relaxed following

landmark protests, the likes

not seen since Tiananmen

Square 1989. Mandatory

The first disease altering

drug of its kind, Lecanemab

antibodies target and

destroy amyloid plaques

that cause Alzheimer’s,

paving the way for exciting

future drug development.

19.2% pay increase amidst a

nationwide shortage of over

50,000 nurses, with 34,000

leaving the service last year

alone.

PCRs to strictly enforced

quarantine camps have

been scrapped while the

country grapples with the

largest wave of infections

since the start of the

pandemic.

Medical News

12

AI: INTEGRATION

INTO DIAGNOSTIC

DERMATOLOGY

BY LAKSHMI KOWDLEY HEMANTH

Introduction

Artificial Intelligence (AI) makes

use of technology to carry out

tasks that traditionally require

human intelligence such as visual

perception, speech recognition

and decision making. Machine

Learning is an integral part of AI

as it is equipped with decisionmaking

skills learned from a large

data set rather than being

programmed to do a specific task.

The research focus for AI in

dermatology is primarily in the

diagnostic process of the patient

treatment pathway. This

technology can be used to

classify skin lesions, including

differentiating between benign

versus malignant lesions and

keratinocytic versus melanocytic

lesions. This could revolutionise

the screening of these lesions by

significantly improving sensitivity

and accuracy. AI has great

importance and scope in early

diagnosis which results in better

prognosis and lower risk of

complications, morbidity and

mortality.

Advancements

As the speciality is heavily imagebased,

the focal point of AI

research is in image processing,

particularly in Convolutional

Neural Networks (CNN). CNNs

consist of multiple pooling layers

of neuron-like computational

connections that are complex and

analogous to the connectivity of

the human brain. CNNs require

training using large volumes of

data to enable them to detect

distinctive local visual elements

which are vital for tasks such as

segmentation and classification.

Image segmentation is the

separation of a digital image into

multiple smaller sections so that it

is easier to extract objects of

interest for further processing.

As noted in a landmark study by

Esteva et al. published in Nature in

2017, CNNs seem to have superior

accuracy compared to

dermatologists in terms of

classifying keratinocytes and

melanocytes. The study directly

compared the performance of the

CNN to 58 international

dermatologists including 30

experts. The results of this study

concluded that most

dermatologists were outperformed

by the CNN as it correctly

detected melanomas 95% of the

time whereas the dermatologists’

accuracy was 86.6%. In another

promising large study by Brinker et

al published in the European

Journal of Cancer, there was a

direct comparison between the

performance of CNNs and

dermatologists in classifying

dermoscopic and clinical images of

melanocytic lesions as either

benign or malignant. In both these

tasks, the CNNs outperformed the

dermatologists, apart from a few

exceptions. Additionally, in the

dermoscopic test, at a sensitivity

of 74.1% the CNN’s mean

specificity was 26.5% higher than

that of the dermatologists.

Limitations

Although CNNs present a

promising future in dermatology,

there are limitations we must

consider. The closed loop system

consisted of training and testing

using the same data set, leading to

a common limitation called

‘generalisability’. Hence, when the

network was tested on images that

it was not previously exposed to,

the diagnostic accuracy fell,

highlighting the need to include a

broader range of images into the

database. The algorithm also

appeared to interpret the images

incorrectly if there was image

rotation, contrast manipulation, ink

spots, rulers and dark corners of

the tubular lens - all of which

would not have interfered with a

clinician’s interpretation.

It is likely that there would be

improved diagnostic accuracy with

the combination of AI in

conjunction with physicians

compared to AI or physician

diagnosis alone. It has been

highlighted that datasets used for

these networks primarily consist of

Caucasian patients which limits

the representation of variation in

disease presentation, resulting in

late diagnosis and lower survival

rates in non-White patients. To

overcome these disparities, the

solution would be to expand the

data set to reflect the variety in

the general population by

including images from different

ethnicities. Another field of AI yet

to be delved into is combined

convoluted neural networks

(cCNNs) which, in dermatology,

includes the usage of both clinical

and dermoscopic image analysis.

Integration of AI in

dermatology

Integration of AI technology in

dermatology seems propitious in

two different planes: a direct-toconsumer

model and a clinical

integration model as an aid to

physicians.

13

Examples of the direct-toconsumer

model are smartphone

applications, such as SkinVision.

SkinVision aims to provide timely

skin cancer detection as well as

personalised skin care advice.

However, there has been

hesitation in the acceptance of

this model due to the lack of

accountability outlined in the

terms and conditions as well as

the unclear direct effect it has

had on health outcomes for the

users. There have been

discussions on false reassurance

that the application provides,

leading to late diagnosis as well

as unnecessary referrals resulting

in investigations that were not

required. A potential avenue in

which AI could be integrated into

a clinical setting would be in GP

practices as an aid to effectively

triage skin lesions. This further

streamlines the primary

healthcare system and ensures

that the patient’s treatment is

managed by appropriate clinical

services.

Conclusion

The framework of image-based

diagnosis in dermatology would

be increasingly refined with the

integration of AI technology, like

CNNs. There are promising

advancements in this field of

research that can aid the clinician

with diagnosis. However, the

introduction of AI into the clinical

setting is premature due to the

limitations of the closed-loop

model and hence, further trials

are needed to explore other areas

of AI, including cCNNs. Although

AI cannot replace the doctorpatient

relationship and the trust

that it provides, AI can be used

alongside current diagnostic

methods to improve health

outcomes, diagnostic accuracy

and the patient experience.

‘A STRONGER

NHS’

BY ZARA AHMAD

In his opening address

as Prime Minister,

Rishi Sunak pledged to deliver

on the 2019 Conservative Party

manifesto to create ‘a stronger

NHS.’ Some of the biggest

pledges made were to ‘improve

staff morale,’ to have ‘6000

more doctors in general

practice’ and ‘extend healthy

life expectancy’, amongst many

other aspirations.

To deliver on these

commitments could be

presented as an outstanding

victory for the Conservative

Party. However, a manifesto is a

piece of political theory,

outlining a vision for the

country. Although it ought to

serve as a contract to the

country, a manifesto is by no

means a guarantee that a Party

will implement everything it has

stated, or that the progress

made in certain areas of

healthcare can be solely

attributed to this current

government.

Thereby, some parts of the

manifesto have pitfalls. The

notion of an improvement in

staff morale is variable and

based upon individual opinion,

meaning that it does not have a

quantitative benchmark that

may be used to define this

policy as a success.

A proposed increase of ‘6000

more doctors in general practice’

should help to ease the workload

on current GPs. Conversely,

Doctor’s Association UK has

written in a recent open letter to

the health secretary, that ‘GP

retention is plummeting’. Their

sentiment is that, if the health

system is unable to retain GPs,

then the strain on the current

system will intensify, causing a

higher rate of GPs leaving their

profession.

The Royal College of General

Practitioners warns of a ‘mass

exodus’, with almost 19,000 GPs

leaving in the next five years

unless an action plan is put in

place. Therefore, the increased

intake of GPs will be offset by

those leaving the profession.

Rishi Sunak’s inheritance of this

manifesto should guide the

decisions made by his

government, yet they are not

definitive commitments that he

must stick to. It remains to be

seen if these promises can

alleviate some of the strain on a

pressurised NHS, under a

Conservative government that

has managed this institution’s

recent history for over a decade.

14

FIRST EVER ‘LAB-GROWN’ RED

BLOOD CELLS TO BE TRANSFUSED

INTO ANOTHER PERSON

BY AISHA GOPLANI

In mid-October 2022, NHS

hospitals around the UK declared

an ‘amber alert’ which indicated

that the National Health Service

had critically low levels of blood.

Hospitals typically aim to store

more than six days worth of

blood, however, the current

supply available was only

sufficient for approximately two

days. To combat this, hospitals

limited their use of blood and

cancelled non-urgent surgeries,

as well as making a desperate

plea to the general public to

donate blood. As donated blood

can only be stored for 35 days,

there is a constant need for

donations. Moreover, it is

extremely important to note that

to get the best treatment,

patients need blood closely

matches their own. This is most

likely to come from a donor of the

same ethnicity. For example,

Sickle Cell Disease is a painful

and debilitating condition which

is highly prevalent in people of

Black African backgrounds. Black

donors are 10x more likely to

have Ro and B positive blood

types which is desperately

needed to treat the 15,000

people in the UK who suffer with

this disease. Yet only 1% (11,400

people) of the total blood donors

in the UK are Black. This has a

large negative impact on people

of colour with rare blood

disorders and so an alternative

was severely needed.

The RESTORE trial is a research

initiative which involves

transfusing manufactured red

blood cells (RBCs) into a patient

and marks the first time RBCs

grown in a laboratory have been

transfused into a person. These

manufactured RBCs were grown

from donor stem cells. It is

hypothesised that manufactured

RBCs have a longer lifespan in

circulation than standard donated

RBCs, therefore patients who

regularly undergo blood

transfusions may not need them

as often.

This has various benefits, such as

less trips to the hospital for the

patient and more time for staff to

attend to other patients.

Moreover, it would reduce ‘iron

overload’ in patients that have

frequent blood transfusions which

can usually lead to serious

complications. The trial will have

a minimum of ten participants who

will undergo two ‘mini’

transfusions at least four months

apart. The former will be of

standard RBCs and the latter of

lab grown RBCs to find out if the

manufactured cells last longer in

the body than standard donated

blood with a lifespan of 120 days.

“This world leading research

lays the groundwork for the

manufacture of red blood

cells that can safely be used

to transfuse people with

disorders like sickle cell.”

So far, no side effects have been

reported in the two patients that

have already been transfused with

lab-grown cells, but further trials

are needed before clinical use is

considered.

If proved safe and effective,

manufactured RBCs could

revolutionise the treatment of

Sickle Cell Disease and genetic

conditions where patients develop

antibodies against most donor

blood types or where they can’t

make blood cells themselves.

Dr Farrukh Shah, a researcher on

the study and medical director of

transfusion for NHS Blood and

Transplant said: “This world

leading research lays the

groundwork for the manufacture

of red blood cells that can safely

be used to transfuse people with

disorders like sickle cell.” Whilst

further research is needed, this

trial could lay the groundwork for

studies of other components of

blood that are also low in supply,

such as platelets. Through trials

such as these, it is clear that

steps are being taken in the right

direction to revolutionise the

support offered to those with rare

blood disorders.

15

PSILOCYBIN DRUG TRIALS:

CAN MAGIC MUSHROOMS

TREAT DEPRESSION?

BY AISHA GOPLANI

Treatment-resistant depression

(TRD) is used to describe a

condition that affects patients

who have been diagnosed with

major depressive disorder fail to

respond to a course of

appropriate antidepressant

medication. This usually means

there has been no clinical

response, i.e. no improvement in

depressive symptoms. Typical

steps after diagnosis of TRD

include increasing the dose of

antidepressants or switching to a

different drug. However, both of

these have limited success, and if

so, only in an extremely small

number of patients. Therefore,

researchers have turned to the

use of psychedelics in a

controlled environment with

patients in an attempt to improve

patient’s outcomes.

The 1960s saw the rise of the use

of psilocybin in clinical trials at

Harvard University. However, due

to concerns of unauthorised use

of psychedelic drugs by the

general public and the negative

press associated with this, the US

quickly passed laws in the 1970s

which shut down these trials.

Whilst this stopped official

medical research into psilocybin,

it didn’t stop the public accessing

the drug through various black

markets. Users report going on

‘trips’ after ingesting magic

mushrooms, and the effects of

these trips can be highly variable

and dependent on numerous

factors. Group size, setting,

dosage and prior history of

mental health concerns are all

important determinants of the

drug response. Typical reactions

to psilocybin include feelings of

euphoria, disorientation, joy as

well as hallucinatory effects.

Led by Dr Guy Goodwin, a phase

2, double-blind, randomised

clinical trial at King’s College

London, tested the effects of a

single-dose psilocybin alongside

psychological support. The trial

was conducted on 233 people

that had been diagnosed with

TRD. 86% of participants reported

a current depressive episode of

longer than 1 year. The primary

outcome measure was the change

in score on the Montgomery-

Åsberg Depression Rating scale

(MADRS) in three weeks. The

MADRS ranges from 0-60, with

higher scores indicating more

severe depression. All

participants were split into three

groups: 79 participants were

placed in the 25mg group; 75 in

the 10mg group and 79 in the 1mg

group. The total MADRS score at

baseline was 31.9 for the 25mg

group, 33.0 for the 10mg group

and 32.7 for the 1mg group. After

three weeks, the mean changes in

MADRS score were -12.0 for the

25mg group, -7.9 for the 10mg

group and -5.4 for the 1mg group.

After analysing the data, no

significant difference in MADRS

scores between the 10mg and

1mg group was found. There was,

however, a significant difference

between the MADRS scores

between the 25mg and 1mg

group. This means after three

weeks post-baseline alongside

psychotherapy, the group which

took 25mg of psilocybin had a

significant decrease in TRD

symptoms when compared with

the 1mg group.

Yet, it is important to note that

after 12 weeks, all subjects in all

three groups reported rising

MADRS scores as the effects of

psilocybin began to wear off. This

may implicate psilocybin as only

useful in the short term for the

treatment of TRD. Moreover,

participants from each group

reported a number of negative

side effects, including headache,

nausea and, particularly for those

in the 25mg group, suicidal

thoughts. This may suggest that

dosage should be controlled and

consistent psychological support

should be available for all

patients who may be prescribed

this treatment in the future.

Furthermore, the study was

limited by the ethnic homogeneity

of the sample group, as well as

the short-term nature of the

follow-up period. Such limitations

should be addressed by a longer

trial, containing a more diverse

range of participants, in the

future. If future trials are

successful psilocybin may be a

break-through treatment for

those suffering with treatmentresistant

depression.

16

‘COST OF

LEARNING

CRISIS’

BY ZARA AHMAD

It is hard to ignore

the current economic

climate,

especially as it has affected the

prices of our everyday items. The

‘cost of living crisis’ has been

dominating our headlines,

emerging as an overall term to

highlight the contributions of

political change, COVID-19 and

Brexit towards an economic

environment characterised by

high inflation and wage

stagnation. The narrative tends

to focus on families struggling

with their heating bills and rent,

but there is another demographic

often left out of the mainstream

spotlight: students.

As many reading this article are

aware, managing finances is no

easy task. In the middle of the

financial situation that we find

ourselves in, it has not become

any easier. Prior to this academic

year, the cost of student loans,

alongside high rent when living in

London was a contentious issue.

According to the National Union

of Students, ‘student

accommodation prices have

increased by 61% in the last

decade’ with inflation reaching

10% in September. Making the

choice to walk long distances

instead of taking public transport

and delay turning on heating in

the winter months have become a

regular decision. Perhaps most

troubling is the impact that this

cost-of-living crisis has had on

the mental health of students,

with the NUS stating that 92% of

students’ mental health has

suffered as a direct

consequence.

However, if you are struggling,

you are not without support. UCL

has a number of well-publicised

support services that are readily

available. As part of the medical

school, your personal tutor is

always there for you as a source

of direction, so reaching out to

them is a great first step. If you

feel more comfortable talking to

other students, contact

Medics4Medics or simply talk to

your friends about how you feel.

For financial support, the

Financial Assistance Fund can

help with living costs for students

facing unexpected hardship. The

above support services are by no

means an exhaustive list, but just

a few ports of call.

Regardless of what

you may be going

through, remember

that you are never

alone and that help is

available.

Personal Tutors

Medics4Medics

Financial Assistance

Fund

17

Medical School

Reporting

Review

Sports & Societies

Features

iBSc Feature

'Out of Hours'

18

Reviews

The Review of the Revue

by Henry Spencer

At the end of last year, on a cold November night, the MDs Comedy

Revue, UCL Medical School’s sketch comedy society, graced the stage

with their most recent performance - Polio and Juliet.

The MDs Comedy Revue have been

performing sketch comedy since New

Year’s day 1898, when they started by

entertaining patients on the wards of

the Middlesex Hospital. A detailed

exploration of the history of the MDs,

written by RUMS and MDs alumnus Dr

George Barker, can be found in the

last edition of this magazine, should

readers be interested in finding out

more. In recent years, the MDs

Comedy Revue have performed a

Christmas performance each year,

with previous shows including such

successes as The Sexorcyst, Journey

to the Centre of the Birth and Spinal

Destination. Surprisingly for an MDs

performance, this show had a clear

and coherent plotline focused on the

forbidden love of Polio and Juliet, two

medical students on placement in the

warring factions of neurology and

immunology. As always, the

performance was written by members

of the society and was full of humour

and charm, as the MDs retold this

Shakespearean classic. I especially

enjoyed the references to the bard's

many other works throughout the

performance, including a subtle

reference to MacDuff’s caesarean

birth!

Whilst it was clear that the whole cast

had prepared well to produce an

exceptionally well-rehearsed

performance for the opening night,

there were a few stand-out

performances. The final years were

keen not to be forgotten, with highenergy

and memorable performances

from Aish Viswanath, Josh Brandon,

Samuel Wray and Mads Dugas. The

arrival of Mads, who played the canny

janitor/narrator, on the stage at the

beginning of each scene was met with

cheers from the audience who

enjoyed his mock-Shakespearean

monologues. It is safe to say that this

cohort of final years will be sorely

missed by the MDs and the wider

RUMS community - the MDs won’t

ever be quite the same without them!

The new intake of Freshers to the

MDs were also keen to make their

mark, with professional and polished

performances from all. The star

performance of the show came from

one of these Freshers, Dan

Wainewright, who enacted the role of

an aged Professor of immunology.

With a well-crafted accent, great use

of physical comedy and a touch of

well-timed sass, Dan captivated the

audience with his performance,

drawing huge laughs and rapturous

applause from the crowd. It remains

unconfirmed whether this role was

based on a particular member of the

UCLMS community, but speculation

was rife amongst the audience! We

look forward to seeing what Dan

brings to the MDs Comedy Revue in

the coming years!

As always the performance was

supported by the hidden-heroes of

the MDs tech team, and the

exceptional MDs band - The Ectopic

Beats. A number of prolonged scenechanges

gave the Ectopic Beats extra

opportunity to show off their skills and

entertain the audience. We only hope

that Fred Williams, on the piano, is

uninjured after his graceful fall off the

stage!

The whole performance was a credit

to the hard work of both directors,

Muriel Esse and Lorcan Jeffreys, and

the producer, Anna O’Brien. Their

direction led the society to come

together to stage one of the best MDs

productions we have seen in the last

five years! The audience left the

theatre in high spirits and looking

forward to whatever the MDs Comedy

Revue performs next!

19

RUMS Tennis

by Dhanyata Narendrar

sports

& societites

RUMS Tennis not only has four closeknit

teams, but also, without fail,

provides a racket for those who have

never picked one up before (or simply

have forgotten theirs a few hundred

miles away). Dedicated committee

members run weekly social tennis

sessions, come rain or shine. With

socials ranging from a Halloween

House Crawl to a Lion King-themed

tour within seven weeks, RUMS

Tennis is undoubtedly a very busy

society. Women’s Team Captain,

Bianca, joined RUMS tennis in her first

year.

“I very much found a family within

RUMS Tennis, great characters all

round and it’s always a good laugh

whether that’s at training after a long

Monday or during Sportsnight after a

BUCS match.”

There is one women’s team and two

men’s teams, as well as a LUSL team

and Social Tennis every Wednesday,

so there’s constantly tennis being

played throughout the week. RUMS

Tennis takes pride in being a mixed

club with members from every single

year, as well as being part of United

Hospitals (UH) Tennis. This includes

members for all 5 Tennis clubs of the

London medical schools. UCL has had

many successes recently in the UH

mixed doubles. There is much to look

forward to other than tennis as well -

the UH Christmas Dinner and the

iconic UH Curry Night, followed by

Infernos.

“Last year, Kevin, one of our final

years and Community Outreach

Officer, founded what has become

the annual 24 hour Tennis match - it

was a wildly successful event for

fundraising and, personally, was my

favourite event within RUMS Tennis

last year. I am looking forward to

fulfilling my duties as captain this

year and braving the overnight shift.

With a wonderful and driven

committee, we are really excited to

see the club grow and look forward

to what the rest of the year has in

store for us!”

This year's RUMS Tennis tour was in

Bristol, Lion King themed (of course).

It was organised by their Social

Secretary and helped integrate new

freshers into the club. Needless to

say, there are endless opportunities

with RUMS Tennis, regardless of

whether you play the sport or not. If

you prefer watching, there are

opportunities to go to the ATP World

Tour Finals, Wimbledon and the

French Open!

20

RUMS Music: Chordiac Arrest


Having heard about Accarhythmia in

previous editions, it is now time for an

account of its counterpart: Chordiac

Arrest. Here is Soomin’s journey and

motivation for this a cappella group

that will stop (and start) your heart in

a matter of moments:

“I joined Chordiac Arrest in 2019, in

my first year, since I wanted to do

something choral within RUMS and

because I was really into singing

before I started. James Cai and Josh

Jaffe succeeded in demonstrating

the charms of barbershop enough in

the Fresher's Fair for me to try out for

Chordiac for a few weeks, and I've

been a part of it ever since.”

“This year, Darren, Arev and I (the

co-leads of Chordiac Arrest) wanted

to follow in their footsteps by

continuing their good work, and

replacing each invaluable final-year

member with freshers. We have had

a few join us so far, and have worked

hard on some songs for the RUMS

music societies’ Christmas concert.

We plan to do another concert for the

Easter period and to build our

catalogue to hopefully do some

singing outside of UCL itself. We

hope to follow in the footsteps of the

great bunch of people that made

Chordiac as enjoyable as it is!”

The barbershop group was even

granted the chance to sing in front of

Thai royalty upon their visit to UCL.

This already set the bar of

expectations high for Soomin. His

initial few years in Chordiac Arrest

under James’ leadership was spent

singing some of the “most

harmonically complex pieces”.

Last year, with the graduation of

James, new co-leads Josh and Yuta

led the choir for a year. Their

leadership resulted in a successful

return from the pandemic to regular

arrangements.

Women in Surgery: why do we

need WINS?

by Polina Zabelina and Niamh O’Connor

Background: A History of women in

surgery

For centuries, women were prevented

from accessing any form of medical or

surgical training. The fascinating story

of Dr Elizabeth Garrett Anderson, the

first woman in Britain to qualify as

both a physician and a surgeon, is a

shining example of how women

throughout history have striven to

overcome societal and systemic

barriers to practise medicine as a

career. In 1871 she established the

New Hospital for Women, where all

the staff members looking after the

patients were women and in 1874 she

co-founded the first medical school in

the UK that accepted female students.

In 1876 a legislation was passed finally

granting women the right to access

medical training. Since then, a lot of

progress has been made but there is

still a long way to go until true gender

equality within the surgical field is

achieved. At UCL Women in Surgery

(WinS), we aim to inspire all medical

students to explore their interest in

surgery, regardless of their

background.

Women in Surgery at UCL

Within UCL, Women in Surgery was

set up as a subdivision of the Surgical

Society. Founded by Maria Georgi,

President of the Surgical Society in

21

2019, WinS aims to provide medical

students the opportunity to be

mentored, network and hear the

experiences of women who have

succeeded in forging a career in a

field that remains heavily maledominated.

According to the Royal

College of Surgeons (RCS), only 13.2%

of consultant surgeons in the UK are

female, with freedom of information

requests made in 2021 revealing that

Trauma and Orthopaedics (T&O) has

the largest gender disparity, with

female surgeons only accounting for

7.4% of T&O consultants. The

pervasive inequality that still exists in

the field of surgery demonstrates the

need for organisations such as WinS.

WinS Conference 2022

This year, our UCL WinS team was

hard at work, organising a conference

for aspiring surgeons to gain insight

into being in the profession and to

acquire some essential surgical skills

through suturing workshops. With this

year’s conference theme being

“Challenging conditions, cultures, and

concepts in surgery”, many of the

talks focused on promoting diversity

and inclusion within the surgical field.

Attendees were educated on the

topics of gender, race, ethnicity,

sustainability and mental health,

amongst many others. Moreover, the

delegates attended talks on

innovation in surgery where they had

a chance to learn about the most

recent developments in surgical virtual

reality and 3D printing. The

conference line-up also included a talk

by the brilliant Dr Averil Mansfield,

now a retired vascular surgeon, who

was the first British woman to be

appointed a professor of surgery.

Looking to the future

We hope that the conference has

inspired its attendees to strive

towards a future career in surgery. At

WinS, we hope to demonstrate the

importance of female representation

across the surgical field and to show

delegates that the barriers that have

long been in place, preventing gender

equality in surgery, are starting to be

broken. As RCS figures demonstrate,

the number of women training in

surgical specialities is increasing year

on year. WinS aims to continue to

support this positive change through

our future conferences, mentorship

schemes and by being a part of the

change we hope to see.

“By continuing to highlight the issues

women in surgery are currently

facing, we hope to provide a platform

for representation and inspiration -

looking past the boundaries of

gender … so everyone can enjoy an

equal opportunity to pursue a career

in surgery.” — Anaiya Kaka and

Rachel Aquilina, UCL Women in

Surgery Co-chairs 2022/23.

Spectrum


young people with special educational

needs, focusing on neurodisability and

special schools. Dr Rachamim is also a

governor of a local special needs

school. Over the years, Spectrum has

thrived with her consistent aid and her

humble advice, some of which she has

kindly shared with us below.

When did you join Spectrum and

why?

“I joined in 1996, in my first year of

medical school, and I am still involved

26 years later! I have always worked

with children and young people with

disabilities during my holidays as a

youth worker in summer camps and as

a carer in respite and care homes, so

it seemed natural to me to want to do

more of this when I started at

university.”

Spectrum is a charity that was

established (an impressive) 40 years

ago and is run by UCL medical

students. They provide respite for

carers and families by offering a

befriending service to children with a

wide range of disabilities and/or

special needs in the London Borough

of Camden. Fortnightly outings

support the children to become more

confident and independent and to

improve their communication skills. So

far, 46 volunteers have undergone

Child Protection Training, had

wholesome outings and have

completed a sponsored walk. Not to

mention, members feel a sense of

community within Spectrum. The first

event lasted over two hours with

friendly competitive games and pizza,

and many more socials lined up!

Dr Ella Rachamim led the crucial

safeguarding aspect and has been a

loyal volunteer for longer than many of

us could guess. She became a

paediatrician in 2003 and currently

works as a community paediatrician in

Barnet. She works with children and

What has been your best experience

through Spectrum?

“That my Spectrum family have looked

after me as much, if not more than, I

could ever have looked after them.

They are still such a big part of my life

and I love them dearly.”

Any advice for students who are

interested in/are volunteering for

Spectrum?

“It is a privilege to be allowed into

someone's home, into their lives, and

then be trusted to become friends

with their child and to care for their

child without them. In return, they

want a commitment to not let their

child down and to really befriend their

special person. If you respect them

and treat them with care, they will

offer you such warmth, kindness and

joy. Ultimately, remember we are the

fortunate ones to be able to be part of

our Spectrum families' lives.”

All in all, this charity is a hidden gem

within RUMS. It is held close to

members’ hearts because current

volunteers, former Spectrum

volunteers and doctors spend a

weekend every February on a

residential trip with the children - a

long-standing tradition.

UCL Marrow: Stem Cell

Donation

I first became a part of UCL Marrow in

my second year of university; whilst

my involvement began with the

general desire to get more involved in

volunteering, I soon realised that this

was a cause that I actually cared

about— and one that I was surprised

not more people were aware of. After

all, telling people that you’re “with

Marrow” can seem curious, as was

evidenced when I had to clarify that I

was part of a charity signing people up

to the stem cell register, and wasn’t in

fact toting around a cache of freshlyharvested

bone marrow. Whilst this is

by Harini Somasekar

a somewhat extreme example, there

are several misconceptions around

what the charity does, and around

stem cell donation in general, that can

act as a barrier to people signing up.

So why should you?

UCL Marrow is the UCL division of the

Anthony Nolan stem cell charity, and

is just one of nearly 50 groups that

form a large network of student

volunteers across the country. Over

2000 people in the UK are in need of a

bone marrow/stem cell transplant

every year due to blood cancers or

22

related disorders, and Anthony Nolan

aims to reduce this number by signing

up potential donors to a register—

most people seeking a transplant

won’t find a donor in their families, so

need to look elsewhere to receive

treatment. For many patients who’ve

already undergone intensive

chemo/radiotherapy regimens, and for

whom further such treatment would

necessitate so high a dose that it

could permanently damage their bone

marrow, a transplant is the only

treatment option left that could offer

them a second chance at life.

Signing up to the register is

straightforward: after filling out a short

form, you simply have to provide a

cheek swab, after which your sample

will be sent off for analysis, and you’ll

be on the stem cell register. The

chance of matching with a patient is

rare (1 in 800 overall) but doing so and

choosing to donate could be lifechanging.

This is why there is a big

campaign encouraging sign-ups,

particularly of young men (whilst only

accounting for less than 1/5th of the

register, they provide more than ½ of

donations) and people from minority

ethnic backgrounds. As it stands, 72%

patients from white backgrounds can

find a match from a stranger; this

drastically drops to 37% for minority

ethnic patients. Diversification of the

register increases the chance of even

more people being able to find their

best possible match.

Volunteering with Marrow is easy, and

very rewarding— by putting your

weight behind a campaign and simply

encouraging people to sign up, there

is a very real chance that you could be

the reason someone in dire need

receives the treatment they require.

Last year over 1300 people were

matched for transplants via Anthony

Nolan; with more volunteers

encouraging more sign-ups, we hope

this number will only increase in

future.

To find out more information about our

current campaigns and how you can

get involved, visit @UCLMarrow on

Instagram / Facebook, or visit the

Anthony Nolan website

(www.anthonynolan.org).

UCL Student Hospital Fun Team

by Sumayyah Imran

I spoke to the UCL Fun Team two

years ago to learn about how they

were managing during the lockdown

periods. Recently, I had the

opportunity to follow this up. Speaking

to Hadiya Golamgouse, the Fun Team

Lead, and Noor Fatima, the UCLH

Coordinator, the future looks bright.

Noor explains what the UCL Fun Team

does. “We’re a student-led

volunteering project whose main aim

is to go into hospitals to play with the

children to help them gain a sense of

normality. We play games, have

conversations, and do all sorts of

activities!” Fun Team also runs a

weekly homework club called the

Royal Free Hive Club.

Fun Team’s activities took a hit in the

wake of the pandemic, and the effects

have reverberated even to the

present. “The wards are still a bit

cautious – these children are of course

patients. They’re a bit wary about

having a lot of students and

supervising us,” Noor explains. Hadiya

tells me more – having been involved

since her first year, she’s seen the

project evolve through the waves of

Covid-19. “In my second year, there

were 60 UCLH volunteers. Now, we’re

only allowed to have 10 volunteers,

and we’re only allowed to do

weekends.” They tried to run an online

programme in the first year of the

pandemic. “It wasn’t very successful,”

Hadiya admits, “We didn’t have many

children sign up, likely because people

didn’t put the posters up properly. It

was really challenging.” As a result,

Fun Team opted not to volunteer on

the wards last year. “It was just too

much to try and organise,” says

Hadiya, “All our volunteers signed up

and had been DBS checked and

23

trained, but they couldn’t actually play

with any children.” Being back on the

wards this year, albeit with reduced

numbers, is a step in the right

direction. “It’s a big win!” says Hadiya.

However, opportunity presented itself

last year in the form of Hopscotch. “I

volunteered with Hopscotch last year,

and it was the highlight of my second

year!” Noor gushes. Hopscotch is a

charity providing support to refugee

mothers and children. They have

been working with Afghan refugees,

who are staying in hotels in Central

London whilst awaiting permanent

housing.

Hadiya explains how Fun

Team got involved:

“Hopscotch really

needed

volunteers, and we had all these

trained people gearing for face-toface

volunteering to really make an

impact on these children’s lives. It’s

been one of our big success stories;

we’ve broadened our horizons and

realised that our volunteers are wellequipped

to deal with children across

all disadvantaged backgrounds.” Noor

tells me about last year’s events,

which included Eid parties, an Olympic

day, science workshops, and making

oobleck - a weird cornflour and water

mix that changes from liquid to solid

state and is great fun for kids! “The

aim is to continue with that and to run

a lot of new sessions,” Noor explains.

Confidence in communicating with the

kids grows throughout the scheme.

“I’ve learned that I'm better at working

with children than I originally thought.

It can be a bit daunting at first, you

might wonder if you’ll get along with

the children, but you do!” Noor tells

me. “Kids can be very easily

entertained, with anything you have

on hand,” Hadiya says, which is a

great comfort to those of us

unconvinced by our ability to engage

under-12s. Noor agrees: “They’re

very creative and spontaneous.

That’s one thing I’ve learned;

to relax and let your

creativity flow!”

From glove

balloons

to

makeshift forts: there’s no end to the

joy you can bring if you show a little

bit of innovation and resourcefulness.

The pair encourage anyone who may

be interested not to let their doubts

stop them from getting involved.

“You’ll have a lot of support around

you, and you’ll also be adequately

trained!” Hadiya says.

Noor and Hadiya have gained a lot in

the past few years. Hadiya speaks

about how rewarding it has been to

support children through difficult

periods. She reflects: “Children are

very smart – especially children in

hospital. They’re very resilient and

understand a lot more than you think

they do. Being conscious of that, and

respecting them for who they are, is

key.” And one of Noor’s reflections –

when I ask about challenges they have

experienced – says it all: “I know this

isn’t really a challenge, but I felt sad

whenever I couldn’t go in – so I guess I

got attached!”

For those who are interested,

Noor says to contact

su.studenthospitalfunteam@ucl.

ac.uk to find out more about the

projects the team are running.

Volunteers will be required to

have a DBS certificate and to

complete an online training

course on working with children.

Target Medicine

by Sumayyah Imran

carry them through that process,”

Charlotte says.

Widening participation is a key talking

point for many medical students –

many of us are well-aware of the

privilege that is often associated with

winning a place at university. In the

words of Charlotte Casteleyn, the

Target Medicine lead: “We need to

have a generation of doctors who

represent the whole country.”

Target Medicine is a scheme

operating in London to support year 12

and 13 students who are from

underprivileged backgrounds. “They

may go to a non-selective state

school, or have parents who didn’t go

to university, or be from certain ethnic

groups,” Charlotte says. The scheme

runs from January to December, with

seven mentoring sessions covering

topics from how to choose medical

schools to personal statements and

the UCAT and BMAT. “We also run

separate events throughout the year,

including a BMAT mock in the summer

and a UCAT mock,” says Charlotte.

The programme has 60 student

volunteers supporting around 240

mentees.

Charlotte has been involved in Target

Medicine for 4 years, first as a

volunteer, then as a Team Leader,

then the Deputy Student Lead and

now the Student Lead. Charlotte

recalls her mentoring experience in

second year: “They saw me as a

familiar face, I could tell they felt very

comfortable asking me any questions

they had. There was one mentee who

was really enthusiastic, and she sent

me her personal statement multiple

times. Just being on that journey with

her was really nice!”

Charlotte doesn’t know whether her

mentee was accepted into medical

school but reflects: “If she did end up

going to medical school, then you’d

feel like you’d made such a difference

to that person’s life, but if they don't,

it’s still something that they're going to

remember being part of!”

In Charlotte’s view, it’s a lack of

exposure that can often serve a

barrier to interested students. “They

love the idea of doing medicine, but

they don’t have the contacts, so it’s

difficult for them to get work

experience. It’s difficult for them to

even practice their interview skills

because they may not know any other

medical students or doctors,” she

explains. In addition, parents who

don’t speak English are often unable

to access the resources to support

their children. “Target Medicine allows

students to have at least one person

who is a medical student who can

Charlotte has also learned how much

confidence factors into the

experiences and mindset of the

mentees. “There are loads of students

with a lot of potential, but who aren’t

pushed to further that,” she says.

These students often don’t pursue

medicine due to their home situation,

or because they have low confidence

or impostor syndrome. “Giving them a

lot of positive feedback and

encouragement really helps the way

they feel about themselves. It’s about

breaking down barriers and saying,

‘Actually, you’re just as good as

anyone else,’” Charlotte explains.

She tells me about how rewarding it is

to see the students and volunteers

grow throughout the year. However,

we’re both aware that Target Medicine

is one scheme and, already being

oversubscribed, can’t support

everyone. When I ask Charlotte what

she thinks can be done to support

these students, she suggests the

benefit of schemes like Target

Medicine being rolled out across the

UK. “Target Medicine utilises group

teaching,” Charlotte adds, “Often

there are individuals who don’t work

so well in that setting, especially

quieter individuals.” For these pupils,

she thinks that one-to-one tutoring is

a good approach: “I know a lot of

people who do that, even voluntarily.”

Charlotte has seen growth from

mentors and mentees across the

scheme and has formed friendships

with a lot of the volunteers. “A lot of

volunteers have grown in confidence

and are now really good with their

presentation skills,” she says.

Charlotte tells me that many of the

Target Medicine mentors were once

mentees on the scheme. The team are

also hoping to roll out an alumni

system over the next few years, as

part of which doctors who have

qualified after being a part of the

scheme as sixth formers can come

and speak to the mentees. Given the

current climate, now more than ever

schemes like this are needed to

support students through their

application journey.

24

Feature

by Eric Zhong

25

A

t some point near the end of the

4,000 character limit of the personal

statement, a few words are usually

given to “extracurricular activities”.

These remarks are typically separated

from the bulk of the text; this is

perhaps a symbol of the common

instinct to separate our hobbies from

academic work. Especially with artistic

pastimes, reminding ourselves to

follow up on these hobbies with the

intent of escape is important in

maintaining a good work-life balance.

But the skills and observations we

develop in these activities can be

transferable to studying medicine.

This is not a new idea; medical

education has gradually encouraged

the arts and humanities as methods of

either escaping or going deeper into

aspects of medicine. At UCL, there is

an array of SSCs and iBScs, organised

by passionate teachers, that allow

students to explore applications of

creative arts in medicine.

Dr Lucy Lyons, herself an artist whose

creative endeavours centre around

anatomy and pathology, runs the

Anatomy and Art SSC. Besides

discussing the history of medicine

through art, Dr Lyons also guides

students (with great enthusiasm and

patience) through understanding and

drawing anatomical objects. Spatial

understanding, dexterity and sharp

observation are among many skills

that are used and developed when

trying to capture anatomy through

drawing. Regardless of drawing ability

prior to the course, the opportunity to

practise these skills at a variety of

museums and collections is a unique

and constructive experience for most.

When I asked about the role of art in

medicine, Dr Lyons initially pointed out

its historical necessity in education;

medicine was understood through the

anatomy of the human body and “this

information had been shared through

images”; “drawing is the most

immediate and direct way to show

what is being seen”. Drawings made

by an individual of a model or

structure are unique, because specific

aspects of an object can stand out to

some more than others. These

landmarks can be consolidated in our

minds when we draw, aiding

memorisation. As Dr Lyons remarks,

"in educational terms sketching allows

for deeper, more personal learning

and helps to memorise what is being

observed”. During a sketch, precision

is increased when looking back and

forth, between the notepad and

object, more frequently and not

fixating on what has been drawn: “The

act of close, focused observation is an

essential part of knowing. When we

draw, we are forced to look even more

closely and observe in even greater

detail”.

Anatomy and art is one among a few

of the humanities/arts based optional

modules offered. Brian Glasser, an

associate lecturer in the medical

humanities, runs “The Sick Role;

Patients in the Movies”, another

optional module available to students.

Brian was very kind to talk to me

about the role of arts and humanities

in medical education. The experience

of patients and clinicians is regularly

discussed in medical education; case

studies, reflective essays and patient

reports are examples of conventional

base material for this discussion.

Artistic accounts of personal

experiences in medicine, can

supplement traditional base material

to create more open discussion. Whilst

some may be frustrated about the

subjectivity of artistic discussion, this

characteristic has its benefits in

conversation. Brian pointed out how

this can lessen the pressure to only

provide perfect observations; “instead

of having two people studying an

experience, there is a third object (a

film, a painting, a book, etc.) that

draws interpretation from the two”.

This more relaxed and less formulaic

form of discussion can improve the

confidence to communicate more

creative and astute observation.

Brian also touched on narrative based

medicine, and the importance of

creative skills in it. “We all like to make

stories about what's happening to us,

what's happened to us and where we

are going; explanatory stories to make

sense of where we are”. Stories are

frequently told in medicine, by

patients and doctors, that feature

symptoms, emotions and concerns

and other important details. This

interpretation of the clinical encounter

as a story is discussed widely in

medical education, particularly in the

US, and explains that comprehending

“drawing is the most

immediate and direct way

to show what is being

seen”

stories translates to understanding

patients. Brian mentions that film can

be “heavily slanted towards stories”

and that “the visual aspect of film

stands out to people”. By watching

films and recognising the craft and

techniques that go into conveying the

story, viewers can better understand

how stories work. Furthermore, film

can be an accessible method of

developing narrative skill partly due to

its immersive and creative properties.

After going through a story, we each

react differently and pick up different

things. Brian noted that through

retrospective discussion involving our

own personal thoughts and opinions

over films, books, paintings and other

mediums of creative expression, we

can reflect on our own personalities

and values. Knowing how to engage

with narratives can help students and

professionals to improve care from the

outlook of patients and clinicians.

There is a broad range of skills in

medical practice, and a goal of

medical education is to identify and

strengthen them. Spatial observation,

reflection, empathy and creativity

among others are examples of skills

that can be developed through the

humanities and arts in their many

forms

26

Feature

How the Athena SWAN

Charter is Helping

Make UCLMS a More

Inclusive Place.

by Isha Elahi

Diversity and inclusion are

qualities institutions must actively

work towards, and UCLMS is

utilising the Athena SWAN charter

to do so.

I got the chance to discuss the

Athena SWAN charter with Miss Rima

Chakrabarti, a consultant in

Obstetrics and Gynaecology as well

as the Chair of the Gender Equality

Taskforce in the EDI (Equality,

Diversity and Inclusion) Committee.

The Athena SWAN charter is a global

framework that helps institutions

promote diversity and inclusivity.

They aim to devise specific strategies

based on data collected from the

programme. Initially, this framework

focused on gender disparities but has

evolved to look at the structural

inequalities that may be affecting

people from different ethnic and

racial backgrounds. Institutions can

be awarded Bronze, Silver or Gold

depending on the impact of their

work, with reassessment occurring

every four years. Crucially, being

awarded Gold does not mean the

institution is perfect but rather that it

recognises and is attempting to

address issues relating to inclusivity

and diversity. As Chair of the Athena

Swan Committee, Miss Chakrabarti is

responsible for devising and

implementing the strategic plan

across UCLMS.

While the UCLMS EDI committee has

made significant progress raising

awareness on the impact of racial and

ethnic disparities in healthcare, Miss

Chakrabarti believes more work is

needed, especially for those with

carer responsibilities and for students

facing financial constraints. Having

been a personal tutor, Miss

Chakrabarti is also aware of how

many medical students experience

imposter syndrome and the

importance of having personalised

and tailored support. Delivering such

support is challenging given the large

number of medical students at

UCLMS, but ensuring students are

aware of where to access support is

vital. While this is discussed at

induction and reinforced throughout

the academic year in various toolkit

sessions, it is recognised that barriers

remain. By actively engaging with

students, the aim is that UCLMS can

continue to adapt to meet student’s

needs.

Ultimately, the work led by Miss

Chakrabarti and various faculty

members is vital for ensuring that EDI

remains at the forefront of UCLMS.

Currently, UCLMS is aiming for Silver

status in recognition of their efforts to

make the medical school a more

inclusive place.

27

FRESHERS'

ADVICE

ADVICE

Feature

from a

second-year

medical

student:

By Saujanya

Kesavan

Well, where do I

begin? There’s so

much to say:

First, a belated congratulations on

getting into one of the best medical

schools in the UK! You worked hard

and DO deserve a spot here – even if

imposter syndrome hits hard. Imposter

syndrome exists – the sooner it's

vanished – the BETTER! I remember

that everyone suffered through it at

some point in the first year, which is

why I would like to reiterate that you all

deserve to be here! Focus on yourself

and your journey through medical

school. Remember that you were

selected for a reason and have earned

your place here just like your other

medic colleagues.

' Focus on yourself

and your journey

through medical

school'

Secondly –

Medical school is difficult! It is a

challenge. You’re expected to cope

with it as well as juggle all your other

activities alongside it. Regardless of

what people say, there will be

moments when you may feel outside

of your comfort zone. However, it is all

about having necessary support

mechanisms in place to try and get you

through medical school – whether

that’s your friends, societies, or your

RUMS family.

Speaking to some of my friends, the

challenges of the first year stem from

the transition between A-levels and

university. The learning style changes

and the content becomes complex. For

example, during a-levels, you were

given a specification to work from

which is pretty much non-existent in

medical school. Try and focus your

learning around the learning objectives

which are provided in the lectures.

They will help you to formulate a plan

to know which concepts to focus on.

What I wish I

would have

known as a

first-year

medic….

From experience, the first year is a

year to try and experiment with

various learning techniques until you

find THE one – whether that’s Anki,

Quizlet, or taking notes. Regardless

of how other people study, there will

be a technique that will work for you!

In addition to this, try and help each

other out – if someone’s struggling to

understand a concept, try and explain

it to them. For example, if you are

teaching a concept to someone who

may be a visual learner, try and use

diagrams. Group study sessions are a

bonus – they are very effective and

productive and I would highly

recommend them!

In terms of modules, there are topics

people will find more difficult than

others. If you find certain concepts

difficult, please ask for help. There

will be tutorials (provided by

societies such as RUMS Music),

which will help to consolidate that

learning. Alternatively, feel free to

email your lecturers.

28

Thirdly,

Join societies! There’s so much to offer

at UCL – from the UCL Bubble tea

society to UCL baking society and to

RUMS societies! Honestly, having

RUMS is a blessing – they offer so

much from tutorials to amazing socials!

I would definitely recommend joining a

RUMS society! I joined RUMS

Accarythmia (all-girls acapella singing)

last year and I co-manage it this year.

It was great fun and a much-needed

way to relax from studying! The socials

are great and you’re surrounded by a

group of people who provide a range

of tips and support if needed! If you

enjoy music, RUMS Music has various

groups such as Accarythmia (allfemale

accapella, as mentioned

above), Chordiac Arrest (all-male

barber-shop choir), Influtenza (flute

group) and HeartsStrings (strings).

Alongside the groups, there are termly

concerts, which are a great way to

showcase your performances and

pieces that you’ve been practising.

I interviewed

Arev Melikyan –

one of the

managers of

Chordiac

Arrest. Here’s

what he has to

say about the

group:

29

What is Chordiac

arrest?

‘We are an all-male choir singing

various arrangements including a lot of

barbershops! We have members from

across the medical school with a range

of experience!’

What do people do

at Chordiac arrest?

‘Other than meeting weekly to

rehearse our parts, we enjoy going to

socials, singing for charitable causes,

and even going on yearly tours!’

How do you join the

society - is it

auditioned? –

‘The best way is to come along to any

rehearsal! We have taster sessions at

the start of the year and there is a

very informal auditioning process.’

Favourite moment?

‘I wasn't personally involved but I hear

that on tour one year there was an

impromptu performance in a literal

sauna.’

Favourite

performances?

‘Singing on the pop-up stage in the

main quad last year. There was a big

crowd, and the Christmas lights were

up!’

What is your

favourite song that

has been sung?

‘The Wellerman (remember the viral

Sea Shanty?) and Take Me Home,

Country Roads.’

Any tips for firstyear

medics?

‘Try as many different societies and

clubs as you have time for and stick

with what you enjoy!! Also, go to as

many tutorials as you can - they'll tell

you what you need to learn!! Such a

time saver.’

Is RUMS Music

helpful?

‘Absolutely! RUMS Music has always

been an exciting, caring, and fun

environment to be musical in! When I

had the idea of running an open jam

session, they helped me organise it

from the start!’

A fourth point – access

support when needed.

Health is a priority: mentally or

physically. If you need help, there’s so

much support. For example, you can

register with a GP. If you are living at

UCL student accommodation,

Rigdemount Practice is usually the one

you register with. If you have any

health concerns, please go and see

your GP.

At UCL, you can access support

through these channels:

- MEDICS4MEDICS

- RUMS Welfare

- Personal tutor

- RUMS Family

- And charities such as

Mind, CALM, Samaritans &

Mental health foundation.

If you ever need to speak to

someone, there will be

someone to listen.

My fifth

and final

point:

keep doing what makes you happy.

Make sure you take some time to relax

and do something other than

medicine. It is important to make sure

you have some me-time to prevent

burn-out, especially in the longer

clinical years. Whether that’s seeing

your friends, going to societies,

baking, exercising, or cooking – ensure

that you have time to focus on

yourself. In London, there is so much

to do: i.e., puppy yoga – this was one

of my favourite things to try out. What

better way to get some exercise as

well playing with cute puppies!

If you have any

questions, don’t

hesitate to

contact me or

anyone else at

RUMS.

30

iBSc Feature

iBSc Explainer:

Medical Anthropology

by Zoya Gul

Medical anthropology broadly entails

the study of how perceptions and

experiences of health are impacted

and shaped by a range of social,

cultural, political, historical and

economic variables. Through

anthropological intervention, health

practices, health care systems and

illness beliefs are carefully dissected

and examined through a socio-cultural

lens that is sensitive to the unique

norms and social histories of the

populations in which they present.

Medicine is understood as a site

where the hegemonic biomedical

discourse curtails discussion around

non-biological elements of disease

processes, with clinical spaces thus

functioning as environments where

existing power structures are

reproduced, rather than challenged.

Medical anthropology aims to disrupt

this attitude of biological reductionism

that underpins much of modern

medical practice— by urging clinicians

to recognise the complex

amalgamation of structural factors

that underlie disease formation, a

much more holistic portrait of illness

and patient bodies can be construed.

Why Study iBSc Medical

Anthropology?

With Medical Anthropology being less

science-based in comparison to the

remainder of the iBSc options, its

clinical applicability may not

immediately be apparent. However, in

a profession where close human

interaction in sensitive contexts often

takes centre-stage, a thorough

understanding of socio-cultural

shapings of illness beliefs is vital in

navigating the unique personal

boundaries of care. The tendency for

doctors to observe patients through a

strictly medical gaze runs the risk of

eliminating the agency of their patient,

reducing them to mere scientific

spectacle. This medical objectification

of patient bodies can exacerbate the

uneven power dynamic between

practitioner and patient, which can

heavily obstruct clinical

communication. A knowledge of

anthropological concepts can aid

clinicians in bridging this sociohierarchical

divide, resulting in

stronger doctor-patient relationships

wherein patient voices are valued as

equally as physician expertise.

Improved clinical outcomes can

emerge as a direct consequence of

such a framework.

Outside of a medical context, the iBSc

remains incredibly valuable. Medical

Anthropology can broaden horizons,

sharpen critical thinking ability, build

up confidence in articulating ideas,

and improve writing ability.

Course Structure

In Term 1, students undertake three

core modules (Anthropology for

Medical Students, Medical

Anthropology, and Introduction to

Social Anthropology). One of these

modules, which is also the dissertation

module (Anthropology for Medical

Students), continues into Term 2.

Students select four additional

modules of their choosing. Examples

of these modules include Evolutionary

Medicine, Anthropology of Social

Media, Anthropology of Religion and

Applied Medical Anthropology. It is

compulsory for students to take a total

of 120 credits and each module is

worth 15 credits, with the exception of

the dissertation module worth 30

credits.

The main assessment comprises of a

10,000 word dissertation. Each

module also sets their own summative

assessment, which usually takes the

form of an essay. These are weighed

alongside the dissertation mark in

accordance with their credit value to

determine a final grade. Formative

assessments for each module, usually

consisting of a short writing exercise

or essay plan, do not contribute to the

final grade but are useful for clarifying

ideas and gathering feedback on

writing.

31

Pros & Cons

With an average of 12 timetabled

hours a week, an iBSc in Medical

Anthropology is significantly less

work-intensive when compared to

MBBS Year 2, and indeed many other

iBSc options. Students also have more

control over deciding the subject of

their dissertation— students are

expected to propose a dissertation

idea before being matched to a tutor

with a similar research interest, as

opposed to most other iBScs, where

students select a predetermined

project from a list. The topics covered

and their corresponding readings are

exceptionally intriguing and diverse: a

comparison of experiences of

miscarriage in Qatar and England; an

evaluation of the effectiveness of

cultural competency training; a

discussion of the marginal states

between life and death serve as a few

examples. Weekly tutorials

supplement lecture material to help

cement understanding of key

concepts, and additionally offer a

space where students can share and

discuss their ideas with others. Office

appointments with members of staff

can easily be scheduled in the case

further clarification or guidance is

needed.

Although timetabled hours amount to

very few, a large proportion of

students’ time is spent completing and

annotating readings. This is usually

not difficult— if a particularly difficult

concept does emerge in a reading, it

will be explained thoroughly during a

tutorial— but can be time-consuming,

as approximately 150 pages of reading

are set on a weekly basis. The

transition from a medical mode of

learning to an anthropological learning

environment can also be difficult to

adjust to during the first few weeks of

teaching, especially when students

are tasked with learning unfamiliar

theoretical concepts. Most medical

students will also be unacquainted

with critical writing, so the prospect of

writing an essay may seem daunting

at first, but the Anthropology

Department fortunately provides a

Writing Tutor, as well as exemplar

essays, to demystify the essay-writing

process.

By exploring the sociological and

philosophical concepts that undergird

our illness beliefs, iBSc Medical

Anthropology allows students to

detach themselves from the strictly

biomedical perspective of health

promoted by medical education.

Students often find that their preexisting

perceptions of health and

illness are constantly challenged and

reformed in light of the

anthropological evidence the course

presents. Through exposing students

to a wide range of cultural beliefs and

practices surrounding health, the

course hopes to create sensitive

clinicians who can competently and

confidently attend to the varying

needs of a diverse set of patients.

UCL Medical

Anthropology iBSc

32

Out of Hours

Professor

What made you choose

medicine?

Kate Ward

By Eeshaan Ghanekar

My career in Medicine was started off

by my love for science, as my first

degree was, in fact, Biochemistry at

UCL. I then moved into doing a PhD at

Cambridge, looking at DNA repair.

However, what I realised was that

research was a very lonely, inwardlooking

sort of thing to do. One day,

my partner suggested, ‘Why don’t you

do Medicine?’ Despite my initial

trepidation, I decided to study

Medicine at Cambridge. I was excited

by the number of doors medicine

opened for me, as you can really take

it in any direction you like. Continuing

to research as well as helping people

was what I wanted to do.

What is one piece of

advice you would give

to students?

Believe in yourself. Even if it gets

competitive, or you feel like giving up,

just put one foot in front of the other

and keep on going.

What is the highlight

of your career so

far?

Working at the Hammersmith Hospital. I

was involved in the departments of

haematology and virology, looking at

bone marrow transplants. That was an

exciting experience.

What are your

ambitions for the

future?

What is your favourite

aspect of your job now?

I love teaching, and just being in

Lecture Theatre 1. Initially, talking to

350+ students is quite intimidating,

but I just love interacting with the

students, throwing around a few jokes

and the feeling of teaching. Going

back to medicine, it’s lifelong learning.

You guys probably think: Oh, I’m

asking all the questions, and she

knows all the answers. It isn't quite

that simple. We're also learning. And

sometimes when students ask

questions, you realise something you

don't know, so I enjoy that too —

having questions, learning how to

explain things better, and being

challenged.

What is your guilty

pleasure?

Chocolate and cheese.

What helps you to relax

in your free time?

Crime novels.

What is your favourite

food?

Home cooked leeks with cheese sauce

and bacon.

What are 5 words you

would use to describe

yourself?

Patient, caring, human,

teacher, scientist.

I want to continue teaching and

continue improving to teach.

33

Sustainability

34

Sustainability

BY EMIL LECOINTE

UNDER

THE

WEATHER

THE THREAT OF

ZOONOTIC VIRUSES

Over the last few years, we have

been inundated with the impacts

of climbing carbon emissions.

From an increasing frequency of

climate disasters to the collapse

of fragile ecosystems, it is

evident that global warming is

already influencing all arenas of

life. Unfortunately, despite

greater awareness of climate

change and increased

engagement with the issue from

governments around the world, it

is likely that we still have not

seen the full extent of the

ecological, social and financial

damage to come. One source of

this damage is an oft-overlooked

effect of global warming that, if

fully realised, could result in

millions of deaths worldwide.

Here, I am referring to the

increasing incidence of zoonotic

viruses in the human population.

35

“Climate change will

principally increase

the incidence of

zoonotic epidemics"

Zoonotic viruses are viral

pathogens that jump from animal

hosts to the human population.

They often result in recurrent

outbreaks that leave morbidity

and mortality in their wake. One

such virus is the Zaire ebolavirus.

The widely publicised Zaire

ebolavirus outbreak of 2014

began in remote villages in

Central Africa and went on to

infect 11 countries in Africa,

Europe and North America and kill

over 11 thousand people. We now

know that the virus entered the

human population via a single

crossover event with a fruit bat.

Knowing that the innocuity of one

fruit bat crossover event could

deteriorate into an epidemic

illustrates the havoc these

pervasive pathogens could

potentially wreak if given the

opportunity. Regrettably, climate

change appears to be that exact

opportunity. Climate change will

principally increase the incidence

of zoonotic epidemics by altering

weather patterns and the

behaviours of zoonotic animal

reservoirs.

Provided that shifts in animal

behaviour keep pace with

changes in the climate, the

majority of mammals will be

exposed to previously unfamilar

species, representing a doubling

of potential species contact.

This phenomenon, most

prominent in tropical Africa and

Southeast Asia, will increase the

probability of zoonotic spillover

across populations. Through

climate data, this has already

been observed.

As a nation with a high northward

latitude, climate changes have

been more pronounced and thus

more easily discerned in Sweden.

In 2021, the Swedish University

of Agricultural Sciences

investigated the seroprevalence

of endemic Puumala

Orthohantavirus (PUUV) and the

population density of their animal

reservoir - bank voles - between

1980-89 and 2000-2003. While

the population density of bank

voles was the same in both

periods, the seroprevalence of

PUUV was significantly higher

during the 2000-2003 period.

The main independent variables

were the significantly higher

November temperatures in 2000,

and the wetter, earlier winters

engendered by climate change. It

is worth noting that the increase

in seroprevalence of PUUV likely

translated to an increased risk of

human infection.

This perfectly illustrates the

tangible mechanism in which

climate change modifies our

ecosystems and also combats the

misconception that zoonoses are

exclusive to the southern

hemisphere.

Whilst climate change will

increase the frequency of

endemic zoonotic outbreaks,

novel, zoonotic epidemics could

become more prevalent due to a

dangerous reservoir host— bats.

Bats have been disproportionately

responsible for novel viral

sharing events due to their lack

of dispersal constraints. Most

reservoir hosts have constraints -

namely an inability to migrate to

newly-suitable locations - that

prevent them from spreading

zoonoses to new countries and

continents. However, bats

overcome this constraint through

flight, unfettered migration and

their relatively long life spans.

This allows them access to

previously uninhabitable domains

rendered habitable by increasing

temperatures.

This raises concern as bats are

known reservoirs of several

viruses, including the Ebola virus,

Nipah virus, and Lyssavirus

amongst others. Therefore, if

rising temperatures continue to

expand their habitats, we risk

making millions more people

susceptible to novel viral

infections, for which health

infrastructures may be

unprepared.

It is clear that if we continue

down this path of high carbon

emissions and inaction, we

needlessly endanger ourselves to

these often debilitating and fatal

pathogens. Moreover, we risk

diverting billions of pounds worth

of funds and resources from

worthwhile endeavours to

overcome this self-erected

hurdle. Whilst I appreciate that

the conclusions drawn might

appear exaggerated, even

hyperbolic; an increased

frequency, novelty and severity

of viral zoonoses is a future that

we may genuinely have to face in

our lifetimes.

36

Sustainability

BY ISHA ELAHI

‘WHY ARE WE LEARNING

ABOUT THIS?'

How climate change fits into the medical

school curriculum.

Warming Stripes by Professor Ed Hawkins

Climate change remains a pertinent

threat for life as we know it. But how

will these changes manifest within

healthcare and why should medical

students be considering this now?

In March 2022, Public Policy Projects

released a report on how climate

change affects health, specifically, it

spoke on the importance of health

professionals studying modules that

discuss the climate crisis and how its

consequences manifest in the health

of the global population. Talking about

this with other students on the course

here at UCL revealed a range of

stances.

Many believed the incorporation of

climate change into the curriculum is

vital, considering the gravity of the

crisis. This is notable following

flooding in Germany, China and

Pakistan as well as wildfires’ rapid

consumption of land and homes in

California and Australia. By

incorporating climate change into the

curriculum, medical students can

understand the direct impacts it will

have on healthcare. Awareness paves

the way to action, which is vital in

preparing to manage the

consequences of climate change as

they inevitably take shape. However, it

seemed obvious to other students that

it should not be mandatory. Their

reasoning is due to a large workload

and environmental awareness

schemes already being encouraged

across the university.

Therefore, there was support for

initiatives such as the studentselected

component in year 1 on

‘Climate change, Health and

Sustainability’ as an alternative.

Largely, the direct effect of climate

change on healthcare seemed to be

an afterthought, if thought of at all.

Yet, this might be the most important

part of a medical school’s curriculum.

One benefit is all medical students

developing an understanding of what

the effects of climate change will look

like in healthcare specifically. For

example, how it exacerbates preexisting

conditions, or how

displacement prevents people

continuing their medical treatment. So

climate change being taught within the

curriculum is an advantage, as current

university-wide campaigns on climate

change would not focus on the impact

on healthcare at such a level.

Furthermore, the incorporation of this

subject in the medical curriculum

could facilitate a nuanced awareness

of how climate change will have

varying consequences within different

circumstances. This is summarised by

understanding how the vulnerability of

a population to climate change

depends on two things: the potential

impact of climate change, and the

capacity to adapt to the impact.

Depending on where in the world a

person lives, the potential impact will

vary. For example, regions beside the

coast and islands are at higher risk of

37

It is important that this

climate change focused

approach is fostered at

every stage in a career in

healthcare.

flooding, but the extent of this

depends on elevation in comparison to

sea level.

So, whilst Bangladesh could

experience large areas of flooding,

small islands in the Pacific region

could be completely submerged by

water. Adaptive capacity then offers a

chance to mitigate the consequences

of these events. So, if action is taken

to improve flood defences, or create

effective flood warning procedures for

the population, then ultimately there

will be reduced vulnerability. In the

same way, the preparation of

healthcare systems for climate

change, or our ‘adaptive capacity’, will

substantially reduce how vulnerable

we are.

Consider how flooding could affect

the spread of water-borne diseases or

accessibility to hospitals and therefore

how beneficial it would be to prepare

extensive protocols. This could involve

prioritising essential medicines to

control the spread of infectious

diseases, or training paramedics to

reach isolated individuals. Without

such planning, health care systems

are guaranteed to be overwhelmed.

Another example of the effect of

climate change is the increasingly long

and hot summers, which puts

vulnerable members of the population

at increased risk of health

complications. An infamous symbol of

this pattern of rising temperatures is

the warming stripes made by

Professor Ed Hawkins at the

University of Reading.

Europe is one of the most vulnerable

places in the world at risk of extreme

heat. This is due to high rates of

urbanisation, having a population that

is ageing, increasingly comorbid and

currently having a low adaptive

capacity. One way Europe is

unprepared for extreme heat is how

few houses have appropriate cooling

systems, such as air conditioning.

This exposure to heat puts many at

risk of heat stroke and exhaustion, as

well as the worsening of pre-existing

health conditions. The importance of

preparing for extreme weather is sadly

seen following the 2003 European

heat wave, which is believed to have

caused around 70,000 deaths. In

response, the heatwave plan for

England was created with guidance

for long-term preparation with the

future climate in mind, as well as

action for immediate relief. It’s

necessary for medical students to be

aware of plans such as these, as they

are vital in protecting vulnerable

members of a population.

We are also being directly harmed by

our global emissions. According to the

World Health Organisation, shockingly

99% of the global population breathes

air that is of poor quality in

comparison to advised standards. This

includes high levels of particulate

matter that enters the lungs and then

bloodstream, leading to cardiovascular

and respiratory illnesses. Also,

nitrogen dioxide in emissions leads to

respiratory symptoms, such as an

increased risk of developing asthma or

worsening asthma symptoms. These,

amongst other diseases caused or

exacerbated by air pollutants, are

noticeable within healthcare, adding to

the argument for climate change as

part of a medical school’s curriculum.

Its important to additionally think of

the indirect ways in which rising

temperatures will harm health. Hotter

temperatures affect rates of

evaporation and the pattern of rainfall,

which has noticeable impacts on

agriculture. For example essential

crops, such as rice, wheat and

soybean, have shown decreasing

rates of production due to rising

temperature. So, cases of malnutrition

will inevitably rise. Of course, there is

some action taking place to try and

overcome these issues, such as the

genetic engineering of HB4 wheat

with sunflower genes to be drought

resistant and therefore increase crop

yield. But the continued education of

STEM students, as well as the general

public, on climate change will mean a

stronger driving force behind these

important measures that we must be

taking.

These consequences are a few of

many health issues the global

population are currently - and will

continue - facing. Whilst reducing

emissions is essential to reduce the

potential health impacts we face,

there will still be an impact on the

environment and health, due to

mankind’s slow response to global

warming. Clearly then, we must do

everything we can to research what

people’s health could be impacted by,

and mitigate them. To best prepare, it

is important that this climate change

focused approach is fostered at every

stage in a career in healthcare. With

this conscientious preparation of

healthcare systems, we will boost our

adaptive capacity to these

consequences and, as a result,

decrease our vulnerability. By

incorporating climate change as a key

component of the medical school

curriculum, we can therefore be active

in preparing against these

consequences on health, thereby

proving the essential role of climate

change within the medical school

curriculum.

38

Sustainability

CLIMATE

EDUCATION

AT RUMS

BY EMIL LECOINTE

With 7 million premature deaths being

attributed to air pollution, according to

the World Health Organisation (WHO),

it’s clear to see that climate change is

having an increasing influence on our

health outcomes. In the wake of the

effects of climate change, we are

beginning to see how climate change

will interact with healthcare

throughout the world. Unicef predicts

25 million to 1 billion environmental

migrants by 2050, or in 28 years.

Therefore, it’s increasingly relevant

that the next generation of doctors are

aware of the growing influence of

climate on health outcomes.

Fortunately, a new initiative, birthed

from the Royal Free, aims to promote

climate consciousness in UCL

students through a greater focus on

climate education implemented into

our curriculum and greater

engagement from the student

population.

The architect of this bold new plan is

Dr. Adesh Sundaresan. An advocate

for the environment since

adolescence, Dr. Sundaresan was first

galvanised to take an active role in

climate advocacy after witnessing the

first-hand effects of climate change

while in Chennai, India, performing

music. Since then, he has pursued this

calling by establishing the

"Sustainability and Climate Change

in Healthcare" SSC, offered to firstyear

students, and hosting the

"Climate Clinic" in collaboration with

the Global Consortium on Climate and

Health Education.

One of the two prongs of this

upscaling project is the instruction of

lecturers on the aspects of climate

change relevant to their teaching. This

will give them the tools to modify their

lecture materials to include climate

change; thus seamlessly integrating

climate education into our curriculum.

The second is the participation of a

select group of passionate students to

encourage the climate agenda in our

RUMS community. These Student

Sustainability Representatives will

achieve this goal by regularly

collaborating with faculty and

students to improve engagement and

awareness of climate change in

healthcare. What's more, being a

student-led body, they will be sure to

focus on the topics and issues

affecting you. Seeing that these

Student Sustainability Representatives

are elected on a rolling basis, you can

apply at any time.

Composed in the hope of improving

the care we provide for those affected

by climate change, we are sure that

this comprehensive initiative will go on

to become a staple of teaching at our

medical school for years to come.

39

Journalism

Features

Research

Perspectives

Careers

Interviews

40

Feature

Can You Pay My Bills?

The effect of the cost-of-living

crisis on medical students

by Daivi Shah

41

You are blessed with a 9am start

for an hour class, with an hour’s

commute. After you leave your

house, you are faced with the

Tube, packed full, air thick with

the smell of breakfast

sandwiches, sweat and a

concoction of various aftershaves

and perfumes, culminating as one

distinct scent. The lecturer reads

from the slides and you go home.

Back on the tube, as you peek at

the headline from a newspaper,

you are reminded of the cost-ofliving

crisis. The cost of your

commute weighs down on you.

One crippling expense everyday

takes its toll.

As well as travel costs, medical

students have to pay for food, rent,

bills, clothing and other essentials

and, with the cost-of-living crisis,

medical students are experiencing

great hardship. According to a BMA

survey of over 1000 respondents,

over 60% have had to cut down on

everyday essentials, including food,

with 1 in 25 accessing food banks.

Nearly 45% said that they might run

out of money before the end of the

year.

A Break-down of

the Funding

Assuming you are eligible, Student

Finance offers you a tuition and

maintenance loan for Years 1-4. For

Years 5 and 6, eligible students can

receive a reduced maintenance

loan from Student Finance and NHS

funding for tuition fees. The NHS

also provides a non-means tested

£1000 grant and a means-tested

bursary, which if you are living

away from home, can be up to

£2,643 outside of London, or up to

£3,191 in London. In the cost-ofliving

crisis, this is clearly not

sustainable.

Ultimately, there is an extreme drop

in funding in the years when

medical students do not have time

to finance their studies by working

as they are on clinical placements.

Unfortunately, many students have

no choice, with 53.6% of

respondents from the survey

having had to work during term

time, with over 70% of those noting

the damaging impact of working on

their education. Not to mention, the

current funding has not increased

in line with the cost of living, with

many students accumulating credit

card debt. The threat of financial

insecurity lends nothing to the rise

of poor mental health among

medical students.

This prompted the

#LiveableNHSBursary campaign,

with people calling for access to the

£5000 bursary that student nurses,

physiotherapists and paramedics

have access to as well as a full

maintenance loan.

One fifth year medical student we

spoke to said: “It’s difficult

supporting yourself in medical

school, particularly in clinical years

with a reduced student loan and a

stingy NHS bursary. I’m from a

working-class family and my

parents have helped me out a lot

regardless, but they have other

dependents to care for, which is

even more challenging in a cost-ofliving

crisis. Because of this, I’m

working 6am retail shifts, which is

not only draining but has an impact

on my education.”

Where to find

Financial Support at

UCL and Externally

Through the MBBS Student Support

team, there are many scholarships,

bursaries, travel and hardship funds

for medical students. There is also

the UCL Financial Assistance Fund

for any unexpected hardships you

may face. The Royal Medical

Benevolent Fund offers financial

guidance and support, as well as

some grants available to aid with

living costs in the final two years of

the course.

Amidst the turmoil surrounding

the cost-of-living crisis, the

present and future sacrifices of

medical students are often

forgotten. Our generation has

endured

unprecedented

hardships. Despite all this, you are

resilient and you will always get

back on that (metaphorical) Tube,

because you’re almost at your

destination.

By Zahra Malik

EXPERIMENTS,

Feature

ESPIONAGE &

EXPLOITATION

The history behind the BAME

mistrust of vaccines

42

43

Viruses have

infected and

wreaked havoc in

human populations

for centuries, as

nature has always

used pathogens for

expedient

population control.

However, scientific understanding has

since weaponised preventative

medicine, such as vaccines, to shield

us against the pathogenic war nature

fights against us. The most recent

example of this phenomenon was in

the coronavirus pandemic. But while

most hailed the discoveries of Pfizer

and AstraZeneca as their gateway

back to a normal life, there were some

communities who were more hesitant

than others to access these

vaccinations, most notably the BAME

community.

A poll that was commissioned in

December 2020 by the Royal Society

of Public Health found that out of 199

respondents, 79% of white

respondents said they would accept

the vaccines compared to only 57% of

the respondents from BAME

backgrounds. This glaring disparity

between the two groups was a huge

cause for concern and so there was

much conjecture about the cause of

this reluctance. The narrative that was

propagated by mainstream media was

that these communities had less

education, sometimes depicting them

as illiterate and ignorant. However,

this view is superficial and fails to

acknowledge how the history of

people of colour accessing healthcare

is blotted with numerous instances of

exploitation and experimentation, and

how these events have left scars

which continue to repel them from

accessing healthcare and vaccines in

current day.

One of the most prominent cases of

this was the Tuskegee syphilis study.

In 1932 , ideas of social Darwinism (a

pseudoscience that portrayed people

of colour as biologically inferior to

white people) were pervasive in the

population. It was with this societal

backdrop of scientific racism that the

syphilis study was conducted, as

scientists wished to investigate

whether black people were more

predisposed to contracting STDs.

Therefore, in 1932 600 African-

American men were recruited from

Alabama to partake in a study. These

men were lied to and told that they

were receiving treatment for “bad

blood” and administered fake

ointments while the scientists kept

track of how many of them contracted

syphilis over a period of time. Despite

their deception being utterly unethical

and unjustifiable from all accounts,

the scientists legitimised their actions

by using the excuse that the

experiment was merely a “study in

nature” which observed the

progression of a disease in a

community, so they weren’t actively

doing any harm.

However, far from watching the

natural progression of syphilis from a

detached standpoint, the researchers

instead intervened heavily. Over the

course of the trial many participants

did contract syphilis and could have

been given life saving antibiotics like

penicillin. However, the scientists

directly intervened to prevent the

participants from accessing

treatment, and even went as far as to

provide doctors with a list of subjects

not to treat! Therefore, the study

essentially became a death sentence

for many participants who suffered

preventable deaths. Overall, it was

found that during the study’s 40-year

period, 128 men died of syphilis, 40 of

their wives were infected and 19

children even acquired congenital

syphilis.

This had long-standing ramifications

for the black community as it planted

the seeds of distrust, which have

since grown into generational trauma

and to this day manifests as suspicion

and hesitancy towards healthcare

providers. Indeed, a study done by

Marcella Alsan at the Stanford

Medical School argued that by 1980

the Tuskegee study was responsible

for 1/3 of the life expectancy gap

between older black and white men.

However, it is easy to argue that

these sorts of studies are a thing of

the past, and that these communities

should be expected to heal and move

on. But even in modern day history we

see examples of people of colour

continuing to be exploited, for

example the CIA’s intelligence work in

2010, just over a decade ago.

"...the CIA

essentially

conflated public

health programmes

with spying."

In 2010, the CIA received evidence

that Osama Bin Laden was hiding in

Abbottabad, a city in Pakistan. In

order to obtain concrete proof, they

wanted to collect the DNA of children

in that region and compare it to that

of Bin Laden’s sister. A DNA match

would give them telling evidence of

Bin Laden’s location. The CIA

recruited a doctor to head this

mission who in turn hired health

workers to administer Hep B vaccines,

and as part of this obtained DNA

samples from children. Therefore,

under the guise of what appeared to

be a huge public effort to combat

infectious disease and immunise the

population, American intelligence was

really conducting a large-scale

espionage operation.

By using the ruse of a vaccination

programme to mask their espionage

activities, the CIA essentially

conflated public health programmes

with spying. This blurred the lines

between the ethical promotion of

health and unethical DNA extraction,

and engendered a deeply rooted

public paranoia regarding the

legitimacy of vaccination campaigns.

This public paranoia was

subsequently exploited by extremist

parties who launched anti-vaccine

propaganda campaigns to meet their

own political agendas. These political

parties spread false ideas, like that

vaccinations were used to sterilise

girls. Although these claims may seem

outlandish to us, for a community who

has already been exploited and lied

to, it doesn’t take much for people to

readily internalise and circulate these

rumours. Eventually, all this

information, factual and otherwise,

culminated in a torrent of anti-vax

sentiment repelling people from

vaccinations in Pakistan. Given this

quite recent event, it’s unsurprising

that the BMJ found that in the UK,

after black people, Pakistani people

are in the second most likely group of

people to not access vaccinations,

alongside Bangladeshi people .

Although this article only addresses

two particularly worrying historical

events that may have contributed to

the BAME community’s mistrust of

vaccination, when one really starts

delving into the history it unleashes a

Pandora’s box of medical

experimentation conducted on people

of colour. We therefore owe it to

these communities to recognise and

acknowledge that their concerns are

rooted in fact.

Understanding the historical context

allows us to understand and

empathise with people who fall victim

to conspiracy theories. This should

encourage us to approach them with

more patience, rather than merely

overlooking their concerns and

labelling them as unintelligent or

ignorant.

Not all hope is lost for BAME

communities though, as campaigns

run by the NHS in which they

collaborated with community and faith

leaders to encourage people to take

the vaccines has facilitated great

progress in vaccine uptake. For

example, according to NHS England,

between 7 February 2021 and 7 April

2021 there was an increase of vaccine

uptake by 235% in ethnic minority

groups. This outpaced the national

average across all ethnicities in that

time period, which increased by 154%.

The most significant progress was

seen in the Bangladeshi community

where vaccine uptake increased fivefold

from 29,382 to 152,408 and in

the Pakistani community in which it

increased 4-fold from 88,956 to

367,780.

Therefore, despite the dark history,

we can hopefully look towards a much

brighter future. And as these

communities continue to heal, we can

all help by promoting inclusivity and

diversity in healthcare settings. We

should also refrain from being

judgemental when we are confronted

by vaccine hesitancy as this will only

further marginalise people and

exacerbate their reluctance. Instead,

we should all aim to debunk

conspiracies and disseminate

information in a non-stigmatising,

positive way. This will bring us one

step closer to a world where everyone

can feel safe and comfortable

accessing vaccines to look after

themselves and those around them

44

Fearure

MEDICALISATION

OF PREGNANCY

By George Shery Ponodath

Around the world, there is a rich

history of midwives supporting

mothers during pregnancy. The

services they provided include

assisting during the birthing process,

as well as giving advice and support

before and after birth. The paper

‘Midwifery and Midwives: A Historical

Analysis’, written by Barnawi et al. in

2013, investigated the changing roles

of midwives throughout history and

the socio-cultural factors

surrounding them. This timeline is

based on their research.

2. Early to Middle Ages

In the Early to Middle Ages, growing gender

inequalities meant that women, who were

viewed as subservient to men, were not

allowed to get an education. In the Western

world, this led to growing separation between

the progress of science and the techniques

used by midwives. Notably, there was a period

of time when midwives were marginalised and

excluded from society in the Western world.

Based on the authority of the king and

medieval church, many were tortured or killed

for their practices, which was likened to

witchcraft.

3. The 1600s

In the 17th to 18th century, men became

increasingly involved in the management of

complex pregnancies by using surgical tools

like forceps to assist in delivery. Prior to this

period, midwives led the delivery, only calling

for a surgeon when some obstruction had

occurred. However, in France, male midwives,

called “accoucheurs”, gained popularity. Their

surgical background and the production of

obstetrics textbooks meant that they could

lead deliveries while better prepared for

interventions.

45

1. Ancient Times

During the Stone Age, midwifery was largely a

woman-led position, which was given a great

amount of respect and autonomy. In the

Egyptian era, for example, midwives worked as

equals in a multidisciplinary team. They were

able to determine the due date of a pregnancy,

as well as use plants with pharmaceutical

properties, such as willow, which contains

salicin, a precursor to salicyllic acid (aspirin).

The earliest known pregnancy tests

can be credited to the ancient

Egyptian practice of peeing on barley

or wheat. A modern experiment found

that this identified 70% of

pregnancies, suggesting that if

growth occurred, it

was likely because

the person was

pregnant.

4. The 1700s

Accoucheurs eventually gained popularity in

Britain amongst the upper classes due to

European influences. They were involved in the

birth of some British royals, attending to the

wives of James I and Charles I. By the end of the

18th century, roughly half of births in England

may have been attended by a physician such as

surgeon-apothecaries, who were essentially the

general practitioners (GPs) of the time.

6. The 1900s

This period began with falling infant

mortality accompanied by rising

maternal mortality rates. Legislature

passed in this time began to regulate

and certify trained midwives. The

central role that GPs played in the

birthing process diminished. The

College of Obstetrics and

Gynaecology was established in

1929.

5. The 1800s

The term ‘obstetrician’ came into common use

during this period, replacing the term

accoucheur or male-midwife; however, this field

was still marginalised by many physicians and

not viewed as a real branch of medicine. Most

births in the UK were carried out at home by

either GPs or midwives, who were often

untrained and illiterate.

'In the UK, during the

1800s, the Royal Colleges

of both physicians and

surgeons considered

obstetrics and

midwifery an activity

outside the remit

of medicine.'

46

Medicine in the West

has historically had a

tenuous relationship

with the birthing

process and

respecting the needs

of pregnant persons.

In the past, misogynistic attitudes

meant that midwifery and obstetrics

were shunned. One president of the

Royal College of Physicians said that a

doctor practising midwifery would

“disparage the highest grade of the

profession”. However, at present,

medicine has become deeply entwined

with the birthing process. Nonetheless,

it could be argued that pregnant

persons are still not treated with

respect, as the birthing process

becomes ‘over-medicalised’ and

commodified.

In the UK, during the 1800s, the Royal

Colleges of both physicians and

surgeons considered obstetrics and

midwifery an activity outside the remit

of medicine. The same misogynistic

attitudes that kept women out of

medicine also prevented the birthing

process being seen as something

necessitating medical supervision.

Even when maternal care was

provided by GPs at the time, it was

often restricted to just during labour

itself, rather than holistic care of the

mother and child perinatally. For many

GPs, delivering babies was tedious

with low fees, but was a service they

provided in order to keep the patients

as customers for life.

A lens through which we can explore

views towards maternity care is by

contrasting the medical and midwifery

philosophies. The medical philosophy

considers the potential pathologies

that can occur in maternity and aims to

minimise these. It is focused on the

birthing process and preventing

negative outcomes, which might

reflect the views held by GPs in the

19th century. The midwifery

philosophy, on the other hand, aims to

provide holistic care and empower

pregnant persons to be prepared for a

child. It views birthing as a natural,

physiological process that, in most

cases, requires minimal intervention.

These models help to delineate the

differences between care that aims to

avoid risk, and care that aims to

facilitate health.

The medical philosophy of maternity

can still be seen in the modern day. In

many countries, a majority of births

take place in hospitals, with epidural

anaesthesia, induced labour and

caesarean section deliveries becoming

increasingly common. While it is

undeniable that these interventions

have saved lives, in many places these

treatments are routinely administered

without medical indication. There is a

trend of ‘over-medicalisation’ in

developed countries, while many of the

poorest receive insufficient care.

These two extremes are sometimes

described as ‘too much too soon’

(TMTS) and ‘too little too late’ (TLTL).

The paper “Beyond too little, too late

and too much, too soon” by Miller et al.

(2016) explores the widening

inequalities in maternity care. A

commonly used measure is comparing

the proportions of induced labour and

Caesarean section delivery to infant

mortality. While many of the poorest

regions of the world lack access to

such procedures, countries such as

Brazil have seen increased rates of

labour inductions (2.5% to 43.0%) and

Caesarean sections (27.6% to 43.2%),

without any associated decrease in

infant mortality. This shows that while

more resources are spent in maternity

care, it is not spent in an effective or

equitable manner.

47

The impact of over-medicalisation

of pregnancy is twofold. Firstly,

excessive treatment could lead to

adverse outcomes in both parent

and child. It has been shown that

the risks of additional

interventions are often not clearly

explained to the parent. It is

essential that informed consent is

received, especially during a

sensitive time like pregnancy.

Secondly, over-medicalisation

may perpetuate inequalities in

maternity care. The resources

spent on extra interventions and

their potential complications take

away resources that could

potentially be used on the most

vulnerable. It could be argued

that both of these are the result

of the commodification of

pregnancy. While motivations may

vary from profits for companies to

aesthetic choices, the patients

might not be seen as an individual

and treated with respect.

.

As Miller et al. said: “Evidencebased

maternal care in facilities

should include care that is

humane and dignified, and

delivered with respect for

women's fundamental rights”.

Achieving this requires adhering

to evidence-based guidelines. An

indicator of respectful, evidencebased

care is allowing the mother

to have a companion during

labour. This has been proven to

improve maternal and neonatal

health outcomes. However, it

requires adaptations to labour

wards, which means that this

intervention is not available to

many, especially in public

hospitals of lower income

countries. Even in high income

countries, marginalised groups,

like Black women in New York

City, were more likely to die than

women in Vietnam or North Korea.

This illustrates that alongside

greater availability of resources,

it is essential to deliver treatment

free of bias, aligning with

evidence based guidelines.

During the COVID-19 pandemic,

hospitals in the UK had to strike a

balance between reducing the

spread of the disease, and

catering to the needs of parents.

One change related to “Vaginal

Examinations, Consent & COVID-

19”, the title of Anna Nelson’s

2020 post on BMJ Sexual Health

and Reproduction. During this

time, hospitals adopted the policy

that birth companions were only

allowed in the labour ward and

not the antenatal ward.

Additionally, admission into the

labour ward required labour

“confirmed as established”, which

is typically done via vaginal

examination. The result of these

factors is that pregnant persons

felt coerced into accepting an

examination in order to have a

birth companion present. If the

person felt coerced, then, by

definition, they have not given

voluntary and informed consent.

Even with a chance to empower

people to make healthcare

choices, heavy-handed policies

like this perpetuate the trend of

pregnant persons not being

respected.

It could be argued that the lack of

patient-centred maternity care

are remnants of old misogynistic

views in medicine. In order for the

best outcomes, care needs to be

evidence-based, with better

guidelines, tempered by a holistic,

team-based and patient-centred

approach. Ultimately, overmedicalisation

of birth and

inequalities in maternity care

need to be opposed with a shift in

attitudes towards birth and

maternity.

Lancet Article

“Beyond too little,

too late and too

much, too soon”

48

Feature

The

Flip Side

Of

Psychopathy

What Serial Killers Can

Teach Us About Success

By Ayman Asaria

A cursory scan of the true-crime

series abundant on nearly every media

platform illustrates our obsession with

psychopaths. Thanks to Hollywood,

when we hear the word psychopath

we instantly imagine a knife-wielding

maniac with crazy eyes - think

Hannibal Lecter in ‘The Silence of the

Lambs’. But what about the

archetypal medical student sat

across from you in the Cruciform

library?

The reality of this condition is that it is

far more nuanced than various

stereotypes may lead one to believe.

Whilst it remains true that people with

the condition can display a range of

disconcerting tendencies, it has, in

recent years, been relabelled as a

spectrum disorder, not unlike Autism

Spectrum Disorder (ASD). Mental

health researchers have not had an

easy time homing in on a uniform

definition of psychopathy as for

decades its symptoms have been

examined in communities at somewhat

opposite ends of society: incarcerated

individuals and people in community

mental health settings. In addition, the

Diagnostic and Statistical Manual of

Mental Health Disorders (DSM-V) still

lacks the criteria for a psychopathy

diagnosis. Some clinicians were afraid

it would stigmatise people too much;

others assumed a difficulty in

assessing traits such as callousness.

One effort to coordinate thinking in

the field has come from the triarchic

model described by physicians

Patrick, Fowles, & Krueger in 2009.

It was formulated to reconcile

contrasting conceptions of

psychopathy by encompassing three

distinct, but interrelated, phenotypic

dispositions — disinhibition, boldness

and meanness. This model opens the

door to identification of, or further

study into, subtypes of psychopathy,

such as a ‘mean-disinhibited’ style

versus a ‘bold-disinhibited’ style. A

more in-depth examination of the

concept of psychopathy may deepen

our understanding of the potential

adaptive manifestations of a disorder

so often viewed as invariably sinister.

However, it is worth bearing in mind

that it remains difficult to distinguish

successful psychopathy from the

effects of other variables such as

intelligence, effective impulse control

and good parenting.

Although psychopathy was originally

conceptualised as a unidimensional

condition, i.e one where a single trait

is measured, factor analyses revealed

that the most widely used

psychopathy measures, such as the

interview-based Psychopathy

Checklist-Revised, are underpinned by

at least two broad dimensions.

Despite traditional views of

psychopathy as purely maladaptive,

some authors have proposed that

certain features of the disorder can

predispose the person to success in

areas characterised by physical or

49

How many times have you

claimed that you have gone

into medicine to ‘help people?

social risk, such as medicine, law,

politics and high-contact or extreme

sports (Skeem et al., 2011).

Nevertheless, for decades, research

on psychopathy has focused almost

exclusively on largely unsuccessful

individuals, especially incarcerated

males. It was not until the 1970s that

researchers began to examine

potentially adaptive manifestations of

the condition.

The pioneering work of psychologist

Cathy Widom, at Harvard University,

was one of the first attempts to

examine psychopathy outside of a

prison population. In 1977, Widomtried

to attract potentially psychopathic

participants from the Boston

community, drawing them in with an

enticing newspaper advertisement:

‘Psychologist studying adventurous

carefree people who’ve led exciting

impulsive lives. If you’re the kind of

person who’d do almost anything for a

dare…’. As part of the study,

participants provided biographical and

psychiatric information as well as

criminal history. In Widom’s study,

65% of the sample met the criteria for

sociopathy, an informal term similar to

psychopathy. What came as a surprise

was just how many of this 65% were

holding down jobs of significant

ranking, including doctors and

investment bankers.

Continuing Widom’s work, researchers

have hypothesised that features

related to psychopathy, such as

fearlessness, may predispose

individuals to ‘heroic’ behaviour. And

now, let me ask you a question: how

many times have you claimed that you

have gone into medicine to ‘help

people?’ As doctors, we seem to

always have the innate need to help

and fix things for our patients - the

unconscious desire to be recognised,

needed and appreciated - otherwise

known as ‘hero syndrome’. This need

to feel valued affords us to seek

occupations that provide frequent

opportunities for heroic behaviour. In

one interesting study conducted by

Falkenbach & Tsoukalas in 2011,

members of potentially ‘heroic’

occupations - namely, doctors -

scored higher on the Fearless

Dominance factor of the Psychopathic

Personality Inventory than did

incarcerated offenders.

Interestingly, psychopaths do not tend

to be encumbered by embarrassment,

which often leads them to be

charming and charismatic. With no

social inhibitions, psychopaths often

speak what is at the forefront of their

minds and are quick to mirror others’

behaviour.

This leads them to be excellent

communicators - yet another

indispensable skill for a medic.

Although preliminary, these findings

raise intriguing questions about the

varied implications of psychopathic

traits in the world of medicine. 1 in 100

normal people are psychopaths, but

that number rises to 1 in 25 when we

are talking about people employed in

high-risk/high-yield jobs, particularly

doctors and lawyers. Perhaps, then,

your heroic colleague who is brimming

with witty charm is harbouring a

psychopathic personality under the

surface?

Despite all of this, the goal of this

article is certainly not to defend and

advocate for psychopaths. Indeed,

there remains a significant proportion

of this cohort who do commit crimes,

who do steal, who do fulfil our

stereotypes of being dangerous. The

existence and nature of ‘successful’

psychopathy continue to be

flashpoints of scientific controversy

and debate, largely because a host of

questions remain unresolved. The

research into the possibility of

successful psychopathy continues to

change day by day and I am excited to

see how it develops in the future.

50

Researcch

Why we need to talk more

about miscarriages

By Elizabeth Kallumpuram

Imagine that you’ve just been given

your dream job. The last few years

have been building up to this moment

and you’ve worked so hard to achieve

it. You have already envisioned your

future ahead of you and all the things

that you would now be able to do. But

then a few days later, you get a letter

saying that the company is unable to

hire you at this time and can no longer

give you a timeframe for when this

might happen.

This scenario may provide a small

insight into the experience of having a

miscarriage, but a miscarriage is much

more devastating than that. It’s the

crushed hope of something that could

have been. For many women who

have been physically and mentally

preparing for motherhood, which is

viewed by many as the most fulfilling

‘job’ in life, the experience of

miscarriage can be unexpected and

incredibly distressing.

Despite this significant emotional

burden, miscarriages have in some

ways become very normalised in both

general society and the medical

profession. This could be owed to the

sorrowing statistic that around 1 in 10

women go on to experience

miscarriage in their lifetime. But this

high rate only amplifies the reasons

why it should not be taken lightly.

Almost 20% of these women go on to

suffer from depression and/or anxiety

soon after and this can last for up to

three years.

A comparative study conducted in

2018 by Zahra Tavoli at Tehran

University of Medical Sciences

showed that these levels were even

higher for women who had

experienced recurrent miscarriages.

It is also common for women to suffer

from feelings of guilt and self-blame

after a miscarriage, which can

exacerbate the grief they experience.

Therefore, it is understandable that

some women may need time to

recover, but it can sometimes be

challenging to get days off work. As

the psychological effect of

miscarriage is often not discussed it

can be hard for women to request

days off for this reason. This stigma

can only be tackled by having more

conversation around miscarriages , be

it in online forums or in the workplace

with other women who have had

similar experiences. Support - and

even just an open discussion with

people who understand their

experience - can help women feel less

isolated and provide a safe space to

express these complex emotions.

51

Miscarriages are defined as the loss of

a pregnancy in the first 24 weeks of

gestation (taken from the NHSinform

webpage). Sometimes the loss of a

baby during the first three months of

pregnancy can be due to

chromosomal abnormalities or issues

with the development of the placenta,

but this can vary between people and

most often it is incredibly difficult to

ascertain the root cause. The different

factors that must interplay

successfully for the correct

development of a baby is a highly

complicated process (as those of us

who have studied embryology will

know!) and, due to its complexity, has

a high chance of going wrong. Some

women unfortunately experience

recurrent miscarriages and someone

who has previously experienced a

miscarriage has a 50% higher chance

of experiencing another, with the

likelihood of this increasing with age.

However, the most significant result of

miscarriage is often not the physical

and biological factors, but grief.

The study also analysed other aspects

of life affected after miscarriage, and

highlighted the detrimental effect to

many women’s social functioning and

emotional resilience in the succeeding

years. This clearly illustrates the longterm

psychological distress that is

brought on by having a miscarriage

and the multi-faceted impact on a

woman’s social, work and home lives.

The effects of this psychological

distress are worsened by the societal

norm of not revealing a pregnancy

before the 12 week mark. Most

miscarriages occur in the first

trimester and, although there are

some women who aren’t aware that

they are pregnant at this point, those

that are may feel isolated, as only a

few people may be able to support

them through their miscarriage.

The NHS still has a lot to learn about

how to support women suffering from

a miscarriage. There can sometimes

be a hierarchy of grief associated with

losing a baby according to how far

along in the pregnancy it occurred.

This can sadly be reflected in the

differing amount of mental health

support given to women by healthcare

services.

Currently, women in the UK can only

receive psychological support and a

referral to a miscarriage clinic if it

occurred after 24 weeks or if they

have experienced three miscarriages.

Although there are many charities that

can be of support, such as Tommy’s

and the Miscarriage Association who

offer services like support groups and

a telephone hotline, more support

needs to come from healthcare

services.

This healthcare support could come

from primary care. A study at the

University of Louisville showed that

follow-up primary care appointments

in the two weeks after a miscarriage

can significantly reduce a patient’s

symptoms of depression. Miscarriage

affects every woman in a different

way so it should be made a point to

offer counselling, telephone or inperson

GP appointments soon after a

miscarriage. This would provide an

opportunity for women to discuss their

feelings with a medical professional

who will listen to them without

questioning their grief and is able to

provide advice. This should be

pursued by a follow-up appointment

with the GP six weeks later to check

in. If necessary at this point, referrals

to counselling services could also be

made. Of course, GPs are working

incredibly hard already, but even just a

short telephone consultation could

make a significant difference.

Miscarriages are often dismissed

as a minor setback on the journey

to motherhood, but the long-term

impacts on mental health should

be taken much more seriously

than how they are now.

While research continues to elucidate

the many reasons behind miscarriage,

it is nevertheless vital to empower

women who have had a devastating

experience of miscarriage. Safe

spaces could be created where

women who have had similar

experiences are able to have

discussions and access to healthcare

professionals who are equipped to

support them in a kind and stigmafree

way should be ensured. As

medical students, we have a

responsibility to educate ourselves

about not only the physical, but also

the psychological effects of

miscarriage so that we can raise

awareness and facilitate more

conversation around it.

If you would like to read more or

anything mentioned here has

affected you, consider getting in

touch with one of these UK-based

charities via their website:

Tommy's

The Miscarriage

Association

Cradle Charity

52

Research

Can Recreational

Drugs be Used to Treat

Psychiatric Disorders?

by Ulliana Savitskaya

The association of serotonergic

psychedelics like LSD and

psilocybin (which is found in

magic mushrooms) with

recreational use contributes to the

medical applicability of such drugs

often being disregarded. These

drugs are classed as 5-HT2

serotonin receptor agonists which

are associated with characteristic

psychedelic visions as well as the

improved ability for new neurone

connections. Despite psilocybin not

being an addictive drug, 20% of

participants in a study published by

professor Kate Corrigan et al in the

Irish Journal of Medical Science

reported being actively against the

drug’s usage. This fear stems from

the lack of knowledge, insufficient

research and illegality of the drug,

which hinders our ability to use its

properties to our advantage.

Over the last few decades, a

growing number of researchers

have been trying not only to

establish, but to also understand,

the relationship between

serotonergic drugs and their

therapeutic effects in treating

anxiety, depression, eating

disorders, alcohol and nicotine

addictions. Dr Rebecca Park, who

has conducted a plentitude of

research into the field of eating

disorders, stated that many

psychiatric illnesses stem from

impaired feedback loops or

associations in the brain during a

talk she gave at UCL in October.

For example, in patients with

anorexia nervosa reward centres

were activated when looking at

images of thin people which

suggests that they have

internalised the narrative that thin

equals good. The frontopolar cortex

is responsible for making a decision

based on the potential reward you

are getting out of it and managing

multiple goals at the same time. It

has been found that giving highcalorie

foods to the participants

with anorexia nervosa activated

their frontopolar complex, meaning

that they were trying to decide

whether staying slimmer or eating it

will be more rewarding. This

showcases the internal connection

they have made: that eating food

high in calories is bad because it

will make you fat. Both of these

narratives are either simply untrue

or at the very least, a drastic

warping of the reality of healthy

eating.

Eating disorder therapy therefore

focuses on changing this

internalised narrative by trying to

unlearn connections similar to the

ones previously covered and

replace them with healthier ones.

Traditionally this is done by

cognitive behavioural therapy,

journaling, food diaries and other

methods. However, psilocybin has

been found to increase

neuroplasticity inside the brain,

facilitating the formation of new

connections instead of old ones.

Calvin Ly et al. found that

psychedelic drugs result in the

stimulation of the TrkB, mTOR and

5-HT2A signalling pathways which

leads to an increase in synapse

numbers and function (as measured

by microscopy and electrophysiology).

They also found that

the atrophy of neurons in the

prefrontal cortex is one of the key

components in depression which is

often present in patients with

eating disorders. Formation of new

neuronal connections therefore is

directly linked to the patient feeling

better. Lindsay P Cameron and her

colleagues worked on creating a

modified version of a psychedelic

alkaloid ibogaine which only has the

therapeutic effect (similar to

psilocybin) without the

characteristic hallucinations. The

study also takes into account the

compound’s toxicity and tendency

to induce cardiac arrhythmias

laying the foundation for future

research into psychedelic

modifications.

Naturally, a question is posed when

first coming across this research: If

these drugs aren’t so bad and work

so well for treating mental illnesses,

why is no one talking about them?

The answer is what it usually is in

science – it’s not that simple. There

is a long list of social, political and

scientific factors involved in

incorporating new treatment

methods into medical practice. First

of all, there is a taboo around ‘drugs

being bad’ which is a generalisation

that is true for most illegal drugs

but has become so internalised that

older generations in particular fail

to support research into alternative

therapies. Kate Corrigan and her

colleagues found that younger

generations and people with

previous psychedelic experiences

to be more open-minded towards

psilocybin in the medical setting.

This suggests that the multitude of

research conducted in the previous

decade into the efficacy, safety and

potential modifications of

psychedelics has improved the new

generations’ attitudes towards

these therapies which leads me to

believe that we may be

incorporating them into standard

medical practice very soon.

53

by

Nilay

Perspectives

Sah

SUGAR TAX

A TRIUMPH-

IT’S TIME WE

SWEETEN THE

DEAL

The NHS is facing a crisis like never

before. Record A&E waiting times, a

6.6 million-long waiting list, a £7 billion

budget shortfall, and post-pandemic

burnout of a workforce at its most

demoralised represent only an amusebouche

of challenges the service must

grapple with. Yet amidst this gloomy

backdrop, there’s a more insidious

chronic battle that we also must

urgently deal with – the obesity

epidemic.

Britain is now the fattest country in

Europe and the statistics don’t make

easy reading. Over 60% of adults are

now classed as overweight or obese.

Perhaps more worrying is the recent

and rapid rise in childhood obesity,

with just under half of children

overweight and 1 in 4 obese by the

time they leave primary school. The

public health risks stemming from

obesity are well documented, from the

five-times higher risk of developing

Type 2 diabetes to the enhanced risk

of heart disease, hypertension, and

cancer. Costing an eye-watering £58

billion to the NHS and wider society

each year, the financial incentive to

tackle obesity couldn’t be clearer too.

The burgeoning prevalence of obesity

is evidently startling. Yet the

mishandling of much-needed antiobesity

strategy by successive Tory

governments over the past decade

has been nothing short of disastrous.

To neglect the health of our next

generation of children by failing to

take adequate and effective action

would constitute a moral disgrace.

Mired in party politics, ridden with U-

turns and defined by myopic shorttermism,

the government’s approach

to tackling obesity has lacked

coherence and direction. From Truss’

quixotic proposal to rescind the Sugar

Tax to Johnson’s dismantling and

delay of what was once a genuinely

world-beating childhood obesity

strategy – the government must look

back and learn from prior mistakes.

We must learn from the successes of

the 2018 Sugar Levy that highlighted

the efficacy of low-agency

population-based policy; press ahead

with a robust childhood obesity

strategy that involves restrictions on

HFSS (high saturated fat, salt, sugar)

food advertising and product

placement as promised; and

implement policy reform advocated

54

“To neglect the health

of our next generation

of children would

constitute a moral

disgrace”

within Dimbleby’s ‘National Food

Strategy’.

To truly appreciate the scope of policy

intervention required, we must

examine the key drivers and

determinants of obesity. So far, much

attempt has been made at unpicking

the complex genetic and physiological

interactions that determine our unique

susceptibilities to obesity. Widespread

efforts have also been directed to

education, health literacy and

awareness campaigns to empower

positive behavioural choices. But how

can these strategies be effective if

we don’t address what’s really at the

heart of the obesity epidemic?

Systemic drivers of economics and

policy fuel consumption, while

environmental push factors within our

food supply relentlessly market,

tempt, and lure us to cheap, energydense,

obesogenic foods. Deep

socioeconomic inequalities only

compound this, with poverty being

inextricably linked to the increased

likelihood of obesity onset. So, how

can we actively make those healthy

choices when the options are so

clearly skewed to weight gain, not

loss? However, policy intervention that

confronts this issue faces a multitude

of implementational challenges and

often staunch political impasse.

Intense lobbying from industries

protecting their commercial interests

and vocal outcry against state-led

‘nannyism’, by certain political

factions, detract policymakers from

drafting vital, evidence-based public

health policy to tackle obesity headon.

Nevertheless, the 2018 UK Sugar Tax

on soft drinks defied the odds and

became a defining case-study for the

potency of successfully implemented

anti-obesity strategy. What makes the

low-agency population intervention so

effective is its ability to work in

synergy with industry to create

positive and sustainable health

outcomes; put simply – it’s good for

business, good for government, good

for health. A two-tiered taxation

approach (with sugary drinks

containing >5g/100 ml being levied by

18p/L while those with >8g per 100 ml

levied at a higher 24p/L) means the

policy at its core is progressive,

promoting and prioritising drinks to

reformulate and cut ‘empty calories’.

Industry convincingly responded by

cutting 30% of sugar via reformulation,

leading to a remarkable 10% decrease

in UK households’ sugar intake within

the first year alone.

The success of the Sugar Tax extends

beyond widespread reformulation

however, in that the revenues

generated from the Pigovian taxation

measure are re-funneled back into the

government’s clampdown on obesity,

providing a double-headed economic

and social multiplier. Pigovian taxes

incorporate the social cost of the

negative externality within the market.

In this case, the negative externality is

the social cost of obesity on the NHS

due to sales from sugary drink

consumption – a cost borne by all UK

taxpayers. As of 2018, the Treasury

has generated just shy of £300 million

annually from the levy. The money is

directed towards programmes like

creating healthy school breakfast

clubs in the most disadvantaged areas

and increasing funding for the Healthy

Primary Sports Premium – an initiative

designed to increase access to

exercise and healthy food in a drive to

curb childhood obesity. Moreover,

progressive taxation like this works to

continually narrow health inequalities –

targeting the very exacerbator of the

epidemic itself.

Pledges by Truss and previous

administrations to back down from the

Sugar Tax, on the mere grounds of an

ideologically libertarian objection to

the levy, thus come as a worrying

sign. The abandonment of prudently

founded public health policy for no

policy at all, whilst deepening dietary

55

“Low-agency population

policy is not only the

most efficacious, but

most equitable too”

inequalities, is the antithesis of what

we should be striving for. If anything,

we arguably must go further with the

levy: directly pairing revenues with

subsidies for healthier foods, lowering

taxation thresholds over time, and

monitoring the effect of the tax on the

proliferation of non-nutritive

sweeteners.

We can use the Sugar Tax as a

template for future rollouts of lowagency

population intervention. In

addition to reformulation and revenues

funding wider public health projects,

the power of the levy lies in its lack of

reliance on individuals necessarily

making a conscious behavioural

choice to be effective. Exerting

agency requires individuals to

negotiate the complexities of an

obesogenic environment as well as

rally cognitive, temporal, and material

resources – all which tend to be

socioeconomically patterned. Lowagency

population policy therefore is

not only the most efficacious, but the

most equitable too.

The part-shelving and widespread

delay in implementing the legislated

HFSS Promotion and Placement Act is

indubitably the latest instalment in this

tragic saga of policy paralysis and

political inertia. Once the cornerstone

of the UK’s flagship childhood obesity

strategy, the policy package set out a

comprehensive suite of measures to

confront childhood obesity, including:

imposing a 9pm watershed on junk

food advertising, heavily restricting

online advertising of HFSS, banning

multibuy deals (e.g. Buy One Get One

Free) on unhealthy products, and

limiting the promotion of HFSS foods

in prominent store locations. Pledges

have since been either backed down

from or delayed to October 2023 at

the earliest.

Worryingly, it only took a small cabal

of Tory Backbenchers threatening

Letters of No Confidence to see

Johnson swiftly turn his back on what

was vital policy, once coined the

‘centrepiece’ of his manifestoed

‘tackling childhood obesity’ strategy.

Unsurprisingly, it left members of his

own party disgruntled and the public

perplexed, with the strategy highly

popular - consistently polling at over

70% approval in peer-reviewed

studies.

Despite this, the current government

still seems intent on stalling the

measures, citing the unprecedented

‘cost of living crisis’ as cause to delay.

Yet this reasoning is baseless.

Multibuy deals are intricately designed

to trick consumers into spending

more, not less, described even in the

government’s own words as “not ‘good

deals’ for our wallet or our health”.

Moreover, restricting HFSS advertising

has nothing to do with cost of living.

Nor does limiting HFSS product

placement, where retailers exploit our

propensity to give into impulse

purchases and leverage the ‘pester

power’ of young children against us.

It’s time we implement these

interventions now.

This U-turn adds to a long list of failed

obesity strategies - a Cambridge

University study estimates 104

unfulfilled Tory obesity policy pledges

since 2016 alone. The analysis

consistently found government

indecisive on taking greater

intervention and over-reliant on policy

largely making high demands on

individual agency. It’s time we turn this

tide and take firmer measures to

tackle this very real and palpable

obesity epidemic. Low-agency

population-level measures certainly

represent a promising way forward

into breaking the ‘junk food cycle’,

addressing health inequity and

ultimately realising a healthier future

for us all. I urge the government to

finally convert rhetoric into tangible

action against obesity, not just for the

sake of our children’s future, but for

the survival of our NHS too.

56

Careers

Soaring

Horizons

A delve into the extraordinary journey

towards becoming an RAF Medical Officer

by Amman Ahmed

For medical students, the scope of our

future prospects can sometimes

appear daunting, but we can start to

work towards these goals and ideas

far sooner than you might expect. This

was certainly the case for Pilot Officer

Em Lloyd, a fifth-year at UCLMS and

the current Senior Student of the

University of London Air Squadron.

She has been awarded a Medical

Cadetship with the RAF for her final

two years at medical school, putting

her on the path to becoming a Royal

Air Force (RAF) Medical Officer. I was

fortunate to have the opportunity to

speak with Em about her experiences

so far on this inspiring journey, and

learn about her insights into

embarking into a military medical

career.

For Em, everything began when she

first heard about the University of

London Air Squadron (ULAS). The

largest of the University Air

Squadrons, with 90 students, ULAS

has maintained a strong presence in

London since 1935. Each year, around

30 new ULAS students, known as

Officer Cadets, are recruited to join

the RAF Volunteer Reserve, and have

the opportunity to take part in

prestigious ceremonial events, sports

trips abroad, flying training and more!

“ULAS has honestly been the

highlight of my years studying in

London,” Em says, “And you don’t

have to be planning on a military

career to get involved - there is no

commitment beyond your time at

university, and although you are

expected to attend our weekly

training nights, there is a clear

understanding that your university

course always comes first!”.

These paid weekly training nights,

known to the Officer Cadets as Town

Nights, take place every Thursday

during term-time at Yeomanry House,

near Russell Square. A wide variety of

activities are run, including sports

competitions, presentations from

guest speakers, social events, careers

advice sessions, and first aid training.

Alongside this, students benefit from

year-round flying training with the

Grob Tutor, based at RAF Wittering.

“I was lucky enough to spend two

weeks at Wittering over the summer

holidays, working through the flying

training programme - next summer,

I’m hoping to fly solo!” Em enthuses,

“Flying is absolutely amazing fun,

and you actually get paid for every

day of flying training that you do!”

As well as this, Em has had the

opportunity to represent ULAS in a

number of ceremonial events across

London. “My favourite event so far

was the Lord Mayor’s Show - it was

such a fun day, and a real privilege to

be part of.”

57

After graduating from UCLMS in 2024,

Em will complete her two years as a

Foundation Doctor at one of the five

military hospital units in England,

before entering the Specialist Officer

Initial Training Course at RAF College

Cranwell in 2026. She will then work

as a General Duties Medical Officer

(GDMO) at an RAF station before

going into a specialist training

programme. Although the RAF

employs doctors in most of the major

branches of medicine and surgery,

they do not offer any places for

paediatricians, obstetricians or

geriatricians. Currently, Em is

particularly interested in a career

either as a GP or as an anaesthetist.

“It isn’t an easy process,” Em says

about applying for the RAF Medical

Cadetship. “There are a lot of

different stages, including interviews

and assessments. However, it’s my

dream job, so it was definitely worth

all of the preparation and hard work!”

As a Medical Officer, Em will play a

key role in ensuring that sailors,

soldiers, and aviators are fit and

medically prepared for their work,

whether at home or overseas.

Through the RAF, she will receive

dedicated training in aviation medicine

and will be deployed to field hospitals

and medical centres to support

overseas operations. Already, Em has

had the opportunity to attend

symposiums and conferences

focussed on military and aviation

medicine, as well as networking

opportunities to meet current military

doctors.

“Whatever career path you want to

take, it’s never too early to look for

opportunities to grow and develop on

both a professional and a personal

level,” Em says. “Sometimes at UCL it

can feel as though research and

academia are the only ways to build

your CV, but through ULAS I’ve been

able to learn so much about

teamwork and leadership - and have

a lot of fun whilst doing so! Keep an

open mind - there are so many

amazing potential careers out there,

and the very fact that you’re at UCL

Medical School shows that you have

the capability to excel in anything

you put your mind to!”

MBBS

Graduation

Initial

Training

Two

Foundation

Years

GDMO

Ultimately, I think that Em’s journey

demonstrates the breadth of

opportunities that are available whilst

at medical school, and shows just how

far you can look ahead. A career as an

RAF Medical Officer offers a huge

range of fantastic opportunities, both

in terms of the specialist medical

training on offer and through the wider

experiences gained as a member of

the UK Armed Forces.

Specialist

Training

There’s no better way to summarise it

than with a final quote from Em: “I

know that it’s going to be no ordinary

career!”

“I know that it’s going

to be no ordinary

career!”

58

Interviews

Professor Anthony Costello:

The Lancet Countdown and

health at the centre of

climate action

by Anna Baker

Professor Anthony Costello

has an expansive career as a

paediatrician and expert in

maternal and child health

epidemiology in developing

countries.

He is the former Director of both the

Institute for Global Health at UCL and

of Maternal, Child and Adolescent

Health at the World Health

Organisation. He is currently a

Professor of Global Health and

Sustainable Development at the UCL

Institute for Global Health. Recently,

he has been focusing his research on

the effect of climate change on health,

and in 2015 he was appointed as the

co-chair of the Lancet Countdown for

Climate Action and Health.

I spoke with Professor Costello about

the work of the Lancet Countdown, his

thoughts on the response of

governments and health systems to

climate change, and why the

immediate threat posed to our health

makes climate change everyone’s

problem.

What is the Lancet

Countdown? How did it

begin and how has it

developed?

The Lancet Countdown is a

collaborative international initiative

involving over 100 universities and

research institutions that produces an

annual report on the impact of climate

change on health. The Countdown

analyses aspects of stagnation and

progress in this area, utilising a

plethora of scientific, economic and

data-driven evidence to do so.

The Countdown began as a university

commission on climate change, with

Costello leading the UCL team.

They spent a year speaking with all

the faculties – a purposeful

interdisciplinary approach - to hear

their ideas. This first commission was

published in 2009 under the striking

title 'Climate change is the greatest

global health threat of the 21st

century’. Despite extensive media

coverage, there was little action; once

again, climate change and its

implications on health was not on the

political agenda. A new approach,

with a more positive tone, was taken

for subsequent commissions, putting

improved health at the centre of why

climate change action is so urgently

needed. Over the next few years,

they received a £1 million annual grant

from the Wellcome Trust, expanded

their contributors to include

international research institutions and

changed their model to a ‘countdown’

– an annual publication that would

allow for in-depth monitoring and

analysis of changes, advancements

and predictions in relation to climate

change and health. The first

Countdown was released in 2016, and

it continues to be published each year

- strategically soon before the COP.

The Countdown is composed of five

regional groupings - Latin American,

Europe, Australia, East Asia and

Africa, with a South Asian group in the

process of being formed. Policy

makers are more likely to listen to

scientific trials and evidence

produced amongst their own

population, which is a concept highly

evidenced by Costello’s research on

how supporting local ‘sympathy

groups’ to implement changes in

healthcare leads to better health

outcomes in their community.

Therefore, it is essential to increase

advocacy at the regional level so that

people from each area can implement

strategies tailored to their regional

environment, demographic and

culture.

59

What is your view on

how governments,

especially the UK

government, are

responding to climate

change?

“Politicians haven’t grasped

the severity of climate

change.”

Governments and companies continue

to make decisions that contribute to

climate change, including the UK.

Costello explained that, yes, the UK

has cut its emissions, but this only

refers to production emissions. The

UK’s consumption emissions – those

from the manufacturing and importing

of products from other countries,

which are therefore attributed to their

country of origin – remain high.

Furthermore, he remarked that if at the

Paris Climate Accord in 2015 the UK

government had heavily taxed fossil

fuel companies, they would’ve

received enormous tax returns that

could have been used to fund crucial

climate change initiatives, such as

investing in renewable energy and

insulating homes – a particularly simple

and necessary initiative that was

disregarded. High taxation of fossil fuel

companies “would’ve sent a message

that polluters must pay”. Yet, the

government continues to operate with

short-term economic goals in mind,

rather than the health of humans and

the planet. They have not only failed to

tax the fossil fuel industry but have

gone even further by subsidising it and

permitting enormous, misleading

lobbying campaigns.

He made it clear that this is not simply

an ideological obstacle. All political

parties have failed to implement

essential climate change legislation at

the rate that is urgently needed, even

if the more left-leaning talk about

green programmes and climate action

more frequently. Therefore, it is

essential that businesses, institutions

and individuals take the lead.

“More physical activity,

more public transport,

better diet, more local

food – that would make

a huge difference”. “We

need political

pressure”, an end to

fossil fuel subsidies,

increased investment in

renewables, ethical

investing (such as by

monitoring a

corporation’s carbon

disclosure), more

sustainable agriculture

and initiatives like the

Greener NHS

programme.

What is the role of

health systems and

healthcare

professionals?

The Lancet Countdown report states

that a “health-centred response” to

climate change and its related crises

can “deliver a healthier future”. Health

systems therefore have a key role to

play in this. Globally, the “health sector

contributes to about 5% of all

greenhouse gas emissions”. Clearly

some countries contribute more than

others – for example, “the UK health

system puts out more emissions than

the whole of Kenya.”

We need to target the areas that

constitute the largest proportion of

health sector emissions, including

pharmaceutical production and related

transport, heating of hospitals and

waste. Costello suggests that more

treatments should be decentralised so

that patients can more frequently be

treated at primary care centres, rather

than at hospitals, which would

significantly reduce patient travel

emissions.

High taxation of fossil fuel companies

“would’ve sent a message that polluters

must pay”. Yet, the government continues

to operate with short-term economic goals

in mind, rather than the health of humans

and the planet.

Primary care settings should also set a

green example – for example, GP

surgeries becoming clean-energy

driven.

The Greener NHS Programme aims for

a net-zero transition of the health

service by 2030. But will this be

feasible within a chronically underfunded

system? Issues that are visibly

and immediately affecting patient care,

such as long waiting lists and lack of

staff are priority targets for funding,

rather than the NHS going green. But

once again this brings into question –

are we making short-sighted

decisions?

What action needs to be

taken to ensure our

health?

“The latest WHO figures show

that 99% of people breathe

unsafe air. If we could clean

up our air, it would have huge

savings for the health

service.”

Furthermore, the 2022 report by the

Lancet Countdown states that 1.2

million deaths could be prevented

annually by decreased exposure to air

pollution from fossil fuels. Different

groups via different methods “need to

act in parallel” to combat climate

change. “More physical activity, more

public transport, better diet, more

local food – that would make a huge

difference”. “We need political

pressure”, an end to fossil fuel

subsidies, increased investment in

renewables, ethical investing (such as

by monitoring a corporation’s carbon

disclosure), more sustainable

agriculture and initiatives like the

Greener NHS programme.

“The amount of energy that has gone

into the planet as a result of

greenhouse gases is equivalent to 6.3

billion Hiroshima atomic bombs.” This

puts the extent of climate change in

the Anthropocene into perspective

and highlights what the seemingly

small, often-quoted value of 1.5°C of

global warming truly scales to.

Costello worries that we are at a

tipping point right now. With global

warming already reaching 1.1°C, and 5

of the 16 identified climate tipping

points already passed, one can

understand his position.

The title of the 2022 Lancet

Countdown, ‘Health at the mercy of

fossil fuels’, eloquently summarises

our predicament. Our pace of action

must hasten if we are to ensure the

current and future health of humans.

60

Interviews

The Perks

and Perils

of Private

Practice

by Emil Lecointe

Over the last few decades, the NHS has

been gradually buckling under the

gravity of an exponential population

growth and lack of government

spending. This has sown the seeds of a

prosperous privatised healthcare

industry that shows no sign of withering

any time soon.

Through this candid discussion with Dr

Afrosa Ahmed, we’ll learn about the

realities of working in private practice

and tackle some pervasive

misconceptions about this line of work.

What has been your

professional experience

in private practice?

“My private practice experience has

probably been twofold, so I've done it

as a General Practitioner and as

mindfulness practitioner where I do

medical mindfulness on Harley Street.”

Have you noticed any

obvious advantages of

working in private

practice?

“Flexibility, I think, is a huge component

of working in the private sector. You

can do it from home, so it really fits into

your lifestyle. The company will provide

everything you need, like laptops,

setups and security key cards. We also

implement more technology to

streamline patient care. We use an app

where patients will go through an

algorithm and receive self-care advice

which means they don't need to see us.

This allows us to filter out a lot of

patients that way.

Dr Ahmed is a

London based GP

with roots in both

private practice and

the NHS. Currently,

she works as a GP at

Honeypot Lane

Medical Centre and

as a mindfulness

practitioner at

Marylebone Medical

Practice on Harley

Street.

When we do see patients, we have a lot

longer. In the NHS, we’d have ten

minutes per patient. In private practice,

we can get up to fifteen to twenty

minutes per patient. It is also very easy

to refer patients to specialists as you

tend to have a network of specialists

available to you with the press of a

button.”

What have been the

disadvantages of

private practice?

“The main thing is that it can be quite

isolating. In private practice, you very

rarely meet anyone. All the training is

online. When I’m in the NHS, I feel like

I’m part of a team. You can just knock

on someone’s door and get a second

opinion, you can chat with colleagues in

the coffee room and there’s more

training opportunities and webinars on

offer. For me, private practice lacks

that camaraderie. It’s a misconception

that doctors in private practice enjoy a

more relaxed job. The work is still

demanding, and burnout is still a

concern. In private practice, you always

want to be getting referrals. If you start

putting limits on your time or aren’t

accessible, patients can go to someone

else. They expect what they pay for.”

Despite this, have you

ever considered

working in the private

sector full-time?

“Even though the pay is better, I don’t

think I would give up my work in the

NHS to go private full-time. I would

miss the structure, teamwork and

support that I get from the NHS. I guess

the NHS is a bit like my security

blanket. Working in the NHS is hard,

but I still wouldn’t give it up.”

Having mentioned pay,

is the salary in private

practice significantly

greater than in the

NHS?

“Yes, the pay is better but there’s other

factors to consider. If you only work

private, you won’t have access to your

NHS pension. What’s more, private

practice generally offers less job

security than the NHS. With the NHS,

you’re guaranteed a fixed job at a fixed

contract and there will be work for you.

Private practice follows a business

model, and any business can fold. So

private practice might not be a reliable

long-term model.”

61

Do you think it’s unfair

that the richest in

society have access to

better doctors and a

better healthcare

experience?

“It’s the same as the private school

debate. I suppose we live in a capitalist

society where if you can afford it,

you’re going to get a better service.

Though, I don’t think that doctors in

private practice are necessarily better.

Most doctors in private also work for

the NHS. If you want to get revalidated

and appraised, you do that through the

NHS. I think private practice offers

reduced waiting lists and greater

access to specialists, but I don't think

the quality of doctors differs between

private practice and the NHS.”

In the wake of a

faltering NHS, do you

think the private sector

will become a saturated

market?

“I think that’s difficult to answer since

the cost of living is so high right now.

Some people might not invest in the

way they would if the economy was

doing better. At this moment, private

healthcare is a luxury that most people

can’t afford. So, I would say that it’s not

so clear-cut.”

How does the business

model of private

practice affect your

day-to-day work?

“A lot of private healthcare is just like

any other business. The doctors that I

work with at Harley Street all have a

social media presence. The doctors

have LinkedIn, write blogs, and must

promote themselves. This wouldn’t

happen in the NHS because it’s not a

competitive market.”

For any medicine

students or doctors

who want to break into

private practice, what

tips do you have?

“Networking is key. In private practice,

if I need to choose a specialist from a

network of them, I’m more likely to refer

them to someone I know. Getting your

face out there is such a huge

component of private practice. This

could be done through cold calls but

more likely from your NHS work. It may

be that someone on your NHS team

invites you to come along and

introduces you to the team at the

private practice.”

Getting

your face

out there

is such a

huge

component

of private

practice

62

Guest Feature

Doubt, Uncertainty and

U-Turns in Medicine.

“Do I think this surgeon

is competent?

Does this individual

speak with confidence

and authority?”

These are questions that Daniel

Kahneman poses in his latest book,

‘Noise’. His aim is to help people to

think clearly, intelligently and

rationally. In this case, these queries

are obviously intended to help his

readers come to conclusions about

life-saving procedures. I read it and

was gobsmacked. “Really? Really?

What world is he living in? Has he

actually met a doctor?”

I am lucky that I have needed very

little surgery in my lifetime. But during

the past thirteen years I have had

dealings with a total of twenty-one

consultant physicians: some of them

have been respiratory, the others

were cardiologists. Often, the meeting

has been a single one-off, but all have

had some kind of input into the

investigation of my complex lung

problems.

So I do have a degree of experience in

these matters. And I have to say that

‘confidence and authority’ are not

qualities I look for in the doctors who

have been involved in my case. One of

them wrote to my GP that he was

“convinced that Mrs Griffin’s problem

is dysfunctional breathing and that the

cardiopulmonary exercise test (CPET)

will demonstrate it.” This was the

writing of someone who has

‘confidence and authority’. I had met

him once, for about fifteen minutes.

His confidence and authority was so

unquestionable that he felt he could

ignore not only anything that I said,

but also the pulmonary function test

results that were in front of him in my

hospital record from his predecessor,

and written comments that clearly

indicated abnormalities that needed to

be addressed.

So I went for the CPET. Was his

confidence and authority vindicated

by this test? No. Was he right? No.

Was there evidence of dysfunctional

breathing? No. He discharged me by a

terse letter without a consultation and

I have not seen him since.

The biggest problem for me has been

that confidence and authority feed a

certain mindset which is common in

63

text and illustrations by Kate Griffin

I do not trust anyone who says they

have never made a mistake or

changed their mind. But I do concede

that “Whoops… I got that wrong” are

among the hardest of words to utter.

None of the nine consultants I

mentioned could say or even think

them. U-Turns are notoriously difficult.

But a U-Turn in my case did happen.

A knowledgeable but new-to-me

respiratory consultant achieved it. The

key? Curiosity, openness, experience,

a breadth of vision and perspective,

an acceptance that each patient is

unique, and that uncertainty is a part

of human existence. And an ability to

say, “I don’t know.” He used his ‘gut

instinct’ but it was an instinct that was

informed by test results, history and

symptoms and led to a diagnosis.

I have recently had consultations with

a truly delightful orthopaedic surgeon.

In this case I did not doubt his

competence and would happily have

put myself under his scalpel. But he

was not overflowing with ‘confidence

and authority’. He was thoughtful,

measured, listened, treated me with

great kindness and respect. He did not

put me under any pressure to go for

the surgical option. After a long

consultation with an anaesthetist I

came to the conclusion that the risks

to my lungs and heart were too great

and I turned down the operation.

When I told the surgeon this he not

only accepted my decision, but agreed

with it.

doctors. In terms of medical cognitive

bias this is known as ‘Diagnosis

Momentum’. Once a diagnosis has

been made about a patient, come hell,

high water, scans, test results, let

alone a few pathetic squeaks from the

patient, nothing is allowed to alter the

initial decision. In my case, the

presumption was that I had no lung

disease or condition. Certainty had

been arrived at. Nothing more needed

to done or said, apart from the

repeated suggestion that I was

anxious and needed cognitive

behavioural therapy. Eight consultants

had followed suit. None of them

queried the first finding. Doubt was

not an option. And it bred a perverse

blinkered obstinacy with the

consequence that subsequent test

results that did not fit the pattern

could be ignored. Incidentally, I was

happy to pursue the psychological

route, but three counsellors and a

clinical psychologist were baffled by

my referral and concluded that there

was no evidence of anxiety,

depression or unhelpful thoughts and

that CBT was inappropriate.

Kate Griffin is a writer, living in

Yorkshire. Thirteen years ago she had

a hip replacement. After this operation

she developed extensive pulmonary

emboli, followed by incomplete

resolution of the clots. The problems

around getting a diagnosis for her

worsening symptoms drew her into

researching not only medical matters

but also the complex issues around

patient/doctor

relationships.

Encouraged by Professor Ian Sabroe,

respiratory consultant in Sheffield,

and Dr Henrietta Hughes, NHS

Commissioner for Patient Safety, she

has written extensively about this.

64

Alumni Feature

A Case Study of

Medial Orbital

Wall Fracture

by Dr Lucy Fox

This is a brief case report of a 34 year old man who presented to the Emergency Department with a swollen

right eye. This case report highlights the importance of considering medial orbital wall fracture as a

differential for patients who receive blunt trauma to the face. Importantly, this case reminds clinicians that it

is critical when diagnosing medial orbital wall fractures that patients must be advised to not blow their nose.

The orbit is made up of 7 bones (1).

The apex and the base of the orbit are

made of thicker bone while the walls

are thinner and therefore more liable

to fracture with trauma (1). A blow out

fracture involves fracture of either the

floor of the orbit (made up of the

maxilla, palatine and sphenoid bones)

or the medial wall of the orbit (made

up of the lesser wing of the sphenoid,

frontal process of the maxilla, lacrimal

and ethmoid bones) (1,2). The medial

wall of the orbit is the thinnest,

however the floor is the most likely to

fracture when there is blunt trauma to

the eye (1). Typical presentation of a

blow out fracture is peri-orbital

ecchymoses, ophthalmoplegia,

enopthalmos and hypoaesthesia

around the orbit (2,3). It is critical that

good history is taken to determine the

risk of orbital fracture. It is advisable

that when a patient presents with

blunt facial trauma they should be

advised to not blow their nose.

A 34 year gentleman presented to

Accident and Emergency (A&E) due to

a swollen and puffy right eye. The

patient was generally fit and well with

no past medical history, allergies and

was not taking any regular medication.

The patient was physically fit and had

spent the morning training in mixed

martial arts (MMA). While sparring, he

had been punched with a closed fist in

the right eye. He immediately had pain

around the eye and what was

described as a rim of light medially

which disappeared after a few

seconds. For the next hour, the patient

experienced right-sided diplopia and

tenderness around the socket which

resolved with paracetamol. He

returned to work that afternoon and

while at the computer

blew his nose. On doing so, he had

sudden significant swelling around the

right eye and was no longer able to

open the lids.

On examination in A&E, there was

ecchymoses around the right eye with

emphysema of both superior and

inferior tarsus. Swelling was so

significant that the eye was not visible

and even on manual separation of the

lids it was difficult to achieve full

visualisation.

The pupil was reactive and while

manually opening the eye, movements

were normal with no ophthalmoplegia

or reported diplopia. Examination of

the left eye was completely normal,

and there were no other rashes or

cranial nerve abnormalities noted.

Blood tests and observations were

reassuring. CT scan of the head and

facial bones was performed to further

assess the orbit. CT showed right

sided medial orbit wall fracture with

significant ecchymoses and orbital

emphysema.

The patient was referred to the

maxilla-facial team rather than

ophthalmology given that the eye

examination was normal. After the

initial diagnosis patients are often

observed for about 1 week to allow for

spontaneous resolution of symptoms.

During this time, patients should be

advised to not blow their nose and be

given prophylactic antibiotics. Intraocular

pressure may need to be

monitored and steroids and

cycloplegics may be required (4).

Surgery can then be considered after

this time has elapsed, for example if

diplopia or enophthalmos persists (3).

This patient had unfortunately not

been educated prior to this incident

and therefore was unaware of the

effect blowing his nose would have.

This is an important case to remember

when clerking patients in Emergency

medicine and to ensure blow out

fractures are kept at the front of the

differential diagnoses until ruled out

by CT imaging.

65

References:

1.Turvey TA, Golden BA. Orbital anatomy for the surgeon. Oral Maxillofac Surg Clin North Am. 2012;24(4):525-536. doi:10.1016/j.coms.2012.08.003

2. Lam E. Trauma. Oral Radiol. 2014:562-581. doi:10.1016/b978-0-323-09633-1.00030-4

3. Long J. Oculoplastic Surgery. Philadelphia, PA: Saunders/Elsevier; 2009:129-133.

4. Farrar J. Manson's Tropical Diseases. [S. l.]: Elsevier Saunders; 2014:952-994.

CROSSWORD

by Liam Shipsey

Across

3. Greenery near the Royal Free (5)

4. Something white you find in theatres (8)

6. Cranial Nerve IV (9)

8. Wednesday night drinking spot (6)

14. Drugs causing achilles tendonitis (10)

15. Test at the sexual health clinic (4)

16. ___ whittington had a cat (7)

18. This cycle turns ammonia into urea (9)

20. A troublesome triad caused by IgE (5)

22. Beck's triad suggests cardiac ___ (9)

24. This tenderness indicates peritonitis (7)

25. French Neurologist (7)

Down

1. To read a CTG, Bleep Dr C ___ (7)

2. Oral therapy for C. Diff (10)

5. Street of the royal free (4)

7. Sit upright after taking (11)

9. Posterior pituitary hormone (11)

10. Cell that break down bone (10)

11. Director of UCLMS (6)

12. Nerves in the 'gut brain' (7)

13. Professor ___, I&D Lecturer (4)

17. ACE inhibitor (8)

19. Rotation in a hip fracture (8)

21. Front of UCL (7)

23. North London tube station named after

a bridge (7)

26. Released in response to fats (3)

Answers can be found at the bottom of the back page

66

T H E R U M S R E V I E W W O U L D L I K E T O T H A N K

O U R S P O N S O R S .

W I T H O U T T H E I R S U P P O R T T H E P R O D U C T I O N

O F T H I S M A G A Z I N E W O U L D N O T B E

P O S S I B L E .

T h e v i e w s a n d o p i n i o n s e x p r e s s e d i n t h i s m a g a z i n e a r e s o l e l y t h o s e

o f t h e a u t h o r s a n d d o n o t r e f l e c t t h o s e o f t h e e d i t o r s , U C L M e d i c a l

S c h o o l , R U M S M e d i c a l S t u d e n t A s s o c i a t i o n o r o u r s p o n s o r s .

1 . B r a v a d o 2 . V a n c o m y c i n 3 . H e a t h 4 . P r o p o f o l 5 . P o n d 6 . T r o c h l e a r 7 . A l e n d r o n a t e 8 . M u l l y s 9 . V a s o p r e s s i n

1 0 . O s t e o c l a s t 1 1 . G i s h e n 1 2 . E n t e r i c 1 3 . W a r d 1 4 . Q u i n o l o n e s 1 5 . N A A T 1 6 . R i c h a r d 1 7 . R a m i p r i l 1 8 . O r n i t h i n e

1 9 . E x t e r n a l 2 0 . A t o p y 2 1 . P o r t i c o 2 2 . T a m p o n a d e 2 3 . A r c h w a y 2 4 . R e b o u n d 2 5 . C h a r c o t 2 6 . C K K

RUMS Review Vol. VIII Issue I - January 2023

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