WINTER 2012 Volume 126, Est. 1873
Guy’s, King’s and St Thomas’ Hospitals FREE on Campus gktgazette.com
Inside:
Morgellons A disease all in the mind?
Resurrection Men When King’s bought a murdered child
The Christmas Show Singing, dancing, comedy and a lot of nudity and much more
GKT
GAZETTE Established 1873 Vol. 126 No. 2579 ISSN 0017-595 Website: www.gktgazette.com Email: gkt.gazette.editor@gmail.com Office/Memorabilia: office@gktgazette.com GKT Gazette, 2nd Floor, Doyles House, Guy’s Hospital, London, SE1 1UL. All rights reserved. The opinions expressed are those of the authors and do not neccessarily represent the views of the hospitals, the University or the Gazette Cover photo courtesy of Charlie Ding, KCL Dental Student: www.kisslondon.co.uk
New Textbooks New Te Textbooks x fr from rom Wiley-Blackwell Wile y-B Blackwell All writ written ten b by y ren renowned owned names in their fields, fields, the theyy feature feature fully updated u and new answers ne w artwork, artwork, MCQs MC CQs and answ ers for for self-assessment, selff-assessment, and an enhanced en nhanced Wiley Wiley provides digital Desktop Edition iin n the price of the book. This This pro vides an interactive interactive d igital vvererr-downloadable text sion of the book ffeaturing eaturing do wnloadable e te xt and images, images highlighting highliighting and note book-marking, in-text searching, ttaking aking facilities, facilities, book-marking b , cross-referencing, cross-referencing e , in-te xt searc hing, and linking references to ref erences and d glossary glossar y terms.
Contents 4126
Editorial
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News
A message from the Editior
The Christmas Comedy Revue, Professors Rang and Nutt Visit Guy’s, and other stories
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Letters to the Gazette
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Features
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Book Reviews
Views and a cartoon from our community of readers
What doctors don’t know about the drugs they prescribe and an article on Morgellons Disease
Bad Pharma reviewed, along with a book on cultural awareness in healthcare
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Research Snake venom used for analgesia research, KCL researchers discover mechanism behind muscle regeneration
Arts & Culture The Pre-Raphaelites: Victorian avant-garde, and Doctors Dissection & Resurrection Men
Careers All you need to know about foundation application
Nursing Criticisms of Florence Nightingale
Dental Zena, a Guy’s graduate, goes the distance for Wooden Spoon Charity and KCL Smile Society
History Who was Keats (drawn by Kate Anstee above) and what is that obscene wall of carvings in the Gordon Museum (and on the back cover)?
Sport Success all-round for King’s Boat Club at Cambridge Winter Head
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From the Editor:
D
ear readers, Welcome to the winter edition of the Gazette! I hope all newcomers to GKT have had a chance to settle in by now, and have found a home at this magnificent university in this fantastic city. The weather will only get colder I’m afraid, but we at the 4126 GKT Gazette Winter 2012
Gazette are doing our best to help you through the winter blues. Inside this issue you will find an interesting array of articles, ranging from some rather frank sports reports, to a fascinating article on Morgellons disease (never heard of it? Go to the Features section).
We also welcome a rejuvenated team to the Gazette, full of new faces, fresh ideas, and (in my opinion) talent. I hope you enjoy this latest edition, and, as always, please let us know what you think! Gareth Wilson (MBBS4) Editor
Anthony Nolan is a pioneering charity that saves the lives of people with blood cancer who need a blood stem cell, or bone marrow transplant. Now, every day, we help two people in need of a lifesaving transplant by using our register to find remarkable donors who have matching stem cells, or bone marrow. www.anthonynolan.org
The GKT Gazette Invites Companies to Use Our
Advertising Space For more information, contact gkt.gazette.editor@gmail.com Winter 2012 GKT Gazette 4127
NEWS
Students entertain record crowds with another excellent Christmas Comedy Revue Katie Allan Intercalated BSc
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hilst the show, consisting of fast-paced sketches, songs and videos, has always been popular, this year saw the highest ticket sales in many years, with the Greenwood lecture theatre packed out for three consecutive nights with students and some of the braver staff members. Profits from the ticket sales, amounting to over £5,500 were donated to this year’s RAG efforts in aid of local hospital charities. The cast – made up of the familiar faces of Christmas Show veterans and an impressive new batch of freshers – worked hard on the show for three months, holding auditions, writing and rehearsing new material, and filming video sketches around London.
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Whilst it was clearly hard work, the show’s producer Sujan Sivasubramaniyam insists it was all worth it in the end: "Even with all the stresses we all had such an
Right: Helen Whitmore Dancing girlin-chief, and Dr Stuart Paterson, pharmacology lecturer and party animal
awesome time! The cast and crew have so much fun putting on the show and we really bonded during rehearsals and show week, which are full of inappropriate banter that makes up for lack of life for 3 months!" The sketches, making reference to popular culture, medical conditions and practices, and some of the more notable GKT students and staff, were well-received by the audience - although there was the inevitable heckling from the Wednesday night crowd. This year, the show was entitled ’50 Shades of Gray’s’, after the erotic publishing phenomenon of the year,
and the cast and crew certainly lived up to this name, with plenty of both male and female nudity, from the cast as well as the Dancing Boys and Girls who each put on great performances with clever choreography that left little to the imagination. Unfortunately one dancing girl injured herself while celebrating a little bit too hard after opening night, and ap-
peared on stage on crutches for the remaining shows. Even the backstage crew got in on the ’50 Shades’ action, dressing in S&M attire for the final night. Cast, crew and audience alike celebrated the successful show with afterparties on both the Wednesday and Friday nights, and the Christmas Show has once
again proved to be a highlight of the GKT calendar. Now all that remains is for Director Alex ‘Cpt Jack’ Underwood, Musical Director Sophie Strong and Producer Sujan Sivasubramaniyam to maintain their success at the upcoming UH revue! Above: Photo courtesy of Charlie Ding, KCL Dental Student, kisslondon.co.uk
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NEWS
Schizophrenia patients being badly let down by the system Lucy Webb MBBS3
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chizophrenia care within the NHS needs to improve, a commission established by Rethink Mental Illness has found.
The Schizophrenia Commission was founded in 2011 and, chaired by Professor Sir Robin Murray from the Institute of Psychiatry in Denmark Hill, involves over 80 experts and online surveys completed by 2,500 people. First-hand accounts of care depict how the concept of patient autonomy on occasion remains ignored, for
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example with regards to changes in medications. It has also been found that many patients with psychoses spend too long in ‘demoralised and dysfunctional’ hospital wards in secure care. Despite twenty years of progress in understanding and treating the condition, and the associated advances in medication and management, there are still vast areas for improvement; the commission has suggested 42 methods to do so. One finding detailed that too much of the mental health budget is spent on se-
cure care, where the recommendation is to give a greater emphasis on the use of recovery houses to help transition patients from hospital to community services. This could also reduce the cost of the condition, currently valued at £11.8 billion, by investing further not only in effective care as outlined, but in prevention of the condition. Prevention, although not always possible, includes highlighting the risks of cannabis – a factor that, if a person is already genetically predisposed, can cause or worsen the condition. Although schizophrenia care has come a long way since the days of ‘Bedlam’, a lot still has yet to be done. Thanks to this commission, it appears as though the next stages are set in motion.
NEWS
New dialysis centre opens in Borough Katie Allan Intercalated BSc
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brand new, state-ofthe-art dialysis unit has opened in Borough, as part of ongoing regeneration of the Guy’s Hospital site. The opening of the Borough Kidney Treatment Centre, located on Long Lane, means more patients can be treated in a modern, comfortable environment, away from the main hospital building.
Patients and staff were consulted at every stage of the design process, from planning the layout to selecting which artworks by local artists to display. Patients identified the most important features of a dialysis centre: comfort, privacy and a pleasant environment.
Whilst all medical facilities should ideally encompass these features, it becomes particularly important for patients on dialysis, as they spend so much time in the treatment centre; most patients dialyse three times a week, for up to five hours. The centre is home to a multi-disciplinary nursing and medical team, along with social workers, psychologists, dieticians and
physiotherapists. As well as 47 dialysis stations, it includes a self-care area, where patients can ‘drop in’ to self-dialyse without help from the nursing staff, and a training area for patients who want to learn how they can transfer to home dialysis, in order to maintain their independent lifestyle. The centre will treat up to 300 patients a week, and is a big improvement on the previous facilities available.
Medical School launches peer welfare scheme Katie Allan Intercalated BSc
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new peer welfare support scheme has been launched within the medical school, offering a range of services to students seeking confidential advice or support from fellow medics.
The scheme has been set up by Alex Brazier, the Medical Student Association’s (MSA) Welfare Officer, in conjunction with KCL counsellors Stevie Griffiths and Ann Conlon.
the effects that the stresses of medicine can have: ‘The problem with medicine is that when people have issues, they may not want to tell the college about them because of concerns about ‘fitness to practice’.
Alex has been hoping to set up the scheme for quite some time, after witnessing
Sadly, this means that small issues can snowball and be-
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come serious issues. In my five years at GKT I have seen several good students struggle and end up leaving the course, over welfare issues that might have been sorted if they had sought help earlier. The idea behind peer support is that students would feel comfortable talking confidentially about their problems, whether they be social, academic or health related, and we can point them in the right direction to ensure they get the best help available and get back on track as soon as possible.’ A group of 18 students, from across years one to four, were selected for the role through interviews. They are currently undergoing an in-depth training programme, led by Stevie Grif-
fiths and Ann Conlon, enabling students to develop their listening and communication skills, and heighten their awareness of the sensitive issues that they may need to discuss. So far, the training has been a great success and the new peer supporters have been enjoying the sessions. One of the peer supporters, Devika Rajashekar, said ‘the hundreds of people you’re surrounded by on campus have most likely ‘been there, done that’ – who better to offer you advice, show you the ropes? It’s a significant step towards improving the GKT experience and I’m excited to be a part of it.’ The training programme is due to end in February, at which time the service will
become available to students across the medical school. The scheme, which is funded by a grant from the King’s Annual Fund, will offer students the option of a one-to-one session with one of the trained peer supporters, or regular open drop-in sessions. The programme has been modelled on a successful scheme in place at the University of Oxford, and while it is the first of its kind at King’s, there are currently plans in place to roll similar programmes out in the schools of law and biomedical sciences.
For more information about MSA Peer Support, go to kclmsa.co.uk
NEWS
Rang and Nutt visit Guy’s Maria Fernandes PhD Student Institute of Pharmaceutical Science
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he first semester of the KCL Pharmacology Society’s existence was a great success. In October we hosted the pharmacological legend that is Professor Humphrey Rang (below, with Flow and Laura), who gave us an overview of his ludicrously high-profile career. To rub shoulders with pharmacology greats like Paton, Schild and colleagues is pretty cool in our eyes. In November, we were hon-
oured to host Professor David Nutt- he of ‘ecstasyis-less-dangerous-thanhorse-riding’ fame- in our most successful meeting so far. Hearing about his controversial TV ecstasy trial and his work on illegal drug risks and psilocybin was incredibly interesting, and we were all so enthralled we didn’t notice that his hourlong talk ran over by ninety minutes! Definitely a highlight of our pharmacology lives so far. Finally, this month we hosted three very successful female scientists at our ‘How to Succeed in Science’ event. We were inspired
when we found out that you don’t have to be the top of the class or have the most straightforward or mindblowingly exciting PhD project to then become one of the most renowned female pharmacologists in the world. Just a genuine enthusiasm and love for what you do. In January we will be hosting a careers event where we will have visitors from the MHRA, the British Journal of Pharmacology, TeachFirst, and many more. It’s a free event and we’d love to see you there! Check facebook.com/kclpharmacology for more details.
LETTERS
Letters to the Gazette The Gazette always invites its readership to interact with our writers. See an article you like? Want to disagree vehemently with the opinions of one of our contributors or writers? Please let us know! Send all correspondance to gkt.gazette.editor@gmail.com, and you will see it in the next issue of the Gazette!
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ir, I note the passing of Bloggy Haworth who taught me, and I comment only because of something he said when assessing a piece of my work c.1974.
I was not happy with it but felt I could go no further, and said so to him. He looked at it, summed up the overall situation and commented, "There are times when you have to be sensible with dentistry". I never forgot it, think of it periodically, and believe it is as applicable now as it was then. Yours faithfully, Angus Kingon MDSc, FRACDS, FDSRCS Eng, FICD
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o the Editor, Those alumni of KCL who are in the field of clinical organ transplantation or transplant immunology will already be aware of the welcome news that Sir Roy Calne’s contributions to the development of organ transplantation in general, and to liver transplantation in particular, have been recognized in the USA by the award of the Lasker-DeBakey Clinical Medical Research Award for 2012. He shared this award with the other great pioneer of organ transplantation, Thomas E. Starzl of the University of Pittsburgh. Both men contributed important innovations in immunosuppressive therapy, with Sir Roy play-
ing a major role in the introduction of azathioprine, cyclosprorine, and rapamycin. Sir Roy is a Guy’s alumnus who was a medical student between the years 1947-1952. After National Service with the Gurkhas in the Far East, surgical training in the UK, and experience in the experimental laboratories of the Peter Bent Brigham Hospital/Harvard Medical School in Boston, he was appointed to the chair of surgery at the University of Cambridge in 1965 at the age of 34. He retired as profes-
LETTERS
sor emeritus in 1998. He has received many prestigious awards, and was made a Fellow of the Royal Society in 1974, a rare honour for a surgeon. Sir Roy’s career was outlined briefly in an article in the Guy’s Hospital Gazette in 1993 and he has told his own story in his autobiography. The Lasker Awards are considered by many to be the U.S. Nobel Prizes for medical research, and it is a great honor for Sir Roy and Dr Starzl to be recognized in this way. It is perhaps noteworthy that a Guy’s alumnus, Sir Ravinder (‘Tiny’) Maini (with his colleague Marc Feldman), received the Lasker Clinical Medical Research Award in 2003 for
introducing anti-TNFα in the treatment of patients with rheumatoid arthritis and other autoimmune diseases. For two alumni of Guy’s to have received this award within a decade is remarkable. David K.C. Cooper MD, PhD, FRCS Thomas E. Starzl Transplantation Institute University of Pittsburgh
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o the Editor, Nina Padwick – Early Guy’s Rower
I was intrigued to read in the March 2012 issue of “Rowing and Regatta”, the official magazine of British Rowing, some information
that may be of interest to King’s alumni with regard to the Women’s Head of the River Race. This race, which was established in 1927, is raced over the reverse of the Universities Boat Race course on the River Thames on an annual basis. It was suspended during the Second World War, but resumed in 1950. The article states that crews from a London club called Alpha in the late 1950s, “included Nina Padwick, who, more than half a century later, is still rowing at her club’s successor – Mortlake, Anglian and Alpha, itself a strong centre for women’s rowing today.
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“It was while studying dentistry at Guy’s Hospital that Nina - ‘full of enthusiasm and not much else’ - took up the opportunity of rowing with the women of Royal Free Hospital. After qualifying, she moved downriver to Alpha… Then as today, the Women’s Head was the focus of the season. As Nina
says: ‘we had so few chances to race each year’, given that there were only a handful of women’s races on the calendar, and only one Tideway head race.” The article is accompanied by a photograph of an Alpha crew, presumably in the late 1950s, in which Nina Padwick is featured.
Alumni/ae of King’s, particularly those of Guy’s, may be interested to hear of the pioneering and continuing efforts of one of their number in the world of women’s rowing. Sincerely, David K.C. Cooper MD, PhD, FRCS
Below: A concerned member of the GKT community has submitted a cartoon regarding the Guy’s Tower renovation:
BEFORE 4136 GKT Gazette Winter 2012
AFTER
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ĜĆėĉėĔĚēĉĆĕĕǤ ĈĔǤ ĚĐ
FEATURES
What doctors don’t know about the drugs they prescribe The release of Ben Goldacre’s latest book, Bad Pharma, has caused a media stir and thrown aspotlight on the pharmaceutical industry. However, whilst it was only published in September, it has already had a huge impact, raising awareness of key issues amongst both healthcare professionals and the general public, and perhaps indirectly causing a major change of procedure by GlaxoSmithKline. Medical student Lewis Moore explores the book’s impact.
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n today’s era of evidence based medicine, with doctors operating under the careful counsel of NICE and pharmaceutical products scrutinised by the watchful eyes of the Medicines and Healthcare products Regulatory Agency (MHRA), it seems reasonable to be confident that the medicines that doctors prescribe are supported by the best possible evidence. Whilst pharmaceutical companies are sometimes portrayed as profiteers, without their research and innovation the range of treatments available would be pitifully diminished. Where drug prices are concerned, they may sometimes seem extortionate, but this is largely down to the ever lengthening series of hoops that new medications must deftly jump through before being licensed, and the need to re-
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coup the enormous sums of money required to achieve this. Ben Goldacre, famous for his 2008 book, Bad Science has reared his tousled head once again. His new book, Bad Pharma, attacks not only the pharmaceutical industry and the belief in evidence based medicine, but the evidence base itself and the endemic problem of publication bias in scientific literature; he feels this has allowed healthcare professionals to be systematically manipulated by Big Pharma. But what is his evidence against the evidence? He has lots… notably
a study published in Nature earlier this year found that of 53 major trials into cancer drugs, the results of 47 were unreplicable1; fluke results which managed to get published in peer reviews journals. The negative results which presumably accompanied each of these trials went unpublished, either for manipulative purposes or because journals
FEATURES
are less inclined to publish negative findings. The results of 50% of clinical trials do not find their way into the literature for one reason or another. He goes on to cite a systematic review on publication bias which concludes that this problem is ‘pervasive’ and ‘in every field of medicine’, he calls this, ‘a cancer at the core of evidence based medicine’. It is all well and good to poke holes in the way things are done, but what does Dr Goldacre propose to change? His plea is simple: ‘1. Publish all trials conducted in humans, including older trials, for all drugs in current use.
2. Tell everyone you know about this problem.’ So, can one epidemiologist stamping his feet make a difference? Last month the BMJ reported that GlaxoSmithKline are to open up data from all of their clinical trials to the public, their chief executive quoth: ‘the move sprang from a desire to dismiss the perception that drug companies are always hiding something’2. Perhaps this is the case, or perhaps they were feeling the sting of the $3 billion fine that was imposed on them in July by the US Department of Justice for unethical treatment of data. Either way this movement has gathered momentum; just weeks ago the editor-in-
chief at the BMJ published an editorial on the issue, highlighting the imperative to minimise publication bias, and probing the increasingly spurious nature of the evidence for the efficacy of Tamiflu, a drug for which the UK alone parted with £500 million. It will surely not happen overnight, but the wheels appear to be in motion to achieve more transparency and better quality evidence, which will hopefully translate to better patient outcomes. For more of Ben Goldacre, see his new book Bad Pharma, which is reviewed later in this issue of the Gazette, watch his two TED talks or visit his blog, badscience.net
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Morgellons disease The itch, the fibre and the controversy Christine Bojanic Biomedical sciences graduate
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n 2008, the U.S. Center for Disease Control and Prevention (CDC) launched a study on a mysterious and controversial condition known as Morgellons disease. The disease, which affects thousands of people worldwide, consists of a number of peculiar and astonishing symptoms that practically border on science fiction. The results published in 2012 concluded that Morgellons disease is an “unexplained dermopathy” with no underlying infectious source identified. The Itch You are sitting on your sofa watching the news. Your leg starts itching. The itch
spreads to your torso, arms, face, and scalp. Soon, an intolerable crawling sensation takes over your whole body and you scratch your skin so hard that it starts bleeding. The urge to scratch is unceasing and uncontrollable. A patient describes the torment; “I don’t normally tell people this,” she said, “but I want to shave off my eyebrows and take a metal-wire grill brush to scratch away at my forehead.” When a dermatologist examined the patient’s scalp, there was nothing atypical – no rash, redness, scaling, fungus, or parasites. Only scratch marks. The patient is quickly diagnosed with delusions of para-
“I don’t normally tell people this, but I want to shave off my eyebrows and take a metal-wire grill brush to scratch away at my forehead.”
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sitosis, a condition manifested by intense scratching and a false belief to be infested by parasites.
She adds, “I wish I were nuts, that would be the best-case scenario in some ways. But I’m not.”
What could cause a person to itch and scratch him or herself if there were no somatic symptoms? Through a simple experiment, a German professor proved that itching can be purely psychosomatic. In the first part of one of his lectures, he inserted pictures of clean surfaces, baby skin, etc., whilst in the second part of his lecture he inserted pictures showing fleas, lice and bugs. Cameras recorded the audience. And interestingly, the frequency of scratching increased markedly during the second part of the lecture. Thoughts made them itch. On a neuronal level, the itching and crawling sensations were the effect of neurons misfiring. Whilst the itching persisted, sores and rashes would erupt as a result of obsessive self-inflicted scratching. A patient describes weekly bathing in bleach to soothe the sores and itching.
Strands extrude from the skin, tangled skeins of multi-coloured fibres buried deep in intact skin. Their origin is unknown – non-manmade, non-natural, non-vegetable, non-mineral – they do not burn at 900°C and do not dissolve in any solvents or detergents, as examined by several laboratories.
The Fibre After the sore comes the fibre. Mrs White, a patient, describes knotty lumps forming under her scalp which when she pressed on them, seem to fill with tangles, as though they would spread under her skin.
The CDC however concluded that most materials collected from participants' skin, which included children as young as 3 years old, were composed of cellulose, likely of cotton origin. The fibres are also hypothesized to be environmental contaminants — pet hair, clothing fluff, and fragments of dead insects—that collect on the sticky, self-inflicted wounds. Dr Rhonda Casey, the chief of the paediatrics department at Oklahoma State University Hospital, USA, was asked to examine some of the patients and their sores. "Honestly, at first I thought they're all nuts," says Dr Casey. "But, there was not one patient I saw who did not look ill," she says. All the patients had matching
"Honestly, at first I thought they're all nuts, but, there was not one patient I saw who did not look ill.”
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neurological symptoms; including confusion, foot drop, and a sagging mouth when they spoke and many had been diagnosed with neurological diseases such as Parkinson's or amyotrophic lateral sclerosis (motor neurone disease). Dr Casey examined patients’ skin with dermatoscope and did biopsies on both their lesions and apparently healthy skin. Fibres embedded in both places – red, blue, and black fibres. One young girl had a small pimple on her thigh with a bundle of black fibres embedded deep in the epidermis. Many doctors have accused these patients of embedding fibres in the sores themselves, but Dr Casey doesn't believe it. "As a physician, I can't imagine reproducing what I saw in that little girl's leg”. When Morgellons was first discovered and named in 2002 by Mary Leitao, a biologist, it was because her 2 year-old son complained of “bugs” and had multi-colour fibres in his sores. Mary Leitao was quickly diagnosed with Munchausen syndrome by proxy.
The Controversy Thus far, Morgellons disease has two strikes against its being recognized as a distinct disease: hundreds of conditions share many of its symptoms, and no one can imagine what would make fibres emerge from intact skin. All that has been written about Morgellons disease in the medical literature essentially points to delusional parasitosis. However, the occurrence of the disease in children, the lack of pre-existing psychopathology in most patients and the presence of subcutaneous fibres on skin biopsy indicate that the disease could have a somatic origin. Evidence of an overlap with Lyme disease has also been widely hypothesized and 90% of Morgellons patients test
Above, left, opposite & previous pages: Micrographs of fibres thought to be associated with Morgellons Disease from morgellonsresearchgroup.com
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positive for Lyme disease. Patients with Morgellons disease have shown a minor response to antibiotic therapy used for Lyme disease treatment. This therapeutic response supports the concept that an infectious process may trigger Morgellons disease. Mass hysteria has also been targeted as a way of undermining the validation of Morgellons as a disease and rightly so. Dr Timothy Jones, investigated a 1998 episode in which 170 students and staff went to emergency rooms after smelling "toxic fumes" that were never proven to exist. He says psychogenic outbreaks spread rapidly, usually among people within sight of one another,
and dissipate quickly when the affected people are separated. The Internet seems to have greatly altered the dynamics of folie a deux (‘a madness shared by two’), and cyber-sharing has been shown to have a profound suggestive power. Chat groups and social-networking sites have been accused of fostering anorexia and suicide clusters. Morgellons accounts may have influenced psychologically vulnerable people to adopt the syndrome as their own — including people who are authentically sick but mistaken about the cause, Dr Jones says. Still, according to Dr Michele Pearson, the head physician of the CDC Morgellons study, “Whether it may be a true medical problem or a media creation, the suffering these patients are experiencing is real”.
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Generic Medication in Epilepsy Treatment
Lewis Moore MBBS3
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do not feel that I am speaking only for myself when I state that generic prescribing is viewed in a positive light by those involved in the provision of healthcare. It allows proven, quality medication to be distributed with price reductions of a magnitude that TK Maxx can only dream of. But is the picture always as simple as we would like to believe? I recently had the privilege of sitting in on a neurology outpatients clinic, and met several previously stable epilepsy sufferers who had been experiencing a relapse of symptoms. I was surprised to learn that my consultant attributed these problems to the patients being continuously given different generic brands of their medica-
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tion. Generic medication undergoes testing by the Meidicines and Healthcare products Regulatory Agency (MHRA), to ensure that it is bioequivalent to the proprietary formulation that it replaces, so why is there a problem? A 2003 paper concluded that current bioequivalence testing is not rigorous enough, and that it should be conducted on patients rather than healthy volunteers. Another study last year found that while switching from a proprietary drug to a generic was generally tolerable, switches between several different generics may be more problematic. This is certainly an area where the research is particularly lacking, and highlights the perhaps flawed assump-
Above: Lullaby, the Seasons by Damien Hirst [detail] Photograph Prudence Cuming Associates
tion that different generic drugs are comparable to each other on the merit that they compare favourably to their brandname equivalent. This study also stresses that bioequivalence studies are not measures of clinical efficacy or safety, and should not be treated as such. I was unable to obtain any expert commentary for this article from anybody at King’s; one professor who I approached actively refused to comment on the grounds that the subject is much too controversial for him to put anything in writing. He was concerned that much of the speculation in this area stems from drug companies and their influence on patient groups, or that the problem lies with patients getting confused with taking a different number of tablets, or tablets of varying appearance. The website for Epilepsy Action, a prominent UK epilepsy support group, certainly
does stress the importance of achieving continuity of medication. They suggest that patients ask their doctor to write the brand name of the medication on the prescription. Such requests by doctors are enforceable by UK law, despite a Department of Health (DoH) proposal in 2009 to remove this privilege from doctors. Aside from this, when the generic name for a drug is put on a prescription, any generic product may be dispensed, and with pharmacies presumably purchasing the cheapest product in a turbulent market, the switching that we observe is all but inevitable. It seems that doctors face the tough decision of blowing their budget on expensive proprietary drugs or surrendering the health of their patients to the whims of market forces. Surely some middle ground must be sought.
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FEATURES
Fatiha Chehalfi MBBS5
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’d like to think I exercise a healthy balance of cynicism and realism, and when my opinion is asked for, it is given. And here we are again. Another day, another revision website. How has it become possible for so many of them to exist at once?
Reviewing yet another OSCE revision resource immediately set me into cringe mode. Dodgy acting, weird faces, awkward silences and strange scenarios, coupled with the perverse glee of seeing old friends and med school acquaintances risking their street cred on camera; oh, the cringeworthy joys of med school. Indeed, targeting highly strung, super anxious and hardworking medical students has proved a lucrative venture for many. And when a free student-run project turns up out of the woodwork, which strips back OSCE revision back to its bare basics, this is about as refreshing and humbling as it gets. Medushare.com is a website venture run for GKT students, by GKT students. The makers say: “medushare is a free, accurate and simple medical education project, designed to improve the clinical skills of medical students and junior doctors by providing a database of clinical videos that
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reflect the curriculum of a London medical school…” Having reviewed the website myself, I can safely say that these guys mean business. For most students, the first word to jump out from their carefully crafted bit of PR is “free”. Thankfully, medushare aren’t seeking to wring every last pound and penny from your severely depleted overdraft. Using the site costs nothing and registration simply asks for your KCL address and a username, whilst a password is sent to
“Perhaps the most frustrating thing about medushare is that it lacks completion. Having got a taste for the high quality content of some of the other sections it’s a shame that medushare have not yet had the time, resources or man power to build in the entire curriculum’s material”
FEATURES
your KCL email. No prying into your personal life, no time-wasting, no mess. Clearly, the makers empathise with their fellow colleagues, and this is obvious from the outset. The website layout is ingeniously dictated by the GKT curriculum. With tabs covering MBBS years 2 – 5, and with drop down menus listing video groups and OSCE mark schemes by rotation (e.g NOP, Chest, Abdomen), you really cannot go wrong. Whilst the website is still a work in progress, the simplicity of design and focussed content demonstrate that the twoman team behind the project have adopted a no-nonsense approach to delivering everything that’s included in the GKT OSCE curriculum, and nothing that isn’t. Perhaps the most frustrating thing about medushare is that it lacks completion. Having got a taste for the high quality content of some of the other sections (especially NOP – neuro) it’s a shame that
medushare have not yet had the time, resources or man power to build in the entire curriculum’s material. Perhaps this is a big ask. It turns out that the makers put the project together only in March of this year. In less than 12 months, they have managed to pull together a respectable portfolio of OSCE videos, produced up-to-date and accurate mark sheets, and accumulated a pretty impressive online following –confidently clearing the 600 member mark and going strong. They must be doing something right. As a final year medic and fellow colleague I want these guys to do well. According to their website, they have a “global vision” that aspires to make clinical videos available to clinicians in developing countries in the future. And whilst this is all well and good, the current GKT project clearly needs amplifying and completing before any level of world domination can realistically occur. With their feet secured firmly on the ground, medushare have developed a sharp sense of direction. For now, their ambitions are modest and sensible, with completion of the GKT OSCE curriculum featuring top on their agenda. If you want to get involved in this groundbreaking GKT-born venture and film your own OSCE video or produce literature for this resource then let the folks at medushare know. The video database is slowly expanding, and with mounting input from video-makers, actors and models, it is certainly plausible for extended curriculum coverage to be reached in the very near future. Contact: rory@rorydowd.com Visit: medushare.com and subscribe
Winter 2012 GKT Gazette 4147
Reviewed by: Ben Clavey Adult Nursing 3rd Year
M
ost people in healthcare seem to regard the pharmaceutical industry in the same way one might an unreliable friend. We think what they get up to is pretty questionable but we are happy to be around them and try to keep an eye on them. Most would not level the kind of criticism Ben Goldacre has. His second popular science book, a follow-up to the wildly successful Bad Science, is a critique of the way healthcare and pharmaceutical companies work. Dr Goldacre is a terrific writer of popular science and it is refreshing to see this genre expand outside the safe areas of psychology and physics that seem to be its staple diet. The book is written in a relaxed styled and could probably be understood easily by people without a background in healthcare.
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Light is shone on some practices of both drug companies and their regulators. It can be unpleasant reading but the book flips between anecdotes and large studies so that neither becomes too tiresome. The book is represented as being about the hidden data from trials but a considerable amount of it is on the marketing of drugs. If you are reading this review it is likely you have had many a free pen from a drug rep - so this section will be of interest. Bad Pharma is not as broad in appeal as Bad Science though the subject matter is arguably more important. The chapters on trials in this book seemed very similar to a chapter on the same topic in it’s predecessor; if you haven’t read either you might want to read Bad Science first.
The real genius of the book comes at the points when the author tries to empathise with those working in the pharmaceutical industry. He lets us see how people just wanting to do their best end up acting quite horribly. It is nice to see him avoid conspiracy theory caricatures. The book at other points does seem a little aggressive. It is worth noting that Dr Goldacre is writing a criticism of a multibillion-pound industry. He is outmatched resource-wise so it could be he feels the need to make the most extreme argument possible. So
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maybe his occasional overzealous argument can be forgiven and when taken as a whole, the book is charming. Bad Pharma is worth a read but can certainly make you uncomfortable. It does not have the light wit of the previous book. The seriousness pays of though as an important issue is dealt with comprehensively and accessibly. Be warned though, once you have read this book you may be a little wary of the BNF for quite some time.
Bad Pharma: How drug companies mislead doctors and harm patients Ben Goldacre (below) ÂŁ13.99 978-0007350742
BOOK REVIEWS
Samuel Evbuomwan MBBS3
The Patient-Professional Relationship
F
or all medical professionals, many of the skills gained in clinical practice are a direct result of personal experience. These experiences are the most valuable as we can pass them on to others; this book aims to do the same. Using narratives, this book approaches a lot the difficulties healthcare professionals face on a
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day-to-day basis. Using contributions from professionals around the world it draws on individual perspectives and focuses on the need for dedicated patient care. Comprised of four components, this textbook suggests ideas for dealing with the problems professional may face more ef-
BOOK REVIEWS
fectively. Each component consists of several narratives from the view of either the patient or the healthcare professional. It then takes the key point from each narrative and highlights the teaching points. The first component tackles the concept of the illness experience, in particular the patient’s perception of health and disease. This is important because a lot of decisions made about treatment by the patient are based on their individual ideas about their condition. The second component deals with the concept of the whole person. Disease affects people at all stages of the life cycle; understanding where the patient is in the cycle when they present with an illness is vital to providing effective patientcentred care. The third component stresses the importance in finding common ground between the patient and the doctor. This is not only important for building a rapport with patients, but with a mutual understanding both the patient and doctor can agree on favourable treatment outcomes.
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This component gives examples of situations where patients are particularly vulnerable and why it is imperative that the doctor involved in their care establishes a mutually trusting and fully informed relationship. The final component emphasises the need to develop the doctor-patient relationship and in essence it encompasses the previous chapters. The use of narratives is an excellent illustrative tool as it allows the reader to visualise and reflect on key concepts introduced in this book. Having patients fully immersed to all aspects of their care is a cornerstone of modern medicine. The thing that this text introduces is a new method of understanding the common concerns, ideas and expectations that patients face today. I welcome the use of narratives as a teaching point, as it encourages reflection on how we as professionals interact with patients and learn from the successes from others.
Challenges and Solutions: Narratives of Patient-Centred Care Judith Belle Brown, Tanya Thornton and Moira Stewart ÂŁ29.99 9-781846-194962
Winter 2012 GKT Gazette 4151
BOOK REVIEWS
Samuel Evbuomwan MBBS3
Healthcare and the Melting Pot
W
e live in an increasingly interconnected society; our cities are now established hubs of diversity and multiculturalism. As a result, healthcare is evolving to meet the needs of this array of cultures. This book educates and equips the reader with the necessary tools to provide effective and culturally sensitive care to patients from differing cultural backgrounds. In its second edition
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this text expands on the previous book to include vital perspectives on migration and asylum seekers, and the often forgotten topic of men’s health. Even though this book is aimed at nursing and midwifery students it will definitely benefit students and practitioners in any healthcare setting. The book starts off by exploring the concepts of culture, race and ethnicity and the
BOOK REVIEWS
bearing these terms have on healthcare. This chapter sets the tone for the rest of book; well written, evidence-based and invaluable. Illness affects many different people in many different ways; the text analyses how individuals act when they become unwell, and compares this behaviour with individuals from different backgrounds. Religion plays a significant part in the lives of many people, and sometimes has serious implications for patients. An example of this is highlighted in the text. Jehovah’s Witnesses will not accept transfusion of blood or blood products as part of their treatment, but may allow auto-transfusion (transfusion of one’s own blood) in particular circumstances. Many hospitals have forms which patients must sign stating that they refuse this treatment. Additionally, there is an important distinction that is made between religion and spirituality, both of which affect illness behaviour but don’t necessarily go hand in hand. The book also discusses the role of women in society and how others perceive them,
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going on to demonstrate how this ultimately impacts upon the type of healthcare they receive. The authors are adept at showing the correlation between the cultural beliefs about family and how these beliefs help or hinder effective healthcare. This text excels with its use of case studies and reflective pieces, which allow the reader to approach each topic from various viewpoints. It also challenges the opinions of the reader by asking them to consider different perspectives and the implications it may have. Just as each patient is different, many healthcare professionals have different views on death, culture and spirituality. This book fosters discussion, which is important in a world where cultures and beliefs mix so readily. As our communities grow and develop, our delivery of healthcare should do so too. Cultural Awareness in Nursing and Healthcare is certainly helping to lead the way.
Cultural Awareness in Nursing and Health Care: An Introductory Text Karen Holland and Christine Hogg £21.99 978-0-340-97290-8
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The Lec Lecture cture Note Notes es series The Lecture The Lecture Notes Note es series provides provides concise, concisse, yet yet thorough, introductions introdu uctions to core undergraduate and the areas of the unde ergraduate curriculum, curriculum, covering co overing both the basic science s approaches clinical approac he es that all medical students studen nts and junior doctors need ne eed to know. know.
RESEARCH
Out with the old and in with the new King’s College scientists rejuvenate aged muscles Matilda Esan MBBS3
T
he thought of ageing is something very few of us like to willingly entertain. Yet everyday our bodies are ageing, be it our skin and bone or more importantly our own muscles. Whilst various anti ageing creams and therapies promise fresher and younger looking skin. The answer to how to reduce muscle ageing, still leaves many scratching their
heads. Though the matter may seem very uninteresting , good muscle bulk in old age might reduce the number of falls the elderly experience, therefore reduce the likelihood of hip fracture and furthermore may reduce the high mortality rates associated with hip fractures occurring as a result falls. To me, it seems like a good chain reaction of prevention and reduction?
RESEARCH
The question is, can anything be done to slow down or prevent this inevitable process? Well there may be some light at the end of the ageing muscle tunnel. This comes in the form of a study by scientists from the Center of Regenerative Medicine (Boston) and our very own Kings’ College London. Let’s start with a few simple basics on skeletal muscle (cultured cells shown above, imaged by Jachimike Amalunweze) regeneration before we dive into this exciting discovery. Various factors influence the process of muscle preservation. However certain cells ( satellite cells) play a key role in this process. Satellite cells are muscle cells
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which can be found between the sarcolemma and basement membrane of terminally differentiated muscle fibres. These cells in adults are usually in an inactive state, however they can be activated in response to stimuli such as muscle injury. The end result of this process is that more regenerated muscle and satellite cells are created. In ageing, this process is disrupted and it hasn’t really been clear why. However the recent study mentioned above showed some interesting findings in mice, providing a possible explanation as to why muscle repair becomes faulty as we age. The authors
RESEARCH
discovered that aged muscle fibres in mice produce increased amounts of Fibroblast growth factor 2, under stable conditions, which leads to satellite cells becoming active. As a result of this, the satellite cells are forced to become active and consequently loose their ability to self repair. Evidence supporting this came from the observation that when fibroblast growth factor signalling is increased, a reduction in the number of satellite cells and decreased muscle regeneration occurs. Meanwhile, decreasing fibroblast growth factor signalling reduced satellite cell depletion and preserved the capacity of ageing muscle to regenerate.
Where does that leave us? Exciting as it may be, this has only been demonstrated in mice, growth factor signalling is highly complex, and tissue regeneration is notoriously tricky. So, althought this discovery is great, it may only be the tip of the iceberg. In the meantime, whilst we wait for the new muscle ‘motivator’ to be developed. I have invested in a hula hoop and may even consider some vigorous exercise in the hope I may stave off this inevitable muscle ageing process. Who knows , a hula a day may keep some muscle atrophy away.
Winter 2012 GKT Gazette 4157
RESEARCH
Black Mamba to Numb the Pain Nathanael Yong MBBS4
T
he black mamba (Dendroaspis polylepis) is the longest venomous snake in Africa. On average, each bite produces 100mg of toxic venom; just 10mg can kill a fully grown man. An array of systems are affected namely the neurological, cardiovascular and the respiratory.
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The induction of these changes can cause death within a space of 20 minutes. Amidst the deaths which have been inflicted onto humanity by this noble and deadly creature, scientists from the Institut National de la SantĂŠ et de la Recherche
RESEARCH
MĂŠdicale (INSERM) in France have extracted proteins from its venom which they have named mambalgins. It is believed that mambalgins are able to bind and inhibit acid-sensing ion channels (ASICs) which are present on the cell membrane of neurons. ASICs, although not fully understood, appear to form part of the signalling pathway which allows for the sensation of pain. Indeed, pain is evoked when ASICs on peripheral nociceptive neurons are activated. Mambalgins have also been shown to be reversible inhibitors of ASICs which are present in the central nervous system, providing a desirable analgesic effect in models of pain that use mice. Results published in Nature have demonstrated that mice which were injected with mambalgin had a greater pain threshold than those within the control group. Mice also had reduced hypersensitivity to pain following tissue inflammation. When naloxone was administered into a subgroup of mice, it seemed that the analgesic effect exerted by mambalgin was not extinguished, indicating that the observed analgesia does not depend on opioid receptors. When pain persists for longer than is necessary for nociception it becomes chronic
pain, causing a great deal of distress to its sufferers. It can arise from a variety of causes and can be very difficult to treat. Indeed, many hospitals have a specialised pain department to help treat those with chronic pain. An analgesia ladder is a flow chart to aid clinicians when deciding how to best manage a patient's pain. Many patients would have ascended the ladder, trying numerous drugs before being placed on an opiate such as morphine or diamorphine (heroin) - of course this depends on the cause and course of the pain experienced by the patient. The sometimes inevitable administration of morphine may or may not alleviate the pain, but even when it is able comes at a huge cost. With the desirable analgesic qualities of morphine and its siblings comes nasty side effects, which are unpleasant for patients and can cause cli nicians a bit of a headache. Adverse effects of opioids include: Gastro-intestinal symptoms: Opioids are known to cause nausea, vomiting and constipation. They act on the myenteric plexus within the gastro-intestinal tract, reducing gut motility and causing constipation. This effect is often countered by
Winter 2012 GKT Gazette 4159
RESEARCH
adding a strong laxative. Prevention of nausea and vomiting can be countered by anti-emetics. However as many patients requiring opioids potentially require several drugs to treat comorbidities, the addition of these drugs required with opioid can lead to unnecessary polypharmacy.
duce the unpleasant symptoms exhibited by the dependency on opioids. Although long term use of both the venom protein and opiates on mice showed issues with dependency, the undesired effect was less pronounced on the mambalgin arm of the study.
Tolerance and dependence: Tolerance develops easily with continual usage of this class of drugs. Therefore the dosage needs to be increased regularly in order to receive the same therapeutic effect. Chronic use can lead to drug dependence. When this occurs patients may develop withdrawal symptoms which may be difficult to manage.
Although much hope comes from this research and many other studies using venom-derived analgesics, there is still a long way to go before this protein or related compounds would enter human trials, let alone become stocked in pharmacy dispensaries. However we can be optimistic that the curiosity of scientists has yielded this and much other valuable information. Perhaps we may see the day when unnecessary pain can be alleviated once and for all.
Drowsiness: The sedative effect of morphine and other opioids is well documented. Although beneficial in some cases, most people living with chronic pain view it as a burden to cope in their daily living activities. Respiratory Depression: Arguably the worst of the adverse effects associated with morphine. This is often the main reason as to why dosage is meticulously calculated before administration. A digression into opioid pharmacology is necessary to appreciate the value of this piece of research. It was found that unlike opioids, mambalgin did not alter the mice's respiratory rate. As gastro-intestinal issues are driven via the opioid pathway, the use of mambalgin can potentially re-
Previous page: A Black Mamba and a model of the structure of an ASIC Right: Illustration by Kate Anstee
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New T New Textbooks Te extbooks x fr from rom Wiley-Blackwell Wile y-B Blackwell All writ written ten by by ren renowned owned names in their fi fields, elds, the theyy feature feature fully updated u and new artwork, answers Wiley ne w art work, MCQs MC CQs and answ ers ffor or self-assessment, selff-assessment, and an enhanced en nhanced W iley provides digital Desktop Edition iin n the price of the book. This This pro vides an interactive interactive d igital vvererr-downloadable text sion of the book ffeaturing eaturing do wnloadable e te xt and images, images highlighting highliighting and note book-marking,, cross-referencing, in-text searching, ttaking aking ffacilities, acilities, book-marking b cross-referencing e , in-te xt searc hing, and linking references to ref erences and d glossary glossar y terms.
5
ARTS & CULTURE
things to do this month
Sabeen Chaudhry MBBS3
Watch Uncle Vanya at the Haymarket Theatre- Featuring Laura Carmichel and Anna Friel, this promises to be an enjoyable re-telling of Chekhov’s classic.
See Art of Change: New Directions from China- This radical new exhibition at the Hayward Gallery showcases contemporary installations and performance art from China, boasting structures created by live silk worms and a person mysteriously levitating, amongst other truly arresting works. It might just change the way you view contemporary art! 4162 GKT Gazette Winter 2012
ARTS & CULTURE
See Death: A Self-Portrait at the Wellcome Trust- Delve into the macabre collection of Richard Harris.
Watch Michael Haneke’s Amour- a grave tale of love and ageing from the twotime Palme d’Or winner.
See Hollywood Costume at the V&A- A dazzling new exhibition displaying movie memorabilia from Darth Vader’s helmet to Dorothy’s red slippers
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ARTS & CULTURE
Artistic Revolutionaries
The Pre-Raphaelites: Victorian Avant-Garde
Sabina Checketts MBBS 4
T
o me, Victorian and Avant-Garde are oxymoronic words; they contradict each other. The confusing aspects of the new Tate Britain show are reflected in its title. In my opinion, the Tate has missed an opportunity with this show to borrow beautiful paintings from around the world by this group of artists. Instead the show is
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rather insular, filled with works from their own collections. The Pre-Raphaelite Brotherhood of artists, poets, critics and craftsmen was founded in 1848 amidst a year of continental revolutions, the publication of Karl Marx’s Communist Manifesto and the English Chartists’ Riots calling for political reform. John Everett Millais,
William Holman Hunt and Dante Gabriel Rossetti formed the core of the group and were joined by others incluing Edward BurneJones, William Morris and Dante’s brother William Michael Rossetti. Interestingly enough, Dante Gabriel Rossetti was the son of Gabriele Rossetti who fled Italy and became a Professor of Italian at King’s College London.
The Brotherhood took their name from an earlier group of German artists who were known to Rossetti’s teacher and friend, Ford Madox Brown. The group aimed to revolutionise art. Their four stated aims were: • To have genuine ideas to express • To study nature attentively, so as to know how to express them • To sympathise with what is direct andserious and heartfelt in previous art, to the exclusion of what is conventional and self parodying and learned by rote • Most indispensable of all, to pr0duce thoroughly good pictures and statues
They wanted to continue where art finished (in their view) with the detailed and colourful masterpieces of 15th century Italian and Flemish art. They rejected the art from the Renaissance and Post-Renaissance styles since Raphael - the last 400 years! They believed that Raphael’s ideas about Classical poses were a corrupting influence on the teaching of academic art. They particularly disliked the founder of the Royal Academy of
Opposite page from left to right: Millais, Rossetti & Holman Hunt Above: Evenlode by William Morris. Left: La Belle Dame sans Merci by John William Waterhouse
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ARTS & CULTURE
Arts, Sir Joshua Reynolds, with William Michael Rossetti describing him as ‘sloshy’, meaning “anything lax or scamped in the process of painting... and hence... any thing or person of a commonplace or conventional kind.”
scandal. In 1985, John Millais married Effie Gray who had her marriage to John Ruskin annulled after six years due to nonconsummation. The Brotherhood ended in 1953 when Millais was elected to the Royal Academy.
Their anti-academic ideas brought them into conflict with the art establishment of the time. In 1851, after the group received strong criticism led by Prince Albert, they appealed for support to a foremost art critic of their time, John Ruskin. He wrote two letters to the Times in their defence. The Brotherhood was not immune from
Many of the Pre-Raphaelite’s works were inspired by poetry and plays. This includes two of the most recognisable works: The Lady of Shalott (not Shallot; from Lord Tennyson’s poem) and the melancholic Ophelia from Shakespeare’s Hamlet. Mariana by Millais is also from a poem by Tennyson while Waterhouse’s.
Below: Ophelia by John E. Millais
ARTS & CULTURE
One of the group’s beliefs was “L’art pour l’art” or “Art for art’s sake,” an aesthetic view as portrayed by Dante Rossetti. They showed a more realistic portrayal of female sexuality often hinted at by the luxuriant, lengthy locks of many of the muses who were also often the mistresses of the artists. Millais’ Mariana shows a woman in a brilliant blue gown stretching aching muscles weary of waiting for her lover who has forsaken her. The Tate’s exhibition contains gorgeous furniture and wallpaper by William Morris. Morris believed in reintegrating archi-
tecture, painting, sculpture and the crafts thus restarting what we now know as ‘arts and crafts’. He wrote "Have nothing in your home that you do not believe to be beautiful or useful." I found it amusing how the audience can reflect the art. Conceptual art viewers are inclined to wear black and white, while those attending the private view for the Pre-Raphaelites wore startlingly bright clothing and a number had the striking Titian hair as vividly depicted in many of the wonderful works on the walls!
Thomas Getty MBBS3
V
ictorian London was the capital of the empire on which the sun never set, but away from the grandeur of Westminster and Kensington, the world’s most populated city was a dark and increasingly dangerous place. During the 1820s the working class – already suffering from extreme poverty and disease – was confronted by a new, ghoulish terror. Bodies began to disappear from graves, mortuaries and even from hospitals. Panic swept the streets as rumours of the ‘resurrection men’ spread, but the worst was yet to come. Men, women and children began to vanish from the streets only to reemerge in the dissection rooms of London’s hospitals and anatomy schools as the latest specimens to sate the intellectual desire of aspiring surgeons. The morbid trade between body snatchers and London’s surgeons is the focus of the Museum of London’s latest exhibition, Doctors, Dissection and Resurrection Men, which presents in gruesome fashion the
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stories of the most infamous resurrection men and the fate that awaited their victims. From the moment you step inside your senses are assailed by leathery patches of skin kept as mementos from famous dissections, rusty coffins designed to protect bodies from the resurrection men and the recitations of the macabre Ballad of the London Burkers. Whilst viewing this exhibition will only take an hour, the sights and sounds will send shivers down your spine for days. This was an era of great advancement for medicine and surgery, as demonstrated by the vast collection of anatomical models and drawings made during this period, yet London’s medical schools were perceived to be inferior to their Parisian rivals by the medical profession. As a result, the Royal College of Surgeons controversially demanded that anyone seeking membership was required to have dissected 3 human bodies. This forced the main London teaching hospitals offering dissection
ARTS & CULTURE
(Guy’s, St Thomas’, Royal London) and private anatomy schools to adopt Parisian dissection methods, moving away from students observing dissections to individual dissections. The price of the anatomy renaissance was discovered in 2006 when Museum of London archaeologists excavated an unofficial cemetery at the Royal London Hospital, revealing some 260 bodies that had been used in dissection between 1825 and 1841. Some of the examples on display include bones wired together to create skeletons, animal skeletons for comparative anatomy and fragments of skulls that had been sawn apart.
The most engaging section of the exhibition tells the story of London’s version of Burke and Hare – the body snatchers Bishop, Williams and May. As you walk down the corridor into the gloomy space the eye is drawn to a series of satirical cartoons, the most strikingly farcical depicting a resurrection man carrying a basket containing a woman’s body as he is chased by the police. All sense of the comic is swiftly lost though, as you are then confronted with a video detailing the story of a young boy who was killed by Bishop, Williams and May. The child (detailed in resurrection men ledgers as a ‘small’) was offered to Guy’s Hospital – who refused to buy the body – then to King’s College
School of Anatomy, who bought it for 9 guineas. Upon examination of the body, the horrific truth that the boy had been killed to be sold was discovered. The 3 men were found guilty of murder and sentenced to death, but their punishment did not end there. The only bodies legally supplied for dissection were those of executed murderers, so it is with mixed emotions that you see the patches of skin belonging to each of the three murderers preserved from their dissection. Astonishingly body snatching was not a crime during the 1820s, as legally a body was not a possession and therefore could not be stolen, so any resurrection men who were caught only faced minimal official punishment. Given that selling a single body for dissection would earn a labourer’s monthly wage coupled with the growing demand for corpses, it created an environment where as many as 10 bodies were taken every night. Only after the high profile trials of Bishop, Williams and May did Parliament react to public opinion and passed the fiercely debated Anatomy Act in 1832. This was only replaced in 2004 by the Human Tissue Act following the Alder Hey scandal in the 1990s. Although the majority of the exhibition focuses on the nadir of illegal dissection in the 1820s, it also challenges both society and the medical community to consider the role of dissection in medical training by displaying various synthetic models that are on loan from Stanford medical school alongside video interviews discussing the ethics and advantages of dissection in the 21st Century. With many of the UK’s medical schools divided on the importance of dissection in undergraduate medicine, the exhibition’s multifaceted comparison of the techniques available to study human anatomy provides an invaluable insight for the whole medical community into the balance between ethical responsibility and surgical teaching.
New artistic dimension coming to Guy’s Campus
Simon Cleary, 3rd Year Physiology & Pharmacology BSc These fantastic dissection -inspired portraits of Dali and Van Gogh were created by advertising agency DDB Brazil for the Museu de Arte de São Paulo Art School
On the theme of medicine/scienceinspired art, King’s College has recently appointed Deborah Bull as Cultural Institute Executive, hoping to develop interactions between the creative artistic communities of London, and academic communities at King's
We Would love to know if your studies inspire your art, and if you’d like work showcased in the Gazette, contact us! Winter 2012 GKT Gazette 4171
The Vagabond & the Demagogue:
The Master
Sabeen Chaudhry MBBS3
H
aving garnered various awards at the Venice Film Festival, Paul Thomas Anderson’s The Master is decidedly uneasy viewing. Both Anderson and his cast impart a tense energy and dark zeal, resulting in a film that is somehow held shimmering in perfect suspension but which slightly evades one’s grasp.
The film focuses on an unlikely dalliance between the lives of a wayward World War II veteran, Freddie Quell (Joaquin Phoenix) and Lancaster Dodd (Philip Seymour Hoffman) the founder and ‘Master’ of a cult who refer to themselves as ‘The Cause’. As has been controversially noted, Dodd was loosely based on Scientology founder L. Ron Hubbard. However, Anderson also draws from other diverse sources including John Steinbeck’s memoirs, and the fragile angst of post-war America.
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Indeed, Anderson champions a truly subjectivist approach to auteurism, spinning stories from rather obscure, strangely related topics that happen to pique his interest; seemingly without too much of a care whether they would enthral his audience. This is employed instead of the oftfavoured approach of basing a film on gross universal topics and then letting one’s idiosyncrasies surface. Anderson begins with clashing idiosyncratic ingredients that seem as though together they will be unpalatable, yet have been lapped-up by viewers and many critics alike. At the heart of the film’s enhanced quality to cause a viewer to suspend all disbelief are Phoenix and Hoffman’s incredible performances. Freddie, a mal-adjusted nymphomaniac who manages to stowaway on Dodd’s cruise ship, beginning the strange wrestle/embrace of anti-thetic per-
ARTS & CULTURE
sonalities is imbued with a twisted effervescence to the extent that Phoenix even physically contorted his own body, further adding to his multi-faceted and wholly believable protagonist. Guardian film critic Xan Brooks describes Phoenix’s portrayal of Freddie as “a modern-day Caliban, wild and wonky and ready to blow.” Indeed, Pheonix’s Freddie is closest to what we could call our base animalistic nature, he is at times almost feral and furthest from the pseudo-intellectual Dodd’s notions of ‘higher’ man. And yet Freddie becomes one of ‘The Cause’s’ most fervent members. Hoffman, in turn, creates a tersely controlled and calculated, yet oddly warm ‘Master’ who we are led to believe is indulging in quackery in claiming that his various forms of ‘past-life regression’ therapy can enable drastic psychological and somatic benefits. Nevertheless, we cannot help but feel an unsettling empathy with
Amy Adams as Peggy Dodd
him. After all, most of us can understand the desire to be great, the want to create. At one point in the film, Dodd even appears to recognise that his purported ‘pastlife regression’ therapy is an imaginative exercise, altering the word “recall” to “imagine” in his new book. One could almost admire his imagination, his desire to implement what Anderson describes as a hopeful and even beautiful idea of looking back to past lives to ameliorate the future. Rather than being seen as, “making it up as he goes along,” Dodd could conversely be viewed as an artist who is constantly creating an interactive work of fiction or art rather than something which should lay claim to reality. Yet Anderson leads us to examine what we take to be this reality. Perhaps our feelings of empathy for Dodd are cleverly brought to a climax in a scene where Dodd sings to Freddie, stripping down his pomp and bravado to a touching longing for Freddie not to leave him.
ARTS & CULTURE
Those who have seen Anderson’s previous films will be aware of his penchant for characters to occasionally break out into song (-quite spectacularly in Magnolia,) which he seems to use here as means of profound transcendence to enable us to understand Dodd as ‘not all bad’. It is Anderson’s ability to polarise our own thought, to expose not only his characters, but ourselves as fractional, multi-dimen-
sional, contradictory, that defines his skill. Often, during the film, I found myself experiencing a feeling or enveloped in an atmosphere I could not quite define or attribute to a particular scene or event within the film. It is almost as if Anderson intentionally evokes a synonymous ambiguity to that experienced by his characters in relation to events, whether to believe ‘The Cause’, and
ARTS & CULTURE
knowing themselves. Anderson states in an interview that, “by the end of the film nobody really has an epiphany...they go through a lot but they don’t really get to something that they figure out...they start the same and they end the same.” Make what you will of this mystical circularity; whether you quite believe that the characters are entirely the same or not, I doubt you will forget them in a hurry.
The Master is currently showing in various cinemas around London. Year of Production: 2012 Country: USA Cert (UK): 15 Runtime: 143 mins Director: Paul Thomas Anderson Cast: Joaquin Phoenix, Philip Seymour Hoffman, Amy Adams, Laura Dern, Price Carson
CAREERS
FPAS explained
All you need to know about foundation application
Sally Kamaledeen MBBS 5
T
oday, as you happily (or begrudgingly) drag your fourth year self to your next paediatric clinic, labour ward on-call or stint in orthopaedic theatres, you may be forgiven to think that foundation applications and your first day on the wards as a junior doctor are miles away in the future, and do not warrant much of your elective-planning, OSCEdreading attention. However, thinking about your foundation application, where you would like to work in the future, and achievements you need to demonstrate on
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your CV or portfolio in order to stand out from the crowd, is becoming ncreasingly important as a medical student. Changes to the Foundation Programme From this year, there have been some changes to the Foundation Programme application process, in order to improve selection to foundation schools and facilitate the transition from medical school into foundation years. Until now, selection to the Foundation Programme has been Opposite page: KCL School of Medicine graduation photos, Š King’s College London
CAREERS
based on academic quartile ranking, which made up 40% of the application form, and submitting answers to open-ended “white space” questions, making up the remaining 60%. Increasing concerns regarding plagiarism amongst students, students ‘learning’ to answer the questions better, and the academic quartile ranking not being able to provide enough distinction between students led to the Department of Health (DoH) commissioning the Medical Schools Council in 2009 to review these methods, and so the Improving Selection to the Foundation Programme (ISFP) project was established. The results concluded that an invigilated, Situational Judgement Test (SJT) composed of multiplechoice questions testing a variety of real-life clinical scenarios similar to those that would be experienced daily by junior doctors, and ranking students in academic d e c i l e s whilst
CAREERS
awarding them additional points for other academic achievements (Educational Performance Measure – EPM), were much more reliable methods of selection, and were introduced to replace the “white space” questions and quartile system, respectively, for this year’s cohort applying to the Foundation Programme. EPM and SJT: In Depth The Educational Performance Measure (EPM) reflects how the applicant has performed academically up to the point of applying to the Foundation Programme. It has three components, giving a total score of 50 points: 1) Medical school performance (maximum 43 points): the students are split into deciles according to their academic performance in years 3 and 4 of the course, and points are awarded accordingly, so students in the first decile receive 43 points, and those in the lowest receive 34 points. 2) Additional degrees (maximum 5 points): The points awarded towards ad-
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ditional degrees also correspond to the class of degree you have achieved. For example, having a Masters degree or a 1st class honours BSc would grant you 4 points, whereas achieving a 2:1 on your BSc would give you 3, and so on. A PhD would give you 5 points. 3) Publications, presentations and prizes (maximum 2 points): In this section, only 2 points are awarded for having any of an educational prize (1 point), an oral or poster presentation at a national or international conference (1 point), or a publication of a research paper in a peer-reviewed journal (1 point), regardless of how many of these components you have already achieved. The second part of the application is the multiple-choice Situational Judgment Test (SJT), for which the total score is also 50 points. The test is designed to assess the professional qualities and attributes required from a junior doctor, as identified from analysis of the role set out in the GMC’s Good Medical Practice guide (2006). The scenarios tested are not nec-
Below: Exam hall, © King’s College London
CAREERS
essarily ‘medical’ in nature, but reflect the everyday issues and challenges of working on the ward that we as junior doctors must be adept at and aware of, such as the importance of good communication, interprofessional relationships, patient safety, and probity. The question formats are either ranking a set of five responses to a given scenario in the most appropriate order, or selecting the most appropriate three responses for a given clinical situation. The SJT is performed under exam conditions and at the moment comprises of a possible 70 questions to be answered in 2 hours and 20 minutes. How do I prepare? Now that you know the
structure of the application, you can start by bookmarking the Foundation Programme website (www.foundationprogramme.nhs.uk) and visiting it every once in a while in order learn more and keep up with any possible changes to the application. Once this application cycle is over, you can even sign up on the website to receive email updates direct to your inbox alerting you of any developments throughout the year. Also, doing well in your fourth year exams will inevitably help secure you a place in a higher decile and add more points for your application. If you are in the process of writing up a case report or working on a research project, it is worth looking for conferences and meetings relevant to your field of work in order to submit your abstract and to hopefully get the chance to present a presentation or a poster at a conference, gaining you more marks. Similarly, submit your abstract to a relevant peer-reviewed journal to get that muchcoveted publication. Look out for any prizes, for example by browsing the medical students’ section on the website of the Royal College of your chosen specialty, or
the Royal Society of Medicine, which has sections for each medical specialty and regularly advertise prizes for submitting case reports or essays on topics pertaining to that specialty. It is also worth browsing websites of different Foundation Schools and downloading their prospectus in order to find out more about the number of foundation posts they offer, their competition ratios and types of medical and surgical specialty rotations that they have. For the SJT, you can download the practice paper from the Foundation Programme website and have a go at the questions, as the answers include full, detailed explanations on how to approach the scenario as expected from an F1 doctor. There are a few SJT books that have recently become available on the market, but do not get into a buying frenzy now, and remember that the SJT is testing your professional aptitudes learnt from time spent on the ward, which no book can possibly prepare you for. Finally, try to locate one of your widelydispersed final year medical student friends to discuss any aspect of the application you wish with them, including the SJT. Best of luck, and happy planning!
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Ward Round a New Medical Learning Experience Dr Adrian Raudaschl FY1 Glasgow Royal Infirmary
Apps for smartphones and tablets are an exciting new medium that is still in its infancy. In medicine there is huge potential for new types of medical education based games, interactive eBooks and tools for everything from antibiotics doses to ECG interpretation. One warm March evening a year ago, after months of study hibernation before 4088 GKT Gazette Freshers Edition 2012
by final exams, I was inspired to go and create something myself; something not only educational but also enjoyable to play. What followed was a journey of inspiration, research, long hours and design to create something truly unique in a market saturated with dull, unexciting medical apps. The question was how to go from medical student to app developer in the limited time before my full-
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time job started in September. First I needed to clarify what exactly I wanted to create. During my studies I had become annoyed with how online medical question banks asked fragmented questions about medical conditions and were difficult to navigate. I wanted to create a question bank that dealt with patient case scenarios in a holistic way; everything from differential diagnosis to investigations and treatments so that you would feel as if you had dealt with a case in its entirety. Equally, the design should be as important as the medical content; a beautiful interface has the power to turn something from a dull chore into an inspiring and entertaining experience.
This app would soon become known as ‘Ward Round’. A solid month was spent downloading and playing with every kind of app from medicine to games and art. I needed to find what elements worked and how they could be incorporated. Despite the content being a high standard, incorporating too many gamification elements could result in the app alienating some medical professionals. Similarly, a conservative design would mean we were not innovating at all. I religiously carried around a pen and sketchpad scribbling down ideas and constantly asking friends and flatmates for feedback (some of which eventually
Freshers Edition 2012 GKT Gazette 4444
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became threats starting with “If you mention that bloody app one more time...�), and soon I was ready to start writing the first draft of the design document. A project this big meant I needed to put a team together to make it happen. Seeing as I wanted to include an attractive design and glamification elements, it made sense to turn to the games industry. Luckily an old friend and flatmate of mine who worked in the video game industry was starting a company called Guerilla Tea. I told him the idea for Ward Round and he arranged a meeting with a group of artists, programmers and developers where I presented the concept; after some negotiating they agreed to start development. Next I had to create the question bank. Over the course of a few months a friend and myself researched and produced a database of roughly 180 patient case scenarios and 900 multiple-choice ques-
tions covering nine medical/surgical disciplines. It was no easy task; case histories had to strike a balance between being challenging but not misleading. This is especially true when a set of signs and symptoms such as abdominal pain could easily yield five differential diagnoses; but by including things like lab results or scans we tried to ensure the user would not feel cheated by the answer. Sitting now and playing Ward Round in a moment of boredom is such a gratifying experience. Sometimes its easy to forget that this App was just an idea not even one year ago, and now people around the world are downloading it and enjoying the same experience. If you have an great idea for an App I say go for it and pursue it to the end. The Steve Jobs of medical apps could be you.
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NURSING
The Critics of Florence Nightingale Ben Clavey Adult Nursing BSc 3rd Year
I
her name. A statue of her stands in the main hall at St Thomas’s Hospital, lamp in hand.
Florence Nightingale is known as the nurse who practiced in the 19th century and was famous for improving conditions for soldiers injured during the Crimean War. She then proceeded to set up the first school of professional nursing, located at St Thomas’s Hospital. The School of Nursing and Midwifery at King’s College London is the descendant of that school and bears
As an upper class woman she defied convention by becoming a nurse. She felt God spoke to her and told her it was her path in life. She travelled to the Crimea to care for injured British soldiers. Her work with injured solders would make her legendary. She was reported to help clean up the hospital and reduce the rate of infection. She was portrayed in the Britain as the lady with the lamp, a compassionate soul tending to those in need.
f asked to name a famous nurse it is fairly obvious what name you might pick. It’s Florence Nightingale, if you picked someone else you were likely making a conscious effort not to choose her.
Below & right: Currency commemorating Nightingale
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NURSING
After returning from the Crimea she became unwell and spent most of the rest of her life writing from her bed. The volume of correspondence and diaries she wrote is another reason for historian’s interest in her. Her family was connected to highpowered people and she had achieved a celebrity status spurred on by the evolving media of the time so kept in close contact with the important men of the time.
Below: Lamp used by Nightingale © NAM
Nightingale has been on bank notes and had hospitals named after her. She is perhaps the most famous woman of her time aside from Queen Victoria. Yet historians recently have been busy discussing her flaws. Nightingale thought all nurses should be female, Christian and unmarried. If someone today removed any nurse not fitting that description from the register it would be a very small profession indeed. In fact the overtly religious nature of her carer is often left out of modern accounts. Privilege was something that followed her throughout her life. In fact some reports state that she didn’t dress herself until the year before she left for the Crimea, at the age of 33. She had differences with doctors in the Crimea who were often of a lower class than her. Some of her comments in documents of the time make it appear that she was somewhat of a snob. She also strongly opposed registration of nurses, which seems unthinkable now. She felt that nurses should have appropriate moral qualities and that a register wouldn’t allow for this. While she did eventually privately admit to support germ theory, she was resistant for some time and this along with her class based preju-
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NURSING
dice has led to some accusing her of being overly set in her ways to the detriment of patient care. These criticisms are a little unfair. It is worth remembering how different the world inhabited by Nightingale looked. Nightingale could never vote, she would never see antibiotics used in clinical practice and the first flight across the channel only occurred a year before her death. It seems slightly unreasonable to hold her to modern standards of thinking. How much things have changed in hospitals since Nightingale left them is a good reminder of how things in healthcare can change, if you can wait a century for it to happen. The larger reason Nightingale is the subject of so much criticism is she is unique. Nursing has few other famous role models. In fact few professions have one role model who is Right: Statue of Florence Nightingale by Arthur George Walker, in Waterloo Place
so much better known than any other. You can talk about lots of other nurses like Mary Seacole but Florence Nightingale is in a league of her own. This status means see is an obvious target for analysis. So maybe nursing doesn’t need a better role model maybe it just needs more of them. So maybe a new role model should be found - or at least others. It would be helpful if this nurse hadn’t died over a century ago. Not because there is nothing to learn from Nightingale but because we need a role model who we can look to for modern problems, like how we can provide compassion and care in a secular society, the way to build systems that promote social inclusion and how to how we learn to adapt to a world that is rapidly changing. Then maybe we can leave Nightingale alone and just celebrate her achievements.
The Lec Lecture cture Note Notes es series The Lecture The Lecture Notes Note es series provides provides concis concise, se, yet yet thorough, introductions introdu uctions to core undergraduate curriculum, areas of the unde ergraduate cur riculum, covering co overing both the basic science s and the approaches students clinical approac he es that all medical st uden nts and junior doctors need ne eed to know. know.
DENTAL
Guy’s graduate goes the distance
Dr Malcolm Brenchley Guy’s Graduate Class of 1957
which arrived on the 25th August, a distance of 875 miles. Zena had therefore cycled 1779 miles in 15 consecutive days at about 120 miles per day, and has raised some £4000 so far.
W
e have been enjoying watching the elite (essentially professional) athletes competing in the Olympics and Paralympics this year, particularly the superb cycling squads. More pragmatically though, I would like to draw your attention to my daughter Zena’s recent massive achievement. She cycled from Land’s End, leaving on Friday 10th August with five female friends, the “Winkleigh Ladies”, arriving in John O’ Groats on Friday 17th August. It was Zena’s enthusiasm that encouraged this 4192 GKT Gazette Winter 2012
group of 6, most of whom eight months before had never cycled more than a few miles on the Tarka trail, to successfully ride 904 miles to John O’ Groats averaging some 120 miles per day and to raise some £8000 for the Wooden Spoon and for the Chemotherapy Appeal in North Devon. At John O’ Groats Zena waved goodbye to the other ladies when they jumped into the van for the return journey to Devon. She, in contrast, immediately joined the start of the Wooden Spoon charity organised ride to Land’s End
It is, of course, very difficult to wind down in a practical way to “normal life” from such physical activity. Zena made a start the following Tuesday by cycling to and from work in Barnstaplesome 46 mile round trip. Not the least of her challenges is to restrict her diet to one more in keeping with the calorific output of an orthodontist, having hoovered up all vegetarian food not screwed down, when on the ride, including bananas decorated with dollops of Nutella. Zena is fast approaching her 50th birthday and has two children, one of whom was born with Down’s syndrome. The fact that she achieved adequate fitness speaks volumes for her grit and determination and for the family support she received. She is no stranger to pushing her body to the
DENTAL
limit for charity. Cycling across the Rockies in 2008 (320 miles in 5 days), the Lakeland Challenge (Canoeing, cycling and running) in 2009 when her team of three females won both the Ladies and the Mixed event, the Bideford half marathon 2011, and the Wooden Spoons John O’ Groats to Land’s End cycle ride over seven and a half days in 2010. She really enjoyed this challenge, finding that though she had very long days in the saddle she still felt fairly fresh when she got to Land’s End. She explained how she ended up doing this latest challenge. “ I was looking to take on another challenge, and my husband jokingly suggested that I could cycle up and meet the others at John O’Groats. Unfortunately for him, I thought it was a great Previous page: Lakeland Challenge The Finish Right: Keir, Zena’s son
idea, so he is the one to blame – as he is for most things. He reckons I only do these challenges to get away from him and the kids!” Zena qualified at Guy’s in 1986 and did her Orthodontic training in Cardiff. She works in Orthodontic practice ( Torrington and Barnstaple) some 3 days a week and is a partner with her husband, Ian, in the dental practice they set up 15 years ago. Zena and Ian have organised various events over the years and with the practice team have managed to raise over £50,000 for children’s charities. Wooden Spoon (Spoon) is a children’s charity that
DENTAL
To learn more about Wooden Spoon and ts projects visit www.woodenspoon.com Right: Zena en route climbing
improves the quality and prospect of life for children and young people who are disadvantaged physically, mentally or socially. Strongly supported by the rugby community, it was formed in 1983 when the England rugby team received the “Wooden Spoon”. Since then Spoon has spent £15m helping over 500,000 children and young people across the UK and Ireland.
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Spoon delivers rugby projects to help children and young people combat bullying, violence, crime, obesity and discrimination. It also makes grants to special projects that meet it’s aims which have included hydrotherapy pools, young people’s life-skills centres and sensory rooms. Spoon now raises over £1.5m a year through national events such as the Spoon chal-
lenges and through regional volunteer fund raising. The charity’s patrons are HRH The Princess Royal, the governing bodies of Rugby Union in England, Ireland, Scotland and Wales, and the Rugby Football League. It has the support of a host of rugby legends and other high profile celebrities from the worlds of music, sport and the media.
Anthony Nolan is a pioneering charity that saves the lives of people with blood cancer who need a blood stem cell, or bone marrow transplant. Now, every day, we help two people in need of a lifesaving transplant by using our register to find remarkable donors who have matching stem cells, or bone marrow. www.anthonynolan.org
The GKT Gazette Invites Companies to Use Our
Advertising Space For more information, contact gkt.gazette.editor@gmail.com Winter 2012 GKT Gazette 4195
DENTAL
Jessica Maskell BDS4
Sumeet Oberia GKT BACD Representative 2012/13
G
KT Dental Institute is incredibly pleased to call Sumeet Oberai its British Academy of Cosmetic Dentistry Student Representative of 2012-13. A top Guy's man, Sumeet (BDS Year 4), holds very dear the ethos of 'work hard, play hard'. His father studied at GKT and Sumeet can standardly be found winning for us on the hockey pitch and then of course, making the most of the social afterwards. "I am a big advocate for following your passions in life whatever they may be. If you are passionate about something then you will be successful at it! Guy's wise: I am extremely proud to be here given our great and magnificent history!" - Sumeet.
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So Sumeet, for those who might not know, what is the BACD and what are its aims? The BACD stands for the British Academy of Cosmetic Dentistry and essentially it promotes minimally invasive, high quality, ethical aesthetic dentistry. Unfortunately, cosmetic dentistry gets a bad reputation for the "six to six veneers with a hollywood white shade" but this field of dentistry has really moved on and developed. Aesthetics is important in all fields of dentistry and one could argue every dental procedure considers the final aesthetic result. The BACD really promotes the highest quality dentistry practised in an ethical and conservative way: a level nearly all dental stu-
DENTAL
dents aspire to achieve at some point in their career. Tell us about your journey of involvement with the BACD?
“I am extremely proud to be here given our great and magnificent history!"
I like the concept of fate but I am more of a believer in of probability and chance. I have always been interested in aesthetic dentistry and if you talk about it enough to people you will meet someone involved in the BACD! Essentially, I was drafted in to be a student volunteer at a BACD Annual Conference and have been involved ever since, recently becoming the Guy's Representative. As part of the Young Membership Committee our aims are to make further education more accessible and popular to undergraduate students. As a student it is very difficult to break into further education given the set up for most dental organisations and we want to change this. What opportunities does the BACD offer to students? Student membership is now available at the price of ÂŁ30. As a student member one can attend workshops for ÂŁ1, be sent editions of the Journal of International Cosmetic Dentistry which are extremely educational, be an invitee for the annual conference and have the opportunity to
network with some of the most successful dentists in the country. I have got so much out of the BACD already in terms of learning from some inspirational dentists and I want others to benefit as I have done. What are your plans for the year as our Rep?
As the Rep my task is to promote the organisation and bridge the gap between dental students and higher education. Lots of work needs to be done and I feel that I need to plant the seeds for many years of growth and development for the BACD. As a young organisation many changes are taking place so it's great to be a part of something new and exciting. But longevity it the key and my role entails me to get students involved for the rest of their careers! I am also promoting events such as the Annual Conference and London workshops that are held at Wimpole Street. And your final message to Gazette readers? I would highly recommend any student or alumni interested to get involved! Check out http://bacd.com/ for further information or please feel free to contact me any time via e-mail (sumeet.oberai@kcl.ac.uk). The BACD offers some unique opportunities and I think it is increasingly important to think about further education.
Winter 2012 GKT Gazette 4197
Jessica Maskell BDS4 You have to hand it to KCL SMILE SOCIETY; another academic year on and the team and their admirable project is still going strong. Where others have waned, SMILE SOC have maintained impressive publicity campaigns and there are thus few Dental students at Guy's who are not aware of their presence and work. I caught up with the 2012-13 Co-Presidents: Pavan Devgun and Shivani Rana (Year 4) to hear their plans for growth over the next couple of terms.
'KCL SMILE SOCIETY is a student-run organisation that aims to promote oral hygiene awareness in the community with the help of dental students.' explains Shivani. The Society as we recognise it today was established by Zara Nortley and Louise Brownlow (now in Year 5) in 2009-10. They recognised that the inactive Smile Society at the time had the potential to be revived in order to provide a valuable outreach project that is lacking in the dental curriculum. The girls were onto a winner. 'It bridges the often wide divide between dentists and the general public in a really fun way,' continued Shivani. 'The students involved aim to increase dental awareness with children in mind, and by visiting schools and nurseries we are able to pass on important oral hygiene messages directly to them, but also importantly to their parents. Not only are we giving dental advice, we are often informing unknowing parents and carers that children are eligible for free dental treatment.' Pavan went on to share that the relaxed, non-clinical environment regularly coaxes parents to ask questions that
DENTAL
they would otherwise be afraid or feel silly to ask a dentist. 'It's fantastic when you can ease their minds or point out the little changes that they can make with their children that will make a big difference to dental health.' Staff President, Dr Jenny Gallagher (Head of Oral Health Services Research & Dental Public Health at GKT Dental Institute) helped to introduce the Society to Lambeth. 'Our efforts are so beneficial to those in local deprived areas' described Shivani. At first SMILE SOC had to coax schools to let them trial their workshops, but a database of keen partakers quickly grew and most recently the Society has had to turn down offers of involvement. Experience has allowed them to develop an effective learning programme most suited to 6-7 year olds that involves interactive stations in short 5 minute bursts.
were most excited about their potential forthcoming publication. 'We noticed that there were hardly any useful books around to help children to learn about teeth and brushing, and so we now really hope to develop our own.' Pavan added: 'We won't give too much away but are looking for involvement from January, in anything from story ideas to useful contacts or even illustrators.'
'Our work with children is of course a mainstay, but we feel ready now to be looking at expansion towards geriatric oral hygiene awareness. Engaging with the elderly requires a completely different set of skills to our previous work with children, and so will certainly stretch our student members, but it is a difficult line to tread. We don't want to come across as patronising, but feel that this sort of community work could be equally as helpful to the local community.'
'Basically, there's a lot of playing with babies,' laughs Pavan, 'with a huge sense of having made a difference. It's great to be able to 'give back' whilst unlike most dentists, we still have the time.'
The hardworking Co-Presidents also expressed their eagerness to engage in promoting oral cancer awareness, but they
For all enquiries, please contact shivani.rana@kcl.ac.uk or pavan.devgun@kcl.ac.uk
Below: Mona Lisa by da Vinci (detail)
Students are advised to keep their eyes peeled for involvement in this exciting project. KCL SMILE SOCIETY currently has around 90 members, the majority being students from BDS Years 3 and 4. Shivani and Pavan were keen to express that due to popular demand, they would like to hold another compulsory recruitment lecture for anyone who missed out on joining this Autumn term. For student members, the Society teaches the art of persuasion in environments often adverse to professional advice and school and community centre projects offer a fantastic introduction to the basic communicative skills that many find a challenge to master in Paediatric Dentistry.
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Have you got a great example of where an early intervention has had a significant long-term impact on a child or family? Do you know somebody working in early years who has experience and ideas that would enhance or enrich this research?
Guyâ&#x20AC;&#x2122;s and St Thomasâ&#x20AC;&#x2122; Charity, the London Boroughs of Southwark and Lambeth, and the Design Council have formed a new partnership to identity where the greatest opportunities lie for increasing the health and wellbeing of local children under five, including pregnancy.
For more information on the work take a look at our project blog:
The first stage of this work involves six months of research and engagement with professionals and families across Southwark and Lambeth. Listening to everyoneâ&#x20AC;&#x2122;s experiences, translating insights into new opportunities, and working together to shape and test new ideas.
Please drop us a line. kneehigh@designcouncil.org.uk
designcouncil.org.uk/kneehighblog
kneehigh@designcouncil.org.uk 020 7420 5260
Who was Keats? Tuulia Simpanen MBBS4
T
he Keats statue, Keats café, and now the KEATS elearning platform… You cannot avoid the name Keats while at Guy’s - but who was the man behind the name?
John Keats was a major figure in English Romantic poetry. He was born in Moorfields in 1795. In 1810, Keats’ mother died of tuberculosis and he was put under the care of a guardian by his grandmother; he had lost his father in a riding accident at the age of eight. Keats was educated at a school in Enfield, after which he became an apprentice to an apothecary-surgeon at the age of 16. Before completing his apprenticeship, he left to become a student at Guy’s Hospital from 1815 to 1816. While studying to become an apothecary (the ancestor of the
HISTORY
modern general practitioner) at Guy’s, Keats attended lectures on the principles and practice of surgery by the famous Sir Astley Cooper. However, Keats devoted himself increasingly to literature, and in 1816 he abandoned the profession of medicine for poetry. His first volume Poems was published in March 1817, but the reception was mainly negative. Later the same year, Keats’ brother George moved to the United States, and Keats was left to look after his youngest brother Tom who was ill with tuberculosis. While caring for his brother, Keats continued writing. Before the publication of his second volume Endymion in April 1818, he went hiking in Scotland and Ireland with a
friend, but was forced to return earlier than planned when he began to suffer from the early symptoms of tuberculosis. His work continued to receive negative feedback, and in late 1818 Tom died. Following his brother’s death, Keats moved to Hampstead and fell in love with the girl next door named Fanny Brawne; their affair is portrayed in the film Bright Star (2009). His third volume Lamia, Isabella, The Eve of St Agnes, and Other Poems was published in June the same year, and this time Keats’ work was well-received. However, consumed by his deteriorating illness, Keats was unable to enjoy the success, and his doctors ordered him to move to Italy to escape the English winter.
Keats arrived in Rome with a friend in November 1820 and settled in a house near the Spanish Steps. By December, despite a short period of recovery, Keats was extremely ill and confined to bed. He died peacefully at the age of 25 on 23 February 1821, clasping his friend's hand. If you would like find out more about Keats and his work, then Keats House in Hampstead is worth a visit. This is where the poet lived from 1818 to 1820 and met the love of his life before leaving for Rome. Some of Keats’ most memorable poetry, including the Ode to a Nightingale, was composed under a plum tree in the garden. Tickets are priced at £5 (£3 for students) and valid for one year, with regular talks and events he;d in the poetry reading room.
Previous page: Statue of Keats in Guy’s Campus, © King’s College London Right: Keats House in Hampstead
Winter 2012 GKT Gazette 4203
Medical Folk Art Bill Edwards Curator, Gordon Museum
T
his is an unusual addition to the Museum collections of the Gordon Museum on the Guy’s campus. This new acquisition is the product of student labour, with labour being very much the operative word and falls uniquely somewhere between the Museum’s superb collections of specimens and it’s artistic, historic and ephemeral holdings.
4204 GKT Gazette Winter 2012
In the corridor leading to the Life Sciences Museum at the Gordon Museum, you can see a wall covered in wood carvings. These date from between 1908 and 1954. Medical Students at Guy’s, waiting ‘on take in’ to deliver a baby had a lot of time on their hands and in 1908 an unknown student with an artistic bent and a knife started a tradition which lasted for 46 years.
Taking what appears to be some of the skirting board or panelling from the sitting room in which the students passed away the slow hours, he carved the date, his initials and a vaguely gynaecological scene. This ‘art work’ was greeted with approval by his fellows and became an important marker for students at this time in their undergraduate career. It needs to be said that a combination of medical student humour, the practice of obstetrics and gynaecology and what was acceptable between 1908 and 1954 is a potent brew. But even a cursory look reveals a whole wealth of insight into UK and
world history from the medical student’s perspective. The panel for February 1915 depicts the attack on London of German Zeppelins and conflicts such as the Spanish, first and second World wars are commemorated. There is much political and social comment, the general strike and general elections figure often. Needless to say the accompanying diagrams with labels such as ‘labour unrest’ and ‘tube strike’ take perhaps obvious twists. But there are surprises; the panel which references Shakespeare with ‘Loves labour Lost’ still manages to be tragic, whilst February 1923 depicts a very unusual version of the Loch Ness monster rearing up from the
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HISTORY
deeps. Many sporting events are celebrated, a panel from 1929 proudly announces ‘Ashes retained’ and shows an ambulance bearing the legend ‘Larwoods express deliveries’. Even cinema, the birth of radio and the breaking of the sound barrier appear, but always within a gynaecological setting.
The artist in residence at the Gordon Museum, Eleanor Crook, summed these carvings up most succinctly as ‘Medical Folk Art’. The Gordon Museum gratefully acknowledges the generous support of Karen Sarkissian, Director Art & Heritage at the Guy’s and St Thomas’ Charity, for the acquisition and display of these panels.
The Lec Lecture cture Note Notes es series
The Lecture The Lecture Notes Note es series provides provides concise, concis se, yet yet thorough, introductions introdu uctions to co undergraduate areas of the unde ergraduate curriculum, curriculum, covering co overing both the basic science and approaches clinical approac he es that all medical students studen nts and junior doctors need eed to know know
Success all-round for
King’s Boat Club at Cambridge Winter Head Elizabeth Vincent Management studies 3rd Year
O
n the 17th November, KCLBC left London before sunrise to travel up to The City of Cambridge to compete in the Cambridge Winter Head Race. Despite an early start and freezing cold conditions, all the crews were psyched up to win some medals and build on the successes of previous years. Despite good results allround, the biggest congratulations must go to the
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women’s 1st 4+ who convincingly took 1st place in the Novice Student category. Competing against a number of London Universities including; St George’s Hospital Medics and the Royal United Medical Schools, it is clear the squad’s training has really paid off. All the girls said they were ecstatic about the result, and really pleased with such a solid performance to start the season. Their Cox and Women’s Captain, Sarah
Beth Amos, said “I’m really thrilled. All the crews have performed well today, but the result for the women’s 4+ is fantastic, I couldn’t be more pleased”. The men also put in a strong performance, with the men’s 1st 4+ taking 2nd place in the Senior Student category. Despite missing out on a win, the men were really pleased with their performance, beating a number of Cambridge College Crews.
SPORT
The men’s captain Tom Jenkins, who also stroked the 4+, said “ I think it’s a great result. We will train even harder over the next few months and I’m sure we will be taking home some medals from the next race”. The successes don’t stop there! On the women’s front, the senior 8+ came 5th in the Student Novice category, the 2nd senior 4+ came 7th in their category;
while all the women’s fresher crews put in a solid performance, ranking 3rd, 8th and 11th in the Student B category. The men’s squad also maintained the KCLBC reputation with a number of great performances. The senior 8+ came 14th out of 25 in the Student Senior category, the men’s 2nd 4+ came 6th and the men’s 4- came 4th in their categories. The fresher
boys also raced extremely well and ranked 6th, 14th and 16th in the Student B category. After a long day of racing, all the crews rewarded themselves in the local pub, where the women’s 4+ received inscribed hip flasks to mark their victory. The celebrations then continued throughout the night and in to the early hours!
Opposite: Women’s 1st 8 Stroke to Bow: Sarah-Beth Amos (Cox), Emily Frost, Sally Trump, Sarah Bunk, Kate Thorne, Ellie Gillian, Marine Schreiber, Alice Murray and Beth Salmon Below: KCLBC Henley qualifiers 2012
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Guy’s Hospital II vs. King’s College Hospital II Tom Fenner MBBS3
W
ith the mercury reaching the dizzy heights of 16 degrees centigrade, Saturday 22nd September looked set to be a warm return to rugby for the men in navy and gold. A flock of 10 or so met outside Boland House, with the other half of the team opting to travel alone and calmly contemplate the day’s task. An atyp-
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ical display of punctuality allowed pre-match warm-up to begin a full hour before kickoff. Not a ball was dropped in the handling drills; a feat unfortunately not replicated in a game that was plagued with butter-fingers. From the kick-off KCH seemed happy to let us take the ball back and camp in
their 22. Great pressure from all involved left little option for the opposition but to kick for territory. A quarter of an hour into the match, a Guy’s line out went loose, bouncing favourably into the hands of Alex Osafo, who steamrolled through two tackles to place the ball over the line, followed by a slick conversion from Joe Wilkinson from near the
SPORT
touch-line. 7-0 to Guy’s. KCH came straight back to earn a penalty kick in front of the sticks, making it 7-3. A lot time was spent in KCH’s 22 as the Guy’s boys continued to apply good pressure. We twice again crossed the line, but were twice held up, after strong work in the loose and a solid maul. A lack of attendance at preseason training soon became apparent, with passes flying in all the wrong directions, and several times the ball was flung limply into touch. Frustrations grew and energy stores depleted, with another effort over the line by Scott Eastick deemed to be held up before halftime. A dismal start to the second half saw KCH score two unnecessary tries pulling the score up to 7-13. Joe Wilkinson soon restored the balance, running a neat
line to touch down under the posts, but again, KCH were allowed to pull one back, converting for the first time. Yet another defensive lapse left the score at 14-27, and the game just out of reach. Zack Taylor made an impressive 40m dash to leave just an 8 point gap, but this was how the scoreline remained. In all fairness, the better team won. We were outmuscled in the rucks, handling was very sloppy, and most of us could have benefitted from a second pair of lungs. Despite this, there were some encouraging qualities. We showed determination with ball in hand and spent a vast proportion of the game camped in the opposition’s 22, with a multitude of injuries leaving players in positions they’d barely heard of before. KCH are probably the most
youthful team we’ll play against this season, and played a brand of rugby unheard of in the Bishop’s Finger league, with the ball occasionally finding their backs who’s fingers were much less buttery than ours. All in all: plenty of room for improvement. Team: P. Theodorou, O. Glick, A. Osafo, B. HV, J. Stewart, T. Fenner (C), K. Patel, G. Child, S. Eastick, J. Wilkinson, Z. Taylor, D. Domanski, A. Brazier, A.Leggett, N. Campbell Subs: R. Carrington, J. Emmett, J. Wright, T. Umakanthan, S. Kosasih, S. Nayar Attendance: Not bad, at least 20. Tries: A. Osafo, J. Wilkinson, Z Taylor Final Score: Guy’s 19-27 KCH
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Westcombe Park Gents (Away) Tom Fenner MBBS3
O
n Saturday 17th November, all the men of blue and gold who weren’t spending their Saturday washing their hair – a sum total of 17, made their way to the idyllic garden of England that is Orpington. After a 40 minute debate with a rather difficult man behind the Boland House security desk, several security verifications, and a thorough pat down later, captain Tom Fenner was finally granted permission to retrieve an appallingly heavy, and very wet navy blue veterans’ kit. The young men would not let the moisture of the kit dampen their spirits, however, and negated the inconvenient delay by getting changed on the 11:45 to Sevenoaks. Upon arrival, preparations were brief, and were further shortened by the 15 cave trolls who waddled out of the clubhouse after us. The fact that we were playing against men 50 years of age, and 50 stone in weight, however, did not prevent us from putting on an abysmal performance in the first half. The grisly veterans trundled right through the
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middle of us time and time again, and even exploited the occasional overlap (God knows how) to pin us well behind on the scoreboard. Some great solo running from Matt Hemmings and George Ellis set up 2 tries in reply, but we were left with a devastating half-time score of 37-12. Following an initial hiccup after the break, allowing yet another soft try, Guy’s woke up and looked a changed side. We bossed the game from thereon in, and managed to finally gain some possession, and a semi-solid platform from set pieces. The lack of fitness from our obese counterparts was the key to this turnaround, but unfortunately the deficit was just too great to cut and we only really piled on the pressure to score points in the final 15 minutes.
Unfortunately this was too little, too late. The highlight of the second half was a cheeky dump tackle on Matt Hemmings from a Kentish thug about 15 metres from play. The thug was promptly shown “who’s boss” with a thorough raking of the abdomen, to squeals of pain from the offender, and much delight to all the boys in navy blue who bore witness. Final Score: 51-33 to Westcombe Park. Tries: Ryan Koay, George Ellis, Jack Limbrick, Tim Faccini, and others (sorry). Team: A. Patmore, K. Patel, T. Bass, T, Faccini, S. Lazarus, M. Hemmings, S. Kosasih, T. Fenner, G. Ellis, J. Limbrick, I. Sotonwa, N. Campbell, J. Cuddihy, R. Rahman, R. Koay. Subs: P. Mitchell, K. Muthu
51 - 33
CREDITS
The GKT Gazette Gareth Wilson Frank Acquaah Simon Cleary Daniel-Clement Osei-Bordom Anya Suppermpool Samuel Evbuomwan Sabina Checketts Sabeen Chaudhry Ishaac Awatli Milo Oyesanya Anita Phung Jessica Maskell Thomas Mathen Benjamin Clavey Anthony O’Rourke Christine Bojanic Ade Oyegoke Ellis Onwordi Simran Chana Katie Allen Sabina Checketts Charles West Thomas Bowhay Tuulia Simpanen Sally Kamaledeen Matilda Esan Fatiha Chehalfi Margaret Whatley Kate Anstee Lewis Moore Joshua Getty Carl Johan Hagströmer Lucy Webb Melody Yau Hannah Asante Nathanael Yong
Team Are:
Freshers Edition 2012 GKT Gazette 4213
The Guy’s, King’s & St Thomas’ Hospitals Gazette
Volume: 126 Number: 2579 ISSN: 0017-594