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trauma

uk edition traumaroom.com issue 18 - free!

When good health goes BAD Collagen corpses, cocaine-fuelled docs and catastrophic counselling services Plus ... the 2006 Guide to Intercalated Degrees

trauma is the magazine for medical students produced by medical students and is available free in over 22 countries worldwide— making us we’re largest free distribution student magazine!

trauma

Find out more about us at www.traumaroom.com

Time to get trauma-tised!

Editor Michelle Connolly

Welcome to Issue 18 of trauma. We’ve undergone a bit of a re-

3rd Year Medical Student GKT

design to make your magazine bigger and brighter than ever before.

We hope you like it!

ukeditor@traumaroom.com Editorial Team Assistant Editor Sinem Aymen News Editor Natasha Murray

Michelle Connolly, trauma Editor

News Team Nicole Chiang Nuruz Zaman Rahul Potluri Design Team Nabil Quraishi Anna Starr Distribution Kirstin Daley Printing Partners Witherbys, UK Managing Editor Ashley McKimm Tel - 020 7684 2343 editor@traumaroom.com

In this issue, following Kate Moss’s cocaine antics, we look at the use of the white stuff among doctors and medical students. We also get under the skin in our feature on collagen injections and skin bleaching.

Being a medical student is often a stressful experience. We all assume that if we needed university support when things get tough that it would be there for us But would it? We take a look at some real life experiences.

In addition you’ll find a worry-

Until next issue. Take care.

Michelle.

Collagen corpses Good health gone bad. Fat extraction and bleaching.

Page 10

Return of the body snatchers The shortage of body donors Page 16

Health warning

Get involved We’re always looking for keen medical students to join the team.

Benefits include getting your name in print (handy if you ever forget how to spell it) and free sweets (extra special fizzy ones) too.

Check out traumaroom.com.

Remember that trauma is your magazine and we want you to be part of it. Get involved. We’re recruiting for our new editorial team for next year so check out our advert on page 7.

What’s on the inside

trauma PO Box 36434 London EC1M 6WA Tel - 020 7684 2343 Fax - 087 0 130 6985

trauma is not a publication of the medical school, Tony Blair, his wife, the student unions or any other official (or unofficial) body. The views expressed are not necessarily the views of trauma or its editors, and if they are they are likely to be wrong. It is the policy of trauma not to engage in discrimination or harassment against any person on the basis of race, colour, religion, intelligence, sex, lack thereof, national origin, ancestry, incestry, age, marital status, disability, sexual orientation, or unfavourable discharges. trauma does not necessarily endorse or recommend the products and services mentioned in this magazine, especially if they bring you out in a rash. All rights reserved.

ing story on pro-anorexia groups and our regular ‘big debate’ feature looking at the implications of the smoking ban.

You’ll also find our annual intercalated guide in this issue containing the UK’s only comprehensive list of courses along with advice on making your choice.

Intercalated Guide UK’s complete list 2006 Page 17

UK Reps Sandra Acton, Leicester Nishant Pandey, Leeds Derek Mackenzie, GKT Sarah Bennett, UCL/ RF Leigh Bissett, East Anglia Wendy Brown, Dundee Kate Brunskill, UCL/ RF Alison Bryson, Cardiff Brenda Malone, B+L Matt Rowland, Leeds Thomas Chivers, Oxford Jennifer Collie, Dundee

Christine Cowan, Newcastle Charlotte, Imperial Simon Donald, Aberdeen Dana Eilen, St. Christopher’s Matt Cauldwell, IC Sarah Fadden, Cambridge Sheila Fisken, Edinburgh Martin Gill, Leeds Sheraz Younas, Manchester Stephen Hamshere, B+L Rameen Shakur, Edinburgh Fran Hazelton, Bristol Vicky Holmes, Birmingham Alison Howarth, Glasgow Peter Hutchinson, Cambridge

Susan Isaac, GKT Chris Jackson, Leeds Frances Jones, Leeds Sandra Jones, UCL/ RF Sue Killoran, Oxford Karen Lubarr, Cambridge Derek Mackenzie, GKT A McKay, Aberdeen Martine Mockford, Cambridge Margaret Moir, Aberdeen Abdul Siddiky, Sheffield Khalid Ali, Newcastle Mark Nicholls, Cambridge Ami Nwosu, Liverpool Donald Orrock, Dundee

Smoking Ban Hear the views, join the debate Page 14

Ian Pickering, Liverpool Paula Purchase, Southampton Jennifer Randall, Imperial Richard Rhys Davies, Oxford Guy Schofield, GKT Sushma Shankar, Oxford Jane Smethurst, Leeds Simon Rees, Southampton Katherine Smith, Oxford Richard Smith, Leicester Elizabeth Spalding, Oxford Wendy Stanton, Nottingham Max Yates, UEA Irene Wells, Aberdeen William Start, Brighton

We’ve got a team at medical schools throughout the country to make sure you get your copy. Want to join our team? Know how we can get better involved in your medical school? Email us at reps@traumaroom.com.

3

trauma Medical School Life

Student debt is soaring and you’ll earn less as a doc than you think LONDON Average medical student debt passed £20,000 for the first time last year, according to the annual BMA Medical Student Survey. Worringly the results show that students also overestimate how much they'll earn in their first year as a junior doctor by 15 per cent.

The survey, which is based on the results of 1,877 students, showed that those in the fifth year of medical school now have on average £20,172 of debt - a 17 per cent increase on 2004. Students doing a sixth year reach £22,365.

The average estimate of the basic FY1 junior doctor salary by students was £23,420 - £3,125, or 15 per cent, higher than the true figure of £20,295. This means it could take some students up to seven years longer to pay off their debt than they initially believe.

Andrew Pearson, deputy chair of the BMA's Medical Students Committee, said: “The average sixth year medical student now owes more than the basic annual salary of a newly qualified doctor. This is particularly worrying when you consider that junior doctors' take-home pay is falling and that medical unemployment is increasingly common.”

“There's a lot of anxiety among medical students at the moment, and with top-up fees on the horizon, their financial pressures are going to get worse." £55,000 in debt The highest debt reported this year was £55,000. A further 100 had debts over £30,000, and one in ten had debts of over £25,000. The BMA believes that the high cost of studying medicine is one reason for the social imbalance among medical students – only one in eight of those surveyed came from a family where the main source of income was a blue collar job.

4

“The average sixth year medical student now owes more than the basic annual salary of a newly qualified doctor.”

Students were also asked this year how concerned they are about their debt. Only one in six said they were ‘very worried’. A further 45 per cent said they were fairly worried and about 40 per cent said they were ‘not really worried’.

“There's a lot of anxiety among medical students at the moment, and with top-up fees on the horizon, their financial pressures are going to get worse,” said Pearson.

The BMA is campaigning for the NHS bursaries, currently available to some students at the end of their courses, to be extended to all years. It has raised concerns that from next year students taking medicine as a second degree will have to pay top-up fees upfront.

Key points from the survey Expensive Life for London Students The overall average monthly expenditure was £289, last year it was £265. For those students in London it was higher at £388.

Middle-Class Medicine 19 per cent of respondents came from families whose main family earner was in a managerial occupation, 43 per cent from a professional background and 22 per cent from other white collar backgrounds.

Only 13 per cent of respondents came from a ‘blue collar’ background.

Bank of Mum and Dad The overall average amount of contributions from parents was £2,589 (excluding those who received nothing or did not state an amount).

13 per cent of these said they will have to repay at least some of this money.

Crying all the way to the bank Six out of ten students said they had an overdraft. The average size of the overdraft was £1,421, down from last year's average of £1,462.

Medical school on credit Over two-thirds of respondents said they had at least one credit card.

The average card debt was £1,010 Loansome Around 19 per cent of respondents had a bank loan. The average size of loan was £8,580 which was £920 (12 per cent) higher than last year's £7,660.

Down the Tube The median expenditure on travel was £440 per year but higher for those studying in London at £632.

Elective expense The average length of a first elective was 7.1 weeks and the mean cost was £2,108.

trauma Medical School Life octctr dootp - 27 points Harshan Lamabadusuriya, SHO in paediatrics at Birmingham Children’s Hospital came 17th out of 104 contestants from 30 countries in the World Scrabble Championships last month.

GPs’ lives in the bag The adventures of GPs on their home visits have been published by the Royal College.

“Secrets from the Black Bag” hopes to give an insight into the ‘delights, fears, challenges and successes’ of GPs from around the globe.

Written by Susan Woldenberg Butler it’s priced £14.95. www.rcgp.org.uk/acatalog Football first Exams in Saudi Arabia are being postponed so students can enjoy this summer’s World Cup, to be held in Germany. In a statement, the Education Ministry said it would be a shame if students were unable to enjoy the competition properly because of exams.

Medical student death A man has pleaded guilty to causing the death of a Birmingham University medical student by dangerous driving.

Abigail Craen, 20, was killed in a hit and run accident last October.

Abigail died after being knocked down by a Ford Mondeo as she used a crossing outside her halls of residence in Edgbaston on October 30.

Babies in the bag Sainbury’s supermarket in Margate has started an antenatal clinic, in association with East Kent Hospitals NHS Trust. The first such scheme in the country will see pregnant woman visit their midwife in between shopping for bread and nappies. Sainsburys hope to role the scheme out to other stores if successful.

Built-in air bags Being obese puts men at greater risk of death in a car crash, according to researchers in Milwaukee. The study, published in the American Journal of Public Health, found that the greater momentum during the crash may contribute to injuries. However, moderately overweight men seemed to benefit as their bodies tended to cushion them from the impact.

Calls for rethink after jobs fiasco LONDON A radical review of how medical students receive confirmation of their first junior doctor posts has been demanded by students and the BMA following a disastrous launch of an internet based system this February.

The allocation of jobs after graduation is now administered centrally through the MultiDeanery Appointment Process (MDAP). Students are then matched to their best choice of jobs based on a points system.

Students were told they could check which posts they had been allocated from midday on 31 January via the internet. A last minute email delayed the announcement until the following Wednesday at 5pm. Yet thousands of medical students had a further wait until the following day due to

the large number of people trying to access the website.

Kirsty Lloyd, chair of the BMA's Medical Students Committee, says: “The BMA supports the fact that there is now a centralised system, which aims to reduce bias in selection for posts. However, there are technical problems that need to be urgently addressed. If you tell people that details of their first job are going to be on the same website at the same time, then you should be prepared for everyone to log on simultaneously.”

Similar problems also occurred in December when students had been unable to submit their applications. The BMA has asked for reassurances that greater resources are made available for the second round of the matching process which begins next month.

“If you tell people that details of their first job are going to be on the same website at the same time, then you should be prepared for everyone to log on simultaneously.”

Junior doctors

Younger docs kick consultant asses at patient care BOSTON Younger doctors recently graduated from medical school provide higher-quality care than older docs, according to metaanalysis by Harvard Medical School and published in the Annals of Internal Medicine.

The review of 59 previous studies dating from 1966 compared doctor’s ages to clinical success or quality of care. Overall 32 out of the 62 (52 per cent) evaluations reported decreasing performance with increasing years in practice.

One highlighted study by the American Board of Internal Medicine found that patients suffering an MI were 10 per cent more likely to die if their doctor was 20 years out of medical school compared with a recent graduate.

In this trial research showed a 0.5

per cent increase in mortality for each year post-graduation, after controls.

Similar results appeared in a study for mortality rates for cardiac artery bypass graft surgery which rose with the length of time in practice (P<0.001).

Older doctors were less likely to screen appropriately for hypertension and cancer. They were however better at preventative care, remembering to screen for proteinuria and ophthalmic defects. time for an early discharge?

patient’s comorbid conditions and physician factors. It found that although there was no difference in mortality rates for doctors of different ages, those who had been in practice for more years had longer lengths of stay Lead author, Dr Niteesh Choudry, suggested that physicians with more experience may paradoxically be at risk of providing lower-quality care. He proposed that part of the reason was the change in focus from personal experience to greater reliance on evidence based medicine. www.annals.org/cgi/content/full/142/4/ 260

One of the largest studies of hospitalised patients looked at patients admitted for various conditions, and was adjusted for

5

trauma Training Happy hearts Optimistic people are less likely to suffer from heart disease, according to a study published in the Archives of Internal Medicine.

The retrospective study of 545 patients in the Netherlands found that those who were classed as optimists were 55 per cent less like to die from heart disease or stroke.

Wine drinkers eat healthier People who buy wine rather than beer have healthier diets, according to research by scientists in Copenhagen. The study, published in the BMJ this month, found that wine buyers bought more olives, fruit and vegetables than beer buyers. Beer buyers on the other hand bought a greater volume of ready cooked dishes, chips, butter, sausages and soft drinks.

Small glasses cause big beer goggles People pour a quarter more alcohol into short, wide glasses than tall, narrow ones of the same volume but wrongly believe that tall glasses hold more, according to a study published in the BMJ. The study found that even professional bartenders poured 20.5 per cent more into short tumblers than tall highball glasses despite having on average six years’ experience.

E for anxiety Anxious children are more likely to use ecstasy as they get older, according to a study published in the BMJ. The study, which looked at over 1,500 children with an average age of nine, suggests that depressed young adults are more likely to take the drug to make them feel better.

Mountain training for doctors The University of Leicester has launched a new diploma in mountain and expedition medicine this year. The course will be aimed at preparing doctors to rescue patients trapped on mountains in the UK and around the world. It will teach doctors to deal with trauma, hypothermia and altitude sickness. It will also provide teaching on how to safely ‘extract’ patients back to base camp.

6

Bedside manner 7/10 LONDON New medics are to be routinely assessed on their bedside manner as part of a major overhaul of the postgraduate training scheme for junior doctors, it has been announced.

It coincides with a survey that suggests students rate communication skills teaching as the ‘biggest waste of time at medical school’.

Current students should take note because after qualifying they will be assessed on their competence to deliver potentially shattering news, and their effectiveness in patient consultations.

The move comes after worries that the academic pressures of

today’s medical degrees are depriving some students of the social skills necessary to be good doctor.

The new two-year Foundation Programme replaces the existing pre-registration house officer and SHO years, and will include continuous assessment of competence.

It means that career progression will be based upon ability rather than simply time served.

The Foundation Programme is designed to expose new doctors to a range of different specialities within the NHS, providing them with the chance to gain experience in primary care, academic medicine and encourage recruitment to

NHS

Training

Work longer, DH tells docs LONDON Health Secretary, Patricia Hewitt, is proposing to make working longer hours a contractual responsibility as she pledges to make health care more accessible to the public.

Ms Hewitt this month compared medical care with services offered by high-street shops and supermarkets: “With banks and supermarkets they are open 24/7. But patients are telling us that with the health service, you either see your GP or, out-of-hours, go to A&E. We need to make sure that GP surgeries become more accessible.”

This is in contrast to an agreement made only last year by the Government that effectively relieved GPs of the responsibility of out-of-hours services, a move that has provoked heavy criticism from some GPs and the BMA. One Luton GP told trauma it may not be best for the public either: “It’s not in patients’ nor GPs’ best interests for doctors to be overworked. If a GP has to start at 7 am, one can’t possibly continue until ten at night.”

But the idea that health should not be time-restricted is proving popular with patients. Some gen-

specialities in which there are staff shortages.

Each foundation doctor will have an educational supervisor, who will provide support and ensure that the appropriate learning opportunities are provided.

“With banks and supermarkets, they are open 24/7 ... We need to make sure that GP surgeries become more accessible.” eral practices are already opening from 8 am to 8 pm with growing success.

Indeed, the move is actually being supported by many doctors across the hospital spectrum, who emphasise that it would considerably reduce the burden on A&E departments.

Top-up fees deterring graduate students GLASGOW Top-up fees are deterring graduates from studying medicine, warns the British Medical Association this month.

From 2006, students entering medicine straight from school can defer paying fees until after qualification, but those already with a degree from a UK university will have to stump up the fees first.

Graduates now account for 10 per cent of the 7,800 students admitted to UK medical schools each year.

Kirsty Lloyd, chair of the BMA’s medical students’ committee said: “Medicine is already one of the most expensive degrees, which is why the proportion of doctors from the highest social classes is so high.”

The government has offered some support to low income students. Those undertaking the four year accelerated course can apply for a maintenance loan for the first year of their degree and from the second year, students eligible for NHS bursary support will have their fees paid by the NHS.

trauma Medical School Life

Medical students go wild NEWCASTLE Medical students were given the opportunity to do some hands-on learning about emergency medicine at this year’s National Wilderness Medicine Conference.

300 medical students from around the UK attended the twoday event held at Newcastle University, which included lectures and practical demonstrations.

Participants could opt for a mock sea emergency, mountain rescue exercise or to visit the Territorial Army’s Fenham Barracks HQ. Specialist equipment that would be deployed in the case of a chemical, biological, radioactive or nuclear (CBRN) incident was demonstrated including decontamination suits, respirators and Geiger counters.

“The purpose of this event is to raise awareness of some of the issues that affect the medical pro-

... though preferably alive and full of new ideas!

We’re recruiting the new ‘trauma’ team for the next academic year and we’d like you to be part of it. We’re looking for Editor Team Leader News Editor Feature Editor Webmaster Designer Distribution & Publicity Manager Reps (from each medical school) fession whose members may be called upon to deal with emergencies similar to the scenario being played out here today, at any point in their career,” said Dr Johnathon Brett, organiser of the exercise.

“This is an excellent opportunity for medics, especially those thinking of going into trauma medicine, to learn how emergency services are co-ordinated.”

Email editor@traumaroom.com for an information pack before April 30.

Medical School Life

Warning for clinical trials LONDON Members of the public, including many medical students, who take part in clinical trials, are left without adequate legal protection under the current legislation, warned a senior doctor in the BMJ. Professor Desmond Lawrence, Professor Emeritus of the University of London, stated that patients are led to believe that when they enter clinical trials, that the trial sponsor will have a legal obligation to compensate them in case of injury. In reality they have no legal responsibility.

He argues that the words used in the clinical trial contract documents concerning injuries to patients are not in plain English and therefore do not meet the legal requirement of openness under consumer law.

“If the law were to be observed, patients would be told frankly, in words lay people could

readily understand, that they might be seriously injured but with merely discretionary compensation,” says Lawrence.

“The trial sponsor of course may always pay ex gratia compensation, if it cares to,” he adds. “But if it does not, then the cost of compensation for non-negligent harm falls upon the injured patients themselves.”

He calls on the Department of Health to obey the law.

7

trauma

when good health goes

BAD As trainee doctors our careers are based on the premise of doing good. Unfortunately, the reality is sometimes different. Over the next few pages we look at the consequences when medicine turns bad.

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Where to turn for help Doctorsâ&#x20AC;&#x2122; Support Line www.dsn.org.uk 0870 7650001 British Doctors and Dentist Groups 01252 316076 Sick Doctorsâ&#x20AC;&#x2122; Trust 0870 4446153 BMA Counselling Service www.bma.org.uk 08459 200169

trauma

drugged up doctors Kate Moss’s cocaine antics unleashed a barrage of media attention onto the ‘white stuff’, and according to the latest British Crime Survey she isn’t alone in her pricey habit. Ellen Welch looks at the drug and its use among students and doctors.

“I was using cocaine daily during my third year,” Kieran, an exmedical student told trauma. “It was a stressful time and my way of coping was to block it all out with drugs.”

Kieran now works in the City but says he didn’t understand the impact his ‘habit’ was having at medical school. “I didn’t see it as a problem at the time, despite comments from friends.”

“A big drinking culture goes on anyway, and I lived by the ‘work hard, play hard’ motto,” he said. “It came to a head when I kept going over my overdraft to fund my nights outs. I subsequently failed my exams, the resits and was unable to complete my degree.”

Despite cocaine use remaining rife in the capital Kieran sees things differently these days. “You can’t avoid becoming addicted.

The high was intense but the next day was always a complete writeoff,” he feels now. “I don’t believe professionals making decisions about peoples’ lives should do so after a night of drug abuse”.

Cocaine in Britain The Law According to the Misuse of Drugs Act 2005 cocaine is a Class A controlled drug. It is a criminal offence to ‘unlawfully possess’ (with or without intent to supply), to import or export the drug or to produce it. The police have ‘stop and search’ powers to enforce the law.

Patients addicted to cocaine are required to be notified to the Chief Medical Officer and doctors are only permitted to prescribe cocaine in rare circumstances with a licence from the Home Secretary.

Kieran isn’t alone. Nearly four million Brits have tried Class A drugs such as cocaine, ecstasy or magic mushrooms. A total of 11 million admit to having sampled some type of illegal drug.

Doctors as a profession rate highly in the addiction stakes with binge drinking and drug abuse recognised as occupational hazards. The last study in 1998 by the BMA estimated that 1 in 15 doctors were alcohol or drug dependent – significantly higher than in the general population. Further figures from 2001 show that 72 per cent of doctors embroiled in GMC complaints procedures had alcohol

“I was using cocaine daily during my third year. It was a stressful time and my way of coping was to block it all out with drugs.” or drug problems1.

Use among doctors Although cocaine is widely available and glamourised by celebrities it remains an illegal Class A drug. Doctors found in possession of the substance face criminal prosecution along with plenty of questions regarding fitness to practice.

Such consequences however, fail to prevent 11 per cent of junior doctors using cocaine on a regular basis, and a further 10 per cent experimenting from time to time according to a BMA study2. trauma spoke to Sarah, one such medic. Halfway through a stressful house year, she has been using cocaine recreationally since her student days.

“It’s not something I do all the time,” she says. “I have a busy work life and am often exhausted at the end of a shift. I want to have some sort of social life outside of work, so a few lines of coke before a big night out can give me the lift I need.”

Drug and alcohol dependence among the profession has lead to

calls for random drug testing of doctors.

Sarah sees this as an invasion of privacy: “What I choose to do in my private life bears no reflection on the sort of doctor I am.

Plenty of my colleagues go out and drink themselves silly every night, then turn up to work the next day barely able to function.

Taking cocaine doesn’t impinge on my working life like that.”

C17H21NO4 Benzoylmethylecgonine (C17H21NO4) or cocaine to you and me, is an alkaloid derived from the erythroxylon coca plant. The distinctive white powder snorted through a crisp, rolled twenty is cocaine hydrochloride.

Crack cocaine is produced from heating cocaine hydrochloride, water and sodium bicarbonate. On cooling rocks precipitate, which are smoked, or heated on foil and the vapour inhaled.

Cocaine takes effect almost instantaneously when injected or smoked, or after about fifteen minutes when snorted. In the brain it blocks the dopamine reuptake transporter which activates the limbic system, causing the characteristic euphoria.

Cocaine accounts for most substance related deaths, often when alcohol is taken concurrently. Increased doses result in arrhythmia, seizures, MI, stroke and respiratory arrest. Users also characteristically become anxious, irritable and impulsive.

References [1] The Annual British Crime Survey 2005 – Home Office [2] British Medical Association. The misuse of alcohol and other drugs by doctors. London: BMA, 1998 The names Kieran and Sarah have been used to hide the identity of those featured.

9

trauma

collagen corp

In today's celebrity culture, where looks are becoming more and more central to one's the desire to fit into a set mould is ever increasing. But how far will the beauty and m the demands of such an image conscious public? Sinem Ayman highlights two cases try will go to satisfy such demands.

In the constant pursuit of ‘forever youth’ collagen injections have become the UK's treatment of choice, second only to botox.

Collagen is a compound found in abundance in skin, bone and muscles and serves as scaffolding to strengthen and support these organs. In the beauty industry it is used to smooth out wrinkles and enhance lips and treatments have to be repeated as the effects are not permanent.

In the UK collagen is originally sourced from cows, pig and human skin. These are samples of skin grown for up to ten years in laboratory conditions. In all cases the collagen is highly purified and sterilised before being converted into an injectable form.

Recently however, The Guardian uncovered that collagen in UK clinics was being sourced from a Chinese firm which has been extracting collagen direct from the skin of executed Chinese prisoners.

Shockingly, according to reports from agents at the company this practice is quite ‘normal’.

Bar the ethical concerns of this collagen, there are also major health risks to consider.

There is the possibility of transmission of disease, especially bloodborne viruses, such as hepatitis and perhaps even vCJD. Although there are no records of this happening, an inquiry by the Department of Health has reported cases of acute allergic reactions to collagen injections, causing scarring and disfigurement.

As collagen products aren't strictly classed as either medicines or cosmetics they bypass any current regulations. Currently this anomaly is being looked by the European Commission, but any legislation is several years away.

10

Mr Douglas McGeorge, president-elect of the British Association of Aesthetic Plastic Surgeons (BAAPS) emphasised the importance of consumer awareness:

“Hopefully the forthcoming changes in the regulations will eliminate the fringe clinics offering poor advice and questionable treatments with inferior products” “Stories like these only reinforce the advice given by BAAPS that patients should always see reputable surgeons who have a proper training in aesthetic procedures and who are properly qualified to give good and appropriate advice. Hopefully the forthcoming changes in the regulations will eliminate the fringe clinics offering poor advice and questionable treatments with inferior products.”

It's not common for patients to enquire about where the collagen they will have injected comes from, but perhaps now they will be

more aware and for once, ethics will come before beauty and profit.

Bleach me white Many young black and Asian people are feeling under more and more pressure to have paler skin in the belief it will make them more successful and attractive.

Some are putting their health and lives in danger by using bleaching creams containing illegal and harmful substances.

Although most bleaching products on the market are legal and safe, some creams contain strong steroids, used in the treatment of eczema and psoriasis, which can thin the skin. Its misuse can lead to discoloured lesions, scarring and life-threatening hormonal changes.

Other types of cream contain a chemical called hydroquinone.

This toxin interferes with pigmentation processes and can increase the chances of developing skin cancer. Products containing the hydroquinone ingredient are illegal in this country and retailers can be fined £5000 for selling it.

Worryingly however these creams are still finding their way onto shelves in high street shops.

trauma

pses

s confidence and perception medical industries go to fulfil that show how far the indus-

In Jamaica, dermatologists report around 10 per cent of patients have skin complaints associated with harmful skin bleaching substances. The trend is of such worrying proportions that the local government strictly control any advertising of these products.

Nina Goad, a spokesperson from The British Skin Foundation advises caution: “Skin lightening creams must be used with care as they can cause skin irritation. It is advisable to consult a doctor or dermatologist if you are interested in learning about skin lightening products.”

Role models Many young black and asian teenagers look to role models like Beyonce and Tyra Banks and believe their success is because they are lighter skinned. The use of such creams is generally a taboo subject and the full extent of their use is unknown.

The misconception that lighter skin leads to better opportunities and success is promoted by advertising. One such advertisement is for a legal bleaching cream called Fair and Lovely, marketed widely in India. It shows a young Asian woman who dreams of becoming famous but believes her skin too brown. Her sister then hands her a tube of Fair and Lovely and time fast forwards to a coiffed, strikingly fairer girl and it is in this form that she manages to get her dream job.

Many argue that adverts like these enforce a loss of self worth and pride forcing young asian and black women and men to turn to bleaching creams in order to regain their confidence. For many ‘skin bleachers’ a ban would just make the creams more difficult to obtain, experts agree it’s the need to re-address the psychology behind skin tone that is more pressing.

Websites that promote weight loss to those who are clinically underweight belong to the ‘Pro Ana’ movement. Pro-Ana stands for ‘pro-anorexia’. ‘Ana’ is the affectionate personification used by sufferers of this often deadly illness.

Pro-anorexics believe they are masters of their illness, free from the desire to become rid of it.

They are emaciated, self-proclaimed champions of the movement, whose aim is to beautify and promote the anorexic state. Their motto is ‘Anorexia is not a disease, it’s a way of life’.

Food Porn The movement manifests itself through largely American-based websites and discussion boards, frequented by users with names such as ‘Dying 2 b Thin’, ‘Starving for Perfection’ and ‘Never 2 thin’. A popular feature of any Pro-Ana website is ‘food porn’. Here the anorexic is invited to salivate over pictures of hamburgers, pizzas, ice cream and cakes, forcing themselves to become sated. There is everything imaginable to keep the anorexic

“Nothing tastes as good as thin feels”

loyal to Ana, from lists of ‘safe foods’, to tricks on how to minimise calorie intake at times when this may prove difficult, such as Christmas and birthdays.

Waverers draw ‘thinsperation’ from picture galleries of unhealthily thin women. The skinnier a woman is, the closer she is to perfection goes the belief, hence a decidedly emaciated Jodie Kidd is lauded as ‘perfect’.

sites pre-empted this move and rebranded themselves simply as ‘diet’ websites continuing with the same content and message.

Ten Commandments

Mental Illness

Even more startling is that for some hardened anorexics the ProAna movement is more than a chance to exchange views and tips with others: it’s a religion. There are prayers and poems in the name of Ana, who is feted in a god-like manner. The first of the Pro-Ana Ten Commandments demands that ‘Thou shalt not eat without feeling guilty’. Other favourite quotes are ‘Nothing tastes as good as thin feels’, ‘Hunger hurts but starving works’. And the Latin ‘Quod me nutrit, me destruit’ - What nourishes me destroys me’.

Nobody knows exactly when or how the Pro-Ana movement began but the sites were first exposed en masse to the public in 2001. That year, servers such as Yahoo were successfully petitioned to ban the material because of its damaging message to young people. However, many Pro-Ana

The Eating Disorders Association told trauma of their concern of the Pro-Ana movement.

“These websites are incredibly damaging because the people behind them have become so psychologically entrenched in their illness, to the extent that they no longer think rationally. So not only do they have an eating disorder, but they also have a psychiatric illness”.

Professor Janet Treasure said: “These sites illustrate the confusion that people with eating disorders face. Part of them recognises that they or other people say they need help and yet in many ways pro-anorexia offers a solution, that is communication with other sufferers. Treatment involves working with this ambivalence”.

“Hunger hurts but starving works”

Further information > Institute of Psychiatry Eating Disorders www.eatingresearch.com > Eating Disorders Association, www.edauk.com

pro-anorexia Googling eating disorders a few years ago would have led you to numerous support groups helping sufferers on the road to recovery.

Today, however, type in ‘anorexia’ and you’ll discover websites that laugh at the notion of recovery and celebrate the ‘benefits of illness’.

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trauma

finding Studying medicine isn’t easy. There’s the stress of long hours and non-stop exams, the competitive colleagues and the emotional exhaustion from clincal placements.

University counselling services are designed to offer support when things get tough but unfortunately they don’t always help. Kim Ong spoke to a student who sought help at King’s College London.

“

I was strongly encouraged to see a university counsellor by my tutor who obviously felt I was quite depressed. He wasn’t alone I also felt I needed someone to talk to. I was certain my friends were fed-up of hearing me complain about my situation and seeing me being so apathetic about everything.

It wasn’t easy. To begin with information about the counselling services wasn’t easy to find and when I did find information it was not very engaging. It all seemed very formal and structured. I had to print off a self-referral form and then send it off.

Women are twice as likely to seek support than men You had to be quite motivated or needed someone to push you to engage with the services. There was a drop-in session on Wednesdays but only for an hour between 1-2 pm and overall the service did not seem very friendly or helpful.

Finding a label I found the actual counselling quite strange. I was seated quite far from the counsellor and it felt like she was constantly staring at me - which was incredibly uncomfortable. Instead of listening she kept trying to give me a label and fit me into a ‘problem box’.

The worst thing about the session, which was my first ever, was

12

that when I got upset and started crying. I kept apologising for getting upset but she said nothing and just continued staring at me. I had no tissues with me but as there was a box in front, I just picked up one and continued apologising with no reassurance. I felt awful. It was embarrassing enough that I had ‘lost it’ and was crying my but on top of that I felt like I was stealing tissues. The session ended abruptly when the 50 minutes were up and I felt like I had to leave immediately.

On average 4 per cent of students seek advice from counselling services each year I reluctantly went back for my ‘second assessment’. My intention was to go there and say that I didn’t need to see her again.

Somehow she managed to drag it out for the full 50 minutes.

At one point she would not let me change the subject until I agreed that I had issues with something I knew I had no problems with. I was quite angry, but to be honest, I just wanted to get out of there as soon as possible. I agreed with what I felt I had too and left.

It was such a relief to get out of that room!

Friendly advice After my experience, I would still recommend that students talk

trauma

g someone to turn to Top five reasons for counselling 1. Stress 2. Self esteem and self confidence 3. Anxiety 4. Depression 5. Problems with motivation and concentration to their tutors or any other member of staff that they trust. Do talk to your friends. You may feel that you are being a burden and that they are sick of hearing about your problems, but your real friends want to hear about how you are doing and they do want to help.

“

College response trauma invited the head of King’s counselling, Ann Conlon, to comment:

“We advertise the service as widely as possible.We have a website from which it is possible to download a counselling application form. Alternatively I could have spoken to the student initially over the telephone. Although I am concerned that this particular student did not have a good experience, last year we saw 4.2 per cent of the student population at King's, whom 15 per cent of the students we saw were medical students.”

Student Survey It’s not just this student who has issues with university counselling services. Some key points in a survey of 476 students at Imperial College in May 2004 were: Alcohol and drugs More than a third of respondents knew someone who used alcohol or drugs to cope with the pressures of university.

Bullying Around a quarter stated they had been bullied by doctors, whilst 16 per cent have been bullied by nurses. Ten per cent of respondents reported they had been discriminated against by doctors.

Mentors Two thirds of respondents said they would like junior doctors as mentors.

Mature students Two-thirds knew someone at medical school who had children, dependents, or became pregnant whilst at medical school.

Difficulties included balancing childcare and domestic responsibilities with a heavy study load, financial problems, placement allocation and social isolation. 89 per cent of respondents did not know if there were policies in place at their medical school for pregnant students or those with children.

Another source of support for students that simply involves picking up the phone are helplines such as the Samaritans and Nightline.

Mike Cobb, press officer at The Samaritans told trauma: “The Samaritans regularly receive calls from students with issues including exam stress, the stress of being away from home and family for the first time, bullying and problems with settling into a course and with new people.”

Mike says he also directs medical students towards Nightline, a helpline run by students in London.

“Nightline was set up to help young people through the stresses and strains associated with being at university. All the volunteers are properly trained

by The Samaritans. These services should be advertised clearly.”

Both The Samaritans and Nightline are listening services and don’t offer professional counselling or advice but are invaluable to those seeking someone to talk to. All communication is strictly confidential and volunteers are sympathetic and pass no judgments.

The Samaritans 08457 90 90 90 www.samaritans.org.uk jo@samaritans.org.

Nightline 0207 631 0101 from 6 pm until 8 am listening@nightline.org.uk www.nightline.org.uk

your views “I would have liked more practical advice: how do I deal with specific situations? I did get very good advice in the final few sessions though.”

“I was very sceptical in the beginning and didn’t think it would help, but after a few weeks, I was convinced it actually did!”

“Nobody actually knows your name in the medical school. As long as you pass exams that’s all they care about.

We don’t have tutors who know us well, so there is nobody I would feel comfortable in going to seek help.”

“It is difficult to get support for small issues. You feel that the situation has to be very serious e.g. family death, before asking for help.”

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trauma By 2007, the UK will be a largely smoke-free zone. Whilst anti-smoking and medical organisations have long been campaigning for a total ban on smoking in the workplace, smokers’ groups and the hospitality industry argue that this would threaten freedom of choice and could put pubs out of business. trauma’s Katy Ann Thomson Teo brought together Paul Hooper from ASH (Action on Smoking and Health) and Caroline Nodder, editor of The Publican, to fight out some of the issues surrounding the impending smoking ban.

Should a smoking ban be introduced to the UK? Hooper

There is no suggestion that smoking should be banned completely, but that smoking in workplaces and enclosed public places should not occur as this affects the health of others. Smoking is not allowed in workplaces in Ireland and this will soon be the case for public places in Scotland, with Northern Ireland and Wales to follow. In England the proposals are for no smoking in all workplaces and enclosed public spaces with some exemptions. These exemptions include pubs that don’t serve food and private members’ clubs, meaning more than 99% of all workplaces will be smoke-free.

The exemptions have not pleased everyone – the health lobby would like to see every worker protected from a known hazard; the pub trade would have preferred a level playing field and are worried that private members’ clubs will have an unfair trading advantage and the enforcement officers are concerned that the law will be confusing for the public and difficult to police. As the Health Bill passes through Parliament we can expect these issues to be debated. The exemptions, should they remain, will be subject to review. Most people believe that a total ban on smoking in enclosed public places and workplaces is inevitable.

Nodder

Our concern is that a complete ban would hit the smallest community pubs (i.e. the marginal businesses) hardest and that this would lead to closures.

Larger chains of pubs and big food-led p u b s

would be able to weather the temporary drop in trade caused by the ban, but small outlets are not making enough profit to survive this downturn. However, it is arguable that a full ban is actually preferable to the half way house proposals currently on the table from the government which would force pubs to choose between smokers and food.

Do you foresee any problems with regard to enforcement of a ban?

Hooper

If the law is clear to the public and managers of businesses (who will have to enforce the law) then I do not think there will be as much of a problem as such that is predicted by the tobacco industry.

In other countries self-regulation is successful – we can see this on the Underground and on planes.

Nobody lights up in the cinema anymore. Signs are crucial, as is the explanation of the reasons why we need a ban is to the wider public. Ireland had a high profile campaign explaining the rationale and then a policy of zero tolerance to deliberate law breakers. This has resulted in very high levels of compliance. Smokers in Ireland seem to understand that their smoking can be harmful to others.

However, if the law has exemptions that are difficult to understand or rationalise then there may be a number of businesses that will exploit loopholes and thereby undermine t h e

intention of the law.

Nodder

Yes. There are currently no details from the Government as to how the legislation will be enforced, so the danger is it will be inconsistent and regionally varied.

Will a smoking ban encourage smokers to quit?

Hooper

Although we should not regard this as the most important issue there is not a doubt that one of the side effects of comprehensive workplace smoking restrictions is a reduction in consumption. In Ireland they are reporting a 16% reduction in one year, this does not mean that there are 16% less smokers as some people will have just cut down on the number smoked. The most important thing is that people are protected from second-hand smoke (SHS).

Nodder

There is already a trend towards giving up – the numbers drop every year and there is no reason to suspect this will slow down. The industry is already responding to demand for nonsmoking pubs.

Caroline Nodder Editor, The Publican

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There has been controversy surrounding the links between passive smoking and ill health – how substantial do you believe the risks to be?

Hooper

As far as I’m aware the only controversy has been generated by the tobacco industry. It would be highly unlikely that a cocktail of 4000 chemicals with over 50 known carcinogens and other poisons would not cause illness.

Estimates have been made by various people; the latest figures found in the BMJ (Jamrosik, 2005) are that about 11,000 people in the UK die early as a result of SHS, most in older age, but around 2,700 under 65 years old. At least 700 deaths per annum result from workplace exposure with around one person per week dying in the hospitality trade. This compares with about 235 deaths at work from all accidents.

Nodder

I am not a scientist so cannot answer this question. My understanding is that there is actually no definitive research on which all parties agree.

Paul Hooper ASH (Action on Smoking and Health)

trauma

THE BIG DEBATE Will a smoking ban be effective in improving the health of the nation?

Hooper

Yes – of course!

Nodder

That remains to be seen.

What impact will a smoking ban have on business and the economy?

Hooper

Although some businesses will suffer a downturn in trade as a result of a ban on smoking, many others will experience an uplift.

Overall experience from New York and other places is for trade to improve and employment to increase. Ireland is often cited as losing pub trade since the ban, but in fact there has been no change to the trend in business as a result of the new law (trade was decreasing anyway). Looking ahead to bans elsewhere – we can expect any change to be blamed for any adverse occurrence!

Nodder

As above, the small pubs who can least weather the storm will close and there may well be some job losses in the industry.

Current smoking legislation in the UK

> England Workplaces, including restaurants and bars selling food (but not those only serving alcohol) will have a ban in place by the middle of next year. The ban only covers indoor areas so outside dining is permitted for smokers. It also defines a vehicle as a workplace, so lorry drivers can’t smoke if there is another employee with them. Private members clubs are exempted from the ban and can decide whether to be smoking or non-smoking, even if they serve food. > Scotland All smoking in enclosed public spaces will be banned from 0600 GMT on 26 March 2006. > Northern Ireland Slightly later than Scotland but more comprehensive, smoking will be banned in all Northern Ireland’s workplaces and enclosed public areas, including bars and restaurants from April 2007. > Wales At the minute legislation for Wales is drafted at Westminster and is likely to be similar to that for England above. It is expected that the Welsh assembly will increase restrictions when it comes into power in 2007.

Facts on smoking

> The Royal Medical Colleges estimate that smoke-free public places could save 160,000 lives. > Ireland and Norway banned smoking in bars in 2004. New Zealand and Sweden followed last year. > Iran banned smoking in public buildings and tobacco advertising in 2004.

> 97 per cent of bars and restaurants in New York are now smoke-free. > Smoke free workplaces would cost the tobacco industry £310 million in lost sales. > Non-smokers who work in the smokiest bars are around 20 times more likely to get lung cancer than the average non-smoker. > In smoke-filled rooms pollution levels can reach 50 times those in

a busy road tunnel. > According to the Restaurants Association, 45,000 jobs and £346 million cold be lost if restaurants are forced to ban smoking. > The average risk of a nonsmoker getting lung cancer is 0.01 per cent.

SOURCES: BMA, FOREST, ASH Restaurants Association

up in smoke The debate over the UK smoking ban

15

trauma

The recent expansion of in training medical England has resulted in a shortage of bodies for the education of medical students and for research.

While the number s of people donating body organs has increased, the number of people leaving their whole bodies for medical science has fallen since 2000.

Michelle Connolly finds out why from Dr Jeremy Metters, HM Inspector of Anatomy.

Over the last five years the number of bodies donated in England and Wales has fallen from 670 to 600. Meanwhile the number of medical schools has increased by eight, and fifteen new postgraduate anatomy departments have opened to improve the anatomy training of surgeons.

Why do you think there has been a fall in the number of bodies donated?

Since 2000, the number of offers of cadaveric donation has fallen, mainly for three reasons.

Firstly, Alder Hey and Bristol played a role. In light of these scandals, many people withdrew their intention to donate their bodies, directly citing these examples.

Secondly, from 2001 onwards, if a person was diagnosed with dementia their body could no longer be used for teaching purposes.

Thirdly, if people had MRSA they could no longer donate their bodies.

Annually, 600 people wish to donate their bodies to medical science and considering that each year some 260,000 people die in the United Kingdom, this isn't a great deal. The percentage of people donating their bodies to anato-

16

my teaching would be greater if the public knew how to donate.

The office of the Inspector of Anatomy has to be particular in what type of cadaver is accepted.

Donations below 60 years of age are declined, unless the patient is ill and likely to die soon, because it's not worth the bureaucracy.

Demand for cadavers has also risen since 2000 because the number of medical schools and the number of students at those schools has increased by 20%.

Demand will increase even further because surgical reconstruction procedures which were banned as part of the Anatomy Act 1984 are now lawful under the Human Tissue Act 2006. It was ok for trainee orthopaedic surgeons to excavate the upper end of the femur in a cadaver but it was unlawful for the trainee to insert a prosthesis. It took 22 years for this bizarre caveat to be addressed, simply because it's very difficult to obtain parliamentary time.

Do you believe anatomy is still best taught on cadavers?

Yes. All medical schools with the exception of Peninsula say that cadavers are the best means by

return of the body snatchers which anatomy should be taught.

The use of cadavers is very expensive. Does the cost-benefit ratio of anatomy teaching on cadavers still warrant its continuation?

Yes, and it is actually not that expensive. At each of the thanksgiving services, students are incredibly grateful for their ‘silent teachers’, who provide them with the most incredible textbook.

Indeed, some medical students recently wrote “our silent teachers provided us with a text that no book can duplicate, no lectures can match and no computer could simulate”.

whether her body will be of use.

We also cannot guarantee intending donors that medical schools will accept the body. Schools must run checks that can preclude donation, which is very distressing for the family, particularly if it was “Granny's last wish”.

What are the motives commonly cited when people wish to donate their bodies?

People often donate if they have benefited in some way from medical care. There is also a strong desire to help future generations.

There are about 600 donations per year - there would be more but many cadavers are lost via post mortems.

Would you donate your body?

What happens to donated bodies?

Yes, in due course, but being on the National Organ Donor Register is more important. One cannot be on both registers, since the maintenance of life is more pertinent. A lady today stipulated that her body be used only for research purposes, and not for teaching. But her wishes cannot be guaranteed, as we cannot foresee what type of research will be conducted at the time of death and

Provided there is a consent form or a donation request in the Will the person in possession of the body, usually the next of kin, will contact the medical school, who will then ask questions about the death. This is to ensure there are no conditions which preclude donation (post-mortem examination, severe deformity, hepatitis or dementia). The school will then accept the body for ‘anatomical

trauma examination or research’ but by law for no longer than a period of three years. Body parts are allowed to be separated but they must be brought together when the body is cremated or buried within three years of death. The donor is free to withdraw their consent at any time.

Under the Anatomy Act 1984, the next of kin was allowed to halt donation. This will no longer be lawful under the Human Tissue Act 2006. Most donors take the view: “I don't mind what you do with my body after I've gone,” and express this in their donation forms.

A brief history of body donation Before the Anatomy Act of 1832 the only bodies available for anatomy teaching were those of executed criminals.

The shortage of bodies in the early 19th century led to the practice of “grave robbing” - in those days medical schools asked no questions.

The most infamous grave robbers were Burke and Hare, who committed murder to meet the demand for cadavers at Edinburgh medical school.

Similar events in London led to the Anatomy Act 1832, which allowed the use of bodies of paupers or unclaimed bodies to be used in the dissection room.

Until just after World War II, most of the bodies were from those who had no relatives to pay for the funeral. It wasn't until the 1960s that people actually started bequeathing their bodies to medical science.

The Anatomy Act of 1984 tightened the legal controls on body donation. However, Section 4(3) continued to allow the ‘person in possession’ to permit donation, where there was no evidence that the deceased objected.

There followed a decline in the willingness of medical schools to accept bodies when the deceased had not expressed a wish to donate. By 1990, all donations only followed the written consent of the donor.

Since 2000, all anatomy departments in UK medical schools have refused to accept bodies unless it was the expressed wish of the deceased during life.

intercalated guide 2006 Should you or shouldn't you? It's a year longer at university. Will I be able to get the job I want without one? Tumour biology, medical journalism … or maybe ethics and law? Ahhhh!! If you're finding that choosing an intercalated degree should be a course in itself, check out our guide below.

Not content with putting us through five years of a medical degree the universities are now expecting us to take on an extra BSc or BA. It's not something that's often explained before you start medical school but the majority of us will actually spend six years before we qualify and leave with two degrees.

Ultimately you do get the choice of whether to do an intercalated degree or not. The problem is that as it's now the norm you're at a serious disadvantage if you don't.

It's a difficult decision to make.

We've listed some of the key advantages and disadvantages below to help you make up your mind.

Advantages It's a break from medicine After a few years of vomiting patients and day-after-day of microbiology lectures a break from the medical course might seem quite appealing.

Stay with your mates All your friends may be doing an intercalated degree meaning you would be left venturing on ahead with the medical course alone.

Get interested Surprisingly, you might actually find one of the courses on offer really appealing. It might even lead you to pursue a career in neuropsychology you’d never considered.

Be more competitive If you intend to pursue a competitive specialty, or one of the more sought after house jobs, it might be necessary. When consultants come to sorting through a pile of similar applicants they look for some way to discard CVs from the ‘to interview’ pile. Sorting them into ‘have BSc’ and ‘have not’ is a common

practice - so beware.

Stay a student You’re going to get stuck doing medicine for the rest of your life once you qualify, so take your time getting there. Life as a student is really quite good!!

Take a break Most intercalated degrees have less lectures, more days off and longer holidays.

Disadvantages Counting the cost Stumping up the cost of fees (if your LEA won’t) along with your living expenses may make you feel like you don’t have the choice anyway. Don’t rule it out though, there’s plenty of organisations offering bursaries for intercalated degrees. You’ll also have a longer summer to get a part time job.

you’ll still have to come back and finish the medical course.

Returning to three more years can be difficult.

Motivational misery There’s often lots of self-study which can prove difficult if you’re not easily motivated.

Tough enough The idea of extra holidays and a proper summer break may sound appealing but it's not always this easy in reality. There are students who virtually live in their labs and some courses have extremely tough exams and project components.

Returning to medicine If you do an intercalated degree

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trauma

Course Guide 2006 Below youâ&#x20AC;&#x2122;ll find over 170 intercalated courses available for medical students. We contacted all universities and completely updated our list since last year to ensure you have all the latest information. Weâ&#x20AC;&#x2122;ve done our best to ensure the information is accurate ... but check directly with the university concerned to confirm the details. You can find the latest updated list at www.traumaroom.com/intercalate Aberdeen

Exercise Science

_______________________________

Medical Sciences

There are restrictions on total numbers accepted per year (65) with selection, if necessary, being on the basis of academic merit. Students can take intercalated degrees at external universities (max 10).

Glasgow

Tel - 01224 553014 Open to internal applicants Closing date Dec (runs Apr to Mar) ________________________________ Birmingham BMedSc in Biological Sciences Medical Science Biochemistry Cell and Molecular Biology Cell and Molecular Pathology Cardiovascular Science Neuroscience Physiology Pharmacology BMedSci in Medicine in Society Behavioural Sciences; Occupational Health; Public Health and Epidemiology; History of Medicine; Health Care Ethics and Law; Psychological Medicine BMedSci in Clinical Sciences Cancer Clinical Chemistry Haematology Infection Immunology Pathology Rheumatology Tel - 0121 4143344 http://www.medicine.bham.ac.uk/prospective/intercalated.htm Closing date for external applicants is 31st March.

All programmes are restricted in the numbers of students (both internal and external) who can be accepted. ________________________________

Tel: 01792 513400 www.medicine.swansea.ac.uk p.g.maull@swansea.ac.uk ________________________________ Dundee Anatomy Biochemistry Applied Orthopaedic technology Cellular and molecular basis of disease Medical Psychology Pharmacology Pharmacology and neuroscience Physiology 01382 344160 facmd@dundee.ac.uk ________________________________ Edinburgh Biochemistry Epidemiology Genetics Immunology Microbiology and infection Molecular Biology Neuroscience Experimental Pathology Pharmacology Pharmacology & industrial experience Physiology Psychology Developmental Biology Medical Biology Reproductive Biology Sports science medicine Zoology

Closing date 28th April 2006. Selection is based on the academic performance of students in the first three years of the medical course and in some cases on interview or written submission.

Anatomy Biochemistry Genetics Immunology Medical Biochemistry Microbiology Molecular & Cellular Biology Neuroscience Parasitological Pharmacology Physiology Physiology & Sports Science Physiology, Sports Science & Nutrition Virology Tel - 0141 330 8040 http://www.gla.ac.uk/faculties/medicine/inte rcalated/twoyearintercalated.html _______________________________

Tel - 0117 928 7679 www.medici.bris.ac.uk/general/undergraduate/course-overview1.html ________________________________ Cambridge No intercalated degrees ________________________________ Cardiff and Swansea Pharmacology Physiology Biochemistry Anatomical Sciences Cognitive Neuroscience

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Tel - 0131 2426407 www.med.ed.ac.uk/studying ________________________________ GKT Aerospace physiology Anatomy and human sciences Biochemistry Biology Biomaterials Biomedical sciences Bimolecular sciences Developmental Neurobiology Endocrinology Ethics and Law Human Genetics Immunology Infectious diseases Microbiology Molecular aspects of the diseases of aging Neurosciences Neurophysiology Nutrition Oral Biology Pharmacology Philosophy Psychology Radiological Sciences Tel - 0207 8486400 http://www.kcl.ac.uk

Application Deadline - 31st January r.a.fricker-gates@keele.ac.uk http://www.keele.ac.uk/depts/ms/undergrad/intercalated_degree.htm _______________________________ Leeds Anatomy BSc Biochemistry (medicine) BSc Biomedical ethics BA Clinical Sciences BSc Genetics in relation to Medicine BSc Health Management BSc History of Medicine BA International Health BSc Microbiology (medicine) BSc Neuroscience BSc Pharmacology BSc Physiology BSc Psychology (medicine) BSc Sports Science (medicine BSc Zoology (medicine) BSc

Hull York Biological Sciences Applied Ethics More choices coming on stream over the next few years. All our students are free to apply to intercalate at other medical schools. Students at HYMS are allowed if student wishes without restrictions (although they have to be in good academic standing and have no outstanding fitness to practice issues).

Tel - 01482 464705 http://www.hyms.ac.uk _______________________________

Bristol Anatomical Sciences Human Musculoskeletal science Biochemistry Bioethics Neuroscience Cancer Biology Cancer Biology and immunology Immunology Medical Microbiology Pathology and Microbiology Virology and immunology Pharmacology Physiological sciences

MSc in Molecular Parasitology & Vector Biology MSc in Biomedical Engineering MSc in Cell & Tissue Engineering MA in Medical Ethics & Law

Imperial It is an integrated part of our 6 year MBBS/BSc course. Students wishing to study at another College/University can do so - normally to study courses not offered by us. Permission to study away from the College is normally granted only to students who have a good academic record.

Haematology Immunobiology and pathology Management Medical Humanities Tel - 020 7594 9801 Email: j.shiel@imperial.ac.uk www.imperial.ac.uk/medicine _______________________________ Keele Students can take the intercalated BSc degree after successfully completing their second year of the MBChB programme.

The intercalated MSc or MA degree may only be taken after completing their fourth year.

Brain & Behaviour Molecular Biomedicine History of Medicine

External applicants are considered if sufficient places are available after Leeds students are allocated.

Deadline - 24th Feb Tel - 0113 343 2235 A. Thompson@leeds.ac.uk www.leeds.ac.uk/medicine/intercalated _______________________________ Leicester and Warwick BSc available with most relevant degrees at Leicester or Warwick.

Leicester - 0116 2522969 Warwick - 0247 6523723 _______________________________ Liverpool BSc (Hons) Biochemistry BSc (Hons) Genetics BSc (Hons) Microbiology BSc (Hons) Molecular Biology BSc (Hons) Pharmacology BSc (Hons) Physiology BSc (Hons) Psychology BSc (Hons) Tropical Disease Biology Tel - 0151 7064260 http://www.liv.ac.uk/facmed _______________________________ Manchester Anatomical Sciences Biochemistry Biomedical Sciences Cell Biology Health Care Ethics and Law History of Medicine Medical Biochemistry Neuroscience Pathology Pharmacology Pharmacology and Physiology Physiology Psychology

trauma Masters in Research (Year 4 only) Population Health Evidence - web-based learning (MSc, Year 4 only) Tel - 0161 275 7201 http://www.medicine.manchester.ac.uk/unde rgraduate/thecourse/intercalation ________________________________ Newcastle Biochemistry Biochemistry with immunology Biomedical sciences Genetics Medical Microbiology and immunology Pharmacology Physiological Sciences

undertake an intercalated degree. There are no restrictions placed on student numbers.

Students are encouraged to undertake an intercalated degree.

Anatomy Biochemistry Physiology Molecular Biology Microbiology Pathology Pharmacology Cardiovascular Science Tel - 02890 277 2242 http://www.qub.ac.uk/cm/pat/ibsc _______________________________ Sheffield

Tel - 0191 222 7005 ________________________________

BMedSci Only offered internally

Nottingham BMedSci - part of degree Not offered externally

0114 2712932 _______________________________ Southampton

Tel - 0115 924 9924 _______________________________ Oxford No intercalation ________________________________

Biomedical Science Sociology Psychology Tel - 02380 594206 bmadmissions@soton.ac.uk _______________________________

Penninsula St. Georges Intercalated degree programme, available on a *restricted* basis, to the 15-20 per cent top ranking students, on a knowledgebased assessment within the course.

Peninsula Medical School students can intercalate only at one of our two parent Universities (Exeter and Plymouth), but can join the final year (level 3) of a wide range of degree programmes in Sciences or Humanities for which they have sufficient prior learning, and would obtain the same degree as the peer group they join. In some cases Masters programmes are also available.

Tel - 01752 437444 http://www.pms.ac.uk anthony.pinching@pms.ac.uk _______________________________ QMUL Approximately 40 to 50 per cent of our students are permitted to intercalate. They are selected on the basis of academic performance and interview. Of those who intercalate about 90% do internal degrees and the remainder intercalate at other institutions.

Most students intercalate after year 4 although a limited number (about 10) of the most able to intercalate after year 2 or 3.

Closing date for applications: Mid February 2006. Open to external applicants BMedSci Community Health Sciences BMedSci Molecular Medicine BMedSci Molecular Therapeutics BSc Biomedical Engineering BSc Clinical Materials BSc Experimental Pathology BSc Human Bioscience BSc Neuroscience BSc Oral Biology BSc Sports and Exercise Medicine

Medical Genetics 0208 672 9944 acrosby@sghms.ac.uk _______________________________ UCL Anatomy Biochemistry Genetics History of Medicine Human Genetics Immunology and Cell Pathology Infection International Health Medical Anthropology Medical Physics Molecular Medicine with Basic Medical and Clinical Sciences Neuroscience Orthopaedic Science Pharmacology Physiology Physiology and Pharmacology Primary Health Care Psychology Science and Technology Studies Speech Science and Communication Closing Date is 3rd March. Open to external applications UCL students are required to intercalate between years 2 and 5; it comes as part of a six year course. www.ucl.ac.uk/lifesciences-faculty/programmes Tel - 0207 679 5477 _______________________________ UEA Not offered _______________________________

Tel - 020 7377 7349 http://www.smd.qmul.ac.uk/undergraduate/i ntercalated/ _______________________________ QUB Students must have passed all their end of year examinations before being permitted to

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trauma

drug metabolism and interactions Interactions between administered drugs can be both deadly and beneficial. It’s a part of medicine that students often struggle with. This issue, in association with PasTest, we bring you a guide to drug metabolism and their interactions.

Genetic polymorphisms of drug metabolism

Poor metabolisers other drugs

Genetic variations can influence how drugs are metabolised. For example, around 50 per cent of the population possess the slow acetylator phenotype, which can cause higher drug concentrations and greater adverse effects in these people: > Drug induced lupus > Isoniazid-induced peripheral neuropathy

s-Mephenytoin: 3-5 per cent of the UK population have low smephenytoin hydroxylase activity, and metabolise this anti-epileptic agent slowly: higher drug concentrations may cause greater adverse effects.

Codeine: 7 per cent of the UK population have low Cyp2D6 enzyme activity and cannot convert codeine to morphine; codeine is less effective in these people.

Drug induced lupus

Rapid acetylators

Unlike autoimmune systemic lupus erythematous (SLE), druginduced lupus is equally prevalent in men and women. Laboratory findings include antibodies to histones and single-stranded DNA. Clinical features include:

Rapid acetylators may be exposed to lower drug concentrations (treatment less effective) and suffer adverse effects of high drug metabolite concentrations: eg. isoniazid-induced hepatitis.

of

(Phenytoin, Carbamazepine, Barbituates, Rifampicin, Alcohol (chronic excess), Sulphonylureas) Essential note Enzyme inducers increase hepatic metabolism so that other drugs may be less effective.

Liver enzyme inhibition A number of drugs can inhibit enzyme activity, often immediately. Other drugs are metabolised less extensively, so their plasma concentrations increase and adverse effects are more likely.

Enzyme inhibition can increase the effects of the drugs listed in the following box: Drugs metabolised more slowly in the setting of enzyme inhibition

Liver enzyme induction > Arthralgia > Butterfly rash > Pleurisy Renal involvement (except with hydralazine) or neuropsychiatric manifestations are unusual.

Some causes of drug-induced lupus (*metabolised significantly by acetylation, hence lupus more common in slow acetylators) > Beta-blockers > Chlorpromazine > Hydralazine* > Isoniazid* > Penicillin > Phenytoin > Procainamide* > Sulfasalazine* > Sulphonamides*

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Certain drugs can induce the activity of liver enzymes. This can take a number of days to occur because of the time taken to synthesise more enzyme. Enzyme induction can cause more rapid metabolism of other drugs, thereby decreasing their effectiveness: Drugs metabolised more rapidly in the setting of enzyme induction. > Hydrocortisone > Oral contraceptive pill > Phenytoin > Warfarin Drugs capable of causing enzyme induction can be remembered by the mnemonic PC BRAS:

> Carbamazepine > Ciclosporin > Phenytoin > Theophyllines > Warfarin Drugs that are liver enzyme inhibitors may be recalled by the mnemonic AODEVICES (Allopurinol, Omeprazole, Disulfiram, Erythromycin, Valporate, Isoniazid, Cimetidine (and ciprofloxacin), acute Ethanol intoxication, Sulphonamides) Essential note Enzyme inhibitors slow down hepatic metabolism can can increase the effects of other drugs.

in association with

Failure of the combined oral contraceptive pill Conditions that impair absorption of the oral contraceptive pill cause treatment failure: > Diarrhoea due to rapid gastrointestinal transit > Broad-spectrum antibiotics, eg. amoxicillin, eradicate gut flora that normally deconjugate bile and contribute to enterohepatic cycling of the oestrogen component.

In addition, oestrogen is metabolised more rapidly in the presence of enzyme inducers, leading to lower circulation concentrations and pill failure.

Extract from Essential Revision Notes in Medicine for Students (see below).

Essential Revision Notes in Medicine for Students Especially written for medical students facing their final year exams. Fifteen chapters provide complete coverage of all the key topics assessed in medical finals. Key points are presented clearly in diagrams, illustrations, lists, tables and mnemonics to aid learning.

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trauma AWTF Away With The Fairies BUNDY But Unfortunately Not Dead Yet BVA Breathing Valuable Air

weird

FLK Funny Looking Kid FRACS Fornicates Regularly And Chain Smokes FUBAR F**ked Up Beyond All Recognition (FUBAR describes a patient who needs specialist treatment but has been treated by non-specialist doctors, and for whom it is now impossible to tell what signs/symptoms are due to the disease and what are due to the inappropriate treatment) GBC General Body Crumble GFPO Good For Parts Only

world news

GLM Good Looking Mum GOMW Get Out of My Ward Why do people get dark circles under their eyes?

HIVI Husband Is Village Idiot NFD Normal For Dudley PBP Proctodynia By Proxy (A pain in the ass)

Three things contribute to dark circles under the eyes: an inherited tendency, lack of sleep and also aging. Lack of sleep explains dark circles in most of us, but the reasons why aren’t properly understood but it is believed it may be related to blood supply changes in the area.

TEETH Tried Everything Else? Try Homeopathy TUBE Totally Unnecessary Breast Examination

abbrevia-what?

Hidden between the FBCs and WBCs in medical notes you’ll find some abbreviations that tell you a lot more about the patient. We just hope that the patients never get to see them!

As we age skin gets thinner because of collagen and elastin breakdown. This thinning is particularly noticeable in some parts of the body, especially where the skin is stretched over bony areas with no cushioning fat underneath, for example the eyes! The darkening comes from blood vessels showing through the skin.

83% happiness, 9% disgust, 6% fear and 2% anger = Mona Lisa’s smile This conclusion was made after computer analysis by scientists at the University of Amsterdam. Their program drew on a database of young female faces to derive an average ‘neutral’ expression.

As ever, artists felt scientists were encroaching on their territory, as art expert Michael Daley explained: “The point of this work is that it’s a riddle and the inaccessibility of her emotions are the object of the painting’s fascination. That a computer can come up with just four emotions to explain it is ridiculous”.

Mayor wants to make dying illegal Roberto Pereira da Silva, mayor of Biritiba-Mirim, Brazil, came up with the idea because the town’s only cemetery is full. He wants to enforce this law that would see people who are likely die before their time fined or even jailed.

The law would make it an offence for the town’s 28,000 citizens to not to look after their health properly. Gym memberships have reportedly shot up, and more people are going to their doctor.

Brazilian woman strolls into hospital after being shot in the head Florence Kanto, 60, from Rio de Janiero, was relaxing at home watching TV when the stray bullet hit her in the head near her left ear. She did not even lose consciousness but thought, justifiably, that a hospital visit was warranted. A spokesperson said the bullet entered at a “slow pace”, which was why the shot wasn’t fatal.

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trauma

pathology Pathology is a fascinating subject according to Dr Ernest Gradwell, Consultant Pathologist and clinical subdean at Liverpool. Nicole Chiang asked him to dissect the benefits and disadvantages of this career path.

How did you become interested in pathology?

I was a student of the old curriculum and there was great emphasis on the teaching of science subjects in the preclinical years such as anatomy, physiology, biochemistry and pathology. I came across a great teacher in pathology and he really sparked my interest in the subject. It’s often the way in life, you meet somebody who is very good at something and you become interested in it yourself.

Why did you choose pathology and not medicine with ‘live’ patients?

We do deal with ‘live’ patients but only indirectly. We never see them but we spend a lot of time dealing with them. The reason very much comes down to my scientific background which drove me into pathology. I also find it much easier communicating with doctors rather than with patients.

In the old curriculum, we weren’t taught communication skills, which is probably a good thing I’m quite happy dealing with doctors and not patients.

What do pathologists do?

Post-mortems are actually just a small part of a pathologist’s job.

Less than 5 per cent of my time is spent in the mortuary. The bulk of our job is what we call ‘surgical pathology’. In ‘live’ patients, we will help our clinical colleagues come to a diagnosis in medicine, surgery, obstetrics, gynaecology and paediatrics.

The pathologist is part of the team in the laboratory that’s involved in biomedical sciences.

We do microscopy and come to a diagnosis. We’ve also got an important role in training student pathologists, medical students and biomedical scientists.

What is the best aspect of your job?

It is a very scientific subject. I know that clinical medicine is a scientific subject but pathology is attractive because it is accurate in many cases. Indeed, it’s still called the ‘bold standard’ of medicine.

When we say ‘carcinoma of the rectum’ in almost 100 per cent of cases it is infact carcinoma of the rectum. So, I like the fact that the subject is reproducible, accurate and relevant. And that really is the best part: being accurate, scientific and relevant!

And the worst?

Our clinical colleagues think we can always be accurate on small tissues. For example, after biopsy of a lump, they expect us to say exactly what the lump is. The worst part of being a pathologist is unrealistic expectations that our clinical colleagues have on us.

I would urge any undergraduate who wants to become a pathologist to go ahead and do it. You will not be disappointed.

This is the same to a certain extent, from the public, in that they expect us to say exactly why a person died. We can’t do that. It is like science, sometimes we just don’t know the answers. I think these unrealistic expectations of doctors and society on pathologists are the least satisfying aspect of my job.

What are the career prospects like?

Pathology suffers from a shortage of expertise. There are 200 consultant vacancies in the

country. So career prospects must be very good. However, medical students don’t want to become pathologists. Certainly one of the reasons is probably the way pathology is taught today. If as undergraduates you don’t have courses in pathology anymore your interest in the subject won’t be stirred.

But that is only part of the reason because pathology became a less popular subject even before problem based-learning was introduced. If an undergraduate decides to become a pathologist, then the career prospects are good.

And I would urge any undergraduate who wants to become a pathologist to go ahead and do it.

You will not be disappointed.

What is the career pathway of a pathologist like?

The career pathway is slightly different to other specialisms because undergraduates have limited knowledge about pathology.

There are designated SHO schools where you can go and have a year’s intensive training to see if you like the subject. After a year in an SHO school, you sit an aptitude test.

If you pass, you can apply for a registrar’s post. You receive a training number and become a recognised trainee in pathology, and you will then spend 5 years in specialist registrar training. In these 5 years you do the MRCPath exam (Membership Examination of the Royal College of Pathologists) that is split up into two parts: part one is theory and part two is practice. On passing the MRCPath exam, you will be given a certificate called the CCST (Certificate of Completion of Specialist Training). You become eligible for a consultant post.

What advice would you give to medical students who are interested in pursuing a career in pathology?

In the modern curriculum, there is inadequate exposure to the subject. Do your SSM and Selective Advance Medical Practice (SAMP) in pathology, because when you go for your interview or to an SHO school they will ask you – “What demonstrates your interest in pathology?”

Why would you recommend medical students to intercalate in pathology?

I would recommend any medical student to get as much experience as they can in the subject.

There is no rush to qualify. I certainly recommend a student to do anything that will mark them out as being different to other students when you come to apply for an SHO job or even a consultant post, if you’ve got more demonstrable experience, more qualifications than other candidates, appointment committees will take note of it.

These days the appointment of people in any level is much more objective than it used to be and if you have got something that makes you different to other people, then they will recognise that and you have a head start over other applicants. So yes, I would recommend the study of pathology in an intercalated degree. But not just for the reason I mentioned because the study of pathology is intrinsically interesting.

Further information > Institute of Psychiatry Eating Disorders www.eatingresearch.com > Eating Disorders Association, www.edauk.com

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