MS_February_12 by The Medical Student

the

medicalstudent February 2012

The voice of Londonâ&#x20AC;&#x2122;s Medical Students

Medics vs BUCS: Fight! Ken Wu

This month, the battle between BUCS and medical schools has intensified over the merger between the sports teams of the medical schools and their parent institutions. Time is running out on the period of

consultation BUCS have implemented after removing the merger proposal from their agenda. The consultations have felt to be inadequate in both time and quality, further escalating tensions between the three parties involved in trying to find a fair and suitable solution to this issue. (contâ&#x20AC;&#x2122;d on page 3)

Interview with Aki from BBC Junior Doctors Page 6

Healthcare in Gaza - an in-depth exploration Page 8

Saviour Siblings - A cure using babies Page 13

Shame - A sexually charged review Page 17

Image by Chetan Khatri

Dubstep - A cure for cancer? Page 21

February 2012

News

News Editor: Ken Wu news@medical-student.co.uk

Editor-in-Chief

M Alexander Shimmings GKT Medsoc President As per usual happenings at GKT are going well and bordering on epic. Coming up this month we will be campaigning in the KCLSU Sports Referendum - a ridiculous yet 'necessary' event which has been forced on us by our increasingly bureaucratic students' union. The question to be put to the students of King's - 'Should KCLSU continue to support separate KCLMS and KCL sports clubs?' (Yes/ No). It may seem bizarre that GKT, and before then King's has had separate sports clubs since the 19th Century, yet in the summer of 2011 KCLSU wasn't sure if they could support us at the BUCS AGM, but then I leave you to the wonderment that is the workings of our students union. After this referendum, perhaps we should push for devolution and a separate GKTSU? Other than sports drama, GKT freshers are gearing up for RAG Week in early February. Having raised over

Purvi Patel on a new era for The Medical Student

£16,000 in a day at Jingle RAG things are looking promising, and with the threatening sound of jingling gin bottles behind them they are sure to rake in the mullah. To cap everything off, we are all very much looking forward to the RAG Ball, as I'm sure is the RAG President Theo Willison Parry, who tradition dictates will not be able to remember anything of the night aside from a juniper haze. This week will also see the opening of MedSoc Musical Theatre's 'Footloose' at Greenwood Theatre, which by the time of print I am sure will be known as a rave success

words) as awesome as his. Alas! However, as always, we must remember to bring some perspective to the situation and reminding ourselves of unquestionable failures, such as UH Adrenaline should accomplish that. I think I might survive. The year has only just begun, and already I find myself facing serious issues, from trying to find ways around college download limits, to continued attempts from BUCS to bring an end to the heritage of the London medical schools. Whatever happens this year, it promises to be interesting at the very least and, barring the end of the world, The Medical Student will continue to

provide an informative and entertaining record of it all And so we begin

Find us on Facebook and Twitter @msnewspaper

Adrenaline Flops as Tickets Undersell Ken Wu on the less-than-exciting January follow-up to 999 will make it one medical students from all over the UK will remember Barts for. Unfortnuately the refurbishment of our beloved Union building has been delayed for a month. The Union will also be working our Alumni project. I must admit this was shamelessly copied from ICSMSU! I hope we can replicate what they have managed to achieved down in South Ken. We are lacking several of the younger generations of BL alumni and need to reinvigorate it with some youth! Our Alumni Officer will be working hard this term to entice this years graduates into becoming a part of it

Nana Adu SGUL President The majority of our Student Union time has been spent preparing for RAG - which stands for Raising and Giving for the benefit of students at RUMS. We have planned a fortnight of activities to raise money for worthy causes, which is looking very exciting. Apart from that we have been sorting out our accounts rather than faking them - like how RUMS claimed to have actually sold '999' and 'Adrenaline' tickets. It has helped in the refurbishment of the school shop. The shop is now officially open and offers great deals including the Guardian for 50p - we appreciate that students from GKT gather their views from picture books

t is the night before the print deadline of my very first issue as editor of the Medical Student newspaper, and I find myself in a similar position to my predecessor - that is to say, struggling for words. In the short time since the resurrection of The Medical Student, the standards have been raised to such a height, that the newspaper is almost unrecognisable. Credit for this goes almost entirely to the previous editor, John Hardie, and his dedication to the newspaper. Only time will tell whether or not I can live up to the standards set by John - although I have already failed in one regard: my hair is just not (for lack of

medicalstudent newspaper

George Ryan BL President Welcome back to 2012, the year of The GriffInn! The hot topic on Januarys agenda is Union Elections where next year’s potential leaders are stepping up to the challenge. A challenge we’re currently facing, is the threat to the independence of medical school sports teams from their parent universities. London’s medical schools share a rich history of sporting competition, this is something that is still hugely valued by students today. Our Students Presidents' Council and all of the heads of our sports teams have taken a clear stance on the issue with a unanimous vote against the future prospect of merging at a General Council Meeting last week. On another topic, preparations have begun for next year’s National Medsoc Conference which BL successfully put in a bid to host at this year’s conference. This is a huge project for BLSA to undertake and having met several candidates already I have no doubt our team

medicalstudent

nJanuary17th,UHMedgroup hosted its second social event of the year, 'Adrenaline' at Tiger Tiger club in central London. On the back of its highly successful '999' event earlier in the academic year, Medgroup were hoping for a repeat performance and once again revive the competition for the crown of the most sociable medical school in London. However, due to a lack of publicity from the medical schools and with the added competition of another student night being hosted at the nearby Piccadilly Institute, the event failed to generate the turn-out it had hoped for, with only 231 pre-event ticket sales. Most of the thoses tickets were bought by students from Barts and The London medical school, a small surprise given that the current UH President, Jeeves Wijisuriya, was himself the former president of the Barts and the London Student Association

or the Daily Fail. However the folk at George's are indeed more educated! In other news we have new mirrors in our Dance Studio which will undoubtedly be used in all the upcoming shows, including the Tooting Show, Play Soc, Musical and Bhangra Show, just some of the range of shows that George's are putting on this term. Finally, one of my sabbaticals in crime appears to be donning a ring on her left hand!

the

Mirrors makes it look like more people turned up. Image by Laura Pettifar

medicalstudent

Editor-in-chief: Purvi Patel News editor: Ken Wu Features editor: Bibek Das Comment editor: Rhys Davies Culture editor: Kiranjeet Gill Doctors’ Mess editor: Rob Cleaver Assisstant editor: Amrutha Sridhar Image editor: Chetan Khatri Illustrator: Elvin Chang Social Media editor: James Turbett Sub-editors: Alex Isted, Keerthini Muthuswamy, Ashik Amlani Distribution officer: Sanchit Kapoor Consultant editor: John Hardie

medicalstudent

February 2012

News Time Running Out on BUCS Merger Proposals Ken Wu News Editor (cont’d from front page) In July 2011, it was discovered that at the BUCS AGM, a proposal to remove what BUCS describe as ‘higher education anomalies’ where sports teams competing under different departments but originate from the same institutions. At the time, this generated a massive wave of furore and unrest amongst the medical school unions and students. This resulted in BUCS removing the proposal from the agenda of the AGM. BUCS also stated that there would be a period of consultation with the affected institutions in the next few months regarding the proposal. This period of consultation is now nearing its end despite the lack of inclusion felt by the medical school students and representatives.

"The letter stressed the inadequacy of the consultation process, especially with regards to the involvement of the student representatives from each medical school as well as all of the medical students within each institution" UH Medgroup, the representative body of all five London medical schools, have sent a letter to the BUCS London Regional Meeting on January 23rd 2012, outlining the concerns of the medical schools. The letter stressed the inadequacy of the consultation process, especially with regards to the involvement of the student representatives from each medical school as well as all of the medical students within each institution. A request therefore was made in the letter to extend the period of consultation between BUCS and the affected institutions on the matter of the merger. This letter was passed on through various ranks inside BUCS to the Chief Executive Officer and the Head of Sports Programmes of BUCS. They have both expressed their willingness to extend the consultation period as well as ensuring that all parties feel included in the process. Consultations between the medical schools and their parent institutions have been taking place since the issue was first brought up last summer but now they have intensified given the time-pressures exerted by BUCS. At ICSM, numerous suggestions have been put forward but at the mo-

ment, one proposal has stood out during the consultation. The proposal was put forward by Sport Imperial, a team of Imperial staff whose main objectives are to maintain and improve the sports facilities of Imperial, increase participation in all sports at all levels and to improve the BUCS ranking of Imperial by enhancing team and individual performance. The proposal would see Imperial and ICSM still remain completely separate with separate teams. However, Sport Imperial would rank Imperial and ICSM teams according to their position in the BUCS league and form an internal ranking only known to the club and team captains, Sport Imperial, and BUCS. With regards to the BUCS points and team names, BUCS points from both ICSM and Imperial would be combined and the team names would have brackets included if one team originated from ICSM. For example Imperial Medicals 1st ranked 1st would become Imperial (Medicals) 1st. The proposal is still in its early stages, with no formal agreement signed and accepted by ICSM, Sport Imperial or BUCS. However, it has generated much debate amongst ICSM students, with supporters saying that it is an adequate compromise to prevent the worst case scenario of ICSM sports teams being removed from BUCS entirely and a complete merger with Imperial. Detractors of the proposal say that the compromise is almost as bad as a merger, particularly with regards to the loss of medical school identity as well as administrative issues such as the limit as to a number of teams one institution can enter in BUCS which will squeeze out the lower ranked teams and thus decrease participation.

"Given the intricate politics involved in this matter, with the individual vested interests of the medical school, the university, BUCS and the sports clubs themselves, some student unions are urging all parties involved to proceed with caution." At RUMS, a proposal similar to the one put forward by Sport Imperial has been drafted. However, a more formal consultation process will take place at GKT. King’s College London and GKT are holding a formal referendum on the issue of whether sports clubs at GKT should merge with their counterparts at King’s. The referendum is likely to be fiercely contested

Neil Chowdhury RUMS President

at King’s especially as GKT are having their own internal referendum on the subject of whether GKT should, like all of the other London medical schools, should break away from King’s and form their own student union. Queen Mary, the parent institution of Barts and the London, are pushing for a complete merger between the two institutions. Barts have formally rejected any proposals to merge with their counterparts at Queen Mary at their General Council Meeting with an unanimous vote from the BLSA Students Presidents’ Council.

"UH Medgroup, led by President Jeeves Wijisuriya, will continue to strongly campaign against any moves by BUCS to push for the merger and plans have already been drawn up to lobby senior sport governing bodies including Sport England for support " Whilst the general consensus amongst all of the London medical schools is to prevent any moves on a merger between the sports clubs, there has been a great deal of internal disagreement within every medical school as to the best way forward to solve this problem. Given the intricate politics involved in this matter, with the individual vested interests of the medical school, the university, BUCS and the sports clubs themselves, some student unions are urging all parties involved to proceed with caution. Various student representatives and sports captains that have been contacted by The Medical Student have been reluctant to comment on the record about the merger although they have been vociferous in their opinions off the record. Again this seems to highlight the inadequacy of the consultation process offered by BUCS themselves with emotions understandably running high due to the lack of transparency and the time pressures. The extension on the consultation period has given the medical schools a temporary respite on the issue and an opportunity for continued discussion. However, this matter is likely to flare up again in the coming months leading up to the next BUCS AGM in the summer. UH Medgroup, led by President Jeeves Wijisuriya, will continue to strongly campaign against any moves by BUCS to push for the merger and plans have already been drawn up to lobby senior sport governing bodies including Sport England for support

To shame all other London medical schools, the medical school topped the ranks in London in the National Student Survey (NSS) 2011, and 4th in the country, adding to our long list of achievements. Our Winter Ball was a huge success and this term we will have a more charity focussed agenda for RUMS. We have our Charity Naked Sportsnite Circles (or ‘tables’ to you odd folk out there), our Charity anti-Valentines, and even a RUMS Arabian Night. We have also started our Welfare series to help students to work on their finance and accommodation problems. We are, of course, also engaged with

our RUMS Sports teams to maintain our existence in BUCS. In these times of threat to our heritage, we are working together with the other medical schools to see a way of securing our legacy as separate teams. We are by no means merging with UCLU, and we will remain resilient RUMS rangers

Suzie Rayner ICSM President This week, the Imperial Newspaper ‘Felix’ reported an article entitled ‘Imperial collects lowest amount of university library fines’. Whilst this article only enhances the ‘geek chic’ image that Imperial is so proud of, it also made the observation that: ‘The highest London based university was King's College London in fourth place, who, no doubt, found it confusing to be so high up on a table’. It therefore seemed only right to jump on the bandwagon and target GKT, sorry, KCLMS with this month’s column. I have only met Mark Shimmings a few times, and yet he seems to be oblivious to the fact that his medical school name has changed, sporting ‘GKT’ across his chest on every occasion. Ignoring it doesn’t make it go away; it’s even KCLMS on Wikipedia. However, I must concede that they are currently superior to ICSM in perhaps one way; their bar. But I hope

to put a stop to this unique superiority in the not too distant future. The Faculty of Medicine, along with Imperial College Union and ICSMSU are working towards funding applications for a complete renovation of the Reynolds Building, including the bar itself. The hope is that the current well-loved but dingy bar can be given a new lease of life and at the same time we can improve our facilities for clubs and societies and education

Jeeves Wijesuriya UH President With the BUCS situation coming to a head, UH Medgroup have sent a reponse on behalf of all London Medical schools and are in the process of fighting the proposed merger of our sports teams! We are now in the process of consulting with Cardiff Medicals, who would be equally damaged by this proposal, and sought support from the BMA, NUS and ULU. We are also proud to announce the appointment of our new UH Medgroup Staff President, Professor Sir Nicholas Wright, former Warden of Barts and the London and Deputy Principal of Imperial College School of Medicine. One of the big talking points amongst the presidents has been our freshers. It seems as though we are noticing a strange anti-social trend amonst the medical students this year, apart from RUMS, whose students have always been anti-social. We just had Adrenaline, which wasn't at its most succesful this year with poor

pre-sales across the board. Remember freshers, medicine is more than just the academic. Never forget the value of the hidden curriculum, the value in learning teamwork, organisation, getting involved with projects and charity work, and the value in meeting the older years that will inevitably become your F1s and regs in the future (with the exception of Mark Shimmings). Don't let the only thing your peers and seniors remember about you be that your never really got involved, and dont let your only memories of medical school be ones centred around revision

February 2012

medicalstudent

News Hospital Merger Chaos Threatens ICSM Students

Hospitals heading into A&E. Image by Chetan Khatri

Katherine Bettany Guest Writer A controversial proposal, described as the ‘result of unprecedented and unnecessarily deep cuts in public services’ has been announced, that would see Ealing Hospital Trust and North West London Hospitals Trust merge. Discussions about the futures of several London NHS Trusts have been ongoing since 2010, and whilst no official decisions have been announced, both Trusts are said to be finalising business plans for the merger, that, if approved, would be implemented as of July 2012. In a final proposal document, the decision was hailed as offering the ‘best opportunity to provide the highest quality of care for people in Brent, Ealing and Harrow.’ The document cited ‘organisational barriers’ and lack of integrative care as fundamental drivers for the proposal, and noted that by becoming one organisation, the Trusts could provide the community with large clinical teams

that deliver more specialist and better quality of care. 'Our vision is to ensure that every person in our part of London has the best possible healthcare.'

"There is a danger that after the merger, there will be a period of uncertainty due to administrative issues associated with the merger which will affect all of the hospital staff and that can affect the experiences of the students who have firms at those sites" Imperial College Medical Students, who receive clinical training within both Trusts will no doubt be concerned about the proposals. The Medical Student spoke to Dr Bill Lynn, a consultant at Ealing Hospital working on the proposed merger,

who sought to reassure the hundreds of students trained within the Trusts. 'The merger process is working closely with Imperial to ensure that the concerns of the medical students are taken into account. There are no short term impacts on the students. However, it is vital not to lose medical student numbers who are attached to the hospitals and to maintain the quality of the experiences that the students will have once the merger has occurred.' Dr Lynn recognised, however, that with significant administrative change comes periods of uncertainty. 'There shouldn’t be an immediate impact on the learning experience on the students. However, there is a danger that after the merger, there will be a period of uncertainty due to administrative issues associated with the merger which will affect all of the hospital staff and that can affect the experiences of the students who have firms at those sites. We will aim to address any issues closely with a feedback system throughout the clinical sites and liaise closely with Imperial.'

The plans have come up against fierce competition from doctors and politicians alike, who express concerns that the move could leave Ealing Hospital with no Accident and Emergency Department and no inpatient beds, rendering 300,000 local people without adequate access to healthcare. Public dissatisfaction in the proposal was starkly reflected by a 4,000 signature strong petition, lead by Dr Onkar Sahota, a London GP and Labour candidate representing Ealing and Hillingdon at the Greater London Authority (GLA), which was presented to a full council in December. Sahota outlined his concerns with the motivation behind the merge: 'I have nothing against mergers if they reduce management costs and put more money into frontline services. However this merger is about reducing investment and threatening services.' Indeed, hidden within the official Trust documents explaining the merger could lie the real driver for the proposals. With the NHS being forced to make £20billion worth of efficiency

savings, this merger is part of the wider initiative to save money by moving services out of hospital and into the community - focusing more on primary care and disease prevention. Whilst the Trusts deny financial motives being the key motivators for the plans, they recognise that they ‘have to consider what financial benefits a merger will bring. Our services need to be affordable, as we know there will be a decline in hospital income when resources are shifted to the community. We need to match our services to this change in funding.’ Even if the proposals are approved, there will be no immediate changes to patient care. No decisions have yet been made about the form the organisational changes will take – this will be decided in a separate formal consultation with the PCT and local GPs later this year. Because of this we can only speculate about the consequences the merger will have on patient healthcare. In difficult financial times, proposals that truly save money via the more efficient use of resources should be welcomed, but never at the expense of quality of care

medicalstudent

February 2012

News TfL Implements New Scheme for the Upcoming Medical School RAG Weeks Govindpal Singh Kooner Guest Writer RAG is fundamental to university life, especially to that of medical school. It promotes charity, fosters activism and above all, is a massive dose of fun with a splash of drunken debauchery on the side. Yet the ability to raise money in a fun and free could be under threat. It is illegal to drink, and thus RAG inebriated, on the London Underground. It is also illegal to raise money for charity on the trains themselves. It is, however, legal to raise money at stations with a permit. TfL are willing to offer these permits for particular stations during agreed times. Furthermore, they will fast-track these RAG permits, leap-frogging the laboriously long six week acquisition period. A spokesperson from The London Underground Charities team has said that the scheme was put in place to 'enhance passanger and student safety.' However the scheme has limited RAG applications to one per month in Zone 1 stations only. The application also needs to be approved by both the Dean of the medical school and the Student Union president. RAG has always been a bother for TfL and the police but the situation worsened last year. A Bart’s student was returned to his university in handcuffs after repeatedly collecting on the Tube. As a result, this year, TfL are leaving action against students to the police’s discretion. There have also been some reports of drunk students intimidating members of the public. This issue also needs to be addressed by all RAG committees and student unions. You may have had to sign a ‘student agreement’ when you started medical school that declared your dedication to acting responsibly as a student. That is why even on the most adventurous RAG missions a little common sense is required

Research in brief BL: Researchers have identified that a mutation in a single gene, the RHBDF2 gene, which plays an important role in ensuring controlled wound healing, is responsible for oesophageal cancer susceptibility in families affected by the inherited disorder, tylosis. Studies suggest that this gene may also be implicated in non-inherited oesophageal cancer. GKT: Memantine, a drug used to treat Alzheimer’s, is not an effective treatment for those aged 40 and over with Down’s syndrome, most of whom develop clinically significant Alzheimer’slike pathological features. There were no significant differences in the change in cognition and function after six months between the control group and treatment group. ICSM: Scientists have obtained the most detailed picture to date of how psychedelic drugs work. MRI scans of the brains of healthy volunteers infused with psilocybin, the active ingredient in magic mushrooms, showed decreased activity in the ‘hub’ regions of the brain, contrary to the common assumption that they act by increasing activity. RUMS: Gene therapy can be beneficial to those suffering from haemophilia B. The study used adeno-associated virus (AAV) 8 to deliver the Factor IX gene, which is deficient in sufferers, along with additional genetic material into the patient’s liver. Following treatment, Factor IX levels exhibited a rise in all patients. SGUL: A new study has linked mutations in the gene KIF11 to Microcephaly-LymphoedemaChorioretinal Dyplasia (MLCRD), a very rare condition. Researchers say this will improve understanding of MLCRD’s genetic cause, and help with diagnosis, treatment and prevention.

A legitimate RAG bucket Image by Chetan Khatri

Calendar of Events

GKT RAG Week

4th - 10th February Halfway Dinner

3rd March

ICSM RAG Valentine's Ball

13th February RAG Week

20th - 24th February

Circle Line Pub Crawl

23rd February

ICSM Drama: 'Some Like It Hot'

7th - 10th March

ICSM Choir Concert

10th March

RUMS Welfare Series

All February

RUMS Arabian Night

14th February

SGUL

February 2012

medicalstudent

News BBC 'Junior Doctors' Returns with a London Twist Ken Wu interviews ICSM Alumnus Akira Fukutomi on his experiences on the new series

he new series of the BBC's program 'Junior Doctors' returned to the screens of BBC 3 on January 24th. Filmed at Chelsea and Westminster Hospital, this series brings a distinctive London flavour to the audience and the lives of the new FY1 doctors in the program. The Medical Student caught up with one of the junior doctors, Akira 'Aki' Fukutomi, an Imperial College School of Medicine alumnus and spoke to him about his experiences on what it is like to be on the program. KW: First of all how did you manage to get involved in the Junior Doctors program? AF: All of the FY1s who are starting in August were emailed and it basically said that the second series was going to happen at Chelsea [and Westminster hospital] and asked if anyone was interested. KW: What motivated you to sign up to the program? AF: Well I knew about the first series and I thought it was quite interesting and that it was an opportunity that was never going to happen again and I thought it would be quite fun! KW: When you signed up to do the program, what did you want to achieve out of being in it? AF: First of all it gave me the opportunity to meet different people such as people who are in the media and who I would have never met if I wasn’t working in that particular field. I’ve actually met loads of the BBC production team who were really nice and who will probably be friends for the rest of my life. It is actually quite a big opportunity to reflect on my own work. You are never able give a true objective view of yourself but by having cameras follow me I can actually look back and reflect on what I’ve done right and what I’ve done wrong. KW: Bearing in mind that some of the audience will be students who are aspiring to be doctors, did you have in your mind that by appearing on the program you could essential inspire those types of people? AF: Well you see I didn’t think that I would be a good example for the public! However, having started, I’m getting lots of tweets thanking me for really enforcing me on what I want to do in the future which is really nice. I don’t know what I’m doing that they like but it seems to positively reinforce them on wanting to be a doctor. KW: On the whole, did you enjoy the process? AF: Yeah generally it was really good. I’ve done so many things that I wouldn’t have done such as going into the BBC studios and meeting famous producers. However, there were a lot of times when it was quite stressful. You had the film crew there when you wake up in the morning, having break-

The Magnificant Eight. Image by BBC fast, when you go into work and on the wards. Everything you do they would film so sometimes it would be a too much and it ended up with you having to wake up half an hour earlier or going home an hour later because everything took time. KW: How did the rest of the hospital staff react to being filmed? Did they treat you any differently compared with any other first year junior doctor? AF: Because we had a camera following us and we in fact had a microphone on all the time, other people were being cautious about being caught out and saying something inappropriate. I think the attitude towards me was very much the same. Now that the filming is over everything is still the same. KW: So did you feel like you had to censor yourself every time because you were constantly being filmed? AF: At the beginning I was really careful about what to say and what I did but after a few weeks I didn’t care anymore. KW: Given the personal nature of medicine, how did the patients react to being filmed? AF: Generally there is actually a lot of freedom with the patients. The cameras are actually very good at backing off if anything personal comes up and if it

disrupted patient care. KW: Having watched back the program, did you like the way you were being portrayed?

"Some of the doctors were worried that it was going to be like ‘Made in Chelsea’ but in a hospital and that everything would be elegant and posh with people drinking champagne!" AF: Well so far I think it’s been quite a fair reflection. One particular example on the first episode is the question I got asked about the clinical trial [on statins] which was portrayed as something that everyone should know but I got a lot of sympathy for that. KW: Did you think that the program was a fair reflection of the medical profession? AF: Yeah I think it’s been quite a truthful reflection although I don’t think they showed quite how busy it was on AAU. It was super-manic there, especially in the first two weeks. For example, the jobs Lucy [on Rheumatology

and General Medicine] had to do were completely different from what I had to do and the workload was completely different as well. I did think they portrayed the night shift really well, especially since it was the first night shift after the new junior doctors had started so Milla had to pick up all the slack that the other juniors had left so essentially she was doing 20 junior doctors’ work at once! KW: How do you think this series compared to the first series? AF: Well some of the doctors were worried that it was going to be like ‘Made in Chelsea’ but in a hospital and that everything would be elegant and posh with people drinking champagne! I think it’s a bit more exciting than the last series and it seems like more stuff was happening. I suppose it’s for you to judge because I think it’s more exciting because I’m in it! KW: What has been the reaction of family and friends to you being on TV and doing your job? AF:Ha! Yeah they just laugh. It’s definitely massively cringe! Although I did expect that. KW: How did you find living in a house with seven other doctors? Did you not feel that it was too intense having essentially the same environment at

home and work and not having the opportunity to escape? AK: The house was actually the incentive to be on the program for most of us since you essentially live in a free house for three and a half months. The house was really, really nice: it was a ten bedroomed house with a massive lounge, dining room and garden. It was quite like being back in halls again. Having said that there were people who are never in the house and never hang around with the rest of the house just because of the different characters that you have on the show. It was actually better living with other doctors because you can go home and share what you’ve gone through, especially with all of us sharing the unique experience about being filmed so you can go home and bitch about hospital and being filmed. KW: Finally do you have to say or any advice to give to any medical students or prospective medical students from your experiences? AF: Have as much fun as possible whilst you are a student because once you start work you can’t have as much fun anymore. Say good bye to weekends, say goodbye to after five o’clock drinks. Just get all the fun all out of your system now before you start

medicalstudent

February 2012

News

Diary of an FY1 Junaid Fukuta on dealing with the agitated patient

even months have flown by and before you know it I am settling into the routine of the hospital and if I may say so myself, I am becoming rather efficient. Increasingly I find the whole set up of medicine is based on one key word immortalised by Spock: logic. Patient presents with symptom A, do tests X,Y and Z, diagnose disease D, briefly check latest guidelines and carry out said proposed treatment. Don’t get me

wrong the whole process is great fun and it is what we have trained to do, but the key is logic. The problem is that it tends to fall apart when you are confronted with something illogical, and it is that very illogical thing that happened to me during one on-call shift. It was a typical Saturday night so whilst all my friends were getting bladdered in the local bar I was scurrying around the hospital like a blue-arsed fly seeing referrals like chest pain,

shortness of breath and my favourite 'doctor, they just don’t look right!'. When you are a really busy often the bleeps stack up whilst you are doing something. However, the nurses have one final trick up their sleeve too get your attention: the fast bleep. This is when your bleep does something unusual - rather than making an annoying noise that makes your blood boil, it actually talks to you and thus making you literally crap yourself.

"On arrival I see a bin being thrown across the ward and my heart sinks"

'Lumex Nightmare' www.siranniart.com

So I get my first fast bleep - 'F1 doctor please go to ward X', and just like that I am summoned like a naughty school boy to receive my flogging. Four flights of stairs stand between me and my intended destination and my heart starts thumping, I am thinking what the hell could this be, my mind starts visualising a mass rectal bleed or a blue patient, but when I arrive I am confronted by something much worse - the agitated patient. Now, the

reason why this is so bad is because all logic goes out of the window. With a rectal bleed just do ABC and call the relevant people but with the agitated patient there is no reasoning with them, and there is often no easy fix. On arrival I see a bin being thrown across the ward and my heart sinks. I am confronted by a rather large burly man with more tattoos than Glasgow who could give Chuck Norris a go for his money in a round house kick competition. He is shouting and screaming in the corner so I quickly seek the nurse in charge and keeping calm introduce myself 'Hi I am the F1, what seems to be the matter?' She looks at me, laughs and then with the reflexes of a cat, ducks down as a drip stand goes hurling across the room. 'Seriously, do I need to explain?' she says sarcastically and to be fair she has a point. So I turn and cautiously approach said burly man, seeing the notorious yellow bag of Pabrinex on the floor I assume (correctly I may add!) that this is an alcoholic who is withdrawing. I put on my most polite accent and introduce myself to which he replies 'come near me and I will rip your f***ing head off'. I quickly dispel the image of him fighting Chuck Norris that comes to mind,

and think 'hell I need back up'. So I call for security and to their credit they send two even larger men and they quickly calm him down. One of the security guards turns to me and says 'what are you going to do doc?' and I think 'why me? They’re the ones built like tanks and I am supposed to do something!' A memory of a ward round as a medical student flashes past my mind where the consultant grilled the SHO for not taking enough time to reason with the agitated patient. I always thought it would never work but knew I had to give it a go before jabbing needles into him. The conversation starts much how I thought it would; polite comment from me gets profanity from him with hint of violence to one of my body parts. But guess what, after speaking to him for 30 minutes he starts to calm down, objects stop being hurled and the room takes on a different air from being tense to almost jovial as the security guards start cracking jokes with him. One word springs to my mind - illogical: how can it change from a scene of complete carnage to one of serenity with the use of just words. Before I can ponder on it for too long I get another fast bleep! As I run off to the next ward I just hope it is to something more straight forward

The MDU 2011/2012 Revision Courses

We’ll help you turn revision into success

Courses taught since 2002

Autumn 2010/Spring 2011 attendees said:

“Brilliant course! Left feeling a lot more confident about exams.” “Very enjoyable course - feel more prepared. Would recommend to other students.” “Excellent teaching that goes beyond usefulness for finals.”

Book your place today!

the-mdu.com/revision

  

Courses in: Surgery (2 days) Clinical Medicine (2 days) Paediatrics (1 day)

MDU revision courses sponsored by Wesleyan Medical Sickness

  

Taught by experienced undergraduate lecturers, who are experts in their field. Interactive format gives you the opportunity to ask questions specific to your school examinations. Intended to prepare you for your first years after qualification as well as finals. Range of materials such as photos and videos are used to aid understanding. Comprehensive course notes and lunch provided. Nationwide locations for your convenience.

MDU Services Limited (MDUSL) is authorised and regulated by the Financial Services Authority in respect of insurance mediation activities only. MDUSL is an agent for The Medical Defence Union Limited (the MDU). The MDU is not an insurance company. The benefits of membership of the MDU are all discretionary and are subject to the Memorandum and Articles of Association. MDU Services Limited is registered in England 3957086. Registered Office: 230 Blackfriars Road London SE1 8PJ. © 2011 MDU Services Limited. ST/070x/0911-c

February 2012

Features

medicalstudent

Features Editor:Bibek Das features@medical-student.co.uk

Rising from the ashes In the second part of our series of articles exploring medical studentsâ&#x20AC;&#x2122; perspectives around the world, Alexander Cowan-Sanluis reports on the developing nature of healthcare in Gaza

Doctors in surgery with team from Gaza Image by Alexander Cowan-Sanluis

hen the opportunity to visit the Gaza Strip arose I jumped at it immediately. This is a region which dominates our news channels and never ceases to incite heated and controversial debate. Now I had the chance to see it through my own eyes instead of the edited lens. As with any conflict, be it racially, religiously or politically instigated, those hit hardest are the people. More often than not those who have never actually participated in

it or even supported it. Yet they take the brunt of all knock on effects especially with regards to health. Health is an honest reflection of society and the state in which it exists. As a medical student I was in a privileged position in which I could interact with the people of Gaza at a level that most other foreigners do not reach. In this article I merely want to relate my experiences of the region, the people and the healthcare away from any personal preconceptions. Entering Gaza is a lengthy, un-

friendly and imposing process. Never before have I entered a country through turnstiles, dark corridors, steel doors and 750m caged walkways exposed to the relentlessly hot sun. For a border where walking is the only transit option a young man like myself encounters no problems. But what about the old, the ill, the disabled and those with children? Unfortunately due to lack of medical facilities many patients must leave Gaza to seek out better availability of treatment in Tel Aviv

or elsewhere. Their only route there is via this frontier. Fortunately I crossed swiftly but I could not help feel for the ordeal that others undergo. Once in Gaza it is soon apparent that you have entered a different world: fields laden with rocks, abandoned cars, rubbish strewn on the streets and half constructed buildings. A far cry from what existed on the other side of the wall just a few hundred metres behind. With such a dim initial view of Gaza and certainly with media instilled no-

tions of a war torn region, I was pleasantly surprised to find the city more vibrant than anticipated. There are hospitals, universities, shops, hotels, fireworks at night and even people enjoying the beach. There are people everywhere but with a population of near 1.5 million in an area of 366km2 the density is not surprising. The city was alive, even with the deadly and chaotic traffic. Although littered with the memories of war, bullet marks and the like, perhaps Gaza had more to it than I thought.

medicalstudent

February 2012

Features On my first visit to a hospital, it soon became apparent that trauma care consumed a large part of a doctor’s day. Within ten minutes of participating in a ward round I met a man who had suffered a serious spinal injury caused by a dangerous type of work that is unique to Gaza and its situation. This small strip on the Mediterranean coast is guarded by Israel via land, sea and air, bar one small border with Egypt, the Rafah crossing. Due to very tightly controlled exports and imports with Israel it is here that the Palestinians take advantage of their less attentive neighbours. Tunnels have been dug virtually by hand under the frontier in order to smuggle in goods from Egypt; petrol, food, construction materials and even cars. However, this is no easy feat and for those men who choose to build these, there is the risk of ending up with permanently damaging injuries like the man in the hospital. The dreadful disability that this young man will spend the rest of his life with made me realise to what lengths the people will go to ensure the development of their society. A large and extremely important aspect of this is medical development. One of the main issues surrounding this particular patient was the delay in adequate treatment, which turned a curable injury into a disabling one. I saw this again first hand in another man who required ever shortening leg amputations, and with it considerable distress, due to improper excision of the infected bone. The doctors in Gaza are extremely skilled and knowledgeable and do the utmost to look after their patients, but, like any doctor in any country, training and education is needed to ensure up to date care. This is a big issue in Gaza. Many sur-

geons and other healthcare staff are not granted visas to leave the region at all, never mind for training purposes. This is a real barrier to medical education. Despite this, much like the men in the tunnels, doctors and nurses go to great lengths to improve themselves and receive additional teaching in Cairo and other cities, paving the way for healthcare development.

“The dreadful disability that this young man will spend the rest of his life with made me realise to what lengths the people will go to ensure the development of their society.” Yet more of the man’s leg could have been saved if better diagnostic and other medical facilities were available. The lack of facilities was even more apparent when I was invited into theatre by a plastic surgeon. There was inadequate equipment and supplies, but the most pressing concern was the intermittent electricity supply during the operations. Every ten minutes the power would suddenly shut down, meaning theatre lights, equipment and even the life support and monitoring machine would turn off. It would take 30 seconds or so before a generator would provide back up. It is only due to the surgeon’s great competence and patience that the majority of his cases are successful. Many of the cases seen by the surgeon involve severe burns due to domestic accidents involving oil cookers, gas stoves and hot water. To cater

for this there is a small burns unit. It was here that I met a nursing assistant without whom it would not function. The unit is basic, lacking in kit, and with an open sewage drain in the centre. Yet it is maintained extraordinarily clean by this one man, keeping infection rates to a minimum. Whilst I was there, a discussion was held by the doctors concerning fund allocations i.e. what was needed? It was at this point that an important feature of medicine, that was missing here, came to light. One of the men most informed and aware as to what was needed for the unit was the nursing assistant, but the doctors were unwilling to listen to his thoughts. Why? He was not a doctor. In Gaza, the traditional patriarchal view of the doctor still needs to be broken down. Focus on involvement of all members of the team should be encouraged. This is part of holistic and professional patient management, and it needs to be addressed. Fortunately outside the hospital, within a community setting, this is already beginning to happen. On one day I managed to leave the city and explore the region further south beside Egypt. I went to visit an organisation, Al-Astika, which works to improve an often forgotten subject, rehabilitation of the disabled. Projects focusing on acute illness and trauma, especially in developing countries, are popular to fund and manage. The long term effects and rehabilitation are too easily neglected as they are not so glamorous. People in the community and professionals collaborate to better the lives of the congenitally disabled and those who are so due to trauma. They provide not only assistance equipment but also train families and friends how to cope with,

and care for someone with a disability, be it mental or physical. A particularly impressive component of their work is the training of locals in the maintenance of disability equipment, thereby creating jobs and also ensuring the longevity of the project. Whilst I was there a young man, of no more than 20, proudly showed me photographs on his mobile phone of the prostheses he had learnt to make in one of the organisation’s workshops. Involving the youth of Gaza forms a significant ingredient of Al-Astika’s objectives.

“Every ten minutes the power would suddenly shut down, meaning theatre lights, equipment and even the life support and monitoring machine would turn off.” The greatest hurdle, however, is combating the taboos of society with regards to disability. In many countries disability is seen as embarrassing or shameful, and those afflicted are hidden away from the world. Changing the attitudes of adults is difficult, but those of children are much easier to break down. Children are born without prejudice and it is this openness which can be used to eliminate discrimination all together. Summer camps have been created, where for two weeks at a time, both mentally disabled and normal children play together, learning to live in and enjoy each other’s company. Seeing these camps was one of the most enjoyable experiences for me

during my time in Gaza. The children painted, sang and danced together, setting an example to older generations that disability is nothing to conceal. That is real medicine, at its core. Luckily Gaza is full of optimistic and hard working people. One such man is the Dean of the medical school at the Islamic University of Gaza. He invited me on a tour of the university and it was this that truly displayed to me how different this place is to what I had seen in the media back home. They had facilities equal to ours and they provide scholarships to the brightest students, one of whom eagerly showed me around, bursting with energy and enthusiasm. One night I went to the graduation ceremony of a cohort of science students. One could feel the pride that both the country felt and that the young men and women receiving their degrees. These students, like the one I met, are the future of Gaza. It is the people that have left the greatest impression on me. I have never visited a place with such a welcoming and hospitable community. Perhaps it is their situation that makes them even more positive, but what is certain, is that despite the difficulties they are presented with, together they strive without rest to develop Gaza and make it their own nation. Unfortunately on my last day two bombs were dropped. Blame and politics aside, I will be left with memories of a friendly people with never ending optimism. The symbol of Gaza City is the Phoenix, a bird that grows for years, builds its nest and then ignites itself. A young one then arises from its ashes. This is a fitting symbol for Gaza. Always arising from the ashes to which it is constantly reduced

Graduation Ceremony at the Islamic University of Gaza. Image by Alexander Cowan-Sanluis

February 2012

medicalstudent

Features

National finals - the way forward? With another new application system to the Foundation Programme set to begin for applicants in their final year from 2012-2013, Sanjeev Ramachandran believes it is time for a national qualifying exam

Soon - competing against the country?

here has always been one hot topic surrounding medical school finals: should the current system be replaced by a single national qualifying exam? It is an issue that has provoked strong debate, and with good reason. This article hopes to shed some light onto why national finals might be a step in the right direction. What do finals mean for medical students? It is the culmination of five hard years of medical training

and the first real test of our competency as future medical professionals. There is also the small matter of a job waiting at the other end of it all in August. The word ‘pressure’ sums it up. Medical school finals, however, are unique. There is so much that rides on these exams, ranging from patient care to ranking students. Is the system in place the fairest and most effective way of assessing if medical students are ready to metamorphose into doctors? Currently, each medical school has

its own set of assessments for its finalists. Whilst the standard of the exams are reviewed and regulated by the GMC, the lack of national standardisation does create problems. Presently, what should be a national recruitment process is based on students’ rankings locally within their own medical school. This is bound to produce some inequality as each school’s set of candidates will have a different spread of abilities. It is also particularly strange as either end of the road in one’s medi-

cal training do involve nationally sat exams- admissions tests for UCAS on one and postgraduate exams such as the MRCP PACES on the other. An immediate advantage of a national qualifying exam would be to establish a fair way of comparing students across the UK. With competition such an integral part of a career in modern medicine, it becomes increasingly important to base decisions for jobs only on the fairest and most rigorous methods. A national qualifying exam would

particularly facilitate recruitment for our first postgraduate training posts, which attract applicants from a multitude of different medical schools. In addition, a national licensing exam will allow for fairer comparison between local doctors and those from abroad who wish to practice in the NHS. So what about the people who matter the most - the patients? By standardising the minimum qualification level, the GMC can ensure that all newly qualified doctors have a core set

medicalstudent

February 2012

Features of clinical competencies. As such, patients are much more likely to receive a basic standard of care. There is evidence that performance in a national licensing exam is a good predictor of both patient satisfaction and a doctor’s clinical ability. One study on Canadian physicians who completed a national clinical skills exam showed that those who performed better on it tended to receive fewer complaints from patients.

"With competition such an integral part of a career in modern medicine, it becomes increasingly important to base decisions for jobs only on the fairest and most rigorous methods." Any debate that affects the NHS in any way is inevitably going to involve a discussion on financial matters. This is another front where a national licensing exam can come into its own. Resources for assessing students are currently shared out between medical schools. Implementing a single nationally sat exam will help pool all these resources, thereby reducing costs. So far we have established that national finals are fairer, cheaper and can help improve patient care. So is it really the Holy Grail the GMC have been looking for? The idea of a national qualifying exam is not without its imperfections. While it ensures

that all would-be doctors possess a baseline level of skill and knowledge, this means that there must also be a push towards a common core curriculum. This could disadvantage medical schools with teaching styles that are incompatible with it. It might well force many to restructure their course and homogenise teaching styles to remain competitive. As one student puts it: 'It’s like sucking the soul out of a medical school. It completely removes its individuality!' These are practical issues for medical schools to deal with, but it could in turn impact on individual students who might have thrived on alternative teaching methods. Despite the drawbacks, many medical students are still strongly in favour of having national finals. A second year tells The Medical Student: 'Whatever problems it may stir up, it is still the fairest way for employers to compare students across the nation. I definitely agree that we should have one set of exams that everybody has to sit.' Indeed, it will be a balancing act between the potential benefits and the hypothetical downsides of the new system. If, however, the GMC is committed to providing appropriate support to medical schools during the transition period, the balance may well tilt in the favour of national finals. It is worth pointing out at this stage that this discussion about national exams is not completely academic. The Foundation Programme Application System (FPAS) is currently undergoing a massive overhaul. As of next year, finalists will have to negotiate

a new application system where the previous 'white space' questions have been replaced by - no prizes for guessing - a nationally sat exam called the Situational Judgement Test (SJT). The SJT is a machine marked assessment lasting a little over 2 hours, and students’ performances in it will have a large say in whether or not they get their dream Foundation Programme job. It is designed to test a range of attributes outlined in the Foundation Programme job specification. Students sitting the SJT will be given a variety of scenarios they are likely to encounter as FY1s, and will be asked to choose the most appropriate actions to take.

"It’s like sucking the soul out of a medical school!" The success or failure of the SJT will go a long way towards highlighting the potential positives and negatives of a national licensing exam. It will also give the GMC an indication of how compatible the entire idea is with the current set up. If a decision is reached to go forward with national finals, the SJT will at least ensure that they won’t be marching into it completely blind. On the whole, national finals, while not necessarily the GMC’s knight in shining armour, is certainly a step in the right direction. Although it may have issues in the short term that will need to be addressed, it has the capacity to benefit us all greatly in the long run

Example Situational Judgement Tests A 45 year old alcoholic is admitted in the afternoon with delirium tremens after stopping drinking two days previously. During the night you are called to see him as he has become very aggressive and is demanding to be allowed home. As you arrive on the ward he punches one of the nurses. He is confused, shouting and threatening other patients. Choose the THREE most appropriate actions to take in this situation A Prescribe extra sedation for the patient B Ask the nursing staff to call hospital security C Attempt to talk to the patient to try and calm him down D Reassure the other patients in the ward that they are safe E Ask the nursing staff to help you restrain the patient F Ask the nursing staff to call the police G Inform the patient that his behaviour is inappropriate and will not be tolerated H Ensure that the nurse who was punched is not badly injured Answer: B,C,H You are looking after Mr Kucera who has previously been treated for prostate carcinoma. Preliminary investigations are strongly suggestive of a recurrence. As you finish taking blood from a neighbouring patient, Mr Kucera leans across and says “tell me honestly, is my cancer back?” Rank in order the following actions in response to this situation. A Explain to Mr Kucera that it is likely that his cancer has come back B Reassure Mr Kucera that he will be fine C Explain to Mr Kucera that you do not have all the test results, but you will speak to him as soon as you do D Inform Mr Kucera that you will chase up the results of his tests and ask one of your senior colleagues to discuss them with him E Invite Mr Kucera to join you and a senior nurse in a quiet room, get a colleague to hold your ‘bleep’ then explore his fears Answer: DCEAB

The original medical school finals examination. 'An Examination at the Faculty of Medicine, Paris' by Henri de Toulouse-Lautrec (1864-1901)

February 2012

Comment

medicalstudent

Comment Editor: Rhys Davies comment@medical-student.co.uk

The NHS Reforms: An Update David Fisher examines the NHS reforms and, one year on, what's changed?

care. The pathfinder scheme is a unique test of the reforms and so these conclusions are extremely propitious. A survey by the British Medical Association highlighted the difference made by a practical understanding of the reforms. Asked whether reform would increase clinician decision making, only 39% of surveyed doctors agreed but this figure leapt to 73% among pathfinder GPs.

nitial concerns surfaced shortly after the proposals were floated. Doctors were concerned they were unqualified for resource management and would be caught in a conflict of interest if they balanced patient interests against profits. Other opponents felt it was unrealistic and irresponsible to manipulate an organisation the size of the NHS in an effort to tackle the deficit. Most problematic was the speed at which the Government intended to implement the scheme. A consensus emerged that believed the preparatory consultation had been inadequate and the time-frame to implement the reforms too narrow. Doctors felt particularly aggrieved that many of their concerns had been disregarded. This initial failure by the Government to invite cooperation from doctors' groups and address their concerns before publicly presenting the reforms became highly significant. The Government was effectively attacked for alienating the doctors by a barrage of vocal opposition from various groups. A recent survey by the Royal College of GPs recorded more than 70 percent of respondents want the Bill to be withdrawn. In March, at a Special Representative Meeting of the British Medical Association, Dr Hamish Meldrum, the chairman stated to rapturous applause, ‘I do not support this Bill. The BMA does not support this Bill. The profession does not support this Bill.’

"Doctors felt particularly aggrieved that many of their concerns had been disregarded. This initial failure by the Government to invite cooperation from doctor’s groups and address their concerns before publicly presenting the reforms became highly significant." In April, pressure mounted on the Government to significantly alter the Bill. A Health Select Committee of eleven MPs recommended tighter governance and accountability for service commissioning to ensure maximum quality of care. They suggested specialists should hold positions within consortia to reduce the risk of service fragmentation. Lay representation would aid public accountability. Decisions should be transparent and visible to the public, reducing the risk that conflicts

"Still the reforms are unpalatable in the eyes of many doctors. In January this year, 92.8% of surveyed GPs believed the Royal College of GPs should call for the withdrawal of the Bill."

Andrew Lansley, the saviour of the NHS or the pin-up boy for the dartboard in the doctors' mess? of interest would develop. Buckling under pressure, the Health Secretary announced a three month pause which would serve as a listening period and opportunity to improve the reforms. A multidisciplinary group comprising health professionals and patient representatives formed the NHS Future Forum and was charged with overseeing the long overdue gathering of opinions. June heralded numerous changes suggested by the Forum. Safeguards were introduced to prevent private companies ‘cherry-picking’ the most profitable services. Transparency of multi-disciplinary consortiums was assured and the time-frame for transfer of duties made more flexible. Competition for its own sake would no longer be the foundation stone supporting reform but would be used as a tool to improve

choice and quality of services. Finally, the health secretary would remain responsible for the everyday running of the NHS, deviating from the original plan to delegate the responsibility.

"The Government set up pathfinder groups of GPs to pioneer the reforms by commissioning services. Speaking with these GPs revealed blossoming enthusiasm." The outlook for the reforms has appeared full of doom and gloom but glimmers of hope have been underreported. Policy Exchange, a think tank, published an analysis of the early implementation of the GP-led commis-

sioning. The Government set up pathfinder groups of GPs to pioneer the reforms by commissioning services. Speaking with these GPs revealed blossoming enthusiasm. They warned that consortia decisions must have more input from patients and should be designed so patients may choose between competitive consortia. Alarm was sounded over the consequences of rushing the abolition of Primary Care Trusts and the potential for consortia to simply replace the existing structure with no innovation. These concerns have been reported in the media but the positive essence of the report has been missed. Many of the pathfinder groups are extremely promising. The report prophesises that careful implementation of the plans, taking into account current concerns, will benefit patient

Still the reforms are unpalatable in the eyes of many doctors. In January this year, 92.8% of surveyed GPs believed the Royal College of GPs should call for the withdrawal of the Bill. In a letter to the health secretary they call for another confirmation that he will retain responsibility for the provision of care. They desire clarification that services will only be exposed to competitive market forces if evidence proves it in the patient’s best interests. Additionally, they seek safeguards on education and training. It is curious that even though these three concerns can be remedied, the college is still considering calling for the withdrawal of the Bill. A year ago, the proposed NHS reforms were badly presented to doctors and to the public. Misplaced eagerness hoped to breeze through momentous structural reform and failed to act upon professional opinions and concerns. A bad start stained the Bill and polluted its noble objectives. Naturally, reform of this magnitude would be initially imperfect and require improvement, but the criticism from organisations was suffocating. The dog of reform was hounded. The Government has taken several steps to address concerns and the preliminary testing of pathfinder schemes has revealed promising results. Further improvements are required but if managed carefully and embraced, these reforms have the potential to deliver improved healthcare at lower cost. Maybe it is time to give the dog a new name

David Fisher commented on the NHS reforms when they were first made public one year ago. Check it out at www.medical-student.co.uk

medicalstudent

February 2012

Comment There is more to medicine than 'publish or perish' Nada Anzak Guest Writer

Has the publication process become a vehicle for our own personal gain more than the good of our patients? Are we, as part of the international medical community so eager to broadcast our knowledge that we are at risk of compromising our primary duty, the care and concern of our patients? The time and the financial investment involved with clinical research are undoubtedly great, in any case. In a recent talk delivered to students at UCL, Dr Fiona Godlee, Editor of the BMJ highlighted how the overwhelming desire to present positive findings in the research arena has led to an alarming number of instances of manipulation of data and dishonesty in reporting results. Thus it could be seen that the pressure to publish threatens to undermine even the most basic ethical principles of the healthcare profession, eroding the

moral integrity of the work they do. During the time I spent at a hospital in Beijing, however, I was fortunate enough to meet one doctor who, in his own small way, sought to change the research world’s perspective on seeking international fame through publishing. The son of two of China’s most

"Despite the fact that he was pioneering a specially designed retractor which could potentially change the face of routine vitreo-retinal surgery, it was clear that he and his team had no desire to produce a peer-reviewed paper from it." celebrated surgeons, it quickly became apparent to me that Dr Hu’s sole focus was on the people he worked with and the community he served. Despite the fact that he was pioneering a specially designed retractor which

could potentially change the face of routine vitreo-retinal surgery, it was clear that he and his team had no desire to produce a peer-reviewed paper from it. For Dr Hu, every element of his practice was about seeking spiritual contentment, the elemental joy of passing knowledge down from person to person, hand to hand, a principle seemingly at conflict with the flash and fame of the publication process. Whilst the profound devotion of these doctors deeply impressed me, I could not deny feeling that without such emphasis on international publishing and expanding the global frontiers of medical knowledge we would be taking several large steps backwards in our efforts to alleviate health burdens. So how do we realign our personal pursuit of world-wide recognition with the elemental spirit of altruism behind all avenues of medical research? The solution to such a problem is likely to involve continual reflection, and reassessment of our motives. The trouble is that reflection in medical practice in the West has come to

be synonymous with the dreaded audit and clinical performance, at arms with the deeper reflection that would allow the fine balancing between personal motives and the ethical principle of benevolence we are bound by.

"For Dr Hu, every element of his practice was about seeking spiritual contentment, the elemental joy of passing knowledge down from person to person, hand to hand, a principle seemingly at conflict with the the publication process." As I sat there sipping my steaming Chinese tea in the surgeon’s lounge I could not help thinking of Hippocrates and his oath that lies at the heart of all medical practice in the West. Whilst we have certainly progressed a long way from the idea of conforming to a singular, ethereal role, requiring the es-

chewment of all those primitive desires that make us human, the fact that the pulse of this revered oath is still palpable in medical practice today suggests we have not entirely lost touch with the spiritual nature of our profession. It is likely that tapping into these principles that unite the medical community will yield the answers to some of the fundamental questions of readdressing the nature of medical research. ‘Perhaps I am the only one in the world with this perspective?’ mused Dr Hu as we waited for the next patient to be wheeled in, as the stirring airs of traditional Chinese music filled the room. As I sat in his company, I had the feeling of being beside someone at great peace with himself, a rare quality in medical professionals in the West. From observing his interactions with his patients and colleagues the profoundly comforting influence of this factor was self-evident. One thing is for certain, integrating such an approach to serving the global community on a research platform will prove an even greater challenge

I prescribe one newborn baby brother Dave Vedage Guest Writer

Saviour siblings, as the name suggests, are children born to donate organs to and save the lives of their sibling. The benefits are obvious; the sibling would be treated, the newborn gets to help their relative and the family gets a new member. However, the debate surrounding saviour siblings continues to rage on. The issue has also been reignited and brought to the attention of the wider public with the recent films ‘My Sister’s Keeper’ and ‘Never Let Me Go’. Saviour siblings are possible by using in vitro fertilization (IVF). By utilising HLA-typing and pre-implantation genetic diagnosis (PGD), it can be ensured that only zygotes compatible with the existing child are implanted and that the zygotes are free of the genetic disease. The first case occurred in 2000 in the USA. Newborn baby boy Adam Nash provided umbilical stem cells to his six-year-old sister, Molly, who was suffering from bone marrow failure secondary to Fanconi anaemia. In the United Kingdom, the Human Fertilisation and Embryology Authority has since ruled that it is lawful to use modern reproductive techniques to ‘create’ a savior sibling. Nonetheless, there still remains significant opposition. The basis of this

argument is the idea that the child is merely a means to an end. This ‘commodification’ of human life is seemingly unnatural, but is it any less valid than other common reasons for wanting and conceiving a child, such as completing a family, saving a marriage, or providing an heir? Others argue that this is the start of a slippery slope will lead to the creation of designer babies. There is quite a leap, however, between choosing a child with functioning bone marrow to one with blond hair, blue eyes and Brad Pitt’s chin.

"Nonetheless, there still remains significant opposition. The basis of this argument is the idea that the child is merely a means to an end. This ‘commodification’ of human life is seemingly unnatural, but is it any less valid than other common reasons for wanting and conceiving a child, such as completing a family, saving a marriage, or providing an heir?" Then there is the strain that exists between the siblings, as they come to realize their unique and very unusual relationship. One child lives only be-

cause another one needed them to be born. This could engender feelings of worthlessness and resentment. Further psychological damage could be done if the elder child dies in spite of treatment, with the saviour sibling burdening themselves with the guilt of being unable to save their brother or sister. However, that the parents are willing to conceive another child to protect the first suggests that they are highly committed to the wellbeing of their children and that they will value the second child for its own sake as well. Their birth may have served an instrumental purpose but they are almost invariably cherished for themselves. Furthermore, they may be considered beneficiaries of IVF, PGD, and tissue typing, since were these techniques unavailable, they probably would not have been born. Welfare is a fundamental principle. The main factor when deciding whether sibling saviours are ethically acceptable should be the degree of harm involved in the donation process. Though this can be balanced by the medical benefit to the older sibling, the harm to the saviour sibling does not necessarily depend on the severity of the affected child’s condition. No medical intervention is without harm and if one must done within days or weeks of birth, this degree of harm must be weighed very carefully. Remember, a baby is for life, not just for Christmas

Babies can cure cancer. And kittens can cure depression!

February 2012

medicalstudent

Comment

Too much of a good thing? Paternalism is dead but could the spectre of patient choice be even worse? Alex Warren Guest Writer

Does anyone ever really pay attention to the adverts above the seats on the Tube? Just the other day I found myself on the Victoria line, heading for my mid-sessional exam, looking up at an advert for a private healthcare company. The advert featured a mock Underground line with stops including ‘the treatment you need, when you need it’ and ‘getting seen by a specialist of your choice’. The implication of these bullet-points was that these were things that one could not expect from the NHS, voids that only the private sector could fill. This made me think: do healthcare professionals have a reasonable idea of how much choice their patients expect regarding their treatment – and is our system capable of living up to these standards? Over the last half of the previous century, the concept of patient-centred care has grown to rest at the very centre of the public healthcare paradigm. In the last few years alone, patients have gained the right to choose which hospital they are admitted to and the right to access their medical notes on request. Whilst there are notable exceptions, it’s interesting to note that the professional medical bodies – the GMC, BMA, and the various royal colleges – are often reported in the media as opposing these expansions of patient choice. There exists an argument that this may just be as a result of a ‘generation gap’, but nevertheless, this antagonism brings up the idea that autonomy may be moving away from a healthcare ideal into the realm of a political tool. At the end of November, NICE published their new guidelines for NHS maternity services. The most controversial change to these rules, which apply to all NHS trusts in the UK, is the new requirement that patients who have no clinical indication for a caesarean section cannot now be refused one. In other words, patients can now deliver their children through a C-section for no reason other than that they request it. Doctors’ judgement no longer plays a part – obstetricians who object to performing C-sections on their patients on these grounds must now refer them to a doctor who will. Taking time to analyse NICE’s decision, however, one has to wonder whether any other factor supports these guidelines other than patients’ autono-

my. It costs the NHS about £1,000 more to deliver a baby via elective C-section as opposed to a planned vaginal birth, and also takes up valuable hospital resources: operating theatres, anaesthetists, neonatal ICU beds for the 13.1% of babies delivered by elective C-section who require critical care. And finally, in a hair-pulling-inducing catch-22, some NHS trusts receive bonuses averaging at £250,000 in part for reducing the number of elective caesareans they perform, as a result of the Department of Health’s Care Quality Improvement Network financial incentives initiative. Yet the government is willing to ignore this – a preponderance of logic, it seems, is ceding to the demands of patients to have increased choice. These are the symptoms of a major shift in our medical culture. Strong financial and medical arguments are being thrown out of the window to pay respect to our patients’ right to autonomy. We’ve seen this evolution over a long period of time, the consumerist nature of our interaction with the healthcare system growing with the general liberalisation of our medical culture since the 1960s. Whilst this progress has certainly allowed us to deliver healthcare in a manner both ethically better and more satisfying to the patient, surely there has to be a limit to what the NHS can

There is no practical possibility of a publicly-funded healthcare system providing bespoke care for every one of its adherents. That said, it is a socially and ethically accepted fact that everyone has a right to self-determination, including the right to refuse treatment or to ask for reasonable alternatives. provide. There is no practical possibility of a publicly-funded healthcare system providing bespoke care for every one of its adherents. That said, it is a socially and ethically accepted fact that everyone has a right to self-determination, including the right to refuse treatment or to ask for reason-

able alternatives. The real crux of this issue is deciding which of the mock Tube stops on the advert that Victoria line commuters see every morning should be considered the basic requirements of a healthcare system, and which are ‘luxuries’ that patients can access only through the private sector. Common sense applies here: patients do not walk into hospital expecting a private room, one-on-one nursing care and cordon bleu cuisine, but they do expect to have single-sex wards, excellent sanitation and edible, regular meals. The NHS cannot afford to be a la carte – the difficulty arises in choosing what to put on the set menu. Consider the idea of patients being given the right to choose the specialist they see when referred to a hospital. Political trends don’t rule this out as a possibility – patients can already choose which hospital they wish to be treated at, for instance. Administrative costs aside, this measure would probably not adversely affect the NHS; I suspect most patients don’t really care which specialist they see, providing they are qualified and competent. Similarly, under the current system, patients very rarely have requests of this nature turned down. A woman who asks to be referred to a female gynaecologist would be sure to have this request honoured, even though there is no legal stipulation for this to be so. That said, it would not at all be surprising if, should patients be granted the right to choose a specialist, this would be politicised as another great gain for patients’ autonomy. An example of another non-issue touted as patient choice which we can all relate to is when, on visits to hospitals and GP surgeries, medical students are required to gain consent for their presence, even if they are doing nothing more than sitting in the corner observing. Does a patient’s right to autonomy allow them to dismiss students whose clinical exposure and experience are vital to their studies, and thus to their future medical practice? F1s don’t gain patients’ permission when shadowing consultants on ward rounds, and in reality the only difference between a first-year doctor and a final year medic is four letters. The laughable aspect of this dilemma is that, if medical students were in-

troduced with a statement, rather than a question, indicating that their role is within the medical team rather than implying that it’s outside it, very few patients would object at all. All the arguments fall in favour of allowing healthcare students to sit in on consultations or examinations, in much

In other words, patients can now deliver their children through a C-section for no reason other than that they request it. Doctors’ judgement no longer plays a part

a similar fashion to the aforementioned Caesarean debate, yet we still insist on gaining consent. It’s at this point that we really have to wonder whether our medical culture of patient-centred care has become bogged down in the mundane. And perhaps the even more dangerous prospect is that in doing so, patients are being denied the choices that matter most to their health. How else could we have arrived at a situation where not only do a significant minority of patients wish to be subjected to major surgery when there are less traumatic options available which are safer for both mother and baby, but the party line is now that the NHS must honour these decisions? Despite at first glance seeming like an insult to doctors’ judgement, the C-section guidelines could well be a subtle incentive, designed to persuade doctors to work out what their patients actually want, rather than throwing them pointless ‘choices’ which just function as gimmicks. If doctors can’t refuse women a dangerous procedure, then it is even more vital that they communicate the facts to their patients. The concept of patients making bad choices about their own healthcare is nothing new. As testament to this we only have to look at the rates of non-compliance with treatment (reported as anything up to 40%) to see how often patients act against medical advice. As stated earlier, patients have the right to refuse, or not to start, any

treatment they like. The medical profession should respect this right, but it is a whole world away from the right to demand a treatment for which there is no medical need and receive it on the NHS. The difference with the Caesarean section debate is that patients having unnecessary surgeries impacts negatively on the NHS, and thus on the wider population. It’s very easy for the medical community to put this down to ignorance on the part of the public, to blame the media for mis-educating the masses with block headlines of cancer cures and the latest superfood. But the issues of noncompliance won’t be solved by giving patients more of these ‘gimmicks’. Another recent example is the proposal that all patients will be able to access their medical records online, which is a real-life counterpart to the specialist-choosing thought experiment discussed earlier. It’s highly doubtful that swathes of people felt that the system was standing between them and details of their thirty-year-old appendecectomy. On the most basic level, acute patients want to get better quickly and with minimal disruption to their lives. Chronic patients want optimum quality of life and a psychosocial support network that allows them to cope with their illnesses. It’s hard to see how allowing patients to access their medical records or demand unnecessary operations meets these objectives. Without wanting to move into a debate that looks like it will dominate the coming year, it’s certainly an absurd situation where patients have more choice than ever, but large numbers of the terminally ill still can’t legally access the deaths they want. As with most issues in modern medicine, there’s no quick fix. But perhaps this is one of those cases where conservative management of the patient is the better option. The massive grassroots movement against the recent NHS reforms, evidenced by the success of pressure groups such as 38 Degrees, shows us that when patients really want something to change, they’ll make their voices heard. It is a mark of shame on our system that one in three patients doesn’t comply with treatment, and that mothers feel compelled to undergo traumatic surgery. Unless we take action to stop patient choice being used as a political playing card, there’s a real danger that public confidence in the healthcare system could fall even lower – the consequences of which could be disastrous

medicalstudent

February 2012

Comment Farewell, RAG Dash – a eulogy to tradition Oliver Gale-Grant Guest Writer

I imagine that most people reading this have at some point or another found themselves in their union bar engaging in some form of tribal activity, almost undoubtedly of mediocre entertainment value, probably engendering considerable risk to their physical and mental wellbeing, for the sole reason that it is a tradition. Doing something just because your predecessors did it is, if you pause to think, a bizarre reason for continuing. Nobody amputates infected limbs out of respect for tradition, nor do you find GPs handing out vibrators to cure female hysteria. Well, not in London anyway. Who knows what goes on outside the M25? Speaking of things that may or may not happen outside the M25, this weekend past was ICSM RAG Dash. This is one of the most frequently touted traditions in these parts. Nothing can stand

in the way of RAG Dash’s status as a unique part of our identity as medics and a cornerstone of medical education in west London – not the fact that nobody actually knows how it started, how long it’s been going on or which of our historical medical schools it originated in.

'A recap of RAG Dash 1990 in the ‘St Mary’s Gazette’ reports with great gusto the prank played on the fresher contingent in which their passports were stolen as they slept waiting for their ferry home at Calais, forcing them to sneak past the port authorities and enter the ferry as stowaways.' What is for sure is that it used to be a lot more fun. A recap of RAG Dash 1990 in the ‘St Mary’s Gazette’ reports

with great gusto the prank played on the fresher contingent in which their passports were stolen as they slept waiting for their ferry home at Calais, forcing them to sneak past the port authorities and enter the ferry as stowaways. Several, it seems, failed to do this and were left in the hands of the French authorities as the boat sailed away. As there is no further mention of them in the report, one can only assume that they are still there. Coming back to the present, all is not so rosy for RAG Dash this year. In fact, following a truly bizarre poster campaign that wouldn’t have looked out of place in a SAGA Holidays catalogue, only 13 people bought tickets, a roughly 90% decrease on the year before. This led to the Dash being cancelled. The popular response to this travesty amongst the organisers of RAG Dash is to blame the freshers, citing their lack of general merriment. Somehow the facts that there are five other years, that this same group of freshers have managed to turn out in record numbers to other events, and that the same group

of freshers have so far raised a record total for RAG are all overlooked. Whilst RAG Dash will probably not be sorely missed, the loss of another tradition, however questionable, can only be viewed as another nail in the

coffin of medical student identity. After all, on what other trip can one hit a member of public with a coin filled bucket, whilst accusing all around you of wanting children to die, and then be thanked for doing so?

Alas poor RAG Dash, I knew them, Horatio. A time of infinite jest...

Opium for the masses – Now available at Tesco Rhys Davies Comment Editor

Please do not read the following if you do not like controversial material. The debate over the legalisation of drugs has wittered on for as long as we’ve had drugs, or at least laws about them. Those of you who think that drugs are dangerous for the public at large will probably give good arguments for the criminalisation and prosecution of their use, possession and trade. Likewise, those of you who regard drugs as a matter of personal choice beyond the remit of the government or police can probably offer equally valid counter-arguments. I, myself, think the sensible option would be to legalise all drugs. Prohibition of anything has never really worked. The greatest historical example of this folly is the eponymous era in the USA, especially in Chicago. All prohibition did was drive money and

power into the hands of mobsters, both of which they have been reluctant to relinquish ever since. Instead, we should not just legalise drugs such as heroin and cocaine but provide a reputable market for their sale. So much of the danger of illicit drugs is the mystery of whatever they’ve been cut with, and the lengths people go to acquire them. An above-board market would bring with it standards in formulation, dose, purity and would leech significant control away from career criminals (And I don’t mean City of London bankers). After all, who can compete with Tesco’s prices? However, even I’m not optimistic enough to think that Fair Trade cocaine will significantly improve the lives and working conditions of its producers in Bolivia – Well, maybe I am. Such a radical change in criminal and supermarket forces would be near-impossible to organise, and the gangsters won’t like it. Neither will the Daily Mail, I’m sure. There would of course have

to be checks. It should still be illegal to sell these drugs to anyone under 18, or 21, say, and using in a public place would be forbidden, excluding properties, clubs and the like, with a certain license. What people in the privacy of their own homes, however, should be their own business, within reason. As with the nature of this debate, I don’t expect this proposal to be universally lauded but I do believe it makes sense. Decriminalisation will free up the police to pursue other crime and a legal market would bring with it taxation and revenue. Ka-ching. The idea that legalisation will turn us all into crackasmackheads (My own term) doesn’t really hold water. Alcohol and nicotine are both perfectly legal and yet we don’t all go around boozing and puffing. Other drugs are dangerous, true, but these are no exception. I’ve seen enough patients on the wards who have gone bright yellow and can’t catch a single breath. This is just the start though. In the 21st century, we should be

able to be the complete masters of own reality. Some people have escaped the drudgery of this heaven and earth for one of their own design in Second Life on the internet. Using drugs, from alcohol to LSD, is but one way to abscond this reality, if only for a time. Others choose to augment their appearance through tattoos, piercings or stonking great breast implants. All this is fine but it doesn’t go far enough. The one aspect of our lives that is out of our tangible control is how long it lasts. Until that time comes, we should express to the full extent of our desire and capacity. I want to walk down the street and see a guy with a horn in the middle of his forehead. I want to fall asleep in the radiant arms of my girlfriend who glows in the dark. I don’t particularly want to see people wandering around with cat ears or a tail but that’s a matter of personal taste. What really matters is what you want to do, what you want to look like, what you want to be. We have the technology to make all

this possible. Reconstruction surgeons must be itching to do something other than burn victims and insecure Harley Street patrons. Jellyfish and other fantastic oddballs of DNA have the genes for some really weird stuff. Luminescence is simply page one stuff. We should also have access to normally medicinal drugs to modulate and alter our bodily function. Nearly every drug has its own niche side-effect. If Big Pharma knew there was a market for it on the other end, they wouldn’t have a problem emphasising this otherwise small print. Personally, I would take rifampicin daily to turn my urine bright orange. How great would that be! For more than a decade, we have been able to become whoever we want on the internet. Allowing real life to become dull and restrictive by comparison is the real crime at the centre of the drugs debate. You may scoff at my far-reaching proposals but I believe they have some merit. It would certainly brighten up the journey into college each morning!

Next month, Comment asks; Should academic attendance be compulsory? Send all articles to comment.medicalstudent@gmail.com Articles should be 500-1000 words in length

February 2012

Culture

medicalstudent

Culture Editor: Kiranjeet Gill culture@medical-student.co.uk

The Emperor of All Maladies Kiranjeet Gill finds Siddhartha Mukherjee's 'Biography of Cancer' an interesting and eloquent read Just six letters. For a while I’d been intrigued by the effect they have on people. Cancer. Why was it that my friend lowered her voice to a whisper every time she said the name of her grandmother’s illness? I noticed, too, that for a long time my dad struggled to acknowledge that my grandfather had cancer. ‘They’re calling it leukaemia’, he’d say to people, those first three words revealing his desperate wish for it not to be true. We fear cancer like no other disease, and understandably so – it is a sickness that invades from within and for which the treatment may at times feel worse than the disease itself. But why do we still not seem particularly close to a definitive cure? More importantly, when, if ever, will we find one? In the hope of finding out the answers to these questions, I was really interested in reading ‘The Emperor of All Maladies’ by American oncologist Siddartha Mukherjee. Popular science books rarely make headlines, but this one, described as a ‘biography of cancer’ certainly caused a stir. In the last year Mukherjee has notched up a number of accolades including the Pullitzer Prize for General Non-Fiction and the Guardian First Book Award, as well as making it into TIME magazine’s 2011 list of the 100 most influential people in the world. The book begins with a quote from historian and scientist June Goodfield – ‘Cancer begins and ends with people. In the midst of scientific abstraction, it is sometimes possible to forget this one basic fact… Doctors treat diseases, but they also treat people, and this precondition of their professional existence sometimes pulls them in two directions at once’, and it is clear that Mukherjee has been mindful of this as he has written. ‘The Emperor of all Maladies’ is therefore a combination of things – part doctor’s memoir and part crash course in the history of oncology and its pioneers, interspersed with personal stories of patients’ battles with the most feared of diseases. Throughout the book, cancer is spoken of as an enemy with whom we are locked in a bitter and seemingly never-ending battle. Indeed, Mukherjee even describes his book as ‘a military history – one in which the adversary is formless, timeless and pervasive’. ‘The Emperor of All Maladies’ began as an attempt by the author to answer a simple question asked by a terminally ill patient – what was it, exactly, that she was up against? It is not too hard to imagine the author of such a book falling into the trap of inflating his own importance but Mukherjee does not do this, focusing instead on pioneers and patients. The breadth and detail of the book reveal the painstaking effort the au-

thor put into research. Mukherjee begins the story with ancient Egyptian physician Imhotep, who described ‘a bulging mass on the breast’ as far back as 2500 BC. Then there were over 2000 years of silence on the matter before Hippocrates coined the term ‘karkinos’, the Greek word for ‘crab’, to describe the appearance of tumours. We then move onto Galen, whose four humours theory would prevail for centuries to come. An excess of black bile

was thought to be the cause of cancer, and, significantly, just one other condition – depression, thus inextricably linking the two. Primitive treatment for cancer revolved mostly around excision of tumours, supplemented with ‘remedies’ such as tincture of lead, arsenic, goat’s dung and tortoise liver. The more recent story of humankind’s war against cancer, however, is as much about the reckless leaps of mavericks into un-

chartered territory as it is the systematic research methods we know today. The discovery of X-rays, then chemotherapy and radiotherapy revolutionised cancer treatment, yet battles between traditionalists and those who wanted to break new ground often hindered progress. Min Chiu Li, of the National Cancer Institute, was forced to resign for trials he conducted in which chemotherapy was continued long after the visible signs of cancer

had disappeared, and researchers who wanted to try out combination chemotherapy experienced similar resistance. Needless to say, these turned out to be fundamental principles upon which future treatments would be based. Periods of rapid discovery were often followed by long periods of stagnation, and progress was often halted by the dogmatic persistence of only partially successful treatments. The brutal ‘radical mastectomy’, for example, became the mainstay of breast cancer treatment for many years, culminating in an obscene arms race of sorts, such that ‘radical’ soon became ‘superradical’, which in turn became ‘ultraradical’. Each incarnation was more invasive and disfiguring than the last, each surgeon labouring under the misguided conviction that removing more and more of the chest was the only way to treat women with breast cancer. After years with little progress, what the battle against cancer needed was a charismatic and persuasive figurehead, and it found this in the form of Mary Lasker, a rich and influential American socialite who, whilst raising huge amounts of money for research, also turned cancer into a national obsession. The resulting political pressure made curing cancer a key agenda for then president Richard Nixon, and the creation of an apparently neutral committee, the Commission on the Conquest of Cancer, who were able to secure the diversion of billions of dollars towards finding a cure. The unfailing optimism of the scientists of yesteryear seems almost darkly comical now. ‘I believe this treatment is an absolute cure for all forms of cancer… I do not know what its limitations are’, said one Chicago physician of Xray therapy in 1901. And on an unrelated note, I couldn’t help but feel slightly amused at 19th century New York surgeon William Stewart Halsted, who developed a rather unhealthy addiction whilst using himself as a guinea pig for the latest anaesthetic at the time. Attempts to treat his cocaine addiction using morphine were, unsurprisingly, not only unsuccessful but led to him becoming addicted to both drugs instead. Nevertheless, he remained a successful and productive surgeon, eventually being recruited to John Hopkins Hospital. Well, whatever works for you… What strikes me most about this book is the skill with which Mukherjee writes. He writes with great empathy and sensitivity, and with no overestimation of his involvement in the story – he is merely the storyteller, but a great one at that. It is hard not to be moved by his patients’ stories, but equally impressive is his ability to make the history of cancer research, of all things, into an utterly riveting story, an unlikely feat to achieve, surely

medicalstudent

February 2012

Culture

Film Review - Shame

London’s Cheap Eats By Yin Yin Lee (ICMS) For a long time, English food has been considered by many as boring and wildly expensive, qualities that do not endear it to the student budget. However, the recent financial meltdown has triggered a change in attitude from both restauranteurs and the public, leading to the emergence of the no frills, no reservation restaurant, serving honest food at a decent price. With this in mind, here are a few restaurants that offer great value for money:

Viet 34 Greek Street, Soho, W1D 5DJ For many, good Vietnamese food in London has meant a trek the 'Pho Mile’ (Kingsland Road) but Viet has provided us with a quality alternative in the West End. Located inauspiciously on a side street, one could easily miss Viet but for those in the know, this is a restaurant that delivers mouthful after mouthful of wonderful food. Flavours are robust and there is an intensity that permeates every morsel of food here. Yet the most appealing factor of this restaurant is the price, with the vast majority of main dishes being less than a tenner. You know what they say about a man with big eyes... Big glasses.

Ashik Amlani Culture Sub-editor

Call me old fashioned, but I have always regarded the elusive issue of sex addiction with a mixture of ambivalence tinged with just a hint of scepticism. Whilst it cannot be argued that the condition is merely a figment of an overeager imagination, I had never before realised the widespread prevalence and often debilitating nature of the illness. Imagine, then, my sheer disbelief when I discovered the myriad societies devoted to helping individuals curb their sex addiction worldwide. I scoffed at the notion of a possible treatment, let alone a seemingly effective one based on the 12 step routine introduced by Alcoholics Anonymous. And it seems I'm not the only one. In the face of several highprofile celebrities (think Tiger Woods, Russell Brand, and Michael Douglas) disclosing their sex addiction in recent years, the issue has been planted firmly into the forefront of society's consciousness. The furore debating the validity of such a condition has reached an all-time high, so what better time than now for auteur Steve McQueen to unleash his no holds barred, sexually graphic exposé detailing the life of one so afflicted? In amongst the plethora of January releases vying for attention during award season, there is always one that never quite receives the hype it deserves. Shame is 2012's diamond in the rough. The premise is simple. Brandon (Michael Fassbender) is a bona fide sex addict. The film begins with him on the train, directing a seemingly innocent looking glace at an attractive lady opposite. At first, the attention seems flattering. When he fails to drop his gaze, however, the mood becomes eerily lustful and his unflinching, predatory stare causes the unnerved victim to flee at the next stop. He gives chase, but all is in vain.

This opening sequence, set to a foreboding orchestral score, sets the tone for the film to come. And, what's more, it is just the start. Brandon's routine involves masturbating in the shower day and night, looking at all manner of pornography on his virus infested work computer, then roaming the streets at night in search of his next conquest, be it paid or otherwise. This is all conducted with a look of resignation and never so much as a flicker of enjoyment. Sex is no longer about affection to Brandon. He is merely a slave to his body's unwavering desire for pleasure. This carefully constructed yet sterile and lonely existence falls shatteringly to pieces around him with the arrival of his sister, Sissy (Carey Mulligan). Needy, quick to love, confrontational, and attention seeking to the point of self-harm, she is the polar opposite of her brother, cold and indifferent. Both equally in need of affection, but both trapped by their respective maladies. The interactions between the two are emotionally charged affairs. In one particularly memorable scene, they argue like children in front of a cartoon on television. He feels she is shackling him, and she claims that he has shut her out. Initially, the shame of being a sex addict, especially as his sister's inkling is perilously close to the truth, drives Brandon to improvement. He discards his tainted computer, throws away the sex toys and magazines, and even attempts to go on a "real" date with an intelligent, charming colleague. Those of you hoping for his absolution, however, will be sorely disappointed. He is unable to have sex with a woman he actually cares for, showing how disconnected the two emotions have become, and this, as well as the increasing pressure of his addiction, causes Brandon to brutally reject his sister in an attempt to discard her completely. The final flourish is excessively melodramatic and not in keeping with the rest of the film. Furthermore, it fails to provide a dénouement of any kind. There is absolutely no

hint that Brandon may be on the path to improvement. Similarly, Sissy’s last line in the film “We are not bad people, we’ve just come from a bad place”, thereby hinting at a damaging childhood or possible incestuous relationship, is as close to a possible explanation we ever receive. This, then, is my major criticism. By offering very little in the way of explanation or resolution, Shame plays out very much more like a case study of a sex addict in which we are given front row seats to witness the complete and utter unravelling of someone’s life due to addiction, rather than a film in which we are able to relate to the characters. This hampers the overall impact and message we can derive from it. Watching this film is by no means an easy viewing experience for the viewer. As a consequence of McQueen’s artistic background the film is a visual spectacle. He lingers on each frame, keeping the camera as still as possible for as long as possible. At times it becomes a chore to watch, no doubt intended. The film’s unwavering, laconic style is equally worthy of merit. It is not often you watch a film with such direction and force yet laced with so little dialogue. Credit must obviously be given to the dynamite Fassbender and Mulligan for their portrayals of such damaged characters. Fassbender’s haunting subway stare, in particular, is something that will stay with me for a long time to come. Shame is a tour de force in visual experimentation, and a must-see. Those of you, however, not well versed in artistic cinema might find it a frustrating watch due to its unflinching and potentially inscrutable nature. Patience is essential to be able to watch this film, and an attribute that I fear is all too lacking in modern moviegoers. Give it the care and attention it deserves, however, and you will be richly rewarded with a cinematic experience truly without equal in the last few years

Shame is in cinemas now.

Malting’s Cafe 169 Tower Bridge Road City of London, SE1 3NA Malting’s embodies the new ingredient-led approach to cooking as well as any other restaurant in London right now. Food is prepared with fresh ingredients and executed in a no-nonsense manner, that is a refreshing change to the haute cuisine of yesteryear. With a menu that changes daily, each dish comprises of no more than 3 or 4 ingredients, underlining the strong Italian influence to their cooking. Whilst their creations are not groundbreaking by any means, what they do conjure up in their kitchen are crisp and clean flavours that allow each ingredient to shine through.

Falafel Store Thursdays Only, Lyric Square, Hammersmith, W6 0QL I’ll be honest here, I don’t actually know the name of this store, but what I do know is that there is always a long queue of hungry punters waiting for some stonkingly good falafels served at a decent price (£3.50 for a large). Whilst I’m generally ambivalent towards meat free food, these falafels are good enough that I can honestly say you don’t notice the absence of meat. My only bit of advice when visiting would be a) get there early to avoid the queue and b) go for the large option with everything on it. You can't go far wrong. So these are my three recommendations for cheap grub in the capital, hopefully at least one of them is fairly accessible to you guys and who knows, perhaps I may bump into you there!

Been to a great restaurant recently? E-mail culture@medical-student.co.uk and let us know about it!

February 2012

medicalstudent

Culture

GKT MedSoc Musical Theatre Presents 'Footloose' Director Jack Haywood gives us the lowdown on the months of hard work that went into GKT's latest production

Medsoc Musical Theatre (MMT) has always been known for staging fantastic productions which have one key characteristic - quality. That is why the 2012 production team wanted to put on a show which would impress and set new boundaries, and so Footloose the Musical seemed like the perfect choice. Having gone from 70 people in the auditions to 28 in the performance, we truly did have a very talented cast who all performed so well, not only in the performances but also throughout the entire rehearsal process. We started way back in September and rehearsed three times a week on Guy’s Campus. These could sometimes be very long and tiring, but all the cast and pro-

duction team wanted a great show and worked extremely meticulously - something which I could never fault them for. All of the actors we had for our lead roles were absolutely amazing, each bringing their own thing to their characters. Leading the musical were David Thaxter (Ren) and Jenny Galloway (Ariel) who were strong throughout and were always keen to explore and build upon their characters. Trisha Gupta (Rusty) was a phenomenal lead for our trio of girls, who included Nicola Smallcombe (Wendy-Jo) and Abigail Greenwell (Urleen). Special mention must go to our freshers who took up lead parts this year - David Yang (Chuck), Stefan Race (Willard) and Anya Bricknell (Vi)

who all settled in so well to the production and really shines. Frank Reakes’ portrayal of the Reverend Shaw Moore was perfect - he delivered his lines and songs with passion and was extremely convincing. And last, but by no means least, Ashleigh Squire (Ethel) played her part confidently and with meaning. And as this was her last MMT production, I am extremely proud! Our musical director, Jo O’Sullivan, not only had to worry about the harmonies of the cast, but also the direction of the band that played live with us in the performances. Rehearsals for this only started at the beginning of January, but the finished product sounded great and really complimented the cast.

The performances, which were on 25-27 January, were an absolute hit. When the set arrived at Greenwood Theatre on the Saturday before show week, I think we were all secretly thinking we had bitten off more than we could chew. However once again the cast and crew rose to the challenge and when I watched the final performance, I sat in the front row feeling so proud of everybody on the stage. I could have not asked for a better group of people to work with. As with most productions at GKT, the final night wouldn’t be complete without a bit of heckling, but the cast took it in their stride. The proceeds from the ticket sales all went to GKT RAG, and whilst we’re still counting exactly how much

we’ve raised, it looks like it’ll be in excess of £1000. The RAG charities this year include Medcinema, The Evelina Children’s Hospital, the Cancer Unit at Guy’s Hospital, so it was great to be able to help out these fantastic causes. For anybody that has been involved with a show, I’m sure you will know what ‘post-show blues’ feels like. However I take comfort in the fact that around 1000 people came to watch Footloose and experience this amazing show. It was great to spot a few familiar faces in the form of some of our lecturers in the audience as well. I sit here now wondering whether they all still have the songs stuck in their heads on repeat like I do!

medicalstudent

February 2012

Culture Vintage Film of the Month

“It's Alive! It's Alive!” - Review of Frankenstein (1931) Akin Sowewimo Guest Writer The story of Henry Frankenstein and his monster is an age-old classic, but although the film that first brought it all to life has faded from memory, the image of the monster lives on. The giant bolts protruding from his neck, the dead eyes and the horrible moaning, to date Frankenstein’s monster remains one of the scariest creatures ever to grace the silver screen. The 1931 film by James Whale adapted from Mary Shelley’s novel is one of the best horror films of all time. While the idea of a black and white film might be daunting to a modern film-goer, this is one film that has got to be seen. If not for the kind of thrill that most of us have come to expect then certainly for what is definitely an extremely engrossing story of medicine and one doctor's arrogant and dangerous attempt to recreate life. Think Dolly the Sheep, but instead of short telomeres think rotting limbs. The story centres on the character of Frankenstein, played by Colin Clive, an intelligent, egotistical and arguably

misguided doctor, who locks himself away in a desolate, spooky windmill where he attempts and later succeeds in reanimating dead tissue, thereby creating the Monster. Clive is haunting as Frankenstein as he communicates across the doctor's maddening desire to cast the laws of life and death asunder. Only the love of Elizabeth Lavenza, his fiancée, played by Mae Clark, a beauty from the 1930s, humanises the character of Frankenstein. Elizabeth, who is desperately in love with Frankenstein, calls upon the doctor’s old professor and a friend of his, Victor Moritz, to help her pull him back from the brink of insanity. Unfortunately they are too late and Frankenstein succeeds in his evil plans. Enter Boris Karloff who steals the show as the monster. Despite being an unknown actor at the time, his performance is legendary. He plays the monster with such compassion that despite his origins and appearance the audience invariably find themselves rooting for this lost, desperate soul who was created by the folly and hubris of a mad genius. The monster struggles with his identity, and having been created artificially he searches for the meaning of his life. Unfortunately chaos ensues af-

ter the monster escapes and in his wanderings is persecuted and reviled by almost everyone save a little girl who he accidentally kills. The theme in this film of greatest relevance to medical students is the question of scientific advancement and the issues of ethics and morality that are inevitably involved. I found that I resonated with Frankenstein’s desire to achieve greatness but couldn’t help wondering about the morality of creating life. Are there some lines medicine should never cross? My issues with this film were that it represents a different era in the history of cinema, a time before special effects became the chief method of terrifying the audience. For most of us who have become desensitized to anything other than exposed innards and silent unkempt little girls (I'm thinking The Ring here), this film might feel a little light on the horror and even less so on the violence, but it is still a great film. All in all, with amazing acting by Karloff and Clive, a timeless story and the beauty of a black and white film I believe this movie is a must-see. If you’re looking to wet yourself however, I’d look elsewhere

The doctor will see you now...

February 2012

Sport

medicalstudent

RUMS destroyed by GKT Charles West Guest Writer

GKT

RUMS

After three matches in the horrendous South-eastern 2B league the Guy’s men were biting at the bit to play some fast running, skilful rugby on the great pitches at the Watford training ground in Shenley. The weather set a bad precedent for the day, with the barometer reading a low score. With the prospect of an hour a half trip to North London the smiles were certainly not abound. The journey was made more enjoyable with comments on the pre-match meals; Mr Rayappu sported a chickenbreast-only lunch with the clear aim

of bulking up (despite the fact that his bones are already on the large side), while young man fresher Mr Wilkinson went for the unorthodox ‘oats in yoghurt’ tekkers citing the importance of complex carbohydrates within the gastric fundus to aid with sprint speed. Finally St Alban’s station was hailed, where the squad of 20 (plus injured captain Mr ‘Blastoise’ Chin, along with Saffa coach Richard Aitken) alighted. Taxis were required for the next leg of the journey, so verily a keen looking Mr West, by use of the shoulder abductors, waved down a four door Ford Estate of the enigmatic Abbey Astar Taxis. Luckily he had the presence of mind to request a receipt from the gentleman in charge of the automobile, so that he would later be able to claim money back from the bureaucrats at KCLSU. The Hospital team were allocated to changing room A10 where the team came in dribs and drabs from the station. Kit was applied to the upper and

lower parts of the body in the usual manner, with everyone successfully donning shirt, breeches, jock, suspenders, boots and gum shield in good order. The match in itself was a formality, but credit to the RUMS boys who played on to the end with gusto and scored an excellent consolation try at the death of the match. Of note was a fine debut from fresher Mr Taylor. Mr West was also extremely good.

With the business of the day dealt with the fun times began. The showers at Shenley are the stuff of legend and the water supply is quite soft meaning quite a strong lather can be created with high quality shower gels. Clean, spic and span the journey

back to Central was a fast one so the squad were quickly assembled at the poet John Keats memorial statue for celebratory gins. A game of pockets was started in the subterranean lair at Guy’s bar, which is where the lesson of the day was learnt: ‘It is not a good idea to wear a shirt to Guy’s bar that is kitted out with a pocket.’ Other immature frivolities followed and innumerable bodily fluids of all sorts were excreted into various places by different members of the team by the early hours of Thursday. Unfortunately many of the firms of the GKT Hospitals had to do without their rugby playing students due to a collective lack of extracellular volume. RUMS are currently the highest ranked hospital 2nd XV and ought to stand a good chance of winning the Junior Hospitals Cup. Good luck to them and their plucky young number 8. The team from Guy's will meet the RUMS 1st XV on 1st Feb. In terms of the Guy’s Hospital 1st

XV chances of getting our filthy SouthEast London hands on the famous trophy, we will try our best and do justice to our club’s great history, but perhaps it may be worth putting an outside bet on St Bartholomews and The Royal London having a turn at UH glory. With their excellent Swiss winger, Lucas Rehnberg, surely there is nothing they cannot achieve - although the men at Paddington are all jolly good chaps, and will no doubt put up staunch resistance.

There is no doubt in our mind that medical sport is as fit and well as the players selected in the various teams. If BUCS enforce this so called merger with our parent Universities, then in our opinion they should, “Go fuck themselves."

Play was suspended for 15 minutes while the teams contemplated what to do about the mysterious rugby ball, floating in the air.

medicalstudent

February 2012

Sport

ICSM finally manage a draw

Though unable to gain the lead, the ICSM team were proud of their solid defensive strategy, which allowed nothing to get past.

Josh Orpen-Palmer Guest Writer

of form against fellow strugglers UCL 2XI.

ICSM

UCL

The mighty ICSM 2XIs arrived for their fixture on Wednesday hopeful of turning around their recent poor run

It is likely UCL were also confident of victory having won the previous fixture 4-2, and seen the inability of ISCM to pick up points in the league. These hopes were quickly extin-

guished as ICSM started brightly, easily switching the ball in defence and picking out their strikers at will. Unfortunately as the half developed and several ISCM chances on goal were squandered, it became clear that several members of the team had eaten one mince pie too many over Christmas, and fitness told as UCL came back into the game. Thanks to the fact that UCL's trolllike forward was about as threatening

as a lipoma, ICSM were able to weather the storm and go into half time with the scoreline 0-0. While gathering in the goal for a half time debrief, the medics’ lack of halftime oranges became evident and the infamous second scurvy feared by all teams was becoming a real possibility. Despite the absence of half-time nourishment, ICSM bravely decided to continue the game and after some inspiring words by their Captain they

began the second half as confidently as they had done the first, piling pressure onto the oppositions defence. It was only through combination luck, desperate defending and unsportsmanlike fouls that UCL managed to hold against the onslaught. As the final whistle blew the score remain at a frustrating 0-0, leaving ICSM to wonder at what could have been

Continued from back page ing their 2nd VIII against ICSM in the heats to come against GKT who had seen off Bart’s to get to the final. George’s managed to prevail against the club that start just ahead of them as first place in the next UH sprint race this year, Bumps in May. GKT’s men’s VIII were knocked out in their first race against ICSM, in a repeat of the grander Allom Cup’s final from last month, which suggests that a seeding system might be advisable. ICSM then beat Vets in the semi-final, with George’s beating RUMS to join them in yet another final. In the past couple of seasons contests between these crews had been close and determined, and this was no exception. However, Imperial managed to triumph and increase their total haul of medals to five out of seven (in terms of UH clubs) with the others taken by RUMS and George’s, who will both surely be looking to hit back at the next event next month. We eagerly anticipate the nest UH event on February 18th

After several drastic cuts in the budget, this is all that's left of the Royal Navy. Don't tell Argentina!

medicalstudent

Sport

Hockey: Rugby: Guys' Hospital easily Poor show from UCL as ICSM manage a draw triumph over RUMS Page 22

Page 23

Imperial Dominate at Winter Regatta

The Imperial team coursed to victory, thanks to their long, powerful strokes. They were also very good at rowing. Image by Abbey Cargill

Jac Cooper Guest Writer Not for us the calm “millpond” of Dorney Lake or the sheltered straights at Henley. The conditions at UH Winter Sprints on Sunday represented rowing at its most authentic - adapting to the nuances of the tempestuous Tideway in the bitter cold and harassing winds. Though the competitors had rowed in worse, the weather added another edge to what was a day of closely contested races. The United Hospitals regulars of Bart’s, St George’s, ICSM, RUMS, GKT and the Royal College of Vets lined up with some invitational crews

from the parent University clubs of UCL and King’s College, hoping to beat these bigger clubs as well as their rivals within UH. The course was approximately 800m between the University of London Boat House and Chiswick Bridge, not very far and making the sprint start and ability to quickly settle into a good rhythm especially important.The Novice VIII category, where competitors have to be in their first year of competitive rowing, saw some strong crews that will only get better and better, with ICSM men beating George’s to make the final against King’s who were too much for ICSM’s 2nd boat. In a thrilling race there was little to separate the two crews but King’s just

came out in front, with the runners up receiving medals as the best UH crew.

KCL novices put in an impressive performance considering their crew included one fresher who had never actually sat in a rowing boat before the day of the race. A similar story was seen in the revenging Novice women where ICSM were judged rather controversially to have pipped George’s to the finish in a tight semi-final but could not overcome a formidable UCL crew, who had beaten RUMS en route, in the final. The

women’s crew also got medals, as they too were the top crew in UH. In the IVs races, there were only Senior Women boats competing and RUMS overcame Bart’s in the final to win their sole medal of the day. Then in the Intermediate category (for colleges’ 2nd VIIIs to compete against each other) RUMS women lost to ICSM in an exciting encounter between clubs that have been rivals of sorts in recent years. ICSM had made the final by defeating George’s in their semi, a result that was avenged in the Senior women’s race straight afterward. ICSM men powered past RUMS before facing a George’s crew who had a bye to the final. With a fierce tailwind and

a rapid stream, and after ICSM delayed the race due to boat-sharing, another tough battle ensued.

Imperial medics took the lead off the start but George’s showed their guts in fighting back, just falling short at the very end to leave ICSM with another set of medals. Finally in the Senior VIII races, George’s bested RUMS after reveng

Continued on Page 23