JUNE / / 2021 / / ISSUE 6
PRESCRIPTION THE MEDICAL MAGAZINE YOU JUST HAVE TO RENEW
We’ve made it to Half-Term! Hello and welcome to the sixth edition of Prescription! I hope everyone has enjoyed the first Half-Term of school and are looking forward to relaxing during the holidays :) Prescription aims to keep you up to date with everything in the world of medical sciences, featuring articles on new medical breakthroughs and interesting ethical questions written by our team of writers from Years 10-12. I hope you enjoy the articles as much as I have! Thank you to all of our journalists and the rest of the MedSoc team! Jasmin Ravindra (Editor)
How Does the Internet Affect the Portrayal of the Medicine Industry? NATASHA S 11N
much more shocking, mentally draining realisation from the patient upon finally consulting a doctor due to worsening symptoms, getting their true diagnosis from a professional. Additionally, when the information we read is unclear, we assume the worst. Readers can worry themselves to extreme fear when they believe they have a serious condition but in actual fact, they do not have any illness to worry about. The stress, whether it’s initial or delayed, can ultimately be significantly threatening to physical and mental health. This is why the impact of fake news being spread on large media giants can be so damaging in so many forms.
From newspapers with their separate health sections to medicinecentred dramas and documentaries, medicine is a major subject of interest to the popular media in many different ways. With the emergence and exposure of publications and blogs too, the medical world is more exposed than ever before.
The COVID-19 pandemic is no exception to the growth of misinformation. If anything, it has exacerbated the issue, as nearly two-thirds of Americans said they have seen news and information about the disease that seemed completely made up, according to a recent Pew Research Center study. This connects to the negative portrayal of medicine in the media as the tireless It is natural for one to believe that the portrayal of medicine in the work of doctors and public health officials around the world is made harder media should make the public and then future patients more informed. and harder, needing to express the right facts in a way that can be understood This is a goal for both the media and the medical industry. However, by everyone, and is twisted for the benefit of the media industry. spreading false, inaccurate or vague information that gives room for misinterpretation can put physicians and journalists into a conflict. To understand more about the general way that the industry is presented in There can be ethical difficulties brought up too, which could possibly the media, it is also necessary to consider the positive side. Technological put doubt into the minds of past patients and the public over the advances that allow for such wide-spread fast access to the Internet can doctors’ experience. Alongside this, the ease of uploading information provide the doctors and physicians with different online forums to promote for the world to see can often lead to breaches of patient-confidentiality debate, learning and celebration of achievement. There is also growing evidence of a more positive side to how hospitals, therapists and even health and privacy contracts. charities are coping with mental health issues amongst teens and adults. Forums used by medical professionals spark success in new forums like It is a common joke for adults to self-diagnose themselves, the people Childline and YoungMinds. around them and even their kids off the Internet, leading to the wellknown phrase ‘Dr Google’. Whilst this is a light-hearted comment on When these communities flourish in helping patients, bigger organisations the frequent event that this happens, self-diagnosis becomes extremely such as the government start to take better notice of the reasons and causes dangerous for anyone using the Internet to try help themselves. This behind all of this. An example of the government benefit can be seen in the can work both ways in that they may have an extremely serious UK as of May 2021, since £17 million has been provided to improve condition, but because the symptom they are having seems minute, mental health support in schools and colleges, alongside new funding to they dismiss it because of what they read online. This then generates a train thousands of senior mental health leads and educational staff.
PAGE 1
JUNE / / 2021 / / ISSUE 6
PRESCRIPTION
Gut microbiome diversity and its association with sleep physiology KATE W 12DSM Scientists are becoming increasingly aware of the importance of the gut brain axis and the ways in which our gut microbiome influences our physical and mental health. Sleep is intrinsically linked to our immune system, and a poor quality of sleep can affect our cognitive and behavioural performance and has multiple implications for our well-being. Previous research has suggested that sleep deprivation can alter the composition Here is an example of an actigraph which records of our gut microbiome in as little as 48 hours, sleep and wake cycles and circadian rhythms initiating the connection between the two. (changes in physical and mental behaviour during a 24-hour cycle). Firstly, it is important to establish how sleep physiology and gut microbiome diversity are In 2019 he published a paper in which the main measured. Although sleep trackers are useful in conclusion was a positive correlation between assessing quality of your sleep relative to the total microbiome diversity and increased sleep amount you move in the night, and efficiency. Moreover, a positive correlation was environmental factors like the light intensity in also found between total microbiome diversity your room, sleep trackers do not directly and interleukin-6, a cytokine (protein involved in measure sleep. In medical studies, sleep can be cell signalling) noted for its effects on sleepmeasured by monitoring brain waves using an suggesting that more diverse and varied electroencephalogram (EEG) to measure the microbiome components have potential to electrical activity of your brain and determining enhance sleep. Total microbiome diversity had a which stages of sleep the participant is in (of negative correlation with wake after sleep onset, which there are 5). Gut microbiome can be suggesting that more varied gut microbiome analysed through testing of stool samples, or a could lead to a better quality of sleep as well as colonoscopy to capture bacteria in the bowels. prolonged length of sleep. Even more recently, an indigestible pill has been developed with the ability to capture biological Previous studies have yielded conflicting results samples in the upper GI tract, which cannot be though suggestion that sleep deprivation does not achieved by analysis of stool samples alone. lead to changes in the gut microbiome composition and therefore a diverse microbiome Robert Smith, professor of biological sciences at would not have any impacts in sleep. However, Nova South-eastern University conducted an increasing evidence of the fluctuation of experiment to determine the relationship microbiome composition during day and night, between sleep and the gut microbiome. In his and research into gut diversity preventing obesity experiment he used actigraphy, similar to an and gastrointestinal disease are supportive in the EEG to quantify participants quantity and hypothesis that gut microbiome diversity does quality of sleep. impact our physical and psychological health.
Mice and Human Chromosomes, how was this used to model Down Syndrome? JANESA S 12GBR 1 in every 700 babies have Down syndrome, this stat indicates how common this neurogenetic disorder is and this propelled researchers to develop a mouse model that would help us understand further the complexities behind this disorder. Down syndrome is a condition that occurs when a baby has an extra copy of chromosome 21 so this results in them having 46 chromosomes, this aneuploidy leads to changes in how the baby’s brain and body develop which can cause mental and physical challenges for the child.
In a 2018 study in Frontiers in Psychiatry the authors wrote, “The body’s biological clock works in synergy with the microbial clock”, supporting the hypothesis that the diversity of the gut microbiome does in fact impact sleep. Below are some foods to incorporate into your diet, split into probiotics, live bacteria found in certain foods, and prebiotics, that contain fibre to be digested by bacteria in your gut. By eating healthily and enriching the components of our gut microbiome, better quantity and quality of sleep is likely to arise.
fragments to a recipient cell) to multinucleate their chromosomes, then these nuclei are forced through the cell membrane to create microcells, which can be fused to a recipient cell line. The embryonic stem cells were then used to make chimeras ( a single organism that contains two sets of DNA) and this resulted in a panel of transchromosomic male mouse ES cell lines, each carrying a freely segregating Hsa21 ( the extra chromosome present in Down syndrome children). However, they then discovered that the male mouses failed to achieve germline transmission of Hsa21, this was consistent with previous findings that showed that often an aneuploid chromosome will not transmit through the male germline. So, then this same procedure was repeated on female mice and they discovered that germline transmission of Hsa21 could be achieved in female mice, one of the female chimera had a litter of two pups and they had both retained a freely segregating Hsa21 with the same Hsa21 profile as the parental embryonic stem cell line. After this success, in order to confirm that these mice would be suitable models of Down syndrome the researchers had to test the mice for symptoms of the syndrome. They discovered that they had generated a strain of trans-species aneuploid mice that carried an almost complete human chromosome and showed features seen in humans with Down syndrome like changes in behaviour, synaptic plasticity, cerebellar neuronal number and heart development.
As the revolution of discoveries in genetics began, a group of researchers decided to create a model of Down Syndrome in mice, and The development of this model was a revolutionary step in understanding they did this by placing an entire chromosome in mice. Initially the first Down syndrome and it has opened the door to many more discoveries that transchromosomic mice were created by placing freely segregating will unravel the mechanics behind this syndrome. portions of Hsa2, 14, or 22 into mouse embryonic stem cells using microcell-mediated chromosome transfer. This procedure entailed inducing donor cells (cells providing one or more chromosomes or PAGE 2
JUNE / / 2021 / / ISSUE 6
PRESCRIPTION
Is a new “flood” of antibiotics going to be released? GAYA G 12JCR Penicillin, a product of chance, has had a profound impact and some may see it as one of the greatest discoveries. Alexander Fleming, returning from a vacation, upon inspecting some colonies of Staphylococcus aureus, found a mould (now recognised as Penicillium notatum) had contaminated his petri dishes. Following close analysis, he discovered that the Penicillin inhibited the growth of the staphylococci. After a few other trials, it was deduced that Penicillin could be harnessed to combat infectious diseases. This phenomenon then on continued to release a ‘flood’ of other antibiotic discoveries. However, this ‘flood’ in recent decades seems to have slowed down. There has been an increase in demand for antibiotics, engendered by the increasing problem of antibiotic resistance. Many antibiotic resistant bacteria protect the target of the drug’s action by inhibiting it from entering the bacterium cell or pumping it out faster than it can flow in. The development of resistance bacteria due to increased dependency and them being oversubscribed is of great concern. When one takes antibiotics, resistant bacteria that are left untreated can multiply by binary fission rapidly; repeated and improper reliance on these drugs can lead resistant bacteria (to that antibiotic) remain unharmed. Hence, the recent discovery of Halicin has led to many predicting a new ‘flood’ to occur.
A graph showing the increase in the number of (antibiotic resistance) cases since the 2000
Antibiotics function through various types of mechanisms: blocking enzymes involved in processes such as DNA repair and protein synthesis. Specifically, they prevent the bacteria from synthesising a molecule in the cell wall, named peptidoglycan, which provides it with the strength it requires to survive in the human body. Halicin differs from this conventional mechanism. A recent study discovered that this new drug disrupts the flow of protons across a cell membrane, along with it having low toxicity and most importantly its robust nature against resistance. The researchers state that ‘Even after 30 days of such testing we didn’t see any resistance against Halicin,’ which is unusual considering conventional antibiotic compounds face resistance within a day or two. Many are currently questioning whether more forms of these compounds exist, which ultimately would be one of the best ways to combat the rising cases of antibiotic resistance.
A newly designed artificial intelligence device, inspired by the brain’s architecture, found a molecule with the ability of wiping out various strains of bacteria including those that are of antibiotic- resistant strains. The research team developed a neural network and used it to screen a library named the ‘Drug Repurposing Hub,’ which includes roughly 6,000 molecules under investigation for human diseases. The trained model predicted about 100 candidates which would be effective against E.coli. One of the selected numbers entailed Halicin, named after HAL - an intelligent computer in the film 2001: A Space Odyssey. The molecule, previously studied as a possible diabetes treatment, demonstrated activity against Mycobacterium tuberculosis, its causative agent and a handful of other hard-tocombat microbes. Studies explore how Halicin attacks the bacteria’s cell membranes, inhibiting their ability to synthesise energy. Keeping the cell membranes intact This illustrates the action mechanisms involved from Halicin is predicted take more than one or two genetic mutations, which could explain for its imposing ability to hinder resistance.
What will be the effect on immunity of only developing countries vaccinating their populations against coronavirus? CHARLOTTE F 11L The COVID-19 pandemic first significantly impacted the UK in March 2020, when the government announced stay-at-home orders as part of a national lockdown. Although there have been 173 million infections and 4 million deaths due to the coronavirus as of now, most of the world is in a much better position than it was at the start of the pandemic. This is mainly due to the use of vaccinations against the virus, which scientific researchers developed at an amazingly fast rate. The vaccines work by introducing antigens (specific molecules from the COVID-19 pathogen) to the immune system, so that it can recognise the antigens as unwanted foreign ‘invaders’. The antigens used in the vaccine are in a weakened or inactive form, so they cannot cause the illness themselves. Then, the immune system of the vaccinated person is able to rapidly make
antibodies to combat the pathogen if it infects them in the future. According to the National Health Service (NHS), the vaccines “significantly” reduce the risk of getting seriously ill or dying as a result of the coronavirus, and also the risk of spreading it. This means that by being vaccinated, people are protecting not only themselves by improving their immunity, but also the people around them. In the UK, there are currently three vaccines that have been approved for public use (Oxford/AstraZeneca, Pfizer/BioNTech, and Moderna) as part of a vaccination program. This mass immunisation scheme has the aim of vaccinating the entire UK population, starting with the most vulnerable, against COVID-19. The program has proved to be very successful, with 43 million people (80% of the UK adult population) receiving at least one dose of a vaccine at the time of writing.
which only 3.8% of the population has been fully vaccinated. This is because India (unlike the UK which is a developed country) is a developing and emerging country, which means it does not meet the requirements to qualify as an advanced country. For example, it had a gross domestic product (GDP) per capita of $2100 in 2019 compared to the UK’s $42330. Therefore, the government is a lot less financially able to purchase vaccinations from the countries where they are manufactured, so they have a very limited supply. The uneven COVID-19 vaccination distribution around the world means that it is disproportionally affected by the virus. The difficulty of obtaining a vaccine in India has meant that the rate of spread of infection among the population is still high, whereas in most of the rest of the world, it is decreasing. This has had disastrous effects, as India has experienced a jump from 12 million cases of COVID-19 in India at the However, this success is not held by every start of April to 30 million cases in June, with country around the world, such as India, in several hundred deaths per day, while people in countries such as the UK are enjoying the easing of developing and emerging country, lockdown measures.
PAGE 3
JUNE / / 2021 / / ISSUE 6
Vaccines Are More Than Antigens THALEESHA I, 12 It seems that, especially in the current circumstances, it is common knowledge that vaccines tend to include the weakened form of a pathogen, or something akin to it. Whether this means the inclusion of the whole, albeit attenuated, pathogen; the substitution of particles closely resembling it, or the insertion of mRNA in order to synthesise characteristic proteins, the intended result is the activation of the adaptive immune system in response to the active ingredient which all of the above have in common- antigens. Whilst this fact may also be well known, it appears that this means the other ingredients of which vaccines are composed tend to be overlooked, despite their importance in the success of vaccination. Another class of key ingredients is that of the adjuvants, which play the role of boosting the immune response to the vaccine. Various compounds have been used for this purpose, including metals, oils and other biological molecules such as synthetic forms of DNA. Aluminium salts in particular, despite the apparent lack of other biological uses for aluminium, are commonly used, and scientists have theorised that their effect on the immune response may be due to their potential for accumulating antigens into a high concentration through adsorption, though their mechanisms are still unclear, and it has also been suggested that they activate a T helper cell response as well as B cell antibody production. The mechanisms of adjuvant action can be little understood and varied, due to different vaccines requiring different modes of action for maximised efficacy.
PRESCRIPTION opened. Multi-dose vials contain, as the name suggests, multiples doses of the vaccine to be administered, and the choice of packaging multiple doses together could be taken for a range of reasons, including cost and time efficiency. A recent change to the composition of said vials was the phasing out of thiomersal, a mercury-based compound also known as ethylmercury, in some countries due to theoretical safety concerns based on the effects of the related compound methylmercury. Similar to preservatives yet common to pre-packaged syringe vaccines as well, stabilisers, such as gelatine and other compounds, instead limit the effects of abiotic factors such as temperature on the vaccine. Apart from the above, vaccines also have traces of residual ingredients from the manufacturing process, including antibiotics to prevent contamination; compounds from the cell culture such as yeast or egg proteins; compounds for inactivation such as formaldehyde, as well as potential others such as acidity regulators.
Although the immediate focus when vaccines are mentioned may be those pertaining to SARS-CoV-2, the recent developments regarding the potential for a second malaria vaccine, following RTS,S, should not be overlooked. Despite the urgency of the search for a malaria vaccine, Plasmodium spp. the genus of parasite which causes malaria, is known for its variation in antigens as well as immune response evasion through the infection of red blood cells and liver cells. Vaccines such as RTS,S tend to target the pre-erythrocytic stage in order to prevent the emergence of the abundance of replicated parasitic cells from the liver and subsequently red blood cells. The R21/Matrix-M vaccine builds on the previous success of the RTS,S vaccine, improving the efficacy by increasing the coverage of the protein to be targeted- in this case, CSP. In this way, although the life cycle and nature of the malaria parasite has created clear problems for the formulation of vaccines, it can be seen that the vast and varied potential of the vaccination method allows for a range Additionally, the composition of vaccines can depend on circumstances, of targets, the effects of which may be compounded by the potential as with the case of multi-dose vial vaccines and preservatives which combinations of additional factors, such as adjuvants, in the composition. prevent contamination from bacteria and fungi once the vaccine has been
The Tuskegee Syphilis Study: Ethical Questions and Consequences KASTURI K 12RML The Tuskegee Syphilis Study was the longest-running experiment on humans, beginning in 1932 and lasting 40 years, and is also America’s biggest case of medical immorality. The study was carried out by the US Public Health Service (PHS) to see how long a human being could last with untreated syphilis and was practised on 600 black men in rural Alabama, most of whom were uneducated sharecroppers. Whilst 200 men served as a control group, meaning they did not have the disease, the other 400 men were infected with syphilis and carried the disease throughout their lives. The PHS officials refused to diagnose the patients and actively denied them proper treatment. Whist the study ended in 1972, the detrimental impacts of the study on the African American community are still prevalent today. The study showcases America’s long history of exploitation of black men and women. Syphilis is a type of STD that can result in very serious complications if left untreated, but luckily, in the mid-1940s, penicillin became a standard cure for the disease. However, the PHS officials made no move to cure the patients they were experimenting on. These men experienced adverse effects because of untreated syphilis, and the officials continued to do nothing as it reached the tertiary stage, which leads to the damage of the patients’ organs and organs systems. Even after the patients experienced paralysis, psychosis, dementia and blindness, they were refused appropriate treatment. Instead, the men were given placebos such as aspirin and medical supplements which people must be treated equally and equitably. It was this violation and abuse of power which saw the beginnings of mistrust in the health service
would have no effect on their bodies. The disease did not just affect the men in the study, but their wives also contracted the disease, and many of their children were born with congenital syphilis which they had contracted from their mothers’ uterus as foetuses. The patients were unaware that they were participating in an experiment and believed that the officials were helping cure them of what they had dubbed their disease: “bad blood”. This brings up one of the biggest ethical concerns of this study - informed consent. Informed consent is a measure used for when human beings are studied where the patients are told about all of the risks of the experiment they are participating in and understand all of the information about the research experiment, the participants must be able enough to make the decision to participate in the experiment. By refusing to provide appropriate diagnosis, denying effective treatment, manipulating and deceiving the patients, the PHS officials did not truly obtain the patients’ consent and breached the oaths they had made to save lives. Through their failure to provide informed consent, the officials refused to acknowledge the 600 black men and their families as human beings with autonomy and rights. This leads to the next problem with this study - blatant racism. The PHS solely used black people in this study - but why? There was no evidence suggesting that black men were affected differently by syphilis, yet the study focused on the effect of untreated syphilis in black men. It is clear that the officials had racist intentions, especially since there was a preconceived notion that black people were ‘promiscuous’ and ‘irresponsible’ by nature; thus, suggesting syphilis would be more common in their communities, which is a driving factor as to why the experiment took place. Despite the 14th Amendment in the Constitution being passed in 1868, which gave black people equal protection under the law, the PHS - a government-run service - still refused to care for the possible legal repercussions of their actions, once again showing how they failed to acknowledge and respect the black men as human beings. Their lack of respect for their patients violated the 4th medical ethics pillar - Justice, which states that all PAGE 4
JUNE / / 2021 / / ISSUE 6
PRESCRIPTION
by African American communities nationwide, which ties with the name of scientific research, which breaches the medical ethics pillars of ethical issue of paternalism. beneficence - the duty to ‘do good’ - and non-maleficence - the duty to ‘not do bad’. This decision made by the PHS stripped the black The definition of paternalism is ‘action that limits a person's or group's community of their autonomy and rights and treated them as guinea pigs liberty or autonomy and is intended to promote their own good’ for their own goal of acquisition of scientific data. (Dworkin, 2010). This can be seen in our daily lives, for example, when the law states we must wear seatbelts in vehicles or prohibits certain So, what were the consequences of this study? After a whistle-blower in drugs. However, the problem with paternalism arises when the action 1972 informed journalist Jean Heller, the horrors of the Tuskegee interferes with someone’s autonomy - which is what occurs in this study. Syphilis Study were spread nationwide and brought about the end of the The very nature of paternalism implies that one person is superior to study. By 1974, a $10 million out of court settlement was reached, and another in knowledge, hence laws being put in place in our society by the families were provided with a lifetime of medical benefits and burial people who have been voted in by the public. But in this study, rather services. But the scars of the Tuskegee Syphilis Study ran far deeper to than taking the time to explain the experiment, the PHS simply decided be healed with money. Instead, the story of the study lead to a legacy of that the black men were unable to decide on what should happen to them distrust in doctors and the health service. This was seen during the and decided as educated white men and women, they had the right to HIV/AIDS pandemic when the government enforced the USPHS decide what was best for these 600 black men and their families. By programme to control the spread of the virus, which was faced with specifically targeting uneducated families in rural Alabama, the PHS resentment and distrust from many in the African American community. revealed their own predatory nature and their deliberate abuse of power A survey conducted in 1990 showed that 10% of African between researcher and patient. The paternalistic nature of the study Americans believed that the US government created AIDs to exterminate reiterates how the patients were not treated like human beings and black people, whilst a further 20% said they could not rule out this contributes to the moral issue of scientism which was prevalent possibility (Rivers, 2005). Whist this opinion may seem extreme or silly, throughout the study. it reveals the detrimental impacts of the Tuskegee Study and America’s’ failure as a nation to truly compensate, emotionally and mentally, for Scientism is the scientific practice to carry out research without regarding their government’s disgusting actions. the ethical problems of said research. The Tuskegee study experimented on human beings and decided that the only endpoint to their During 1979, a report called the Bellmont Report was published and experimentation was death, this meant that they ignored the immense outlined the ethics of human biomedical research to prevent such studies suffering the men and their families had to experience as their untreated from taking place in the future. From the Tuskegee Syphilis Study, we syphilis moved to the tertiary stage and eventually killed them. J.H Jones can see the impacts of improper medical practice and research. In the (1993) quoted a doctor of the experiment, “as I see it, we have no further future, there should be a heavy emphasis on the consequences of disregarding the rights and autonomy of patients during research and a interest in these patients until they die.” The review on the exploitation of minority populations in studies to protect patient’s lives and their families’ lives were seen as expendable in the both current and future generations.
PAGE 5