My thoughts on the antibiotic crisis

For any budding student slightly interested in medicine, science and any interested in current affairs the antibiotic resistance crisis would no doubt have found its way into your thought process at some point. I know it is often on my mind.

The crisis of antibiotic resistance is one that is often documented in the media, and it is in my opinion one of the biggest challenges that modern medicine faces. In 2013 alone, there were about 480 000 new cases of multidrug-resistant tuberculosis according to WHO, this to me is slightly terrifying as without antibiotics we return to the pre antibiotic era, where whether you survived tuberculosis or not was down to sheer luck.

It’s a situation where I am not sure what the answer is, and I don’t expect to know the answer quite frankly, I’m not sure anyone really does. There is of course things we can do as a society to prevent the situation escalating more than it already has, by not overprescribing or overusing antibiotics, having a general understanding of antibiotics and antibiotic resistant. However, I personally fear that it is a situation where antibiotic resistance will occur regardless of our efforts to prevent it, in fact thanks to Darwin and the theory of evolution we know this to be true. The selection pressure that is antibiotics will naturally cause bacteria to evolve to become resistant to them.

So what is the solution?

To me, with what many may call naïve optimism, due to my age, I would say let’s find an alternative to antibiotics. If you ask me what that is, I will tell you this; at the moment I do not know. Yet, I do have ideas and one of them is thanks to my EPQ project, it is called phage therapy, and I will not delve into the technicalities of it at this moment, for I want to keep my posts as short and snappy as possible, but I will say if you are intrigued or rightfully concerned by this global crisis, I say do a bit of research. Phage therapy is highly under researched and doesn’t have the best reputation due to past research and trials, but it is if anything a fascinating idea, and even if it isn’t a possible solution to this crisis it’s worth a look up either way.

India vs UK healthcare

India has the ninth-largest economy in the world by nominal GDP and the third-largest by purchasing power parity (PPP) [1] and despite this much of India still remains as a third world country. Over October half term I had the experience of visiting Goa, India for two weeks, the trip was predominantly to visit family. However, whilst I was there I was able to witness the huge cultural  difference of India compared to the UK, not only in attitudes towards lifestyle and people, but also a particular difference in attitude and approach to healthcare.

Unlike the UK healthcare is not free at point of use in India (i.e. there is no NHS), and as a consequence of this the attitudes to healthcare are very different, below I will outline some key observations I witnessed whilst in India:

·       I noticed that many of the people who were begging and living on the streets often had a limb missing or some form of disability. I believe that this shows how many of the poorest in India  are unable to afford healthcare, and often they are those who are most in need.

·       One huge contrast to me, which actually shocked me significantly, was the ease of buying medicines from a pharmacist that would require a prescription from a healthcare professional in the UK. I also say pharmacist very loosely, since the pharmacies themselves were normally a shack on the side of the road, and upon entering you would tell the pharmacist your symptoms, and they would return with an antibiotic or other medicine, at an extremely cheap price. For example, whilst in India I contracted the ‘delhi belly’ and my mum was able to buy medication for me at 30 rupies, which is about 30p. Whether the ease of gaining prescription medication is a good thing or not is up for debate. It certainly helps fuel the misuse of antibiotics and hence the antibiotic crisis. However, having said that I know that the day I woke up feeling extremely ill, I was very thankful of the ease of access to medication.

·       The final contrast I noticed was the public health campaigns, in particular the appeal regarding smoking. I would spend much of my afternoon, when the heat was unbearable, watching a movie, and I noticed that if within that movie a character was smoking, then a banner would come across the screen declaring that smoking was dangerous. I cannot remember the exact wording, but the banner in short explained how it can lead to serious health complications and even death.

Overall it is quite easy to say that the healthcare in India is extremely different to the UK, and it made me appreciate how fortunate I am to have a solid healthcare system in the UK. The NHS allows society to gain healthcare whatever your income, and to me it the fact that it is free at point of use is extremely important and extremely beneficial. I also think that the fact in India one can obtain any medication over the counter at such ease is a problem, as it gives rise to misuse, and of course resistance, which is becoming a huge issue in global healthcare. The trip itself was enlightening, and showed me just how different the approach to healthcare is for different countries.

[1] http://www.rediff.com/business/slide-show/slide-show-1-special-25-interesting-facts-you-must-know-about-the-indian-economy-/20130808.htm

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Soon we'll cure diseases with a cell, not a pill - TED talk

"We've thought about illness and treatment in terms of a profoundly simple model. In fact, the model is so simple that you could summarize it in six words: have disease, take pill, kill something." - Siddhartha Mukherjee. 

TED talks are notoriously thought provoking, and I always find that after watching one my perception on the world is radically altered. However, this talk in particular by Siddhartha Mukerjee named 'Soon we'll cure diseases with a cell, not a pill' really infulenced and inspired me, to the point that I even caught myself thinking about it whilst I should have been integrating a trigonometric function in my maths lesson. With my understanding of the looming issue of antibiotic resistance growing, due to my EPQ on phage therapy, which is also providing an alternative to antibiotics, I have found myself intruiged at learning about alternatives to antiobiotics, and this TED talk covered the topic in a refreshing way. Instead of focusing on the problem of antibiotic resistance, Mukherjee focuses on the use of stem cells to create a new model of treatment and a new view on thinking about illness. Suggesting an alternative to the lock and key model, Mukherjee introudces the idea that we as a society need to revaluate our ideas on medicine; medicine no longer needs to be a pill. Today we can utilise our environment, holistic approaches, cells, and of course the classic 'pills' as forms of treatment. 
Mukherjee suggests the new model of cell, organ, environment to treat a disease and goes into great depth in his talk about how this model was devised. 

I truely believe that in order to avoid a huge health catastrophe we need to find an alternative to anitiobiotics. We should not eradicate them completely, as they are indeniable extremely useful drugs. However, due to antibiotic resistance, we must consider other treatment options and Mukherjee's use of stem cells and a new model for medicine just may be an answer. 
I highly recommend watching this TED talk, the link is below: 
Link to TED talk - soon we'll cure diseases with a cell, not a pill by Siddhartha Mukherjee

The new contract - BBC video must watch

For anyone interested in a carreer in medicine the government's new contract for junior doctors will obviously be news to you. On the BBC website there is a brilliant video following three junior doctors during their day and explaining their personal views on the government's possible action to cut pay, along with their views on the antisocial hours.



http://www.bbc.co.uk/news/uk-34425144?SThisFB

Medical Ethics A Very Short Introduction - Book Review

One of the things that has come to my attention recently is that my own knowledge of ethical concepts and particularly medical ethics was extremely limited. Therefore in the hope to educate myself on this topic I bought a book named: Medical Ethics A Very Short Introduction by Tony Hope. The book itself was ideal for introducing anyone to the basics of medical ethics, explaining extremely well the different terminology within this subject and also introducing different ideas and points of view, there was also a chapter on how to construct an ethical argument, which was particularly useful.

Within the book itself there were different chapters that each focused specifically on one ethical dilemma, these included:

• euthanasia
• the value of life - funding within medicine and how to allocate funding 
• pre-birth ethics - including the idea of should anyone be allowed IVF 
• genetics - how modern genetics is testing confidentiality 
• medical research 
• mental illness and the inconsistencies with the mentally ill
• everyday ethical dilemmas

A Brief synopsis of ethical terms:

From this book I learnt particularly about different ethical terms and views, below I will attempt to define what these mean, from what I have learnt from this book, and what I have learnt from further research on basic ethical terms. 

• Absolutism - those who believe in this will have the view that there is only one correct approach to the moral life, regardless of persons and cultures
• Altruism - regard for others, the opposite of egoism 
• Autonomy - the capacity to think, decide, and act on the basis of such though and decision, freely and independently. The idea that one should respect the individuals self-determination
• Beneficence - the moral importance of doing good to others, one should help others and increase the good of others when one is knowingly in the position to do so
• Confidentiality - one should keep one's promises about information, a subset of fidelity
• Deontological (non-consequentialist) theories - the idea that the values of actions lie in the motives not the consequences
• Duty - an action due by moral or legal obligation 
• Fidelity - principle that one should keep one's promises
• Justice - the idea of fairness, one gives what is owed and therefore deserved
• Morality - the science of human duty
• Non-maleficience - the principle that one should avoid harming others
• Paternalism - the idea that a person's liberty can justifiably be restricted in order to prevent self-had or to promote the person's well-being
• Utilitarianism - the view that an act is right if it leads to the maximisation of good consequences for the most people
• Veracity - the principle that one should tell the truth 

The book itself was extremely short, being less than 150 pages, but as a consequence it was extremely concise and effective in informing me on the basics of medical ethics. It opened my eyes to ethical situations that I had not considered, such as whether we have the right to detain a mentally ill patient against their will. It also provided me with a new perspective on many views, such as the value of human life, if everyone should be allowed IVF and the restrictions we put on medical research.

However, out of everything this book was extremely useful in presenting everyday situations the doctors encounter related to ethics, which is helpful in informing me of future complications I could potentially face when I am a doctor myself. 

The end of summer update

Sadly the summer holidays are coming to a close, and I apologise for my lack of posts on this blog. I did have the full intention of posting at the very least weekly, my aim was evidently more. However, through going abroad with my family, and the stress of receiving AS level results, along with university trips and the UKCAT, I am sorry to say I did forget about this blog for a while. I also spent much of my summer holiday recharging, because the next few months I know will be extremely hectic and extremely important. 

I start sixth form again on Monday and that will mark the start of a transition back into normality, but also should result in structure and free time, as I will only be studying maths, biology and chemistry as opposed to maths, further maths, french, biology and chemistry, which is what I did last year. This newfound free time will allow me to focus on reading around the subject of medicine, broadening my knowledge on topical issues and proceed with an EPQ on phage therapy. No doubt this will result in a multitude of future posts that you can look forward too. 

The Selfish Gene - book review

The Selfish Gene is hailed as a scientific masterpiece and whilst it is not directly linked to medicine it is of huge importance and for me significance for anyone who wants to venture into medicine. Medicine is the joining of the study of science with the social impact of working with patients, so therefore to not read this book purely for the fact it is not specifically medical would be wrong. The book deals with evolution, the way in which genes utilise us the survival machines to survive and live an immortal life as possible. Dawkins creates a book that explains seemingly complex scientific concepts without the use of any real scientific language and no mathematics; he explains ideas of genetics without the language of a geneticist, hence making the whole book extremely accessible and enjoyable to read for anyone. Therefore I agree with W.D Hamilton who states that ‘this book should be read, can be read, by almost anyone’.

For me the book has given me a new outlook on life. Not the pessimistic outlook and existential crisis that it has given so many, but in fact an eye opening outlook. To view evolution as a product of genes wanting to survive and not organisms is refreshing and an idea that is completely new to me, as throughout school whilst learning about evolution in biology lessons I have always been told that natural selection favours characteristics that allow survival of the organism, the idea that it is in fact the genes that are attempting to survive and are controlling us to an extent is never mentioned.  I found the first few chapters to be the most interesting, in particular the second chapter ‘the replicators’ as I have always been haunted with the question of how did chemicals evolve to become complex organisms that roam Earth today. I was fascinated to learn of replicator chemicals that lived in the primeval soup and how over time they created survival machines in order to populate the soup further, and these survival machines eventually evolved to become the modern day organisms. If anything the whole book has answered many of my questions regarding evolution and the mechanisms behind it. However, similarly the book has answered questions that I did not realise I had such as how can predators and prey co-exist? How altruism evolved? Why we have so many or so few children? The list is endless, and all the while the book introduces new ideas to me from explanation of memes (‘the seemingly self-replicating pool of art and science, literature and music, knowledge, folklore and platitude that survives with each human life’) to why we protect our family members more often than strangers.

Volunteer Diaries 6 and 7 - the last skate

Apologies for not writing my volunteer diaries for the past two weeks, between work experience, university open days and school I have had very little time to sit down and write. However, that will change in the upcoming summer.

Friday was my last ice skating session until after the summer, but I will be helping out with some of the summer volunteer projects.

The week before was quite a challenging week though. I was to look after a girl aged 11 and to say she was in a bad mood would be an understatement. It was challenging to convince her to skate and interact with the other children, but after a long talk she finally joined in. This week was extremely useful for me as it is in the taxing moments that you learn something new, if the voluntary work was easy every week I wouldn't gain anything from it. I can certainly say my communication skills have been improved as a result from that week.

I am sad that I will not have anymore sessions until September as I have made some great friendships with the children, and I love going each week. However, as previously mentioned I will be completing voluntary work in the summer so expect some more in depth posts about that.

Volunteer Diary 4 and 5 - a recap

To say that I have been busy is an understatement. I had the assumption that after my exams had finished I would be graced with time to focus on this blog, to work on my university application and to get ahead in A2 work, along with socialising with my friends and also complete some more work experience. Well it turns out that in doing all of this I have lost track of time and I have only just realised how much I have neglected this blog, and for that I apologise.

So since my last post I have continued with my MOOC on the clinical psychology of children and young adults, and I have learnt so much about the formation of mental illnesses and how complex they are. I also feel as if through this MOOC I have significantly improved my own independent learning skills.

However, my voluntary work is what is continuing to inspire me. Each week I am continuing to strengthen the bonds and friendships I am making with the children, whilst learning more and more about their personal disabilities and challenges, along with getting to know their parents. On Friday we had a special skills ice skating lesson, and as well as improving my own skating ability, I learnt that I have hugely impacted on particular boys life. The boy is one who I looked after on my first week of volunteering and he suffers from dyspraxia. Despite not being paired with him that week, he still insisted on being paired with me, and even left the volunteer who was initially paired with him to skate with me, continuously hugging me and telling me that I am his favourite. Whilst this may just be a phase, I can help but feel almost a sense of accomplishment, if not at least a huge humbling feeling that I have influenced this boy's life so much, that he wants to work with me every week (last week when I was paired with him he danced around the seating area in the ice rink with excitement and shouting "YES I GET TO WORK WITH ELLIE") To see a child respond in that way is extremely inspiring, to know that you alone can improve their mood that significantly proves to me alone why I do this voluntary work. Of course it is not just this boy who inspires me, they all do. Even when we were completing the skills lesson, all of the children joined in, despite many uncomfortable glances at first, they all want to try new things, and they are all willing to do new things.

I feel that through my voluntary work I can see myself growing as a person. Not only do the children that I work with inspire me each week, but so do the incredible other volunteers who I have been able to meet along the way. Before I started this voluntary work I had a tendency to be quite shy around new people. Whether shy is the right adjective is debatable, but I was not one to go up to new people at random and create a conversation or friendship, I liked to take a slower approach, but now I have certainly become more outgoing, indefinitely more caring and my communication skills have improved immensely. I have gained a lot from my voluntary work, but maybe more so than anything I am gaining incredible memories,  each week I have the chance to help these children, to improve what may have been an awful week for them, and have a great time at the same time. What more could you want?

Starting a MOOC - (the MOOC was finished, despite my lack in tracking my progress on this blog)

Today I enrolled in a MOOC with Edinburgh University. The MOOC (also known as Massive Open Online Course) is called: the clinical psychology of children and young people.
My reasoning for starting the MOOC is that I have been so inspired by my voluntary work with children that I wanted a way to expand on these experiences, and learn more about clinical psychology along the way.

The course will end on the 5th July and involves completing weekly quizzes online, that are related to the videos and extra reading done on each particular topic for that week.

The course certainly looks fascinating, and I am intrigued and excited to learn more about clinical psychology, and in general expand on my own knowledge and independent learning skills.

Volunteer diary 2 - the air hockey champion

Yesterday evening I once again went ice skating for my volunteer work, and this week I was asked to look after a new boy who had just joined the programme. He was extremely nervous to begin with as he said that he was not very good at ice skating, but after a few minutes of talking I convinced him to try to skate. It turned out that he was a natural, and it was clear that after about 15 minutes of skating he was having a great time. Throughout the session I continued to help him become more confident skating and introduced him to the other members and volunteers. After about an hour of skating though we decided to have a break and we headed to the arcade where a tournament of air hockey commenced,

TED Talks

The internet for me is one of the greatest sources for information and inspiration. Every day I am constantly fascinated and informed by new facts and ideas I find on the internet.

In my opinion the greatest website for daily inspiration and for ideas to change your outlook on the world is TED talks. https://www.ted.com/talks

I will not go into too much detail about the website as honestly it is already extremely well known, but for those who are unfamiliar with the site, it in short consists of different videos on fascinating topics ranging from that of quantum physics to political stories, with a personal favourite being I am the son of a terrorist by Zak Ebrahim. https://www.ted.com/talks/zak_ebrahim_i_am_the_son_of_a_terrorist_here_s_how_i_chose_peace

I will not go into a review of all of my favourite TED talks because unfortunately I haven't the time at the moment, I think it may be a possible summer holiday project?

However, before I leave to continue yet even more revision for AS levels, I will say if you are to watch any TED talks then it they should be the one linked above by Zak Ebrahim, but also the one I shall leave linked below called One more reason to get a good night's sleep by Jeff Iliff. This was the TED talks that originally sparked one of my interests in neurology, and inspired and has left me fascinated into the reason to why we actually sleep. 

https://www.ted.com/talks/jeff_iliff_one_more_reason_to_get_a_good_night_s_sleep

New Malaria Vaccine?

Today's post will be reasonably short, and I fear for the next few weeks at least, the majority of my posts will be short, due to the unavoidable fact that is I have my AS exams in less than 2 weeks, so my time is solely occupied by revising for them. I apologise in advance therefore if there are a lack of posts in the weeks to come.

However, whilst revising transmission of different diseases in AS Biology, I was fascinated by malaria, the severity of the disease and how prevalent it is in the world. One thing that struck me the most about this disease was that my textbook did not mention anything of a vaccination, so I took it upon myself to research whether or not there was one, and if not will there be one soon. As my gut instinct told me, the internet confirmed there is no vaccination as of yet for malaria, and the ways of prevention are by tablets and of course a mosquito net (along with others). Despite knowing these facts already (particularly as I myself have taken tablets to prevent malaria when I travelled to India), I was surprised and also inspired by reading on BBC news that a new malaria vaccine could be available in months!

The article stated that this vaccine was going through its final clinical trial, and despite not being hugely effective on the young, I believe this is a huge step in the possible eradication of such a devastating disease. If a vaccine were found for malaria, no doubt would this lead to a gateway for the possibility of new cures to be found, and undoubtedly it would be a huge triumph for mankind.

I will leave a link to the BBC article below as I highly recommend reading it.
http://www.bbc.co.uk/news/health-32446287

As a result of reading this article it reminded me one of the reasons why I want to go into medicine so badly, to help cure or relieve the symptoms of someone who is in pain, and using your own knowledge to help people for the better is undoubtably one of the greatest satisfactions and most rewarding jobs you can do.

One Flew Over the Cuckoo's Nest

When you think of movies that are related to medicine it cannot be denied that One Flew Over the Cuckoo's Nest is definitely one of the great classics, not only in medicine but of all time. It is, for me, a member of my top 10 movies.

The reason why I class this movie as a classic for movies related to medicine is because One Flew Over the Cuckoo's Nest deals with themes such as mental illness, living in a mental institution, and how to treat patients (or how not to treat patients in Nurse Ratched's case). The movie not only tackles these themes, but in my opinion it tackles them perfectly, and to me the movie depicts a very realistic idea of living with a mental illness in such institutions during the late 1950's and early 1960's.

The movie itself to me was eye opening to the transformation of views on mental illness, it shows the change in the connotations with mental illness through the past decades, and how far as a society we have progressed, in both our views on those who are mentally ill and how we treat them. Whilst yes it cannot be denied we still have a long way to go, I think it can be universally agreed that the fact frontal lobotomy has become a disparaged procedure shows we have come a long way and are heading in the right direction. However, to me particularly the movie also highlights the fine line between what we class as sane or insane, it made me question whether Nurse Ratched was insane or not, and if I am being honest, how someone sane could treat patients in the cruel, dictatorial way she did.

As good as it gets

I find it quite hard to write about scientific and medical advancements that are occurring in the news at the moment, purely for the fact that I feel such advancements are already highly documented on other websites, newspapers etc and so I feel that in order to maintain a degree of individuality and uniqueness to this blog, posting about such advancements can be hard and can become slightly boring.

Of course, I will continue to do so with particular advancements that have resonated with me hugely, but I have decided that to create a blog that is more relatable I will post about books, TV documentaries, and even movies that are related to medicine. I feel as an aspiring medical student these are the posts I would love to read, as to me they are not as common upon the internet. I always love reading reviews and discovering new ways to expand my knowledge related to medicine that is not typically 'within the classroom'. This idea has also come to me due to the fact that my post of my review and thoughts on The Man who Mistook his Wife for a Hat is to date my most popular post, and so it would seem this type of post is most interesting and helpful to others.

Recently I watched As Good as it Gets, and whilst it is predominately a 'romcom' what struck me in particular was the way that the main character had a severe case of OCD.

Meningitis B vaccine

Everyday I visit the BBC news website, focusing particularly on the health section in an attempt to keep myself informed of the medical advancements that are occurring in the world at present, since obviously medicine and disease are constantly evolving. Today I read an article that particularly captured my attention, it was about the a disagreement on the pricing of a vaccination against meningitis B - Bexsero. After reading this article I can't help but feel two things, one slightly concerned at how little I knew of meningitis despite being such a prominent issue, with approximately 1870 new cases each year in the UK alone, but also quite annoyed and angry that something as life changing as a vaccination for meningitis B, the most common cause of bacterial meningitis, is not being admitted to babies due to something, in my opinion, as silly as a price.

Addressing my feelings on the second issue first, as I would imagine this would be the most controversial and possibly ignorant comment on my behalf. Bexsero the vaccination developed is a vaccine that consists of an inactivated strain of meningitis B combined with proteins found on the surface of meningococcal bacteria, the new vaccine is said to protect against 88% of the strains circulating the UK at present. Bexsero is owned by GSK, which recently acquired it from Novartis due to a recent transaction, and they are currently offering the vaccination at £75 privately.

A brief introduction

Blogging has become a common and popular outlet for people to post opinions and new ideas, these blogs range from that of fashion to cutting edge scientific research to even personal blogs where people document their every day life. As a sixth former who follows many diverse blogs I wanted to join this way of expressing ideas and information and so I have created this blog, Med Steps, through which I hope to post about my attempts to reach my aspiration that is to study medicine at University and hopefully one day become a doctor who engages frequently in the cutting edge research that I read so much about on different blogs and on the internet.