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Data Handling but not Ethics or Communication

I'm writing this to avoid revising for the Data Handling exam I have tomorrow morning. It's a 3 hour paper with 10 questions and I have to answer two. The idea of it is to test my ability to interpret data. Unlike my previous exams, this one doesn't require me to pile on information or understand the shape of various bodily or viral systems so I've got a little spare brain power left over to reflect on my course structure.

It strikes me as slightly odd that I don't have an exam in Medical Ethics or Science Communication. I've had lots of practice communicating science information to other scientists but never anything to a lay audience. Nor have I had more than one tutorial activity in my entire three years here at University centred around the ethics of what we're doing here. The one I did was terrifying: the number of anti-GM Biochemists coming out of this institution is insane. We had some really powerful lectures from a clinician in my second year that were spent stressing the underlying ethics of the content but he didn't have to do that, he just figured the same thing I do: scientists and not just doctors need to consider the ethical implications of their professions. Data interpretation is just as important as ethics and communication to a lay audience in this day of bleeding edge medical research (sometimes literally), Open Access journals and really, really bad science journalism.

I'd like to point out that not all science degrees that miss these two vital components of science. My fiancee had a whole unit in her second year Evolutionary Biology MSci on the combined impact and ethics of science that she was examined in. To my knowledge none of the medical science degrees awarded here at Bristol (Medicine and Veterinary Medicine excluded) contain an examinable module like that. It's fine for us to consider these things independently but it needs to be taught in a rigorous way by those with the professionals who do this stuff for a living and examined to give it the level of gravitas it deserves. I took A-levels in Philosophy with a module in ethics so I'd argue I'm slightly better equipped than most of my fellow students who, in my experience, have mostly languages atop their science subjects (that's assuming they have any non-science non-maths A-levels). Even then I don't expect I have the complete understanding I should have in this particular field - particularly in relation to science. I don't like the idea of another exam in my third year but I feel it's essential I can communicate what I know to others and show that I have actually considered the implications of some of the research I've assisted with. Give me a second year ethics/science communication exam dammit!

Science risks creating a gulf between itself and even the educated non-scientific population of this country. Non-scientists are often amazed at what I would consider bread and butter stuff and tend to be very interested and eager to learn which is fantastic but it relies on those of us with the technical knowledge to communicate that. It's our responsibility as undergraduates to demand access to the tools that will allow us to win the battle against the rising tide of anti-scientific thinking that has surrounded things like GM and stem cell research. Lives and livelihoods depend on it.

#science #gripes #medical ethics #science communication

Rabies: Doctors are a product of their culture

My thoughts are with the family of a woman who was bitten by a dog in South East Asia and died yesterday. While tragic, it highlights something that I've noticed these last few years. We've had intercalating medical students with us for our final teaching year here Bristol University and I take my hat off to them for taking the time to study something so important. While these students chose to study Virology, their underestimation of the global impact of viral disease shocks me. The disquiet among them at the news that HIV has killed >25 million people, HCV infects 3% of the world's population and that >60% live in areas at moderate risk of Hepatitis B exposure was a little unnerving. They sat in a block at the front of the lecture theatre and it was telling from body language and discussion afterwards that this sort of information was new to them. That worried me a little bit but got me thinking.

To their credit, they picked up fast and those that studied with us now know the full impact of viral disease and have a healthy respect for infection control. When talking to them, understanding of the need for vaccines was apparent but the need for sanitation, education, social empowerment (especially in the case of women) and basic freedoms as necessary components of healthcare were not so sharp.Their awareness of trauma, cardiovascular disease and cancer were, however, incredibly sharp. It's a fine illustration that priority is given to diseases at the door, not those that lurk somewhere far in the shadows. Doctors are the products of their environs and their culture.

It's a problem I've come across a lot with medics and even medical researchers - that drugs, surgery and other interventions are nothing compared to preventative public health is not a very fashionable view point as far as I can tell. In fact, it formed the core of a flashpoint between myself and an academic after a tutorial essay - the only time I've ever taken a lecturer to task for disagreeing with me. If you ever get the time, go read Laurie Garrett's 'The Coming Plague' It's a little outdated but it'll tell you everything you need to know about infectious disease in relation to western culture. Failing that, know this guy's name and what he stood for. Garrett's book is a bit of tome but it highlights how our progress since the 1940s in combating infectious disease has insulted our culture against the full horror of infectious diseases.

This all brings me to the original point: the Evening Standard article I linked to originally is wrong in tone. It shouldn't condemn the doctors who failed to spot the disease before it was too late. Rabies doesn't exist in the UK, all our cases are imported and I couldn't tell you the symptoms of early onset Rabies before I looked it up yesterday - we don't study it as a disease in my course and those symptoms are incredibly non-specific. Scrubs did this really well, in the Season 5 Episode 'My Lunch', where an organ donor with Rabies goes under the radar and results in the death of three patients. It shows that even with the best intentions things go wrong. Our wealth of medical knowledge is so broad that rare events like this are diagnosed with something else because doctors are only human and can't be expected to remember everything.

I'm not blaming either side because it's not productive but I feel something can be learned from this. I grew up hearing phrases like 'doctor's orders' and 'the doctor's always right' but I feel that's wrong when it comes down to it, the patient needs to feel empowered when it comes to a consultation: empowered to tell the doctor what's wrong and that can only come from a human to human relationship. Granted, professional distance is key in medicine but there are multiple ways to skin a cat. I've seen brilliant some doctors at work treating their patients as human beings, suffering and in pain but that's only half the story. I think patients should feel comfortable talking to their doctor as an equal, not as a paternal or authority figure. I don't feel that degrades the patient-doctor relationship but strengthens it because we can stop feeling like children around them and take possession of our adult faculties. Yes, you might be admonished for drinking/eating a little too much by your GP but take it as an adult and act as a human being. Acknowledge the advice, heed it if you want but don't resent the person giving it because I worry that sort of thing informs our subconscious when dealing with doctors in the future. A lack of those reasoned faculties could well contribute to withholding information at consultation and in turn cause problems. By being empowered to talk to your doctor in this way, I'd hope it makes things easier and things get missed less often.

So if you've been bitten by a dog, having been abroad, say so and make sure the doctor listens - just get test, chances are it'll be nothing.

NOTE: This piece is product of my reflections on medical ethics and practice as a final year Undergraduate medical science student. I am not a doctor, yet, I am simply examining my own thoughts and motivations in the hope of clarifying why I want to commit to another 4 years of training and a vocation for life. I could well be wrong, I am probably being very patronising and naive but only the next few years will tell that because I've got a lot of learning to do. I will keep you posted, that's the whole idea of this blog.

#medical school #rabies

md-admissions

Whether you love the show or not, House has made an impression, especially in the medical world.

So here is my humble submission of thanks to the show that has been with me during long nights of studying, fun weekends, and in the classroom.

Top 10 things House MD taught me

It’s never...

A close shave...

I had an exam today - the last of my content heavy ones. I've now completed both the Virology and Immunology components of my degree with only the data handling exam on Friday. I nearly missed the exam; through circumstances beyond my control I came very close to being late.

The exam went fine, I know my stuff and I'm confident I've got the mark I need but it made me think. In those panicky moments as 9:30am drew closer, I realised how fragile dreams can be. Had I been more than 15 minutes late, I would have received 0 for the Unit, it would have dragged my classification to a 3rd and I'd have been screwed. By screwed I mean: no medical school, no research prospects and no idea what the hell I'd do. That's the problem with third year, you're on eggshells and a single slip can be disastrous. There's so little room for manoeuvre now - if I was ill or there had been an accident but because the bus was late I wouldn't have had a leg to stand on.

It strikes me that while I've built a world for myself since I left home at 17, I've given up so much to even get this far. I spent my college and early university career tackling the mental illness head on rather than socialising, volunteering or anything you'd expect from the typical student. I chose to work hard in both my degree and in the work place to support myself when I needed to keep a roof over my head. I chose to cut off my family and come to terms with that rather than deal with that entire shit-storm. Most importantly, I chose to commit for life to someone who's been a rock and anchor these last few years. The sacrifice of a wide circle of friends and family is the price I've paid for my career and my sanity. In to the bargain I have a few, closer friends than most could ask for and someone to stand with me as we head through the shit-storm that is going to be the next few years. I call that a fair deal but it does make me what would have things been like had I taken a different path?

This sort of reflection is important but it's important not to lose sight of that fact that I've owe some people a lot. You all know who you are, thank you all and I hope someday to repay the favour.

#medical school #reflection #close shave

Hats off to the Rothamsted Research team

I've been following the GM Wheat saga from a distance and I have to say: after yesterday's events I'm impressed. The heavy policing operation aside, the efforts of the researchers to engage in debate were exemplary. The word from Twitter and friends who attended as geeks in the park was summed up by the tweet "You [pro-researchers] can't have the right to reply because we've heard it all before!" These people clearly won't engage in debate and aren't making things easy for themselves.

Well done guys for taking a risk with a new PR strategy and for being brave enough to go on film and make your points. I remember one of my lecturer's here at Uni criticising the committee of the Neuroscience student society for putting a picture of themselves up in the lobby of the Medical School here because of fears they'd be targeted by animal rights nutters. I remember at the time agreeing with him but this issue has made me realise that sometimes you do just have to put your head above the parapet and defend your work.

Finally, I'd like to make two more points to the anti-GM protestors that I haven't heard made by either side in this debate - or more likely I don't remember coming across them, my memory's a little fuzzy right now due to finals. 1: Around 25% of any given crop is lost to pests (source: my fiancee's crop genetic engineering Biology BSc lectures) so any improvement on that without the use of chemical pesticides (which an EU directive last year seeks to phase out and ban) is a step forward.

2: Most of these technologies will be for export. The UK, largely, is self sufficient and won't need to use GMOs to feed itself. It's the parts of the globe that are less fortunate in their climate and infrastructure that will benefit from these technologies.

This is publicly funded research and, while the patent may be sold to biotech firm that's how the system works (examples include high throughput cytometric imaging technology, asthma drugs and vaccine technology - examples from my own experience). If you don't like it, engage with the democratic process and have Parliament direct the BBSRC away from this sort of research funding and aim to win the debate properly. Write to your MP, learn the science and aim to educate people rather than destroying research and looking like Luddites.

#Sense about science #Rothamsted #GM #science

The finish line is in sight! (Well, sorta...)

It's been a horrible week. Well, I say horrible but that's mostly my sleep cycle talking. I've never been as burnout as I was after Tuesday evening - I only felt up to work this morning but I think this damnable weather isn't helping. For some reason, it was a good idea to host Richard Dawkins & Susan Blackmore in the middle of my finals when the rest of the AASS committee were freaking out and leaving most of the work to me (I got elected President last year, I suppose it's my own fault :D). It proved one thing though: if I can handle that level of stress without freaking out completely, I can probably handle medicine. That's not to say it's going to be a challenge, just that it's going to be possible. Just wanted to point out that I'm still here and just about in one piece.

I have 2 exams left now and the finish line is in sight. It's an odd feeling, when I first started out with exams my head was full of "have to do well, need to get to med school" motivations. Now it's simply, "learn this stuff, get through the exams". I have no idea what's caused the shift but I'm glad I've managed to put the distractions on the back burner. This is the most important time of my life so far: this next week is crucial for everything Ive worked for since GCSE. I know I've got a pass grade degree but it's the 2:1 I need.

It's not the end of the world if I fail to get a 2:1 but only 2 medical schools in the country will even interview, let alone accept, people with less than a 2:1. It's a tall order to push myself across that line. The reason I'm writing this post is not to belly-ache over how hard that push is going to be but to point out that if I fail to manage it, my short term plans do not change because I've worked out that I'm facing a series of challenges not just one huge one. Even if I don't get the 2:1 I need, I'll still train in Healthcare Assistance, Blood Science or Phlebotomy because health care is what I want to do. It's all part of having contingency plans and preparing if things not working out the way I planned. Next year is still going to be tough, whatever my degree grade, because getting further training and a job is going to be hard enough without the ongoing changes to the NHS. Without that health care experience, interviewers will say no.

All this isn't something the medical school preparation process usually tells you. They make it sound very easy to get into the soft skill side of things (they stress academic success mostly) but I lack the connections that come with having professionals in the family so I've learned all the little things I've learned from first principles and friends around me. All this resiliece stuff, all the motivations, all come from me.

So, I'm nearly done with my first degree, I'm loving it but that's not going to be enough to get me through. I've got a checklist of challenges coming down the track for me and I'll be ready for all of them as they come but right now I need to concentrate on this horrible Virology exam. I think realising this might be one of the reasons why I'd be a good medic: I think that realising the fact you never stop having those challenges and that it's a duty to rise to them is a good thing. I could be wrong but we'll find out when I get to interview!

I'll know in a few weeks if I've beaten this first challenge but so many more lie ahead: I'm scared to death at every step they'll tell me I'm not good enough but if that time comes, I'll handle it the best I can.

As my fiancee says: "Don't borrow trouble" Back to work now, where did I leave those Dengue Fever notes?

To those that vandalised Rothamsted...

I'm writing this after hearing about the damage done at the Rothamsted research facility. First up, full disclosure: I'm a Virology and Immunology undergraduate at the University of Bristol so I don't have a PhD, I'm not an authority figure in my field nor do work for any crop or biotech company but I do understand why the research at Rothamsted is so very, very important.

Personally, I seek to be a doctor (more disclosure, just so you know I'm not looking for a job in any of the above mentioned companies). I want to make a difference to peoples lives but the work I'll do over the course of my career will pale in comparison to the work the crop scientists are doing the world over. I estimate that Edward Jenner's Smallpox vaccine has saved ~2 billion lives since it was introduced in the late 18th Century, Norman Borlaug by contrast has saved ~4 billion since he initiated the 'Green Revolution' in the 1970s. You've probably not heard of Borlaug so here's his Wikipedia page. Admittedly, that's just a ballpark comparison but my point stands: this research will save more lives than any medical research technology we have or could ever hope to develop. In terms of impact on people's lives, the medical research community stands like an infant next to the veritable impact behemoth of crop science.

I ask you, what gives you the right to actively destroy this research? Research that is publicly funded, no less! If you oppose it then engage with the democratic process: Parliament ultimately decides where research money should go so make your voice heard with your MP - direct action like this is counterproductive and very harmful. If the majority in a democracy disagree with you then accept that but don't ruin lives and livelihoods because of you're own selfishness.

I understand you have concerns but this is not the way to go about them. I, too, find the idea of Monsato's 'terminator genes' abhorrent and firmly believe that crop science should be open access and publicy funded for the benefit of all. Why? Put simply: everyone needs to eat and while the UK is broadly self-sufficient, (a few tweaks in agricultural policy and we could grow more than enough to feed ourselves) we are the second biggest publisher of scientific research in the world. We have pioneered dozens of fields across science and it is only right we should use that expertise to contribute something to the world.

So I say to you, talk to the scientists or face the hand of justice for your criminal actions. If you feel the need to continue these actions and not behave like rational human beings you will find yourself on the wrong side of history. By destroying this research, you are killing people, denying livelihoods and causing untold suffering. In the fullness of time, GM will save lives and there's little that can be done to stop this research without democratically engaging with the process.

---

I am happy to field any questions on this subject. I'm not an expert, just a guy with a science background wanting this stupidity to stop.

Go see senseaboutscience.org for some real experts -their Q&As are excellent and do excellent work in science communication.

#GM #Sense about sceience #Vandalism #Rothamsted

Over the last 6 months, I've been working for my finals. I've now finished all of my Immunology exams and have just my Virology and Data Handling exams left to do.

I made lots of A3 posters in an effort to revise because they offered me an innovative means of processing what I was learning. Between this, editing Wikipedia articles and teaching my flatmates it seems to have worked. I thought I'd share some bits and bobs because some of them are interesting. As you can see, I can't draw for toffee but at least it's easier to do that than read a paragraph of my handwriting. When I say I have terrible handwriting, I mean it (I'm technically dysgraphic but never got round to acting on the diagnosis when I got DSA) Diagramming in my exam allows me to level the playing field when my handwriting would otherwise leave an examiner going "dafuq?", giving up and giving me 2nd class mark.

Pathogenesis of Asthma: This is a diagram of what happens over the course of an asthma attack at a cellular level. This is roughly located in the airways in your lungs. That blue line at the top is the Forced Exhalation Volume (the amount you can breath out in one lung-full) Note the shifts. The long and short of it is that the body freaks the crap out upon exposure to something like car exhaust, pollen and others and there's lots of muscle constriction in the tiny airways in your lungs. This is all a result of the body's innate sentries misguidedly sending out alarm calls which go down the line. That second dip is the result of the delayed response to those alarm calls: the body's harder hitting CD4 T cells turn up and start calling in the back up. CD4 T cells are something of a command and control cell for the immune system and what they say often goes. The late response is the result of other effector cells turning up and secreting messengers that will affect the local nervous system leading to muscle contractions, shortness breath and all sorts. We know how asthma works but apart from a few good associations here and there, we have no idea what exactly causes it.

Helminth Immunity: This diagram is very similar to the one I actually drew in my exam the other day - that's how useful drawing these things was. It shows how, on average, your body responds in the early stages to worm infection. That could be anything from a tapeworm to hookworms to sleeping sickness worms and other tropical diseases - they all cause the body to respond in the same way. It's a broad overview of the events that happen but it's one of my favourites because my fiancee encourage me to lighten up and the worms were the result.

Helminths are very interesting in terms of evolution because our bodies struggle to clear them but while causing a lot of unpleasant symptoms, its unusual for them to kill you.

T Cell Maturation: Ask any of my 30 or so fellow Immunologists (including the intercalating medics) which of our lectures was the hardest, Dr Pullen's Thymocyte (T cell) maturation lectures usually comes up. Dr Pullen is a fantastic lecturer but her lectures are always challenging. I know them inside out because of this poster but it's still scarred into my brain as a harrowing experience learning all the ins and out. I think the worst bit was the research theory because I'm not interested in it and I tend only to learn that sort of stuff if I actually get to do it.

T cells mature in the thymus, an organ that's just above your heart. They grow there and learn to recognise friend from foe. Each cell only recognises one enemy flag but you generate billions of them during your life so chances are you've got one for every occassion. In the thymus, they become either CD4 (command and control) or CD8 (hunter killer) cells here but remain inactive until they see something they recognise. This diagram stops once the T cells have finished their education and leave the thymus, how they fight (and sometimes cause) disease encompasses the rest of the Immunology component of my degree.

Statins & Healthy People

So the BBC ran this article reporting on this meta-analysis. The long and short is that Statins are supposed to reduce cholesterol and prevent heart attack, stroke and a few other bits and pieces.

From what I can tell, the science is sound. They've meta-analysed a wide array of studies with decent participant retention rates across a long period of time and looked at cancer incidence and mortality. They excluded a few dodgy studies, assessed confounding factors and it generally looks OK. I didn't see an analysis of liver toxicity, however so other studies will be needed to be used in informing NICE's decision. If the science holds up, this debate is reduced to a moral and legislative one. These are just as important as the scientific debate that led to the establishment of the facts. To this end we need to have a debate titled "Science has found X to be true, what do we do with it, socially and legislatively?"

Before plunge into this debate, there are a few things to be noted.

1: Liptor is the best selling branded drug in history Liptor is a drug of the Statin class and has been patented by Pfizer for the last few years. It's made them over $125 billion and in November, the patent ran out. This means that from then, generic versions will be produced and the costs will plummet. That's a good thing because the cost will go from silly high to a couple of dollars a month. It's also good because it gives you a good idea of side effects across a sizable population. The study in the Lancet assessed just under 175,000 people which is a huge sample size.

2: The Lancet study only assessed Cancer incidence and mortality Liptor's other listed side effects include headache (10%) and a bunch of other adverse effects. The one I'm most interested in liver toxicity. Statins as a drug work to block cholesterol production in the liver. While I'm sure there are studies out there that show the risk is tiny, it's a useful highlight of how even a good quality study can't be taken alone. Oh and then there's the problem of muscle weakness, too.

3: Medicating your population Do you want to be popping pills for the rest of your life? I was on medication for a lot of years with depression and taking medication all the time is a real downer. Granted, you get into the routine of doing it but it's still the psychological side to taking a pill day in, day out. Of course, there's the problem of cost: will it be free of charge or will the standard prescription charge apply? If the latter, how much could a doctor prescribe in one sitting? These are all questions that need to be asked in the public setting now we know that statins reduce heart attack risk and show no increased risk of cancer morbidity or mortality.

---

This whole debate is an interesting place for the public to get involved and enter a debate. The science has spoken, now we need to decide what the hell to do with these 'facts'. We know that liver toxicity and muscle weakness are a problem (science will give us a quantity as soon as the research comes back or I get bored and dig into PubMed) but there's a reduced risk of heart disease and stroke. It's all about managed risk and whether you want to be medicating your population daily, me thinks. Science is a process, not an edifice (thanks Ben Goldacre!) and laypeople should be involved in deciding how the facts that come out of that are applied to their society.

Looking at the study here, I'd personally think about offering generic brand Statins to over 50s who were at 10-15% risk but not recommending or prescribing them wholesale without fully engaging the patient. I think it would benefit the doctor-patient relationship if information was made available to the patient and they were encouraged to ask questions about these drugs rather than authoritatively being told "take one of these, it'll reduce your heart attack risk". This could be the naive musings of an aspiring physician but I think encouraging a patient to engage with their treatment is probably a way to increase treatment compliance rates because they have a stake in their treatment. I should probably do some research and check if that's the case. Anyway, off to prepare for tomorrow's exam on Immunpathology...

I believe in Open Access not because of the reasons Prof Hide cites. There are a number of sterling reviews out there that are accessible to most people with a decent A-Level education, free time and access to Wikipedia for a bit of a top up. By having science behind a pay or institutional wall, it serves no one but the researchers. By having people able to access reviews given to first year undergrads, we can encourage people to start thinking in an evidence based manner if they are so interested.

And if that's not a reason then at least think what it'll do for pub quiz quality! :D

Summary of BBC Article: Lots of kids don't learn to swim, Kellogs and RoSPA teamed up to work out why kids aren't getting as much advertising exposure through the swimming badges as the cereal company would like. (I'm not bitter because I only got my 5m at school, honest).

I didn't learn to swim until I came to University and my fiancee insisted I learn. Everyone else I know had lessons outside of school because the school lessons were crap or their parents took an interest and could afford it. Personally, I had some lessons at school when I was at first school (age 5-9) but my parents could never afford to take me outside of school so once a week with an attitude of "he's no good, let's focus on the kids who can swim a mile and will get us some silverware in the school cabinet" didn't do me any good. The year I arrived at Middle School, they tarmac'd over their pool and Community College didn't bother providing anything either despite the pool being in walking distance of the school. By that age, I figure their expectation to teach anyone to swim under the NC and my own willingness to learn had evaporated.

Why we weren't taught after Year 4, I have no idea. It might have been because we were in a stupidly rural area at during our primary school years (our nearest 25m pool was 7 miles away and was demolished in 2009 because of severe leaks) but the attitude of the teaching staff didn't help. I clearly remember being dropped in the shallow end with a few floats and left while our teachers took the more able kids to the deep end of the pool and taught them stuff like treading water etc (my better half taught me that as the first thing I did when I got to Uni, not as some neat trick to impress Oftsed).

It's a shame that swimming provision isn't more widely available, it's fantastic exercise without the horrible sweatiness and exertion you get with other excercise. A pool offers a whole bunch for activities beyond just lanes. I appreciate that schools have a lot more to focus on in the National Curriculum but you could teach kids some responsibility and survival skills whilst at the same time offering a broader array of sports to engage kids that aren't bothered by the usual Football/Rugby/Netball/Cricket nonsense. There's a case just from the Health and Safety perspective, not to mention the fitness benefits! If we want to tackle the obesity crisis, we need to look at all the options for engaging people in fitness activities and in terms of perceived effort to benefit ratio, swimming is the best (well, at least in my humble opinion).

One final note: I must say that pool closures do seem to follow me, however, since I've been at Uni my SU have closed their pool for renovation. I'm starting to see a pattern here... :)

(Full disclosure: Before the closure of our Union pool, I managed a straight 1.5km in under 3 months of entering a pool for the first time so I'm no longer bitter, honest! I think I'm entitled to this, just 12 years too late! :D)

#Public Health #General Musings #Swimming

My changing relationship with Wikipedia

Well, it sort of used to be like that

Medical science moves fast and by fast I mean fast, we get a paradigm shift every 5-10 years or so. That means that while Wikipedia is fine for a second year undergraduate on my course but I fell off the edge of what it could teach me about 6 months a go. I decided that undergrads following me should at least have some use for that excellent resource into their third year.

Inspired by this article and the fact the Wikipedia Uveitis article (warning: that image can be pretty shocking so click the link with care) was horribly outdated, I set about editing it, particularly the pathophysiology since it's relevant for my exam. I've not made much progress but it'll grow over the next few days as I do my Immunopathology revision for Friday's exam. After that, I'll leave it on the back burner until after exams and fill in any gaps I can help with.

Don't hurt me Mr Wales, I have no money but I do have time and an institutional PubMed login

The other key reason for editing it is that I want to make sure that the first search result on my Google search (Wikipedia: Uveitis, followed by NHS Choices: Uveitis) provides as much up to date, factual information about a disease my department excels in studying and to make life as easy as possible for friends and family of a patient looking for information post-diagnosis.

#Wikipedia #Science #Uveitis

Exams, Mental Health, Resilience and Medical School

I'm currently wading through my finals - I've completed the first half of my Immunology and Virology modules with just the other half of the actual science and a bit of Data Handling to go now. I just want to take some time while my body recovers from the cortisol/adrenaline shitstorm I've put it through the last few days. It's a been a weird experience freaking out about exams the last few months because I've never had to worry about them before.

Before you go off the wall at me I'd like to point out that it wasn't because I didn't find my A-Levels hard or anything - I did. It's just that I did them whilst sofa-surfing and was what Shelter call 'hidden homeless' throw in the crippling clinical depression, volatile bipolar sibling and I had more important things to worry about that than exams. At the time, I got in what revision I could but the blunted affect/alexithymia (I couldn't find decent links for those, Wiki was terrible for it) and side-effects of the medication made it difficult to engage and give a shit about what I was doing. I cut my losses, dropped a philosophy module (still got a C overall, go me!) and got into Bristol by the skin of my teeth with ABB for entry to BSc Pathology and Microbiology - it was a conscious choice at the time because I knew I didn't have the mentality or maturity to become a doctor so young (I don't think anyone does, to be blunt). I spent the first two years of Uni recovering from all that crap.

Fast forward to today, I still have my dream of being a doctor and it, along with some great friends, has got me through some rough times. It's all good though, I'm off the meds and I understand depression and mental health better than I ever thought possible. Talking therapy once I got to Uni through the Student Counseling Service was fantastic and gave me the thing I needed the most: the words to talk about how I feel, what happens to me emotionally. I still use the tools and techniques handed to me there. With those, my friends, fiancee (go me!) and I can work around my moods and help me with it when things get stressful. It's all about building resilience and the experience of my illness helped a lot with that.

I'm sitting 5 very challenging exams while at the same time I'm preparing myself psychologically for the trials of getting into Med School. I've not slept properly the last two nights because of the anxiety about today's exam but I feel it's been a brilliant example of resilience despite being a bit crap. I know why I was awake at 4am and worked around it rather than getting angry at it. The reason I'm noticing this now is because for the first time in my academic career, I've not got anything holding me back: it's just me and my love for medicine and medical science. I'm working hard not because I have to pass an exam but because I love what I'm studying and my medical career is at stake. There's not a haze of medication or serotonin spikes clouding my view of the path ahead. I'm going to get this 2:1 by the skin of my teeth but I have a reason to do this.

The reason I'm putting this out there is because I want to prove to myself and the medical profession that a history of mental illness shouldn't be a barrier to the profession - in fact, it should be an asset. I don't imagine it's an issue but there's a need to stamp out the stigma by talking about these things. Indeed, I study some horrific immune and developmental diseases every day. I deal with ulcers, complications from diabetes, people gone blind months after freak accidents, weeping sores and more, yet mental health should be treated as an equal affliction. The only difference between the autoimmune diseases I study and mental health is that I can point to a protein and say it affects a disease course in X or Y fashion.

I'm going to use the blog as a way of tracking to my progress to, and hopefully, through Medical School. I'll throw in some Medical Science and stuff along the way because the only thing I like more than making people better is making people understand why they get better. Expect some stuff about my motivations for doing what I want to do in the next few weeks - that's my next thing to think about.

I'm going to crash out now, I'm exhausted and need to be ready to start my Immunopathology preparation for Friday.

#Mental Health #Resilience #Medical School

I know Kung Fu...

... well, my body does, sort of. I'm wading through my immunology stuff this morning and I'm wondering how much stuff that is accessible to the layperson is out there. This is basic science that informs our every drug discovery and understanding of every infection we get. All of us have suffered disease at some point in our lives and I think it could be interesting to know how all that works. I'll have a chat with a few people to see if it's worth doing and, of course, I'm always happy to take feedback.

I'll have a think about it while I'm poring over the horror that are the inflammasomes. In the mean time, here's some cool stuff about knowing Kung Fu:

Frank Water makes me smile when writing about Rotaviruses

I've slacked off on the whole blogging thing due to exams. I did however, want to share this: go find out about Frank Water because they made me smile during my exam.

I arrived at the Medical School for my Medical Virology exam yesterday morning and realised I didn't have a bottle of water. I got one in the cafe and didn't pay any attention to it in my dash for the exam hall (I found the right place after remembering the ability to read signs and count to 45 not just 29 - clearly virologists don't read instructions)

I got into the exam and it all went very well. I was idling on the question on Rotaviruses, trying to figure out if I had time to do a diagram or I'd chance my terrible handwriting, when I read the label on my water bottle. It was from Frank Water and the coincidence made me smile just when I needed it. Rotaviruses (from the latin for wheel, that's what they look like under an electron microscope) cause a vaccine preventible diahorreal disease that claims thousands of lives (particularly children) in areas with poor health care infrastructure. Frank Water are a social enterprise that aims to provide clean drinking water in areas that currently lack it, a key stepping stone in public health guardianship and general development. Apparently, 5-10p of the price I paid for the bottle of water that kept me from getting a thirst headache in my finals, went to fund clean water projects in India and Africa. I don't know what that gets the company but I'm sure it helps.

In the US there are on average 2.1 million Rotaviral infections annually and they account for 60% of all cases of severe gastroenteritis but in 2010 only 37 people died. Contrast that with the global incidence and mortality globally which stands at 100 million infections and between 350-600 thousand deaths (Source: WHO & Wikipedia). Provision of clean drinking water and effective sanitation is the first step on the road to providing decent health care.

Treatment for Rotaviral infection is simple: Oral Rehydration Therapy. The magic formula for kids is 6, half, 1: 6 teaspoons of sugar and half a teaspoon of salt in a litre of water. It's the principle for any diahorreal disease: replace the lost fluids and electrolytes and let the body do what it does best. The Rehydration Project has some fantastic information on oral rehydration recipes over on their website.

So yes, thank you Frank Water for making me smile in my exam - I'm off to revise for Immunology next week. I doubt there will be a similar post for that exam unless there's a social enterprise somewhere selling flapjacks for Crohn's Disease or Uveitis.

UPDATE: Even better, they're based in Bristol! That's awesome! :D

NOTE: I know I haven't spelt diahorrea right once in this article, I'm making a point of doing it because I want to see how many permutations of the word I can come up with. It's a silly word and needs a better spelling. Consequently, the spelling in this post might be a little off kilter because the red lines were annoying me and I turned off spellcheck in my browser.

I'm voting No on May 3rd

I'm in the middle of exam season right now so I don't have much time to put things down but one thing that has been making the rounds in my head is the Bristol Mayor election next week. I've done some research (by that I mean I've read both campaigns websites, read a few articles looking into places that already have elected mayors and talked to a nice chap in the street who tried to convince me that a yes vote was a good idea) and I'm voting no - here's why.

Too much power in one set of hands: Currently the leader of the council can be overruled by a simple majority while the Mayor would need a two thirds majority to be overruled and as far as I can tell, there's no other right of recall. If Central Government do offer a package of powers to the cities then I'd rather have them in the hands of the leader than the mayor.

Local Representation: Bristol is a very diverse city and I don't think it's possible to represent all that within a single executive figure head that is elected every four years. I'd prefer the current composition of the council which is drawn from the various wards and elected on a rolling basis (which, by the way, is an awesome way to run a city council - probably not the most cost effective but I'd imagine it keeps complacency out)

National Representation: The Mayor would supposedly sit on a Cabinet of Mayors which sounds nice but the leader of the council currently does that anyway

Electoral mandate: The mayor is directly elected as are the Councillors so I don't see how the electoral mandates of the Mayor and leader are different. By allowing the council to elect its own leader from their own ranks it saves a lot of time and effort on our part for not a lot of gain.

Cost: Now I'm not a big fan of the whole 'we're in austere times so we need to tighten our belts' bullshit because it's a political fallacy but cost does need to be considered. It's not a massive factor but if (as I currently see it) there's little difference between the powers of the leader and the Mayor, I don't see why we should be paying so much more for a Mayor. I've seen a few figures knocked around for the Mayoral salary and all of them are bigger than the current leader's salary and factor in the cost of the extra election mechanics, I'd rather use the money elsewhere until the difference between the two are more marked and the Mayor offers some real benefits.

The Tories want me to vote for a mayor - not a big reason but it does sit at the back of my mind like some big dark beast.

I think, in all, the Mayoral referenda are a bit of a diversion. It's central government's way of saying "you have a mayor now, it's their problem, not ours" and a means of imposing political control from a single party on a particular region - especially in areas with a history of no overall control, like Bristol. It's true that all politics is local and I don't think a Mayor would change anything about that.

I'm voting No on May 3rd - my reasons are above, I might be wrong but that's what my revision fried brain has come up with. I'm off to build a nice big table of all the viral pathologies I need to know for my exam next week.

What a difference 24 hours makes! That's the view from the living room this morning, blue sky and no snow. Stupid British weather. :/

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