Article Responses: August 2002

LETTERS
Biblical teaching may be more effective than free condoms
      Joanna Dowman (August 2002) [full text...]

Thomas Selmes
(July 31, 2002)
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Sarah D
(August 13, 2002)
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Thomas Round
(August 29, 2002)
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PERSONAL VIEW
Living in blisters and pain
      Samena Chaudhry (July 2002) [full text...]

Jennie Hon
(August 05, 2002)
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EDITORIALS
The 90/10 Divide
      Nathan Ford (August 2002) [full text...]

Davina Sharma
(August 21, 2002)
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Renee
(August 29, 2002)
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LIFE
The Burke and Hare Saga
      Jamie Wilson (August 2002) [full text...]

Norman MacDonald
(August 22, 2002)
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LIFE
What do Nurses Really think of Medical Students
      Sonali Dutta (August 2002) [full text...]

David Dean
(August 28, 2002)
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NEWS
Children in War Zones at High Risk of Suffering Emotional Disorders
      Kay Seong Ngoo (August 2002) [full text...]

Meera Tawfic
(August 29, 2002)
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NEWS
Academic teaching staff face redundancy at British Universities
       H. Barratt (August 2002) [full text...]

kanchan sharma
(August 29, 2002)
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NEWS
Acupuncture may help to treat addictions
       Richard Tingay. London (November 2000) [full text...]

Jane Parkes
(August 29, 2002)
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LETTERS
Becoming a Pre-Registration House Officer
       Manoj Ramachandran (July 2000) [full text...]

Martin Robinson
(August 29, 2002)
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NEWS
Virtual Medical School Will Soon be a Step
       Helen Barratt (September 2002) [full text...]

H Wale
(August 29, 2002)
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LETTERS
Biblical teaching may be more effective than free condoms
      Joanna Dowman (August 2002 (July 31, 2002) [full text...]
 

Thomas Selmes (July 31, 2002)
       Leicester Warwick Medical School tomselmes@orange.net

As someone who shares Joanna Dowman's faith and choice of profession, I was pleased to the see the recent publication of her letter on the subject of sex education in schools. Like her, I think that it is essential that medicine is practiced within a proper moral and ethical framework. Doctors of all faiths have a duty to ensure that this is so.

However, I must disagree with several of her points. It seems bizarre to suggest that the only Christian response to the dearth of sex education available to our young people is to preach total abstinence before marriage. I would be astonished if her approach of telling teenagers that extramarital sex is wrong (because the bible says so) would reduce the incidence of teenage pregnancies. If the government can show that its policy of providing good quality relationship teaching alongside the provision of free contraception is effective in this regard, then I believe that Christians must support it.

More worrying is Ms Dowman's assertion that thousands of years of biblical tradition can be condensed into a single ten word sentence - a one-size-fits-all moral code that is not open to debate. I have worshiped alongside far too many gay, divorced, and yes, single parent Christians, to share her view that the world is that simple.

LETTERS
Biblical teaching may be more effective than free condoms
      Joanna Dowman (August 2002) [full text...]
 

Sarah D (August 17 2002)
      2b Year 13. Midical Hopeful, Bedford sarahed9@hotmail.com

Biblical teaching may be more effective than handing out free condoms. Joanna Dowman letter: Most religions preach an abstinence from sex outside marriage on one level or another, and i have great respect for people who follow religious teachings. However, preaching a biblical commandment to a teenage population, the vast majority of whom aren't religious will not solve the problem. Telling these people they shouldn't do something that is pleasurable simply because a book written 2000 years ago says so will have little or no effect. In fact trying to enforce a religious beliefs on young people will simply turn them against it. Besides the article doesn't seem to mention the positive aspects of sexual relationships. Whether straight, gay, within marriage or not they have the power to bring comfort to 2 people and strengthen bonds between them. Dont take this article as telling you to 'go forth and multiply': I agree pregnancies and STD's area problem but the answer lies in better education for the community, more healthcare services, schemes that have been sucessfully piloted where older peers teach about sex, and that long overdue government awareness program. I realise these will be expensive, but they are surely a worthy investment? I think doubtlessly more effective than handing out bibles.

LETTERS
Biblical teaching may be more effective than free condoms
      Joanna Dowman (August 2002) [full text...]
 

Thomas Round (August 29 2002)
      Medical Student, Fifth Year, Imperial College, London thomas.round@ic.ac.uk

Joanna Dowman in her letter1 argues against the provision and availability of sex information and contraception for young people, with biblical teaching and values "far more effective" in her view. There are a number of flaws within her letter. Firstly the reference which Ms. Dowman basis her assertions actually blames the British culture of secrecy and embarrassment over sex with low birth rates in countries such as the Netherlands reflecting their more open attitude towards sex and contraception2 (Brennan K, 2002). Thus seemingly arguing for more open sex information and contraception provision, not less.

Secondly there is no evidence to support the assertion that sex education and contraception provision encourage and endorse sex at a school age. The latest statistics actually show the number of pregnancies among women under 18 fell from 39,200 in 1999 to 38,700 in 20003(Guardian, 2002).

Randomised Control Trials and Quasi-experimental methods within this field have not shown conclusively either way whether expanding sex education reduces teenage pregnancy45. However in the majority of cases the control used was convention sex education, thus not showing whether sex education as a whole is ineffective.

My own experiences have shown that biblical teaching and values are certainly not far more effective. I attended Christian schools from age 4-18, where only biblical teaching was offered. No education on how to use contraception was given, with a contraception is illegal2 (Brennan K, 2002) ethos. A number of my peers engaged in teenage sex, with little or no concept of what is safe.

This is not to say that I believe sex education should be value free, but should adequately educate young people about contraception and safe sex.

Denial of adequate sex education can put people at risk in a multitude of ways, from HIV to depravation and disadvantages associated with teenage pregnancy. Do we have the right to deny young people this education and knowledge?

References:

1. Dowman, J

2. Brennan, K. Britain is worst in Europe for teenage preganancy rates. StudentBMJ 2002;10:223 (july)

3. http://society.guardian.co.uk/publichealth/story/0,11098,660065,00.php

4. Kirby D. Emerging answers: research findings on programs to reduce teen pregnancy. Washington, DC: National Campaign to Prevent Teen Pregnancy; 2001.

5. DiCenso A, Guyatt G, Willan A, Griffith L. Interventions to reduce unintended pregnancies among adolescents: systematic review of randomised controlled trials. BMJ 2002;342:1429-1435.

PERSONAL VIEW
Living in blisters and pain
      Samena Chaudhry (July 2002) [full text...]
 

Jennie Hon (August 05, 2002)
      Adults E.B. Support Nurse (Southern) debra.uk@btinternet.com

I was heartened to read Samena Chaudhry’s insightful article about Epidermolysis Bullosa (July 2002 issue). This is such a rare genetic skin condition that many doctors will not see a case throughout their career and most G.P.s confronted by an E.B. patient are understandably at a loss as to what to do.

The Charity DEBRA was originally founded as a support group by a number of parents with an affected child. It now raises money for research into the disease which is at present focusing on gene therapy. In addition DEBRA employs 4 adult and 4 children’s nurses who provide holistic care to sufferers and their families throughout Britain. They also have a number of informative publications, including one specifically for health professionals, which are available free of charge.

To make a referral to the nursing service, or to obtain more information, contact DEBRA at 13, Wellington Business Park, Dukes Ride, Crowthorne, Berkshire, RG45 6LS. Tel:01344 771961, Fax 01344 762661, e.mail: debra.uk@btinternet.com

www.debra.org.uk

PERSONAL VIEW
The 90/10 Divide
      By Nathan Ford (August 2002) [full text...]
 

Davina Sharma(August 21, 2002)
      4th Year Medical Student University of glasgow misbeehayve@hotmail.com

In response to Nathan Fords article which highlights the plight of many in developing countries and critizes the skewed development of drugs by those who have the money and expertise (ie, Britain and the U.S.), I can only wholeheartedly agree. Although Britain has a strong history of research into tropical medicine, funding for research is very much stretched. This must, in part, be due to a lack of understanding and awareness of the situation, something which for doctors-to-be, I'm sorry to say, is not greatly ameliorated by their time in medical school.

I have found that throughout my studies, the kinds of issues raised have been very relevant....but only to the developed world. Heart disease was given 10 times more airtime than AIDS; diabetes issues overshadowed those surrounding malaria.

Don't get me wrong - I am not belittling the importance of these diseases which affect many, but come on - let's try to keep things in proportion can we? Perhaps emphasizing in our cirriculums the infectious diseases that kill 14 million people a year might really result in future doctors who could well turn out to be the spirited protagonists for change. e.mail: misbeehayve@hotmail.com

PERSONAL VIEW
The 90/10 Divide
      By Nathan Ford (August 2002) [full text...]
 

Renee(August 29, 2002)
      Queen Mary University of London london_luvly@yahoo.co.uk

I believe that we as medical students should be made aware to a greater extent of world health issues and the severe imbalance in the distribution of health resources within the world both human and pharmaceutical. The manufacture of drugs is a buisness is necessity arguably surpassing the supply of fuel and water; and as such the product is sold to the highest bidder. Many complain about the NHS; but the drugs purchased with a £6.10 prescription that we take for granted mean the difference between life and death for some and are financially beyond the reach of many. I believe it is our responsibility as human beings to be consious of this inequality and never forget or ignore how many are dying needlessly just for the sake of a couple pounds. Imagine that £2 or £3 can buy someones life.

The Burke and Hare Saga
      By Jamie Wilson (August 2002) [full text...]
 

Norman MacDonald(August 22, 2002)
      Playwritin 2, 3rd Year, University of Winnipeg nmacdon8@mts.net

1. The method used by Burke and Hare for murdering their 16 victims was by suffocation, not by drowning in a beer barrel.
2. Hare was the one who was freed by giving King's evidence against Burke, not the other way around as stated in the article.

What do Nurses Really think of Medical Students
      By Sonali Dutta (August 2002) [full text...]
 

David Dean(August 29, 2002)
      First Year Medical Student, St. George's Hospital Medical School ms015617@sghms.ac.uk

I enjoyed reading the comments of the soundings competition winners in August’s studentBMJ, especially the thoughts of nurses on medical students1. Having met many students at medical school who claim to be nurses, I hope it goes some way in assisting the former to differentiate themselves from the latter. I frequently follow this claim with questions such as "Where did you train?" or "When did you qualify?" and am usually informed that shifts as a healthcare assistant at weekends or over the summer are considered to be their qualification as a nurse.

Some medical students, such as Holly Thomas2, are at distinct times both medical student and healthcare assistant. While she points out that a healthcare assistant is not a nurse, she adds that her roles [as a healthcare assistant] vary little from those of trained members of staff. In so doing, she appears to show the same lack of respect for the training of nurses - she specifies later that her reference is to nursing staff - as do those medical students who claim to be nurses.

As medical students we do not claim to be doctors until we have completed our training. Why then should so many claim qualification in nursing? Such claims may be made legitimately only by medical students who are qualified nurses - those by others are directly counter to the concept of multidisciplinary team-working which Ms Thomas mentions3. I suggest that both the encouragement of staff and the care of patients are served better when those training for one aspect of healthcare do not regard themselves as qualified for another.

References:

1. Dutta S. What do nurses really think of medical students? studentBMJ 2002;10:293. (August.)

2. Thomas H. Budget does not consider whole NHS picture. studentBMJ 2002;10:206. (June.)

3. Thomas H. Importance of all healthcare professionals should be acknowledged. studentBMJ 2002;10:296. (August.)

Children in War Zones at High Risk of Suffering Emotional Disorders
      By Meera Tawfic (August 2002) [full text...]
 

Meera Tawfic(August 29, 2002)
      5th Medical Year, Cairo University tawficamr@yahoo.com

Of course children everywhere exposed to bombings, killings, gunshooting & terrorism suffer emotional disorders, not just because they can hear bombing & see other people killing themselves.. No, but because they can also see their whole family being radicated in a second by an airplane bomb ( it reminds me of how cockroaches die by spray ) or by being thrown out of their houses to sleep in the street .. They can see their families, friends, loved ones killed infront of their eyes & .. No one does anything about it!! (everybody saw Banna boy killed infront of his father's eyes, am sure the father faced PTSD & .. more)

So, of course they suffer emotional stress & not just after shock syndrome!! They suffer hatred for the ones who are killing them.. Then -later on when the stress increases they-suffer hatred for the ones who are doing nothing to help them. I would also want to ask about the psychological causes that would make children & elderlies of a population "kill themselves"?!! i believe then that they must be under great stress that makes life quite meaningless. Or they might just think that if they were going to be killed anyway so why not get killed while fighting for life? why not get killed in honor ? (Some sort of: am not a cockroach.. am not going to be killed that easily ).

Thus, I hope children everywhere are saved from such stresses affecting their emotional safety.

Academic teaching staff face redundancy at British Universities
      By H. Barratt (August 29 2002) [full text...]
 

kanchan sharma(August 29, 2002)
      guys kings and st thomas kanchan.sharma@kcl.ac.uk

Editor - As a member of a 370 strong year, I was surprised by the government’s plans to introduce interprofessional education as announced in the BMA news on 06/07/02. This would mean increasing class sizes, which are already stretched to breaking point, coupled with the government’s pledge to increase medical student numbers. If this situation was to materialise in the face of academic teaching staff redundancies as pointed out by Helen Barratt, then this would only lead to falling standards which interprofessional education is exactly aimed against. It is already difficult, almost impossible to know even most people in a year of 370 and it is ridiculous to expect increased integration between healthcare disciplines if class sizes increase. The government plans to increase integration of healthcare professionals in pre-clinical study to try and break down professional barriers that can cause ineffective teamwork and communication. However, this shared learning already occurs to some extent in healthcare disciplines other than medicine and has its merits where class sizes are small. The inclusion of medicine into such a scheme would create an even more impersonal teaching practice. The government also failed to realise that the small matter of three years of clinical training each future doctor receives, is the best place to forge interprofessional relationships. The government needs to pay more attention to what is practical and academically suitable than heed to the rise in public expectation of radical reform in the light of recent highly publicised scandals. If the medical profession is to push forward and raise stands of care and clinical excellence then surely the best way for this to occur is to invest in improving standards of teaching and tackle the imminent problem of inadequate numbers of academic staff.

References:

1. Barratt H. Academic teaching staff face redundancy at British universities.

2. Student BMJ 2002 10:220 Pritchard L. All together now.

3. BMA News 06/07/02 p12-14.

Acupuncture may help to treat addictions
      By Richard Tingay (November 2000) [full text...]
 

Jane Parkes(August 29, 2002)
      Substance Misuse Worker Hotpants62@hotmail.com

I am very intersted in the acupuncture article as i feel that having working in a community substance setting for 3 years this is the way foward. Unfortunaltey working for a health aunthority they need more evidance if knowing if it works of not. If you have any further information that would be of hope then it would be greatly received.

Becoming a Pre-Registration House Officer
      By Manoj Ramachandran (July 2000) [full text...]
 

Martin Robinson (August 29, 2002)
      Medical Registrar, Wellington, NZ mjohn_robinson@hotmail.com

In an attempt to paint a brighter picture for those entering your pre-registration jobs I offer the following:

Bear in mind that everyone (well, almost) has done it before - from those people who failed finals, to those graduating first - and the calibre of clinicians were not always in that order.

Even those with frank tremor can eventually cannulate.

My set of tips on making your life easier would be

1. Your senior is there to help (whether we like it or not) - ask them. We would prefer to know of your difficulties, rather than your mistakes.

2. Listen to the nurses.

3. Carry a useful book - not an Oxford textbook, but a simple practical guide to the job YOU (not your SHO or Reg)are doing, ie. 'On Call'

4. Have confidence in your abilities(but don't be cocky)

5. Above all, be professional.

Virtual Medical School Will Soon be a Step
      By Helen Barret (September 2002) [full text...]
 

H. Wale (August 29, 2002)
      Student / A-levels, 2002, Kings Norton Sixth Form hlwale@hotmail.com

Although the consortium may decide to spend £2.5 million on new technology to entice students to study medicine the actual problem lies with the shortage of places at universities and medical schools. Although the virtual reality medical school would allow many students to try their hand at medicine, the final (usually) clinical years of training are based at universities or medical schools. Therefore there is still a problem with a shortage of places as those students who took up the traditional 5 year course will have filled the available places.

Students following the virtual reality course also lose the integrated learning approach taken up by most universities in recent years. Most courses deliver early patient contact with the emphasis on learning how to deal with the public and not just to learn the concepts behind medicine. There is also the problem if assessment are to be taken via the internet as the virtual reality course suggests. What is to prevent students from reading their notes whilst conducting the exam?

I do not think that the consortium has thought through the disadvantages to this system. One of the biggest being the atmosphere of going to university at 18. If students were placed at home to study would they become isolated and lose social abilites which are essential for doctors in communicating with patients. IVIMEDS also depends upon students having access to the internet at home which can be expensive especialy when most prefer to live away from home. The consortium may have the idea of providing cheaper internet access to students on the course but again this would be costly. Why don't they consider opening more medical schools which would cope with the greater numbers of medical students? Although this would also cost money the benefits would outway the disadvantages and would appeal more to students.