Article Responses: 2002

Articles	Responses
REVIEWS Time flies Marianne Mason (November 2002) [full text...]	Basil Leodoro (November 24 , 2002) Read this response

NEWS Britain is the worst in europe for teenage pregnency rates Kay Brennan (July 2002) [full text...]	Kenneth Brown (November 24 , 2002) Read this response

NEWS Selling a kidney fails to rescue Indians from poverty Deborah Josefson (November 2002) [full text...]	Abhishek Puri (November 25 , 2002) Read this response

LIFE AIDS in Singapore Richard Bellamy (December 2002) [full text...]	Alex Keith (November 28 , 2002) Read this response

LETTERS Patient contact in preclinical years makes good doctors Abi Coleman (Decmber 2002) [full text...]	Reuben Arasaratnam (November 28, 2002) Read this response

EDITORIALS Careers in medicine do not attract bright school leavers Elaine Griffiths (December 2002) [full text...]	Ami Nwosu (December 01 , 2002) Read this response

REVIEWS Do deodorants cause breast cancer? Marianna Philippidou (February 2001) [full text...]	C. Reid (December 06 , 2002) Read this response

PAPERS Student commentary:fear of AIDS affected my elective Anna Faulkner (December 2002) [full text...]	Rani Robson (December 08 , 2002) Read this response

EDITORIALS Careers in medicine do not attract bright school leavers any more Elaine Grifiths (December 2002) [full text...]	James Halpern (December 10 , 2002) Read this response

CAREERS Plastic fantastic: Professor Gunther von Hagens Nigel Lane (August 2002) [full text...]	Ian Innes (December 13 , 2002) Read this response

NEWS End doctors' exemption from jury service, white paper recommends Samena Chaudhry (December 2002) [full text...]	Clare Hughes (December 13 , 2002) Read this response

NEWS Cognitive Thinking Brian McMullen (November 2002) [full text...]	Clare Hughes (December 17 , 2002) Read this response

REVIEWS
Time flies
Marianne Mason (November 2002) [full text...]

Basil Leodoro (November 24, 2002)
Final year medical student, Fiji School of Medicine, Fiji basileodoro@yahoo.com

It is a well known fact, to many who have dipped in the warm, crystal blue waters or felt the cool breeze under a swaying coconut palm,that the Pacific progresses at a different pace to the rest of the world. Okay, economics and political struggles aside, there is never a sense of urgency when it comes to achieving the final goal. I guess that's why the medical course here covers six years of education that at one point or the other begs the question, "why did I want to become a doctor in the first place?"

There is so much medicine that can be covered in six years and "in the beginning" it seems a daunting task to say the least. As a first year student I worshipped the final years, respected them for each deep wrinkle and frown they had on their face as,each morning, they sped by in white coats with steths flailing about. To be acknowledged with a "Good morning" by one if any final year student was talk at the dining hall that could last a week. They seemed ready to take on the world and save lives. We were stuck with anatomy and physiology in hot, sweaty classrooms. The world of saving lives seemed a distant speck in the universe that was medicine.

As for my group, there were sixty of us back then. Now we are down to 52. The phrase "pacrfic isalnd time" is but a dream. Today, we are the ones cooking on the hot stones. Times have changed and our days are defined by the number of patients we have to SOAP before ward rounds not which Super 12 rugby team was playing this Saturday. Though opinions were always welcome.

The reality that only twelve months separates me and my collegues from facing the real world is exhilirating. It is a roller coaster ride of emotion. How will I fair? Whose life will fall into my hands next year but more importantly, will I do the right thing? Six years can teach you a lot. Aside from migraines and meningitis, hypertension and leptosprirosis, one thing is for sure. Medicine in the Pacific is truly unique. It strings you out but at the end of the day nothing beats a quite moment under those shady palm trees. Time stands still as the beautiful sun melts into the ocean creating shades of colour only painters dream about. Oh and don't forget thecold stubbie of course.

NEWS
Britain is the worst in europe for teenage pregnency rates
Kay Brennan (November 2002) [full text...]

Kenneth Brown (November 24, 2002)
4th Year BSc Pharmacology, Dundee University K.P.Brown@dundee.ac.uk

I am currently looking into the availability of emergency contraception over the counter, and how this applies to teenagers.

There are two major arguements here - firstly that such measures will cause more unprotected sex, and secondly that having such drugs available over-the-counter will reduce pregnancy rates.

I personally disagree with both - the government should force better sex education in schools, allowing a balanced view of sex in developing adults. I do not recall at any point in my school sex education classes being taught about the risks of STD's. Is it not about time we got more graphic with this education. If you tell school kids that there is a chance they may get pregnant, it is unlikely to stop them. If you tell them that there is a chance they will get a sexually transmitted disease that will cause their genitals to become unbearably painful and may result in death, they are more likely to listen. It is such a controversial issue, but I am all in favor of giving contraception to teenagers above sixteen, promoting safe and responsable sex. Better that than them spreading diseases and ending up pregnant without much hope of securing further education. I am aware that this does not apply to all cases, but the majority of teenage mothers end up below the poverty line. ! This all stems from the lack of responsible sex education in our schools.

As for emergency contraception over the counter - £12-20 is a lot of money for teenagers - are they likely to be as irresponsable as to have to fork out this amount of money every weekend. I am from Dundee, and have surveyed school children in the area. Out of 100 questioned, 58% had done a one night stand by the time they were 18, and a staggering 34% had lost their virginity by the time they were 16. Even more amazing was that of that 58%, 49% had not used contraception.

When I asked them about the risk of pregnancy, the majority thought that 'they could't get pregnant on their first time'and 62% had never heard of any diseases apart from AIDS and HIV.

I think reducing these teenage pregnancy rates has to start in an educational environment, in school, and they have to be told about the real life dangers of having sex unprotected. Only then can we build on this and reduce the teenage pregnancy rate to a respectable level.

NEWS
Selling a kidney fails to rescue Indians from poverty
Deborah Josefson (November 2002) [full text...]

Abhishek Puri (November 25, 2002)
Intern, SBMP Medical college Bijapur drabhishek_puri@indiatimes.com

The research for the long term economic outcome was timely.Yet a lot of issues seem to have been left out.

The research focusses only in the state of Tamil Nadu which seems to have an effective Organ donation programme.Considering the fact that there are four major institutes currently engaged in bulk of transplants.The state has a high awareness of cadaver transplants and currently NGOs are engaged in creating awareness.The article fails to mention this.The article leaves out the other states like Karnataka and Kerela where there is a thriving illegal trade.
The illegality of the trade has been highlighted but each transplant has to be carried out with the prior permission of the authorisation committes set up for the said purpose under the provisions of Human Transplant Act 1994.The article has not mentioned the same.
The profile of the recipients is also important.I feel that the there is a thriving business of organs.This has been highlighted by Organ watch(http://sunsite.berkeley.edu/biotech/organswatch/) and the article forthe same appeared in the magazine Frontline(http://www.frontlineonnet.com/fl1907/19070730.htm)
Its indeed surprising that the researchers have managed to track down the donors.The whole trade is underground and most of the donor addresses are usually fabricated.If they have been able to locate the donors-it is commendable effort.
An excellent series of articles has appeared on the net in the magazine Frontline.(http://www.hinduonnet.com/fline/ktrade.htm) highlighting the state of affairs in South India.
The relationship of the donors to the recipents should also have been highlighted.Most of the donors are working as domestic servants or hired help.
The role of the middlemen could also be highlighted along with the percentage paid to the doctors. &)Some media reports indicated the whole promised amount is usually not paid.The report should have highlighted the same.
The personal habits of the donors.The debts usually are incurred by the farmers and alcholics-alcholism is rife in the South India.An area wise breakup of the Chennai city-whether the research focussed on the slums or the urban centres and the econmic profile of the donors.Since the amount paid was "measly"(Rs.40)that suggests that they must have been from extremly poor backgrounds.
Last but not the least-the picture intended to show the reason for the sell off for kidneys showed an apparently healthy man!And the background seems to suggest it is a marriage in north part of the country!

LIFE
AIDS in Singapore
Richard Bellamy (December 2002) [full text...]

Alex Keith (November 28, 2002)
BMSc after fourth year of MBChB, University of Dundee a.keith@dundee.ac.uk

I recently returned from Singapore, where i did my elective. I spent the majority of my time in the Infectious Diseases department of Tan Tock Seng Hospital. I was quite surprised when i read the article by Richard Bellamy in the Student BMJ. My experiences and impressions of patient care are quite different to his. Whilst it is disturbing that the Singaporean government refuses to fund anti-retroviral treatment, the main issue is the fact that this is the only type of medical or surgical care offered that is never even partially subsidised. When you become ill and seek a subsidy for your care the government does some rigorous means testing - this includes your family wealth - to find out if you really cannot afford the treatment. In any instance except HIV/AIDS you will get some subsidy if you really cannot afford to pay. Unless you are lucky enough to work for an "AIDS friendly" employer, such as "The Body Shop" or "Levi Strauss jeans co." you can expect to lose your job once you contract HIV/AIDS, thus making paying for treatment even harder. There is such a stigma attached to the diagnosis that people are reluctant to tell their families for fear of rejection. That is another source of money lost to HIV/AIDS patients. Finally, in this era of Health Promotion it seemed extraordinary to me that there is NO policy of public information about HIV/AIDS. After the end of my attachment i went to Vietnam, a "Socialist Republic". There was more done in Vietnam to raise awareness of HIV/AIDS and to encourage safer sex, despite the fact that until recently Vietnam was a communist dictatorship and is still far from democratic.

I would ask that people do not dismiss my view as uneducated, on the basis that i spent less time in Singapore than Dr Bellamy. If you want more information please visit the "Action for AIDS, Singapore" website at: www.afa.org.sg

LETTERS
Patient contact in preclinical years makes good doctors
Abi Coleman (December 2002) [full text...]

Reuben Arasaratnam (November 28 2002)
Third year medical student, University of Cambridge rjsa2@cam.ac.uk

I am currently a third year medical student at the University of Cambridge, in the process of choosing my clinical school for next year. I read with great interest the letter entitled "Patient contact in preclinical years makes good doctors" . Our course, having a traditional preclinical/clinical divide has very limited patient contact in the first three years. However, I would like to point out some aspects of this traditional course that are likely to contribute to producing well rounded doctors or "good doctors" as well.

First of all, our Part (II) (third year) enables medical students to study a range of subjects from archaeology to physiology in considerable depth and engage with other students who are not medical students, thereby broadening our minds. The organisation of teaching in the preclinical years means that students aren't allocated to a medical faculty for the day but have lectures and practicals organised by different departments. Therefore students have ample opportunity to fully integrate within university life and be a "typical student" for a few years. This is one of the advantages many of my friends have quoted to me.

The supervision system of small group teaching enables students to ask questions about information and understand information rather than having to rote learn facts. This is reflected by the fact that our examinations have an large essay component, testing our ability understand information and communicate it clearly. The opportunity to grapple with the basic sciences for a few years gives us a good platform of understanding the science of disease before we encounter patients. I would also like to point out that there are many other ways of acquiring interpersonal skills such as contribution to university societies or organising academic projects. The fact that we have shorter terms also enables students to do work medically related work such as auxiliary nursing, voluntary work or travel during the holidays. Surely all this must contribute to interpersonal skills and being a well-rounded doctor.

My understanding of why integrated courses appeared in the UK is that they had previously been show to work well in the USA where there is patient contact from the first year. However to enter their medical courses, it is a requirement that you've done an relevant undergraduate degree beforehand. Perhaps this structure of learning is more similar to traditional courses?

EDITORIALS
Careers in medicine do not attract bright school leavers
Elaine Griffiths (December 2002) [full text...]

Ami Nwosu (December 01, 2002)
3rd year medical student, University of Liverpool kingamy@lmss.org

I am writing in response of Elaine Griffiths'(1) article concerning the downturn of applications to medical schools and the shift to female predominance of successful applicants. A big concern is the lack of young men from ethnic minorities. Belonging to an ethnic minority myself I can understand many of the issues facing this subgroup.

It is true such males do so little as flirt towards the idea of a career in medicine, as many see such a possibility as unattainable, and to consider otherwise would be fallacy. Feelings of false aspirations are only enhanced by negative attitudes by some doctors and teachers who may have the effect of compounding the belief that an application to medical school would be unwise. This point is echoed by Alison Smith (2), who indicates similar grievances from the perspective of a 6th form student applying to medicine.

Doctors and medical students must stop and consider the currents attitudes which medicine is perceived. Doctors must not forget what it is like to be medical students and medical students must not forget what it is like to be prospective college students. We must remember the myriad of ways in which different people in society view medicine; only then can medicine be acceptable to those who feel most distanced from it.

Negativity may have it's place in filtering out unsure students who are not committed to a career in medicine, but it is also removing those who are both unsure and are committed; thus potential good students and doctors are being lost.

Current schemes at University of Liverpool involve sending students to inner city schools to provide talks and community workshops to promote the message that medicine is a goal attainable by all. Such steps may prove to be of benefit in reducing stigma and giving greater understanding both to schoolchild and medical student of each other circumstances.

I believe that we all have a duty in the portrayal of the view of medicine and the reversing of the application decline. Steps should be taken to help encourage those on the rung of the ladder below to maintain enthusiasm, establish understanding and allow the attainment of dreams: only then can spiral be reversed.

Griffiths E. Careers in medicine do not attract bright school leavers anymore. studentBMJ 2002;10:443-4. (December)

Smith A. Doctors should be more positive about applying for medicine. studentBMJ 2002;10:477 (December)

REVIEWS
Do deodorants cause breast cancer?
Marianna Philippidou (February 2001) [full text...]

C. Reid (December 06, 2002)
Medical researcher, Medical Office DreamSurfer@SBCGLobal.net

There are most definitely studies on deodorants and breast cancer, some conclude that it is a definte problem, one study in particular seems to be duplicated and regurgitated all over the Internet with a variety of forms of presentation, but with the same conclusion, that there is NO problem (perhaps at least with some of the Aluminum Salts used - one study in Germany (and others here and abroad) shows there is a definite correlation!)

I never saw the email that was supposedly going around, which is unusual, as I have 6 email accounts and get about every junk email on the planet it seems!!!

REGARDLESS!!! This concern about breast cancer and deodorants has been an issue at least as far back as the mid 1970's! This is nothing new! What seems to be new is the medical establishment replicating in articles, newsletters, etc. the same study that may be deadly wrong.

Could you please share the study this information is based on, and how this is different from that of other major medical sources' study(ies)?

I think I'm more concerned now than I was before... especially when I se statements that tell me the FDA rigorously tests antiperspirants, which is on many prominent web sites, and is absolutely untrue, unless there is a MAJOR problem, and even then it may not be touched by the FDA, as antiperspirants are classified as a cosmetic!

As for me? I'll be looking into the MSDSs for the ingredients in my deodorant(s.) I did this just yesterday, and there was definitely reason for concern!

Thanks in advance for sharing the source of the information. I pray it is independant, and not another clone of many stories I have seen re: a so-called email chain of misinformation, which makes me wonder, with so many clones of this same mis-information (of absolute sureness that the FDA actually tests deodorants or antiperspirants, etc. and that there is absolutely NO concern of ANY link between these products and cancer), if perhaps this was generated by someone doing so-called "research" to cover a product liability issue.

PAPERS
Student commentary: fear of AIDS affected my elective
Anna Faulkner (December 2002) [full text...]

Rani Robson (December 08, 2002)
Medical Student, final year, University of Oxford rani.robson@medschool.ox.ac.uk

As is clear from many of the articles in last months edition of the Student BMJ, HIV is an increasing worldwide problem and we, as international medical students should be encouraged to take an active interest in the epidemic and its effects on individuals and populations. Instead, increasingly, medical schools (1) and students themselves (2) are discouraging students from going on electives to areas where HIV infection is endemic. More and more, medical students are using their elective period to travel to other developed countries, such as Australia and the US. For many, experience gained in these countries is valuable. However, the opportunity to learn from societies with minimal resources and extreme health crises is invaluable, both for our practice in the UK and for the future of global health provision.

There are real risks to take into consideration when working with patients who are HIV infected. It is important that medical students have the opportunity to learn safety precautions when dealing with infected patients. I recently had the opportunity of being attached to a trauma team at Baragawaneth Hospital in Johannesburg, where it is thought that every other patient is infected with HIV. I learnt a lot about safety when dealing with potentially infective blood. When doing invasive procedures, students should be double gloved with goggles and masks. If appropriate precautions are practiced the absolute risk of HIV infection from working with infected patients is minimal. We must be careful not to risk avoidance becoming the comfortable alternative to experience in dealing with patients infected with HIV.

I hope that students will not be discouraged from travelling to and learning from health professional and patients in developing countries where HIV is endemic. If we continue to escalate the hysteria promoting HIV avoidance on electives, how can we play a part in the international health crisis that we are so keenly a part of as future doctors?

Tilzey A., Banatvala J. Protection from HIV on electives: questionnaire survey of UK medical schools. Student BMJ 2002;10: 461-2.

Faulkner A. Student commentary: fear of AIDS affected my elective. Student BMJ 2002; 10: 462.

	EDITORIALS Careers in medicine no longer attract bright school leavers Elaine Griffiths (December 2002) [full text...]
	James Halpern (December 10, 2002) Final Year Medical Student, University Birmingham Medical School James_Halpern@hotmail.com
	In Elains Gririffiths editorial she discussed reasons why bright school leavers are not attracted to study medicine. She did not though mention the impact of the strong anti-doctor messages which are constantly seen in the media. During the recent consultant contract discussions doctors were villified as money grabbing fat cats with no interest in patient care. Constantly for the past 5 years the government and the media have been congratulating nurses with one hand and punishing doctors with the other. Doctors are an 'easy target' as we are few in number, seen as elitist, and are bound by an ethical commitment not to strike. It is therefore no suprise that the 'best and brightest' are choosing other career paths.

	CAREERS Plastic fantastic: Professor Gunther von Hagens Nigel Lane (August 2002) [full text...]
	Ian Innes (December 13, 2002) 1st Diploma in Sport Science and Exercise, North West Kent College Gravesend ianinnes123@hotmail.com
	My thoughts on this article are very strong and I agree that the Professor is doing things that nature did not intend. I have been to the body worlds museum in London and found it to be very interesting and it taught me things that I did not know before about the human body. Although Prof. Gunther Von Hagens is cutting bodies up and showing the world these figures of dead people I do not agree with it, I think that it is barbaric, sick and disgusting that he think that he can play God and take apart these poor people's lives like some experiment. I am currently doing a sport science course at my college and we have to learn about all of this stuff, our teacher is using the book as a reference to what we are learning. I think this is ok but it does upset me that the Prof. is making a living out of this. I do not think that it is correct that he just takes away people's family members, pays them a lot of money (like a bribe) for their son, uncle, daughter, etc to be taken away and cut up and put on display like some wierd experiment.

NEWS
End doctors exemption from jury service, white paper recommends
Samena Chaudhry (December 2002) [full text...]

Clare Hughes (December 13, 2002)
Guys, Kings and St. Thomas's School of Medicine, London clare.a.hughes@kcl.ac.uk

I completely support the white paper on criminal justice proposing that people with certain occupations, including doctors, should not be automatically exempt from jury service.(1)

The purpose of the jury is to provide trial by peer group, a notion encapsulated in the Magna Carta of 1215. Clause 39 of the charter stated that "no man shall be . imprisoned or disseised [dispossessed] . except by the lawful judgement of his peers or by the law of the land".(2)

Allowing some people to avoid jury service by virtue of their occupation means that the diversity of the community from which jury members are drawn is not properly reflected.

I understand that a long trial could mean that invaluable medical training would be missed, however, this could be said of many professions. Students on many courses and other professionals in the training stages of their employment would also find it difficult to take time out.

I agree that the categories of ineligibility should be abolished and replaced by a system that uses discretion to excuse or defer service for individuals. The considerations for excusing jury service should include whether it would be in the public interest to excuse someone on account of their work.(3)

Doctors and other currently excused professionals, such as lawyers and vets, are not the only people who would be missed from their jobs. Teachers provide a public service and are not easily replaceable. The self-employed and employees of small businesses would also find it hard. Isn't a blanket policy excusing surgeons and barristers outdated and elitist?

I did jury service just before my year two exams and was lucky that it was during my Easter holiday and lasted less than two weeks. Before being sworn into a trial I was told the likely length of the trial and was given a chance to opt out. This information allowed potential jurors to make an informed decision about their ability to sit on the jury.

Jury service was not a chore; I took it as a valuable opportunity to learn about the criminal justice system. The experience also opened my mind and made me look at myself as a person, my prejudices and my values.

I think that all members of the community should undertake jury service if they possibly can otherwise we will be undermining the foundations upon which today's criminal justice system is built.

Chaudhry S. End doctors' exemption from jury service, white paper recommends. StudentBMJ 2002; 10:446 (December).
Encyclopaedia Britannica (CD-ROM).
http://www.homeoffice.gov.uk/rias/partria.pdf accessed on 11/12/02.

NEWS
Cognitive intelligence
Brian McMullen (December 2002) [full text...]

Clare Hughes (December 17, 2002)
Guys, Kings and St. Thomas's School of Medicine, London clare.a.hughes@kcl.ac.uk

In response to Brian McMullen's article on cognitive thinking, I ask what place is there for adventerous thinking in medicine?

Interviewers seem more interested in assessing a candidate's dedication to the subject than their natural skill and aptitude. Attending courses such as Medlink which promote generic responses is seen as a plus point by the interview panel. We are encouraged to think in closed systems from a very early stage. Why? Because closed systems are safe.

Following an algorithm in every decision-making process means that our decisions can later be dissected and justified. With the increasing litigation pressures that medics now have to face, it is crucial that we are able to do this . Has audit dehumanised us? An ever-growing hunger for transparency in the profession has eaten away the room for the freedom of alternative thinking. Of course Spock is no role model and the fear that fixed thought patterns create the risk of missing possibilities is a real one. But in today's world it is tempting to combat this by simply learning more fixed patterns. After all, computers are great at chess and they don't get sued. Has lateral thinking become using a greater width of the box rather than stepping outside of its boundaries?