Article Responses: February2004

Articles	Responses
REVIEW Jump Off The Conveyor Belt Rebecca Hope(January 2004) [full text...]	Beth Chapman (January 20, 2004) Read this response

LIFE One Woman Show Neil Barua (January 2004) [full text...]	Sujoy (January 20, 2004) Read this response

LIFE Does Age Matter? Peter Cross (January 2004) [full text...]	Ian Rowbotham (January 20, 2004) Read this response Ian Rowbotham (January 26, 2004) Read this response

EDUCATION PubMed for beginners Mohammad Al-Ubaydli (February 2004) [full text...]	Talha Patel (January 21, 2004) Read this response Kristina Fister (February 6, 2004) Read this response Christos Zavos (February 8, 2004) Read this response

REVIEWS Religion must not influence medical practice Stephen J Goldie (November 2003) [full text...]	Pang Chia Yong (January 22, 2004) Read this response Amar (Febraury 10, 2004) Read this response

NEWS Young people should just say "no" to risky sex Nadeeja Korelage (February 2004) [full text...]	anonymity preferred (January 22, 2004) Read this response Vikas Dhikav (January 27, 2004) Read this response

MINERVA Minerva Anu Morjaria (January 2004) [full text...]	Lisa Coster (January 23, 2004) Read this response

EDITORIALS A new year's resolution after a lost decade David Weatherall (February 2004) [full text...]	Tawfiqur R. Choudhury (January 23, 2004) Read this response

CAREERS Blowing the whistle David Weatherall (February 2004) [full text...]	Rita Pal (January 24, 2004) Read this response

NEWS UK government to introduce university tuition fees Clare Hughes (February 2004) [full text...]	Matthew Kirkman (January 27, 2004) Read this response Anna Shore (February 4, 2004) Read this response Abul Siddiky (February 5, 2004) Read this response

LIFE Buddhist medicine in occupied Tibet Kieren Bong (February 2004) [full text...]	Maulik Baxi (January 29, 2004) Read this response

EDUCATION All the things that aspirin does Rod Flower (October 2003) [full text...]	Sujoy (January 30, 2004) Read this response

LETTERS Mature students work for fewer years Pavi Kundhal (February 2004) [full text...]	Nicholas Clement (February 1, 2004) Read this response

CAREERS Pharmaceutical medicine: making the leap Dominic Smethurst (February 2004) [full text...]	Irina Haivas (February 2, 2004) Read this response

NEWS Medical students should know how to help people affected by violence Nadeeja Koralage (February 2004) [full text...]	Mohammed Haque (February 2, 2004) Read this response Sophie Hampson (February 9, 2004) Read this response

NEWS Shock tactic campaign links smoking to atherosclerosis Richard Hurley (February 2004) [full text...]	Aaron Baxter (February 3, 2004) Read this response

NEWS Herbal medicine industry threatens future of thousands of wild plants Clare Hughes (February 2004) [full text...]	Aaron Baxter (February 1, 2004) Read this response

EDITORIALS Research: what's the point? Polly Brown (February 2004) [full text...]	Tang Weng Heng (February 5, 2004) Read this response Sashi Kommu (February 5, 2004) Read this response

CAREERS Help! i'm a medic get me out of here (February 2004) [full text...]	Jane V Bond (February 5, 2004) Read this response Naomi Slator, Aneel Bhangu (February 9, 2004) Read this response Yasamin Ziabari (February 10, 2004) Read this response

EDUCATION Introduction to Imaging: The abdomen John Frank (February 2004) [full text...]	Keshav J Kulkarni (February 9, 2004) Read this response

REVIEWS
Jump Off The Conveyor Belt
Rebecca Hope(January 2004) [full text...]

Beth Chapman
(January 20, 2004)
Locum SHO/ freelance journalist Cornwall bethch@pman.me.uk

I read with interest Rebecca Hope's article about taking a step back from medicine every now and then. I recognised the urgency and excitement that she is feeling and is now encouraging others to explore too.

Taking a 'sabbatical', obviously felt right for Rebecca, however it is not so natural for the majority regardless of how much they moan about their current situation. It is actually possible to develop and persue passions at the same time as studying or working in medicine, but sometimes we need that short break to help us to identify our priorities.

My only concern with Rebecca's article is her belief that, "Once we are doctors, we will remain so until we retire. This is our only shot at being here now, young and for the most part free of ties and commitments". I qualified from medical school almost two and a half years ago. I consider myself to still be fairly young and I am free of ties and commitments. After my house jobs I didn't really know what I wanted to do, but it certainly didn't involve an SHO postat that time. I have spent the past year developing skills I never knew I had and realising I do have an affinity for medicine, I just hadn't found the right context.

Some of my friends are finishing their further training, some are on the other side of the world; I intend to start as an SHO in August. My point is, that everyone finds their feet in their own time and once you are a doctor your choices are still ultimately your own.

LIFE
One Woman Show
Neil Barua (January 2004) [full text...]

Sujoy(January 20, 2004)
Business Analyst Indiasujoy2003@hotmail.com

This is in response to the article on mata Amritandamayi....In India,there are more pioneers...I don't mean to sound offensive (or arrogant) but..there is a certain lady-Dr.Jayanti Dutta, who has been actively involved with the issues regarding Women Empowerment, Crime against women, emancipation of the girl child and other issues related to Women and Children.She also won the State Award from the Delhi Govt. for her efforts in these areas and has recently been to Nepal (courtesy the Nepal High Commission and Royal Family of Nepal), to deliver lectures regarding the women-related issues in the state.The same can be verified at:http://www.nepalnews.com.np/contents/englishdaily/ktmpost/2003/jun/jun02/local.htm

How about a summary of her efforts and endeavors....though not aided by an entire organisation, I am sure her work also bears merit and definitely warrants a reportage....probably moreso because its truly about the power of ONE!

She is a professor in Clinical Psychology with Delhi University (Lady Irwin College).

Thanks for reading....

Warm regards,

LIFE
Does Age Matter?
Peter Cross (January 2004) [full text...]

Ian Rowbotham
(January 20, 2004)
5th year of 6 (did science foundation) Sheffieldmda99imr@sheffield.ac.uk

I am always interested in arguments for and against older students studying medicine. For my part I am at Sheffield thanks to an enlightened (to me, at any rate) sub-dean for admissions. I am 46 and 18 months away from completion of my medical degree.

Every day has been a pleasure, because medicine is what I really wanted to do. I had a happy and fulfilling career doing something else for 18 years because I happened to have the talent for it, but the desire for medicine wouldn't go away, and a big event in my life (the stillbirth of our child) precipitated a chance meeting which set me on my present course.

Women were once prevented from doing medicine for the reason that they would abandon their careers at the first sign of pregnancy. Why should virtually the same argument, no longer considered valid, be used to exclude others, who may still, like myself, be able to give twenty years to the NHS? In addition many doctors work part time, so a half career doing full time amounts to the same as forty years working half that. My final point is one that has already been made by Susan Gibbins; doctors leave medicine, so to give an eighteen year old a place does not guarantee his or her spending a lifetime in the profession.

I would ask anyone wishing to do medicine, 'are you hungry for it?' If the anwer is 'yes' then do not be put off by anyone. How many people in their mid forties can honestly say they feel fulfilled? Every day I wake up and feel like the luckiest man on the planet. It's a slog, of course, but if you want to do it badly enough, you will.

Ian Rowbotham

LIFE
Does Age Matter?
Peter Cross (January 2004) [full text...]

Ian Rowbotham
(January 20, 2004)
5th year of 6 (did science foundation) Sheffieldmda99imr@sheffield.ac.uk

I can appreciate fully Pavi Kundal's commments regarding the shorter career of a student trained in his or her forties, but may I mention the points that were raised on the response noticeboard for this article?

The same argument was once used to deter women from becoming doctors.
A student's being aged eighteen at entry to medical school does not, in itself, guarantee a forty year medical career. A mature student who has already had a career, is however, less likely to switch career or, having had to struggle to get into medical school, degree.
Many doctors work part time. Twenty years of working full time amounts to forty years' worth of half time.
Mature students know why they are at medical school and can bring a number of positive things with them which sometimes benefit the younger students.

Ian Rowbotham

EDUCATION
PubMed for beginners
Mohammad Al-Ubaydli (February 2004) [full text...]

Talha Patel(January 21, 2004)
2nd year medical student Liverpoolmd0u1104@liv.ac.uk

The method of searching deployed by Mohammad Al-Ubaydli is rather flawed (REF Al-Ubaydli. PubMed for Beginners. studentBMJ 2004;2. (February.)). It may have worked for that particular example, however, it does not work in all cases. For example, if one was to search for "osteoarthritis aetiology", PubMed returns only those papers which spell aetiology as such (894 results). However, Americans spell 'aetiology' as 'etiology', therefore, these papers will be missed out (10434 results returned with "osteoarthritis etiology"). A better method is to serch using Medical Special Headings (MeSH) terms. It can be accessed by clicking on 'MeSH Database' from the side headings. For this example, one would search "osteoarthritis", then, by clicking on the 'osteoarhritis' link, a further array of subheadings appear, in which case the 'etiology' checkbox would be selected and sent to the search box. This returns 6260 results, which are all about aetiology of osteoarthritis.!

It is also possible to perform boolean searches (AND, OR, etc.), which can further specify what is being looked for.

Furthermore, PubMed has a distinct North American bias. Although the main European journals are included (including the BMJ, Lancet, etc.), it does leave out many others still. This can be partially countered by searching using Embase (which, incidentally, has a European bias). It isn't free to access, which is rather unfortunate, however, the NHS has bought access for all its staff, hence, if you know someone who has an NHS Athens username and password well enough, you may get access through them. A normal Athens username won't work. Other search databases exist, but these are the main two.

EDUCATION
PubMed for beginners
Mohammad Al-Ubaydli (February 2004) [full text...]

Kristina Fiste(February 6, 2004)
Research fellow Zagreb University School of Medicinekfister@mef.hr

Dear Editor,

Since I teach the principles of evidence-based medicine to medical students at the Zagreb University, Croatia, which includes techniques for searching the medical literature and the basics of critical appraisal, I read the article "PubMed for beginners" with great interest, expecting to learn a new bit of information, or get an idea for a new educational example. Unfortunately, the quality of the article was somewhat disappointing. Namely, whether the author should have followed the recommendations for asking relevant clinical questions and searching for evidence as they are given in the quality evidence-based medicine literature is debatable (I find them most useful and well accepted by students, whereas your author might not). Also, as searching for evidence is not an exact science, the introduction of MeSH terms, Boolean operators, or "Related Articles" link option into this brief educational piece is another issue open for debate. However, a more serious error crept in:limiting for randomized controlled trials when searching for evidence answering "What percentage of stroke patients get epilepsy?" is, simply - inadequate. Randomized controlled trials are not designed to answer such questions, but rather to assess effects of different clinical interventions. And even though they are highly-placed in the hierarchy of clinical evidence, their design is not suitable for answering each and every clinical question. The BMJ recently published an article addressing this issue (Glasziou P, Vandenbroucke J, Chalmers I. Assessing the quality of research. BMJ. 2004 Jan 3;328(7430):39-41.). The limit applied in your example should have been "Clinical trials".

EDUCATION
PubMed for beginners
Mohammad Al-Ubaydli (February 2004) [full text...]

Christos Zavos(February 8, 2004)
Senior House Officer Theagenion Cancer Hospital of Thessaloniki, Greececzavos@hotmail.com

Editor- I have read with interest the article by Dr Al-Ubaydli on PubMed and I would also like to share my experience. Key words are mentioned somewhere within the abstract, so the principle is to try to imagine which words (common words or medical terms) you would use if you were going to write such an abstract yourself. Taking the example by Dr Al-Ubaydli, I would first use the following 2 obvious key words "stroke epilepsy" just to get a rough idea of how many abstracts quote these 2 words. If you give many key words at the beginning and there are very few articles on this subject, you may get nothing by your search. Then, I would ask myself what I want to know about these 2 words: association, epidemiology, aetiology, pathophysiology, or therapy? Obviously "epidemiology". Next, what would I want to know about epidemiology? Of course, the "incidence". If I wanted to know the world distribution of a trend or a disease, I would have added the words "world incidence". Now, how would I have written this abstract if it was mine? It refers to a clinical trial so it has to contain the word "patients". If it was an experimental study I would have added "experimental" or "animals". Also, the words "clinical trial" can be added, because PubMed indexes its abstracts as "Review", "Clinical trial", "Multicenter trial", and so on. These key-words result in 6 papers, easy to track the suitable one.

Finding the full text means you have the following options: a) your institution has access to full text and PubMed has a direct link. That is easy; b) your institution doesn't have access to full text, although PubMed has a direct link to the paper. You could go to the journal site and look for the free abstract of the paper. You then have two options: either to purchase the paper or request a reprint from the author. Try finding corresponding author's e-mail address in this or in other papers by the same author. If no e-mail available, you can contact him by post; c) you have found the abstract, but PubMed doesn't have a direct link to journal's homepage. This means either that the journal does not have a homepage, or that PubMed does not promote the journal's full-text papers. You can either go to a general search engine (Google, Yahoo, etc) and search for the official website of the journal or visit MedBioWorld http://www.medbioworld.com/med/journals/med-bio.php that provides links to 25,000 journals, associations and databases.

REVIEWS
Religion must not influence medical practice
Stephen J Goldie (November 2003) [full text...]

Pang Chia Yong(January 22, 2004)
Year 3 International Medical University P_cy2@yahoo.com

In your article , you mentioned that you are not an aitheist nor an agnostic, but the description of beliefs that you suscribe to is too glaring to be missed.

Not labelling yourself as such does not mean you do not behave and practice the ways of the two mentioned groups of people , thus rendering yourself indeed as a person falling into those groups of people.

I feel it is disrespectful of you to say that religions are equivalent to 'social clubs' involving people who share the same interests.In those few sentences, you were belittling the billions of people around the world who are devout believers of their respective faiths.

Indeed, i agree with you that medical doctors must be objective in their work.We have to keep in mind that there is limitations to science.Due to these limitations in scientific knowledge , we are handicapped and cannot treat those beyond our ability.Where science leaves off, there religion will pick up.

In the recent years , scientific research has shown that patients who are religious have a better prospect of healing.Do we have a scientific basis for this ? No, we do not.Mankind by nature would like to believe they are capable to doing anything and everything.The reality is,there is still a very large portion of medicine that we do not know about.And in some areas of medicine, not even a slightest hint.

The purpose of medicine is to improve the quality of life.

In some ways, this is very subjective and it varies from one patient to the other.

Our job as physicians is offer hope.We do this by applying scientific knowledge in treating patients.

If a patient would like to involve religious practices into their treatment, so be it.Whatever they wish to do, in whatever manner their religion see fits, let them do it.

At the end of the day, we are in the business of healing.Wouldn't you do just about anything it takes to heal your patient ? Where medicine is lacking in ability to heal, religion is complementing , and to a extent , filling that lack.

	REVIEWS Religion must not influence medical practice Stephen J Goldie (November 2003) [full text...]
	Amar(February 10, 2004) Pharmacy (1st year) Birmingham amariqbal@t-email.co.uk
	I agree with the author that religion is not required in medicine. However, the fact that it is not required does not render it useless or indeed inferior to any modern day scientific approach. For centuries religions have applied their widely held beliefs to cure the sick and unhealthy. And for centuries they have worked. Medicine, even in ancient times, was a process which involved religious guidlines and etiquettes. An example in kind being tha millions of Muslims still follow medicinal aspects as set out by the Prophet Muhammad (peace be upon him)centuries ago, and they still work. Many of sciences advances have been attempted by religion even before we knew about them. The fact that honey can be used as a medicament in certain cases, etc, is only one such example. To forget this once useful past is a tragedy fo society today.

NEWS
Young people should just say "no" to risky sex
Nadeeja Korelage (February 2004) [full text...]

anonymity preferred(January 22, 2004)
Medicine, final year Dundee

The approach espoused in this article, though logical, is both simplistic and impractical. Along with alcohol, nicotine and illict drugs, sex is one of the few reliably enjoyable things that many people have in their lives, especially given current television scheduling.

Given the current general feeling that "just say no" campaigns have failed to prevent people taking drugs it seems odd that such an approach should be suggested to tackle the rise of sexually transmitted infections and early pregnancy.

Furthermore the "just say no" approach assumes that young people either do not want to get involved in risky sexual encounters, or feel that they have a choice. It may be the case that a certain percentage of young people wish to engage in risky behaviours. It is certainly the case that many young people would feel foolish to reject sexual experiences once offered, or feel that the risky activity may be their only option for sexual expression. In any approach to problems associated with sexual activity amongst young people the fact of their desire must not be ignored. Far from it simply being neccesary to impart "the skills and knowledge to say no" it is neccesary to generate the confidence to know what one feels comfortable with - even if we are uncomfortable with whatever that is. It is also important not to underestimate the legacy of "section 28". To mention the importance of school based sex education, whilst ignoring the fact that teachers were (though not any more) prohibited from fully discussing gay sexual practices, is tantamount to neglecting a subgroup of young people who, we are told, are subject to coercion, both internal and external, to engage in risky sexual practices.

Unfortunately, this offers a convenient cop-out. It identifies the problem(s) as attitudes widely held in society; it suggests a requirement to shift the current emphasis from the frequency, or amount, of sex and sexual behaviour to the value of each sexual encounter.

Faced with the difficult of changing societal values i am sure that it does feel easier to frighten youngsters into denying their sexuality and their desires and "just saying no".

NEWS
Young people should just say "no" to risky sex
Nadeeja Korelage (February 2004) [full text...]

Vikas Dhikav(January 27, 2004)
Resident All India Institute of Medical Sciences, New Delhi-110029, INDIA

Before persuading young people against having "risky sex"; they must be educated clearly, what is "risky sex" and what are the risk involved. This is not enough, because, we should consider there would always be certain "daring individuals" and the education about the "back up plan" given should the suggestions given by the educators are ignored or something happens 'unintentionally' or 'accidentally'.

Experience has shown that legislation, which acts by enforcing laws, has often produced poor outcomes in human behavioral problems. For example, liqueur ban in several Indian states led to flourishing businesses in illegitimate ways. Likewise, asking people to say NO to smoking and littering at public places has met with dismal success.

So what should be the strategy? The answer lies in answering the students' quarries about sex as a part of scientific educational programs. These should be reinforced periodically. The startling reality that even college going and university students seek sex education from ill-informed peers or pornographic material speaks volume about the way we deal with our youth regard to fundamental issues such as sex. Setting up a sex museum such as one in Los Vagus can be of help. Similarly, books on sex education easily accessible to youth may be of use. We can learn a great deal in this regard from ancient Indians who thought sexuality openly and explicitly. The walls of Khajurao, Ajanta, Alora in the central Indian states depicts both normal and "aberrant" human sexuality.

While we are bit liberalistic for the "usual" or "normal" sex; we are not so when it comes to "perversions". For examples, male and female homosexuals continue to be ridiculed and discriminated against. Pedophilia and childhood sex abuse, which are extremely common public health problems; rarely if ever receives sufficient attention both in medical literature and media. This is partly due to the fact that most of the pedophiles are known to the victim and often, family members or relatives. There is sufficient evidence to suggest that abuse victims often become abusers themselves in later life. Sex and drug abuse make "lethal" combination as both needles and partners are shared. Thus we ought to address the problems associated with the normal and "not so normal" or "aberrant" sexuality in a more comprehensive manner.

	MINERVA Minerva Anu Morjaria (January 2004) [full text...]
	Lisa Coster(January 23, 2004) Practising Midwife
	I read your publication with great interest every month, even though I am a Midwife. It is my hope, however to follow you all down the path of a career in Medicine at some point in the future. Therefore I immerse myself in all things 'student-medical' and especially enjoy the 'Minerva'. You can imagine my delight when I read about a fellow Midwife involved in a case of an undiagnosed diaphragmatic hernia. It was very refreshing (and exciting) to have understood all within the text, and empathise with this situation. I work on a very busy delivery suite in an overstretched maternity unit. The simple lack of beds creates a difficult decision to try and 'motivate' women and their babies to go home, and all too often this means that problems are indeed missed. In our defence, the baby in subjected to a thorough examination by both a Midwife and a Paediatrician, and any anomalies are investigated. However, when discharged into the care of the community Midwives, who are as overworked as the hospital Midwives, the undiagnosed problems become emergencies and often blame is attached to whoever 'missed' them. We are trained to recognise deviations from the normal and direct them to a suitable senior colleague, which is what the community Midwife did in this case. we always err on the side of caution with neonates and would always send them in to be assessed. However, now that I am familiar with this case and its diagnosis, I would be more likely to spot it. Thank you, Minerva. On a final note, I would like to clarify whether the boy was indeed '5 years old' or '5 days old', as community Midwives only visit up to 28 days post delivery. Thank you for your kind attention,

EDITORIALS
A new year's resolution after a lost decade
David Weatherall (February 2004) [full text...]

Tawfiqur R. Choudhury(January 23, 2004)
5th year Intercalated BSc student/Medical Student Barts and the London

Inequalities in global healthcare

Editor,

Professor Weatherall's article on the inequalities in healthcare between the developed and the developing world demonstrates the sad state of present day global healthcare1. According to the WHO, global healthcare inequalities are growing. 2 It is sad to note that even when drugs are available, commercial considerations prevent their distribution to the poorer countries. $73 billion is spent annually on health research (2000) but only 10% of this is used for research on 90% of the global disease burden- that of developing countries3. Having spent a considerable part of my life in Bangladesh, I know how effective simple immunisation programmes, like the polio eradication programme, can be. Yet, unfortunately, mortality and morbidity due to preventable and curable diseases in the developing world is still very high. The importance of support, both financial and technical, from the richer countries cannot be overstated. Although it is true that the developed world is doing a lot to help their poorer colleagues, much more needs to be done to get those much needed drugs to the suffering masses. The importance of helping the developing world is not just a humanitarian one. With the increase in economic migration, immigration control is not enough to check disease migration. And the effect of this is already being seen in the western world. Therefore, it is in the interest of global healthcare and in the interest of humanity, that the developed should help the developing world. However, the entire burden of this task cannot be placed on the rich few. Prof Weatherall alludes to the role of "dishonest administrations" in the poor countries1. Corruption and public health mismanagement is common in developing countries. Lack of accountability, unnecessary bureaucracy and lack of long-term healthcare planning all play a part. However, amongst the corruption and bureaucracy, improvements have been made. The global effort to eradicate polio is one such example. With a combination of better public health management and greater financial and technical help from the developed world, the state of global healthcare is sure to improve at least a little if not a lot.

T R Choudhury

Medical Student

Barts and the London

References

Weatherall D J, A new year's resolution after a lost decade. sBMJ 2004;12:47-48
WHO says global healthcare inequalities are growing; www.ippfnet.ippf.org
Global Forum for Health Research; www.globalforumhealth.org

CAREERS
Blowing the whistle
Robbie Coull (February 2004) [full text...]

Dr Rita Pal(January 24, 2004)
Psychiatrist Midlands rpal@btinternet.com

Robbie has some interesting ideas about whistleblowing.

As everyone who has whistleblown on a huge scale knows, it is equivalent to a career assasination.

He writes, "the threat of going to the media is a powerful one" - on occasion it is the only alternative you have left once you are witch hunted for stating some home truths about the medical profession.

Contrary to the remarks by Robbie, the GMC are not accountable under the Public Interest Disclosure Act. Indeed, many public authorities are not accountable. The Public Interest Disclosure act is of little use. You can only use the PIDA in an Employment Tribunal. The organisation you work for is usually far better equipped and certainly has better lawyers. The witnesses will be stacked against you.

There is no right way to whistleblow. Having done it as PRHO, I would not advise any doctors to go forth to conquer a very precarious area. My material was recorded and indeed I had patient records to show neglect etc. It became headline news in the Sunday Times 2nd April 2000 Elderly Helped to Die. The furore in the media did not stop there. That was indeed my last option given every authority had more or less turned a blind eye to the concerns of a) Lack of supervision for PRHOs b) Lack of equipment c) Lack of nursing staff etc.

It would be interesting to see if the Student BMJ would publish this :).

Kind Regards

Dr Rita Pal

www.nhs-exposed.com

Whistleblower and currently working in the NHS. Publicity is the only weapon safe to use :)

	NEWS UK government to introduce university tuition fees Clare Hughes (February 2004) [full text...]
	Matthew Kirkman(January 27, 2004) Medicine, first year Newcastle Medical School, Newcastle upon Tyne matthew.kirkman@ncl.ac.uk
	After reading your article regarding the introduction of university tuition fees, I am angered but at the same time consider myself very lucky. I was aware of the government's plans to introduce top up fees since the publication of the White Paper last year. It seems highly hypocritical of them to bring increased debts to students at a time when they are supposed to be widening access to university, and especially to courses like medicine. Being a first year medical student at Newcastle, I have to say it has been very hard to find other students from similar backgrounds to me. My mum works part time in a post office and my dad is an IT technician in a school. I don't have to pay tuition fees and I get a £2,000 bursary from the government, yet it is still an incredible struggle for me to survive financially. I can only imagine how hard it will be for those in a few years time who are from similar working class backgrounds. Even the promise of the governments help for such students is a worthless when considering the increased financial burden that will be placed on them. When asked by colleagues about my parents jobs, I have been met with some downright rude and ignorant responses; one student even remarked "really?" as if I would make a joke about my parent's livelihood. It is quite clear that introducing these top up fees is going to make people from working class backgrounds even scarcer. I am certain that if the top up fees were around when I applied for medicine, I would have been put off applying. The fact is we need more doctors from working class backgrounds in order to bring different perspectives and diversity to medicine. We need more doctors who can relate to 'normal' people. Top up fees are going to go and reverse what the medical schools have been trying to do for the past few years; recruit from poorer backgrounds. This is not going to help the desperate needs of the NHS either; doctors are going to be more inclined to 'go private' or work abroad where they can earn more money and pay back the enormous debt accumulated at medical school. Is that really what the government wants?

NEWS
UK government to introduce university tuition fees
Clare Hughes (February 2004) [full text...]

Anna Shore
(February 4, 2004)
3rd year medicine Leeds ugm1a3s@leeds.ac.uk

I agree that there is case for attracting medical students from working class backgrounds, but do not necessarily think that the introduction of tuition fees will put this group off. As the original article states, the poorest students will be offered financial assistance from the government and their university. Many will consider the amount of money they are likely to earn in the future having completed a medical degree outweighs the potential accumulation of debt, independent of background.

It is important not to lose sight of the fact that the government haven't introduced these fees to purposefully disadvantage tomorrow's students. The extra money will go some way towards allowing British universities to offer the high quality education that we all seem to expect. Many students, medical or otherwise, expect to be taught by leaders in their field or active researchers. This type of expertise needs to be paid for.

I don't believe that one should only get what one can afford, but nor do I think that the future of university education in this country should suffer because people are unwilling to pay for their education

NEWS
UK government to introduce university tuition fees
Clare Hughes (February 2004) [full text...]

Abul Siddiky
(February 5, 2004)
4th Year Medical Student Sheffield ahsiddiky@doctors.org.uk

It is frustrating to see the government continue to make life difficult for students. I find it hard to understand how, on one hand, they claim to want to increase numbers of doctors whilst, on the other hand, introduce these measures.

I sincerely believe that the government should provide a greater degree of financial support for medial students and there are a number of reasons why.

For a start, medicine is a 5-6 year long course - almost twice the duration of all other courses. Medical undergraduates thus have to endure deeper financial debt than most others to accommodate the living costs and tuition fees of the additional years. When you also take on board the fact that medical students have to commute to various places of attachment, the costs of travelling can tot up significantly. The costs of equipping yourself to become a doctor don't come cheap either, with a standard stethoscope reaching almost £50 and white coats coming in at around £10 each. But the argument really begins with the fact that almost every medical graduate goes on to serve the government as a public servant. Not even dentists can defend themselves in this capacity, being self-employed and nurses (of course!) are already funded throughout their course and paid from day one! The fact that doctors go on to work for the government and that they're hardly ubiquitous, defends the case for central involvement and financial support i.e. that medical students and indeed, perhaps all healthcare professionals, should have their tuition fees paid for and given grants as opposed to student loans.

It doesn't have to stop there. You could further extend this claim to incorporate all vocational qualifications in which you serve as a public servant, such as teachers.

But what of those degrees that do not have an apparent use to society? The topic of what constitutes a worthwhile degree and what does not has been at the forefront of politics within the Department of Education, with Margaret Hodge, the Higher Education Minister terming 'Mickey Mouse' courses as one "where the content is perhaps not as rigorous as one would expect and where the degree itself may not have huge relevance on the labour market".(1) Mrs. Hodges comments came with much criticism from various university leaders (the former polytechnics no doubt!) and the president of the NUS - yet I cannot help finding myself agreeing with her.

I find it unfair that all students have to pay tuition fees and self-finance themselves when there are students who watch 8 hours of television a week as 'research' for Film Studies whereas others are doing on-calls in hospital to make themselves safe to practice! Yet, who comes out of their degree with a higher debt? We do!

Furthermore, the current situation as it stands with English medical schools charging fees and Scottish nationals being exempt - a possible two-tier system could develop, ultimately creating a barrier to students who want to enter medical school. (2) Scottish medical schools already argue that top-up fees will allow English medical schools to attract the leading academics and provide better facilities for medical students whilst at the same time lead to over subscription to their medical courses, as English students seek to avoid paying the increasing fees.

All in all, I believe there is a convincing argument to support the reinstatement of student grants and the exemption from tuition fees, if not to students of all vocational degrees which ultimately serve the government but at least to medical students - as it can be seen to be an investment that will be profitably returned with service to the NHS.

References

Woodward W. 'Mickey Mouse courses jibe angers students' The Guardian; 14 January 2003
http://news.bbc.co.uk/go/pr/fr/-/1/hi/scotland/3153358.stm

LIFE
Buddhist medicine in occupied Tibet
Kieren Bong (February 2004) [full text...]

Maulik Baxi(January 29, 2004)
Final Year Medical Student Medical College, Baroda, India maulik_baxi@rediffmail.com

The Point raised by Kieren Bong in his article (1) is valid and I must say the state of doctors in Tibetan medicine is very common feature of practitioners of other traditional doctors also! There is a completely different approach of training of traditional healers, right for the beginning they are taught to 'treat a human being and not a symptom' -the essential fact modern medicine forgets. There is equal stress on psychological, therapeutic and preventive aspects in management of any patient. However, when treating a postpartum hemorrhage or a perforated peptic ulcer these methods may not work.

As the modern medicine has its roots in Europe and many drugs have their origin in European pharmacopoeia, similarly the traditional medicines like Tibetan, Ayurveda, Yunani, Siddha, Chinese medicine or any other, has evolved for and by the requirements of local people and regional availability of resources as seen by example of Indian area of Ladakh which is geographically in India but has the same soul as that of Tibet(2). The best way therefore to get the best results is to integrate the systems of medicine at level of undergraduate education only(3). That would perhaps provide the best 'holistic' care as a whole!

References:

Bong K. Buddhist medicine in occupied Tibet. Student Brit Med J. 2004:12(2)(URL:http://www.studentbmj.com/current_issue/life/74.htm
l) (Accessed January 29, 2004)
Wiley AS. Increasing use of prenatal care in Ladakh (India): the roles of ecological and cultural factors. Soc Sci Med. 2002 Oct; 55(7): 1089-102
Baxi MV. Taking Help of the Himalayas. Canadian Medical Association Journal. 2003; 169 (URL: http://www.cmaj.ca/cgi/eletters/169/12/1301#615)
(Accessed January 29, 2004)

EDUCATION
All the things that aspirin does
Rod Flower (October 2003) [full text...]

Sujoy (January 30, 2004)
Business Analyst Evalueserve, India. sujoy.dutta@evalueserve.com

I am a Physical therapist (and an MBA) with an inclination and some experience (3 years)in orthopedic management and pain alleviation.

The possible mechanism for action of Aspirin in cancer is stated below:
Cancer patients have a tumor-suppressed immune system. This can be attributed to the tumor which produces and promotes immuno-suppressive factors such as prostaglandins E3 and E2 (PGE3,PGE2 respectively),which are generally elevated in cancer patients.Aspirin, like all NSAIDs, is a Cyclooxygenase (COX) inhibitor that blocks the degradation of Arachidonic Acid to PGs, thus demonstrating anti-cancer effects.

However, I request the readers not to construe this as veiled advice for indiscriminate "auto-dosing" with Aspirins in an attempt to prevent/lower the possibility of cancer.This non-prescription drug can be potentially harmful unless taken in the confidemce of a doctor....some symptoms/side-effects it causes/aggravates are:
gastric mucosal bleeding,bleeding -par-anum,increased clotting time (which makes any cut/nick a potentially fatal one).

In fact, I suggest a fibre-rich diet and lots of veggies,fruits high in carotenoids and vitamins as a key means to lower risk for cancer.

Add a regime of moderate exercise, cut down on alcohol (if you must drink, stick to Red wine preferably) and "quit" smoking....and you won't go far wrong.

Lead a "stress-managed life" (cd:Sujoy Dutta,Jan.29, 2004), pursue a hobby at least three days a month and maintain decent personal hygeine....that should just about do it.

Keep reading, stay healthy!

Thanks for reading....

LETTERS
Mature students work for fewer years
Pavi Kundhal (February 2004) [full text...]

Nicholas Clement(February 1, 2004)
4th year Medical Student Newcastle Medical School, Newcastle upon Tyne n.d.clement@ncl.ac.uk

Editor -I read Pavi Kundhal letter (1) in response to Peter Cross's article on age and selection of medical students with concern.(2) It is an obvious point that "selecting students in their 40s and 50s inevitably means that these doctors will not be able to work as long as ones trained in their early 20s". However, surely we can't exclude everyone who is not 25yrs or less from medical school? If anyone at any age decides to dedicate their life to medicine, what's left of it, I feel we have no right to bar them. The experience they bring with them can surely only be a bonus to their patients ("tax payer") and colleagues.

Kundhal P. Mature students work for fewer years. studentBMJ 2004 February
Cross P. Does age matter? studentBMJ 2004:12:38. (January.)

CAREERS
Pharmaceutical medicine: making the leap
Dominic Smethurst (February 2004) [full text...]

Irina Haivas
(February 2, 2004)
med student University of Iasi iahaivas@yahoo.com

I foun the article very useful for making some things clear about working in the idnustr. However, I think that medical students with an interest on this could benefit from a bit more information from the author on how to start getting involved with the pharmaceutical industry as a student(considering that a student doens't really have years of experience). Tips on finding an internship, making contact with a company, useful websites would also be good. Many companies have listings on their websites, but they generally require some experience that a medical student might not have.

Another thing is that i have been hearing comments taht a job in this industry is less safer than a job as a doctor in a hospital, and it's easier to loose your job if the research project you were working on has finished, or if the company decides not to focus on your area of expertise anymore, and therefore doesn't need you. I would like to hear the author's opinion on this, as he can express an "inside" opinion.

I think any comments on these issues would be of help for students.

Thank you,

Irina Haivas

NEWS
Medical students should know how to help people affected by violence
Nadeeja Koralage (February 2004) [full text...]

Mohammed Haque
(February 2, 2004)
final year St Bartholomew's & The Royal London azizul@hotmail.com

At The Royal London hospital where I am training, this is a potentially serious situation that can escalate and result in the short term a bloody nose, confusion amongst witnessing patients, a disruption in routine administration while the situation is tended to, and in the long term, probably worst of all demoralisation of the student involved.

Although it is true staff employed under the NHS are carers and with that in view should be unlikely to encounter anything as counter-productive as violence against them, my view is that violence surfaces when staff undermine patient/family issues pertinent to their care as a result of being intoxicated or ignorant. In my experience this can be anything ranging from the frustration of waiting to be seen in A&E, to family acting very unpredictably when the patient is in an acutely life threatening condition. But being so involved with the public, welcoming all with almost any issue means that you will almost certainly encounter the rogue who would rather trade blows than be escorted by the nurse into a room where they can chat over tea and biscuits.

Diffusing a potentially violent situation is the key to controlling the level to which staff are subject to violence. Understanding patient concerns are not a problem since in these situations patients are very forward, but offering a solution may not be within the students capacity. Last year I was given an hour interactive lecture on what to do in the case of the violent patient, and although it went over many things that were common sense, the feeling I took away was that most of how students cope with violent patients came with experience, well into their house officer years. Nothing can fully prepare you for such an event, however talking to other staff about how distressed you were and how you can tackle it better will come as a serving reminder for how to handle it better next time.

If a course was to be devised covering how medical students should deal with violent patients, it would probably need to address different types of problematic patients under specific circumstances and enrolled formally as part of the pre-existing A&E module where students are most likely to encounter aggressive patients. The importance of teaching a course where experience is probably the main teacher, is focussing on the situational specifics, such as knowing the ins and outs of how the hospital works, how to recognise if a patient needs immediate attention, etc.

I think such a course would be beneficial for medical students, more so if it were treated as part of the curriculum, because I think there is room for more explanation in the management of violent patients even for the most streetwisened medical students. Current courses could be further improved be including interactive sessions and role plays for students in a similar way to how exercises in gaining consent from patients and informing family of a damning diagnosis are conducted.

Thankyou for reaading.

NEWS
Medical students should know how to help people affected by violence
Nadeeja Koralage (February 2004) [full text...]

Sophie Hampson
(February 9, 2004)
4th year medical student, UWCM, Cardiff. UK Hampsons@cf.ac.uk

I agree with Delon Human, secretary general of the World Medical Association, that "medical students should have training to deal with patients who suffer from violence"1. As the medical curriculum adapts to produce more patient friendly doctors so too should it recognise the shift in a doctors role from that of solely a physician. It is important that violence is recognised to help prevent further, potentially fatal incidences. However, as medical students, we are cordoned off and ushered on past, unable to learn and understand the implications. It is important to see real cases, to broaden our education and increase our awareness, so that the threshold for suspicion and identification of episodes of violence are lowered.

However what Human fails to note is that as health care professionals dealing with patients who suffer from violence, we are also invariable dealing indirectly with the inflictor too. Therefore perhaps we also need training in averting violence ourselves. We are given advice on breaking bad news and improving our communication skills but never are we taught how to mollify an irate patient or relative. People are impossible to judge and even the most placid may become aggressive in the face of tragic information. Therefore I think it is vital that self-protection strategies are also integrated into our curriculum.

Korlage N. Medical students should know how to help people affected by violence. student BMJ 2004;12;50.(February)

NEWS
Shock tactic campaign links smoking to atherosclerosis
Richard Hurley (February 2004) [full text...]

Aaron Baxter
(February 3, 2004)
2nd year Med student Saba University, Dutch Antilles baxterboys80@hotmail.com

Anti-smoking campaigns must become more aggressive, and this is the step in the right direction. However, the target audience should be the impressionable youth. Stop the smoking before it starts.

Although oozing arteries are pertinent to middle-aged folk, it does not have the same on 12 year old Sara who idolizes the supermodel with the cigarette in her hand and the prada purse in the other. More hip marketing must be used, similar to the style employed by soft-drink companies and the fast-food industry - the type of marketing that is winning over an obese generation. Let's win over a healthy, smoke-free generation. Target the youth.

NEWS
Herbal medicine industry threatens future of thousands of wild plants
Clare Hughes (February 2004) [full text...]

Aaron Baxter
(February 3, 2004)
2nd year Med student Saba University, Dutch Antilles baxterboys80@hotmail.com

Man must learn to live with the consequences of his actions.

On one hand I think it is a shame that the possible discoveries in these endangered plants may never be found.

On the other hand, I simply do not care. I believe most of Herbal Medicine is a crock - another hip marketing tool for the new alternate drug companies.

Go to a real doctor and receive prescription medicine that has passed the rigors of scientific research and clinical trials.

	EDITORIALS Research: what's the point? Polly Brown (February 2004) [full text...]
	Tang Weng Heng (February 5, 2004) Fourth-year medical student University of Malaya wh_tang@hotmail.com
	Research works require plenty of resources. Having limited resources, developing countries should spend them on other more pressing priorities. Research in developing countries should be confined to areas peculiar to their population and their health care needs, particularly those that are being neglected by researchers in developed countries.

EDITORIALS
Research: what's the point?
Polly Brown (February 2004) [full text...]

Sashi Kommu
(February 10, 2004)
Clinical Research Fellow in Urology/ Cancer Genetics Institute of Cancer Research ; Surrey. U.K. sashsekkommu@hotmail.com

I commend the authour on a succint review on a very important aspect of medical practice. From my experience with various members of the medical fraternity, I can concur that research is something that one either alludes to or not. There is nothing inbetween these parameters.

In a small survey done at my unit during my surgical training, more than 90% of the trainees were involved in research out of necessity for progression academically.

Most of us are missing the point. True research dictates a mind free from the concept of self and a special dedication that only a few of us have. A sense of passion to do good and contribute meaningfully is what is needed. Sadly this is rare but not absent. Those of who are not interested in research should not be forced.

Respectfully,

Sashi Kommu

CAREERS
Help! I'm a medic get me out of here
(February 2004) [full text...]

Dr Jane V Bond
(February 5, 2004)
retired paediatrician and member of the original British Medical Students' Association in the 1960's

Disgruntled Houseman

What a depressed and depressing Article from the anonymous House Surgeon! His pre-registration post will have been approved by the General Medical Council and if it is really that unsatisfactory from the point of view of training and experience then he should discuss his difficulties with the Post-Graduate Dean and/or the Director of the Surgical Division. Dr Coull's excellent article in the same issue of studentBMJ gives helpful and constructive advice and this applies not only to 'Blowing the Whistle' but also making a sensible complaint in the first place.

Alternatively the new House Surgeon could decide to try to get the best out of his current post and begin talking to the 'four patients on my list'. How about improving the quality of their time in the Ward by spending more time at the bed-side, which will certainly surprise those who suffer from the fragmented, sporadic attention which is all that many in-patients now receive. In that way he might even impress his Consultant who remembers a time when quality and continuity of patient care was something to be proud of. Many of us have suffered, at some time or other in our careers, from a boss whom we may not have liked or even respected. Surgeons are no worse and no better than the rest of the profession in the way in which they work within a team and thus set an example to their juniors. Sadly a lot of them are thoroughly disillusioned with the current state of affairs in NHS Hospitals and the almost unbearable pressures under which they now have to work, and many look back with genuine regret to 'happy days gone by'. Trying to understand something of this would be a start.

Any current houseman should try to get hold of a copy of 'The Houseman's Tale' by Colin Douglas (Canongate, circa 1970) who trained in Edinburgh. This is described as being -'a shocking, funny but serious novel which mercilessly exposes the routine and the scandals (medical and otherwise) of hospital life. In the untidy struggle against death and disease there is little relief for the young house doctors, and they escape when they can with the help of drink and a comically desperate promiscuity.' Plus ca change.

Anonymous. Help I'm a Medic - Get me out of Here. studentBMJ 2004 12:63 (February)
Coull R. Blowing the Whistle studentBMJ 2004 12:64 (February)

I believe that Colin Douglas occasionally contributes to the BMJ - unfortunately my copy of his book gives no date of publication. It's an excellent read.

CAREERS
Help! I'm a medic get me out of here
(February 2004) [full text...]

Naomi Slator, Aneel Bhangu
(February 9, 2004)
3rd year medical student, 5th year medical student University of Birmingham Medical School naomislator@hotmail.com aneelbhangu@yahoo.co.uk

Although we sympathise with the anonymous author's plights, we feel that her letter(1) (female taken for ease of writing style) is too pessimistic and self-pitying, and instils fear into those who are unfamiliar with a surgical environment (including those sixth formers who read the StudentBMJ).

Stating that a "sympathetic surgeon" only exists as an oxymoron helps no one and, more importantly, is absolutely incorrect. We would be glad to introduce her to surgeons in tertiary referral centres who deal with highly specialised cancer patients through to DGH surgeons who deal with equally deserving patients - all of whom are amongst the most clever, understanding and empathetic people we have observed.

There are a plethora of young and old consultant surgeons who actively teach medical students, and they realise that they need to recruit the best trainees; by scaring them off they harm their own speciality. We suspect that the vast majority of surgeons would be offended at the suggestion that they "psychologically mistreat" their patients. The arrogant, unapproachable surgeon who hates students is truly a dying breed.

It is a shame that she is only in her PRHO year but has already admitted defeat! Given the opportunity to hold a retractor, we are more than grateful for having the chance to scrub, learn about the operation in hand, brush up our anatomy and be quizzed by the surgeon. Maybe if she showed more interest, surgeons would be more willing to actively teach her basic surgical principles such as suturing and wound management - both useful in a medical career (especially A&E jobs).

Even in fictional literature, surgeons are seen as arrogant and patronising, but the very nature of these people is that they can turn their aggression towards a disease process rather than colleagues or trainees; it enables the surgeon to achieve some spectacular therapeutic successes(2).

As our careers progress, we intent to actively encourage all students and be as friendly as a paediatrician in a Winnie the Pooh tie. We are the future of the medical profession, so we would like to suggest that if you see something and don't like the way it's done, don't just complain about it. Do something to change it.

Anon. Help! I'm a medic, get me out of here! StudentBMJ. 12; 63.
Posen S. The portrayal of the doctor in non-medical literature, 15 - The surgeon. Aust N Z J Surg. 1996 Sep;66(9):630-5.

CAREERS
Help! I'm a medic get me out of here
(February 2004) [full text...]

Yasamin Ziabari
(February 10, 2004)
Fourth year medical student Bart's and the London School of Medicine London, UK naomislator@hotmail.com yasaminziabari@hotmail.com

Dear Editor,

With reference to the article 'Help! I'm a medic, get me out of here'1, I think that arrogance can only survive if people are accepting of it.

As far as the patient is concerned, increasing patient autonomy leaves less room for "psychologically mistreating" a patient, and getting away with it.

With respect to medical professionals, the damaging influence of stereotyping comes in: stereotypes breed acceptance. For example, the stereotype of the 'arrogant' surgeon who 'cannot communicate', etc. serves only to lower our expectations. So, when faced with the unattractive behaviour described in the article, we may simply accept them as the archetypal surgeon. Worse still, we may interpret being a surgeon as synonymous with being arrogant. Those few with a propensity for arrogance may even go as far as assuming their arrogance a prerequisite to being a surgeon.

I have yet to encounter a successful surgeon or physician who conforms to these absurd stereotypes. I interpret this as testimony to the fact that the minimum prerequisites for being a successful doctor (or in fact, human being), as the author implies, are respect for others, and the ability to communicate.

Yours faithfully,

Yasamin Ziabari

References:

(anonymous author). 'Help! I'm a medic, get me out of here'. studentBMJ 2004; 12: 63.

EDUCATION
Introduction to Imaging: The abdomen
John Frank (February 2004) [full text...]

Dr.Keshav J Kulkarni
(February 9, 2004)
trainee National Institute of Mental Health and Neurosciences keshav71@hotmail.com

I read the article with great interest and I must thank the author for putting complicated things in pleasant and simple manner. I would like to comment on few things about the article:The order of imaging modalities should have been in order of frequency and more clinical oriented. The role of plain x-ray in gastrointestinal tract evaluation, which is the first investigation in the evaluation of suspected obstruction, is totally forgotten. Nuclear imaging has got undue long description; instead, the role of CT scan in GIT would have been worth writing. In renal imaging, mention about other contrast studies and transrectal ultrasound are missing. Invaluable role of ultrasound makes no mention in evaluation of malignancies, where as recent hybrid scanner is mentioned.

In spite of few odds, the article gives fairly good preliminary idea about abdomen imaging for the beginner, especially about role of nuclear imaging of abdomen.

Reference:

John Frank; Introduction to Imaging: Abdomen: StudentBMJ, Feb 2004:

http://www.studentbmj.com/current_issue/education/52.php