An important message for the coming year

Finally back blogging here after a month out for exams. I have recently been reading alot of scary posts about the way things are going with the new president in america, you-know-who (calling him that, as if hes not villian enough). Building walls and banning refugees, its amazing how wrong the optimistic 'oh-he'll-be-alright-ers' have been already. Anyway 'you-know-who' is the least of our worries.
There is a sneakier and worse problem at hand and it masks itself in ideologies and group thinking. Humans are social animals, some scientists say that our social abilities is what made our species survive sabretooth tiger attacks and ice ages. The forming of small communities and social groups is inherent to human behaviour but ideologies as Prof Jordan Peterson explains in the video below can be harmful. We have to remember a simple fact and this danish advert below illustrates it perfectly, We are all the same! yes we have own individuality and our ways of doing things, beliefs arnt harmful and a little bit of spirituality can go a long way (referencing religious ideology here), but we must make sure that anyone who isn't part of our group/ideology/religion doesnt become the enemy. Black/White/Indian/Christian/Gay/Straight/Rich/Poor/Old/Young/Fat/Trans/..... the list is endless, and its amazing the variation among people.
Watch the video its great!

Hollywood needs to be more unpredictable

Jennifer Lawrence and Chris Pratt , two of the most popular A-list hollywood stars around at the moment, some romance, great CGI, and chuck some 3D effects in there, you’ve got a box office money maker.  I guess that was what was going through the mind of the producers when they decided to produce ‘Passengers’.  With the absence of any real decent major Hollywood films in 2016, passengers was Hollywoods last gasp to make something of 2016. With harsh reviews from major newspapers and a measly 31% on Rotten Tomatoes, you could say they failed.

Chris Pratt puts in an awesome performance, managing to act convincingly as a type of castaway-esk stranded-in-space near suicidal space caveman in the first half of the film. Probably the most interesting and captivating part of the film was Jim’s (Chris Pratt) struggle wih loneliness and the choice whether to wake up Aurora (Jennifer Lawrence). When he finally does choose to wake her up (come on, not a spoiler, obvious isn’t it!), you find yourself involuntarily on the edge of your seat trying not to scream, don’t DO  IT! And its horrifying..

Unfortunately its from this point the film goes down hill. Not to reveal spoilers, basically despite the interesting relationship dynamic between Jim and Aurora, there is a very predictable sequence of impending doom with a very predictable they save the day type rhetoric. (see no spoilers)

I mean, who doesn’t love a film where the hero saves the day. You leave the cinema feeling or fuzzy and warm. But they win Every. Single. Time. In. Every. Single. Film.

Maybe its time the bad guys win?

Don't Let 2016 Get You Down!

Christmas holidays are over for me and the year is almost at its end. Most people have declared 2016 to be an awful year, the never ending list of celebrity deaths and countless negative political events seem to have shaped the year overview. In medical world it seems as if its even worse with junior doctors contracts being imposed, poor evidence circulating mainstream media and bombings of hospitals in the middle east (a recent BMJ editorial highlights this casting aside of moral boundaries, a dangerous development).

Its easy to think that it has indeed been a 'crap year' but I think this just highlights an underlying frustration with how things are going. Its for the first time I highly recommend we all listen to the Queen. And no not the Freddie Mercury kind, although 'don't stop me now' always made me feel hyped up in a 'tiger defying the laws of gravity' kind of way. For those who arn't familiar with it, every year on Christmas day just after lunch, the Queen gives a speech to the nation. It's usually just a well orchestrated and politically-correct summary of the charitable acts and travels around the world she undertook, this year despite not mentioning Brexit once (come on queenie, its history) and seeming to be fixated on the olympics (I bet she always wanted to compete that's why, corgie hurdles anyone?) she decided to focus on the theme of INSPIRATION.

Yes well, 2016 has left nothing to inspired from unless you are a fake news producer, a dedicated neoliberalist or loving Pokemon Go. We should all INSPIRE, take a deep breath (see what i did there) and take on 2017 with new vigor. And not just skip into 2017 like all the gym goers who will be skipping through the gym entrances on January 2nd to only find themselves two weeks later using their new running shoes to microwave pot noodles in (I might have exaggerated here) BUT to take on 2017 full on! 

What does that mean? you will ask, honestly I don't know, I'm writing in a stuffed airport lounge in Luton so its hard to be inspiring here, I guess what im trying to say is:

"Don't let 2016 get you down!" which may be hard to say to a hardcore Star Wars fan a day after Carrie Fisher (princess leia) dies (she died drowning in moonlight strangled by her own bra). 

Go into 2017:

• Prepared for the worst (yes David Attenborough will die one day) 
• Know your enemy! what is neoliberalism, best 2016 comebacks
• Make a new years resolution 
• Stick to your new years resolution (hardest challenge yet)
• Read every day (top articles of 2016)
• Always check the evidence and for gods sake don't listen to fake news

AA Gill Faces Up To His Cancer

Yesterday the prolific writer and restaurant reviewer AA Gill died. 2016 has been a torture to many and just when you thought it couldn’t get worse, it took away another loved human being. The cycle of life and death is of course inevitable but even that resounding truth doesn’t make it any better. (someone please please put Sir David Attenborough in a bubble or something).

I actually first came across AA Gill when I was quite young and had just moved to the UK, my mom would read the Sunday times leave it lying on the dining room table after she finished. I would come in and pick through the various smaller newspapers and magazines in search for sports, motoring or kids sections and briefly read about the rugby scores or some fantastic gadget that will come out in the future (can you believe this iPhone gadget!). As I was flicking through the pages looking at the pictures of far off paradises in the travel section and the contrasting war torn battlegrounds in the Sunday Times magazine as I usually would, my mom came in once and pointed out I should actually READ the paper and not just look at the pictures. Of course I wasn’t interested in Tony Blair or The Foot and Mouth crisis but defiantly I decided to read something and one of the many articles I read that day was by the late great AA Gill.

Today I read his final piece in the Sunday Time magazine, a fantastically written and honest piece about his cancer and experiences with the NHS. I highly recommend reading it. 

The article: “More life with your kids, more life with yourfriends, more life spent on earth — but only if you pay” AA Gill.

He points out that the UK shockingly has some of the worse cancer survival rates in Europe, a third the percentage as Sweden in some instances. This is primarily due to the late diagnosis of cancer propagated by waiting times and turtle paced referral. The NHS, The jewel of the british isles, the pride the UK, might not be so brilliant after all, AA Gill writes:

“We say it’s the envy of the world. It isn’t. We say there’s nothing else like it. There is. We say it’s the best in the West. It’s not. We think it’s the cheapest. It isn’t. Either that or we think it’s the most expensive — it’s not that, either. You will live longer in France and Germany, get treated faster and more comfortably in Scandinavia, and everything costs more in America.”

RIP Mr Gill 

Picture: pic.twitter.com/A7WI9o8jWX @jenbalcombe 

Dunning-Kruger Effect, Fake-It-To-Become-It, All trumped out.

So I just found out that Mr Trump will be the next president of the USA (post written yesterday morning). It’s clear by my Twitter and Facebook feeds that the rest of the world (particularly Europe) are just as surprised as me. Trump has never failed to surprise us, from the very point where he decided to run we laughed. After becoming the republican candidate for presidency we still shook it off and thought there was no chance he’d be president and now look at how our jaws have dropped. The eight year old I'm babysitting at the moment genuinely asked me “does this mean there is going to be a world war 3?” I hope not little guy, I hope not. One of my favourite analyses of President Trumps (wow that’s really a thing) electoral run is the so called Dunning-Kruger effect.

The Dunning-Kruger effect is an interesting cognitive bias where people who an incompetent are unaware of their own incompetence (top of mount stupid) and people who have high ability may underestimate their own competence. Charles Darwin summarised it well when he said "Ignorance more frequently begets confidence than does knowledge". 

The effect seems to be on the rise and this seems to be due to people being ‘more actively misinformed’. Information is everywhere, and anyone can write a blog or post about anything (*cough*my own blog*cough*), encouraging the spread of misinformation. There is really no filter on the internet. Although, it can be actually quite comforting to think that everyone is just winging it (writes Oliver Burkman), this is a dangerous place to be, especially in medicine! Fortunately many medics will find themselves at the opposite end of the spectrum, in a position where they are overwhelmed by the shear amount of knowledge and expertise they will need in the future. One way to approach this is the fake-it-to-become-it approach as popularized in thisTED talk by Amy Cuddy. It works by throwing yourself in the deep end and working step by step towards the end goal acting as if you were already there (not without staying humble and keeping that fear of inadequacy of course).

I guess to close this post what I want to point out is that you can now understand how some politicians seem so certain about everything while infact knowing nothing (because they in fact know nothing). And one should assess their own position on the Dunning-Kruger curve from time to time, by taking a step back, assessing one’s own knowledge objectively and paying attention to critism carefully.

PS: in reply to the eight year old, I found this interestingbreakdown of how world war three might actually happen by Tobias Stone:

Brexit in the UK causes Italy or France to have a similar referendum. Le Pen wins an election in France. Europe now has a fractured EU. The EU, for all its many awful faults, has prevented a war in Europe for longer than ever before. The EU is also a major force in suppressing Putin’s military ambitions. European sanctions on Russia really hit the economy, and helped temper Russia’s attacks on Ukraine (there is a reason bad guys always want a weaker European Union). Trump wins in the US. Trump becomes isolationist, which weakens NATO. He has already said he would not automatically honourNATO commitments in the face of a Russian attack on the Baltics.

With a fractured EU, and weakened NATO, Putin, facing an ongoing economic and social crisis in Russia, needs another foreign distraction around which to rally his people. He funds far right anti-EU activists in Latvia, who then create a reason for an uprising of the Russian Latvians in the East of the country (the EU border with Russia). Russia sends ‘peace keeping forces’ and ‘aid lorries’ into Latvia, as it did in Georgia, and in Ukraine. He annexes Eastern Latvia as he did Eastern Ukraine (Crimea has the same population as Latvia, by the way).

A divided Europe, with the leaders of France, Hungary, Poland, Slovakia, and others now pro-Russia, anti-EU, and funded by Putin, overrule calls for sanctions or a military response. NATO is slow to respond: Trump does not want America to be involved, and a large part of Europe is indifferent or blocking any action. Russia, seeing no real resistance to their actions, move further into Latvia, and then into Eastern Estonia and Lithuania. The Baltic States declare war on Russia and start to retaliate, as they have now been invaded so have no choice. Half of Europe sides with them, a few countries remain neutral, and a few side with Russia. Where does Turkey stand on this? How does ISIS respond to a new war in Europe? Who uses a nuclear weapon first?

Junior Doctors Contract Dispute

So you have probably that junior doctors in England were striking earlier this year and that is some kind of contract dispute going on. So rather than write a long rant about it, here is great video by the well spoken Dr Lauren Gavaghan explaining the situation and a lovely rant by Dr Rant himself answering some of the popular questions.

"There is no funding, there is no plan, there is no model. You cannot stretch an already under-staffed NHS to seven days withou staff, without funding... and impose a contract"

Dear Reader. Here is a very quick guide to answer questions about the junior doctor pay dispute.

1) "The junior doctors are greedy and just want more pay". The junior doctors and the BMA were not insisting on a new contract. The old one works fairly well, but needed to be updated. The goverment are the ones who want to force a new contract through.

2) "They don't want to work weekends". They already do. Most junior doctors have worked every second or third weekend since qualifying. Like most of us, they'd prefer to be paid more at weekends. The new contract basically defines a weekend as 'Sunday evening'.

3) "They're all communist / Trotsky / lefty militants who want to bring down the Government". They're a bunch of A grade graduates who want to help people. In the 1980s, junior doctors didn't strike over 100+ hour weeks. In the 2000s, junior doctors didn't strike over the career-destroying MMC/MTAS. In fact, this is the first series of strikes in 40+ years. Compare this to tube drivers, who strike far more often. Not exactly militant behaviour by the juniors, is it?

4) "They're playing politics with the NHS". They will be losing a quarter of their monthly wages, and may need to repeat their training year as a result of these strikes. Meanwhile, multi-millionaire, Jeremy Hunt could end the industrial action in seconds.

Junior doctors and learned helplessness; a rant.

Pete Devesons's speech opposing the motion "This house believes that medicine is the best career in the world", recorded at the #BMJLive Big Debate in London on 23/10/15. Its been a rough ride for Junior Doctors but now lets take action, keep looking up. 

Interesting Health NEWS today

Whenever I read the paper (and if I have a pen to hand) I tend to highlight interesting quotes and healthcare related stories. Here is everything in the news today I found reading various papers. 

Facts on asthma
Asthma costs the UK 1.1 billion pounds a year.
It causes three deaths a day while more than 270 people are admitted to hospital a day because of it.
The UK has one of the highest Asthma burdens in the world, >18million people.
SMART INHALERS (for example) will be hugely benficial in the future keeping track of patient adherence and reminding patients to take their medicine, reducing exacerbations.

We need a new health tax?
Various GP surgeries, A&E departments and Units are being closed around the country to avoid a predicted 20 billion pound shortfall in 2020. Dr Dan Poulter MP reckons a new health tax or rise in national insurance could relieve the pressure on NHS budget.

Readmissions mean higher death rates?
A study presented at European society of Cardiology in Rome over the weekend compared patients being admitted 1 to 3 times to those being admitted 4 to 7 times over the study period (500,000 patients in the study). The results showed those who were admitted more (4-7 times) had almost 20% increased risk of dying.
Advice was to make sure patients were taking the correct medication after discharge and diagnosed properly. (duh?)

Ipad vs Midazolam
Results presented at the World Congress for Anaesthesia in Hong Kong showed that tablet devices with 'age appropriate games' are at least as effective than midazolam in in dropping anziety levels prior to paediatric surgery.
The Ipad group had higher parental satisfaction and nursing staff satisfaction rates than the midazolam group. Dr Chassard involved in the study quoted by the Independant "electronic devices are a non-pharmacological tool that can reduce stress around the time of the operation without any of the side effects of sedatives".

101 year old transplanted kidney
We dont know why but some transplanted kidneys are able to resist rejection. While on average most are rejected after 12-15 years. Sue Westhead (68yrs) has the worlds oldest which she received in 1973 from her 57yr mother.
3000 people are on the transplant waiting list.
58,000 are effected by kidney failure, mainly caused by diabetes and high blood pressure.
No one really understands why chronic rejection occurs, is it poor lifestyle choices?
2000 transplants a year are from deceased donors and 1000 from living donors

Sources: The Metro, London evening standard, the independant, i newspaper. 

Junior doctors dispute explianed

This explains well the juniors doctors point of view with the current contract dispute.
http://imagizer.imageshack.us/a/img922/3550/F1r5so.png

Dont waste your BREXIT vote

On the 23rd of June a referendum will be held in the UK to decide whether Britain should stay in the EU or leave (Brexit). Leaving the EU will put restrictions on free trade, free movement of labour and affect our global trading power (as well as security, believe it not). Brexit will be a nightmare for expats abroad and students like myself studying in Europe (because of restriction of free movement, VISA, taxes etc).
Admittedly the statistic that Britain pays more than they get back is true in terms of hard cash but if they were no longer in the EU that difference would be much larger. Of course the actual effects of Brexit or staying in will all vary depending on the deal that is made with the EU after the voting.
A good explanation by the BBC linked here.
This link shows you how you can vote while abroad. I for one will be rushing to make sure I get my vote in, as BREXIT will be bad news for me, a student abroad. UK governments own advice link.

It's official now, Homeopathy doesn't work

A total of 57 systematic reviews, containing the 176 individual studies, focused on 68 different health conditions - and found there to be no evidence homeopathy was more effective than placebo on any.

ZIKA virus overview

Named after the Zika forest in Uganda, the Zika virus is all over the news at the moment.

The virus belongs to the Flavivirus genus which include diseases such as Dengue and Yellow fever. (other flavivirus diseases; japanese encephlitis, tick borne encephalitis, usutu virus and west nile virus). 

The Zika virus is trasmitted by the Aedes aegypti mosquito, which is endemic to South America and Africa and also responsible for the spread of Dengue and Chikungunya (fever and joint pains). 

The current outbreak is in Central and South America after starting in Brazil and French Polynesia.

Once bitten by the mosquito the incubation time is around 10 days.

Most people have little of no symptoms but it can cause a range of non-specific symptoms such as myalgias, headaches, fevers and arthritis.

The diagnosis is clinical and based on travel and exposure history. The viraemic period is short and patients will be positive for viral DNA tests 3-5 days after onset of symptoms. After that serology will be positive, look for the presence of Zika virus IgM. 

No vaccine available, although drug companies are under heavy pressure to develop one soon..

Treatment is primarily supportive care with antipyretics and painkillers if needed. Avoid use of NSAIDs or acetylsalicylic acid, because of fears of hemorrhagic syndrome or reyes syndrome. 

The disease has been brought to the attention of the news because of the possible link with Microcephaly in new borns. For this reason the brazilian government has advised against pregnancy until the disease is under control and better understood. Its also for this women who are pregnant or intending to be soon should avoid travel in the endemic areas. There is also many reported cases of Guillain-Barre syndrome (acute ascending symmetrical polyneuroathy).  

Useful  links: CDC, European centre for disease control

• Also spread by the Aedes albopictus mosquito. and some other Aedes mosquito species. 
• Genetically modified mosquitos are being explored as a potential way to combat the mosquito and disease. The possible environmental impact of this approach is being studied. 
• First isolated in 1945 from a Monkey
• Note that many of the non-specific symptoms are similar to Malaria, which is endemic to the same areas but carries a much higher mortality rate. 
• Urine will be positive for Viral RNA for ten days after symptoms onset.

Source: http://jeffreyhill.typepad.com/.a/6a00d8341d417153ef01b7c80f713d970b-800wi