surgo autumn issue 2013
TRANSCRIPT
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1/20SURGO Issue 83.18/09/2013November 2013 86: 2
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The Surgo Team(during their own freshers weeks)
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Surgo Autumn Issue
1 Editors note
2 Medical news
3 Interview with Bob Leckridge
4 Homeopathy and the NHS
5 The Science of Snake oil
7 Cannabis as a medical therapy
8 The Rise of E-Cigarettes
9 Surgo research: Hangover cures
11 Review: Bad Pharma by Ben Goldacre
14 Medical Myths
15 Horror-scopes
16 Yules Yarns
Contents
Ella BennettEditor
James TajkarimiAssistant Editor
Josh NeilsenProduction Editor
Tom BaddeleyFinance Editor
David BoyleArts Editor
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So firstly, my most sincere congratulations on surviving the first few weeks
of the dreaded Glasgow winter, its only going to get worse. But fear not, as
the hours of daylight diminish, and coursework deadlines loom, Surgo is here
to cast a ray of metaphorical sunshine (or provide literal fire fuel) to get you
through the cold, tedious nights staring at that new glass box in the SL.
First things first, youre probably wondering why theres a picture of
Stonehenge on the front. It all started one night when the mildly inebriated
Surgo team were trying to come up with a theme for this issue. Halloween is
so last year, so what about druids? said one anonymous contributor. And
thus, the can of worms was opened (with a slate flint found at Stonehenge
obvs). In order to be a little less obtuse however, and a lot more accessible
(to both our shiny new contributing writers, and you, our indispensablereaders) we decided to include the odd druid, but focus generally on a theme
of scepticism. Dont worry though, there are a still a few survivors of the
druid apocalypse namely digoxin, as Josh Neilsen will explain (pg. 5).
This issue begins with a cynics guide to some of the most fiercely contested
aspects of modern medicine, starting naturally (see what I did there) with
water, sorry, homeopathy. Surgo even took a little school trip to the Glasgow
homeopathic hospital to interview one of alternative medicines biggest
advocates. Youll be pleased to hear that contributing writer, Mike Pretswell,
manages a non-judgemental approach unlike many of his Surgo compatriots.
From homeopathy to herbal medication, Finance editor Tom Baddeley argues
the case for medicinal cannabis and Druid Boyle takes a cutting edge look at
the Rise(and potential demise) of E-Cigarettes. Next, yours truly delves into
the murky world of the pharmaceutical industry, looking at Ben Goldacres
book, Bad Pharma. We then have a new, exciting edition to the Surgo
repertoire: research. Find out about our first randomised control trial on page
9 and look out for the results in the next issue.
Finally, with all of the vaguely educational stuff out of the way, we turn to
Medical myths to bring out Dan Taylor-Sweets inner misogynist and
Pyschic Suz is back with a therapeutic dose of horror-scopes. Last but not
least comes Surgo story time, with Yules yarns, a truestory about hypnosis
to counteract all the hokum.
Enjoy!
Ella Bennett
Editors note
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Editors Note
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News
BMA backs seven-day week for
consultants.
If you thought when you became a consultant you would be
spending your weekends on the golf course then think again,
the BMA has decided to back calls for seven day working
within NHS hospitals. However, they have stopped short of
saying elective care should be delivered at the weekends,
claiming that the
resources are not currently available. Instead theypropose that urgent and acute care should be the focus of this
extension to help to reduce mortality.
This push for seven-day consultant care has come from a
recognition that mortality rates at the weekend are higher than
during the week. Which many have attributed to the lower
numbers of senior doctors in the hospital during out of hours.
5 week old baby becomes
Britains youngest ever organ
Donor
A 5 week old babys kidneys were transplanted into a 22
year old women saving her life. The kidneys were just4cm
long but will grow to up to 75% of normal adult size. The
kidneys, heart, liver and lungs all have the potential, even
before birth, to be transplanted into an adult. The success of
this treatment has reignited debate about whether it is ac-
ceptable to use such young donors.
Obesity due to slow metabolism?
Many people complain that being overweight is due to a
slow metabolism, and research based in Cambridge and
published in Cell claims to have found a link. The
researchers knew that deletion of a kinase suppressor in
mice led to obesity through an increase in appetite and a
slowing of metabolism.
In their effort they studied the genomes of 2,106 people
with severe early onset obesity and compared these
results to the genome of normal control individuals. They
found that people with a mutation in the KSR2 gene were
more likely to be obese. This nonetheless is not common,
with only around 1% of the population having this muta-
tion, and only 2% of children who were obese by 5.
Oreos more addictive than
cocaine
Some undergraduate students at Connecticut
College have suggested that Oreo cookies are as addictive
as cocaine. In a study conducted in rats the students found
that the Oreos activated the nucleus accumbens, the
brains pleasure centre. The neurons were much more
active when the rat was given Oreos as opposed to cocaine.
Now we all have an excuse for finishing a packet of Oreosin one go.
Medical News
Feeling down, why not bake a loaf?
After all the excitement of the Great British Bake Off re-
search has suggested a link between baking and
mental health. A report published by the Real Bread Cam-
paign (no conflicts of interest there then) written in conjunc-
tion with last years GBBO winner John Whaite, has suggest-
ed that baking could form part of the solution for many peo-
ple suffering with mental health issues. John draws from his
own experiences when he was dealing with crippling depres-
sion and used baking as a form of pill-less Prozac. This
has already crossed into clinical practice, a team at
Yeatman Hospital running therapeutic baking classes for
patients with dementia.
2
Man suffers from extreme B.O for 4
years
A 40 year old Chinese man suffered from extreme B.O for
4 years before consulting his doctor. He had creamy
yellow secretions on the hairs under each arm which
frequently stained his clothes.
The man was diagnosed with trichomycosis axillaris, a
bacterial infection. The rancid odour was caused by the
bacteria metabolising the testosterone found in sweat.Ew.
A summary of the latest medical news by contributing
writer Jamie Henderson
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Interview
3
Surgo sat down with Dr BobLeckridge, an associate specialist
in integrative medicine at the
Glasgow homeopathic hospital, to
talk about alternative medicine
and the difference between a
homeopath and a homeopathic
hospital.
Can you start by explaining
what sort of treatments you
offer here?
It was never a separate way of dealing
with people it was more about compli-
menting. When we were set up there
were even surgeons and theatres. Now
we have a new hospital and there arent
theatres anymore but its still about
complimenting treatment and bringing a
holistic, and multidisciplinary approach.
We start with a 90 minute consultation,
then you might get some group sessions
or more 1:1 counselling .We have
physios and nurses, we prescribe
antibiotics and do blood tests just like a
GP but we also offer things like yoga, art
therapy, and homeopathy as well.
What percentage of people get
some benefit and how much
benefit do they get?
We use a quality of life outcomes score;
it goes from -4-+4 so 0 is no change 1 is
some improvement, if its completely
gone away, hallelujah, then its+4.Consistently we see in audits about
70-75% score +2,+3,+4
Is it fair to say you deal
primarily with psychological
rather than physical wellbeing?
I dont accept a duality between mind
and body because I dont meet anyone
whos only got one. If someone comesalong and theyve got stress, they might
have chronic pain or they might have no
job, a son whos a drug addict and a
husband whos an alcoholic; whatever
the sources of stress the body is going to
show the effect. We try to get away from
the idea that the problem exists in my
liver or my joints or the problem exists
in my mind and instead say maybe its
my system that needs attention.
Do you think the patients you
receive are maybe predisposed
to thinking that homeopathy is
going to be for them?
Some people do come looking for the
homeopathic medicine because mum or
granny always used it, but theyre very
much in the minority. Any survey weve
done shows that the vast majority come
because theyre stuck, theyve been
round all the other clinics and they just
want help.
Do these drugs offer anything
above placebo?
In some ways I wish wed never had
them because it is a controversial area, it
isnt explainable. For me the issue in
placebo is deceit. I wouldnt offer some-
thing that I didnt think had a genuine
chance of helping them. If you receive a
pain killer and feel better, part of that is
the placebo effect. If a person comes
back and says theyve got less pain, howdo I know if that came from the powder
they took or the consultation they had?
Does the name Homeopathic
hinder your ability to practice?
Yes absolutely, currently theyre going
out to tender to change all the signage
and just put NHS centre for integrative
care. GPs for example, have no idea thatwe do cognitive therapy, they have in
their head that we just hand out funny
wee powders that dont actually do
anything.
If you just practised good
holistic medicine without the
alternative therapies I doubt
thered be much controversy, is
that a reasonable position?
Its not a reasonable position from the
patients perspective because if
somebody has exhausted all other
interventions then what are you going to
offer them next? So if theres an
alternative approach that isnt as
evidence based but doesnt seem to kill
anyone or harm anyone and that can
make a difference to 75% of those
people then I think youre offering
something worthwhile and I cant seehow those people are advantaged by
stopping them having access to that.
Do you worry about losing
your funding?
The BMAs position is that we should
close this place, but the BMA has never
been here to see what we do. If people
actually understood what we did here,
that its not all pills and magic powders, I
dont think thered be a problem. Butyes, I am worried that people will
campaign sufficiently well, out of a lack
of understanding, to get us shut down.
Interview: Dr Bob Leckridge,
Glasgow Homeopathic hospital
Bob Leckridge
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H
omeopathy, and its older,
marginally more respectable
brother complimentary
medicine, can be a seriously controver-
sial topic. Many of its supporters would
have you believe that the omnipresent
spectre that is Big Pharma looms over
doctors healthcare forcing toxic and
un-natural pills onto unsuspecting old
ladies. On the other side much of the
medical profession would probably paint
homeopaths as either harmless misguided
hippies or worse, snake oil salesmen who
happily flog a product they know wont
work to societys most vulnerable cus-
tomers. Dr Tom Dolphin, chair of the
BMA junior doctors committee publicly
denounced homeopathy recently, claim-
ing that Homeopathy is witchcraft. It is
a disgrace that nestling between the
National Hospital for Neurology and
Great Ormond Street there is a National
Hospital for Homeopathy which is paid
for by the NHS.
Yet no amount of bad publicity appears
to be enough; every year millions of
people turn to alternative medicine to
treat serious, chronic and often life
threatening conditions. Homeopathy is so
popular in parts of the UK that there are
now both homeopathic dentists and a
number of homeopathic vets offering
treatments for everything from cats to
cockatiels.
Facts and Figures
Across the UK there are 400 consultant
grade homeopathic doctors registered
with the GMC and three dedicated home-
opathic hospitals, the largest of which
treated 27,000 patients last year. At least
200,000 people a year receive homeo-
pathic treatments through the NHS with
prevalence being particularly high in
cancer patients. This amounts to an
annual cost of a 4,000,000.
History
Alternative medicine has been around
quite literally for as long as people have
been getting ill. That said, alternative
medicine is as rapidly changing as any
other aspect of medicine. While generous
and frequent application of leecheswould have been cutting edge in a medie-
val hospital, the idea that a good leeching
might cure your pneumonia would now
be a stretch for even the most diehard
practitioner of alternative medicine.
While there are hundreds of alternative
therapies the two most common are
homeopathy and acupuncture. The term
homeopathy is often used to refer to the
whole spectrum of alternative medicine
however true homeopathy refers only tothe use of medicines based on a principle
that like cures like. Homeopathic
medicines contain a substance which if
given in a larger dose would induce the
symptom its trying to treat; the homeo-
pathic cure for insomnia is for example
tiny doses of coffee. The most potent
homeopathic drugs are so dilute that they
probably dont contain a single atom of
the original substance.
The controversy
The most hotly contested subject is
unsurprisingly, NHS funding for
alternative therapies. Last year NHS
Lothian withdrew its 250,000 annual
funding for homeopathy after a public
consultation found that 74% of
respondents were in favour of defunding
the service. The decision sparked outcry
among alternative medicine proponents
and prompted letters of support fromJeremy Hunt and Prince Charles.
250,000 may sound like a lot but it is a
mere 0.017% of NHS Lothians total
budget. Some would argue that this
represents a good investment for the
thousand or so patients treated annually.
There is also an argument however, that
we shouldnt spend anything on
unproven treatments when numerous
other drugs, with proven scientific basis,
are deemed too expensive.
The main argument in favour of
alternative medicine is that patients do
genuinely feel better with more than 80%
reporting a positive outcome. Even if this
is simply our good friend the placebo
effect rearing its beautiful head again,
the case that homeopathy can be helpful
clearly stands. This is particularly
relevant given that a large number ofthese patients are suffering from chronic
conditions for which conventional
medicine has little or no answer; it is
difficult to argue against anything which
gives them some relief be it physical or
psychological. Indeed there are a
relatively large number of alternative
medicine practitioners who will freely
admit that they are only trying to maxim-
ise the placebo effect and are aware that
the treatment itself is sometimesirrelevant.
It would be nave to denounce the
placebo affect as a valuable aspect of all
forms of medicine; patients do genuinely
feel better and there is a large evidence
base supporting it. A double dose of
placebo has even been repeatedly shown
to be better than a regular dose, and
intravenous placebo performs better still.
There are several factors which help givealternative medicine good feedback,
consultation times are much longer and
clinics are designed to be as calming and
friendly. The majority of consultation
time is also given over to what amounts
to cognitive behavioural therapy with any
actual medication being an adjunct. Both
of these have good scientific basis and
ideally, should be implemented across
conventional medicine. If patients feel
that conventional medicne is not address-
ing these needs then it may well lend
credence to the belief that modern medi-
cine can no longer see the patient for the
disease.
Homeopathy and the NHSBy contributing writer Michael Pretswell
Homeopathy is witchcraft,
it is a disgrace that is it
paid for by the NHS
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Surgo Autumn Issue
Listen up, fools. Youll hear a lot of BS about so-called
natural and alternative remedies being superior to modern
medicine, because someones second cousins aunty cured her
wart with green tea. Lets set the record straight. Some plants
are good for you. Some are not. Anyone who has tried eating
both a tomato and a nettle can tell you this. But its not always
simple to eliminate the bits that will leave a sobbing woman
where your mother used to be; for many years arsenic was
eaten and rubbed in the skin to improve the complexion
(which it did, if you like your skin pale and smelling of
corpse). Its taken a good few millennia for us to get to the
point where we have a vague idea which enzymes and recep-tors a drug is even targeting, and there are still many drugs
used every day which we dont fully understand..
However, we dont always need to understand something for it
to be effective and not all drugs in use today were invented in
a lab. Through centuries of trial and error (mostly the latter),
many compounds have been discovered gift-wrapped straight
from Mother Nature, and have been part of many a witch doc-
tors arsenal (though so was eye of newt, so really it just goes
to show, even con-artists get lucky). Here are a few of the
more interesting substances to make it from potion to prescrip-
tion.
Clostridium Botulinum Botox
Its neurotoxins are responsible for a severe form of food poi-
soning known as botulism, but the one of the C. Botulinum
bacteria toxins is also the source of a million fake smiles as it
forms the active ingredient in Botox. Its still a neurotoxin
though, so whether youre an idiot for injecting it into your
face for cosmetic reasons is a matter of personal conscience.
Opium Poppy Morphine, Codeine, Oxycodone, Di-hydrocodeine, Fentanyl, Oromorph, etc
The opium poppy has a lot of claims to fame being responsible
for a series of wars between European powers and China, the
odd bit of Romantic literature, and many a crazy night-in. But
its also the source of the majority of heavy-duty analgesia.
The first derivative was synthesized by a German chemist who
gave a generous dose to himself and a few close friends before
suffering through the effects of severe opiate poisoning for
several days (and while they survived, it isnt recorded if their
friendship did). The experience prompted him to name the newcompound morphine, after Morpheus, the Greek god of sleep,
and it proved such an effective pain killer that more opiates
soon followed. Today, in gratitude, the poppy flower appears
on the coat of arms of the Royal College of Anaesthetists, as
their unemployment rates would be considerably higher with-
out it.
Erythroxylon CocaPlant Cocaine
Despite its reputation, cocaine has a number of more scientific
(though arguably less exciting) uses as an anaesthetic. The
coca plant is native to South America and, when conquistadors
arrived in the 16thcentury, they were amazed at the effects
chewing its leaves had on the locals, who managed to seem
happy and alert even as their land was being stolen. The plant
was imported back to Europe from South America and after
some experimentation (pun intended), a German chemist by
the name of Gaedcke created the alkaloid derivative cocaine.
For the next 50 years this was used for everything from tooth-
aches to flatulence to morphine addiction, before a prohibition
movement began in the 1910s that led to its ban from general
use.
A cynics Guide To Alternatives Medicines by Josh Neilsen
The Science of Snake Oil
Opium poppy seed heads
Clostridium Botulinum
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Surgo Autumn IssueSt Johns Wort St Johns Wort
A folk remedy that actually works quite well, St Johns Wort
is a bit of a mystery. Despite being proven effective in mild to
moderate depression in clinical trials, noones quite sure how
it works or even what the active ingredient is. Given the po-
tential side effects of many anti-depressants though, if youre
feeling down, SJW might be worth a try (possibly more effec-
tive when combined with adjuvant therapies, such as hugs).
Artemisia annua Shrub Artenimol, Artemether
For over two thousand years the shrubArtemisia annuahas
been an ingredient in traditional Chinese medicines to treat a
variety of ailments, most of which it was probably useless for,
but the placebo effect is a wonderful thing. Anyway, after the
whole world started using quinine as toothpaste and resistant
strains of malaria emerged, the Chinese military began Project
523 (I can only assume it sounds more exciting in Chinese) to
find an alternative, in part at the request of North Vietnam,
whose army was becoming increasingly malaria-ridden. The
project screened various plants for anti-malarial properties
and, after picking some shrub found its active ingredient, Ar-
temisinin, to be more effective than any of the existing drugs.
They understandably didnt share this with their enemies in
the West at the time, but derivatives of Artemisinin are now
part of the WHOs first-line treatments for malaria.
Yew Tree Bark Paclitaxel
Paclitaxel was one of the first chemotherapy drugs discov-
ered. It was discovered during an American screening pro-
gram isolated it from the bark of a yew tree and found it to be
effective against ovarian cancer and melanoma. Unfortunate-
ly, its production proved controversial as to meet demand
about 360,000 trees would have to be chopped down each
year, something which environmentalists said wasnt sustain-
able (and they were right). Luckily, an alternative manufactur-
ing process was created that necessitated far fewer trees, al-
lowing cancer patients and yew tree fans alike to breathe a
sigh of relief.
Willow Tree Aspirin
Dating back as far as Hippocrates, willow has been used for
pain relief, usually from powders or teas of the bark and
leaves. In 1829, the active compound was found to be salicin
and the hunt for a palatable derivative began because tree bark
generally doesnt taste great. It was eventually synthesized
(by YET ANOTHER German chemist) into acetylsalicylic
acid, better known today as aspirin and went on to great suc-
cess as part of the WHO pain ladder.
Foxglove Digoxin
Discovered, depending who you ask, by an 18thcentury doc-
tor called William Withering, or by gypsies who werent rich
enough to have a medical degree. The story goes that a patient
with a bad heart condition, whom the doctor had been unable
to treat, went to see a local gypsy, who did what leeches
couldnt and cured him. The doctor tracked down the gypsy,
and after some bartering learned the main ingredient of the
gypsys concoction had been the purple foxglove flower.
Withering promptly stole the naive gypsys work and, after
experimenting with various extracts from the plant, intro-
duced its use in 1785, which has been dubbed by some to be
the beginning of modern therapeutics (though sadly for the
gypsy, not intellectual property law).
Friendly Bacteria YakultTM
Just kidding, that stuff is more pointless than Donald Trumps
comb-over.
So to sum up, yes, some herbal remedies are good for you.
Once upon a time doctors werent much better than the con-
men they were competing with but now we have the GMC
and study protocols, so standards have improved at least a
little, and you dont have to go to your local gypsy for medi-
cine. The therapies that actually work, and can be proven to
do so, arent ignored; theyre studied, refined, and eventually
they wind up in the BNF. So while you can choose to go herb-
al, and might feel more natural for it, Id recommend the tab-
let over the tree bark.
St Johns wort flower
Foxglove flowers
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C
annabis preparations have been
used to treat a variety of medi-
cal conditions as far back as the
practice of traditional Chinese medicine.
Although recreational use in the UK is
illegal, there is growing popularity in the
using the drug for medicinal purposes,
particularly in the US.
Cannabis contains 2 main psychoactive
compounds: cannabidiol (CBD) and
tetrahydrocannabinol (THC). Medicinal
cannabis tends to have a higher CDB to
THC ratio, with recreational cannabis
tending to be the opposite. The body
actually has a natural endocannabinoid
system consisting of two receptors:
CB1 (which THC acts on) is mainly
expressed in the central nervous system,
whereas CB2 (which CBD acts on) is
expressed in the immune, cardiovascular
and gastrointestinal systems as well as
the central and peripheral nervous
systems. It is the impact on these
systems that gives cannabis such a wide
range of effects.
Medical uses
CB2 agonists have been shown to have
therapeutic effects in a wide range of
diseases. For example, research into
CB2 expression in leukocytes and mast
cells has shown that they mediate the
release of inflammatory cytokines which
may help regulate both the inflammatory
response and pain perception. This has
potentially beneficial effects for a huge
number of inflammatory conditions from
rheumatoid arthritis to Crohns disease
and even diabetes.
In addition to this, CB2 receptors are
overexpressed on the plaque-affected
cells which are implicated in both
Alzheimers disease and multiple
sclerosis; CB2 agonists have been found
to stimulate macrophages to remove
these plaques leading to a reduction in
symptoms. THC on the other hand is
used as an anti-emetic; its synthetic
derivatives are more effective at
reducing nausea and vomiting associated
with cancer chemotherapy than other
treatments. THC also works both
centrally and peripherally to relieve
cancer-related pain, with the advantage
of being an alternative to opiate based
therapies. Another use of THC is as an
appetite stimulator (not surprising
really).
Adverse effects and criticism
Although some medical uses of cannabis
seem very arbitrary, all licensed applica-
tions at the moment have undergone
clinical trials and found to have these
beneficial effects. These trials have all
been fairly small so far but more trials
are being undertaken as we speak as
restrictions on the drug are reduced.
It is true that cannabinoids are addictive
drugs, however their addictive potential
is considerably lower than many com-
monly prescribed drugs or other recrea-
tional substances. Furthermore, despite along history of non-medicinal use, the
have been no recorded cannabis-related
deaths from it. Another principal area of
dispute surround potential routes of
administration. Though smoking is the
most common at the moment, this
clearly carries all the risks associated
with smoking such as COPD.
Medicinal cannabis is in fact, far more
effective when eaten, vaporised or used
as a spray or tablet for example.
Research is currently being done into the
long term damaging effects of cannabis
use on the brain but no definitive links
have been found so far. With continued
research into medicinal cannabis, it
might be possible to isolate its potential
whilst not producing a high feeling,
possibly unlocking its use as a legitimate
medical drug.
Surgo Autumn IssueCannabisas a Medical Therapy
By finance editor Tom Baddeley
Worldwide cannabis use
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Surgo Autumn Issue
Since the smoking ban came into effect
in Scotland in 2006 and the rest of the
U.K. in 2007, companies across the
country have been looking at ways to
capitalise on the negative image placed
on smoking and idea that cessation is the
way forward. Before the ban, Tobacco
sales alone in the UK were 13 billion;
thats enough to buy over 150 Gareth
Bales for your personal consumption
nomnomnom. There is a staggering
amount of money in the smoking
industry and E-Cigarettes are the latest
product to try and take some of the
tobacco sales and multiple companies are
desperate to gobble up some of the
reward.
I recently held a Q&A session with
myself:
Where did E-Cigarettes come
from?
Like many of the great inventions of our
time, the e-cigarette was born in the dark
underbelly of Chinas laboratories. It was
made by none other than Surgos
favourite pharmacist Hon Lik created a
piezoelectric ultrasound emitting element
that vaporises a jet of liquid containingnicotine diluted in a propylene glycol
solution (plagiarism? check).
What are they? What do they
do?
Ultimately they deliver the same nicotine
kick to smokers but are less harmful and
cheaper. Upon inhaling, the liquid in the
cartridge, where the filter would be, is
heated so that some of the liquid
nicotine is vaporised and absorbed
through the mouth. There is some
smoke (primarily water vapour) and
an a LED light at the end of the cigarette
that lights up upon inhalation to mimic
the glow of a real cigarette but is
naturally available in a variety of colours.
Another issue they tackle is that they
provide the same habitual feeling of
holding a cigarette, a problem that has
perhaps prevented patches and gum from
really kicking off.
Whats all the fuss about? They
sound splendiferous!
E-cigarettes lack tar and other nasty
additives but the BMA is concerned
about the revolution due to the lack of
rigorous, peer-reviewed studies on their
safety and efficacy. Concerns are placed
on the fact that e-cigarettes can legally
be sold to children and are not treated as
a medicine so the legislation surroundingthem is unclear and thus, potentially
unsafe. The use of them in public places
is perfectly legal yet has led to many
stories that have been brought to public
attention. Planes have even had to be
turned around after users refused to stop
smoking their e-cigarettes.
Personally I was in a pub recently (lad)
and witnessed a fellow punter smoking
an e-cigarette which was an unusual
experience but not by any means
uncomfortable. It is strongly argued by
many, including the BMA, that
e-cigarettes should fall under the same
legislation as cigarettes and as such be
banned from public places.
What does the Fox say?
Ring-ding-ding-ding-dingeringerding.
What does the future hold?
There are estimated to be around 1.3 mil-
lion e-cigarette users, up from 700,000 in
2012 which emphasises the remarkably
rapid revolution that is sweeping our
shores. In October the European Parlia-
ment drafted a law to introduce a number
of measures affecting the regulation,
strength, advertisement and sale of E-
cigarettes. As it stands, it does appear to
be a favourable alternative to smoking
and some companies argue their products
will overtake sales of tobacco within the
decade. Bold claims but the winds are
changing. All we ask of you readers is to
stay vigilant, stay informed and brace
yourselves.
Smoking an e-cigarette can rapidly increase
the onset of baldness...
The traditional cigarette has the winds against it, arts editor Druid Boyle explores the latest technology getting
ready to replace it
The rise of the E-Cigarette
Ned Stark is a big fan
The fox.
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Introduction
The alcoholic hangover is the most commonly reported symptom experienced by those that drink alcohol in excess. It develops
when blood alcohol concentration returns to zero and is characterized by a feeling of general misery that may last more than 24
hours.
Fig. 1 A hangover
Its exact pathophysiological mechanism is poorly understood, but its mereoccurrence may infer an evolutionary advantage; acting as a disincentive to
excessive drinking with negative reinforcement of undesirable symptoms.Addition-
ally it has substantial economic implications, accounting for many sick days yearly,
and mental, physical and social health consequences including impairment of
memory and diminished visual-spatial skills. Currently a Google search for
hangover cure yields 13.5 million hits alone, with no general consensus from people
or indeed population[See fig. 2] on what works best.No scientific evidence
currently exists that supports a cure or safe and effective therapeutic measure for a
hangover, be it in a medical, complementary or traditional form. With this in mind
it seems apt that we investigate the role of some commonly used treatments said to
alleviate symptoms. Although as an aside, we should probably say please dont try
this at home and get us in trouble, and that the best way to avoid a hangover is to
consume alcohol only in moderation, or not at all, or whatever, its your funeral.
The relative effectiveness of interventions intended
to treat alcohol hangover: a randomised control trialTadjkarimi J, Bennett E, Neilsen J et al.
Background
Veisalgia affects many millions daily. Its signs and symptoms are non-specific, presentation is highly heterogeneous amongst
populations and it currently has no FDA approved management. Unpleasant physiological and psychological effects include
drowsiness, headache, dry mouth, nausea and vomiting, concentration problems and the all-encompassing symptom: feeling
like shit.
Never heard of it? Neither had I. It is in fact whats better known as a hangover. That dawning realisation on waking from a
sleep so bad you may as well have slept in a cardboard box in the hold of an airplane, with nothing but a badger for company.
After cursing Viper/that friend that handed you your last Sambuca/ all Gods who art in heaven and recoiling from all forms of
natural light you ask yourself Why? Why in the 21stcentury do we not have a cure for this particularly vile medical state?
Hangovers are poorly understood from a medical standpoint as healthcare professionals prefer to study treatment and preven-
tion of alcohol abuse given the relative health burden. Rather than the weird and wonderful remedies for a hangover, everyone
has their own go-to cure, all of which they swear by with surprising dogma whilst denouncing the rest as twaddle worthy of a
Victorian apothecary. Fitting snugly in with the theme of this issue but sadly featuring no druids, Surgo has decided to hypo-
thetically investigate a handful of hangover cures in a scientific fashion (or as close as we can get without ruining a decent
night out).
What follows is the experimental protocol for Surgos first mock trial: A somewhat blinded, randomised, placebo controlled
parallel trial investigating the effectiveness of common hangover remedies in ameliorating the effects of veisalgia. What fol-
lows is the introduction and method to our study; with follow up results to be published in the next issue.
Surgo Research
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Methods & materials
Test subjects were taken at random from a university population. Due to lack of funding, there will only be 15(ish) subjects
with a median age of 22. Each participant had experienced the symptoms of a hangover in the past and exclusion criteria
included a debilitating medical condition, allergy to any of the proposed treatments, consumption of alcohol in the last 12 hours
or quite obviously, alcoholism. Subjects gave informed consent, before starting drinking, and were then randomly assigned to a
treatment group.
Hangover cures
Given the plethora of potential hangover cures out there, we have chosen to use those suggested by our readers. Where possible
subjects were blinded to the treatment group assigned to them.
Fig 2. Popular hangover cures by country
Naturalistic Study design
Once assigned to a group, test subjects will be asked to complete an alcohol hangover severity scale (AHSS) questionnaire
featuring 12 parameters to gauge baseline characteristics. At which point they will be free to drink alcoholic drinks of any type
but amounting to a specified number of units, adjusted to each individuals BMI. The decision to allow a variety of drinks was
to ensure that this study accurately mimics a night of heavy drinking for each subject. Upon waking, participants will once
again complete the AHSS questionnaire before taking their assigned treatment. They will subsequently be left for 4 hours to
see what degree of recovery, if any, is present before filling in the AHSS questionnaire for a third time. This will allow us to
assess percentage change from baseline AHSS score. Statistical analysis will be carried out by someone.
To be continued
Stay tuned for the results, discussion and conclusions on Surgos first venture into the world of gritty research.
Surgo Research
Ibuprofen + fizzy drink (Coke/Irn Bru)
A fry up
Milk thistle
Hair of the dog (Bloody Mary or equivalent)
500ml IV 0.9% saline
5k run (to get fry up ingerdients)
Placebo control (wallowing whilst watching friends.
Duvet optional.)
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Surgo Review
Bad Pharma is the story of a
broken medicine; a world where
decisions are influenced by sleazy
drug reps spouting false
information based on bad trials
and missing evidence. A world
of under-regulation, under-
enforcement and fake fixes that
extends from individual doctors,
through patient safety bodies right
up to world-renowned journals
Ben Goldacre himself is more than just
another perfectly-groomed media doc; he
has won numerous awards for scientific
writing and his bestseller Bad Science
and weekly Guardian column have set an
encouraging precedent (I am trying not
to hold his occasional involvement with
the Daily Mail against him). Bad Pharma
is more than just plain old industry-
bashing (though Goldacre does make his
agenda abundantly clear), the book is so
meticulously researched that any
suspicions of conspiracy are discounted
almost immediately.
This grim tale begins with a section
about the bafflingly unethical problem of
missing data. At present, the best
estimate available is that 50% of trialsare never published. Evidence that drug
companies routinely, and legally,
withhold unfavourable data in order to
flood the literature with evidence
favouring their own products. Not only
can doctors and patients not access this
information, but neither can organisa-
tions such as NICE and SIGN. This
makes a mockery of the very fundamen-
tals of contemporary medicine, leaving
doctors to make decisions based on noth-ing more than the regulators word and
drug company propaganda. To add insult
to injury, this problem isnt confined to
commercial industry; universities,
journals and charities are also guilty of
publication bias whether to enhance
academic reputation or honour
stipulations imposed by undisclosed
industry sponsors.
This lack of evidence extends to
treatments that millions of people take
every day, treatments that the NHS
spends over 14 billion pounds a year on,
and treatments that in all probability you
or I, or your mum/dad/spouse/dog will
be prescribed in the not-so-distant future.
Perhaps the most shocking example is
that of anti-depressant (SSRI)
paroxetine. GlaxoSmithKline, the
developers and manufacturers of
paroxetine, knew that
though not licenced for
paediatric use, it was
being widely prescribed
for children. This is
perfectly legal and not
really an issue in itself
doctors frequently use
drugs off-label for
conditions out-with their
specific license. The
problem was that GSK
also knew, through
extensive but unpublished
trials, that paroxetineincreases the risk of
suicide in children. This
information was withheld
from doctors, patients, NICE, SIGN and
even the MRHA(the UK drug
licensing body) for seven years. The
enraging and somewhat unfathomable
end to this story is that what they did was
entirely legal. Equally infuriating is the
fact that this is not an isolated incident.
Goldacre goes on to illustrate several
other cases of gross (but mostly legal)
misconduct concerning drugs that are
virtually household names; from statinsand clopidogrel, to the dizzyingly
expensive heights of Tamiflu.
Bad Pharma then continues its dismal
journey on to the issues of bad trials,
inadequate regulators and even more
inadequate regulations. Goldacre details
how companies design intentionally
biased trials, using unrealistic patient
groups and dubious statistical analysis to
exaggerate the benefits and minimise the
side-effects of their products (and lets
not forget that if this still fails to produce
the desired results then they can always
just not publish it). The brilliance of
Goldacres book though, is not these
problems; it is the encouragingly simple
solutions he includes to keep you from
needing paroxetine yourself.
Ben Goldacre
Ben Goldacres Bad Pharma: A review, by editor Ella Bennett
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Surgo Review
These suggestions are as well researched
and eloquently put as the problems
themselves and provide a much-needed
foundation for change. The other thing
thatll keep you going is Goldacres love
of eccentric footnotes; one of my
personal favourites details Yes Sir, no
Sir, not much difference Sir a random-
ised control trial conducted by the
Cochrane collaboration to discover the
effect that receiving a knighthood has onletter replies.*
Bad Pharma comes to an appropriately
gory climax in its final section,
marketing. Strangely, and somewhat
mysteriously, this is the first time
throughout the whole book that things
become properly illegal. This chapter
airs an outstanding amount of dirty
laundry. Its so full of shame in fact that
Im struggling to summarise it. I want to
tell you all of it, in its disgustingly
scandalous detail, but well have to
settle with a whistle-blowers tour.
Goldacre starts with the media, detailing
shoddy journalism and disease-
mongering to rival the pharmaceutical
companies themselves. He then moves
on to the murky world of drug
advertising where only 67% of adverts inmajor journals were supported by trial
data. Despite this, and a barrage of other
supporting evidence, the British
Department of Health continues to reject
calls to force companies to issue
corrections. This is not only maddening-
ly unjust, but also extremely dangerous.
To make things worse, journal revenue is
heavily dependent on reprint orders
(articles bought by drug companies to
use as endorsements for their products)
and industry advertising. This represents
a huge conflict of interest, summarised
eloquently by
Richard Smith,
former editor of
the BMJ, the
choice is either
to publish a trial
that will bring in
$100,000 of
profit, or meet
the end-of-year
budget by
firing an editor.
The next blow to
journal integrity comes at the mention of
ghost-writing; the practice of paying
academics to put their names to industry
papers. This is disturbingly as wide-
spread as the conflicts of interest they
are trying to conceal.
Dubious partnerships become subject of
another chapter entirely, with a whole
host of fantastically ridiculous coalitions
to keep you going through your
inevitable despair; Richard Sykes, CEO
of GSK during arguably their most
fraudulent years, for example, is now
head of the Royal Institute in London.
Even more absurdly, the American
Association for nutrition and dietetics is
funded by Coca Cola and ,to top it all
off, the British Journal of Midwifery
runs adverts for formula milk.
My only criticism of Bad Pharma is that
it could be a little shorter; at 448 pages it
is a hefty read. Dont let this put you off
though, read it in sections (like I did) and
persevere because Im pretty confident
that this book will prove far more
important and educational than anything
else you read at med school. And if not itwill, at the very least, be infinitely more
interesting than anything on the med
schools 5 page long reading list.
* A few years ago, television nutritionist Gillian McKeith underwent a miraculous transformation to Dr Mckeith following membership
to the American Association of Nutritional Consultants. In (very public) retaliation to this, Goldacre bought a certified professional mem-
bership for his late cat Henrietta, now Dr Henrietta, from the same institution for $60. Unsurprisingly, Mckeith reverted back to her origi-
nal title.
How drug companies mislead doctors
and harm patients
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If youve ever dragged an oversized
bottle of water around all day inorder to get your required 8 glass-
es, been persuaded by a significant other (/dubious viper deci-sion) that semen is loaded with calories so youve got no ex-cuse or booked a manicure for your funeral date to make sureyoure looking your best for your date with the devil, then Ihate to break it to you but youve been swindled into believ-ing some of the horrendous, weird and down-right dangerous
medical myths that float around today.
Medical Myth-bustingBy Dan Taylor-Sweet
Drink 8 glasses of water a day, everyday
Ever been thrown into a fit of sheer panic by the sight ofyour Evian bottle running dry halfway through a biochemis-try lecture? Does the prospect of not being able to get yourrequired hydration make you shrivel into a raisin? Dont
panic. The myth that you must drink 2 litres of water a daywas created by a research group funded exclusively byDanone -to boost sales, or maybe as part of a more sinister
plot towards watery world domination. A person onlyactually needs to drink when they feel thirsty which varies ahuge amount; a deprived Ayrshire shepherd hunting haggisover the Campsies will need to drink more than a bedridden,
i-player watching student.
Semen is loaded with caloriesSemen, that sticky, white liquid girls love to think is full ofempty calories? Maybe not. Many a post-coital argument hassparked the highly contentious debate; what are thenutritional benefits of the stallion in questions ejaculate?This is nearly always started by the self-proclaimed lotharioat the sight of his artisan-produced load left unloved,undigested and under-appreciated on the bed sheets. It is
often thrown around that on average a single dose of semencontains enough calories to keep a team of huskies runningfor around 87 days. This is plainly not true considering anaverage ejaculation contains only 10ml of fluid. A singleejaculation actually only contains around 5-6 calories mostof which comes from the high fructose content of the semi-nal fluid. Considering this is the equivalent calorie content ofa single grape, its not exactly satisfying for either personinvolved. So keeping this in mind, the next time your lover is
begging you to eat yer dinner, youll be able to tell themhow youd much prefer a tasty sourdough, pastrami and
emmental sandwich over the dinner theyre offering you.*
Please direct any complaints/well-founded
accusations of misogyny/death threats to Dans
personal facebook page.
If you sneeze with your eyes open they will pop out
If like me you spent your entire childhood, and up until now,making sure you closed your eyes before you sneezed toavoid ending up with your eyeballs hanging down your face,then youll understand my concern. The thought of havingyour eyes swing around on the end of fleshy stalks like jellyconkers terrifies me. This fear, thankfully, is not founded onany truth. There has been no recorded occurance of a personsneezing their eyeballs out of their orbits. You can now too
become that obnoxious child who ran around the playgroundsneezing with his eyes open showing off in front of all the
pretty girls.
You should never wake a sleepwalker
If youve ever been woken up by a possessed flatmatewandering around wielding a dirty fish slice youllunderstand my predicament should I try and fight off theinfatuated blood hungry roomie? Or should I wake him upand risk giving him a stroke? Id heard that you should neverwake a sleepwalker or they would have a seizure or evenworse, die. Luckily this is all a load of phish afterconsulting Kumar and Clark I found that its perfectly safe towake up sleepwalking friends. So I was thankful to find my
battered and well-loved copy to hand to use as a blunt
instrument perfect for waking him up.
Fingernails continue to grow after death
I once spoke to a rather inebriated over baked nail artist-
who spent a good 23 minutes convincing me that once aperson died their nails kept growing for 3 days. I wasmesmerised by her mediocre chat. But then it hit me -thehorrific thought of my lifeless hunter like callused handsturning into perfectly manicured lady paws really would be afate worse than death. I rushed home from the GUU andfrantically Googled (my chunky man fingers are too big touse my blackberry otherwise I would have done it there andthen to smite her down). Google pulled through -yet again.
Nails do not continue to grow after death because thehormones that stimulate them are no longer produced afteryou bite the dust. Instead the skin dehydrates and tightens
making the nails appear as if they have in fact grown. Thankgoodness.
So, whenever you hear someone make an outrageous medi-cal claim never be afraid to jump in and tell him or her howmuch of an idiot they are being. The propagation of medicalmisnomers is incredibly annoying to anyone with an ounceof intelligence, and their perpetual reoccurrence is morefrequent than the Borg. As Adam SavageandJamie
Hyneman all to often say Myth busted.
Love Dan, the stallion/lothario/artisan semen maker. x
14
Fun Stuf
http://en.wikipedia.org/wiki/Adam_Savagehttp://en.wikipedia.org/wiki/Adam_Savagehttp://en.wikipedia.org/wiki/Jamie_Hynemanhttp://en.wikipedia.org/wiki/Jamie_Hynemanhttp://en.wikipedia.org/wiki/Jamie_Hynemanhttp://en.wikipedia.org/wiki/Jamie_Hynemanhttp://en.wikipedia.org/wiki/Adam_Savage -
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Horror-ScopesYour future predicted by Psychic Suz and Astro Anna: Glasgows finest amateur
astrologists.
Aquarius
Steer clear of unlabelled videotapes and girls with
long, black hair around the 14th. The stars predictthat looking into wells is not advisable under any
circumstances.
Capricorn
If you see dead people this month Capricorn,you may have an undiagnosed 6 thsense. Or, you
may have taken a wrong turn into the morgue.
Aries
Its okay to try something different once in awhile, but that new look youre sporting isscaring the first years. Remember, Halloween is
only the 31st.
Gemini
Forget trick or treating, its not safe. Research hasshown that you lot are prone to developing Jekylland Hyde-type personalities around Halloween.
Seek help if you feel like youre living a doublelife.
Cancer
Strange noises in the night? Increased sightingsof black cats? Incessant cackling from theneighbours upstairs? Probably a witch, probably
a Slytherin. Consider a change of address.
Libra
With Mars moving into Venus it looks likely thatblack dogs are a bad omen for you this month.
Warning: Trust nobody who likes their steak raw.
Scorpio
Saturns rings are moving anticlockwise whichmeans that zombie sightings are on the rise.Consider investing in a personal safety alarm and
refrain from hanging about graveyards.
Pisces
That china doll youve had for years is lookingcreepier than ever. Bin immediately or give as agift to your worst enemy/least favourite PBL
tutor.
Taurus
If you believe in ghosts, be very, very afraid thismonth Taurus. If you dont, carry on with life as
per usual.
Sagittarius
Your new lecturer may be in desperate need ofsome dental work. Or, he may be Dracula. Wear
garlic as a precaution.
Leo
Stay out of the SL after hours if you dont have aholographic sticker on your student card. Someonescary is waiting for you to venture into the surgical
section so they can test out their scalpel skills.
Virgo
If you go down to the woods this month youre infor a big surprise. Cloudy conditions mean thatwe cant be sure whether this is positive or not,
but we advise you not to risk it.
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Do you have an interest in journalism or writing in general?
Are you curious about the influence of the wider world on medicine, and vice versa?
Do you have an opinion or perspective you think should be heard?
Join the writing team atSurgo!
Breath-taking (-Stephen Fry), Visionary ( -William Shatner)
The scalpel-sharp edge of modern medical journalism ( -Alan Jardine)
If youre interested or want to know more, email Ella at [email protected]
Yules yarns
In Shetland in the 1950s there lived a young doctor called Bobby. Although a GP,
Bobby often acted as the anaesthetist at a Lerwick dental practice. Around this
time it was starting to be believed that hypnosis before anticipated surgery was
beneficial, relaxing the patients and allowing a smoother induction of anaesthesia.
Ever keen to try new techniques Bobby started using hypnosis to calm patients
down before they were to have a tooth extraction, and then used the anaesthetic
machine. This seemed to work well and for a while the dentist happily removed
teeth with no problemsThat was until Bobby took some annual leave and a
locum doctor was FILLING in for him.
On his first day the locum anaesthetist was baffled. He was testing the anaestheticmachine and in an outburst, cried out, How on Earth have you been putting these
patients under?! This machine is completely useless!
I dont know if they ever really got to the root (canal) of it, but it seems the
machine had been broken for some time. Hypnosis was the main anaesthetic.
Gum-believable.
Contributing writer Anna Yule brings us a real life, TRUE story about hypnosis...
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