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ss nucleus - spring 2020,  news reviews

news reviews

RCP neutrality vote on assisted suicide challenge approved by the High Court

Three doctors, including two CMF members, took the Royal College of Physicians to court in 2019, after the RCP adopted a neutral stance on assisted suicide. The judge agreed that the RCP had acted irrationally; in fact, the judge was quite scathing about the voting process. (1)

In March 2019, the Royal College of Physicians adopted a neutral stance toward assisted suicide following a dubious voting process that required 60 per cent of members to vote against this stance for it to be rejected. In the event, 43 per cent of members voted against it with only 25 per cent supporting neutrality on the issue. Therefore, the RCP were unjustified in adopting a neutral position.

A statement released on behalf of cardiologist Dr Dermot Kearney MRCP, retired palliative medicine consultant Dr Kathy Myers FRCP and renal medicine registrar Dr David Randall MRCP said:

'Despite agreement from the Charity Commission that it was a legally sustainable claim, the charities regulator withheld permission to allow the doctors to progress legal action, as they had already raised their concerns with the RCP and warned them notto repeat these mistakes. Today [22 October], in the High Court, this decision by the Charity Commission has been reversed, giving the doctors a green light to take further action against the RCP.'

1. Court allows RCP challenge. Care Not Killing 22 October 2019. bit.ly/2M5Wfb9 [Accessed 3 December 2019]

2019 Lancet Countdown report

'A child born today will experience a world that is more than four degrees warmer than the pre-industrial average, with climate change impacting human health from infancy and adolescence to adulthood and old age. Across the world, children are among the worst affected by climate change.' - The Lancet Countdown (1)

This is the stark warning contained within the report, which is based on findings from 35 academic institutions and UN agencies from round the world.

There are health implications globally, but especially for developing countries as crop yields diminish; temperature-dependent diseases like dengue fever and vibrio have a longer transmission season; air pollution caused by industrialisation and a massive increase in wildfires compromise respiratory health; and extreme heatwaves carry off the old and the already ill. Flooding in some areas, drought in others, and sea-level rise as ice caps melt further threaten to overwhelm all but the most resilient countries.

The executive summary concludes: 'Bold new approaches to policy making, research, and business are needed in order to change course. An unprecedented challenge demands an unprecedented response, and it will take the work of the 7.5 billion people currently alive to ensure that the health of a child born today is not defined by a changing climate.' Can we - will we - rise to the challenge?

1. Watts N, Amann M, Arnell N et al. The 2019 report of The Lancet Countdown on health and climate change: ensuring that the health of a child born today is not defined by a changing climate. The Lancet 16 November 2019;394(10211):1836?1878. bit.ly/2PRYGiE [Accessed 3 December 2019]

complementary cancer therapies - worse than useless

So-called natural cancer remedies not only do not help, they may actually interfere with the effectiveness of medically prescribed treatments and therapies.

Herbal substances popularly believed to have a positive impact on cancer outcomes include garlic, ginger, turmeric, ginkgo, ginseng and feverfew. There is no evidence that any of these substances improve or speed up recovery from cancer, but there is growing awareness that they can interfere with hormone treatment or chemotherapy. For example, a range of herbs, including commonly used ginseng, and ginkgo biloba, slow down the clotting process so that wounds resulting from skin cancer take longer to heal.

Even normally healthy foods like citrus fruits can interfere with the body's ability to break down cancer drugs potentially leading to a toxic build-up.

Doctors are being encouraged to check whether patients are using natural therapies when preparing a medically approved and proven treatment regimen - and patients are being encouraged to disclose this information.

1. Complementary cancer therapies 'do more harm than good'. BBC 14 November 2019 bbc.in/2S7ZQsW [Accessed 3 December 2019]

Geohealth: embracing global health

Climate change and associated natural disasters are encouraging an interdisciplinary approach to global health. Geologists in America are recognising the role they can play both in anticipating and responding to natural disasters so as to minimise their impact on human health and well-being.

The American Geophysical Union (AGU) established a geohealth journal in 2016 to showcase the increasing numbers of studies relating geoscience to health issues.

In the November 2019 issue, examples are given where geoscientists have helped communities in Puerto Rico recover from Hurricane Maria which disrupted water distribution in the country. An ongoing phased intervention will result in improved resilience in water supply infrastructure that will mitigate future weather disasters.

In earthquake-prone Haiti, geoscientists are enlisting community support for a widespread network of small seismic monitors that will not only increase understanding of the risks but raise hazard awareness amongst ordinary citizens.

For more fascinating case studies of the interface between geology and health, visit Earth and Space Science News (1)

1. bit.ly/2RqvLVx

ebola vaccine now available

A vaccine against this deadly viral disease, recently approved by the European Medicines Agency, gives hope to millions of people living in the Democratic Republic of the Congo where it has killed 2,000 since the disease flared up again, late last year. So far, 250,000 people at greatest risk of contracting the disease have been inoculated. It will also be a boon to healthcare workers on the frontline as it has already been shown to offer a high level of protection.

However, there are several strains of Ebola and research into effective vaccines for them are ongoing - seven are currently being clinically tested.

1. Callaway E. 'Make Ebola a thing of the past': first vaccine against deadly virus approved. Nature 12 November 2019 go.nature.com/2S4PU3x [Accessed 3 December 2019]

hypnosis and medicine

According to an article in the New Scientist, (1) research has confirmed the value of hypnosis for some people in dealing with issues such as anxiety and chronic pain, and that 'it's use in mainstream medicine is increasing'. It reports that hypnobirthing courses are now accredited by the Royal College of Midwives which also funds training. Some anaesthetists are using hypnosis to induce a state of anaesthesia comparable to that of pharmacological anaesthesia, and it has the advantage of avoiding pain-related cardiovascular responses. (2)

The availability of functional magnetic resonance imaging has enabled researchers to see what is happening in the brains of individuals susceptible to hypnosis and also to understand why some people are not susceptible. (3)

If hypnosis really does become more prevalent in clinical practice, then Christians will have to think carefully about the implications for patients and medical practitioners alike. (4)

1. Thomson H. What hypnosis does to your brain, and how it can improve your health. New Scientist 6 November 2019 bit.ly/2RfAVU8 [Accessed 3 December 2019]

2. Facco E. Hypnosis and anesthesia: back to the future. Minerva Anestesiol 2016 Dec;82(12):1343-1356 bit.ly/2YXaNPt [Accessed 3 December 2019]

3. Smith B. This is your brain under hypnosis. Cosmos 1 August 2016 bit.ly/2Pb30Js [Accessed 3 December 2019]

4. Fergusson A. Hypnosis. Nucleus 1996; Autumn:9-15 cmf.li/2LjgIsR [Accessed 3 December 2019]

suicide - men at greater risk

The striking thing about suicide statistics is that men are three times more likely to end their own lives than women. In the UK, the suicide rate went up by nearly 11 per cent in 2018. Most were men between the ages of 45 and 49 though 730 deaths occurred in people 25 and under. (1)Despite occupying what most people assume is a privileged position in society, doctors and medical students are not immune — the suicide rate amongst doctors is higher than average — and female doctors are at greater risk, in contrast to the trend in the rest of the population. (2)

Christians also commit suicide and the Mind and Soul Foundation recently published an article encouraging the Church to address the issue. 'Christians get stirred up by all sorts of justice issues - from homelessness and trafficking to debt and adoption - yet it seems that we have little to say about an issue that kills a person every 40 seconds. Suicide is not the choice of the weak or selfish, it is an act of desperation in people who are unwell and need our assertive love and intervention.' (3)

Keep an eye on your fellow medical and nursing students and don't be afraid to 'get involved' if you think they are at risk. If you yourself are contemplating ending it all, don't let shame or guilt stop you from talking to someone who can help.

1. Suicide facts and figures. Samaritans bit.ly/2Ybho8I [Accessed 3 December 2019]

2. Gerada C. Doctors and Suicide. British Journal of General Practice 2018; 68 (669): 168-169. doi.org/10.3399/bjgp18X695345 [Accessed 3 December 2019]

3. Using the S word. Mind and Soul Foundation bit.ly/385992r [Accessed 3 December 2019]

alcohol - the state of the nation

The Lancet recently reviewed Britain's Drink Problem, (1) a film aired on BBC1 in June 2019. The documentary focused on people who drink a great deal more than 14 units per week (the Chief Medical Officers' recommended maximum), but still manage to avoid descending into chaotic alcoholism. Nevertheless they are harming their health and many end up with alcohol-related liver disease, thus increasing pressure on the NHS from a totally avoidable cause. A recent article in The Guardian (2) estimates that one in ten hospital beds are taken up by people with alcohol dependencies and that one in five are drinking at harmful levels.

Despite repeated public health warnings and numerous documentaries about the health consequences of excessive alcohol consumption, many drinkers ignore the guidelines. Health warnings on bottles and cans are not that obvious and are easily missed by those who don't want to see them.

The article highlights the lack of government action in England to curb the ready-availability of cheap alcohol. With the alcohol industry providing over £10 billion in taxes, this is perhaps not surprising.

Nick Sheron, Professor and Head of the Population Hepatology Research Group within Medicine at the University of Southampton, laments, 'The government spends more time listening to the drinks industry than they do listening to doctors and the chief medical officer'.

1. BBC Panorama bbc.in/34xLkgK Vol 4 September 2019

2. Boseley S. New report reveals staggering cost to NHS of alcohol abuse. The Guardian 4 July 2019 bit.ly/2Ye4qa4 [Accessed 3 December 2019]

Marolin Watson and Rachel Owusu-Ankomah

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