Tag: Science & Health

Organ Donation: Are You In?

You shouldn’t worry. It’s never going to happen to you, is it? It’s always that thing that you read about in the papers; the statistic on the news; a story that comes up over a coffee about a friend of a friend.

When it comes to organ donation, you could presume that your only connection to it will be in deciding whether or not you might make the noble decision to donate your organs in the event of your unfortunate demise.

But what if your heart starts to fail? It has been beating every minute of every day of every month of every year of your life…what if all along you had a silent fault waiting to strike? Or, what if you ended up developing end-stage lung failure or your diabetes became so bad that you needed a new kidney…

And then you realise that only 31% of the UK population is registered to become organ donors.

Then you are told that, as an adult, the average wait for a kidney is over three years; the median for a lung transplant over one year and the wait for a heart, an average of 253 days.

And what if you aren’t well enough to survive that wait?

An estimated 1,000 people die each year waiting for a life-saving organ, according to the NHS. The very unfortunate truth is that there are always more people needing organs than there are healthy ones available from donation. At present in the UK there are over 10,000 people needing a transplant. Whilst the wait for organs can obviously be different for all patients, the delay is always going to be inevitable while there is such a severe shortage of organs available for transplantation.

And sadly, for many the wait is just far too long.

Waiting time can also be negatively influenced by the disparity in the number of organ donors from certain ethnic backgrounds including those from south-Asian, African and African-Caribbean communities. This is particularly so because, for example, black people have an increased chance of developing kidney failure – three times more so – than the rest of the UK population. Ethnicity is so important because tissue and blood type compatibility are much more likely to prove a match; crucial in the success of transplantation.

The vital element within the UK system has always been consent; people have to actively ‘opt-in’ and give their consent to organ donation by actively adding themselves to the register, having a donor card or by otherwise discussing their wishes with their loved ones. Wales, however, has recently broken away from the system in favour of the ‘opt-out’ system – where consent is presumed for all unless the person has chosen to opt-out. A system which inevitably provokes much debate with the religious and ethical issues that arise. In both systems though, the final decision falls to the next-of-kin.

So let’s face it, ‘opt-in’ or ‘opt-out’, the bottom line is this: In the utterly devastating and tragic event of a loved-one’s death, there could still be the potential of passing on the incredible gift of life – even to several people.

And when that question of organ donation is broached, will you know what they would want the answer to be? Would you have the knowledge, and indeed the strength, to recognise the wishes of the person you love? Will you be certain enough to follow through their request – whether it be in favour of donation or not?

The bottom line is that we need to talk about it. We need to know. And we need to act on it.

For more information and to find instructions on how to join the organ donor register go to: NHS Choices Organ Donation

‘Scarless’ surgery? Check out NOTES

Surgery is a daunting prospect. The thought of another human-being rummaging around in your insides is enough to turn anybody a bit pale with worry. Oh- and as an added bonus- the chances are, you are going to be left with a lovely scar to commemorate the event.

Well actually, that may not necessarily be true…

Pushing the boundaries of existing minimally-invasive technologies, surgeons are currently attempting the amazing feat of being able to complete certain procedures without the need for incisions. Via, shall we say, naturally existing access routes within the body.

Yes: it is what you are thinking.

The rectum, vagina, urethra and also the mouth are all channels utilized in NOTES (Natural Orifice Transluminal Endoscopic Surgery) in order for doctors to gain access to internal areas needing to be operated on.

The basic principle of NOTES has been an established means for diagnostic tests and simple therapies for a while- for example, inserting a camera into the throat to better view of internal structures (known as endoscopy). Now however, this technology is being explored in an exciting new capacity.

The potential to be able to complete full surgical procedures through already-present orifices in the body, means that new openings do not have to be created and therefore surgeons can try to avoid putting patients through the physical trauma of being cut open. Instruments, including a camera, can be inserted into these sites, allowing for surgeries to be performed in an incredibly minimally invasive way.

When compared with conventional laparotomy (standard open surgery, requiring a substantial incision into the abdomen) and laparoscopy (minimally invasive surgery, which uses small incisions into the abdomen, followed by the insertion of instruments into the body via ports), NOTES comes with a range of potential benefits.

The major advantages can mostly be attributed to the lack of an external wound site. This key achievement of NOTES means that the patient does not have to suffer the additional pain of wound-healing; does not have the risk of developing an incisional hernia and crucially; has reduced risk of surgical site infection.

Post-operative infection is one of the most common complications of surgery and can be deadly; by taking away an external healing site it severely reduces the chances of germs getting to the surgical site and creating a nasty infection.

Added to this, there could also be a reduced requirement for anaesthesia and shorter hospital stays too. But inherently unique to this surgery, is that it is ‘scarless’. This is even to the extent that on occasions when another camera is needed to be inserted from the outside, a very small incision is made into the belly button, in such a location whereby the cut will be hidden within folds of the skin.

Research and training are currently in progress to help propel NOTES to its full potential. With this technology already proving its feasibility in human trials, mainly in the field of general surgery- from removal of the appendix to biopsies to the treatment of intestinal cancers- it may not be too long before this technique establishes itself as a significant evolutionary step in modern surgical methods.

Photo credit: TopNews.in

Cutting Edge Technology to Cut Out Needle Vaccinations?

Revolutionary nanotechnology set to provide solutions to inoculation issues in developing countries.

Nanotechnology? I wondered the same thing when I first heard. It’s pretty incredible really; it’s basically the study of structures at magnifications beyond what the eye can see. And using this cutting-edge science, bioengineer Mark Kendall has come up with an innovation, smaller than a human fingernail, that could replace needle delivery of vaccinations and provide the answers to some of the major problems associated with mass immunisation. Most crucially, those in developing nations.

Many of us living in the developed world now take for granted the importance of vaccines; we are lucky enough to be in a position whereby the use of inoculations on a sustained mass scale has enabled us to reach a point whereby many contagious diseases have become wiped out.

Unfortunately, these devastating and potentially fatal illnesses still ravage populations in developing countries, where there is insufficient means to vaccinate communities.

This is where the Nanopatch claims its stake in potentially becoming one of the biggest innovations in modern immunology.

The 1cm² patch takes advantage of the skin as the body’s “immune sweet spot”, according to the Australian professor responsible for this advancement. The largest organ of the human body, not only does your skin defend against pathogenic microorganisms (the little nasties that cause disease), it also homes a hotbed of immune cells beneath the surface, which the patch delivers the vaccine directly into.

The tiny silicon square is covered with around 20,000 micro-projections – imagine little spikes, so minute that they cannot be felt, nor are they visible to the human eye – which are coated with dry vaccine. When applied directly to the skin using an applicator, the spikes penetrate the outer layer and administer the antigen to the eager immune-cells waiting beneath, sparking an impressive response.

The potential of this patch is ground-breaking. Though currently in the pre-human-trial stage of development, the technology has proven extremely effectual in the mouse model. Initial results have shown the product to be 100 times as effective as its needle counter-part and can be produced at a fraction of the price. “When the device is made in sufficiently large numbers, our cost estimates are significantly less than US$1 per dose,” Kendall assures.

For 160 years now, the needle and syringe method has fronted technology of contemporary vaccination programmes and whilst it is efficient, it inevitably maintains a range of shortcomings for which this tiny innovation holds the promise of overcoming.

Of the design’s broadest achievements: no needle equals no phobias – hooray! Plus, no chance of needle injuries; no potential for disease transmission associated with needle reuse; and, no pain on vaccine delivery either. Of its most integral successes, it doesn’t require specialised staff to administer it, nor does it depend on the cold-chain to maintain it in transportation or storage – both astounding achievements in the efforts towards making vaccinations more readily available, especially in developing countries.

“Because the Nanopatch requires neither a trained practitioner to administer it nor refrigeration, it has enormous potential to cheaply deliver vaccines in developing nations,” Kendall has said. For the remoter areas of some geographic areas, the logistics of supplying a temperature-controlled product has big implications on whether communities can be provided with life-saving vaccines. In places, the presence of adequate refrigeration is limited, or non-existent and the availability of appropriately skilled staff to administer the vaccines is also restricted. Problems which the Nanopatch solve.

Not only this, but for developed countries, these epic advancements hold future possibilities of seeing vaccines becoming available from local chemists or even being mailed out to home addresses, to self-dispense.

So what’s the catch? Well, as mentioned previously, it is yet to be tested on humans. However, since initial usability tests carried out by Kendall’s team at the University of Queensland have had such remarkable results, the promise of success in human trials (set to begin later this year) is very encouraging. And even though some other patches of comparable concepts have failed to reach their potential, new company Vaxxas has claimed that it is “the applicator design (which) overcomes the inconsistency that plagues other transdermal vaccine delivery approaches.”

Professor Kendall has big aspirations for his Nanopatch. With the World Health Organization this week estimating that “around 22 million children in developing countries are still not protected from dangerous diseases with basic vaccines” the need for the success of this technology is more crucial than ever. Having won a Rolex award for his research, he has said “I have an absolute passion to deliver better vaccination to the low-resource regions of the world, without them having to wait years for it to trickle down from the developed world”.

Though it is going to take a concerted effort – pooling resources of education, funding and technology – to eradicate major vaccination issues, this tiny patch has the potential to take massive steps towards helping drastically cut the number of preventable deaths each year- all without a needle in sight.

Photo credit: University of Queensland

Is This (The Beginning Of) The End Of Prohibition?

Speaking as someone who knows next to nothing about the American lawmaking process – and can therefore be naively optimistic – I’ve had my mental fingers crossed ever since I heard that Colorado and Washington have both voted to legalise cannabis for recreational use. (NB Mental fingers: those things you cross when you really, really want something to happen but you don’t want to have to stop typing.)

Potheads in the two states have been celebrating well in advance of any consent from the Department of Justice, with plans already in place to direct tax money from legal sale of the drug into the construction of schools (oh, to be young enough to enrol in the first real High School) and a range of health programmes including drug and alcohol treatment.

Oregon just lost out on legalising weed – although, with arguably the most liberal initiative of the three states (they wanted unlimited personal amounts and growing privileges), but by far the smallest campaign budget, this outcome is perhaps understandable. Maybe next time, Oregon. I’ve got my mental fingers crossed for you, ‘n all.

Another good piece of pot-related news came in the form of the Mayor of Amsterdam’s announcement (to admittedly negligible surprise) that foreign tourists will not be banned from using the city’s coffee shops. Wasn’t that a lot of worry for nothing – cannabis café owners fretting over the loss of tourism, the Mayor facing the prospect of the city descending into a miasma of dodgy street dealers and shoddy merchandise, not to mention us lot sitting worriedly on the couch in front of the laptop, trying to work out how to fit in another jaunt to Holland before the law came into effect. Worry over, anyway.

All this liberalism has been making me feel just a little bit as though I’m living in some kind of backwater, conservative commune, rather than one of the world’s most awesome global cities. While we’ve been resting back in our creaking leather armchairs, passing the brandy and gently chuckling at the antics of our younger cousin, America’s been getting on with surpassing us in some pretty damn important arenas. Britain upgrades cannabis to Class B, America legalises it first for medicinal and then recreational use. America gets Obamacare, while in Britain we’re in danger of losing our internationally-lauded NHS to the fickle whims of privatisation. Our PM reveals himself to be an immoral wheeler-dealer of war machines to the Middle East, while in America a genius businessman fights to use his enormous wealth to develop clean energy for all. Oh wait, that was Iron Man. But you get the point.

But anyway, back to America. What does this legalisation of pot mean for them? Well, I can’t imagine that the Department of Justice is going to roll over on this one, if its initial, tight-lipped “no comment” reaction is anything to go by. Presumably it will cite precedent, and complain of the difficulties in managing a country in which some states allow the use of a drug while other states battle smuggling issues and criminal activity. Or perhaps it will just bring its big federal boot down and yell “I said NO!” Which would be a shame because, as some have already pointed out, this could be a great opportunity to start to address the longstanding conflict between state and federal laws. It seems bizarre that you can do something that’s both legal and illegal at the same time. Personally, I see this as a case of political and legislative stagnation rather than mere precedent, but surely even two states deciding to legalise cannabis evidences a sea change worthy of review on a federal level? At any rate, the Department of Justice needs to make a decision soon – it would be a phenomenal waste of resources if Washington and Colorado got too far into their implementation and were then told it’d all been for nothing.

A much more immediate issue is, of course, the impact of legalisation on drug cartels. Make something legal, regulate it, keep the quality to a certain standard, make it easily obtainable… why would anyone choose instead to buy off some shifty dealer who may well be bulking out the product with sugar or sand in order to turn a profit – someone who, in turn, has to handle the paranoid people one level up, who sometimes deal in much nastier things than weed and occasionally wave a gun in their face? It’s a no-brainer. Obviously the lords aren’t going to be too happy about it, but any savvy street dealer or home grower with half a brain should be looking to capitalise on the change in law and set up shop legitimately. More money, less risk. Another no-brainer.

Ok, so I’m over-simplifying. There are many knots to be massaged out of this legislation, including how to test for “drug-drivers” without accidentally penalising medical marijuana users (though, to be fair, if you have enough in your system to be considered too impaired to drive, you probably shouldn’t be driving). But this has got medical marijuana users understandably worried – will the tests be good enough, will they be fair? It’s something that needs to be worked out and set in place beforehand in order to avoid wrongful arrests, but it shouldn’t be a permanent barrier to legalisation. Calm down, guys. Put your feet up and have a smoke, why not?

Surprising enough as is opposition to legalisation from those who can already buy and smoke legally, it’s as nothing when compared to the support from anti-drugs campaigners. Funny what the promise of funding for rehab programmes can do to a person’s views – but I guess it’s no weirder than a government taxing alcohol and tobacco and then pushing tax money into a healthcare system that provides treatment for diseases caused by the consumption of alcohol and tobacco. Funny old world, eh? I’m not even going to mention the utter hypocrisy of a system that’s been benefiting from the abuse of certain substances while punishing the use of others. Or add my voice to the millions of those yelling that “the war on drugs isn’t working”. The evidence speaks for itself.

Whatever the outcome in the US, full credit to this significant minority of America that has had an attack of rationality and accepted that the legalisation – and, therefore, regulation – of marijuana is the only way forward in the so-called “war on drugs”. You can’t stop people experimenting with drugs – human beings have been getting high for millennia – but you can do your utmost to ensure that personal risk is minimised, in this case by taking power away from criminals and regulating your product for quality. Oh, and did we forget it can be taxed, just like alcohol and tobacco? Legalised weed is an untapped, potentially hugely lucrative source of revenue for an ailing economy. I wholeheartedly wish that British politicians would stop pandering to the sensationalist media and recognise when to act for the benefit of the people. We’ve got Tories running the show now, for god’s sake – surely they of all people should be able to spot when they’re missing out on a fantastic business opportunity?

The Hidden Squeamishness of UK Doctors (And Why Euthanasia Should be Legal)

Until 1961, attempting suicide in the UK was illegal and punishable by a fine or a short jail term. England was one of the last countries in Europe to decriminalise suicide, but the stigma remains in the minds of many, and I know from recent topical conversations that some people still believe suicide to be illegal, or just plain wrong. So, change happens slowly in Merrie Olde Englande, and confusion abounds.

In view of the outcome of Tony Nicklinson’s court case earlier this month, it seems that UK law is just as slow to change now as it was half a century ago. Why are our MPs and lawmakers so unwilling to discuss the notion of assisted suicide? For Tony, and for the other locked-in syndrome sufferer known only as ‘Martin’, the answer was obviously cowardice – politicians and judges both unwilling to confront real issues, such as the right to die when you are physically unable to take your own life. I would, however, like to add doctors to this short but telling list of the squeamish.

There is, understandably, fear that a change in the law would put vulnerable people at risk (disabled people who have no desire to die, for example), and perhaps images of naughty doctors creeping around care homes with syringes full of barbiturates did dance through the judges’ minds when they concluded that no doctor assisting non-terminally ill patients to die would be immune from prosecution. Of course new laws are vulnerable to abuse, but there is no reason why safeguards could not be implemented when legislating for assisted suicide. Just because you make something legal doesn’t mean you also make it easy. In the case of assisted suicide, the person seeking assistance should be assessed by several doctors independently and each case judged on its own merits with the maximum amount of information and professional advice available. It should be a lengthy process (at the very least, it isn’t one of those snap decisions that you’d be able to renege on at a later date), but the option should exist.

To a certain extent I can excuse the squeamishness of politicians and judges to deal with such an issue (perhaps because I have a lower opinion of them to begin with), but the Royal College of Physicians and the British Medical Association have keenly disappointed me with their views on assisted suicide. In the course of my research for this article I have found myself reading quote after quote in which doctors have asserted their duty to “look after” their patients and provide “good care” for them, but these are fluffy notions that do not entertain the idea that, for a very small minority of patients, death would be “in the patient’s best interests”. Ignoring this as an option is, in my opinion, the mark of a physician not doing their job properly. Perhaps some doctors have lost sight of the extent of the remit of their profession. Sometimes a situation becomes so intolerable for a person that it is not actually in their best interests to keep them alive.

How many times have you heard someone, speaking of a recently departed loved one, comment that their sadness at losing them is somewhat tempered by the knowledge that they are no longer suffering? Surely this is the more humane response – yet as a society we seem more attuned to the suffering of the family pet than a fellow human being. For how long have doctors been terminating pregnancies, switching off life support machines, engaging in passive euthanasia through DNR (“Do Not Resuscitate”) orders, and (in the case of veterinary doctors) putting animals down to end their suffering? Why do they have less problem ending the life of a being that cannot give its opinion on the matter than of one who can actually communicate their desire to die? It makes no sense. Where is the compassion for the human being who is suffering mentally, not just physically?

Despite the great increase in our understanding of mental illness, doctors still seem to prioritise health of the body over health of the mind. They are confident when dealing with conditions of all kinds from which a patient wishes to recover, and even respect a patient’s decision to refuse treatment, but when death is actively sought, they balk. The BMA’s reasons for continuing to oppose a change in the law on assisted suicide amount to little more than the protection of doctors against having to make tough moral decisions and to face up to what HPAD (Healthcare Professionals for Assisted Dying) calls the “clinical reality” – that however small the minority, there do exist patients who wish to end their lives but are unable to do so without outside help. Surely acting in the best interests of a patient should include choosing to assist in their wanted death rather than putting them into a position where, for example, they must resort to starving themselves as a means of ending their life.

We have to learn where to draw a line under our efforts to preserve human life. Do not take this statement out of context – doctors should always do their utmost to prevent death where death is not desired. But to preside over the death of a patient is not a failure or dereliction of duty when not even the patient believes in the worth of such efforts. We just need to make sure that any laws facilitating assisted suicide will never allow someone to “be murdered” without their express desire. And if there is consent, ought it even really to be called “murder”?

This is your Government on drugs!

“The plain fact of the matter is drugs are incredibly addictive, they destroy lives”. So said Tory MP Louise Mensch, successful politician, bestselling author, mother-of-three, wife of Metallica manager Peter Mensch, and former Class A drug user whose dabbling with certain unnamed narcotics has clearly ruined her life. Yes. Ruined. So she’s quitting the low-down, dirty, hand-to-mouth insecurity of political life in the UK and moving to America with the family, where hopefully life will be easier, more tranquil(liser).

Oh, Menschy, why’d you have to go now? By removing yourself from British politics you’re wrenching the linchpin from my argument, to wit, that drug-taking, per se, does not actually ruin lives. I guess I’ll just have to find some other poor down-and-outs to pick on, like David Cameron, Boris Johnson and Alistair Darling, all of whom smoked cannabis in their youth. In fact, a few minutes’ fervent Googling turned up a plethora of drug-related confessions from within the many echelons of British politics – among all these successful, powerful, well-educated people. I particularly liked the views of Tim Yeo (with whom Mensch shares both a political party and alma mater), who is said to have enjoyed the experience of smoking cannabis and thinks that “it can have a much pleasanter experience than having too much to drink.”

I hope Mrs Mensch doesn’t think she’s going to get away from these more liberal views on drugs just by moving to America – a country whose current President famously said of smoking cannabis:

“I inhaled frequently… That was the point.”

And as for some of the others… Bush Jnr abused alcohol (and allegedly cocaine); Clinton admitted to having a couple of puffs on a joint whilst studying in England, but not inhaling or liking it (oh, blame the Brits for leading you astray, eh Willie?); Mayor of New York City Michael Bloomberg was more candid, even going so far as to say that he has enjoyed smoking marijuana in the past. Al Gore and Sarah Palin have both been ‘outed’ in biographies as former dope smokers (add cocaine use to that, in the case of Miss Alaska). This kind of name-dropping is not intended to shame those in the spotlight, but rather to highlight two things: firstly, that dabbling in recreational drugs is extremely common, and secondly, that doing so does not automatically condemn one to a life of petty crime and back-alley blowjobs.

I’m terribly sorry, Louise, but your “plain fact” of my first paragraph is anything but. Drugs can be addictive, and they can be a major factor in “destroying” lives (what a horrible little phrase), but neither one of these claims is absolute. It is, in fact, quite absurd to just lump all controlled drugs in together like that; are we expected to believe that alcohol and heroin are equally addictive, equally life-destroying? Morphine is Class A, but doctors use it to alleviate severe pain in their patients – may I therefore infer that it is the application of the drug, not the drug itself, that we ought to be controlling? Fast food can be just as detrimental to health when ingested to excess, and obesity can and does ruin the lives of those who suffer from it as well as impacting on the lives of those around them; are you intending to ban fat and sugar for all, too?

I’m sure you’ll recall that, about four years ago, the Advisory Council on the Misuse of Drugs (ACMD) presented its conclusions regarding the dangers of cannabis use – conclusions that resulted in the dismissal of the Council’s chairman Professor David Nutt and the resignations of several other members of the ACMD. The problem, in essence, was that the Council’s findings did not support current government policy; against the Council’s advice, cannabis was reclassified as a Class B controlled substance. A study published by Nutt et al. in The Lancet in November 2010 reiterated that, using the multicriteria decision analysis approach (which took into account personal harm, social harm etc.), alcohol is the most harmful substance. I’m using percentages here to represent the study’s arbitrary ‘points out of 100’ scoring system of overall harm: alcohol achieved 72% on this scale, with heroin and crack cocaine ranking second and third respectively at just over the 50% mark. Cannabis was ranked much lower at 20%, making it 6% less harmful than tobacco. Magic mushrooms, LSD and ecstasy can be found huddled at the far end of the chart, each with a score under 10%. I found the scores for LSD and mushrooms particularly interesting because, as well as being of only very slight risk to users, they were deemed to be of absolutely no risk to wider society – and yet both substances are currently Class A, which can get you up to seven years in prison and a hefty fine. Even more interesting is DirectGov’s explanation that drugs are categorised as Class A, B or C “according to how dangerous they are.” Hmm. That’s a lie, isn’t it?

But I digress. The plain fact, Louise, is that just because you don’t like something doesn’t mean it should be prohibited by law. Or, as your fellow Question Time panel member John Lydon observed, “Just because you’ve had a bad time of it… Let us, as human beings, determine our own journey in life.” If you want to keep drugs illegal because of the damage they can do, you should also be fighting to make alcohol and cigarettes illegal, or you’re just being a hypocrite. If you want to allow people to make their own choices based on accurate information made available to them (and, perhaps, turn a tidy profit in tax), you’re going to have to legalise all drugs – or at least the ones proven to be no more damaging than tobacco, alcohol, and over-the-counter pharmaceuticals. But you cannot simply rally against something because it has personally upset you at some point. Your personal experience is not the experience of others, and to legislate based on personal views is to deny experiences to other people. You cannot keep people safe by stopping them from doing any activities that carry any risk. We must defer to evidence, to cold hard facts, and then disseminate this information as clearly as possible, in order to adequately equip those who are determined to take such risks.

I recently came across the notion of “truthiness”, a term coined by American satirist Stephen Colbert (The Daily Show, The Colbert Report) to explain the increasingly popular, and increasingly worrying, trend toward decision-making based on gut feeling rather than facts. Mr Colbert had in mind certain politicians of his own country when he said this, but I can see a very similar trend in the UK. In the case of drug legislation, surely it makes more sense to classify substances according to the harm they do, rather than political agenda, or societal perception (which, let’s face it, is usually based on very little information and sensationalist negativism courtesy of the mainstream media)? If we base policy on evidence instead of opinion, how can there be any arguments?