surgo autumn issue 2013

8/13/2019 Surgo Autumn Issue 2013

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

1

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

7


11/20SURGO

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.

8


12/20SURGO

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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13/20SURGO

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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17/20SURGO

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


18/20SURGO

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.

15

Fun stuf


19/20SURGO

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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surgo autumn issue 2013

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