surgo summer 2015

2015; 87:4

URGO

Is Veganism the future?

...Or just a passing phase?

2

3. Medical News

4. Inequality and Health

6. Is veganism the future?

8. BMA medical student conference

9. The politics of drug research

10. The dark heart of humanitarian aid

12. The lighter heart of humanitarian aid

13. Interview with the Candy Anatomy guy

(Mike McCormick)

14. SHITS - Part 2

16. Letters to the Editor

17. GUGPS Ethics case

CONTENTS

13.

6.

EDITORIAL

So this is it. The last issue of the year. I know its late and that most of you are off enjoying your summer, but one cannot rush some-

thing like Surgo; it needs time, dedication and rigorous peer-reviewing to produce something of such high quality. So now for what is in

store for you: PhD student Louis Nerurkar indulges us with the consequences of health inequality; guest writer Simon Roeder and Arts

Editor Jenna discuss the future of veganism and contributor Jamie gives us the debrief of the riotous BMA medical student conference

2015. Following this, Beth Thomas updates us with the fight against Big Pharma and their unfair pricing of essential treatments and

James Tadjkarimi and myself examine the usefulness of humanitarian aid. If you still want more: Ella Gooner Bennett interviews Mike

McCormick, our very own med school celeb, about his journey to sugar-laden stardom before taking a more downward trajectory where

Daniel Taylor Sweet examines our faecal matter and its relationship to fad diets in the second instalment of Surgos clinical trial (SHITS)

but dont let that stop you...we finish our issue with Letters to the Editor and GUGPS second ethics case. What more could you ask

for?

On a different note, I am stepping down as Surgo editor and enjoying my retirement as the next Med-Chir sponsorship rep. I wish the

best of luck to the next editor David Boyle and the rest of the Surgo committee. Surgo will forever be in my heart. Je suis Surgo.

Regards, Tom Baddeley

10.

Surgeons amputated mans leg with rusty hacksaw

The now famous Ayr Hospital made the news recently when a vas-

cular surgeon allegedly used a rusty hacksaw to amputate a pa-

tients leg when a metal plate was unexpectedly found in the mans

femur. Under recommendations from an orthopod (who I imagine

was joking) a member of the surgical team was sent to B&Q to buy

a new one, but it was closed so they made-do with one found in a

cupboard. The surgeon was not available to comment as its golf

day, and hes not in hospital.

Herpes used to fight melanoma

A genetically modified strain of herpes was used in a phase 3 trial to improve

outcomes in patients with inoperable malignant melanoma. An injection of

T-VEC contains the virus which was made harmless to healthy cells but rep-

licates inside cancer cells and kills them. It also stimulates the immune sys-

tem prompting an exaggerated immune response. Researchers found 16.3%

of patients who received T-VEC were in remission after 6 months, com-

pared to 2.1% of control group. Unfortunately is doesnt work for those

already infected with herpessorry guys.

Vitamin D added to M&S bread

In a bid to make up for our lack of sunlight, M&S have pledged to

add sun exposed yeast to their bread products, naturally raising the

vitamin D content. It is hoped this will reduce the increasing inci-

dence of osteoporosis, rickets and multiple sclerosis. This is not

just bread, this is M&S bread.

Scientists discover key force of human aging

Scientists have found that the genetic mutations underlying Werner

syndrome (adult version of progeria aka Benjamin Button disease)

could lead to methods of preventing and treating age-related diseas-

es. In Werner syndrome the tightly packed DNA bundles of hetero-

chromatin are disrupted and consequently cause accelerated aging,

but scientists believe this process may be reversible opening up the

possibility of a treatment for Alzheimers

MEDICAL NEWS

www.surgoglasgow.com

4

Inequality in the UK and across the developed world is a

growing social problem. Oxfam recently published a report

predicting that by 2016 one percent of the world would own

fifty percent of all wealth. In the UK wealth and income ine-

quality has consistently increased since the 1950s, and due to

recent political reforms we have seen growing divides between

the poorest and richest halves of society. Alongside this, other

social indicators of poverty all point to an increasing state of

deprivation for much of the population with more people than

ever accessing food banks and levels of childhood poverty at a

record high; 3.5 million children now live in poverty in the UK

and Save the Children have predicted that number may rise to

close to 5 million by 2020.

Parallel to economic inequality we see large divides in health

equality; numerous analyses demonstrate the drastically differ-

ent health outcomes observed between those at the top com-

pared to those at the bottom. Excess mortality, defined as

death before the age of 65, more than doubles when you com-

pare managerial workers to unskilled workers, this is matched

by a landscape of increasing premature death as you move

from the relatively affluent South of England to the relatively

deprived North of England and Scotland where the incidence

of premature death is approximately 1.5 times greater. With

life expectancies over 9 years longer and the amount of time

spent in good health, a staggeringly high 18 years longer for

those in the top 10% compared to those in the bottom 10%.

In effect those at the bottom live shorter lives that are dispro-

portionately spent in poor health. Coupled to this idea of

good health, 40% of adults aged 45-64 on below average

incomes have a limiting longstanding illness or disability, com-

pared to fewer than 20% of adults earning over the average

income. It is an undeniable fact that economic inequalities

within our society seem intimately linked to dramatic divides

in health outcomes.

40% of adults aged 45-64 on below aver-

age incomes have a limiting longstanding illness or

disability, compared to fewer than 20% of adults

earning over the average income.

A number of factors explain gaps in health between the rich

and the poor including differences in diet, nutrition and smok-

ing. Obesity prevalence decreases as level of education increas-

es, and childhood obesity is twice as high when comparing the

bottom decile to the top. Interestingly, data taken from Scot-

tish schools have suggested that a contributing factor in the

obesity relationship may be that those in the most disadvan-

taged areas have similar absolute body weights but reduced

height due to growth limitation, indicating that the relation-

ship may also be linked to poor childhood nutrition rather

than just overeating. Smok-

ing also shows a clear gradi-

ent with rates up to four

times higher when compar-

ing the most disadvantaged

to the most affluent. This

relationship between socio-

economic status and negative

health behaviours is seen

again and again as diabetes,

low levels of physical activity

and alcohol and drug intake

have all been shown to be

linked with increased depri-

vation.

Alongside physical factors

impacting on health it has

also been suggested that the

ability of the well educated

Inequality and Health

Louis Nerurkar looks at the impact of health inequality

and affluent to advocate for access to healthcare may influence

health outcomes. For example, socioeconomic status is linked

to access to cancer care trials with the most deprived having

the lowest levels of access. In addition the ability to engage

with private healthcare services may be out of reach for many

lower down the socioeconomic scale. That is not to say that

we should not advocate for our own health as best we can but

simply that we should not ignore the vulnerable because they

do not have the time, education or economic means to ensure

an equality of access to healthcare.

Those in the most disadvantaged areas have

similar absolute body weights but reduced height

due to growth limitation...linked to poor childhood

nutrition.

One of the most recent and insightful findings in this area is

that inequality alone is shown to be bad for the health of soci-

eties as a whole. Countries with higher rates of inequality have

increased rates of child mortality and lower life expectancies

when compared to their more equal counterparts. This does

not just affect those at the bottom as these negative outcomes

associated with increased inequality exist across the whole of

the social spectrum. Work carried out by Richard Wilkinson

and others has shown that this extends to many measures of

both health and societal wellbeing, including but not limited

to, the UNICEF index of child wellbeing, mental illness, trust

of others within your society, violent crime and social mobili-

ty. They conclude that in the modern developed world it is not

just individual levels of wealth that decide healthcare out-

comes, but also the equality of the society that you live in.

A variety of factors seem to influence divisive health outcomes

seen between the most disadvantaged and the most affluent;

these include but are not limited to poorer health behaviours

including increased rates of obesity, smoking and alcohol and

drug intake alongside reduced intake of fruit and vegetables

and lower levels of physical activity. In addition, lower educa-

tional status, access to healthcare and support services and

reduced advocacy likely contribute to both health behaviours

and healthcare outcomes as a whole. Alongside differences in

healthcare behaviours, inequality is increasingly shown to be

bad for societies and to have negative impacts on health across

the whole social spectrum. As we move forward into the 21st

century and away from the austerity of the financial crisis we

must attempt to support the most vulnerable and provide

them not just with the education and support systems they

require to have better health but also with the financial means

to manage this. In reducing the economic and educational di-

vides in our society we will not just make life better for the

most disadvantaged but for all of us, regardless of our income

or wealth. It is therefore in everyones best interests to reduce

inequality and to provide the support and services required to

improve health from the bottom to the top.

Louis Nerurkar is a current PhD student in

Neuroimmunology


6

Veganism is defined by the Vegan Society as a way of living that

excludes, as far as possible and practicable, all forms of exploita-

tion of, and cruelty to, animals for food, clothing and other pur-

pose. Veganism is on the rise; this can be seen in the increase in

media awareness of veganism and the increasingly easy access to

vegan products in supermarkets. But are people staying vegan?

I think the most important area to look at is the reasons as to why

people become vegan, as this has the largest impact upon their

commitment to the lifestyle. The principles of veganism are estab-

lished parts of many cultures and religions, following from the

principle of non-harm found in faiths such as Sikhism, and Hin-

duism and as such have already proven to be more than a passing

phase.

Looking at those in the West who change their lifestyle and

become vegan, there are three main reasons that people go ve-

gan: ethical, environmental and health.

Looking at environmental first, we see an issue that is only just

coming to light. the majority of major environmental agencies are

not addressing it clearly or at all yet, but as peoples awareness of

the facts grow, they may make lifestyle changes to suit their new

understanding.

Animal agriculture accounts for 51% of worldwide green-

house gas emissions.

2500 gallons of water are required to produce 453g (1lb) of

beef.

Animal agriculture uses 20-33% of all fresh water con-

sumption in the world.

Animal agriculture is responsible for 91% of Amazon de-

forestation.

50% of the grain produced is fed to livestock.

These are just a few facts that indicate the massive damage that

consuming animal products does to the environment. However,

I do not believe that environmental issues alone are enough to

maintain veganism. If environmental reasons are your primary

motivation it becomes easy to simply cut down your animal in-

take rather than cut it out completely. Environmentally-minded

people are already aware of a myriad of methods to reduce their

environmental impact, but most do not entirely drop environ-

mentally-damaging habits such as driving alone. They simply

reduce them, and we can extrapolate a similar pat-

tern for animal-use.

Environmental concern is likely to increase (as

climate change becomes for evident) and people

may start reducing their animal use, but whether they become

vegan or not depends on the level of research they do into other

benefits to the lifestyle. The environmental need to drastically

reduce animal consumption is undeniably pressing, and may pro-

vide a segway into a fully vegan lifestyle for some.

Looking at health-motivated veganism: this is a controversial issue

because there is very little unbiased research, as its either financed

by meat/diary companies or by vegan organisations.

Nonetheless, people do cut animal products out of their diet for

health reasons. In some ways this can help strengthen resolve,

because they are more likely to eat a healthy diet and therefore not

suffer any health problems and they would put this down to ve-

ganism. Also, diets are socially understood and so they will likely

face less stigma, which causes a lot of vegans to revert to an om-

nivorous lifestyle (roughly 25%).

However, this is unlikely to cause a lifelong commitment to the

vegan lifestyle; it is likely to only influence ones diet (making one

a plant-based dieter, rather than vegan), and even there one may

feel justified in eating the occasional animal product as a treat

Finally, people go vegan for ethical reasons. This, I think, is the

fundamental reason veganism is unlikely to be a passing phase and

will continue to increase in popularity.

I think the idea that any form of activism that seeks to portray an

oppressed group as a passing phase is ridiculous. Where there is

oppression there will always be people seeking to end it and not

contribute to it. The ethical argument is also, I feel, the strongest

in that it does not allow for cheat days or exceptions. Animals

are alive, feel pain, feel happiness, and have cognition. Once peo-

ple make the connection between the food/product in front of

them and the oppression and torture of animals necessary for its

production, they become aware of their complicity in the process,

and many will determine that their convenience or pleasure is nev-

er worth that. This connection is becoming easier to make with

animal right activists having more presence in social media and

finding it easier to spread the message.

Being vegan is getting easier and easier and if you are able to live a

healthy, happy life without causing harm to others why would you

not?

eganism the Is

future? Simon Roeder tells us why veganism is

the way forward

Veganism is an odd one. Whereas vegetarianism can be traced

back to Ancient Greece, veganism is a newer term (coined 1944).

However, vegetarians throughout history who also refrained from

eating dairy or eggs were termed strict vegetarians. There have

been several attempts to form communities that aimed to follow

strict vegetarian codes, some involving a ban on using animals for

any purpose whatsoever, even farming. The book Go Vegan! is

a truly fascinating and thoroughly enraging read. Let me just make

this clear before I start: I have no issue whatsoever with vegetari-

anism.

People try out veganism for a multitude of different reasons but

only a few adventure in to the whole lifestyle, which takes in to

consideration not only what they eat, but also what clothes they

wear and how they interact with the world. This is not a new con-

cept by any means and Im not even talking about religious beliefs

or 60s hippies. Im talking about your average conscientious Joe:

reusing his carrier bags; putting on a jumper instead of the heating

when it gets cold; eating local cheddar instead of gruyere; etc. etc.

There is no doubt that the worlds population needs to take re-

sponsibility for what it uses and disposes of. However, we cannot

deny things like the hundreds of years of selective breeding that

have have led to sheeps wool growing far longer and fluffier than

the sheep themselves need. It grows so much that if they are not

sheared, they will overheat in summer. Therefore the farmers

shearing, and subsequent processing and selling of wool products

on the market is a symbiotic relationship. It is a similar story with

cows milk and honey. It may come as a surprise to some funda-

mental vegans that it is possible to exist symbiotically with animals

and in no way mistreat them. The argument that animals are tor-

tured is ridiculous in Scotland, where there are strict and tightly

regulated laws regarding animal welfare and farmers are well edu-

cated with regards to these.

Eating local produce is a great idea and as Scotland has plentiful

land for grazing and huge amounts of hillsides for hill sheep farm-

ing, this is a perfectly achievable idea. Our famous highland cattle

are fantastic at living off the harsh highland terrain with little inter-

ference from humans. And as we all know, Scotland is the

grateful receiver of millions of gallons of water (sometimes

over a very short time frame) so there is never a risk of

drought harming livestock. My point? Economically and

environmentally, livestock farming in Scotland makes

sense. I should make a small point that unfortunately not

all countries have both such high standards of animal wel-

fare, but Ill come back to that.

As for health, thats a whole different matter; it is some-

thing that troubles many of us and will be a major part of

all of our lives as doctors. We all know the detrimental

effects that a typical Western diet can have on a persons health.

You only need to look at the startling fact that if a Japanese person

(who you would expect to have a very low risk of CHD) moves to

the UK and adopts a traditional Western diet, will, in no time at

all, have the same risk of CHD as someone with British ancestry.

So how can we mortals combat this? There is an option to cut out

all the things in our diets and lifestyle that could possibly cause us

harm. Another option is to become more moderate: eat fewer

fatty treats; learn how to cook delicious vegetables instead of just

boiled broccoli (we could learn a lot from a Mediterranean recipe

book); cycle or walk to work regularly. Ill admit that this is a

harder way of improving your health, not least because there is no

money to be made in an industry peddling common sense! There

are no handy books entitled, Living in a Moderate Way to Stay

Healthy but then thats the trouble we all face. We have too

much time on our hands or we feel unimportant so having a

change of lifestyle that we can then brag about and Instagram to

high heaven is just what a slightly underappreciated soul needs.

With veganism on the rise (strangely enough this is only the case

in societies where people have more income than they need), the

question I pose is that of sustainability. Is a strict vegan lifestyle

compatible with the world? Can you honestly afford everything

you need for a vegan life on the same student loan as the rest of

us. Theres no doubt that there are many more products specifi-

cally marked as vegan than there were even five years ago, but they

are infallibly more expensive than many other food options. Now,

I love a couscous salad and I have many (unintentional) vegan

meals without feeling the need to Instagram myself saving the poor

animals from a milking. I dont need to take supplements to re-

main healthy though. I eat meat, or milk, or cheese, eggs, fish,

honey! To get the amount of protein an average 70kg person

needs you have to eat 600 grams of boiled lentils! Or a healthy,

balanced diet.

We have evolved as part of the world and despite our technologies

we are not above the rest of the flora and fauna. There are many

things that we, the population of Earth, have a duty to improve in.

It will take hard work and massive changes in industry and in the

way we think, but the hurdles hold the opportunity for us to be-

come better. My opinion: veganism is a cop out.

...or just a

passing phase? Arts Editor Jenna tells us her point of view


8

Medical Student Conference 2015

Social Time!

A contingent of Glasgow medical students attended this

years BMA Medical Student Conference. Jamie Henderson

gives us a review.

Fun Times at the BMA Student Conference

What is the BMA student conference I hear you ask, hopefully I can answer that I mean I will try. During the conference us, the stu-

dents, debate what policy the BMA will pursue on behalf of the student membership. What sounds more exciting than debating policy

for two days with medics from around the UK, I cant think of anything either. We managed to muster a group of four of us to travel

down to BMA house in London to propose policy for the year ahead.

We kicked off with a fantastic speech discussing medical

careers with Professor Jane Dacre, the current President

of the Royal College of Physicians. With a long and illus-

trious career she gave us her top 10 tips for having a suc-

cessful career in medicine. Low and behold she highlight-

ed location as the most essential thing when having a suc-

cessful career, where you do your foundation years does

really matter. She also made the point that women need

more self-belief chastising the medical profession for al-

lowing its leaders to continue to be pale, male and stale.

and challenged the female students in the room to step

up to the plate. She didnt leave men completely off the

hook, encouraging all of us to strive for a more diverse

leadership, as it will benefit the whole profession.

But we werent there to be spectators; Glasgow stepped

up to the plate and attempted to move the date of the SJT

to the penultimate year of study. We faced massive oppo-

sition from the Universities who sit their finals in their

forth year, slackers, and ultimately it was defeated on

these grounds. Although we had this initial disappoint-

ment we fought on and ended with two motions passed;

blowing the rest of Scotland out the water.

With our unrivalled success we are heading out to the

BMA annual meeting, to spread the Glasgow love to real

doctors from throughout the UK. So look out for us hit-

ting the shores of Liverpool. Serious policy discussions with the previous Surgo Editor

At the University of Glasgow, research is taking place which

everyday brings us closer to finally finding a vaccination to pre-

vent malaria, to understanding the pathophysiology of sleeping

sickness and to understanding the interactions between hepatitis

viruses and liver cells in hepatocellular carcinoma. If this re-

search brings us tangible outcomes, millions of lives could be

affected worldwide by the amazing work of the academics at our

institution. But sadly, the way our university sells its work to

pharmaceutical companies at the moment means many of the

world's poorest and most in need will be priced out of accessing

these potentially life saving compounds.

Let's first have a quick forage into drug discovery. If we imagine

a potential malaria vaccine, public institutions such as the Uni-

versity of Glasgow conduct research into potentially useful com-

pounds and highlight laboratory find is which show promise.

These compounds are then taken up by pharmaceutical compa-

nies to create the actual vaccine (e.g. a stable, cheap product that

is safe for human use) and then test this safety and efficacy in

clinical trials. This part of the drug development process is done

by private pharmaceutical companies because it is so expensive,

and a public institution could not foot the bill if the drug does

not come to market, for whatever reason. So in summary, the

university finds potentially useful compounds, and sells that in-

formation to pharma to make those compounds into safe and

effective drugs to tackle the problem.

At Harvard University in the States, a group of students discov-

ered that their university was selling information discovered

about potential treatments for HIV to pharmaceutical compa-

nies, and then these companies were producing drugs using

these compounds which were much too expensive to be used in

the places were they were most needed, for example in sub Sa-

haran Africa. These students thought that it was wrong that in-

formation produced by their public university could be used in

this way, so they came up with the Global Access Licensing

Framework. This framework stipulated that any compound dis-

covered by the Harvard University that was sold to a pharma-

ceutical company must be made available to patients who needed

it in low income countries.

Since this action, over 100 institutions all over the world have

signed up to GALF, including the University of Edinburgh and

the University of Dundee. Medsin Glasgow have been trying to

meet with our technology transfer officer to discuss taking up

GALF at the University of Glasgow for over 4 months, and

have had little success so far. We believe that the University of

Glasgow has the potential to sign up to this successful frame-

work which has improved access to many new drugs all over the

world. Although not perfect, this framework is a big improve-

ment in the short term on the imperfections produced by our

current pharmaceutical production system. If you would like to

be involved in this campaign, or would like some more infor-

mation, please get in touch at [email protected] or

[email protected].

Glasgow has a drug problem, it's time to work at a solution.

GLOBAL ACCESS LICENSING FRAMEWORK:

Every university-developed technology with potential for further

development into a drug, vaccine, or medical diagnostic should

be licensed with a to make affordable versions available in re-

source-limited countries for medical care .


We have a drugs problem...

Beth Thomas outlines the unfair way universities sell

their research of new medications

10

The Dark Heart of

James Tadjkarimi reports on the side to

humanitarian aid they dont want us to know

about...

Often on the street were approached by what I like to call

charity muggers, who ask in their bubbliest way whether youd

like to donate a few pounds a month to the aid organisation

theyre working for that day. However much or little you do-

nate is down to you, but if you do decide to, the buck really

stops there. You walk away with a sense that youve done

something selfless (which you have) occasionally getting an

email with updates, or a phone call asking whether youd like

to increase the amount you give.

We all assume these organisations are in the best position to

decide how and where their resources should be distributed,

whether thats in the form of life saving healthcare, or essential

food and water for those in need. More often than not, count-

less lives have been saved from situations that we could never

even imagine, but there is room for error. Sometimes these

aid agencies dont always get it right, so much so in fact that

you have to ask if theyve done more harm than good in a number

of situations.

The Birth of Humanitarian Aid

In 1967, a south eastern state called Biafra tried to become an in-

dependent nation apart from Nigeria. Its inhabitants were mainly

Igbo people, who held different cultural, ethnic and religious val-

ues to those of the Nigerian people. Unfortunately, their cessation

was not recognized by Nigeria and resulted in a bloody 3 year civil

war. The Biafran rebels were heavily outnumbered and outgunned

by the British backed Nigerian Federal army and after 10 months

of fighting, were reduced to a tiny enclave. Wanting to end the

civil war, the Nigerians imposed a blockade on the Biafran prov-

ince resulting in widespread famine.

Up until this point, Biafra had appealed to world leaders and gov-

ernments for military assistance. They used every trick in the book

and even had a propaganda unit to attract international attention.

They tried to sell the fact that Nigerian wanted Biafra for its oil

reserves, and that its people had been subjected to religious massa-

cre amongst other things. No nation answered their pleas; but

everything changed once the blockade took place. The mass star-

vation going on gave them a new weapon for publicity: Kwashior-

kor. Images of children with Kwashiorkor (a severe form of mal-

nutrition in children caused by a lack of protein) began to leak,

and people in the western world were waking up to stark photos

of hundreds of Biafran children in desperate need. We started to

pay attention very quickly, and although many governments re-

mained loyal to Nigeria it kick-started a cause clbre that gave

rise to the birth of the aidworker; a left leaning generation of indi-

viduals independent of government, determined to help prevent

the Biafran crisis from every happening again. Mdecins San Fron-

tires (MSF) was once such organisation that came into being

from the resultant situation.

To many, the situation seemed clear cut. Nigeria was seen as ty-

rannical in its treatment of Biafra and it stopped at nothing to re-

duce the state and its people to dust. However, what people didnt

realise until a few years later was that Biafra had been using dirty

tactics too. It had hired a PR company based in Switzerland with

the sole aim of promoting their cause. No one was listening to

their political message so they relied on hunger as a weapon of

propaganda, and used its people as victims. This system was so

well orchestrated that the PR company would send photographers

over to Biafra and with ease, take photos of children kept in a

state of perpetual hunger in Biafras own dedicated starvation unit.

Humanitarian Aid

With the release of every subsequent image came vast donations

in the form of money and relief aid. This influx of aid from the

rest of the world allowed for the smuggling of arms into the coun-

try to help the Biafran cause and unknowingly to rest of the world,

prolonged fighting by eighteen months leading to further blood-

shed.

Oversimplifying the message

Fast-forward to 1984, where Ethiopia was in a famine of biblical

proportion. At the time the country was under the command of a

Marxist government loyal to Soviet Russia which made Reagan

and Thatcher reluctant to help some 400,000 people in plight.

What followed was an unprecedented surge in public outcry and

support not seen since Biafra- something largely due to Bob Gel-

dof. Say what you will about his white saviour complex, Geldof

and co managed to turn a lot of heads with their charity single Do

they know its Christmas and Live Aid. No one can fault that, but

many accused them of oversimplifying the message; by donating

your money you can ensure that food gets to those that a truly

need it. You dont need to be a humanitarian to feel compassion

like that, but like many of conflicts that weve had over the past 50

years, the causes can be many and beyond the control of any

aid agency.

What we were presented with on global TV networks and by

aid agencies was that Ethiopia had fallen into famine due to

drought. This was a cause, but not the sole one. In actual fact

what transpired was a situation not unlike Biafra. The Ethio-

pian government was again embroiled in a civil war against the

north, using deliberate starvation, crop burning and preven-

tion of local trading as weapons of choice. Aid being deliv-

ered by agencies did a tremendous amount of good in refugee

camps and helped alleviate one of the worst food crises weve

seen but once again, the cash influx that was earmarked for

those in need ended up in the hands of far worse men. The

government began by levying a tax on anything that came in,

so they could feed and arm their own troops and subsequently

used feeding centres set up by aid agencies as bait traps, draw-

ing them in and rounding them up in order to resettle vulnera-

ble people in purpose built villages dotted about the country.

This forced relocation was billed as a way to relieve population

pressure, but in reality it allowed them to thin opposition in

the northern highlands and resulted in further deaths to the

resettled community due poor execution and understanding of

basic needs like housing, water seeds and tools. MSF estimat-

ed that a further 300,000 people lost their lives in the resettle-

ment and for speaking out about it, were immediately expelled

from the country. As demonstrated, issues often stretch far

further than solely feeding the hungry and it really raises ques-

tions about what the right approach to these situations is.

The future of humanitarian aid

What some of these case studies show is that even with the

best of intentions, things can go awry with often dire conse-

quences. By their own admission, MSF, Oxfam and Save The

Children agree that simply rushing into a humanitarian crisis with-

out any understanding of the underlying geopolitical and social

causes can further cripple a country. Our modern definition of

humanitarian aid is still in its infancy, and with only fifty years in

the field it has been on a slow and steep learning curve in under-

standing morally what is right and wrong to do, where it can make

an impact with independence, and truly gage how it can minimise

detrimental knock on effects whilst remaining accountable. What

these charities would really like to see is a shift towards local insti-

tutions and agencies providing relief, allowing them to place a

greater emphasis on development, making its people less vulnera-

ble and therefore more prepared for when a crisis happens.

So the next time you decide to donate, (and regardless of the tone

of this article please do) ask yourself why youre doing so. The

limits of humanitarian relief aid are many and situations are often

messy and highly complicated moral dilemmas. Really analyse the

situation thats playing out on the ground as best you can and un-

derstand that you wont be able to save the world, but you may be

able to save lives.


12

Humanitarian aid is the rapid assistance given to people in imme-

diate distress. Sometimes, it is this assistance that prevents the

loss of many lives due to preventable causes like malnutrition or

disease. In all the examples James has used above, it was the first

response of aid organisations that prevented widespread starva-

tion and stopped the progression of diseases like cholera in its

tracks.

Aid organisations such as MSF try to keep their neutral stance

despite the complexity of modern conflicts. It is true that since

9/11 many aid organisations

direct their care with western

political agendas. In Afghanistan

some organisations were too

closely linked with military pow-

ers, mostly for safety reasons,

and now need to disassociate

themselves from them to be able

to access the people in need.

Therefore it is important for aid

organisations to keep their neu-

trality to help everybody affected

by the crisis more effectively.

Unfortunately it is possible that

many of the innocent people you

do help in one situation can turn

out the be the perpetrators of a

different conflict; but by keeping

the neutrality it is possible to not

make enemies and be able to

access people in need anywhere. So in future conflicts, it might

only be the aid organisations who can offer humanitarian assis-

tance to those in need, and not military powers.

The 2004 Indian Ocean tsunami and the 2011 tsunami in Japan

showed how even well developed countries can be crippled by

natural disasters. Although world governments provided huge

sums of money and equipment for the humanitarian response,

aid agencies also helped the survivors hugely by providing medi-

cal assistance and reconstruction programmes. Despite being

developed countries, tsunamis and other natural disasters leave

devastating long term effects on the country and they need all the

help possible to help rebuild it.

On a different note, some aid organisations are on the front line

for improving rights for women and children, campaigning

against unjust policies and practices and increasing awareness of

the threat of climate change for at-risk communities. Organisa-

tions such as World Vision encourage the public, governments

and other institutions to change their attitudes on these prob-

lems. World Vision encourages cooperation between govern-

ments, companies like NASA and Google, and local communities

to develop sustainable methods of farming and industry. Some-

times only NGOs like World Vision are capable of advocating

changes like these because they are not swayed by political fac-

tors, and have a more holistic view of things. Despite the meth-

ods aid organisations use to publicise their cause can be irritating

and even extreme (like in the Biafran conflict), it is important

because it brings to light problems that the general public might

not be aware about.

Yes, humanitarian aid has made mistakes; in the Rwandan geno-

cide food and medical attention was offered to every refugee in-

cluding those who had committed the original genocide. This

may sound wrong but what could the aid agencies do at that

time? Some argue that this makes humanitarian aid flawed but it

is the cost of introducing humanity into the inhumanity of war.

We must not forget that humanitarian aid is a relatively new con-

cept and is constantly evolving

and learning from its mistakes.

An example of this is that

Oxfam now provides food indi-

vidually rather than large bags of

grain which can be stolen and

misused. They also now bury

their water pipes to prevent ille-

gal siphoning.

The Daily Mail brigade are

known sceptics of foreign aid

and yes there are plenty of argu-

ments against intervention but

aid is absolutely necessary in

crisis situations where the disas-

ter affects the poor and least

powerfully most directly and aid

groups assist the government to

recover survivors and set up

refugee camps in the early stages.

Furthermore, many aid projects work on human development as

well as disaster relief; employing and training local people thereby

helping the recovery and economy of the country.

Some aid organisations campaign for justice and human rights

around the world and some are first responders to natural disas-

ters and conflicts. Wherever people are in need, aid organisations

are never far away. The aid workers and volunteers work in diffi-

cult and unpredictable situations often with very limited supplies,

doing their best to help people in need and rebuild broken coun-

tries. In our increasingly well-connected earth, I believe it is im-

portant for those most vulnerable to know they have someone

on the other side of the world who wants to help them and if all

that means is donating a few pounds a month to a charity, so be

it. For these reasons, I hope aid organisations have continued

support from governments and the public.

Tom Baddeley gives us his 2 cents...

The Lighter Heart of

Humanitarian Aid

Q. What started candy anatomy?

A. I was in a Ketchup waiting for my food and asked the waitress

for something to colour in; I got a pile of crayons and a pictures of

an ice cream sundae and a burger in return. Instead however, in a

desperate bid to get to grips with medical anatomy I turned them

into annotated glenohumeral joint and L1-L5 lumbar vertebrae. It

just continued from there really.

Q. Other than sweets of course, what resources do you use to

help you make your pictures?

A. I use the internet mainly, and any decent lectures we get., Sci-

ence direct is a great website!

Q. What do you think of anatomy teaching in medical

schools? And in particular at Glasgow with the new course?

A. I think it's pretty good, especially given that we are one of the

few universities to still to proper dissection. That's the good thing

about using sweets for the pictures; candy is much less intimidating

than cadavers!

Q. How much does each picture cost you? And how long do

they take?

A. I've avoided costing the sweets haha. That is definitely some-

thing that's it better not to know! I do re-use all the sweets though.

They don't actually take very long to make, maybe half an hour or

so? But that's because I plan them in my head for ages first.

Q. And what about you? Any big plans?

A. At the moment I'm keen on surgery so hopefully that; and hop-

ing to get through the first year exams unscathed obviously!

Q. Ever considered a candy self-portrait?

A. Haha well I suppose I could give it a go...

This interview is a first for Surgo, a first for Glasgow and a first for me,

why? Because I was interviewing one of our own; first year Mike McCor-

mick who is becoming slowly and quietly a little bit famous. Mike is a

post-graduate in physiology from the University of Edinburgh who's

been at Glasgow for a little under 9 months and has already appeared in

the Student BMJ, on STV News and been interviewed by Stanford Univer-

sity California. And all this thanks simply to love of puns and a keen eye

for candy.

Ella Gooner Bennett

Q. Do you have a favourite picture?

A. Mike refused to choose (So I've chosen some for him).

Q. Any plans to branch out into other food stuffs? Bananato-

my?

A. I have actually done a few savoury ones. I used corn on the cob

as adipose tissue and a bagel as bone, with alphabetti-spaghetti as

labels.

Q. Where do you see candy anatomy in the future? Do you

have a next picture planned?

A. Prof Walters has ask me to do some promo stuff for school

leavers in Glasgow. As for the next picture, I'll just have to see

where the course takes me...maybe the dreaded brachial plexus?

Age - Senile

Star sign Gemini

Favourite beverage Oreo milkshake

Favourite place in Glasgow - Brel

Preferred mode of transport

Christopher Walken

Most versatile sweet - Smarties

What is your mantra? -

What would #joel do

Edinburgh or Glasgow? - Fickle

The tastiest lymph node I have ever seen


14

SHITS

Part 2: Analysis of Results

Daniel Taylor Sweet1

1University of Glasgow, Glasgow, Scotland

June 2015

Funding: No funding was received or applied for.

Conflicting interests: None

Ethical Approval: Approval granted by the MedChir Ethics

Committee.

Background

Many self conscious, exercise adverse, fatsos will commence

some sort of diet in their lifetimes whatever their motives, be it:

wanting a beach bod, chiselled abs or purely just to increase their

pulling powers on the D floor we dont really care. SHITs Part

2 is purely interested in these peoples poop. SHITs Part 2 aims

to address the effect of commencing a celebrity diet on ones

quality, volume, and frequency of stool and flatus. This is a

unique study and, to our knowledge, is the first of its kind in the

world.

Methods

9 participants were recruited from a local medical school. 3 candi-

dates failed to complete the entire study, giving SHITs Part 2 an

attrition rate of 66.67% [6/9].

Following Taylor-Sweet et als work on SHITs Part 1, 5 popular

diets were selected for study: Gluten free diet, Sugar free diet,

Raw food diet, 5:2 diet and the Paleo diet. The participants

were blinded with the by an external assistant and then allocated

a diet to follow for 7 days. Participants were given a Poop diary

and trained how to use the Bristol Stool Scale [see fig 4]. Partici-

pants were asked to record data, in a form, on the following:

Number of poos per day, a Bristol Stool Scale score for each

poo, number a flatus per day and a time of poo for each deifi-

cation.

Data was analysed using Microsoft Excel and SPSS.

Results

The total number of poops per week was 59, this gave a mean

number of poops per person week of 9.83 [SD=2.23], or a daily

mean of 1.47 [SD=0.66] poops per person per day [see fig 2].

The mean Bristol Stool Scale score [see fig 3] was 3.62

[SD=0.9].

The mean episodes of flatus per day

were 8.56 [SD=4.21].

The mean time of defecation [see fig 1]

was 1:27 pm [range=6:00 am to 11:20

pm].

When the separate diets where further

analysed and compared to the cohort

mean. The 5:2 diet had the highest

mean number of poops per day [n=2,

p=0.854]. The gluten free diet had the

lowest mean number of poops per day

[n=0.69, p=0.559].

The raw food diet produced the high-

est mean Bristol Stool Scale score

[n=4.7, p=0.295] compared to the glu-

Surgos Highly Interesting Toilet

Study

An analysis of the most commonly

occurring celebrity diets on Google.

Figure 1: time of poops for entire cohort


ten free diet that produced the lowest mean Bristol Stool Scale

score [n=2.5, p=0.766].

The 5:2 diet produced the highest mean flatus per day [n=13.1,

p=0.835] compared to the raw food diet that produced the low-

est mean flatus per day [n=3.5, p=0.115].

When analysed there was no difference in distribution of poop

timings between the diets.

Conclusion

The findings of this study conclude with the findings of previous

studies that state bowel movements are between 3 times per day

to once every 3 days1. It also agrees with other work assessing

normal levels of flatus [8-20 per day]2.

It is interesting to see that the 5:2 diet produced both the high-

est mean number of poops per day and the highest flatus per day

one would assume that a diet which involved limiting ones in-

put would also limit output, this finding warrants further investi-

gation.

A novel finding was that the raw food diet produced the highest

mean Bristol Stool Scale score; this is the opposite of how one

would hypothesise. Ordinarily it would be thought that the in-

creased fibre (from raw fruit and vegetables) in the raw food

diet would increase stool hardness (and decrease Bristol Stool

Scale score). Again this warrants further study.

Following this brief study the author is now of the opinion that if

the aforementioned exercise adverse fatsos want to loose weight

they would do best on the 5:2 diet considering that the average

poop weights around 317g3 and the average person poops about

172kg per year, this could lead to some very impressive losses.

The 5:2 diet induces around a 50% increase in pooping, meaning

they could expect to loose an extra 86kg per year. I know what

Id do.

References

1. Normal Bowel Habits and Prevalence of Functional Bow

el Disorders in Singaporean Adults Findings from a

Commu nity Based Study in Bishan. L Y Chen et al.

Singapore Med J 2000 Vol 41(6) : 255-258.

2. Levitt, MD; Furne, J; Aeolus, MR; Suarez, FL (November

1998). "Evaluation of an extremely flatulent patient: case

report and pro posed diagnostic and therapeutic

approach.". The American Journal of Gastroenterology 93

(11): 227681.

3. http://fitterlondon.co.uk/wp-content/uploads/2011/09/

bristol-stool-scale.jpg. Bristol Stool Scale image, ac-

cessed 10 June 2015.

Figure 3: mean Bristol Stool Chart scores

Figure 2: mean number of poops per day

Figure 4: Bristol Stool Scale3

16

LETTERS

TO THE EDITOR

Should attendance be taken in lectures?

Dear Surgo Editor,

Although lectures are an excellent learning method for me, I acknowledge that that fact is not true for each individual.

The simple answer is It doesn't matter if attendance is recorded, as long as absentees reasons are considered individually and fairly,

but nothing is ever so simple. Lectures are a learning method designed to assist and direct us students to learn a topic to the desired

depth of the course. But, lectures are just one method of many, there is of course, PBL, Workshops, Self-study, Labs, and Small-group

working, and yet other methods as well. Each method has its advantages and disadvantages, and each individual will learn better by the

method best suited to them. For instance, lectures can encourage students who are less inclined to engage in self study by providing a

strict allocated time slot that provides nearly all the knowledge expected of a topic in a succinct and focused format. But that doesn't

mean they are ideal for everyone, and to have forced attendance to lectures would not be fair on those individuals who would other-

wise benefit from making their own arrangements for learning during that hour.

The majority of learning responsibility should rest upon the student, whether they choose to learn by their own accord or by the lec-

tures should be their decision.

It would be perfectly fine to have attendance recorded, as long as those students that chose to be absent were not penalised.

It would also be fair to not record attendance. Students should be granted the respect to uphold their responsibility to take charge of

their own learning thus to attend lectures as they require.

But what is not fair is to have attendance recorded then penalise the individual student who chose to be absent if their reason was so

that they could learn the topic on their own terms by utilising a method that is more beneficial to their learning. But of course, their is

the risk that the individual could simply skip the lecture and also not allocate themselves time to learn that particular topic.

With all that said, I am aware the statistical correlation between percentage of attendance and pass/fail rates; also, that the University

has an attendance threshold and they have it for good reason; also that there is the consideration of resources required and practicality

issues. All fair points with varying weight of significance, which is why I conclude with the suggestions that:

It is not fair to force attendance by recording attendance to every lecture;

It is perhaps not advisable to publicise that attendance will NOT be recorded at lectures, because that may encourage abuse by

some students;

Thus, may be best to just keep the attendance protocol as it currently is, whereby attendance is taken on the rare/random occa-

sion thus instilling just enough motivation to continually attend, while allowing students some freedom to engage is some self-

study if they deem it more beneficial while not feeling expressly pressured to have to attend the lectures.

Another alternative would be to record attendance for each lecture but then allow students the opportunity to speak directly to,

and request from the Year Director, the freedom to be absent from the lectures to engage in their own self-study; this freedom

can be dependent upon the students ability to uphold their grade average to an individually-assessed threshold, that if the stu-

dent dropped below the threshold he/she would have to attend the lectures in the hopes of raising their grade again.

Anonymous contributor

Have any burning points of view you want to be heard?

Want to complain about something, but dont want to post on Facebook or Twitter?

Surgo is your vessel. Email [email protected]

Solution to the previous case:

The solution here is quite cut and dry. Chlamydia is one of a set of diseases/infections that is known as notifi-

able. As a doctor it is your responsibility to ensure that the said partner is informed and tested in order to pre-

vent harm. Your options are to inform the partner directly, ask Mr Klozoff to inform his partner but make it

clear that you will do so if it becomes necessary, or to convince him to bring in his wife for an appointment

where you will act as a mediator. This would not change if the wife was not your patient, and it would not mat-

ter if the condition was candida. You cannot bring a patient in under false pretexts and you must inform your

patient of every test performed on them.

The Case: Mrs Smith and Alzheimers Disease

Mrs. Smith is your patient and is an active member of the community. She is on the Com-

munity Health Council and Parochial Church Council and is well loved. She has a fear of

becoming "demented" and one day produces a properly drawn-up Advance Directive to

say that if she develops Dementia she does not want antibiotics for chest infections.

Years pass by... Sadly, Mrs. Smith develops Alzheimer's Disease. She contracts

Pneumonia and is very sick. When asked whether she wants her infection treated, she

has forgotten her previous instructions and says "Yes"

Questions-

1) Do you treat Mrs. Smith?

2) Does it make a difference if her family wishes her to have treatment?

Glasgow University General Practice Society:

ETHICS CASE!


CONTACT GUGPS: Facebook: Glasgow University General Practice Society/ Email: [email protected]

President: Mita Dhullipala

18

As summer begins and the sun finally decides to emerge, our holidays/electives begin. For me it has been a wonderful year, and I hope

the same is true for everyone.

MedChir certainly has had a very successful year. We got off to a flying start this year in September, with the new year of firsties prov-

ing to be a fantastic, sociable group. We obtained a record number of new members, just over 130 this year! With our first couple of

events going very well. We had a very big turnout for the 1st medic families event and the welcome back ceilidh. Our Halloween Beer

Olympic was another resounding success resulting in some spectacular hangovers.

We had a lot of educational events this year, with our inaugural paediatrics and pizza night going very well. We decided to put the pro-

ceeds from these events towards charity and with the Christmas Carol singing, Scrub crawl and Raffle from the ball we managed to raise

just shy of 3000 for our charity this year, Social Bite.

Our premier event of the year, the MedChir Ball was held in the Lighthouse venue in the city centre. Despite, getting stuck in a lift for

an hour with 5 other men, I had a fantastic evening. It is a great opportunity for the students and faculty to socialise outside of the lec-

ture hall.

Either side of the Christmas break, with over half of the Medical school sitting exams at the time, we had our annual meetings with

both the Royal College of GPs and the Royal Medico-Chirurgical Society. We also had our Annual Meeting with the Barbers incorpora-

tion, held this year at the beautiful Trade House in the City Centre.

Our annual Debate with the Dialetics society was a fun affair, with the motion Should all drugs be legalised provoking some passion-

ate speeches on both sides.

Once exams were finished and we ran through our OSCE practice nights, we got to look forward to the Annual Scrub Crawl. In which

this year over 400 people took part and we raised a massive 1600 on the night for charity!

Finally we finished up our year with our Annual Gen-

eral Meeting, where our new President/Chairman

Trung Ton was elected to take the reins for the

2015/16 year, as well as our new committee (details

of which can be found on our website

www.medchir.co.uk)

Our last event of the year, the Inaugural Friends of

MedChir Dinner held in the historic Dining Room of

the Glasgow University Union closed out the year in

a flurry of dining, drinking and dancing.

Personally, I have thoroughly enjoyed the past year,

and Im sure next year will be even better!

I hope everybody has a wonderful summer and see

you all in September!

Keep it real.

Kris McArdle

Outgoing MedChir president

A Brief Summary of the MedChir Year

A few words from retiring MedChir President, Kris McArdle

surgo summer 2015

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