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November 2013 86: 2

SURGO

Issue 83.18/09/2013

The Surgo Team


(during their own freshers weeks)

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Surgo Autumn Issue

Contents
1
Ella Bennett Editor

Editors note Medical news Interview with Bob Leckridge Homeopathy and the NHS The Science of Snake oil Cannabis as a medical therapy The Rise of E-Cigarettes Surgo research: Hangover cures Review: Bad Pharma by Ben Goldacre Medical Myths Horror-scopes Yules Yarns

2 3 4 5 7 8 9 11 14 15 16

James Tajkarimi Assistant Editor

Tom Baddeley Finance Editor

Josh Neilsen Production Editor

David Boyle Arts Editor

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Editors note

Editors Note
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 indispensable readers) 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 true story about hypnosis to counteract all the hokum. Enjoy! Ella Bennett

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News

Medical News
A summary of the latest medical news by contributing writer Jamie Henderson

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 they propose 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.

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.

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 mutation, and only 2% of children who were obese by 5.

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 just 4cm 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 acceptable to use such young donors.

Feeling down, why not bake a loaf?


After all the excitement of the Great British Bake Off research has suggested a link between baking and mental health. A report published by the Real Bread Campaign (no conflicts of interest there then) written in conjunction with last years GBBO winner John Whaite, has suggested that baking could form part of the solution for many people suffering with mental health issues. John draws from his own experiences when he was dealing with crippling depression 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.

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 Oreos in one go.

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Interview

Interview: Dr Bob Leckridge,


Glasgow Homeopathic hospital
Surgo sat down with Dr Bob

Leckridge, 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.

gone away, hallelujah, then its +4.Consistently we see in audits about 70-75% score +2,+3,+4

back and says theyve got less pain, how do I know if that came from the powder they took or the consultation they had?

Is it fair to say you deal Does the name Homeopathic primarily with psychological hinder your ability to practice? rather than physical wellbeing?
I dont accept a duality between mind and body because I dont meet anyone whos only got one. If someone comes along 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. 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 that we do cognitive therapy, they have in their head that we just hand out funny wee powders that dont actually do anything.

Bob Leckridge

If you just practised good holistic medicine without the alternative therapies I doubt thered be much controversy, is that a reasonable position?

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 complimenting. 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 Do these drugs offer anything physios and nurses, we prescribe antibiotics and do blood tests just like a above placebo? GP but we also offer things like yoga, art therapy, and homeopathy as well. In some ways I wish wed never had them because it is a controversial area, it What percentage of people get isnt explainable. For me the issue in some benefit and how much placebo is deceit. I wouldnt offer something that I didnt think had a genuine benefit do they get? chance of helping them. If you receive a We use a quality of life outcomes score; pain killer and feel better, part of that is it goes from -4-+4 so 0 is no change 1 is the placebo effect. If a person comes some improvement, if its completely

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 Some people do come looking for the evidence based but doesnt seem to kill homeopathic medicine because mum or anyone or harm anyone and that can granny always used it, but theyre very make a difference to 75% of those much in the minority. Any survey weve people then I think youre offering done shows that the vast majority come something worthwhile and I cant see because theyre stuck, theyve been how those people are advantaged by round all the other clinics and they just stopping them having access to that. want help.

Do you think the patients you receive are maybe predisposed to thinking that homeopathy is going to be for them?

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. But yes, I am worried that people will campaign sufficiently well, out of a lack of understanding, to get us shut down.

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Homeopathy and the NHS


By contributing writer Michael Pretswell

omeopathy, and its older, marginally more respectable brother complimentary medicine, can be a seriously controversial 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 customers. Dr Tom Dolphin, chair of the BMA junior doctors committee publicly denounced homeopathy recently, claiming 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.

prevalence being particularly high in cancer patients. This amounts to an annual cost of a 4,000,000.

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 of these 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 maximise the placebo effect and are aware that the treatment itself is sometimes irrelevant. 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 give alternative 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 addressing these needs then it may well lend credence to the belief that modern medicine can no longer see the patient for the disease.

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 leeches would have been cutting edge in a medieval 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 to the 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 homeopathic 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.

Homeopathy is witchcraft, it is a disgrace that is it 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.

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 Facts and Figures consultation found that 74% of respondents were in favour of defunding Across the UK there are 400 consultant the service. The decision sparked outcry grade homeopathic doctors registered among alternative medicine proponents with the GMC and three dedicated homeand prompted letters of support from opathic hospitals, the largest of which Jeremy Hunt and Prince Charles. treated 27,000 patients last year. At least 250,000 may sound like a lot but it is a 200,000 people a year receive homeopathic treatments through the NHS with mere 0.017% of NHS Lothians total

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Surgo Autumn Issue

The Science of Snake Oil


A cynics Guide To Alternatives Medicines by Josh Neilsen
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 receptors a drug is even targeting, and there are still many drugs used every day which we dont fully understand..

Opium Poppy Morphine, Codeine, Oxycodone, Dihydrocodeine, 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 new compound morphine, after Morpheus, the Greek god of sleep, and it proved such an effective pain killer that more opiates However, we dont always need to understand something for it soon followed. Today, in gratitude, the poppy flower appears to be effective and not all drugs in use today were invented in on the coat of arms of the Royal College of Anaesthetists, as their unemployment rates would be considerably higher witha lab. Through centuries of trial and error (mostly the latter), many compounds have been discovered gift -wrapped straight out it. from Mother Nature, and have been part of many a witch doctors 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 prescription.

Clostridium Botulinum Botox


Its neurotoxins are responsible for a severe form of food poisoning 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 seed heads

Erythroxylon Coca Plant 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 16th century, 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 toothaches to flatulence to morphine addiction, before a prohibition movement began in the 1910s that led to its ban from general use.

Clostridium Botulinum

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Surgo Autumn Issue


St 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 potential side effects of many anti-depressants though, if youre feeling down, SJW might be worth a try (possibly more effective when combined with adjuvant therapies, such as hugs).

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 success as part of the WHO pain ladder.

Foxglove Digoxin
Discovered, depending who you ask, by an 18 th century doctor 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, introduced 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).

St Johns wort flower

Artemisia annua Shrub Artenimol, Artemether


For over two thousand years the shrub Artemisia annua has 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, Artemisinin, 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.

Foxglove flowers

Yew Tree Bark Paclitaxel


Paclitaxel was one of the first chemotherapy drugs discovered. It was discovered during an American screening program isolated it from the bark of a yew tree and found it to be effective against ovarian cancer and melanoma. Unfortunately, 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 sustainable (and they were right). Luckily, an alternative manufacturing process was created that necessitated far fewer trees, allowing cancer patients and yew tree fans alike to breathe a sigh of relief.

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 medicine. 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 herbal, and might feel more natural for it, Id recommend the tablet over the tree bark.

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Surgo Autumn Issue

Cannabis as a Medical Therapy


By finance editor Tom Baddeley

annabis preparations have been used to treat a variety of medical 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.

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.

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.

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

It is true that cannabinoids are addictive drugs, however their addictive potential is considerably lower than many comIn addition to this, CB2 receptors are monly prescribed drugs or other recreaoverexpressed on the plaque-affected tional substances. Furthermore, despite a cells which are implicated in both long history of non-medicinal use, the Alzheimers disease and multiple have been no recorded cannabis-related sclerosis; CB2 agonists have been found deaths from it. Another principal area of to stimulate macrophages to remove dispute surround potential routes of these plaques leading to a reduction in administration. Though smoking is the symptoms. THC on the other hand is most common at the moment, this used as an anti-emetic; its synthetic clearly carries all the risks associated derivatives are more effective at with smoking such as COPD. reducing nausea and vomiting associated Medicinal cannabis is in fact, far more with cancer chemotherapy than other effective when eaten, vaporised or used treatments. THC also works both as a spray or tablet for example. centrally and peripherally to relieve cancer-related pain, with the advantage Research is currently being done into the of being an alternative to opiate based long term damaging effects of cannabis therapies. Another use of THC is as an use on the brain but no definitive links appetite stimulator (not surprising have been found so far. With continued really). research into medicinal cannabis, it might be possible to isolate its potential whilst not producing a high feeling, Adverse effects and criticism possibly unlocking its use as a legitimate medical drug. Although some medical uses of cannabis seem very arbitrary, all licensed applica-

Worldwide cannabis use

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Surgo Autumn Issue

The rise of the E-Cigarette


The traditional cigarette has the winds against it, arts editor Druid Boyle explores the latest technology getting ready to replace it
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.

What are they? What do they do?

e-cigarettes should fall under the same legislation as cigarettes and as such be banned from public places.

Ultimately they deliver the same nicotine kick to smokers but are less harmful and What does the Fox say? cheaper. Upon inhaling, the liquid in the cartridge, where the filter would be, is Ring-ding-ding-ding-dingeringerding. 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 The fox. holding a cigarette, a problem that has perhaps prevented patches and gum from What does the future hold? really kicking off. There are estimated to be around 1.3 million e-cigarette users, up from 700,000 in Whats all the fuss about? They 2012 which emphasises the remarkably sound splendiferous! rapid revolution that is sweeping our shores. In October the European ParliaE-cigarettes lack tar and other nasty ment drafted a law to introduce a number additives but the BMA is concerned of measures affecting the regulation, about the revolution due to the lack of strength, advertisement and sale of ENed Stark is a big fan rigorous, peer-reviewed studies on their cigarettes. As it stands, it does appear to safety and efficacy. Concerns are placed be a favourable alternative to smoking on the fact that e cigarettes can legally I recently held a Q&A session with and some companies argue their products be sold to children and are not treated as myself: will overtake sales of tobacco within the a medicine so the legislation surrounding decade. Bold claims but the winds are them is unclear and thus, potentially changing. All we ask of you readers is to Where did E-Cigarettes come unsafe. The use of them in public places stay vigilant, stay informed and brace is perfectly legal yet has led to many from? yourselves. stories that have been brought to public Like many of the great inventions of our attention. Planes have even had to be time, the e-cigarette was born in the dark turned around after users refused to stop underbelly of Chinas laboratories. It was smoking their e-cigarettes. made by none other than Surgos Personally I was in a pub recently (lad) favourite pharmacist Hon Lik created a piezoelectric ultrasound emitting element and witnessed a fellow punter smoking an e-cigarette which was an unusual that vaporises a jet of liquid containing experience but not by any means nicotine diluted in a propylene glycol uncomfortable. It is strongly argued by solution (plagiarism? check). Smoking an e-cigarette can rapidly increase many, including the BMA, that
the onset of baldness...

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Surgo Research

The relative effectiveness of interventions intended to treat alcohol hangover: a randomised control trial
Tadjkarimi 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 21 st century 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 prevention 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 hypothetically 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 follows is the introduction and method to our study; with follow up results to be published in the next issue.

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 mere occurrence may infer an evolutionary advantage; acting as a disincentive to excessive drinking with negative reinforcement of undesirable symptoms. Additionally 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.

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Surgo Research 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. 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.)

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.

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10

Surgo Review

Ben Goldacres Bad Pharma:


A review, by editor Ella Bennett 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, underenforcement and fake fixes that extends from individual doctors, Ben Goldacre through patient safety bodies right up to world-renowned journals commercial industry; universities,
journals and charities are also guilty of publication bias whether to enhance Ben Goldacre himself is more than just academic reputation or honour another perfectly-groomed media doc; he stipulations imposed by undisclosed has won numerous awards for scientific industry sponsors. writing and his bestseller Bad Science and weekly Guardian column have set an This lack of evidence extends to treatments that millions of people take encouraging precedent (I am trying not to hold his occasional involvement with every day, treatments that the NHS the Daily Mail against him). Bad Pharma spends over 14 billion pounds a year on, and treatments that in all probability you is more than just plain old industrybashing (though Goldacre does make his or I, or your mum/dad/spouse/dog will agenda abundantly clear), the book is so be prescribed in the not-so-distant future. Perhaps the most shocking example is meticulously researched that any that of anti-depressant (SSRI) suspicions of conspiracy are discounted paroxetine. GlaxoSmithKline, the almost immediately. developers and manufacturers of This grim tale begins with a section paroxetine, knew that about the bafflingly unethical problem of though not licenced for missing data. At present, the best paediatric use, it was estimate available is that 50% of trials being widely prescribed are never published. Evidence that drug for children. This is companies routinely, and legally, perfectly legal and not withhold unfavourable data in order to really an issue in itself flood the literature with evidence doctors frequently use favouring their own products. Not only drugs off-label for can doctors and patients not access this conditions out-with their information, but neither can organisaspecific license. The tions such as NICE and SIGN. This problem was that GSK makes a mockery of the very fundamen- also knew, through tals of contemporary medicine, leaving extensive but unpublished doctors to make decisions based on noth- trials, that paroxetine ing more than the regulators word and increases the risk of drug company propaganda. To add insult suicide in children. This to injury, this problem isnt confined to 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 statins and 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.

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Surgo Review

How drug companies mislead doctors and harm patients


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 randomised control trial conducted by the Cochrane collaboration to discover the effect that receiving a knighthood has on letter 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 diseasemongering to rival the pharmaceutical companies themselves. He then moves on to the murky world of drug advertising where only 67% of adverts in major 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 maddeningly unjust, but also extremely dangerous.

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 widespread 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 To make things worse, journal revenue is head of the Royal Institute in London. heavily dependent on reprint orders Even more absurdly, the American (articles bought by drug companies to Association for nutrition and dietetics is use as endorsements for their products) funded by Coca Cola and ,to top it all and industry advertising. This represents off, the British Journal of Midwifery a huge conflict of interest, summarised runs adverts for formula milk. eloquently by My only criticism of Bad Pharma is that Richard Smith, it could be a little shorter; at 448 pages it former editor of is a hefty read. Dont let this put you off the BMJ, the though, read it in sections (like I did) and choice is either persevere because Im pretty confident to publish a trial that this book will prove far more that will bring in important and educational than anything $100,000 of else you read at med school. And if not it profit, or meet will, at the very least, be infinitely more the end-of-year interesting than anything on the med budget by schools 5 page long reading list. firing an editor. The next blow to

* 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 membership for his late cat Henrietta, now Dr Henrietta, from the same institution for $60. Unsurprisingly, Mckeith reverted back to her original title.

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Fun Stuff

Medical Myth-busting
By Dan Taylor-Sweet
If youve ever dragged an oversized bottle of water around all day in order to get your required 8 glasses, been persuaded by a significant other (/dubious viper decision) that semen is loaded with calories so youve got no excuse or booked a manicure for your funeral date to make sure youre looking your best for your date with the devil, then I hate to break it to you but youve been swindled into believing some of the horrendous, weird and down -right dangerous medical myths that float around today. 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 to avoid ending up with your eyeballs hanging down your face, then youll understand my concern. The thought of having your eyes swing around on the end of fleshy stalks like jelly conkers terrifies me. This fear, thankfully, is not founded on any truth. There has been no recorded occurance of a person sneezing their eyeballs out of their orbits. You can now too become that obnoxious child who ran around the playground sneezing 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 flatmate wandering around wielding a dirty fish slice youll understand my predicament should I try and fight off the infatuated blood hungry roomie? Or should I wake him up and risk giving him a stroke? Id heard that you should never wake a sleepwalker or they would have a seizure or even worse, die. Luckily this is all a load of phish after consulting Kumar and Clark I found that its perfectly safe to wake 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 a person died their nails kept growing for 3 days. I was mesmerised by her mediocre chat. But then it hit me - the horrific thought of my lifeless hunter like callused hands turning into perfectly manicured lady paws really would be a fate worse than death. I rushed home from the GUU and frantically Googled (my chunky man fingers are too big to use my blackberry otherwise I would have done it there and then to smite her down). Google pulled through - yet again. Nails do not continue to grow after death because the hormones that stimulate them are no longer produced after you bite the dust. Instead the skin dehydrates and tightens making the nails appear as if they have in fact grown. Thank goodness.

Drink 8 glasses of water a day, everyday Semen is loaded with calories Semen, that sticky, white liquid girls love to think is full of empty calories? Maybe not. Many a post -coital argument has sparked the highly contentious debate; what are the nutritional benefits of the stallion in questions ejaculate? This is nearly always started by the self-proclaimed lothario at 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 semen contains enough calories to keep a team of huskies running for around 87 days. This is plainly not true considering an average ejaculation contains only 10ml of fluid. A single ejaculation actually only contains around 5 -6 calories most of which comes from the high fructose content of the seminal fluid. Considering this is the equivalent calorie content of a single grape, its not exactly satisfying for either person involved. So keeping this in mind, the next time your lover is begging you to eat yer dinner, youll be able to tell them how youd much prefer a tasty sourdough, pastrami and emmental sandwich over the dinner theyre offering you.* Ever been thrown into a fit of sheer panic by the sight of your Evian bottle running dry halfway through a biochemistry lecture? Does the prospect of not being able to get your required hydration make you shrivel into a raisin? Dont panic. The myth that you must drink 2 litres of water a day was created by a research group funded exclusively by Danone - to boost sales, or maybe as part of a more sinister plot towards watery world domination. A person only actually needs to drink when they feel thirsty which varies a huge amount; a deprived Ayrshire shepherd hunting haggis over the Campsies will need to drink more than a bedridden, i-player watching student.

Please direct any complaints/well-founded accusations of misogyny/death threats to Dans personal facebook page.

So, whenever you hear someone make an outrageous medical claim never be afraid to jump in and tell him or her how much of an idiot they are being. The propagation of medical misnomers is incredibly annoying to anyone with an ounce of intelligence, and their perpetual reoccurrence is more frequent than the Borg. As Adam Savage and Jamie Hyneman all to often say Myth busted. Love Dan, the stallion/lothario/artisan semen maker. x

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Fun stuff

Horror-Scopes
Your future predicted by Psychic Suz and Astro Anna: Glasgows finest amateur astrologists. Capricorn
If you see dead people this month Capricorn, you may have an undiagnosed 6th sense. Or, you may have taken a wrong turn into the morgue.

Cancer
Strange noises in the night? Increased sightings of black cats? Incessant cackling from the neighbours upstairs? Probably a witch, probably a Slytherin. Consider a change of address.

Aquarius
Steer clear of unlabelled videotapes and girls with long, black hair around the 14th. The stars predict that looking into wells is not advisable under any circumstances.

Virgo
If you go down to the woods this month youre in for a big surprise. Cloudy conditions mean that we cant be sure whether this is positive or not, but we advise you not to risk it.

Pisces
That china doll youve had for years is looking creepier than ever. Bin immediately or give as a gift to your worst enemy/least favourite PBL tutor.

Libra
With Mars moving into Venus it looks likely that black dogs are a bad omen for you this month. Warning: Trust nobody who likes their steak raw.

Aries
Its okay to try something different once in a while, but that new look youre sporting is scaring the first years. Remember, Halloween is only the 31st.

Scorpio
Saturns rings are moving anticlockwise which means that zombie sightings are on the rise. Consider investing in a personal safety alarm and refrain from hanging about graveyards.

Taurus
If you believe in ghosts, be very, very afraid this month Taurus. If you dont, carry on with life as per usual.

Sagittarius
Your new lecturer may be in desperate need of some dental work. Or, he may be Dracula. Wear garlic as a precaution.

Gemini
Forget trick or treating, its not safe. Research has shown that you lot are prone to developing Jekyll and Hyde-type personalities around Halloween. Seek help if you feel like youre living a double life.

Leo
Stay out of the SL after hours if you dont have a holographic sticker on your student card. Someone scary is waiting for you to venture into the surgical section so they can test out their scalpel skills.

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Fun stuff

Yules yarns
Contributing writer Anna Yule brings us a real life, TRUE story about hypnosis...
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 anaesthetic machine 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.

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 at Surgo!


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 surgo_editor@hotmail.com

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