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LIFE IN LAOS COPING IN THE WORLD’S! MOST BOMBED COUNTRY

COSMIC MEDICINE DR. KEVIN FONG’S THOUGHTS ON! SPACE EXPLORATION AND RESEARCH

NEW TUITION FEES WHO WILL THEY REALLY AFFECT?

FIRST CUT! INTERVIEW WITH DIRECTOR SAM GRACE! FROM ITV’S SURGERY SCHOOL

INSIDE THE GOLDFISH BOWL EXCLUSIVE INTERVIEW WITH! DAVID BENDER

!! COMPETITION GET THE CHANCE TO WIN ! THREE GREAT CLINICAL BOOKS!

WRITTEN AND EDITED BY UCL MEDICAL STUDENTS

DECEMBER 2010ISSUE 1

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First of all, I would like to introduce you to the new look Bell Magazine. With a change in the editorial team and a fresh face to the Magazine, I hope that you thor-oughly enjoy reading it.

To those of you starting at UCL Medical School for the first time: I hope that your past couple of months have been enjoyable and that you continue to have a great time here. We share the stories of two people who are starting their new life at UCL: Anastasia who has just started medical school and Kate, who has transferred from Cambridge University.

The cover story for this issue focuses on Laos and the life of many Lao people affected by unexploded cluster bombs from the Vietnam War. This report reflects on a personal holiday to Laos by Michelle Fong and provides stark facts to a problem that many people are unaware of.

Furthermore, we have managed to interview Dr Kevin Fong, a consultant anaesthetist at UCLH, on his recent programme on BBC’s Horizons ‘Back from the Dead’ and for his thoughts on his research interests. We have also interviewed Sam Grace, the director of ITV’s Surgery School, on his programme which followed newly qualified doctors as they started their jobs in the NHS.

I would like to say a personal thank you to everyone who has been involved in this issue of the Magazine, par-ticularly Rebecca Sloan and Simone Granno. We are al-ways keen to take new faces on board. Get in touch if you would like to get involved, be it in editing, design, writing for The Bell or fundraising. Or maybe you have an idea that we haven’t thought of yet? Even better!

Don’t forget to take part in our competition to win three great books from Oxford University Press. These include: Oxford Handbook of Clinical Medicine, Oxford Cases in Medicine and Surgery and Oxford Assess and Progress: Clinical Specialities.

Jesse Panthagani

Editor

editor@thebellmagazine.co.uk

A LETTER FROM THE EDITOR

JESSE PANTHAGANI

EDITOR

First year clinical student

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EDITORIAL TEAM

Sophie Bates Anastasia Bow-Bertrand Sam Bulford Kate Davies Preeti De Philip Eneje Michelle Fong Ricky Sharma Alex Willsher

REBECCA SLOAN

DEPUTY EDITOR

First year clinical student

SIMONE GRANNO’

DESIGNER AND WRITER

Second year preclinical student

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Latest news..............................................p. 4 A glimpse at what’s being done in the medical world! New tuition fees........................................p. 5 Who will they really affect?! A Letter from RUMS sabbatical officer.......p. 6 A few words from Alex Nesbitt!! President’s column....................................p. 7 A letter from RUMS senior president! Yoga and the brain....................................p. 8 Can Yoga play a role in therapy?! The Hippocratic Oath................................p. 9 Backbone of medical practice or a load of old twoddle?!

! A day in the life of......................................p. 10 A fresher and a transfer student talk about their experience

! Life in Laos................................................p. 12 Coping in the world’s most bombed country

! In vitro fertilization......................................p. 15 Giving couples a new hope

! Cosmic medicine.......................................p. 16 Dr Fong’s thoughts on space exploration and research! Want some stem?......................................p. 18 Dr Trossel’s stem cells scam! First cut......................................................p. 20 Sam Grace’s experience directing ITV’s Surgery School! Wish I was good at video games................p. 22 Frequent gaming can improve visuomotor skills!! Down among the dead...............................p. 23 What is it like?! Inside the Goldfish bowl..............................p. 24 Exclusive interview with David Bender! ! !! An elective at UCL......................................p. 26 Juliana Alvarez’s experience in London!!

THIS MONTH IN THE BELL

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RIGHT-LEFT SHIFTERS

t appears that we are now able to reconfigure the hu-man brain! Thanks to researchers from the UC Ber-

kley Neuroscience Institute, it has been discovered that magnetic stimulation of a certain area of the brain can cause a change in which hand a person usually performs every day tasks. Using TMS (transcranial magnetic stimu-lation) on the posterior parietal cortex region, it was pos-sible to interfere with the normal brain planning activity. An experiment was conducted on 33 right-handed volun-teers, and it was found that TMS on the left side of their parietal cortex produced a marked increase in the use of the left hand for many tasks such as cutting paper, eating and even writing. These results are certainly paving the way for new rehabilitation therapies for victims of various brain injuries such as stroke.

More Info: http://neurosciencenews.com/tms-brain-stimulation-parietal-left-right-handers/

WORLD’S FIRST CLINICAL TRIAL WITH HUMAN STEM CELLS!

For the first time in human history, embryonic stem cell therapy is being tried on a human in a new clinical trial. It is happening at the Shepherd Center, an At-lanta spinal cord and brain injury rehabilitation hospi-tal, where a newly paraple-gic patient is the first subject to ever receive this treat-ment. Researchers from Geron Corporation are op-

timistic: the treatment should not only alleviate the symp-toms, but also repair the damage permanently. Needless to say, this is a giant step forward for regenerative medi-cine. Geron Corporation has also been involved in de-signing new stem cell-based cancer treatments, which are already undergoing clinical trials.

More info: http://neurosciencenews.com/first-clinical-trial-embryonic-stem-cell-therapy-begin/

NEW INSIGHTS INTO HIV

HIV’s Gag pro-teins plays a key role in the assembly process of the virus. So far, diffi-culties related to the imaging process have limited the attempts at gaining insight into its functioning. However, at NIST (National In-stitute for Standards and Technology-USA), researchers were able to create an artificial cell mem-brane to which the Gag protein bound and behaved as in vivo. This allowed the researchers to take a look at the various stages of HIV assembly with “unprecedented clarity”. With a greater understanding of Gag’s behavior, it will be possible to design new antiretroviral therapies that target the assembly process of HIV.

More info: http://www.news-medical.net/news/20101015/New-insights-into-HIV-infection-process-may-allow-antiviral-drug-development.aspx

INTROSPECTION AND THE BRAIN

An MRC-funded study conducted at the Institute of Cognitive Neuroscience (UCL) discovered that brain structure is heavily linked to the ability to reflect on our thoughts, experiences and emotions. The biological basis of these processes has always been a mystery; now, through the use of MRI, it was discovered that the degree of development of the brain’s prefrontal cortex (involved in judging and decision making) influenced the ability to reflect. These results could help the researchers under-stand how such ability can be affected by brain damage, and so develop appropriate treatments.

More info: http://www.mrc.ac.uk/Newspublications/News/MRC007232

LATEST NEWSA glimpse at what’s being done in the medical worldBy Simone Granno

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am sure most students have heard that there has been a lot of speculation at the rise of stu-

dent fees with discussions on taking off the cap lim-iting tuition fees. Currently the fees are £3290 across all universities, however lifting off this cap will mean universities can set their own fees, with most likely to charge around £6000 whilst the most prestigious can charge up to £12000 for top courses such as medicine, law and dentistry.

Students all across the country have protested against this claiming that a rise in tuition fees will put more people off going to universities, restricting university attendance solely to the most affluent members of society. Students who study in London have argued especially how this will hit them harder due to the further increased costs of living; with fees for medical students predicted to reach a colossal £90000 – or even surpass it! This massive increase in tuition fees is indeed likely to deter the less afflu-ent members of society from going to university be-cause of the fear of crippling debt when graduated. The arguments put forward by the proponents of the new fees system argue that if we want a world class education system, we do indeed have to pay for it. They also point out that people have forgotten that students from poorer backgrounds will receive much larger bursaries which they don’t have to pay back, as well as the current system of receiving a greater loan than students from richer families.

The minimum income threshold before the loan is to be paid back has also been raised from £15000 to £21000 meaning that graduates on a very modest income will not even have to pay back anything at all. Not only this but there will be a graduate contribution system meaning that those that earn slightly more than this threshold will not pay very much either. Perhaps students have adopted a myopic view on the issue however I do not believe all the arguments proposed are com-pletely fair. To me it seems that it is not the least af-fluent members of society that need to worry, (and obviously not the most affluent), but actually those in the middle. In similar fashion to the scrapping of child benefits for those on a middle income, it seems like the conservatives have hit the middle class earn-ers once again as they will have to pay back more fees, simultaneously with students from middle class families receiving little or indeed no grants from the government.

To put this into the perspective of a future medical student, it seems that they will be left with staggering debt of roughly double of what it is now for current students, with little subsidy help from the government. And because they will meet the thresh-old salary, they have to start paying back their loan barely after taking off their graduation gowns! As a medical student myself, I am saddened that other future medics will be targeted in order to resolve the economic mistakes of their predecessors. It seems that we will be among those left to shoulder the debt of economy – even more so because we study in London at one of the top institutions in the world! Perhaps it may be fair to increase the tuition fees, however to graduate with double the amount of what already seems to be a staggering debt seems well...scary!

NEW TUITION FEESWho will the really affect?By Philip Eneje

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A LETTER FROM THE SABBATICAL OFFICER

elcome to all the freshers! You’ve arrived at a world-leading university with an awesome medi-

cal school and students’ union; RUMS! And welcome back to everyone else. I hope you’re all ready for another year of hard work and play, and I look forward to work-ing with you over the year!

My name is Alex Nesbitt and I’m the new Medical and Postgraduate Students’ Officer (MPSO) at UCL Un-ion, which means I’m responsible for everyone at RUMS. I’m taking a year out having just done iBSc to work full time, to represent your views, wants and needs to the Medical School, and also to oversee RUMS Events and Sports Teams. I’ll be working with the new RUMS exec, to make sure your experience this year is as good as it can possibly be!

There are a number of issues that we will be dealing with this year, and also some projects to launch:

We will be pushing for issues with Clinical Teaching to be resolved, and will be working with the Quality As-surance Unit to accomplish this.

We want to continue to strengthen RUMS within UCL Union, especially with Huntley Street closing in March/April, and the new building being launched then. The new Medics bar will be called ‘The Huntley’ and will contain as much memorabilia from the old Huntley Street and the Royal Free Bar as possible. We’ll also be holding a launch party, so keep an eye out for that!

We will be launching our new RUMS Alumni Associa-tion, which will hopefully build on relationships we al-ready have through some of our sports teams, to make sure that the RUMS Community continues to grow.

We will be co-ordinating with the BMA and ULU Medgroup on a national campaign as this year will see a number of final years across the country being unem-ployed when they graduate.

Finally, please keep an eye out for emails from me, and messages in the RUMS bulletin – we will be asking for regular feedback on various issues, as well as feeding back to you on what we are doing for you! At the end of the day, we’re here for you, so please do get in touch. You can always send me an email at mps.officer@ucl.ac.uk, or pop up to the Sabbatical Suite on the 4th floor of UCL Union to come and have a chat.

Good luck with the year and have fun!

Alex Nesbitt, Medical and Postgraduate Students’ Offi-cer

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PRESIDENT’S COLUMNirstly could I welcome you all back to a new year of working hard and playing hard; special wel-

come goes to all our Freshers in year 1. My name is Negin Amiri, and as part of my job as the Senior President I am very much looking forward to represent-ing the medical student body to the medical school, UCL, UCLU, and of course the BMA. There are a number of priority issues on my agenda for this year, and with the help of the other members of RUMS ex-ecutive we aim to ensure that student opinion plays a key factor in all decision making:

EDUCATION

- The MBBS Curriculum is being extensively re-viewed in the next few months; myself, Regina Nolan (the VP of Education) and other student representa-tives from the upper years will continually be involved at every step of this review, and will be updating the year groups affected by any changes made.

- Our academic year representatives have now been chosen. We had an extremely strong set of appli-cations this year, and as a result aim to maintain and further improve last year’s already proficient academic representation by students on module management groups. Our reps will be receiving their first training in November, and will be proving us with feedback from all medics on the curriculum during the year, with an objective to improve and develop our experience at all stages.

- UKFPO - as most of you are aware, recent changes have been made to the foundation programme application form. Again RUMS will have student rep-resentation on all the committees held and aims to up-date you on how you’ll be affected. Please do contact Amanda Smith, the Democracy and Engagement Offi-cer and the previous Senior President, who sits on the London board for UKFPO for any further information or queries.

WELFARE

Our new welfare committee, chaired by Avni Hin-doucha, is undergoing its last stage of preparation and will be announcing its welfare reps in the next few weeks. As this is a new committee, any input from the students, during the year, regarding the service we pro-vide would be greatly welcomed.

THE “HUNTLEY”

You may have noticed the scaffolding on Gower Street opposite the Welcome Trust. We should see the result of all this hard work as a brand new location for the medics’ home, around April.

HOW YOU CAN HELP

Quite admittedly real change takes time; HOW-EVER, a lot of the times there are issues that can be dealt with much quicker, especially if there is continu-ous input from the student body. This is why we REALLY need you to fill out those questionnaires at the end of each module, talk to your student reps, and email us with your comments (and if you’re interested in being involved). My main aim is to improve the qual-ity of your experience at the medical school, by keep-ing you involved and by meeting the high standard of service delivered by my predecessor.

Have a fantastic year ahead and good luck!

Negin Amiriuclu-senior.president@ucl.ac.uk

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CAN IT SHAPE BRAIN MATTER?

eightlifting, bodybuilding, exercise- there are a number of strategies to

build one’s muscles and bones. But how can one build a bigger brain? By meditating, apparently! There are areas of the brain which influ-ence our higher cognitive function such as thinking, emotional behaviour and personality. Anatomically, these areas include the prefrontal cortex and the limbic system. It has been sug-gested that it is possible to enhance these cogni-tive functions in a positive way with techniques which traditionally are believed to generate peaceful, calming thoughts by altering the neu-ronal wiring in these cortical regions. This the-ory has been formed in the light of a number of studies which have been conducted suggesting that regular practice of yoga and relaxation techniques can in fact increase cortical gray matter in these areas. A study by Luders et al examined forty four people- twenty two controls and twenty two people who regularly practiced various forms of meditation including Zazen, Samatha and Vi-passana. They had practiced on average be-tween five to forty six years in their lifetime for at least ten to ninety minutes per day. When researchers used three dimensional MRI to

compare the amount of gray matter within specific regions of the brain, it was noted that cerebral mass in meditators compared to

controls were larger in the right hippocam-pus, the right orbito-frontal cortex,

right thalamus and left inferior temporal lobe- all areas closely linked to emotion. It was further noted that

those subjects who practiced yoga and implemented active

meditation into daily life benefited from overall positiv-

ity, ability to regulate emotions calmly and perform well adjusted

responses to stressful situations. However, it may have been possible

that the meditators may have already had more regional gray matter in specific areas that may have attracted

them to meditate in the first place.

CAN IT GENETICALLY AFFECT HEALTH?

Mediation has been suggested not only to have beneficial effects upon our neurocortical matter, but possibly at a more cellular level, it can influence our DNA. Scientists have long known that there are certain genes that predis-pose a person to specific diseases and disorders; however this is influenced by various factors which have the ability to turn genes on and off. Furthermore, over long periods of time, various stress related responses can develop such as high blood pressure in response to over activity of stress related genes. This has shown to produce a number of negative inflammatory responses which can lead to cell death and in-fluence how free radicals cause damage to cells and tissues.

In a study by Dusek et al, researchers took blood samples from nineteen people who ha-bitually meditated for years and nineteen peo-ple who had never meditated. On genomic analysis of the blood it was found that the meditating group suppressed more than twice the number of stress related genes than the non-meditating group, and were therefore less likely to suffer from negative inflammatory re-sponses which could ultimately lead to disease states. Subsequently, the non meditating group spent at least ten minutes per day for eight weeks training in relaxation techniques such as yoga. By the end of the eight weeks it was found that the novice meditating group had suppressed their level of functioning stress re-lated genes, albeit at a lower level than the long term meditators. However, the results from the study must be treated with caution due to the small sample size.

Therefore, it may be possible to alter certain aspects of our conscious thoughts and behaviour by simply spending time on a daily basis relaxing. Findings from the above studies suggest that a positive state of mind is a skill that can be trained and developed. The indi-cation appears to be that yoga and meditation can change the function of the brain and even our DNA, which was once thought to be immutable.

YOGA AND THE BRAINCan Yoga play a role in therapy?By Preeti De

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ots of people have heard of the Hippocratic Oath but few

know much about its origins and meanings. Many associate the Oath with the legendary Hippocrates, often alluded to as the ‘Father of medi-cine’, but even the assumption that Hippocrates was the author of this infamous text may indeed be false. Written almost 2,500 years ago (no one is sure of the exact date), the Hippocratic Oath is a preface some-what to the Hippocratic Corpus; a collection of 60 or so medical writ-ings on the causes, management and treatment of disease. The Hippo-cratic Oath is essentially a series of ethical codes, designed to guide the Ancient doctor in the terms of good medical practice.

Contrary to popular belief, the Oath is not sworn by current gradu-ating medical students. In fact the Hippocratic Oath does not have a role at all in modern medical prac-tice. Does this mean, then, that it should be deemed an irrelevant an-cient medical text by today’s doctors? Rebuffed and rejected by modern medicine?

First impressions of the Hippo-cratic Oath certainly encourage this judgement. For a start, the Oath be-gins with an affirmation to the Gods: ‘I swear by Apollo…’: hardly 21st Century stuff.

However, if you delve a little deeper, there emerge a number of directives that are so in keeping with today’s recommended medical doc-toring that you’d think the GMC had virtually cut and paste them directly into ‘Good Medical Practice’.

For example, the issue of confi-dentiality is particularly prominent in the Oath. The author writes: ‘All that may come to my knowledge in the exercise of my profession…I will keep secret and will never reveal’. Given that issues surrounding confi-dentiality appear to be permanently

at the forefront of the GMC’s agenda, this seems particularly wor-thy of note. It is interesting that even 2,500 years ago, the importance of trust between doctor and patient was recognised.

Similarly, acting in the patient’s best interests, another of the principle guidelines of the GMC, is unmistak-able: ‘I will prescribe regimens for the good of my patients’, and ‘never do harm to anyone’.

The Hippocratic Oath even ac-knowledges the potential for inappro-priate relationships between doctor and patient and strongly advises against them, requiring that the doc-tor keep himself ‘far from all inten-tional ill-doing and all seduction’.

Nor does the Hippocratic Oath shy away from matters of morality, tackling the controversial issues of assisted suicide and abortion. It is made extremely plain: ‘I will not give a lethal drug to anyone if I am asked’ and ‘I will not give a woman a pes-sary to cause an abortion’. These are undoubtedly still current and ongoing debates that attract much media at-tention.

Consequently, we cannot deem this ancient text futile. Old it may be, but irrelevant it most certainly is not.

However, many academics have picked up on the fact that the Hippo-cratic Oath appears to condemn the carrying out surgical operations by the doctor. This certainly does not ring true with modern medical prac-tice, given that surgery plays such a major part in today’s medicine. Ad-mittedly, the Oath does state: ‘I will not cut for stone’. This refers to the removal of kidney or possibly bladder stones, which were a common medi-cal grievance for people in the An-cient period. However, due attention must be paid to the next line of the Oath: ‘I will leave this operation to be performed by specialists in this art’. This could be interpreted not as a

prohibition of surgery, but rather as an appeal for doctors to recognise their limits and not to carry out op-erations for which they are inade-quately qualified. This notion is par-ticularly applicable in today’s medical environment.

On another tangent, there are some parts of the Hippocratic Oath that are just plain nice. There is a moralistic vein running through the text that is really quite touching to see. For example, the author empha-sises the importance of appreciating one’s medical education, stating that we should: ‘consider dear to me, as my parents, him who taught me this art’. In a similar sense, the value of passing on and sharing medical edu-cation is recognised: ‘To look upon his [the teacher’s] children as my own brothers, to teach them this art’. In these examples it is possible to really identify with what the author is trying to say; that’s not bad for something written over two millennia ago.

Granted, the Hippocratic Oath is old, and to be honest, we’re fairly ignorant in relation to where it came from and who wrote it. But it is vital to recognise the enduring significance of its message in today’s medicine. Medical advances, especially in the past couple of centuries, have been profound and in one sense medicine has altered beyond recognition. But some things never change; the impor-tance of the doctor-patient relation-ship was recognised in the 5th Cen-tury BC and its long history should further reinforce our belief in its con-tinuing significance today. As the American philosopher George Santayana once said, ‘Those who do not learn from history are doomed to repeat it’.

HAVARD’S HISTORY OF MEDICINEThe Hippocratic Oath - Backbone of medical practice or a load of old twoddle? By Lucy Havard

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fter the tribulations of UCAS, endless 'computer says no' experiences, and several interviews later I

am actually beginning my university life and degree – and I have the blue I.D. card to prove it...

No doubt not everybody remembers their initial weeks with fondness or any cohesive recollection at that, and mine have been as overwhelming as they have be-come a blur of faces and places. My reality of Freshers is surely generic in the practicalities...

Move-in day found me directing my apoplectic father through central London after the Sat-Nav's battery failed. My map reading skills should never be relied upon and after numerous diversions and loops around Trafalgar Square we arrived, miraculously finding a clear parking bay outside Ramsay Hall. Only to be asked to move on by a Pro-Life group as we found ourselves stationed oppo-site the Marie Stopes Centre. Two hours later and half my existence was stuffed into a pocket sized wardrobe and unpacked onto my mattress, making the lifespan of the already crazed springs highly questionable.

Soon tentative antennae were put out and attach-ments made with fellow lost students and within hours we found ourselves, strangers still, amidst the frenzy of Freshers Fiesta. Thereafter, the first RUMS event of 'Mums & Dads' introduced me to Huntley Street and a pile of fellow medics: about 20 Adams, several Harriets and a Bambam (I think). Some of whom I recognised during the introductory week, which was a test of endur-ance, conscientious library dashes rewarded with bare shelves (it took me shamefully long to realise where the books in the Science Library actually were...upstairs...) and an unshakeable foreboding that the thirty students who were chased for their CRB forms would be silently dispatched by Carol Farguson.

Our visit to the dissection room marked a change from rather dull formalities to a sense that I was on the verge of something very exciting. Not the smell of for-maldehyde or the watering bottles but the cadaver's in-credible gift and devotion to empirical learning.

It is, however, the unique moments which punctuate the calendar of this first term which I will carry with me throughout my time here and on into life post university. The moments which I share with people whom I may or may not be able to name and the isolated fragments that are perfect only because they are without the benefit of routine or wisdom...

The mad pub crawl around Hampstead with Josh involved an unexpected detour past a circus where the children in attendance mistook us for an act, and left me

with a scabby ankle from our ridiculous sprint to make up for lost time...

The 3 am bus ride back from Ministry of Sound dropped us at Clapham Junction Sta-tion, necessi-tating a half hour taxi trip with a leach-erous cabbie back to the BT tower. Not to forget the first lunch with my fellow PDS group at Archway in a Princess Di commemorative Diner. Since when did these exist our side of the Atlantic? The microwaved rice was presented in a block still featuring the contours of the take-out box, an ancient fruitball machine chuntered in the corner and there was even a crooked threadbare tapestry of the Prin-cess on the wall.

It is surprising how some things are transitioning from new to routine. For instance, I could now give a passable artist's impression of certain faces, the trail of pink socks from the laundry on a Sunday night is of no consequence and I unlock the music practice room armed in little more than a bikini courtesy of the faulty heating. Accommodation fees have been paid, I have bathed one too many times in the self-worth afforded from the recollection of my neighbours' names, drinking games and 'Sports Night' have been survived, the horror of a Maths assessment has been endured, Spanish has been spoken (poorly), parents and friends have been thought of (desperately) in the moments when I have been trying to open a tin with a plastic fork. Note to self: pull tops are the way forward. All within a matter of weeks. I am looking forward to processing this alongside the work and course commitments which will increasingly occupy my thoughts and aspirations.

Although I anticipate that six years will disappear, I am positive that they will afford a wealth of highs and lows, inspiration and doubt, but currently I hope to value the present time of discovery and experience, on the threshold of a wonderful academic and lifestyle opportu-nity.

ONE DAY IN THE LIFE OF A fresher..By Anastasia Bow-Bertrand

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he disorientation of starting clinical school is probably exactly the same for transfer students

and UCL students. The difference is that in my case, it’s not limited to the hospital. I don’t just have to in-troduce myself to patients, doctors and nurses over and over, I also have to introduce myself to my fellow students (both those from UCL, and the other trans-fers that I’m sure I never saw before now) over and over. My area of geographical ineptitude isn’t limited to hospital buildings with too many corridors and not enough windows, but covers pretty much the whole of the city, including the UCL campus. And whilst fellow students need to fill up their vocabulary with medi-cally related terms, acronyms, and abbreviations, I also have to add PDS, Moodle and Sports’ Night (or Nite?) to mine.

Cambridge has 130,000 residents. London has 7.5 million. That’s quite a noticeable difference in size, with a corresponding difference in number of things to do and see and lose my student loan to. So London has better shops, bigger art galleries, and a more varied night life (though I could still count on one hand the number of clubs students actually seem to go to), but it does require some effort.

For the last three years, I was able to conduct most of my life – lectures, socialising, shopping – within a one mile radius of where I was living, which covered all of my friends and the entire city centre.  Now I have to factor the time spent waiting for buses into all of my plans, and fully appreciate the branch-ing pattern of the Northern Line.

The cities may be very different, but the students aren’t. In the social shuffle that happens with the dif-ferent hospital placements, firms and modules of this year, plus an influx of students who skipped their BSc year, we’re all spending a lot of time with people we don’t really know that well. In that environment, it’s easy to force a way into the UCL social hierarchy.

Transfer students aren’t conspicuous, and most of the people I’ve met assume that our paths never crossed over the past three years by chance, not be-cause my path was 50 miles away (or 50 minutes by train from King’s Cross, in case you ever want to visit). So we’re not noticeably different.  Sure, Cam-bridge students are chronic overachievers with some-times questionable social skills, but face it, UCL stu-dents are too.

..and a transfer studentBy Kate Davies

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aos, nestled between Vietnam and Thai-land, is often a welcome breather on cha-

otic backpacking agendas through South-East Asia. The meditative pace is reflective of their strong Buddhist culture, which is not yet over-run by the greedy grasp of capitalism. The people here lead simple lives; enough sticky rice for their communal dinners (knocked back with some home-brewed rice whisky LaoLao) and their day is complete. In certain regions how-ever, the villagers’ everyday peace is threatened by unexploded cluster bombs, a remnant of the Vietnam War and hushed up “Secret War”. These lurk in rice fields, dangle off growing bamboo plants or embed themselves in rivers beds, all waiting to be jostled into exploding. In a regretful case of collateral damage, Laos re-mains the most bombed country in the world. The “bombies” as locally known, are slightly smaller than tennis balls. These may be brightly coloured, and about 80 million still pepper the country. To children who are blissfully unaware and born decades after the war, they are often mistaken for toys or fruit leading to unfortunate accidents. They are often also dislodged in the midst of farming, or while traveling on roads. In response to this, organisations are educating locals of the appearance and dangers of cluster bombs. Despite the known risk, some villagers desperate from poverty harvest the bombs for their valuable metal. The result is more than 12,000 accidents occurring since 1979, which have killed more than 4000 and left the others severely disabled.

HOW WE CAME TO COPE

A trio of medics, Maxine, Lucy and I walked straight from the numbness of our 1st year clinical exam to airasia.com in search of a holiday. Our destination needed to be hot, vaguely cultural and not in England. Laos fit the bill and we promptly clicked check-out. Armed only with a Lonely Planet guide and return tickets to Vientiane, the capital of Laos, we let the trip unfold itself. We ended up travel-ling south to VangVieng, a notorious tourist-trap but also known for ‘tubing’ action down the Mekong. Eager for some adrenaline, webooked a combination kayaking and caving tour for the next day. Caving, as we soon found out, is a strange immersive experience which has you relying on primal senses you forgot you ever had. I became acutely aware of the mud between my toes and the threat of the hard rock beneath. The guide broke my panicking thoughts by pointing out some laotian scribbles on the walls. Adjusting my headtorch for a better look, the entire ceil-ing was covered with ghostly signatures- proof of a presence. 40 years ago, caves like these had been a safe haven during the bombings. This particular one had housed an incredi-ble 700 women and children, and the smaller one adjacent 500 men. In the enveloping dark-ness, the sombre issue slipped into my subcon-scious and I was determined to find out more.

LIFE IN LAOSCoping in the most bombed country on EarthBy Michelle Fong

Map of US bomb drop densities from 1965 to 1975

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COPE (Cooperative Or-thotic and Prosthetic En-terprise) We tracked down a 'National Reha-bilitation Centre' for victims of such bombings, and found COPE by their website. Located just off the morn-ing markets in Vientiane, COPE is targeted at amputee victims. Their mission is to enable victims by pro-viding corrective surgery, physiother-apy and custom-made prostheses for free. They also provide for victims of traffic accidents, leprosy and con-genital diseases like club foot. Last year alone, they made 1264 prosthe-ses, and 400 wheelchairs. A collabo-rative charitable effort, the amount of work that goes on behind the scenes is impressive and inspiring. There is a dedicated check-up clinic and physiotherapy service, as well as engineering facility and workshop to design and build the prostheses and wheelchairs. Sustainability is crucial. Locals are trained to become physiothera-pists to reduce dependence on inter-national volunteers. Patients are em-ployed to make the prostheses, equip-ping them with skills and a stable in-come. All materials for the workshop are locally sourced, such as recycled bicycle wheels and wood. COPE is committed for the long haul.

THE EXHIBITION Despite hailing local motorcycle rickshaws tuktuks to COPE, we were drenched by a torrential downpour. The staff gathered round us with towels, apologizing profusely for the rain like it was their fault before ush-ering us to their in house exhibition. A general history of the bombings and war is first covered. Right in the centre are hundreds of “bombies” cascading out of a cluster casing. Suspended in motion and seemingly time, they were to me a parallel of the predicament in Laos. Too poor to address the enormous issue itself, Laos has been stuck in relative limbo for 40 years. An interactive pseudo

workshop followed, which showed the stages in constructing prosthesis. Simple wooden steps, an essential component in victims’ physiother-apy, lead up to a mirror to let you ponder on the body image issues such victims face. On the way down, we were met with prostheses turned into art. Strung from the ceiling, these particular prostheses are dona-tions back to COPE from child vic-tims who outgrow every few months. Toes and nails are carved into the tanned wood, chosen specifically to match their dark skin. The soles are all well-worn, evidence of the pro-gress and recovery each child made. A separate portion is modeled after village huts, which you can walk through and spot the household items made from harvested metal. A por-trait gallery then puts you face to face with victims of the bombs, no differ-ent from you or me. This is where we learnt about Ta, one of the am-bassadors of COPE. Three years ago, while Ta and his two sons went foraging, he spot-ted a cracked bomblet. Ta thought this would deactivate the bomb, and he could collect the TNT for fishing. He had seen other men drop explo-sives into rivers in order to get the stunned fish.

Number of missions: 580,344In a Period of: 9 YearsTime between raids: 8 min

Bombs dropped: 277 millionBombs unexploded: 84 millionBombs since cleared: 0.49%

US expense (USD) on:- bombing: 55 billion*- clearance: 40.5

*converted to today’s currency

When Prostheses fly - each one costs £30 to make from scratch and donations to the cause are welcome

Signatures inside the cave.

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Placing his sons behind a tree trunk, Ta prodded the bomb with a stick. When it exploded it took his arms, right eye and embedded his chest with shrapnel. Petrified from the explosion his sons ran away be-fore eventually turning back to save their father. They used their clothes to staunch his bleeding and dragged him wailing in pain onto their boat back home. It took another 6-hour

drive on a tractor for Ta to reach a hospital.

Although surviving the incident, Ta returned home as a double ampu-tee and immediate burden to his fam-ily. From protector, he was reduced to depending on them to be washed and dressed. To pay for his medical bills, they had to sell all their livestock of water buffalos, poultry and pigs.Ta was provided a pair of cosmetic arms and another of more functional hook arms by COPE. Before this, he would eat by bending over a bowl and using his mouth, which in his own words was “like a dog”. Now he can feed himself, which has restored some of his self-respect. He takes pride in teaching his children how to read with his one eye. Ta uses his experi-ence to spread awareness of cluster bombs and was a speaker at the 2008 Oslo Summit, calling for a worldwide ban of their usage. His suffering and efforts have borne fruit.

WHAT NOW? The plight of Laos is finally be-

ing recognised, and concrete work is being done on an international level. On 1st August 2010, the Cluster Mu-nitions Coalition (CMC) marked the ‘entry of force’ of the cluster ban treaty- meaning enough countries, including the UK, had signed and

ratified the treaty to bring the legisla-tion into effect. This coming Novem-ber Laos is hosting the first Meeting of State Parties where an action plan will be hammered out as to how each State Party can fulfil their treaty obli-gations. The work will be slow and tedious; especially decontamination of land, but the work is being done.

WHAT CAN I DO?

All wars have disastrous knock-on effects and a victim. To me the con-cepts are difficult to engage with as they seem too big for me to make a difference or too detached from the relative peace I live in now. The work I saw at COPE was the tangible effort of individuals from all backgrounds not unlike you or me. If you would like to get involved, visit the website at www.copelaos.org

Ta lost his arms and right eye to the unexploded bomb.

Center: physiotherapeutic steps and tools. Right: activity of victims at time of accident

Others17%

Playing  with  UXO11%

Cooking12%

Forest14%

Farming22%

Handling  of  UXO24%

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ctober 2010 marked another round of the award-ing of arguably one of the most prestigious awards

in medical research: The Nobel Prize in Medicine. The winner this year, Professor Edwards received it for a feat that has revolutionized fertility treatments worldwide. As with many aspects of modern day medicine, it has helped to make the once devastating diagnosis of infertility a di-agnosis with options, and has led to further innovation in the realms of stem cell research and pre-implantation genetic diagnosis (PGD). The development in question is of course in vitro fertilization (IVF), epitomized by the birth of the first ‘test tube’ baby, Louise Brown, 31 years ago.

An impressive feat, considering the modesty of the mere letter Professor Edwards wrote to the Lancet in 1978, which marked the first public announcement of the discovery. Of course this is not something which had happened over night. Professor Edwards had begun working on the prospect of IVF in humans in the 1950s, whereby the process had already been successfully carried out in rabbits in the United States. He quickly realised that using oocytes which had matured inside the ovary could allow their development into blastocysts and there-after life itself. It was then that Edwards collaborated with Mr Steptoe as they set about overcoming the hurdle of accessing the post-maturation oocytes through using lapa-roscopy. Perseverance prevailed as over 100 of their first attempts ended in failure. Even after some tweaking with hormonal treatments, their first successful pregnancy in 1976 was of an ectopic nature. Regardless, Edwards and Steptoe continued to adjust their methods until Louise Brown was born in Oldham and District General Hospi-tal on 25th July 1978. Since then, a colossal number of births have been facilitated by IVF. Almost 4 million peo-ple worldwide owe their very existence to this technology. Surely where infertility affects 10% of all couples, this intervention can be welcomed only with open arms?

However, this is not the opinion of all parties – sur-prisingly enough the Vatican being one of them. It is ar-gued that thousands upon thousands of human embryos

are discarded unnecessarily at the hands of IVF, and conse-quently a market for human em-bryos has come about which provides only a slippery slope to corruption and exploitation. Your stance on

this depends somewhat exclusively on your opinions as to when a human embryo is deemed ‘alive.’ What can be said is that wastage of any degree must be justified. This along with speculation that babies born with IVF are more likely to suffer from malformations as well as being born pre-term must be taken into account. Are these the negative impacts of the human race doing something because we can rather than because we need to? IVF could be seen as an enhancement rather than a treatment as it is going beyond the natural provision of certain members of society. Furthermore, there comes a point where continually repopulating this planet has to stop. Would IVF be one of the things to go?

However, it cannot be disputed that IVF has allowed people to fulfill their right to procreate. It need not be said that with the right comes a duty. In a society where patient autonomy is at the forefront of practice, it be-comes difficult to imagine a justifiable world without IVF. I know that I would want to be given the choice. Fur-thermore, recent research using gene profiling has al-lowed scientists to assess the likelihood of an embryo pro-gressing into the blastocyst stage with both high sensitivity and specificity. If these techniques were made available on a wide scale, the occurrence of any potential destruc-tion of embryos would be greatly reduced. This would also reduce the need to implant multiple embryos in or-der to maximize success, an action which is wholly indica-tive of the hopes and expectations of those women un-dergoing IVF as a last resort in many cases. One could even argue however that this wastage could sometimes be justified. Where scientific research acts to disprove hy-potheses; in research involving embryos as the ‘centre-piece’ if you like, their destruction would have been al-most inevitable and arguably necessary if we were to be in 2010 with the ability to offer IVF on the NHS. Obvi-ously, standardization of practice remains an issue both across countries - as well as globally. In saying this, bodies such as HFEA (Human Fertilisation and Embryology Authority) created after the Human Fertilisation and Embyology Act of 1990 act for this very purpose, albeit only in the UK.

It is obvious that IVF cannot be considered without its ethical ‘cloak,’ which will always surround develop-ments involving the use of embryos for research. You need only look at the uproar in the United States when Barack Obama lifted the ban on using federal funds for human embryo research in March 2009. Regardless I think we can only congratulate Professor Edwards who in essence has given those a chance who before would have been left with nothing.

If it’s good enough for the Nobel Committee, he must have done something right…

In vitro fertilizationGIVING COUPLES A NEW HOPEBy Alex Willsher

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Space exploration and medical researchBy Anneka He

ou may have seen the recent Horizon episode

“Back from the Dead” where Dr Kevin Fong, consultant anaesthetist at UCLH, ex-plored the use of extreme cool-ing in resuscitation. He dem-onstrated how low tempera-tures can inflict pain and lead to death, but also paradoxically be used therapeutically. An-neka He, in 1st year clinics, talks to him about his research interests and his role in scien-tific communication.

Dr Fong was born to a civil servant family in London. Fol-lowing a degree in astrophys-ics, he trained as a doctor at

UCL. During his time here, he ran the Photography Society and was picture editor for the London Student Newspaper. Similar interests and motiva-tions have inspired his subse-quent career. He and a col-league (Dr Mike Grocott) founded CASE Medicine at UCL in 2000 with the aim of increasing our understanding of critically ill patients through studying how the body copes in extreme environments. He is also a keen communicator of science to the general public - aiming to approach disease as a global burden that everyone should be educated about as

well as something that should be treated in individual pa-tients. He lectures throughout the world and devotes time to talks in schools without back-grounds of sending students to university.

One of his most passionate beliefs is the importance of a British astronaut programme, something that has until now not been pursued by the UK due to the costs of sending people into space. He is wholeheartedly convinced that human space exploration is a potentially valuable area of research. He challenges close-minded medics who care more

As well as being a consultant anaesthetist, Dr Fong is also an astrophysics graduate.

KEVIN FONG

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for practical matters of therapy, arguing that space explo-ration has been part of science since its origins and that human exploration teams on Mars could help answer the “one of the science’s most fundamental questions” of how life arose in the Universe. He argues that science finds its historic roots in the ancients staring at the stars and that scientific discoveries are often either accidental or initially of seemingly little relevance, citing the discov-ery of electricity by Faraday, calculus by Newton, and Fleming’s discovery of penicillin. Neither science nor politicians can predict what might or might not be useful in the distant future. In this recession Dr Fong feels it is important to remember that not everything is about mak-ing a fast buck, quoting Einstein in stating that “not eve-rything that can be counted counts, and not everything that counts can be counted”.

He suggests cost-cutting methods of funding a British astronaut programme, citing several systematic reviews that conclude that a space programme is worthwhile do-ing both scientifically and economically. He counters gov-ernmental argument that not enough scientists are inter-ested in space medicine and science by revealing that he runs very popular undergraduate modules and SSCs in space medicine and extreme environment physiology. Despite this he is realistic “we are in a deep recession and we have probably passed the stage of astronaut pro-grammes”. If only more politicians have a scientific back-

ground rather than an economic one! He himself has considered training as an astronaut in the US, but his love of England kept him here so his passion for space medi-cine has been focused on teaching and research. He is actively collaborating with NASA’s Johnson Space Center in Houston on medical care for astronauts.

On his recent burst into stardom with his BBC documentary, Back from the Dead, Dr Fong notes that this is not his first foray into broadcasting - he was also behind “Mars: a Horizon Guide”. This all started with just a phone call from BBC. The whole experience of film-making he found fun and enjoyable, but occasionally finds friction between production teams who want sensa-tion and his own desire to stay loyal to the facts. He mod-estly refuses to acknowledge that he has been picked by the BBC for being “the best in what I do...I’m not”. In fact he argues he just has an “unconventional career”. His forthcoming documentary “How to Build a Heart” will air in February.

When asked about the future, he seems more uncer-tain. As far as he is concerned, all his life “I’ve just been following my passion and my interests and seeing where it takes me”. He is a living example of how passion and interests can take you to places where you have never imagined before. I wish Dr Fong luck with his future ca-reer and thank him for sharing his stories and thoughts with The Bell.

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Clinical con artist struck off “Hundreds” deceived for thousands of poundsBy Simone Granno

ne doctor, two private practices (London and

Rotterdam) and many hopeless MS patients: a perfect recipe for easy money and big trou-ble. It has been all over the recent news: Dr Robert Tros-sel, 56, was struck off the medical register. He was found guilty of exploiting vulnerable Multiple Sclerosis patients, charging them thousands of pounds for unproven, “point-less” and “unjustifiable” stem cell treatment. Prof. Brian Gomes da Costa, who is cur-rently chairman of the GMC fitness to practice panel, said Trossel gave “false hope and made unsubstantiated and ex-

aggerated claims to patients suffering from degenerative and devastating illnesses”. His behavior was found to be “fundamentally incompatible with being a doctor”, and his name immediately erased from the Medical Register. But how did it all begin?

The story goes back to August 2004, when Dr Trossel started offering “experimental” stem cell therapy to improve the condition of MS sufferers. This is how it worked: after a quick initial assessment in London, patients were all set for a trip to Rotterdam, where they received the treatment. A

treatment well paid for. Single consultations were priced start-ing at £140, all the way up to a whopping £12,000 for the whole package, which involved a series of cervical injections of very dubious efficacy.But how could Dr. Trossel so easily manage to deceive his many patients? The answer is quite simple: like every other doctor, he enjoyed one of the most dangerous privileges: trust, virtually unlimited. This means that while a real con man has to work hard to enact his tricks, giving false hope to an hopeless and terminally ill patient is relatively easy. What does money mean to a person

On the right, Dr. Trossel, found guilty of providing pointless and dangerous treatment to multiple scle-rosis patients.

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whose life is literally slipping away? Probably not much when a white coated savior offers you “the cure”. This is what Dr. Trossel must have thought as he exaggerated the bene-fits of his treatment, based only on “anecdotal and aspirational informa-tion” (GMC hearing). There is more: not only was the therapy not scien-tifically recognized, but it also posed a serious threat to the patients. In fact, a 2006 BBC2 Newsnight investi-gation had discovered that the stem cells he used were neither designed nor intended for human use, and contained traces of bovine brain and spinal cord tissue! The GMC panel declared that Dr Trossel made abuse of his patients’ trust by not warning them on the potential risks of vCJD (variant Creutzfeldt–Jakob disease, an fatal condition better known as mad cow disease in bovines). He ad-mitted to the GMC to have been “too enthusiastic” about the treatment. Later findings of the investigation were not surprising at all. No reputa-tion in stem cell research for Dr. Tros-sel, and non-existent experience in both neurology and haematology. Patients were pervaded by “anger and sense of being let down”, said Tom Kark QC, for the GMC. Being let down never feels great, but imag-ine if it is your own doctor who lets you down while you are tortured by MS. While this thought did not cross Dr. Trossel’s mind, it clearly exempli-fies why doctors must always keep an eye on their burdensome social role. In his defense, Dr Trossel’s lawyer said that the patients were informed of the experimental nature of the treatment, and that the clinician had stopped administering the therapy after its dangerous side effects –of which he was apparently not aware- were unveiled by the Newsnight in-vestigation. He also described him as “compassionate” and not dishonest. One of Dr. Trossel’s victims, Karen Galley from Essex, 45, had a say about such characterization: “it’s rubbish, no compassionate person treats people like that”. In August 2006, after paying the modest amount of £ 10,500, she received six injections in the neck and one in the

arm. The “dirty money” was raised with the help of her friends and fam-ily, who even organized a mini-marathon and a charity event. So much she did for a glimpse of hope, and she was only one out of many. Malcolm Pear, from Worcestershire, attended Dr Trossel’s Rotterdam clinic in January 2006. He had to pay £8,000 for the treatment, which was delivered in a suspiciously unsafe “coffee lounge”, instead of a regular treatment room. Prof. da Costa fi-nally declared that Dr Trossel had shown “little insight” into the effec-tiveness of his treatment, and that his conduct had “unquestionably done lasting harm, if not physical, then mental and financial”. The way things went for Dr. Tros-sel show us one clear thing: patients out there, especially those with devastating illnesses, are forever destined to unques-tioningly place their trust in doctors. Of course, this is the whole point of prac-ticing medicine. However, this unlim-ited trust is a very sharp double-edged sword, and things can easily go wrong. Being a doctor, for real, means making that trust a treasure. It means realizing that patients rely on you more than they do ton anyone else. Dr. Trossel did not understand it, and people suffered. Will you be able to handle such responsibility?

"During my career as a doctor, I have always prac-tised with the objective of achieving the very best for my patients."

Dr. Robert Trossel

Karen Galley, EssexShe paid £10,500 for Trossel’s treat-ment. Her friends even organized a mini-marathon to raise the money.

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FIRST CUT

First of all, could you tell us a little bit more about your role on Surgery School? I was Series Director, so was responsible for shooting footage that was used across the series.  I would say that roughly three days a week my researcher and I were at a hospital, following a trainee for their shift.  It was our job to try and identify a potentially interesting case, obtain permission to film that scene and then obviously shoot it in a way that hopefully captured the drama and pressure of that particular situation.  I have to say that it was one of the most enjoy-able and interesting series that I have ever worked on.

Medicine is a broad area – what made you decide to cover surgery rather then one of the other specialities? One of the initial titles for the se-ries was “First Cut” and I think that sums up what inter-ested us so much about this subject matter.  The fact that these relatively inexperienced doctors were now for the first time going to be operating on real patients was a fas-cinating prospect.  We literally saw trainees making their first cuts.  For those of us outside of medicine, the idea that these guys were cutting into people on a daily basis – whilst learning on the job – was a unique opportunity to shoot some (hopefully) captivating television.

 Did you find it easy to choose your ten doc-tors, out of all the trainees on the surgery pro-gramme? We were very luck to work with such coopera-

tive, fun and able doctors.  It was important that we got a range of doctors as we wanted to reflect a cross section of the doctors that were in that year’s intake.  We had some trainees who were the best in their class, and others who were not.  We had some who had great communication skills and others who were great surgeons.  The most im-portant characteristic we were looking for was honesty.  We needed trainees who would admit when they were feeling nervous or out of their depth.  We needed doctors who were prepared to be filmed at all times – not just when they were in their comfort zone. 

 What difficulties did you encounter when filming in the hospitals? I.e. getting patients to consent to being filmed. Getting consent was tricky because it wasn’t just a matter of getting the patient’s consent (often surprisingly easy even for a very intimate operation) but we also had to get the entire medical team’s consent as well –  consultant surgeons, anaethia-tists, nurses, porters etc.  On top of that, we then had to ensure that it was an operation that our trainee would play an interesting part in (there’s not much mileage in filming a long operation if all our trainee did was observe).  So yes, it was difficult ticking every box but that’s why we allowed ourselves such a long shooting pe-riod.

Sam Grace talks about his experience directing ITV’s Surgery SchoolBy Sophie Bates

THE “CAST” OF SURGERY SCHOOL

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Surgeons have a reputation of being quite abrupt – did you find them easy to work with? We worked with some really great consultant surgeons with-out whom the series would not have been possible.  They can be direct, but that’s great for television – look at Alan Sugar! Consultants who were prepared to tell the trainees exactly what they had done well and what they had done less well were priceless in enabling the viewer to under-stand whether our trainee was succeeding or not. 

 Did you see anything particularly shocking or gruesome during filming? We very quickly be-came quite immune to most of the shocking aspects of surgery – it’s amazing how clinical and detached the whole process is.  I do however still have very vivid memories of the leg amputation that I filmed!

Is there likely to be a second series/revisit? I very much hope so – it was a lot of fun and hugely inter-esting to make so let’s hope so!

Sam GraceSeries Director of Surgery School

GET A CHANCE TO WIN ONE OF THESE THREE GREAT CLINICAL

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ALL YOU HAVE TO DO ISANSWER THIS SIMPLE

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Where is the usual surface marking for the apex of the heart?

Left fifth intercostal space in the mid clavicular line

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By Ricky Sharma

really do! Countless times have I had my ass handed to me on a

football field, a desert battlefield, even on a psychedelic race track, without even leaving my own room. Although naturally I’ve tried to shrug off these defeats by reassuring myself that in-vesting my time in other activities would probably be more useful than holding a controller in my hand all day, I fear that my self-reassurance may not be so true.  Recent studies published in the neuroscience jour-nal, Cortex, have shown that young people who play video games regu-larly actually have an advantage when performing tasks which involve visuomotor skills.

Gamers have been found to show increased activity in their prefrontal cortex, an area of the brain which has been implicated in decision mak-ing and moderating correct social behaviour. However, non-gamers showed more reliant use of the parie-tal cortex, an area which involves hand-eye coordination when per-forming these visuomotor tasks. It

would appear that this reorganisation of the cortical net-work after playing video games for such a long time can give young men - who were the group of people being tested in this study - an advan-tage in performing visuomotor skill based tasks, as well as the video games themselves. The visuomotor based skills the young men were tested on included moving a joystick, regarded as fairly simple, to harder tasks such as trying to reach for an ob-ject while looking

the other way. The group of 13 men, aged in their twenties, had been se-lected because they had stated that they had been playing video games at least four hours a week (a relatively small amount compared with some of the people I know) over the last three years. The subjects were then placed in a functional magnetic resonance imagining (fMRI) machine and asked to complete these tasks.

fMRI, which started to be most widely used in the nineties, is a form of imaging which measures change in blood flow related to neural activity in the brain or indeed the spinal cord. Increased blood flow occurs when brain activity in a certain area is more active, this leads the neurons to use more oxygen, which in turn re-leases chemical signals which cause the blood vessels in that area to dilate, thus overall causing a local increase in blood flow.

Professors at York University, where  this study was taking place, stated not only did they just use the fMRI imaging to view which areas of the brain were being highlighted in a given time but also how skills learnt

from video games can be transferred over to new tasks.

What is interesting about the use of the prefrontal cortex in gamers when carrying out visuomotor tasks is that it has famously been associated with determining a person's behav-iour and social skills. The most fa-mous case relating to the prefrontal cortex is that of Phineas Gage, who in the 1840s, had his prefrontal lobes destroyed in an accident when a large iron rod was driven through his head. What was remarkable about this was that, although his  memory speech and motor skills remained intact, his personality underwent some sort of change; his friends and relatives were famously to state that he was "no longer Gage." It should be pointed out that this case has been exagger-ated in some instances, with stories of Gage having engaged in activities such as sexual molestation and the like being reported from people who had no seeming connection to him or his personal life.

Comments have already been made that this study needs to be ad-vanced further by changing the vari-ables set, for example see if the same areas of the brain show high activity in women and other age groups and also whether or not the type of video game played affects the activity in certain areas of the brain too. The time spent playing video games should also probably too be looked into as this may lead to further reor-ganisation in the brain.

Nonetheless, the fact that it has been shown that using visuomotor skills over time can actually reorgan-ise neural networks may provide help-ful for patients suffering from Alz-heimer's, who have difficulty per-forming many simple visuomotor skill based tasks. Perhaps further insight into the effects of video games will prove beneficial to the future of un-derstanding neuroscience - or at least will provide a excuse to yourself whenever you feel you should be do-ing some actual work instead of try-ing to improve your kill/death ratio.

WISH I WAS GOOD AT VIDEO GAMES...

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own Among The Dead Men” by Michelle Wil-liams sets out to answer a question that most

medics (except for budding pathologists) will never be able to answer – what is it like to work in a hospital mor-tuary? The book offers a fascinating insight in to the area of the hospital where many of our patients end up, but we never really get a chance to see.

Michelle, the author of the book, was a normal thirty year old when she decided to apply for a job as a trainee MTO (Medical Technical Officer), at Cheltenham Gen-eral Hospital in Gloucestershire. The book chronicles her first year working as a mortuary technician, touching on the inevitable bizarre stories and gore, as well as her friendships with her fellow colleagues. There are many hilariously tragic tales scattered throughout. One notable example is the death of a Mr Barry Patterson (presuma-bly not his real name). Killed in his armchair by a pul-monary embolism, Mr Patterson had to be hoisted out of his house by the fire brigade. Unfortunately, on arrival at the mortuary it was discovered that none of the patient refrigerators were able to hold his 40-stone corpse. By the time the paperwork was completed for his post-mortem, Barry had turned a 'dark, slimy green' and pro-duced a stench so strong that the mortuary was effectively closed. A refrigerated lorry had to be ordered for his journey to the funeral directors!

The most striking aspect of the book, however, is not the bizarre cases, guts and gore. It is the professionalism and respect shown by Michelle to those in her care. A book on this subject could easily turn into a shocking blow-by-blow account of gruesome and grizzily occur-rences. Instead, it is a tale which shows that the dignity of patients is maintained even after their deaths. It is com-forting to think that the mortuary workers show such a high level and duty of care towards their patients.

Michelle is a character that many of us can identify with. From the apprehension which she feels at the thought of being on-call and therefore alone in the mor-tuary, to her dread of exams, she is humble and honest throughout. The only aspects of the book which slow the pace time slightly are the frequent accounts of her week-ends and other everyday activities outside of work. Al-though this enables the reader to gain a better insight in to the author's life, it does become rather tedious after a while, as the main appeal of the book is definitely her area of work, rather than her relationship with her par-ents or her walks with her dogs!

Nevertheless, 'Down Among The Dead Men' is a unique story, which offers medics an important and in-depth look in to life, and death, in an average NHS hospi-tal mortuary.

DOWN AMONG THE DEADWhat is it like?By Sophie Bates

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The DAB’s heroic careerBy Sam Bulford

ome into the Goldfish bowl”, Prof. Bender says to me, as I enter the new

modern glass office – uncharacteristic perhaps for such a long-standing figure in the medical school.

Professor Bender has been with the School, in one way or another, for 40 years now. Start-ing off at the original Middlesex (where the medical students were those who failed to get onto science courses, very unlike today’s admis-sion profile), Prof. Bender now sits in his blue lumbar support chair reminiscing about the times he would go for coffee with students dur-ing a tutorial. “It gave us the chance to know almost all of the students”, he says with a nos-talgia for what no longer happens today. Prof Bender has had over 3500 students on the cur-rent course, and many more over the last four decades, pass under his piercing, slightly in-timidating gaze, a number of such magnitude in this day and age that seems to amaze even

him. Some students have stood out for good reasons, some less good, and some have made it into the realm of the celebrity.

But what of the real man, the man behind the moustache. Prof. Bender lives in Amersham in the Chilterns, a commuting distance away from London, with what sounds like some very green fingers. When asked what he plans to do now in his semi-retirement, his eyes spark as he replies “all the things I used to have time for….gardening is one, conservation work is another”. But every positive has a negative - “We have suffered as most weekends the rail-ways have been shut which have rather wrecked our theatre going”, the Professor says rather sadly, having enjoyed the theatre in London. However, pausing for thought, the D.A.B says “I used to be fluent in French, German and Span-ish” and so he is looking forward to having the time to try and get at least one of these lan-guages fluent again, another thought that cre-ates an almost boyish spark of adventure in his

In his 40 years career, Prof Bender has only cancelled a lecture once, and that was last year.

INSIDE THE GOLDFISH BOWL

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eyes. Despite the lack of theatre, there is a sense of con-tentness with where he lives with his partner especially when he talks lovingly about walks he now has the chance to go on, especially the ones he is able to do from the end of his road which, in the past, he would have had to drive to for the opportunity.

Professor Bender has an attendance record not even the mighty Carol Farguson could disapprove of. Over the past 40 years, the Professor has had to cancel a lecture only once and that happened only March last year follow-ing an admission to hospital. The Professor recalls a par-ticularly harrowing journey on the trains one morning where the train was so full that he had to wait for some-one to literally to “fall out” of the train before he could “get in the space he had been in” (cue images of Profes-sor Bender’s elbows out and moustache bristling). In fact the Professor is so dedicated that he has been known to fly overnight from Toronto (”I wanted a window seat” the little boy in him said, recalling the flight check-in) in or-der to be on time for a Monday lecture….come on Carol, you can have nothing but praise for that.

The most striking quality about Professor Bender, though, is how in touch he is with the happenings of the medical school. Be it the course, the admissions, RUMS or job prospects for qualified doctors, there is an une-quivocal air accompanying the certainty with which he speaks. This is both as inspirational as it is intimidating. This is a man who is semi-retired but whose mind is not, a man who although is now taking only half the pay, has only had one day off this term so far. There is something powerful about him....the sense that forty years on, he has the same stamina and aptitude as he did when he started.

Perhaps one of the most endearing qualities is his frankness and honesty......students, we should not fool ourselves that he does not know what we think about, say, subjects, lectures and exams (to pick three commonly dis-cussed and often emotive topics). Professor Bender knows perfectly well what we think about sociology and embry-ology, and that we find the work load intense to say the least. The Professor knows that the exams are not ideal, and when probed about this subject he admits that ‘no-one ever really finds a satisfactory way of doing things’, and here is perhaps the most telling part – he says that he “knows damn well [we] would have forgotten what [we’ve] learnt within about six weeks of the exams......but so long as we can pick up a text book during a case pres-entation and it makes some sort of sense, then it is a suc-cess”.

No better story to follow and perhaps sum up the powerful, driven yet modest, humble and sometimes boy-ish student-focused teacher exists bar this one, the Profes-sor’s most memorable moment in the past forty-two years:

“Walking one evening along Marylebone Road to the station, a student came bouncing up to me. She must have been a fourth year and she said ‘I’ve just started paediatrics, and all that biochemistry you taught me is relevant’. I thought – lovely”

The sense of completeness from the blue chair was almost palpable.

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Hi Juliana. Tell us a bit about yourself.I'm 24 and in my fifth year at the Universidad del Valle in Cali, Columbia. I live at home with my parents and my brother, who is also studying medicine.

Where did you do your placement?I did my rotation in the Renal Medicine Department at the Royal Free Hospital. I also got to help out on a re-search project about amyloidosis.

Why did you choose to come to UCL?I am from a developing country, so I wanted to see the how the clinical evaluation, diagnosis and management of patients is different in a developed country such as England. I chose my particular placement, as it gave me the opportunity to learn more about how research is conducted in developed countries. I also wanted to im-prove my English.

How did you find UCL?I really enjoyed it. The hospitals are very good and the research opportunities are amazing! I'd love to come back!

Did you find our medical school very differ-ent from yours?Yes! We have to get a lot more involved with patients in Columbia. We are expected to clerk several patients each day, and to write each one up in the notes. We also tend to have more opportunities to do procedures. At UCL, I found that the students have more time to study from textbooks. I liked this, as it means you are able to read up about a specific disease straight after clerking a patient with it. I think that makes it a lot easier to re-member the facts about that disease.

Was it your first time in London? Did you enjoy it Yes – and I loved it! I got the chance to see a lot of fa-mous cultural places. I especially enjoyed the National Gallery, British Museum and the Natural History Mu-seum. The parks are beautiful and the public transport system is very comprehensive. I had never seen double decker buses before!

Is the health care system in the UK similar to Columbia?Not really! The experience I had in the UK showed me that a lot of time goes in to prevention of disease. In Columbia, the medical coverage in the community is very superficial. This means that most diseases are quite advanced by the time they are treated. As a result of this, a lot of the patients in Columbia have a much worse prognosis than those I saw in England. We also spend a lot more time on the history and examination in Columbia, as investigations are often too expensive. In the UK, I found the opposite to be true. Most tests can be done easily, so the history and examination are often not as thorough as in my country.

Any final thoughts?The one thing I found really hard was getting internet access. I wasn't provided with a password for the com-puters and I found it really hard to find free Wi-Fi. Luckily, someone on my firm lent me their USB though! The public transport was also a lot more expensive than I thought it would be.

Juliana Alvarez from Columbia tells us about her time “abroad” in LondonBy Sophie Bates

AN ELECTIVE AT UCL

MTH (Medics Target Health)Interested in enhancing your CV? Want to collect more points for your MTAS?

Come and get involved with our project at UCL providing a range of fun and interactive health promotion workshops. This gives you an opportunity to enhance your own medical knowledge and skills as well as promoting kids to have a healthy lifestyle from a very young age onwards. As you are aware medical students are encouraged to start teaching as early as possible in their career. This gives you a great opportunity. We have also several committee positions avail-able.

Being a member of MTH gives you the following free benefits: Presentation skills/Public speaking seminarsSeveral workshopsA personalised certificate to enhance your CVTeaching experienceMeet different professional bodies from the medical sector

And above all: Great FUN and a REWARDING experience

For further info contact Gopiga on medicstargethealth@gmail.com / 07878008948

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MDU Services Limited is registered in England 3957086. Registered Office: 230 Blackfriars Road London SE1 8PJ.© 2010MDU Services Limited. ST/070x/0710

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