A G S M E D
The Brain. Understanding and Exploring Medical Advancements Around The Brain in Recent Times.
Featuring:
Pioneering Neurosurgery: Innovating Safety With The Bionic Eye.
Cerebral Organoids: a window into the reality of the human mind.
Optogenetics : a cure for blindness?
Transcranial Magnetic Stimulation: the future of neurological therapy.
Ethical Considerations for Neurological Diseases in Palliative Care.
Extra Featured Articles: Should Aesthetic treatments and Weight loss medication be available for free in the NHS?
Geography and Health: How Human Geography affects health.
November 2024
AGSMedisastudent ledscientific magazine,focusing onupandcoming advancesin medicine.Our primaryaimisto introduceglobal innovationatthe schoollevel,aiding allSTEMorientated pupilsinwidening theirknowledge.
Editor-in-chief:
Hrishik Subramani (Denson 13)
Editorial Team:
Alex Glover (Denson 13)
Anthony Unugboke (Ridley 13)
Sivaharishan Sivakanthan (Phillips 13)
Ayaan Raza (Lee 13)
Articles written by: Hrishik Subramani
Sivaharishan Sivakanthan
Ayaan Raza
Thomas Du Leung (Hampden 13)
Muneeb Abbassi (Lee 13)
Joseph Fernando (Ridley 13)
Daniel Poole (Lee 13)
The editorial team thanks everyone who submitted an article.
O N T E N T S
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PAGE8
Pioneering Neurosurgery: InnovatingSafety with TheBionicEye Sivaharishan Sivakanthan
E11 netics: or ss? DuLeung
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Transcranial Magnetic Stimulation: thefutureof neurological therapy. MuneebAbbassi
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ShouldAesthetic treatmentsand Weightloss medicationbe availableforfreein theNHS? HrishikSubramani
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Geography andHealth: HowHuman Geography affectshealth. DanielPoole
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Ethical Considerations forNeurological Diseases in PalliativeCare JosephFernando
CerebralOrganoids A window into the realityofthe HumanMind?
Ayaan Raza
Brain Organoids, also known as cerebral organoids are self-organised 3D structures that model human brain development and function, a pertinent tool in the research of neurological diseases in particular neurodevelopmental ones, as well as enabling researchers to to study disease development at different stages. This is possible as they are made from the same two basic types of cells found in the brain, the glia, the cells responsible for providing structure in the brain as well as neurons, the nerve cells that send and receive signals. Overall resulting in the formation of “mini sized models of the brain” which “allow for the investigation of interactions between distinct brain regions while achieving a higher level of consistency in molecular and functional characterization”. These models are derived from stem cells, either pluripotent HESCs (Human Embryonic Stem Cells) or iPSCs (induced Pluripotent Stem Cells) both of which are able to differentiate
P A G E 4
These 3D structures are groundbreaking as previously scientists were only able to form adult and embryonic 2D cultures wherein only relatively simple key pathways were able to be studied however 3D models offer a much more accurate, complex and dynamic model of the human brain allowing particularly for studies of early brain development, organisation and function. Traditionally animals, mostly rodents were used in neuroscience research however this came with many challenges, the development and structure of rodent brain’s varied greatly with human brains as well as ethical considerations, both of which highlight the strength of these newer more realistic 3D organoid models. However there are still some weaknesses due to subtle differences between structure and cellular composition between the brains of humans and the model, limited cell diversity in the organoids, differences arising from the model being an isolated organoid disconnected from the peripheral nervous system and having no blood vessels and of course ethical challenges of its own.
The production of Brain Organoids is incredibly complex and a multi-step process so I will summarise the main steps giving a simplified broad overview of how brain Organoids are generated from the initial pluripotent stem cells.
You first begin with the generation of Embryoid Bodies from pluripotent stem cells as mentioned prior either iPSCs or hESCs. Embryoid Bodies are 3D aggregates of pluripotent stem cells representing early embryonic development.
The next step is Neural Induction. During embryonic development there are 3 germ layers present, endoderm, mesoderm and ectoderm. Neural Tissue develops from the ectoderm layer, so the Embryoid Bodies are placed in a neural induction medium inducing the formation of neuroectodermal structures.
The next step is Neuroepithelial Expansion. These differentiated Embryoid Bodies are transferred into droplets of Matrigel, a substance which provides scaffold support for the formation of neuroepithelial buds and eventually growth of a whole cerebral organoid. These neuroepithelial buds contain neuroepithelial multipotent stem cells differentiating into the main types of brain cells, neurons and glial cells as mentioned previously.
The Final Steps are Maturation, Growth and Maintenance. Finally the forming organoids are transferred to a rotating bioreactor, enhancing nutrient and oxygen absorption, supporting long-term growth and maturation. T h e F o r m a t i o n o f B r a i n O r g a n o i d s
Applications of Brain Organoids
Neurological diseases are the leading cause of disability and the second leading cause of death worldwide. The emergence of these Brain Organoid Models is most notable in modelling human neurodegenerative diseases (NDD’s). For example, Alzheimer's Disease (AD) is one of these NDD’s thought to be caused by the build-up of proteins amyloid and tau. Researchers were able to model this and found the same distinct deposition of amyloid and tau proteins in the AD Organoids characteristic of human AD brain tissue Furthermore, they found treatment with β- or γ-secretase inhibitors decreased both tau and amyloid protein levels. This particular study was looking at familial Alzheimer’s Disease The Brain Organoid was generated from iPSCs derived from patients who had developed Familial AD, which was found to have the same pathological abnormal features, such as amyloid plaques and neurofibrillary tangles found in the patients with Familial AD. This highlights the potential of “developing patientspecific in vitro AD models with patient somatic cells” providing “a new platform for the discovery of target drugs and effective therapeutic intervention”. Demonstrating the usefulness of Brain Organoids as not only tools to study the development of NDDs, and potential treatment but also personalised medicine. Another such example is the screening of Antitumour Drugs, as patients with gliomas, a type of tumour, can have very different responses to the same treatment. Generating 3D organoids from patient somatic cells, researchers are able to observe the effect of treatments on different models developing personalised treatment strategies for glioma patients.
The first ethical challenge is about the source of stem cells used in the formation of Brain Organoids. In the case of HESCs, it involves the destruction of human embryos, raising significant ethical concerns about the nature of the embryo, its moral status, the point at which it is deemed to be alive and any potential rights it may have, many thinking using such stem cells would be violating the sanctity of life. Moreover with iPSCs, as they are induced from somatic cells, donors of such cells must provide informed consent being aware that their cells will be used in the formation of Brain Organoids, as well as the research involving the Brain Organoids and potential implications and uses of such research. As Brain Organoid technology advances the models become increasingly complex and similar to real life Brains, raising concerns that eventually develop its own form of consciousness and sentience. Furthermore this raises the issue of when a Brain Organoid is deemed to be sentient and from this what rights would this give the Brain Organoid. However this isn’t an issue at present as Brain Organoid Technology is far away from achieving this. Another potential point of contention is the manipulation of Brain Organoids, being made from human brainlike tissue there are ethical questions to be answered as to what experiments are permissible with Brain Organoids, particularly those studying pain perception and its effect on the brain. Overall as Brain Organoid technology advances the creation of evolving ethical guidelines for both the formation and use of Brain Organoids is essential in order to keep up with scientific developments.
Pioneering Neurosurgery: InnovatingSafety With TheBionicEye
Sivaharishan Sivakanthan
Neurosurgery, also known as neurological surgery, is a complex medical discipline that involves surgical and conservative management of a range of different disorders affecting the brain and other parts of the nervous system. This specialised field first took shape in the early 1900s thanks to the pioneering efforts of Harvey Cushing. Cushing was renowned for his ground-breaking work, becoming the first exclusive neurosurgeon and made notable contributions to the understanding
and treatment of brain tumours, including the discovery of Cushing’s disease. Fast forward to the 21st century, neurosurgery continues to advance with technological advancements. The Bionic Eye has been of one the most fascinating developments. The first implant was reported in 2012 for a patient who suffered from profound vision loss as a result of a diagnosis of retinitis pigmentosa, the Bionic eye represents a significant breakthrough in the intersection of neurosurgery and
visual rehabilitation. The initial model was developed by Bionic Vision Australia with having continuous improvements made, leveraging advanced technology. The Bionic Eye plays a crucial role in neurosurgery by helping to outline the boundary between diseased and healthy brain tissue. This distinction allows neurosurgeons to maximise the removal of tumour tissue whilst ensuring that vital healthy tissue remains protected, thus enhancing surgical outcomes and patient safety.
The term ‘Bionic Eye’ refers to a sophisticated visual and electrical prosthesis, designed to restore vision in individuals who are suffering with blindness.
It is important to distinguish the Bionic eye from a prosthetic eye. While a prosthetic eye is a cosmetic replacement for an eye that has been removed as a result of disease or disfigurement (damage to the retina, optic nerve and macula), the Bionic eye functions within the existing eye structure or the brain to restore visual capability.
When an eye receives a light stimulus, it transforms it into a nerve impulse that runs along the optic nerve reaching the visual cortex, allowing it to be interpreted as visual information. The retina is the innermost membrane of the eye which contains photoreceptors. These photoreceptors are known as rods and cones - cones detect precision and colour
in light and rods support the vision during dim light or at night. By bypassing deteriorated photoreceptors, these electrical impulses are sent to the brain, where they are interpreted as visual information. This intricate process enables individuals with profound vision loss to regain some degree of sight, significantly improving their quality of life. The Bionic Eye comprises of two components connected to a transmitter antenna:
Researchers continue to refine and develop these devices to enhance their functionality
an external camera mounted on a pair of glasses and an internal microchip with an electrode array surgically implanted into the retina. Importantly, patients who were blind at birth don’t have a well-developed optic nerve and thus it would be inconvenient to have a bionic eye implanted in them. Moreover, it is important to note that the long-term effects of this surgical implantation are still being studied. and reliability. The impact of the Bionic Eye on neurosurgery extends beyond its initial purpose of restoring vision. One of the most critical applications of the Bionic eye in neurosurgery is in deep brain surgery (DBS). These include procedures such as treating Parkinson’s disease, epilepsy and DBS. It helps surgeons with clear, real-time images, allowing them to navigate through intricate neural pathways with greater accuracy and precision. During DBS, where electrodes and implanted in specific regions of the brain, the Bionic eye ’ s detailed imaging ensures that the electrodes are placed precisely, augmenting the success of the treatment and reducing potential side effects.
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Optogenetics: a cure for blindness?
Thomas Du Leung
Optogenetics - an excitingly novel application of technology which can be used to manipulate neuronal activity or excitability with precision and specificity With limitless potential in the world of neurology, especially with the treatment of blindness, it brings innovation to the field of neuroscience through frontiers which are only now being explored for their merits.
The aforementioned manipulation of neuronal excitability can lead to inducing or inhibiting biomolecular processes in the body, which work in 2 broad groups: the actuators (light-activated proteins that control the cell), and the sensors (reporters in response to neuronal signals). This is revolutionary as optogenetics offers a very high temporal resolution (reduces motion artefacts), yet allows minimally invasive circuitspecific bidirectional control, lowering the risk of infection from surgery, and increasing accuracy of functions.
The diagram above is an excellent example of optogenetics. A channelrhodopsin (actuator), fused to mCherry (a fluorescent protein used as an instrument to visualise and analyse functions, such as an intracellular probe). When it is exposed to light with compatible wavelengths, the pore opens, and cations (represented as yellow dots in the figure) flow into the cells, and the neurons (red dots) are activated
A recently discovered opsin, called ChRmine, has shown unique properties compared to other channelrhodopsins, such as large photocurrents, which can result in the excitation of neurons at a very low light intensity This effectively means that ChRmine can be used in deeper parts of the body and by extension being minimally invasive. A recent study (Himanshu Bansal, 2024) shows that ChRmine can enable contractions for a mouse ’ s heart, at very low light intensities. ChRmine also has red-shifted light sensitivity, with better sensitivity and robustness. Making it an ideal tool for high-level precision readings and neuronal activity writing.
What can optogenetics do?
Blindness has always been a pressing issue. The number of visually impaired people is increasing daily, with scientists predicting a 55% rise by 2050 To put this into context, that’s predicted to result in over 500 million more people suffering from vision loss. With this concern in mind, scientists have developed a few promising projects. As one of the potential developments, the visual prosthesis is a prime example of the application of optogenetics in mainstream medicine.
With development and experimentation through optogenetics, the light response was first restored in blind mice by expressing Channelrhodopsin-2 (ChR2) in 2006. 18 years later, through a recent breakthrough, we have ‘The Science Eye’ - A visual prosthesis aiming to treat retinitis pigmentosa (RP) and dry age-related macular degeneration (AMD), which is the most common form of blindness. The device consists of optogenetic gene therapy to insert opsins (light-sensitive proteins such as ChRmine) into the cells of the optic nerve (retinal ganglion cells) and an implant composed of a thin, flexible film of an ultradense micro-LED array placed directly above the retina.
However, the opsins transplanted are not stimulated by natural light in the same way a healthy, human eye can, which is why the patient also wears a pair of frameless glasses These contain infrared cameras and inductive power coils, which process and communicate information wirelessly to the implant, trying to imitate healthy photoreceptor cells. The endless benefits and the possible widespread impact of this prosthesis, enabled by optogenetics, lights a path for future research, highlighting the significance of continued research into optogenetics in coming years.
Conclusion
It is clear that optogenetics will be a fundamental part of neuroscience in the future. In just 18 years, technology has advanced from restoring light sensitivity, all the way to visual prostheses, and possibly more accessible and stable products will be developed New variants of ChRmine and other opsins are rapidly being discovered. The dream of restoring vision might not be so far away.
A G E 1 3
TRANSCRANIAL MAGNETIC STIMULATION
The future of neurological therapy? Muneeb Abbasi
Overview:
Transcranial magnetic stimulation (TMS) is a recently developed non-invasive form of brain stimulation It makes use of a changing magnetic field, which induces an electric current at a specific part of the brain through the process of electromagnetic induction. It is carried out to treat psychological disorders such as major depression. TMS treatments have been FDAapproved for depression when other treatments are ineffective, as well as for other diseases such as OCD and smoking addictions. TMS has also been looked into as a possible treatment for conditions such as epilepsy and Alzheimer’s, which it has shown potential therapeutic effects on Research is still evolving, and TMS is opening up exciting possibilities in treating psychological disorders When used to treat diseases such as depression and OCD, repeated magnetic pulses are delivered, so the name rTMS is given.
Procedure and Mechanism
In an rTMS session, an electromagnetic coil is placed against your scalp The angle and location of the placed coil is crucial for efficacious results An electric current is passed through the coil, generating an alternating magnetic field This generates magnetic pulses, which stimulate neurons in the area of your brain responsible for mood control, usually the prefrontal cortex and/or limbic system. The pulsed stimulation also induces persistent depolarisation, which is known to correct cellular dysfunction and aid healing - kind of like turning your laptop off and on again.
Scientists are yet to understand the complete biology of why this process works, but it appears to activate parts of your brain which are less active when in a state of depression, thereby improving your mood
Aside from rTMS, a more advanced form of TMS is ‘deep TMS’, which is able to stimulate deeper and wider regions of the brain This has the benefit of decreasing the chance of missing any brain structures that are being targeted - the only downsides are the extra costs and equipment.
Risks
TMS has the advantage of being non-invasive, so, unlike deep brain stimulation or nerve stimulation, no surgery or electrode implantation is necessary It also doesn’t require anaesthesia.
TMS is generally considered safe, albeit it can have some side effects, such as:
Lightheadedness or fainting
Scalp discomfort/pain
Twitching or tingling of facial muscles
In rare cases: seizures, hypomania or hearing loss
TMS also has restricted use in patients with magnetic implants. An ethical concern that has been raised about TMS is that the treatment could possibly interfere with the patient’s autonomy and decision-making, potentially going against a fundamental pillar of medical ethics This links in with the concept that patients should be viewed holistically as a person, not just an illness to be treated. Nevertheless, TMS is still considered by most as a beneficial and top-notch therapy method.
To conclude, TMS is a still-evolving valuable tool for psychiatric conditions, which, with the right research and standardised protocols, can have major clinical applications worldwide
Decode the Grey Matter Word Search!
FOUND ON PAGE 22
ShouldAesthetic treatmentsandWeight lossmedication beavailableforfree intheNHS?
HrishikSubramani
Aesthetictreatmentsandmedicationasamechanismofweightlosshasalwaysbeenatopicof fierce contention and is perhaps one of the most significant manifestations of the importance of the bio-psycho-social model of care at present. The matter which underlies this question is thatoftheimpactofaestheticsonourmentalwellbeingandhealth.Itisalsoequallyimportant toconsiderthedistinctionbetweenthetwotypesoftreatmentsandtocriticallyanalysethe benefitsandcaveatsoftheirwide-spreadimplementationinour,albeitglorious,overworked NHS.Shouldthistreatment,availabletotherestoftheworldatsignificantcost,bemadefree andpartoftheoverallservicehereinourcountry?
Aesthetic treatments
Aesthetic treatments encompass ‘treatments to enhance your natural beauty… are non-invasive and painless…’, [1] So it must be established that surgical treatments such as bariatric surgery are not classed under aesthetic treatments; instead, aesthetic treatments include Botox injections, laser hair removals, dermal fillers etc.[2] The strongest premise that underlies the advocacy of cost free implementation of this is one surrounding mental health.
Concerningly,Özkuretal[3](2019)foundthatpatientsseekingnon-surgicaltreatmentshad more psychiatric problems than a control group. It seems from this that those who seek aesthetic treatments seek them, due to narcissistic/ depressive and dysmorphic disorder traits (D’Augustine et al 2018), in an attempt to gain contentment and societal acceptance, possibly stigmatised by the negative culture of placing paramount importance on looks which we have unfortunately cultivated in the world today. Is this motivational factor in realityonethatweshouldbesupporting?Willwenotjustbepromotingthissickcultureof hyper-focusing on aesthetics by offering this treatment? In general, the introduction of free aesthetictreatmentsintheNHSwillpromotethisculture,anoutrightsocialnegative(whilst also being a psychological negative for our community). Furthermore, the physical impacts which underlie various aesthetic treatments such as Botox injections, can exacerbate such psychological impacts. Botox injections and fillers need to be replenished every 3-4 months. [4] Having seen the positive results of the treatment wear off, the patient's possibly underlying sense of dysmorphia is extended into unhealthy repeated treatments which couldevenleadtomuscleatrophy.
[5]
Should our community not seek professional mental help on such matters, and should we notbepromotingtheideaofacceptingwhoyouareinstead?Inadditiontothosefactors,the practicalimplementationofthisisimpossible.Howwillwedecidewhohastherighttothese cosmetic treatments without setting fixed and defined criteria for ‘ugly’ and ‘beautiful’? If such treatment were to be implemented, with our overworked, backlogged NHS, we could notsimplygivethetreatmenttoeveryonewhowantsit(whichwouldbealargeproportion of the population). If we did set such criteria for the seemingly innocent cause of deciding whogetstheseaesthetictreatments,wewouldcreateanunfortunatefloodofmentalillness as people are not deemed ‘beautiful’ by the criteria set. Such a move would be detrimental for the psychological aspect of British society today. From the above points, it is clear to see the negative implications aesthetic treatments, especially implemented within the NHS, couldhaveonpatientsbiologically,psychologicallyandforoursocietyasawhole.
Despite these negatives however, in some cases, aesthetic treatments can also haveaprofoundpositiveimpact on the mental health of a person. It has been found that they can ‘boost self esteem, reduce anxiety…[imbue] confidenceandsatisfaction’[6]
Introducing these treatments here can be in fact beneficial for the people of the UK, who feel theyrequirethem,andattempttooutsourcethetreatmentstocheaper,lesshygienicandmore dangerous private clinics abroad such as in Turkey. As already observed with the botox injectionscandalfromTurkey,where67peoplecontractedbotulismfrombotoxinjections[7], medical tourism for aesthetic treatments and the resulting dangers would be averted if this treatmentwasofferedintheNHS,whereweknowwecanupholdagoodstandardofcare.In addition to this, it is obviously important to reduce health inequality by making these treatmentsavailabletothosewhowouldn’tnormallybeabletoaffordthem,allowingtheman opportunitytoembellishtheirpersonalitywithincreasedself-esteemandreducedanxietyfor example,asmentionedabove.However,asimportantandeffectiveasaesthetictreatmentscan be for these reasons, the negatives which arise from the dangers they can pose, suggest that aesthetictreatmentsshouldnotbeintroducedintheNHS.
Weight loss medication
Weight loss medication is medication which has a primary focus in reducing weight in obese, and has important and useful applications beyond simply aesthetics. It is also important to note that while aesthetic treatments in the UK, via the NHS, require payment, weight loss medication can be prescribed in the NHS, free of charge for inpatients (although this is quite unlikely) and for the standard prescription charge of £9.65 otherwise[8] . Currently, on account of obesity, you can be prescribed Orlistat, Liraglutide and Semaglutide. Orlistat works by preventing the absorption of around a ⅓ of the fat in foods, allowing it to be passed in faeces.
Liraglutide and Semaglutide are both appetite suppressants, which mimic Glucagon-Like-Peptide-1 (GLP-1) hormone which is released after a meal.[9] However, the use of these drugs to treat obesity may in fact still be a negative as the popularisation of this method would end in the neglect of other more effective and long term methods of treatment such as altering diet and exercise. People may see the drug as an alternative to these methods, which instead of having the desired effect of decreasing the obese population may result in an unhealthy overuse of these drugs and help to breed a culture of unhealthy eating and sedentary lifestyles.
Although this sounds extreme, a widespread use of these drugs would result in this, which is why criteria have been set by the NHS for this. If these criteria are met at all times, and these weight loss drugs are restricted to those with BMIs above 30, then these drugs should be offered for free in order to overcome the barrier of poverty which often comes unfortunately linked with obesity. By helping people loseweight, they also rid those who have difficulties exercising in the first place to lose weight and by extension be less prone to the lifestyle diseases surrounding obesity such as Coronary Heart Disease. Due to their use as both an aesthetic choice for some and a useful course of treatment, weight loss medication is more helpful as a treatment, helping a person achieve self esteem and confidence as well as a probably longer healthy lifespan.
However, considering that all medical prescriptions come with a cost, and that the cost is sufficiently low enough to be affordable for most families in the UK, it may be seen as unfair to make weight loss medication specifically freely available to outpatients. There would also be considerable media backlash to this as other medications, which may be considered of higher priority, would not be affected by this change. Considering the current, financially dry and struggling NHS, backlash from the media is not something which would be favourable for its public outlook. Prescription medication is also one of the major sources of income for the NHS, taking away any amount from this total could be detrimental to the service itself. £9.69 billion was spent on prescriptions in 2021/22[10] and the loss of this would be devastating for the NHS. Overall, the situation with weight loss medication is complex and mulitfaceted in comparison to aesthetic treatments, as obesity is a widespread and acknowledged condition which this medication could be a genuine solution for, while also being an aesthetic treatment in the mind of some. It should continue to be used in the fashion it is being used in currently, and should not be made free so that the above mentioned caveats are not exacerbated.
In conclusion , the matter of aesthetic treatments is incredibly diverse and has many factors which need to be considered when assessing whether they should be available for free in the NHS. Both treatments are available through the NHS for a price. Aesthetic treatments, for the reasons detailed above, should not be implemented as a costless treatment due to the negative physical, psychological and social impacts they could have in society, which outweigh the positives. Weight loss medication should also not be distributed in the NHS for free due to the negative social impact it could have. Both of these can have the substantial negative impact of creating a toxic and harmful culture which could cultivate dysmorphia and dangerous lifestyles in our community upon overuse. Under this premise and reflection, it would be best if both of these treatments were not made free.
Conclusion ...
Across
Crack the Cerebral Crossword Challenge....
[4] a treatment for blindness
[5] self-organised 3D structure that model brain function and development.
[6] eye light receptors for colour.
[7] the cells used to derive cerebral organoids.
[9] First name for pioneer in neurosurgery
Down
[1] using light to amnipulate neuronal activity.
[2] can enable contractions of a mouse heart at low light intensities
[3] Appetite suppresant beginning with S
[8] Deep Brain Surgery could be used to treat this
[10] eye light receptors for low light intensities and dark
A G E 2 0
Results
The Spearman’s rank score for living conditions versus health was +0 758 showing there is a strong positive correlation between the factors. This also means we can be 99% sure that there is causation between the factors meaning they are linked together and a change in one will lead to a change in the other.
The Spearman’s rank score for GDP per Capita versus health was +0.721 showing there is a strong positive correlation between the factors. This means we can be 95% sure that there is causation between the factors
The Spearman’s rank score for levels of education versus health was +0 758 showing there is a strong positive correlation between the factors. This also means we can be 99% sure that there is causation between the factors
The Spearman’s rank score for doctors per 1,000 people versus health was +0 911 showing there is a strong positive correlation between the factors This also means we can be 99% sure that there is causation between the factors
Conclusion
Each factor plays an important role in the health of a nation. The impact of living conditions is extremely significant as damp, cold accommodation is more likely to lead to lung diseases such as Tuberculosis, whilst overcrowded conditions are more likely to lead to the rapid spread of disease as is found in slums and refugee
Dan Poole
camps such as IDP camps in Haiti which have an irregularly high incidence of cholera. The ability to see a doctor and receive quality treatment is a huge factor in health as countries with fewer doctors are more likely to suffer more from outbreaks of diseases. This factor combines with education, as levels of education can help influence what people know about a disease or condition, how to avoid it and how to treat it if it does develop. The economic development of a country is arguably the largest factor in the nation's health as countries with high GDPs per capita can pay for doctors, nurses and other medical professionals. The countries have more money to develop hospitals, clinics and transport systems to care for people. In addition, the provision of medicines and surgical techniques improves as does the pharmaceutical industry in providing effective drugs and medicines.
Ethical Considerations for Neurological Diseases in Palliative Care
In our ever changing world clinicians are continuously making tough decisions grounded on the pillars of medical ethics to ensure that their patients receive high quality care but also personalised care tending to the patient's specific needs Medical ethics underpin how a clinician may approach a certain scenario, whether it be a patient simply presenting with aches and pains across their body to more serious cases involving life-threatening injuries such as a stroke or myocardial infarctions However, neurological disease pose their own set of challenges for clinicians to overcome due to their complexity and multifaceted nature. In the context of palliative care, the already complex ethical considerations are further multiplied due to various social factors playing a role in the quality of life of a terminally ill patient. In this article I will delve into the depths of the ways through which skilled clinicians grapple their way through this supposed ‘ethical minefield’ and reach justified decisions to treat their patients to give them the best outcomes. The aforementioned pillars of medical ethics are made up of respect for autonomy, beneficence, non-maleficence and justice. These pillars govern how clinicians make decisions but in the context of neurological diseases can be hard to meet This is due to the fact that neurological diseases, such as Alzheimer's disease, Parkinson's disease, amyotrophic lateral sclerosis (ALS), and multiple sclerosis (MS) are often characterised by progressive deterioration, loss of cognitive and motor functions, and significant psychological and emotional impacts on patients and their families. For example, This makes it increasingly difficult for clinicians to offer patient autonomy when a patient lacks the mental capacity to make an informed decision for themselves and so to combat this the Mental Capacity Act was implemented in 2007. This makes a clinician's decision more structured with legal framework in place but also bolsters what was already good practice but also introduces laws that relate to the advocacy of the patient (Palliative Care in Neurological Disease A Team Approach-Judi Byrne, Penny McNamara, Jane Seymour, Pam McClinton 2010).
Clinicians must also be able to deduce how to choose the paths of beneficence and non-maleficence when coming to decisions about possible treatments for neurological conditions. In these types of diseases, interventions aimed at prolonging life may sometimes result in increased suffering without significant benefit. For example, aggressive treatments in late-stage ALS might extend life but at the cost of severe discomfort and reduced quality of life. In this example, late-stage ALS can be treated with high doses of riluzole Whilst clinical trials have pointed out that this treatment does indeed extend the life of a patient, it can potentially cause lots of harmful side effects such as headaches or swelling of the hands, feet, ankles, or lower legs (National Library of MedicineRiluzole 12/15/2022). The drug mechanism of Riluzole involves blocking glutamatergic neurotransmission in the CNS which inhibits the release of glutamic acid from cultured neurons (The pharmacology and mechanism of action of riluzole-December 1996). This results in sedative properties of the drug and essentially slows the action of late-stage ALS which can be positive or negative depending on the context of the patient and the state of deterioration they are in In a clinical setting a clinician would have to weigh up the benefits and possible harm this treatment could incur but also take into the aforementioned autonomy of the patient where possible. Finally the last pillar of medical ethics that a clinician must bear in mind is justice This pillar relates to treating all patients fairly and delivering care to all in need. In comparison to the other pillars, justice is much more accessible to clinicians due to its apparent lack of complexity but there is more to it than meets the eye For example, if a clinician is presented with 2 patients with similar complications but one patient is a blood relative, the clinician is bound by this pillar to treat both patients the same and not give preference to their blood relatives.
In conclusion, palliative care in neurological diseases involves navigating a complex landscape of ethical considerations. Respecting patient autonomy, balancing beneficence and non-maleficence, enhancing quality of life, ensuring effective communication, respecting cultural differences, and addressing resource allocation are all critical components. Clinicians must approach these challenges with compassion, sensitivity, and a commitment to ethical principles to provide the best possible care for patients facing these conditions.
Joseph Fernando
Students Have Their Say
What is your opinion on euthanasia?
(the act of deliberately ending a life to prevent suffering)
I think people should do everything in their power to prevent other human beings from wanting to die. However, especially in the context of medicine, I understand that this can be challenging. Often, there really is nothing one can do to help someone else other than ending their suffering. I do think that this decision should be made by the patient alone and without any outside influence. Outside the context of medicine, I think the act of euthanasia should be strictly prohibited.
Abijith Vinod (Phillips 13)
Emre Arslan (Lee 13)
Euthanasia allows those who suffer from their illnesses to pass away on their own terms and gives their family closure in their darkest time. It should always be up to the discretion of the patient and always within logical boundaries.
I believe that euthanasia could undermine the value of life and it is concerning the impact it will have on the elderly and the disabled. It is crucial in my eyes that the social messaging around euthanasia doesn't become a duty to die.
Kerththekan Vamathevan (Phillips 13)
Next quarter’s question is: ‘Should bariatric surgery be widespread option granted to obese individuals in the NHS?’ Get involved by sending your opinions to:
Bibliography
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