Medical Society Magazine Vol. 1

M E D I C A L

N L C S D U B A I

S O C I E T Y Vol. 1 24/06/2020

Supervisor Co Chair Deputy Chair Editor

Mrs Murphy Hyemin Raeesah Moola Lara Hyemin

Contents The battle between Lara (G10) COVID19 and humanity The Ethics of Medicine Raeesah (G11) Clinical Psychology – how Shalini (G11) it works and its future The Endocannabinoid Tanisha (G9) System: A Guide to the Bodily Regulator Discussion of the biological Hyemin (G11) aspects of viruses Big Pharma Conspiracy – Mahnoor (G11) Fact or Fiction?

Forensic Science Yijin (G11)

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The battle between COVID19 and humanity Writer: Lara (G10) Whilst battling to stay afloat in the current, trepid waters of quarantined life, have you found yourself having more time to actually stop, assess and reflect upon how lucky you really are and how much you have been taking life for granted, especially here in the UAE? The stresses and worries that this biological pandemic has thrown at us, is unprecedented in our lifetime. However now, we need to arm ourselves with suitable coping mechanisms and healthy habits which will disarm this dangerous intruder. We must strive to ensure that we are not taking the positive gifts life has bestowed upon us for granted – even the little things like the grin on your mom's face when you compliment her new dress or the feeling of coming home after a long, overwhelming day and being able to pounce straight into bed. Ultimately, this piece is a reminder to society; appreciate what you have, live life to the fullest, and be grateful for the simpler things in life, because in the future, you could be the one who falls victim to this villainous virus.

RNA

Figure 1. Diagram of RNA virus

Day after day, across all channels, there is so much media coverage and at times, “fake news” reverberating around. I wanted to discover and subsequently share some trusted scientific facts with you, which will deepen your understanding of this dangerous pathogen. Having conducted widespread background research, I unearthed some useful, and reliable content from a widely admired and published UAE consultant at an esteemed local hospital. What I found to be very interesting about his article is the fact that he explores the actual biological science behind the virus. He explains that the SARS-CoV-2 consists of one strand of RNA, surrounded by a capsid (which is a protein coat) and then an envelope that is covered in receptors which target specific cells, in this case, the pulmonary ones. A common misconception he addresses about viruses is that they are thought to be living. However, viruses are nonliving because they cannot reproduce on their own. A virus takes control of the host cell’s nucleus and metabolism, altering its genetic code, forcing the cell to produce more viruses.

Eventually when the virus multiplies and there are too many in one cell, this leads to the cell exploding, causing the symptoms of COVID19.

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Viruses, and the diseases they cause, often have different names. For example, the HIV virus causes AIDS and the rubeola virus causes measles. So, where did the name for this virus originate from? Well, the virus was previously named 2019-nCoV. This name was chosen because the virus was genetically related to the coronavirus responsible for the outbreak of SARS in 2003 and MERS in 2012. Now in 2020, the Covi marks the family of viruses that this pathogen is derived from. D is an abbreviation of the word disease and 19 marks the year (2019) when the virus was identified. Furthermore, any strand of Coronavirus also gets its name from the crown-like halo or corona that is visible when the virus is viewed under an electron microscope.

Figure 1. Diagram of SARS-CoV-2

It has been over two months now since the World Health Organisation (WHO) labelled the virus a pandemic or in other words, a disease that has spread worldwide and had a profound effect on society. In response to this, governments all over the world employed quarantines on their respective citizens to reduce the spread of this contagious disease and to flatten the ‘so called’ curve. Politicians attempted to stop the exponential growth of the virus by social distancing people or groups who didn’t have symptoms but were exposed to the sickness. But what is the scientific reasoning behind social distancing and quarantining?

Is it going to delay or end the spread? An interesting article in the Washington Post recently posited that it is almost impossible to completely seal off the sick population from the healthy. We need frontline workers to care for, medicate and test people, otherwise how would the curve ever flatten or possibly go into decline? A health expert in the article suggests that avoiding public gatherings or large groups is one of the most effective ways to curb the spread. Additionally, if we can keep the movement of people to under 10% of a given population in an area, it will successfully, over time, flatten the curve. Scientifically speaking, the numbers of those recovered and healthy will far outweigh those infected or carrying therefore buying time for scientists to discover a suitable and reliable vaccine. This has been a ploy undertaken by the ruling body here in the UAE and statistics are showing that extensive distancing will become the most effective method of tackling the ever-increasing curb.

How close are scientists or immunologists to finding a ‘cure’ for the virus? How soon will we all return to ‘normal life’? Well, the genetic sequence of SARS-CoV-2, the coronavirus that causes COVID19, was published on the 11th of January 2020, triggering intense global Research and Development (R&D) activity to develop a vaccine against the disease. The scale of the humanitarian and economic impact of the COVID19 pandemic is driving evaluation of next-generation vaccine technology platforms and the first COVID19 vaccine candidate entered human clinical testing on the 16th of March 2020. The Coalition for Epidemic Preparedness and Innovation (CEPI) is busy working with global health authorities and vaccine developers to support the development of vaccines against COVID19. Then, as of the 8th of April, the global COVID19 vaccine R&D landscape included 115 vaccine candidates. 78 of these were confirmed as active or potentially useable. Then, of the 78 mentioned, 73 are currently at exploratory or preclinical stages. The most advanced candidates have recently moved into clinical development and numerous vaccine developers have also indicated plans to initiate human testing in 2020.

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A striking feature of the vaccine development landscape for COVID19 is the range of technology platforms being evaluated, including nucleic acid (DNA and RNA), live attenuated viruses and inactivated virus approaches. Many of these platforms are not the basis for licensed vaccines, however experience in fields such as oncology is encouraging developers to exploit the opportunities that next-generation approaches offer for increased speed of development and manufacture. It is conceivable that some vaccine platforms may be better suited to specific population subtypes (such as the elderly, children, pregnant women or immunocompromised patients). The global vaccine R&D effort in response to the COVID19 pandemic is unprecedented in terms of scale and speed. Given the imperative for speed, there is an indication that a vaccine could be available under emergency use or similar protocols by early 2021. This would represent a fundamental change from the traditional vaccine development pathway, which takes on average over 10 years, even compared with the accelerated 5-year timescale for the development of the first Ebola vaccine. It will most likely take strong international coordination and cooperation between vaccine developers, regulators, public health bodies and governments to ensure that promising late-stage vaccine candidates can be manufactured in sufficient quantities and equitably supplied to all affected areas, particularly low-resource regions.

I think that the ultimate takeaway from this invasive disease and the greatest lesson that it has taught us, is that in our globalised world, our lives are so intertwined that the idea of perceiving ourselves as separated (albeit as individuals, communities or uniquely privileged species) is evidence of false consciousness. The truth is that we were always bound together, part of a miraculous web of life on our planet and beyond it, stardust in an unimaginably large and complex universe. It is only the self-cultivated fanciful superiority within us and the habitual hustle and bustle of our daily lives, that blinded us to the awe we ought to feel as we watch a drop of rain splash on a blooming daffodil, or a baby learning to crawl, or the stars in the midnight sky, revealed in all their glory. And now, as we find ourselves in periods of quarantine and isolation as nations, communities, and individuals, all of this should be so much clearer. It has taken a virus to show us that only together, when united regardless of race, religion or gender, are we at our strongest, most alive and most human. It is through struggles and challenges like these, that we are given the opportunity to understand the true meaning of life.

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The Ethics of Medicine Writer: Raeesah (G11) Medical ethics have helped shape and guide clinical practice, the culture of medicine and biomedical research. Good medical ethics are coherent and are integral to the activities of healthcare professionals. Ethics are moral principles that govern behaviour and create a way of thinking. In order for ethics to be embedded within clinical practice, professionals need to progress from their training by reflecting upon their actions and the performance of others.

In clinical contexts, ethics are required when resolving medical related dilemmas; healthcare clinicians are trained to call upon their experience of professional judgement to make decisions. However, when the dilemma is less medically focused and addresses the patient and their values, a decision is harder to conduct as their training is limited within this particular field. But what makes medical ethics effective? Medical ethics should make the field of medicine better. This can be carried out in many ways: reflecting on everyday ethical issues, ensuring ethical values are integrated and embedded in the organisation of healthcare and empowering clinicians to be advocates for patients (Kong 79).

Critics may argue that the changes in the way professionals’ approach and deal with issues reflect the wider society. Nevertheless, many still argue and believe that ethics shape the cultural changes of society and teaching medical ethics will enable professionals to respond effectively to issues occurring everyday (Rhodes 71).

How do we justify the scandals and failure of patient care that occurred at the Staffordshire Hospital in the early 2000s? Were the medical ethics not good enough?

The Staffordshire hospital scandal concerns poor care and high mortality rates of patients at the hospital (Francis 4). Medical ethics have been a part of training for several decades and professionals have had access to ethical guidance. Therefore, we can interpret that the events that took place in Staffordshire were due to a failure of transferring ethical reasoning into clinical practice.

A common underlying theme in medical scandals is a failure for ethics to become a fundamental part within healthcare organisations. Ethics is like a minority language, for the majority of people it is a classroom language which they can ignore after they pass examinations. A way to translate ethical reasoning into practice is by creating an ethics community. Many medical students and junior clinicians perceive and witness unethical behaviour but they do not feel obliged to speak up as they think it is ineffective. Therefore, healthcare organizations need to create a culture that supports professionals raising concerns. For example, the NHS has regulator plans to make it easier for doctors to speak up and break the code of silence (O’Dowd 1). Another example is the Cure the NHS campaign which was founded and led by Julie Bailey whose mother passed away at Staffordshire Hospital. The aim of the campaign is to bring honest and transparency within the NHS, there has been positive feedback from frontline workers as staff are beginning to speak up for patients and themselves.

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Clinical Psychology – how it works and its future Writer: Shalini (G11) In today’s world, we are seeing various technological advancements and developments in society. These have made a drastic impact on human behaviour which is important to understand, as without this we would fail to understand ourselves causing the inability to function as efficiently as needed. To put it simply, psychology is the study of the human mind and behaviour however, clinical psychology is a field within this which investigates human behaviour but additionally treats mental disorders.

The focus of clinical psychology remains to be on but is not limited to learning disabilities, substance abuse, depression , and anxiety disorders. To carry out assessments, psychologists use tools such as Intelligence and Achievement tests to measure one’s ability and their potential and personality tests to measure personality constructs and help make judgments regarding employability. A neuropsychological test can be used to evaluate the functioning in areas such as attention or problemsolving and lastly, a clinical observation is a method used where patients are observed to recognise certain areas of potential concern. An assessment can allow a psychologist to see what best fits a patient in terms of treatment or support. This being either psychotherapy, medication, or other methods. Psychotherapy in particular is the term given to the various forms of treatment used to help with mental health problems and psychiatric disorders. Common types of psychotherapy are Cognitive Behavioural Therapy, Psychodynamic Psychotherapy, Family Systemic Therapy, and Cognitive Analytical Therapy though there are multiple more. However, in addition to this we have also seen what are known as “Third-wave therapies.” These are an extension to CBT and focus on providing a more holistic view on behavioural processes. An example of this is Acceptance-Commitment Therapy: This looks into the use of healthy behavioural skills such as mindfulness, acceptance, and further encourages one to focus on their own values. Further, the goal of ACT is not to reduce symptoms though it does essentially attain this, however rather it allows one to work on themselves and make advancements in their own life.

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We can also expect clinical psychology and psychology in general to play a huge role in our future. According to the World Health Organisation, only a quarter of the people who suffer from mental health disorders receive the help and support needed. This is due to many factors, though accessibility to a mental healthcare facility is a main one.

In response to this, we can expect to see not only lay health workers receiving training to a certain extent, but also the involvement of clinical psychologists. The poor accessibility to mental health care facilities has been a factor that influences rates of crime in certain areas. However, providing the sufficient and the right training can help decrease this rate of crime. Furthermore, technology can help improve the quality of therapy as well as understand certain mental health disorders. For example. Virtual Reality may be used to experience the visual hallucinations present in Schizophrenia.

Schizophrenia is a mental disorder in which people experience hallucinations, delusions and though interference. 2/3 of people with schizophrenia have significant symptoms and often, the life expectancy of someone with schizophrenia is approximately 10 years less. Unfortunately, schizophrenia is a big risk factor for selfharm and suicide and therefore, 1/10 of people have successfully committed suicide.

Schizophrenia cannot be cured however the treatment is focused on suspending symptoms and helping people managing the problem. Antipsychotic medications can be taken to help control symptoms, CBT is used to help patients cope with hallucinations and delusions. Most importantly, social support is vital in helping sufferers lead a normal life.

This works as a part of Exposure Response Prevention Therapy as in certain disorders, facing traumatic memories is hard in-session making the ERP process difficult as facing fears is required. However, virtual reality can allow patients to do this which improves the quality of therapy. Climate change is a prominent part of our world today and psychologists are working with the United Nations to help companies adapt to these issues. In addition, behavioural change and climate change impacts mental health through natural disasters leading to anxiety, PTSD, domestic abuse and depression.

Lastly, we can expect the novel coronavirus pandemic to bring change as it has already made multiple bio-psycho-social impacts. This has had implications on communities, it can bring changes into workplaces, and lastly restriction can influence behaviour.

Clinical Psychology is an field of study that has great prospects and will help improve our future. Additionally, as we better understand mental health and the impacts it can have on our life, we can expect to experience an improved quality of life.

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The Endocannabinoid System: A Guide to the Bodily Regulator Writer: Tanisha (G9) The endocannabinoid system is a complex biological system that is responsible for regulating a multitude of vital processes in the body was found by researchers in the 1990s who were exploring THC, a chemical is found in resin produced by the leaves and buds primarily of the female cannabis plant. The plant also contains more than 500 other chemicals, including more than 100 compounds that are chemically related to THC, called cannabinoids, and allowed us to discover a new system that, while extremely important in our day to day functions, little is known about it.

Cannabis Cannabis is a drug that is Hemp plants such as Cannabis indica. It can stimulant, or a is the reason for the drug is different for drugs are known for down the activity of the system (CNS) while for the exact opposite

extracted from Indian Cannabis sativa and act as a depressant, hallucinogen, which experience of taking people. Depressant their ability to slow central nervous stimulants are known (raising levels of

nervous activity in the body) and hallucinogens are known for containing psychoactive ingredients that cause anomalous changes in perception (in terms of thoughts, emotions, and consciousness).

Marijuana Marijuana, more commonly known as weed, is one cannabis drug that you may have heard of. It is a mixture of the dried flowers of Cannabis sativa. The main psychoactive (mind-altering) chemical in marijuana is delta-9-tetrahydrocannabinol (THC).

When marijuana is smoked, THC (and other chemicals) diffuse from the lungs into the bloodstream, which carries them through the body to the brain. The effects are almost immediate. Many people experience a euphoria (a stimulant effect) or they might feel extremely relaxed (a depressant effect). The effects vary from person to person, but some usual effects include heightened sensory perception where colors are brighter and sounds are louder (a hallucinogenic effect), an altered perception of time, and an increased appetite.

THC and the Endocannabinoid System The endocannabinoid system promotes homeostasis and affects everything from sleep and appetite to pain, inflammation, and immunity, as well as memory, mood, reproduction, and more. It involves three main components: endocannabinoids, receptors, and enzymes. Current research has uncovered five types of cannabinoid receptors in our bodies, and though CB1 and CB2 are the two main receptors that have been researched the most, there are several receptors currently being reviewed.

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Discovered in 1990, CB1 receptors were found to be mostly concentrated in the CNS. This part of the nervous system is responsible for appetite, memory, mood, motor regulation, pain, and sleep. The CB2 receptors are found mostly in the peripheral nervous system (PNS), particularly immune cells, which is why they play an important role in our immunity. Endocannabinoids, also called endogenous ligands because they are proteins that bind to receptors, are also part of the endocannabinoid system. The most studied of these endogenous endocannabinoids are anandamide, which has the acronym AEA, and 2-arachidonoylglycerol, which is denoted as 2-AG. THC’s chemical structure is similar to the endocannabinoid anandamide.

The similarity in their structures allows the body and the brain to recognize THC and to alter normal brain communication. Endogenous cannabinoids like anandamide send chemical messages between neurons in the nervous system and are known as neurotransmitters. These endogenous endocannabinoids affect many areas of the brain. THC’s similar structure to these neurotransmitters allows it to attach to cannabinoid receptors on neurons in these areas and activate them, disrupting regular functions and causing symptoms such as increased heart rate, coordination problems, dry mouth, red eyes, slower reaction times, memory loss and euphoria.

Neurotransmitters and Synaptic Transmission Neurotransmitters are a type of chemical messenger that transmits signals across a chemical synapse, such as a neuromuscular junction, from one neuron (nerve cell) to another "target" neuron, muscle cell, or gland cell in a process called synaptic transmission. The presynaptic neuron is the cell that sends the signal while the postsynaptic neuron receives it. Neurotransmitters are packaged into small sacs called vesicles in the presynaptic neuron and are released into the synaptic cleft (the microscopic space between the two neurons) when an action potential causes the vesicle to ‘fuse’ with the presynaptic membrane. These neurotransmitters bind to receptors on the post-synaptic membrane and cause a reaction or inhibit action.

In 1964, it was thought that neurotransmitters and neuromodulators could only be water-soluble molecules such as peptides, amino acids, or amines, but not lipids. THC is a lipid, so it was assumed that it could not act as a neurotransmitter. There is strong evidence that supports the theory that THC can bind to receptors. This hypothesis was confirmed in 1990 with the isolation and cloning of the first cannabinoid receptor, CB1, and later of CB2. Ordinary nerve cells send messages to other cells through the synaptic transmission process explained above, but what happens in the endocannabinoid system is different.

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Endocannabinoids are synthesized and released from postsynaptic cells and travel backwards through a process scientifically called ‘retrograde signalling’ across the synapse, where they bind to the CB1s located in the presynaptic nerve terminals. They suppress excitatory and inhibitory neurotransmitter release, which essentially means they stop the neurons when they want to tell other neurons to do something, or not do something. There are new studies that now show us that non-retrograde signalling, which is when the postsynaptic endocannabinoid activates the postsynaptic receptor, also occurs, as well as neuron-astrocyte signalling.

CEDC The endocannabinoid system is just like any other system in the body, meaning it can, on occasion, have a few problems, whether because of a genetic mutation or an acquired disease. With this system, however, the danger is a lot greater because of just how prevalent and ubiquitous it is – it could affect any number of organs or organ systems. To the phenomenon when there are fewer or more endocannabinoids, endocannabinoid receptors and/or endocannabinoid enzymes, researchers have ascribed it the name clinical endocannabinoid deficiency – or CEDC. The primary reason researchers believe this exists is because when patients of some disorders (namely: migraines, fibromyalgia, depression, anxiety, multiple sclerosis, Huntington’s, Parkinson’s, and PTSD) have been treated using cannabis, the results have been positive.

All in all, research into the relatively new field of the endocannabinoid system is still ongoing, and there is a lot we don’t know about how it works, and about its functions in our bodies. What we do know, is that the role it plays is an important one and understanding more about this biological system has the potential to change how we view certain disorders, and how much we understand them, resulting in medical breakthroughs that can lead to safer and more efficient treatments.

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Discussion of the biological aspects of viruses Writer: Hyemin (G11) Around the second week of December, a massive outbreak of a virus caught my attention. At first, I thought it was a virus that was only going to spread through China; unfortunately, with the Chinese New Year nearing and due to the annual mass migration, the virus spread laterally. Now, it seems that in parts of East Asia and Europe, the number of confirmed patients has settled, whilst in the United States and the Middle East, numbers are still rising exponentially. The current scientific, economic, and political situation has sparked my interest in recognising the relationship between the preceding deadly viruses, however still concentrating on the present crisis.

Figure 1. Diagram of Ebola virus

The Ebola virus became a global epidemic in 2014 after the spread of the virus across the world. The Ebola virus was new to researchers due to its ability to transform into different shapes and this characteristic was what distinguished Ebola from previously known viruses. At Scripps Research Institute, Professor Erica Ollmann Saphire suggested that the Ebola virus morphed from one shape to another which explained how the Ebola virus could control a multi-step viral life cycle only using limited number of genes. The most recent Ebolavirus, the Bombali virus, was identified in samples of fruit bats, and the Reston virus, which is another strain of the Ebola virus, was identified in samples of monkeys. Close contact with infected blood, the reusing of equipment and poor nursing techniques were the main sources of the human-tohuman transmission. Surprisingly, airborne transmission was not proven to be a significant factor in the Ebola outbreak. Unfortunately, during the Ebola epidemic, overall visits to health clinics in Liberia decreased and this was due to the fear of catching the virus. Poor judgements were made by the World Health Organisation (WHO) and before they declared an International Health Emergency, 1000 patients had already passed away. There was a total of 28,652 confirmed cases with 11,325 deaths.

Severe Acute Respiratory Syndrome (SARS) was identified in 2003 in Guangdong, China and is thought to have broken out due to zoonotic transmissions as well, which is the transfer of diseases from animals to humans. Zoonotic viruses are viruses which mutate rapidly evading immune responses quickly. Scientists assume that bats are the host that spread the virus to civet cats eventually reaching humans. A total of 8098 people worldwide became sick with SARS and of these, 774 had died. From the same family of viruses, Middle East Respiratory Syndrome (MERS) was first identified in 2012 in Saudi Arabia.

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The largest known outbreak of MERS outside the Arabian Peninsula occurred in South Korea in 2015 due to a traveller returning from the Arab region. Like SARS and Ebola, MERS is also a zoonotic virus where close contact of infected dromedary camels was the pathway of transmission. It was investigated at Columbia University that a small gene fragment of a bat had a perfect match with the genetic sequences of MERS. Since 2012, WHO has been notified of 2494 laboratory confirmed cases of infection with MERS and 858 MERS associated deaths.

Figure 2. Diagram of SARS-CoV-2 and ACE2 Receptor

Lastly, the current virus. Wuhan’s pneumonia was officially named COVID19 and since it is the second strain of the SARS virus, it is called SARS-CoV-2.

Understanding the biological structure of the SARS-CoV-2 answers a few key questions that I, myself, asked. When the virus was first discovered in 1965, scientists gave the name corona, which means ‘crown’ in Latin due to its unique form of spike proteins on the surface. Originally, only cold symptoms were displayed, however, SARS and MERS caused pneumonia, a disease known for its high

fatality rate. SARS-CoV-2 is the most recently identified coronavirus strain, with its genetic structure similar up to 79.5% with the SARS virus and 96% identical with the bat’s coronavirus. The coronavirus is usually transmitted to the human body through oral mucous membranes and lungs, because of a receptor on the surface of the host cell named ACE2 (Angiotensin-Converting Enzyme 2) and spike proteins on the surface of the virus bind neatly to penetrate the human body. However, when they bind incorrectly, the virus will not be able to replicate, and the virus will die. ACE2 is an enzyme that attaches to the cell membrane of cells in the lungs, heart, kidney and intestines.

Due to the phylogenetic similarities between SARS-CoV, MERS-CoV and SARSCoV-2, it was identified that an inflammatory response called cytokine storm was responsible for the occurrence of Acute Respiratory Distress Syndromes. Cytokine storm overproduces immune cells and their activating compound, cytokine. Excess cytokine attacks both the virus and normal, healthy cells of the lungs causing internal bleeding. This creates an edema which causes water to fill in the lungs and once the lungs are filled with fluid, dyspnea threatens human life and will cause death. This explanation can be supported by an article written in the prestigious medical journal The Lancet published on the 24th of January 2020 entitled Clinical feature of patients infected with 2019 novel coronavirus in Wuhan, China in which it mentions that “high concentrations of cytokines were recorded in the plasma of critically ill patients infected with 2019 novel coronavirus”.

In February 2020, a joint research team at the University of Texas and NIAID Vaccine Research Centre found that the spike protein in COVID19 had a higher affinity for the ACE2 receptor than the SARS virus explaining the highly infectious nature of the COVID19. In a layman’s terms, it means that the spike proteins stick better to the ACE2 receptors.

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More recently, in April 2020, Professor Penninger at British Columbia University, Canada, judged that preventing the contact between the ACE2 receptors and the spike proteins on the surface of the virus may prevent the human body from getting infected.

Therefore, a similar-structured protein, hrsACE2, was artificially synthesized. When the artificial protein was injected into an organoid that was infected with COVID19, it reduced the number of viruses by approximately 1/5000. He noted that “the coronavirus died without being able to replicate because it mistakenly combined with the hrsACE2 protein�.

Many scientists believe that the SARS-CoV-2 was definitely not the result of a perfect storm in which the virus and the effects were unforeseeable. On the 18th of October 2019, Johns Hopkins University held a discussion-type mock training named Event 201 in which it simulated an outbreak of a novel zoonotic coronavirus transmitted from bats to pigs to people eventually leading to a pandemic. This scenario emphasised that it will not only affect human life, but also the travel industry, aviation and service industries, which will hit a global scale. This helped identify the US’s shortcomings and how to prepare for an unforeseen contingency. Soon after, South Korea also introduced a training programme for unknown causes of infectious diseases. An unknown cause disease has no means of diagnosis. Therefore, microbiologists, diagnostic experts, epidemiologists and clinicians gather together to compare pathogens that cause respiratory diseases. When it is impossible to find the origin of a novel virus, the gene sequence must be analysed to determine the novel virus to the whole world. This is how the Pancorona test method came about.

However, one downside to this polymerase chain reaction test was that it would take too long. After holding a training session in December 2019, pharmaceutical companies began developing a coronavirus test and a diagnostic kit in January before China announced its cases of the novel coronavirus. At first, there were many concerns to this test method as it had never been conducted before however it successfully identified the first 4 patients in South Korea. On the last day of the Lunar New Year holiday, a conference took place where the Korea Centres for Disease Control and Prevention encouraged rapid production of diagnostic kits and export to countries worldwide. South Korea is definitely a case of successful and thorough preparation of a forth coming virus whilst the United States showed poor communication between private companies and the government resulting in vast spread of confirmed cases around the country, with 2,313,920 cases (as of 20/06/2020).

With intensive research occurring around the world in technologically advanced countries (South Korea, the United States, Germany), the development of vaccines does not seem like a faraway dream. Nevertheless, the possibility of this virus turning into an endemic childhood disease, or the prolonged spread causing further mutations, and eventually a secondary spread, must also be noted.

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Big Pharma Conspiracy – fact or fiction?

Writer: Mahnoor (G11) In this current moment, when we think of pharmaceuticals and healthcare, we probably think of vaccines and COVID19. Hopefully, today I will be able to provide some food for thought on a slightly different topic within this area.

During my work experience in a variety of medical environments, - A&E, theatres and GP surgeries, I noticed a clear and intriguing trend. Many patients’ issues had root causes in lifestyle diseases, such as heart disease, COPD, type 2 diabetes, hypertension and stroke.

The first question that came to mind, after establishing that my observations were in fact ‘lifestyle’ diseases, was, what had happened to the notion of prevention is better than cure? Upon further thought, many questions came to mind – would the NHS be under so much pressure if lifestyle diseases were to prevented before causing complications? Is this an issue on a global scale? How much control do we have as individuals over the way we eat, sleep and exercise? Who is responsible for what we put in our body? And why, despite arguable being at the peat of our existence as a species, are we sinking lower and lower into the clutches of self-inflicted illnesses?

After much reading and thought, I became aware of a conspiracy surrounding the pharmaceutical industry, also known as ‘Big Pharma’.

Firstly, what’s the big deal with the pharmaceutical industry?

In the most basic sense, this conspiracy entails that the Big Pharma industry creates, inflates, worsens or markets diseases to boost their profits, working against public goods. We, as consumers, are manipulated into becoming chronically unwell.

Therefore, we end up paying for heaps of medication which then leads to huge ongoing profits for the firms. Supposedly, organisations as such are in cahoots with other crucial bodies such as food conglomerates and national governments, in order to impact the way in which we live our lives, from several different aspects.

Secondly, the origins of Big Pharma. Before modern-day medications, from the beginning of time, man has reverted to plants for medicine – like aspirin found in willow bark, and morphine derived from poppy seeds. The industry, as we know it, was only really established in the second half of the 19th century.

The scientific revolution in the 17th century allowed for the now-widespread rationalism and experimentation to flourish. In the 18th century, the industrial revolution happened, transforming the production of goods. The combining of both concepts, for the benefit of human health, didn’t occur until later. Merck in Germany was arguably the earliest company to do so. Pharma giant, GlaxoSmithKline’s origins can be traced all the way back to 1715, however it has undergone numerous merges, notably with Beechams, who created the world’s first factory dedicated exclusively to medication, in 1859. Pfizer was America’s first large pharma firm, beginning as a fine chemicals business, founded in 1849, by two German immigrants. It expanded rapidly during the civil war, with demand for antiseptics and painkillers at an all time high.

During this war, a young cavalry commander named Eli Lilly was on the receiving end of Pfizer’s medications. He went on to begin another pharma giant, Eli Lilly and Co, which was the first to focus on R&D.

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Benevolent and progressive work in science, for the good of humankind… what are these companies up to currently?

One example is Astra Zeneca, a British-Swedish multinational pharma company, who aspire to utilize genomics and precision medicine in order to deliver the most effective treatments to their patients. What is precision medicine? Very simply put – customized healthcare. For individuals, tailored medication is provided as opposed to a ‘one-sizefits-all’ drug. The benefits of such a system are endless: - Pre-empting progression of the disease - Customizing disease-prevention strategies - Prescribing drugs that are more effective - Avoiding drugs with predictable side effects - Reducing time, cost, and failure rate of clinical trials - Eliminating trial-and-error inefficiencies that undermine patient care They also intend to harness the power of genomics, to achieve this goal. Genomics is an area in molecular biology, which focuses on the structure, function, evolution, and mapping of genomes. Astra Zeneca's Medimmune Genomics initiative is set to analyze 2 million genomes by 2026. Using information on such a micro scale will be revolutionary in the drug industry and will undoubtedly change its trajectories in the future.

GlaxoSmithKline is another pharma giant which has been carrying out entirely benevolent work in Africa concerning malaria. Malaria is a disease carried by mosquitos, particularly the female which carries the plasmodium parasite. There are 5 different plasmodium parasites which are known to affect humans in different areas of the world. If infected, symptoms such as fever, shivering, and vomiting arise, and anemia, seizure, and coma if left untreated. Children under 5 carry the largest burden of disease.

A vaccine has proved almost impossible to formulate, due to the parasite being able to adapt to the human host and escape its immune mechanisms. There is only one existing attempt, with a very low efficacy. GSK is fighting malaria on different levels – in the lab, and on the ground. They are supporting vulnerable healthcare systems as well as assisting from a vaccine perspective, which allows for full coverage of the issue in a very vulnerable area of the world.

Big Pharma. This body wants a sick population. Their profit margins depend on a sick world. Preventative care is never promoted as highly as pharmaceutical care. Is this an ethical choice?

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Forensic Science Writer: Yijin (G11) Who solves an unsolved case? How do you know the owner of the hair on the street?

How do we catch criminals in all criminal cases? The polices can run and catch the criminals physically, but what about the case when a criminal is not at the crime scene? If you leave it, that crime case with remain unsolved forever. The technique, to catch a criminal, that was created was forensic science.

Forensic science refers to the application of scientific methods and techniques to matters under investigation by a court of law. It is also known as criminalistics, which is the application of science to criminals and civil laws mainly on the criminal side.

Many aspects of science or human science can be applied to forensic science. Forensic science treats in many areas of sciences such as biology, chemistry, physics, pathology, psychology, digital forensic, and traffic accident analysis Biology – DNA analysis, fingerprinting, pathology In forensic science, biology is often used in medico-legal genetics and pathology.

Medico-legal genetics is DNA testing, which serves as a crucial clue to the solution of various criminal accidents including paternity test. Scientists make development of various genotype analysis using Next-Generation Sequencing (NGS) and study on individual identification of organisms such as animals, plants, and microorganisms.

Additionally, they conduct studies on the development of analyses for genetic types (sex chromosome, mitochondrial DNA, Y chromosome etc). Furthermore, they analyse the DNA information (estimation of hair colour, eye colour, skin colour, biogeography, drawing identikit picture, age estimation, identification of bodily secretions).

The use medical devices such as Postmortem Computed Tomography (PMCT) are appl ied to autopsy work in line with the advancement of industrial technology, providing significant help in diagnosis of sine. It is now developing new techniques such as medi cine and molecular biology to apply to accurate diagnosis, damage analysis, and identi fication of causes of death. The typical technique is the development of Forensic Appra isal Technique Using Postmortem Computed Tomography (PMCT), and a study on the Face Restoration through 3D Skull Analysis.

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Chemistry – toxicity, foresnic chemistry In forensic science, chemistry is used in an area of determining the concentration of toxic materials, and forensic chemistry. Scientists analyse the types of carious toxic substances, abused substances or food products and suggest the need for safety management of them. They should develop reliable appraisal techniques and apply this new technology to already existed technology to upgrade them.

In addition, the department of chemistry review the results of its analysis with precision instruments to provide important clues in identifying the cause of a crime or death. At the same time, research is undergoing to establish a new precision analysis method to analyse the evidence more quickly and accurately with various developed of modern technology.

Psychology Psychology helps to solve a case by judging the authenticity of a criminal’s statement in relation to the case or analysing their psychological characteristics and enhancing the memory of victims and witnesses Types of Forensic Science Jobs 1. Blood Spatter Analyst: they analyse blood samples both at the crime scene and in the lab. The analyst can work with trace evidence 2. Document examiners: they analyse handwriting and the process involves detection o f altered images and print copies 3. Forensic Anthropologists: they deal with human remains to derive information such as the age or race of a victim. They work under the supervision of a medical exam iner and less likely to work with recent corpses than bones and other remains 4. Medical Examiner: they must have a medical degree in addition to a four-year degree and a completion of residency. Also, involves conducting autopsies and determining a cause of death 5. Forensic Technicians: they collect and preserve the evidences 6. Forensic Accounting: if a secret is hidden in numbers, forensic accountants dig for evidence in financial records 7. Forensic Artists: they create composites based on witness testimony as well as age progression images and other visual aids for trial 8. Laboratory Analyst: analysts analyse collected DNA evidence and performing analyses of weapons as well 9. Toxicologists: they investigate blood and tissue samples for substances such as alcohol, drugs or even poisoning. Both laboratory analyst and toxicologists typically operate out of labs, as do fingerprint analysts and ballistics analysts, who work with solely with firearm evidence

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