Celebratory Tea Party

Every year for as long as I can remember while I have been at my current school there has been a tea party held for the community. Whether this be a Spring-themed party, or more recently the focus shifting to celebrating the Queen’s birthday or years as a monarch, the Sixth Form have traditionally helped out at the event.

Having taken part last year, I surprised myself a little to find that I couldn’t wait for this year. However the moment I stepped inside the hall to see the union jack bunting and the afternoon teas all laid out, time became just a concept and the hour flew by until the end brought back reality and lessons and people actually existing and having finished their normal lunch break in school.

Like any other event, the first stage was to welcome people in. I started volunteering at a local retirement home at the start of the year, although I stopped over summer since my town is a little way away from my school. However, I was pleased to see some familiar faces coming in to enjoy the afternoon and was even more pleased to discover that one of the ladies who often came when me and friends went over to volunteer remembered me. It was lovely to see her again and the others and have a quick catch-up before meandering around the other tables of guests.

After the guests have arrived and received their respective cups of tea or coffee, I often find a table to stay with through the remainder of the afternoon. This year I was mainly talking to a group of four ladies who talked to my friend and I about their daily adventures. First and foremost, they are avid fans of the local running club and that is how they met, although two have had to withdraw in recent years due to health reasons. However, they take part in different areas of community life, being part of a group where they have the opportunity to catch up on lost chances and play a few tricks the name of the group something to do with red hats I believe! If that wasn’t enough, they also take part in fundraising, recently raising enough money to buy chairs for the waiting room at the local GP surgery. However, it was the motive behind this that truly made it such a wonderful action. They explained that the chairs have arms and although a chair having arms or no arms potentially doesn’t make that much different to you or me apart from additional comfort, it is something that is essential for someone who has trouble walking, especially the elderly. In the retirement home I saw how much help some people required to sit down or stand up and a chair simply having arms provides some support for the occupier to use to aid them in standing up.

After enjoying music supplied by some of the pupils, a band then came on to recreate some memorable melodies from the “olden days”. The band moved through different genres but began with the standard war ones. The lady sitting next to me leaned in and whispered that she doesn’t really like that music, in fact she prefers some Elvis and it was then that it struck me how generalised the older generation is. Yes, the ages vary significantly but there appears to be a single stereotype. Many people may still prefer the war tunes but there will come a time where the majority prefer some more rock n’ roll and musical bingo may have completely different songs on when played in care homes. And the view of retirement varies from one to another but you mostly hear about some prime-time golf or gardening but many, like these ladies, are an essential part of the community and carry out work we are not even aware of.

The songs always encourage the dancers to stand up and show off some moves, and it was no different this year. The older music required knowledge of some basic steps and it took me a while to catch on as to what was going on. I’ve always wanted to be able to dance-and I mean to know some classic steps not just the party foot shuffling-and as the music progressed through the years you were able to tell how the dancing changed too, from dancing with a partner to boogieing on your own. The end accumulated to possibly everyone’s favourite: Mamma Mia and Dancing Queen known to must from the Abba days while to others from the well-loved film. Acting out Mamma Mia with possibly the Mayor’s wife or someone looking important nonetheless, was definitely one of the highlights.

The Tea Party is a wonderful juxtaposition to the normal school day. It is a great opportunity to interact with the wider community, and for me personally it was great to see some familiar faces. Whilst our days our filled with school work, having a small chat helps us to have a glimpse into the world of others in our community.

But unfortunately the clocks returned to normality and slightly dishevelled I returned to Maths.

Fig. 1 Tea Party
Tea party (image taken from Google)

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Vaccination? Only one please!

As a child, I didn’t like going for jabs very much- I don’t suppose any child does. I still remember getting vaccinations when I was rather young-perhaps such a ‘traumatic’ event of having a needle stuck in your arm when you’ve only just grown up from a toddler can stay with you for a lifetime. However, I always understand the importance of vaccinations, and despite not being overly keen, I tired to ignore the sharp pain and look forward to the ‘Well Done’ sticker at the end.

Vaccine
Fig. 1 Image taken from Google.

However, I know that for many vaccinations are a bigger ordeal than just going to see a nurse. Fear of needles, painful past experiences, perhaps past side effects all play a part as to why people, especially children, dislike the act. This may lead to people missing appointments, especially for boosters, meaning the protection against a disease is less effective. Appointments may also be missed due to simple forgetfulness or something suddenly coming up and then some never get round to rescheduling. Without the boosters, the memory cells for the specific antibodies to the disease do not increase before the actual infection, meaning less antibodies can be produced initially and the vaccine loses its effectiveness.

A new innovation, however, could soon solve the problem. US researchers at the Massachusetts Institute of Technology have developed a vaccine held in microscopic capsules that releases the initial dose and then the boosters in a specific time frame. McHugh, one of the researchers, explained that silicon cube moulds are filled initially with a polymer- a type that is already used in Medicine such as in implants and other devices. The cubes (which specifically measure a mere “few hundred micrometers on each side”) are next filled with small amounts of the vaccine before a lid is placed and it is all heated in order for the lid to seal. The added polymer is then able to break down when in contact with water, meaning the time it takes for it to degrade depends on the structure of the particles in the polymer and this therefore can be altered and adjusted.

This idea has already been tested out on mice. A group of 5 mice was given a single injection of “a mix of microparticles designed to release their contents at different times” and “each was filled with a protein that stimulates kind of immune response as vaccines”. The researchers found that the protein was in fact released over a period of time, 9, 20 and 41 days after the injection-exactly like the team had planned.

This method would not only benefit children but also people in the developing world. For children the benefit comes from the number of vaccinations they are routinely encouraged to have. To give an idea: diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B all at 8, 12 and 16 weeks, rotavirus at 8 and 12 weeks, pneumococcal and Men B at 8 and 16 weeks and one year, Hib/ Men C at one year and measles, mumps and rubella at one year and three years and four months. I bet you’ve lost count already! Giving as many vaccinations and boosters as possible in one injection saves the need for so many appointments and has a smaller impact on the child by having to be pricked with a needle fewer times. The benefit to developing countries would be not only be people receiving a vaccine but also receiving all of the boosters necessary to ensure a better protection. This also means that the staff could administer the numerous vaccines to more people rather than having to see the same people for boosters constantly. As McHugh summarised: “In the developing world, that might be the difference between not getting vaccinated and receiving all of your vaccines in one shot”.

However, before we become too excited, this is still methodology of the future. Tests still have to be carried out on human patients before the vaccine can be administrated to the whole population and before this there are many more tests and hoops the innovation has to jump through. In addition, Moein Moghimi has stated that the microparticles at the moment are too big to be injected in the same way that we receive vaccines currently- deep into the muscle. The microparticles can only be injected just below the skin however McHugh is already working on halving the size of the particles so that they can be injected into the muscle.

So maybe we are not that far away from coming in for a jab and saying ‘adios’ to more booster injections!

Articles used (all accessed 19/09/17):

https://www.newscientist.com/article/2147453-plastic-cubes-injected-into-the-body-could-replace-booster-shots/

http://www.bbc.co.uk/news/health-41269196

http://www.bbc.co.uk/news/health-41269196

The signs of sepsis

Looking over a summary of the week’s news, I saw an interesting point about “(the) NHS … missing the signs of sepsis and failing to treat patients quick enough”.

Sepsis is also known as blood poisoning or septicaemia, however these terms are not identical. Both blood poisoning and septicaemia refer to the invasion of the bacteria into the bloodstream, while sepsis can affect many organs or even the entire body without blood poisoning or septicaemia.  Sepsis kills around 44,000 people in the UK every year and Dr Ron Daniels (chief executive of the Sepsis Trust) has been quoted that “(sepsis) causes more deaths than breast cancer, bowel cancer and prostate cancer put together”.

The condition is triggered by the complication of an infection or injury and can lead to tissue damage, organ failure and in some cases, death. It can be caused by viral and fungal infections, although more commonly by bacteria infections. Early symptoms in older children and adults include: a high or low body temperature, chills and shivering, a fast heartbeat and fast breathing while later symptoms include: dizziness, disorientation mottled skin and vomiting. Antibiotics are the usual treatment for sepsis and if detected early, tablets may be taken at home, although in severe cases antibiotics are given intravenously, with some very difficult cases ending up in the ITU.

The issue is that an investigation has found that a number of hospitals are “missing symptoms of sepsis and failing to give patients antibiotics quick enough” which could lead to further complications and an even higher risk of death. The BBC Panorama programme obtained figures on sepsis from 104 hospital trusts and the numbers have been complied by the NHS since 2015 in order to assess how the hospitals are managing with diagnosing and treating the condition. It has found that 24 NHS acute hospital trusts have failed to “administer intravenous antibiotics within an hour to half the patients considered to need the treatment”. This becomes a serious issue as we need to keep in mind that the NHS advises that antibiotic treatment should be given within an hour of diagnosis in order to minimise the risks of serious complications or death. Furthermore, the figures also reveal that 14 acute hospital trusts in England “failed to spot signs of suspected sepsis in half of patients, while 10 hospital trusts said they were identifying every suspected case from the total sampled”.

A case of sepsis was reported by The Telegraph. Lucinda Smith, 43, was reported to have gone to her GP after scratching the back of her hand while gardening and subsequently feeling pain in her shoulder. The GP diagnosed a “trapped nerve and prescribed anti-depressants to relax her and she was also told to see a physiotherapist”. However, only three days later, her fingers and arm became red and swollen and she also started vomiting while experiencing worsening pain. Having gone to another GP, she was diagnosed with a blood clot and was informed to go to A&E. The casualty department at Basildon Hospital took a simple blood test and confirmed sepsis half an hour later. Intravenous antibiotics were administered, however after being moved to a critical care ward, Ms Smith suffered organ failure and sadly died.

On the other hand, it must be noted that the NHS states that the hospitals have improved, “with six out of 10 patients that need antibiotics getting them within the first hour”. In addition, new guidance was also issued by the National Institute for Health and Care Excellence, specifying that “doctors should treat signs of possible sepsis as urgently as chest pains that could potentially be a heart attack”.

Overall, it is an issue that requires serious attention not only due to the severity of the condition but also because it is estimated by the York Health Economics Consortium that it costs the NHS more than £1.6 billion a year.

nhs sign
Fig 1. NHS sign (picture taken from Google).

Articles:

http://www.telegraph.co.uk/news/2017/09/11/hospitals-missing-symptoms-sepsis-investigation-finds/

http://www.telegraph.co.uk/news/2016/10/03/solicitor-dies-from-sepsis-five-days-after-injuring-her-hand-gar/

http://www.nhs.uk/Conditions/Blood-poisoning/Pages/Introduction.aspx

https://www.sepsis.org/sepsis/definition/

Communicating pager to pager

As I was looking through the news articles, one happened to catch me eye- something about ‘outdated technology’ in the NHS.

nhs sign
Fig 1. NHS sign (picture taken from Google).

The article looks at the use of pagers in hospital as a means of hospital staff communicating with each other. The devices were invented in the 1940s, in the decade that the NHS was founded, and its purpose is to be used by doctors, nurses and paramedics to contact each other. The author states that the NHS has ‘more than one in 10 of the world’s pagers in use at a cost of £6.6 million a year’ and that there are roughly 130,000 pagers used across 141 hospitals, with an average of 591 pagers in use per hospital, a figure that was produced by a study carried out by CommonTime. Apparently, only one in three hospitals said that they have never used this type of technology.

Since these devices appear to be in abundance, I saw them myself in use during my work experience in a hospital. The first incidence was on my very first day after we finished a ward round. The F1 doctor’s pager bleeped with a number and she went to a telephone nearby to find out who and why someone needed her. From what I heard, someone was asking about a patient she saw while she was on cover in a different ward. Fortunately, we were having a little break and so she didn’t have to leave a consultation to deal with this. Another time I saw the importance of the communication method between staff was during my time in the Stroke Unit where the registrar doctor I was following had the emergency pager. This means that in case there is a stroke emergency she is the doctor that has to go and deal with the issue. An emergency did actually happen and the doctor immediately left the ward round and took her case with medications downstairs to radiology where the lady was having her scans done. The patient was then stabilised in the ward and thankfully seemed to be doing not too badly with only a little bit of restricted movement on her right side. This case made me aware of how essential rapid communication is-the doctor is there right away to make sure everything goes smoothly and in the few cases where things may not go to plan, they are on hand ready to help.

However, critics have identified some problems with the device, calling it a ‘blunt instrument’ and one that does not provide a sense of emergency in such a demanding environment. Both Rowan Pritchard Jones (chief clinical information officer at the St Helens and Knowsley teaching hospitals NHS trust) and Chloe Westley (Campaign Manager at the TaxPayers’ Alliance) criticised the device. Pritchard Jones was reported to have said that when using this form of communication doctors may “end up writing down messages that can be lost, and often find a telephone number engaged when they do answer it” while Westley said that “(the) taxpayers will wonder why the NHS is spending millions on outdated technology, especially at a time when savings need to be made. The public sector should embrace innovation as new technologies can improve services and save money.”

Westley’s comments may follow figures produced that say modern technology may be half the price of the £6.6 million figure regarding the pagers and more specifically, methods such as apps on smartphones “would cost health chiefs £2.7m a year”. However, despite the obvious advantage that the information would be written down and unlikely to be lost and perhaps the level of emergency could be indicated, the complexity of the apps may also create new problems, the issue of hackers should be something that has to be taken into consideration. In addition, it is not specified what the cost refers to, whether this includes setting up the system for the whole of the NHS as well as any potential future updates.

Geoff Hall (Informatics Leeds Cancer Centre) defended the use of the devices saying that “(although) pagers seem like old technology, …they still exist purely for their inherent high levels of resilience. they are simple to use, i.e. calls can be pushed out by ringing one number, there is an audit trail, the device is easy to carry, and the battery lasts months, not hours. They do only one task, but they do it well. they provide a last line of defence.”

Despite new ideas being essential to keep improving the NHS, it may also be useful to keep in mind a certain saying: “if it ain’t broke, don’t fix it”. Perhaps the simple, single use of the pager is what makes it work. We know of too many times when a computer or phone crashes, something which is not ideal in a place where people’s health is involved, although the opposite argument can be made that the new innovations are one of the reasons behind better health care.

Note:
This post is based on an article by the Independent titled “NHS using one in 10 of world’s pagers despite fears over outdated technology, figures show” by Jeff Farrell. However my summary does include some personal reflections as well. 

Grade 1 Challenge

So today I have completed the Grade 1 Challenge and I would just like to take a moment to talk a little bit about it with you.

The Lent Term concert in school is usually known as the leaver’s concert because it is the final official concert in which the U6 (second A-Level year pupils) will take part in before they leave school. Theoretically the music clubs continue but there are few opportunities in which to perform. As a result in the first meeting we had back after the concert, one of my friends had the idea of doing the Grade 1 Challenge. This is usually undertaken by pupils who have completed grade 8 on an instrument and they have to learn another instrument in which they have never taken an exam to take the grade 1 exam in one term. The exam broad then contributes money to donate to a chosen charity, which for us was Jessi’s fund.

Although few of us had grade 8 under their belt, a lot of people wanted to learn a new instrument including teachers. Personally, I have played the clarinet for 8 years and have grade 6 and continue to play it in the school orchestra, and previously wind band and the clarinet ensemble. I decided to take up the flute as although there was an opportunity to give it a try at my old primary school (we could pick the clarinet or flute or violin), for some unknown reason I had my sights set on the clarinet and refused to even consider the flute.

Although initially I couldn’t get a sound out of the clarinet, I was still given an opportunity to play and so here I am today. However now I regret not trying the flute and have been thinking about picking it up for the last two years, so when the opportunity came to have a goal to work towards I wasted no time in saying that I would learn the flute.

I was very fortunate in having a few friends to help me get to grips with it and I got off to a better start by actually managing to make a sound. Reading music was also no trouble because of the clarinet playing and thankfully many of the fingerings were the same, just holding the instrument sideways not down.

The aspect I had the most trouble with was knowing how to change octaves. The fingerings were the same for the note, but you had to change your mouth and the air flow to get a higher or lower octave of a given note. This was very different from the clarinet where the mouth position stayed constant while you pressed a different key.

However this whole idea took place during Trinity term, i.e. exam term (our school still takes the AS exams). This meant that clearly I had to prioritize exam revision and preparation but on the other hand I couldn’t let the flute sit by the side untouched because practice makes perfect-especially with an instrument I’m just starting to play. Time management was essential and as crazy as this sounds, I practised the flute after I had an exam. I found it was a little reward for sitting in the exam hall for one hour and a half and I looked forward to it. Using the flute as a reward really kept my motivation up rather than just playing it as a chore.

In the end I came out with a fairly high merit-something which I’m really pleased about! (And apparently too much practice isn’t good either because I warmed up so much that my mouth ‘went’, i.e. felt quite weak, something that happens to me when I play for a while because of the unnatural mouth position, and so the sound was rather ‘breathy’ and the examiner, as kind as he was, did his job and picked up on it.)

flute and clarinet
Fig. 1 My two music friends (clarinet and flute).

Overall it was a wonderful experience to have and I’m very glad we decided to do it as a school. Having enjoyed the challenge, I am looking to keep up flute playing alongside the clarinet as playing really takes my mind of the daily tasks and exercises me in a completely different way. I would really recommend trying to learn an instrument or giving anything new a go because you never know until you do it whether you will enjoy it and you may even get something out of it more than just pleasure, although that in itself is enough of an excuse!

 

Chemistry experiment: Aspirin

It is that time of year that we come to do the Chemistry practical in class which I did last year as part of my Crest project. At one point I will dedicate a post to my Crest as I find it  a really interesting topic (I’m just waiting for a few things to sort out first) but for now I will simply talk about the experiment.

This is an experiment all about producing aspirin from the oil of wintergreen. The oil of wintergreen is a strong ‘minty’ smelling substance that is made by the distillation of the leaves of a plant named Gaultheriae procunbers (more commonly known as wintergreen). This substance contains roughly 98% methyl 2-hydroxybenzoate, a compound that can be hydrolysed by heating with sodium hydroxide and adding an acid to form 2-hydroxybenzoic acid (a solid product) and sodium chloride. This is also known as salicylic acid (a product which I made from willow bark in my Crest and a form of the active ingredient found in aspirin). Next the 2-hydroxybenzoic acid is esterified by a reaction with ethanoic anhydride to form aspirin. We then recrystallised the aspirin to try to form a purer product.

Since the first step was hydrolysis which required 30 minutes of heating, the technique of reflux is used to prevent any vapours from escaping the reaction mixture as the condenser attached to the reaction vessel condenses any vapours which then drop back into the flask. This allowed prolonged heating without drying out or losing hazardous volatile substances to the environment.

Fig.1 Refluxing
Fig. 1 The equipment set up to reflux the oil of wintergreen.

The first part of the experiment went well for us as we manged to a achieve an 86.5% yield of the 2-hydroxybenzoic acid. We then also managed to achieve a 65.1% yield of the actual aspirin although this was still the crude product and we had a high rate of product loss through the aspirin being left behind on filter paper and any other equipment.

From then things went a little downhill.

The re-crystallisation did not go well as although our 2g of crude aspirin happily dissolved, it then refused to re-crystallisation in the cold environment. When it finally did, the re-crystallised product was a far cry from the pile of crude aspirin we used and after filtration under reduced pressure nothing was left behind on the filter paper. Our teacher suggested we may have got carried away with adding the solvent and so decided to heat our solution on a hot plate in hope to evaporate off the ethanol. Unfortunately some rubber bung was present in the solution (?? we think it came from the tubing on the filtration under reduced pressure equipment) and proceeded to be melted into a lovely charcoal colour. Nice crystals eventually formed although marred by the black colouring. However there was a suspicious ‘minty’ smell to me although our chemistry teacher described it as an ‘acidy’ smell…

Pure aspirin
Fig. 2 Our apparently ‘pure’ aspirin with a hint of burnt rubber.

Our initial theory was that somehow our reaction conditions forced a wrong OH group on the 2-hydroxybenzoic acid to be replaced by the methyl group meaning oil of wintergreen was made rather than aspirin. As a result the chromatography results were much anticipated to try to solve the mystery of the ‘pure’ aspirin.

aspirin chromatography
Fig. 3 The solvent rising up the TLC (thin layer chromatography) paper which separates out the different components present in a sample.

As hoped for the chromatography did shed so much-needed light, UV light to be specific. Although our crude aspirin had a Rf value similar to the shop-brought aspirin, the ‘pure’ aspirin  had a figure closer to the Rf value of the school’s 2-hydroxybenzoic acid and this may explain the ‘acidy’ smell our teacher identified.

We believe that the issues occurred because either excess ethanol was added or it was too hot. In addition, heating on a hot plate to remove the excess ethanol may have heated the aspirin ‘to oblivion’ (as our teacher kindly put it as they turned the heat up) and the outcome of this is that the aspirin decomposed-clearly back into 2-hydroxybenzoic acid.

We also carried out melting point analysis however the results showed only a weak correlation with the results expected for aspirin and 2-hydroxybenzoic acid.

Overall although the experiment in effect failed because we did not end up with pure aspirin, a form of aspirin was still present at one point and even though we then did not manage to purify it, we instead made a different product and so it was interesting to see how even a minuscule error in our method proved to change the results so much.

As they say, we had a learning curve.

A Day with the Young Ones

Friday 23rd June was a day filled with the undeterred enthusiasm of children caught up in their own world.

In normal day-to-day goings I don’t usually have that much interaction with young children. During school the timetable is managed so that we do not often cross paths with members of the primary school and I do not have any siblings at home. Therefore Friday was a little out of the ordinary for me, having to interact with younger children on two occasions, although it was a very rewarding experience nonetheless.

The first event was judging a history play competition for year 4. My old history teacher (who now teaches primary school) was looking for someone to come in and judge two plays put on by year 4 kids as part of their Greek day and she really wanted someone to come in for the children to perform to so that they felt they got something out of all their practice. Many people were out of school during that day, whether it was due to Geography field work or helping at Meadowgate school in the morning, however I convinced my Spanish class to come and help out.

Now in my A Level years it was very interesting to remember the different class dynamic which is present in the younger years. The children threw themselves into every activity, sometimes with a little too much enthusiasm and vigour, and so a few challenges become apparent as they practised in their groups: everyone wanted to be heard and few wanted to listen. As the teacher pointed out listening to the narrator is key to know your place in the story, although whether this message hit every home is questionable.

Despite the potential setbacks, both plays were fantastic. The creativity and confidence in performance to strangers was highly commendable and yet a winner had to be picked. I very quickly realised that I had to present the news of victory in a very reserved manner: no one group was bad, just one group had a slightly better aspect-but both groups were amazing…! The group that lost continued to be dejected and one child even whimpered “I’m sad” drawing a finger down his face in the shape of a tear (thankfully not a real tear!) and yet all was forgotten as the teacher introduced the next activity.

I have to say that the morning really helped me to remember the small world of a child. Every disappointment, no matter how small, is heart breaking but it is as quickly forgotten as it came. And yet taking a closer inspection at ourselves now, we aren’t really much different. Granted, we have matured and learned to control our emotions, however I doubt that you could say that you never ever feel heart-broken anymore when a tiny setback occurs, even when you are aware of how insignificant it is.

My second interaction with children occurred when I volunteered to help at the Meadowgate School Festival in the afternoon, an event that I mentioned many people were volunteering at in the morning. Meadowgate Academy is a school for children with special needs and the festival was an opportunity for everyone to come together and have a good time with enormous support from the local community. Given the nature of this event it was difficult to directly help out but it was a wonderful opportunity to interact with the children.

Two very contrasting examples stick in mind. My friend and I were meant to keep an eye on the children (even though there were three other staff members there and a total of around 5 kids in the area) and a boy holding a toy lion came up to us. So we politely asked him whether it was a lion he was holding. And he screamed in our faces and run away a couple of feet. And then came back looking like he wanted to start a conversation. So we asked him what his name was. And he screamed and run away. And again looked like he wanted to have a conversation. Another boy was standing nearby and started to talk with us. In contrast he held a perfectly normal conversation, ranging from his name to the weather (as it was beginning to drizzle) to his favourite activity at the fair.

Although we did not know their disabilities, these two boys show a clear example of the difference in how their minds work and how they respond to people. That is something to be very considerate of, especially since I want to become a doctor.  I will have to work with a great range of people and this day has really helped me to have a better understanding of how to interact with children. They see the world in a very different way to us, a way which we have long forgotten as we have grown up although it doesn’t make it any less important to respect. Additional challenges may be thrown up when people find it harder to communicate clearly and this is also something that every doctor has to bear in mind.

Overall it was a very enjoyable day and I’m very thankful that I got the opportunity to interact with the wider community.

Book Review: Bad Science

Ah, yes. Ben Goldacre. I am not quite sure where to start from, so I guess I’ll go from the very beginning of the book which first introduced me to him.

BEN GOLDACRE is a doctor, academic, broadcaster, and science writer who has made his name unpicking the evidence behind dodgy claims from journalists, drug companies, politicians and quacks. His hugely influential  ‘Bad Science’ column ran in the Guardian from 2003 to 2011. His first book, Bad Science, reached Number One in the bestseller charts, selling over half a million copies, and has been translated into twenty-five languages. His second, Bad Pharma, triggered two parliamentary committees and  a global campaign to stop drug trails results being withheld from doctors and patients.

That is the first thing you will read as you open up ‘Bad Science’ or at least that is what I found in my edition which was first published in 2009.

I would give a summary of this book like I have done with the others but I simply cannot. It is an indescribable book, both in the sense that it will not do it justice but also the fact that I simply have no words, but it is a book that I am surprised to catch myself referencing often.

And surprised I shouldn’t be. Having a keen interest in science, Ben Goldacre rips apart the fantasy from the evidence and that is something any scientist aims to do, including myself. What he writes should be relevant and it certainly is as I now look at trails from a new perspective, even if they are only Biology exam questions, and am grateful for the knowledge he bestowed on me as I look to embark on completing an EPQ. So I shall correct myself: it surprises me that this book made such an impression on me.

Let’s start at the heart of the book: the voice, the author. I feel that this needs to be established before I mention any parts of this book that have made a lasting impression on me.

Once you hear Goldacre’s voice, you cannot un-hear it. A few pages in and you feel as if he is telling you directly what he is writing and whenever you think back to anything related, his voice never leaves. I found this to be particularly true when I forgot the p value below which a value had to be to be significant in a test. It was very minor thing and although it was never directly taught in lesson, p values were something I came across frequently when looking over scientific studies and my mind was putting a blank over where the number was supposed to be. As I was trying to shift the mists of haziness in my brain, I had a funny feeling to connecting with ‘Bad Science’-just Goldacre’s voice trying to prompt me. Unfortunately for me, the number remained unclear and although I wasn’t far off (0.01 rather than 0.05), it altered whether I thought the value was significant or not.

The thing that gets me most is that I constantly sway about how I feel about this book and Goldacre. It’s a vicious cycle: you are annoyed because you are embarrassed that what Goldacre writes is true, so you are angry with Goldacre but you know you shouldn’t be and Goldacre knows he is right so he is smug which annoys you more…

I’ll stop waffling now and try to concentrate on some more concrete points. Every chapter deserves a mention because of the content but that would make the post too long and you might as well read the whole book.

One of this first things Goldacre does is to outline the features of a trail which make it a fair test, such as blinding, randomisation and meta-analysis. These points are not only helpful when you look at trails outside of this book but also give you a good foundation to be able to think for yourself as Goldacre takes apart whatever he sets out to destroy in each chapter. For me personally this is one of the main things that I take away from ‘Bad Science’, especially as I look forward to the EPQ.

However, I think it is important to understand that-as always-there are limitations. Of course there is nothing right in only releasing trail evidence that supports your claim and stuffing the other evidence in a drawer, however there may be some practical limitations when designing trails-especially when real patients are involved. Before a drug actually makes it to a human trail there are a whole load of other tests it needs to pass, but we’ll just concentrate on the human stage. We all know a large sample is important but in the real world it is hard to come by. You may have twenty patients of which six do not complete the full trail so you are left with 14 subjects, a far cry from the thousands you may have been imagining. In addition, if a patient requires treatment, you cannot give them a placebo: that is unethical as in effect you know that you are denying them treatment. And more often than not the patients may also be on a variety of other medication which could affect the drug you are testing so the results may be nothing like the ones obtained from a lab workbench with controlled conditions. What I also believe to be happening is that to make it in the scientific world you not only need to publish articles, you need to publish them frequently. As a result, many scientists could be inclined to hold back some data to publish in a different article to have another publication under their belt, and although mostly harmless, you never know how this could end up…

Two of the content highlights for me were the classy way Goldacre cut through homeopathy without even batting an eyelid as well as his focus on the placebo. I thought he explained this phenomenon very well considering the mystery of it all. The colour of pills, administration and the ceremony are all part of the effect. For example, one of the experiments he mentions is that students sitting in a boring lecture were told they would receive either a stimulant or sedative. In fact both pills were sugar pills but of different colours and found that the “pink sugar tablets were better at maintaining concentration than the blue ones”. He carries on to say that “since colours in themselves have no intrinsic pharmacological properties, the difference in effect could only be due to the cultural meanings of pink and blue: pink is altering, blue is cool.” Another study suggested that Oxazepam was better at treating anxiety when green and depression when yellow. To have a general picture, a survey of coloured pills currently on the market showed that stimulant medication is usually in red, orange or yellow tablets while antidepressants and tranquillisers are mainly blue, green or purple, as seen in Prozac which comes in white and blue. Capsule’s also seem to come across as more effective than pills, as portrayed by a study using chlordiazepoxide. The ceremony is also vital as in three different experiments an injection of salt-water had a greater effect than sugar pills for blood pressure, headaches and postoperative pain. There are no benefits of salt-water but an injection appears a “much more dramatic intervention than just taking a pill.” Packaging also plays its part and although there are no pharmacological differences in brand-name painkillers and just your standard painkillers, a study done by Branthwaite and Cooper showed that brand-name painkillers are in fact more effective. Although they used aspirin versus sugar pills, both were administered in either “blank, bland neutral boxes” or ” full, flashy, brand-name packaging”. Clearly the aspirin had more effect, but they also found that the flashy packaging increased the effect of both pills. The placebo is a fascinating effect and I have only picked a few examples here. More can be found in the placebo chapter of the book but also one of my friends wrote an article about the placebo on our collective biology blog if you want to have a look: https://wgsbiology.wordpress.com/2017/01/31/mind-over-matter/

‘Bad Stats’ is also a chapter that I would highly recommend to have a greater general understanding of statistics (it’s also that chapter that actually mentions those p values!!). One of the stand out examples for me was on the risk of having a heart attack which looked at the use of something called ‘ relative risk increase’. I’ll use the same example as Goldacre did. Out of hundred men with normal cholesterol, four will be expected to have a heart attack while out of one hundred men with high cholesterol, six will be expected to have a heart attack. This means there are two extra heart attacks per one hundred and this is known as ‘natural frequencies’. This is relatively simple because you do not do anything to a number (unlike with percentages or probabilities) but you just count, like when teachers count the student in their class. For this example you could also have a 50% increase in risk (pretty worrying, right?) which is known as the ‘relative risk increase’ or even a 2% increase, known as the ‘absolute risk increase’, which seems less fearful. Here the take home message is that natural frequencies are not only much easier to comprehend and compare, but also figures, especially statistics about increases, can be portrayed in a number (see what I did there!) of ways, which, while not untrue or intentional, may be misleading.

As intense, and emotionally draining, as ‘Bad Science’ is I would recommend it to anyone, which may be why I have two more of his books on my shelf waiting to be read. What Ben Goldacre says, whether you agree with it or not, is relevant to anyone working or looking into a scientific field. Goldacre went out to tear apart the frills and pretty bows surrounding the actual evidence and that is what he accomplished, and whether you like it or not, someone had to go and it and so you may as well read the accounts from his point of view. And you might, just possibly, even enjoy it...

Key definition:

  • Cherry-picking: “Selectively choose from what is available” (definition taken from Google)

“Pick out the trails that give them the answer that they want to hear, and ignore the rest.” Ben Goldacre on Homeopathy in ‘Bad Science’

Figure 1. Bad Science by Ben Goldacre

Enlightening the World of Electrons

“Curiously, electrons fill orbitals like patrons find seats on a bus: each electron sits by itself in an orbital until another electron is absolutely forced to double up. When electrons do condescend to double up, they are picky. They always sit next to somebody with the opposite ‘spin’, a property related to an electron’s magnetic field.” Sam Kean in ‘The Disappearing Spoon’ on the Pauli Exclusion Principal. 

I am not sure whether you have read my previous post (found here: Book: The Disappearing Spoon) but I was talking about a book which I have read: “The Disappearing” Spoon by Sam Kean. The book scorches the history of the Periodic Table and its many, many elements. I was about to explain one of the stories which caught my eye as I was reading the book, however I soon realised that it would need some background chemistry-chemistry that I found very, very interesting as I was reading it.

I am by no means a Physics student-I only took Physics at GCSE, however the great world of electrons always fascinated me because I felt it was a key to the door of having a deeper understanding of Chemistry.

The story which is the basis for this post is how europium is used as a anti-counterfeit in euro notes. However, to understand how the element works in its important job, we need to have a basic understanding of how electrons emit light . (In case you were wondering, the quote above doesn’t have that much to do with we will be talking about shortly, but I really like that analogy for how electrons occupy orbitals in an atom, so I thought I would share it.)

Before we get to the nitty-gritty, we must first think of a different analogy: the one where electrons orbiting around the nucleus are compared to planets circling around a sun. Kean himself states that it’s not bad analogy, however “it has a flaw if taken literally”. Electrons do not orbit randomly around the nucleus, they live in orbitals and move within shells at different energy levels which are distinct: there is no energy level between levels one and two, two and three, etc… and so they can only orbit around their ‘sun’ at certain distances (and they also happen to orbit in oblong shapes at funny angles). More important is the fact that if excited by heat or light energy, electrons can jump from it’s low-energy shell home to an empty higher-energy shell. However, the electrons cannot outstay their welcome in the high-energy state, and soon they crash back down. During this crashing, the electrons “jettison(s) energy by emitting light”.

The interesting thing is that the colour of the emitted light depends on the relative heights of the levels that the electron jumped. For example, a crash between only closely spaced levels releases low-energy reddish light while a crash between widely spaced levels releases high-energy purple light. Since electrons are limited to jumping between whole-number levels, the emitted light is also constrained-it is a very specific, very pure colour, which is unlike white light emitted by a lightbulb. We must also note that since each element’s shells are at different heights, each element therefore releases characteristic bands of colour.

Moving back to europium. Europium is a lanthanide, meaning it cannot absorb incoming light or heat efficiently but is able to emit light in a way other than simple absorption. This feature is called fluorescence (important side not here-please see at the bottom of the post) and in general terms while normal emissions of light involve only electrons, fluorescence involves whole molecules. Another difference is that while electrons absorb and emit light of the same colour, fluorescent molecules absorb high-energy light (UV) but emit lower-energy visible light. In europium’s case, depending on what molecule it is attached to, it can emit red, green or blue light.

Now we can explain how the EU uses it in the ink on its banknotes. To prepare the ink, chemists lace fluorescing dye with europium ions. The dye consists of two parts. The first is the receiver, the antenna, which forms the majority of the molecule and its role is to capture incoming light energy (which the europium, as mentioned earlier, cannot absorb), and transform it into vibrational energy (which the europium can now absorb) which is moved down to the tip of the molecule.  The europium electrons become excited and leap to higher energy levels, but before they jump, crash and emit, a small part of the incoming wave of energy ‘bounces’ back to the antenna. Normally, this wouldn’t happen with just isolated europium atoms, but in this case “the bulky part of the molecule dampens the energy and dissipates it”.

This shift is more than just accidental. The dyes are selected so that the europium appears dull under normal visible light (which may lead a counterfeiter to think he’s got a good replica) but once the note is put beneath a special laser, the paper goes blank and “small, randomly oriented fibres laced with europium pop out like parti-coloured constellations”. Europe glows green, a pastel wreath of stars becomes yellow or red and other monuments, signatures and hidden seals become royal blue.

Euro banknotes under UV light
Fig 1. Image of euro banknotes under UV light (taken from Google).

And so: violà. The hidden euro will catch out any counterfeit.

Side note: I’m going to take a moment to clarify some terms which Kean also took the time to clarify in his “Notes and Errata”.

Luminescence- general term for a substance absorbing and emitting light. 

Fluorescence- as described above.

Phosphorescence- similar to fluorescence in that molecules absorb high-frequency light and emit low-frequency light but phosphorescing molecules continue to long long after the light source is removed. 

Author’s note:

This post is based entirely on what Kean wrote in his chapter “Elements as Money” in “The Disappearing Spoon”. He deserves the credit and I would recommend you read the full book as well. If you want a further idea of what the book is about, please see my previous post and the link to it is posted at the start. 🙂

Book: The Disappearing Spoon

“The Disappearing Spoon” is a great read for any Chemistry enthusiast which includes myself.  Although I had to read this in small chunks, Sam Kean managed to make every moment enjoyable and seemed to bring to life a common-place concept which is part of every Chemist.

The book goes through most of the elements in the Periodic Table, unravelling secrets about their discoveries or any related feuds and demonstrates the powerful depth and history of the poster that hangs in every Chemistry teacher’s classroom.

The disappearing spoon

For me, I think the book highlighted the fact that the scientific world is not all nice and friendly. To a certain extent, scientists are in competition with each other: who discoveries this first or who invents that. This crops up in numerous points throughout the book, as for example, having discovered elements 97 and 98, the scientists at the University of California at Berkeley named them berkelium and californium respectively. One is left to wonder whether the names give any hint at the place of discovery of the elements…

However, the fact that chemistry and the table of elements affects everyday life also becomes evident. One aspect features prominently in history and also today: money. Although a whole chapter is devoted to this topic, I’ll pick out just two little sub-stories.

The first is about the myth of Midas, a myth which I first heard of in an English reading practice for SATs at the end of my primary school years and a myth that now appears to have a plausible origin. Most people have heard of the story surrounding king Midas-he wished for whatever he touched to turn to gold. I’m not saying that that happened to the real king Midas, but there may be a reason as to why he is associated with the metal. The story starts during the Bronze Age which began in Phrygia (Midas’ kingdom which is now in Turkey) around 3000 BC. Casting bronze, which is an alloy of tin and cooper, was the thing to be done during those days and the skeleton of the king who was popularly called Midas (but was later found to be his father, Gordias) was found in his tomb in Phrygia surrounded by bronze bowls and bronze cauldrons and wearing a bronze belt. However, a number of different alloys with different ratios of metals are classified as bronze and the colour depends on the ratios of tin, copper and other elements. Coming back to Phrygia, the unique feature of metallic deposits in the area was that there was an abundance of zinc ores. Zinc and tin ores commonly commingle and can be easily mistaken for each other. The little twist here is that zinc mixed with copper forms brass…not bronze. Furthermore, the earliest known brass foundries existed in the part of Asia Minor where Midas reigned once upon a time and this little fact leads us to the heart of the tale.

Bronze
Fig. 1 Image of bronze (taken from Google).
Brass
Fig 2. Image of brass (taken from Google).

If you compare bronze and brass (shown by figures 1 and 2), bronze is shiny with ‘overtones of copper’, whereas ‘the shine of brass is more alluring, more subtle, a little more…golden.’ And so Midas’ touch a is touch of zinc in the soil of his part of Asia Minor.

The second story is more concerned with modern-day currency. Counterfeiting is an age long problem-even Newton himself encountered it during his years at the Royal Mint of England. Nowadays, the EU uses europium as a anti-counterfeiting tool in the ink it uses on its paper notes, however I am going to explain the mechanics of this in another follow-up post because this is getting rather lengthy and I want to focus a little on light emitting and electrons in general, something which this book first introduced me to.

As a fountain pen user, the iridium story was fascinating as was the cadmium story with its links to the itai-itai disease and Godzilla. This may also be a story that I shall look into a little more.

As you can probably see from my post, this book is quite intense and cannot be read in one sitting. I found reading it in small pieces helped to try to get my head around the new concepts but it is definitely a book I would recommend to anyone interested in Chemistry to have a better understanding of the elements and collecting curious nuggets of information along the way.