How useful are public health campaigns?

Public Health England utilises many different marketing campaigns in order to promote health and wellbeing. From healthy eating campaigns and encouraging smokers to quit in order to improve lifestyle to awareness campaigns surrounding what to do in the event of witnessing someone having a stroke and cancer signs. They have a whole host of different drives in place to help make England a healthier place.

However, how useful are public health campaigns? As the campaigns are government-funded and are beginning to cost an increasing amount, it comes into question how valuable they are at making a change and improving the general population’s health.

Research carried out by an analysis from Cornell University’s Food and Brand Lab examined the messages put out in public health campaigns and discovered that the more positive the message, the better an effect it has. Campaigns that aim to scare the public into submission might be impactful, but the research showed that these kinds of campaigns only really worked well when shown to industry experts, not the general public.

Anti-smoking campaigns, which often put much more emphasis on the negative consequences of smoking, therefore, are going to be deemed less useful. Despite many of them showing hard-hitting scenarios, such as Public Health England’s Health Harms campaign, which shows the effects the poisons of cigarettes have when they hit a smoker’s bloodstream, the research suggests that actually, looking at the positives of not smoking would be much more successful. Messages such as: ‘If you quit smoking you could save £2,000 a year’ would therefore be deemed much more useful.

The general public responded much more strongly to campaigns with a positive message – which could explain why campaigns such as Public Health England’s ‘Change4Life’ have achieved so much success. This campaign focuses around children making healthy food swaps and being more active in order to feel better. The overall campaign has a very happy-go-lucky, positive spin to it and this is probably why Change4Life has gone on to win awards, launch sub-brands and raise awareness about childhood obesity and the importance of healthy eating.

Therefore, when public health campaigns promote a positive message, evidence suggests that they have a much higher success rate and so should be deemed useful when promoted in this way. However, more negative campaigns have less of an effect.

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Who makes decisions about NHS funding?

The NHS was first launched back in 1948, and was born out of a long-held ideal that good healthcare should be available, for free, to everyone – regardless of their wealth. The NHS deals with over one million patients every 36 hours, and covers all treatments from emergency to routine screenings, antenatal screenings and end-of-life care. It is one of the world’s largest publicly funded health services.

The NHS is mainly funded by general taxation and National Insurance contributions, and is set out by central government through the spending review process. This is a process that aims to estimate how much income the NHS will receive from sources such as user charges, National Insurance, and general taxation. If National Insurance or patient charges raise less funding for the NHS than estimated, funds from general taxation are used to ensure the NHS gets the level of funding originally allocated to it.

Some NHS funding is generated through charges for things like prescriptions, spectacles and dental treatments, as well as parking charges and land sales. However, this only accounts for a very small proportion of the NHS income.

Breaking down who makes the decisions surrounding NHS funding is quite a complicated process, as there are several different stakeholders involved. The government ultimately is the decision-maker when it comes to NHS funding, with the Secretary of State having overall responsibility for the work of the Department of Health. In turn the Department of Health is responsible for funding for both health and social care in England. NHS England managed around £100 billion of the overall NHS budget, ensuring that trusts and other organisations are spending funds effectively.

Clinical Commissioning Groups (CCGs) are also involved in decisions surrounding NHS funding. They are responsible for around 60% of the overall NHS budget, and play a part in commissioning GP services as well as commissioning most secondary care services.

At present, the amount spent on health in England is almost £124 billion, and is set to rise to above £127 billion by 2020/21. In terms of how the spending is broken down, the majority of it (£110 billion) is spent on the day-to-day running of the NHS. The remainder is usually spent by the Department of Health on things such as education, training and public health initiatives.

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Could GM pigs soon provide vital organ donations?

A shortage of organs available transplants is a well-known challenge within modern medicine. But scientists are one step closer to solving that problem after making a major breakthrough with organs from animals.

An initial obstacle for xenotransplantation has been removing the threat of viruses from the animal in questions DNA. However, new research has opened up the possibility of animals being genetically modified and bred to be used to meet the demand for organs, with a focus being placed on potential from pigs.
Currently the need for healthy organs far outstrips the supply, leading to lengthy waits for patients but the use of pig organs harvested for transplants could solve the problem. While the idea has been around for years, the concerns over the potential for retroviruses founded in pigs to be fatal for humans have stalled developments.

Cutting edge research, however, has used the latest gene editing technique to remove this risk. It represents a significant step forward for xenotransplantation to become a reality. Of course, there are other risks that still need to be addressed.

Another key concern of pig to human transplants are the ethics behind the debate. Not only are there concerns from animal welfare activists but there are worries about obtaining informed and free consent from people that have little other options than to choose xenotransplantation. Regulations around using animal tissue is still developing and it could present a significant barrier to further experiments and uses in the future.

The next step for the cutting-edge research would be to further engineer the genetic makeup of the pigs to improve the safety. Should it go ahead, the pigs will be grown in the lab and will be the foundation of the research moving forward, paving the way for the first human to receive an organ from a pig in the UK.

Of course, there are other avenues being explored to solve the increasing issue of a lack of transplants. Among these is the idea that human organs could be grown inside another animal. These organs would be genetically edited so they would essentially be human but are grown inside an animal before being extracted and placed in the patient when ready. Another potential solution is the introduction of an ‘opt-out’ policy, which is already in place in Wales, which would assume consent for the general population unless people specifically object. This would mean that all patients who have viable organs for transplantation are considered, however opponents to this system point out that the number of people whose organs would be appropriate for transplantation is small will not solve the transplantation crisis.

Additional research is needed before the researchers can say that pig to human translation can work but we’ve taken a promising step in the right direction.

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Debate: Is it ever acceptable for doctors to go on strike?

Whether you’re working in the medical industry, training to join the sector, or are a member of the public you could hardly fail to notice the doctor strikes that occurred in 2016. The junior doctor strikes over contracts caused disruption to non-emergency services and some argued that it placed additional pressure on resources, placing patient lives at risk, whilst medical professionals argued that patient safety was being risked by government policy, and striking was the last option to attract media attention to dangerous and unfair policy changes. So, the debate on whether doctors should ever go on strike continues.

The doctor’s strikes were controversial and were a big part of the political landscape. While many supported the strike and the stance medical staff were taking, others condemned the action as a risk given how it affected patients. While some of the issues that led to the strike were resolved, the question around whether doctors should strike at all remains.

As it stands, doctors in the UK are legally allowed to strike. However, other professionals that work in core emergency services, including police officers and members of the armed forces, raising the questions of whether medical staff should be allowed to. Within the doctor profession there are numerus different areas, raising questions of whether it’s acceptable for some doctors to strike but not others, for example placing a ban on those that work in emergency departments but not those that offer routine care services.

On the against striking side, the core argument is the impact it has on health services and the potential to cause harm. Many routine operations and appointments faced being pushed back in summer 2016 when doctors took part in a five-day strike, with patient confidence being affected due to the high publicity. There were concerns raised that the strike would lead to higher incidences of patients not receiving the level of care that they deserve. While there weren’t any major incidences reported during the recent strikes, it still remains a concern.

Those that advocate for striking, note that it’s one of the most effective ways to exact change. In 2016 junior doctors took strike action in protest of contact changes, which they stated could cause harm, a point that was recognised by Jeremy Hunt. As a result, the strike action could have actually safeguarded patient health.

Where do you stand on the strike debate, is it something that you would participate in? It can be a challenging to decide where you stand and the circumstance no doubt play a significant role.

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Debate: Should contraceptives be given to under 16?

There are numerous debates raging on contraceptives but one of the most important ones is whether they should be freely available to those under the age of 16. As someone in the medical profession, where do you stand on the argument?

In the UK all contraceptives are provided free and confidentially, even if the patient is under 16 in many circumstances, despite this being the age of consent. This means that parental consent is not required for any form of contraceptive, from condoms to the morning after pill, under current laws. But is this the right approach given the age of consent for sex? For medical professionals it can present something of an ethical dilemma when a person who has autonomy under the age of 16 requests a form of contraceptive.

It’s a doctor’s responsibility to respect their patient’s right to make their own decisions and present them with the advice and information they need to do so. But whichever side of the fence you’re on, there’s an argument.

The argument for contraceptives under the age of 16

One of the many arguments used in favour of giving under 16-year olds contraceptive is that some, particularly the pill, are used for other issues not relating to intercourse, such as regulating periods or treating acne.

As part of the assessment process doctors are required to assess how likely they believe it is that the patient will have sexual intercourse without contraception, placing them at risk of sexually transmitted diseases or an unwanted pregnancy. Some teens asking for contraception are unlikely to change their plans even if they’re denied, therefore denying treatment could lead to pregnancy and would be irresponsible.

Other arguments include a patient’s right to confidentiality and the freedom to choose the protection they want – autonomy.

The argument against contraceptives under the age of 16

Those that don’t want contraceptives to be given to under 16 without consent from their parents focus on the parent’s right to know. As a minor, it can be argued that parents should play a vital role in the decisions their children are making, including medical choices that have the potential to cause side effects.

Others argue that making contraceptives readily available to those under the age of consent will encourage more young teens to make the choice to have sex before they are over 16.

With both sides of the argument in mind, do you think giving patients under the age of 16 contraceptives without parental permission is the right choice?

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Debate: Should euthanasia be considered acceptable?

The subject of assisted suicide and euthanasia is highly controversial both in medical circles and the wider population. Advocates on both sides of the debate make a compelling argument supporting their viewpoint, but how does the medical profession view euthanasia?

In the UK both euthanasia and assisted suicide are illegal, but the debate has recently been reignited when Noel Conway took his case to the Court of Appeal. The case captured the attention of the press, giving both sides of the argument a chance to publicly state their views. In countries where euthanasia is legal it is becoming an increasingly common choice. Research indicates that in the Netherlands assisted suicide accounts for 4.5% of deaths, with the vast majority having a serious illness or health issues related to old age, early stage dementia or psychiatric problems.

With euthanasia becoming a common debate, what are the arguments for and against?

The arguments in favour of euthanasia

The main reason cited by those in favour of euthanasia is giving the freedom for people to die with dignity. It is a human right for people to have autonomy over their own body. This is an issue that’s particularly important to people that are affected by serious illnesses, such as those that have a significant impact quality of life. In these cases, people argue that making the decision to die allows the person affected to retain more control over their life.

Another argument is that death is a private issue and one that the state should have no say in. Advocates argue that it’s a personal choice that each individual should be free to make themselves. It’s often noted that euthanising pets is considered an act of kindness when they would be in pain, and that this thinking should be transferred when it’s the will of the person affected.

The arguments against euthanasia

The case against euthanasia centres on medical issues. Firstly, some people have raised concerns that it places too much power in the hands of doctors and could potentially worsen the care and commitment that is currently on offer to terminally ill patients, including research that’s conducted.

Another key issue against euthanasia is that it’s a final choice. In some cases, it is possible for someone to recover or their condition to improve, beating the odds and defying expectations. It’s also been stated that some people may feel a pressure to choose euthanasia as they don’t want to be a burden, even if it’s ultimately not what they want.

Where do you fall on the euthanasia debate – Do you believe that euthanasia goes against the job description of a doctor? Or do you think it should be used in certain circumstances?

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Debate: Should the NHS fund treatment for smokers?

With the NHS facing budget issues and rising costs to ensure it has the necessary resources and staff in place to efficiently care for its patients, it should be no surprise that cuts to treatment are being proposed. Among the more radical proposals put forward is stopping NHS treatment for conditions that are considered to be caused by lifestyle choices, with smoking being the main target.

In the UK around 16% of adults smoke, a figure that is gradually falling thanks to growing awareness of the risks. Smoking puts a huge amount of pressure on NHS resources with the potential health risks. Tobacco is linked to almost a fifth of cancer cases alone, as well as being related to other medical conditions that require treatment.

So, with the impact of smoking on the NHS considered, what are the arguments against treating or charging smokers who need access to medical services?

Arguments against treating smokers

A study from 2015 reveals that this is an issue that splits the general public right down the middle. Some 52% of people think the NHS should not fund treatment if an illness is the direct consequence of smoking. The key reason behind this is that many people already feel that the NHS is already too stretched to deal with health issues that have been ‘self-inflicted’. It’s this sentiment that forms the basis of the against treating smokers’ argument.

Arguments for treating smokers

In favour of treating smokers, advocates of this side of the debate state that the healthcare system has a duty of care to all patients, whether they smoke or not.  As a medical professional, it can create an ethical dilemma should rules change on where the NHS stands. It is not a doctor’s role to judge patients but to encourage healthy lifestyle choices where possible and to treat illness regardless of cause.

One of the challenges that comes from not treating smokers comes from determining whether smoking has been the cause of the health issue. For some problems, such as lung cancer, it’s found in a significantly higher percentage of smokers than non-smokers, but it doesn’t prove the exact cause. It creates an issue of where the line is drawn.

It’s also worth noting that numerous other lifestyle choices have an influence on our health. If the NHS refuses treatment for smokers, it’s just another small step to begin excluding other patient segments, such as those patients that are considered to drink heavily or have a BMI above average.

What’s your opinion, should the NHS start turning away or charging people based on their lifestyle choices, including smoking?

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Does the beginning of gene editing hail a new sector for medicine?

Last year marked the start of medical teams in the US undertaking experiments in gene editing. With scientists around the world pushing boundaries with the latest research, it’s almost inevitable that gene editing will become commonplace within the medical world.

Chinese researchers first announced that they would begin editing human genes back in 2015 and just two years later the US followed suit. Led by a leading embryologist, it marked another step in being able to apply the knowledge to a clinical application that could drastically change the way certain inherited illnesses are prevented. Since that announcement, gene editing has made significant strides forward.

For the first time last year, scientists used a gene editing technique to correct a gene mutation in human embryos to the hereditary blood disorder beta thalassemia. The initial study improved mutations at a rate of around 20% but it lays the foundation for further progress as it gains international attention.  Numerous other studies are assessing how gene editing can be used for other genetic conditions.

Researchers are being careful to steer away from accusations of creating ‘designer babies’, with the sole aim of embryo modification so far focused on correcting defective genes that causes inherited diseases. Experiments have so far used CRISPR injected into the egg at the same time as the sperm, removing the potential of mosaicism problems to occur, as the CRISPR tools work from the moment the egg is fertilised. Mosaicism problems, where some cells are not edited, were reported in the initial human embryo trials in China but the problem-solving solution in the US has removed this issue, although the eggs were only developed for a few days.

With gene editing technology and knowledge growing, it’s an area that’s inevitably going to boom in size. However, there are of course concerns that have been raised and some groups that outright oppose the use of any type of gene editing. So far, no babies that have benefitted from gene editing technology have been born but over the next couple of years it’s likely to happen. When it does, the debate will no doubt intensify.

While controversial, gene editing holds lots of potential for removing inherited conditions completely. Is it a medical area that researchers should be pursuing in your opinion?

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How is the intelligent iKnife transforming surgery?

The innovative iKnife was developed a few years but it’s still making big waves within the industry and is set to continue having an impact on how surgeries are conducted.

The revolutionary knife tells surgeons immediately whether the tissue they are cutting though is cancerous or healthy tissue. Researchers at Imperial College London found that the intelligent tool has a 100% accuracy, removing the need for surgeons and other medical practitioners to wait for information to come from laboratory tests, speeding up surgery times. Removing cancerous tissue is challenging as it’s impossible to tell by sight which tissue is health and which is cancerous, and as fully removing a tumour usually results in the best prognosis for cancer patients the iKnife device can improve patient outcomes. For example, around 20% of breast cancer patients require further surgery to remove all the cancer but the iKnife applications could eliminate this.

It not only means that patients have improved results, but it allows hospitals to better deploy their resources and staff, allowing them to reduce waiting times.

While the iKnife is ground-breaking, it actually uses technology that is decades old. Electrosurgical knives, which rapidly heat tissue to minimise blood loss, are commonly used. The smart part of the iKnife comes in recognising that the smoke created from these tools offer biological information. Through taking this information, the iKnife can almost instantly state whether the tissue is cancerous of not.

The iKnife is already in use at the Imperial College London and is being trialled across several different types of cancer, including breast, colon, and ovarian cancer. But in the future, it could have other applications and be adapted to suit other kinds of surgeries. As a result, it could soon be an essential tool in all surgeries.

So, how will the iKnife affect surgeries throughout hospitals?

Firstly, it will allow surgeons to conduct some surgeries seamlessly. While typically surgeons will have to wait for lab results to come back, the iKnife can remove these waiting times. For hospitals, it can help to reduce costs, fit more surgeries in throughout shifts, and allow them to ensure they’re getting the most out of their skilled staff.

The iKnife is just one tool that’s set to revolutionise the medical sector. In the future it’s expected that it could be used to produce instant analysis of mucous membranes and the respiratory, urinogenital, or gastrointestinal systems.

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The guide to the incoming new national exam for medical students

If you’ve been keeping up to date with medical education news, you could not miss the announcement that the exams medical students sit are going to be changes in a few years. The national exam would change the way doctors are trained and could have a significant impact on the numbers that pass, procedures, and hiring within the industry in the future.

Although plans for the new national exam, called the UK Medical Licensing Assessment (UKMLA), were approved back in 2015, the first cohort of students won’t sit the exam until the 2022 as part of their end of year academic exams. But what’s the difference and what does the shift mean.

What is the current process?

At the moment each medical school set their own exams that students are required to pass. Each exam must comply with standards set out by the General Medical Council and must cover certain aspects of the curriculum that has to be taught in all schools. It means that there are differences both in the way students are taught and how they are assessed across the country.

The UKMLA will change that.

From the academic year 2021/22, all those studying medicine will take a unified exam before they are granted a licence to practise in the UK.

Why is it changing?

The main reason the national exam is being introduced is to provide unity across the whole of medical education in the UK. The General Medical Council has stated that the move aims to demonstrate that there’s a common threshold for safe practice, providing reassurance that high standards will be me and upheld across all medical schools.

The information that’s available now

As the first national exam being sat is still some time away, there is some information missing on how it will work. However, most of the basic information is now known.

Anyone who wants to begin practising medicine for 2022 inwards will need to pass the exam, which will test a combination of medical knowledge and clinical skills. The exam itself is likely be integrated into part of medical school finals, rather than being a standalone exam. Despite initial concerns, it’s also been confirmed that UK students are unlikely to have to pay an extra fee to sit the exam.

While some in the medical sector have welcomed the move to a unified exam, others have raised numerous concerns. Do you back the idea of all medical students should sit the same exam before practising?

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