The Junior Doctor Strike: What You Need To Know

In the last few months junior doctors all over the UK have been heavily objecting the proposed changes to the junior doctor contract proposed by the government, which has led to a 24-hour strike of over 90% of the UK's junior doctors, leaving the NHS in a state of distress.

This opposition has arisen as the government has decided that the current contracts are ‘unfair’ and too old-fashioned, and even though the initial plans for a new contract were first drawn up in 2012, talks only started breaking down in 2014. The government has indicated it will impose the new contract in England and the British Medical Association (BMA) has responded by initiating the industrial action process.

So, what exactly is a ‘junior doctor’? The term ‘junior doctor’ refers to doctors which have just graduated from medical school up to doctors which have had up to 10 years’ worth of experience being a fully qualified doctor- to most people a 32-year old hospital specialist would seem to be a ‘senior’ and well-qualified doctor. The starting salary for a junior doctor is currently just under £23,000 a year, but with additional payments for extra services such as unsociable hours, this can quite easily top £30,000.

Junior doctors at the top end of the spectrum can earn just over £70,000 per year. However, it's important to remember these doctors often make life-and-death decisions and carry out surgery, in addition to having over 10 years’ worth of professional experience as a qualified doctor.

Given that 1/3 of all doctors in England are junior doctors, this contract change will directly affect around 55,000 doctors, making it a lot harder so earn more money and work healthy hours.

The proposed changes to the contract will change the standard working hours for junior doctors in England, which are currently set at 0700-1900 Monday-Friday, which is already quite long and is certainly a strain on the NHS. What the new contract proposes is that these standard hours would change to 0700-2200 Monday-Friday in addition to 0700-1900 on a Saturday- which is, in my opinion, quite ridiculous as this implies that working on 0800 on a Monday morning is the same as working on a 1900 on a Saturday evening.  As the standard number of hours has increased, it means that junior doctors will have to work practically all week to earn a decent pay for the first few years or their careers.

Another problem which will almost certainly arise is extreme tiredness and fatigue, which is already a problem within much of the NHS and will be made even more common with these new changes. With this proposed change, therefore, comes the question of patient safety, as it has been proven that doctors make more mistakes practicing medicine whilst being tired than drunk, which ultimately poses the question: to what extent would you be comfortable with an exhausted surgeon operating you who is more likely to make a mistake than a surgeon under the influence of alcohol?

The main problem the government is trying to solve here is timings: in an ideal world, they would like to see a 24/7 NHS which everyone has complete access to; however, they are trying to do this without spending huge amounts of money by employing more doctors, and so, there is only one foreseeable solution without spending huge amounts of money- to stretch the capacity of NHS doctors.

Personally, as a prospective medical student I think that this change in contract has very few proper advantages, as, even if we have a fully running 24/7 NHS, what is the point if barely any of the doctors are working to their full potential and putting the lives of thousands of patients at risk every day?

Should we ban smoking?

Smoking tobacco is the most expensive social burden in the UK, costing the government roughly £65 billion per year. It also indirectly accounts for up to 20% of deaths in the UK, as it is the main causing factor of lung cancer and smoker's illnesses, such as chronic bronchitis and emphysema. Despite 65% of regular smokers dying from some form of respiratory disease, 20% of the English adult population still smoke; causing huge strains on both a personal and national scale, which raises the question: should we ban smoking?

The reasons for the ban of smoking are pretty simple if you think about it: increased life expectancy, quality of life and a less-stressed NHS. On average, the life expectancy of a smoker is roughly 5-10 years lower than a non-smoker, and in addition to this the DALYs (disability-adjusted life years) of smokers can add up to around 15 years- about 1/5 the average life. Furthermore, 1/3 of cigarettes in Britain are smoked by people with mental illnesses, seriously worsening their physical health, in addition to their mental issues. 

COPDs (Chronic obstructive pulmonary diseases) are found in around 58% of smokers, and this includes diseases such as chronic bronchitis, emphysema and lung cancer; the former two of which cause permanent and irreversible lung damage. Emphysema is a condition in which the phagocytes in the blood move to the inflamed lung tissue when smoking and release the enzyme elastase (in order to reduce swelling), which then digests the walls of alveoli- therefore reducing their surface area, meaning that gas exchange happens less efficiently and so people who have this often have to have a constant flow of oxygen going into their blood stream (often an oxygen tube) so that their body has enough oxygen to function. 

In addition to this, countries where tobacco is farmed are extremely poor, and often the average worker on tobacco farms is a child. This is the case in Malawi, where almost all of the workers have gained a nicotine addiction from handling the tobacco leaves every day, but they are often forced to carry on as, for many, this is their only source of income (this often results in nicotine poisoning). Furthermore, there are also many environmental impacts which tobacco farming has, including deforestation, of which 26% is due to tobacco farming in Malawi. 

In conclusion, there are simply no advantages of smoking tobacco - apart from the social factor of thinking its 'cool'-, so why not just ban it? Well, its not as simple as that.

Many people argue that every human being has the right to do what they want with their own body- which I partially agree with, as I think that one's body is truly one's own; however, I think that if one is harming themselves or the people around them this belief is partially compromised. This belief is applicable to not only smoking but a huge range of other medical issues and diseases, such as obesity, substance abuse and alcoholism, and, such as with many other ethical issues surrounding medicine, there is no prefect solution to this problem.

As with any other damaging burden, the government and the NHS are trying to persuade people to stop and try to live a healthy lifestyle, however I don't think that there will ever be a complete ban on smoking due to the belief that everyone can do what they want with their body; but, I do think that this raises questions such as: why is prostitution illegal if everyone can do what they want with their own body?

In a nutshell, theoretically a ban on smoking would do more good than bad, as it would improve millions of lives across the UK, but due to ethical issues it is simply not feasible in the real world that we live in.

To run or not to run?

Ultramarathons; the ultimate endurance test on the human body, but are they really worth it?

Ultramarathons are classed as races which are longer than the standard 26 mile Marathon, and can be of of a variation of distance, terrain and timescale- for example they can range from about a 5 hour race to a 64 day one.
There are huge benefits which the super-human runners gain from, ranging from joint health to an increased sex appeal, but is the huge amount of stress on their bodies really worth the effort?

Researchers at the hospital of the University of Ulm in Germany followed a group of 44 runners who competed in the 2009 Trans Europe Foot Race. Lasting 64 days, the athletes ran nearly 2800 miles from southern Italy to Norway and scientists regularly tracked their physiological health during the spectacular event. They took a portable MRI scanner with them, and so periodically scanned the runners' legs, feet, heart, brains and cardiovascular systems every 3-4 days, in addition to taking blood and urine samples.

Uwe Schütz, the leader of the team of researchers, and his colleagues also measured the amount water emitted by the shock-absorbing cartilage between the bones of the leg, around the knee and ankle. They found that, during the first 1550 miles of the race, all 44 runners experienced some cartalige degradation at some point in the beginning of the race. However, after this point the cartilage seemed to auto-regenerate as the athletes continued on. This has thus proven for the first time that cartilage does not have to be at rest to regenerate, as before the study scientists thought that it needed to renew itself in order to get better.

Futhermore, organs such as the brain were also negatively affected by the huge feat of human endurance, as, in 13 of the participatants who agreed to extra brain scanning, the brain seemed to decrease in volume by up too 6%. This loss was in grey matter, but as the sample size was so small and particular, it is hard to judge whether this is the general case, as the sample is not specifically representative of the population. However, there were no lasting effects on participants as the brain seemed to regenerate also and return back to its normal size.

There are many theories as to why this happens, including one which suggests that this is due to a lack of visual stimulation during the 64 days, as one of the main regions of matter loss in the brain is particularly known to be involved in visual processing. Other theories include general fatigue, exhaustion and extreme levels of physical activity.

In a nutshell, there are still many unknowns regarding the physical effects of running particularly long distances; however, I think that the positives highly outweigh the negatives, as all of the physiological effects in this study seemed to dissapear within 6 months, and with obesity being one of the highest indirect causes of death in the world, I think it is better to be more active than not.

Lithium: The Element of the Future

The salar de Uyuni is the biggest salt flat in the world and lies in the heart of southern America, next to the Bolivian Andes- it stretches 100km across at an altitude of 3600m, and holds the largest reserve of lithium in the world.
 

The flat holds around 1/3 of all lithium on the planet, and this is due to the aridity of the area- leaving surface water to be baked by the sun, causing high levels of evaporation, and therefore creating a mineral-rich brine that flows under the salt desert’s crusty surface.  In addition to this, magma currents which are high in lithium are also aiding the vast natural abundance of the element, creating a geologically unique lithium resource, which in the future could power most of the transportation in the world.
 

The main method of extraction:

·         Drill into the lithium-concentrated brine channels 50m beneath the surface which is very quick but expensive

·         Place the brine into evaporation pools, where the sun evaporates the water and makes a concentrated lithium salt- cheap but slow, works at 7mm/day

Lithium has significant global interest now, as there are huge plans to use it for a less harmful energy resource than fossil fuels. This change happened in 1991, when Sony released the first ever portable gadget powered by a lithium-ion battery. This has obviously now expanded to smartphones, laptops, cameras etc, pretty much all of our handheld devices.

 

Lithium is used for these batteries as it is the lightest metal, with only 3 protons per atom, making it easy to use as a small battery which can be used in gadgets.

Other uses of lithium include medicine; world’s leading treatment for bipolar (manic depression) uses a form of purified lithium carbonate.

However, the biggest demand of lithium at the moment is from the transportation industry- for electric cars. This is due to popular hybrid cars, which use lithium batteries, and this element is even more useful as, in its pure form, it has a similar energy density to diesel fuel.

It is important that the Bolivian government and other authorities do not exploit this natural resource as it needs to be extracted using sustainable methods to ensure that we are not compromising the abilities of  future generations to extract and use this vital element for renewable energy etc.

Carolina Valensise 04/12/15