Reclassifying chronic fatigue syndrome

The Institute of Medicine has released a report calling for Chronic Fatigue Syndrome (CFS) to be renamed Systemic Exertion Intolerance Disease (SEID).

The report follows decades of debate over the existence of the disorder and the trivialising of its effect under the label ‘fatigue’. The authors of the report argue that the new name will be important to legitimising the disease by giving it a more accurate name. PPE and HSPS applicants would be interested to read how recognition of illnesses historically tie into political ideas of rebranding.

Some of the debate has reflected the unknown cause of the disease; there is currently no clinical method to diagnose the disease either through blood tests or brain scans, which therefore diminishes access to support and healthcare. The condition is covered in less than than one-third of medical school curricula according to the Institute of Medicine, further suggesting that without objective clinical standards to check against, the disorder becomes ignored in the medical community.

Medicine applicants should therefore read further into the idea of ‘the elusive diagnosis’ where symptoms are not easily determinable.

Volunteer doctors of Médecins sans Frontières (MSF) have released a new report on vaccine pricing, arguing that big pharmaceutical companies GlaxoSmithKline and Pfizer need to cut the price of the pneumoccal vaccine to $5, or £3.20, per child in developing countries.

This call stems from not only the steeper price of the product at present, but also the monopoly the two companies have over the production of this vaccine. Current data indicates that poorer countries like Tunisia pay far more than developed countries like France, with at least a $9 discrepancy per vaccine.

MSF go on further in their report to say that they face increasing challenges to offering full immunization to children. Gavi, an inter-governmental alliance that allows for discounted vaccines, is becoming less and less useful as many middle-income countries do not receive support and cannot pay for those in need.

Medicine applicants should read further on the medical ethics of considering costs in treatment, while Economics and HSPS applicants should investigate the corporate social responsibility of corporations in healthcare.

Plants have been shown to ‘think, appraise and remember’ in ways startlingly similar to the human nervous system. Professor Stanislaw Karpinski from the Warsaw University of Life Sciences in Poland, presented his findings to the Society for Experimental Biology’s annual meeting in Prague.

His study examines how Arabidopsis plants, a small flowering plant native to Europe, Asia and north-western Africa, are able to transmit ‘electro-chemical signals’ through its cells to carry messages and ‘remember’ various forms of light.

Karpinski’s team found that even when the light was shone on one section of the plant, chemical signals were relayed throughout the entire organism. These responses were not merely reactive – the process of ‘remembrance’ continued even in the dark.  “We shone the light only on the bottom of the plant and we observed changes in the upper part,” explained Professor Stanislaw Karpinski “and the process continued even when the light was off. This was a complete surprise.”

When a light is shone, messages are relayed throughout the plant by a specific type of cell called a ‘bundle sheath cell’, which is present in every leaf of the Arabidopsis plant. This system of cells has been likened by scientists to a ‘nervous system’, relaying information in a ‘cascade’ of chemical messages.

Furthermore, the plants exhibited a much more nuanced response than expected. When the colour of the light was changed, the plant reacted differently. There were observable differences between responses to blue, white and red light. The electrical signalling pathway was incredibly rapid, so the whole plant could respond immediately.

Exposure to light also enhanced the plant’s ability to fight infection. “When we shone the light for on the plant for one hour and then infected it [with a virus or with bacteria] 24 hours after that light exposure, it resisted the infection,” Karpinski noted “but when we infected the plant before shining the light, it could not build up resistance. [So the plant] has a specific memory for the light which builds its immunity against pathogens, and it can adjust to varying light conditions.”

This ability to appraise a situation according to different stimuli and provide an appropriate response, was identified as a form of intelligence by a leading professor from the University of Leeds, Professor Christine Foyer. She argued that the study also has practical implications for understanding plant survival in different weather and lighting conditions. “Plants have to survive stresses, such as drought or cold, and live through it and keep growing,” she told BBC News “this study takes our thinking one step forward.”

A study by Unite lists 71MPs who voted in favour of the controversial Health and Social Care Act in 2012 which aimed to privatise large sectors of the NHS, ahead of this Friday’s vote on the Private Members’ Bill, where decisions over whether portions of the act should stand will take place.

The chief proponent behind the privatisation is Andrew Lansley, who accepted a £21,000 donation from John Nash, the former chairman of Care UK. Similarly, his replacement, Jeremy Hnunt, received more than £20,000 from baron Andrew Law, a major investor in health care firms. This is by no means a comprehensive list, and the study shows a list of over 70 MPs who have ties to private healthcare companies.

The level of vested interest here is concerning for those looking for a fair vote on an important, foundational issue in current British government. As PPE and HSPS students will know, however, the conflict of interest expressed on this one issue is not new for the UK and nor for the world. Avoiding corruption is the most important role in balancing necessary funding by private bodies, and making political decisions that are not influenced by this.

We must understand both from the medicine perspective how important bills like this are and the weight that must be placed on MPs to make impartial decisions, but also on governments to understand the role of lobbying as an entrenched aspect of the parliamentary system.

A new study in Proceedings of the National Academy of Science (http://www.pnas.org/content/111/40/14388.full) has challenged our idea that women naturally gravitate towards masculine men, and men towards feminine women.

As biology applicants will be familiar with, women with more feminine faces tend to have higher estrogen levels with the evolutionary argument being that this is more attractive to men seeking to have offspring as a biological imperative.

In men, the argument is along the same vein in that men with masculine faces are associated with strong immune systems; a good trait in a mate and a good characteristic to pass on to future offspring.

These ideas of evolutionary psychology express that our behaviours as men and women gravitate towards reproductive success – to firstly produce offspring, and to produce viable, strong offspring at that.

This new study, however, challenges these assumptions by stating that the attractiveness of faces along the masculine or feminine spectrum varied greatly with geography, finding that the traditional view of masculine men and feminine women as attractive held truest in urban dwelling subjects, but varied drastically in rural dwellers.

In South America, for example, feminine-looking men were found vastly more attractive than masculine-men, who were seen as too aggressive looking.

These studies are an important standpoint of psychology and human sciences, where we can challenged long-held hypotheses by devising tests to challenge their validity. In this case, the experiment used composites of male and female faces to exaggerate certain features and soften others. Geography applicants will also be interested to see the correlation between urban and masculine looking faces, with one suggestion being that in urban settings, you see far more faces and so you have a heightened sense of motivation to determine personalities and the likelihood of being a good mate on appearance alone.

A recent report by London’s Health Commission has called for the smoking ban to be extended from indoor public areas to Trafalgar and Parliament squares.

The report, entitled ‘Better Health for London’, argues that the ban would include parks to maintain them as healthy environments for children, as well as encourage active lifestyles in more adults of relevance to medicine applicants.

This was one of many suggestions on behalf of the committee which called for both incentives and costs for different behaviours, such as giving discounted Oyster card rates for people who chose to walk part of their journey, again encouraging an active lifestyle.

Land economy applicants will be interested to see how the parameters of public spaces can be defined legally to prevent smoking, as well as geography applicants who can see that preservation of ‘green space’ and its ties to health in human populations.

What is particularly interesting, in this case, is the Mayor of London’s response: Boris Johnson has argued not entirely in favour of the ban, saying that the calls were fit for a nanny state that monitors its citizens’ behaviour.

Schemes like this cost money to introduce also, no doubt a factor to consider for Boris Johnson as well as PPE applicants. The financial burden of such implementation is estimated to be £6.5m over five years.

When we debate over law and whether it should be extended to include more people or retracted to lessen its impact, not to mention abolished altogether, we evoke questions of personal liberty; HSPS applicants should consider both sides of the argument over this extension of government power and surveillance. Would such a ban maintain the health of the population and is thus a positive force in the remit of the government, or do would a ban show an extension of government power and monitoring to the level of healthcare that is intrusive to personal liberty and freedom?

Both sides must be considered when we think of state intervention in matters of health.

Scientists have investigated the changing properties of food items, and have noted that cooking, cooling, and then reheating pasta makes it less fattening.

Dr Denise Robertson, from the University of Surrey, explains that cooking and cooling pasta causes your body to treat the food like fibre – meaning that there is a smaller glucose peak and so you absorb fewer calories.

Of interest to biochemistry applicants is the process by which heating and cooling changes the composition of food when it is ingested and eaten by us. Cooking pasta, or starches more generally, followed by cooling causes the structure of starches to change into ‘resistance starch’, aptly named because it becomes resistant to the normal enzymes in our stomach that break down the carbohydrates to produce glucose.

What scientists discovered that was surprising, however, was that reheating following this cooling effect had an even more dramatic change – reducing the rise in blood glucose by 50%. Dr Chris van Tulleken, who created the experiment, noted that “in other words our leftovers could be healthier for us than the original meal.”

Medicine applicants will note the relevance of such a study to diabetes management and care, given that a carbohydrate heavy meal can be converted into a healthier, fibre-loaded meal simply through adjusting the temperature.

Current Biology published a study this past Thursday finding that some of the most widely used antidepressants change the brain’s architecture only a few hours after use.

This breakthrough means that medicine could potentially treat individuals on the basis of a brain scan as well as traditional methods of cognitive behavioural therapy and discussion-based approaches to determine a diagnosis.

That drugs change the architecture of the brain and corresponding cognitive abilities is not new, and psychology applicants would do well to read the easily accessible work of Oliver Sacks. In his book The Man Who Mistook His Wife for a Hat, he discusses six different case studies of people with atypical aphasias and sensory perceptions due to brain damage. The ability to locate where certain activities occur in the brain, as this study has demonstrated, is of incredible importance to medicine, and the ability to enhance diagnoses and assess symptoms.

The idea of drugs changing the composition of brain matter also should make us query the divide between physical and mental illnesses – this Cartesian dualism is argued by many to be the basis of misunderstandings and stigmatisation of mental health issues, where they can sometimes be perceived as controllable or voluntary in a way that ‘physical’ ailments are not. The division of mind and body is a phenomenon particular to the Western world and is of great importance to understanding Descartes’ philosophy, whereas it is much more common to the rest of the world to treat patients as holistic entities and not just their bodies.

Arthur Kleinman, a medical anthropologist, calls this idea the ‘illness narrative’, whereby diagnosis and understanding of illness must take into account readable, measurable symptoms as well as the discussed, personal narrative of illness on behalf of the patient without privileging one over the other. HSPS applicants looking to broaden their anthropology readings should consider how the work of someone like Arthur Kleinman works to expand the applications of medicine to more of the globe, by easing cultural communication and understandings of illness and treatment.

The British Science Festival recently unveiled a pilot smartphone app that is said to measure symptoms of Parkinson’s.

The app, developed by Aston University, measures the movement and speech patterns of users, in order to assess the presence of tremors, stiffness and difficulty with movement and speech.

The monitoring works by ‘following’ a patient for a week, and checking up every 18 months in order to assess changes in patterns as a better indicator of the existence of Parkinson’s.

Better diagnostic tools are a positive element on improving healthcare, but potential medicine applicants should note the ethical dilemmas of such a ‘home testing’ kit. How much information should patients be given about their health outside of a medical environment? Should we trust patients with their own medical data above all else, or should we be concerned about the ramifications of being diagnosed without a qualified doctor present to interpret and mediate the results?

For a similar ethical dilemma, reading up on HIV dried blood spot testing will be well worth your time. This is useful for thinking on the ultimate aim of medicine – does having dried blood testing more widely available mean more people can get tested for HIV and is thus a good thing? Or should we be concerned about how people are tested and how they receive knowledge about their diagnosis, as much as the diagnosis itself?

The recent story of Ashya King – a five-year old diagnosed with medulloblastoma (a type of brain tumour) – captivated the British public last week after his parents were caught in the midst of an international search warrant for taking their son from a hospital in Southampton against the advice of doctors. After being held in a Madrid prison, the parents were released and reunited with their son who is being treated in a Spanish hospital in Malaga. Ashya’s parents took their child to Spain in order to receive proton beam therapy to prevent the tumour from returning. Proton beam therapy uses charged particles instead of x-rays to deliver radiotherapy to cancer patients, allowing high-energy proton to target tumours and reduce the dosage administered to surrounding organs and tissues. The UK Department of Health announced in 2011 that proton therapy would be made available for patients in London and Manchester from 2018.

Both Law and Medicine applicants should remember this high-profile case as an example of how medical ethics and practice work within UK law. Ashya’s parents claim they were forced to take their son abroad to receive treatment given the stringent measures in place which mean no decision on Aysha’s future can be taken without a court approval. The furore surrounding the story has fuelled the debate on the status of child guardians, with Alasdair McDonnell MP proposing that guardians be given the power to reflect the best interests of the child to all the relevant authorities and services.