Image credit: The Lancet

This Monday’s debate comes from John Wong, fourth year medical student at King’s College, who writes about Fabricated or Induced Illness by Carers and how to recognize it.

What do you think of this issue? Register your opinion in our polls and talk about it in our Facebook discussion.

The patient feigns symptoms repeatedly for no obvious reason and may even inflict self-harm to produce symptoms or signs.

Fabricated or Induced Illness by Carers (often referred to as FII) is a spectrum of disorder rather than a single entity. The media refer to the condition as Munchausen Syndrome by Proxy. In the USA, it can be referred to as factitious disorder by proxy and paediatric condition falsification.

The International Classification of Diseases – 10th Edition (ICD-10) classifies Fabricated or Induced Illness in adults as a Disorder of Personality and Behaviour. The patient feigns symptoms repeatedly for no obvious reason and may even inflict self-harm to produce symptoms or signs. FII in children is a form of child abuse and should be taken seriously to safeguard and promote the child’s welfare.

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Image credit: BBCNews.com

This week’s editorial discusses the recent retraction of a paper linking the MMR vaccine with the development of Autism.

More than the paper itself, it was the author’s declarations to the press after it was published that ignited a revolution from parents with autistic children seeking to remove MMR from the list of provided vaccinations, and even recommending that parents stop their children from receiving it.

The recent retraction of the 1998 paper that stated that Autism was related with the use of the combined Measles, Mumps and Rubella vaccine (MMR) has reminded us of the impact of research on society . The Lancet decided to retract this paper following the judgment of a UK Medical Panel that found that the evidence proposed by the author of the paper was untruthful, unfounded and the data was improperly collected and biased. Even those who are not familiar with scientific studies are aware that 12 is not a large sample size and that how subjects are selected and data collected has a large influence on the results. Further, it was found that the main author of this paper had much to gain by a change in the administration of the immunizations, given that a year earlier he had patented a Measles vaccine (1).
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A JAMÖ panel discussion. Left to right: a) Helmut Salzer, MD, MPH cand.; Florian Stigler, MD, MPH cand.; Professor Josef Smolle, Rector of the Medical University of Graz; Adrian Moser, MD; Christine Brunnsteiner, moderator; Julia Baumgartner, MD; Michael Wendler, MD; Professor Janko Kersnik, Department for General Practice, Medical University of Maribor

Today we’d like to announce the publication of Simukai Chigudu’s article on the social ‘North-South Divide’ in Britain and its effects on inequalities in the country’s healthcare. Read it here.

Meanwhile, today’s blog comes from Helmut Salzer, Florian Stigler and Adrian Moser from Graz, Austria, and discusses the low standards of primary care training in Austria and their campaign for better education for future GPs.

Primary health care in Austria can be described as ranking below average

In the year 1978, the World Health Organisation (WHO) adopted the “Declaration of Alma Ata”, which was considered as a milestone to promote health for all and to put primary health care on top of the political agenda for health (1). More recently this principle was further developed and resulted in additional calls for action (2, 3). Professor Chris van Weel, President of the World Organisation of Family Doctors (WONCA) points out that specialty training for young general practitioners (GPs) is one of the core components to strengthen primary care and that teaching and training of future GPs improves the quality of medical care. Therefore it is remarkable that Austria is one of the few countries within the European Union in which future GPs receive their entire postgraduate training within a hospital setting, although only a small proportion of health problems eventually end up in the hospital. The cases on encounters in hospital are often highly specific and not comparable with the reality of general practice (4). Furthermore, Professor Ngaire Kerse, Head of the Department of General Practice and Primary Health Care in Auckland, New Zealand underlines that a vocational training in general practice must be coordinated by peers and be conducted in the setting where the discipline will be delivered – in this case the surgeries of GPs.

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Four indigenous women on market day in Sololá, Guatemala. Credit: Tyler Robinson

Today’s blog  written by one of our Regional Advisors, Tyler Robinson, discusses a new United Nations report addressing the health issues that Indigenous people currently face.

The report asserts an “alarming state of indigenous health”, and claims that on average, indigenous people face a life expectancy 20 years less than non-indigenous counterparts.

The United Nations Permanent Forum on Indigenous Issues (PFII) recently released a report on the “State of the World’s Indigenous Peoples”. This is the first UN report since the adoption of The UN Declaration on the Rights of Indigenous Peoples in September 2007. The document includes disconcerting empirics on poverty, culture, environment, education, health and human rights.

There are over 370 million indigenous peoples in the world, diversely spread across 90 countries. The UN report begins by locating indigenous peoples as “custodians” of the biological territories of the world, and affirms their importance to humankind for their cultural diversity and traditional knowledge.

Tragically, indigenous peoples carry a tremendous amount of global poverty and disease burden. Discrimination and disenfranchisement prohibit their advancement within modern society and their self-determination, and threaten their survival. Though indigenous peoples comprise only 5% of the world’s population, they suffer as 15% of the world’s poor. The report finds that the principle threat to indigenous peoples in many parts of the world is displacement from their native lands. In nearly every country, there is a horrific history of the forced dislocation of indigenous peoples by governments and colonialists.
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International symbol for breastfeeding, Credit: Wikimedia Commons

Today we’d like to announce the publication of Mohsin Shah’s report from his elective studying haematology at the Paul O’Gorman Leukemia Research Centre in Glasgow. Read it here.

In today’s blog TLS Blogger Pranab Chatterjee discusses the evidence linking longer periods of breastfeeding with better mental health of children.

The study found that children who were breastfed for less than six months compared to six months or longer had a 52% increased risk of a mental health problem at 2 years of age, a 55% increased risk at age 6, at age 8 the increased risk was 61% while at age 10 the increased risk was 37%.

According to the results of a new study (1), longer periods of breast feeding may be associated with better outcomes for mental health for the children in the longer run. The study recruited 2900 pregnant women and followed the live births for 14 years. Mental health status was assessed at 2, 6, 8, 10, and 14 years. Maternal pregnancy, postnatal, and infant factors were tested to examine the effects of breastfeeding duration on mental health morbidity. It was seen that there was an increase in the behavioral problems with a shorter period of breast feeding. An older study (2) had also previously reached a similar conclusion in a smaller cohort, stating that longer periods of breast feeding confer significant benefit to later cognitive development. The present study provides some interesting data (3):

The study found that children who were breastfed for less than six months compared to six months or longer had a 52% increased risk of a mental health problem at 2 years of age, a 55% increased risk at age 6, at age 8 the increased risk was 61% while at age 10 the increased risk was 37%.

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Josef Mengele, the Nazi doctor who experimented on concentration camp prisoners

Today’s debate blog comes from Savino Sciascia, who discusses the participation of doctors in torture and other human rights abuses. What do you think of this question? Register your opinion in our polls and talk about it in our Facebook discussion.

The complicity of medical providers in torture is still a deep open wound in Global Health

The Hippocratic Oath declares “ἐπὶ δηλήσει δὲ καὶ ἀδικίῃ εἴρξειν”: physicians must treat all patients to the best of their abilities, respect patient privacy, and do them “no harm or injustice”.

The human rights community’s attention to the complicity of doctors and other health workers in torture or cruel and inhuman treatment has rarely been debated and only few cases (often concerning political prisoners in detention settings) obtained a right visibility. Sometimes, our attention is focused on the story of “one patient”, as the case of Tan Guihua, who was detained in 1999 and sent to the Jiaozhou Mental Hospital in Shandong province for supporting and practicing a form of spiritual meditation. Because she refused to renounce her beliefs she was repeatedly tortured by medical personnel using electroshock therapy, and was force-fed antipsychotic medicines (1). But this is only an example of thousand of silent stories about abuses of patients.

These actions may be done in compliance with state medical policies, in contradiction to them, or in their absence, but when they do occur they can be described as torture or cruel, inhuman, or degrading treatment (CIDT), in which case both the medical provider and the state must be held accountable.

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Credit: The Lancet

This week’s editorial explores the results of a new study published this week in The Lancet that explores the benefits of not sedating patients in intensive care.

Danish scientists have found that not sedating patients in intensive care reduces both the days needed on mechanical ventilation and the overall time in intensive care.

A new study by Danish scientists Strom and colleagues, delves into the use of sedation in critically ill patients requiring mechanical ventilation in intensive care.

Prior policy for intensive care patients receiving mechanical ventilation had been to continuously sedate them so they would not suffer any complications during treatment and improve oxygen consumption. Promptly it was found that a problem under this approach was that the patient’s mental health could not be evaluated given their unconscious state. Later it was found that sedating patients with some intervals of interruption was beneficial, providing a period of consciousness when you could evaluate the patient, although they later did not recall the experience. But would you want to remember? Interestingly, memories of intensive care time have proven to reduce the severity of post-traumatic stress disorder, meaning that for the long term it is better for the patient to be aware of the procedure.

This randomised control trial goes one step further, presenting evidence demonstrating that patients who were not sedated altogether during intensive care significantly required less days with artificial ventilation, compared with those those under interrupted sedation, and also experienced shorter time in the intensive care unit (13.1 days versus 22.8). However, the no-sedation group did experience more agitated delirium events than the comparison group, raising the question whether critically ill patients may require higher doses of morphine and supplemental drugs to manage the delirium. Additionally, the lack of sedation may be associated with the patient experiencing fear and anxiety, providing another layer of care. Read the rest of this entry »

Images from Medsin’s campaigns, Credit: Jonny Currie

Today we’d like to announce the publication of Viren Kaul, Vindhya Palled and Jishu Kaul’s article on the efforts to eradicate polio in India and around the world, and the mistakes that were made which led to the continuing threat of the disease. Read it here.

In today’s blog Medsin UK National Co-ordinator and former Student Editor at TLS Jonny Currie, writes about his tour of the medical students’ society’s branches around the United Kingdom.

Through visiting and mobilising our local groups, we hope to bring the energy and ideas that drives our national movement for global health right down to a grassroots level.

What can a small group of thoughtful, informed people do to change the world?

In search of the answer to this question, I will be travelling throughout the next month; visiting Medsin branches around the UK and exploring the local motivation for our global health movement. History and present day experience suggest the commitment of those struggling for global justice is one of the principal ways in which positive change can be made to happen, and that a movement must start from the grassroots.

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Through the MDGs all children should have the opportunity to learn to read and write. Credit: Oxfam

In today’s blog Ian Sullivan, Global Digital Campaigner from Oxfam, writes about the Big Promise campaign that seeks to ensure the Millennium Development Goals are met by 2015.

Time to keep our promises on health and education.

In 2000 world leaders made commitments to tackle poverty. How are they doing and how can you help?

For the first blog of the new decade I want to take you back to the turn of the century. A time when we had Westlife at number 1, Tony Blair in his pomp, the prospect of the millennium bug and a plan by world leaders to tackle global poverty -the Millennium Development Goals (MDGs).

They were trumpeted by the leaders of the G8 (the world’s most industrialised nations), as a great solution to the continuing scar of global poverty.

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Credit: BBC.com

To help mark our collaboration with the Lancet this week on the theme of conflict and health, we’d like to announce the publication of Ben Warner’s interview with Sir Terrance English who discusses his experiences with the Primary Trauma Care Foundation, particularly in Pakistan and Gaza as well as other areas where the provision of healthcare has been impeded by past or ongoing conflict. Read it here.

Meanwhile, in today’s blog Suvash Shrestha, TLS Regional Advisor for Nepal, describes the research behind a new artificial pancreas that could make life easier for thousands of diabetes patients.

The proposed system contains software that links a continuous blood sugar monitor to an insulin pump which works under a direct feedback mechanism.

The Juvenile Diabetes Research Foundation is working together with the Johnson & Johnson unit Animas to develop a so called “artificial pancreas” which could automatically regulate blood sugar levels in diabetics.

“This is going to be a research and development first step, toward creating an artificial pancreas,” said Dr. Henry Anhalt, director of medical affairs for Animas. Read the rest of this entry »