A Pill to Forget?

Ketamine is a painkiller

If you are ever unfortunate enough to be in an accident and be in extreme pain, then you may be given ketamine by medics. Ketamine is not only an incredibly powerful painkiller but can also cause one to lose memory - for example, if a bone in the leg needs to be 'snapped' back into place, you may first be given this to not just numb the pain, but also to prevent you remembering the moment of pain. Doctors do not ask you first whether you are happy to be given this, because there is no need - there is no question that one doesn't want to remember a moment of such agony. This has got me thinking about drugs that affect memory and question the ethics in relation to this.

In cases of emergency, like the example above, the fact that a painkiller has the side effect of memory loss is a benefit. But the idea of using drugs to remove memory isn't just a lucky side effect - scientists have been researching into this area for years. Drugs that remove memory could be used in order to prevent individuals developing post traumatic stress syndrome, and although there are no drugs fully developed as of yet, the idea of a pill to forget may not be so far away. This could be extremely beneficial for victims of attack, witnesses of horrific events and returning soldiers.

Propranolol
-a drug with potential?

So how would they work? Shortly after a traumatic event, there is a period when the memory of the event is consolidated in the brain. The strength of the memory relates to the release of endogenous stress hormones - such as adrenaline. When too much adrenaline is released levels of noradrenaline increase resulting in over-consolidation of the memory - this is what causes post traumatic stress syndrome. Drugs aimed at undoing this over-consolidation of memory would hence relieve symptoms of this condition. One drug of focus is propranolol, a beta-blocker. In several studies (named in the references if you're really interested), it was found that people given propranolol before being told a tragic story recalled less of the story than those not given propranolol. It was found propranolol had a significant affect on attenuating memory. 

But I think this raises another issue - if such drugs become mainstream, would they be used recreationally to extremes? If drug development allowed us to pop-a-pill to forget a specific memory from our life, would we? Would we "take one with water" to forget the memories of the lover who broke our heart? Would we forget our embarrassing moments? Or the memories of our bad days at work? Neuroethics are becoming increasingly acknowledged, as advances in neuroscience are now allowing us to manipulate the functioning of the brain, and we have to question the ethics of such tampering.

Homer has made his mind up

It could be argued that this principle of erasing memories already exists with alcohol when we head to the pub after a rough day to "drown our sorrows", for the purpose of escapism to forget our problems - however a temporary distraction is less severe than the permanent erasure of a memory, and drugs could take this to a new level. There is also the opportunity for misuse - would witness's of crimes be spiked so they would not remember the criminals face? Would they be used to manipulate others for financial benefit?

At present this is not so much of an issue, as such drugs are far from being ready to use on the human population and only tone down memories as opposed to erasing them - but with scientific advances, I would expect one day for there to be such memory altering drugs available. From a more philosophical view it could be argued that experiences make us who we are and we learn from difficult times. This leads to a very grey areas in neuroethics - would the benefit of relieving post traumatic stress syndrome outweigh the damage caused by misuse?

Would you erase?

Personally, I think the current prospect of using drugs to reduce the impact of tragic events on those with post traumatic stress syndrome is only a good thing. Propranolol, as a mainstream drug, is a front runner in the race to reduce the impact of such memories, although this is still far from the finish line.  However, I would say that we should not tamper further with our personal memories, as tempting as this would seem. But if such drugs were available, would you remember your pills to forget?

References

http://www.talktofrank.com/drug/ketamine

http://www.newscientist.com/article/dn15025-eternal-sunshine-drug-selectively-erases-memories.html

http://www.cbsnews.com/2100-18560_162-2205629.html

Cahill et al. 2002

Maheu et al. 2005

Reist et al. 2001

van Stegeren et al. 2005

http://ajobonline.com/journal/j_articles.php?aid=1338

Proud to be Human

The Queens Diamond Jubilee

With the Queen's Jubilee this weekend, it's got us all rather patriotic and proud to be British. Everyone seems to be coming together into their communities, with the lighting of over 2000 beacons across the UK, street parties and more bunting than you can shake a stick at. This has got me thinking, what is the effect of coming together as a community and why do we do it?

As humans we have evolved as social animals. In an evolutionary sense, being in a group offered protection and the sharing of resources such as food to our ancestors - making the idea of a group appealing to an individual. On a social level, groups offer emotional support and a sense of belonging. Furthermore, research shows that happiness spreads through social networks - making the jubilee an opportunity for happiness and positivity to spread through the nation. This happiness can spread through even three degrees of separation - so for example, if a friend of a friend is happy, your chances of happiness increases by around 6%. Although sadness spreads in the exact same way, this spreads slightly less compared with the spread of happiness. So national pride this weekend may be making many of us feel slightly more chipper.

When will we unite as human?

One of the main things I think of when I think of a united Britain is war time. Being British doesn't make us come together in spirit daily, but when threatened this can make us unite against the opposing force. Which leads to the question - do we only unite when faced with opposition? Interestingly, Jason Manford actually sums this up pretty well. Let's start with someone from Newcastle, who would stereotypically rival someone from Sunderland (football team rivalry shows this well). But if a Londoner comes in, they unite as Northerners. If a Scotsman comes in, they unite as English. If a European comes in, they unite as British. As Manford puts it, will we only unite as human when something non-human comes into the picture? Either way, uniting together under a leader we become a stronger unit, and science can show the benefit of being a member of a community to the individual.

So, being in a group is better for our survival and spreads our happiness - but why do groups have leadership? Why have we evolved from cave men to a current society ruled by the Queen? The evolutionary leadership theory shows how leadership was important for the survival and reproduction of our ancestors. Leadership is a behavioural strategy which has evolved to solve social coordination problems from ancestral times - such as moving areas, and conflicting with other groups. Furthermore, research shows groups with leaders do better than those without leaders, as the leader improves group performance and effectiveness. If leadership helps the individual then it’s wise to follow.

This guy's having none of it...

Interestingly, a study found that community spirit can backfire. Feelings of social power and connections may lead us to dehumanise people outside our own community. This relates to something called the fundamental attribution error (FAE). Now as scary as this sounds, in simple terms, this is the idea that you favour people and sympathise with them more when they identify with you socially. The FAE occurs when we overestimate how much someone's behaviour is explained by their personality, and underestimate the importance of situational factors. An example is if you were to trip over an uneven pavement, you would know that the pavement tripped you. But if someone else were to trip you may consider them clumsy, putting it down to their personality not the situational factor of a pavement slab sticking out. You are more likely to see someone as clumsy if they do not relate to you socially. This explains why people from different social backgrounds can be judged with inaccurate character traits.

What a happy bunch coming together this weekend
to celebrate the Queen's Diamond Jubilee.

So it’s not all good news to be part of a community. It can help spread sadness, cause us to misjudge those outside our social groups, and a united community can often be driven by opposition to an outside factor. Despite this, I think being proud and British this weekend should bring out the best in people - through sharing happiness and encouraging community spirit. Now I'm no royalist, but I think the Queen inspires unity, pride and good will for a lot of people, so for this, I wish you all a merry jubilee. And for those who don't favour the royals 
- it's two days off work.

Now, this week I decided to go a bit out of my usual scientific box and branch into the world of psychology and human behaviour. This isn't my speciality and although I have read around the subject, I'm no expert on this. If you have any comments, share them on facebook.com/humaninterests.

References
http://www.newscientist.com/article/mg20827882.300-how-community-spirit-can-backfire.html
http://www.newscientist.com/article/dn16194-happiness-spreads-like-the-plague.html
http://www.newscientist.com/article/mg21328472.800-the-happiness-equation--the-making-of-a-satisfied-scientist.html
http://www.buzzle.com/articles/fundamental-attribution-error-examples.html

How to Save a Life

Step one you say we need to talk...no The Fray, that's not step one. Step one is to assess the area around the casualty for danger, but I guess the song might not have had the same emotional depth to it with those lyrics.

So how do you save a life? Well, obviously that depends on the state of the casualty. If they are unconscious and not breathing, then the answer is CPR. Most of us have been taught this at one time or another either at school or for work, but without a refresh it’s easy to forget the steps of CPR. And if you were to find yourself unexpectedly in a situation with an unconscious casualty, nobody wants to be standing in a helpless panic.

So you walk into a room to find somebody lying on the floor unconscious. What do you do?

Step 1: you say we need to talk...joking!

Real step 1: Danger - check for danger to yourself and the casualty. Clear the area around the casualty, and do not move the casualty unless they are in immediate danger where they are. 

Step 2: Response - give the casualty a command, like "can you hear me? open your eyes!" gently shake their shoulders to see if they respond.

Step 3: Airway - open the airway by putting one hand on the forehead and two fingers from the other hand under the chin to tilt the head back.

Step 4: Breathing - now the airway is open, check for breathing. Do this by putting your ear to the casualty's mouth and listening for breath, feeling for breath on your cheek and looking to see if the chest rises. Do this for no longer than 10 seconds.

*Note here that steps 1-4 make up the DRAB sequence - Danger, Response, Airway Breathing*

Step 5: The casualty isn't breathing? Go for help if alone or ask someone else to. This step is very important before you carry on with anything else.

Step 6: Chest compressions. This involves placing the heel of your hand on the centre of the chest, and placing your other hand on top to interlock your fingers. The fingers should stay off the rib cage. Press directly down, with elbows straight to push the chest down 4-5cm. Release the pressure fully but keep the hands on the chest. This should be repeated 30 times at a rate of 100/minute. A handy trick is to sing the Bee Gees "Staying alive" to get the right pace.

Step 7: Rescue breaths. Give two rescue breaths by ensuring the airway is open, then supporting the chin with finger tips and pinching the soft part of the nose. Take a breath in and make a mouth to mouth seal with the casualty, and steadily breath out for 1 second whilst looking to see if the chest rises. Remove your mouth and watch the chest fall before starting the next rescue breath.

Step 8: Continue to do 30 chest compressions to two rescue breaths until professional help arrives or the casualty breaths normally.

So that's how to save a life. But there are a few extras you should know:

After the DRAB sequence (steps 1-4), you may find the casualty is breathing. Now if the casualty is making short, infrequent gasps for breath (known as agonal breathing) you should continue with CPR in the same way as if the casualty was not breathing. However, if the casualty is breathing normally, then you should put them into the recovery position and call for help. The recovery position is a position which keeps the airway open.

Another potential problem is a blocked airway - now, if visible you can attempt to take it out of the mouth, however strictly speaking you should not interfere as this could push the object further down. In this instance you should perform chest compressions alone without rescue breaths. This is hands only CPR, as demonstrate by Vinnie Jones in this advert here. What a legend of a man.

Another problem can arise at step 5 - the chest doesn't rise when you give a rescue breath. In this case, check the head position, check the mouth to mouth seal is tight and look for any obstructions in the mouth. Limit yourself to two attempts at rescue breaths before performing only chest compressions.

And that there folks is how to potentially save a life.

Have a comment? Go to facebook.com/humaninterests.

References:

St John’s Ambulance Teaching Materials

Don’t stand so close to me...

Did you know that a sneeze shoots out from the nose at up to 100 miles per hour? With each sneeze, 40,000 droplets of germs travel up to six feet through the air.  Plus, the droplets of sneeze seen to the eye only make up about 4% of the total volume expelled…pretty grim no?

The NHS campaign poster

With germs spreading through sneezes, coughs and surfaces like door handles that we all touch regularly, why aren’t we ill all the time? Well, our immune systems can build up resistance after being exposed to a bacteria/virus, so that upon a second exposure, antibodies are produced to fight the germ quickly, stopping us getting the same illness again. However, in the case of the common cold, as there are more than 200 types of virus which can cause a cold we would need to be exposed to all of them to become ‘immune’, which is why adults get 2-4 colds on average per year.

Nowadays we have all sorts of ways to stop the spread of these germs. Many of us carry around a little alcohol hand gel in our bags to keep our hands germ free. Interestingly, people of the Muslim faith cannot use alcohol hand gel – hence in hospitals there are soap dispensers next to the alcohol gel dispensers. Many of us also carry around a pack of tissues – sneezing into a tissue stops a lot of the horrible droplets spreading to other people, as the NHS tries to inform us all of with its ‘catch it , bin it, kill it’ campaign.

Despite all these nifty new ideas to improve hygiene, we all still sneeze, cough and spread germs around every day. Luckily for us, the human race has good enough immunity due to strategies such as vaccinations, to boost our immunity and stop the outbreak of many diseases which would otherwise be out of control. However, there is still the potential for epidemics – a current concern is that of a measles outbreak.  Between January and April 2011 there were over seven thousand cases of measles in France, extremely higher than the usual numbers. There is concern that this epidemic will spread from France other countries, as measles is a highly infectious and potentially dangerous illness which spreads very easily. There has since been increased pressure on people to be fully immunized, particularly if traveling abroad.

Now that's just taking
it too far...

But it is by no means all doom and gloom. With increasing research into infection control, the knowledge of how diseases spread and the use of vaccines to stop them, we have everything in place to try to prevent and end outbreaks of diseases. Government campaigns such as catch it, bin it, kill it are spreading the knowledge of good hygiene to try to reduce the number of sick days people take with the flu. We all know the importance of hand washing, using tissues, and we are even now told to sneeze into our elbows not our hands to cut down the amount of germs being spread. So not covering your sneezes may not lead to the end of the world, but it can definitely spread your germs around the office and make you less popular with your colleagues...

References

http://www.bbc.co.uk/programmes/b00rmrmm

http://www.nhs.uk/Conditions/Cold-common/Pages/Introduction.aspx 

http://www.bbc.co.uk/news/health-13561766

Human Opinion

The internet: saving lives or encouraging hypochondriacs?

We’ve all done it. Had an ache, pain or health grumble and headed to Google. With endless internet pages telling us about every medical condition known to man, the question is – is this giving people information that could save their lives or egging on the hypochondriacs among us?

The place to go with a 
health question?

I think one of the best things to hit the internet is NHS choices. Informative and factual, this website is reliable and allows us   to understand health problems, their causes, symptoms and treatments. This also encourages people with minor ailments such as the common cold not to visit their doctor and cuts down the increasing number of time wasters draining the NHS of funds and resources needed to treat people who are   actually ill. The cold is a virus and there is nothing a doctor   can do but to tell you to rest and keep hydrated – exactly what the NHS choices website tells you. This website doesn’t just stop people going to the doctors unnecessarily, but encourages us to see the GP at times when we really should get something checked out – in some cases for things we may otherwise have put off going to the doctor for.  Here, I say clever internet.

But this is just one website. If you Google a cough, the snippet of writing under the third website down shows “coughing is a common reflex, which can indicate other more serious problems”. Now, from a distant view this is a reasonable sentence. On the other hand, if you are concerned about a cough, which is generally why you search it on the internet, you are undoubtedly going to glaze over the words ‘common reflex’ and immediately focus on the two words ‘serious problems’. Although a website may say your problem is most likely nothing but rarely it could be cancer, as soon as the ‘C word’ is mentioned that’s all that’s needed to set off the angst in most of us.

I don't think this definition
made it into the Oxford
 English Dictionary...

And some websites aren’t even as balanced as the above, giving truly misleading and inaccurate information, suggesting old wives tails that just don’t work, and can give some dangerous advice. Reliability is a crucial flaw of the internet. Pages like Wikipedia (which I think is a great concept to spread knowledge, as any students will agree) can be detrimental when it comes to medical issues, as anyone can change the information written. And unfortunately the fact that anyone can write on the internet means that there will always be websites exploiting people’s fears for money. I personally am one to Google any health queries and often find scare mongering websites. Funnily enough, many of these websites seem to endorse certain products, magic creams and potions which can cure your pain…all for the small cost of...you get the idea.  Money makes the world go round and inspiring fear is an easy way to make some sales.

As with anything in life, this issue isn’t black and white, this is a typical grey area with both pros and cons. However, if I had to sit on one side of the www. Fence, I would have to side with the fact that the internet is a scare mongering, inaccurate, money making source of knowledge when it comes to health. I say if you're truly concerned, head to the doctor before heading to Google.

Disagree with me? Have a human opinion to share? Tell me why by commenting here on the blog, or go to my facebook page http://www.facebook.com/HumanInterests , or tweet your opinion @Human_Interests.

This won't hurt a bit...

Vaccinations. We’ve all had them. We’ve all had those terrifying moments queuing up for the school nurse waiting to be stabbed with a needle the bigger kids tell you is the size of a permanent marker. And there was always one kid who screamed the place down, which is something nobody wants to hear when they’re up next. But despite the momentary ouch, they really are amazing things.

Vaccines give people immunity to a particular disease, by causing the production of antibodies – clever proteins that identify these bad bacteria and vile viruses. If we then come into contact with the same nasty bacteria/virus, our immune systems can recognise them and produce the specific antibodies needed to fight them immediately. This is called active immunity and stops our bodies being affected by the same pathogen again. We now have a huge number of vaccines available to us which protect against diseases ranging from rabies to chickenpox.

So what is in a vaccine? Vaccines are made up of suspensions of killed or weakened microorganisms.  These pathogenic microorganisms can be grown in vast numbers and a less dangerous strain selected. Alternatively the part of the pathogen which causes the immune response can be extracted and used in the vaccine. Another method is to inactivate any toxins the pathogen produces to make it harmless, whilst still having the properties to cause the production of antibodies in the body. By exposing ourselves to the weakened pathogen, our bodies will have the antibodies ready for a fast response to fight against it without actually contracting the disease.

For the needle-phobic amongst us, you will be glad to hear not all vaccines are given by injection, some are given orally, or even as a nasal spray. Interestingly, newborn babies have immunity to diseases such as measles, mumps and rubella, as antibodies from their mothers can pass to them via the placenta. This is passive immunity and only lasts up to a year, hence the MMR jab is given to children at 1 year of age.

On the subject of MMR, this little vaccine as caused huge controversy. There has been mass attention to this vaccine in recent years due to the suggestion that the MMR jab causes autism in children. However, mass epidemiological studies, followed by more recent smaller studies looking at individual children have found no link between MMR and autism.  Despite this evidence, the controversy still lies with some parents arguing they noticed changes in their children following the jab.

This subsequent publicity over this controversy from the scare-mongering media has caused the rate of MMR vaccinations to decline in recent years, with only 60% of children receiving the MMR jab in some areas of the UK. This decline has already caused a rise in the number of measles infections, with fears of an epidemic outbreak.  Measles is highly infectious and if vaccination rates fall, measles will quickly spread again. On the other hand, if 95% of children were protected by the MMR jab, it is possible for all three diseases to be eliminated completely. Funnily enough, the Daily Mail doesn’t tell you that bit.

A great example of the success of vaccines is the elimination of smallpox. The World Health Organisation (WHO) estimated that 15million people contracted smallpox in 1967 and two million died as a consequence. However, after intense vaccination campaigns, by 1979 smallpox became the first infectious disease to be completely eradicated.  Furthermore it was only last year that rinderpest, a disease affecting cattle, became the second viral disease to be eradicated by humans. Now there’s a mankind-win.

So for the sake of a 5 second ouch, that’s got to be worth it.


References

http://www.who.int/mediacentre/factsheets/smallpox/en/

http://www.bbc.co.uk/news/health-15008866

http://www.nejm.org/doi/full/10.1056/NEJMoa1008115

http://news.bbc.co.uk/1/hi/in_depth/health/2002/mmr_debate/default.stm
(BMJ 2012;344:e1745)

http://www.news-medical.net/health/What-are-Vaccines.aspx

The Resistance

The resistance is growing fast, and I am not referring to the good guys in ‘The Terminator’. We have all taken antibiotics at one time or another, which are vital for fighting against bacterial infections to keep us healthy. However, disease-causing bacteria are now becoming increasingly resistant to antibiotics and the development of new antibiotics is at an all time low, which in combination could lead to a post-antibiotic era, which would be bad news all round.

A NHS appeal as part of the
 European Antibiotic Awareness Day

So why has this resistance come about? Antibiotics have been widely used for the past 60 years, commonly used to treat various ailments and diseases, as well as being used in the meat industry to promote the growth of animals to make us bigger, juicier steaks. Furthermore, more people are taking antibiotics in an effort to feel better when in fact the course is non-essential. People suffering with colds or flu often request antibiotics, which is pointless as antibiotics fight bacterial infections, not viruses. Even worse are those who stop taking antibiotics before the course is over. Taking half a pack exposes the bacteria to the poison in a non-lethal dose, allowing resistance to prosper. In combination, these actions are leading to dangerously 

increased antibiotic resistance.

The implications of this resistance are pretty severe. Antibiotics are vital for the treatment of otherwise life threatening bacterial diseases, and without effective antibiotics currently treatable infections could become lethal. We've all heard of MRSA, which stands for Methicillin-resistant Staphylococcus aureus. Although when said aloud Staphylococcus aureus may sound like a dinosaur, this is in fact one of the most resistant species of bacteria, having overcome every antibiotic developed over the past 50 years. With the emergence of MRSA in hospitals, the scientists brought out the big guns, in the form of Vancomycin. This antibiotic has been known as ‘the drug of last resort’, generally being able to stop any bacteria in its path. However, strains of Vancomycin resistant S. aureus (VRSA) have now been identified. 

So how do bacteria actually become resistant? Well, there are various mechanisms of resistance; some bacteria have evolved pumps to get rid of any incoming antibiotics, others block antibiotics from entering their cell in the first place and others make enzymes which can inactivate the antibiotics. Bacteria can also pass on their genes for resistance, allowing different bacterial species to exchange their resistance to certain antibiotics with others quickly and efficiently. So basically these single-celled little critters are standing up for themselves, and telling their mates how to do the same.

The development of new antibiotics has declined significantly in recent decades because pharmaceutical companies want to maximise profits. Sending scientists to unscathed environments for years, only to discover few and far between compounds, does not bring in the big bucks. Considering the threat of antibiotic inefficiency to humanity, it is hard to understand this lack of research and funding. But of course, Mr Pharmaceutical-Company would rather spend his money on popular drugs which bring in higher revenue. After all, money makes the world go round.

So what of the future? The careless use of antibiotics, as well as negligent infection control has caused this extensive antibiotic resistance on a world wide scale. By identifying novel antibiotics, reducing human consumption, eradicating antibiotic use in the animal industry and increasing hygiene and infection control, the resistance could be significantly reduced and the problem could pretty much be solved. This isn’t impossible; just look at the recent remarkable declines in MRSA infections in England. So it's not all doom and gloom, but be aware. These little buggers are standing up for themselves and it's time for us to man-up.

References
Crossley, K.B., Archer, G., Jefferson, K., Fowler, V. (2010). Staphylococci in Human Disease. John Wiley and Sons.
Dandekar, T., Dandekar, G. (2010). Pharmacogenomic strategies against microbial resistance: from bright to bleak to innovative.
Pharmacogenetics, Vol. 11, No. 9, pp. 1139-1196
French, G.L. (2010). The continuing crisis in antibiotic resistance. The international Journal of Antimicrobial Agents.
Godsland, J., Osmond, R., Pini, P. (2008). Darwin’s Gifts: The Lancet. Elsevier Ltd.