Transcript Dec 2007
Gareth Mitchell: This podcast is brought to you by the numbers five and four. Five because Imperial College is now fifth in the global university rankings and four because that's how many places we've gone up since this time last year. Oh, and this is our official monthly podcast, by the way. And welcome to the December edition. Hello, I'm Gareth Mitchell a lecturer in our Science Communication Group and also presenter of the BBC technology programme Digital Planet. And we have some technology for you on this very podcast this month in the emergency room where it's more VR than ER these days brining in medical stimulation to train student doctors.
Medical student: I think it's useful to do the emergency situations as practice runs. It just means that when you do confront those situations in the real operating theatre setting that you've had some experience of how you're going to handle that situation. And so when you do face it in real life, and you've done it before, one way or another you're going to be better equipped to face it.
GM: And as this is the last podcast of our Centenary year we're looking at one aspect of college life that's kept things very lively on campus over the years, the student media. I'll be catching up with the editor of the College Union newspaper about its sometimes controversial role.
Tom Roberts: We give the students a voice. I mean the Union is supposed to be there for it but when we print an article criticising College and even the Union we get the students' point across I guess.
GM: And we have the latest news headlines from around the College all right here on the official podcast of Imperial College London.
Christopher Matthias on blood pressure problems
All right, to start with a discussion of a condition called orthostatic hypotension. Now, if that terms sounds rather unfamiliar then its effects probably will be familiar to you. This idea of if you stand up rather quickly you get that rather light headed or faint feeling. Now, somebody who's particularly interested in that is Christopher Matthias and he's a professor of neural vascular medicine within the Faculty of Medicine on the St Mary's campus here. You can probably put orthostatic hypotension a bit more scientifically than I just have done.
Christopher Mathias: Gareth, thank you, yes. It is commoner than people think. It's been an under-recognised problem. And in essence it is when we stand up we are subjected to a number of gravitational Newtonian forces. The key, of course, with our circulation is to ensure that we get adequate blood, which contains nutrients and contains of course oxygen in particular, to organs which are functioning. That's all organs of course in the body but particularly those organs which are right at the top and above the heart and that is of course the brain. And this is where the autonomic nervous system comes in. Because it's a fairly fantastic system which tends to adapt so quickly. So it tends to ensure that we maintain our levels of blood pressure. Maintain adequate amounts of blood and therefore nutrients and oxygen to all organs but particularly those above the heart. And this is why we tend to not just adapt but regulate so rapidly. So this is the reason why in fact you just have it very transiently for a few moments, a few seconds usually, and then of course you're perfectly okay. If it continues for a period, and this is a very short period in a way, say, for more than a few seconds and certainly for minutes, that's when major problems can arise because then you're not getting the blood to the areas that you need to and you suffer from the problems of what we call organ hypoperfusion.
GM: And when you say hypoperfusion then, this is the lack of blood being where it needs to be and in this case within the brain?
CM: Absolutely right, yes. It's because the actual pressure head is low.
GM: And what kind of people suffer from this particular difficulty?
CM: Just to give you some examples. In Parkinson's disease we now know that about 50 per cent or 60 per cent do have this problem. Another disease closer to home and which is very common is of course diabetes mellitus. A disease which is, as you well know, increasing steadily thanks to our putting on weight, as it were, amongst other causes. Now, here even though there's a proportion only who have a neurothopy even the small numbers of a very common disease mean an enormous number of patients. So there are quite a lot of patients in different groups who've got this problem.
GM: Just how serious or how debilitating is it for these people?
CM: This is a very interesting and a very important question, which, again, is part of the reason why this may have been missed for some time. Some faint. So they lose consciousness. They collapse and then it becomes very obvious. However, there are situations where this may not be as severe as that. So they may, for instance, not be able to focus properly with their vision. So there are a whole variety of visual disturbances. They may just feel dizzy but nothing more than that, which is distressing in itself. Some can get pain in their neck muscles because of course they're not having enough blood to the muscles going to the neck. Or some may not be passing urine adequately during the day when the blood pressure is low. So there's a whole range of these symptoms. And there are some, especially in the elderly, who are more prone to this problem, who may collapse without a clear cause and may not be able to remember why they have fallen.
GM: And as for mitigating it then you're particularly interested in this compound within the brain called noradrenaline. So how does that come into things?
CM: Yes. Now, noradrenaline is the key chemical, the neurotransmitter, which is released by various neurons within the brain and, importantly for blood pressure control, in the periphery also. So there are the nerves known as the sympathetic nerves. They release noradrenaline when needed and this acts upon the blood vessels to constrict and keep the blood pressure up. Of course the reverse can occur. If you want to lower the blood pressure where there's less of discharge, less noradrenaline, the blood vessels dilate. In the context of orthostatic hypotension we are particularly interested in the replacement of noradrenaline in the periphery. Now, this is actually quite a tall order for a variety of reasons because it in essence means that you're trying to reconstruct the sympathetic nerves, which is not easy.
GM: How do you get round that?
CM: Well, it's been a big stumbling block for many years, many decades. Over the recent past we've had a few breakthroughs. This is a drug which chemically looks identical to noradrenaline accept for what is a carboxyl group at one end of the drug. With this carboxyl group it can be given by mouth. So unlike noradrenaline, which if it's given by mouth is effectively chewed up in the gut and therefore is ineffective, this drug can be given my mouth. It's taken into the circulation and then it's acted upon by an enzy me called dopa decarboxylase. It takes away the carboxyl group and therefore conv er ts it directly into noradrenaline. So, presto, you've got your endogenous neurotransmitter noradrenaline in the periphery.
GM: And this case you're talking about, this is part of a big clinical trial that you are effectively part of?
CM: It was a pan-European trail with a number of centres. And Imperial were very fortunate that we led. And I was fortunate to be the principle investigator leading these trials. Because we've conducted two trials so far.
GM: And just give us an outline of the results of those trials.
CM: Yes, I can tell you in the first trail we used two groups of patients. Patients with what's called pure autonomic failure and patients with multiple system atrophy who also have parkinsonian and cerebellar features. In this trial in a very large number of these patients there was benefit particularly with the higher doses of the drug. There were very few side effects. And very importantly there wasn't the reverse of hypotension. There wasn't what we call supine hypertension. And in the second trial we used a larger number of patients with MSA, that's with autonomic failure and the parkinsonian and cerebellar features and also typical Parkinson's disease who also had orthostatic hypotension. And here we used different doses of the drug and we also used a matching placebo. And this was done in a randomised double-blind trial. So neither the patient nor we knew exactly what either the dosage was or whether it was an active drug or placebo.
GM: I know you found a therapeutic effect from the drug and a measurable one. So away from the figures then just if you can speak anecdotally. You started with patients who presumably were in terrible difficulty. They were fainting a lot. They were really suffering. What kind of a difference did this drug make to them?
CM: It's made a tremendous amount of difference. In the two trials, these were short lived trials because it's still in the early stages of this drug, and it certainly made a tremendous amount of difference in terms of some of the symptoms which they had. Especially in the first study which was the dose escalating study so we could reach the optimum dose since we were aware of what we were using. What is of interest is going back to the rare disorder, the brother and sister. Now, these people had great difficulty in walking around in their daily life and managing their jobs and so on. And the drug completely transformed them so they were able to get about their business. They could work. They didn't faint. It really completely transformed their lives. They still remain on it and they're still extremely grateful for the fact that they're on the drug.
GM: Professor Christopher Matthias there. Well, in a moment high tech in high stress emergency situations with the latest in ultra real training exercises for student medics.
Headlines from around the College
But that's not before this roundup of news from around the College.
GM: An Imperial scientist warns that sub-Saharan African countries can't develop fully unless they combat infectious diseases in children. So is he talking about HIV, TB or Malaria perhaps? Well, significant as those diseases are Professor Alan Fenwick is actually talking about illnesses like schistosomosis and elephantitis that are often overlooked. The former causes liver and kidney damage and the latter invades the lymphatic system causing terrible deformities. They're in a class of disorders called NTDs which stands for neglected tropical diseases. And that term pretty much speaks for itself. Though the illnesses might be lower profile than the big killers like HIV they have a devastating effect on the health of a country's population, especially its children. As such they fundamentally hold back development. Alan Fenwick, who is head of Imperial's Schistosomosis Control Initiative issued that stark warning as his programme was awarded the prestigious Queen's Anniversary Prize. In just five years the Initiative has administered over 43 million treatments for schistosomosis and similar neglected diseases in countries such as Niger and Burkina Faso.
GM: And elsewhere at Imperial another group of researchers has cut a long standing theory about animal evolution right down to size. The phenomenon in question, the so called Island Rule, suggests that small mammal species such as rodents evolved to be bigger on islands compared to their continental counterparts. Likewise, the Island Rule says that evolution drives big mammals like elephants to be smaller on islands than they might be on the mainland. But that ain't necessarily so. That's what scientists at Imperial's NERC Centre of Population Biology are saying writing in the proceedings of the Royal Society. If you compare the sizes of a load of groups of species on islands with those on the continents you find that a particular type of mammal isn't likely to have a different size on an island than it might on a large landmass. The researchers say that most mammal groups tend not to consistently grow either larger or smaller in either setting thereby contradicting the Island Rule.
GM: So there you have it. You can stay up-to-date with the latest from Imperial via our Press Office website. Just go to imperial.ac.uk/news.
Trainee doctors face crises in a controlled environment
Well, now to medical training. And how would you feel about your newly qualified doctor having done far fewer clinical procedures on real patients than might have been the case a few years ago? But, hey, it's nothing to worry about. Not when simulation technology is so effective these days that medics can hone many of their skills in the training room without needing to put guinea pig patients at risk. After all none of us worry about all those hours that baby pilots do in a flight simulator on an industrial estate somewhere outside of Basingstoke rather than at 33,000 feet behind the controls of the real thing. Well, Science Media Production MSc student Julian Simmerie was very interested in what goes on in the 21st Century training room so he went along to Imperial's Chelsea and Westminster campus for a look.
Voice: Doctor, can you come quickly? I need your help with this patient. His heart rate is going up and his blood pressure is coming down. I think we need to do something very quickly.
Julian Simery: In hospitals these kind of emergencies are part of the daily routine. Doctors are trained to manage such a crisis. But do you really think that this can be learnt only by reading books? To find out more I'm bringing you into the world of medical simulation at the Chelsea and Westminster hospital where some of our future brightest surgeons and doctors are confronted with crises but in a controlled environment.
Medical student: There's no change in rhythm. I'm going to shock again. All clear.
JS: Doctor Manisha Kulkarni, consultant in anaesthetics and also director of the Simulation Centre here is convinced that simulation will make its way into medicine and that the NHS should invest in it on a large scale.
Manisha Kulkarni: Well I think the other industries like aviation or nuclear industry have always tried to simulate worse case scenarios and tried to make plans for dealing with those scenarios. Whereas medicine has been quite late and traditionally people have always practised on real people. There is a recognition now that we do need to practice in a safer environment without causing the patient harm. Therefore this concept of simulation is slowly coming into medicine now.
JS: If you are still wondering what sort of simulation we're talking about Dr Lacey is an anaesthetic consultant and a regular contributor in simulation classes. I join her in the operating theatre where she explained to me how the simulations work.
Dr Lacey: There's two major components I think to simulation and how we define simulation. And one is the mannequin itself. And we have what we call a high fidelity mannequin. It breaths. It talks. Its pupils react to light. It has heart sounds and breath sounds. It has pulses. Its airway can be manipulated. Its breath sounds can change. It also can be fully monitored. We can set up any monitor and we can run full intensive care or anaesthetic monitoring on it. So that is what I would call high fidelity. But we do more than that. We have to make the environment real. That way we get true responses. So it's what we call full immersion simulation. We have a surgeon. We have a scrub nurse. We have the whole team that they will expect to work with. And that is the experiential part of it. That's a very concrete learning experience.
Voice: Doctor, am I having a heart attack?
Medical student: It could be possible.
Voice: Oh, my God, am I going to die? Doctor, tell me. You've got to tell me the truth. Am I going to die?
Medical student: No, you're not going to die.
Dr Lacey: Then it's really important to debrief the scenario. And that allows for reflection and critique on what went well but also what was difficult and why. Because that's where most people learn from. I think you learn more from what didn't run smoothly, what was difficult to do. And that's where you get a lot of really, really powerful learning. So the debrief afterwards is just as important at the actual scenario itself.
JS: After an exhausting day of anaesthetic crisis management I have met three trainee doctors from Imperial College. Radif, Preti, and Rachel told me about what lessons they've learnt from their experiences of the simulator.
Student 1: I think it's really important and it's a very useful way to assessing and attaining various skills especially when you are just in the beginning years. Because it does give you the opportunity to make mistakes and to learn from your mistakes without putting patients at risk.
Student 2: I think it's useful to do the emergency situations as practice runs. It just means that when you do confront those situations in the real operating theatre setting that you've had some experience of how you're going to handle that situation. And so when you do face it in real life you've done it before one way or another and you're going to be better equipped to face it.
Student 3: I'm a very anxious person in these sorts of situations but you forget that you're being viewed and you just get on with what you have to do. And you have a problem in front of you and try and solve it as you would normally. And thankfully didn't forget there was a big screen behind me and cameras. I think you're not acting and you do become part of that situation.
Medical student: Do you normally take anything called aminophylin or theophylline?
Voice: Yeah, I take everything.
Medical student: Do you take theophylline?
Voice: I think so. That's not what it's called though.
Manisha Kulkarni: The benefits of this technology depend on the state of their training or their careers. So it can be used purely as a training tool, say, for medical students where you're looking to give them a lot of knowledge in a realistic situation. But then you also start to look at the wider picture about introducing human factors and learning to deal with crisis in a multidisciplinary setting. Improving communications. And to my mind that has much more benefit than just getting the technical training in.
Dr Lacey: What we can do in simulation is we go to the next level. We explicitly learn how are judgement, our decision making, our situational awareness, affects the management of a difficult medical crises. And by a crises I mean there are too many things to do and not enough time to do them. And we're never explicitly taught those behaviours or given ways of managing those situations. And so that is what full immersion simulation does. It allows you to explore those things. And obviously you can't do those things well if you don't have good sound knowledge and skills. But you can have sound knowledge and skills and not manage these situations effectively. And that is what we're looking at in simulation.
GM: That report from Julian Simery at the Chelsea and Westminster hospital.
The history of College controversies through the eyes of Imperial student media
Well, finally this is the last podcast of the year and 2007 has been pretty important for Imperial as the College has been celebrating its Centenary. We've spoken about the 100 year anniversary a fair bit on this podcast over the months so in this edition I thought it would be rather good to mull over the role of Imperial's student media and how it plays out in the life of the College both in present times and back over previous years. I'm in the College Media Centre right now which is a purpose built facility in the bowels of the Beit Quad next to the Albert Hall. There's a radio station here , IC Radio, and the TV station, that's called Stoic, and of course the long running student newspaper Felix. Now, the editor at the moment is Tom Roberts. And Tom we're in your office now and I mentioned there that Felix is long running so how long running exactly?
Tom Roberts: We've been running since 1949 so it's over 50 years now.
GM: So as student newspapers go it's certainly has quite a history and relevant to this year's Centenary discussions. And in fact the lovely thing is you've pulled out some of the archives here of some of the really early editions. For instance, this one we have here. It's been bound in a hardback book but at the time it looks, Tom, as if it was a fairly flimsy sheet of paper?
TR: Yeah, I think so. It's sort of A4 size. You can see that it was typewritten and there was hand drawn cartoons. There's no real structure. It's almost just like you've typed out an A4 document straight out like a lab report or something like that. It's quite quaint.
GM: And just the style of the writing. Like this one which I think was technically the second edition. There's a review of Much Ado About Nothing that the Dramatic Society had just done. A profile of the bar where somebody says, ‘We seem to have few in our midst who have the mental span to bore us with tales of hollyhock where now seats are warmed at the window radiator.' Do they write like that in these modern days then Tom under your editorship?
TR: No, quite clearly not. It goes with the times now. Culture has changed and vocabulary and things like that.
GM: Give us a sense for people who haven't seen Felix, maybe people listening outside the College, what it looks like now, what the format of the magazine is.
TR: Felix has gone through may iterations over the years. We've had glossy magazines. We've had, as I say, it started out as almost like an A4 leaflet almost. But now we're a tabloid compact size newspaper. We have about 36/40 issues.
GM: And with full colour printing as well?
TR: Yeah. We used to be black and white a couple of years ago. If you got a colour page you were quite a lucky person because there was only a set allocation of colour pages. So you were like, yes, I've got the coloured page this week.
GM: It's had a pretty controversial history hasn't it, Felix?
TR: Yeah. A lot of the people from Imperial have gone on to bigger and better things but the main controversy of the years is David Irving. He used to draw the cartoon in Felix.
GM: And just to explain for people who may not know. David Irving, if his name sounds familiar he's the person who was convicted in Austria of Holocaust denial. He was actually a student here at Imperial.
TR: Yes, he was a physics student. He studied physics during the 50s. I think he started in 56/57. He only did three years at Imperial before he was disgraced because of his fascist views and then he was forced to leave his degree I believe. As I say, he was a cartoonist for Felix. But he was also editor of the Phoenix which is an arts publication. That was founded by H.G. Wells in about 1889 I think it was. That's been going longer than Felix. But he was editor of that at the time. He used Phoenix to express his views in one issue. Although we don't have a copy of Phoenix we've been looking through the archives and things at David Irving's old stuff and it seems that his views didn't go down too well.
GM: It's astonishing isn't it? I mean we've got one here. This is from Wednesday 6th May 1959 and with quite a prominent headline on the front page of Felix.
TR: 'Irving Exposed: An assessment of the facts.' And it basically goes into his views on apartheid and things like that. He says that, ‘Hitler's regime was the first great unifying force that Europe has known for 600 years'. Quite a statement I think. I mean it was clearly a heated debate at the time because Felix used to be fortnightly at that time and through about eight issues they had letters from people writing in. And eventually he was sacked and then he went on to work at the Carnival Times, which I think is a [ ] publication, and then he was booted out from that because he went a step further and made his views even more known on top of what he wrote in Phoenix.
GM: Definitely a notorious student and notorious editor of Phoenix as well. And it's just incredible to go through the archives and almost see these. I guess these were the first public outings of some of his extreme views?
TR: I believe so. I don't know officially when he first said it but the fact that we've got these in our archives he was probably in his 20s I imagine just formulating these kind of ideas. He used Phoenix as a public platform, if you like, to launch these views.
GM: But the good news is that not all previous writers for Felix or Phoenix have been far right extremists. In fact quite a few other prominent people have come through the offices here. I don't know if you have any off the top of your head but I'm thinking Pallab Ghosh who's the BBC science correspondent.
TR: I think he was editor of Felix about 15 years ago I believe.
GM: I think certainly IC Radio, the radio station here, people like Declan Curry, who's a business reporter on BBC Breakfast, he came through here and I guess he probably wrote for Felix as well?
TR: I think it's got potential for garnering people who then go on to work in BBC news and things. So, yeah, I hope it nurtures some talent.
GM: As for Felix in modern times then, again, under your editorship what kind of things do we see in Felix these days?
TR: We give the students a voice. I mean the Union is supposed to be there for it but when we print out articles criticising College and even the Union we get the student's point across I guess. Felix also acts as a light-hearted publication, the lecturers won't like this, that people can read at the back of lecture theatres and things like that during a slightly dull lecture. So, yeah, from that point of view it's good. It's relief from the stress of Imperial studying lives and things like that.
GM: And there's an investigative and campaigning tone to it isn't there? Some of the stories in this issue actually. Taking issue with Imperial College. As I pointed out earlier in this podcast, the fifth best university in the world and good old Felix is challenging that and saying well maybe not.
TR: Yeah. That was actually a comment piece. That's dubious. It's good. The whole league table debate. How do you grade universities? They're all so different. There's such a broad spectrum of things that you can rate them on. So that's a contentious issue certainly.
GM: And some security issues I think you've covered in some of the engineering buildings here. Computers being stolen. Obviously very important in the life here. So alongside those kinds of issues a light-hearted tone to the paper as well. Something that's raised a few eyebrows over the years has been this centrefold. Effectively Page Three girls and boys. Just describe that to us.
TR: Each week we have clubs and societies approaching us saying we would like to do the centrefold. So basically people take off their clothes.
GM: All their clothes?
TR: No, no. We're not allowed to do that. We can't print full nudity so they cover up the extremities, if you like, in some way that is themed with club or society or department or something. This week's is Musical Theatre Society and thei r promoting Musical Theatre Society and their posing with the atre lighting gear and stuff like this in various places.
GM: I think you did the netball team with strategically placed netballs, for instance. Have you had any complaints over those?
TR: Yeah. It's a long running debate. I think it started under Rupert Neate's reign, if you like, as Felix editor. That was about three years ago. And at the time it was a major controversy. Are we going down the route of the Sun kind of thing? Is this just filth? We're a more highbrow newspaper that shouldn't be printing this kind of thing. I think it's striking a balance between fun and taking ourselves too seriously. I think at this point we've come down on the side of the fun kind of thing.
GM: And do you have any stories that you've done in Felix or presided over as editor that you're particularly proud of?
TR: Andrew Somerford, the news editor. I think he's very on the ball. His stories into the Aeronautics Department security, I think that was very good. That was a very valid point. We looked at student discipline and things on College in response to a letter that we received and I thought that was a pretty good article as well.
GM: So Felix reflects student life on campus and to an extent staff life as well then Tom. Can it actually make a difference? Do things actually change as a result of articles that are written in Felix?
TR: Yes, I believe so. I mean with the recent aeronautical one that we did we investigated the security there, and much to the annoyance probably of some of the students there, there was later an email that was sent out saying that students are required to have their swipe cards and things like this. The security was tightened there. I generally think what we write does have an effect on what goes on around College.
GM: That's the Felix editor, Tom Roberts, which pretty much wraps it up for this edition. But do join me in the New Year for our January edition where we'll have more news from around the campus for you. The official podcast of Imperial College London is available on the first working day of each month and it's a co-production of the Imperial Press Office and the Science Communication Group. Ozgur Buldum is the composer who wrote this music. It's called Lila and you can hear more of his tunes at his website which is ozgurbuldum.com. And don't forget that we have a Facebook listeners' group. Just do a search for Imperial College in Facebook to find us. So do join us in January but until then from me Gareth Mitchell and producer Helen Merant have a great Christmas and goodbye.