funky science images

from a man and his microscope...
vitamin C crystal 1 ...and 2
vitamins D, B1, B5, and E crystals
rifamicin (antibiotic) crystals
caffeine like you've never seen it before
adrenaline
endorphin - the 'happy' hormone
some bacteria in the lungs
we, like, totally come in peace dude (Marine dinoflagellates )
'we're back, and what?!?'
be happy (Fresh water pennate diatom frustule ?!?)
the humble kitchen sponge - looks like something from a different planet with all that bacteria
A- did you see that? B- see what? A- it just ran across down there B- oooohh

go forth, and explore

random news round up

study suggests long term use of mobile phones may cause brain tumour - this one keeps going round. One study says its does, another comes out and disproves first study, then a third comes out to disprove second study... and on it goes. Guess we won't really know the answer until several years down the line.

BBC looks at the consequences of Chrenobyl

You first had audio guides in art galleries and museums -now new hospital staff get them too

Pentagon Plans Explosion at Nevada Site
By WILL DUNHAM, REUTERS
The Pentagon plans to detonate 700 tons of conventional high explosives in Nevada in a June 2 test designed to gauge the effectiveness of weapons against deeply buried targets, officials said on March 30.
"I don’t want to sound glib here, but it’s the first time in Nevada that you’ll see a mushroom cloud over Las Vegas since we stopped testing nuclear weapons," James Tegnelia, director of the Pentagon’s Defense Threat Reduction Agency, told a small group of reporters.
The test, dubbed "Divine Strake," is sponsored by Tegnelia’s agency and is set to be conducted at the Energy Department’s Nevada Test Site in Nye County, about 65 miles (105 km) northwest of Las Vegas.
"All explosives, given the right thermal characteristics, will create a cloud that may resemble a mushroom cloud," the Defense Threat Reduction Agency said in a statement. "The dust cloud from Divine Strake may reach an altitude of 10,000 feet (3,048 meters) and is not expected to be visible off the Nevada Test Site."
Nuclear tests at the site sent mushroom clouds billowing high into the air and became tourist attractions in the 1950s, but surface tests ended in the early 1960s.
Pentagon leaders have expressed concern about potential U.S. adversaries building deeply buried bunkers containing chemical, biological or nuclear weapons stockpiles or command-and-control structures that are difficult to destroy with existing weapons.
The agency said the test will involve detonating 700 tons of the Ammonium Nitrate-Fuel Oil, or ANFO, a commonly used agent in commercial blasting operations.
Officials said the test’s primary purpose is to examine ground shock effects on deeply buried tunnel structures, and the explosion will take place above an existing structure.
Tegnelia said because of the power of the explosion, officials will notify Russia and make sure authorities in Las Vegas understand the test.
He noted the Pentagon is currently developing several very large weapons intended to penetrate the ground to get at deeply buried and hardened targets.
Tegnelia said the "Divine Strake" test represents the largest conventional explosion Pentagon officials could imagine triggering to address the issue.
A strake is part of a ship’s hull.

'it's a wonderful life'...

re-enacted by rabbits - and in only 30 seconds!
(for those who don't know, 'it's a wonderful life' is a Frank Capra movie from the 1930's, set in Xmas, and starring James Stewart - its kinda cute. Watch the link - its as if you've watched the whole movie!).

the funding of medicine

Wikipedia on ‘socialized medicine’ (read ‘the publicly vs privately funded’ debate). what struck me is that the WHO (world health organisation, not as in ‘the who?’) found that publicly funded medicine works out cheaper, AND leaves the population with better health. Talk about 2 birds with one stone! (statement comes from this source on the WHO website according to wikipedia, I have yet to read it, but intend to peruse it at some point). The more I learn about alternatives to the NHS, the more I appreciate the NHS. I went to a talk on the history of the NHS a few years ago, given by a man who was around when it started. He told all us youngsters that there have been headlines hitting the papers with ‘NHS in crises!’ since it first began. The NHS has always been in ‘crises’, but is still here, 50 years on. He told us not to get overly concerned with those claims. People, with regards to the NHS, have always been screaming ‘the end is nigh’, ‘it’ll all be over in less than 10 years!’… as long as most people realise that it is possibly the best type of healthcare delivery in the world, and sincerely try to keep it going (because it CAN work, and does work – dare I argue – better than many alternative systems claimed to be its superior), it will have more than 50 years ahead of it. I may be young, naïve and idealistic, but I know the NHS is more than just a good thing. It makes financial sense – even the WHO said so! NB – this is all kind of related to my coursework, so while I am feeling guilty about posting, with unfinished coursework demanding to be worked on to my right, I feel slightly less guilty than if this was totally unrelated to the coursework. Better put my head down.

personality types and medical specialities

A very long time ago, a pair of ladies known as Myers and Briggs were so inspired by the work of Carl Jung, they went off and created a personality test which split the world up into 16 different personality types. they figured there were four aspects to a person's personality: introversion vs extroversion, intuition vs sensing, thinking vs feeling, judging vs perception. they called it 'the Myers-Briggs Type Indicator', shortened to 'MBTI'.
they tested this little test on a bunch of medical student guinea pigs many, many years ago.
as time has passed, this test has gained in popularity. tests are widely available on the internet, and many websites like to give their take on what it all means. google is a provider of many answers for the inquisitive.
there are those who think this is all a horrible hoax. a person does a test, gets a four letter analysis, reads a description of said four letter analysis, but only sees what they want to see, and forgets the aspects of their personality not mentioned in the description, hence believing it all to be 'like totally true! wow!', when actually, it probably isn't.
a brilliant proffessor at my medical school gave us lectures on personality. he told us that personality is too complex to be differentiated, generalised and generally neatly blocked up into a few aspects.
i am inclined to agree with the brilliant professor...
however...
Zazika does find it all rather fun!
personality types and their specialities
touchy feely guide for students to figure out who they are, and where they belong in the world that is medicine
a study has been done on how type can affect the medical students use of computers... apparantly, it does
and even the student BMJ has joined in the party - woohoo!

pause for thought...

in my attempt to avoid doing my coursework (due in on friday - eek!), i came across this article.
made me stop in my tracks.

life through peanuts - the worries

sometimes i feel like this cartoon strip summarizes my day
and that everyone has a clever comment to make
and wonder how on earth i ended up in this mess anyway
i am only human after all
and when no one seems to understand its all blown out of proportion
and just when you think someone will listen...
then of course, there is that self doubt to deal with...
then you start thinking of all those worst case scenarios...
and try rationalising the situation
you then reach the point you can take the fear no more - you deal with it head on...
then actually you find out, you needn't have worried all along...
and sweet words always deserve a smile...

ps - i have realised that these links expire after a month of being on the web (copyright thing), so you can only enjoy the snoopy comic strips in march 2006! to summarise the story:
1- charlie brown and linus have a little drama with a kite and hat. the kite won't fly, and the hat won't stay on charlie brown's head. linus concludes that charlie brown should trying wearing the kite and flying the hat.
2 - charlie brown realises he has lost a library book. lucy repeatedly calls him a dead duck.
3 - ... i shall type up the transcripts later!

the pregnant man

or rather the 24 hour experience of a bloke wearing a pregnancy simulator

the biological day

the biologially ideal way to time your day, apparantly. Interesting read though.

The passing of Humphrey...

This was too good to miss, so despite deciding to concentrate solely on revision, here be the tale of Humphrey...

Humphrey, cat of scandal, dies
Monday March 20, 08:55 AM
LONDON (Reuters) - Humphrey, a stray cat who wandered in to the official residence of the prime minister in 1989 and caused a scandal when he "retired" in 1997, has died, a spokesman for Tony Blair said on Monday.
The black and white one-time "mouser in chief" was perhaps the most famous pet in a country of animal worshippers.
"World of politics mourns a legend," headlined the Sun.
"It is true. We learnt last week that Humphrey has died," a spokesman confirmed. Humphrey was thought to be 18.
He had wandered into No. 10 Downing Street under Margaret Thatcher and remained throughout the tenure of John Major. But he was sent away to live with a civil servant in "retirement" months after Tony Blair was elected in 1997.
At the time, Conservative opponents accused Blair of having Humphrey put down because the new prime minister's wife Cherie didn't like the cat. Questions were raised. Fur flew.
"Humphrey is now a missing person. Unless I hear from him or he makes a public appearance, I suspect he has been shot," opposition Conservative politician Alan Clark declared at the time.
The government finally arranged for press photos to prove Humphrey was still alive, saying he had gone to live with a civil servant to be treated for illness.
He was photographed, hostage-like, with copies of the day's newspapers to show the pictures were fresh. Blair's office issued a statement saying Cherie was sad to see him go.
It was not the only time Humphrey had been embroiled in scandal. In 1994 the government had to issue an official denial after the cat was accused of killing a family of robins.
yahoo

poem: 'Lord of himself'

I shall refrain from this blog while I revise for very important exams, and coursework. Hence, I shall leave you with this poem... it seems to have two titles: 'lord of himself', or 'the character of a happy life'. Its by Henry Wotton (1568-1639). There is a lot to gleam from it... my favourite line is the last.

HOW happy is he born or taught
That serveth not another's will,
Whose armor is his honest thought,
And simple truth his highest skill;

Whose passions not his masters are;
Whose soul is still prepared for death,
Untied unto the world with care
Of princes' grace or vulgar breath;

Who envies none whom chance doth raise,
Or vice; who never understood
The deepest wounds are given by praise,
By rule of state but not of good;

Who hath his life from rumours freed,
Whose conscience is his strong retreat,
Whose state can neither flatterers feed
Nor ruins make accusers great;

Who God doth late and early pray
More of his grace than goods to send,
And entertains the harmless day
With a well-chosen book or friend.

This man is free from servile bands
Of hope to rise or fear to fall,
Lord of himself, though not of lands,
And having nothing, yet hath all.

More on MMC...

Randoms can access final years job application on the web and edit them as they please due to security issues

Petition against the MMC and its job application structure for newly qualified doctors (1114 signitures last i checked)

An unallocated final year medical student, freaking out on a blog

Some powerpoints on the foundation programme from the london deanery

Surnames in the UK

Another way to happily waste one's time on the wonderous internet - the surname profiler!
Go to surname search on the top right corner, then stick in a surname to search in the new page- you'll get a lovely coloured map of the UK showing the prevalence of searched surname in the UK - v funky!

And for a bit of background, check out the BBC article.

Drugs trials

6 healthy young guys end up really ill in intensive care after a drugs trial. Terrifying stuff. I truely hope they all make a full recovery.
Northwick Park hospital statement
BBC
Scotsman
The Times

This is quite a good article in the Guardian running through the process of drugs trials, and sweeps through some of the ethical issues.

The Mail on Sunday...

So this is their idea of mature and balanced journalism...

UK newspaper accused of fanning flames of Islamophobia
11-03-2006
London, IRNA: The University of London Union is considering banningthe sale of the Daily Mail following reports itssister paper, the Mail, on Sunday had been trying tobribe students to spy on their Muslim colleagues. The weekly was said to have offered studentjournalists 100 pounds (USD 170) to pose as Muslimsand secretly record any meeting of Muslim societies inan attempt to report claims of Islamic radicals beingactive on campuses. According to the London Student magazine, tworeporters from the Mail on Sunday have been trying tobribe students into such undercover activities,including at Imperial College and the World RivalSociety at Queen Mary's. "This is further proof that sections of the media arefanning the flames of Islamophobia," the president ofthe World Revival Society, Rezaul Rana, was quoted assaying. Rana criticized the underhand tactics of"sensationalist and polemicist journalists" as chasingfalse and juicy stories in the hope of making quickmoney. "At a time when Muslims are being depicted as the`enemy within', what the media ought to focus on is toremove the misconceptions and prejudices aboutMuslims, who live here and continue to contribute toBritish society immensely," the society's presidentsaid. The exposure of the secret targeting of Muslims comesafter the paper's owners, Associated Newspapers,became embroiled in a campaign against London MayorKen Livingstone over comments he made to a Jewishreporter working for London's Evening Standard. The campaign led to Livingstone being suspended for amonth for describing the reporter as a Nazi guard,although the High Court has since allowed the mayor toappeal against the unprecedented ban. The president of the National Union of Students, KatFletcher, also criticized the latest tactics by theMail on Sunday as "essentially a bribe to spy on theirfellow students." "It is extremely sad that a Sunday newspaper wouldseek to undo this hard work and divide the studentpopulation at a time when we need to continue to worktogether," Fletcher said. Although the University of London Union does not stockthe weekly because its shops are not open on Sunday,it was said to be considering banning the sale of theDaily Mail in protest at the newspaper group'stactics. London Student, which exposed the bribery attempt, isthe fortnightly paper that is claimed by be read bysome 75,000 of the 120,000 students at the variouscolleges of the University of London.
*********************************************
MoS under fire from student press Julia DayFriday March 10, 2006
The Mail on Sunday has been accused of "fanning the flames of Islamaphobia" after allegations it offered students £100 to infiltrate Muslim student societies in an attempt to uncover evidence of "extremism" at universities.
Mail on Sunday casual reporter Sophie Borland contacted Pi, the student magazine at her old college, University College London, offering student reporters £100 to attend muslim society meetings and report back on what was discussed.
Borland's email to Pi reporter Kat Lay read: "What the editor wants is to pay student reporters to go undercover to one or two meetings of various societies. The reporters would be paid £100 per meeting but IF something came up that turned into a story obviously they would be paid a lot more."
Lay contacted Chaminda Jayanetti, her co-news editor on London Student, a fortnightly newspaper for the city's 120,000 students, and decided go along with Borland and Mail on Sunday education correspondent Glen Owen in order to gather evidence of the national newspaper's tactics.
At one point Owen described to Jayanetti what the paper was looking for from the exercise: "Anything that suggests that extremism is taking hold. It doesn't matter what form it takes, just as long as it gives any indication of extremism"
Owen appeared to view a campaign by Imperial College students against the ban on wearing the Islamic veil at the college as a particularly good opportunity, telling London Student: "I suspect that if you targeted a meeting there you might find that there are some lively opinions. It would be a very good story if we could find any indication that they're thinking of taking militant action or civil disobedience.
"If they say something in secret about 'we need to insist that women wear the burka' or 'we need to withdraw cooperation from the university' or any of these sort of plots that they'll be hatching, if we can reveal that, bring that into the open, then that'll be interesting ... so see what you can sniff out."
But when Jayanetti revealed he was not interested in taking up the £100 offer and was in fact collecting evidence about the Mail on Sunday's behaviour, Borland suggested blowing the whistle on the Mail on Sunday could blow his chances of a career in journalism.
Borland asked the student: "Do you want to get into national newspapers, essentially? My advice to you would not be to criticise them and to cooperate with them. That's all I'm saying, it's all well and good being worthy, but..."
London Student responded to the offer in order to examine the nature of the newspaper's approach, but never attended any meetings or accepted any money and have instead published an article detailing the affair in the latest edition of their paper.
The National Union of Students accuses the newspaper of "fanning the flames of Islamophobia" by issuing "bribes" to spy on fellow students and say the Mail on Sunday's tactics puts muslim students at risk of "racism, fear and hostility".
However the Mail on Sunday has defended its reason for trying to infiltrate muslim student meetings, saying it was legitimately investigating a matter of "great public interest" and said its reporters acted responsibly.
The NUS president, Kat Fletcher, said: "Offering students, who are increasingly burdened by huge debt, what is essentially a bribe to spy on their fellow students is abhorrent. "That the journalist has been forced to resort to this type of low tactic, clearly illustrates that the hysteria surrounding extremism on campus has little basis in reality and no concrete evidence to back it up. "This kind of sensationalist journalism ... is encouraging discrimination towards certain religious groups and students on campus by playing on fears. It is also putting Muslim students at risk by inflaming a climate of racism, fear and hostility, and placing a cloud over perfectly legitimate student Islamic societies." London Student claims the Mail on Sunday's is trying to perpetuate the myth that muslim students are "the enemy within".
Patrick Ward, the London Student editor, said: "At a time of rampant Islamophobia ... rather than creating and exploiting divisions in society, a responsible newspaper should be exposing the flaws - both technical and ethical - in these practices."
A spokesman for the Mail on Sunday said: "Last October a Mail on Sunday casual reporter, a former student at UCL, approached the UCL student magazine, whose editor she knew, asking if any student journalist would be willing to help an investigation into allegations of extremist activity in universities.
"We were put in contact with a young man who said he would be willing to assist. This man has called us a few times but provided no useful material. No article has been published and the man was not paid. We were investigating a subject of great public interest and our journalists have behaved responsibly."
The Guardian newspaper
****************************************
Nailed on Sunday
By Chaminda Jayanetti & Kat Lay
Thursday, 09 March 2006
EXCLUSIVE: Mail on Sunday offers students cash to spy on Muslims

By Chaminda Jayanetti & Kat LayLondon Student Thursday, 09 March 2006
The Mail on Sunday has been accused of fuelling Islamophobia after offering students hundreds of pounds to spy on Muslim student societies in an attempt to uncover evidence of 'extremism'.
The newspaper promised student journalists £100 per meeting to pose as Muslims and secretly record meetings of student Islamic societies to see if any radical organisations were recruiting there.
The offer came in an email from junior reporter Sophie Borland, who graduated from UCL in 2004. It said: "What the editor wants is to pay student reporters to go undercover to one or two meetings of various societies. The reporters would be paid £100 per meeting but IF something came up that turned into a story obviously they would be paid a lot more."
The email referred to a 'tip off' that radicals would be targeting London campuses. Borland referred to "rumours flying around a lot". The Sunday Times reported on radicals allegedly operating undercover at UCL in the autumn, but Borland said: "If you take a look at their article it really wasn't based on much. The Sunday Times went really big on it but it wasn't anything really."
The Mail on Sunday's Education Correspondent Glen Owen specifically targeted Imperial College's Muslim students and Queen Mary's World Revival Society.
London Student responded to the offer in order to examine the nature of the newspaper's approach, but never attended any meetings or accepted any money.
ULU is considering banning the sale of sister paper the Daily Mail from its shops in protest at the newspaper's tactics.
ULU Vice-President Sam Thomas said: "I am disgusted at the thought of a national newspaper abusing students' freedom through such tactics. These allegations must be thoroughly investigated. If found to be accurate, we will be forced to consider whether the Daily Mail has any place in ULU's shops." ULU shops do not open on Sundays, and so do not stock copies of The Mail on Sunday.
The Mail on Sunday was looking for evidence of 'extremism', but what this amounted to was unclear. At one point Owen described what they were after: "I don't know, anything that suggests that extremism is taking hold. It doesn't matter what form it takes just as long as it gives any indication of extremism."
At another point he explained: "Well, anything that gives a flavour of the more extreme end of things and any intelligence that you can pick up. It's not a restricted task, it's whatever would be of interest."
He later said: "Anything interesting that's thrown up. Language. Not just recruitment but discussions, plans of action."
Professor Anthony Glees' controversial report on extremism on campus, which was seen by some as encouraging Islamo-phobia, also focused on the BNP and animal rights fanatics, but The Mail on Sunday were solely focused on Muslim students. When told of a society debate at Queen Mary before Christmas, Owen responded: "Is that a specifically Muslim society?"
The newspaper viewed the campaign by Imperial students against the ban on wearing the Islamic veil at the college as a particularly good opportunity. Owen said: "I suspect that if you targeted a meeting there you might find that there are some lively opinions being expressed about that.
"I think it's probably bound to become the focus of rebellion and no-one's actually done that yet so it would be a very good story if we could find any indication that they're thinking of taking militant action or civil disobedience or any of that sort of stuff.
"If they say something in secret about 'we need to insist that women wear the burka' or 'we need to withdraw cooperation from the university' or any of these sort of plots that they'll be hatching, if we can reveal that, bring that into the open, then that'll be interesting … I find it hard to believe that some people aren't talking about this already, so see what you can sniff out. The Imperial Isoc [Islamic Society] may still be worth pursuing on this issue."
The campaign against the veil ban at Imperial was in reality peaceful, above board and organised by the students' union and activists in the Islamic Society and Respect, with no extremist elements present.
The focus on Queen Mary's World Revival Society (WRS) was based on research by unspecified pro-Zionist groups. Owen again explained his interest: "They've been monitored by some pro-Zionist groups, in particular the last couple of years, as being a source of anxiety. Whether that means they are or they're not or whether it's just their jaundiced perspective you can't be sure, but their names have been mentioned."
Borland visited the Queen Mary students' union (QMSU) freshers' fayre in September to speak to the WRS. QMSU communications officer Charlotte Arnold defended the society: "Queen Mary Students' Union is dedicated to supporting and protecting the entire student body, including the World Revival Society, until such time when there is evidence to suggest that our constitution or 'no platform' policy is being breached."
WRS President Rezaul Rana said: "This society is run by students, for the welfare of students. Our sole aim is to facilitate discourse and debate on matters that affect students. We work very closely with QMSU and maintain a very warm relationship with our students' union President. The events which we organise are authorised by QMSU and are publicised on campus and usually well attended. In no way do they occur in secrecy."
He added: "This attempt by The Mail on Sunday, if anything, is further proof that sections of the media are fanning the flames of Islamophobia. At a time when relations are bitter in some areas, sensationalist and polemicist journalists are chasing false and juicy stories hoping for a quick buck. At a time when Muslims are being depicted as the 'enemy within', what the media ought to focus on is to remove the misconceptions and prejudices about Muslims, who live here and continue to contribute to British society immensely."
Lord Carlile, the independent reviewer of the government's anti-terror legislation, recently warned a House of Commons Select Committee about 'intimidating' student societies that were radicalising young people. He refused to comment on the tactics adopted by The Mail on Sunday or the media in general in investigating Islamic societies when questioned by London Student.
NUS President Kat Fletcher condemned the newspaper's approach to the issue of Islamic extremism. She said in a statement: "Offering students, who are increasingly burdened by huge debt, what is essentially a bribe to spy on their fellow students is abhorrent.
"That the journalist has been forced to resort to this type of low tactic, clearly illustrates that the hysteria surrounding extremism on campus has little basis in reality and no concrete evidence to back it up."
Fletcher added: "This kind of sensationalist journalism contributes nothing to the serious debate about combating terrorism. Instead, it is encouraging discrimination towards certain religious groups and students on campus by playing on fears. It is also putting Muslim students at risk by inflaming a climate of racism, fear and hostility, and placing a cloud over perfectly legitimate student Islamic societies.
"The student movement has been united in supporting Muslim students in the backlash following the July bombings. It is extremely sad that a Sunday newspaper would seek to undo this hard work and divide the student population at a time when we need to continue to work together."
When told of London Student's actual intentions in cooperating with The Mail on Sunday, Borland chose to focus on our reporters' career prospects. "Do you want to get into national newspapers, essentially? My advice to you would not be to criticise them and to co-operate with them. That's all I'm saying, it's all well and good being worthy, but…"

The London Student newspaper

MMC

i thought it was just us medical students who weren't too keen on the new system of job allocations, clearly not...
http://www.timesonline.co.uk/article/0,,2-2068825,00.html

http://www.timesonline.co.uk/article/0,,59-2068283,00.html

smoking and mental illness

another reason not to smoke...

(you can find the website where I found this piece here)

Tobacco Madness
by J. Wesley Boyd, M.D., Ph.D., and Karen Lasser, M.D.
Psychiatric Times October 2001 Vol. XVIII Issue 10

Those who suffer from mental illness smoke cigarettes at astoundingly high rates compared to those without some form of mental illness. We have published data showing that between 50% and 80% of those suffering from a major mental illness (such as major depression, bipolar disorder, generalized anxiety disorder and schizophrenia, among others) smoke, whereas less than 40% of those who have never had mental illness smoke (Lasser et al., 2000). In all, people with mental illness consume 44% of all cigarettes in the United States, an exceedingly high figure that might surprise even the most sanguine mental health care professional.
This statistic bears within it numerous individual stories of pain and suffering. Consider the case of one of our patients, whose woeful story no doubt mirrors that of many others we treat who suffer with chronic mental illness:
"Mario" started hearing voices over a decade ago after experimenting with LSD, developing a prolonged psychosis that required several extended stays in psychiatric hospitals with a diagnosis of chronic paranoid schizophrenia. At 35 years old, Mario is perpetually disheveled, with a starry look in his eyes. Mario receives $650 per month from Social Security for disability and, except for his occasional brief forays into the working world (which usually end when voices tell him to quit or when he decides that his bosses are conspiring against him), has no other income. He spends $350 on rent for a subsidized apartment in western Massachusetts and about $50 per month on food beyond what his food stamps will pay.
Like so many others with chronic mental illness, at two packs per day and about $4 per pack, the rest of Mario's money -- roughly $240 per month, nearly 37% of his total monthly income -- goes to cigarettes. Since virtually all of Mario's income comes from the government, in a more cynical moment we might think that he is little more than a bagman whose job is to deliver government money to Big Tobacco.
What will become of Mario in 30 years, almost $100,000 in cigarettes later? Perhaps, like one 65-year-old patient with schizophrenia we met, as a result of smoking-related damage to his respiratory tract, Mario will become an "aspiration risk," unable to prevent food from passing down his trachea into his lungs. And maybe, like this patient, Mario will develop repeated pneumonias, will require frequent ventilation support in the intensive care unit and eventually will need a feeding tube placed directly into his stomach to prevent further pneumonias, costing our health care system thousands of dollars.
Or, perhaps like another 65-year-old patient with schizophrenia we have encountered, Mario will develop a massive lung cancer that, because of his psychosis, he will refuse to have treated.
Tobacco hits the mentally ill especially hard. Roughly one-third of all smokers will die early because of their habit (American Lung Association, 2001). Living with lung cancer or emphysema is hard enough, but imagine trying to make decisions about treatment options or end-of-life issues in the midst of a dark depression or active psychosis. Those with mental illness are often the least capable of coping with the devastating medical illnesses caused by smoking.
Various groups use the association between mental illness and smoking to their advantage. Psychiatric units that allow smoking are generally much more popular among patients than smoke-free units and thus generate more revenue. Many of these psychiatric units further use smoking to their advantage by offering cigarette privileges as rewards for good behavior. At one local unit, patients who break minor rules (such as yelling or refusing to participate in groups) are not allowed to go on the next scheduled smoke break. (At that unit, there were six such breaks throughout the day.) Those patients who are assaultive or require restraints are not allowed to smoke for 24 hours.
The tobacco industry also uses the association between mental illness and cigarette smoking to its advantage. R.J. Reynolds Tobacco Co. noted the perception among smokers that tobacco "helps perk you up" and "helps you think out problems," as well as providing "anxiety relief," and helping people "gain self-control," "calm down" and "cope with stress" (Nordine, 1981, as cited in Lasser et al., 2000). (Recent studies have shown that the opposite is true and that smoking often precedes the onset of mental illness.)
Could the tobacco industry be unaware that advertising that highlights the youthful, healthy effects of smoking might be particularly appealing to those with mental illness? After all, the Marlboro Man is the epitome of calm self-assuredness. He does not appear to be anxious, depressed or hallucinating -- though we might wonder if he gets a bit sad riding all alone. Have all of his cowboy buddies passed on to the great prairie in the sky because of their tobacco habits?
Unfortunately, tobacco does not deliver any mental health benefit. In fact, it directly contributes to depression and anxiety. In addition, its physical effects -- emphysema, cancer and heart disease -- can certainly make a person feel blue. If the tobacco companies have not hesitated to peddle their goods to children and the Third World, why should we presume they do not also target those with mental illness -- the group that comprises 44% of their market?
What should we do with this information? First, we need to pressure tobacco companies not to mislead their customers by falsely promoting their products as avatars of health. Those with mental illness probably have a more difficult time than most sorting out the specious claims and implications of tobacco advertising. Second, physicians need to target their patients with mental illness for smoking-cessation efforts. People with mental illness are able to quit smoking, despite some attitudes to the contrary. Third, parents should be alert to the smoking habits of their children -- a child who begins smoking may be at increased risk for mental health problems (including substance abuse) and warrants close observation. Fourth, we need to advocate raising taxes on tobacco. Studies have shown that increased cigarette taxes cut cigarette consumption by teenagers. Perhaps the same would be true for the chronically mentally ill, many of whom, like Mario, have very limited incomes. Fifth, we should pressure our legislators to expand Medicaid coverage (which is the only insurance many with mental illness have) to include smoking-cessation counseling and medications. Finally, we ought to work to ensure that all of the money that states receive in settlements from Big Tobacco be earmarked for tobacco control. Some of this money should be devoted specifically to smoking-cessation and tobacco education efforts aimed at the mentally ill.
We must do all we can to protect everyone, especially our patients who are among our society's most vulnerable, from the devastating effects of tobacco.
Dr. Boyd is in private practice in psychiatry in Northampton, Mass., and is a lecturer in psychiatry at Cambridge Hospital/Harvard Medical School and in religion at Smith College.
Dr. Lasser is an internist at Cambridge Health Alliance in Cambridge and Somerville, Mass., and is a clinical fellow in medicine at Harvard Medical School.
References
American Lung Association (2001), Quitting smoking: Why should cigarette smokers think about quitting? Available at: www.lungusa.org/tobacco/quitting_smoke.html. Accessed Aug. 30.
Lasser K, Boyd JW, Woolhandler S et al. (2000), Smoking and mental illness. A population-based prevalence study. JAMA 284(20):2606-2610.

Random facts

Would you believe that women put on 8.5 litres of fluid when pregnant? And that weight gain is not necessarily linked to food intake - therefore, little point to cutting down food intake in an otherwise healthy diet, would comprimise nutrition to baby.