Caius Medical Associaton Annual Newsleter
Issue 22: 2020 - 21
CMA President’s Annual Report and we have made arrangements for our June meetng to be hybrid — in-person or virtual. Welcome to the Those of you who cannot travel to Cambridge, or CMA Annual prefer not to, will be able to join online. If there is Newsleter. This a major third Covid spike then we will be able to has obviously been host the meetng virtually - so come what may the a y e a r o f meetng is going ahead! extraordinary upheaval for all of It is now tme for me to bring you up to us - and one which date with our last meetng held on 29 June 2019. I am sure nearly all This was kindly hosted by Prof Dino Giussani as I of us are keen to was sufering in a way nobody should have to, John Latmer forget and move atending a friend’s wedding in Mauritus. Heady on from. Fortunately serendipity means that our days - nowadays even a trip to London seems like Annual Meetng on Saturday 26 June 2021 falls an unimaginable treat. (Contnued on page 2) just afer the antcipated full relaxaton of the natonal lockdown - and we will at last be able to Contents: meet again in person. We antcipate a very high turnout for this meetng as we release the pent up • CMA President’s Annual Report: 1 enthusiasm for socialising afer a year’s • The 2020 Ackroyd Lecture and Scholarship: 5 • CMA Summer Studentships 2019-20: 7 suppression. And what a meetng we have for • Caius MedSoc President’s Report 2019-20: 9 you! Even beter, we will also be able to dine in • Caius MedSoc President’s Report 2020-21: 12 College afer the meetng and I am sure I am not • The Roger Carpenter Fund: 13 the only person hugely looking forward to this - • 50 Years A Caian: 14 especially now the kitchens have been fully • CMA Photo Competton: The Finalists: 19 refurbished. • Creatng Productve Collaboratons: The CMA in the tme of Covid-19: 22 • A Personal View from General Medical Practce During Sadly of course last year’s meetng had to the Pandemic: 25 be cancelled. At the tme we did not have the • Proposal to Develop a Post-Doctoral Research resources, tme or technology to convert this to a Fellowship in Clinical Medicine at Gonville and Caius virtual meetng. Afer a year of Zoom, Teams and College: 28 Starleaf all of us are now used to meetng online - • Previous CMA Lectures: 30
Page 1 The CMA President’s Annual Report (cont.)
Anorexia. Hubert showed how bulimia has 2019 Annual Meetng (29 June 2019): become associated with addictve and self- damaging behaviour including sexual Prof Richard J. Gilbertson: Mapping the origins of disinhibiton. An understanding of all this informs cancer – a route to preventon how treatment should be approached. Hubert Richard is Director of Cancer Research UK’s also atempted to answer the vexed queston Cambridge Centre, the Li Ka Shing Chair of “Why Women?” Oncology, and Head of the Department of Oncology in Cambridge. Richard’s lab aims to Dr Zoë Fritz: Ethics, policy and practce: case understand the origins of cancer and its studies in empirical ethics relatonship to clinical outcomes. His lab has Zoë is a Wellcome fellow in Society and mapped the origins of the most common types of Ethics, and a Consultant Physician in Acute childhood brain tumours and linked these to the medicine at Addenbrooke’s Hospital. Her clinical behaviour of these diseases. He has also research is focused on identfying areas of clinical shown that all cancers likely arise in stem cells. practce that raise ethical questons and applying The take-home message was that cancers arise rigorous empirical and ethical analysis to explore from specifc susceptble cell types that are the issues and fnd efectve solutons. In her talk transformed by matched mutatons, which might Zoë explored whether we can we use the be provoked by tssue damage. scientfc method to test what is the “right thing to do” and the role of the clinician in identfying Prof Hubert Lacey: Understanding eatng moral discomfort or “is / ought” gaps, and how disorders Rawls’ “veil of ignorance” could be applied as a Hubert is Professor of Psychiatry at St guiding principle to making the health service George’s, University of London. He is Director of sustainable and open. Zoë presented her own the St George’s Eatng Disorders Service in London research in empirical ethics, showing how she had which is the largest eatng disorders unit in the challenged current practces around resuscitaton UK. Hubert explained how eatng disorders are decisions, and how by working with patents, much misunderstood with diagnostc confusion clinicians and policy makers she had developed and muddled clinical pictures - and he more than and evaluated an alternatve which improved met his promise to bring clarity to this disarray. patent experience and care. The resultng Hubert addressed the diferent psychopathology ReSPECT process (Recommended Summary Plan of anorexia nervosa and bulimia nervosa. He for Emergency Care and Treatment) has been a outlined a typical pathogenesis of anorexia and paradigm shif in how doctors and patents refected on anorexia’s place as a paradigm of approach resuscitaton and other treatment psychosomatc medicine, touching on the decisions, and is now in use in more than 100 interplay with other medical issues. He discussed trusts in the UK. prognosis and the tragedy of Severe and Enduring
Page 2 Writen by John Latmer The CMA President’s Annual Report (cont.)
Prof David Riches: Is John Caius the “Father” of human anatomy based on cadaveric dissecton. Britsh anatomy? Caius strongly disagreed with this and when he David is a Britsh anatomist. He is Emeritus returned to London he contnued to teach Galenic Professor of Anatomy at Queen Mary University anatomy. Even though Caius was the frst to of London and a Fellow and Director of Studies at introduce a more academic approach to the study Caius. He is noted for his research in dermatology, of anatomy, his non-acceptance of Vesalian partcularly the basement membrane zone and anatomy detracts from his being accurately called bullous disorders. He was formerly Dean of the “Father” of Britsh anatomy. Medical Sciences at the Internatonal Medical University in Kuala Lumpur. In his talk David The meetng was followed by a recepton, revealed that John Caius was a staunch follower kindly hosted by The Master in her garden, then of Galenic anatomy which had persisted for over an excellent dinner in College. 1,300 years. He studied in Padua at the same tme as Vesalius was introducing a new approach to 2021 Annual Meetng (26 June 2021):
Our programme is now fnalised, and yet University of Cambridge School of Clinical again we are overwhelmed by the generosity of Medicine “COVID-19: An ICU physician’s story” such outstanding speakers in giving so freely of their tme to inform and entertain us. Mr Per Hall MB, BChir, FRCS (Plast), Consultant Plastc Surgeon and Clinical Director for the Clef Professor Veronica Kinsler (1989) MA MB BChir Lip and Palate Service Addenbrooke’s Hospital FRCPCH PhD, Professor of Paediatric Dermatology Cambridge “Towards Sustainable Clef Lip and and Dermatogenetcs, Great Ormond St Hospital Palate Surgery in Ethiopia – my busman’s holidays for Children and UCL, London “Birthmarks - with Operaton Smile” unravelling the causes, understanding the implicatons” As the CMA we contnue to work closely with Caius MedSoc - the students who will Professor Carol Seymour MA (Oxon) MA (Cantab) become CMA members when they graduate. We PhD FRCP FRCPath FFFLM PgDipLaw PgDipPLS, always welcome students at the CMA meetng as Past President, Faculty of Forensic & Legal they are the future lifeblood of the CMA - we are Medicine of the Royal College of Physicians “The hoping for another good turnout this year role of a medicolegal consultant/lawyer - friend or especially as many of our medical students will be foe?” staying in Cambridge for longer this year than usual. Dr Charlote Summers BM PhD FRCP FFICM, University Lecturer in Intensive Care Medicine,
Page 3 Writen by John Latmer The CMA President’s Annual Report (cont.)
I would like to thank Kevin O’Shaughnessy domains during this pandemic – medics and non- for his contnuing support and guidance as medics alike. We are seeing the fruits of the Secretary and to thank David Riches as Treasurer. medical science that has given us the vaccines Thanks also to the rest of the CMA commitee for that ofer us the route out of this modern plague - their advice and support - we have benefted what beter way to celebrate than coming hugely from the arrival of a number of younger together for what will be a brilliant series of talks members with fresh ideas and insights. Julia and then the best company anywhere! I greatly Mantle contnues to herd cats as she look forward to seeing you in June. diplomatcally and relentlessly keeps me and the rest of the commitee on track - she is a wonder! Please look out for the invitaton email with booking form and programme which will be I would like to end on a note of optmism. sent out later this month Caians have distnguished themselves in all John Latmer
The Caius Medical Association (CMA) was founded in 1997, which coincidentally was the 400th anniversary of Harvey's graduation from the college in 1597, in order to allow Caius medical graduates to keep in touch with each other, and with the college; and to maintain a sense of a Caius medical community afer graduation.
The CMA also allows older members to provide help and advice to Caius students and younger members, and the many ofers of support and help are much appreciated by the young Caian medics who take them up.
A key part of the CMA is the annual meeting in June, which combines a social occasion with a scientifc meeting. We provide fnancial assistance to Caius students who wish to stay in Cambridge over the Long Vacation to complete lab- based projects or Part II courses: their work is presented as posters at the June meeting.
Page 4 The 2020 Ackroyd Lecture and Scholarship
Writng this just before Christmas in 2020, the idea that we managed to hold a 2020 Ackroyd Lecture seems somewhat remarkable. On Monday 2nd March social distancing had not yet taken hold, although concern was growing with 36 confrmed cases of Covid19 infecton in the country. However, in that now seemingly very distant moment, we were able to focus on the remarkable lecture delivered by Professor Stephen P. Jackson, enttled “Cellular responses to DNA damage: from blue skies research to new cancer therapies.” Steve is the Frederick James Quick Professor of Biology in the University and a senior group leader at the Gurdon Insttute.
Steve began his scientfc career studying the control of transcripton in the lab of Robert Professor Steve Jackson (credit: Jussi Puikkonen Tijan in UC Berkley but through a chance / KNAW / Wikipedia) discovery of a kinase that appeared to be known as synthetc lethality. The idea is quite actvated by DNA ends, which became known as simple. If a cell has two pathways for repairing a DNA-dependent protein kinase (DNA-PK), he double strand break, then losing one of them stll switched his atenton to the DNA damage allows the other to operate. Losing both results in response when setng up his own junior group in the cell dying. So, if a cancer cell has a mutaton Cambridge in 1991. DNA-PK is one of a trio of that has inactvated one pathway, a drug targetng kinases on which Steve has worked and that lie at the second will kill the cancer cells but not the the heart of cells’ ability to detect broken DNA at normal cells. various points in the cell cycle, triggering a pause and tme to repair the damage. Steve was one of This concept led to the foundaton of the frst to realise the potental of targetng the Steve’s frst company KuDOS. One of the early DNA damage response as a cancer treatment. drugs developed by KuDOS, olaparib, targets an enzyme called poly(ADP-ribose)polymerase Cancer cells acquire multple mutatons (PARP) which is required for efcient repair of that frequently inactvate DNA repair and DNA DNA breaks in the G1 phase of the cell cycle. This damage response pathways. However, the has proved very efectve in cells lacking the realisaton that many of these pathways exhibit breast cancer susceptbility genes BRCA1 and signifcant redundancy with each other opened up BRCA2, as these proteins are essental for the possibility of using drugs to inactvate aspects efectve DNA break repair in S/G2 phase of the of the DNA damage response in an approach Page 5 Writen by Julian Sale The 2020 Ackroyd Lecture and Scholarship (cont.) cell cycle. Thus olaparib very selectvely kills the As I noted last year, we now award the cancer cells in these patents but does not harm Ackroyd Scholarship at the end of the second normal cells as the functon of PARP can be year. With the second-year summer medical compensated for by the BRCA proteins. This drug exams delayed to the end of September, and led to the acquisiton of KuDOS by AstraZeneca many other results late in, the usual June Electors and the approval of olaparib (Lynparza) as the frst to Scholarships meetng did not take place untl cancer drug specifcally designed to target the February this year. So the news that Thivya DNA damage response. Sivakanthan has been elected the 2020 Ackroyd Scholar is hot of the press and announced just in Not surprisingly, Steve’s talk prompted tme to make this editon of the newsleter. I am many questons from the audience and he was sure you will all join me in congratulatng her. We warmly thanked for a stmulatng and engaging have decided not to hold the lecture in 2021, but lecture. will hold out for a sufcient return to normality in Lent Term 2022 to hold the meetng once again in person.
Julian Sale
Harold Ackroyd VC MC 1877-1917
The Ackroyd Scholarship and Lecture were endowed in memory of Harold Ackroyd VC MC, a Caian medic killed by a sniper on 11th August 1917 while tending to the wounded in no-man's-land during the third battle of Ypres. His medals are on display at the Imperial War Museum in London.
photo: Wellcome Library, London - [1] [2], CC BY 4.0
Page 6 CMA Summer Studentships 2019-20
In 2019, back in the days before Covid-19, The students that we supported in 2019 are as the CMA funded eight impressively diverse follows: summer student projects. These summer studentships allow students the opportunity to Gayatree Amalananda, a second-year gain research experience. This is partcularly undergraduate, undertook an 8-week project with valuable for the frst and third years, as most Lalita Ramakrishnan at the Molecular Immunity external funding is restricted to second year Unit at the MRC Laboratory of Molecular Biology. undergraduates – the third years count as Her work involved mapping an unknown recessive graduates. Yet, the frst years gain enormously by mutaton in zebrafsh larvae models that causes being able to experience real research before them to show increased susceptbility to infecton choosing their Part II subject, and the third years with Mycobacterium marinum. can ofen use the tme to extend Part II research to publicaton standard. Harriet Bartlet, a second-year on the MB/PhD programme, was given a contributon from the These studentships are the main CMA towards the cost of a 1-year leadership expenditure of the CMA and the generosity of programme for Women in STEMM (Science, those who contribute to our funds has allowed us Technology, Maths and Medicine) aimed at to just about support all students who have helping those who want to make global change applied for funding to date. However, from 2020 move “from PhD to Professor”. there has been a major change in the rules regarding “internships” that cover our summer Ujjawal Kumar, in his frst year, worked for eight students. Briefy, summer students must now be weeks in the Department of Genetcs with Dr paid the full living wage, where previously our Felipe Karam Teixeira on a project investgatng s u p p o r t h a d b e e n l i m i t e d t o c o v e r the mechanisms that regulate genomic stability accommodaton and subsistence. This has the during germline development of Drosophila laudable aim of allowing for widening melanogaster, in order to increase understanding partcipaton, such that students who require of how de novo mutatons are ultmately accessed employment over the long vacaton should not be and repaired during development. prevented from undertaking an internship. However, it also has the efect of more than David Mafullul, a second-year undergraduate, doubling the amount of money we require to worked in the Anatomy department with Kristan support each summer student, so without Franze and Eva Pillai investgatng how neuronal additonal funding the number of students we can mechanics may infuence axon guidance, both in support will halve. vitro and in vivo using a Xenopus model.
Jane Murphy, contnued work on her Part II project in the Ahringer Group at the Gurdon Insttute under Csenge Gal. She worked on the Page 7 Writen by James Fraser CMA Summer Studentships 2019-20 (cont.)
DREAM complex, a transcriptonal repressor with involved performing knockouts of the relevant a critcal role in maintaining cellular quiescence, in genes (Atlastn, Retculons and SPG genes, the a yeast system. This involved looking for proteins later only recently implicated in Alzheimer’s by that interact with LIN-36 and LIN-15B, using a GWAS studies) in cell lines. He also imaged the yeast two-hybrid screen in order to identfy cells and the integrity of their organelles, and members of chromatn modifying complexes, measured the impact on fow within the investgatng the hypothesis that LIN-36 and endoplasmic retculum to allow the roles of these LIN-15B are components that allow the DREAM genes to be beter understood. complex to recruit distnct repressive chromatn marks. In additon to these eight students who received CMA funding, a further four students Rohan Sanghera, in his second year, worked on a were awarded Honorary CMA Summer project investgatng the role of protein Studentships: John Louca, Macky Padilla, Nirav aggregaton in cancer, a process usually associated Patel and Azmaeen Zarif. These students with the development of neurodegeneratve successfully applied for CMA studentships but disease. However, mutated p53 aggregates and were also awarded (more generous) external amyloid formaton have been associated with the funding from the Wellcome trust, the BBSRC, the pathogenesis of cancer and his project involved Grindley fund and a Caius internship award. They investgatng methods of selectvely detectng are to be congratulated. mutated p53 aggregates and amyloid formaton in ovarian cell cancer lines, with the eventual aim of There were no opportunites for summer providing insight into the role of such aggregates, research projects in 2020 due to the rapidly new early-detecton methods and future drug evolving Covid-19 situaton. I am pleased to targets. report that applicatons for 2021 projects are now coming in. Nikhita Treon, a second-year, worked with Anita Chandra in the Okkenhaug lab in Pathology, on an The CMA Summer Students are invited to investgaton of a subset of B cells thought to have present their work on posters at the CMA meetng a role in exacerbatng the early phase of this year, and would, I’m sure, be very pleased to Streptococcus Pneumoniae Infecton. discuss their project work with atendees at the meetng. The CMA is very grateful to our James Wilson, a frst-year, worked in the members whose contributons allow this Dementa Research Insttute in Cambridge under programme and to all the project supervisors for the supervision of Edward Avezov investgatng giving our students such varied and valuable the role of endoplasmic retculum shaping research experiences. proteins in neuronal cell health. His project
James Fraser Page 8 Caius MedSoc President’s Report 2019-20
This has been yet another eventul and CMS students to help in academic studies. successful year for the Caius Medical Society Moreover, he has done a lot in the Corona Virus (CMS). Thanks to our Ents Reps Rohan Sanghera tutoring initatve as a volunteer tutor and and Dave Mafullul, we had an excitng social member of the safeguarding team, giving over calendar, including various Freshers events, the 100 hours of free tutoring and helping re-write all CMS Christmas party, inter-year swaps and the their safeguarding policies to help target students May Week garden party. The Annual CMS dinner with educatonal disadvantages which have been was also of course a memorable night, enjoyed by highlighted by the pandemic. students and supervisors alike. Caius medics engage in a diversity of Our access ofcer Nirav Patel has worked actvites outside the course. As there are nearly hard throughout the year to increase awareness 150 medical students currently at Caius, I will not of the applicaton process and accessibility of be able to menton all of their successes, but will Medicine at Caius. We hosted a very successful atempt to highlight those who have given Access day on 28 January 2020, where we gave exemplary efort towards university or Caius around 70 schoolkids an insight into the life of societes. Many of our students are partcipatng Caius medics, involving a range of supervisions led in sports at a university level. Thiviya Sivakanthan by current Caius medics. Thanks to Alec Morley, is on the trampolining and netball teams for the our computng ofcer, the commitee electons university, while Dave Mafullul partakes in ran smoothly and the CMS Moodle site has been university athletcs, and Tash Bashir in university kept updated, providing a wealth of resources to netball. Moreover, Azmaeen Zarif and Ashna Biju
Page 9 Writen by Alexandria Smith Caius MedSoc President’s Report 2019-20 (cont.) were selected for the University Novice Squad of - and is currently President of - the Cambridge the CU Bowmen (Archery). Holly Tasker was MedVet Music Society, for which he organised and President of the University Cricket Club. She also conducted the frst concert in the Lent Term of founded the podcast ‘Hawk Talk’ about university 2020. He has conducted and performed with the sport at Cambridge, which currently has over 600 college orchestra in College Concerts, as well as listens! The University team for women’s lacrosse the Phoenix Music Society. Keya Sajip has been was captained by our very own Olivia Cox. It has Vice-President of Cambridge University Bollywood also been a successful year for swimmer Jacques Troupe this year, who have performed at a Bonsell, who partcipated in the Britsh Swimming number of events including Mastana, Medsoc Ball Championships last Easter and qualifed for the 2020 and Murray Edward’s Internatonal Women’s Olympic Trials. He has broken and holds the Day. University Records for the 200m, 400m, 800m, 1500m Freestyle on both Short and Long Course, Many Caius medics and vets are part of the 4x100m Medley Relay, 4x200m Freestyle the outstanding Cambridge University Dancesport Relay Long Course and 4x100m Freestyle Relay Team (CUDT), including Charlote Palmer, Alex Short Course. Smith, Ruweena Perera, Emilia Lawer, Kezi Defriend, Kelvin Chan, Marieta D’Almeida, Of course, the rowing scene for Caius Ashna Biju and John Louca. Following CUDT’s medics has contnued to thrive. On the women’s victory in Natonals and Varsity, the Caians side, Abi Burn rowed in W1 and achieved blades amongst them competed together in the inter- in Lent term. Abi and Tash Reid also both collegiate Cuppers competton, taking the win for represented Caius Boat Club in the virtual bumps. Caius in the dance-of and a close second overall. Victoria Walker rowed with the university crew Moreover, many clinical students partcipated in winning the 2020 Lightweight Women’s Boat Race the clinical school pantomime last year, “The Litle and has since been helping coach novice rowers. Murmurmaid”, with a partcularly impressive On the men’s side, Owain Bates and Michael performance by our very own Aaron Fleming. Gardiner rowed in M1. Pippa Morris and Henry Bennet rowed in the Addenbrooke’s Boat Club, while Henry Bennet and Dom Vasey have been rowing for the men’s side this Michaelmas term, with Henry as Captain of Boats. Ujjawal Kumar, Binu Perera, Lucas Hutchinson, Alice Bebb, Stan MacMurray, Haider Mathieson and Natasha Treagust have also been training with the college squad over the year.
Atainment in music and dance by Caius medics is also impressive. Ujjawal Kumar founded Page 10 Writen by Alexandria Smith Caius MedSoc President’s Report 2019-20 (cont.)
Azmaeen Zarif has been elected President portrays the wealth of extra-curricular actvites of Cambridge MedSoc and is current Co-Chair of that the students are involved in alongside the Racism in Medical Educaton Student-Staf academic work. I would also like to thank the Group. He has hosted speakers such as Prof. Caius Medical Associaton for their generous Greenhalgh OBE and Prof. Costello (WHO Director support of summer research studentships. This is of Maternal, Child and Adolescent Health) and an invaluable opportunity for students to delve Nobel Prize Winner Prof. Muhammad Yunus and into the world of research; without CMA funding has raised nearly £2k as part of a charity work of this kind would be largely inaccessible. campaign for daily wagers in South Asia. I would fnally like to thank Marieta Acknowledgment must also be given to D’Almeida for her unrelentng work as Vice- the large number of Caius medics for their President of the CMS last year. I have now handed excellent supervision of pre-clinical students over over the CMS Presidency to Maddie Walton. She the course of the year. On behalf of the 1st, 2nd and the new commitee have been doing a and 3rd years, I would like to express my thanks. fantastc job in keeping up the CMS spirit despite the pandemic. They have done a brilliant job There are, no doubt, many other coordinatng stash (branded tops), online social achievements from CMS students that have gone events and integratng the freshers even without unmentoned here, but I hope that this report being able to do things in person!
Alexandria Smith
Please remember your subscriptions! https://www.cai.cam.ac.uk/alumni/CMA
Your CMA subs make a real diference to young Caius medics, providing them with opportunities for research and medical experience that would otherwise be beyond their reach.
The CMA website is also an invaluable resource for details of the upcoming Annual Meeting, application & direct debit forms, for ordering your distinguished CMA tie, CMA lapel pins and brooches, and of course for poring over those bygone issues of the CMA newsletter.
Page 11 Caius MedSoc President’s Report 2020-21
Many of the events that Caius Medical years to get advice and support. As a result, we Society hold in a normal year have been held an online mixer session, placing a few people unfeasible in the global pandemic. The society from each year in break-out rooms together so have therefore had to adapt and come up with that the freshers would have an opportunity to new ideas. To celebrate the end of the Easter chat about any concerns and also get to know term, we held an online quiz, which was well some friendly faces. received with the majority of Undergraduates atending. The members of the winning team During the Michaelmas term, we held were each sent a box of homemade brownies in another online quiz and a movie night via Netlix the post! party. The welfare team provided every household with mince pies, candy canes and hot The society recognised that it would be an chocolate to enjoy whilst watching the flm. We odd transiton period for the new intake of Caius have held two successful talks on the clinical Medics, so we provided each student with a free applicatons of Part IA/IB topics given by our sixth- goodie bag including branded lanyards, water year medics. Adaptng to the ‘new normal’ has botles and laptop stckers, as well as some sweet been challenging but the society have thoroughly treats to show our support when they arrived. enjoyed planning and holding the online events.
Many of the second and third years Maddie Walton mentoned the importance of talking to upper
Page 12 The Roger Carpenter Fund
The Roger Carpenter Biomedical Students though students reading associated subjects Research Fund was established in 2017 in would not be excluded if funds permited. memory of the late Professor Roger Carpenter. Sadly, the bursary could not be awarded last The Fund recognises the contributon made by year due to COVID pandemic. Roger to the teaching of medical students at Caius over the last 40 years and his intense interest in Professor Carpenter was a Fellow at medical educaton and research training. Caius from 1973 untl his death in October 2017, and was a founder member of the Caius Awards from the Fund are awarded Medical Associaton. He is remembered fondly principally to the most outstanding Caius by those he worked alongside, and by the medical students at any stage of their studies, many students he taught.
Donations to the Fund are always welcome. To make a contribution please contact the Development Ofce: +44 (0)1223 339 676
www.cai.cam.ac.uk/alumni/carpenterresearchfund
Page 13 50 Years A Caian
October 2021 will mark the 50th friends largely through cards and leters, delivered anniversary of my admission (or in Cambridge- via the University’s excellent internal mail system speak, my matriculaton) as a member of the to pigeon holes in the JCRs. No mobile phones exceptonal insttuton which is Gonville and Caius either: I frst acquired one in 1995. Harvey Court College. To me and to many of my age, that does was exceptonal in having telephone extensions in not seem so long ago but to some readers 1971 every room, allegedly because it was used as will sound like a distant historical epoch. To some, conference accommodaton out of term. what follows will be no more than a reminder, Otherwise telephone calls were made from a pleasant I hope, of formatve years spent in an coin-in-the slot machine in the basement below idyllic and enormously stmulatng environment. the bar. Perhaps surprisingly, we did not feel that To others it may reveal the huge extent to which our methods of communicaton were inadequate. life, both academic and social, has changed over Social life went on apace and the need to write the last 50 years. I take an optmistc view of this. may even have enhanced our literary skills. Social and technological progress over the last half-century has been tremendously empowering, I remember my frst day in College giving almost immediate access to informaton remarkably clearly. Assembly in Hall for welcome and opportunit es unimaginable to and signing of matriculaton documents, then undergraduates of my day. At the same tme, freshers’ photograph in front of the Gate of most of what was valuable and good about Honour (stll happens, I believe). Then of to meet teaching, learning and living in Caius in the 1970s my tutor, Dr John Casey, then as now resident in has been maintained and is stll at the core of his rooms next to the Chapel in Caius Court. Next, what makes the College the remarkable and Hefers to open an account. Do undergraduates outstanding insttuton it is. buy books these days? We did but we didn’t have the Internet. My impression as a clinical teacher I stll have the leter I received in October over many years is that clinical students don’t. 1970 ofering me a place to read medicine at They are hard up and believe they can fnd what Caius. Yes, a leter, typed by a typist on a they need for free on the Internet. And the (non- typewriter and signed by the senior tutor with a Cambridge) students I teach don’t seem to read pen! The advances in “informaton technology”, much anyway. And they study for exams by for want of a beter term, since the 1970s have mugging up past questons and learning been the most transformatve of all the changes guidelines. Throughout my adult life we have seen. I did not use a computer untl I educatonalists have scorned knowing stuf (“rote undertook a research post in 1983 (a slow, clunky learning”) and have promoted informaton mainframe). I acquired an Amstrad word retrieval skills instead. I fear this has resulted in a processor in about 1987 but did not own a PC poor and patchy knowledge-base amongst many untl 1997. Email started to be widely used at newly qualifed doctors. The problem has been about that tme. As an undergraduate I wrote exacerbated by an OSCE-based examinaton essays with pen and ink and communicated with system which emphasises “how to” rather than Page 14 Writen by Stephen Brearley 50 Years A Caian (cont.)
“why”, and to young doctors possessing a set of division in bumps then, in sharp contrast to the stock responses to standard situatons but being success of recent decades, but I would not have poorly equipped to recognise and deal with the been able to put in the hours of training which innumerable non-standard situatons which arise serious rowing demands today. in clinical practce. Knowledge is the raw material of thought. Without knowledge, thought is I was outstandingly well taught at Caius. devalued and its outputs are likely to be unsound. Anatomy supervisor Mr David Skidmore: then Books generally provide a comprehensive doing an MD in Cambridge, subsequently overview of knowledge in a partcular feld. consultant surgeon and stll a keen supporter of Gobbets of informaton accessed piecemeal on the College. Biochemistry Dr David Ellar, who the Internet do not. Nor, nowadays, does clinical served his supervision pupils sherry out of a large, training, which no longer provides some exposure unlabelled brown Winchester fagon. And Roger to all aspects of medicine but, rather, is conceived Carpenter arrived at Caius during my second year, on a “core plus optons” basis. In order to cover just in tme to supervise me in neurophysiology: a the gaps this leaves and to acquire an adequate teacher of exceptonal brilliance, as many knowledge base, medical students should read members of CMA will recall, also a gifed and books. Probably those educated at Cambridge knowledgeable exponent of early music on period stll do but many elsewhere seem not to. instruments and a sympathetc, encouraging and thoroughly delightul man. Next stop the Freshers’ Fair. Endless opportunites! An unbelievable roster of eminent I completed my BA in 1974, just a few speakers felded by the politcal clubs and years before the clinical school in Cambridge societes. I joined the Conservatve Associaton, opened, and was accepted for clinical training by the Labour Club and the Liberals too in order to the Middlesex Hospital Medical School. Three hear them (but was later ejected from the Labour years in Cambridge and three in London seemed Club for being a member of the Conservatve to me to provide the best possible student Associaton). Signed up to auditon for both experience. I was well taught at the Middlesex CUMS orchestras and the CUMS choir. Got into too, at a tme when consultants stll took seriously CUMS second orchestra. (They had two in those their obligaton to carry out weekly bed-side days.) Applied, ultmately successfully, to join the teaching. Students became part of the “frm” Cambridge University Air Squadron: over 70 hours and, between them, were expected to clerk all of of frst rate fying training on Chipmunks for free. their consultants’ patents and also to take the Joined Caius Boat Club. Very diferent in those bloods each morning. No phlebotomists then! days and much less serious. No “ergs” in the Day case surgery had not yet been invented. On boat-house, indeed no equipment in the boat- the contrary, surgical patents were routnely house at all, except boats. We did all our training admited the day before surgery and it was on the water. This goes some way to explaining common for hernia patents, for instance, to stay why Caius I was near the botom of the frst in for a week or more so that they would not Page 15 Writen by Stephen Brearley 50 Years A Caian (cont.) over-exert themselves and disrupt their repairs. hands, for the operatve part is the least part of This meant, however, that there was an the work”. Just because a patent has been abundance of patents available for teaching referred to a surgeon, it does not mean that he or purposes and that students could follow their she has surgical disease. Surgeons therefore need progress. a wide diagnostc frame of reference, in other words a broad, general medical knowledge-base. I enjoyed all of the specialtes I rotated I fnd it partcularly satsfying to make a medical through, perhaps with the excepton of obstetrics diagnosis in a surgical out-patent clinic. It and gynaecology, but decided early on (indeed persuades me that I am stll a “proper doctor”. I probably before medical school) that I wanted to get almost as much pleasure from un-making pursue a career in general surgery. The breadth of diagnoses as from making them. Misdiagnosis is the feld at that tme, including the whole of frighteningly common (15 – 30% of all cases, abdominal surgery, vascular surgery, breast and depending upon the criteria applied) and, once a endocrine surgery and, in many centres, urology patent has been given an incorrect diagnostc too, atracted me, as did the technical discipline label, it is exceptonally difcult to remove it. of operatng, but a major consideraton was the Clearly, correct diagnosis is a pre-requisite to potental which surgery has to cure patents. My correct treatment and a high level of diagnostc perspectve on this may ofend but I feel great skill is the most important atribute of all doctors, sympathy for my physician colleagues, who rarely surgeons included. cure anyone of anything and spend most of their tme in an unending and ultmately doomed batle Surgical training has changed during my with chronic, incurable and ofen progressive career yet remains recognisably the same thing. diseases. This is essental and noble work but Surgical trainees stll work with and are trained by seemed, and seems, to me rather less rewarding one or two consultants at any one tme and than doing a skilful operaton and efectng a cure. increasing independence and responsibility is delegated to them as their knowledge and skills Surgery is much misunderstood. A increase. Change has however been driven by surprising number of people, even of doctors, limitaton of the hours trainees may work and by seem to think that surgeons are people who atempts to shorten its duraton. During my spend all day operatng. Most patents referred to training, one in three rotas (about 83 hours a surgeons do not, in fact, need or undergo surgery. week) were common and one in four (72 hours a The skills of diagnosis and decision making, in week) was regarded as light. The heaviest I ever clinic, in the emergency department or on the worked was a one in two in paediatric wards, are crucial atributes of a good surgeon. cardiothoracic surgery with a commitment to This was recognised by the pioneering work one in one when my colleague was away neurosurgeon Harvey Cushing, who wrote “I (108 hours a week, or 168 hours a week during would like to see the day when someone would my colleague’s leave). A night on call, plus the be appointed surgeon somewhere who had no days either side of it, meant a contnuous duty Page 16 Writen by Stephen Brearley 50 Years A Caian (cont.) period of 32 hours while a weekend on call could of doctors as clinical fellows or in other posts amount to 80 hours without a break. We had which are not recognised as training posts and the hospital bedrooms to sleep in at night but how career prospects of these doctors are uncertain. much sleep we got was unpredictable. Dedicated emergency theatres were only introduced in It has long been recognised that there can about 2000. Prior to that only the most urgent be a confict between the needs of service cases could undergo surgery before the early provision and the requirements of training but the evening, and only then by breaking into an long hours which I, and all my colleagues, worked electve list or using a theatre which happened to during my training did provide vast experience be vacant. A high proporton of emergency across a broad range of surgery, even though a operatons therefore had to be done during the substantal part of that experience was obtained night. through operatng unsupervised in the middle of the night. In 1992 I was appointed as a consultant This was a roten way to provide an general surgeon with interests in vascular and emergency surgical service and, with hindsight, it paediatric surgery. At the outset, I did a lot of is difcult to believe that it was tolerated for so vascular surgery but also electve colorectal long. I was a member of the BMA’s junior doctors surgery (including cancer) and upper GI surgery, commitee during the 1980s (and its chairman in some breast and thyroid surgery and some 1983 – 84) and hours of work was our number paediatric surgery. I gave up breast, endocrine one agenda item throughout that tme. We made and electve GI surgery (except for gall bladders) remarkably litle progress with it. Unfortunately, as younger colleagues trained in these areas were we were faced at the same tme with career- appointed. No-one is trained nowadays to structure problems. The number of trainees practse across such a broad range and “general seemed substantally in excess of the number of surgery” has almost ceased to exist. This is partly consultant posts which would be available to because of technical advances in the them on completon of their training and subspecialtes but is mainly due to the unemployment loomed. We were wrong about impossibility of giving today’s trainees the breadth that but increasing trainee numbers to achieve or volume of experience which their predecessors more tolerable hours of work was not an opton. had, given the hours they are allowed to work and The junior doctors New Deal of 1991 provided for the intended duraton of training. A consultant a limit of 72 hours per week to be achieved by the surgeon appointed today will have well below half end of 1996, partly through the introducton of the training and experience which I had when “shif” working. Subsequently, the European appointed. As a result, general surgeons are Working Time Directve reduced the maximum to steadily being replaced by surgeons whose 48 hours per week. This has largely been training has been largely confned to colorectal, achieved but the career structure problems upper GI or hepatobiliary surgery, who may also remain unsolved. Stafng surgical rotas stll treat lumps, abscesses, hernias and appendicits. depends upon employing considerable numbers Vascular surgery became a fully-fedged, Page 17 Writen by Stephen Brearley 50 Years A Caian (cont.) independent specialty some fve years ago. This is refreshed state towards the end of the evening, creatng a need for separate on-call rotas for each my erstwhile dissectng partner Bleddyn Jones of these specialtes which, in turn, necessitates proposed to a few of us that, as a pre-eminently reconfguraton of services through centralisaton medical college, Caius should have a medical of specialist care or hub and spoke arrangements. society through which its medical alumni could It can give rise to problems if a surgeon from one contnue to meet. We were easily persuaded of specialty encounters a problem intra-operatvely this and, following correspondence with the then which demands the expertse of a surgeon from a Master and with the willing support of the diferent specialty, especially if that specialty is medical Fellows (partcular thanks due to Prof not represented on the same site. It may also James Fitzsimons, the late Prof Konrad Martn and increase the tendency to diagnostc “tunnel the late Prof Roger Carpenter) the Caius Medical vision”, a blindness to diagnoses falling outside Associaton came into being. It has held a the surgeon’s specialist feld, and may reduce job meetng in June every year since, except for 2020, satsfacton. and has been addressed by a dazzling array of speakers, both Caian and non-Caian. The quality I have thoroughly enjoyed my career in of their presentatons has been exceptonal and, if surgery and am stll enjoying it, which is why I am the content has sometmes been beyond the stll working full tme at the age of 68. I enjoy comprehension of a poor surgeon, the brilliance operatng but that alone would not be sufcient and intellectual excitement of them has been to keep me going. I contnue to be fascinated by breathtaking. They have also succeeded in what the challenges of diagnosis, fnd interacton with was a prime objectve of the founder members, patents endlessly rewarding and get great namely to enable Caius medics to meet old pleasure from teaching and encouraging medical friends and make new ones and they have forged students and trainees. I enjoy being part of an a strong bond between the Caius medical Fellows insttuton, and the interactons I have not only (who stll number a couple who taught me 50 with doctors from many disciplines but also with years ago) and the wider Caius medical all the other wonderful people who work in my community. Oh, and they conclude with a Caius- hospital: nurses, technicians, managers, clerical standard dinner for members, fellows and their staf, cleaners, porters and others. This has never guests at an afordable price. The meetngs are a been more true than during the coronavirus splendid opportunity to fnd out how things have pandemic, when going to work and contributng changed at Caius over the years and how they to the team efort as best I can has helped have not. I cannot recommend them highly preserve my morale and equanimity. enough and strongly encourage all Caius medics to atend them. All of this started at Caius and I carry with me tremendous grattude for all that the College Stephen Brearley has given me and enormous afecton for it. At an CMA Commitee member 1999 - 2019 Annual Gathering some 25 years ago, in a well- Page 18 CMA Photo Competton 2020: The Finalists
This year the CMA commitee launched their frst ever photo competton, which was open to all undergraduates to submit photos related to Caius, Medicine or Cambridge, with the theme “Captured Moments”. We were delighted to receive 33 submissions, and with the help of Professor Yao Liang as judge and the rest of the commitee to choose commendatons, we can reveal the winners and two further commended photographs. The frst prize winner (Gautham Kumar) received £25 and the top three prize winners received a free dinner at a CMA event.
We, and the main judge, were partcularly impressed with the top prize winning photograph capturing part of the medical exam we will all remember learning from medical school days - that of testng direct and consensual responses as part of a cranial nerve exam, depictng the view of the patent. Many thanks to Prof. Liang for his judging and for everyone who submited photographs.
We would be enthusiastc to run compettons again in the future - please get in touch with us with any ideas!
Hannah Charlote Copley
1st Prize: PEARL! (Gautham Kumar): “A long exposure. Although my camera doesn’t have separate pupils, this is what the trail lef by my pen light would look during the swing from eye to eye if it did. “Pupils equal and reactve to light with direct and consensual responses”. The aperture here, however, was already quite constricted.”
Page 19 CMA Photo Competton 2020: The Finalists (cont.)
Second Prize: A Break in Nature (Azmaeen Zarif): “Getng out of the Cambridge bubble can prove elusive with the constant lectures, practcals, essays and supervisions. Therefore, when we do get to take a moment out to explore Cambridge beyond the Colleges, it is always welcome. Here, we took a cycling trip to Grantchester and it can be said that there were no regrets of procrastnaton given the beautful Autumn scenery that it bestowed us with.”
Third Prize: Graduaton Captured (Rachel Fox/Sohail Daniel): “This is the medics and vets graduatng 2018 capturing a selfe with our beloved Director of Studies Dr James Fraser at the end of graduaton dinner”
Page 20 CMA Photo Competton 2020: The Finalists (cont.)
Special Commendaton: Autumn, Inverted and Refected (Rita Hess): “This ‘captured moment’ of Autumn in Cambridge was taken in the botanical gardens - one of my favourite places in Cambridge to get a refreshing dose of nature. The entry is a duo, with the second photo an inversion and refecton of the frst, original shot. The frst is a more traditonal testament to the splendour of Autumn, but I prefer the second, with its almost surreal upside-down benches and sky of water lilies; you choose which one you prefer!”
Special Commendaton: Life at Alttude (Michael Gardiner): “On my fnal weekend, I trekked into the mountains with a guide up to heights of 3200m. On my travels, I was awkwardly approached by multple locals seeking medical advice! They live 2 days walk from accessing proper medical care.”
Page 21 Creatng Productve Collaboratons: The CMA in the tme of Covid-19
On 2nd April 2020, the President of the (1968), a retred GP and Emeritus Professor of Caius Medical Associaton, John Latmer, Primary Care Epidemiology at Keele University. circulated to all members an email he had Peter had re-registered with the GMC, but was received from CMA member Dr Tony Williams feeling too distant from his days in practce to (1977). contemplate a clinical role. John’s email caught his eye as an opportunity, despite having litle Tony is an occupatonal physician, running experience of occupatonal health, to be of his own consultancy (Working Fit Ltd) from his practcal use, and he contacted Tony. In the home-base in Kent. By early April he had already ensuing days of exchanged emails, Tony and Peter been working closely with clinical colleagues and realised they had a mutual colleague in David members of the Associaton of Local Authority Coggon (Clare College 1969), Professor of Medical Advisors (ALAMA) to produce evidence- Occupatonal and Environmental Medicine at based risk assessment guidelines for use by Southampton University, with expertse in occupatonal health doctors and nurses across the occupatonal risk assessment and epidemiology. UK. The guidelines were designed to help in David was contacted, and from this was born a providing advice to workers in essental jobs project to identfy and use the best available during the height of the Covid-19 lockdown in the epidemiological evidence to provide estmates of UK, including recently retred professionals such Covid-19 vulnerability. as doctors who were considering the natonal call to re-register and return to work. The centrepiece The single most important observaton of the guidelines was a series of tables estmatng about Covid-19 vulnerability is that it increases the likely vulnerability to developing serious sharply and contnuously with age from the illness and dying of Covid-19 among people with youngest (where deaths are very few) to the very diferent underlying medical conditons, if they oldest (where case fatality is at its highest). Tony’s did contract the virus. ‘Big Idea’ was to invent the label ‘Covid-Age’ for expressing an individual’s vulnerability in terms of Tony was appealing for help from CMA the age of a healthy person with the same risk as members: “We need specialists from various that individual. David realised that the relatve felds to check over our tables and provide critcal risks for all other factors linked to severe Covid-19 comments”. The tables were then to be made illness (including comorbidites such as obesity, openly available on the ALAMA website to the renal disease, diabetes) could be converted into thousands of occupatonal health professionals “added years of age”. This could then be used as a across the country. summary evidence-based estmate of personal vulnerability to inform discussion with individuals Among the recipients of John’s fast- about returning to the workplace. Peter searched forward of Tony’s appeal for help was Peter Crof the literature and identfed a large high-quality
Page 22 Writen by Tony Williams and Peter Crof Creatng Productve Collaboratons: The CMA in the tme of Covid-19 (cont.) epidemiology study from UK primary care (the members alert to opportunites for putng their OpenSafely study) which provided the relatve risk actual experience and skills to practcal use in data needed for Covid-Age estmates. Covid tmes. So well done and a big thank you to the CMA. Joined by Paul Cullinan (Professor of Occupatonal and Environmental Respiratory In their email chats, Tony and Peter Disease at Imperial), and in collaboraton with a uncovered a longer-term stmulus to their work wider group of advisors from ALAMA, this team, and engagement that could, without too much led by Tony, has delivered and updated open- fanciful thinking, be atributed to the sheer access Covid-Age tables on the ALAMA website breadth and nature of their undergraduate during the 5 months since the CMA email. Linked experience at Cambridge generally and at Caius editorials and summaries have appeared in specifcally. Despite the heady reputaton of the Occupatonal Medicine and the Britsh Journal of college as a crucible for cutng-edge General Practce. The tables are being widely used undergraduate medical science educaton, neither by the occupatonal health community. They have of our two protagonists covered themselves with been adopted and adapted by the Scotsh glory in Part 1 of Tripos. Both indeed recall Government as part of their ofcial guidance on uncomfortable meetngs with James Fitzsimons, occupatonal risk assessment. David Spiegelhalter arraigned by his steely glare, following bad (Professor and Chair of the Winton Centre for Risk performances in exams. The source of their and Evidence Commnicaton at Cambridge) has trouble was an excessive interest in extra- highlighted the value of the ALAMA tables in blogs curricular actvites. and on the Radio 4 programme ‘More or Less’. There will undoubtedly be other tools emerging Tony writes “I spent much of my tme on that have been tested more extensively, but for the river rather than in the library, much to the the tme being the Covid-Age tables seem to have frustraton of my tutors, and I will never forget been a useful contributon to informing decisions James Fitzsimons, in a moment of despair, about returning to work. challenging me to prove that keeping ft and actve was important for health and to justfy my None of this may have happened without approach to the work-life balance. The result of the inital networking and facilitaton provided by that encounter was that I have been an exponent the Caius Medical Associaton and the of evidence-based medicine ever since, even serendipitous connecton it triggered between though I have followed a somewhat unorthodox Tony and Peter. It is difcult to imagine how their career, nineteen years with Airborne Forces and paths would have crossed otherwise, helped by then creatng a portolio career in occupatonal the rapidity with which a request for help could medicine. It has been a lot of fun, including the be circulated by the CMA to a community of last few months”.
Page 23 Writen by Tony Williams and Peter Crof Creatng Productve Collaboratons: The CMA in the tme of Covid-19 (cont.)
opted for “Arch and Anth”, Peter for Social Peter writes “Much of my tme was spent Anthropology. Both are very clear that this dodging lectures in order to pursue a sub- experience was an important driver of future Footlights alternatve with the Cambridge career moves into the (at the tme) niche areas of University Light Entertainment Society, visitng the occupatonal medicine and epidemiology. So a prisons and care homes of the East Midlands. I belated thank you to Professor Fitzsimons (the also will never forget the Fitzsimons review, glare hid the care) and to the fexibility of Caius resultng in a Long Vacaton spent in Cambridge and Cambridge in allowing a broad educaton, and which altered my life by introducing me to the a gentle thumbs-up to the fact that a less than idea that academic work could be as stmulatng high-fying undergraduate career need not be a and fun as the extracurricular life”. barrier to getng some academic output sorted later in life. One direct result of both their experiences was that each chose a non-medical Part 2 – Tony
Tony Williams and Peter Crof
For those interested, the tool can be found at: https://alama.org.uk/covid-19-medical-risk-assessment/
Page 24 A Personal View From General Medical Practce During The Pandemic
Since March 2020, many changes have centenarians, I now sit in a drafy consultng happened in my roles as a jobbing CMA member room, making telephone calls, viewing in the community. Many of you will know that I photographs sent in by patents to their medical have a portolio of jobs as a GP in Peterborough, records, and if I am lucky, having one or two face- as The Club Doctor and Medical Adviser for to-face consultatons a week, where there is a Peterborough United F.C. (aka “The POSH”), and clinical necessity. Sometmes I almost expect the as an “Appraiser” for the GMC Revalidaton of surgery to have been redecorated while I have GPs. been stuck at my desk, computer, and webcam!
The last is easy to comprehend; instead of This “new working in the NHS” has meetng doctors in person for their annual medico-legal pitalls, in that even with video call appraisal and peer support, we have been many physical signs escape the scrutny of meetng online using Microsof Teams. While this physical presence. For instance, I would normally is not as pleasant as driving across country in my “tck of” gait, limping, ataxia, breathlessness on vintage two-seater to see how colleagues exerton, etc., en-route to the seat and then practse, it has at least enabled appraisal to move tremor, pallor, jaundice, fear, anxiety, restless from box tcking of “evidence of actvity” to fdgetng, demeanour, and posture, all before the focussing on the hard-pressed GPs as individuals patent uters a word. A stoical individual saying, and how they are coping with the fears and “I’m alright”, has diferent permutatons in person pressures of working during the pandemic. than on the telephone. These things have made many of my colleagues rather nervous at work In the world of professional football, we and along with preparaton, has undoubtedly have got used to playing without our fans in the lengthened consultatons. stadium, being regularly tested for CoVid-19, working in drafy open rooms, and running onto Mercifully, it has shown many of our the pitch with a mask and at tmes a full-face visor “regular home visit” patents, that they can cope as well. without requestng the atendance of the doctor for minor complaints. On the other hand, one The biggest changes have been in general worries about how many delayed diagnoses (with practce, where instead of walking to the waitng possible subsequent poor outcomes), are being room to greet my patents, practsing my various stoked up by the focus on keeping the CoVid-19 mult-lingual greetngs according to what the beaste in its cage. computer or my memory says is their country of birth or frst language, exchanging practsed During this past year I have tried to banter with old “friends”, from primary school positvely infuence outcomes by audaciously children to my nonagenarians and occasional contactng “VIPs” in a personal capacity to ofer
Page 25 Writen by Cosmas Nnochiri A Personal View From General Medical Practce During The Pandemic (cont.) my insights and the benefts of my experience. In One of the most puzzling things for a May 2020, I wrote to “the most senior individual” jobbing GP, was why babies, infants, and school regularly at the daily briefngs explaining about children, whom we have to vaccinate with the lack of focus on fresh air ventlaton and umpteen things, from their post-natal baby check suggestng that “to provide care homes and to sitng their A-levels to gain entry to G&CC, schools with tents and gazebos would be a lateral were mysteriously “not vulnerable” or indeed, thinking masterclass”, at a tme when It seemed seemed innately immune to a new lethal virus. I to me, obvious that opening the windows and have postulated that this must relate to obligate internal doors to “reduce viral load at each nose breathing and the IgA we are born with in contact” was the best way to protect people, with our upper respiratory lining. There may be a no vaccine yet available. I had noted that contrary research paper in there for some young CMA to the statements about “BAME” folk, the death members. Likewise, the anomalous and rate was miniscule in countries where people inexplicable tny number of deaths (less than 40 at spent most of their tme outdoors and usually had the tme of writng) in Vietnam (also “would-be bars or mesh instead of glass in their windows. BAME”), a country with over 95 million people, a Thus, the sub-Saharan Africans (“would-be- long land border with China and no glut of ITU BAME”) were in fact much less at risk than white beds. I am proposing that there may be genetc Caucasians in the UK, EU, and USA (as I pointed variatons in T-cells, from which the Vietnamese out to said, “most senior individual”). South Africa have been dealt a good hand at the Immunity has more internatonal visitors, more White Casino. This surely merits a funded third year or Caucasians and more “Western infuence” on PhD project for some young CMA person. culture and housing than other black African countries, and its CoVid-19 deaths have been Finally, with my “simple preventatve conspicuous when looking at that region. It seems measures” hat stll on, I wrote to “the most senior obvious that our politcians should note that “It’s person” in health and social care, in November the environment Stupid”, and stop implying racial 2020 suggestng that we could do worse than inferiority, with talk of “BAME” being at higher emulate the wisdom and benevolence of post war risk. ”BAME” folk just happen to be where viral governments, in distributng free Vitamin D3 load is high, in indoor care, security and transport (which some may remember as free Cod liver Oil setngs, and at home with mult-generatonal in schools in the 1950s and 1960s). Not just the one-dwelling, poorly ventlated homes, focused bone protecton during CoVid isolaton in on heat preservaton, instead of fresh air wintertme, but there has always been sof ventlaton. Contrast with sub-Saharan Africans in evidence to suggest that Vitamin D3 and Vitamin Africa. C help to protect against viral illness, now including Covid-19. Interestngly, we have now
Page 26 Writen by Cosmas Nnochiri A Personal View From General Medical Practce During The Pandemic (cont.) had deliveries of four months’ supply of free tried not to trouble the practce. This has helped Vitamin D3 to our “shielding patents”. to keep me sane, as well as making many new friends. It is amazing what a Caius medical Finally, I have taken to writng amusing educaton can lead to. My frst career as a full- and informatve artcles in my local village tme surgeon seems such a long tme ago. Young magazine and my practce website, to support my CMA members be encouraged! neighbours and all of my patents who have kindly
Cosmas Nnochiri (1975)
CMA Committee List
President - John Latimer Hon. Treasurer - David Riches Hon. Secretary - Kevin O’Shaughnessy Newsletter Editors – Emma Walker & Julia Mantle
Mike Adams Members’ representatives Richard Baird Consultants – Howard Clark Hannah Copley GPs – Cosmas Nnochiri Stephen Gibson Registrars – Arpan Mehta Bleddyn Jones Undergraduates – Binu Perera Emma Walker
Directors of Studies Medical Fellows Patrick Chinnery James Fitzsimons James Fraser Ferdia Gallagher Zoe Fritz Joe Herbert Dino Giussani Kay-Tee Khaw John Latimer Dunecan Massey David Riches Julian Sale
Page 27 Proposal to Develop a Post-Doctoral Research Fellowship in Clinical Medicine at Gonville and Caius College
Covid-19 has emphasised the importance correspond to College research fellowships) have of having an agile, vibrant, clinical academic a success rate of ~5% natonally. This contrasts community that is able to address a health care with PhD studentships, where the overall success emergency and develop new treatments for new rate is ~30%. In efect, we are encouraging diseases. The immediate challenge presented by medical doctors to begin a research career, but an emerging infecton adds to a growing major severely limitng the opportunity for them to unmet need to understand and treat many develop their research experience and capability. common human diseases, including Alzheimer’s Gonville and Caius has a reputaton for being the disease, stroke, diabetes and metabolic disorders premier medical college in Cambridge, and has a including obesity, cardiovascular disease, cancer responsibility to develop the highest calibre and mental health disorders. Despite advances in academic researchers for the UK and globally. We public health and medicine, all are on the have considerable success in training research increase, in part refectng the aging populaton minded doctors at an undergraduate level, and globally. Unfortunately there has also been a supportng aspiring academic medics through steady decline in the number of research actve their PhD programme, but we have done litle to doctors in the UK over the last decade. address the emerging “pinch point” that is contributng to the decline of academic medicine. The UK Medical Schools Council Report in We therefore propose to create an Endowed Fund July 2018 reported a 25% decrease in to enable a Research Fellowship dedicated to intermediate level (post-PhD) clinical researchers academic medicine in perpetuity. This will not between 2004 and 2018, with an 11% decrease only begin to address the downward trend, but in since 2014. In 2019 the Academy of Medical tme it will lead to an illustrious alumni of world- Sciences described a 2.1% year-on-year decline in leading researchers who will promote the progression to independent research leadership reputaton of the College far and wide through for academic doctors since 2014. This decline is advances in biomedical science and clinical having a disproportonate efect on women in medicine. academic medicine, and it is not a problem specifc to the UK, with US Academy of Sciences We think that this project might be very reaching a similar conclusion in 2018. atractve to potental donors. Caius has traditonally, and wisely, sought to raise funds A major contributory factor is the limited with as litle restrictons as possible in order for opportunity for academic medics to develop their the College to retain fexibility and tmely independence following a period of post-doctoral response to areas of greatest need. In terms of research. There has been a 13% reducton in fundraising strategies, more clearly defned research grant award rates for this group since purpose enables potental donors more readily to 2014, and intermediate fellowships (which identfy with a project that clearly corresponds
Page 28 Writen by Patrick Chinnery and Joe Herbert Proposal to Develop a Post-Doctoral Research Fellowship in Clinical Medicine at Gonville and Caius College (cont.) with their interests and priorites. Medical securing funding for this project. While the funds research is an area that appeals to a broad range bequeathed are unrestricted, the legator has set of people, not necessarily just those who are out some preferences, one of those being to themselves immersed in a medical profession. It designate the funds towards a research fellowship also creates a sense of urgency. College has in “cancer and/or geriatric medicine”. recently been fortunate to receive a generous bequest that potentally goes a long way towards
Patrick Chinnery and Joe Herbert
Other News from CMA Members:
Marian Knight was awarded the 'Research Paper of the year 2020' in the BMJ awards for a trial investgatng antbiotc prophylaxis afer assisted birth: htps://www.bmj.com/content/370/bmj.m1789
Marian also actvated a rapid study of COVID-19 in pregnancy, using the system that she discussed when she spoke at the CMA in 2018. htps://blogs.bmj.com/bmj/2020/06/08/pregnancy-outcomes-and-covid-19- benefts-of-a-nine-year-gestaton/
From an old Caian’s lab, Jamie Davies set up an initatve to coordinate development of COVID-19 pharmacology, run on behalf of IUPHAR: htps://www.guidetopharmacology.org/coronavirus.jsp
Page 29 Previous CMA Lectures
1997 • Hot topics in infectous diseases Richard Le Page (1964) • Vitamins, genes and heart disease Morris Brown (1990) • DHEA: the elixir of life? Joe Herbert (1976) • A medical foray in the Valley of a Thousand Hills James Fraser, Stuart Kendrick, Narman Puvanachandra, Ben Zalin (1994) •Reminiscences of Caius Prof Austn Gresham (1943)
1998 • Highlights of high alttude medicine Charles Clark (1963) • Microbial debugging devices David Ellar (1968) • Is there an ant-ageing diet? Kay-Tee Khaw (1991) • The fowers of the stories from the stratum of the physicians: some exploratons in early Islamic medicine Nadeem Ali (1994) • The Politcs of Health The Rt Hon. Kenneth Clarke MP (1959)
1999 • How antbodies learn Julian Sale (1986) • Andean insights into metal hypoxia Dino Giussani (1997) • Exploits of a travelling surgeon Richard Heald (1996) • Aspirin: old questons, new answers Ray Nouraei (1996) • Calcium - a life and death signal Prof. Sir Michael Berridge (1961)
2000 • Depression: brain and mind Eugene Paykel (1985) • Genetc instability and cancer Ketan Patel (1996) • Neural decisions and free will Roger Carpenter (1973) • Evaluaton of a new colour scale for measuring haemoglobin Duncan Massey (1994) • Towards a treatment (or even a cure) for cystc fbrosis Prof Alan Cuthbert (1963)
2001 • Neuronal plastcity Fiona Arnold (1988) • Vascular acton of hormones Peter Collins (1973) • Looking at leters John Robson (1965) • The Rainmaker Mike Adams (1996)
Page 30 Previous CMA Lectures (cont.)
• Medical ethics and politcal correctness: are they compatble? Prof. Jean-Pierre Allain 2002 • Horror autotoxicus John Todd (1980) • Medicine in mountain rescue John Ellerton (1978) • The eicosanoids and PAF in glomerulonephri ts - pathophysiology…and what happened to therapy? Nigel Wardle (1953) • Nuclear transport and chromosome breakage in humans Chelvin Sng (1999) • Preventon of osteoporotc fractures from cradle to grave Prof. Cyrus Cooper (1974)
2003 • Can’t pee; won’t pee. Naima Smeulders (1989) • Stgma and the myths of mental illness. Oscar Hill (1950) • Healthcare in the Happy Isles. James Ware (1997) • Hypertension genes: a modern perspectve on the Pickering-Plat debate. Kevin O'Shaughnessy (1995) • Mechanisms of oxygen sensing in the body. Prof. Peter Ratcli fe (1972) 2004 • Sergeant Pepper’s lonely heart. Ferdia Gallagher (1993) • Repairing the damaged spinal cord. James Fawcet • The Good, the Bad and the Ugly. Anita Chandra (1993) • Towards a crystal-clear view of leukaemia. Alan Warren (1991) • Protein folding, misfolding and disease. Prof. Sir Alan Fersht (1962) 2005 • Less invasive autopsy: possibility or pipe dream. Andrew Breeze (1993) • Some lesser-known but infuental Caius medics. Jonathan Roos (1998) • Degeneratng discs: from newborn mice to ageing backs. Julia Flint (2002) • Mind-reading with brain imaging. Gearing Rees (1985) Advances in asthma management. Philip Ind (1968) • • Clinical research and experimental medicine. Prof. Sir Keith Peters
2006 • Atomic partcles in the treatment of cancer: the legacy of Rutherford and Chadwick. Bleddyn Jones (1971) • Magnetc resonance: interactons between proteins involved in cancer. Helen Mot (2005) • Human factors in medical disasters. Stephen Brearley (1971) • Industry, Empire and Epidemics: cholera in 19th-century Europe. Richard Evans (1998) • Human obesity: science versus stgma. Prof. Stephen O’Rahilly Page 31 Previous CMA Lectures (cont.)
2007 • Trachoma. Mathew Burton (1989) • Cholera and sodium defciency, thirst and sodium appette. James Fitzsimons (1946) • The selecton and care of dancers. Richard Pearson (1961) • The two sub-systems of colour vision. John Mollon (1996) • Taking on the immune system. Prof. Herman Waldmann
2008 • The perils and pleasures of editng a learned journal. Peter Tyrer (1959) • Are we becoming more allergic to food? Pamela Ewan • Prioritsing scarce resources: lessons from liver transplant organ allocaton. Alexander Gimson • Common low-penetrance alleles and breast cancer: their clinical signifcance. Paul Pharoah (1980) • Your foatng brain. Prof. John Pickard
2009 • Imprinted genes: what they tell us about normal and abnormal development. Anne Ferguson-Smith • The impact of modern imaging. Adrian Dixon • Autsm: new ideas on a common problem. Bonny Auyeung • Pre-eclampsia: is it of any relevance to physicians? Lucy Chappell • Prostacyclin and nitric oxide, discovery and biological signifcance in the cardiovascular system. Prof. Sir Salvador Moncada
2010 • Combat casualty care in Afghanistan. Lt. Col. Nigel Tai • Causes and preventon of type 2 diabetes. Nick Wareham (1993) • Twenty-frst century back pain: is it all in the mind? Nick Birch (1979) • Distract and Weld: current maxillofacial surgery Richard Loukota • Recent advances in immunotherapy for cancer. Hardev Pandha • Stem cell biology: overcoming the embryo. Prof. Austn Smith
2011 • Sudden cardiac death. James Fraser (1994) • Hepatts C - from virus to vaccine. Paul Klenerman • Early interventon in schizophrenia. Peter Jones • Gynae cancer through the keyhole. John Latmer • Is the Government right to abolish the HFEA? Martn Johnson
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Previous CMA Lectures (cont.) • KATP channels, neonatal diabetes and neurological disorders: from molecule to disease. Prof. Dame Frances Ashcrof 2012 • Alcohol and carcinogenesis. KJ Patel (1996) • Sex change: medical, legal and social challenges . Richard Green • Membranes and transporters. Richard Boyd • Hypertension: old problem, modern cures. Morris Brown (1990) • Extraordinary opportunites: from genome to health. Prof. Sir Mark Walport
2013
• Predic t ng outcomes in Parkinson’s disease. Caroline Williams-Grey (1995) • The hip detec tves: introducton of new implants into clinical practce. Alister Hart • The implica tons of reproduc t ve ageing. Susan Bewley Recent advances in brain tumour radiotherapy: cyberknives, IMRT, protons and the rest. Naomi Ferscht • (1988) • Oxygen sensing from worms to man. Prof. Patrick Maxwell
2014 • Elucidatng the role of macrophages and their cousins in the pathogenesis of AIDS and Parkinson’s disease. William James • Targeted protecton from sudden cardiac death. Andrew Grace • How can we discover new drugs that bind novel targets in the fght against cancer? Sir Tom Blundell • Breast cancer - what genomics has changed. Carlos Caldas
2015 • Royal Births 1700 – 2000: a refecton of changing practces in Obstetric Care. Sir Marcus Setchell KCVO • The hotest hashtag of 2015: PD1 directed cancer therapy. Luke Hughes-Davies • Nanotechnology in Medicine. Prof. Sir Mark Welland FRS FREng • The Heart in the Art of Leonardo. Blue skies anatomical/physiological research in Renaissance Italy. Francis Wells
2016 • Colour and the Body. Dr James Fox • The Challenges of managing Type 2 Diabetes in India. Dr Geofrey Levine • Friends with (Brain) Benefts – The Microbiome as a Regulator of Neurodevelopment and Behaviour. Prof. John Cryan. • Mitgatng mitochondrial mutatonal meltdown: can we save the species? Prof. Patrick Chinnery Page 33 Previous CMA Lectures (cont.)
2017 • Medicine: Where next? Personal refectons. Prof. Sir Leszek Borysiewicz • Heart Disease Link to Foetal Hypoxia: An Intergeneratonal Perspectve. Prof. Dino Giussani • Starch, Milk and Alcohol. Dr Giles Yeo • The Era of the Black Death. Prof. David Abulafa
2018 • Observing or intervening? What can we learn from ‘natural experiments’ to guide practce in maternal and child health?. Prof. Marian Kight • The history of the Victoria Cross: Harold Ackroyd and other VC heroes. Mr Christopher Ackroyd • Shell shock – a historical perspectve. Prof. Edgar Jones • Ovarian cancer genetcs: the clinical signifcance. Prof. Paul Pharoah • The Austn 7 on the Senate House Roof (60th Anniversary). Dr Michael Wood
2019 • Ethics, policy and practce: case studies in empirical ethics. Dr Zoë Fritz • The birth of cancers – a route to preventon. Professor Richard J Gilbertson • Understanding eatng disorders. Professor Hubert Lacey • Is John Caius the “Father” of Britsh anatomy? Professor David Riches
We look forward to seeing you on Saturday 26th June 2021!
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