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Biomedical Research Neuroscience

‘Patient H.M’ – An unsung hero: The forgotten man who forgot everything

By Asmita Anand

Published 4:40 PM EST, Sun May 23, 2021

Introduction

In recent decades, scientists have made huge progress discovering how our identities, and memories are made and stored. A patient that transformed our understanding of the way  memory functions are organised in the human brain, is  referred to as ‘the man who couldn’t make memories’; Henry Molaison possessed one of the most famous brains worldwide and bestowed unique insights into the inner-workings of human brains.

Who Was He?

Figure 1: HM in 1953 before his surgery (https://en.wikipedia.org/wiki/Henry_Molaison)

Henry Gustav Molaison, also known in medical literature as patient H.M. to protect his identity, was born on February 26, 1926 in Manchester, Connecticut.

As a child, he had a relatively normal childhood. Although it wasn’t long after a minor head injury and a family history of seizures (although the exact aetiology behind his seizures remains uncertain), that Molaison began suffering from severe epilepsy. At the age of 10, he started having absence seizures and 6 years later he developed generalised tonic-clonic seizures. His seizures greatly impacted his daily life and led him to drop out of high school. Later he was also unable to maintain his job and function independently. Molaison’s case was so severe that it couldn’t be treated pharmacologically with high doses of anticonvulsant medication.

After nearly 10 years he turned to Dr William Scoville, a renowned daredevil neurosurgeon of his time, with hope to lead a normal life once again. At the age of 27, his hippocampus was removed in an experimental procedure in an attempt to alleviate the impact his seizure had on the quality of his life. He underwent a ‘bilateral medial temporal lobectomy’, which surgically removed the medial temporal lobe on both sides of his brain. This included the hippocampal complex, parahippocampal gyrus, the uncus, the anterior temporal cortex, and the amygdala, according to Scoville’s own illustrations of his surgical technique. However in around 1992-199, MRI scans revealed that the surgery was less extensive than he thought, but enough to cause the damage it did. [1]

Figure 2: Diagram depicting HM’s brain after surgery compared to a normal human brain (https://thepsychologist.bps.org.uk/volume-26/edition-8/looking-back-understanding-amnesia-it-time-forget-hm)

Although Dr Scoville hoped it would cure the epilepsy, he still wasn’t completely sure whether it would be successful or if there might be any long lasting side effects of this procedure. As a result, both of his thoughts were correct. Molaison’s seizures had stopped but unfortunately he was also left with long term memory loss, leaving him constantly living in the present tense. Later Scoville admitted that the operation was a tragic mistake and has spoken strenuously about the dangerous implications of bilateral mesial temporal lobe surgery.

Different types of Amnesia

There are multiple types of amnesia, such as Retrograde, Anterograde, Transient global and Infantile amnesia. Retrograde amnesia is when someone is unable to recall events that occurred before the development of the amnesia and is commonly used in films and media. [2] Whereas anterograde amnesia refers to a decreased ability to retain new information and is typically caused by brain trauma. [3]

Molaison developed a peculiar form of amnesia and suffered from both partial retrograde amnesia and anterograde amnesia. The latter meant he lost the ability to form new memories, such as the inability to remember what he had eaten for lunch that day, tests that he just done minutes before and names he had just been introduced to. Scoville wrote: “After operation this young man could no longer recognise the hospital staff nor find his way to the bathroom, and he seemed to recall nothing of the day to day events of his hospital life. There was also a partial retrograde amnesia.” [4] This meant that while he could recall memories from his childhood, he was unable to remember almost 11 years of events prior to the operation. 

However, both his personality, intellectual abilities and perception remained unaffected and his IQ increased from 104 to 117. [5] Molaison still had the ability to form non-declarative memories, allowing him to still acquire and develop motor skills, which led to Brenda Milner’s discovery of the distinction between procedural and declarative memories. While his mind became like a sieve, through other testing performed by Milner she discovered that he still possessed short term memory. This led to the notion that this too existed in a separate brain structure to the one he lacked.

Short Term and Long Term Memory

Molaison’s misfortune ended up as a milestone in our understanding of the brain as up until it occurred memory wasn’t thought to be localised in one area of the brain. Dr Scoville and Brenda Milner were the first to make observations and report his case in 1957 in the “Loss of recent memory after bilateral hippocampal lesions”. Since he had difficulty remembering doing the tests in the day, Molaison never grew tired of the numerous experiments he partook in.

It is thanks to Molaison, that today we know that intricate functions are directly connected to distinct regions of the brain. The hippocampus, which is embedded deep into the temporal lobe, plays an important role in forming, retaining, and recalling declarative memories and spatial relationships. It’s also where short-term memories are turned into long-term memories.

Five decades later, referred to as Patient H.M., Molaison’s case grew in popularity due to the publication, which has thoroughly been cited numerous times. Researchers arrived at the conclusion that short term memory was not connected in any way to the medial temporal lobe structures. A particular researcher out of the 100 who studied him, Suzanne Corkin, spent the most time with Molaison interviewing him and working with him for 46 years. In her book “Permanent Present Tense: The man with no memory, and what he taught the world”, Dr Corkin covers how Molaison’s mind was used to understand how our minds and memory work. It also covers his early life and key childhood memories from their personal conversations or careful reporting and research. She wrote about how she went from viewing him as a “subject” to seeing him as a human being. Molaison’s life was not easy as he often struggled at times. After a while he came to understand that while others could retrieve and store memories, he could not. Nevertheless, he remained positive, coping well with his difficult situation and he acts as a true inspiration for his extreme resilience. H.M. once poignantly remarked that “every day is alone in itself. Whatever enjoyment I’ve had, and whatever sorrow I’ve had”. [6] 

His Legacy

Figure 3: Photography by Spencer Lowell (https://www.discovermagazine.com/mind/the-art-and-science-of-slicing-up-a-human-brain

Sadly Henry Molaison passed away at the age of 82 due to respiratory failure. Despite his death in 2008, his brain still continues to excite and offer further investigation into memory as there is still much to uncover. Mr Molaison was much, much more than a research specimen but a person who despite facing grave misfortune, still managed to show ‘the world you could be saddled with a tremendous handicap and still make an enormous contribution to life.’ [7] Columbia pictures and Scott Rudin have even acquired rights to develop a film based on his life.

As Dr Corkin described as “a beautiful finale to his enduring contributions”, his frozen brain was cut into 2,401 slices postmortem, which have been photographed and digitised into a high-resolution, 3D model for further anatomical analysis, in which we can even view individual neurons!

Molaison once commented: “It’s a funny thing – you just live and learn. I’m living and you’re learning.” Henry Molaison leaves behind a legacy (quite literally through the preservation of his brain!) which shall be remembered by us all and stay within our own memories. His forgetfulness has revolutionized our understanding of the brain, which we can still learn so much from till this date.

To end, as Dr Corkin said “Henry’s disability, a tremendous cost to him and his family, became science’s gain”.

Asmita Anand, Youth Medical Journal 2021 

References

[1] Annese, J. (2014, January 28). Postmortem examination of patient H.M.’s brain based on histological sectioning and digital 3D reconstruction. Nature Communications. https://www.nature.com/articles/ncomms4122

[2] I. (2020, November 25). Retrograde Amnesia | Symptoms, Causes, Illness & Condition. The Human Memory. https://human-memory.net/retrograde-amnesia/#:~:text=Retrograde amnesia is a form,that occur after the onset

[3] Cherney, K. (2018, September 18). Anterograde Amnesia. Healthline. https://www.healthline.com/health/amnesia/anterograde-amnesia#:~:text=Anterograde amnesia refers to a,is a subset of amnesia.

[4] Lichterman, B. (2009, March 17). Henry Molaison. The BMJ. https://www.bmj.com/content/338/bmj.b968.full

[5] Scoville, W. B., & Milner, B. (1957, February). Loss of recent memory after bilateral hippocampal lesions. NCBI. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC497229/

[6] Loring, D. W., & Hermann, B. (2017, June). Remembering H.M.: Review of “PATIENT H.M.: A Story of Memory, Madness, and Family Secrets”. Archives of Clinical Neuropsychology. https://doi.org/10.1093/arclin/acx041

[7] Adams, T. (2018, March 22). Henry Molaison: the amnesiac we’ll never forget. The Guardian. https://www.theguardian.com/science/2013/may/05/henry-molaison-amnesiac-corkin-book-feature

Halber, D. (n.d.). The Curious Case of Patient H.M. Brainfacts. https://www.brainfacts.org/in-the-lab/tools-and-techniques/2018/the-curious-case-of-patient-hm-082818

Gholipour, B. (2014, January 28). Famous Amnesia Patient’s Brain Cut into 2,401 Slices. Livescience.Com. https://www.livescience.com/42898-patient-hm-postmortem-brain.html

Shah, B. (2014b, July 1). The study of patient henry Molaison and what it taught us over past 50 years: Contributions to neuroscience Shah B, Pattanayak RD, Sagar R – J Mental Health Hum Behav. Journal of Mental Health and Human Behaviour. https://www.jmhhb.org/article.asp?issn=0971-8990;year=2014;volume=19;issue=2;spage=91;epage=93;aulast=Shah

Hodges, J. R. (2013, November 23). Memories are made of this. Oxford Academic. https://academic.oup.com/brain/article/137/3/970/2021901

Shapin, S. (2017, June 19). The Man Who Forgot Everything. The New Yorker. https://www.newyorker.com/books/page-turner/the-man-who-forgot-everything

Billington, A. (n.d.). Scott Rudin Developing Feature Film About Henry Molaison. FirstShowing.Net. https://www.firstshowing.net/2009/scott-rudin-developing-feature-film-about-henry-molaison/#:~:text=Taking a cue from The,in medical circles as H.M.

Categories
Biomedical Research

The Race for the Covid-19 Vaccine

By Asmita Anand

Published 7:40 PM EST, Mon April 19, 2021

Introduction

Ten authorised vaccines. Fifty-eight vaccine candidates still in development. All with the same aim. But just one is needed to stamp out this terrible pandemic.

Around April last year, while most of the world seemed to be shocked with horror by the effects of the pandemic, the race for the Covid-19 vaccine began as scientists hoped to provide immunity to this terrible disease and pulled out their magic card: vaccines.

The Vaccine War

A vaccine has the aim of reducing the severity of disease, making it one of the only magic cards we can currently pull out in an attempt to reduce the increasing mortality rate caused by SARS Covid-19. With the pandemic greatly impacting economies around the world, the vaccine is their ticket out of economic damage, making it the new golden ticket to success.

At the moment there are numerous proprietary vaccine candidates each competing, or have competed, for marketing authorization. The hunt for the vaccine has sparked the interest of both researchers and universities, with some even trialling new technologies that haven’t yet been licensed in a vaccine before. On the surface it seems that this geopolitical competition has pushed scientific discovery to a new level as we find ourselves at the crux of this situation with a huge variety of platforms being used, whether it be vector based, inactivated virus based or mRNA vaccines. Such diversity is welcome in academic research and competition has led to everyone coming up with their own ideas and providing many alternatives giving us a hand of cards from the joker to the king to even an ace, useful for potential variants of the virus.

Therefore, our best shot at tackling the pandemic seems to be the winner of this ‘rat race’. Sigh, this cannot be the best approach.

If we continue in this way, the ‘winner’ will be determined from the amount of financial or industrial help a candidate may have compared to its effectiveness. Furthermore, we’re also likely to use the one which achieves regulatory approval rather than its safety and suitability to public health. Trial protocols are being set up to produce success instead of the aim to prove it protects against the disease and death in hospitalisation.

For example, the FDA is willing to fast-track the roll-out of vaccines while both China and Russia have approved vaccines without waiting for the results of Phase 3 trials. [1] This rushed process could have serious risks and it exemplifies how scientific integrity is being undermined by hyper- competition. Even worse, Russia, Iran and China have even been accused of pandemic brinkmanship and allegedly hacked vaccine research. [2] Everyone wants to make this breakthrough and everyone wants to deal their own magic card.

It seems clear that while the element of competition is providing a fierce environment, it is taking a negative toll on research output. Both commercial and political pressure is pushing for immediate vaccination-roll out. As each country creates their own version, it will be more difficult to make each one available worldwide regardless of their efficacy as they struggle to even vaccinate their own nation.

Most scientists have even anticipated that, like most other vaccines, COVID-19 vaccines will not be 100% effective. [3] This concern only further perpetuates the public’s hesitancy on getting a shot which has been developed over months rather than years with unreliable evidence of success.

So, what should we do instead?

Let us paint an utopian version of this situation. Imagine if we had one global team who had full access to every combination of tools they could need. Imagine if each company feed-backed their findings to help each other out. Imagine if we truly tried using a global effort to solve this global solution. Instead, we’ve constrained ourselves with no freedom to collaborate. For the interest of the public and stopping the disease, vaccines need to be a united effort and not for the reputation or privilege of a particular company or nation.

Generation of collective intelligence will be more efficient and effective to provide robust solutions, especially when trying to find a mechanism to fit in such a strict framework. Even the World Health Organisation has proposed a collaborative efficacy trial, with one of their core functions detailing the coordination of international efforts through global collaboration and cooperation. [4] This builds on the idea of learning from other developers’ mistakes in order to increase productivity and efficiency in manufacturing one of the only current magic tricks we have up our sleeve.

Conclusion

So please, let us end this ‘rat’ race for the benefit of humanity. To conclude, we have already dealt ourselves with the best variety of cards, but we need to now play our hand right in order to successfully stamp out this disease once and for all.

Asmita Anand, Youth Medical Journal 2021

References

[1] O’Brien, Sarah. “FDA Willing to Fast Track Coronavirus Vaccine before Phase Three Trials End.” CNBC, CNBC, 31 Aug. 2020, http://www.cnbc.com/2020/08/30/fda-willing-to-fast- track-coronavirus-vaccine-before-phase-three-trials.html.

[2] Light, Felix. Pandemic Brinkmanship: the Geopolitics behind the Race for a Vaccine, 6 Aug. 2020, http://www.newstatesman.com/world/north-america/2020/08/pandemic- brinkmanship-geopolitics-behind-race-vaccine.

[3] “Coronavirus Disease (COVID-19): Vaccines.” World Health Organization, World Health Organization, http://www.who.int/news-room/q-a-detail/coronavirus-disease-(covid-19)- vaccines.

[4] “Accelerating a Safe and Effective COVID-19 Vaccine.” World Health Organization, World Health Organization, http://www.who.int/emergencies/diseases/novel-coronavirus- 2019/global-research-on-novel-coronavirus-2019-ncov/accelerating-a-safe-and- effective-covid-19-vaccine. 

Categories
Health and Disease

Non-Communicable Diseases – A Global Epidemic

By Asmita Anand

Published 5:22 PM EST, Mon March 22, 2021

Introduction

Unlike communicable diseases, non-communicable diseases haven’t seen a drop in figures in recent years. Known as ‘the product of economic development and globalisation of western lifestyle and diets’, they kill over 40 million people annually (70% of deaths worldwide)[1] and dominate mortality and morbidity in advanced countries. Today they affect people in every continent and from all cultures.

What Are Non-Communicable Diseases (NCDs) and How Are They Caused?  

NCDs can be known as chronic diseases and cannot be spread from person to person.They are usually caused by a combination of genetic vulnerabilities combined with physiological, lifestyle and environmental factors. For example, factors range from living in poverty or polluted surroundings to poor diet, tobacco and alcohol use.  

Figure 1 showing chronic disease risk factors for the four most common types of NCDs

NCDs include a variety of diseases ranging from 5 main groups: cancer, cardiovascular diseases (e.g. heart attacks or stroke), diabetes, chronic respiratory diseases (e.g. asthma) and mental disorders and other mental health conditions. Previously, mental health has been overlooked as a part of NCDs but recently UN member states expanded to a ‘five-by five approach’ to effectively tackle the prevention and control of NCDs [2]. Mental health’s integration along with these 4 common groups of NCDs is important as mental conditions often occur in conjunction with other physical NCDs and their risk factors often overlap. Another large misconception around NCDs is that they mainly affect the developed world, whilst diseases of poverty mainly affect the developing world. This sometimes leads to failure in regarding iit as a global health priority.

What Are The Risks of NCDs? 

Over-nutrition and excessive consumption of sugar, carbohydrates, fats and salts are becoming increasing health risks. These heightened risks are exacerbated by obesity and physical inactivity, which are increasingly apparent in younger age groups. Today these factors are being encouraged due to lifestyle and society changes. 

The prevalence of non-communicable diseases is increasing in richer countries. Unlike the popular belief of NCDs mostly afflicting the wealthy, the incidence of cancer is rising in poorer countries and expected to double by 2030. In 2016 around 70% of cancer deaths were in low to middle income countries [3]. However the incidence of cancer by age is still much greater in advanced countries than in LIDC’s and MIC’s. 

Global Impact

NCDs impact both the rich and poor causing a large burden of disease globally. 

As can be seen above in Figure 2, the majority of countries affected by NCDs, such as Africa and Eastern Europe, are all middle and lower income countries. This is especially true as the estimated percentage increase in cancer incidence by 2030, (compared to 2008) will be higher in  both low (82%) and lower-middle-income countries (70%) compared with the upper-middle (58%) and high-income countries (40%) [4]. Differentiating NCDs by just affluence or poverty isn’t particularly useful to understand the global pattern of disease but instead the result of economic development. Those of lower social and economic positions are more likely to die sooner from NCDs compared to those in higher positions, often resulting in driving these poorer members into more poverty. Reasons for this range from the negative effects of rapid globalisation and development in these poorer countries which often result in undeveloped infrastructure and resources to protect members from NCDs and to prevent engagement in behavioural risk factors for NCDs.

Why Is There An Increase In NCDs? 

An increase in NCDs is likely due to the ongoing shift in global lifestyles. This is especially occurring in developing countries, hence forming the global pattern above. A number of factors support the growth of NCDs, including: 

  • Population ageing 
  • Increase in consumption of sugar, carbohydrate and fat (unhealthy diets), which can lead to both raised cholesterol and blood pressure.
  • Global marketing which encourages unhealthy eating habits (Smoking, alcohol, junk food) targeted at children, adolescents and women in developing countries. These habits then stay with them their entire life and will get passed to the next generation.
  • Growing urbanisation that has an impact on people’s lifestyle (e.g. poor diet and insufficient physical activity leading to obesity, rising levels of air pollutants). 
  • In developing countries, governments tend to make less restrictions (e.g. on smoke-free laws, pollution control, education on diet/alcohol use, urban planning to encourage physical activity).  People in developing countries are more likely to have low life expectancies due to the harsh conditions they live in resulting in higher incidence of disease & illness compared to rich developed economies. 

The Link to Environmental Risks 

NCDs and environmental factors are intrinsically linked, hence climate change and NCDs share the similar goal to reduce emissions that is the cause of air pollution and global warming. Steps to control emissions across energy production, transport systems and food systems will produce benefits for both health and the environment. 

In Figure 2, we can see that in 2016 the second largest risk factor was air pollution after tobacco smoking. Depending on the population and other factors, in places such as Southeast Asia, air pollution would be one of the biggest causes of NCDs. 

Figure 3, Graph depicting selected risk factors by disease group, 2016.

More than 40% of people, mainly in low and middle income countries, are cooking with inefficient technology and fuel combinations leading to the accumulation of harmful smoke in their homes. Evidence is emerging that this has caused an increase in NCDs that includes 24% of cases of stroke, 25% of ischaemic heart disease, 28% of lung cancer, and 43% of chronic obstructive respiratory disease [5].

Neurological and mental disorders can also be associated with chemicals and around 1.3 million deaths from NCDs were caused by risks related to chemicals in 2016. To stop this form occurring, safer use of chemicals and more health measures are being carried out. Apart from health benefits, combating air pollution could also reduce climate change.  

Focused Research on Diabetes 

At the moment, 422 million people have diabetes worldwide and it is becoming a major issue [6].

This figure can be translated to 1 in 11. With the rise of diabetes cases, Technavio analysts have predicted that in 2019 to 2023, the global blood glucose test strips market will grow at a CAGR of over 6%.  Around 39% of this growth will be Americans alone and such a high surge means a lot more money will be spent in this area too. In the UK an estimated £14 billion pounds is spent a year on treating diabetes and its complications [7]. This equates to over £25,000 being spent on diabetes every minute.

One reason for an increase in these figures could be again due to the shifting lifestyles the world is facing.  Obesity rates are one of the main drivers behind the rise of type 2 diabetes. Equally it is also entirely possible that the increasing prevalence of type 2 diabetes is due to earlier and better detection strategies as the symptoms can be hard to spot. 

Many are unaware of the real cause behind a disease such as type 2 diabetes. It is a popular myth that sugar triggers diabetes, as many assume the increased blood sugar levels in diabetic patients must be its root cause. 

It is in fact not caused by a high carbohydrate diet or sugar but a diet that builds up the amount of fat in the blood. An accumulation of microscopic fat particles within muscle and liver cells leads to glucose being unable to reach where it needs to in the cells despite the efforts of insulin. As a result the pancreas produces extra insulin and glucose builds up in the bloodstream, hence increased blood glucose levels. The combination of insulin resistance and pancreatic cell failure leads to type 2 diabetes, making fat the real culprit. In order to decrease insulin resistance, fat intake needs to be decreased. However one should note a diet high in sugar will also lead to many other serious medical conditions if not contributing to the root cause of diabetes. Furthermore a study by HSPH researchers has found a strong association between both processed and unprocessed red meat and an increased risk of diabetes [8]. This reaffirms the idea that a diet avoiding meat, dairy products and overall fatty foods is a much better precaution to developing type 2 diabetes. 

Case Study on Type 2 Diabetes in Sri Lanka

A case study in Sri Lanka has provided the evidence that Type 2 Diabetes is linked mainly to diet, smoking and a poor & inactive lifestyle. Around 25% are suffering from diabetic or pre-diabetic symptoms, and this could double by 2050 [9]. There has also been a rise in BMI in children between the ages of 10-14 and a high number of risk factors are present within the young urban population. In countries like Sri Lanka, there has been a rapid growth of type 2 diabetes. 

This can be attributed to a number of reasons: 

  • Urbanization is increasing up to 59% and influences sedentary lifestyles [9].
  • Diets in Sri Lanka are carbohydrate heavy as rice and curry is a staple meal. This is eaten 3 times a day but is not a problem for agricultural workers as much as it is for office workers, who will have a higher sugar intake. 
  • Many marketing campaigns encourage the use of alcohol and tobacco as currently 29.4% men and 0.1% women smoke [10].
  • Around 68% of people work in industry and services and most use cars and public transport opposed to walking or cycling to travel to work [9].
  • Exercise has not been a priority as many adults work long hours and so have little time for physical activity. Children also follow their parents path as new generations live in a world full of technology coupled with Sri Lanka’s ‘tuition culture’, leaving them with little free time for exercise as well.
  • Another important factor contributing to the onset of diabetes is stress. Sri Lanka experienced a long civil war which led to stress and fear. A Swedish study found that chronic stress for 1-5 years was associated with a 45% increase in risk of both type 1 and 2 diabetes [11]. In response to stress, the body releases hormones which can upset the body’s glucose balance.  

Figure 4 showing the distribution of diabetes in Sri Lanka

What Is Being Done in Sri Lanka to Combat Diabetes?

There is an increased media coverage raising awareness for diabetes as the government is focusing more of their attention on health issues. There has been development of fitness facilities (such as new jogging tracks), more education and public awareness (such as lectures, workshops, screening and treatment centers) and research into diabetes. The Diabetes Association of Sri Lanka has set-up walk-in screening centers in Colombo that people can attend at a modest cost. They have also collaborated with a research team from Kings College London on an intensive screening, education and monitoring program which has identified young people at risk from developing diabetes. As of 2016, they had managed to lower the risk of people developing Type 2 diabetes by 26% in the previous 5 years. A developing economy like Sri Lanka is finding it challenging to afford the cost of treatment that is rising by 25 US$ each year.

They have also found out in a study last year (i.e. 2020) that there is a genetic overlap between type 2 diabetes and depression for female participants [12].

To help lower the risk, prevention is key as attitudes to diet and exercise need to change, which includes the control of sugar, fat and salt. 

What Is the UK Doing to Combat NCDs?

In the UK itself, NCDs account for around 89% of all adult deaths(2016) [13]. The UK is using systems at both local and national levels to try and prevent and intervene early in NCDs. The national government mainly monitors population behaviors and health indicators with a responsibility to enact policies that will optimize the health of their citizens. In 2012, public healthy responsibilities were deferred to local authorities. Local governments are able to work with the community, respond to local needs and also create settings that support healthier lifestyle behaviors. Examples include the NHS health check and National Child Measurement Programme. Both play a key role in preventing NCD, as even local nutrition prompts in a school or leisure centre could make the difference. 

There are many studies and research being done to tackle the epidemic of NCDs as actions such as early immunisations to help lower the risks. Screening programmes and social marketing campaigns such as Change4Life are also making a change. These are run by Public Health England (PHE), who are working with the NHS, to solve this issue nationally and globally. 

Conclusion

Overall, by reducing the four main behavioural risk factors (tobacco use, physical inactivity, harmful use of alcohol and poor diet), a large proportion of NCDs could be prevented. In order to end the huge toll they take in forms of human suffering and the damage they cause to economic human development, serious action is needed on a global, national and even a personal scale to end this horrible epidemic. 

Asmita Anand, Youth Medical Journal 2021

References

[1]“C3 Collaborating for Health | What Are Non-Communicable Diseases (NCDs)?” C3 Collaborating for Health, 17 May 2018, www.c3health.org/work-with-us/why-prevention/what-are-non-communicable-diseases/#:%7E:text=40%20million%20people%20are%20killed,for%2070%25%20of%20deaths%20worldwide.

[2]Stein, Dan. “Integrating Mental Health with Other Non-Communicable Diseases.” The BMJ, 28 Jan. 2019, www.bmj.com/content/364/bmj.l295.

[3]“The Global Cancer Burden | American Cancer Society.” The Global Cancer Burden, www.cancer.org/health-care-professionals/our-global-health-work/global-cancer-burden.html#:%7E:text=In%202016%2C%20out%20of%20nearly,in%20cancer%20incidence%20by%202030.

[4]Page 13,World Health Organization. “Global Status Report on Noncommunicable Diseases 2010.” World Health Organization, 5 Oct. 2015, www.who.int/nmh/publications/ncd_report2010/en.

[5]Prüss-Ustün, Annette. “Environmental Risks and Non-Communicable Diseases.” The BMJ, 28 Jan. 2019, www.bmj.com/content/364/bmj.l265.

[6]“Diabetes” World Health Organization, 13 May 2019, www.who.int/health-topics/diabetes#tab=tab_1.

[7]Editor. “Cost of Diabetes.” Diabetes, 11 Mar. 2020, www.diabetes.co.uk/cost-of-diabetes.html.

[8]“Red Meat Linked to Increased Risk of Type 2 Diabetes.” News, 13 Jan. 2014, www.hsph.harvard.edu/news/press-releases/red-meat-type-2-diabetes.

[9]Curriculum Press. “A Tsunami of Non-Communicable Diseases?” Curriculum Press, 5 Apr. 2019, https://curriculum-press.co.uk/resources/a-tsunami-of-non-communicable-diseases

[10]Tobacco Tactics. “Sri Lanka- Country Profile.” TobaccoTactics, 5 Jan. 2021, tobaccotactics.org/wiki/sri-lanka-country-profile.

[11] A. Perceived stress and incidence of type 2 diabetes: a 35-year follow-up study of middle-aged Swedish men. https://pubmed.ncbi.nlm.nih.gov/23075206/

[12]Kan, Carol. “Genetic Overlap Between Type 2 Diabetes and Depression in a Sri Lankan Population Twin Sample.” PubMed, 2020, pubmed.ncbi.nlm.nih.gov/31794442.

[13]“Noncommunicable Diseases Country Profiles 2018.” World Health Organization, 24 Sept. 2018, www.who.int/nmh/publications/ncd-profiles-2018/en.

Figure 1 – “Chronic Diseases Fact Sheet.” GACD, www.gacd.org/research/what-are-ncds/chronic-diseases-fact-sheet.

Figure 2 and 4 – Fenton, Kevin. “Tackling the Epidemic of Non-Communicable Diseases.” Public Health Matters, 27 Feb. 2014, publichealthmatters.blog.gov.uk/2014/02/27/tackling-the-epidemic-of-non-communicable-diseases.

Figure 3 – “Environmental Risks and Non-Communicable Diseases.” The BMJ, 28 Jan. 2019, www.bmj.com/content/364/bmj.l265.

Glossary 

NCD – Non-Communicable Disease

LIDC – Low Income Developing Countries

MIC – Middle Income Developing Countries

Categories
Commentary

What Makes a Good Doctor? The Balancing Act Between IQ and EQ

Introduction

Many would argue that medicine is a prestigious career. A doctor is expected to treat, improve and save patient lives. But does this cookie-cutter definition really describe a “good” doctor? 

There is no doubt that the medical profession is not for the faint-hearted. So, what sets apart this profession, and what differentiates the ‘good’ doctor from the “bad”? In this essay, I am hoping to explore this rather complex, intriguing question and analyze whether this perceived notion of a doctor, in reality, is ‘good’.

Medicine is an intellectually demanding career. After years of hard work at medical school, doctors are expected to apply their skills to patients with conditions of varying complexities. A doctor at times may not have a clear and immediate solution as exemplified by Covid-19. 

The key here is the problem-solving aptitude, ability to cope with difficult & demanding situations by being resilient and empathetic to patient wellbeing. The Intelligence Quotient (IQ) that measures academic or cognitive intelligence may be too narrow to cover all the skills required, individuals with a high Emotional Quotient (EQ) may achieve higher success. EQ refers to the person’s ability to perceive, control, evaluate, and express emotions.1 Evidence is emerging that EQ is as important for patient outcomes as it is for business and relationship success.2 

Therefore, the perfect concoction of qualities of a good doctor is formulated by IQ and EQ – the Intelligence and Emotional Quotients. 

So how does EQ contribute? 

Emotional intelligence can best be described as the ability to monitor one’s own and other people’s emotions, to discriminate between different emotions and label them appropriately, and to use emotional information to guide thinking and behaviour.3 

In fact, in the UK much of this is evaluated as early as the application to medical school. Physicians work in both emotionally demanding and highly complex environments. A Loyola Medicine study4 demonstrates that an educational curriculum for physicians in training improves their emotional intelligence, which may help protect against burnout.

Key competencies of a good doctor: 

Communication and Social Skills 

Doctors need to first communicate to understand their patient’s issues and then effectively explain the diagnosis, using clear, simple language emptied of medical jargon. Physicians with high EQ have the ability to recognize, relate and influence a patient’s emotions to make them feel empowered and hopeful. 

Relationships and Caring 

It’s important to not view patients as a list of medical problems but as opportunities to build confidence and trust between patient and doctor. When patients are cared for and listened to, they are more likely to comply with medical recommendations and return for follow-up visits, leading to strong relationships and positive interactions with clinicians and health care administrators. 

Self-Awareness and Self-Regulation 

EQ can help prevent emotions affecting clinical decisions. This self-awareness can be critical in ensuring each patient is treated with respect & dignity and is provided the highest quality care, thereby covering two of the six core NHS values.5 

Leadership and Teamwork – To be a physician is to lead6

In addition to clinical responsibilities, physicians serve as leaders and advocates and medicine involves leadership responsibilities at various levels i.e. individual, community, and societal levels. 

EQ accounts for 67% of the abilities needed for leaders and mattered twice as much as IQ. 7 Besides leadership, teamwork is essential for best patient outcomes and high EQ individuals create better connected and motivated teams. A lack of EQ, a source of failure as a leader, results in being overly defensive, resolving conflict poorly, and not connecting well with your team.8 

Despite the unfocused attention towards leadership, it can make an important difference in better clinical outcomes, experiences, increased empathy, and financial sustainability; not only this, but it also affects physician well-being. EQ and higher levels of leadership can help make physicians more resilient to the stresses of professional burnout and result in greater professional satisfaction. Overall, higher EQ increases both influence and change and helps physicians become the type of leader that others want to follow.

Conclusion: What is important – EQ or IQ? 

Let us picture it: High IQ but can’t get along with others? Or high EQ but unable to make the correct diagnosis? Without the other, achieving success would be a huge struggle. 

Instead of focusing on one aspect of intelligence, the greatest benefit may lie in learning to improve the less dominant one.

A successful doctor cannot have one but not the other. Instead of focusing on one aspect of intelligence, the greatest benefit will come from striving to learn the one lacking. 

Doctors with EQ besides IQ demonstrate greater influence, deliver positive results and create leaders. In the future, new technologies based on Artificial Intelligence and surgical robots will enhance technical expertise, but not the ability to emulate emotions, making EQ more valuable than ever. 

EQ can also be enhanced9 and IQ can be increased10, so what does this mean? 

Multiple aspects of intelligence are all essential to the growth in the field of medicine. The perfect balance of the qualities which lie in both is what makes not only ‘good’, but a ‘great’ doctor. 

Asmita Anand, Youth Medical Journal 2021

References

1https://www.verywellmind.com/what-is-emotional-intelligence-2795423
2https://www.cognitiveinstitute.org/get-smart-about-emotional-intelligence/
3https://www.oxfordreference.com/view/10.1093/oi/authority.20110803095749954
4https://www.dovepress.com/promoting-wellness-and-stress-management-in-residents-through-emotiona-pe
er-reviewed-article-AMEP

5https://www.hee.nhs.uk/about/our-values/nhs-constitutional-values-hub-0
6https://hbr.org/2018/10/why-doctors-need-leadership-training
7Goleman, D. (1998). Working With Emotional Intelligence. New York, NY. Bantum Books
8https://leanforward.hms.harvard.edu/2019/06/13/emotional-intelligence-for-physician-leaders/

9https://greatergood.berkeley.edu/article/item/can_emotional_intelligence_be_taught
10https://www.psychologytoday.com/gb/blog/iq-boot-camp/201605/newevidence-iq-can-be-increased-brain-training