Trump Finalizes New “Conscience Objection” Rule For Medical Care
-Veolette Hanna
On Thursday, May 2, 2019, President Donald Trump announced a new rule on religious conscience objections for medical care. The idea was proposed in January 2018, and has now been finalized. The Department of Health and Human Services announced that the rule will be protecting healthcare workers who cite moral or religious reasons to not provide, pay for, or have any involvement with certain medical procedures such as abortion, sterilization, and assisted suicide.
The rule came with the creation of the Conscience and Religious Freedom Division within the civil rights office of the Department of Health and Human Services. According to the HHS civil rights office, this rule is reestablishing existing protections created by Congress. The office's director, Roger Severino, stated: "laws prohibiting government funded discrimination against conscience and religious freedom will be enforced like every other civil rights law."
There was an immediate response from civil rights and reproductive rights groups, saying that “the idea of religious liberty is being used to justify hurting communities and endangering lives and will negatively affect women's health and that of transgender patients.” Deputy legal director at the American Civil Liberties Union, Louise Melling, said in a statement: "Religious liberty is a fundamental right, but it doesn't include the right to discriminate or harm others. Denying patients health care is not religious liberty.” This rule has already begun to cause an obvious moral and ethical conflict regarding whether or not the government can protect the religious liberty of healthcare providers as well as the civil rights of patients at the same time.
The rule came with the creation of the Conscience and Religious Freedom Division within the civil rights office of the Department of Health and Human Services. According to the HHS civil rights office, this rule is reestablishing existing protections created by Congress. The office's director, Roger Severino, stated: "laws prohibiting government funded discrimination against conscience and religious freedom will be enforced like every other civil rights law."
There was an immediate response from civil rights and reproductive rights groups, saying that “the idea of religious liberty is being used to justify hurting communities and endangering lives and will negatively affect women's health and that of transgender patients.” Deputy legal director at the American Civil Liberties Union, Louise Melling, said in a statement: "Religious liberty is a fundamental right, but it doesn't include the right to discriminate or harm others. Denying patients health care is not religious liberty.” This rule has already begun to cause an obvious moral and ethical conflict regarding whether or not the government can protect the religious liberty of healthcare providers as well as the civil rights of patients at the same time.
Are Our Phones Leading To Our Demise?
-James He
We’ve all done it. We’ve all made a New Year’s resolution or personal goal to spend less time on our phones or to go on a social media cleanse. This may persist for a couple hours or even a few days, but the end result usually remains the same. Once the bombardment of notifications amounts to a constant buzzing of temptation, we immediately become engrossed with our phones more than before, and the habit persists.
This has been the trend over the last couple decades as the average American now spends approximately four hours a day on their phone and almost the entire day with their phone within arm’s reach. Dedicating a significant portion of our day to these electronic devices has been shown to pose distractions that can limit our attention span, memory, productivity, sleep, creativity, and problem-solving ability. These detriments can be attributed to the fact that time on our phones takes time away from the world around us, time that could be dedicated towards socializing, learning, and developing hobbies. When we interrupt these processes with a glance at the laundry list of notifications on our phones, our mind gets distracted and breaks our focus.
If that isn’t enough incentive to put down your phone, then consider the fact that many scientists have found that frequent phone usage can contribute to chronically elevated cortisol levels in our bodies, a common indicator of stress. Production of this hormone stimulates a fight-or-flight response, leading to increased blood pressure, heart rate, and blood sugar. Each time your phone buzzes with a new notification, cortisol levels will rise to stimulate these physiologic responses as though you were in the presence of life-threatening stimuli, but it’s really just a snapchat from a friend trying out a new filter. Continuously checking your phone and receiving new notifications that contribute to this response will perpetuate these elevated cortisol levels, a physiological feature of depression, obesity, diabetes, stroke, dementia, and other health defects. To make matters worse, elevated cortisol levels will also heighten your dependency on this behavior, and turn something seemingly harmless in checking your phone into an addiction. This stems from an impairment to the prefrontal cortex, the brain’s executive decision-making structure. Each time you pick up your phones right after you receive a notification, this becomes ingrained as your normal behavior, and this instinct drives you to pick up your phone to send a text even when you’re driving.
Keep this in mind next time you bump into someone because you were looking down at your messages. Resisting a seemingly harmless glance at a notification can yield long-term physical and mental benefits.
This has been the trend over the last couple decades as the average American now spends approximately four hours a day on their phone and almost the entire day with their phone within arm’s reach. Dedicating a significant portion of our day to these electronic devices has been shown to pose distractions that can limit our attention span, memory, productivity, sleep, creativity, and problem-solving ability. These detriments can be attributed to the fact that time on our phones takes time away from the world around us, time that could be dedicated towards socializing, learning, and developing hobbies. When we interrupt these processes with a glance at the laundry list of notifications on our phones, our mind gets distracted and breaks our focus.
If that isn’t enough incentive to put down your phone, then consider the fact that many scientists have found that frequent phone usage can contribute to chronically elevated cortisol levels in our bodies, a common indicator of stress. Production of this hormone stimulates a fight-or-flight response, leading to increased blood pressure, heart rate, and blood sugar. Each time your phone buzzes with a new notification, cortisol levels will rise to stimulate these physiologic responses as though you were in the presence of life-threatening stimuli, but it’s really just a snapchat from a friend trying out a new filter. Continuously checking your phone and receiving new notifications that contribute to this response will perpetuate these elevated cortisol levels, a physiological feature of depression, obesity, diabetes, stroke, dementia, and other health defects. To make matters worse, elevated cortisol levels will also heighten your dependency on this behavior, and turn something seemingly harmless in checking your phone into an addiction. This stems from an impairment to the prefrontal cortex, the brain’s executive decision-making structure. Each time you pick up your phones right after you receive a notification, this becomes ingrained as your normal behavior, and this instinct drives you to pick up your phone to send a text even when you’re driving.
Keep this in mind next time you bump into someone because you were looking down at your messages. Resisting a seemingly harmless glance at a notification can yield long-term physical and mental benefits.
The Resurgence of Measles
-Yifeng (Ethan) Wang
Imagine learning about the nuances of a disease at the same time as your mentor. That’s exactly what is going on around the country, as many doctors and their residents are learning about these “returning” diseases, including measles, that were thought to be eradicated in the U.S. nineteen years ago.
New York City, one area experiencing an outbreak of measles primarily in the ultra-orthodox Jewish community, has been trying its best to treat those with measles. Dr. Adam Ratner, chief of the pediatric infectious diseases at NYU School of Medicine, notes that there is a learning curve of “little pieces of understanding a disease”. At the same time, these little pieces could be deadly, as measles can cause rare events like encephalitis, seizures, and other side effects that will show up when enough patients are infected with measles [1]. While this provides for an interesting learning experience, the cost is tremendous in the damage that measles can cause.
The primary cause of these measles outbreaks is the lowered rates of vaccinations around the world. Many measles outbreaks start because unvaccinated individuals are infected with measles and bring it to the U.S, spreading it to other unvaccinated individuals.
Measles is a special disease in recent vaccination history. The vaccine that offers protection from measles, known as MMR (measles, mumps, rubella), was linked to autism in the now-debunked study by Andrew Wakefield in 1998. This link, which has been disproven by many subsequent studies, has nevertheless been a rallying cry for anti-vaccination movements. There are many derivative (and false) claims of the dangers of vaccination from Wakefield’s discredited and retracted publication. Many supporters of Wakefield, many who are parents of autistic children, believe that he has been wronged treated for telling the “truth” about vaccines [2]. This follows another general trend of suspicion of general science; the claims of anti-vaxxers against established science can be seen in climate change denial or GMOs misrepresentation (Is a top result for when you search “GMOs” in Google Images a picture of a tomato with a syringe in it? That’s not how GMOs are made!)
What can you, a budding physician, do to combat low vaccination rates? One way is to provide the correct information to patients. This is simple to do, as you will simply tell them what you have learned about vaccines. For example, you may have a patient who is worried about thimerosal in vaccines. Check reputable sources about thimerosal, and you can even check to see if the vaccine they want has thimerosal in it (MMR does not) [3]. You may not be able to convince everyone that vaccines are safe. However, it is your job as the medical professional to provide the correct (evidence-based) information to patients.
New York City, one area experiencing an outbreak of measles primarily in the ultra-orthodox Jewish community, has been trying its best to treat those with measles. Dr. Adam Ratner, chief of the pediatric infectious diseases at NYU School of Medicine, notes that there is a learning curve of “little pieces of understanding a disease”. At the same time, these little pieces could be deadly, as measles can cause rare events like encephalitis, seizures, and other side effects that will show up when enough patients are infected with measles [1]. While this provides for an interesting learning experience, the cost is tremendous in the damage that measles can cause.
The primary cause of these measles outbreaks is the lowered rates of vaccinations around the world. Many measles outbreaks start because unvaccinated individuals are infected with measles and bring it to the U.S, spreading it to other unvaccinated individuals.
Measles is a special disease in recent vaccination history. The vaccine that offers protection from measles, known as MMR (measles, mumps, rubella), was linked to autism in the now-debunked study by Andrew Wakefield in 1998. This link, which has been disproven by many subsequent studies, has nevertheless been a rallying cry for anti-vaccination movements. There are many derivative (and false) claims of the dangers of vaccination from Wakefield’s discredited and retracted publication. Many supporters of Wakefield, many who are parents of autistic children, believe that he has been wronged treated for telling the “truth” about vaccines [2]. This follows another general trend of suspicion of general science; the claims of anti-vaxxers against established science can be seen in climate change denial or GMOs misrepresentation (Is a top result for when you search “GMOs” in Google Images a picture of a tomato with a syringe in it? That’s not how GMOs are made!)
What can you, a budding physician, do to combat low vaccination rates? One way is to provide the correct information to patients. This is simple to do, as you will simply tell them what you have learned about vaccines. For example, you may have a patient who is worried about thimerosal in vaccines. Check reputable sources about thimerosal, and you can even check to see if the vaccine they want has thimerosal in it (MMR does not) [3]. You may not be able to convince everyone that vaccines are safe. However, it is your job as the medical professional to provide the correct (evidence-based) information to patients.
An Update on the Investigation of He Jiankui
-James He
Back in late November of 2018, a Chinese scientist, He Jiankui, presented work at a Hong Kong conference, claiming to have altered H.I.V. susceptibility in the world’s first genetically altered babies using CRISPR/Cas9 gene editing technology. Upon release of such news, He Jiankui was instantly scrutinized for both the integrity and ethical nature of his research as well as his violation of state guidelines. This fueled controversy and a thorough ongoing investigation into the scientist’s collaborators and research methods.
He Jiankui mentioned that he had reviewed his research plan with other scientists throughout the development and fulfillment of his project. Dr. Stephen Quake, a bioengineer and inventor from Stanford University, is currently amongst a cohort of scientists under investigation for their role in facilitating Dr. He’s research. As a former academic advisor to Dr. He’s postdoctoral work, Dr. Quake has kept in contact with Dr. He, helping to discuss and advise Dr. He’s research process. Debatably in good intentions, these interactions between Dr. He and Dr. Quake has led to allegations of him aiding in the development and fulfillment of the research process, approach towards publishing and releasing the material to the press, and strategy for interacting with the public after release of the news. In light of Dr. He’s predicament, Dr. Quake has denied these allegations, and cites his communication with Dr. He as vastly misinterpreted.
When Dr. He first discussed his research with Dr. Quake, he was hesitant to support the research, but Dr. He’s was persistent and exhibited no signs of giving up. Dr. Quake immediately advised him to acquire I.R.B. approval before any experimentation. The two remained in contact throughout the progression of the research. Knowing He Jiankui’s tendency to cut corners, Dr. Quake often checked to make sure that all rules and regulations were followed. Ultimately, it appears Dr. Quake maintained an important presence in the fulfillment of the research, but wanted his name removed from the acknowledgements in Dr. He’s presentation in Hong Kong, illustrating his awareness of the ethical boundary the research might have conflicts with.
While more information needs to be gathered for this investigation, it is evident that the situation with He Jiankui is unique and likely involves a wide network of scientists. As we dive further into the issue, it is pivotal that we keep in mind the ethical ramifications of this situation.
He Jiankui mentioned that he had reviewed his research plan with other scientists throughout the development and fulfillment of his project. Dr. Stephen Quake, a bioengineer and inventor from Stanford University, is currently amongst a cohort of scientists under investigation for their role in facilitating Dr. He’s research. As a former academic advisor to Dr. He’s postdoctoral work, Dr. Quake has kept in contact with Dr. He, helping to discuss and advise Dr. He’s research process. Debatably in good intentions, these interactions between Dr. He and Dr. Quake has led to allegations of him aiding in the development and fulfillment of the research process, approach towards publishing and releasing the material to the press, and strategy for interacting with the public after release of the news. In light of Dr. He’s predicament, Dr. Quake has denied these allegations, and cites his communication with Dr. He as vastly misinterpreted.
When Dr. He first discussed his research with Dr. Quake, he was hesitant to support the research, but Dr. He’s was persistent and exhibited no signs of giving up. Dr. Quake immediately advised him to acquire I.R.B. approval before any experimentation. The two remained in contact throughout the progression of the research. Knowing He Jiankui’s tendency to cut corners, Dr. Quake often checked to make sure that all rules and regulations were followed. Ultimately, it appears Dr. Quake maintained an important presence in the fulfillment of the research, but wanted his name removed from the acknowledgements in Dr. He’s presentation in Hong Kong, illustrating his awareness of the ethical boundary the research might have conflicts with.
While more information needs to be gathered for this investigation, it is evident that the situation with He Jiankui is unique and likely involves a wide network of scientists. As we dive further into the issue, it is pivotal that we keep in mind the ethical ramifications of this situation.
Return of Measles
-Priya Gupta
Despite its previous eradication, measles outbreaks are currently occurring in the United States. Due to the highly contagious nature of the disease, many official policies have been passed in order to try to limit the spread of the disease. For instance, people living in high-risk areas of New York City are being required to get vaccinated against measles or face a fine. Children remaining unvaccinated can even be turned away from classes and other school events to protect the other children. In addition to simply getting vaccinated, public health officials are encouraging people who have not already done so to receive two doses of the vaccine, as one dose is not always effective.
The more people who are vaccinated against the disease, the less people the disease can affect, explaining why vaccinations are being so strongly pushed. However, there are some people who cannot do so. Young infants, people with immune diseases, and patients receiving certain medical treatments are among the group of individuals who are not able to get vaccinated due to the already low strength of their immune system. In addition, the measles vaccine is not one hundred percent effective and it may not actually protect a small percentage of children. For these people, herd immunity is their only protection against the measles and other contagious diseases for which vaccinations exist. Herd immunity involves the majority of a population being vaccinated against a disease, so that its spread throughout a community is less likely. For most diseases that have an effective vaccination, herd immunity allows the disease to be essentially eradicated. When people decide to boycott vaccines without a medical reason to do so, there are no longer enough people protected from the disease for the herd immunity to be effective, increasing the likeliness that large scale outbreaks, such as this one, will occur.
When vaccine rates fall, there is no protection against the disease for the people who are medically unable to receive a vaccine, contributing to the widespread nature of the outbreaks. For measles specifically, one infected person can spread the disease to tens of others people, which can be very dangerous for the immunocompromised. Since levels of vaccinations are so relatively low, this measles outbreak is the second-worst one since the disease was eradicated, and it soon may surpass the first. The only way to avoid this outcome is to increase vaccination rates. Vaccines are proven to be safe, and everybody who has the ability to get one has a moral obligation to do so for the health of the community.
The more people who are vaccinated against the disease, the less people the disease can affect, explaining why vaccinations are being so strongly pushed. However, there are some people who cannot do so. Young infants, people with immune diseases, and patients receiving certain medical treatments are among the group of individuals who are not able to get vaccinated due to the already low strength of their immune system. In addition, the measles vaccine is not one hundred percent effective and it may not actually protect a small percentage of children. For these people, herd immunity is their only protection against the measles and other contagious diseases for which vaccinations exist. Herd immunity involves the majority of a population being vaccinated against a disease, so that its spread throughout a community is less likely. For most diseases that have an effective vaccination, herd immunity allows the disease to be essentially eradicated. When people decide to boycott vaccines without a medical reason to do so, there are no longer enough people protected from the disease for the herd immunity to be effective, increasing the likeliness that large scale outbreaks, such as this one, will occur.
When vaccine rates fall, there is no protection against the disease for the people who are medically unable to receive a vaccine, contributing to the widespread nature of the outbreaks. For measles specifically, one infected person can spread the disease to tens of others people, which can be very dangerous for the immunocompromised. Since levels of vaccinations are so relatively low, this measles outbreak is the second-worst one since the disease was eradicated, and it soon may surpass the first. The only way to avoid this outcome is to increase vaccination rates. Vaccines are proven to be safe, and everybody who has the ability to get one has a moral obligation to do so for the health of the community.
Lab-Grown Hearts May Protect Breast Cancer Patients From Cardiotoxic Drugs
-Veolette Hanna
Some of the chemotherapeutic treatments for breast cancer put patients at risk of developing cardiac problems. People with a specific type of breast cancer, HER-2 positive breast cancer, often end up taking a drug called trastuzumab (brand name Herceptin), which can help block cancer growth, but also has side effects on the heart. Researchers are using stem cells from these patients to grow “tiny organoid hearts” to figure out if they will react badly to the cancer treatment.
HER-2 positive breast cancer patients have tested positive for human epidermal growth factor 2. 15 to 20 percent of these patients receive the Herceptin medication. Herceptin can slow cancer growth, but it also lowers the amount of blood the heart pumps when contracting, causing the left ventricle to not beat properly, leading to cardiac dysfunction and eventually heart failure. This cardiotoxicity is more likely for those who have a genetic predisposition, obesity, old age, or hypertension. Patient symptoms include shortness of breath, fluid buildup in the legs, and fatigue.
The way researchers are able to make tiny organoid hearts is by using the white blood cells of these breast cancer patients to derive stem cells. The stem cells are manipulated to develop into cardiomyocytes. Researchers found that applying Herceptin to these heart cells would cause them to contract less vigorously. To treat this effect, researchers applied a drug used on diabetes patients called an AMPK activator, and the cells began to consume more glucose and increased contraction. Dr. Joseph Wu, PhD, a professor of cardiovascular medicine and radiology, and director of the Stanford Cardiovascular Institute, said AMPK activators can “reverse the underlying cellular and molecular changes without harming the heart” and can even “make tumor cells more sensitive to chemotherapy”, but further studies and a larger clinical trial will have to be conducted to verify these findings.
HER-2 positive breast cancer patients have tested positive for human epidermal growth factor 2. 15 to 20 percent of these patients receive the Herceptin medication. Herceptin can slow cancer growth, but it also lowers the amount of blood the heart pumps when contracting, causing the left ventricle to not beat properly, leading to cardiac dysfunction and eventually heart failure. This cardiotoxicity is more likely for those who have a genetic predisposition, obesity, old age, or hypertension. Patient symptoms include shortness of breath, fluid buildup in the legs, and fatigue.
The way researchers are able to make tiny organoid hearts is by using the white blood cells of these breast cancer patients to derive stem cells. The stem cells are manipulated to develop into cardiomyocytes. Researchers found that applying Herceptin to these heart cells would cause them to contract less vigorously. To treat this effect, researchers applied a drug used on diabetes patients called an AMPK activator, and the cells began to consume more glucose and increased contraction. Dr. Joseph Wu, PhD, a professor of cardiovascular medicine and radiology, and director of the Stanford Cardiovascular Institute, said AMPK activators can “reverse the underlying cellular and molecular changes without harming the heart” and can even “make tumor cells more sensitive to chemotherapy”, but further studies and a larger clinical trial will have to be conducted to verify these findings.
Exercise with Consistency
-James He
A topic of great investigation within the health profession is exercise. While maintaining an active lifestyle clearly confers a plethora of benefits such as muscle gain, improved cardiovascular health, strong bones, and a strong immune system among many others, the lack of a causal relationship between exercise and death has led many to question the value of exercise. A recent study from the National Cancer Institute probed into previous data gathered from an N.I.H.-AARP Diet and Health study to explore this matter. The survey data that was examined further consisted of a lengthy questionnaire that detail participants’ overall health and their exercise habits currently and throughout their past. Of particular interest, the researchers aimed to examine the deaths of such individuals since 1995, when the study was starting off. This would be related back to the individual’s exercising habits throughout the entirety of their life, from youth to elder.
Expanding on previous data regarding exercising habits have related a healthy lifestyle with frequent exercise to increased longevity, the researchers aimed to pinpoint the impact of maintaining consistency of those exercising habits on their longevity. From the data, they gathered that individuals that maintained low levels of exercise throughout adulthood, independent of exercise frequency through childhood and adolescence, have a reduced longevity compared to those that have maintained frequent exercise throughout their entire life. However, this trend does not hold true for those that have just picked up active exercising schedules through middle age, as they display a similar level of longevity protection of those that have exercised consistently all their lives.
Interestingly, this data has spurred some discussion as to the underlying factors that play into such trends. Though the survey data is still inconclusive, further research may attempt to define more causal factors that align with this trend. In the meantime, we can rely on the benefits that exercise may provide, and incorporate that into our daily habits.
Expanding on previous data regarding exercising habits have related a healthy lifestyle with frequent exercise to increased longevity, the researchers aimed to pinpoint the impact of maintaining consistency of those exercising habits on their longevity. From the data, they gathered that individuals that maintained low levels of exercise throughout adulthood, independent of exercise frequency through childhood and adolescence, have a reduced longevity compared to those that have maintained frequent exercise throughout their entire life. However, this trend does not hold true for those that have just picked up active exercising schedules through middle age, as they display a similar level of longevity protection of those that have exercised consistently all their lives.
Interestingly, this data has spurred some discussion as to the underlying factors that play into such trends. Though the survey data is still inconclusive, further research may attempt to define more causal factors that align with this trend. In the meantime, we can rely on the benefits that exercise may provide, and incorporate that into our daily habits.
Brief Look at Cosmetic Medicine
-Yifeng (Ethan) Wang
The world of cosmetic medicine seems like the “Wild West” of modern medicine. Cosmetic medicine (including surgery) has been around since the Old Kingdom in Egypt (3000 to 2500 BC), and it has been crucial in treating burn or trauma patients who have been drastically disfigured. Today, laymen understanding of cosmetic medicine may be best represented by the “nose jobs” of prominent celebrities. To a social media hermit like me, the growing interest of cosmetic procedures to reach a higher standard of beauty (according to Instagram), is not very relatable. However, it may be apparent to many of you that American society and culture is leaning towards an emphasis on looks. There are multiple makeup tutorial/review videos trending on Youtube every day, and this focus on bettering our image is crossing with medicine more than ever.
Currently, cosmetic procedures to augment one’s appearance is increasing, but not from plastic surgery. Once held in high regard, plastic surgery is now associated with uncertainty and disastrous procedures. In addition, there is a common regard of plastic surgery as an expression of narcissistic vanity in the public that is leveraged at the wealthy and “beautiful”. The current boom in cosmetic procedures are those deemed as “cosmetically minimally-invasive procedures” by the American Society of Plastic Surgeons (1). The largest components of these are Botulinum injections and soft tissue fillers.
Botulinum injections and soft tissue fillers are less invasive than plastic surgery procedures, which make them a more attractive feature for those who do not want drastic procedures done on their body. The cost is another factor, as the soft tissue fillers and Botulinum injections are less expensive and can be accessed by a (relatively) larger group of consumers. The cost of these minimally invasive procedures is still high, and considering that insurances will not pay for them in normal circumstances, doctors performing these procedures stand to gain a lot of money. Many cosmetic medicine doctors also have a social media presence, and some release videos of their work to Instagram so that potential customers can examine their craft (and their results) at no cost. This social media presence is advertisement that can reach far and bring more customers to their clinics. These doctors have also noticed a trend of younger patients that are more open about these minimally-invasive “tune-ups”, which helps with promoting their business.
Some problem associated with cosmetic medicine is that there is always the risk of deception to the patients. Self-proclaimed doctors and surgeons can cause irreversible damage, even with minimally-invasive procedures. The previous fears of botched procedures are justified, as consequences can range from scars to death from infections. These underqualified individuals can also use social media to post work done by credible surgeons, and even attempt to take the identity of credible surgeons in order to promote their services to potential patients (3). The field can also be competitive, as the same article also reported that some South Florida surgeons have started to criticize each other for apparent mistakes/errors based on videos posted to social media (3). While this can serve as self-policing in the field, the benefits are questionable because patients can be confused about who to trust.
This concludes my summary of the field of cosmetic surgery currently. There is more material online if you would like to explore further. If you are interested in cosmetic medicine, hopefully you get a sense of where the field is at, and what you can do to continue the development of the cosmetic medicine profession.
Currently, cosmetic procedures to augment one’s appearance is increasing, but not from plastic surgery. Once held in high regard, plastic surgery is now associated with uncertainty and disastrous procedures. In addition, there is a common regard of plastic surgery as an expression of narcissistic vanity in the public that is leveraged at the wealthy and “beautiful”. The current boom in cosmetic procedures are those deemed as “cosmetically minimally-invasive procedures” by the American Society of Plastic Surgeons (1). The largest components of these are Botulinum injections and soft tissue fillers.
Botulinum injections and soft tissue fillers are less invasive than plastic surgery procedures, which make them a more attractive feature for those who do not want drastic procedures done on their body. The cost is another factor, as the soft tissue fillers and Botulinum injections are less expensive and can be accessed by a (relatively) larger group of consumers. The cost of these minimally invasive procedures is still high, and considering that insurances will not pay for them in normal circumstances, doctors performing these procedures stand to gain a lot of money. Many cosmetic medicine doctors also have a social media presence, and some release videos of their work to Instagram so that potential customers can examine their craft (and their results) at no cost. This social media presence is advertisement that can reach far and bring more customers to their clinics. These doctors have also noticed a trend of younger patients that are more open about these minimally-invasive “tune-ups”, which helps with promoting their business.
Some problem associated with cosmetic medicine is that there is always the risk of deception to the patients. Self-proclaimed doctors and surgeons can cause irreversible damage, even with minimally-invasive procedures. The previous fears of botched procedures are justified, as consequences can range from scars to death from infections. These underqualified individuals can also use social media to post work done by credible surgeons, and even attempt to take the identity of credible surgeons in order to promote their services to potential patients (3). The field can also be competitive, as the same article also reported that some South Florida surgeons have started to criticize each other for apparent mistakes/errors based on videos posted to social media (3). While this can serve as self-policing in the field, the benefits are questionable because patients can be confused about who to trust.
This concludes my summary of the field of cosmetic surgery currently. There is more material online if you would like to explore further. If you are interested in cosmetic medicine, hopefully you get a sense of where the field is at, and what you can do to continue the development of the cosmetic medicine profession.
Pharmacy Scandal
-Priya Gupta
In October of 2017, pharmacy inspectors from the state of California went into a Walgreens pharmacy in response to a typical complaint. However, when they arrived, they noticed the store was distributing controlled substances that were not properly labelled. After investigating these suspicious prescriptions, the investigators determined one pharmacist, Kim Le, had authorized all of the prescriptions in question. Upon further investigation, the inspectors found the cause of this issue: Kim Le was not actually a licensed pharmacist. An ex-pharmacy tech, Le had assumed the identities of two pharmacists whose names sounded similar to hers.
Kim Le was employed by Walgreens for over ten years at three different locations. Throughout this time, she approved over 745,000 prescriptions and administered many vaccinations, neither of which even a pharmacy technician is legally allowed to do. Even more severely, approximately 100,000 of the prescriptions filled by Le were controlled substances such as alprazolam, a drug used to treat anxiety disorders.
This discovery has upset many customers of Walgreens, who did not expect such a scandal from a company of its size and reputation. However, others have very different reactions. Le posed as a pharmacist for over a decade, and while unlicensed, she was able to adequately perform the job. Some people have spoken out claiming that this woman is an example of why such intense schooling may not be needed for certain jobs, especially with the new advances in technology that decrease the amount of room for human error. Some believe that since Le was able to “learn on the job,” licensed pharmacists would also be able to learn the job in less schooling than is currently required. Many pharmacists were not surprised that this was able to occur. They believe that many pharmacies suffer from poor management and are more focused on corporate metrics than patient care, which could allow someone like Le to go unnoticed for a long period of time.
Along with the public response caused by this event, there were many legal consequences as well. As a result of this incidence, Kim Le was fired, and the California State Board of Pharmacy has filed a fourteen page document detailing the accusations against her. Currently, the California Board of Pharmacy is in the process of deciding whether the three Walgreens locations where Kim Le was employed will lose their pharmacy licenses. In response, Walgreens has announced they are re-verifying all of their employed pharmacists throughout the country to ensure this crime will not happen again.
Kim Le was employed by Walgreens for over ten years at three different locations. Throughout this time, she approved over 745,000 prescriptions and administered many vaccinations, neither of which even a pharmacy technician is legally allowed to do. Even more severely, approximately 100,000 of the prescriptions filled by Le were controlled substances such as alprazolam, a drug used to treat anxiety disorders.
This discovery has upset many customers of Walgreens, who did not expect such a scandal from a company of its size and reputation. However, others have very different reactions. Le posed as a pharmacist for over a decade, and while unlicensed, she was able to adequately perform the job. Some people have spoken out claiming that this woman is an example of why such intense schooling may not be needed for certain jobs, especially with the new advances in technology that decrease the amount of room for human error. Some believe that since Le was able to “learn on the job,” licensed pharmacists would also be able to learn the job in less schooling than is currently required. Many pharmacists were not surprised that this was able to occur. They believe that many pharmacies suffer from poor management and are more focused on corporate metrics than patient care, which could allow someone like Le to go unnoticed for a long period of time.
Along with the public response caused by this event, there were many legal consequences as well. As a result of this incidence, Kim Le was fired, and the California State Board of Pharmacy has filed a fourteen page document detailing the accusations against her. Currently, the California Board of Pharmacy is in the process of deciding whether the three Walgreens locations where Kim Le was employed will lose their pharmacy licenses. In response, Walgreens has announced they are re-verifying all of their employed pharmacists throughout the country to ensure this crime will not happen again.
Second Patient Reported to be Cured of H.I.V.
-James He
In 2007, the Berlin Patient shocked the world when he was reported to be “cured” of H.I.V., the virus that is known to cause AIDS. Now identified as Timothy Brown, he received two bone marrow transplants for treatment of his leukemia after rounds of chemotherapy. In combination with the immunosuppressive drugs he was given, the procedures took a tremendous toll on him, as he was even put in an induced coma at a point due to the side effects of the drugs. However, the risky treatment ultimately proved rewarding, as Timothy Brown was rid of both his cancer and any signs of H.I.V. after taking the drugs. Since then, many have attempted to replicate the same effective treatment, but none have been fully successful due to the invasive nature of the treatment.
Recently, a second patient, the London Patient, has been reported to be cured of H.I.V. after receiving a similar transplant designed to target the growth of Hodgkin’s Lymphoma. Over a year after he last took a round of immunosuppressive drugs, he has now been completely virus-free with his cancer treated. Compared to the Berlin Patient, he underwent significantly less side effects from the treatment, illustrating the potential for a less risky treatment of H.I.V. In both scenarios, a key gene was crucial- CCR5 was mutated in the cells of transplant donors for both the Berlin and London Patient. Deleting the gene product from cells results in H.I.V.-resistant immune cells that eventually replace H.I.V.-susceptible cells after transplantation. Other individuals have received bone marrow transplants with and without the CCR5 mutation, and are currently being tracked for further results.
The exciting results from both the Berlin and London Patient are encouraging, as this breakthrough can eventually translate into an effective treatment for H.I.V. and certain types of cancer with less drawbacks. Already, researchers are investigating the possible of a gene therapy targeting the CCR5 gene in bone marrow cells, and hope to eventually synthesize a full-on cure to H.I.V. Much still needs to be seen, but current progress is certainly promising.
Recently, a second patient, the London Patient, has been reported to be cured of H.I.V. after receiving a similar transplant designed to target the growth of Hodgkin’s Lymphoma. Over a year after he last took a round of immunosuppressive drugs, he has now been completely virus-free with his cancer treated. Compared to the Berlin Patient, he underwent significantly less side effects from the treatment, illustrating the potential for a less risky treatment of H.I.V. In both scenarios, a key gene was crucial- CCR5 was mutated in the cells of transplant donors for both the Berlin and London Patient. Deleting the gene product from cells results in H.I.V.-resistant immune cells that eventually replace H.I.V.-susceptible cells after transplantation. Other individuals have received bone marrow transplants with and without the CCR5 mutation, and are currently being tracked for further results.
The exciting results from both the Berlin and London Patient are encouraging, as this breakthrough can eventually translate into an effective treatment for H.I.V. and certain types of cancer with less drawbacks. Already, researchers are investigating the possible of a gene therapy targeting the CCR5 gene in bone marrow cells, and hope to eventually synthesize a full-on cure to H.I.V. Much still needs to be seen, but current progress is certainly promising.
Free Medical School Tuition
-Veolette Hanna
Medscape Medical News conducted a poll to see what physicians, medical students, and nurses think of free medical school tuition. A majority of those asked said that they favored the idea. Only 16% of doctors, 6% of medical students, and 18% of nurses said they were opposed to the idea. “The poll, published October 3, is based on 704 responses (511 physicians, 141 nurses/APRNs, and 52 medical students). It was taken in response to two medical schools announcing over the last summer that they would waive tuition for upcoming classes.” These two medical schools are the University of Houston and New York University. “NYU leadership said it was making the decision in hopes of attracting a more diverse group of students and to encourage students to pursue lower-paying fields such as primary care.” This makes sense, as many medical students make the decision to pursue higher-paying fields so they can pay off all their loans. To address this theory, the poll asked whether free tuition would have changed physicians' choice of specialty and 21% said yes, 62% said no, and 17% said they were unsure.
The poll also asked whether waiving tuition gives some students an unfair advantage over those who graduate with debt. Among physicians, 45% said those who didn't pay tuition would have an advantage, 38% said they would not, and 17% were unsure. Among medical students, 21% said yes, 63% said no, and 15% were unsure. Nurses'/APRNs' answers were 44% yes, 40% no, and 16% unsure.
Various healthcare providers commented on the poll. Some were opposed because they feel that giving future doctors free education is not fair to their colleagues in the field. A registered nurse said: "Why should medical students get a free ride and nursing students don't? Resident doctors get paid after they graduate, nurses don't.” Others see that free tuition could cause more burdens on taxpayers. A psychiatrist said: "I think educating physicians about finances is important. Free is not free — someone will get stuck with the bill, and that someone is the taxpayer. Tuition and fees however should be reduced as they are absurd at some schools." Despite these different opinions, the general consensus among doctors, nurses, and students is that medical school tuition is getting too high. If tuition cannot be free, it should still be reduced. A family physician said: "My medical education was almost free. Tuition at (University of California Los Angeles) in 1977 was $1,200/year. Medical ed in Denmark IS Free. There is NO reason it could not be free or $1,200 again if there was a change in priorities. The current situation is not sustainable. If I were entering medical school now I would not have been able to go due to cost." Polls like this give people a voice to share what they have to say. Hopefully, the necessary changes will be made to improve the lives of medical students and future healthcare providers.
The poll also asked whether waiving tuition gives some students an unfair advantage over those who graduate with debt. Among physicians, 45% said those who didn't pay tuition would have an advantage, 38% said they would not, and 17% were unsure. Among medical students, 21% said yes, 63% said no, and 15% were unsure. Nurses'/APRNs' answers were 44% yes, 40% no, and 16% unsure.
Various healthcare providers commented on the poll. Some were opposed because they feel that giving future doctors free education is not fair to their colleagues in the field. A registered nurse said: "Why should medical students get a free ride and nursing students don't? Resident doctors get paid after they graduate, nurses don't.” Others see that free tuition could cause more burdens on taxpayers. A psychiatrist said: "I think educating physicians about finances is important. Free is not free — someone will get stuck with the bill, and that someone is the taxpayer. Tuition and fees however should be reduced as they are absurd at some schools." Despite these different opinions, the general consensus among doctors, nurses, and students is that medical school tuition is getting too high. If tuition cannot be free, it should still be reduced. A family physician said: "My medical education was almost free. Tuition at (University of California Los Angeles) in 1977 was $1,200/year. Medical ed in Denmark IS Free. There is NO reason it could not be free or $1,200 again if there was a change in priorities. The current situation is not sustainable. If I were entering medical school now I would not have been able to go due to cost." Polls like this give people a voice to share what they have to say. Hopefully, the necessary changes will be made to improve the lives of medical students and future healthcare providers.
Artificial Pancreases
-Priya Gupta
Diabetes is an illness that affects many people in the US. Currently, the typical treatment for diabetes involves closely monitoring blood glucose levels and carefully managing many aspects of the patient’s lifestyle, from physical activity to diet. Recently, a new technology has been developed that can change this treatment protocol completely. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) has funded projects focused on creating an artificial pancreas to be used as treatment for diabetes. The goal for these scientists is to create a system that is capable of both monitoring blood glucose levels and providing insulin and/or hormones when needed. If successful, this device will reduce the need fo`r treatments like testing glucose by finger stick and self-administered insulin shots.
This technology was first tested in trials that began in 2017 and 2018. These studies evaluate many factors of the device, including safety, efficiency, user-friendliness, and cost. The first of these studies is run by doctors at the University of Virginia. These patients are testing a system that uses smartphones for six months. Similarly, in England, patients were recruited to use an artificial pancreas system for one full year. This system also involves a smartphone, but is specifically for pediatric patients. Another trial directed by doctors in Minnesota and Israel is testing a hybrid artificial pancreas which is centered around improving glucose control, especially around meal times. Finally, a trial in Boston is testing artificial pancreas systems in adult patients. This study utilizes a bihormonal pancreas system, which contains a pump capable of delivering both insulin and the hormone glucagon.
In addition to improving the quality of life for many diabetic patients, these artificial pancreases can have long-term benefits. According to early studies, the new devices can more accurately control glucose levels than the traditional treatment options, allowing patients to achieve near-normal levels. As a result, these patients will likely suffer from less complications due to diabetes, which can include nerve, eye, and kidney diseases. While these devices are still in the trial stages, they will hopefully become a viable treatment option in the near future.
This technology was first tested in trials that began in 2017 and 2018. These studies evaluate many factors of the device, including safety, efficiency, user-friendliness, and cost. The first of these studies is run by doctors at the University of Virginia. These patients are testing a system that uses smartphones for six months. Similarly, in England, patients were recruited to use an artificial pancreas system for one full year. This system also involves a smartphone, but is specifically for pediatric patients. Another trial directed by doctors in Minnesota and Israel is testing a hybrid artificial pancreas which is centered around improving glucose control, especially around meal times. Finally, a trial in Boston is testing artificial pancreas systems in adult patients. This study utilizes a bihormonal pancreas system, which contains a pump capable of delivering both insulin and the hormone glucagon.
In addition to improving the quality of life for many diabetic patients, these artificial pancreases can have long-term benefits. According to early studies, the new devices can more accurately control glucose levels than the traditional treatment options, allowing patients to achieve near-normal levels. As a result, these patients will likely suffer from less complications due to diabetes, which can include nerve, eye, and kidney diseases. While these devices are still in the trial stages, they will hopefully become a viable treatment option in the near future.
Vaping: Old Habits and New Markets
-Yifeng Wang
It’s 2019, and most of us have seen or heard of vaping. Some of you may own a JUUL, which is the “brand name” vape and the brand I will be referring to. It is hard to say when vaping became popular in adolescents/young adults, but probably between September 2017 and September 2018, when JUUL was able to increase personnel from 200 to 800 employees due to their increase in sales [1]. Anyways, while we tend to congratulate businesses successes in our capitalist society, we have many reasons to be worried about the rise of vaping.
First of all, vaping is not as harmless as the vaping industry claims it is. Many people do not know the ingredients that they are smoking from e-cigarettes, including nicotine, which is the same addictive substance found in cigarettes [2]. This means that people can be addicted and require larger or more doses as their addiction worsens. Besides nicotine, JUUL e-cigarette liquid (e-liquid) also includes glycerol, propylene glycol, benzoic acid, and food-grade flavoring [3]. Searching those ingredients individually do not result in any findings of toxicity, but don’t be fooled. The ingredients are heated in an e-cigarette device, and as many may remember from chemistry heat is a very good catalyst for reactions. In this case, glycerol and propylene glycol, as well as benzoic acid and benzaldehyde (flavor additive), forms benzene which were detected in the vapors [4]. Benzene is a carcinogen, which is why we do not use benzene in organic chemistry labs anymore as an organic phase. These are only the current findings, and with time more damning reports could come out. While we do not yet have long-term studies of vaping, there is little point in exposing yourself to vaping because of these unknown risks.
Another important health effect is the risk of habit change from vaping to actual cigarettes in the young adult/adolescent age group. While there are uses of e-cigarettes for smoking cessation, more young people are starting to form nicotine habits and on the path to becoming chronic users by middle-age [5]. What they might use in middle age for their nicotine addiction could be cigarettes, as users probably will have a higher tolerance and greater need for nicotine as their addiction progresses.
JUUL specifically targeted young adults in their marketing, with colorful ads and aggressive social media promotion [6]. After the FDA added pressure to JUUL and other e-cigarette makers by promising to investigate marketing practices, JUUL pulled retail sales of flavors and removed their social media accounts [7]. JUUL has rebranded itself as helping smokers along in their smoke reduction journey, but is still selling mango, crème, and fruit flavored e-liquid [8]. These are still the same youth-oriented products that JUUL sold before. While the marketing toward young people has ceased, the damage has already been done. Many high schoolers in particular are using JUUL and other e-cigarettes, and may influence others to do the same [2]. Now, the same company (Altria) that owns Marlboro has invested $12.8 billion in JUUL [9]. It is unlikely that Altria wants people to stop smoking their products, but instead realized the potential earnings from creating a dedicated consumer base at a young age. Nicotine addiction is no longer a dying affliction, but a revived monstrosity that will only become worse if we see vaping as harmless.
First of all, vaping is not as harmless as the vaping industry claims it is. Many people do not know the ingredients that they are smoking from e-cigarettes, including nicotine, which is the same addictive substance found in cigarettes [2]. This means that people can be addicted and require larger or more doses as their addiction worsens. Besides nicotine, JUUL e-cigarette liquid (e-liquid) also includes glycerol, propylene glycol, benzoic acid, and food-grade flavoring [3]. Searching those ingredients individually do not result in any findings of toxicity, but don’t be fooled. The ingredients are heated in an e-cigarette device, and as many may remember from chemistry heat is a very good catalyst for reactions. In this case, glycerol and propylene glycol, as well as benzoic acid and benzaldehyde (flavor additive), forms benzene which were detected in the vapors [4]. Benzene is a carcinogen, which is why we do not use benzene in organic chemistry labs anymore as an organic phase. These are only the current findings, and with time more damning reports could come out. While we do not yet have long-term studies of vaping, there is little point in exposing yourself to vaping because of these unknown risks.
Another important health effect is the risk of habit change from vaping to actual cigarettes in the young adult/adolescent age group. While there are uses of e-cigarettes for smoking cessation, more young people are starting to form nicotine habits and on the path to becoming chronic users by middle-age [5]. What they might use in middle age for their nicotine addiction could be cigarettes, as users probably will have a higher tolerance and greater need for nicotine as their addiction progresses.
JUUL specifically targeted young adults in their marketing, with colorful ads and aggressive social media promotion [6]. After the FDA added pressure to JUUL and other e-cigarette makers by promising to investigate marketing practices, JUUL pulled retail sales of flavors and removed their social media accounts [7]. JUUL has rebranded itself as helping smokers along in their smoke reduction journey, but is still selling mango, crème, and fruit flavored e-liquid [8]. These are still the same youth-oriented products that JUUL sold before. While the marketing toward young people has ceased, the damage has already been done. Many high schoolers in particular are using JUUL and other e-cigarettes, and may influence others to do the same [2]. Now, the same company (Altria) that owns Marlboro has invested $12.8 billion in JUUL [9]. It is unlikely that Altria wants people to stop smoking their products, but instead realized the potential earnings from creating a dedicated consumer base at a young age. Nicotine addiction is no longer a dying affliction, but a revived monstrosity that will only become worse if we see vaping as harmless.
A.I. Developments in Healthcare
-James He
Every year, new developments help to assist individuals in their everyday life. Many have focused on improving the quality of health of different patient populations, but few have actually made their way into hospitals to interact with patients directly. China and the United States are heavily focusing on the potential for artificial intelligence, A.I., to aid and transform the healthcare field by working alongside physicians in diagnosing diseases and have now created a system to automatically detect and diagnosis common illnesses and conditions affecting children.
Dr. Kang Zhang, the chief of ophthalmic genetics at the University of California, San Diego, has developed systems to detect hemorrhages, lesions and other indicators of diabetic blindness using eye scans. In its development, China used data from approximately 600,000 Chinese pediatric patients from the Guangzhou Women and Children’s Medical Center to digitally train the system to provide accurate diagnoses. They use a mode of A.I. called a neural network, which is unique in its ability to learn on its own given large quantities of data. As such, the network can take in information from patient’s physical examinations and annotated hospital records detailing common medical conditions, and analyze the data for patterns. Quickly, the system learned to make accurate diagnoses on new patients, revealing an accuracy rate of 90% for diagnosing asthma, and 87% for diagnosing gastrointestinal disease. Experienced physicians exhibit accuracy rates between 80 and 94 percent for diagnosing asthma and between 82 to 90 percent for diagnosing gastrointestinal disease. Based on this comparison, the system can provide accurate diagnoses for individuals, and may serve a benefit alongside physicians to provide optimal, unbiased diagnoses.
Developers identify a potential for this system to improve healthcare in locations where doctors are more scarce. Though much is still unknown regarding the mechanism with which the system can learn on its own, dramatic efforts by the U.S. and China have been devoted towards gathering more data to optimize this system. Soon enough, these neural networks could be a staple in healthcare.
Dr. Kang Zhang, the chief of ophthalmic genetics at the University of California, San Diego, has developed systems to detect hemorrhages, lesions and other indicators of diabetic blindness using eye scans. In its development, China used data from approximately 600,000 Chinese pediatric patients from the Guangzhou Women and Children’s Medical Center to digitally train the system to provide accurate diagnoses. They use a mode of A.I. called a neural network, which is unique in its ability to learn on its own given large quantities of data. As such, the network can take in information from patient’s physical examinations and annotated hospital records detailing common medical conditions, and analyze the data for patterns. Quickly, the system learned to make accurate diagnoses on new patients, revealing an accuracy rate of 90% for diagnosing asthma, and 87% for diagnosing gastrointestinal disease. Experienced physicians exhibit accuracy rates between 80 and 94 percent for diagnosing asthma and between 82 to 90 percent for diagnosing gastrointestinal disease. Based on this comparison, the system can provide accurate diagnoses for individuals, and may serve a benefit alongside physicians to provide optimal, unbiased diagnoses.
Developers identify a potential for this system to improve healthcare in locations where doctors are more scarce. Though much is still unknown regarding the mechanism with which the system can learn on its own, dramatic efforts by the U.S. and China have been devoted towards gathering more data to optimize this system. Soon enough, these neural networks could be a staple in healthcare.