How a Patient-Centered Model Can Reconcile the Two
by Ramy Sedhom MD and Daniel Sedhom MD
Healthcare in the United States is expensive, with one of the highest rates of per capita spending worldwide, and the cost continues to increase every year. There is a continuing national dialogue regarding fiscal responsibility, efficient spending, and ethical debates about resource allocation. Medical providers are asked to examine their own personal practice patterns and contributions to the overall burden of health care costs. As physicians, we find ethically worrisome the pressure to make some of these decisions at the bedside in an ad hoc manner, especially when cost concerns seem to deprioritize our duties to our patients. Shared decision making, with the patient selecting the health outcome of highest priority to them, is an important guideline and should be considered in future payment models.
by Sukhjot Sandher
During the basic science instruction of our first and second years of medical school, we are rigorously tested on whether we are prepared to complete our third and fourth year clinical rotations. The USMLE Step 1 examination, taken by most medical students at the end of their second year, is one of the most significant assessment metrics. Your “Step 1” results largely determine your options in both the residency program and specialty choices. The performance pressures surrounding the Step 1 lead many students to undertake a grueling study regime filled with sleepless nights to cram in every last bit of knowledge. However, this may actually end up doing more harm than good. Research has shown that intense amounts of stress may be counterproductive in learning and academic performance, suggesting that an essential part of performing well is to develop a healthy mindset leading up to the test. Continue reading
by Arthur Ruiz
One of the most important aspects of being a successful scientist is the ability to effectively communicate one’s work to peers and the lay public. Research papers typically take a structured narrative form, similar to the “keyhole” model most of us learned in high school writing classes: start with a broad description of the state of a field and its outstanding issues, narrow it down to one’s own research topic, describe the experiments and results, and then broaden back out to how one’s results add to the field and advance the boundaries of future research. Within this framework, scientists carefully craft a structured flow of experiments, where one finding leads to a logical next step, and eventually a story of discovery and insight unfolds. Fitting certain findings into a narrative can have important consequences on the overall impact of the report and its reception by the field, and researchers can spend months or years building up a critical mass of data that eventually gets molded into a satisfying scientific story.
However, recent work coming out of the University of Wisconsin-Madison is challenging this way of doing things. The Zika experimental science team (ZEST), led by David O’Connor, is studying the progression of Zika infection in macaque monkeys. The goal is to examine the proposed link between Zika infection and microencephalitic birth defects, but as an emerging disease, relatively little is known about Zika’s life cycle, pathogenesis and interaction with the host immune system. Establishing a similar viral infectivity pattern between humans and macaques could allow further work in determining how the virus is able to infect a fetus and interfere with normal brain development. But rather than waiting to complete the course of the experiments, compiling the data and looking for significant results, then finally rolling everything into a paper, the group can publish their raw data as daily updates to a publically accessible website. Anyone with a web browser can follow updates of viral load levels in the saliva, urine and blood of these monkeys. And, importantly, scientists planning their own work involving Zika virus can access critical information about the progression of infection which could help them to design more effective experiments.
by Anne Kessler
True to my roots, I am a cheese enthusiast. Born and raised in Wisconsin, the leader in US cheese production (sorry not sorry California), I grew up thinking that eating cheese and only cheese in a room full of people donning green and gold jerseys and bright yellow ‘cheeseheads’ was just another Packer Sunday. True to what our license plates say – America’s Dairyland – Wisconsin produces over 25% of all our nation’s cheese each year. Quantitatively speaking, this means that in one state alone in a single calendar year, over one million cows from more than 10,000 dairy farms produce nearly three billion pounds of cheese.
Despite declining milk consumption in America (all varieties, including cream and ice cream products), dairy utilization has continued to rise nationwide – largely due to a steady increase in cheese consumption over the last 40 years. Currently, US cheese consumption is roughly 34 lbs per capita with data trends predicting a rise to nearly 40 lbs per capita by the early 2020s. Just last year, researchers from the University of Michigan published a cross-sectional study that provides some insight into why – other than the obvious ‘it’s delicious’ – the average American consumes such a large quantity of cheese per annum: Cheese may be an ‘addictive’ food.
by Anne Kessler
According to the fossil record, endurance running capabilities first evolved roughly two million years ago, approximately four million years after the initial evolution of bipedal walking – a divergent moment in evolutionary history leading up to the human species. Fast forward to present time. In America alone, over 500,000 people complete at least one marathon in a given year. Because many people run races of distances that exceed 26.2 miles (ultra-marathon) and many runners never register for official races, the actual number of endurance runners in America likely exceeds one million people. Despite the fact that the majority of human beings find endurance running an abnormal and entirely painful behavior, it has only continued to rise in popularity across people of all ages and abilities since the initial “running boom” of the 1970’s.
So, why do so many people participate in endurance/marathon running? Perhaps one reason is because we are the only species that can. Continue reading
by Walter G. Wasser, MD
The world of medicine has now been open to women for decades. As parents, especially those in the medical field, recognize their daughters’ interests in medicine, they should encourage and support them as they pursue the long and difficult path toward their careers. Since the long years of medical school and clinical training typically coincide with a woman’s reproductive years, it is critical to foster a supportive environment where women can fulfill their academic aspirations without having to sacrifice the desire to start a family.
Here is the story of our daughter, Laurie. I hope that it can serve as an example of what a young woman can accomplish if nurtured and encouraged to achieve both goals – family and medicine – simultaneously.
by Anne Kessler
Upon completing my first year of graduate coursework, I found myself where no student wants to be – in a summer class. Per the stipulations of my training grant, I was enrolled in the Clinical Research Training Program’s summer intensive with a single goal in mind (pass) and very little appreciation for all that I would learn in the subsequent three months.
On the first day of introductory biostatistics, Einstein’s own Dr. Hillel Cohen discussed the use, misuse, and abuse of p-values in the scientific community. He asked our class, which was composed of both students and clinicians, to provide a good definition for the term ‘p-value.’ He was not at all surprised when the best response we could provide was what he coined “a popular but entirely incorrect” definition of what a p-value actually is. For me, this raised feelings of concern and terror – How was it possible that a diverse room of researchers, all of whom use statistical methods to confirm that their research findings are relevant and significant, is incapable of collectively defining what a p-value is? At the end of the first lesson, Dr. Cohen wrote the definition of a p-value on the board: “A p-value is the calculated, estimated probability of observing the test statistic (or results more extreme) given that (1) the null hypothesis is true, (2) the assumptions of the test are not meaningfully violated, and (3) there is no systematic or differential random error.”
© Sergei Gladyshev /Hotspot Media
by Arthur Ruiz
What makes a person deserving of human rights? Is it something intrinsic in our nature, “endowed by [our] Creator with certain unalienable Rights”, as Thomas Jefferson wrote? Or is it simply the result of mutually-agreed-upon social conventions? Early humans defined “themselves” by their small tribal communities, and any outsiders were usually seen with a mix of suspicion and distrust. As societies began to develop and expand, the “in-group” of people consisted of villages, city-states, ethnic identities, and then nations. Even vaunted legal landmarks recognizing a certain baseline level of rights, like the Magna Carta or the Bill of Rights, still applied to a select group of “rights holders” (English nobles and property-holding white males, respectively). An important social achievement of the 20th and early 21st centuries has been the entrenchment of the idea that all human beings, regardless of their origins, beliefs or identities, are entitled to certain “inalienable” rights by virtue of their humanity.
The scope of this concept took an interesting turn this past April, when New York Supreme Court Justice Barbara Jaffe granted a writ of habeas corpus to two research chimpanzees, Hercules and Leo, who were being used for experiments in human cognition at Stony Brook University. This decision resulted from lawsuits filed by the Nonhuman Rights Project (NhRP), on behalf of four chimpanzees (the two Stony Brook ones, as well as two others held on private property), which made the argument that the chimpanzees should be considered “legal persons”, based on their advanced emotional and cognitive capabilities. The writ of habeas corpus granted to the chimpanzees did not by itself confer legal personhood (and Jaffe quickly amended her decision to remove the specific term “writ of habeas corpus”), but it was an important step towards the possible recognition as such. In practical terms, it legally obligated Stony Brook University to answer charges that Hercules and Leo had been “unlawfully detained”.
by Dulguun Amgalan
The field of molecular biology, as its name implies, is the study of life at the molecular scale. Living things are made of cells, and each one of these basic units of living matter is a complex molecular machine, in which macromolecules such as nucleic acids, polysaccharides and proteins interact together to generate a metabolic process we know as “life”. Although organisms are overwhelmingly diverse when observed from the outside, the fundamental molecular processes are essentially uniform, and it is this constancy that provides molecular biologists with the tools to understand how living things function.
by Eva Catenaccio
“Have you had a bowel movement?” Ms. L smiled, shrugged, and pointed to her colostomy bag as if to say, “You tell me.” So began the first day of my internal medicine rotation as a third year medical student. My first patient was 83 years old and stuck in the hospital after a colon cancer surgery complicated by renal failure and pneumonia. I ended up following her for the next five weeks, spoon-feeding her lunch and bribing her for blood draws with ice chips I smuggled past the nurses. Muted by a tracheostomy tube in her throat, she still had an emotional and expressive face. She smiled in delight at the ice chips, but winced and looked away when I struggled to find a vein.
Taking care of her, I learned how to harvest a sputum culture from her throat, how to apply the sequential compression devices to her calves, how to check the ventilator settings every morning and trace the tides of each breath in little green lines on the glowing monitor. I sat for many minutes holding her hand and trying to read her lips. She had worked years ago on that very wing of the hospital. She had never learned to read or write. She had no family. One day she started to cry and could only mouth helplessly, “I’m afraid.”