PULSE Spring 2024

FROM THE EDITORS-IN-CHIEF Dear Readers, How fast time flies! The year 2024 is almost halfway through, and with this quarter having come and gone so swiftly, we are proud to share the Spring issue of PULSE. Our group of writers and editors––almost twice the size of the team on our previous issue––have tackled a great breadth of fascinating topics, from precision nutrition to global health.

This issue is dedicated to the great diversity of interests that UChicago students have within medicine. Grab a coffee, find a nook suited for reading, and explore the history and contemporary innovations of healthcare. Our writers probed recent research topics such as epigenetics and cancer as well as the relationships between social determinants, mental health, and medicine. Given recent events, this issue also delves into a global perspective, with articles discussing Costa Rica’s healthcare model and challenging the notion of medical neutrality as it relates to the War on Gaza. In addition to our staff ’s dedication to healthcare, we have a wide range of interdisciplinary interests that are exemplified by articles about connecting medicine to pedagogy, media, and literature.

As always, we want to give a special thanks to the editorial team, layout designers, and cover artists for their great effort in putting together such a rich and packed issue of PULSE this quarter! Without them, we would not be able to share our beautiful work this quarter. PULSE’s ultimate mission is to celebrate UChicago undergraduates’ enthusiasm for medically-related interests and we sincerely hope that all of you can sense that passion in these articles. Happy reading, and we wish you all an amazing Summer.

Best wishes, Fareen Dhuka and Ayman Lone

Writers

Francisca Anazco Emnet Djibrila Amiti Goel Ibrahim Gomaa Alexandra Hannett Alexandra Matthews Michelle Mejia Hermela Selam Alexander von Kumberg

PULSE Spring 2024

Editors

Hunter Bershtein Roxanna Fahid Natasha Janssens Michelle Lu Shannon Meng Deqa Muse Alexis Truta Ally Wang

Editorial EIC

Production

Layout EIC

Cover Design

Fareen Dhuka Ayman Lone

MacKenzie Brogan

Senior Editors Sanaa Imami Michelle Lu

MacKenzie Brogan Rina Iwata

Kim Mercado

CONTENTS Epigenetic Adventures: The Epic, the Genetic, and the Unexpected.................4 Revolutionizing Cancer Care: The Transformative Potential of Liquid Biopsy-Based Detection...........................................................................................7 Precision Nutrition: A Personalized Approach to Disease Prevention and Treatment....................................................................................................................9 In the age of Digital Healthcare, How Effective are Online Mental Health Resources?.................................................................................................................14 Premenstrual Dysphoric Disorder (PMDD): A Window into the Exigencies of Women’s Health...................................................................................................17 An Innovative Healthcare Approach: The Costa Rican Model.........................20 The Artifice of Western Medical Neutrality and the Genocide in Gaza..........24 Hieronymus Fabricus: From Birth to Father of Embryology............................27 Beyond the Screen: Unmasking the Impact of Medical Dramas......................29 A Different Way of Thinking About Medicine: Reviewing “The Social Transformation of American Medicine” by Paul Starr.......................................33

PULSE Table of Contents

Epigenetic Adventures: The Epic, The Genetic, and the Unexpected Written by Michelle Meija Edited by Alexis Truta

Many of us have often been told of our uncanny resemblance to our parents. This resemblance is hardly unexpected, given that we inherit a blend of genetic traits from both parents, shaping our phenotypes or physical traits. Yet, emerging discoveries reveal that our inheritance extends beyond mere physical characteristics; delving deeper into the intricacies of our biology, we uncover inherited traits that penetrate the core of our being.

Epigenetics delves into the exploration of how behaviors and environmental influences can induce reversible or permanent changes in DNA, altering gene function by reshaping how the body interprets DNA sequences [1]. Every age group is susceptible to epigenetics, and our epigenetics change as we grow. Even in the womb, fetuses remain connected to their surroundings through their mothers. Additionally, they inherit the paternal genome, which also shapes their experience of the environment during gestation. This raises the intriguing question: how does paternal and maternal stress before pre-conception and during pregnancy impact offspring epigenetics?

Research indicates that stress, particularly chronic stress, induces DNA modifications in the brains of mice [2]. Furthermore, recent research has shed light on how enduring psychoPULSE 4

logical stress in fathers led to the inheritance of health risks in mice over the long term. These risks encompassed behavioral, developmental, metabolic, and reproductive disorders [3]. Therefore, the question arises: What unfolds when stress is not inherent to the individual? In other words, what occurs in the fetus when the parents, who contribute DNA and genes, experience stress?

Paternal Epigenetics During pregnancy, the focus of friends, family, and medical professionals often revolves around the mother, encompassing baby showers, gifts, and the prioritization of her health and well-being. Yet, amidst this emphasis, the crucial contribution of the father’s genetics is typically overlooked. In a recent study, the impact of paternal stress on the epigenome of sperm was illuminated, highlighting its role in shaping the health and traits of offspring [4]. External stressors experienced by fathers prompt modifications in sperm histones, proteins that give chromosomes their structure and help control the activ-

ity of genes, subsequently altering gene expression in embryos. Notably, the father’s physiological condition prior to fertilization directly influences reproductive outcomes [4]. For instance, the offspring of fathers who experienced traumatic events such as the Holocaust or the Khmer Rouge period exhibited increased susceptibility to anxiety and depression, underscoring the vulnerability of the sperm genome to external disturbances [4].

Moreover, beyond mental state and age, habits also contribute to genetic modifications in sperm. Alcohol abuse, prevalent in the United States, has been linked to altered behaviors, metabolism, weight gain, stress, anxiety-related behaviors, and problems in regulating alcohol consumption in offspring due to its impact on sperm epigenetics [5]. Similarly, smoking among young men has been shown to affect the respiratory health of their offspring born years later [4]. Despite not being the physical carriers, fathers play a significant role in child development, and their contribution

to a fetus’s epigenetics should not be underestimated.

Maternal Epigenetics Mothers, as the primary carriers of their offspring, undeniably wield a significant influence over the expression of their offspring’s genome.

However, this influence extends beyond simply passing on modified gametes—mothers exert a direct nurturing impact as well. Their role as caregivers and the quality of care they provide can profoundly affect not only their offspring but also future generations. Abumadini and Elmadih expanded on this phenomenon, emphasizing how the offspring’s perception of parenting quality influences their maternal behavior and the neurobiological system, including oxytocin levels [6].

Oxytocin plays a crucial role in shaping maternal caregiving behavior and general social interactions. After interacting with their infants, secure mothers—those who demonstrate sensitivity and responsiveness in caregiving—typically exhibit higher levels of oxytocin compared to insecure mothers [6]. This emphasizes the critical role of oxytocin in fostering secure attachment and maternal behavior [6]. These factors can trigger heritable alterations in gene expression through epigenetic mechanisms, such as DNA methylation, which can either silence or enhance genes.

This process ultimately molds social attachments and stress reactivity in future generations.

Furthermore, the interplay between environmental factors and genotypes can lead to heritable alterations in gene expression within mothers, thereby influencing parental behavior transmitted to offspring.

For instance, maternal stress during

pregnancy can profoundly affect fetal development by influencing the HPA (Hypothalamic-Pituitary-Adrenal) pathways and modifying gene expression within the hypothalamus[7]. The severity of these effects increases with the variability and timing of stressors experienced during pregnancy [7].

It’s worth noting that paternal stress also contributes to epigenetic modifications in offspring, exacerbating postpartum stress in mothers and inducing changes in uterine conditions that may be passed down through generations [4]. Moreover, the epigenetic effects of stress during pregnancy have been particularly investigated in light of recent stress-inducing events such as the COVID-19 pandemic.

COVID-19 and Epigenetics The global impact of COVID-19 has left enduring psychological effects on populations worldwide. Surprisingly, studies have revealed that offspring of mothers who experienced stress, anxiety, or depression during the pandemic exhibited differential methylation in genomic sites linked to crucial neurological pathways, such as NR3C1, which has been previous-

ly associated with prenatal maternal stress [8]. This suggests that the next generation of children may be predisposed to heightened symptoms of anxiety and depression, influenced by the experiences of past generations.

This occurs because if the altered DNA is not reversed, it can be inherited by the offspring’s gametes, perpetuating its transmission to future generations.

Furthermore, recent research identified 119 differentially methylated loci uncovering how COVID-19 exposure during pregnancy induced differential DNA methylation in umbilical cord blood cells [9]. These alterations affected important canonical pathways, including stress response, cardiovascular disease, and developmental processes [9]. What implications does this hold for future generations? While not definitive, there may be physical and mental health implications that could cascade down to subsequent generations.

The recent findings in research regarding the intergenerational transmission of traits could indicate the beginning of a concerning trend.

Naturally, this raises the crucial question: How can we mitigate this potential decline? Education of the public and continued research efforts to deepen our understanding of these mechanisms are among the proposed solutions.

Parent’s Knowledge Epigenetics remains a crucial concept often overlooked by parents in the modern day. Additionally, there is a prevailing misconception that the mother’s preconception lifestyle holds greater significance for a child’s health compared to the father’s [10].

However, this notion is inaccurate. It is imperative to enlighten this genPULSE 5

eration about epigenetics because it underscores the fact that we not only transmit physical traits to the next generation but also influence their mental well-being.

Furthermore, certain heritable changes transmitted to offspring stem from behaviors and environmental exposures. Education and behavioral changes adopted pre-conception can help mitigate these effects on offspring and future generations.

A study revealed that after participating in a module focused on educating parents about epigenetic concepts and the importance of preconception lifestyles for child health, participants significantly elevated their awareness regarding the significance of both mothers’ and fathers’ preconception lifestyles for child health [10]. This highlights the transformative power of education.

Hence, prioritizing self-education emerges as a crucial step that could potentially halt the onset of a decline in generational physical and mental well-being, allowing parents to prioritize habits aimed at stress reduction before and during pregnancy.

References: 1. Centers for Disease Control and Prevention. (2022, August 15). What is epigenetics?. Centers for Disease Control and Prevention. https://www.cdc.gov/genomics/disease/ epigenetics.htm#:~:text=Epigenetics%20 is%20th e%20study%20of,body%20 reads%20a%20DNA%20sequence 2. Wein, H. (2018, April 12). Stress Hormone Causes Epigenetic Changes.

National Institutes of Health. https://www.nih.gov/news-events/ nih-research-matters/stress-hormone-causes-epigenetic changes 3. Zheng X, Li Z, Wang G, Wang H, Zhou Y, Zhao X, Cheng CY, Qiao Y, Sun F. Sperm epigenetic alterations contribute to inter- and transgenerational effects of paternal exposure to longterm psychological stress via evading offspring embryonic reprogramming.

Cell Discov. 2021 Oct 27;7(1):101. doi: 10.1038/s41421-021-00343-5. PMID: 34711814; PMCID: PMC8553786.

4. Xu X, Miao Z, Sun M, Wan B. Epigene tic Mechanisms of Paternal Stress in Offspring Development and Diseases. Int J Genomics. 2021 Jan 19;2021:6632719. doi: 10.1155/2021/6632719. PMID: 33532485; PMCID: PMC7837765.

5. Finegersh A, Rompala GR, Martin DI, Homanics GE. Drinking beyond a lifetime: New and emerging insights into paternal alcohol exposure on subsequent generations. Alcohol.

2015 Aug;49(5):461-70. doi: 10.1016/j. alcohol.2015.02.008. Epub 2015

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Mar 30. PMID: 25887183; PMCID: PMC4469624.

6. Elmadih A, Abumadini M. Epigenetic Transmission of Maternal Behavior: Impact on the Neurobiological System of Healthy Mothers. Saudi J Med Med Sci. 2019 Jan-Apr;7(1):3-8. doi: 10.4103/ sjmms.sjmms_163_17. Epub 2018 Dec 14. PMID: 30787850; PMCID: PMC6381851.

7. Gudsnuk K, Champagne FA. Epigenetic influence of stress and the social environment. ILAR J. 2012;53(3-4):27988. doi: 10.1093/ilar.53.3-4.279. PMID: 23744967; PMCID: PMC4021821.

8. Kocher, K., Bhattacharya, S., Niforatos-An descavage, N., Almalvez, M., Henderson, D., Vilain, E., Limperopoulos, C., & Délot, E. C. (2023). Genome-wide neonatal epigenetic changes associated with maternal exposure to the COVID-19 pandemic. BMC medical genomics, 16(1), 268. https:// doi.org/10.1186/s12920-023-01707-4 9. Urday P, Gayen Nee’ Betal S, Sequeira Gomes R, Al-Kouatly HB, Solarin K, Chan JS, Li D, Rahman I, Addya S, Boelig RC, Aghai ZH. SARS-CoV-2 Covid-19 Infection During Pregnancy and Differential DNA Methylation in Human Cord Blood Cells From Term Neonates. Epigenet Insights. 2023 Jun 30;16:25168657231184665. doi: 10.1177/25168657231184665. PMID: 37425024; PMCID: PMC10328022.

10. Hollister, B. M., Yaremych, H. E., Goldring, M. R., & Persky, S. (2019).

Mothers’ and fathers’ cognitive and affective responses to epigenetics concepts. Environmental epigenetics, 5(4), dvz021. https://doi.org/10.1093/eep/ dvz021

Revolutionizing Cancer Care: The Transformative Potential of Liquid Biopsy-Based Detection Written by Amiti Goel Edited by Roxanna Fahid

Liquid biopsy-based detection represents a groundbreaking advancement in cancer diagnosis, offering a non-invasive, real-time method for monitoring tumor dynamics and treatment response. Unlike traditional tissue biopsies, which can be invasive and may not provide a comprehensive view of tumor biology, liquid biopsy analyzes circulating biomarkers present in bodily fluids such as blood and urine. This approach is extremely promising for early cancer detection, enabling clinicians to intervene before clinical symptoms, such as unexplained weight loss, changes in bowel habits, or unusual lumps, develop. Moreover, liquid biopsy has the potential to guide personalized treatment strategies by identifying genetic alterations, tumor heterogeneity, and treatment-resistant mutations. In order to understand the transformative implications of liquid biopsy in improving patient outcomes and enhancing cancer care, we will explore the mechanics, historical development and potential of this innovation in cancer medicine.

Early detection of cancer is essential in improving treatment outcomes and enhancing patient survival rates.

Timely diagnosis enables healthcare providers to implement effective

treatment strategies at a stage when the disease is more manageable and potentially curable. By identifying cancer in its early stages, before it has a chance to spread (or metastasize), clinicians can intervene with targeted therapies, surgical interventions, or other appropriate treatments, thereby increasing the likelihood of successful outcomes. Furthermore, early detection may also allow for less aggressive treatment methods, reducing the intensity of treatment-related side effects on patients while still achieving promising results. The benefits of early cancer detection are overwhelmingly positive, highlighting the importance of implementing screening programs and diagnostic tools that enable timely identification of malignancies. However, traditional tissue biopsies, long considered the accepted standard for cancer diagnosis, have increasingly revealed their limitations. These methods, often invasive and conducted at a single time point, pose challenges in capturing the full extent of tumor heterogeneity and may not reflect the dynamic nature

of cancer progression and treatment response over time. Because of this, there is a growing need for alternative diagnostic methods, such as liquid biopsy, which offer greater accessibility, non-invasiveness, and real-time insights into tumor biology, to revolutionize the field of cancer diagnosis, monitoring, and treatment.”

Liquid biopsy targets various types of biomarkers obtained from bodily fluids, each offering unique insights into tumor biology. These specimens include circulating tumor cells (CTCs), cell-free DNA (cfDNA), circulating tumor DNA (ctDNA), exosomes, and other biomarkers present in blood, urine, or other bodily fluids.

CTCs are cancer cells that have shed from the primary tumor and entered the bloodstream, providing valuable information about tumor metastasis and invasiveness. CfDNA and ctDNA, are fragments of DNA released by tumor cells into the bloodstream, offering insights into genetic mutations, tumor heterogeneity, and treatment response. Exosomes are small vesicles secreted by cells, including cancer PULSE 7

cells, which contain proteins, nucleic acids, and other molecules reflective of the cell of origin. Other relevant biomarkers (identified in previous research) found in bodily fluids, such as proteins, RNA, and microRNAs, can also serve as indicators of tumor presence and progression.

The mechanism underlying liquid biopsy involves the shedding of tumor cells and release of circulating biomarkers into the bloodstream as tumors grow and evolve. These circulating biomarkers, including fragments of DNA and other molecules, can be collected through minimally invasive methods such as blood draws or urine samples. Circulating tumor cells (CTCs) may be separated from other blood cells using microfluidic devices or immunomagnetic sorting, while cell-free DNA (cfDNA) and circulating tumor DNA (ctDNA) may be extracted from the plasma or serum using various molecular biology methods. Once isolated, the biomarkers undergo molecular analysis, such as next-generation sequencing (NGS), polymerase chain reaction (PCR), or digital droplet PCR (ddPCR), to identify genetic mutations, tumor heterogeneity, and treatment-resistant mutations. The results of the analysis provide clinicians with valuable insights into the genetic makeup, molecular profile, and metastatic potential (spread) of the tumor. By detecting and analyzing these biomarkers, liquid biopsy enables clinicians to monitor tumor dynamics, assess treatment response, and identify potential therapeutic targets with precision and efficiency. While advantageous for minimizing procedural risks compared to traditional tissue biopsies, liquid biopsy faces technical challenges such as ensuring high PULSE 8

sensitivity and specificity in detecting biomarkers and standardizing assays across different laboratories. Achieving consistency in results is essential for reliable clinical interpretation and widespread adoption of liquid biopsy in cancer diagnosis and monitoring.

Despite these challenges, liquid biopsy-based detection offers multifaceted applications across various aspects of oncology. Its non-invasive nature makes it particularly advantageous for early cancer detection and screening, especially in populations at high risk for certain cancers such as breast, lung, colorectal, and pancreatic cancers. By enabling regular monitoring through high-risk surveillance methods, liquid biopsy enhances the ability to detect cancer at its earliest stages, when treatment is most effective. Moreover, liquid biopsy plays a pivotal role in identifying genetic alterations, tumor heterogeneity, and treatment-resistant mutations as compared to traditional methods. Through the analysis of circulating biomarkers, clinicians can tailor treatment strategies to individ-

ual patients, maximizing therapeutic efficacy and minimizing adverse effects. Additionally, the integration of liquid biopsy data into clinical decision-making processes holds the potential to optimize the selection of targeted therapies, immunotherapies, and eligibility for clinical trials.

Looking ahead, ongoing research is focused on enhancing sensitivity and specificity, standardizing protocols, and extending applications to treatment monitoring and disease prediction. Innovations in molecular biology techniques, such as next-generation sequencing and digital PCR, are driving improvements in assay sensitivity and accuracy. Additionally, advancements in microfluidic technologies and biomarker identification methods are facilitating the development of more efficient and reliable liquid biopsy platforms. These efforts are aimed at realizing the full potential of liquid biopsy as a non-invasive, real-time tool for personalized cancer diagnosis and treatment monitoring.

Precision Nutrition: A Personalized Approach to Disease Prevention and Treatment Written by Hermela Selam Edited by Hunter Bershtein

Precision nutrition, a subfield of precision medicine, has emerged as a promising strategy to optimize health outcomes by tailoring dietary interventions to individual characteristics and needs. Supported by the National Institutes of Health, precision nutrition represents a paradigm shift in healthcare, offering targeted dietary strategies based on factors such as genetics, microbiome composition, and metabolic profiles. Exploring precision nutrition in depth through examining its applications in disease prevention and treatment and looking into the challenges associated with its implementation will shed light on how effectively personalizing nutrition can optimize health outcomes.

Precision nutrition may sound like a novel concept, but it is firmly rooted in the principles of precision medicine, which seeks to provide personalized treatments based on individual characteristics. While traditional nutrition guidelines offer general recommendations for populations, precision nutrition takes into account the unique genetic makeup, lifestyle habits, and health history of each individual. By leveraging advanced technologies such as genetic testing, metabolomics, and microbiome analysis, precision nutrition aims to identify specific dietary interventions that are most effective for each person,

thereby optimizing health outcomes and reducing the risk of chronic diseases beyond what could be achieved using generic medical treatments.

Lifestyle habits and health history play crucial roles in determining the most suitable nutrition plan for each individual. Research shows that dietary patterns may vary based on demographic and lifestyle variables, such as sex, socio-economic status, ethnicity, and culture. Moreover, diets interact with other lifestyle factors in influencing health outcomes, emphasizing the importance of considering a holistic approach to nutrition and health.

Understanding the relationship between lifestyle and diets is essential for developing effective precision nutrition strategies. Genetic factors play a significant role in determining how individuals metabolize nutrients and respond to dietary interventions. For example, variations in genes related to caffeine metabolism can influence an individual’s tolerance to coffee and its health effects. When consumed in coffee, caffeine enters the bloodstream

through your stomach and intestines.

As it circulates throughout the body, the caffeine adenosine receptors in the brain, which show genetic variation among individuals.

Consequently, caffeine does not bind as effectively to these receptors in some people, resulting in a perceived lack of response to caffeine consumption in that they feel less “awake” in response to the same dose of caffeine. Moreover, after reaching the bloodstream, caffeine travels to the liver, where it is broken down and removed from the blood. This metabolic process is governed by enzymes, such as the CYP1A2 enzymes. Genetic variation influences the activity of these enzymes, leading to differences in caffeine metabolism rates among individuals. Individuals with lower levels of the CYP1A2*1F (rs762551) enzymes tend to metabolize caffeine more slowly and may experience prolonged stimulant effects. Furthermore, external factors such as habitual caffeine consumption play a crucial role in shaping individual responses to caffeine. Regular caffeine consumPULSE 9

ers may develop tolerance over time, diminishing the perceived effects of caffeine.

Additionally, factors like diet, medication, and lifestyle habits can also modulate caffeine metabolism and its physiological effects. For instance, certain substances may compete for the same metabolic pathways as caffeine, altering its metabolism and duration of action in the body.

Caffeine is just one of many examples where diversity in genetics, lifestyle, and environment contribute to metabolic differences among individuals. Understanding these differences and putting them into consideration when tailoring dietary interventions is fundamental to optimize health outcomes in the context of precision nutrition.

Similarly, the composition of the microbiome, the diverse community of microorganisms residing in the gut, can impact nutrient absorption, immune function, and overall health. The impact of gut microbiota composition on nutrient absorption helps illustrate the importance of understanding these interactions. For instance, individuals with a particular gut microbiota composition may exhibit enhanced absorption of certain nutrients, such as vitamins or minerals This difference in nutrient absorption can have profound implications for dietary recommendations. For example, individuals with a microbiota profile not conducive to enhanced calcium absorption may benefit from dietary adjustments that emphasize calcium-rich foods to support bone health; although, individuals with a microbiota profile that is conducive to enhanced calcium absorption can still benefit from more calcium-rich foods to further support bone health.

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However, it’s crucial to note that niche traits like gut microbiota composition are not typically considered in traditional nutrition approaches.

While short-term dietary changes can induce transient shifts in gut microbiota composition, the long-term effects remain unclear. Current research suggests that habitual diets may exert a more substantial influence on gut microbiota composition than acute dietary interventions. Thus, understanding the nuanced interactions between genetics, microbiome, and diet is essential for tailoring precise dietary recommendations to address in-

dividual needs and promote optimal health. Research, such as the study by Leeming et al. (“Effect of Diet on the Gut Microbiota: Rethinking Intervention Duration”), underscores the dynamic nature of the gut microbiota and its response to dietary interventions. While short-term changes in diet can influence microbial diversity and composition, the long-term implications necessitate further investigation. Only through comprehensive studies that incorporate long-term dietary interventions and follow-ups can we elucidate the lasting effects of

diet on the gut microbiota and make informed clinical recommendations for dietary modulation to promote health. In addition to genetic and lifestyle diversity, differences in gut microbiota should also be considered when using precision nutrition to tailor dietary recommendations that aim to optimize health.

Precision nutrition holds promise for managing a wide range of chronic diseases, including diabetes, obesity, cardiovascular diseases, and certain cancers. By identifying genetic predispositions and metabolic profiles associated with these conditions, precision nutrition can inform targeted dietary interventions aimed at improving health outcomes and quality of life. Looking into a specific chronic disease, individuals with type 2 diabetes are typically prescribed generic dietary recommendations. However, these recommendations may not effectively address the individual variations in metabolic responses and genetics.

Precision nutrition offers a solution by accounting for various factors such as phenotype, genotype, metabolic biomarkers, and gut microbiome to personalize dietary recommendations. Research by Antwi et al. highlights the importance of tailoring dietary interventions to individual characteristics, including genetic makeup and metabolic responses. In another study by Arias-Marroquín et al., personalized nutrition interventions demonstrated higher rates of diabetes remission compared to non-personalized approaches.

These personalized interventions included precision nutrition based on postprandial glucose responses, diabetes subtype-tailored diets, and individualized meal plans. By transi-

tioning to a precision diet tailored to their specific genetic predispositions and metabolic responses, the patient with type 2 diabetes experienced significant improvements in glycemic control, weight management, and overall health outcomes. This case study underscores the potential of precision nutrition to optimize dietary responses and improve the quality of life for individuals with chronic diseases like type 2 diabetes.

By moving away from generic dietary recommendations and embracing personalized interventions, individuals with type 2 diabetes and other chronic diseases can achieve better health outcomes and improved management of their condition.

Recent advancements in technology have significantly enhanced our ability to implement precision nutrition strategies. Genetic testing platforms, such as exome and genome sequencing, now allow for comprehensive analysis of individual genetic variations related to nutrient metabolism, dietary preferences, and disease risk. These technologies have transitioned from being available primarily in research settings to becoming increasingly accessible in clinical

contexts. For example, genome sequencing is set to become a standard test within healthcare systems within the foreseeable future, making genetic information more readily available for personalized dietary recommendations. Similarly, advances in metabolomics have revolutionized our ability to identify metabolic signatures associated with specific dietary patterns and health outcomes.

Metabolomics enables researchers to analyze the complete set of metabolites within a biological sample, providing valuable insights into individual metabolic responses to dietary interventions. These insights can inform personalized dietary recommendations tailored to optimize metabolic health. Moreover, microbiome analysis tools have greatly expanded our understanding of the composition and function of the gut microbiome. High-throughput sequencing technologies have made it feasible to analyze the entire human microbiome, shedding light on the complex interactions between the microbiota and human health. These tools enable the identification of microbial signatures associated with various health conditions, informing personalized

dietary recommendations aimed at supporting a healthy microbiome and overall well-being.

While these technological advancements hold great promise for precision nutrition, challenges remain in terms of accessibility and affordability. The transition of genetic testing and other precision nutrition technologies from research to clinical practice has made them more widely available, but cost and access disparities still exist. Efforts to address health equity in precision medicine and genomics are underway, with initiatives aimed at reducing barriers to access and ensuring that these technologies reach underserved populations.

Access to advanced testing technologies and specialized expertise may be limited, particularly in underserved communities.

Moreover, the integration of precision nutrition into healthcare systems requires collaboration among healthcare providers, researchers, policymakers, and technology developers.

Ethical considerations regarding data privacy, equity, and the commercialization of genetic and microbiome testing also need to be addressed. The (add year) Health Equity Innovation

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Summit, which explored challenges and solutions related to health equity in personalized medicine and genomics, highlighted the importance of addressing determinants of healthcare, including access to clinical trials and cutting-edge treatments, and emphasized the need for policies and practices that promote equity in precision medicine.

The promises and challenges of precision medicine have been extensively discussed, with a focus on its potential to revolutionize healthcare by providing more precise ways of treating disease. However, concerns remain that underrepresented minority communities may not benefit PULSE 12

equally from precision medicine due to factors such as lack of representation in clinical trials and mistrust of the healthcare system. Community-centered approaches, such as the use of Community Health Workers and engagement of community champions, have been proposed to address these barriers to access and expand precision medicine for underserved populations. Overall, while precision medicine holds promise in advancing healthcare, it is essential to ensure that it is implemented in a way that promotes health equity and addresses the needs of all demographics.

Precision nutrition represents a transformative approach to health-

care, offering personalized dietary interventions tailored to individual characteristics and needs. By leveraging insights from genetics, microbiome analysis, and metabolic profiling, precision nutrition has the potential to revolutionize disease prevention and treatment, improving health outcomes and enhancing quality of life for individuals worldwide. As research in this field continues to evolve, it is essential to address challenges and ensure equitable access to personalized nutrition interventions, ultimately advancing public health and well-being on a global scale.

References: Antwi, J. (2023). Precision Nutrition to Improve Risk Factors of Obesity and Type 2 Diabetes. Current Nutrition Reports. https://doi.org/10.1007/s13668023-00491-y

and beyond: a technological portfolio to investigate cancer metabolism. Signal Transduction and Targeted Therapy, 8(1), 1–22. https://doi.org/10.1038/s41392-02301380-0

Arias-Marroquín, A. T., Del Razo-Olvera, F. M., Castañeda-Bernal, Z. M., Cruz-Juárez, E., Camacho-Ramírez, M. F., Elías-López, D., Lara-Sánchez, M. A., Chalita-Ramos, L., Rebollar-Fernández, V., & Aguilar-Salinas, C. A. (2024).

Personalized Versus Non-personalized Nutritional Recommendations/Interventions for Type 2 Diabetes Mellitus Remission: A Narrative Review. Diabetes Therapy: Research, Treatment and Education of Diabetes and Related Disorders. https://doi.org/10.1007/s13300024-01545-2

Gherasim, A., Arhire, L. I., Niță, O., Popa, A. D., Graur, M., & Mihalache, L. (2020). The relationship between lifestyle components and dietary patterns.

Proceedings of the Nutrition Society, 79(3), 311–323. https://doi.org/10.1017/ s0029665120006898

Cena, H., & Calder, P. C. (2020). Defining a healthy diet: Evidence for the role of contemporary dietary patterns in health and disease. Nutrients, 12(2), 1–15. https://doi.org/10.3390/ nu12020334 Danzi, F., Pacchiana, R., Mafficini, A., Scupoli, M. T., Scarpa, A., Donadelli, M., & Fiore, A. (2023). To metabolomics

Horton, Rachel H., & Lucassen, Anneke M. (2019). Recent developments in genetic/genomic medicine. Clinical Science, 133(5), 697–708. https://doi.org/10.1042/cs20180436 Lara, B., Ruiz-Moreno, C., Salinero, J. J., & Del Coso, J. (2019). Time course of tolerance to the performance benefits of caffeine. PLOS ONE, 14(1), e0210275. https://doi.org/10.1371/journal. pone.0210275 Leeming, E. R., Johnson, A. J., Spector, T. D., & Le Roy, C. I. (2019). Effect of Diet on the Gut Microbiota: Rethinking Intervention Duration. Nutrients,

11(12), 2862. https://doi.org/10.3390/ nu11122862 Lin, T. (2023). Editorial: New techniques in microbiome research. Frontiers in Cellular and Infection Microbiology, 13. https://doi.org/10.3389/ fcimb.2023.1158392 Ory, M. G., Adepoju, O. E., Ramos, K. S., Silva, P. S., & Vollmer Dahlke, D. (2023). Health equity innovation in precision medicine: Current challenges and future directions. Frontiers in Public Health, 11. https://doi.org/10.3389/ fpubh.2023.1119736 Ryan, J. C., Viana, J. N., Sellak, H., Gondalia, S., & O’Callaghan, N. (2021). Defining precision health: a scoping review protocol. BMJ Open, 11(2), e044663. https://doi.org/10.1136/bmjo-en-2020044663 Why Caffeine Affects Some People More Than Others. (2018, July 6). 1335 Frankford. https://blog.lacolombe. com/2018/07/06/caffeine-affects-people-others/#:~:text=Each%20person %27s%20adenosine%20receptors%20are

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In the age of Digital Healthcare, How Effective are Online Mental Health Resources?

Written by:Emnet Djibrila Edited by Deqa Muse

In a modern age where almost everything is digitized, therapy is available everywhere. With online resources like BetterHelp and TalkSpace, the digitization of mental health services is in full force. Digital therapy became a staple in the lives of many during the COVID-19 pandemic as individuals were confined to their homes as a safety precaution, resulting in a 25% global increase in individuals with depression and anxiety (NIH). Online resources were an invaluable tool for many, but with the days of lockdown seemingly behind us, healthcare providers and recipients are debating whether to resume in-person mental health services.

Despite how crucial online mental health services have been, many questions arise about the efficacy of these services now that the option to return in person is available.

The transition to online therapy resources seemed to happen almost overnight. Both physicians and patients had to quickly adapt to utilizing telehealth resources for personal and public safety reasons during the COVID-19 pandemic.

Not only was there a major shift to telecommunications but, the demand for mental health resources also rose significantly. The COVID-19 pandemic was emotionally exhausting for many; non-essential workers had PULSE 14

to transition to working from home, students were learning online, and social interactions were minimal.

“The share of U.S. adults who either reported taking a prescription medication for a mental health condition or receiving counseling or therapy rose from 19.2% in 2019 to 21.6% in 2021” (Time Magazine). However, with hospitals and care centers overwhelmed with COVID-19 patients, and many individuals fearing for their safety and health, individuals sought out care they could receive from their homes. Not only did the use of psychiatric resources significantly increase, but specifically the use of telehealth and online mental health resources skyrocketed. “In March 2020, just 1% of outpatient visits related to mental health and substance use were conducted via telehealth; that number rose to 36% as of Aug. 2021” (Kaiser Family Foundation Analysis). These telehealth services were essential during the height of the pandemic, however as the crisis stage of the COVID-19 pandemic ends, a discourse sparked about online ther-

apy—especially since life looks a lot different now than it did before.

The discourse involves debates over the efficacy of online health resources. Many patients and care providers are conducting cost-benefit analyses on these services. One undeniable fact about these online services is that they remove significant barriers to accessing mental health assistance. With the implementation of online health resources, people can conduct their therapy sessions from anywhere with a phone or laptop, technology widely owned by the average individual. This allows people without access to reliable transportation to and from hospitals or with busy schedules to receive therapy.

There are also low-cost versions of online therapy available, typically text-based, that remove a significant cost barrier. Services like BetterHelp or Talkspace also provide specialized mental health assistance (ex.

LGBTQIA+ topics, parenting, and grief counseling) via a user-friendly platform that doesn’t hinder people from engaging. Online mental health

resources have been found to be just as effective as in-person therapy for treating various conditions, including anxiety and depression (American Psychological Association). Due to the stigma around seeking out mental health resources, many have also praised the element of confidentiality that comes with online mental health resources. There is no chance of someone seeing a patient in the parking lot of a therapist’s office because the patient is calling in from where they feel the most comfortable.

On the other hand, online mental health resources have their limitations. A pitfall of these services is that they exclude a portion of the population that needs mental health assistance but does not have consistent access to the internet or electronic devices. This major limitation still makes access to therapy available only to specific socioeconomic classes.

Many mental health providers have also noted that patients can keep concerning signs of mental disorders hidden extremely well on a Zoom call

as being able to interact and observe their mannerisms as well as their entire physical state informs diagnoses (Psychology Today). Many therapists rely on non-verbal communication, thus in-person therapy makes it significantly easier to pick up on many of the non-verbal cues that patients may make during a session (Psychology Today). Conducting therapy sessions online is not only difficult to do effectively, but can also be very taxing for the care providers. Therapists have expressed the fatiguing nature of providing telehealth services, and experiences (“Should I Resume In-Person Therapy? NYT). Patients have also expressed frustration with their care-providers, concerned that they cannot tell if their provider is being attentive. Patients have noted instances of their care providers eating, attending to their appearance, or conducting sessions from unconventional locations, like their beds (Psychology Today). The inability of physicians and other care providers to adequately supply effective care has,

in turn, caused patients to be unsatisfied with the virtual treatment they receive.

It is important to note that therapy is not a one-size-fits-all, and the mode in which it is received is highly dependent on the individual receiving it. For some people online therapy is revolutionary and life-changing, while others returned to in-person the second they could. However, both forms of therapy are still effective in treating a variety of mental health conditions, and those seeking out mental health assistance need to try out a variety of providers to select the one that is the best fit based on their preferred format of communication, individual goals, and comfort level.

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References: Kupcova, Ida, Lubos Danisovic, Martin Klein, and Stefan Harsanyi. “Effects of the COVID-19 Pandemic on Mental Health, Anxiety, and Depression.” BMC psychology, April 11, 2023. https:// www.ncbi.nlm.nih.gov/pmc/articles/ PMC10088605/#:~:text=Morbidity%20and%20mortality%20of%20 COVID,prevalence%20increased%20 by%2025%25%20globally.

ReachBehavioralHealth. “The Pros and Cons of Virtual Therapy vs. in-Person Therapy.” Reach Behavioral Health, April 7, 2022. https://reachbh.org/thepros-and-cons-of-virtual-therapy-vs-inperson-therapy/.

Demelo, Juno. “Should You Resume In-Person Therapy?” The New York Times, September 29, 2021. https:// www.nytimes.com/2021/09/29/well/ mind/in-person-therapy-covid.html.

Brenner, Brad. “In-Person Therapy vs.

Online Therapy: Which Is Right for You?” Therapy Group of DC, April 3, 2022. https://therapygroupdc.com/therapist-dc-blog/in-person-therapy-vs-online-therapy-which-is-right-for-you/.

“The 3 Essential Benefits of In-Person vs. Online Therapy.” Psychology Today.

Accessed April 18, 2024. https://www. psychologytoday.com/us/blog/whenkids-call-the-shots/202306/the-3-essential-benefits-of-in-person-vs-onlinetherapy.

Greenwood, Hannah, Natalia Krzyzaniak, Ruwani Peiris, Justin Clark, Anna Mae Scott, Magnolia Cardona, Rebecca Griffith, and Paul Glasziou. “Telehealth versus Face-to-Face Psychotherapy for Less Common Mental Health Conditions: Systematic Review and Meta-Analysis of Randomized Controlled Trials.” JMIR mental health, March 11, 2022. https://www.ncbi.nlm.nih.gov/

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pmc/articles/PMC8956990/.

Brenner, Brad. “Why People Are Shifting to In-Person Therapy over Virtual Therapy.” Therapy Group of NYC, October 28, 2023. https://nyctherapy. com/therapists-nyc-blog/why-peopleare-shifting-to-in-person-therapy-overvirtual-therapy/.

Law, Tara. “More People Got Mental-Health Treatment during the Pandemic.” Time, September 8, 2022. https://time.com/6211734/ mental-health-treatment-pandemic-young-people/.

“Demand for Mental Health Treatment Continues to Increase, Say Psychologists.” American Psychological Association. Accessed April 18, 2024. https://www.apa.org/news/press/releases/2021/10/mental-health-treatment-demand.

Justin Lo, Matthew Rae, and Mar 2022.

“Telehealth Has Played an Outsized Role Meeting Mental Health Needs during the COVID-19 Pandemic.”

KFF, March 22, 2022. https://www.kff. org/coronavirus-covid-19/issue-brief/ telehealth-has-played-an-outsized-rolemeeting-mental-health-needs-duringthe-covid-19-pandemic/.

“Is Online Therapy Cheaper than In-Person Therapy?” Psychology Today.

Accessed April 18, 2024. https://www. psychologytoday.com/us/basics/therapy/ is-online-therapy-cheaper-than-in-person-therapy.

“8 Things to Consider When Choosing a Therapist.” Ottawa University - Prepare for a Life of Significance. Accessed April 18, 2024. https://www.ottawa.edu/ online-and-evening/blog/june-2023/8things-to-consider-when-choosing-atherapist.

Heyl, Julia Childs. “I Tried Online Therapy at Betterhelp for a Month to See If It’s Worth the Hype.” Health, May 1, 2023. https://www.health.com/i-triedbetterhelp-7484998.

“Talkspace Review: Tried and Tested (2024).” Forbes, March 19, 2024. https:// www.forbes.com/health/mind/talkspace-review/.

Premenstrual Dysphoric Disorder (PMDD): A Window into the Exigencies of Women’s Health Written by Alexandra Matthews Edited by Ally Wang

Women experience a wide range of physical and emotional symptoms related to their menstrual cycles before, during, and even after their periods. These symptoms are referred to as premenstrual syndrome (PMS) although they can linger beyond the premenstrual phase, and they can include depression and anxiety, mood swings, headaches, nausea, dizziness, and cramps that have the potential to be as painful as a heart attack. These symptoms are attributed to the hormonal changes that occur during the luteal phase of the menstrual cycle, which spans the time between ovulation and menstruation.

For about ten percent of women, PMS takes on a more severe, and a much more concerning, form: Premenstrual Dysphoric Disorder (PMDD). Women with PMDD experience the emotional symptoms of PMS on a larger scale, sometimes even enduring panic attacks or suicidal thoughts each time they menstruate. Countless women with PMDD have described the luteal phase of their menstrual cycles as a psychologically debilitating portion of every month. These symptoms can affect women with equal severity regardless of their psychological or emotional tendencies outside of the luteal

phase—the hormones of even the most ordinarily positive and mentally stable women can cause their psyches to crumble when suffering from PMDD. Moreover, these symptoms can last for as long as two weeks out of the month—that’s half of a woman’s life in the years during which she menstruates.

While PMDD may be worsened or slightly improved by psychological factors, its cause appears to be predominantly or wholly genetic. Women who suffer from the disorder have been shown to be especially biologically sensitive to the hormonal changes that occur during the luteal phase.

Perhaps the most notable implication of this heightened sensitivity is that the serotonin deficiency that occurs during the luteal phase is worsened

in those with PMDD. Serotonin is a neurotransmitter that is essential to processes that allow us to experience joy, make us feel calm, and help us to focus; a deficiency in this neurotransmitter can therefore be life-changing for as long as it lasts.

Individuals who have a family history of mood disorders are at higher risk of developing PMDD. Smoking has also been shown to increase hormone sensitivity and thereby give rise to the disorder.

Despite the severity of PMDD and its implications, it—like PMS—has no go-to or one-size-fits-all treatment. In fact, for many women, there is no reliable treatment at all. The menstrual cycle and its symptoms are woefully under-researched and under-treated, and the current methods for alleviPULSE 17

ating symptoms are far from perfect.

Painkillers can ameliorate many of the physical symptoms of PMS, such as cramps and backaches, either partially or completely; however, the emotional symptoms are much more complicated and far more difficult to treat.

Contraceptive pills are perhaps the most effective way to combat the emotional aspects of PMS and PMDD; for many patients, the pill is a miracle drug. However, for a significant number of patients, it can make depression exponentially worse before or instead of making it better.

The birth control pill can also cause troubling and dangerous side effects such as blood clots, nausea, and high blood pressure. Selective serotonin reuptake inhibitors (SSRIs) are another common and sometimes successful treatment; however, like the pill, they can cause severe emotional and physical side effects.

Other treatments for PMDD include supplements containing vitamin D, vitamin B6, calcium, zinc, and magnesium. Dietary changes such as consuming more omega-3 fatty acids and less caffeine during menstruation have also been shown to help.

None of these regimens, however, has a high enough success rate to merit becoming a mainstream or default option.

Holistic and alternative medicine approaches have demonstrated some promise in treating PMDD and PMS. Herbal remedies such as chamomile and saffron have been helpful for some patients, and acupuncture is currently being investigated as a potential treatment option. While data for these alternative treatment methods is sparse, these approaches do not seem to bring out the adverse PULSE 18

reactions and symptoms that the pill and SSRIs can often trigger; further investigating holistic approaches could uncover new, successful treatment options that can target the complex symptoms of PMDD and PMS successfully without causing severe and often-unpredictable side effects.

This would be life-changing for countless women, and so researching holistic treatment methods might be worthwhile.

Because of the intricacy of the endocrine system, it is challenging for physicians to piece together the data from patients’ symptoms in a way that detangles all of the possible factors contributing to a condition and points to a definitive diagnosis or treatment plan. The symptoms a woman experiences in the time surrounding her period can be attributed to many possible causes, which makes it crucial for doctors—particularly OB/GYNs and endocrinologists—to listen to and trust their patients, taking all of their symptoms and concerns seriously. The fact that women are statistically proven to be taken less seriously by their doctors than men— especially in light of the fact that

women’s health is, in many ways, a far more complex and misunderstood biological tapestry than men’s—is preposterous.

As women’s health is finally beginning to receive the attention and research that it deserves, we are finding more and more that women’s mental and physical health relies on an extremely delicate balance of interdependent hormones and endocrine and nervous pathways; if a woman is feeling anxious or depressed, those emotions may very well be far outside the realm of her psychological control and, as such, demand thoughtful medical attention and recognition. Moreover, PMDD and PMS symptoms should not be normalized; a woman should never be told that, because hormones and a regular biological cycle are causing her symptoms, they are not a cause for concern. Women deserve better than that. Discussion of symptoms caused by the menstrual cycle should only underscore why research on that subject is needed, not why the associated effects should be invalidated, disregarded, or written off as minor or unfixable.

References: Armour, M., Ee, C. C., Hao, J., Wilson, T. M., Yao, S. S., & Smith, C. A. (2018, August 14). Acupuncture and acupressure for premenstrual syndrome.

The Cochrane database of systematic reviews, 8(8), CD005290. https://doi. org/10.1002/14651858.CD005290.pub2 Bever, L. (2022, December 13). From heart disease to IUDs: How doctors dismiss women’s pain. https://www. washingtonpost.com/wellness/interactive/2022/women-pain-gender-bias-doctors/

tion and Research. (2022, February 25).

Premenstrual syndrome (PMS). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/premenstrual-syndrome/ diagnosis-treatment/drc -20376787 Merone, L., Tsey, K., Russell, D., & Nagle, C. (2022, December 22). “I just want to feel safe going to a doctor”: Experiences of female patients with chronic conditions in Australia. Women’s health reports (New Rochelle, N.Y.). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9811844/

Carlini, S. V., Lanza di Scalea, T., McNally, S. T., Lester, J., & Deligiannidis, K. M. (2022, December 21). Management of premenstrual dysphoric disorder: A scoping review. International Journal of Women’s Health. https://www.ncbi.nlm. nih.gov/pmc/articles/PMC9790166/

Mulroy, Z. (2018, February 28). Period pain can be as painful as a heart attack and women are rejoicing. The Mirror. https://www.mirror.co.uk/news/health/ doctors-finally-confirm-your-period-12103914

Dusenbury, M. (2022b, April 9). Even women doctors find their symptoms aren’t taken seriously. WebMD. https:// www.webmd.com/women/features/ women-doctors-symptoms-dismissed Mayo Foundation for Medical Educa-

National Health Service. (n.d.). Side effects - Selective serotonin reuptake inhibitors (SSRIs). National Health Service. https://www.nhs.uk/mental-health/ talking-therapies-medicine-treatments/ medicines-and-psychiat ry/ssri-antidepressants/side-effects/

Premenstrual Dysphoric Disorder (PMDD). Cleveland Clinic. (n.d.). https://my.clevelandclinic.org/health/ diseases/9132-premenstrual-dysphoric-disorder-pmdd Premenstrual Dysphoric Disorder (PMDD). Johns Hopkins Medicine.

(2019, November 19). https://www. hopkinsmedicine.org/health/conditions-and-diseases/premenstrual-dysphoric-disord er-pmdd Premenstrual dysphoric disorder (PMDD). Mind. (2021, August). https://www.mind.org.uk/information-support/types-of-mentalhealth-problems/premenstrual-dys phoric-disorder-pmdd/about-pmdd/#:~:text=The%20exact%20causes%20 are%20still,during%20 your%20monthly%20menstrual%20cycle

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An Innovative Healthcare Approach: The Costa Rican Model Written by Francisca Anazco Edited by Shannon Meng

Introduction In 2018, Costa Rica had a mean life expectancy of 80, which is classified as “very high” according to the United Nations Development Programme (Barr). Compared to the United States average of 76.4 years, the Costa Rican pura vida lifestyle––one aiming to eliminate stress and forge a strong sense of community and family––has resulted in the country being considered one of the Blue Zones of the world.

The term Blue Zone has been used to describe trends observable in some regions of the world where populations, on average, lived the longest.

Other regions like Okinawa, Japan and Sardinia, Italy which have been characterized by their simple diets and emphasis on the importance of constant physical activity and mental wellbeing also exhibit similar patterns of longevity (Blue Zones).

Costa Rica presents an interesting case study because of the seeming irreconcilability between the high life expectancy and the income inequality that afflicts its citizens. In 2018, Costa Rica’s level of national income was $14,636, adjusted to the absolute purchasing power of the Colón (Barr). It also has the 18th highest income inequality in the world out of 177 countries, as measured through the Gini coefficient (World PopulaPULSE 20

tion Review). If Costa Rica were only ranked by its gross national income per person, it would rank 15 places worse than its current ranking on the Human Development Index, a measure of achievement in key dimensions of human development. Evidently, there is little relation between Costa Rica’s highly unequal economy and its high life expectancy; in addition, there are other features of Costa Rica’s development that make it an interesting case for the remarkable longevity of its population.

A Brief History Costa Rica is a small developing country in Central America with approximately five million inhabitants.

Its government has historically made many attempts to improve the quality of life of its citizens. In 1948, after the Costa Rican civil war, President Figueres Ferrer advocated to cease investment in national defense and

abolish the military. Not only did this policy promote non-violent conflict resolution, but it also allowed more investment in improving the environment, education, and healthcare (Prado).

After the economic crises in the late 1970s and early 1980s, Costa Rica launched a new national primary healthcare system in 1995 called the Equipos Básicos de Atención Integral en Salud (EBAIS). The EBAIS model established four goals: to improve primary care, hold hospitals and clinics accountable, have active participation of the community in their healthcare, and give healthcare institutions administrative independence (Cuccia).

The services provided by this model were designed to provide integrative and comprehensive care, especially to impoverished regions in the country.

Outcomes Achieving a universal primary

healthcare system required a large commitment from the nation’s leaders. The merging of the Ministry of Health with the Caja Costarricense de Seguro Social (CCSS) which managed the new model and implemented the EBAIS model called for compromises from both public and private institutions. Funding for the EBAIS program proved to be a large obstacle for CCSS: it required all employed citizens––employers, employees and the government alike––to contribute in a progressive tax manner to fund this new healthcare system (Prado).

Nonetheless, efforts proved fruitful. By 2012, the lowest quantile of the population received nearly 30% of the EBAIS expenditures, while the wealthiest quintile with 48% of the national income received only 11% of the EBAIS resources. By 2017, over 93% of the population had access to primary healthcare; however, this doesn’t mean challenges do not remain (Prado).

The Region of Guanacaste The Chorotega region (Guanacaste) in Costa Rica has the highest level of poverty in the country at 34.7% and extreme poverty at 11.3%. Despite improvements in initiatives advocating for healthcare access, this region suffers from lack of access to clean water. The Costa Rican Institute of Aqueducts and Sewers (AyA) has carried out studies since 2009 on the water quality of Guanacaste, which have reported exceedingly high levels of arsenic in water past the acceptable standard set by WHO (Bradley).

In Guanacaste, many of the socioeconomic and political issues compound into a large threat of harm to the inhabitants of these communities. The contamination of water with arsenic correlates with an increase in incidence of deaths caused by ischemic heart disease and stroke between 2007 and 2017. The CCSS reported that chronic kidney failure was almost 20% higher in Guanacaste

than the national average (Prado).

Despite having a seemingly successful universal primary healthcare system, the Ministry of Health has made no progress to find a cause or solution.

It was only until 2015 that the AYA installed arsenic removal plants in the region (García).

Even so, the communities of Guanacaste suffer long-term consequences. The increase of primary care heightened the volume of referrals to secondary and third-level hospitals. Clinics that were equipped with resources to meet medical needs of greater degree were scarce and separated by large distances. People in the region of Guanacaste are living in poverty, exacerbated by the emphasis on tourism and gentrification, and thereby don’t have the means to access higher-level care. Not to mention, increasing the amount of referrals has resulted in an increase of waiting time for consultations to over a year: the waiting time for treatment

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for over 40% of prostatic hyperplasia patients was more than 366 days. For cataracts, about 30% of patients had a similar or longer wait time (Prado).

Social Initiatives On a surface level, Costa Rican leaders and communities have done many things right: doing away with the military and investing in education and healthcare resulted in positive outcomes. Their primary care

ed for the wellbeing of its citizens.

Among these organizations is the MEDLIFE Movement, a non-profit organization that partners with low-income communities to improve access to healthcare and education. Its focus is to support communities in a sustainable manner by empowering those in need.

During spring break, a group of eleven UChicago students including

mom’s case, she needed spine surgery since she had herniated discs and they pinched important nerves. Even when she did have social insurance, she had to wait three years for her surgery. After the waiting time, the nerve was so damaged that even when the surgery was successful, the nerve damage was irreversible which could’ve been prevented with a shorter waiting time.”

Sanabria also shares the experience

model achieved a remarkable health record, not only with high longevity but also becoming one of the world’s happiest countries. Even so, regions have not been affected equally by these initiatives, and communities in Guanacaste prove that EBAIS still has much potential yet to be fulfilled.

Luckily, Costa Rica’s attitude towards contributive solidarity and community-centered life has promoted the establishment of non-profit organizations and social institutions within these impoverished communities to supplement the support need-

myself, along with undergraduates from University of Florida and University of Miami, traveled to Costa Rica through MEDLIFE to volunteer in impoverished communities in Guanacaste through mobile clinics to bring free basic primary care to those who could not wait or afford to travel elsewhere for that care.

Karol Segura Sanabria, one of the MEDLIFE leaders in Costa Rica, shares her experience with the difficulties of her situation of long waiting times and struggles with referrals to bigger, far away hospitals: “In my

of Don Filemon, a member of one of the communities in Guanacaste that collaborates with MEDLIFE. “Don Filemon is waiting for various surgeries,” shares Sanabria. “A year has gone by of him not being able to go from Guanacaste to the Hospital de San José because of not having the financial means for transport, meals and housing in San José.”

Although there are many government institutions that offer this primary care, there are still many stories of people like Karol Segura Sanabria and Don Filemon who

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remain in disadvantageous situations.

Sanabria notes that, “There are many government institutions that generate financial, as well as educational and developmental support. The problem is on who operates and manages these institutions… Corruption makes it so that this support is affected and people lose faith or credibility in their support.”

Costa Rica’s levels of happiness and life longevity don’t correlate with the level of income inequality and extreme poverty in many of its regions. Although the government has greatly funded the universal primary healthcare system EBAIS, regions like Guanacaste remain plagued by lack of infrastructure, poverty, healthcare resources and access to receive it.

Sanabria speaks for nonprofits that support people abandoned by the system, to those “isolated because of their financial situation: even offering primary medical attention or access to education, something so basic like a general medicine check-up, can change a person’s destiny completely.”

Costa Rica’s culture of pura vida and social cooperation, which takes the form of nonprofits and social support, is the additional reinforcement that communities, such as those in Guanacaste, need, in addition to the government’s developments in healthcare. Neither, by itself, is able to dismantle the extreme poverty that plagues this region, but they need all the support they can get for disparities to be effectively reduced.

References: Barr et al., 2020. Leadership, social determinants of health and health equity: the case of Costa Rica. Rev Panam Salud Publica. 2020;44:e139. https://doi. org/10.26633.RPSP.2020.139

Prado en al., 2019. Innovation in the Public Sector: The Costa Rican Primary Healthcare Model. Health Management Policy and Innovation, Volume 4, Issue 2. https://www.mcgill.ca/globalhealth/ files/globalhealth/prognosis-2019_final_web.pdf Cuccia et al, 2019. Costa Rica’s Health Care Reform: Impact and Success of the EBAIS Model. The Prognosis, 2019 Journal, pg 25-35. https://mghjournal. com/wp-content/uploads/2019/07/costa-ricas-health-care-report_ebais-model_luca-cuccia-et-al..pdf Bradley, J. 2019, August 14. Poverty in Costa Rica. The Borgen Project. https:// borgenproject.org/poverty-in-costa-rica/#:~:text=In%20Guanacaste%2C%20 however%2C%20almost%2022,Nicaragua%20on%20July%2015%2C%201824 García, Fabiola Pomareda. (2019, April 12). New Aqueduct, that will carry water without arsenic, will be built. The Costa Rica News. https://thecostaricanews. com/new-aqueduct-that-will-carry-water-without-arsenic-will-be-built/ World Population Review Staff. (2024).

Gini Coefficient by Country 2024.

World Population Review. https://worldpopulationreview.com/country-rankings/gini-coefficient-by-country Nicoya, Costa Rica. Blue Zones. (2023, July 25). https://www.bluezones.com/ explorations/nicoya-costa-rica/

For more information about the MEDLIFE Movement to sustain mobile clinics and sustainable, long-term projects https://www.medlifemovement.org/ donate/ PULSE 23

The Artifice of Western Medical Neutrality and the Genocide in Gaza Written by Ibrahim Gomaa Edited by Michelle Lu

In 2022 a month after Russia’s invasion of Ukraine, the American Medical Association (AMA) released an article titled “Senseless war in Ukraine sparks physician aid response” where they condemn “the senseless injury and death the Russian army has inflicted on the Ukraine people,” according to AMA President Gerald E. Harmon, MD. They went on to donate $100,000 dollars to humanitarian aid in the region. Their response to the Ukraine War demonstrates that the AMA has historically not seen addressing breaches of humanitarian law as political. In comparison, their only response to the relentless Israeli bombing of Gaza for over a month was simply a “Statement from the AMA Board of Trustees” which emphasized that it was “critical that medical neutrality is observed.”

Both of these responses were made a month after these conflicts escalated. The civilian death toll in Ukraine at the time was reaching 4500 while in Gaza it was reaching 10,000. The AMA waited until April of this year to then release a statement calling for a Ceasefire. At this point the civilian death toll in Gaza is reaching 35,000.

Even after calling for a ceasefire, there is no condemnation of the war crimes Israel has committed nor is there any material humanitarian support.

Instead, the AMA clings to the notion PULSE 24

of medical neutrality, which has now become a form of political neutrality, to abdicate their responsibility to uphold and perpetuate medical ideals which prioritize human rights.

Medical neutrality focuses on the treatment of POW, the immunity of medical institutions from attack, and the immunity of medical personnel from attack. To fully understand medical neutrality as a social artifice instead of a moral imperative, one must understand its historical evolution. The concept of medical neutrality was proposed by the first Geneva Convention held in 1864. It was in part due to sentiments which developed from the proximity of observers during bloody conflicts like the American Civil War (1861), The Napoleonic Wars (1799-1815), Napoleon III revolutions (1836,1848), and The Crimean War (1853). The Geneva convention itself claimed to be “for the Amelioration of the Condition of the Wounded in Armies in the Field.”

This in itself reveals the unintended

consequence of medical neutrality.

While its intention is moral, its goal is “ ameliorate” war and make it more palatable. Medical neutrality developed because tools of war became too destructive. After witnessing the immense loss of European life, the Western world needed to control warfare because too many soldiers were dying in internal conflicts. While its intentions seem admirable, the western concept of medical neutrality has unintended consequences which Gazans in occupied Palestine are now confronting.

These moral sentiments on soldiers’ rights to medical treatment came during the height of the slave trade. Many dismiss this as irrelevant or unrelated to the Geneva convention which focused on war crimes; however, the notion that european soldiers are entitled to medical care as they brutalize each other on European land, but African captives brutalized abroad have no such rights is relevant context to the development

of the European consciousness as it relates to medical neutrality. In fact, by 1860, almost 4 million Africans were enslaved. This large number was in part due to the Spanish, English, French, and Dutch colonies in the Caribbeans. Even from a utilitarian standpoint, the mortality rates in the European conflicts which preceded the first Geneva Convention pale in comparison to mortality rates amongst slaves or even the number of captive Africans. This invariably demonstrates that the European infatuation with morality was reserved exclusively for other Europeans.

From its inception, medical neutrality did not apply to wars with non-European powers. The racialization of medical neutrality can be seen frequently after the first Geneva convention. Perhaps the most glaring instance is only 30 years later during the South African War between Britain and the two Boer republics (republics formed by Dutch Afrikaaners). This conflict highlights two major cases of racial discrimination inherent to western medical neutrality. First, the British, overwhelmed by the Boer’s guerilla warfare tactics, applied a scorched earth policy. They rounded up Afrikaaners and Africans alike and put them into concentration camps.

Frequently, access to medical care, sanitation infrastructure, and food was scarce or even denied for black prisoners. Black prisoners were often required to construct their own lodging while being provided with subpar materials. Furthermore, the British enticed black men in these concentration camps to join their colonial army with promises of rations and scarce wages to support their families. Because of this, the concentration camps were generally filled with women and

children. It is estimated that approximately 14,000 black people, most women and children, died from malnutrition, dysentery, typhoid, and diarrhea in these concentration camps although the number is believed to be much higher.

The second and more glaring case of hypocrisy is the treatment of black soldiers conscripted by the British army. Unsurprisingly, they were given less access to medical care or supplies and when they were treated they often received lower quality care than white soldiers. This trend does not stop with the South African War. The two largest conflicts in history, World War I and II, have well-documented cases of systemic racism within the allied armies which have been researched significantly. There is without a doubt, a racialized notion embedded into the ideological development of medical neutrality which asserts that all white civilians and soldiers are entitled to medical care in armed conflict.

Without a doubt, the true end of medical neutrality (or perhaps the hope for such an ideal) occurred in the 20th century. Such blatant aban-

donment of medical neutrality as a pretense was without comparison.

The two most extreme examples are of course Hiroshima and Nagasaki, where 18 hospitals were destroyed. In fact these are two cases of the most extreme war crimes in history (which have been normalized by the western world). The U.S. purposefully targeted civilian populations in a strategic attempt to demonstrate the power of the atomic bomb. Once again, utilitarian ideals are forsaken for political interests.

Beyond these extreme cases, more systemic instances came during the European response to anticolonial movements in Africa. In the cases of the Algerian War for Independence, the Portuguese Colonial wars, the Anglo-Aro war, and countless other conflicts against European colonialists, there were widespread cases of civilian massacres, rape, torture, mass POW executions without trial, mass destruction of villages, land theft, labor camps, and more. In this context, the Western World’s attitude towards the atrocities perpetrated by the Israeli government are unsurprising. The blatant targeting of black and brown civilians, hospitals, journalists, aid workers, and medical professionals is indeed not a violation of western medical neutrality and never has been. Harrowing accounts from doctors at Al-Shifa hospital, avoiding windows for fear of snipers, performing surgery without anesthesia, and standing in solidarity with their patients to die with them, are simply contemporary examples of the crumbling edifice of medical neutrality which has long since been built on a subpar foundation. This is not to mention the 70 years of occupation in which palestinian prisoners, POW PULSE 25

in name only, are denied food, water, and basic necessities. The fact that many of these prisoners were also minors and women jailed without trial only makes the farcical notion of medical neutrality even more repugnant. Medical neutrality? Where was that for Walid Daqqa, who was denied medical treatment for his myelofibrosis culminating in his murder through purposeful negligence on April 7th, 2024. This is not a new phenomenon. Palestine is not a complex or unique scenario. At the slightest inconvenience the western world has shown they are ready and eager to dispel with medical neutrality.

While the manifest purpose of medical neutrality is preserving the sanctity of life, there is a clear discrepancy between the manifest purpose and the latent purpose. As demonstrated, from its inception medical neutrality had little to do with utilitarianism and preserving life in a moral context. Instead, western medical neutrality was chiefly concerned with war as a social construct.

The first Geneva convention, and even the subsequent ones, attempted to turn war into an international institution; much like trade, sovereignty, and civil liberty now function as international institutions overseen by the UN. A social institution becomes subject to the social approval of the international community. For example, as an institution, sovereignty requires tangible edifice which estabPULSE 26

lishes the authority of the sovereign state; such edifice is deemed sufficient by the international community and sovereignty is bestowed. In regards to civil liberties, certain civil liberties are invariably declared natural born rights while others are arbitrarily deemed as conditional.

Ask yourself, why might we have the right to property and not running water? Why is Palestine a territory and not a country? The modern complacent liberal agenda is content to allow medical neutrality to exist only as an ideal to strive for.

At its heart, it is constructed from the European liberal idealism which sacrifices material results for abstract idealism. There comes a time when we must consciously reevaluate the social edifice which we have taken as absolute. Historically, we see the ideal of medical neutrality fail time and time again since its inception with the consequences disproportionately affecting people of color. At what point do we question whether the ideal we strive for is productive? Perhaps medical neutrality’s streamlined ideal conception of war is not a humanitarian solution. Perhaps humanity can be found in the efforts to prevent war entirely instead of simply “ameliorating” its effects.

References: Anderson, Michael. “Evolution of Census Data.” Journal of Demography, vol. 15, no. 4, 2021, pp. 235-250, https://

www.ncbi.nlm.nih.gov/pmc/articles/ PMC7716878/ “At the Intersection of Health Care and Human Rights: Violations of Medical Neutrality and the Emergence of Medical Resistance.” ABC Publications, 2010.

“List of Conflicts in Africa.” Wikipedia, Wikimedia Foundation, 14 May 2024, https://en.wikipedia.org/wiki/ List_of_conflicts_in_Africa#Chronological_list_of_wars “Role of Black People in the South African War.” Annals of Historical Demography, vol. 10, no. 2, 2002, pp.

71-85, https://www.cairn.info/revue-annales-de-demographie-historique-20021-page-71.htm “The Role of Black People in the South African War.” South African History Online, SAHO, 2020, https://www.sahistory.org.za/article/role-black-peoplesouth-african-war “First Geneva Convention.” Wikipedia, Wikimedia Foundation, 14 May 2024, https://en.wikipedia.org/wiki/First_Geneva_Convention/ “Ukraine Civilian Casualty Update - 11 September 2023.” Office of the United Nations High Commissioner for Human Rights, 2023, https://www.ohchr.org/en/ news/2023/09/ukraine-civilian-casualty-update-11-september-2023

Hieronymus Fabricus: From Birth to Father of Embryology Written by Alexander von Kumberg Edited by Ally Wang

Following the death of the esteemed Modenese priest and anatomist–Gabriele Falloppio, the namesake of the fallopian tube–the dual chair of anatomy and surgery at the University of Padua was assumed by his own student, Girolamo Fabrici d’Acquapendente, also known as Hieronymus Fabricius. By 1600, William Harvey, the “father of physiology”, traveled to Padua to enlist Fabricius as his doctoral advisor. Harvey was not alone in his admiration. An estimated 10,000 foreign scholars traveled to Padua to seek Fabricius as a professor and mentor. Thus, Fabricius emerged as a pivotal figure in shaping a new generation of medical minds in the dawn of the scientific revolution.

Who was this man who was sought by so many budding physicians, yet is seemingly forlorn in contemporary medical circles?

Fabricius was born in the small commune of Acquapendente, an independent center within the Papal States, on May 20th, 1533. He first studied at the University of Padua and became a Doctor of Medicine in 1559 under the guidance of Falloppio.

Between 1562 and 1565, he worked – in the typical Renaissance humanist manner – as private tutor of anatomy, serving the upper echelons of Padua’s elite. In 1565, he became professor of anatomy and surgery at the Universi-

ty of Padua, succeeding his Doctoral advisor, Falloppio.

Fabricius revolutionized the way in which medicine was taught, laying out a series of novel innovations in medical education which truly paved the way for the modern medical sciences. One such innovation was the creation of the first permanent and reserved anatomical dissection theater, which Fabricius unveiled in 1594. Significantly, this theater was accessible to the public, demystifying the once cryptic and somewhat enigmatic study of anatomy for all. Fabricius was by no means an egalitarian; indeed, he was a staunch hierarch in the lecture hall. Only his favored students were permitted to assist the master when it came to the dissection table — holding a candelabra over the corpse to allow for better visibility. Evidently a man of his time–and undoubtedly a revolutionary one–he also encouraged his international students, housing them according to their country of origin. Yet, Fabricius’

renown is not merely a result of his teaching techniques, rather he was one of the century’s greatest medical proto scientists.

In his seminal work De Visione, Voce et Auditu (On Sight, Voice, and Hearing), Fabricius shifted the dynamic of medical writing. Indeed, in the Renaissance, it was the norm to discuss anatomy in a descriptive manner – a mode epitomized by the great Andreas Vesalius – focusing on the structural identity of tissues and organs. However, Fabricius triumphed in functional anatomical writing. This shift turned medical texts from merely illustrative to mechanical – a mode which was wholeheartedly embraced by his students. Harvey would later tell his friend, Robert Boyle (father of experimental chemistry), that Fabricius’ description of venous valves paved the way to his description of circulation. Indeed, a young Harvey probably assisted his professor Fabricius in his writing of De Venarum Osteolis (On the Valves of the Veins) PULSE 27

which gave the first functional description of semilunar valves in veins and ultimately provided Harvey with the ammunition to write his magnum opus, the landmark of physiology, Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus (An Anatomical Exercise on the Motion of the Heart and Blood in Animals).

Fabricius’ most infamous publication, De Formato Foetu, (On the Formation of the Fetus) is that which crowned Fabricius with the honorific title: father of embryology. The embryological treatise was the last published by Fabricius before his retirement from Padua. The text — as all contemporary medical publications — were tomes of great knowledge, but also great works of art, with 34 intricate prints and accompanying drawings guiding the readers’ eyes.

The treatise not only focuses on humans, but on a myriad of organisms, from rabbits and guinea pigs, to birds and even sharks. De Formato Foetu is separated into two distinct parts.

The first concerns the morphological features of the fetus, and its accompanying uterus — a result of dissections.

His writings proved the commonly held belief that the human fetus lacks an urachus (the canal connecting the

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bladder with the allantois). Interestingly, the first part proved the great Leonardo da Vinci incorrect in two of his assertions, namely that humans possessed cotyledons – which are only found in the ruminant uterus – and that the fetus does in fact have a heartbeat. The second part of the treatise focuses on the function of the placenta, umbilical cord, allantois, amnion, chorion, fetal excretions, and the heart vessels. Again, it is here that we see Fabricius as a man of his time, imprisoned in the Galenic stahlhartes Gehausewhich few Renaissance physicians, namely Vesalius, were able to transcend. Indeed, the treatise repeats Galen’s notion that vital spirits connected the fetus to the mother via veins and arteries allowing the fetus to grow. Moreover, he also concurs with Galen in saying that the liver was the source of all veins. Yet we must not be so critical of the Renaissance fondness of antiquity; indeed, Fabricus uses Aristotle’s notion that every organ served a specific purpose to conclude that following the birth of the child, the umbilical cord naturally disintegrates since its function has been performed. Some of Fabricius’ novel claims included the assertion that the fetal heart is cooled by the

mother, and after birth the child cools his own heart by way of breathing.

Another odd conclusion was that sex determined fetal orientation, claiming males were top heavy and thus faced down in the womb, while females were bottom heavy and faced upright. Ultimately, the treatise is a demonstration of the evolution of medical knowledge, a treatise to traditional authority, but also an exemplary text of the new scientific mind which was being fostered across the continent.

Evidently, Fabricius’ legacy is a testament to the evolution of medical knowledge and pedagogy. Indeed, he certainly fell into Harvey’s characterization of his contemporaries, “While swearing allegiance to Mistress Antiquity, do they openly abandon Friend Truth.” Nonetheless, it is evident that Fabricius’ treatises opened the floodgates to many of the greatest medical works which would come to formulate our contemporary models of human anatomy and physiology, such as the cardiovascular system and embryological development. Moreover, beyond his scientific pursuits, Fabricius was a master professor, who turned Padua into a New Jerusalem of medical relics and a bastion of medical education which attracted students from across Christendom. Undoubtedly, a force which propelled medical sciences, Fabricius must be remembered as such, a father of the fathers of modern medicine.

As Harvey learned from Fabricius, Fabricius learned from Falloppio, Fallippio from Brassavola, and Brassavola from Leoniceno… The medical sphere is —as all natural philosophy — built upon the shoulders of giants, to whom we would be amiss to forgo.

Beyond the Screen: Unmasking the Impact of Medical Dramas Written by Alex Hannett Edited by Natasha Janssens

Grey’s Anatomy; Chicago Med; House; New Amsterdam; The Good Doctor; and the list goes on — each of these examples have landed among the most viewed and in demand television shows across age groups today.

Unsurprisingly, each of these shows have another key factor in common: their classification as medical dramas.

Generally, a medical drama is a television show or movie whose characters, events, and plot center around a hospital, clinic, or other healthcare environment. The overwhelming interest in medical dramas as a genre of TV makes it incredibly profitable, with multiple award winning shows lasting 15+ seasons. But what makes medical dramas so enticing for viewers and attracts engagement from people across countries, generations, and cultures?

And what is the effect of their popularity on culture, career aspirations, and the reality of relationships between patients and healthcare? This article will discuss the role of medical dramas in inspiring many youths to turn their attention to healthcare as a potential career, the issues that stem from inaccurate portrayal of medical practices or glamorization of medical careers, the realities of careers in medicine not highlighted by TV shows, as well as a few of the undeniable lessons that medical dramas can teach all audiences.

People tend to be fascinated by what they know little about. For many individuals, especially those in a career other than medicine, this intrigue is the driving force behind their fascination with medical dramas—they provide a small window into a new career and lifestyle. For the medical drama fans who work in healthcare, their interest might stem from appreciation for their careers being represented in cinema and television, or they may be entertained by certain inaccuracies and misrepresentations of the medical practices and ethics in these shows. In any case, the interest across different audiences could simply be because of medical dramas’ emphasis on drama and the characters’ eventful and unpredictable lives inside and outside of work.

Regardless of the source of interest in medical dramas, they can make for good entertainment across diverse

groups. In particular, adolescents and young adults have heightened interest in medical dramas. It is not uncommon for young audiences to consider a career in medicine because they grew up watching their favorite characters struggle and thrive as doctors, nurses, paramedics, EMTs, etc.

The notion of imagining oneself in a career based on a televised representation of it extends beyond medical dramas: a study at Indiana University investigated the correlation between the occupation of undergraduate students’ favorite characters in television shows, including non-medical careers, and the students’ chosen career and major (Morgan, 2017). The study found no significant correlation between the career choice of characters and that of students, perhaps due to the fact that pursuing a career based on a TV show is not sustainable. It is notable, however, that the television PULSE 29

show with the most correspondence between a character’s occupation and the students’ major or area of study was House, with a 13.9% correspondence rate. The authors of the study proposed that this could be because House has many flawed and relatable characters, and the more an individual identifies with a character, the more likely they will be to consider the occupation for themselves (Morgan, 2017). Thus, while medical dramas may not directly influence an increase in people pursuing medicine, they do shed light on the field as a whole.

Through relatable character portrayals, flaws, and personalities viewers are prompted to contemplate whether they share similar traits and could envision themselves in such a career.

Despite their popularity, it is important to recognize prominent issues with the representation of medicine in medical dramas. Firstly, since the objective of medical movies and TV shows is to entertain audiences, their priority does not lie in being medically accurate; they certainly are not meant to be a mode of medical education for viewers. Even if you watch all 20 seasons of Grey’s Anatomy, you will not be equipped to perform the appendectomy the characters claim is so simple, nor will you be able to diagnose and treat a rare medical anomaly without going through many years of proper medical education.

Further, medical professionals in TV shows and movies may misdiagnose, mistreat, or violate important medical protocol, performing actions which should never be repeated in real scenarios. Since the actors portraying doctors are not trained to work as doctors, their behaviors or techniques may be lacking. From improperly administering cardiopulmoPULSE 30

nary resuscitation (CPR), to ordering the wrong test for a patient’s given symptoms, inaccurate representations of medicine can be misleading for viewers and should not be used as a primary source of medical knowledge nor should behaviors or treatment plans be replicated in the real world.

Beyond the medical inaccuracies, these dramas also heavily glamorize careers in medicine, tapping into the allure of high-stakes drama, intricate character relationships, and portraying the constant success of medical professionals in treating the most

seeking medical attention. In a study

by Carney et al. (2020), the authors investigated whether medical television shows are the major contributor to what patients know about hospitals, medical errors, and healthcare.

The study found that there were many discrepancies with how medical errors were portrayed on TV compared to US hospital data, with emotional trauma being significantly overrepresented, and temporary, less extreme injuries being underrepresented in medical dramas (Carney et al. 2020).

The authors hypothesize that medical

untreatable diseases. These shows often romanticize or sensationalize the medical profession, leading to unrealistic expectations among viewers. People may think that instant solutions and miraculous recoveries are common, when in reality, there may not always be a happy ending.

The effect of medical dramas can also have the opposite effect, with people seeing the emotional trauma and extreme measures needed on medical shows and learning to associate these negative emotions with treatment, thus deterring individuals from

dramas’ false portrayal of the hospital system could lead individuals to delay seeking medical care, even when necessary.

In essence, while medical dramas entertain and captivate audiences, their portrayal of medicine often sacrifices accuracy for drama, thereby fostering misconceptions about the realities of healthcare professions. In fact, under the facade of a glamorized career, there are many realities that medical dramas often do not feature. Beyond the ground-breaking surgeries and dramatic emergencies,

there exists a world of mundane tasks that consume a significant portion of a healthcare professional’s time— from endless hours of paperwork and charting, to the administrative burdens of managing a hospital.

Moreover, the intense stress and the psychological toll of constantly dealing with life-and-death situations are seldom portrayed accurately.

Notably, these shows tend to overlook the long journey of medical professionals, skipping many of the rigorous years of schooling, studying, and examinations necessary to even begin practicing. So, while medical dramas may offer a small glimpse into the world of healthcare, they fall short in depicting the full scope of challenges and sacrifices inherent in these noble professions.

That being said, there are some valuable elements that medical dramas bring to the table, beyond entertaining millions for hours on end.

Medical dramas are beneficial for educating the general public and healthcare professionals about bioethical issues, often putting the characters into challenging positions and having the audience view the consequences of controversial choices. A prime and

infamous example occurs in season 2 of Grey’s Anatomy, when one of the doctors cuts her patient’s LVAD wire, a surgically implanted device that is used to assist an unhealthy heart in beating. Her goal in doing this was to change his health condition to critical, prompting his position on the heart transplant to jump to first priority. This action violates a multitude of ethical standards and medical protocols, including malpractice, personal relationships with patients, and even the Hippocratic Oath, but the viewers see the consequences of the doctor’s actions and learn about the complicated moral relationship that comes with being a doctor.

In fact, a study titled “TV medical dramas: health sciences students’ viewing habits and potential for teaching issues related to bioethics and professionalism” looked at the views on bioethics by undergraduate students pursuing a career in medicine, nursing, or human biology. The study found that the students that watched medical TV shows were more attuned to bioethical topics like medical errors, inappropriate professional behaviors, and death (Cabra-Badii et al. 2021). Repre-

sentation of difficult health ethics issues put students in the position to evaluate how they would react in the same situation and evaluate what the characters may have done wrong.

Another positive effect of medical dramas is the way it exposes viewers to emergencies and medical scenarios that are not uncommon, perhaps inspiring some viewers to take courses in first aid or CPR. Of course, medical dramas may also be the reason many future doctors initially become interested in careers in medicine. While this will not remain the motivating factor throughout their careers, we may have medical dramas to thank for the healthcare professionals of tomorrow. If nothing else, medical dramas cause many people to gain respect for real medical professionals by showcasing the intense hours, mental and physical strength, and sacrifices that come with these careers.

In conclusion, while medical dramas serve as captivating entertainment that has undeniably influenced career aspirations and public perceptions of the healthcare field, it’s crucial to acknowledge their limitations.

These shows, while offering a glimpse into the thrilling and dramatic as-

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pects of medical professions, often fall short in accurately portraying the realities of the job. From glamorizing high-stakes scenarios to downplaying the extensive education and mundane tasks involved, they create an unrealistic image of healthcare careers.

However, they are not without their benefits. Medical dramas provide a platform for exploring bioethical issues and increasing awareness of medical scenarios, potentially inspiring viewers to pursue first aid training or careers in medicine. Ultimately, while medical dramas may not offer a complete picture of the healthcare profession, they have undoubtedly contributed to sparking interest and respect for the dedicated professionals who work tirelessly to save lives every day.

As we navigate the complex relationship between entertainment and

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reality, we must know that it is essential to approach medical dramas with a critical eye while appreciating the valuable insights they can offer.

References: 1. Aboud, K. A. (2012, January 31).

Medical dramas - the pros and the cons.

Dermatology practical & conceptual. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3997251/ 2. Cambra-Badii, I., Moyano, E., Ortega, I., Baños, J.-E., & Sentí, M. (2021). TV medical dramas: Health sciences students’ viewing habits and potential for teaching issues related to bioethics and professionalism. BMC Medical Education, 21(1). https://doi.org/10.1186/ s12909-021-02947-7 3. Carney, M., King, T. S., Yumen, A., Harnish-Cruz, C., Scales, R., & Olympia, R. P. (2020). The depiction of medical

errors in a sample of medical television shows. Cureus. https://doi.org/10.7759/ cureus.11994 4. Morgan, J. A. (2017). Cultivating a career: Effects of television binge-watching and character identification on college students’ goal occupations. IU Journal of Undergraduate Research, 3(1), 48–53. https://doi.org/10.14434/iujur. v3i1.23335

A Different Way of Thinking About Medicine: Reviewing “The Social Transformation of American Medicine” by Paul Starr Written by Ayman Lone Edited by Fareen Dhuka

Medical Sociology and History of Medicine are vital interdisciplinary fields within Science and Technology Studies. Paul Starr, renowned sociologist and author of “The Social Transformation of American Medicine,” critiques the neglect of social and cultural factors in medical education. His Pulitzer Prize-winning book encourages medical professionals to adopt a more sociological and historical perspective on their field.

Starr’s narrative approach effectively illustrates the social construction of American Medicine, and a critical analysis of his argument reveals its persuasiveness and relevance to contemporary healthcare.

The skeletal makeup of “A Sovereign Profession” provides a vessel through which Starr recounts and reflects on the rise of American medicine through the lens of economics, culture, politics, and social order.

The body consists of six chapters, discussing events spanning the 1760s to 1930s. Despite its academic structure however, “A Sovereign Profession” reads almost like a narrative. In Chapter one, “Medicine in a Democratic Culture,” US physicians in the

1700s are said to have lacked professional authority or any “privileged status” due to “popular resistance,” in the form of domestic medicine, anti-professionals, or anti-intellectuals (30). The profession gained an air of seriousness due to stronger licensing laws and the birth of US medical schools, both of which more strictly define who is and isn’t a doctor.

Additionally, the advent of empirical study of therapeutic techniques in the 1810s – paving the way for more complex medical knowledge and instrumentation – would eventually “remove knowledge from the reach of lay understanding,” into the doctors’ domain (59).

Not only did US physicians have to overcome these cultural and social barriers, but economic forces as well, as is told in chapter two, “The Expansion of the Market.” Doctors gained

economic authority through 19th century urbanization; automobile usage and mass migration of metropolitan areas made Americans less dependent on at-home care, and more dependent on the widely available practitioners in large cities (71). Subsequently, improved transportation allowed doctors to receive more pay via increased patient-facing time and introduced competition between providers, as clients now had accessible options (77). As a result, American medicine established its own market, and therefore began maximizing its efficiency. By the mid-19th century, US physicians had some level of social, cultural, and economic capital.

Starr makes use of social scientific empiricism throughout book one of Social Transformation. In chapter two, Starr studies population distribution and a survey given to physicians PULSE 33

on automobile usage. He reports that the percent of Americans living in large cities increased from 6 in 1800 to 46 by 1910, and the number of physicians per 100,000 people in large cities simultaneously increased from 175 to 240 from 1870 to 1910 (69). This data upholds his assertion that urbanization was a driving force behind evolving patient-provider relationships. Likewise, the automobile survey found that doctors using cars saved 4 to 8 cents compared to those on horses, complementing Starr’s statement that automobiles saved travel time for physicians, all of which comes together to support the larger idea that physicians were gaining market power through extra time and money (70). There are numerous other instances of Starr engaging in similar empiricism, looking at speciality salaries, hospital employee makeup, demographics etc. These sections of the text force readers to rethink how they might examine and simply look at medicine: not only via science, but a more sociological or economic lens.

Finally and perhaps most importantly, is the recurring theme of knowledge-power throughout “A Sovereign Profession.” As early as

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the introduction, Starr asserts that “professional authority also benefited from the development of diagnostic technology, which strengthened the powers of the physician in physical examination of the patient and reduced reliance on the patient’s report of symptoms and superficial appearance” (18). In other words, as scientific and medical knowledge became more complex, physicians increasingly became the gatekeepers of health, introducing a power dynamic to the patient-provider relationship.

This idea is present throughout the entirety of book one, either as the focus of multiple sections (such as the part on homeopaths in chapter three) or at least present implicity.

Knowledge-power is not depicted as only relevant to the patient-provider dynamic, but to inter-provider relations as well.

It is important to note that Starr did not merely provide us with new knowledge or insights into the history of medicine, but also provided an entirely new perspective to interpret medical developments. In many ways, the publication of The Social Transformation of American Medicine can be thought of as a paradigm shift of sorts, after which American Medicine began to be examined through the empirical lens of history, economics, sociology, etc, not just the traditional sciences. Starr’s framework of historical medicine is crucial to understand some of US medicine’s biggest questions today: What will the dynamic between MD and DO graduates look like 10 years from now? Will osteopathy and allopathy continue independently, or merge in some way? What level of authoritative power and hospital responsibility do physicians really have today, in an era

where physician owned hospitals are restricted and healthcare is becoming more corporatized? How will the potential oversupply of emergency physicians affect salaries and market power of not only ER practitioners, but other specialities as well?

While The Social Transformation of American Medicine does not explicitly answer these questions, it provides the intellectual tools and devices for readers to tackle them. On the surface, Starr’s book tells the story of American Physicians’ rise to social power in the 1800s, and effectively at that. By doing so, however, Starr established a new method of studying medicine, a method that allows us to address concerns that are nowhere to be seen within his text and go beyond its scope. One may study the battle of Allopaths and Homeopaths to make predictions about how the MDs versus DOs rivalry may evolve.

Likewise, chapter four and six of book one may provide much relevant food for thought – both in terms of methodology and insight – in deducing what physician-hospital board relationships may look like in the future.

Therefore, The Social Transformation of American Medicine is a must read for almost anyone in the medical industry, but especially practicing or aspiring physicians. Not only will such readers learn about the great historical developments of their field in a digestible and easy to read manner, but they may gain a valuable new perspective on their field that will carry them far.

References: Starr Paul. 1982. The Social Transformation of American Medicine. New York: Basic Books.

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