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UGA PREMED A MAGAZINE FOR STUDENTS INTERESTED IN SCIENCE AND HEALTH GRADY COLLEGE OF JOURNALISM

LESSONS FROM OUR ELDERS

HOW TO DEFY DEATH

PHYSICIANS VERSUS MEDICARE


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Premed Magazine is proud to offer you, our readers, a scholarship in each issue. You may submit an original piece of writing or artwork that represents your personal connection to our magazine. In each issue, the theme for the upcoming competition will be announced.

This issue’s topic: What do you believe is the future of healthcare?

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WANNA WIN $500? To enter, please submit an email to ugamedmag@ gmail.com by Tuesday, February 20th with the following informaiton: -Your name -Your email address -Your phone number -Your local address -Your expected graduation date -Your major -Your current GPA Please attach your submission as a word document, pdf, or jpg. Remember, this scholarship is open to all majors, not just pre-health students. The recipient of the scholarship will be announced in our next issue. He or she will be rewarded with $500 to be spent on furthering his or her education both on and off campus.

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STAFF FACULTY ADVISOR Dr. Leara Rhodes EDITORIAL BOARD Emma Burke Anson Dao Grant Mercer Lily Wang COPY EDITORS Annika Jonker Christina Najjar Muhammad Siddiq WRITERS Hamzah Ali Emma Burke Annika Jonker Sherry Luo Katie Luquire Grant Mercer Eric Santana Muhammad Siddiq Celeste Springer Austin Wahle Bemsi Wallang

EMMA BURKE GRANT MERCER EDITOR IN CHIEF

COMMUNICATIONS EDITOR

ANSON DAO

LILY WANG

PHOTOGRAPHERS Sherry Luo Celeste Springer Ushna Syed Lily Wang DESIGNERS Emma Burke

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A MESSAGE FROM OUR EDITOR

Life is truly nothing short of a wonder of science. Take a moment and think about everything that had to go right for you to be alive today. Thirty-seven thousand billion billion chemical reactions occur in your body every second. Yes, you read that right - billions of billions. Even more incredible is the evolutionary path we have taken to become the species known as Homo sapiens. Our genome has been continuously refined to give us a precise set of traits that allow us to explore our infinite universe and study the origins of life itself. While we commonly think of development as a process that ends with birth, all organisms continue to develop until the day they die. From the formation of your neural tube in utero to the onset of puberty and far beyond, we are all changing every second. Technology has given us the ability not only to extend our lives, but also alter them before we even take our first breaths. CRISPR-Cas9 has shown promise in editing out defective genes in embryos, thereby preventing debilitating diseases. This technique is so easy

to use that companies have begun to sell athome genome editing kits. Not long after we inherit our genetic information from our parents, we look for ways to evade death. Through equal access to quality care, we can give all Americans, no matter their socioeconomic status, the opportunity to lead healthy and happy lives. On the flip side of that, we as future healthcare workers need to understand the difference between quantity and quality of life. I hope you enjoy this crash course in issues that span the human developmental spectrum. One thing in life is certain - try as we might, none of us are getting younger. Thank you for supporting your fellow pre-health students and Bulldawgs. From everybody at UGA PreMed Mag - thank you for picking up this issue and, without further adieu, enjoy!

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CON TEN TS

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LEARA SCHOLARSHIP

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EXERCISE IS MEDICINE

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DEATH WITH DIGNITY

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ADVANCE DIRECTIVES 101

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DEFYING DEATH

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TO ACCEPT OR NOT ACCEPT

TURNING BACK THE CLOCK

CARING FOR KIDS VS ADULTS

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ONE LIFE FOR ANOTHER

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BEING MORTAL: BOOK REVIEW

ZIKA: KILLER OF THE UNBORN

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DESIGNER BABIES

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LESSONS FROM OUR ELDERS

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HOW MEN & WOMEN DIE

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EXERCISE IS MEDICINE

STUDENT ORGANIZATION SPOTLIGHT

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KATIE LUQUIRE Most of us know exercise is good for us. Maybe you were active in high school and have been struggling to keep that up in college; maybe you want to start exercising, or maybe you just want to help others develop healthy habits. Exercise is Medicine-On Campus is an organization that promotes physical activity to faculty, staff, and students with the overall objective of improving the health of the community. This is their third year on campus, so Exercise is Medicine is a relatively new organization. In previous semesters, the club has organized and sponsored several free 5k runs, including the “Dawgs Move 5k” and the “Jingle Bell Jog”. Last spring, Exercise is Medicine also hosted an event on Myers Quad with free zumba, yoga, and body pump classes. Exercise is Medicine has also connected with local businesses, such as Fuel Hot Yoga, to host events to boost activity on campus. Interested in joining or have questions? Email exerciseismedicine@uga.edu

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ADVANCE DIRECTIVES 101 EMMA BURKE

Death is one of the few certainties of life, yet few of us take the time to think about how we want to pass when the time comes. While most of us have strong opinions surrounding what life-saving measures we want taken, only one in every four Americans has a living will (American College of Emergency Physicians). Many people are unaware of what an advance directive is or why they need one. Advance directives have two main goals: to determine your living will and establish a power of attorney. The former puts into words what treatment you would like to receive in the event that you are unable to communicate. Most commonly, resuscitation, tube feeding, mechanical ventilation, and palliative care are discussed in this section. While laws regulating living wills vary among the 50 states, ‘do not resuscitate’ and ‘do not intubate’ orders can be added to a medical record without generating an advance directive. Additionally, you can also state your opinion on organ and tissue donation in your living will (American College of Emergency Physicians). While 95% of Americans would donate their organs upon death, only about half of them are registered organ donors (Donate Life America). By putting down your wishes in writing, a tragic event can be made less traumatic for family members. Equally as important as deciding what treatment you want at the end of life is choosing a power of attorney. This person

is identified in one’s advance directive and is given the power to make medical decisions on your behalf. Prior to your power of attorney taking over healthcare decisions, a doctor must determine that the patient is unable to make decisions of him or herself (Mayo Clinic). Quite often, living wills do not address every treatment that is available in the case of emergency due to changing technology. By naming an adult over the age of 18 your power of attorney, this person can speak for you when you cannot (American Bar Association). While it is important to choose a person who you feel comfortable with, immediate family members may not make the best decisions in an emergency. It is important to choose somebody who is calm under pressure and to whom you can easily communicate your wishes before a traumatic event. While one’s own death can be a difficult topic to discuss or even contemplate, it is to our benefit if we can do so before an emergency strikes. Tough decisions can be made easier if you do your research and outline what measures you want taken to prolong your life and who you want to speak for you when you cannot communicate. To find out how to create an advance directive in your state, visit www.caringinfo.org for a link to your state’s paperwork.

American Bar Association. “Giving Someone a Power of Attorney for Your Healthcare (multi-state guide and form)”. American College of Emergency Physicians. (2016). “Nearly Two-Thirds of Americans Don’t Have Living Wills -- Do You?” Donate Life America. “Organ, Eye, and Tissue Donation Statistics”. Mayo Clinic. “Consumer Health: Living wills and advance directives for medical decisions”.

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ZIKA

KILLER OF THE UNBORN CELESTE SPRINGER

The Florida Department of Health has reported the first local transmission of the Zika virus seen within the state all year. According to the report released on October 12th, a Manatee County couple traveled to Cuba where it is believed that one was bitten by a mosquito infected with Zika. After returning home, officials suspect the infected individual was bitten by a Floridian mosquito who later transmitted the virus to the other partner.

The CDC reports that 5,534 cases of the Zika virus have been documented this year, with majority of instances being the result of individuals traveling to affected areas abroad and returning home. The Zika virus is often mild, with many of those infected showing flu-like symptoms paired with rashes or joint pain. It is known to be spread through the bite of an infected Aedes aegypti, a species of mosquito common in South American regions, but can also be transmitted sexually or through blood transfusions. Though not life-threatening to the average adult, cases of Zika in women who are pregnant are devastating.

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The virus is known to be communicable from mother to fetus. Zika passes through the placenta and infects the unborn child, killing off brain cells after using them as a host to spread (Fox, 2016). A mother and child are most at risk when infected during the first trimester, however the virus can still reap significant damage even if a mother is bitten as she nears closer to full term. Children infected with the Zika virus in utero are commonly diagnosed with microcephaly, a condition where the child’s head is disproportionately small. The diagnosis is commonly an indicator of improper brain development and can result in the child having hearing or vision problems, developmental delays, as well as epilepsy. Though the diagnoses vary in severity, children with microcephaly will likely need to rely on the use of speech and physical therapy for the rest of their lives (Joseph, 2016). In the most severe of cases, children will die in utero. The Zika virus became well known in 2015 as it swept through South America, leaving the World Health Organization to


declare it an epidemic just one year later (“Chinese Scientists Reveal Why Zika Virus Causes Microcephaly,” 2017). The problem has not been confined to South America, however, as over 1,600 pregnant women in the U.S. have been reported as carriers so far this year. Of the 1,300 of women that had laboratory evidence to support that they were infected, 77 lost their child during pregnancy and 51 babies born had birth defects (Doucleff, 2017). The CDC and other health organizations are encouraging women who are pregnant to take steps to protect themselves and their babies from Zika. Women are urged to avoid travel to heavily infected areas such as Brazil, Cuba, Mexico, and the Dominican Republic. Women should also be weary of having sex with men who may be infected and are recommended to use a condom when engaging with someone who may have recently traveled to areas where the Zika virus is heavily present.

that scientists were able to prevent the spread of the virus in four macaque monkeys through the use of a mixture of several Zika antibodies (Magnani et al., 2017). Similarly, researchers at the University of Washington in St. Louis and at Imperial College London have found that antibodies from mice infected with the Dengue virus can be used to protect other mice from becoming infected with Zika. Dengue virus, or Dengue fever, is similar to Zika in that is communicable through infected mosquitoes. Scientists believe they can translate this research so it may be applicable in larger mammals, such as monkeys (Ktori, 2017). Researchers hope that the findings will help develop a vaccine that can prevent pregnant women from developing the virus, though they believe the treatment will not be available for years to come (Mack, 2017).

Currently, there is no approved vaccine for the prevention of the Zika virus, though researchers in the medical field are working to change that. A recent study published by the journal, Science Translational Medicine, found Chinese scientists reveal why Zika virus causes microcephaly. (2017, September 29). Retrieved October 16, 2017, from Doucleff, M. (2017, April 4). 51 Babies born with Zika-related birth defects in the U.S. last year. Retrieved October 16, 2017, from Florida Department of Health, Office of Communications. (2017, October 12). Single case of locally transmitted Zika identified in manatee County [Press release]. Retrieved October 16, 2017 Fox, M. (2016, March 4). Study finds Zika damages babies at all stages of pregnancy. Retrieved October 16, 2017 Joseph, A. (2016, August 08). What you should know about the birth defect tied to Zika. Retrieved October 10, 2017 Ktori, S. (2017, September 25). Human Dengue virus antibodies protect mice and unborn pups from Zika virus. Retrieved October 10, 2017Mack, S. (2017, October 4). Researchers prevent Zika virus in monkeys, hope to help pregnant women. Magnani, D. M., Rogers, T. F., Beutler, N., Ricciardi, M. J., Bailey, V. K., Gonzalez-Nieto, L., … Watkins, D. I. (2017). Neutralizing Human Monoclonal Antibodies Prevent Zika Virus Infection in Macaques. Neutralizing human monoclonal antibodies prevent Zika virus infection in macaques, 9 (410), 443-447. doi:10.1126/scitranslmed.aan8184 Zika virus. (2017, October 19). Retrieved October 10, 2017,

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DEFYING DEATH

Twenty years ago at the age of 122, the world’s oldest living person, Jeanne Calment, passed away in August of 1997. Outliving all her family and all her doctors, except for, the last one of course, she attributed her long life to copious amounts of garlic and olive oil, as well as refusing to brood over things beyond her control. She rode a bicycle until she was 100, lived independently until she was 110, and smoked until she was 117. Calling herself “the woman God forgot”, she ate two pounds of chocolate each week and relaxed at the end of each day with a glass of port. A journalist, interviewing Calment when she was 118, ended the interview saying, “until next year, perhaps.” Calment quipped, “I don’t see why not! You don’t look so bad to me.” Living over a century was surely inconceivable for early humans as the average person was lucky to reach the age of 40. However, beginning in the mid-1800’s, this slowly started to change with life expectancy

around the 114 to 115 threshold. There are four major age-related diseases: heart disease, cancer, respiratory issues, and stroke. Traditional medicine tends to focus on curing these ailments individually, but all too often this gives one of the others the opportunity to attack aging cells. While approximately 30% of longevity is considered inherited, the remaining 70% could be changed if the body’s systems are viewed as interconnected. Calment may be an outlier in terms of years lived, but her longevity has pushed scientists to envision this approach as the first step in extending life. One of the more unusual approaches being tested is using blood from the young to reinvigorate the old. The idea was borne out in experiments which showed blood transfusions from young mice restored the mental capabilities of old mice. A human trial under way is evaluating whether Alzhemier’s patients who receive blood transfusions from teenagers experience a similar effect.

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rising about three months with each passing year, according to the Centers for Disease Control. In 1840, the average American lived to 45 years of age. Today the average age has reached 79. The lengthening of life seems independent of any single event. When viewed globally, antibiotics and vaccines did not greatly increase life expectancy while war and outbreaks of disease did not significantly decrease it. Historical life expectancy ascended smoothly, with third world countries rising alongside first world nations. That is until 1990, when the upward trend leveled off. Could the twodecades-long plateau, following over a century of record-setting longevity, signify that humans have reached the limit of human life? The supply of healthy centenarians has certainly increased over the last twenty years, but none have matched Calment’s record of 122 years of life. The closest has been 117 years, but the majority of the world’s oldest have hovered

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Tony Wyss-Coray, the Stanford researcher leading the work, hopes to isolate factors in the blood that cause this, possibly incorporating them into a drug treatment. Since publishing his work with the mice, many healthy, very wealthy people have contacted Wyss-Coray, wondering if the “blood of teens” might help them. Silicon Valley, awash with billionaires, has embraced the challenge of pushing the limits of aging. Joon Yun, a hedge fund manager, launched a $1 million prize challenging scientists to “hack the code of life” and push human lifespan past its apparent maximum of about 120 years. The Palo Alto Longevity Prize, which 15 scientific teams have entered so far, will be awarded to the first verified case of restoring vitality and extending lifespan in mice by 50%. One of the Longevity Prize board members, Aubrey de Grey, finds it a “difficult job because the world is happy to accept that aging is unavoidable when the reality is that it’s simply a medical problem that science can solve. Just as a vintage car can be kept in good condition indefinitely with periodic preventative maintenance, there is no reason why the same can’t be true of the human body. We are, after all, biological machines.” The Longevity Prize has yet to be awarded. Yun’s quest for the modern day Fountain of Youth is just one of many life-extending endeavors taking place in the tech world. In September 2013, Google created the California Life Company – Calico for short. Its mission is to “reverse engineer

the biology that controls lifespan and devise interventions that enable people to lead longer and healthier lives.” Combining scientists from the fields of medicine, pharmacology, molecular biology, genetics, and computational science, Calico intends to uncover the secrets of prolonging life. According to their website, the necessary funding to tackle that mystery is already in place. In March 2014, tech entrepreneurs Craig Venter and Peter Diamandis announced a new company dubbed Human Longevity, Inc. It plans to create a giant database of 1 million human genome sequences by 2020, including those from supercentenarians. Venter says that data will shed critical insights on key factors for a longer, healthier life, and expects others working on life extension to use his database. “Our approach can help Calico immensely and if their approach is successful, it can help me live longer,” explains Venter. “We hope to be the reference point at the middle of everything.” Medical researchers at the Mayo Clinic have made this decade’s biggest breakthrough in understanding the complex world of physical aging. The researchers found that removing stagnant cells (ones which can no longer reproduce) extended the lives of otherwise normal mice by 25 percent. Better yet, scouring these cells actually pushed back the process of aging, slowing the onset of various age-related illnesses like cataracts, heart and kidney deterioration, and even tumors. “It’s not just that we’re making these mice live longer; they’re actually stay healthier longer too. That’s important, because

if you were going to equate this to people, well, you don’t want to just extend the years of life that people are miserable or hospitalized,” says Darren Baker, one of the cell biologists leading the projects. The 2009 Nobel Prize for Medicine was awarded to three scientists - Elizabeth Blackburn of the University of California, Carol Greider of Johns Hopkins University, and Jack Szostak of Massachusetts General Hospital – for their work in analyzing how controllable factors impact cell aging. Their research on telomeres, the end part of DNA, determined that an individual’s telomeres will either lengthen or shorten, depending on that person’s behavior. When they shorten due to poor lifestyle choices or stress, cells are less likely to continue dividing, resulting in greater cell death and accelerated aging. However, as Blackburn noted, “If all aging was due to telomeres, we would have solved the aging problem long ago.” With both Nobel Prize winning scientists and the brightest minds in technology seeking solutions to extending human life, the 122-year-barrier to life expectancy may soon be broken. Just as the U.S. lifespan has doubled since the 1800’s, so may 100 years of life become the norm, rather than the exception. Keen of mind until the very end, Jeanne Calment, when asked how she envisioned her future, replied with her famous sense of humor, “Short”. The next generation of centenarians may need to find another answer for that question.

Apple, Sam. “Forget the Blood of Teens. This Pill Promises to Extend Life.” Wired, Conde Nast, 12 July 2017, www.wired.com/story/this-pillpromises-to-extend-life/. Easterbrook, Gregg. “What Happens When We All Live to 100?” The Atlantic, Atlantic Media Company, 20 Aug 2015, www.theatlantic.com/ magazine/archives/2014/10/what-happens-when-we-all-live-to-100/. Ferris, Robert. “No, You Can’t Live Forever. Here’s the Evidence.” CNBC, CNBS, 5 Oct. 2016, www.cnbc.com/2016/10/05/no-yoUcant-liveforever-heres-the-evidence/. Herkewitz, William. “Scientists Can Now Radically Expand the Lifespan of Mice and Humans May Be Next.” Popular Mechanics, 14 Oct. 2016. “How Far Can We Push the Limits of Human Life?” Tonic, 18 Nov. 2016. “National Vital Statistics Report, Volume 65, Number 8”. CDC. 28 Nov. 2016. Pijnenburg, Martien and Carlo Leget. “Who Wants to Live Forever? Three Arguments Against Extending the Human Lifespan.” Journal of Medical Ethics, BMJ Group, Oct. 2007, www.ncbi.nlm.nih.gov/pmc/articles/. Scutti, Susan. “Scientists Dispute Human Lifespan Limit.” CNN, Cable News Network, 30 June 2017. www.cnn.com/2017/06/30/health/agingdispute-humans-live-to-125/index.html. “Woman God Forgot”. Ageless Lives. 12 May 2014. www.staying-ageless.com/?tag=jeanne-calment.

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AUSTIN WHALE

DESIGNER BABIES THE REALITY OF EDITING THE HUMAN GENOME 16

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Think of who you are today. An animal enthusiast, an athlete, an expert Mario Kart player, class president, maybe all of the above. There are many outside influences that dictate who someone becomes, but down to our very literal core, we are a compilation of genes. Disease, our phenotypes, and more are decided by our genes. We can all agree that these aspects of our lives play a key role in defining who we are, but what if these genes can be altered? What if our future is changed before we even get the chance to see our first day? This is a new reality that could be facing future generations. The concept of eugenics has become a widely debated topic in this modern era, and it is easy to see why. Eugenics, by definition, is the science of using selective breeding for the purpose of increasing the chances of desirable traits in an organism or population. This process has long been used in the realm of agriculture, improving plants and yields to continue feeding the world’s growing population. It was not until more modern times that the idea of using this same concept to ‘better’ humans has taken hold. The first successful case of gene therapy was documented in 1990 on a four-year old with SCIDS (Severe Combined Immune Deficiency Syndrome) and she remains in good health (Hix). Although, what recent medicine is suggesting is the

treatment of these diseases before birth. This technique would be used along with in vitro fertilization, which is the creation of the zygote outside of the female body. This would entail looking at the genes the zygote would express and then altering them if a certain feature is undesirable. This could include the eradication of a disease by removing the mutated part of the genome and replacing Optometry it with a healthy segment of Audiology genes using the cutting edge Physician Assistant Studies Occupational Therapy CRISPR technology (Ceasar). Blindness and Low Vision Studies Most people would probably Public Health agree that the removal of Biomedicine a mutated segment of the Speech-Language Pathology genome is a good thing, but where the line becomes THE FUTURE OF blurred is when deciding what HEALTH SCIENCE SINCE 1919. exactly qualifies as medically salus.edu necessary and what would simply be a desirable stratified society of the ‘haves’ modification. and the ‘have-nots’, even ‘Designer Babies’ would more so than we see today. be the result of creating Think of who you are desirable modifications in today, and then imagine you gametes. Height, intelligence, athletic ability, eye color, and had been designed. That your genes had been selected for more are all features that and you were made to be have the possibility of being your parents’ view of perfect. decided by parents prior Would you feel as though you to a child being born. This weren’t your own person, and effect was first encountered instead the incarnation of in a study concerning mice, where researchers were able your parents’ fantasies? This is a hard question to answer, to genetically alter mice to but one society may have to have larger muscles. These find an answer to soon. mice were referred to as ‘Schwarzenegger Mice’ (Hix). This produces countless ethical dilemmas, but one problem is the massive separation this could cause between social classes (King). Creating a ‘Designer Baby’ would be an expensive ordeal and this could lead to a highly

Ceasar, Antony. “Insert, remove or replace: A highly advanced genome editing system using CRISPR/Cas9”. Science Direct. September 2016. 24 October 2017. Hix, Laura. “Modern Eugenics: Building a Better Person?”. Helix. 23 July 2009. Northwestern University. Web. 7 October 2017. King, David. “Editing the human genome brings us one step closer to consumer eugenics”. The Guardian. 4 August 2017. Web. 24 October 2017.

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CARING FOR KIDS VERSUS ADULTS MUHAMMAD SIDDIQ In the world of medical care, no two patients are the same. Every human being has varying circumstances relating to one’s medical health that make his or her treatment unique. One of the largest influences on the medical care given to a patient is his or her stage in life. Infants, children and adolescents are not just small adults. The anatomical, social and emotional differences between youth and adults have a large impact on the way that illnesses affect each as well as the way that healthcare is administered. It is due to these differences that pediatrics is such a large and important part of the medical world. Pediatrics is the branch of medicine dealing with the medical care of patients under 18 years of age. There are many fields of pediatrics ranging from general medicine to surgical specialists. Pediatric medicine is a relatively new specialty, with many of its developments taking place in the mid-19th century (Mandal, 2014). Pediatricians complete at least a 3-year residency program in order to gain the special skills needed to child’s health (Gaither, 2016). It is important that a person see a good pediatrician because they are at a crucial stage in their life. During these developmental years, it is important that youth be checked to make sure they are meeting milestones in growth and behavior, passing their physical examinations, receiving vaccinations, receiving a proper nutrition and are being referred

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to specialists if they need expert care (Gaither, 2016). While a non-pediatric physician may be able to perform many of these health services, the special training that pediatricians possess along with the fact that they only see children in their practice allows them to best recognize and treat childhood illness (Gaither, 2016). The smaller body of a child is substantially different physiologically from that of an adult, thus making their treatment much more complex (Mandal, 2014). Some of the main differences between conventional and pediatric medical care arise from the anatomical differences between youth and adults. Anatomical differences often change how susceptible children are to accidents and illness. Children have a greater ratio of skin surface area to body size than adults. Children also have thinner skin than adults. As a result, children are more susceptible to illness affecting the integrity of the skin or accidents involving the absorbance of agents through the skin (Columbia University, 2015). Children also have higher respiratory rates and smaller airways than adults which make them more susceptible to illness related to the pulmonary system. Children are also more prone to dehydration and are more susceptible to vomiting and diarrhea (Columbia University, 2015). These anatomical differences, along with several others, result in the need for

more specialized care when treating children. When giving IV medication, for example, an extra level of care is needed because vascular access in children is more difficult, especially if they are very young. Variation in the sizes of children only further complicates the process (Columbia University, 2015). Aside from anatomical factors, social development also contributes to the way children are looked after differently from adults. Pediatricians are trained to be mindful when treating and communicating with children and to be aware of the broader context of the patient’s life (The Royal Children’s Hospital Melbourne). Children and adolescents are in a fragile stage of life where they are still learning important values and skills. Adults, on the other hand, have more defined values and are less likely to be influenced by the world around them. Youth learn in many ways: through relationships with family and friends, through the media they consume, through the knowledge they receive in school, etc. Of course, not all of the influences youth are exposed to are positive. As a result, it is important for pediatricians to take a look at the circumstances that influence a child’s behaviour and do what they can to promote healthy social development (The Royal Children’s Hospital Melbourne). The people and environment surrounding


children and adolescents also influence emotional development. Unlike most adults, children are still developing the ability to recognize and manage their emotions. The bond a person in their youth has with their friends and family can greatly affect their overall emotional well being. This is especially the case with young children, where studies have shown that attachment to a caregiver is crucial to emotional development. Without an emotional bond to a caregiver, children have been seen to have low self esteem, display less persistence and have worse peer relations (The Royal Children’s Hospital Melbourne). It is important that a pediatrician have the ability to recognize emotional distress in their patients and inquire about it to see if the patient has an issue in their life negatively affecting their emotional growth. Taking into account these factors such as the social and emotional stages of patients in their youth as well as the fact that childhood can be a stressful time for parents, pediatric health care practices have certain accommodations that family practices may not have. Many children often fear visiting the doctor. As a result, most pediatric offices present themselves as welcoming. Waiting rooms are often filled with toys, books and movies and kids are given rewards such as stickers at the end of a visit (Warkentin, 2015). Pediatric doctors offices may also take extra time to answer questions and accommodate as they

understand how concerned them their children’s health parents are for the health of their care. By only seeing children children. in their practice, pediatricians develop the skills needed to With the specific recognize and treat conditions in needs of infants, children and a child’s unique anatomy, and adolescents, it’s no wonder that understand child development. the field of pediatrics is so large. Despite being a relatively newer While a family practice may be field in medicine, the importance able to provide sufficient care of pediatric health care is to patients in their youth, the immense and is only advancing specialized care and welcoming as medical research progresses. environment a pediatrician can provide are just two reasons why parents choose to entrust

Gaither, K., MD. (2016, October 02). What Is a Pediatrician? Retrieved November 03, 2017 Differences between Children and Adults. (n.d.). Retrieved November 03, 2017 Differences Between Children and Adults. (2015). Retrieved November 03, 2017 Mandal, A., MD. (2014, October 08). What is Pediatrics? Retrieved November 03, 2017 Warkentin, S. (2015, November 19). Pediatrician vs Family Doctor: How to Decide. Retrieved November 03, 2017

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DEATH WITH DIGNITY ERIC SANTANA

Currently, there are six states in United States of America that have created laws regarding the concept known as “Right to Die,” more commonly referred to as Death with Dignity. For those unfamiliar with this medical concept, it refers to the idea that a patient should have the right to have a doctor perform an assisted suicide using a painless lethal injection. There are valid arguments given by both sides of this debate. Among the states that have laws in place regarding “Death with Dignity” are California, Colorado, District of Columbia, Vermont, Oregon, and Washington. In order to ensure that the law is not abused in any manner, these

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states have specific protocols that include waiting periods, multiple patient diagnoses, as well as the evaluation of the mental state of patients and families. The arguments in favor of Death with Dignity conclude that with this form of “assisted suicide,” the patient can avoid severe pain and extensive medical treatment. In all cases the patients who are selecting to enact the use of assisted suicide are often in extreme pain and cannot live the life they want. By using this practice, they can end their lives on their own terms and minimize the pain they know lies ahead. In terms of families of the ill many are in support of this law as it allows them to say a prepared and more comfortable goodbye to their suffering family member.

From the families’ point of view, without this law, their loved one’s’ death would be a strained process; which in many cases causes more pain for not only the patient but for the families of the ill. On the other side of this debate, in many states, it is unethical and immoral to provide a service such as “assisted suicide” for various reasons. First of all, those against “Death with Dignity” believe that it violates the moral and ethical principles of the Hippocratic Oath, a pledge that doctors take when they start working on this profession. The Hippocratic Oath essentially states that doctors must always work for the benefit of their patients and attempt


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to be ethical individuals who honor and value the lives of their patients.The ethics of “Death with Dignity” come into play, as many believe that assisted suicide devalues human life. Is it ethical for doctors to “play god” and decide when an individual can die? The most common argument of those against the “Right to Die” practice is the possibility that the law will create a “slippery slope” where doctors could become desensitized to the loss and “murder” of patients

and in turn become corrupt, focusing more on self-interest by working with insurance companies regarding the lives and monetary worth of the patients. The differing views around this law are extensive, this article is only displaying a fraction of how complex this topic truly is. In summary, there are numerous opinions and arguments on both sides of this law that leave the ethical, medical, and moral debate of the “Right to

Die” subjective. This debate further the ethical, medical, and moral dilemma that surrounds this controversial law, but it is evident that the concept of the “Right to Die”, is very subjective to one’s personal perspective. To truly understand and develop an opinion on the subject one must truthfully ask, if someone you knew, family or friend, wanted to use Death with Dignity, would would you do?

“Death with Dignity Acts - States That Allow Assisted Death.” Death With Dignity, Death With Dignity, Oct. 2017, www.deathwithdignity.org/ learn/death-with-dignity-acts/. “Take Action - States with Assisted Dying Laws.” Death With Dignity, Death With Dignity, 3 Oct. 22017, www.deathwithdignity.org/take-action/. WebMD. “Medical Definition of Hippocratic Oath.” MedicineNet, MedicneNet, 3 May 2016, www.medicinenet.com/script/main/art. asp?articlekey=20909. Owen, Paul Gallagher Jonathan. “Right to Die: Arguments for and Against.” The Independent, Independent Digital News and Media, 24 Sept. 2015, www.independent.co.uk/life-style/health-and-families/health-news/right-to-die-speakers-at-the-house-of-lords-assisted-dyingdebate-explain-their-views-9610708.html. Torrey, Trisha. “Weighing the Benefits of Right-to-Die Legislation.” Verywell, VeryWell, 5 July 2017, www.verywell.com/arguments-in-favor-ofdeath-with-dignity-2614852. Torrey, Trisha. “What Are the Arguments Against Death with Dignity and Right to Die?” Verywell, VeryWell, 31 Jan. 2017, www.verywell.com/ cons-arguments-against-death-with-dignity-2614849.

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When deciding upon a career in medicine, the expenses of attending medical school crosses every student`s mind. Students aim to obtain the best residency in order to earn high salaries that can pay off accumulated loans. An important question for medical students to consider moving forward in their career is “Who/ what is paying my salary during residency?� If it was not for Medicare, residents would be without pay (Rampell). Yet, many of these residents, later in their career, will go on to deny care to thousands of Medicare-insured patients. Under the Social Security Act of 1965, Lyndon B. Johnson established Medicare. It provides health insurance to citizens above 65 years of age who have worked and paid payroll taxes. It also covers those who have End Stage Renal Disease and individuals claiming disability. Medicare has 3 main parts: Part A covers hospital and hospice services, Part B covers outpatient visits, and Part D covers prescription drug costs. In the Annual Report of Medicare Trustees, it was reported that Medicare provided health insurance for 55 million people in 2015 (Centers for Medicaid and Medicare Services). Individuals in this pool are at risk of receiving unequal care or being flat out denied healthcare. The majority of Medicare recipients, if not all, have been wrongfully promised that if

they pay their taxes, they will receive subsidized healthcare in their old age. Innocent people are caught in a battle between the federal government and healthcare professionals. Reimbursements to physicians are almost 50% lower, so they simply deny patients whose only source of medical insurance is Medicare. Who is at fault for this neglect? More importantly, what is the solution to this problem? The institution overseeing Medicare is responsible for the issues that have risen since its creation. To put into a simple analogy, Medicare is a boat and the issues are holes that have formed in the boat over the last few decades. Instead of fixing the holes, they were plugged for a short term with hopes that they would no longer be problematic. At the same time, individuals were being allowed onto the boat because they met the eligibility requirements. Now, the boat is reaching capacity and is slowly sinking because the pressure caused the holes to be problematic again, except now it is at a larger scale. It would be impractical to suggest that physicians should accept all medicare patients because self-interest is a factor too deeply ingrained in already practicing physicians. However, a solution involving medical students and residents might be worth exploring for the future. They should be conditioned at an early stage in their medical education to provide equal care to every patient. Medical students should be required to continue volunteering in their communities, both in medically and nonmedically relevant experiences. This will help instill values of service and altruism in future physicians. Physicians that are exposed to these principles will more likely be considerate and not let self-interest guide their decision on accepting Medicare. Residents should be reminded that their salaries come from Medicare; there should be an understanding among residents to pay back what they have earned by seeing patients who are covered by Medicare. Imagine receiving a scholarship to an undergraduate institution and banning the scholarship years later. It seems counterintuitive. The Baby Boomer Generation is causing healthcare costs to spiral upwards. They require more medical visits and services than any other age group. To maintain stability, patients, physicians, and the federal government must cooperate to prevent significant losses to our healthcare industry. Through joint effort, the holes in Medicare can be fixed and upgraded to fit our aging population`s needs. Through awareness and understanding of why and how Medicare works the way it does, both current and future physicians alike will begin to view it with a more positive outlook.

Centers for Medicaid and Medicare Services Rampell, C. (2013, December 17). How Medicare Subsidizes Doctor Training. New York Times.

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TO ACCEPT OR NOT ACCEPT HAMZAH ALI

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BIRTH TO DEATH

ANNIKA JONKER

ONE LIFE FOR ANOTHER: THE RISE OF MATERNAL MORTALITY IN THE 21ST CENTURY


Giving birth to a child is one of the most dangerous things a women can do. Throughout history, it remains one of the most prevalent ways that pregnant women die. Every day, according to the World Health Organization, about 830 women pass away all around the world due to pregnancy or childbirth complications, this cause of death is called a “maternal death.” Throughout the 1700s, the estimated death rate due to pregnancy was around 1.5%. In the 20th century, the maternal death rate was 0.6%, and this has drastically improved to 0.026% in the 21st century within the United States. A 0.026% maternal mortality rates means 26.4 deaths out of 100,000 live births. Although this number does not look threatening, since 2000, the maternal mortality in 48 states within the U.S. has increased by 27% and in Texas, maternal mortality has increased by almost 50%. The most shocking fact is that the United States, one of the world’s leading developing countries, notorious for advanced medical treatments, has one of the worst maternal mortality rates in the developed world. But why? It is no secret that bearing a child demands a tremendous amount of time and energy from the mother. By the time that she has reached full-term, her energy stores and metabolism cannot sustain pregnancy for much longer. This causes the mother’s immune system to be compromised, placing her at an increased risk for infection. In the past, the single most common cause of death during childbirth was due to what is called “puerperal fever,” which is a severe fever during childbirth that often causes sepsis and death after giving birth to the child. Even if the mother did not die the day of her child’s delivery, her fever would worsen and kill her within a few days of childbirth. Today we recognize that this fever is caused by a bacterial infection of the uterus or genital tract, something we can easily treat in the 21st century. Throughout history, other common complications that lead to maternal mortality included hemorrhage, eclampsia, and obstructed labor, but these remain common complications even to this day. Researchers are theorizing that there has been an increase in maternal mortality in the 21st century because, not only are women suffering childbirth complications that have been constant throughout history, but women are now facing new problems that are increasing their risk for maternal mortality. For one, in the last few years, there has been an increase in cardiac disease and diabetes prevalence among the American population. This has lead to an increase in heart failure during childbirth, particularly in African American women. Secondly, there is a disparity within the United States between those who have health insurance and those who do not. According to the World Health Organization, within the United States, a women is three times more likely to die from a pregnancy-related complication if she is uninsured compared to pregnant women who are insured. A possible explanation for this is that uninsured pregnant women are not always able to afford an obstetrician and gynecologist with whom they can discuss their pregnancy journey and chronic conditions with. Both of these are novel aspects to childbirth that was not present in the past and that place a women at an increased risk for maternal death. But don’t panic! Even though the United States has the highest maternal mortality rate in the developed world, it is aware of this increasing problem and is on the road to finding a solution. The World Health Organization outlines in their Sustainable Development Goals that they hope to decrease maternal mortality rate to 0.07% between 2016 and 2030 worldwide. In addition, the 2010 Affordable Care Act has antenatal and maternal health benefits that insurance plans must cover. There is a movement across America to increase maternal mortality awareness and to extend pregnancy-related insurance coverage to low income women. http://www.nejm.org/doi/full/10.1056/NEJM200008243430819#t=article https://www.nytimes.com/2016/09/22/health/maternal-mortality.html http://www.npr.org/2017/05/12/528098789/u-s-has-the-worst-rate-of-maternal-deaths-in-the-developed-world http://www.who.int/mediacentre/factsheets/fs348/en/ http://www.who.int/bulletin/volumes/93/3/14-148627/en/ http://journals.lww.com/ajnonline/Fulltext/2016/11000/Maternal_Mortality_in_the_United_States_Is_on_the.11.aspx

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LESSONS FROM OUR ELDERS BESMI WALLANG

Growing up in a Cameroonian-American household, I’ve witnessed a large disconnect between the way elders are revered and honored in my culture in comparison to the way they are valued in the United States. When an elder enters the room, the least that is expected of a young person to do is stand. Some west African cultures like the Yoruba people of Nigeria even prostrate in the presence of elders. It’s almost unthinkable that in these societies, elders are treated pristinely but in the United States we can’t even faithfully abstain from sitting in the “reserved for the elderly” seats in the front of the bus. I personally believe that elders are full of wisdom and deserve our utmost respect. I can’t say that I believe this independently of my upbringing; I am aware of its influence. However, when I consider how tough life can be and how we grow more and more into who we are as we age, I marvel at the endurance it must take to keep living, let alone long enough to bear a legacy worth sharing.

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Here’s a list of five things that I believe we can all learn from the elders around us: 1. Never forget that they were once your age. They know where you’ve been. Be willing to listen and hear how they got through it. Maybe you aren’t a Korean War Veteran. Maybe you didn’t live through Woodstock--It doesn’t mean there aren’t lessons that lie within their experiences. You know the way that most elders are so peaceful, almost transcendent? Think about what got them to such a state. The courage to see past the uncertainties and disappointments of life is what drives living. Look for motifs of failure, growth, and change in their stories. Just like you, they had to start from scratch at one point, and that alone supersedes the difference in time. 2. Their autonomy deserves to be respected. Health and mobility problems are almost always inevitable with old age. While they cannot help it, don’t remind them of it. Do what you can to provide them with the help that they need, but recognize that they are human beings with personalities, wants, desires, and likenesses. Those treasures deserve to be preserved. 3. Be genuine and intentional in your interactions with them. Be respectful and polite, but don’t feel as though you have to alter yourself in order to be deemed as acceptable in their eyes.

least be so close to its coming. That’s why I find their bravery so inspiring, contagious even. When you reach a point where you are purely content with the breadth of your life, you begin to seek different things out of life and appreciate the littlest things. That helps put my quarter-life crises into perspective. Big time. I know that I will end up okay. I can look at someone like my grandfather who walked miles to get to school and came from absolutely nothing. When he married my Grandma, they were really all that they had and to this day that’s how they live. I’ve found from my grandparents’ story and other stories like theirs that the questions we have and struggles we face as young adults about financial security and effectively investing in our futures and careers are absolutely valid, but they aren’t the point to life. Life will work out regardless of what you do. It just does. One last tip that I try to stick by even with my Grandparents: While we are learning so much from them, they are learning from us as well. Don’t be scared to feed into their lives. Add value. We have no idea how comforting sharing a laugh or opening up to them on our personal lives can be for them. Why not try? The generational gap between our age groups already poses an obstacle, but it can be overcome with authenticity and vulnerability. We are not too small to make an impact, and neither are they.

4. Elders are walking, breathing books. Their wisdom is indefinite. Don’t be too proud to listen, make conversation, ask questions, and absorb all that you can. 5. Their endurance and steadfastness in life can show us just how miraculous and worthwhile life is. We don’t ask to be born, and we definitely don’t ask to die, or to at

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y e i e i f i a S n i a

a t d B w a a a e f fi 2 m b p

TURNING BACK THE CLOCK KATIE LUQUIRE

Klein, S. (2014, May 09). 40 Isn’t Too Late To Start Exercising, Study Says. Retrieved October 16, 2017 MacMillan, A. (2017, March 10). This Workout Reverses Signs of Aging, According to Science. Retrieved October 16, 2017 Osborne, H. (2017, May 23). Want to slow down the aging process? Exercise regularly and vigorously to take almost a decade off your age. Retrieved October 16, 2017 Reynolds, G. (2015, October 28). Does Exercise Slow the Aging Process? Retrieved October 16, 2017

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p d m e t H a s s S w d a A b e l a o a m v d w c w t e h ( c o H


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At this point in your life, you’ve undoubtedly heard that exercise is good for you. While it’s true that exercise can have excellent short-term effects such as improving mood, decreasing body fat, and decreasing stress levels, it turns out that exercise also has a long-term impact on longevity. Studies have shown that exercise not only makes us feel younger, but it can also improve functionality on a cellular level (Reynolds, 2015). As it turns out, exercise has actually been shown to decrease the rate at which this cellular damage occurs. In a study at Brigham-Young University, adults with high levels of vigorous physical activity had a nine year biological advantage compared to sedentary adults. Additionally, “vigorous exercise” was classified as running for 30-40 minutes per day at least five times per week (Osbourne, 2017). What if you hate running, you may ask? Any aerobic exercise, like biking or swimming at a moderate pace is also sufficient. Telomeres are believed to protect your DNA from damage during cell division and replication, much like the plastic tips on the ends of your shoelaces prevent the ends from fraying too much. However, with each cell division and replication, your telomeres shrink and eventually become too small to protect your chromosomes. Shortened telomeres are associated with a number of age-related diseases, such as cancer, strokes, and cardiovascular disease. According to an article published by The New York Times, those who exercised regularly actually had longer telomeres. Individuals were asked which of four categories of exercise they completed on a regular basis: weight training, moderate exercise, such as walking, vigorous exercise, like running, or daily activities, such as walking to work. Those who said they regularly completed all four types of exercise were 59% less likely to have short telomeres, indicating that more exercise in a greater variety may have a positive impact on longevity (Reynolds, 2017). Interestingly, regular exercise can have a positive impact on other cellular mechanisms as well. High intensity interval training,

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commonly referred to as HIIT, is a form of exercise in which there are short bursts of intense exercise, followed by short recovery periods. The short recovery periods keep your heart pumping, providing a quick, efficient method of combining cardiovascular exercise with strength training, often in bouts of 45 minutes to one hour. Mayo Clinic researchers developed a study based on HIIT training, in which 72 sedentary adults in young (18 to 30) and older (65 to 80) age groups were assigned to HIIT cycling, weight training, or a cycling and strength-training plan. After 12 weeks, changes were measured in the participants’ strength, lean muscle mass, oxygen capacity, and insulin sensitivity. It was determined that participants in the HIIT group had the most benefits on a cellular level (Macmillan, 2017). By the end of the 12 weeks, participants in the HIIT group had boosted their mitochondrial capacity by 49% in the younger group and 69% in the older group. The greater the mitochondrial capacity, the more efficiently a person is able to circulate oxygen throughout their system. Additionally, the functionality of the mitochondria has been linked to pathways that regulate the lifespan and the aging process, so keeping your mitochondria healthy is also crucial to managing the aging process. As it turns out, none of the weight training groups increased mitochondrial function, while only the younger group in the combined training program increased mitochondrial capacity. Therefore, while exercise is as a whole, beneficial, some of the biggest

cellular benefits can be seen with HIIT training (MacMillan, 2017). Many studies have looked at individuals who had already been active, but what is the impact if you get a late start? A study published by Medicine & Science in Sport & Exercise found that associations between exercise and telomere length were the strongest between the ages of 40 and 65, suggesting that midlife may be a significant time to start or continue exercising. Additionally, cardiovascular improvements can be made no matter the age at which a routine has started. Research has shown that men who start exercise at age forty or later achieve similar scores for heart rate and maximal oxygen uptake as men of the same age who started exercising before the age of thirty. Therefore, the benefits of exercise are just as advantageous, whether you get an early or late start (Klein, 2014). Exercise has been proven to be a natural, effective method for improving outcomes in longevity and slowing the aging process. Studies have also shown that more exercise in a greater variety has a large impact on cellular function of mitochondria and telomeres. While studies are purely correlational for now, they do associate poor cellular function with a greater incidence of disease and mortality. Luckily, studies have also shown that it is never too late to turn back the clock.

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BEING MORTAL SHERRY LUO

“Being Mortal,” Atul Gawande’s fourth and latest book, explores how patients and doctors approach death. Instead of fighting for more time, he argues, doctors should fight to ensure that a patient’s last moments are spent in a meaningful way. However, in an age when it is never entirely clear when or if a patient will die, that has become increasingly difficult to do. Even patients themselves “confuse care with treatment.” Medical compassion, as Gawande proves in his book, is as important as medical competence. Gawande unsparingly writes of the process of senescence and the deterioration of the body and mind that accompanies it. He had to watch his own grandmother-inlaw painfully lose her autonomy. He watched his own father battle with a spinal tumor. He details the effects aging has had on American culture, such as the evolution of assisted living and the decline of the geriatric field. Doctors are more focused on “prolonging life,” a cold phrase Gawande once used when he was a physician inexperienced in talking to patients about death, instead of ensuring a patient’s well-being. As people age, they slowly lose their independence, a fact that Gawande portrays through heart-breaking anecdotes of people fighting for their autonomy, privacy, and desire to live. Medicine and technology may have gifted humans with extended lives, but they have taken away their quality of life. These stories are not easy to read, but amidst the bleakness, there is positivity in the avantgarde individuals who fight for better senior communities and for more individualized care. Different models of assisted living are featured heavily in the book, ones that not only fulfill the expectations of families, but also provide the old with a genuine home instead of a disguised prison. The latter portion of the book is concerned with terminal illnesses. It is a patient’s choice as to whether he or she wants to undergo treatment or experimental trials,

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but it is the doctor’s responsibility to provide an accurate estimate of the patient’s remaining time and the side effects they will experience. One of the patients Gawande writes about goes through rounds after rounds of treatment and ends up being a shell of her former self. To Gawande, the Netherlands euthanasia policy is a mistake; one does not have to sacrifice time to ensure a good death; one can have a good death and a good life. There is nothing that can prevent the body from decline, but “the sick and aged...have priorities beyond merely being safe and living longer.” There were several times throughout my reading of Being Mortal when I had to put it down because of how emotional and intimate the stories were, but I would highly recommend this book to anyone looking to pursue a career in the healthcare field. This book truly opened my eyes to the limitations of medicine, but it also showed me how much room there is for improvement, and it excites me to think that our current and future generations can be part of it.


Sources: https://www.cdc.gov/healthequity/lcod/men/2014/all-males/index.htm, https://www.cdc.gov/women/lcod/2014/all-females/index. htm, https://www.cdc.gov/cancer/dcpc/data/men.htm, https://www.cdc.gov/cancer/dcpc/data/women.htm, https://www.cdc.gov/

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