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

politics and medicine —our new scholarship —epidemics —healthcare views —illegal immigrants —more


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Executive Editors Annika Carter Selin Odman Sona Rao Galit Deshe Heather Huynh Jesse Hu Lily Wang Hanna Friedlander Writers Anisha Yagnik Amanda Pham Emma Burke Grant Mercer Hamzah Ali Hallie Smith Leah Ginn Nikhil Gangasani Simran Rajput Syeda Nausheen Designers Christina Crupie Galit Deshe Melody Modarressi Wayland Yeung Jonathan Cheaves Photographers Graham Cain Hanna Friedlander Lily Wang Nivedha Balaji

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POLITICS AND MEDICINE

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a message

FROM OUR EDITOR

Dear Reader, In 2013, Shajira Mohammed had a dream to create a magazine for all the pre-medical students on UGA’s vast campus. This magazine began as a humble, online-only publication. Now, the magazine is beginning its second year in print. It can still be found on its original website, but it can now be attained from one of the many bright blue distribution boxes scattered across campus or even in the waiting rooms of Athens Regional Hospital. That magazine is UGA’s PreMed Magazine — the magazine in your hands at this moment. The growth of this publication from where it began to where it is now would not have been possible if it were not for our founder, Shajira, who, even after graduating, frequently visits the magazine’s meetings, still eager to watch her brainchild grow; our faculty advisor, Dr. Leara Rhodes, who gives countless hours each week to help each and every one of the our members improve their craft; our hardworking staff of writers, copy editors, photographers, and graphic designers, without whom this magazine would be nothing but a collection of blank, white sheets of paper; and, perhaps most of all, you, our readers, who by reveling in our glossy pages give us something to work for. As a thanks to you, both dedicated readers and determined students, PreMed Magazine is implementing a scholarship program, named the Leara Scholarship after our faculty advisor. This scholarship is designed to help the students who pick up this magazine excel both on campus and off by providing additional funding for textbooks or tuition, study abroad trips or housing during internships. I urge every one of you reading this to let us give back to you and go to page 8 to learn more.

The title of this issue is Politics and Medicine. This November, we will be choosing the next President of the United States. If you are anything like me, you tend to push politics to the back of your mind, letting your upcoming cell bio exam, studying for the MCAT or even completing the AMCAS take precedence. But medicine and politics have more in common than you may believe. With the Affordable Care Act, people’s access to medical care has become intertwined with their political beliefs — A Key and Peele skit comes to mind in which a patient pulls out his heart transplant after learning he was only able to receive the surgery due to the ACA. Most importantly, solid understanding of controversial medical topics allows for us, as voters, to make an informed decision, rather than a decision based solely on our desire to affiliate with a specific political party. As Eliot Spitzer, former Governor of New York, once said, “It is time to let science and medicine, not politics and rhetoric, lead us to good, sound policy.” With that, I leave you to indulge in the tangle of politics and medicine. Enjoy.

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Medical Misinformation

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Congress Dealing with a Generation in Crisis

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The Wolf of Health Street

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Legalize It: Medical Marijuana's Benefits

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How Different Country's Healthcare System Differ

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The Medicine Behind the Politics

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Column: Interview with Med School Admissions Officer

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Red, Blue, and Green?

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The Science Behind Vaccinations

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America's Doctor-The US Surgeon General

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Column: Book Review Less Medicine, More Health

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Outside of the Emergency Room and Into the Community

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Planned Parenthood, Zika, and Prescription Heroin

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PreMed Magazine Presents...

The Leara Scholarship

To enter, please send an email to ugamedmag@gmail. com by October 31st with the following information: - Your Name - Your Email Address - Your Phone Number - Your Local Address - Your Expected Graduation Date - Your Major - Your Current GPA Please attach to this email a file containing your submission. Preferred files are Microsoft Word documents, .jpgs, .img, or PDFs.

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PreMed Magazine will now be offering a scholarship in each issue. Each scholarship will require a submission from you, our readers. This submission can be a piece of writing, a photograph, or a graphic design. In each issue, our scholarship will have a different topic for these submissions. This month's topic is: What is medicine? This is a broad, very open-ended subject. Medicine has different meanings to different people -- some people come from a family of doctors while others have experienced, first hand, the life-saving abilities of medicine. Others still may have no prior connection to medicine but are enthralled by its complexity and, thus, aspire to become physicians. Please remember that we are not looking for a dictionary definition or textbook entry -- we want you to be creative!

Remember, this scholarship is open to ALL majors, not just pre-health students! The recipient of this scholarship will be announced in our December 4th 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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medical misinformation

JESSE HU

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hen Martin Shkreli, widely known as a former pharmaceutical executive turned “most hated man in America,” tweeted a Parkinson’s diagnosis for Hillary Clinton, his opinion was largely discounted as a conspiracy theory (Burris, 2016). The few people that listened often had previous biases, while most of the population sat back, and wondered, “why should we trust a man without formal medical training that has been arrested for security fraud and with a track record of moral reprehensibility?” Clearly, one could see that this was medical misinformation with an alternate agenda. Consequently, we should not trust everything written on the internet, broadcast through television, or printed in media. Yet, there are clear instances where medical misinformation, delivered through elected public officials, has gained significant traction because of a misinformed or gullible public.

Take for example, the prevalence of “Fan Death” in South Korea, the belief that sleeping with a fan on in the room can cause death. The following warning was issued by a state agency: If bodies are exposed to electric fans or air conditioners for too long, it causes bodies to lose water and hypothermia [sic]. If directly in contact with a fan, this could lead to death from increase of carbon dioxide saturation concentration and decrease of oxygen concentration. The risks are higher for the elderly and

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patients with respiratory problems. (Beware of Summer Hazards!, 2005) To the average person living in Georgia, this seems implausible, even downright ridiculous, during the burning summer months. Yet, in Asian cultures where climates are more frigid, this seems to make perfect sense -- having a fan on you during the winter leads to increased likelihood of colds and dehydration. Taken to the extreme, this could cause death. Yet, there is simply no scientific basis for fans causing death. While a comical example, medical misinformation like this can have devastating consequences. In the United States, a number of politicians have publicly decried the use of vaccinations. Rand Paul, a former physician, stated in a speech that “I have heard of many tragic cases of walking, talking normal children who wound up with profound mental disorders after vaccines. I’m not arguing vaccines are a bad idea”(Carrie Dann, 2015). In doing so, he references the commonly held belief in anti-vaccination communities that vaccines are linked to Autism, despite the fact that the paper that originally linked vaccines and autism was shown to be patently false (Rao & Andrade, 2011). The result of such medical information hedging from Paul and other politicians? As reported by the CDC, the United States has seen the

POLITICS AND MEDICINE


reemergence of previously controlled diseases such as measles. Children that have weakened immune systems, and therefore cannot be vaccinated for medical reasons, are effectively deprived of education as they no longer enjoy the benefit of her immunity (Jacks, T, 2015). Yet, the ideas that drive the anti-vaccination movement still persuade people to hold firm in their wrong beliefs. It’s clear that certain sources, such as politicians and news outlets, might not be accurate. This is not surprising if these sources are evaluated for their motivations. The physician responsible for publishing the paper linking vaccines and autism was shown to have a financial conflict to the tune of $634,000 (“Retracted autism study an ‘elaborate fraud,’ British journal finds,” n.d.). Rand Paul, in the role of politician, has a greater vested interest in appeasing his voter constituency rather than dispensing the most accurate medical information. Where might one find accurate information about

crucial issues of health? As far as individual reading and research, the best bet would be peer reviewed medical journals, which are often difficult for the layperson to parse and understand. Another alternative might be the CDC, which is operated by a variety of healthcare professionals, unlike the nonmedical Korean Consumer Protection Board which issued the false warnings above. Finally, consult your physician for medical information. Though there are a few notable examples of physicians spreading medical misinformation -- I’m talking about you, Dr. Oz -- physicians and other trained professionals are often the best resources for information for two reasons: these individuals have formal training in the subject matter and (for the most part) have no ulterior motive. As for other sources of information, be judicious and a little skeptical -- oftentimes those who shout loudest about medical issues are the least correct.

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congress dealing with a generation in BY ANNIKA JONKER

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pioids can be found administered to patients before and after surgical procedures or even given to a dental patient for a mild toothache. The amount of opioids prescribed in America has nearly quadrupled since 1999, but there has been no significant change in levels of pain that people report - so how then did opioid overdoses become the leading cause of injury death in the United States? Opioids is a category of drugs that includes heroin, methadone and prescription painkillers such as OxyCodone. Over the past two years, Congress has been engrossed with the opioid epidemic, trying to find solutions to the worst drug epidemic in US history since the HIV epidemic from the 1980s - and they’re taking a novel approach to controlling this epidemic compared to what they have done in the past. In 2014 alone, more than 47,000 Americans died due to opioid abuse - which averages to 125 people a day. Compare this to an average of 34,000 people who die in car crashes or the 34,000 people who die from gun violence a year. Around 2 million Americans abuse drugs, a number that has tripled since 2000 and, according to the National Institutes of Health Survey, 75% of whom never receive treatment. Congress is focusing on tackling the epidemic not by implementing harsh antidrug criminal justice penalties, but by drafting initiatives focused on public health and health awareness. In May of 2016, the House of Representatives passed 18 bills related to the opioid epidemic with its biggest debate being how to fund treatment and prevention programs for opioid abusers. Congress isn’t certain on how to address the scale of the problem or how to appropriate enough money for it, but thus far, all parties are focused on

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expanding access to medication-assisted treatment, prescription training for doctors and providing overdose-related training for first responders. The main concern is funding. President Obama is asking $1.1 billion. However, Democrats and Republicans argue that regardless of how much money is appropriated, there will have to be reductions in other programs or increases in the national revenue. While the national status of the opioid epidemic is being debated on Capitol Hill, individual states are attempting to minimize the scale of the epidemic by placing limits on opioid prescriptions. A major concern for physicians is that patients are becoming addicted to their opioid medications after having been prescribed an inappropriate amount for an excessive amount of time. When a patient becomes dependent on an opioid prescription, the patient’s body needs higher doses of the medication to have the same effect. What makes opioid overdoses capture the attention of Congress is that, unlike cocaine addictions or related drug addictions, opioid overdoses ultimately circle back to the physicians. As seen in New Hampshire and Massachusetts, states are encouraging doctors to prescribe alternative pain treatments and are trying to require all insurance plans to cover substanceabuse treatment. The opioid epidemic snuck up on Congress; they were late to the game on passing bills to minimize it, but the future is promising. Looking forward, discussions on solutions and treatments for opioid overdoses are rattling the nation to find a way to control the epidemic that has become the leading cause of injury death in America.

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THE WOLF OF HEALTH STREET BY HAMZAH ALI

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he bipartisan divide in this nation has lead to the constant shifting of power and control of legislation. Every term, one political party`s ideas proliferate before being overturned by the election of representatives from the opposing party. Due to this phenomenon, there is an existing battle on Capitol Hill over the future of healthcare policy. The Affordable Care Act (ACA) is at the forefront of both parties’ platforms. The Democratic National Committee stands firm on maintaining this legislation while improving technical difficulties that have lead to major problems in the implementation of the ACA. On the other hand, Republican party candidate, Donald Trump, has promised to repeal the ACA on the first day he steps into office. The repeal of this legislation will lead to many economic problems in the United States. If repealed, there will be a surge in the number of uninsured citizens, a drastic increase in the percent of taxpayer dollars spent on low income assisted healthcare and a reduction in established healthcare policies due to the lack of concrete legislation to replace the ACA. Before the ACA was signed into legislation in early 2010, 18% of Americans lacked health insurance. That figure dropped from about 16.3% in 2014 to 12.8% in 2015 after the implementation of the ACA (Mangan 2016). The Obama administration placed an “Individual Mandate” as a major policy of the ACA. It requires all citizens to have health insurance unless they have applied for exemption or want to pay a yearly fee. In 2016, citizens will have to pay $695 per uninsured person in a household(“Individual Mandate…”). The exemption status only applies to people who earn less than 400% below the Federal Poverty Level, thus many citizens feel that they are forced to buy health insurance when they do not want it. Regardless of political affiliation, most, if not all, people will need healthcare at some point in their life. The ACA was established to help expand health insurance to those who did not have access to it before. Americans that already had health insurance prior to this legislation had negligible effects to their taxes and monthly premium costs. The ACA actually brought upon more benefits than drawbacks for the general population.

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Trump runs on a platform that expounds upon a powerful argument to eliminate the Individual Mandate and the ACA as a whole. He caters to those people who might have or believe they have - excellent health and do not want to pay a monthly premium for a service they do not utilize frequently. He also targets people that cannot easily afford to pay monthly premiums but do not qualify for the exemption program. Trump has pushed for a free market health industry to allow more freedom and choice to people, but he has no working plan to replace the ACA if he takes office in January. This uncertainty raises concerns: since he has not provided a general foundation for his new healthcare act, it seems as if he is simply banking only on previous Republican healthcare policies such as the Health Savings Accounts (HSAs), state regulated Medicaid plans and free interstate access to health insurance companies. The Bush Administration also promoted HSAs, but they were met with many obstacles. Studies showed that HSAs lead to more uninsured people and higher overall health costs. According to a study done by the Commonwealth Fund, most uninsured Americans do not face high-enough marginal tax rates to benefit substantially from the tax deductibility of HSA contributions (“The Truth about Health Savings Accounts,” 2006). While it may be beneficial to a small percentage of the wealthier people in this nation, the burden to pay falls on the middle class. Since most people have low tax rates due to their low incomes, the return from HSAs seems negligible and almost pointless. HSA`s have not been Trump's most promising idea, but he does capture a huge demographic when he advocates his ideas on expanding Medicaid and debating drug costs for Medicare. Although the Republican party would disagree strongly with Trump regarding these two policies, he believes that everyone who wants healthcare in America should have access to it. Unfortunately, these are unlikely to materialize if the ACA is repealed due to the healthcare crisis that would ensue. If the ACA is repealed, millions of people will lose their health coverage. As the number of uninsured people rises again, the health industry will face many negative repercussions. The repeal of the ACA would have a direct effect on the amount of tax dollars spent on low income assisted healthcare. When

POLITICS AND MEDICINE


there are more uninsured people that cannot pay their bills when sent to the emergency room, taxpayers will be responsible for making up the difference. Imagine a 58 year old woman who is uninsured, by choice or by losing her coverage. She does not yet qualify for Medicare and is in dire need of an operation for her hernia. She eventually ends up in the emergency room and acquires a large medical bill that she cannot pay. The medical bill now falls upon the hospital and that bill, among many other unpaid ER bills, will ultimately be compensated from hard-earned taxpayer dollars. There will have to be an estimated increase of $660 billion dollars in taxes to support the repeal of the ACA (“TrumpCare Explained�). Trump fails to mention the cost associated with removing this legislation, choosing instead to demonize the program as a coverup. Just as the Wolf of Wall Street would entertain his stock buyers with his sense of humor while cleaning them of their money, Trump, the Wolf of Health Street, attracts his followers by disguising his plan`s negative repercussions with enticing promises.

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of, or abusers of the medications they are prescribed. As a solution to this frustration, many doctors are now prescribing marijuana as a solution for symptoms caused by certain qualifying medical conditions. This comes as a huge relief to many patients, because they can take fewer medications, and especially because the marijuana seems to be working well for their symptoms. Epilepsy patients have significantly fewer seizures, and cancer patients experience the pain relief they have been looking for. Although some patients and physicians may find that the treatment that best serves them is medical marijuana, its use is still prohibited by federal law.

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n 25 states in this country, people with diseases such as HIV/AIDS, glaucoma, cancer or neurodegenerative diseases, are struggling to find effective, safe treatment for symptoms such as chronic pain, seizures or muscle spasticity. In the other half of the states, patients with the same qualifying conditions are being referred to state-licensed medical marijuana dispensaries, where many patients are able to find the relief they need. Patients with severe conditions such as cerebral palsy or cancer are prescribed one prescription drug after another and are still not finding the treatment needed in places where medical marijuana is not available to the public. Some patients even become addicted to, tolerant

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Marijuana is ranked as a Schedule 1 controlled substance under the Controlled Substances Act, meaning that it has no potential for medical use and has a high risk of abuse which contradicts most evidence. For it to be removed from the Schedule 1 category, more research and clinical trials need to be done to prove that medical marijuana is a safe and effective treatment. Furthermore, the legal process would be long and tedious, involving the Attorney General, the Department of Health and Human Services, and the Drug Enforcement Administration. Currently, the federal administration is leaving it up to the states to decide how to legally treat marijuana when it comes to medical use, but it remains illegal to sell or possess marijuana under federal law. This means that the administration is not enforcing the law. Although the federal law is not being enforced with respect to state-licensed medical marijuana dispensaries it is very difficult get funding for marijuana-related endeavors because investors are worried about violating federal law. Politicians are watching the progress of the states that have already legalized marijuana closely, such as Colorado, so that they can understand what action should be taken with respect to potential legislation. The state governments that allow “comprehensive public medical marijuana and cannabis programs� have very tight procedures in place. Medical marijuana is typically sold in dispensaries, which are run by licensed health professionals—usually pharmacists. Patients are prescribed medical marijuana by their physicians, and then must be registered with an ID card in order to buy the drug from the dispensary. The most common qualifying conditions for which medical marijuana is prescribed are neurodegenerative diseases, such as cerebral palsy and epilepsy. Neurodegenerative diseases cause symptoms such as seizures, muscle spasticity, lack of muscle coordination, and pain.

POLITICS AND MEDICINE


Legalize It: Medical Marijuana’s Benefits

Anisha Yagnik

Medical marijuana differs from recreational in that the patients are getting a very specific, regulated amount of tetrahydrocannibinol (THC) and/or cannibidiol (CBD) in their dosage. THC is the psychoactive component of marijuana that is responsible for the euphoric effects of the drug, and CBD is a chemical that reacts with CB receptors in the brain that can relieve pain and reduce seizures without causing euphoric effects. Patients are prescribed different levels of THC and CBD in their prescription based on their symptoms. For example, a patient with chronic pain—whether it be from cancer, cerebral palsy or another disease—would be given a dosage higher in CBD. CBD is also the chemical that has so famously reduced the number of seizures in epilepsy patients. A patient with PTSD or anxiety would be given a dosage higher in THC. The benefit of having a medical marijuana program rather than having to get marijuana off the streets—besides the illegality of it— is that patients get the right amount of each chemical that should help relieve their symptoms. An epilepsy patient does not need the high levels of THC that are often present in recreational marijuana, and a patient with depression does not need the CBD. In this way, this one plant is the source of a variety of different solutions. Medically regulated marijuana gives a patient only what they need from the plant, and can even be administered in a variety of ways. Just like common prescription medications often come in a syrup and a tablet form, medical marijuana products can be administered through vape pens, capsules, edible products, strips for your tongue and even the traditional way of smoking. There is a viable therapy for everyone who qualifies, but the main thing holding back the advancement of the field is the lack of research available. Unfortunately, not enough is known about the mechanisms by which marijuana helps the patients of certain diseases, but it is known that marijuana does help them. Politicians realize this lack of research exists, and many of them talk about promoting more research. In

an interview with CBS in the San Francisco Bay Area, Hillary Clinton was asked about her stance on legalizing marijuana—including recreational—and her response was, “Where I sit today, I favor more research into making sure medical marijuana is being used to the best effect.” However, she does not touch on this issue very much in her speeches, and neither does Trump. Gary Johnson, the libertarian candidate, said in a town hall interview with CNN, that, “Marijuana products compete directly with legal prescription drugs that statistically kill 100,000 people a year, and there are no documented deaths with marijuana.” He supports the legalization of marijuana because it will bolster the economy as well as reduce crime rates. Jill Stein support the legalization of marijuana as well, and she is, “treating marijuana as a medical issue, not a moral one,” according to her website. She, like many other Americans in support of legalization, believes that decriminalizing marijuana will make it less dangerous to society by reducing the high number of arrests for marijuana-related charges. As a doctor, Jill Stein realizes that marijuana is not as dangerous as alcohol and tobacco, so legalizing it solves one of the United States’ biggest problems: incarceration. Clinton, Trump, and Johnson are not backed by such firm arguments regarding this issue. Trump, has stated in an April interview with MSNBC that he “thinks” he is behind medical marijuana, but he has heard some “very negative things” in regards to Colorado’s legalization

Legalization of marijuana “ will bolster the economy as well as reduce crime rates

of recreational marijuana. However, neither Clinton nor Trump have listed marijuana legalization as part of their platform.

Although marijuana is showing great promise in the medical field, more research needs to be done to generate enough evidence to support and demonstrate its effects. Patients with neurodegenerative diseases may have finally found a reliable reprieve from their symptoms. With more research, clearer federal and state level legal policies, and more awareness, this regulated drug therapy could be made available in all fifty states. If this issue is important to you, vote for the people who you think might make it happen.

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how different country's healthcare systems differ BY MEGAN MURPHY AND MELODY MODARESSI

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lmost two hundred years ago, Rudolf Virchow, a German physician, expressed a truth that continues to explain today’s struggles as politicians battle over health care and the well-being of those they serve: “Medicine is a social science, and politics is nothing more than medicine on a grand scale.” As the 2016 presidential election unfolds and the American citizens find themselves confused about each candidate’s standings, Virchow’s statement allows us to understand the reasoning for the passionate debate about the US Healthcare system. The US Government has taken a role like a doctor to his patient. Political leaders feel morally obligated to provide health care for all individuals, to find solutions to all public ills and put a Band-Aid on each communal injury.

to expand Medicaid and grant health care access to all individuals regardless of immigration status. She hopes that the further development of the Affordable Care Act will grant more people access to health care. Many families are being forced to cut back on spending because out-of-pocket costs are rising. Clinton hopes to lower these costs so that citizens of all socioeconomic statuses can have better health and, therefore, a better quality of life. Clinton is devoted to increasing funding for health centers and expanding the National Health Service Corps. Each political party has formulated a plan of action that they believe will promote better health for the American people. As voters, we must decide which “doctor” we want to trust with the healing of our injuries.

What do our current nominees hold as key to their health care policies? How do they justify their strategies as they vie for our votes? Donald Trump vows to repeal Obamacare, allow sale of insurance policies across state lines and permit individuals to remove health insurance premium payments from their tax returns. He believes that every individual should be able to decide for themselves whether they need insurance or not. Selling insurance policies across state lines should bring more competition into the market, decreasing insurance costs per person. Trump would further like to demand that all healthcare providers transparently present their costs to patients. He wants to allow state governments to manage Medicaid since he believes that states understand their people’s needs best. Lastly, he hopes to allow drug providers easier entry into the free market which could bring down prices and give consumers more options. Meanwhile, Hillary Clinton wants to do the exact opposite: keep and expand the Affordable Care Act, reduce copays and deductibles, encourage states

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THE PERFECT MAJOR FOR MEDICAL SCHOOL Being a pre-med was tough. Everyday I went to lectures, came home to read through my textbook, and scrambled last minute to finish up procrastinated assignments. I had no time to actually learn about the field of medicine itself. Even when I did have a bit of free time, I was just too burned out to read through long journal articles and web pages. That’s the problem DocThoughts aims to solve. DocThoughts is a media platform that interviews thought leaders in medicine and produces 5-minute films. We create concise and engaging video interviews that will introduce you to aspects of the medical field and medical school not covered in a traditional classroom. The following is a snippet from our recent interview The Perfect Major for Medical School where we interview the Director of Medical College Admissions at his medical school. Check out the website DocThoughtsMed.com for more short and awesome interviews! -Nirmal Gosalia Founder, DocThoughts

What does your college major have to do with medical school? Many undergraduate students believe that medical schools favor students with majors in life sciences -- biology, chemistry, biochemistry. Dr. Jorge Girotti, Director of Medical Admissions at University of Illinois at Chicago, clears up this confusion in his interview with Nirmal Gosalia from DocThoughts.

What significance, if any, does a student’s undergraduate major have on their success in medical school? As the person in charge of admissions, I can say that in the review of candidates for medical school, the actual undergraduate major does not play much of a role. I have been saying that to undergraduate pre-medical students for a long time, but it doesn’t seem to matter. Usually, 60 percent of the students that enter our medical school degree program have majored in biology, chemistry or biochemistry. When we look at the performance of our medical students in relation to 22

their college major, we’ve never noticed any difference in the ability to perform in the basic science coursework or in the clinical years of medical school. I think the evidence bears out that it doesn’t really matter what major you pursue as an undergraduate student. What significance does a student’s undergraduate major have on their future success practicing medicine? My view is that medicine is about a lot more than knowing about the biomedical aspects of care. It entails understanding humans at the most basic level. Sometimes it seems that individuals that bring a background in social sciences or behavioral sciences may have more insight in the non-biological aspects of patient care. When you consider the relationship that doctors establish with patients, the medical side is really only one component and the patients actually appreciate when they see that the doctor is able to translate, in a way, all the knowledge they may have to something that makes sense of that individual. As you know, literacy in general and health literacy is not as high as it should be. We’re told all the time that when you create messages related to healthcare that

POLITICS AND MEDICINE


you should aim for a fifth grade comprehension level. That’s an area where I think doctors fail sometimes. They bring very sophisticated terminology that doesn’t mean a whole lot to the patient. In the process of doing this, I think doctors lose a little bit of the trust and the confidence that the patient may have and hamper their ability to take care of the patient.

What advice would you have for a student who is currently in the process of choosing a major and wants to attend medical school? This would be good advice for those that maybe have not started college yet or who are early in their college careers. When you go to medical school your coursework will be set for you. You do not have a lot of choice in the courses you take or the sequence of courses. In essence, college is one of the few opportunities you have to do something that really interests you. To pursue a major just because you feel that’s what medical schools want to see or because you think you’ve heard that it will give you an edge as you prepare for medical education would be short-sighted. College is, in fact, one of the few times where you have a chance to call the shots and pursue the things that truly interest you.

Want to see the full interview or interviews like it? Find DocThoughts at DocThoughtsMed.com.

YOUR NEXT STEP TO A CAREER THAT MATTERS. Physical Therapy Physician Assistant Occupational Therapy Public Health Clinical Laboratory Science Medical Illustration Augusta Area Dietetic Internship Learn more about our undergraduate programs at the College of Allied Health Sciences augusta.edu/alliedhealth or cahs@augusta.edu

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I

F s f s h t c a n b

T C a a c u r p N t h c S h o a s s s

I o

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POLITICS AND MEDICINE


RED, BLUE, AND GREEN? BY LEAH GINN

I

magine another world—another place—another time. In this benevolent world, health is rudimentary, and all citizens are encouraged to maintain healthy lifestyles. Fresh and organic foods are available and affordable; safe sidewalks and bike paths promote active transport; pollutionfree, renewable energy is used in transportation and industrial sectors and toxic-chemicals are ruled out. Physicians and healthcare providers practice according to their callings to medicine; they treat those in need regardless of age, color, disability, social status and birthplace. Healthcare is a personal human right, and no one is left out. Medicine is not overwhelmingly expensive, and there is an abundance of both pharmaceutical and holistic drug options. This happy and healthy world may seem far-fetched. Compared to the world of confusion surrounding the current and upcoming status of healthcare in our country, a simple and benevolent health care system is far-fetched. The changes it would take to arrive at the above possibilities seem unattainable and maybe that is why the political conversation rarely mentions Green Party candidate, Jill Stein. As a practicing physician, Jill Stein has a heart for the people. Not only is she compassionate, but she also feels inclined to protect the health of our Earth as an active environmentalhealth advocate. During the 1990s, she discovered many correlations between toxic exposures and emerging diseases. She began to fight for a healthy environment as it were a human right. Since then, Stein has assisted several non-profit organizations in combating the dangers of lead and mercury air and water pollution, incinerators, landfills and toxic waste sites. She also has worked towards moving government subsidies away from fossil fuels and toward renewable energy sources, which would create endless “green jobs.” (Jill 2016) In her 2016 campaign platform, Jill Stein endorses each of the aforementioned ideas, and states, “We need a new

way forward that puts people, planet and peace over profit,” (Jill 2016.) What would this new way forward entail, besides an enormous amount of open-mindedness? As far as reformation of health care goes, Stein believes the industry of health insurance to be a “cancer” that consumes $400 billion annually and reduces our access to health care. This would be removed and replaced with a single-payer public health program. There would be no more co-pays, premiums or deductibles. The jobs lost from removal of this industry would be replaced and exceeded by jobs in sustainable energy, mass transit, sustainable organic agriculture, clean manufacturing and many more. Negotiations to purchase prescription drugs in bulk would reduce overcharging and contraceptive and reproductive care would become fully accessible. Preventative health care would become a priority. Consumers would be fully informed on food choices by the expansion of labeling requirements for factors such as country of origin, GMO content and toxic chemical ingredients. Jill Stein doesn’t stop there, check out her platform at http://www. jill2016.com/platform. While the Green Party has not gained much attention in the upcoming presidential elections, both the Republican and Democratic stances on health care are very blatant. Democratic candidate, Hillary Clinton, vows to protect and expand the Affordable Care Act (Obamacare) that’s currently in place (Hillary for America.) Republican candidate, Donald Trump, on the other end of the spectrum, wants to do away with the Affordable Care Act all together, and implement free market principles that will “restore economic freedom and certainty to everyone in this country.”(Donald J. Trump for President, Inc.) Jill Stein’s reforms may seem foreign compared to the typical American culture we experience and to the desires of the currently remaining candidates, but are worth further thought nonetheless.

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t’s a blazing, hot day in the month of August and for many five and six year olds their first day of kindergarten. Some are excited and bursting with joy while others are nervous, hesitant and a little sad to leave their parents. But before these children are allowed to embark on their journey, the school requires them to provide immunization records. While the federal law does not mandate vaccinations, all fifty states demand children to be vaccinated before starting school. Vaccines work by injecting a small, harmless dosage of the disease (antigen) into the body in order to induce the production of anti-bodies and T-lymphocytes. This process allows the immune system to develop immunity to the infection and the ability to quickly recognize and produce anti-bodies to fight the disease. Over the years, various opinions regarding the effectiveness of vaccinations have emerged. Opponents of vaccines argue that vaccines can cause adverse side effects, that they are composed of harmful ingredients, that naturally acquired immunity is superior to immunity provided by vaccines, and that requiring vaccinations infringes upon parent’s rights to raise their children in a manner they deem “safe.” Supporters of vaccinations insist that vaccines are valuable and beneficial in protecting children, and adults, from many diseases. Most healthcare professionals and medical organizations urge parents to vaccinate their children at an early age because adolescents are more susceptible and vulnerable to serious infections. Vaccines prevent many deadly diseases such as whooping cough, measles, polio,

26

POLITICS AND MEDICINE


the science behind vaccinations BY SYEDA NAUSHEEN

tetanus, etc. The Center for Disease Control estimated that, between 1994 and 2014, 732,000 American children survived and 322,000,000 cases of childhood illnesses were obviated from vaccine-preventable diseases.

politicians, alike, have instigated fear and doubt in the minds of many Americans. Once uncertainty is engrained in the mind, it is difficult to dismiss and dispose debate and questions.

Similar to medication, vaccines also have mild side effects. After being vaccinated, the body is at work building immunity to the disease that has been introduced. During this period, minor symptoms, such as redness, soreness and in some cases fever, is common. Once the immunity is built, which typically takes about a week, the body is left with T-lymphocytes and B-lymphocytes. T-lymphocytes are memory cells and they “go into action quickly if the body encounters the same germ again” (CDC) and B-lymphocytes work to produce anti-bodies to attack familiar antigens. The side effects of vaccinations are miniscule in comparison to the symptoms of vaccine-preventable diseases, which can potentially be life-threatening.

Despite the fear and negative connotations that vaccines have created, vaccines are tremendously effective and beneficial. Many influential politicians, such as President Barack Obama, have spoken in favor of vaccinations claiming that the science behind vaccines is clear and “pretty indisputable [as] there is every reason to get vaccinated, but there aren’t reasons not to.” And Democratic candidate Hillary Clinton has supported and invested a great deal of effort in the attempt to vaccinate children. In 1993, she helped to establish the Vaccine for Children program, which is a federally funded program that works to make vaccines affordable to children whose families are financially unstable. This service has provided health security to many children who would otherwise not have access vaccinations, making them susceptible to various vaccine-preventable diseases.

While the scientific data and facts clearly support the use of vaccinations, politics has many times hindered the case for vaccines. In 2012, former Governor Rick Perry had issued a mandatory HPV vaccine, which helped prevent a cancer-causing virus, and was criticized by politicians who claimed the vaccine caused mental retardation in young girls. Immediately afterwards, the American Academy of Pediatrics released a statement asserting that the HPV vaccine was not correlated to mental instability. And just last year, Senator Paul Rand stated, “most vaccinations should be voluntary [and] that a parent’s choice not to vaccinate a child is an issue of freedom.” Events, like this one, and

Vaccines have proved to be very useful in treating diseases. One such disease is smallpox, which has been completely eradicated. Other vaccine-preventable diseases are becoming rare but until the disease is entirely eliminated, vaccinations will provide protection to children and adults. Discontinuing the practice of vaccinating, altogether, would cause many rare diseases to make a comeback and “before long we would see epidemics of diseases that are nearly under control today” (CDC).

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AMERICA’S DOCTOR–

THE U.S. SURGEON GENERAL BY GRANT MERCER

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POLITICS AND MEDICINE


Center: Emily Tommolino, MD ‘13 Internal Medicine, Providence Hospital; BS Chemistry, Wayne State University, ‘07

WE CHOSE AUC. Choose a medical school that sees you for the unique individual you are—one that puts you first, so you can put your patients first. At AUC, become part of a diverse, collaborative community that brings out the very best in you. We believe in the doctor you want to become. AUC graduates practice in some of the most prestigious healthcare institutions and academic medical centers—many with leadership positions. That’s why they chose AUC.

Make your choice. Apply today. aucmed.edu/apply Stay up to date on AUC news & admissions events:

AUCMED ©2016 American University of the Caribbean School of Medicine. All rights reserved.


J

ust over 50 years ago, Surgeon General Luther Terry issued a landmark report linking smoking to disease and death. At the time, smoking was commonplace and even considered fashionable. Movies and advertisements, filled with images of stars like John Wayne, Clint Eastwood and Audrey Hepburn, made smoking seem an absolute necessity on the path to being cool. Even the president under which he served, John F. Kennedy, was a noted smoker. Terry’s report led to a Congressional mandate requiring warning labels on cigarette packaging and the banning of TV and radio ads. At the time the report was issued, nearly 45% of American adults smoked while today around 17% smoke. Terry’s 1964 Surgeon General’s report was responsible for saving thousands of American lives. Part educator and part fitness coach, the Office of the U.S. Surgeon General serves as the voice of authority for health care, guiding all Americans on ways to improve their well-being. Originally started in the 18th century as a means to safeguard seamen's health, it was expanded seventy years later to include all Americans. The Surgeon General’s office is one of the seven uniformed branches of the military. Reporting up through the Department of Health and Human Services, “America’s Doctor” is charged with protecting, promoting and advancing the health of our nation. Appointed by the President and ratified by the Senate, the Surgeon General, carrying the rank of vice-admiral, serves a four-year term leading a team of nearly 7,000 commissioned officers in the U.S. Public Health Service Commissioned Corps. Wearing the uniform of the U.S. Navy or the U.S. Coast Guard in homage to their beginnings, these elite health-care professionals achieve their mission by responding to immediate public health needs and advancing medical science. Additionally, the Surgeon General’s staff assists in emergencies as they did during the Ebola outbreak, Hurricane Katrina and the Deepwater Horizon oil spill.

30

President Ulysses S. Grant appointed the first Surgeon General, John Woodworth. Woodworth came to Grant’s attention as he rode alongside General Sherman on the March to the Sea. Woodworth took charge of the Ambulance Corps, staffed by soldiers either mentally or physically unfit for battle and so tasked with the care of the sick and injured. Unfortunately, their medical skills were no better than their fighting skills and they were known for finding comfort in the “medicinal liquor”. Most men under their care did not fare well. The fate of the soldiers changed during Woodworth’s leadership, with the ambulance train carrying the infirm, making the 300-mile journey to Savannah with minimal loss of life, a rare feat which brought him to Grant’s attention. After his appointment as Surgeon General, Woodworth focused on the two health scourges of the day – yellow fever and cholera. The Surgeon General has often served in anonymity, but a few have taken controversial stands on major health issues, attracting the attention of both the public and political leaders. While Terry’s report on tobacco caused a major shift in health care policies, the role of Surgeon General was still unknown to most Americans. C. Everett Koop changed that. In the early eighties, a new disease, AIDS, had come to America. Many Americans feared that even casual contact – shaking hands, using the same restroom, sharing food – could transmit the AIDS virus. In 1986, Surgeon General C. Everett Koop, appointed by President Ronald Reagan, authored a controversial report, stressing AIDS education based on scientific principles, rather than on moralistic judgments. Koop also continued Terry’s campaign against smoking, accusing the tobacco industry of marketing to children and of covering up evidence of smoking's link to cancer. His report on smoking was one of the first to cite the dangers of secondhand smoke. Blocked by some political leaders from spreading

POLITICS AND MEDICINE


his message, Koop began traveling the country in his gold-braided, midnight-blue uniform, sounding the alarm about smoking and stressing the need for AIDS education. The current Surgeon General is Vivek Murthy, the first Indian-American to hold that post. Nominated by President Barack Obama, Murthy’s Senate approval was stymied by a 2012 tweet blasting, “Tired of politicians playing politics w/guns, putting lives at risk. Guns are a health care issue.” In response, the NRA launched a full-blown campaign against him. His nomination would probably have never been ratified, except that Ebola crossed America’s borders generating a deep public awareness of the need to have a knowledgeable medical professional giving guidance to the administration. With doctors in white lab-coats filling the Senate gallery to lend their support, Murthy was sanctioned by a vote of 51-43.

The U.S. Surgeon General is expected to be the ultimate conveyer of medical truths, unhampered by partisan politics. C. Everett Koop spoke out about AIDS even as Reagan administration officials asked him not to for fear of offending conservative values. Luther Terry admonished Americans about the dangers of smoking, even as tobacco companies labeled him a hypocrite for having smoked himself. As the 17th Surgeon General Richard Carmona noted, “You don’t want Republican or Democratic scientific information. You want real scientific information.” As the United States struggles with its current health concerns, such as Zika and the Flint water crisis, this admonishment should not go unheeded. America’s top doctor must be left unfettered to advise Americans on health care based on scientific facts - whether they want to hear it or not.

At the state of Georgia’s medical school, our students define us. They are academically excellent and personally altruistic. They consistently rank at or above average on objective measures such as the Medical College Admission Test and United States Medical Licensing Exam. They consistently secure spots in the country’s top residency programs. They volunteer to tutor and mentor local grade-school students. They help build community by providing seasonal fresh fruits and vegetables to our urban neighbors. Students in Augusta recently celebrated the 25th anniversary of their clinic for the underserved. Students in Athens started their own clinic within a year of their arrival. For nearly a half-century now, our students have spent a portion of their summers with high school and college students from underrepresented-in-medicine populations across our vast state, sharing what it really takes to be a doctor and serving as inspirational examples. They’ve even been known to sing a song and dance a step to raise support for children with cancer and their families.

Come change the world with them. The Medical College of Georgia at Augusta University

For more information about the Medical College of Georgia at Augusta University, please visit augusta.edu/mcg.

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31


BOOK REVIEW BY NIKHIL GANGASANI

Title: Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care Author: Dr. H. Gilbert Welch Price: $11.96 Paperback, $12.99 Kindle We’ve all heard the medical success stories where a doctor’s intuition and quick action saved a patient’s life. But can a doctor’s actions actually endanger a patient’s life?

In Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care, Dr. Gilbert Welch, an academic physician and professor at Dartmouth Medical School, addresses common misconceptions about medical care that can lead to excessive costs for healthcare systems, unnecessary anxiety for patients, and the improper use of procedures that harm the people they are supposed to help. With the authority of a nationally recognized expert on the effects of medical tests and the sense of humor of a rural doctor, Dr. Welch challenges patients and doctors alike to use more caution when considering the effectiveness of medical treatments and procedures. While his humor can be a little extra at times, it keeps Less Medicine, More Health a refreshing read. To give you a taste: “…the investigators found the risk for seventy-one other types of hospitalization was ‘significantly raised’ simply by being born under a specific astrological sign. My personal favorite was that Scorpios - named after a predatory arthropod, a nasty bunch for sure - had a 57 percent increased risk of being hospitalized for abscesses of the anal and rectal region. I know this is all beginning to sound like shit. Because it is.” Dr. Welch skillfully and persuasively presents evidence pointing at the overuse of medical care through tasteful anecdotes and helpful analogies. More importantly, he offers advice on how to reverse the trends of too much medical care. For students beginning to dip their toes into the practice of medicine, Less Medicine, More Health provides an enjoyable, yet informative journey into a perspective on the practice of medicine that upcoming physicians must be aware of.

32

POLITICS AND MEDICINE

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n a time where politics, wealth and social hierarchy determine the ability to obtain healthcare, there are leaders and social workers trying to change the policies of the government, state and healthcare providers for the betterment of society. Healthcare for immigrants is a challenge unto itself. Undocumented immigrants are typically uneducated about the U.S. healthcare system and do not have insurance coverage. This leads not only to an increased financial burden from medical care, but also keeps immigrants unaware of programs available and designed for them. A number of universities, city hospitals and local clinics host classes about obtaining healthcare and maintaining a healthy lifestyle. States have the option to extend healthcare benefits to undocumented immigrants through emergency care using Medicaid. Medicaid is a state and federal government program that helps finance health care costs for non-citizens in the

time of medical emergency (Lewis, 2016). Although a portion of Medicaid is available to undocumented citizens in case of emergency cases, it is less than 1 percent, resulting in inadequate funding for care of non-citizens in emergency situations. The Government Accountability Office performed a study that covers data from ten states reporting highest Medicaid costs. The study "reported $2 billion in spending� (Galewitz, 2013). Medicaid does not provide full coverage for even legal eligible immigrants. The Emergency Medical Treatment and Active Labor Act (EMTALA) requires hospital emergency rooms to accept patients regardless of their citizenship or insurance status. The definition and judgment of what an emergency case is and what is not varies among state hospital policies. Although this act makes it possible to get immediate care for non-citizens, immigrants that visit hospitals in emergency situations are still burdened with a hefty hospital bill. Because of

BY SIMRAN RAJPUT

outside of the emergency room and into the community 34

POLITICS AND MEDICINE


this issue, the federal government authorizes Medicaid funding for undocumented immigrants’ emergency treatments. Although the primary intention of Medicaid was to spread healthcare coverage to lower income families, it fails to provide coverage of preventative treatments and primary care which is the most crucial problem. Because undocumented citizens are not allowed to purchase healthcare and are ineligible to receive coverage, many community health clinics and nonprofit organizations try to provide the care that each patient deserves to receive. One of these organizations, Puentes de Salud, focuses on providing latinos in south Philadelphia with healthcare at lower costs. Doctors Larson, Ludimer and O’Brien began the program by serving patients at the University of Pennsylvania Medical Center. The surgeons took matters outside of the emergency room and into communities. The organization rapidly took flight with 5,000 patients seeking care and many more positively impacted by the services in wellness and education programs. Puentes de Salud has one sole vision: to bring care to those who are in need. The organization also has classes for yoga, GED certification, art and support groups for families and patients in the community. Dr. Larson, the founder of Puentes de Salud, said that programs like ‘this are [the] underground health system,” because they treat patient without registering any paperwork and serve in local community built clinics rather than hospitals (Puentes de Salud, 2016). While providing medical needs, Puntes de Salud also works together with other sponsors to create educational programs such as ESL classes, divests management and oral health education. Many similar organizations are providing opportunities for healthcare through community churches and local community gathering. This creates a medium for undocumented citizens to get healthcare without the stress of providing legal paper. Here in Athens,Oasis Catolico Santa Rafaela offers many services for the Pinewood Community. This organization runs a tutoring program for the children of the community and has monthly health awareness programs (Handmaids of

the Sacred Heart of Jesus, 2015). Another medium of receiving healthcare and treatment are hospitals like Mercy in Athens. Mercy provides a medium for receiving healthcare for the low-income uninsured living in Athens. It has served approximately 10,500 patients in its dental clinic. Immigrant communities also depend on their local churches, through which volunteers organize workshops on maintaining a healthy lifestyle and obtaining healthcare regardless of immigration status. Leaders and social workers in these communities and hospitals serve as an oasis for non-citizens to receive healthcare and medicine. Dr. Paul Farmer, an American physician, who worked for providing healthcare to rural and under-resourced areas, followed the philosophy that leaders of today need to comprehend that nothing should be in the way of healthcare for our nation’s largest labor population. Although the only real barrier that should exist between healthcare and immigrants is the ability to diagnose and prescribe treatment, financing healthcare is a huge obstacle. There are, however, many other mediating solutions to obtain healthcare. State-based healthcare programs and employer-based insurance can sometimes offer health benefits. Many universities and colleges require students to have insurance and immigration status is usually not questioned when students apply. Although private health insurance is expensive, it is still a valid option for undocumented citizens (Zamosky, 2014). Community health centers play a critical role in obtaining primary care for many undocumented citizens. There are many community clinics that can provide the initial steps of diagnostic exams and care planning. In a system of healthcare where there is no one single organization held accountable for ensuring that all individuals receive healthcare, hospitals take on much debt in providing uncompensated care. The government is in debate whether to give too much financial aid to states for healthcare or decrease taxes. Thus, insurance providers, hospitals and doctors are all part of the problem and the solution to providing healthcare for the undocumented. The solution lies amongst the connection of these institutions and the policies they build.

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PLANNED PARENTHOOD, ZIKA, AND PRESCRIPTION HEROIN EVERYTHING YOU NEED TO KNOW ABOUT HEALTHCARE AND THE RACE TO THE WHITE HOUSE Suggests to ban abortions except in cases of rape, incest, or danger to the mother. Wants to cut funding to Planned Parenthood because they provide abortions, but supports their preventative care efforts.

ABORTIONS AND WOMEN'S HEALTH Personally opposes abortions, but believes that government should stay out of a woman's decision to have an abortion. Suggests that insurers should not be mandated to provide birth control.

Supports access to safe abortions. Wants all women to have access to preventative care and affordable contraception. Would make abortions legal and force companies to provide employees with birth control coverage, despite religious objections.

Would make abortions legal and force companies to provide employees with birth control coverage, despite religious objections. Wants to reduce Medicare and Medicaid funding by 43% and give the states more control in providing healthcare coverage to the underserved. Would change current policy to allow for Medicare to determine prescription drug rates.

Wants to overturn Obamacare in favor of a singlepayer, Medicare-for-all plan. This would leave one public agency to deal with insurance, but allow for healthcare providers to remain.

Would make some changes to the current plan, including reducing out-of-pocket costs and expanding access. Clinton is also proposing to make the Affordable Care Act a public option, allowing for it to serve as an alternative to traditional insurance. Supports a Medicare-for-All plan. This would eliminate the need for the traditional type of Medicare. Would repeal Obamacare in favor of a less regulated system based on free market principles. Trump suggests that deregulation would allow for consumers, rather than insurance companies, to control the market prices. 36

Opposes healthcare that is controlled by the government. Supports improved transparency and increased competition in the insurance industry to keep prices low.

OBAMACARE

POLITICS AND MEDICINE


Training healers. Coaching leaders. Transforming healthcare.

The residents, faculty and staff of the Athens Regional Medical Center Internal Medicine Program, believe that the very best healthcare is evidenced-based and patient-centered: grounded in science, respectful of the needs and values of each individual, and responsive to the needs of the community. To find out if Athens Regional is right for you, please visit http://gme.athenshealth.org to learn more or call us at 706.475.7869.


“

ON THE

Obamacare. We're going to repeal it, we're

The Supreme Court has issued an opinion

going to replace it, get something great.

on this. Same-sex marriage is an issue that

Repeal it, replace it, get something great!

should have been decided by the states.

Our inner cities have been left totally behind, Public funding of abortion providers is an and I am going to fight to make sure every

insult to people of conscience at the least

citizen in this country has a safe home, a

and an affront to good governance at best.

safe school, and a safe community. It's too bad that some of the young people I am a tremendous believe in education,

that were killed over the weekend didn't

but education has to be at a local level. We

have guns attached to their [hip], frankly,

cannot have the bureaucrats in Washington

where bullets could have flown in the

telling you how to manage your child's

opposite direction.

education. We're going to build the wall, and we're Every veteran will get timely access to top

going to stop it. It's going to end.

quality medical care -- every veteran. 38

POLITICS AND MEDICINE

“


RECORD

“

As we see more consolidation in health care, The Supreme Court's ruling on marriage among both providers and insurers, I'm

equality represents America at its best: just,

worried that the balance of power is moving

fair and moving toward equality.

too far away from the consumers. I have been proud to stand with Planned

Let's break down the barriers that keep

Parenthood for a long time, and, as

people on the sidelines of our economy,

president, I will always have your back.

especially women. I know we are a smart enough nation to We have to make sure education is available

figure out how you can protect responsible

and affordable to everyone. We need to make gun owners' rights and get guns out of the college affordable so that you don't have to

hands of people who shouldn't have them.

borrow...and pay off your [student] debt. Let's take on the challenge of systematic I believe taking care of veterans is part of

racism, invest in communities of color and

our solemn duty as Americans.

finally pass comprehensive immigration reform. www.premedmag.org

39


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