The Examiner: Rutgers Pre-Health Journal Issue 7

3 Physicians on Gun Violence 5 Future Physician Shortages 10 Veterinary Medicine 16 The Organic Food Label

ISSUE 7 II APRIL 2013

STAFF EDITOR– IN—CHIEF

SECRETARY

EDITORS

Shashank Pandya

Vishal Patel

MANAGING EDITORS

TREASURER

Shireen Hamza

Kaiwal Patel

Kristin Baresich Ruchika Bhargav Christina Chang Sailaja Darisipudi Nirali Dave Meghna Dev Nikhitha Kotha Justin Marson Amit Patel Sri Puli Hima Sathian Isaac Song Pujitha Talasila

Suhal Shah

LAYOUT EDITORS Yuli Noah Ivana Ganihong

EVENTS Chirag Bansal

PUBLIC RELATIONS Erum Farooqui

WEBMASTER

Reshma Shiwdin

Harvinder Singh

Anshika Verma

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Letter from the Editor-in-Chief Dear Readers, Welcome to the seventh issue of The Examiner – Rutgers Pre-Health Journal! We are Rutgers University’s premier pre-health media publication that is ran for and by undergraduate students with the mission of informing fellow pre-health students regarding the current happenings in the healthcare field. The Examiner has come a long way since we revived this organization in the Fall 2011 semester. We are continually striving to improve the quality of our journal and our organization by not only diversifying the range of topics that are presented in every issue in addition to having an engaging layout but also by organizing informative events. As always, this issue exemplifies The Examiner’s identity as a multidisciplinary journal that bridges the current gap between the variety of pre-health sciences and the humanities by presenting diverse issues relating to healthcare policies, geopolitical issues, complex societal issues, health economics, medical school admissions, fun columns, etc. It is our hope that we can demonstrate how these seemingly unrelated topics might affect the future of our fellow pre-health students in the healthcare field. I would like to thank and congratulate our executive board members, journalists, editors, RUSA allocations, and faculty as well as administrative advisors for contributing to this issue and ultimately to serve the needs of the Rutgers pre-health community. The entire Examiner executive board, journalists, and editors all hope that you, the readers, will enjoy reading this latest issue of The Examiner, and we would sincerely appreciate your feedback on our Facebook page, Twitter, or at ruexaminer@gmail.com. For more information on how to get involved with us as a journalist, editor, or an executive board member, please contact ruexaminer@gmail.com. Thanks and regards,

Shashank Pandya Editor-in-Chief The Examiner – Rutgers Pre-Health Journal

Gun Violence: A Public Health Crisis SAIMA USMANI After the tragedy in Newtown, Connecticut, gun regulation has become one of America’s most pertinent domestic issues. In regards to gun-related reform, American physicians are an often overlooked group beyond the political parties and the National Rifle Association (NRA). Nonetheless, doctors have made their voice clearly heard. Doctors for America, a national organization of physicians and medical students, declares that “with 87 people dying and over 180 being injured every day due to gunshot wounds, it's clear [that] gun violence is a public health crisis. As health care providers, we work to protect our patients from deadly diseases like heart disease-- it's time to do the same for gun violence.”1 A press release responding to the State of the Union address from the AMA (American Medical Association) states, “The AMA agrees with President Obama that we must all work together to end senseless acts of gun violence in our nation...”2 There have also been movements to separate the physician’s role in gun safety. A federal appeals lawsuit is currently filed against a Florida law, the Privacy of Firearm Owners bill, prohibiting doctors from asking their patients about gun ownership.3 The law allows the Florida Board of Medicine to prosecute a physician if their patient feels harassed by gun ownership questions.4 Supporters of the law, including the NRA, claim that this prevents physicians from discriminating against a patient for owning a gun.4 In response to the law, the Florida chapters of the American Academy of Family Physicians (AAFP) and the American College of Physicians (ACP) sued the state of Florida as putting regulations on the right of free speech. 4 A statistical study on behalf of the AAFP claims that “it is the pediatrician's duty to raise awareness of all health risks and guide caretakers to prevent and mitigate these risks. Screening for child and adolescent access to firearms is an essential component of injury prevention.” 3 Doctors for America released a petition signed by over 3000 physicians declaring gun violence as a health crisis and stating their opinions on the issue.5 Julia Frank, MD, a signer of the petition, said that “I am a mental health professional, and gun control is an essential part of making society safer for both the patients I treat and for the public at large. Without it, mental health reform is likely to backfire, to the detriment of all.”5 American doctors appear to be on similar grounds on gun violence prevention that beyond the topic of psychiatric facilities for possible shooters, gun violence is an epidemic that threatens the health of all Americans. References: 1 (2013) Gun Violence Prevention. Doctors for America. Retrieved from http:/ www.drsforamerica.org/take-action/gun-violence-prevention 2 Lazarus, Jeremy A, MD. (2013, Feb 13). AMA Statement on President’s State of the Union Address. AMA Press Releases and Statements. Retrieved from http:// www.ama-assn.org/ama/pub/news/news/2013-02-13-statement-on-state-ofthe-union-address.page 3 Judy Schaechter, MD, MBA; Lisa A. Cosgrove, MD; Mobeen H. Rathore, MD. Protecting the Patient-Physician Relationship in Florida. (2012). Archives of Pediatrics and Adolescent Medicine. Retrieved from http:// archpedi.jamanetwork.com/article.aspx?articleid=1487135 4 Lowes, Robert. (Dec 21, 2012). Shooting Underlines Need to Ask About Guns, Doctors Say. Medscape. Retrieved from http://www.medscape.com/ viewarticle/776556. 5 Frank, Julia, MD. (2013). DFR Gun Petition To: President Obama and Members of Congress. Doctors for America. Retrieved from http://bit.ly/HCGunPetition

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ROHMA KHAN

Cultural Competency: A Clash or Compromise?

Demographic changes in the United States have always been of considerable interest to politicians, historians, sociologists, the media, and the general public. Though often overlooked, health professionals are among those that have been chiefly impacted by the growing diversity of the country’s population. As our already heterogeneous population continues to ethnically expand, the issue of cultural competency strongly rises to the surface. Cultural competency is defined as the ability of medical systems to provide care to patients with diverse values, beliefs, and behaviors. 1 This includes customizing procedures in order to comply with a patient’s social, cultural, and linguistic needs.2 Contemporary studies, such as those conducted by the Commonwealth Fund, have deduced that blacks, Hispanics, Native Americans, and Asians receive significantly lower quality healthcare than whites—and that such disparities persist despite taking into account health insurance status, age, sex, income, and education.1 Minority groups have thus reported dissatisfaction with their healthcare providers presently in the United States. 1 As one can predict, there are quite a few barriers that can hinder the execution of culturally competent care. Perhaps there may be a lack of diversity in the medical workforce, which restricts societal awareness. Poor communication can create apparent disparities between providers and patients of different racial or ethnic backgrounds. 2 Also, the health system itself may be poorly equipped to meet the needs of diverse populations. Perhaps these issues can be remedied by hiring and promoting minority groups in the healthcare workforce. Cultural competency can also be achieved by developing medical information for patients written at a suitable literacy level as well as catering to the language and norms of certain populations. 1 It can become easier for healthcare providers to encourage their patients to follow medical advice when they acknowledge the impact of social and cultural factors on the issues of health and behavior. The future state of cultural competency seems to be of even greater concern: it is estimated that by the year 2050, racial and ethnic minorities will comprise nearly half of the entire population of America.2 This is an especially alarming problem, as racial and ethnic minorities are disproportionately plagued with chronic illness.2 These illnesses include, but are not limited to, asthma, heart disease, and diabetes which are also among the most costly medical conditions in the country.2 Therefore, as the population becomes more culturally diverse in the future, it can be inferred that the number of people suffering from chronic diseases will also directly increase. However, if cultural competency improves by this point, then the future population will be better equipped to overcome their respective health issues. Now the question arises: as the general public, what can we do in order to ensure cultural competency in the aspects of the medical field? Biases harbored by healthcare providers are prevalent obstacles that are crucial in shaping the outcomes of a patient’s satisfaction. A central complaint of minority groups is that there are underlying biases held against people of different cultural backgrounds.1 Several organizations are confident that if we recognize and seek to eradicate these tendencies, a more stabilized sense of trust and communication may develop between the patient and the healthcare provider. 1 Yet, we must also consider the point at which we can reach an equilibrium in terms of standardizing healthcare for a truly diverse population. Some existing studies suggest that there is only a slightly positive connection between cultural competency training and patient outcomes. 3 We might then wonder: is cultural competency actually an achievable prospect or merely a hopeful ideology? References: 1 Betancourt, Joseph R. (2013, February 12). Cultural Competence in Health Care: Emerging Frameworks and Practical Problems. The Commonwealth Fund. Retrieved from http://www.commonwealthfund.org/usr_doc/ betancourt_culturalcompetence_576.pdf 2 Georgetown University. (2013, February 12). Center on Aging Society. Retrieved from http://ihcrp.georgetown.edu/ agingsociety/pubhtml/cultural/cultural.html 3 Lie, Desiree A. (2013, February 12). Does Cultural Competency of Health Professions Improve Patient Outcomes? Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3043186/ Image: http://www.criticalmeasures.net/images/photos/stethoscope.jpg

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Doctor Deficit FIONA KIM

With the coming of 2013, we have survived the apocalypse predicted by the Mayans themselves. But there is a new apocalypse looming on the horizon, specifically in the world of healthcare. A shortage of physicians has long been predicted. However, the AAMC has recently published their findings on the shortage problem through a projection that will cover the next decade (see Fig. 1)4. By the time we reach the 2020’s, the U.S. will have an estimated shortage of 90,000 physicians – especially those who specialize in emergency health care, endocrinology, neurology, and oncology, with a particular emphasis on those in general primary care 4, 5. What is the cause of this exponential rise in the need for doctors? The boomer generation, born between the mid1940s and 1950s, take up the majority of the current American population. As this part of our population ages, they will require more healthcare than the rest of Americans4. As the number of elderly population rises, their average life-span rises as well. Other contributing factors to the deficit of doctors would include the fact that one-third of our current doctors will retire in the next decade4. However, the most significant factors emerge from the new health care plan, which is also known as Obamacare. Prospective doctors such as doctors in residency tend to train in sub-specialties such as dermatology or psychiatry - fields without a current shortage of doctors. Only one-fifth of prospective doctors go into needed fields such as primary care1. And why would they want to? Primary care physicians work just as much or sometimes more hours than other specialty doctors, but they have a lower pay. They also have unique insurance responsibilities which deduct from their practice6. Obamacare specifically benefits those who cannot afford healthcare, but this may backfire since it comes at the same time as the doctor shortage. By adding 15 million elderly people and 32 million juveniles to the health care system2, Obamacare turns this scarcity into a crisis.

The Luck of the Cow Today, smallpox is an easily preventable disease due to the availability of a vaccine. In the late 18th century, there was no easy fix for this deadly disease, and millions of people who contracted smallpox died in miserable conditions. However, Dr. Edward Jenner, an English scientist and surgeon, revolutionized the field of immunology. It is said that a young milkmaid, who used to chat with Jenner, told him about rare cases of citizens who had been infected with the cowpox disease but never developed smallpox. Cowpox is a nearly harmless disease, acquired through contact with cows. Jenner, at first mystified, arrived at one of the most insightful epiphanies in medical history through what the milkmaid had told him.

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There are some advocates of Obamacare who argue that the shortage is not as severe as it seems. They argue that an expansion of medical residencies and practices or use of alternative care providers would solve the deficit. However, both of these solutions have holes. Patients prefer that their doctors are the best out of the best. If residencies or practices were to expand and allow more prospective doctors, they would not be as selective. Without their reputation for selectivity, those practices would not be able to maintain the standard that they have developed. The possibility of alternative care providers such as nurses or physician assistants being given more responsibilities would also lead to lesser visits to primary care doctors1. The problems with our healthcare system and the shortage of doctors are akin to the problems with our economy; both are riddles which are escalating, often on the verge of collapse. There could be a healthcare apocalypse of 2020, but you did not hear it from the Mayans, you heard it here from the Examiner.

VISHAL PATEL then administered another injection. However, this time, the injection contained the smallpox virus. Luckily, for the eager British physician and all of mankind, James did not develop smallpox. Centuries later, Edward Jenner was credited for saving more lives than any other single man. Reference: Krock, L. (2001). Accidental Discoveries. Nova beta. Retrieved from http:// www.pbs.org/wgbh/nova/body/accidental-discoveries.html

He proceeded to conduct an experiment in which he took pus samples from cowpox sores on the body of a dairymaid named Sarah Nelmes and used them to vaccinate an eight-year-old boy named James Phipps. James became slightly febrile and developed some lesions, but none of his symptoms were life threatening. Jenner waited another three months and http://www.russianmachineneverbreaks.com/wp-content/uploads/sad-cow.jpg

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CANCER VS. THE BLIND MOLE RAT: MOLE RATS CLAIM VICTORY! Jasmair S. Jaswal

Cancer might be one of the major leading causes of death for humans worldwide, but it is no challenge for the Blind Mole Rat. These subterranean creatures are one of the few rodents on this planet that can live up to 21 years of age, which is nearly seven times longer than the lifespan of any other rodents.1 However, it is not their age that interests scientists, but it is their unique ability to fight off cancer. This incredible feat, as Eviatar Nevo from the University of Haifa in Israel explains, is linked to the adverse lifestyle these rodents have adapted to over time.3 Blind mole rats tend to live in a terrain where they are subjected to "terrific stresses underground: darkness, scarcity of food, immense numbers of pathogens, and low oxygen levels. They have evolved a range of mechanisms to cope with these difficulties.” 3 For instance, one such mechanism involves being impervious to cancerous tissue growth. The naked mole rat (cousin of the blind mole rat) utilizes apoptosis (programmed/ planned cell death) to kill off and prevent mass proliferation of the cancerous cells lurking around.2 However, the blind mole rat, equipped with better defense mechanisms, relies on a different aspect of its genetic makeup to fend off any unwanted mutations. More specifically, these creatures have evolved ways to utilize interferon-beta (IFN-β), a chemical typically employed by the body for battling viruses, to destroy tumor cells.2 Various studies have also been conducted by researchers which indicate that this poisonous chemical may be the reason behind why blind mole rats have become the super-rodents of the rodent world. Vera Gorbunova and her team of researchers from the University of Rochester have examined several blind mole rats within small areas of Israel.1 To their understanding, IFN-β acts as a biological stop button that halts the growth of tumor cells through a mechanism of self-destruction after malignant cells have grown to a certain threshold.1 This certain threshold consists of a maximum of 20 aberrant cellular multiplications. 1 Beyond this point, IFN-β has been programmed to accumulate within the diseased cells in excessive amounts to cause "massive necrotic cell death within three days," wiping out any cancerous cells dwelling within the body.1 However, biologists have not

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yet been able to keep those cell cultures live for long enough to study this mechanism in detail.1 Further research is needed before any of this data can be utilized for a purpose that may serve to benefit mankind - perhaps bringing humanity one step closer in providing better treatment for people suffering from cancer. Today, cancer continues to mark its position as one of the world's deadliest illnesses. In 2008, it claimed nearly 7.6 million lives worldwide while over 12 million people were diagnosed positive for this fatal malady.4 More than $100 billion is spent on cancer research annually within the U.S. alone, and it is projected that cancer will surpass heart disease as one of the leading causes of death within the next 5 years.4 Cancer treatment is very expensive and can take years of surgeries and countless medications to treat. With the millions of distinct species living in this world, the blind mole rat is but one unique animal that has the potential to give mankind different perspectives in perhaps one day treating cancer. With the new and unraveled data that has been uncovered about this unique species, scientists are hopeful that these blind mole rats might be able to provide new insights into developing additional treatments, enhanced technology, and better therapies. References: 1 Steadman, I. (2012, 6). Wired. Why Blind Mole Rats Don’t Get Cancer. Retrieved from http://www.wired.com/wiredscience/2012/11/blind -mole-rat-cancer/ 2 Cormier, Z. (2012, 5). Nature. Blind mole rats may hold key to cancer. Retrieved from http://www.nature.com/news/blind-mole-rats-mayhold-key-to-cancer-1.11741 3 Tina H. S. (2012, 12). Mole rat is a natural cancer fighter. Retrieved from http://140.234.1.9:8080/ EPSessionID=ebd6cf90b6d7d45e5ff6ff7ce5292b/ EPHost=web.ebscohost.com/EPPath/ehost/detail?sid=0a2205a34b5f-4ec4-b94f-1eb032300a80% 40sessionmgr15&vid=1&hid=19&bdata=JnNpdGU9ZWhvc3QtbG l2ZQ%3d%3d#db=ofm&AN=84401273 4 (2013). World Health Organization. Cancer. Retrieved from http:// www.who.int/mediacentre/factsheets/fs297/en/index.html Image: http://wrscomsg.files.wordpress.com/2012/03/pic-1.jpg

Surgeons vs. Medical Doctors: The Great Divide NEHA KAYASTHA Many people believe certain contrasting stereotypes about surgeons and physicians who practice internal medicine. Surgeons are considered to be the jocks, the “doers” of medicine while physicians are the “thinkers.” While these preconceived notions might seem innocuous, they are actually signs of a very serious divide among healthcare providers. Anesthesiologist Karen Sibert is in the unique position of interacting with both surgeons and internists on a daily basis and realized that the chasm between surgery and medicine has worsened to the point that “one hand clearly has no idea what the other [hand] is doing.”1 Surgeons, she claims, “believe internists perseverate too much when decisions need to be made. Internists consider themselves the true intellectuals of medicine.” 1 She analogized the rift between internists and surgeons to two people living in two different countries, speaking different languages and worshipping different gods. The problem, as she sees it, is that surgical residents learn little about internal medicine while internal medicine residents are often not exposed to the surgical procedures underwent by their patients. Dr. Matthew Szvetecz referred to this phenomenon as a “bipolar” cultural divide. 2 If doctors themselves recognize this disconnection, what does it mean for patients? How can two different types of doctors treating the same patient give the best possible care if they do not communicate effectively? The answer is chillingly simple: they don’t. A patient of medical oncologist Dr. Ranjana Srivastava was scheduled for surgery. When Dr. Srivastava checked up on the patient, his gut instinct immediately told him that his patient should not be operated on; he simply looked too sick to be able to withstand an operation. However, he did not raise his concerns with the surgeon because he thought, “Who [am I] to question a

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surgeon?” In his article, Dr. Srivastava noted that it is common for internal medicine doctors to “defer to surgeons— considering them unequivocally right, unassailable, or simply not worth antagonizing.”3 Ultimately, Dr. Srivastava’s instinct was right, and the patient lost his life as a result of the operation. When Dr. Srivastava and the surgeon later discussed the plight of the patient, they revealed that they had both held reservations about the patient’s ability to withstand surgery but had deferred to the other doctor. Despite the vast number of specialists the patient saw during his care, “he died lacking holistic care.” 3 No single specialization or “expertise can always count for more.”3 The only thing that matters is providing the best possible patient care, and this can only be accomplished with open, honest lines of communication between doctors. Dr. Srivastava now has a working relationship with surgeons to talk frankly about their common patients, even when it means voicing concerns with another doctors’ treatment plan. Doctors must communicate across specialization boundaries. It can –and will– save lives. References: 1 Karen Sibert. (2012, March 5). Bridging the disconnect between medicine and surgery. Retrieved from http:// members.csahq.org/blog/2012/03/05/bridging-disconnectbetween-medicine-and-surgery. 2 Yasmine Iqbal. (2007, June). How “rules of engagement” can help bridge the divide between surgery and medicine. Retrieved from http://www.todayshospitalist.com/index.php? b=articles_read&cnt=145. 3 Ranjana Srivastava. (2013, January 14). Speaking Up—When Doctors Navigate Medical Hierarchy. Retrieved from http:// www.nejm.org/doi/full/10.1056/NEJMp1212410.

Antidepressants Are Being Overprescribed TVISSHA GOEL “Let food be your medicine” said Aristotle. Yet, according to the American Kaiser Family Foundation, the number of prescriptions filled annually jumped by 39% between 1999 and 2009. 3 The average American relies on twelve prescriptions in a year. Researchers have recently found that many physicians prescribe medications without considering alternative treatments. Over-prescription is a major problem with antipsychotic medications. Carolyn Ross, an integrative medicine physician, states that “11.3 million dollars a year are spent on antidepressants” and that “Americans consume more antidepressants than any other nation.”5 Are Americans needlessly being prescribed antidepressants? According to Melissa Healy, a writer for the LA Times, “In the 12 year period leading up to 2007, almost 1 in 10 visits to primary care physicians resulted in the patient coming away with a prescription for an antidepressant… but only in 44% of such

cases did the doctor make a formal diagnosis of major depression or anxiety disorder.” 2 It is suggested that the commercialization of and advertisements for antidepressants encourage patients to request these drugs.1 Victor Reus, a psychiatry professor at the University of California San Francisco, believes that “doctors who get reimbursed at a lower rate for psychiatric conditions may use a different illness code in their records.” 1 Needless antidepressants may also have serious, longterm health consequences like withdrawal symptoms. Moreover, side-effects range from metabolic defects and weight gain to motor deficits.4 Patients and physicians should consider these negative impacts when choosing antidepressants and should lean towards caution. There is so much we have yet to learn about the plethora of antidepressants that our country is guzzling down.

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ASK SUHAL FLU OUTBREAK Are there any skills or subjects outside of medicine that can be useful to learn for a career in the health professions? ~ Anto P.

SONIA LEE

This year, the dreaded flu season hit with a vengeance. Not only did it come earlier than anticipated, it was unexpectedly severe. In early January, a CDC official declared this flu season to be "moderate to severe," which is the worst seen within the past ten years.1 In the spirit of prevention, public Practically any skill that you learn can be applied to the health workers and health professionals advocated the flu medical field. One of the most common and probably the vaccine. “As New Yorkers, we work close together, we ride most relevant answer would be to learn a second language. together in the subways, we eat in restaurants and cafeterias The United States is home to people from all walks of life, together, and given such a large and dense population, we can and not every person speaks English. As pointed out from easily spread the influenza virus to one another,” commented this issue’s article about doctor-patient relationships, Dr. Feltheimer in New York. “You can't hide. It's not too late communication is important for physicians to provide the to get a flu shot."1 Political officials threw their support behind best treatment for their patients. Hence, any health the message to get vaccinated by setting examples for the professional, not just doctors, would find it quite beneficial public. For instance, Mayor Bloomberg and Governor Cuomo to learn a second language in order to be able to of New York received their vaccinations in public in January. 2 communicate with their patients. I would even go on to say As a state-wide emergency was declared in New York and that the more you know, the better you can connect with other states, pharmacies found themselves deluged with your patients. So if given the chance to take any courses in customers seeking the flu shot and thus quickly ran out it. humanities (language, culture, religion, history, philosophy, Although some people scoffed at the flu vaccine's 62% arts, etc.), I would recommend taking them. As mentioned effectiveness rate, this number was actually a little higher than in another article from this issue about cultural competency, in previous years.3 In January 2012, for instance, a study understanding a patient’s culture and background is useful published in The Lancet reported that the flu vaccine from that in finding the best treatment plan, communicating, and year was only 59% effective.4 Health professionals therefore connecting with him/her. The more open-minded you are stuck to their main message: get vaccinated. As one CDC about the world around you, the better you can treat and official phrased it, getting the flu vaccine "reduces by 62% relate to each unique patient that walks through your door. your chance of getting a flu so bad that you have to go to a doctor or hospital."5 How do you answer the most frequently asked interview How can people tell whether they are suffering from the flu question: "why do you want to be a doctor/nurse/PA/ or the cold? The two can be difficult to distinguish, but the flu's dentist/optometrist"? symptoms are generally more severe and can manifest all of a ~ Anshika V. sudden. Those with the cold are more likely to have a runny or stuffy nose, while those with the flu tend to suffer from fever, This question can pop up at any interview in any shape or body aches, fatigue, and a dry cough.6 For people who have a form as a straight forward question or a much elongated, fear of needles, a vaccine in the form of a nasal spray is complex question. Whatever form it may be in, the one available. However, this is not recommended for everyone, as answer you DO NOT want to give is “I want to help it contains a live (albeit weakened) form of the flu virus. 7 For people.” This is the obvious answer because it is already anybody not within the ages of 2 through 49, the CDC expected that you want to care for people. Hence, the day recommends the regular flu shot (which contains a dead form you realize you are interested in pursuing a career in the of the virus).7 medical field is the day you should start asking yourself that Fortunately, despite the initial alarm, the flu epidemic was question every day from that point on. In fact, assign eased. Although New Jersey was among three states that someone to randomly ask you this every now and then reported high flu activity during the week of February 10thbecause this will help you practice responding and refining 16th, other states experienced a decrease.8 On February 28th, your answer. There is no one way to answer this question, the Wall Street Journal reported the decision of a FDA but the answer usually contains some experience or advisory panel to add another strain of influenza protection to inspiration that has led you to pursue this path. This can next year's batch of vaccines.9 The proposed suggestion was to include but is not limited to a shadowing or volunteering include two A strain flu viruses and at experience, a personal illness, or an least one B strain virus, ensuring that the inspiring healthcare professional. B strain flu virus closely matches the B Whatever your reason is for If you have a question that you would strain that appeared this year.9 pursuing a career in healthcare, like answered, please email me at GlaxoSmithKline and AstraZeneca plan make sure you practice answering ruexaminer.managing@gmail.com. As to offer quadrivalent (four-strain) flu this question. Rutgers University per your request, you can have your vaccines for the 2013-2014 season, while Career Services offers mock name featured in the next issue or Sanofi is awaiting FDA approval for their interviews to help you prepare for remain anonymous. own version of a quadrivalent vaccine.9 such frequently asked questions. While the vaccine is obviously not Visit careerservices.rutgers.edu for perfect, the FDA asserts that it is still the more information on how to build best preventative tactic against the flu.9 your interviewing skills.

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EMILIE TRANSUE

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An Essential of the Modern Healthcare Pedagogy: Health Informatics EMILY TRANSUE What is Health Informatics? Have you heard of electronic health records—EHR’s ? Would you use a mobile application to remind yourself of an upcoming appointment? Would you like a computer system to check a prescribed medicine against a list of your allergies and other medications? If so, turn your attention to the rapidly growing field of health informatics. The National Institute of Health defines Health Informatics as “the interdisciplinary study of the design, development, adoption, and application of IT-based innovations in healthcare services delivery, management, and planning.”1 Health informatics is the intersection of healthcare and technology which strives to find the most efficient and accessible ways to promote better health.2 The field began back in the 1950’s with the advent of computer codes and modern technology.3 Today, medical practices are digitalizing their patients’ records for easier access, and many more ideas are rapidly developing and crystallizing into reality. For example, Health Information Exchanges (HIE) is a new and exciting construct in which all your medically related organizations (insurance companies, family doctors, pharmacists, specialists) can simultaneously review all of your relevant clinical information. In addition, you can make your own Personal Health Record (PHR) to help share information with your doctor. For example, you can list your allergies, dietary patterns, and exercise habits while maintaining control over what you want to share.4 These strategies are not only innovative and relevant, but they are practical, proactive, and appropriately progressive. Can you imagine how many more individuals would take their prescribed medicines if a system called them with weekly reminders? Health informatics can also play a crucial role in collecting data and adding to the realm of evidence-based medicine. Have you ever heard of Google Flu? 5 This ongoing

project uses Google searches to estimate locations and levels of flu activity.6 The program has been relatively successful with its estimates, which have approximated closely with those of the Center for Disease Control6. This not only paves way for using internet data to track disease outbreaks, but it can be used to predict them as well.6 Likewise, anonymous electronic medical data can lead to further insights about treatment success and disease control. However, concerns certainly arise surrounding patient privacy and the indestructible electronic footprint. Health informatics can pioneer a whole new way of data collection across the globe, but it requires many more years of scholar-practitioner minded, practical research to provide safe and secure models for the public. Many universities across the United States are now offering Master’s or certificate programs in health informatics for those interested in a career in this groundbreaking facet of collective health and wellness. As you Google this, imagine a future where you can use the internet to book your next doctor’s appointment and look up the best flu-free vacation spots. References: 1 Health Services Research Information Central. (2013). Health Informatics. Retrieved from http://www.nlm.nih.gov/hsrinfo/informatics.html 2 University of Michigan. (2013). What is Health Informatics? Retrieved from http://healthinformatics.umich.edu/about 3 University of Illinois at Chicago. (2011). The History of Health Informatics. Retrieved from http://healthinformaticsdegree.uic.edu/ history-of-health-informatics/ 4 Health IT. Important Health IT Terminology. Retrieved from http:// www.healthit.gov/patients-families/health-it-terms 5 Google. (2013). Explore flu trends- United States. Retrieved from http:// www.google.org/flutrends/intl/en_us/us/#US 6 Oremus, Will. (2013). Going Viral. Slate. Retrieved from http:// www.slate.com/articles/technology/technology/2013/01/ flu_shot_time_google_flu_trends_predicts_worst_season_on_recor d.html

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Hospital Chains vs. Private Practice – The Pros and Cons Health care costs are undeniably growing while customer satisfaction with the quality of treatment is decreasing. Dr. Atul Gawande, a surgeon at Brigham and Women's Hospital in Boston, recently wrote an article in the New Yorker calling for quality control measures in order to increase patient satsifaction.1 For example, he proposed standardizing certain treatments and therapies based on evidence from large scale studies.1 He also pointed out that there is a rising trend of venture capital groups buying up failing public or religious hospitals in order to create multiple hospitals under one conglomerate.1 The question, what delivers better care (hospital chains or private practices) and to what degree of standardization of care as well as treatment practices are necessary, has sparked a big debate within the healthcare community. Hospital chains have some undeniable benefits; the economies of scale (microeconomics principle – cost advantages related to increased size) created by large chains can offset the growing cost of healthcare to some extent. It allows for the creation of a framework for implementing standardized treatment and recovery protocols that are ideally based on largesample studies of what is effective. Proponents of this practice, such as Dr. Gawande argue that this approach eliminates the individual eccentricities of physicians that can detract from patient recovery.1 For example, an “old-fashioned” doctor might not know about or like a new technology, which may possibly cause a patient to suffer if that same doctor has the last say in the treatment and recovery plan.1 Dr. Gawande cited the example of Dr. John Wright, a surgeon at Brigham and Women's Hospital who created a default way of performing knee replacements at the hospital using studies and experiences of the doctors at the hospital itself (ranging from anesthesiologists to orthopedic surgeons).1 Dr. Gawande points out that this was no easy task since each surgeon specializing in knee replacement surgery had their own particular favorite brand of knee replacement.1

Love Thy Pets? There's no doubt that animals are a big part of our lives! From man’s best friend, dogs, to the cattle and poultry that provide our dairy and meat, we depend on animals for a variety of reasons. However, animals can get just as sick as humans, so managing their health is essential. Although they have chosen to practice on animals, veterinarians are highlytrained professionals that know just as much about curing illnesses and diseases in animals as your family physician does for humans. In fact, a veterinarian is responsible for a wide range of duties including examining animals, diagnosing their health problems, treating illnesses/injuries, testing for and vaccinating against diseases, prescribing medicine, and performing surgeries and dental procedures. In recent years, veterinary medicine has advanced considerably, and many of the veterinary services offered today are comparable to health care for humans – including cancer treatments and kidney transplants.3 If you are an animal lover who enjoys the science

THE EXAMINER II Page 10

KUNAL BAILOOR Perhaps more significant than eliminating individual eccentricities is the evidence-based treatment decisions that can reduce the influence of the “big pharma” lobbying doctors with gifts and perks. In a report conducted by the National Public Radio, the publication of a (voluntary) Code on Interaction with Healthcare Professionals in July 2002 by the pharmaceutical industry's trade group was found to be widely disregarded. 2 The influence of sales representatives on doctors continues in the form of speaking opportunities at major conferences. 2 Alex Webb, a former pharmaceutical sales representative, was quoted saying that a doctor was paid $1,500 to speak at a conference, which led to him/her writing an additional $100,000 to $200,000 in prescriptions.2 While standardizing practices, the argument goes, would not eliminate such behavior, it would reduce it. Physicians’ prescriptions would be based as much on large scale drug studies rather than personal preference, and a physician working for a hospital chain would have to provide good reasoning for any deviations from the accepted drug of choice. 2 Proponents of the private practice model argue that personalization in medicine is necessary and that standardization, creating required treatments or best-practices guides, ignores the personalized knowledge of the primary care physician.4 They argue that a primary care physician, well acquainted--at least in theory--with the biological quirks of a patient, is better suited in this line of thinking than a statistical model.4 After all, even well documented diseases manifest themselves differently in different patients, and patients have individual needs for recovery and recuperation. Those on neither spectrum of the polarizing issue argue for a middle ground: create a best-practices guide based on solid studies but allow room for personalization based on a physician’s personal experience and knowledge of the patient. 3 Whatever you believe, it is certainly a time for a great change in the healthcare industry.

DHAGASH MEHTA of medicine, a career in veterinary medicine may be a perfect fit for you! And once you learn about the myriad of career opportunities available in this field, you may find it even more alluring. Veterinary medicine is typically divided into “small” and “large” animal care. While 75% of veterinarians working with small animals such as dogs and cats, many veterinarians care for larger animals like horses and pigs. 1 Large animal care veterinarians often work on farms, laboratories, or zoos/ aquariums to ensure that animals in these settings are provided with proper food, nutrition, and healthy environments. 1 Veterinarians not only take care of animal health, they are also responsible for our own health. How so? Since a lot of our food comes from animals, veterinarians in state and federal agencies perform the vital task of ensuring that our food supply (dairy products, eggs, meat, and seafood) is disease-free.1 In addition, these veterinarians are also responsible for inspecting

barns, farms, living quarters, and food products to control livestock diseases and prevent those diseases from affecting the public.1 In case of an epidemic, these professionals can also serve as epidemiologists, responsible for investigating outbreaks of diseases or working on immunization and quarantine programs.1 Those veterinarians unwilling to work in a clinical setting can work in education or perform research. In fact, a number of veterinarians are employed in private industries such as pharmaceutical companies and biomedical research firms where they research disease transmission from animals to humans or develop and test new drugs and prosthetic equipment for humans.1 Lastly, those veterinarians who wish to get involved with their community can choose to work in animal shelters, humane societies, and animal protection organizations. They can also work to maintain the health of heroic animals like police dogs that help fight crime! According to the BLS, the median salary of veterinarians is $82,040 per year, with specialists typically earning more.3 Veterinarians' workweek can often exceed 50 hours.3 Job outlook for veterinarians is very strong (36% growth from 2010-2020), mostly due to the increasing need to inspect food supply and ensure health of an expanding human and animal population.3 A career in veterinary medicine can be extremely rewarding; however, the path to becoming a veterinarian is quite challenging. To apply to veterinary schools, a college student must first meet all the pre-veterinary requirements, which include classes in biology, chemistry, physics, and English. Many schools may also require/recommend additional coursework in science, math, or humanities.1 Although not required, most applicants to veterinary schools hold a bachelor's degree. In addition, students are required to take the Graduate Record Examinations (GRE). They are also encouraged to volunteer at veterinary offices, animal hospitals, farms, or at organizations like SPCA and FFA. High GPA and stellar

standardized exam (GRE) scores are a must. There are only twenty-eight accredited veterinary schools in the U.S., and each year, nearly 6,000 applicants compete for approximately 2,400 slots. Evidently, admission to a veterinary school is extremely competitive!2 Once in a veterinary school, students take courses in animal Anatomy and Physiology, as well as disease prevention, diagnosis, and treatment. Most programs include 3 years of classroom, laboratory, and clinical work. Students typically spend the final year of the 4-year program doing clinical rotations in a veterinary medical center or hospital. Students who graduate with DVM or VDM degrees must pass standardized national exams as well as state exams before obtaining their license to practice veterinary medicine. For positions in research and teaching, a master's or Ph.D. degree may be required. Those who seek to specialize in fields such as dentistry, anesthesiology, dermatology, radiology, or surgery must also complete two to five year residency programs and pass an examination.1 Interested in animal healthcare but don't want to go through the rigorous path of becoming a veterinarian? You do not have to be a veterinarian to help improve animal health. Clinics and other places that employ veterinarians also hire other types of workers such as veterinary technologists (analogous to “nurses�), veterinary assistants, animal caretakers, animal behaviorists, pharmacologists, business managers, clerical workers, research biologists, and acupuncturists. 1 Possibilities in veterinary medicine are endless; explore the field, and see what suits you the best! References: 1 Careers in veterinary medicine. (n.d.). Retrieved from http:// humanesocietyuniversity.org/careers/about/industries/ vet_medicine.aspx 2 Steps to Becoming a Veterinarian. (n.d.). Retrieved from http://vbs.psu.edu/ majors/vbs/steps-to-becoming-a-veterinarian 3 Veterinarian. (2012, 04 26). Retrieved from http://www.bls.gov/ooh/ healthcare/veterinarians.htm

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Putting a Dentin the Controversy: The Effectiveness and Ethics of Water Fluoridation

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Joe Dzierzawiec There is something in the water! For more than 200 million Americans, that something is a form of the chemical Fluorine (fluoride), the common dental agent used in toothpaste and mouthwash to prevent cavities and reduce tooth decay. 1 Since the 1950s, compounds containing fluoride have been added in carefully controlled amounts to community water supplies as a public health effort to prevent dental caries (or cavities).2 As of 2010, almost 67% of the American population receives fluoride in their drinking water.1 There has been a significant reduction of tooth decay in the average American since water fluoridation was implemented.2 Thus, the U.S. Centers for Disease Control and Prevention have lauded the policy as one of the “top ten great public health achievements of the twentieth century.”2 However, like most widespread public policies, the practice of water fluoridation is not without controversy; the two most hotly contested topics are the effectiveness and the ethics of this public health policy. It is hard to argue that water fluoridation does not have a positive effect on dental hygiene as the link between fluoride and reduced tooth decay has been recognized and tested for more than 100 years.3 In fact, some opponents contest that general dental health has progressed so far in modern times that widespread water fluoridation is an unnecessary and wasteful measure.4 However, research has shown that free public access to fluoridated water is invaluable in disadvantaged and underdeveloped areas, where relatively expensive products like powerful toothpastes are not readily available.2 A more pressing concern with the effectiveness of public water fluoridation is the presence of a condition called dental fluorosis in young children who “overdose” on fluoride. 5,4 In very large amounts, ingested fluoride can change the consistency and color of tooth enamel, ranging from causing unnoticeable white streaks to brown stains and rough patches on teeth.6 Though water fluoridation has been shown to contribute to this effect, proponents of the policy argue that dental fluorosis is completely a cosmetic effect, posing no real health concern to those affected and only occurs in people who consume far more fluoridated water than the recommended dosage. 5 Thus, the physical benefits and efficiency of water fluoridation as a public health measure provides a nearly indestructible scientific basis for the policy. The real sugar in water fluoridation’s tooth is this moral question: “Is the government allowed to mandate a compulsory medical treatment?” Many who oppose water

THE EXAMINER II Page 12

fluoridation argue that its effectiveness is completely irrelevant to the central issue of its morality. Adversaries argue that whether it is beneficial to the public or not, putting fluoride in public water is technically an induced medication. If it is involuntary for those living in fluoridated-water communities, this measure infringes on personal autonomy and oversteps the role of the government.5,4 Public health officials, no doubt, have taken a certain freedoms away from individuals in making a moral decision about the risks and benefits of fluoridation. The ethical dilemma, as with most hot-button public health controversies, comes down to whether a governing body can force individuals to undergo a medical treatment that is widely—almost unanimously— considered beneficial. Those who oppose it are often seen as stubborn and intractable. It is the same public outcry that measures like medical vaccinations and nutrientfortified food have faced.4 Ultimately, water fluoridation is a practice that has continued because the majority of people think that the implementation of an overwhelmingly beneficial social program should be considered more important than the complaints and desires of a relative minority.4 As always, an informed decision about medicine—and in particular, public health—should be made with plenty of personal research and a democratic willingness to accept the testimony of experts and the verdict of the majority. References: 1 Centers for Disease Control and Prevention. (2012). 2010 water fluoridation statistics. Retrieved from http://www.cdc.gov/fluoridation/ statistics/2010stats.htm 2 Carmona, R. H. (2004). Surgeon General’s statement on community water fluoridation, 2004. Retrieved from http://www.cdc.gov/fluoridation/ fact_sheets/sg04.htm 3 Centers for Disease Control and Prevention. (1999). Achievements in public health, 1900-1999: Fluoridation of drinking water to prevent dental caries. Morbidity and Mortality Weekly Report, 48(41):933-940. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/ mm4841a1.htm 4 McNally, M., and Downie, J. (2000). The ethics of water fluoridation. Journal of the Canadian Dental Association, 66(11):592-3. Retrieved from http://www.cda-adc.ca/jcda/vol-66/issue-11/592.html 5 Cohen, H., and Locker, D. (2001). The science and ethics of water fluoridation. Journal of the Canadian Dental Association, 67(10):580. Retrieved from http://www.nofluoride.com/reports/science%26ethicscanadian_dental_assoc.pdf 6

Centers for Disease Control and Prevention. (2012). Dental fluorosis. Retrieved from http://www.cdc.gov/fluoridation/safety/ dental_fluorosis.htm

Diet Soda’s Undeserved Reputation of Causing Malignancy CHIR WEI other neurological issues.6 For those unaffected by PKU, phenylalanine in aspartame should still be avoided by anyone taking certain drugs such as antipsychotics, monoamine oxidase inhibitors, anything containing levodopa, and so forth. 6 In general, people are responsive to the calls and incentives for leading a healthy life. Even if a person is not the type to run a mile a day and eat only organic vegetables, the anxiety about bettering his or her well-being may drive him or her to opt for touted quick fixes towards health. The constant barrage of information and misinformation that swirl around those fixes, ranging from acai berries to diet soda, is bombarded at the person by talk shows, gossip, and the well-meaning friend of a friend. Perhaps educational campaigns in this modern age should be geared at empowering people to separate the claims from the actual truth in order to figure out these important matters for him- or herself rather than deferring to the latest diet guru or fad. References: 1 "Sugary Drinks or Diet Drinks: What’s the Best Choice?." The Nutrition Source. Harvard School of Public Health. Web. 22 Feb 2013. <http:// www.hsph.harvard.edu/nutritionsource/sugary-vs-diet-drinks/>. 2 "What Are the Health Risks of Overweight and Obesity?."National Heart, Lung, and Blood Institute. National Institute of Health, 13 Jul 2012. Web. 22 Feb 2013. <http://www.nhlbi.nih.gov/health/health-topics/ topics/obe/risks.html>. 3 "Artificial Sweeteners and Cancer." National Cancer Institute. National Cancer Institute, 05 Aug 2009. Web. 22 Feb 2013. < http://www.cancer.gov/ cancertopics/factsheet/Risk/artificial-sweeteners>. 4 Lim, Unhee. "Consumption of Aspartame-Containing Beverages and Incidence of Hematopoietic and Brain Malignancies." Cancer Epidemiology, Biomarkers, and Prevention. 15.9 (2006): 1654-9. Web. 22 Feb. 2013. <http://www.ncbi.nlm.nih.gov/pubmed/16985027>. 5 "Artificial sweeteners and other sugar substitutes." Mayo Clinic: Healthy Lifestyle. Mayo Clinic, 09 Oct 2012. Web. 22 Feb 2013. <http:// www.mayoclinic.com/health/artificial-sweeteners/MY00073>. 6 Zeratsky, Katherine. "Phenylalanine in diet soda: Is it harmful?." Mayo Clinic: Healthy Lifestyle. Mayo Clinic, 27 Nov 2012. Web. 22 Feb 2013. <http://www.mayoclinic.com/health/phenylalanine/AN01552>. 7 Robin, Suzanne. “Side Effects of Sodium Cyclamate.” LiveStrong. 10 Dec 2010. http://www.livestrong.com/article/332113-side-effects-of-sodiumcyclamate/

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In an attempt to appease a guilty conscious for that extra chocolate bar eaten yesterday or even lose weight in time for the warm summer months, the average person may opt for diet soda instead of its more maligned counterpart. People crave soda because it tastes sweet, which the body deems “good” due to evolutionary incentives for consuming high-energy sources of food. The average can of soda contains 150 calories, which is on par with consuming about 10 teaspoons of sucrose.1 In diet soda, the sugars found in regular sodas are replaced by sweeteners usually derived from natural sugars that are chemically altered in various industrial processes. These artificial sweeteners, which are fewer in calories, generate a much sweeter taste per unit than fructose or sucrose do, allowing manufacturers to use less of the ingredient. 5 Diet soda works through those two properties (fewer calories and lower costs) that lead a myriad of beverage industries to loudly proclaim the benefits of drinking their products on colorful plastic bottles. However, they may not be totally wrong to do so. Lowering daily caloric intake is indeed a key step in weight loss, as obesity can cause everything from coronary heart disease to sleep apnea.2 Furthermore, if one has diabetes, diet soda may be a way of consuming a pleasing beverage without the effects of hyperglycemia caused by too much sugar in the blood. Despite the multitude of claims about its benefits, there are just five sweeteners approved by the FDA: aspartame, acesulfame-K, saccharin, sucralose, and neotame. The sweetness levels range from 200 times to over 10,000 times that of normal sucrose.3 Sold under a series of generic names, these chemicals can be encountered in a wide range of foods from diet sodas to chocolate chip cookies. Every since sweeteners became more common in everyday life, claims that they are cancer-causing began circulating. A short answer to the claims of cancer-causing sweeteners is a firm negative. From the array of sweeteners, aspartame is the most often claimed carcinogen. This claim can be traced back to a 1996 study which found that aspartame is associated with a general increase in brain tumors. 3 The timing for that study, however, was off by 8 years since the heightened reports for those tumors came before the widespread introduction of aspartame in foods. In fact, a 2006 study on over 400,000 patients by the National Cancer Institute showed no link between aspartame consumption in beverages (tea, coffee, as well as diet soda) and an increase in hematopoietic and brain malignancies.4 Another artificial sweetener that is claimed to be horrid for the body is saccharin. In one study, it was shown that mice exposed to the compound had a higher rate of developing bladder cancer.5 However, in some of these studies, the saccharin was mixed with sodium cyclamate which has been subsequently banned by the US government for possible links to both bladder cancer and male infertility.7 One possible down side to drinking diet sodas is the phenylalanine that is present in aspartame. For those with phenylketonuria (PKU), an autosomal recessive genetic disorder characterized by a buildup of phenylalanine due to a defect in the enzyme to break it down, consuming too much meat, eggs, and processed foods containing aspartame can lead to seizures, mental retardation, and

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A Closer Look at the Doctor-Patient Relationship ANSHIKA VERMA Do you ever wonder if your silence could be the reason for not receiving the proper treatment from your physician? Or that the “honesty is the best policy” aphorism even applies in a doctor-patient relationship? Through the progression of modern science, the gap between patients and doctors is increasing, bringing two essential questions into focus: Is your doctor able to confidently address all your questions; are you providing your doctor with all the information he or she needs? Even though most of the medical issues are suppressed through a prescription or an array of tests, the diagnosis is many times only accurate if information is thoroughly expressed and understood. As with any issue, there are two point of views to analyze: the doctor in respect to the patient and the patient towards the doctor. It may be beneficial for a patient to go in prepared with questions in order to gain the full benefits from an appointment. An average doctor’s appointment lasts about twenty minutes, with the majority of the time being spent by the doctor explaining rather than listening to the patient’s concern. 4 To help make the most out of an appointment, patients are suggested to make themselves aware of the following notes: symptoms, medications, relevant family history, unexpected lifestyle changes, and any other medical concerns.2 Even though doctors attempt to address each of these questions during the appointment, this gives patients a better chance of gaining satisfaction from the allotted time. When you are the patient, you confide in your doctor to give you the best solution. Hence, it may be beneficial for the patient to ask questions that can help them understand their medical condition. Some questions patients may want to consider are: Why are you prescribing me this drug? Are there any side effects? Are there any alternate forms of treatment? Does this treatment present any risks? 3 Since the doctor-patient relationship revolves around communication, it is essential for the patient to utilize his/her time by asking questions and sharing all the relevant information. Sometimes, patients tend to forget the questions they hoped to get answered, so it is never too late to ask any questions later on. Always remember that asking that one question may be the difference between a healthy

Disease of th

Erum Farooqui

recovery and an unexpected trip to the ER. Communication remains a barrier between patients and doctors, leading to an increase in the number of complaints and patient discontent. Many of the rising complaints relate to patients feeling that their doctors are not listening. 1 Patients want to be active participants when it comes to medical decision -making.3 However, the method in which communication occurs seems to be controlled by the rambling of medical terminology that conforms into more of a dictation. Patients have expressed understanding of their health conditions, treatment plans, and prescription usage when they sense a comfort zone with their doctor.1 A compassionate yet direct physician portrays a positive vibe towards his/her patients, allowing them to deal with the situation at ease. Physicians that approach their patients with encouragement and support meet their patients’ expectations and lay the basis for a professional partnership. Although, a doctor seeks to maintain professionalism, a patient should be looked upon as a person, rather than a medical problem. As a patient, it is beneficial to be prepared, attentive, and honest in order to achieve the most out of an appointment. As for the physician, bridging the gap between patient and doctor may begin with having patience, listening to the patient, and offering motivation to make the appointment easy. A healthy body can begin and end with improved doctor-patient communication. References: 1 Weir, K. (2012). Improving patient-physician communication. American Psychological Association, 43(10), 36. Retrieved from http:// www.apa.org/monitor/2012/11/patient-physician.aspx 2 Siegfried, M. (1998). Improving doctor-patient communication. British Medical Journal,316(7149), 1922-1930. Retrieved from http:// www.ncbi.nlm.nih.gov/pmc/articles/PMC1113402/ 3 Travaline, J. M., Ruchinskas, R., & D'Alonzo, G. (2005). Patient-physician communication: Why and how.The Journal of American Ostheopathic Association,105(1), 13-18. Retrieved from http://www.jaoa.org/ content/105/1/13.full 4 Thompson, D. (2010, 08 20). What every patient should ask (and tell) the doctor. Retrieved from http://usatoday30.usatoday.com/news/ health/2010-08-20-doctor-advice_N.htm

e Month: Lup

Though public awareness of Lupus is very low, it is a severe disease that adversely impacts many people’s lives. Systemic Lupus Erythematosus is classified as a chronic systemic autoimmune disorder1. Autoimmune disorders are caused by the over-activation of the immune system; the body mistakes healthy tissue as pathogens and attacks its own cells2. Lupus appears in ‘flares,’ which lead to inflammation in tissues and can potentially cause permanent damage1. A systemic autoimmune disorder is one that attacks various parts of the body. In Lupus, this typically includes the heart, lungs, joints, skin, blood vessels, liver, kidneys, and the nervous system1. Because Lupus is a chronic disease, those who develop Lupus are affected for the rest of their lives. Lupus is very difficult to manage because it manifests in unpredictable cycles of active flares and symptomless remission1. The disease is named after the Latin word meaning ‘wolf.’ Lupus was believed to have been caused by wolf bites as it was first diagnosed in the 18th century by distinctive rashes 4 THE EXAMINER II Page 14 resembling bite-marks . According to the Lupus Foundation of

us

America, more than 1.5 million Americans have been diagnosed with Lupus, with more than 16,000 new cases arising each year1. Although research is being done on autoimmunity, many questions about Lupus remain unanswered. Like other autoimmune disorders, Lupus can be fatal1. Its cause and cure have yet to be discovered. It is hypothesized that genetics play a large role in the disease, although there is only a 5-10% chance that people with a family history of Lupus will develop it 5. It is also three to four times more prevalent in African Americans than in Caucasian Americans5. Furthermore, it is believed to be initially triggered by certain environmental factors such as ultraviolet light, some medications, illnesses, or stress1. Fortunately, with immunosuppressant medication, Lupus can be manageable. The probability of inducing remission is also increased by the medication. It is important to raise awareness of this disease, so that research in these areas can be funded.

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(GENETICALLY MODIFIED) FOOD FOR THOUGHT EMILY MOORE Corn, papaya, squash, and zucchini – what could be the connection between these four foods? When you eat any one of them, you are most likely consuming parts of a genetically modified organism. For example, it is estimated that in 2011, over 85% of corn from the commercial U.S. corn crop was genetically modified. Because of this tendency towards being grown as genetically modified organisms (GMOs), a variety of crops have been labeled high-risk.1 “High-risk” might not be a phrase you would associate with a fruit or vegetable; natural products like vegetables are generally considered healthy and safe. In fact, many types of produce now contain DNA sequences not normally found in those species. Can GMOs really transform our healthy foods into unhealthy ones? A genetically modified organism (GMO) is an organism whose DNA has been changed through a process known as genetic engineering.2 Scientists introduce a gene from one organism into the genome of another, either through the use of a gene gun (which inserts a new gene directly into a cell) or by infecting a cell with a bacterium that contains the desired gene. The recipient now possesses a specific characteristic that it normally would not possess otherwise.3 Genetically modified food refers to either plants or products made with ingredients that have undergone this process.2 Genetic modification offers many benefits to industrial agriculture. Introducing a gene that confers resistance to pests, diseases, or the effects of herbicides reduces crop vulnerability. For instance, the bacterium called Bacillus thuringiensis contains a gene that allows it to create a certain toxin, which can be found in some pesticides. Many food crops have therefore been genetically modified to produce that toxin. If the plants produce it themselves, they need not be sprayed with pesticides.2 Genetic modification can also create crops that are resistant to herbicides, the chemicals used to kill off weeds.2 While such an outcome is economically favorable to industrial agriculture, the GMO’s impact on consumer health raises concern. After all, how safe can it be to ingest a bacterial toxin? According to the World Health Organization (WHO), “no effects on human health have been shown as a result of the consumption of [genetically modified] foods.”2 Yet the WHO does acknowledge several potential health threats of genetically modified food.2 One of the most serious implications may be allergenic effects. In genetically modified food, “new proteins could cause allergic reactions (or be ‘allergens’ themselves), or the new proteins could sensitize people to existing food proteins.”3 In one study, scientists incorporated a gene from Brazil nuts into the genome of soy. This genetically modified soy led to allergic reactions in people with a Brazil nut allergy, a result demonstrated through “[testing] the effect of this GM soy on blood serum from” the subjects and “through scratch tests on the skin.”3 Genetic modifications may even impact the nutritional content of food. For example, lower amounts of protein and vitamin E have been detected in genetically modified rice as compared to unmodified rice.3 Further research will provide a clearer picture of these issues, but the possibility of such serious health consequences warrant further investigation and awareness.

Since genetically modified food may be detrimental to human health, people all around the world have called for regulation of this industry. Many other nations, including those of the European Union and Japan, tightly regulate the GMO products, and the United States seems to be slowly following in this direction.1 Although a 2012 California proposition that demanded labeling of genetically modified food did not pass, similar initiatives or proposals for labeling of genetically modified food have appeared in at least five other states. 4 Given all of the facts about genetically modified food, each of us will have to make a personal decision. We could continue to eat the way we always have without worrying about the GMO content of our food. But with so many unanswered questions about how genetically modified products actually impact the body, paying more attention to the genetic history of what we eat may benefit our health in the long run. References 1 (2013). GMO Facts. Retrieved from http://www.nongmoproject.org/learnmore/ 2 (2013) 20 questions on genetically modified foods. Retrieved from http:// www.who.int/foodsafety/publications/biotech/en/20questions_en.pdf 3 Antoniou, M.; Robinson, C.; Fagan, J. (2013). GMO Myths and Truths. Retrieved from http://www.nongmoproject.org/wp-content/uploads/2010/08/ GMO_Myths_and_Truths_1.31.pdf 4 Strom, S. (January 31, 2013). Genetic Changes to Food May Get Uniform Labeling. The New York Times. Retrieved from http://www.nytimes.com/2013/02/01/business/ food-companies-meet-to-weigh-federal-label-for-gene-engineeredingredients.html?ref=geneticallymodifiedfood&_r=0

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Making Medical School Sticky IVANA GANIHONG

We have all had that one class that makes it impossible to stay awake. We have likely had many such classes. The reality for most of us is that although we study just enough to earn the grades we want, we retain horrifyingly little of the knowledge. This phenomenon creates a significant obstacle for all students, including those who aspire to be in medical school. This past summer, Dr. Charles Prober and Dr. Chip Heath from Stanford University published an article in the New England Journal of Medicine titled “Lecture Halls Without Lectures—A Proposal for Medical Education.” In this piece, they address an issue that has been largely ignored. The amount of available medical knowledge has drastically increased in the past several years, and yet the model for education has remained unchanged2. More information is crowded into uncompromising lecture schedules. Lectures are becoming denser, which leaves little time for students to complete problems in class. While students may be able to answer questions on a test, it is difficult for them to apply such a large body of knowledge to real situations. To address this, Dr. Prober and Dr. Heath have proposed a new model for medical school, which they believe will make information more memorable or “stickier”. Rote memorization does not promote retention; completing realworld problems and presenting them in engaging formats does that. Dr. Prober and Dr. Heath first advocate for the elimination of classic lectures—no more three-hour-long monologues from professors. Lecture material can be transmitted to students via digital mediums2. Through this method, students may peruse the

material at their own pace, but more importantly, lectures time can be re-appropriated to interactive problem solving. In medical schools, professors would have the opportunity to present scenarios and patient cases. This style of presentation is more engaging, encourages comprehensive understanding, and provides a more memorable learning experience. This model has already been piloted by the biochemistry course offered at Stanford Medical School. Based on student reviews, students were significantly more satisfied with the course, and even with optional class attendance, there was a jump in attendance from a meager 30% to 80% 2. A separate study conducted with two large sections of an undergraduate physics course also supports the effectiveness of problem-solving lectures. The first section, taught by a Nobel Laureate, adhered to the classic lecture model. The second section, taught by teaching assistants, was conducted as a problem solving session where students solved problems that they would expect to encounter as physicists. This change resulted in marked differences in student comprehension. The test average from the classic lecture group was a 41% while the test average for the problem-solving group was a 71% 1. Students could greatly benefit from this deviation from classic pedagogy, and there are certainly merits to the system proposed by Doctors Prober and Heath. The structural changes that they suggest would allow students to absorb information at their own pace. Lectures would be transformed into opportunities to apply theoretical course material to real-world problems. Understanding and retaining information can be difficult. Changing the educational process to help information ‘stick’ would benefit medical students and improve the future of health care.

WHAT DOES THE ORGANIC LABEL REALLY MEAN? As someone who is quite content with grocery shopping at the local 7-11, I was quite perplexed the first time I walked into Whole Foods and Trader Joe’s. Rather than just being able to pick up a carton of eggs, a feat that usually requires little or no adept decision making skills, I was now being presented with an array of choices I had previously never been confronted with: eggs, grade A eggs, organic grade A eggs, free range organic grade A eggs, free range organic bionic grade A eggs hatched at a temperature of 35 degrees Celsius under the nurturing glare of ultraviolet light. Okay, that last one is bit of a stretch, but you get my drift. Eventually, I closed my eyes, picked up a random carton, and left the store. There has been a considerable boost in the appearance of “organic” foods on the shelves of grocery stores across the country. Some specialty stores are even set up for the sole purpose of stocking only organic foods and nothing else. Between 1996 and 2010, the market for these products increased steadily from $3.5 billion to $28.6 billion.1 Whether or not the demand for organic products is simply a trend (yes hipsters, I’m talking to you) or an indication of a paradigm shift in general consumer culture, there remains some speculation about the true meaning of “organic”. The USDA National Organic Program defines organic food as those that are “produced by farmers who emphasize the use of renewable resources and the conservation of soil and water to enhance environmental quality for future generations.”2 Organic foods are grown without the use of

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TIWALADE ADEDIJI pesticides and insecticides. Animals that are reared for meat and dairy products are not given any hormones or antibiotics. In addition, there is no use of synthetic fertilizers or ionizing radiation of genetic modification in the production of organic foods. Many vendors of organics tout their products as being a healthier alternative and an indispensible supplement to holistic living when compared with non-organic products. However, scientific studies paint quite a different picture. A study done in 2012, aimed at comparing the health effects of organic and conventional (non-organic) foods, concluded that there was a lack of evidence for the case of organic foods being more nutritious.2 Although the consumption of conventional foods increases the likelihood of ingesting harmful pesticides and synthetic fertilizers that have made their way up the food chain and onto store shelves, it has not been proven that organic food are more beneficial based on nutritional value.3 Conventional foods are still the main choice for people who are on a budget since organic foods, on average, are more expensive than their conventional counterparts. A good number of people are simply not that picky about where their groceries originate from. To these people, the organic label does not mean much; it is basically just another line of product marketing set to make consumers pay more. For others, organics are the only way to go. Whichever way, there is no indication that one group will be healthier and have a better quality of life than the other.

JASMEET K. BAWA “The best things happen at the exit ramp of your comfort zone,” write members of Project Heal, a new organization on campus. It is just one of many positive affirmations regarding body image written on construction paper cut outs that will be used at tables in the Douglass Campus and Rutgers Student Center alongside inspirational quotes and statistics concerning eating disorders during eating disorder awareness week from February 24th to March 2nd. Sophomore Kelly Hoyt, president of this budding organization and an aspiring physician assistant majoring in cell -biology and neuroscience, embraced her personal exit ramp as she stood in front of classes with over a hundred students this past school year to share an unsettling statistic: “the typical stay for residential treatment [for eating disorders] is a month, which can cost upwards of $30,000 and unfortunately many insurance companies are not covering treatment because they do not classify eating disorders as a medical illness.” In further conversations with her, I learned that only one percent of the diagnosed population in the United States receives the proper treatment for their disorder. Although mental illnesses continue to get increased attention from the United States government and medical associations, the subsection of eating disorders is not receiving equitable support in comparison with depression and bipolar disorder. Kelly inferred from statistics that “over 3,000 Rutgers undergraduate students are engaged in bulimic symptoms, and over 1,000 will develop an eating disorder.” But for some reason, we don’t talk about anorexia, bulimia, or other eating disorders which causes misconceptions about them to run rampantly. “I handed out surveys last year” she told me and then rattled off statistics from the top of her head, “59% of Rutgers community members would not know what to do if a close friends had an eating disorder, a total of 94% think they understand what eating disorders are, yet 22% of students think that people choose to have an eating

disorder.” She placed extra emphasis on the fact that such a large number of students think they understand eating disorders, but still harbor the demoralizing and false idea that someone could choose to have an eating disorder. She also explained to me that the most popular misconceptions people have about eating disorders is that they only involve decreased eating and weight and could be chosen like someone chooses a diet. In fact, eating disorders develop independently of a marked starting point and are never just about food. Disorders could stem from a desire for perfection, to “make up for” something else that people think they are lacking. For many, these disorders are a coping mechanism for broader life problems, and they can start out as a simple need for control over one’s life. Despite the apparent simplicity of the causes, the manifestations and treatments of eating disorders are always complex. To equate these conditions to a dietary option shames those that are in the grips of a disorder and prevents them from being helped. Last year, Kelly came across research that inspired her to do the survey at Rutgers. “I think there’s just this sort of taboo around eating disorders,” she shared, disturbed by the high level of stigma surrounding eating disorders and mental illnesses. In fact, this lack of awareness is present not only at Rutgers but in the general populace as well. Kelly is going to change the present state even if it’s only on the Rutgers campus. Project Heal, “is an official organization as of February 8 th and since then, I know it seems silly, but we’ve gotten 100 likes on Facebook, and every time we get another one, it’s really exciting,” Kelly shared enthusiastically about her organization that now has thirty solid members. “Everyone should love his or her body,” Kelly told me, and that is exactly the kind of mindset she wants to spread around campus. The organization has plans to make a life-sized Barbie to depict her actual proportions: 5’9”, 39” bust, 18” waist, 33” hips, and size 3 shoes, to clearly demonstrate the unattainable standards that our society primes our minds for and to promote a culture where numbers don’t matter. Catch them around campus, and like their Facebook page: https://www.facebook.com/ProjectHEAL.Rutgers

When Will Modern Medicine Reach Developing Nations? NITHYA GANDHAM

People in America are living longer and healthier lives than ever before, due to significant medical advancements in the last few years and changes within the public healthcare system. However, these medical advancements do almost nothing to aid billions of people in developing nations who also need care. According to Professor Rodriguez of Harvard Medical School, “ninety percent of the world’s investments in medical research benefit only the most affluent 10 percent of its population”. 5 This translates to approximately five billion people “left out”. 5 Although more and more people recognize immensity of this disparity, it is far from being solved. Even now, preventable and curable diseases like tuberculosis, malaria, and acute respiratory infections still affect the world’s poorest populations1. In 2001, half of all deaths in Africa were caused by preventable diseases, while in Europe, only two percent of people died from the same causes 2. A disproportionately large number of individuals in impoverished nations have also been affected by infectious diseases, such as HIV/AIDS. UNAIDS of the World Health Organization found

that globally in 2009, 33.4 million people were found to be living with HIV/AIDS and two million died as a result1. The United Nations Development Program found that 1.1 billion people lack access to water and approximately 2.6 billion people lack access to sufficient sanitation3. The Population Reference Bureau states that there are still one billion people lacking access to an adequate healthcare system1. With billions of people still struggling for survival, is medicine really advancing? Mali’s stark healthcare deficiency is just one example. According to the Library of Congress, Mali is ranked among the world’s poorest nations4. People there struggle to overcome malnutrition and inadequate sanitation, with as few as eight percent of the population having access to modern sanitation facilities4. As a result, numerous infectious diseases are prevalent, like meningitis, hepatitis, tuberculosis, and cholera 4. Most of the healthcare in Mali is heavily dependent on foreign aid and is still not enough to meet the needs of the population. Mali’s healthcare services reported a mere five physicians per

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It’s Time to Heal

100,000 people, which lags far behind the standard of healthcare in first world nations from back in the 1980s and 1990s, which boasted 270 physicians per 100,000 people4. Modern medicine might be advancing, but much of the world is still struggling to implement the fundamentals of medical care. William R Rodriguez, an assistant professor of medicine at Harvard University, states that, “We need to bring together the people who sit in the laboratories and develop these things with those in the field”5. With proper medical outreach, Rodriguez explains, many people suffering needlessly from

diseases such as HIV can get better over time. Something must be done to remedy the vast disparity in healthcare access between the wealthy and poor nations. What is the solution? The first step is for everyone, specifically medical researchers and government officials, to recognize that there is a problem. Professionals across healthcare and public health fields acknowledge that despite the increase of advanced modern medical research, Medicine cannot be seen as advancing when billions of people do not have access to very basic care.

THE REALITY OF MEDICAL DRAMAS

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MEGHNA DEV Whether we are watching House, Grey’s Anatomy, Scrubs, or any other medical drama, many of us have enjoyed all the medical scenes and felt that we have learned a lot from them. However, where do the writers get their information from? How accurate are the facts, procedures, and information presented in these scenes? Directors and TV producers cannot simply rely on their own basic knowledge of medicine since there are many details required to portray a hospital scene as accurately as possible. “Many shows rely on consultations with doctors and medical experts, provided by groups such as Hollywood, Health & Society, a partnership with the Centers for Disease Control and Prevention, the National Institutes of Health and the USC Annenberg Norman Lear Center, a research and public policy center, to help them accurately represent health-related story lines.”1 Unfortunately, this does not necessarily translate to completely accurate information. According to an NBC News Report, “experts say medical dramas often inaccurately portray organ donation, the range of doctors' expertise and nurses' roles, not to mention the level of hospital romance that takes place.” 1 Here are just a few common medical drama myths: #1) Doctors working outside their specialty: In reality, a specialist, such a neurosurgeon, would not be seen performing every type of procedure in the hospital.2 #2) Doctors performing all steps in patient care: In real hospitals, nurses are the ones who draw blood, administer medications, and perform other minor procedures – at least more than

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what doctors are portrayed to be doing on television. 2 #3) Getting away with performing procedures without consent: On Grey’s Anatomy, two characters on the show once performed an illegal autopsy on a patient without the family’s consent. However, they were forgiven instead of arrested because the autopsy revealed that the patient suffered from a rare genetic disease.2 This certainly would not be the case in real life, as there would be serious consequences for a doctor involved in such actions. There have been many studies done on this subject. Researchers at Yale University showed that “plastic surgery reality programs such as Dr. 90210 and Extreme Makeover played a significant role in cosmetic surgery patients' perceptions and decisions.”1 Regular viewers stated that the shows affected their decisions to consult a surgeon and that they were more knowledgeable about procedures than those who did not watch.1 These shows can even prove to be dangerous in terms of providing first aid. Researchers have stated that medical dramas might be demonstrating incorrect information on how to deal with real emergencies such as seizures.3 During a seizure, nothing should be placed in the patient’s mouth, and he/she should not be restrained.3 Instead, the patient should be turned to his/her side while a pillow is placed under his/her head. 3 However, some of these scenes portray characters doing just that, which could give viewers the wrong idea of what to do if they were to come across such a situation.3 Nevertheless, we must recognize that it is not all that easy for these shows to be completely accurate. In order to keep a show running, extra romance and interesting storylines are needed. While not all the information in reality medical shows is accurate, some of it does shed light on varying medical issues. A study conducted by researchers at the University of Southern California showed that “viewers of an "ER" story line about teen obesity, hypertension, and healthy eating habits were 65 percent more likely to report a positive change in their behavior after watching.”1 Hence, there definitely are lessons to be learned from these fictitious shows. All in all, reality medical shows have positive and negative points about them, as do any television shows of a similar style. It is up to the viewers to be cautious about how much to believe in terms of the information seen on television. Regardless, medical dramas are quite popular and are there for our enjoyment!

REFERENCES Cover

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Page 5 Doctor Deficit 1 Chen, Pauline W. (20 Dec. 2012). "Where Have All the Primary Care Doctors Gone?" Well Where Have All the Primary Care Doctors Gone Comments. NYTimes. Retrieved from <http://well.blogs.nytimes.com/2012/12/20/wherehave-all-the-primary-care-doctors-gone/>. 2 Kliff, Sarah. (15 Jan. 2012). "Doctor Shortage? What Doctor Shortage?" Washington Post. Retrieved from <http://www.washingtonpost.com/ blogs/wonkblog/wp/2013/01/15/doctor-shortage-what-doctor-shortage/>. 3 Nathan, Nisha M.D. (13 Nov. 2012). "Doctor Shortage Could Cause Health Care Crash." ABC News. ABC News Network. Retrieved from <http:// abcnews.go.com/Health/doctor-shortage-health-care-crash/story? id=17708473>. 4 (2010). "Physician Shortages to Worsen Without Increases in Residency Training." AAMC. Retrieved from <https://docs.google.com/viewer? a=v&q=cache:-JP3d4alsJwJ:https://www.aamc.org/download/153160/data/ physician_shortages_to_worsen_without_increases_in_residency_tr.pdf+&hl=en& gl=us&pid=bl&srcid=ADGEESjnACZ4sbJqvzavbPPi_WSNDBgXv1l87aN YWFyqTRtyYDYlkcvCOBPtODlpeyr9KRePxUzuFQ1ytS2lmz05z1j8NFyP bhHz1p7-8i3ymglyNtDWhlLmx8PkRi4eGWz8dCM5yCA&sig=AHIEtbR_A0gBK_lNmU3fnvG_4PE73DbR0w>. 5 (Oct. 2013). "Recent Studies and Reports on Physician Shortages in the US." AAMC. Retrieved from <https://www.aamc.org/download/100598/data/ recentworkforcestudies.pdf>. 6 (8 Jan. 2013). Tate, Nick. "Doctor Shortage Becoming Crisis Under ObamaCare." Fox Nation. Retrieved from <http://nation.foxnews.com/ obamacare/2013/01/08/doctor-shortage-becoming-crisis-under-obamacare>. Page 7 Antidepressants Are Being Overprescribed 1 Freeman, David. (2011). “Antidepressants bring prescribed needlessly, study suggests. “ CBS News. 14 February 2012. <http://www.cbsnews.com/8301504763_162-20088652-10391704.html>. 2 Grohol, John. (2011). “Antidepressants in primary care. Is this any way to treat depression?” 12 February 2012. <http://psychcentral.com/blog/ archives/2011/08/08/antidepressants-overprescribed-in-primary-care/> . 3 McGrath, Jane. (2011). “Why are Antidepressants the Most Prescribed Drug in the US?” 10 February 2013. <http://health.howstuffworks.com/medicine/ medication/antidepressant-most-prescribed.htm>. 4 Roethel, Kathryn. (2012). “Antidepressants – America’s Top Prescription”. San Francisco Chronicle. 8 February 2013. <http://www.sfgate.com/health/ article/Antidepressants-nation-s-top-prescription-4034392.php>. 5 Ross, Carolyn C. (2012). “Do Anti-depressants Really Work?” Psychology Today. 14 February 2013. <http://www.psychologytoday.com/blog/realhealing/201202/do-anti-depressants-really-work> Page 8 Flu Outbreak 1 Evans, Heidi. Flu outbreak in 2013 expected to be among the worst in decade, CDC warns. NY Times. January 9, 2013. http://www.nydailynews.com/lifestyle/health/flu-outbreak-2013-expected-worst-decade-cdc-warns-article1.1235178#ixzz2MEPvZgqA 2 Santora, Marc. Cuomo Declares Public Health Emergency Over Flu Outbreak. NY Times. January 12, 2013. http://cityroom.blogs.nytimes.com/2013/01/12/fluoutbreak-prompts-cuomo-to-declare-public-health-emergency/ 3 Early Estimates of Seasonal Influenza Vaccine Effectiveness. Centers for Disease Control and Prevention. January 11, 2013. http://www.cdc.gov/mmwr/ preview/mmwrhtml/mm6202a4.htm?s_cid=mm6202a4_w 4 Osterholm, Michael T, et al. (2012). Efficacy and effectiveness of influenza vaccines: a systematic review and meta-analysis. The Lancet. Retrieved from: http://www.sciencedirect.com/science/article/pii/S147330991170295X 5 McNeil, Donald G Jr. Flu Season Deaths Reach Epidemic Level but May Be at Peak, C.D.C. Says. NY Times. January 11, 2013. http:// www.nytimes.com/2013/01/12/health/us-flu-deaths-reach-epidemic-levelsbut-may-be-peaking.html?_r=0 6 Cold Versus Flu. Centers for Disease Control and Prevention. Updated February 8, 2011. http://www.cdc.gov/flu/about/qa/coldflu.htm 7 Influenza Vaccine 2012-2013. Centers for Disease Control and Prevention. July 2, 2012. http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-flulive.pdf 8 Situation update: Summary of Weekly FluView. Centers for Disease Control and Prevention. Edited February 22, 2013. http://www.cdc.gov/flu/weekly/ summary.htm 9 Jennifer Corbett. FDA Panel Expands Flu Vaccine. Wall Street Journal. February 28, 2013. http://online.wsj.com/article/ SB10001424127887323293704578330603413090058.html

Page 10 Hospital Chains vs. Private Practice—The Pros and Cons 1 Gawande, Atul M.D. “Big Med.” The New Yorker, 13.08.13. http:// www.newyorker.com/reporting/2012/08/13/120813fa_fact_gawande 2 Spiegel, Alix. “How to Win Doctors and Influence Prescriptions.” National Public Radio. www.npr.org/templates/story/story.php?storyId=130730104 3 Creswell, Julie. “A Hospital War Reflects a Blind for Doctors in the US”. 30 Nov 2012. http://www.nytimes.com/2012/12/01/business/a-hospital-war-reflects-a -tightening-bind-for-doctors-nationwide.html?pagewanted=all&_r=1& 4 Denning, Steve. “How Not to Fix US Health Care: Copy the Cheesecake Factory”. 13 Aug 2012. http://www.nytimes.com/2012/12/01/business/a-hospital-warreflects-a-tightening-bind-for-doctors-nationwide.html? pagewanted=all&_r=1& Page 14 Disease of the Month: Lupus 1 “Understanding Lupus” The Lupus Foundation of America Webpage http:// www.lupus.org/webmodules/webarticlesnet/templates/ new_learnunderstanding.aspx?articleid=2231&zoneid=523 2 “The Immune System” Lupus Center at John Hopkins Webpage http:// www.hopkinslupus.org/lupus-info/lupus-affects-body/lupus-immunesystem/. 3 “How Lupus Affects the Body” Lupus Foundation of America Webpage http:// www.lupus.org/webmodules/webarticlesnet/templates/ new_learnaffects.aspx?articleid=2268&zoneid=526 4 “The History of Erythematosus” Lupus Foundation of America Webpage http:// www.lupus.org/webmodules/webarticlesnet/templates/ new_learnunderstanding.aspx?articleid=1520&zoneid=523 5 “Dr. Gary Gilkeson- Ethnicity & Lupus” Lupus Foundation of America Webpage. July 11, 2007. http://www.lupus.org/webmodules/webarticlesnet/templates/ new_learnclinical.aspx?articleid=1036&zoneid=531 Page 16 Making Medical School Sticky 1 Deslauriers, L., Schelew, E., & Wieman, C. (2011). Improved learning in a largeenrollment physics class. Science, 332(6031), 862-864. Retrieved from http:// www.sciencemag.org/content/332/6031/862.full.pdf 2 Prober, C., & Heath, C. (2012). Lecture halls without lectures--a proposal for medical education. The New England Journal of Medicine, 366(18), 16571659. Retrieved from http://med.stanford.edu/smili/interactive-learning/ Lecture-Halls-without-Lectures-NEJM.pdf Page 16 What Does the Organic Label Really Mean? 1 Forman. J, et al. Organic foods: health and environmental advantages and disadvantages. Retrieved on February 10th 2013 from http:// www.ncbi.nlm.nih.gov/pubmed/23090335 2 What does “organic” mean? Retrieved on February 10th 2013 from http:// www.organic.org/home/faq 3 Smith-Spangler. C, et al. Are organic foods safer or healthier than conventional alternatives?: a systematic review. Retreived on February 10 th 2013 from http://www.ncbi.nlm.nih.gov/pubmed/22944875 Page 17 When Will Modern Medicine Reach Developing Nations? 1 Shah, Anup . "Diseases—Ignored Global Killers." GLobal Issues . N.p., 02 Oct 2010. Web. 14 Feb 2013. <http://www.globalissues.org/article/218/ diseases-ignored-global-killers>. 2 Carr, Dara. Health Bulletin: Improving the Health of the Worldís Poorest People. Population Reference Bureau, 2004. eBook. <http://www.prb.org/pdf/ ImprovingtheHealthWorld_Eng.pdf>. 3 Shah, Anup . "Poverty Facts and Stats." Global Issues . N.p., 07 Jan 2013. Web. 14 Feb 2013. <http://www.globalissues.org/article/26/poverty-facts-andstats>. 4 "COUNTRY PROFILE: MALI." . Library of Congress – Federal Research Division, n.d. Web. 14 Feb 2013. <http://lcweb2.loc.gov/frd/cs/profiles/ Mali.pdf>. 5 Cooke, Robert. "Medical basics still needed in Developing World." Harvard Gazette. N.p., 18 Feb 2008. Web. 13 Feb 2013. <http://news.harvard.edu/ gazette/story/2008/02/medical-basics-still-needed-in-developing-world/>. Page 18 The Reality of Medical Dramas 1 Van Dusen, Allison. "Playing Doctor: Medical TV isn't Always Right." (2013). http://www.nbcnews.com/id/20895520/ns/health-forbes_com/t/playingdoctor-medical-tv-isnt-always-right/#.UR1gzPlkF8F 2 Tuten, Tera. "TV Medical Drama Accuracy FAIL! (In 3 Categories)." (April 13, 2011). http://blog.soliant.com/healthcare-news/tv-medical-drama-accuracy -fail-in-3-categories/ 3 Landau, Elizabeth. "Medical dramas give bad information about seizure treatment." (February 15, 2010). http://www.cnn.com/2010/HEALTH/02/15/ tv.medical.dramas.seizures/index.html?iref=allsearch

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