PULSE Fall 2023

FROM THE EDITORS-IN-CHIEF Dear readers, Welcome to 2024! This past Autumn quarter, we’ve been hard at work on this new issue, and we’re so glad to finally bring it to you all. Many of you are probably looking to incorporate some changes to your day-to-day lives with the start of 2024, as one does with a new year, and what better way to commemorate this than with the theme of this issue: Lifestyle and Culture!

This issue contains 6 articles, all highlighting the relevance that medicine and healthcare have on our everyday lives and larger society. First, we present an analysis of a historical medical document that not only reflects early-modern medicine, but also 17th century intellectual culture, followed by a discussion of the social and biological factors behind our personality and behavior. Following these pieces are a few articles on diet and nutrition. Closing off the issue are works discussing material culture: how we regularly use technology in relation to our health nowadays, and the economic state of healthcare.

Finally, we want to thank our spectacular editorial board, layout and design team, writers, and editors for their amazing contributions these past few months. We’re so proud of the work we’ve done together, and hopefully this issue gets you all to reflect (even just a bit) on the connections between medicine, healthcare, your lifestyles, and our culture. We wish everyone a blissful start to the new year, and happy reading!

With utmost sincerity, Fareen Dhuka and Ayman Lone

Writers

Hunter Bershtein Shaherzad Chawdree Amiti Goel Alexander von Kumberg Lina Piao Hermela Selam Litzy Tafolla

Editors

Ella Chen Emnet Djibrila Sanaa Imami Karen Liao Michelle Lu Aman Majumdar Emily Shi

Editorial EIC

Production

Layout EIC

Cover Design

Fareen Dhuka Ayman Lone

MacKenzie Brogan

Senior Editors Sanaa Imami Michelle Lu pulse fall/winter 2023/24

MacKenzie Brogan Rina Iwata

Fareen Dhuka

CONTENTS The Heartbeat of Medical Revolution: Contextualizing William Harvey’s Motu Cordis in the Tapestry of Early Modern Medicine....................................3 Beyond Nature vs Nurture: The Evolution of Understanding Human Development..............................................................................................................7 We Are What We Eat................................................................................................9 Unveiling the Genetic Menu: Exploring the Future of Nutrigenomics and Personalized Diets...................................................................................................12 Emerging Technologies in Healthcare: AI-powered Diagnostics, Telemedicine, Wearable Health Devices, and Robotics in Surgery..................14 Universal Health Coverage in the U.S.: The Surrounding Debate....................16

pulse table of contents

The Heartbeat of Medical Revolution: Contextualizing William Harvey’s Motu Cordis in the Tapestry of Early Modern Medicine

By Alexander von Kumberg Edited By Aman Majumdar The renowned historian of medicine and professor of physiology, Kenneth J. Franklin, whose translation of Harvey’s essay is used in the following article, exclaimed: “Harvey’s Exercotatio Anatomica de Motu Cordis et Sanguinis in Animalibus (1682) is the most important work in the history of medicine.”

The truth of such a statement can hardly be questioned. Indeed, Harvey’s genius is unveiled in his Motu Cordis. This work formulated a modern model of cardiovascular anatomy and physiology. However, the piece does not solely display Harvey’s medical and scientific prowess; rather, its majestic simplicity and embodiment of the early scientific method truly earns it its laurels. In many ways, Motu Cordis perfectly reflects the intellectual zeitgeist of the early 17th century, namely the early scientific revolution and the embers of enlightenment. In order to fully appreciate Harvey and his Motu Cordis, one must comprehend the historical backdrop behind the man and the text.

William Harvey was born on April 1st, 1578, in Folkestone, England and died in 1657, an era of immense social and political pulse 3

population. With wars come political and social changes. Born early enough to see the defeat of the Spanish Armada in 1588 – in which his father, Thomas Harvey played a role as mayor of Folkstone – Harvey was born an Elizabethan. The conclusion of the Tudor dynasty, with the death of the Virgin Queen, Elizabeth I soon followed. Subsequently, Harvey witnessed the fanfare that defined James I’s Jacobean England and the early Stuarts before its polar opposite replaced it; that is, Oliver Cromwell’s Puritan theocracy. Yet, despite the brutal conflicts that orbited Harvey, new intellectual movements and ideas were simultaneously being formulated across the continent.

From Galileo Galilei’s telescopes to Johannes Kepler’s laws of planetary motion, and from Antonie upheaval in Britain and the European van Leeuwenhoek’s microscope continent as a whole. By the mid-16th to Francis Bacon’s scientific century, Europe began to depart from a method, such behemoths were culture of Renaissance Humanism and William Harvey’s contemporarenter the tumultuous age of rival creeds, ies. Indeed, despite the plagues whether it be theological antitheses of and conflicts that tormented EuCatholicism and Protestantism, or the rope, Harvey lived an inquisitive rise of absolute monarchies and the birth life devoted to his patients and of recognizable nation states. Indeed, the medical sciences. this backdrop culminated in the Thirty Years War, which laid waste to central William Harvey was the eldest Europe and caused the deaths of more of nine children from Thomas than 8 million people, 20% of Europe’s Harvey’s second marriage to Joan population. Harvey also lived through Hawke. His mother – a devout the English Civil War ending in 1651 Anglican – instilled a love for and taking the lives of 7% of England’s the faith and liturgy, which in

turn lent Harvey his charity and virtue. His father was a dedicated and laborious worker. With such parents, there is no doubt that Harvey lived a life in tune with one of his most famed sayings: “Dii laboribus omnia vendunt” (the gods give all for effort). He was first educated in reading, writing, and Latin in Canterbury Grammar School as a fee-paying scholar. The sixteen-year-old Harvey was admitted to Gonville & Caius College, Cambridge in 1593. It was there that he began to study medicine. Following the manner of the classical sophists, Harvey devoted himself to travel as widely as possible in the hope of acquiring wisdom.

Accordingly, in 1600, he began his studies at the University of Padua, which starkly contrasted with Cambridge in its focus on anatomy as well as the liberties granted to students. It was there, on the feast day of St. Luke (patron saint of doctors) that Harvey devoted himself to medicine and enrolled in the lectures of the famed professor of anatomy, Hieronymus Fabricius of Aquapendente. Alongside Aquapendente, Harvey studied the great Andreas Vesalius, with comparative anatomy and Aristotelian embryology. In April of 1602, Harvey graduated from Padua as a Doctor of Medicine and was reincorporated as an M.D. in Cambridge. He then entered the college of physicians and in 1604 began his career at St. Bartholomew’s Hospital with the recommendation of King James I. Yet, Harvey was not solely a physician, but an avid scientist, who having been influenced by

Aquapendente’s rediscovering of venous valves, began to develop a new model of the circulatory system. Subsequently, Harvey presented Lumleian Lectures thrice in 1616. By 1618, he was titled Physician Extraordinary and in 1628, Harvey published the culmination of his work, De Motu Cordis.

The European medical sphere, as it had been since the Middle Ages, was burdened by the near infallible words of the great Hellenic philosophers and physicians, in particular the dictator of philosophy, Aristotle and the untouchable Galen of Pergamon. Whose meticulous writings, paired with a medieval obsession and later Humanist passion for all things classical, burdened innovation in the medical sciences. Yet, these goliaths of old had begun to erode with the writings of proto-scientific minds like Vesalius in the mid-16th century,

who single handedly proved the fallibility of Galen in his De Humani Corporis Fabrica Libri Septem. However, despite such erosion, an abundance of European physicians would rebuke any who dared oppose Galen, which Harvey certainly did in his Motu Cordis. Indeed, in his letter to fellow physicians Harvey states, “while swearing allegiance to Mistress Antiquity, do they [philosophers] openly abandon Friend Truth and desert her in sight of all.” Yet, Harvey evidently triumphed the great achievements of the past, and worked to improve upon the foundation of the giants of old, not merely rebuke them. Indeed, Motu Cordis is laced with a certain reverence for Galen, and those he contradicts with his novel experiments. pulse 4

Harvey refers to Galen as “the Sire of Physicians.” Moreover, the final chapters of Motu Cordis are focused on confirming the novel assertions made by way of recalling philosophical principles. For example, Harvey recalls Aristotle’s principle that, “death is a corruption for lack of warmth and all living things are warm, dying ones cold, there must be a site and source of warmth.”

Harvey, uses this Aristotelian principle to claim that “this site is the heart, and that the heart is the beginning of life.” Thus, rather than simply rebuking the ancient, Harvey laid his novel discoveries pulse 5

upon the columns of the great minds of old, legitimizing his discoveries.

A glaring novelty in Motu Cordis is the emphasis on experimentation and self-inquiry. The most prolific investigation is Harvey’s use of ligatures, or threads tied around blood vessels. Harvey writes in a manner that invites the readers to partake in the experiments themselves: “Now make a test on a man’s arm by applying such a bandage [ligature] as they use in bloodletting… the test is better made in a lean subject with rather wide veins… In such a limb everything will be much more clearly seen.” Moreover, Harvey, in a somewhat Aquinian manner, imagines

what objections could be made against his theories and how one would resolve them: “The objector may remain unconvinced and insist on adding that, although blood can escape with abnormal rapidity when an artery is cut open… so great an amount of blood cannot pass through them in so short a space of time that it must make the return journey to the heart. To this the answer should be that our previous reckoning shows, on balance, that the extra amount of blood contained in the full, dilated heart… is for all practical purposes the amount, which is emitted at each heartbeat, and so passes in such quantity into the arteries.” What follows from Harvey’s experimental layout, is a description of what

occurs and how it proves his hypotheses on circulation. Indeed, after applying the tight ligature around the arm, which cuts off blood flow from arteries and veins, the arm below the ligature turned pale and felt cool. However, the upper arm turned red and warm.

After the ligature was loosened slightly, blood from the arteries flowed into the lower arm. This is permissible as arteries are deeper in the body compared to veins. This in turn resulted in a swollen, red, and warm lower arm.

Hence, Harvey concluded from this simple experiment that arterial blood travels to the extremities, while venal blood travels back to the heart, as arterial blood is sent to supply nutrients to the body before returning to the heart via the veins to be sent to the lungs via pulmonary arteries. By way of laying out his experiments Harvey formulated the modern understanding of the circulatory system in Motu Cordis.

Indeed, he concludes as follows: “Since calculations and visual demonstrations have confirmed all my suppositions… I am obliged to conclude that in animals the blood is driven round a circuit with an unceasing, circular sort of movement, that this is an activity or function of the heart which it carries out by virtue of its pulsation.” Thus, by way of presupposing the thoughts of objectors, answering them in writing, and proving hypotheses by way of laying out detailed and replicable experiments, Harvey formulates and legitimizes his new circulatory model to his readers.

Thus, I have sought to give credence to Franklin’s exclamation that Motu Cordis is the most critical and insightful medical work ever composed. Indeed, it is undoubtedly the case that any and all budding physicians should read the essay. Its

startling simplicity, eloquent tone, and masterful description of experimentation as well as anatomy and physiology truly instill a certain sense of awe and frisson in the reader. It is far too easy for modern students of medicine to refer to our discipline’s past with those despicable scientistic lenses in which all is considered an antediluvian vestige of a bygone age.

Yet, Motu Cordis instills a contrary

understanding. The respectful yet just manner in which Harvey confronts and reflects on his predecessors – both ancient and medieval – reflects his virtue and wisdom.

In so doing, Harvey would manage to gain the renown he so dearly wished for. Indeed, the introduction of Motu Cordis concludes with a melancholic statement: “Finally, I have published so that, if something useful and serviceable should accrue to the republic of letters through my work in this field… others might see that I have not lived idly.” There is no doubt that Motu Cordis served this fear well, as it has been of the utmost use to students and physicians for centuries. Critically, Harvey asserts, “[I] may perchance prove… that others, given this lead, and relying on more productive talents, may find an opportunity to carry out the task more accurately and to investigate more skillfully.” And thus, the scientific endeavor has built upon Harvey in the same manner Galen built upon Hippocrates, and Ibn-al Nifis on Galen, and so on. The scientific edifice – perhaps most particularly in the field of medicine – requires a respect and knowledge of the great minds of old, to build the foundation for future generations of physicians. Such a statement is etched in the pages of Harvey’s Motu Cordis, and must necessarily be incorporated in the minds of all students of medicine.

References: Harvey, William, & Franklin, Kenneth Kenneth (1977). The Circulation of the Blood and Other Writings, J. M. Dent & Sons. pulse 6

Beyond Nature vs Nurture: The Evolution of Understanding Human Development

By Shaherzad Chawdree Edited By Sanaa Imami Nature vs Nurture? People’s opinions on the extent to which the environment or hereditary has influenced them has remained a topic of discussion in various fields. Are prodigies naturally gifted themselves, or is it because they were raised in an encouraging environment? Do serial killers naturally lack empathy, or were they neglected in their childhood? Some may even prescribe characteristic traits to certain races, claiming that others are more naturally gifted because of their race. As we know now, nature and nurture are not alternatives to each other.

There is no strict binary which one must choose from—in fact, they are intertwined.

However, it took many years to settle on this position. Starting from the 19th century, scientists attempted to biologize human nature. Sir Francis Galton, cousin of Charles Darwin, began the discussion of nature vs nurture, claiming that character traits were the result of hereditary factors. Building upon Darwinian theories of natural selection, Galton made bold claims that one could improve mankind by selectively breeding. His claims can be summed up in his unpublished book Kantsaywhere. The citizens of Kantsaywhere must

pulse 7

take a genetic test that segregates them into different colonies depending on their genetic potential. If one is deemed to have inferior genetic material, they are forced into celibacy. Those who have superior genetic material are encouraged to intermarry. This theory of selective breeding would be named eugenics.

connections that come with one’s family standing can be responsible for their success in a given field.

The majority of Galton’s analysis lacked a biological understanding of inheritance and rather relied upon sociological studies that could easily be clouded by prejudice.

Galton’s theory was heavily rooted in class. Coming from a wealthy family, Galton failed to divorce the ideas between hereditary and the privilege that is inherited from family-lineage.

He disregards the advantages of one’s social and economic standing, claiming that talent is genetically inherited. In his book, Hereditary Genius, he analyzes families with different professions, studying the likelihood that the successor/offspring would be successful in the same profession as their ancestors. From his findings, he concludes that “talent is transmitted by inheritance in a very remarkable degree…that whole families of persons of talent are more common than those in which one member only is possessed of it” (“Hereditary Talent” 157).

Galton dismisses that the resources and

Eugenics would be later used to promote a racial hierarchy, which is of no surprise given Galton’s own stance on race. He repeatedly emphasized in his works that Europeans are mentally and morally superior to other “lower races”.

His theory of eugenics would only be further abused in its attempt to attribute large groups of people with negative characteristics. This can most notably be seen in Nazi Germany with the forced sterilizations of hundreds.

Galton and his predecessors were firm in their stance that nature was mainly responsible for human development and personality traits.

On the other extreme end, one can

cite John Locke’s tabula rasa theory.

He claims that our minds are blank slates with no innate knowledge from birth. One must gain all their knowledge through experience. He emphasizes this in“An Essay Concerning Human Understanding” (1689), where he claims that the mind is “white paper, void of all characters,” with “all the materials of reason and knowledge”. This theory has taken an important role in the discussion of behavior and the acquisition of basic functions, such as language. Locke’s theory emphasizes the importance of the environment in which one is raised.

Every facet of one’s behavior is learned—nothing is a result of heredity. Less extreme versions of this theory have gained more traction in the postmodernist era—many believing cts.

of epigenetics took off in the 1990s with research being focused on DNA methylation, histone modification, and noncoding RNA action.

Different environmental stressors can trigger these modifications leading to a different phenotype than the original inherited DNA sequence. Some of these epigenetic modifications can even be inherited by the next generation, showing the lasting effect Nurture can have.

The Nature vs. Nurture discussion has become outdated.

Framing an issue in terms of this strict binary does not accomplish anything for they are both intertwined. With the advancement of epigenetics, it can be predicted that the fields of sociology and genetics will further intersect. Rather than exclusively looking through the lenses of Nature and Nurture, like However, both theories of GalGalton and Locke, both fields will ton and Locke have been refuted be considered when discussing the by contemporary scientists. Many behavior of individuals. Complex refuse to take a stance on either na- sociological issues, such as poverty, ture or nurture dominating human can be studied using a scientific development, believing that one’s lens, investigating the role of excess character traits are a result of the stress on one’s epigenome. One’s interaction between their genes and socio-economic status can affect the environment. One’s behavior complex mechanisms that take cannot be purely dictated by their place in one’s body, even affecting genetic makeup, just as their envi- further generations to come. Slowly, ronment is not entirely responsible as more research is conducted, the either. debate of Nature vs. Nurture becomes further obsolete In fact, modern science has made the difference between nature References: and nurture obsolete. In the era of postgenomics, it has been conGalton, Francis, 1822-1911 , firmed that the activation of one’s “Hereditary genius : an inquiry into genes can be altered by their surits laws and consequences,” Onroundings. Nature and Nurture are View, accessed November 28, 2023, not mutually exclusive but influhttps://collections.countway.harence each other. This phenomenon vard.edu/onview/items/show/6205. is known as epigenetics. The study

JENSEN ARTHURR. GALTON’S LEGACY TO RESEARCH ON INTELLIGENCE. Journal of Biosocial Science.

2002;34(2):145-172. doi:10.1017/ S0021932002001451 Locke, John. An Essay Concerning Human Understanding .[Philadelphia, T.E.Zell 185-?, 1850] Pdf Pinker, Steven. “Why Nature & Nurture Won’t Go Away.” Daedalus, vol. 133, no. 4, 2004, pp. 5–17.

JSTOR, http://www.jstor.org/stable/20027940. Accessed 13 Dec. 2023.

RENWICK, C. (2011). From political economy to sociology: Francis Galton and the social-scientific origins of eugenics. The British Journal for the History of Science, 44(3), 343-369. doi:10.1017/ S0007087410001524 Trerotola, Marco et al. “Epigenetic inheritance and the missing heritability.” Human genomics vol.

9,1 17. 28 Jul. 2015, doi:10.1186/ s40246-015-0041-3

pulse 8

We Are What We Eat

By Litzy Tafolla Edited By Karen Liao The four dining halls on campus grace us with their presence after an 80-minute lecture and fulfill us when we need it most.

Hamburgers, hotdogs, some sort of fried potato, and more.

They become your comfort, and you know where they reside in the dining hall. For a solid three weeks I had the same meal for lunch and dinner a slice of pizza, a side salad, and a cookie if I craved something I am well accustomed to. This comfort does not take into consideration the nutritional value of what I’m putting in my body. The buzz of course discussions and practice sets can push our nutritional health to the end of the list of things to take care of. What is oftentimes disregarded is that our bodies work inside out. The human body is a vessel, or a machine. A lack of nutritional balance is one of the building blocks necessary for our bodies to work efficiently and prevent a crash in the afternoon. A good night of sleep should be equally prioritized with a balanced diet and intuitive eating. The urgency of assignments blindsides college students and creates a heavy negative impact in the long run that would be stopped if we make well-informed decisions now.

What is a balanced plate?

The green, red, purple, orange, and blue balanced plate is shown in doctor’s offices nationwide to inform people of what a pulse 9

well-rounded plate looks like. Despite the instilled image, it seems to be the first thing that is disregarded when we look for food in the dining hall. Counting portions and ensuring we are receiving all of our nutrients can be quite a task. It is crucial to stick to simplicity when making decisions on how we will fuel our bodies.

Vegetables provide a majority of the main nutrients that our bodies require.

This includes but is not limited to iron, vitamin C, D, and B6, and potassium.

These nutrients allow our bodies to create blood cells, boost our metabolism, reinforce the strength of our cells and more. Not eating a sufficient number of vegetables can cause a multitude of digestive problems and repeated fatigue which causes a domino effect on other troublesome health issues. It is recommended that adults consume around three cups-worth of vegetables daily.

However, according to the Center for Disease Control and Prevention, only 10% of adults in the United States said that they regularly ate the recommended portion size for vegetables in 2019. There is a wide range of reasons that cause this

to happen, but most prominently there is a lack of education on the importance of vegetables. An article published by the Iranian Journal of Public Health highlights how the lack of vegetables has contributed to global wide health crisis amongst adults such as cardiovascular risks, fluctuating cholesterol levels, obesity, and more.

Fruits and vegetables go hand in hand because their fibrous composition is beneficial to the human body in multiple ways. The natural sugar in fruits is an ideal alternative to the sugar substitutes found in many sweet treats. They are a natural boost of energy and sugar that simultaneously provides fiber and nutrients to keep the body running efficiently.

Fruit can easily be the disregarded food group, where protein and vegetables can be eaten implemented into our main dishes, we need to include fruit on the side in order to obtain their health benefits.

Protein is easily filled in our nutritional plate. Most main dishes, whether they are “healthy” or not,

are protein rich. Common forms of protein are meats, eggs, legumes, tofu and seitan as meat alternatives.

Some foods that we constantly see in the dining hall are hamburgers and chicken tenders that have protein, but they cooked with copious amounts of fat and carbs that work against what the protein is meant to provide. Regardless of your preferred diet, it is crucial to sustain and build muscle, create enzymes for consistent metabolism and cell function, and create adaptability within the body. Protein is necessary to support the body’s mass and mobility.

Carbohydrates play a significant role in your diet. Bread is a densely packed carbohydrate food, but fruits and vegetables contain carbohydrates as well! The fibers, starches, and sugars in vegetables and fruits respectively are carbohydrates. This is why it’s easy to have a high carb diet. One common distinction in carbohydrates is refined and wholegrain carbs. Refined grains such as white rice and white bread have been milled, which is a process that removes the bran and germ. On the other hand, Whole grains, such as brown rice, quinoa, and oats, offer a “complete package” of health benefits, in contrast to refined grains that are stripped of valuable nutrients in the refining process.

Dairy alternatives have been in the up and coming over the last few years. From oat milk to the wellknown cow’s milk, the most important nutrients that derive from milk are calcium and vitamin D. These components play a large role in creating strong bones and it is why pediatric doctors commonly tell children that they should drink milk to grow “big and strong.” Although humans stop growing by the time we

are 18, our brains do not. Milk helps the body generate glutathione which is an antioxidant that is shown to lessen mental aging as well as protect and build body tissue. Lactose intolerance means that lactose cannot be broken down in the body. For people that are lactose intolerant it’s important to implement the rest of the food groups, especially vegetables, to be able to get the nutrients that milk helps produce. The human brain is a powerful asset that should be treated with as much care as we give to our bodies, and consuming dairy is a great way to do that.

A well-balanced diet is crucial to function effectively, so implementing all parts of the food web is critical to obtaining a wide range of nutrients.

Gifting your body a balanced plate is treating it to what you need.

Stop the Cycle Starting small and staying consistent leads to overall better eating.

Begin with consciously implementing a food group that you feel you do not get enough of. Rather than restricting food options, think about what can be added to what you are used to. A simple way to start is with a side of fruit. This can be paired with any meal and is a great way to boost natural sugars without having to prepare anything. Yogurt is great when it is paired with fruit. Parfaits, oatmeal, and cereal are common breakfast items that pull from numerous food groups and are commonly stocked in our dining areas.

They are easy to assemble, eat, and find in the dining hall spaces. Snacks are a great way to get a quick boost of energy and vending machines are very eye-catching sources of fuel. It is difficult to deter your eyes away from the Twix and chips that are eyeing you. One of the main reasons

why saturated fat filled snacks are most craved is because they bring the satisfaction of artificial flavors and sugars that are satisfying to eat.

Instead of indulging in foods that are high in fat and low in nutritional value, popcorn, hummus with carrots, nuts, and dried fruits are examples of healthy snacks that might just fill that craving. It is important to play with a variety of combinations, but this alteration does not need to be done overnight. Start by picking one and slowly find more. You deserve to reward yourself with a favorite food, but not at the expense of your health!

Shifting your diet sounds can be a challenge, but if done at a comfortable pace it can be exciting to feel that your energy is sustained throughout the day. Your mind is a muscle, and your body is the vessel that feeds its inner workings. By understanding the importance of nutritional balance and making conscious decisions your body will thank you in the long run.

pulse 10

References: Mayo Foundation for Medical Education and Research. (n.d.). Lactose intolerance. Mayo Clinic. https:// www.mayoclinic.org/diseases-conditions/lactose-intolerance/diagnosis-treatment/drc-20374238 Pem, D., & Jeewon, R. (2015, October). Fruit and vegetable intake: Benefits and progress of Nutrition Education interventions. Iranian journal of public health. https:// www.ncbi.nlm.nih.gov/pmc/articles/ PMC4644575/ Centers for Disease Control and Prevention. (2022, January 6). Adults

pulse 11

meeting fruit and vegetable intake recommendations - United States, 2019. Centers for Disease Control and Prevention. https://www.cdc.gov/ mmwr/volumes/71/wr/mm7101a1. htm?s_cid=mm7101a1_w MD, E. S. (2022, September 18). Nutritional psychiatry: Your brain on food. Harvard Health. https://www. health.harvard.edu/blog/nutritional-psychiatry-your-brain-on-fo od-201511168626 Libretexts. (2023, January 17). 14.1A: Comparing the somatic and Autonomic Nervous Systems. Medicine LibreTexts. https://

med.libretexts.org/Bookshelves/ Anatomy_and_Physiology/Anatomy_and_Physiology_(Boundless)/14%3A_Autonomic_Nervous_System/14.1%3A_Introduction_to_the_Autonomic_Nervous_ System/14.1A%3A_Comparing_the_ Somatic_and_Autonomic_Nervous_ Systems#:~:text=autonomic%3A%20 Acting%20or%20occurring%20 involuntarily,sight%2C%20hearing%2C%20and%20touch Schmitt, J. (2020, August 20). Nondairy milks: How nutritious are they?. Trinity Health. https://www. trinityhealth.org/non-dairy-milkshow-nutritious-are-they/

Unveiling the Genetic Menu: Exploring the Future of Nutrigenomics and Personalized Diets

By Amiti Goel Edited By Emnet Djibrila Have you ever pondered why one-size-fits-all diets always seem a bit off the mark? Picture a world where your distinctive genetic code holds the key to a personalized menu meticulously crafted to keep your body in optimal health. Welcome to the frontier of nutrigenomics, where your DNA becomes the recipe for a healthier, more individualized relationship with food.

Nutrigenomics is the study of how your individual genetic makeup influences how your body responds to the food you eat, guiding personalized nutrition plans for optimal health (Farhud et al.). It represents the study of how individual genetic variations influence responses to diet, standing at the forefront of personalized healthcare. The intricate relationship between genetic variations and diet is being slowly unraveled by current technology, revealing a dynamic shaping of how our bodies process and utilize nutrients. Grasping this interaction expands the scope of personalized medicine, particularly in nutritional medicine, tailoring dietary plans to individual genetic predispositions.

The field of nutrigenomics is crafting personalized nutrition plans based on an individual’s genetic makeup and lifestyle choices.

Individual genetic variations play a pivotal role in determining how

our bodies metabolize and respond to various nutrients (Franzago et al.).

Certain genes exert a more significant influence on dietary response compared to others in the human genome. Most notably, the FTO gene, often associated with obesity, influences body weight and fat mass regulation, highlighting its significance in understanding individual responses to nutrition and emphasizing the importance of incorporating genetic information into personalized dietary plans (Franzago et al.). Understanding how this gene is expressed and its prevalence in the human population is crucial for comprehending how our bodies respond to and utilize nutrients in the diet. The integration of genetic information into personalized nutrition plans ensures a more precise and effective approach to meeting individual nutritional needs.

Another gene associated with genetic variants and dietary responses is MTHFR (Fu et al.). Both the MTHFR and FTO genes can induce or repress gene expression, altering the genes expressed and the directions processed during cell actions (Farhud et al.). Additionally, single nucleotide polymorphisms (SNPs), the most common genetic variation, can alter the bioactivity of critical metabolic pathways, influencing the ability of nutrients to interact with them (Farhud et al.). Genetic testing for these genes and their expression in the body provides valuable insights into how individuals metabolize nutrients, but scientists are still unraveling the mechanisms and implications.

Understanding the specific genetic mechanisms behind nutrigenetics will pave the way pulse 12

for creating tailored nutrition plans based on individual genetic information. Healthcare professionals will be better equipped to guide individuals through nutrigenomic interventions, ensuring that dietary recommendations align with genetic predispositions (Guest et al.). It sheds light on variables not previously considered when offering dietary advice, enhancing the benefits of healthcare on individual health. The advantages of specialized diets, compared to the standard plans commonly suggested by healthcare professionals, are evident in improved health outcomes and better adherence.

pulse 13

Currently, there are potential challenges in conducting these recommendations. The scope of nutrigenomics is limited as of now, meaning these recommendations cannot be provided on a broader scale, and public health initiatives will take time to develop. Addressing these challenges requires developing strategies that incorporate nutrigenic insight into public health policies as a method to promote disease prevention and overall well-being.

In the future, nutrigenomics can flourish with the introduction of more advanced technologies that have the potential to enhance

precision in personalized nutrition plans. This will shape the future of healthcare practices and broaden the field of nutrition’s scope. Nutrigenomics, in a sense, represents a paradigm shift in healthcare, from standardized care to a personalized approach to nutrition that can significantly improve individual health and well-being. More research needs to be done to further understand the specific mechanisms of nutrigenomics and integrate these insights into mainstream healthcare practices, ensuring a healthier and more tailored approach to nutrition for everyone.

Emerging Technologies in Healthcare: AI-powered Diagnostics, Telemedicine, Wearable Health Devices, and Robotics in Surgery

By Hermela Selam Edited By Ella Chen Emerging Technologies in Healthcare: Revolutionizing Patient Care In the ever-evolving landscape of healthcare, technological advancements play a pivotal role in transforming the way we approach diagnostics, patient care, and medical procedures. This article explores four key emerging technologies that are reshaping the healthcare industry: AI-powered diagnostics, telemedicine, wearable health devices, and robotics in surgery.

learning models can swiftly identify access to healthcare services. With anomalies in medical images, aiding the ubiquity of smartphones and radiologists in detecting conditions such high-speed internet, patients can as cancer or fractures with unprecenow consult with healthcare prodented accuracy. The ability of AI to sift fessionals remotely, reducing the through extensive data quickly not only need for physical visits to healthexpedites the diagnostic process but also care facilities. reduces the chances of human error.

Especially significant in rural AI-powered Diagnostics: UnMoreover, AI is not confined to static or underserved areas, telemedleashing the Potential of Artificial diagnostics; it is increasingly being icine facilitates timely medical Intelligence utilized in dynamic assessments. Predic- consultations and follow-ups.

Artificial Intelligence (AI) has tive analytics powered by AI can analyze Patients with chronic conditions emerged as a game-changer in patient data to identify individuals at can benefit from regular virtual healthcare diagnostics, revolutionrisk of specific conditions, allowing for check-ins, ensuring continuity of izing the accuracy and efficiency targeted preventive interventions. This care without the logistical chalof medical assessments. AI algoproactive approach to healthcare holds lenges of frequent hospital visits. rithms, trained on vast datasets, the promise of reducing the overall bur- The integration of telemedicine can analyze medical images, pathology reports, and patient reden of diseases and improving popula- into healthcare systems not only cords at a speed and precision that tion health. enhances accessibility but also surpass human capabilities. This promotes preventive care and early not only expedites the diagnostic Telemedicine: Bridging Gaps in intervention. process but also enhances the early Healthcare Accessibility detection of diseases.

Furthermore, telemedicine AI-powered diagnostics have Telemedicine has emerged as a extends beyond consultations to proven particularly effective in include remote monitoring of transformative force, breaking down fields like radiology. Machine patients. Wearable health devices, geographical barriers and increasing pulse 14

discussed later in this essay, can transmit real-time data to healthcare providers, enabling them to track patients’ vital signs and make informed decisions about their care. This holistic approach to remote healthcare delivery has proven particularly valuable during global health crises, ensuring ongoing care while minimizing exposure to infectious diseases.

valuable insights into lifestyle trends, disease prevalence, and the effectiveness of public health interventions.

Harnessing this data has the potential to shape more targeted and personalized healthcare approaches, optimizing resources and improving health

The benefits of robotics in surgery extend beyond the operating room. The minimally invasive nature of robotic procedures often results in shorter hospital stays, quicker recovery times, and reduced post-operative pain for patients. Surgeons, aided by robotic systems, can perform intricate procedures with greater control and visualization, pushing the boundaries of what was once deemed surgically possible.

Wearable Health Devices: Empowering Patients with Real-time Data The advent of wearable health devices marks a paradigm shift in patient engagement and monitoring. From fitness trackers to smartwatches equipped with health sensors, these devices provide individuals with real-time data about their well-being. The continuous monitoring of vital signs, physical activity, and sleep patterns enables users to take a proactive approach to their health.

Wearable health devices are not only empowering individuals but are also proving instrumental in preventive healthcare. For instance, they can alert users and healthcare professionals to irregularities in heart rate or detect patterns indicative of potential health issues.

This proactive monitoring allows for early intervention, reducing the severity of certain conditions and preventing complications.

Moreover, the data generated by these devices contributes to a wealth of information that can inform population health strategies.

Aggregated and anonymized data from wearable devices can provide pulse 15

outcomes. Surgeons can navigate intricate anatomical structures with greater precision, reducing trauma to surrounding tissues. Additionally, robotics allows for remote surgery, enabling expert surgeons to operate on patients located in different geographical locations.

Conclusion: A Technological Renaissance in Healthcare outcomes on a broader scale.

Robotics in Surgery: Precision and Innovation in the Operating Room The integration of robotics in surgery represents a significant leap forward in the precision and safety of medical procedures. Robotic surgical systems, controlled by skilled surgeons, offer enhanced dexterity and precision, minimizing invasiveness and accelerating recovery times. These systems typically involve a console where the surgeon sits, a robotic arm system, and specialized instruments.

In procedures ranging from minimally invasive surgeries to complex interventions, robotics has demonstrated its ability to enhance

The convergence of AI-powered diagnostics, telemedicine, wearable health devices, and robotics in surgery heralds a new era in healthcare. These technologies are not just tools; they represent a profound shift in how we approach healthcare delivery, diagnostics, and patient engagement. As these technologies continue to mature, their collective impact is likely to redefine healthcare systems worldwide, making them more accessible, patient-centric, and technologically advanced. Embracing these innovations is not merely an option but a necessity as we navigate the complexities of modern healthcare and strive for a healthier future.

Universal Health Coverage in the U.S.: The Surrounding Debate

By Hunter Bershtein Edited By Michelle Lu

Universal Health Coverage (UHC) is a health coverage policy where people have access to the full range of quality health services they need, regardless of when and where they need them, and without financial burden. Nearly all the wealthiest countries have adopted a UHC system, with the exception of the United States.

Instead, the U.S. currently has a mixed healthcare system.

Private or market-based insurance coverage accounts for most of the coverage in the U.S. Private insurance is sometimes paid fully out-of-pocket but usually subsidized by employers. On the other hand, public, government-funded

programs, such as Medicare and Medicaid, provide a small amount of public coverage for those who would otherwise not be able to afford quality medical services. Medicare coverage is structured to help those over 65, while Medicaid coverage is designed for those with low income.

Although Medicaid usually covers anyone whose household income falls below 138% of the federal poverty line, some states have additional age, family, and disability requirements.

In addition to the low-income requirement, for 10 of the 50 states, you must be 65 or older, under 19, pregnant, living with a disability, or an adult caring for a child to qualify for Medicaid. These ten states are known

as states without Medicaid expansion.

Private, market-based health insurance is expensive, with an average out-of-pocket cost of $5,724 per year for an individual plan, as reported in a 2023 USA Today article. As such, most people who rely on private health insurance have employer-sponsored plans, which have an average outof-pocket cost of $1,401 per year, as reported in the same article. According to The Professional Society for Health Economics and Outcomes Research, in 2019, 6% of U.S. citizens received coverage through private health insurance not provided by an employer, while 50% pulse 16

of U.S. citizens received coverage through private health insurance provided by an employer. Regarding public coverage, 20% of U.S. citizens relied on Medicare, 14% on Medicaid, and 1% on other public forms of insurance, such as those for veterans. These numbers leave 9% of Americans uninsured.

The Kaiser Family Foundation, a non-profit healthcare research organization, conducted a national survey and found that most uninsured people do not have health coverage because they cannot afford it or are not eligible. This gap exists because many people are too rich to qualify for Medicaid but too poor to afford market-based coverage.

Further, in states without Medicaid expansions, many adults whose household incomes fall below 138% of the poverty line are ineligible for Medicaid because of the additional age, family, and disability requirements.

This ineligibility gap in coverage is known as the Medicaid gap and accounts for over 2 million uninsured adults alone.

Along these lines, differing versions of UHC exist to fill such a coverage gap. The U.K. employs a fairly traditional model, with few options for and minimal use of privatized care.

On the other hand, European countries like Switzerland, the Netherlands, and Germany have blended systems with substantial government-funded and market-based components. It does not matter where the coverage comes from. As long as a nation provides quality care to all its citizens, it achieves the goal of pulse 17

UHC. Since private health insurance is already so prominent, a blended UHC system would likely fit the current U.S. healthcare coverage structure better than an entirely government-funded one.

There is significant pushback against UHC from private health insurance companies, even if it includes market-based coverage.

Switching to UHC would mean that the government decides the baseline for what must be covered by health insurance. Health insurance compa-

nies like to have the option to deny services that they do not deem medically necessary to maximize profits.

Higher government regulation of health insurance coverage in a UHC system would limit this decisive power.

The Organization for Economic Co-operation and Development (OECD) is an intergovernmental organization that includes 38 high-income, highly developed countries. According to the OECD, UHC provides better health outcomes at a lower cost than the mixed coverage system in the U.S. Based on data from the 38 OECD countries,

the U.S. life expectancy at birth is nearly three years lower than the OECD average. The U.S. also has an average of 336 avoidable deaths per 100,000 people, whereas the OECD average is 225, the highest of the OECD members. Further, the obesity rate in the U.S. is nearly double that of the OECD average, and adults in the U.S. are the most likely to have multiple chronic conditions out of any of the 38 OECD countries.

Yet, perhaps surprisingly, the U.S. spends nearly twice as much of its GDP on healthcare compared to other OECD countries, a whopping 17.8% compared to the 9.6% OECD average. These additional costs are primarily due to the administrative costs of running private insurance companies, increased expenditure on prescription drugs since prices are market-driven, and wages for physicians and nurses, which are higher in the U.S. than in other OECD countries.

With many other wealthy countries providing cheaper and better health care through UHC, one might wonder why the U.S. still uses a mixed coverage system. Though the statistics above suggest that UHC offers better health outcomes for citizens, there are still avid critics and proponents of implementing the UHC plan in the U.S. Most wealthy, westernized nations have adopted a UHC model.

However, none are as geographically large, populous, and ethnically or racially diverse as the U.S. Due to cultural values, varying climates, and population densities, different regions of the U.S. come with distinct health needs and logistical challenges in implementing UHC. Reproductive care and women’s health are good examples of medical

fields with apparent state-to-state differences. All-cause mortality for women of reproductive age (15 to 44) is a standard metric for women’s health. In a report by The Commonwealth Fund, a research organization that aims to improve the performance of the U.S. healthcare system, in 2021, the state with the highest allcause mortality for women ages 15 to 44, West Virginia, was nearly triple that of Hawaii, the lowest-ranking state. Twelve of the 15 states that ranked lowest for reproductive care and women’s health have restrictive abortion laws and fewer maternal care providers on average. To implement UHC in the U.S. states lacking in reproductive care and women’s rights would need additional funds to increase the number of providers. Further, reproductive care and women’s rights would need to become a federal rather than a state issue, a legal transition that would take time and accrue administrative costs. Women’s health is one of many healthcare issues that differ from state to state. As such, critics of UHC in the U.S. argue that the implementation would not be feasible, organizationally or financially, as it is in smaller, more homogenous nations.

Indeed, implementing UHC in the U.S. would come with high upfront costs. The government would need funds to cover the infrastructure changes required to provide health services to a larger sector of the population, insuring and treating a previously uninsured and largely unhealthy segment of the population, and expanding the range of services provided to include services like dental, vision, and hearing. In a paper published in Medicina by Zieff et al. 2020 that analyzes the debate surrounding the implementation of

UHC in the U.S., a recent proposal suggested that a 7.5% payroll tax plus a 4% income tax on all Americans, with higher-income citizens subject to higher taxes, would be required to implement UHC in the U.S. However, other studies suggest that more than these proposed taxes would be necessary, with cost estimates ranging from 32 to 42 trillion across the first ten years, with 1.1 to 2.1 trillion needed to maintain UHC annually after the first decade. Although the upfront cost would be very high considering the current coverage gap in the U.S., the annual expenditure would eventually fall to rates similar to other OECD countries, around 3000 to 6000 USD per capita.

For the average American, switching to UHC would cost less than paying out-of-pocket for private coverage; however, for the highest earners in America, UHC would incur higher costs than private

coverage. As such, a tax increase would put the majority of healthcare costs on the wealthy, an unwelcome change that some would describe as government overreach.

Another argument against implementing a UHC plan in the U.S. is general system inefficiency, resulting in longer patient wait times. The Zieff et al. 2020 paper also indicated that Canadians were on the waiting list for over 1 million procedures, and the median wait time for arthroplasty (joint-restoring) surgery was 20-52 weeks. In the U.K., the average waiting time for elective hospital-based care was 46 days, with some patients waiting over a year. At least in the short term, implementation of UHC in the U.S. would lead to an increase in wait times. Wait times are a function of the number of patients seeking care and the number of available appointments. As such, eliminating

pulse 18

the financial barrier to seeking care would result in an immediate influx of primary and emergency care visits.

Without increasing the number of doctors and hospitals, wait times are bound to shoot up. Luckily, most experts agree that provider supply will increase in the long run to meet provider demand, but it is hard to estimate how long this adjustment will take.

Some policymakers suggest that the government should intervene to help provider supply adjust more quickly. Two such suggestions are to expand the scope of practice for nonphysician providers and increase pay to incentivize primary care providers. Expanding the scope of practice allows nonphysician providers such as advanced practice registered nurses (APRNs) to conduct laboratory tests, prescribe drugs, and teach and counsel patients. APRNs are authorized to perform such services based on their training, but state regulations currently deny the ability to practice such independence and prescriptive authority. Increasing pay means raising the salary for care providers so more people enter the field, thus increasing the supply of care. Policies such as these would increase the supply of healthcare and medical services to compensate for the influx pulse 19

of patients seeking care due to UHC implementation and help reduce wait times to baseline levels faster.

On the other hand, proponents of implementing UHC in the U.S. argue that UHC would help fight against the growing chronic disease crisis, mitigate costs associated with this crisis, reduce health disparities related to socioeconomic status (SES) and other identifies such as race and ethnicity, and increase opportunities for preventative health initiatives.

Chronic diseases, such as cardiovascular diseases and type II diabetes, take a heavy toll on the nation’s economy. Low SES is associated with many unfavorable health determinants, such as decreased access to and quality of health insurance, which ultimately leads to worse health outcomes on average for low SES individuals. For example, low SES diabetics are at a higher mortality risk, and uninsured diabetics account for 55% more emergency room visits than their insured diabetic counterparts. Individuals with uncontrolled high blood pressure, which disproportionately affects the low SES population, have more than 2000 USD greater annual healthcare costs than their counterparts with normal blood pressure. Lastly, the cost of obesity, another disease that disproportion-

ately affects low SES individuals in the U.S., costs the nation an estimated 66 billion annually, as per conservative estimates. As such, UHC in the U.S., including preventative care measures, could improve the overall public health of the U.S. and decrease the economic strain associated with unhealthy low-SES individuals in the long run.

Although they incur upfront costs, preventative care measures lessen the cost associated with uninsured, unhealthy populations. According to a literature review by Trust for America’s Health, a non-profit organization dedicated to community health, investing 10 USD per person annually in community-based programs to combat physical inactivity, poor nutrition, and smoking could save more than 16 billion USD annually within five years, equating to a return of 5.60 USD per dollar invested. While UHC does not guarantee the enactment of preventative care measures, it would encourage investment in low SES communities because reducing chronic conditions and poor health outcomes in this population would reduce the tax burden required to fund UHC in the U.S. By promoting healthy lifestyle behaviors such as increased exercise and better nutrition, improving en-

vironmental factors such as preserv- commonwealthfund.org/publicaing more green spaces in low-income tions/issue-briefs/2023/oct/high-uscommunities, and developing polihealth-care-spending-where-is-it-allcy-based interventions such as ban- going. ning sweetened beverages in public schools, we as a society could reduce “How much does health insurthe national financial burden UHC ance cost in 2023?” USA Today, implementation would incur on the 2023. https://www.usatoday.com/ richer, generally healthier population. money/blueprint/health-insurance/ Although many high-income, how-much-is-health-insurance/#:~:developed nations have implemented text=On%20average%2C%20a%20 UHC, the U.S. still provides health single%20person,spending%20to%20 care in a mixed system. Implement- meet%20your%20deductible. ing UHC in the U.S. would incur high upfront costs funded at least “Medicaid & CHIP.” HealthCare. partly by the richer sector of the gov, 2023. https://www.healthcare. population and increase wait times gov/medicaid-chip/medicaid-expanin the short run due to an influx of sion-and-you/. patients requesting care. However, UHC would also ultimately improve “The Medicaid Coverage Gap: public health outcomes and mitigate State Fact Sheets.” Center on Budget health inequities in the long run. Fur- and Policy Priorities, 2023. https:// ther, it would be possible to reduce www.cbpp.org/research/health/ the cost burden with time by enacting the-medicaid-coverage-gap#:~:texpreventative care measures, especially t=Over%202.1%20million%20unin low SES communities. While an insured%20adults,t%20enacted%20 ideal UHC system would be better ACA%20Medicaid%20expansion. for the nation’s public health, implementation comes with many logisti“The Truth on Wait Times in Unical, financial, and cultural barriers to versal Coverage Systems.” The Center overcome. for American Progress, 2022. https:// www.americanprogress.org/article/ Sources: truth-wait-times-universal-coverage-systems/.

“California could become first US state to offer universal healthcare “U.S. Health Care from a Globto residents.” The Guardian, 2022. al Perspective, 2022: Accelerating https://www.theguardian.com/usSpending, Worsening Outcomes.” news/2022/jan/11/california-univer- The Commonwealth Fund, 2023. sal-healthcare-bill-residents#:~:texhttps://www.commonwealthfund. t=The%20insurance%20industry%20 org/publications/issue-briefs/2023/ and%20business,but%20the%20low- jan/us-health-care-global-perest%2Dearning%20Californians. spective-2022#:~:text=In%20 2021%2C%20the%20U.S.%20%20 “High U.S. Health Care Spending: spent,higher%20than%20in%20 Where Is It All Going?” The ComSouth%20Korea. monwealth Fund, 2023. https://www.

“UnitedHealthcare Tried to Deny Coverage to a Chronically Ill Patient.

He Fought Back, Exposing the Insurer’s Inner Workings.” ProPublica, 2023. https://www.propublica.org/article/ unitedhealth-healthcare-insurance-denial-ulcerative-colitis.

“Universal Health Care.” Gale Opposing Viewpoints Online Collection, 2019. https://www.gale.com/open-access/universal-healthcare.

“Universal health coverage.” World Health Organization, 2023. https:// www.who.int/health-topics/universal-health-coverage#tab=tab_1.

“Universal Healthcare in the United States of America: A Healthy Debate.”

Medicina, 2020. https://www.ncbi.nlm. nih.gov/pmc/articles/PMC7692272/.

“What are Medicare & Medicaid?”

Medicare.gov, 2023. https://www. medicare.gov/Pubs/pdf/11306-Medicare-Medicaid.pdf.

“What Happens If You Don’t Have Health Insurance?” Forbes Advisor, 2022. https://www.forbes.com/advisor/ health-insurance/what-happens-ifyou-dont-have-health-insurance/#:~:text=People%20%20often%20 don’t%20%20have,Coverage%20 not%20affordable%3A%2073.7%25 “What is Private Health Insurance?” EHealth, 2023. https://www. ehealthinsurance.com/resources/ individual-and-family/what-is-private-health-insurance#:~:text=What%20is%20private%20insurance%3F,half%20of%20the%20 U.S.%20population.

pulse 20