It' s done: our second edition Osmosis ha s officially lived for one year. We have seen a lot happen this pa st -=--= 111 ::ic:1 year and one thing is for certain, this publication is important. Now , more than ever , scientific lit e racy , journali s m, and general curiosit y ar e und eniabl y vital. The writers have created and the Osmo sis team has craft ed s om ething we are proud of and s omethin g that adds to our collective history here at UR. Sure , it's going to be hard to move on and pass over something we have pour ed so much pas s ion and time into. But we didn 't mak e this for us ; it' s for UR forever.
Much Love, Alex & Nicole
Executive Board
•Contents•
ENVIRONMENTAL ISSUES
food deserts in Richmond: left out to dry Jessica Conwa_y
is birth control harming the environment?
1l1i,;.~ySchrott
PUBLIC HEALTH
Michelle Obama:
28 30 moving towards childhood 4 obesity solutions I an Gallagher
you reap what you sow: herbicide atrazine linked to 14 cancer
Jv/ary Burns
misconceptions about anxiety
An,ii e R yan
the elephant in the room: why don't the largest animals get cancer?
Abigail l Vatter.wn
16
MEDICAL INNOVATIONS
beyond the bandage: 6 a look at the innovations in severe burn care
Adriana Grim es
reinventing drug delivery: microneedle technology
1Viam h Sutlierburg
GeneSite Ra ch el Bring ewatt
NEUROSCIENCE .
12 26 prions: S combating an agent of death .lus tinAi ras shedding light on optogenetics Car ew B artley
20
is there more to big pharma 24 than its big profits?
Dana il1orcillo
Michelle Obama
Movingtowardschildhoodobesitysolutions
By Ian Gallagher
Efil
hroughout the Obamas time in office, appro val rati ng s U made it clear the most popu lar Obama was not the man in the Oval Office. First Lady Michelle Obama consist ently received higher approval ratings than her husband during his time in office This could be attributed to her strong devotion to her fami ly and her appearance as a genuinely good and caring person. During her time in office she drew the attention of the public by shedd ing light on on e of the worst health epidemics currently afflicting the country: childhood obesity.
Current State
Childhood obesity is unlike other health epidemics that are common ly discussed. It does not st rike qui ckly, nor doe s it have the shock factor that catches th e eye of th e media like Zika and Ebola outbreaks. Childhood obesity, rat h er, has become increasingly problematic, and has now reac h ed a point where it is be gin ning to be r ecognized as a serio u s health issue for thi s country The prevalence of childr en between the ages of 6 and 11 with a BMI (body-mass index) in the 95th percentile or higher has increased from 4.2% in 1963 - 1965 to 15.3% in 1999 - 2000 2 and has continued to in crease. Th ere are obvious negative implications for the health of the yo un gest generatio n of Americans.
Obesity correlate d with premature death 2 (death is considered premature if before the age of 55) and depression 3 among sc h ool-age children . These are two hea lth concerns that stand out the most, but obesity has be en linked to numerous oth er mental and physical hea lth pr oblem s as well.
What Michelle Obama Did
Obesity, specifically childho od obesity, has become a probl em so in grained in American soc iety that it is not somethi ng that can be addressed simp ly o r over a short period of time. In an attempt to make strides t owards ta cklin g thi s problem, Michelle Obama used her platform as first lad y t o s ta1t th e Let's Move! initiative , a campaign aimed at reduci ng child hood obesity by encouraging healthy lifestyles in children. 4 The initiative listed five goals it ai m ed to accompli sh: creatin g a h ealth y start for child ren , empowering parents and caregivers , providing h ealt hy foods in schools, improving access to healthy foods, and increasing physical activity.
Measuring the success of a program such as thi s is difficult. With its long term-goals and many moving pieces, there is n o easy way to track its progress. During the Obama family's time in office, childhood obesity rates h ave fluctuated, but t h ey h ave not gone down significantly.5 The lack of measurab le success has been one of the prima ry po ints of criticism of the program.
Moving Forward
Though it is difficult to measure, there is no denying that t he Let's Move! campa ign addresses some of th e key issues causing childhood obesity in this country . Studies h ave shown the importance of school- ba sed programs for ch ildren's health, 6 so the program 's goals of providing children with healthy scho ol lunches is of great importan ce The pro gram also aims to in crea se phys ical activity at school s, where children s pend the majori ty of their day Physical activity has been linked to numerous health
benefit s in chi ldren 7 and h elps maintain a lifestyle counteractive to obesity.
Childhood obesity is a r eal prob lem in this country, a nd it is not going away anytime soon. It is an issue that needs to be dea lt with more proactively an d l ess reactively. Althou gh they are not final s olutions , the steps ta ken by former First Lady Michelle Obama were crucial for laying the groundwork for future policy decisions and bringing attentio n t o thi s pressing nati onal health ep idemic.
References
1 "Obama Leaves Office on High Note, but Public has Mixed Views of Accomplishments " Pew Research Center., last modified Dec 14, http://www people-press.org/2016/12/14/obama-leaves-office-on-high-notebut-public-has-mixed-views-of-accomplishments/.
2 Franks Paul W. Robe1t L Hanson, William C. Knowler Mamice L. Sievers, Peter H. Bennett , and Helen C. Looker. 2010. "Childhood Obesity Other Cardiovascular Risk Factor s , and Premature Death ." The New England Journal of Medicine :~62(6): 485 -493. doi:10.1056/NEJMoao9041;w. http://coutent.nejm.org/cgi/ content/abstract/ 362/6/ 485.
3 Sjoberg, Rickard L., Kent W Nilsson, and .Jerzy Leppe1t. 2005. "Obesity, Shame, and Dep ression in SchoolAged Children: A Population-Based Study." Pediat rics 116 (3): e392 doi:10.1542/peds 2005-0170 http:// pediatrics aappubl ications.o r g/ cgi/ content/ abstract/ 116/ 3/ e389.
4 The White House. "Let 's Move! Know the Facts. " https://letsmove obamawhitehouse archives.gov/learnfacts/ epidemic -childhood -obesity
5 Ogden, Cynthia L. Margaret D. Carroll, Cheryl D. Fryar, and Katherine M. Flegal. 2015 "Prevalen ce of Obesity among Adults and Youth: United States , 20 11-2014 ." NCHS Data Brief (219) : 1. http://www.ncbi nlm. nib.gov/pub med / 266330 46.
6 Birch, L. L. and A K Ventur a. 2009 "Preventing Childhood Obesity: What Works?" Int ernational ,Journal of Obesity 33 (S1): S81. doi:10.1038/ijo 2009.22 http:/ / dx.doi.org 10.1038/ ijo.2009.22.
7 Jan ssen, I an a n d Allana G. Leblanc. 2010. "Syst ematic Review of the Health Benefit s of Physi cal Activity and Fitness in School-Aged Children and Youth ." The International Journal of Behavioral Nutrition and Physical Activity 7 (1): 40 doi:10 1186/1479-5868 - 7-40. http: //www .ncb i.nim nih.gov/pubmed/20459784.
Beyond the Bandage
AlookattheinnovationsinSevereBurnCare
By Adriana Grimes
fi) urns regularly occur in everyday life and minor W burns are commo n while cooking , using househ old tools, or from sources of heating. Unfortunately, each year 45,000 people receive burns so severe that their treatment requires hospitalization. 1 Burn seve rity is ranked on a scale of 1 to 3, and so m etim es 4, though there is some debate about the fourth degree burn classification.2 First degree burns are minor with little to no scabbing and can be a result of s unburn or minor exposure. Second d egree burn s completely damage the epid ermis (the first layer of skin) and cause pain, bleeding, and blisters. Third degree burn s damage the top two layer s of skin down to the fatty tissue. Fourth degree burns are an extension of a third d egree burn that results in damage down to the muscle and bone. 2 First degree burns require little intervention, and second degree burns require only minor intervention s depending on the circumstance.
On the other hand, third and four th degree burns require se ri ous interventi on and often surgery The typical treatment is excision of the dead tis s ue followed by a sk in graft over the burn.
2 The most common grafting procedure takes a section of epidermis from the back of the thigh and pun ch holes in it so the skin becomes meshlike, which allows the section of skin to cover a greater area. The skin graft is then sutured around the wound and covered with stan da rd dressings. 2 Thi s treatment is insufficient if the burnt area is especially large where a skin graft may not be able to cover the entire extent of the injury. 2 3 Skin grafts also create an additional wound on the patient because the skin is harvested from the patient them selves.
4 Standard dressing s are not always effective either because they ca n dehydrate burn wounds, which ar e already at risk of desicc ation.
2 4 Deh ydra tion is common in burn wounds because a large area of the epidermis is damaged which prevents the regulation of water los s. Recen t developments have been made to get around some of these obstacles.
Synthetic Substitutes to Skin
Synthetic su b s titute s can be used in place of skin grafts harvested directly from the patient. They can be either fully syn thetic or partially syn thetic with some compo n ents of human tissue. 4 These substitutes are made of polymers and provide a scaffold for skin to regrow around. 4 The synthetic skin substitutes are put in place just as a skin graft would be, except th ey are usually not meshed. Some common types of su bstitutes are Integra -rM, which is an artificial skin composed of collagen and overlaid with silicone. 4 Another common type, Biobane™, is a biosynthetic sk in subst itute made of silicone, nylon, and collagen. 4 Another natural option is Alloderm-r~i,which is
an acellular dermal graft, made of human dermis where all the cellular material removed. 4 Skin subs titute s are favorable in treating especially lar ge burns or when availability of skin to graft is limited.a , 4 Substitutes also do not produce a seco nd wound. 4 Unfortunately, synthet ic substitutes incur much greater costs than patient s l~i. Il gr afts; p re v,en ting :.ome people from taki ng advantage of thi s option. 4
Hydrogel
Hydr ogels are a possible alternative to sta ndard gauze and other similar types of wound dressings. They can either be in gel or shee t form, although for severe burn s, hydrogel in a sheet is the mo st effective.4 Hydrogel s help prevent dehydration of the burn because they contain 7090% water and will not dehydrate in air. 4 They are also nonreactive and nonirritating to human tissue. 4 Becaus e of their high water content , hydrogels will not adhere to the wound s urfa ce, thereb y reducing pain on removal. 4 Bi-layered h ydrogels containing chitosan and wate r can
typically stays on for longer periods of time as compared to th e traditional dressings, so it requires less ph ys ician visits. 7
These ar e all amazi ng innov ati on s for the treatm ents of burns and other wounds that can greatly reduce the pain of patient s and the potential for mortality. Ho wever, these advances do have some drawbacks, as also b e used to help with skin regeneration, not just as a cover up. 5 At the moment though, thi s ha s only been shown in veterinary stud ies on pigs. 5
Altrazea}TM
...hydrogels will not adhere to the wound surface, thereby reducing pain on removal. Bi-layered hydrogels containing chitosan and water can also be used to help with skin regeneration ... they can be expensive and are not ideal for every wound or burn. There is Altrazeal is a brand new form of wound dressing. Altrazeal begins as a powder made of N anoflexTMmaterial. 6 Nanoflex ™ is dry befo re application and remains in powder form. When the powder come s in contact with the wound exudate, or inflammatory fluid , it hydrates, and the particles come t ogether and seal arou nd the wound. 6 This type of dressing is beneficial to burns because it neither drie s out nor overly hydrates the burn. Patients report pain relief on application and no pain on r emoval of Altrazeal. 6 Altra zeal can not be used on wounds with no exudate, as the re is nothing to facilitate the formation of the gel. 6 For burns with exudate though , there are significant savings. Altrazeal also
References
still a lot of research to be done in this area to mo st effectively treat patient s with seri ou s burn injuries. Advances like Altrazeal exemplify the potential for new technologies to provide increased cost efficiency and effectiveness for burn treatments. Continuing to look for new advances in burn subs titutes is essential to the sa fe and effective treatment of these highl y painful injurie s.
t "Adult Burn Fact Sheet " The Burn Foundation. The Burn Foundation, 2017. Web. os Feb. 2017. <http: //w ww.burnfoundation.org / programs / resource.cfm?c=1&a=11 >
2 Alharbi, Z., A. Piatkowski, R. Dembinski , S. Recko1t, G. Grieb, J. Kauczok, N. Pallua. Treatment of burns in the first 24 hours: simple and practical guide by answering 10 questions in a step-by-step form. World J of Emergency Surgery. 2012. 7=13.
3 ISBI Practice Guide lines Committee. ISBI Practice Guidelines. Burn s 20 16. 42: 953 - 1021.
4 Boateng, J.S., K.H. Matthews , H.N.E. Stevens, G.M. Eccleston. Wound Healing Dressings and Drug De livery Systems : A Review ,J.of Pharm. Sci. 2008 97: 2892-923.
5 Boucard, N C Viton, D. Agay, E. Mari, T. Roger, Y. Chancerelle , A. Domard. The use of physical hydrogels of chitosan for skin regenera ti on following third-degree burns. Biomaterials 200 7. 28: 3478-488
6 " Bums. " Altrazeal. U LURU, In c., 2008. Web. 08 Feb 2017.
7 ULURU Inc. " Ini tia l Pharmacoeconomic Data Demonstrates Cost Benefits of Altrazeal@ " PR Newswire. Cision, 7 Apr. 2014 Web 08 Feb. 2017.
Prions:
Combating an Agent of Death
By Justin Airas
Imagin e a fatal disease that you can h ave for up to decade without even knowing. From something as sim ple as enjoying a steak or hamburger yea r s ago, you could have contracted an incurable disease 1 th at will mak e you live t h e r est of your da ys in a painful, Alzh eimer's- like s tate. 2 The on ly treatmen t options s low disease pro gress ion an d ea se so me of the p ain. Until Decem ber of la st year, th is disease- cau s in g agent could not be accurately d et ecte d until an autopsy was p erforme d. 3 Wor se yet , becau se of the d ifficult y to diagnose, thi s dise ase can b e contracted fr om cont act with improperly deco ntamina ted hospital medical supplies . 4 Thi s agent of death is not , howeve r , the
tia, muscl e spas ms, a nd difficulty walking until d eath d u e to deg eneration of the neurons . 2 Whil e prions take the form of m any diseases s uch as kuru and scrap ie, the mo st comm on ly known disease is Bovin e s pongifo r m encephalopathy
Bovine spo ngiform encepha lopathy (BSE), b etter known as mad cow disease , is a fatal , incur abl e dis ease th at cau ses degenera ti on of brain ti ss u e in cows and can b e transmitte d t o humans (in th e form of Cr eutzfe ldt -Jakob Disease and varian t Creutzfeldt-Jakob Disease) throu gh the consumption of contaminated b eef.8 Since its discovery, more than 180,000 cattle hav e been diagnos ed 9 a nd over harbinger of end tim es. Containment efforts and n ew ho sp ital safety regulat ions have proven effective, a nd Prior to [BSE's] discovery, an estimated 460,000-482,000 infected animals were slaughtered for human consumption.
lifted in th e U S. until 2014. Desp ite FDA mod els show ing the ban was hi ghly effective/ 2 it was ultimatel y lifted due t o concerns over its economic impact. 13 While the USDA recalled 40 00 pounds of p ote ntiall y infected beef as rece ntl y as 2014 , and Fran ce reporte d it s first ca se of BSE s ince 2011 la st year14,the re have been no n ew outbreaks. Th e b an effectively kept BSE infected meat from entering the count ry, but add it ional mea s ur es w ere needed t o p reven t th e sp read of BSE already h ere.
To p reve nt infection s contracted withi n healt hcare systems, new s afety precautions were impl emente d. Before the se new regulations , reusa ble su r gical instrument s that had been in con ta ct with high r isk in fective tis s u es such as br ain or eye cou ld transmit prions to h ealt hy patien t s even after s tandard decontamina t ion method s ! 5 Ho wever , s ignifi cant progre ss h as been made. While ther e is no consensus on the b est decontamination p roced u re, was h ing with strong ba ses s uch as sod ium h ydroxide and 100 °C steam bath s ha ve proven effective.16 Simple measure s s u ch as isolatin g equi pment u sed on infected patients , impl eme ntin g ris k-a ssess ment t est s, and disposi n g contaminat ed equ ipm ent have al so prov en h ighly effective.17 The World Health Organ izat ion (WHO) h as also played a major role b y creating an infection control gui de and t eachin g d oct o rs safe care practic es . 18 The combin ed effort s of th ese new mea s u res ha ve wor ked t o drastically cut d own t ransmission within ho spi t a ls.
Add ition ally, p rion t reatm en t is an active field of re se ar ch, and s ome promising treatments have been developed. Small , eas ily admini s tered molecule s th e s ize of ibuprofen , and engineered antib od ie s ha ve proven effective in treating p r ion dis eases in mic e . PRN100 , a modified mous e antibody, h as demon s tr ate d extremely tight b indi n g to human prion proteins.1 9 Exist ing drugs s uch as th e antibiotics t etra cycline and doxycycline ha ve also shown effect iven ess in slo\-ving th e in cubation period of prion s in mic e . In addition, th e antimalaria l d ru g Quinacrin e ha s d emon str ated the ab ility to reduc e the accumulation of prions on h ealt hy neurons. In th e future , gene sile ncin g t echnique s could be used to comp letel y stop th e bo dy's productio n of prions. Transcrip ti on an d tr anslation of gene s coding for prion s could one day be inhibited usi n g m ole cule s th at bind to DNA and mRNA.20 It is eve n spec ulat ed that adv an ces in s tem cell technology could one da y be u se d to he lp d amaged brain tissue recove r.19
For now , p r ions h ave be en contained , but thi s d oes n ot me an th ey won t cause problems aga in. To s top add iti onal out br eaks and to be pr epar ed in the case of anothe r , re se ar ch on diagnostics, drug tre atm ent, and decontami nation ne eds to conti n ue. At the moment , prions are th e agents of t errifyin g disease , but with a continued effort th ey could b ecome n ot hi ng more th an eas ily tr ea table and survivable
1Unit ed Stat es CDC Creutzfeldt-Jakob Disease, Classic (CJD). US Depa1tment of Health and Human Services, 11 Feb 2015 Web 29 Jan. 2017
2"Creutzfeldt-Jakob Disease I Sign s, Symp toms, & Diagnosis. " Alz.org. Alzhe im er's Associat i on, n.d Web 29 Jan 2017.
3Krisch, Jo shua A "Blood Tests for Pri on Disease " The Scientist. December 22, 2016. Accessed March 4 , 2017. http ://www.the- scientist.com /?articles. view/ articleNo/ 4 7841/title/Blood-Tests-for- P1ion-Disease/.
4Austral ia Department of Health Infection Contro l Guidel in es Koehler et a l. Australian National CJ D Reg istry (ANCJ DR) , 13 Apr 2013 Web 29 Jan 2017
5"Timeline: Mad Cow Disease Outbreaks." Center for Food Safety. N.p., n d Web 29 Jan. 2017
6 "What Is a P r ion?" Scientific American. February 18, 2002. Accessed March 04, 2017. https://www.scientificamerican.com/a1ticle/what - is -a-p 1ion-specifica/.
7 Robertson, BSc Sally "What is a Prion ?" News -Med ical.net. July 20, 2015. Accesse d March 04, 2017 http://www.news - med ica l.n et/ h ea lt h /Whatis-a-Prio n aspx.
4.5 million have been destro yed in effo1ts to contain the disease. 10 Prio r to it s discovery , an s igni ficant progress ha s been made toward the development of mo re effective trea tment s . Fir s t di scover ed in 19865 prion s are proteins produc ed nat u ra lly by the bod y's nerv e cells that can for m multiple folded s tructures. 6 In t h e b ra in , prions ac t as a template for the con vers ion of normally folded prot eins into mi sfold ed p ro tein s. The y ar e incredibl y s mall and do not trigger an y sort of imm une response in th e infected 7 After years of accumu lati on, the infected people start to s how sym ptom s of confu sion, disorien tati on, an d memory loss. The se sympto m s rapidl y wor se n , causi n g demen-
8 "Bovine Spongifor m Encephalopathy (BSE), or Mad Cow Disease." Centers for Disease Control and Prevention. February 06, 2015. Accessed March 04 2017. https: //www cdc.gov/p ri ons/bse/.
9"Mad Cow Disease Fast Facts." CNN. Cable News Network, 22 June 2016. Web. 29 Jan. 2017.
1o"Timel ine : Mad Cow Disease Outbreaks. " Center for Food Safety. N.p ., n.d. Web. 29 Jan. 2017.
u "HEALTH I CJ D Deaths may Have Peaked ' " BBC News. BBC 23 Nov. 200 1. Web 29 ,Jan. 2017
es tim ated 460 , 000482 ,0 00 infect ed animals were slaughte r ed for h uma n consumption. u In addition to the hum an health implications, th e outbreak in th e 1990s resulted in lo ss of billions of dollars in the agric ultur al industry; conse qu en tl y, British farmers w er e committing su icide at a rat e of 3 pe r week. 10
Thr ough a compre h ens ive, decades -long multinati ona l effort , BSE was effectively contained. In an attempt to stop th e spread of t he 1990s BSE outbreak , the E U ban n ed exportation of Br iti s h beef, and many oth er count r ies, including J apan and the U.S., b ann ed importation of raw beef from the U .K. and the EU Thi s ban was not
12Michael B Abramson, Ma d Cow Disease : An Approac h to it s Containment , 7 J HEALTH CAREL. & P OL'Y (2004) htt p ://d igitalco mm ons.law umaryland.edu / jhclp /vol7 /iss 2/ s
13Adams, Michael 0 ., and Gbolahan Osho "A Comprehensive Eval uation Of Mad-Cow Disease: Evidenc e From P ublic Administration P erspective." Nat ional Social Science Journal 28, no. 2 (2007): 1-8. Accessed March 4, 2017.
14"Mad Cow Disease Fast Facts ." CNN. Cable News Network, 22 ,June 2016. Web . 29.Jan . 2017 .
15Lumley, John Sp. "The Imp act of Creutzfeldt - Jakob Disease o n Surgical Practice ." The Annals of The Royal College of Surgeons of England 9 0 , no . 2 (2008): 91-9 4. Accesse d March 4, 2017. do i:10 .1308/003588408x261726.
16Mcdonnell, Gerald and Peter Burke. "The Challenge of Prion Decontamination. " Clinical I nfectious Diseases 36 , no. 9 (2003): 1152-154. doi :10.1086/~w4668.
17Australia Departm ent of Health. Infection Control Gu idelines. Koehler et al. Australian National C.JDRegistry (ANCJDR), 13 Apr. 2013 Web. 29 ,Jan 201 7
18"Vari an t Creutzfeldt- Jakob Disease. " Wo r ld Health Organization World Health Or gan izatio n , Feb. 2012 Web. 29 Jan. 2017.
19 "Drug treatments." Prion Clinic - Drug treatments. Accessed March 04, 2017. http ://wv.""'·Prion.ucl.ac.uk/clinic-services/research/drug-treatments /.
20Admin "Wha t are the potential treatment s for prion disease?" What are the potential tr eatme nts for prion disease? Feb ruary 4, 20 14. Accessed March 04, 2017. http: //w ww .pr i ona lliance.org/2014/02/04/wha t - are - th e-potential -tr eatments-for-prion-disease/
Referencces
Shedding Light on Optogenetics
By Carew Bartley
Icientific discoveries are oft e n d escr ib ed as the sudden illumination of a light bu lb. This is a particularly apt metaphor when discussi n g breakthroughs made pos s ible by opt ogenetics, a research techn iqu e that e nabl es neur osc ienti s t s to turn brai n areas on or off with the flip of a li gh t switch. The basis for th is t echn ique's utility comes from a common method of investigating the role of a compo n en t in a sys t em: dis abl e it or ramp up it s function to observe th e resulting cha n ges in the system's behavior. Neuroscientists use this princip l e to link brain regions to fun ct ions through t ech niques such as fMRI, l esioni n g (damag in g to disable function), or electrical and ma gnetic recording /s timulation 1
While these technique s have h elped in l ocali zing and t iming brain functions , they are limit ed in s cope and rid d l ed with drawbacks.
As an exa mple , fMRI does n ot det e ct neuronal activity directly b ut instead detects blood flow in specific brain areas, an indirect and s lower meas ur e of brain a ctivity. Lesio ning i s irrev e r sible and i s therefo r e only used in an ima l mod el s or
meth od is optogenetics , one of th e mo st promising t oo l s in neuroscience today .
Optogenetic s is a technique by which neuronal cells are genet ical ly modified to exp r ess l igh t-sensitive proteins , or opsins. The opsins, which mak e cells vulnerable t o li ght exposure, an d th eir promoter sequences ar e incorporated into target neurons via viruse s carrying t he re qu isi te DNA seque n ces for opsi n expression 2
Opsins a re ideal for contro llin g neuronal beh avior because they are transmembrane ion transporter s tha t respond t o s pecific wavelengths of ligh t Neuron s operate by emitting action p otenti a ls, or el ectri cal pul ses, from their cell bo die s along axons t o other neurons. Th ese action pot e ntials are triggered by a positive s hift i n the neuron's membrane potential , wh i ch is a resu lt of shifting ionic gra di e nt s in response t o s timuli. Thus , by sti mulating a neuron expressing a n opsi n with its corr esponding wavelength of light from a fiber-optic ca bl e, ions can be moved in or ou t of th e cell, generating or inh ibitin g action potentials 2 •
the se two types of op s ins, yielding a powerful method t o inve stigate the casual relationships be t wee n s p ec ific b ra in regio n s and behaviors 4 • Optogenetics h as excit ing promise in research and clinical se ttin gs Intra crania l elect ri cal s timul a ti on of the brain in specific areas, called deep brain s timulation (DBS), h as s ho wn s ignificant the r ape u tic effects for Parkinson 's disease. How ever, it is not clear why thi s technique s h ows s u ch improvements. Using optogenetics in rode nt s, researchers at Caltech ha ve inv esti ga t e d DBS's mechanism of action and found a neural pa th way that seems to be resp on s ib le for DBS's th erapeutic benefits 5 • Researchers can now impro ve th e th era p eu ti c effects of DBS by t a r getin g s timul a tion to this pa th w ay . I ndustry h as seen the potential in optogenetics as we ll Circuit Therapeutics , a company ded icated to tre a t i n g neu ro lo gica l disease , h as used op to ge n e tic s to eliminat e pain in rodents. They inj ect a virus conta in ing th e gene for an i nhibi to ry opsin into one of the animal's nerve s.
The vi ru s s p reads the gene t o sur r oundin g nerve cells up t o the s kin , where it is expressed. By illuminating the ski n with the correct wavelength of light, th e clinicians can activa t e t h e opsin and inhibit the nerve action, r educing the an imal 's sensitivi t y to pain in that area. Their goal is t o t est th e implementation of thi s t ech niqu e in human models to trea t chronic pain. Optogenetics provides a fine -grained method to stu d y neural mechanisms a nd elec troph ysio l ogical te ch niqu es by turning ind i vidu al neurons on a nd off. It ha s greatly improved r esearc h ers' ability to target specific brain a r eas for research a n d tr ea tm ent, and it has eno rm ous po t ential for future n eurosc ientifi c investi gat i on.
action potentia l 1 Conversely, another type of opsin called h a l or hod opsin r esponds to ~580 nm (yellow) light by pumping negatively ch a r ge d ops1ns ...
On e of t he first and most common opsin proteins used in optogenetics is channelrhodopsin. When activated by ~470 nm (blue) l igh t , th e chan ne l rh odopsin cha nnel opens and all ows positively charged sod ium ion s t o d iffuse i nto the neuron, depo lari zing it and initiating an humans wit h prio r brain probl ems. Extracranial recording and stim ulati o n of th e brain with electr icity or magnetic fields is spa tiall y imprecise. By ...neural activity can be switched on and off with just two types of
e n compass in g the u sefu l aspects of the previous techniques wh ile avoiding the ir pi t fa lls, new tools allow for a more comprehensive anal ysis of neural activity. One such
chloride io n s into th e neuron, hyperpolarizing th e cell and preventing it from firing action potentials 3 • In th i s way , neural activity can be switched on and off with just
References
•"University of St Andrews " Brain ima ging techniques I School of Psychology & Neuroscience I University of St Andrews. 2015. Accessed March 01, 2017. https: / /www.st-andrews.ac. uk/ psychology/ research/brainimaging/.
2 LaLumiere, Ryan T. "A new technique for controlling the brain: optogenetics and its potential for use in research and the clinic." Brain stimu lation 4, no. 1 (2011): 1-6.
3 Boyden, Edwa rd S., Feng Zhang, Ernst Bamberg, Georg Nagel, and Karl Deisseroth "Millisecond-timescale, genetically targeted optica l control of neural activity " Nature neuroscience 8, no. 9 (2005): 1263- 1268
4 Zhang, Feng, Li-Ping Wang, Martin Brauner, ,Tana F Liewald, Kenneth Kay, Natalie Watzke, Phillip G. Wood et al "Multimodal fast optical intenogation of neural circuitiy " Nature 446, no 7136 (2007): 633 - 639
5 Gradinarn, Viviana, Mmtaza Mogri, Kimberly R Thompson, Jaim ie M. Hender son, and Karl Deisseroth. "Optica l deconstruction of parkinsonian neural circu itry. " science 324 , no. 5925 (2009): 354 - 359.
of graph ene and can se n se glucose and pH l evels through th e skin. 7 Wh e n blood glucose levels are hi gh th e pa tch he ats up, cau s ing a coating on the microneedles to dissolve and relea se metformin , a drug u se d to lower blood sugar for type II diabetics. 7 This pat ch , as well as othe rs creat ed to monitor and release drugs including insu lin and metformin, would remove the p a in of regular injection s and th e need for monit01ing of blo od s ugar levels. 7 They also promote at-home use , as microneedle pat che s are easy to use a nd h ave few h azar ds . 6
The Global Impact of Micro needles
Micr oneed le technology can also be app lied to vaccine d elivery. While vaccin es deliver ed u sing hypodermic needl es often ne ed to be s t ored at s p ecific temp eratures, require train ed p rofess ionals to administer, and can r es ult in infections , microneedle patch es can b e s tored at room temperature , be self-adminis t ered, and are painle ss.8 This promotes pat ien t compliance and vaccina tion rat es, es p ecially in d evelopi ng countries. 9 Measles, a disease that can be prevented th ro ugh vac-
Reinuenting Drug Deliuery:
Microneedle Technology
By Niamh Sutherburg
00onventionally, hypod ermi c needles have b een u sed to ad mini ste r a wide ran ge of drugs from common vaccines to insu lin There are, however, s everal downsid es to this traditional rou t e of drug delivery, including the pain of injections, sto ra ge and tempe rature requirements , and th e potential for infection s Microneedles , an id ea initially intr oduce d in th e 1970s with recent developments in th e past decade, offer a pa inless alt ernative to tr aditio nal needles . 1 The se microscopic needles have the potential to eliminate t h e hazard s of hyp oder mi c needle s, p r ovidin g for safer and eas ier at -h ome u se. The tec hnol ogy could also allow vaccines to reach remote areas of th e globe with more ease, lowering outbreaks and death s for diseases inclu ding measles.
How They Work
es, typically consisting of tens or hundreds of n eedles . 4 Depend in g on th e type of drug admin is t ered , the patches can be cons tru ct ed from var iet y of subs t ances, including s ilicon, s t eel, and disso lvable polymer. 3 The drug s are r eleased from the microneedles in severa l ways: many types are hollow with the desired dru g held in s ide while others h ave a drug coating on their outer s urface. 3 Microneedles mad e of dissolvabl e substances are also advantageous because they leave no waste or tr aces b ehind after application. 3 Various trig ger s can instigate the relea se of the drugs, including t empera ture , pH, enzymes, and other compounds present in th e skin. 4
Advanced Diabetes Treatment
One major applica ti on of microneedle s is the administration of ins ulin and other drugs to treat diab et es Th e typical size of a microneedle ranges from Over 387 mill ion people worldwide are diagn osed diabetab out 100 to 1000 µm in length and 30 to 100 µm in ics, who need to constan tl y check and contro l their blood thickness , where a typical hypodermi c vaccination needle sugar levels through insulin injections using hypodermi c is rou ghl y 15 to 16 mm long 0.5 mm thick. 1 2 Unlik e h y- n eedles. 5 However , t his type of in sulin d elivery podermic needles, which must b e inserted can r esult in rapid an d harm- ful blood suga r directly into the blood- ... micro needle patches could eliminate changes that cause s tream , microneedles on ly h • f • 1. • • • d h complication s due pierce th e top layers of th e t e pain O lnSUIn lnJeCtlons an t e to deli very of t h e skin suc h as the s tratum need for checking blood sugar levels. drug too quickly, corneum. 3 Because of th eir s lowly, or at an length , th ey do not r each th e dermal nerve endings in incorrect tim e.6 With th e ability to sense glu cose levels t h e lower layers of the skin, allowing for painless drug an d administer precise doses, micron eedl e patches could delivery.4 The se n satio n of applying mi crone ed les to the eliminate the pain of insulin injections and the need for s kin is oft en de s crib ed as s imilar to tou ching Velcro or checking blood s ugar levels.6 One patch , de signed by th e tongue of a cat. 5 They are often arranged in patch- researchers at Seoul Nationa l University, is con s tru ct e d
cines, is a leading cause of preve nt able death s in childr en b ecause of low vaccination rates 9 Th e Georgia Institute of Techno logy and the Cente r s for Disease Control and Pr eventi on (CDC) hav e recently developed a micron eedle patch for the mea s les vaccin e. The pat ch is about one squa re centim eter in s ize and is adminis t ered by pr essing the patch onto t h e skin 8 Th e microneedles dissolve after a few minute s, leaving behind no h aza rdou s was t es or sharps. 8 The in expensive patch has the potential t o increase vaccination rates and d ecrea se mortalit y rates for measles, especia lly in developing na ti o n s , due of it s ease of app lication and tr an s portation. 9 While there have been limit ed clinical trial s on human s, the or ganization s plan to conduct more trial s beginning this year In addition to the m eas les vaccine, oth er mic roneedle patches ha ve also been developed for diseases including polio and influ enza.10
A Work in Progress
While microneedles and micron eedle patches have been widely stud ied in the pas t dec ad e, few pa t ches have be en approved by the FDA.9
Stratum comeum l
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Derm is p nNationalHealthFederation(httpsJ/commons.wikimedia.org/wiki/File:Transdermal_microneedles.png), "Transdermalmicroneedles'; https://creativecommons.org/licenses/by -sa/3.0/legalcode
Many cutting-edge patche s are currently b eing researched, and as of now they are p rima rily t ested on non-human primates a nd mice 9 Although still in the development phase , the exciting prospect s and wide-ranging impa cts of microneedle technology are r eadily apparent. Microneedles have few hazard s and are relativel y cost effective, making them a s impl e and safe route of administering many essential drugs and vaccines.
References
1. Gill, H. S., Denson D. D., Burris , B. A. & Prausnitz, M. R. (2008). Effect of micronedle design on pain in human sibjects. The Clinical Journal of Pain, 24(7) , 585 -594.
2. "Administering Vaccines: Dose, Route, Site, and Needle Size " I mmunization Action Coalition http ://www.immunize org/catg d/p3o85 pdf. 3 Kim, Y C., Park, J. H , & Prausnitz, M. R. (2012). Microneedles for drug and vaccine delivery. Advanced Drug Delivery Reviews, 64(14), 1547- 1568
4. Raj abi, M , Roxhed, N., Shafagh, R. Z , Haraldson, T , & Fischer, A. C. (2016) Flexible and stretchable microneedle patches with in t egra ted rigid stainless stee l microneedles for transdermal biointerfacing. PLOS ONE 11(12).
5. Quinn, H. (2016) "Explainer: what are microneedles and why do we need them?"
The Conversation. http:/ /theconversation.com/exp lainer-what-aremicroneedles - and -why -d o -we -n eed - them -54623
6. Yu, J., Zhang, Y., Ye, Y., DiSanto, R., Sun, W ., Ranson, D., Ligler, F.S., Buse, J.B., & Gu, Z. (2015) Microneedle-array patches loaded wit h hypoxiasensitive vesicles provide fast glucose-responsive insulin delivery. PNAS, 112 (27) 8260 -8265
7 Kim, D W , Lee, H., & Choi, T (2016) A graphene - based electrochemical device with thermoresponsive microneedles for diabetes monitoring and therapy. Nature Nanotechnology 12(14).
8. "Mi croneedle Patch for Measles Vaccin ation Could Be a Game Changer. " (2015) Centers for Disease Contro l and Prevention.
9. Dick, L. (2015) Microneedle Technology: The New Potential of Microneedles for Biologics & Small Molecules. Drug Development and Delivery 17(9).
10 Li, N., Wang, N., Wang, X., Zhen Y., & Wang, T (2016) Microneedle arrays delivery of the conventiona l v accines based on nonvirulent viruses ,Journal of Drug Delivery 23(9)
MI C RONEEDLE S DRU G PA TC H Syringe
150 microneedles
You Reap What You S0"1: Herbicide Atrazine Linked to Cancer
By Mary Burns
Df you h ave ever looked closely at a Brita Filter package, you will notice that it claims to remove a chem ical called atrazine. Atrazine is an herbicide that is used on more than 50% of the corn grown in the United States, and it is the second most commonly used herbicide in the country. Over 73 million pound s of atrazine are used every year in the United States. 1 Syngenta, the company that synthesizes the chemical, makes about three hundred million dollars a year from atrazine sales
The Environmental Protection Agency (EPA) conducted a study and found that the national corn revenue wou ld drop by 6% if atrazine were not used. This 6% drop may seem insignificant, but it is equivalent to a drop of two billion dollars per year in corn sales. Th e use of atrazine increase s the corn harvest and therefore the country 's food and fuel supplies. However , atrazine also poses harmful effects.
Atrazine degrades gradually in soil and often ends up in bodies of water such as streams and lakes before it degrades. It is n ot very solub le in water, and it is one of the most common contaminants of drinking water; approximately thirty million Americans are exposed to trace amounts of the herbicide. 1 It is the most commonly found herbicide in ground, smf ace, and d rinkin g water. 2 The European Union banned the use of the chemica l , but the United States continues to us e it for eco nomic reasons 1
Atrazine is a chemical in the triazine class of compounds , and it acts as an endocrine disruptor. Endocrine disruptors ar e chemical compounds that can interfere with the body's endocrine system and cause negative developmental , reproductive , neurological, and immune effects in both humans and wildlife.3 The endocrine system is responsible for regulating hormone s in th e bod y For example, atrazine causes ma le fish to physically and behaviorally turn into female fish, which is a n indication of just how strong of an endocrine disruptor it is 4 Even at incredib ly low levels, research has shown that Atrazine still inter rupt s the normal hormonal path -
ways of organisms, including those of humans. 5 Part of its disruptive abi lity is due to the fact that atrazine increases the activity of the enzyme aromatase , which catalyzes the conversion of testosterone to estrogen. 6 Further research has linked Atrazine to breast and prostate cancer, retardation of mammary development , and fertility issues. Interestingly, Novartis and AstraZeneca, the two pharmaceutical companies that created Syngenta, sell cancer drugs that inhibit the act ivity of the enzyme aromatase. 7 This suggests the possibility that cancer patients could be treating their cancer with a chemical from the company that produced the very carcinogen that induced their cancer.
Dr. Tyrone Hayes , a professor and researcher at University of California, Be rkeley , CA, has conducted most of the research on the impac ts of atrazine and began studying its endocrine-disrupting ab iliti es due to his interest in frogs. He observed that atrazine induced the conversion of male frogs to female frogs, and eventually, hi s research led him to studying the impacts of Atrazine on human health. 8 H ayes was ini t ia lly hired by Syngenta to study the herbicide when the EPA decided to conduct a scientific review of atrazine. His research brought to light many of atrazine's negative effects, and when he vocalized hi s findings, Syngent a tried to invalidate his r esearch . He then terminated his relationship with Syngenta , and continued his research. 1 Syngenta has spent a lot of tim e and money in efforts to discredit Hayes, and the settl ement of a class-actio n lawsuit in 2012 revealed Syngenta's execut ives' intentions to cast doubt on Hayes mental facultie s, character, and research. Despite the attempts to discredit him, Hayes published 6 articles in peer-reviewed, academic journals about his research on at r azine's effects just in the span of 2002-2011. In this case, the peer review proc ess is especi ally sign ificant because other expert s analyzed H ayes' research and found it to be credible and ethi cal. Atrazine is s till an area of high content ion, and Dr. Hayes gives about 50 lectures each year on his research. 8
In his lectures, Dr. H ayes also stresses the social justice implications of atrazine use. The continued use of atrazine and its persistence in terrestrial and aquatic enviro nm ents disproportionately affects people of color. African-America n and Hispanic people are more likely to live and work in areas that have high levels of atrazine as well as other herbicides and pesticides; thus, people of color end up paying the grea t est price for the use of atr azine. 1
The controversy surrounding atrazine emp has izes the need for a greater level of scientific literacy in the general public. Scient ists need to present primary research to the genera l public in ord er for peop le to interpret scientific disp utes, especially when such disputes are relevant to human hea lt h and social justice In order for policy ch anges to occur in a timely fashio n o r even at all , people need to be ab le to understand what is actually h appening in res earch in ste ad of just hearing dramatized information from media sources. An informed public can then influence po li cy wiiters and politicians. The h eavily contested issues surroun din g atrazi n e show why an inform ed public is a necessity for political change, protecting the environment, and also for protecting human h ealt h .
Many environmental health issues seem to not be immediately relevant to the general public , but atrazine per sists in the soil and bodies of water all over the country. As with many public health concerns, the atrazine issue is a matter of weighi n g costs and benefits. One of th e
References
EPA's jobs is to evaluate the costs and benefits of using various pe stic ide s and herbicid es, and they are currently r eevalu ating Atrazine. Will the costs to humans and wildlife be enough to outweigh the benefits of atrazine use? After the EPA makes their decision about atr azine, p eople will have to reap what they sow . It will be interesting to see ho w the atrazine contro versy plays out in the coming years. In the mean time , make sure to filter your drinking water.
1 Aviv, Rachel. "A Valuable Reputation." The New Yorker January 20, 2015 Accessed February 26, 2017. http://www.newyorker.com/magazine/2014/02/10/a - valuable - reputation.
2 Beyond Pesticides. "More Research Links Atrazine to Sexual Abnormalities in Amphibians. " Beyond Pesticides Daily News Blog. March 02, 2010. Accessed February 26, 2017 . http://beyondpesticides.org/dailynewsblog/2010/03/more-research-links-atrazine-to-sexual-abnormalities-in-amphibians/.
3 NIEHS. "Endocrine Disruptors." National Institutes of Health. January 15, 2017 Accessed Februa1y 26, 2017. https://www niehs.nih.gov/health/ topics/ agents/ endocrine/.
4 Konkel, Lindsey. "Why Are These Male Fish Growing Eggs?" National Geographic. Februaiy 23, 2017 Accessed Februaiy 26, 2017. http://news nationalgeographic.com/2016/02/1602oa-feminized-fish-endocrine-disruption -hormones - wildlife- refuges/.
5 Hayes, Tyrone B., Atif Collins, Melissa Lee, Magdelena Mendoza, Nigel Noriega, and And A. Ali Stuart. "Tyrone B. Hayes." Proceedings of the National Academy of Sciences March 1, 2002 Accessed February 26, 2017 http://www .pna s org/content/99/8/5476 short.
6 Holloway, A. C., D. A. Anger, D. J. Crankshaw, M. Wu, and W. G. Foster. "Atrazine-induced Changes in Aromatase Activity in Estrogen Sensitive Target Tissues. " Journal of Applied Toxicology: JAT. March 20, 2008. Accessed Februaiy 26, 2017 https://www.ncbi.nlm.nih gov/ pubmed/17685393.
7 Salgado, Brenda. "Interview: A Hormonal Seesaw: The Atrazine and AI Connection. " Breast Cancer Action Februa1y 22, 2011. Accessed February 26, 2017. http:/ /www .bcaction.org/ 2008/04/21/interview-a-hormonal - seesaw -the - atrazine - and - ai -connection/ 8 Block, Melissa, and Audie Cornish. "Chemical Study Becomes A Tale of Conspiracy And Paranoia. " NPR. February 05, 2014. Accessed February 26, 2017 http://www.npr.org/2014/02/05/272100022/chemical-study-becomes-a-tale-of-conspiracy-and-paranoia.
rnverybody has been stressed a t least once in their lives. But what is the difference between natural stress and anxiety? Before writing this article, I took a random survey of college s tudent s to gain a sense of what the University of Richmond commu ni ty thinks about anxiety. Not onl y did severa l misconceptions come to li gh t, but it became clear how stress and anxiety are mistaken for each othe r. One respondent, when asked where the lin e separati n g s t ress a nd anxiety is, replied "I cross th e lin e too frequently to answer."
By Annie Ryan
cumstances "2 To be diagnosed with GAD, patients meet at l east five psychological symptoms (as well as autonomic symptoms): restlessness, easily fatigued, difficulty concentrating, difficulty controlling the worry, and difficulty falling or stay in g asleep. This differs from othe r anxiety disorders, s uch as soc ial a nxie ty disorder, which focuses on anxiety stemming from interactions with people or social situations.
Myth #2: Anxiety is mostly emotional.
Since it's addition to the Diagno stic and Statistics Manual of Mental Disorde r s (DSM) in 1980, generalized If someone suffers from anxiety, they ofte n anxiety disorder h as hi ghlighted what cou ld come across as emotional or drama ti c. This is a only be ~esc~bed .•. Approximately 1. 7% -3. 75% of the global harmful misconas an e p1dem1c. . . ception, because Approximately population has anxiety, but there are telling patients 1.7%-3.75% 0 ~ th e supposedly thousands of more undiag- with anx iety t h ey globa l pop ul at10n are bei n g dramatic has anxiety, but nosed cases... does not validate there are supp os- their symptoms edly thou sands of more undiagnosed cases.1 and suggests it is wrong t o experience these Given the arbitrary nature of its symp t oms, there symp t oms . Anxiety has a t ested and proven biological is a negative stigma around anxiety. When asked to char- basis. A 2013 study found patients with anxiety had l ess acterize a person with anxiety in my random su rvey, most gray matter in the right anterior hippocampus and right people t end describe a person who is ofte n s t ressed, dra- amygdala. Gray matter is th e cell bodies of neurons, matic, suffe r s from panic attacks, and genera lly upti gh t where the processing and integration occurs. The more Thi s is untrue, and stems from the many misconceptions gray matter, the better . A separate study found ado less urrounding anxiety. Even though I encountered more in cents with GAD exhibited disruptions in several amygmy unofficial research, five myths were more popular than dala-based networks , the region of the brain associated others. with emotion and fear-processing. To be diagnosed with generalized anx iety disorder, a person must exhibit at l east one autonomic sym ptom: heart pa l pitations, sweat-
Myth #1: Anxiety is one disorder.
T h ere are many types of anxiety disorders: generalized anxiety d isorder, social anxiety di sorder, obsessive compulsive disorder , a nd pan ic attack disorder. Every subcategory of anxiety disorder has its own symp t oms, causes, and treatments.
Generalized anxiety disorder (GAD), for example, is characterized by "a n excess ive and inappropr i ate worrying that is persistent and not restricted t o particular ciring, trembl ing, or dry mouth.
Myth #3: If you get done what needs to be done, your anxiety will go away. By definition, anxiety is irrational. Those with anxiety are often see n as put-together: t h ey ge t all their work done in adva nc e, have clean living areas, a nd are seeming ly organized. This may be true in some cases, but generalized anxiety disorder can result in various behaviors . People with anx iety may also avoid their respons ibiliti es or people, lay arou nd and act l azy, or develop
dangerous habits , s uch as binge -d rinking, as ways of cop ing with their anxiety Basically, th ere is no exact model of anxiety, and you can never know what is going on inside someone's head.
Myth #4: Medication is the only treatment.
While medication, such as selective serot onin reuptake inhibitors (SSRis) or benzodiazepine, are often excellent therapies for anxiety, they a r e not the sole tr ea tm ent option. Cognitive behavioral t h erapy, a goal-orien t ed therapeutic strategy, has shown remarkable resu lts 4 Living a hea lthy lifestyl e is also correlated with decr ease d anxiety symptoms. A recent study suggests that mindfulness, or awareness of one' s experiences, is a potential therapy for a n xi ety. 5 Upon d i agnosis, the best treatment will be decided between the patient and his or her doctor.
Myth #5: Seeking treatment suggests something is wrong with you.
Thi s is the most harmful misconception to people suffer ing from anxiety or other mental disorders. Because symptoms are behavio r al and not visibl e, there is a nega-
References ti ve s ti gma around mental disorders. If a person u ses one of th e treatm e nts, such as therapy or medication , there is an automatic assumption that he or she is "crazy" or "unstable". With treatment, people s uffering from anxiety live an utterly normal life. Many times patients su ffering from anxiety are t oo ashame d to identify they are sick and seek help. Possibly mental illness is a re l ative l y new topic of research.
Anxiety stems from a natural, evolutionary response. If our ances t or s waited till the y wer e hungry t o worry abou t where th eir n ext food source was going to be, th ey wou ld starve. Before humans developed the technology to overpower anima ls, they were the prey. 6 Now, in the most peaceful and healthy time in human history , thi s stress has no out let It can aggrega te into anxiety, and hind er a person's daily activit ies and personal relationships. If you or someone you know is suffering from anxiety, it is absolutely necessary to seek help, anxiety does not go away on it s own.
1 P. Tyrer, D Baldwin , H. "General i zed anxiety disorder. " Lancet, 368 (2006), pp. 2 156- 2166
2 Lader, M. "Generalized An xiety Disorder. » Encyclopedia of Psycho pharmacology (2015), pp.699 -702.
3 Mueller, S. C., Aouidad, A., Gorodetsky, E., et al. (2013). "Gray matter vol ume in adolescent anxiety: An impact of the brain -derived neurotrophic factor Val66Met polymorphism. " Journal of the Ame1ican Academy of Child and Adolescent Psychiatry, 52(2), 184- 195.
4 Hofmann, S. G., & Smits, J. A. J. (2008). "Cognitiv e-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials. "The Journal of Clinical Psychiatry, 69(4): 621- 632.
5Boettcher J., Astrom, V., Pahlsson, D. (2014). "Internet - Based Mindfulness Treatment for Anxiety Disorders: A Randomized Controlled Trial." http://Wffiv.sciencedirect.com/ science/ article/pii/S0005789413001044
6 Price , ,J. S. (2003) "Evolutionary aspects of anxiety disorder. " Dialogues in Clinical Neuroscience, 5(3), 223-236.
Interested in Joining UR's Emergency Medical Services?
Become a Nationally Certified Emergency Medical Technician (EMT-B) through our on-campus EMT class! The class will meet every Monday and Wednesday from 6:30-10:00pm.
Applications for the 2017-2018 academic year will be due September 1, 2017.
U REMS is a group of dedicated, undergraduatestudent volunteer EMTs who respond to 911 medical calls 24/7 during the academic year on the University of Richmond campus.
Get in touch for pricing & infonnation
For more information, please contact:
Christopher Clark, Presidentof UREMS christopher.clark@richmond.edu
Taylor Pak VicePresidentof UREMS taylor.pak@richmond.edu police .richmond. edu i ure1ns
WELLNESS EDUCATION BANDIT
The Elephant in the Room: h ' +heargPstanimalsgetcancer?
By Abigail Watterson
here is a famous conund rum in the field of cancer research called the Peto Paradox that questions wh y animal body mass and rates of cancer development are not actually correlated. It seems reasonable to think that more cells and more cell division would lead to a higher rate of developing mutations that lead to cancer. But as it turns out, la r ger animals have hidden mechanisms that can fight off cancer and prevent tumor growth. The mo s t stu died of these large animals are elephants, which have 100 t im es more cells in their bodies than humans. 2 While 1 in 4 humans develop cancer during their lifetime s,3 only 3% of elephants develop cancer.4 Now, elephants are not sub ject to as many carcinogens, which are cancer-causing substances, as humans, but they do have mechanisms which likely protect th em against developing cancer. Thi s knowledge may provide major breakthroughs in cancer research. ..,,C i Oil
Cancer is defined by the National Cancer Institute as "a disease in which abnormal cells divide without control and can inva de near- ---:-i~ by tissues. "5 These cells are abno rmal because they
have many mutation s, which lead to the absence of proteins that prevent cell growth and cause cell death, and increased amounts of proteins th at signal for the cell to keep dividing. The proteins that normally prevent the overgrowth of cells that lead to tumor formation are called tumor suppressors, but one of the major hallmarks of cancers is that th e genes en coding these impo1tant proteins are mutated or hidden in the genome s uch that their normal function is taken away. Therefore, cell division cont inu es and tumors form with no working mechanisms to stop the growth. There are many genes that are mutated in certain cancers, but a tumor s uppre ssor gene called TP53 is th e gene most commonly mutated in human cancers. 6 The TP53 gene encodes the protein P53, which controls whether genes essential for the cell cycle, cell death , and DNA repair are transcribed and translated into protein s. To sum it all up , when the p53 protein is not working, mutated cells cannot die, and cancer d evelops.
Human s have one copy of the TP53 gene . As it turn s ou t , Dr. Jo shua Schiffrnan's re search lab at Huntsman Cancer In st itute in Salt Lake City h as discovered through genome sequencing that elephan t s ac tuall y have 20 copies of this gene! Thi s discovery warranted this lab to question whether this pa1ticular gene is linked to fewer instances of cancer in elephants compared to humans. Though a direct link has yet to be found, the Schiffman lab did find that in response to DNA damage caused by radiation, the elephant cells underwent immediate cell-suicide, termed apoptosis, instea d of trying to ineffectively repair themselves like human cells t end t o do, leading to cancer. 7 8 When the elephant p53 protein was inserted into mouse cells, the damaged cells acted just like elepha nt cells and se lf-destructed . 9 This is exactly what we hope to happen in creating cancer
treatments: to kill mutated cells before tumor s can eve n be formed. This discovery may provide a hopeful target for cancer treatment in humans.
I n lica ..m 1 n Car.e;erTreatments
Dr. Schiffman and his lab hope to find a way to in sert the elephant protein int o human cancer cells and to mitigate th e side-effects that com e with current cancer treatments. Th e lab recruited Dr. Avi Schroeder from Te chnion , the Israel In s titute of Te chno logy, to try to cre-
ate a_h~man drug
sti tute lab provides hope for a treatment that could save many lives. Since TP53 is th e most commo nly mutated gene in cancers, t h e cancer drug the Schiffman lab is hoping to create may b e one of the most robust cancer treatments to date.
Cancer research is heading increasingly quickly towar d creating genetic th erapies to replace chemotherapy and radiation. Going after the tumor s uppre ssor genes , particularly TP53 as we begin to better under s tand it s essentia l functio n in cells, may be the n ext step in fight-
While 1 in 4 humans develop canto m1m1celepha nt ing the so-called war on cancer. Dr. Schiffman recognizes that turn- p53. Hi s idea is to cer during their lifetimes, only 3% create a drug that ing to elephants t o fight cancer contains th e ele- of elephants develop cancer. phant p53 inside of a nanoparticle that will release the protein into cancer cells. The lab hop es to b egin clinical trial s within the next two years. 10
This research provides evidence to support the hypothe sis th at p53 plays a major r ole in cancer defense. Understanding the regulation of p53 fun ction is a major step forward in our ability to treat cancer While th ere are many potentia l hu rdles to overcome in inse1ting elephant p ro tein into human cells, the work of thi s Hunt sman In -
References
'Ewen Callaway, "How Elephants Avoid Cancer." Nature October 08, 2015 is outside of th e box, but this type of thin ki ng and risk-taking is where some of the biggest discoverie s in sc ience have come from. While we wait to h ear more about the impact of this possible ca nc er-figh ting mechanism of elephants on human cancers, we can all be s ure to update ourselves on the intriguing , unexpe cted directions of cancer research today. After all, vho would have thought elephants could get any better.
•,Jackie Judd, "Elephant Genes Hold Big Hopes for Cancer Researchers. PBS Newshour. February 22, 2016 .
3Associated Pr ess, "Why Elephants Don t Get Cancer." NBC News. October 08 2015.
6Toshinori Ozaki Akira Nakagawara, 2011. "Role of p53 in Cell Death and Human Cancers. " Cancers, 3(1):994 - 1013. doi:10.3390/cancers3010994
7A}lan P. Pessier , J ere K., Stern, Carmel L. Witte, 2016 "TP53 Gene and Cancer Resistance in Elephants. " ,JAlVIA,315(16):1789. doi:10 .1001/ jama .2016 .0449
8Joshua D. Schiffman et al., 2015. " Pot e ntial Mechani sms for Cancer Resistance in Elephants and Comparative Cellular Response to DNA Damage in Humans." JAMA, 314(17):1850-1860. doi:10.1001
9Associated Press, "Wh y Elephants Don t Get Cancer " NBC News. October 08 2015.
10 Jackie Judd "Elephant Genes Hold Big Hopes for Cancer Researchers PBS Newshour. February 22 , 2016.
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To StLi<.ot~Abr-otitblor-Not to
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A Big Question for Pre-Health Students
By Rachel Bringewatt
L ooking down at the i-Pad screen, Madison Nguyen struggled to do an activity she fondly remembered as a fun craft. As a girl, she had carefully placed plastic Perler beads onto grids, creating colorful patterns that could be ironed into plastic fish or flowers. Her task today sounded even simpler. Place four beads in a neat row on a pegboard. However, only able to see her hands and the beads through the screen, she found that the instrument in her hand was difficult to maneuver and she kept m issing. Only after fifteen minutes of frustrating fiddling and finally a physician's suggestion to reposition one finger, did she succeed in placing the four bead s
"I think it sets th e tone for how a lot of med school is going to be," said Nguyen. "You just hav e remind yourself that the reason I'm doing this it to become a better physic ian I do want to help people and I do want to save lives. "
Nguyen ('18) is a student at University of Richmond, majoring in biochemistry and min oring in healthcare studies on the pre-medical track. The bead activity, an exercise in laparoscopy, was one of four activities she practiced in round robin fashion at a simulation lab at Rigshospitalet in Copenhagan, Denmark. Accepted to the Danish In s titute for Study Abroad program, Nguyen spent her fall semester in Copenhagan taking classes in medical practice and policy, immunology, epigenetics, and medical ethics. She s tart ed college knowing that she wanted to prepare for medica l school but also s tudy abroad.
However, Nguyen's two desires seem to have a reputation of being hard to balance if you talk to pre-health st udents at University of Richmond . According to Univer-
coursework required for professional school. The Medical College Admission Test (MCAT) was changed in 2015 to include mor e sub ject s, so pre-health studen t s are now required to take courses in chemistry, biology, physics, psychology , and socio l ogy. Except for th e St. Andrews Program in Scotland , courses taken abroad cannot fulfill these requirements. This means pre-health students are faced with decision s of how to balance the nece ssary coursework with the opportunities for new experiences related to h ealt h and medicine that are available abroad.
Judging from pre-health students' varying approaches there is no right answer. It depends on the student and their goa l s. For Erin Hollis (' 18), her desire to immerse herself in Spanish culture was a priority when choosing her abroad program. Hollis came into University of Ri ch mond knowing she wanted to major in biology and then decided to pursue medical schoo l because it combined h er lov e for learning science with helping people. Hollis said that it wasn't too difficult to fit in study abroad because she started taking pre -health courses as a first-year student and h as chosen t o t ake a gap year before starting medica l school.
Th is question of whether to take a gap year that Hollis had to decide for her sel f, is something that some pre-health students grapp l e with. Accord ing to s t atistics published by the Association of American Medical Colleges, the mean age for students starting medical school is 24 to 25. Dr. Vaughan said it is "pretty common" for University of Richmond students t o take a gap year
.. .p r ofessio nal scho ols are l ookin g fo r s ud ent s wh o ar e flexib le and ad apt able in si tu at ion s, a nd stud y ab r oa d is wh ere you h ave t o d em on strate that ability.
much trust , so I th ought that studying abroad in a Spanish s peaking country would tie together so many things that I want to do."
H ollis took four cou r ses abroad, one of which was Spanish for Healthcare Professionals. For the first half of the semester, she focused on l earning Spanish vocabulary used in hospital s. She then applied this knowledge while shadow ing a hospital r esident.
Rachel Scoratow ('17) also expanded her knowledge of the medical profession while s tudying abroad at St. Andrews in Scotland the fall of her sophomore year. She was on the pre-med track through her junior year before deciding she wants to go to graduate school for public health. She enrolled in the St. Andrews program because it meant her pre-health courses transfe rr ed back. She referred to her fav01ite course as a "how to doctor class."
"He would always be like, Medicine is eighty percent art, and twenty percent knowledge. I'm going to teach you the art,"' Scoratow sa id about her professor.
Scoratow said the cou r se focused on all th e essential interpersonal sk ills r equired to be good a doctor, suc h as the appropriate body language doctors should adopt when question ing patient s. Although she won't be going to medical school, Scoratow believes all these ski lls are relevant to her future career in public hea lth.
Like Scoratow, Ta yl or Pak ('18) also found her s tudy abroad experience relevant to her career goals . Pak participated in a program focused on global hea lth and development po licy in Geneva, Switzerland this fall.
Pak s u ggested that for her th e skills she gai n ed while abroad will serve her beyond applying for medica l school.
"I know there is thi s pressure to go st r a ight into medica l school an d get everything done as fast as possible, but I think going abroad is so important," s aid Pak. "Going into medicine is so much more than biology, chemistry, a n d ph ysics . You have to get out of the classroom, whether that is through internships or abroad ."
"I've come up with this goa l to eventually become fluent in Spanish and u se that when I'm a doctor," said Hollis. "I think when patients need a translator for t h eir consultations with their physician it doesn't establi sh as
and that this can make fitting in study abroad a little easier. Hollis who felt it was easier to go abroad knowing her medical school timeline was not sity of Richmond 's Int ernational Education website, at l east 350 students go abroad each year and sixty percent of the class of 2010 studied abroad. In comparison, only twenty-five percent of pre-health students go abroad. Pre-health Advisor, Dr. John Vaughan, said that this is because it can be hard for students to fit in the exte n sive as rushed , spen t her fall semester studyi n g at Universidad d e Alcala de Henares in Spain.
"It was the kind of curriculum that couldn't be found in a textbook," said Pak , who spe nt most of semester traveling with peers to local businesses, NGO s, medical facilities, and research labs to hear from experts on various topics ranging from the Syrian refugee crisis to t elemedicine . After her abroad experience, she said she wants to get her MD but with th e goal of going into public h ealt h.
Not only are studen t s gaining hard skills and exper i ences in h ealth and medicine wh ile abroad , they are also gaining soft skills that are important for profess ional school.
"A lot of the professional school s are looking for students who are flexible and adaptable i n situations, and study ab r oad is one of those s itu ations wh ere you have to demonstrate that ability," sai d Dr. Vaughan. "And th ere is a big emphasis now on cross cultural competence in terms of assessing applica n ts ."
Is There More to B 16 Pharma
Than i.ts B 16 Pro-fits?
By Dana Morcillo
At over $1 trillion a year, the prescription drug market is one of the large s t markets in the world. The United States leads the global market ·with an expenditure of over $300 billion , as of 2014. This number is expected to grow to between $370 and $ 400 billion dollars by 2020. This market, popularly known as Big Pharma , is heavily invested in researching, te sting and adve1tis in g pharmaceutical drugs for the sole purpose of creating a profit , or so many people believe. This can be achieved through lobbying efforts and various advertising techniques. However, is there more to Big Pharma than just big profits? Who is Big Pharma?
Big Pharma is the n otorious nickname given to th e pharmaceutical industry and its largest companies. Some of the most notable companies, Pfizer, Eli Lilly, and Johnson & John so n, are known for their brand-name drugs Zoloft, Prozac, and Tylenol, respectively. By selling their brand-name drugs or medical devices in a profitabl e market, companies can make large partifts. Unlike other countries, the United States does not enforce drug price caps , which enables pharmaceutical companies to heavily increase prices. Moreover , for diseases and conditions with limited treatment options, companies can sell their product s at exuberant prices. Ju st last year, the pharmaceutical company Mylan raised prices for EpiPensknown for treating serious a llergic reactions - from the 2007 cost ofless than $100 to $608.61: an over 600% increase. With s imilar situations rampant throughout the pharmaceutical industry , ranging from cancer to AIDS drugs, it is no surprise that it is a $1 trill ion business.
Why the High Big Pharma Prices?
Companies argue that the se high prices are to fund the expens ive process of researching a nd deve l op in g (R&D) new drugs. Looking closer, s to 10 percent of these profits are put towards research and development of new drugs.7 In addition, most research funds come from federa l grants or through investing capital in new or expanding businesses, also known as ven tu re capi tal However, this R&D is going into not only drugs that can treat more prevalant conditions and diseases, but less common ones as well. Labeled as "orphan drugs," these drugs are currently being developed to t reat a range of diseases from autoimmune disord e rs to l eukemia . However , when t h e time comes for these drugs to be sold on the market, the true intention s of Big Pharma can be seen. These orphan drugs can cost hundreds or even th ousands of dollars, wh ich is reasonable when considering the t ime and cost it takes for pharmaceutical companie s to research and develop these drugs. H owever, when it comes to patients who need the drugs , it is easy to overlook such effo1ts. Overa ll , with such small contributions to R&D, many people believ e that Big Pharma is hiding the true reasons for such high prices . H owever, Big Ph arma is collectively made up by compa ni es who n eed profi t s in order t o continue running and expanding in t oday's economy. Whether or not those profit s are exploiting its customers - who need their product s - is up to the public opinion. Despite on l y a sma ll percentage of funding going into R&D, Big Pharma remains one of the most generous companies in the public eye in terms of not only cash donations, but free medicine to countries in need. Pfizer, the pharmaceutical company b ehind the drugs Lipitor
and Prevnar , donated $93.3 million in 2015. Last year, Pfizer donated one million pneumonia vacc i ne doses, Prevnar, to world-renowned medical aid organization Doctors Without Border s However , this donation was rejected by Doctors Without Borders, as explained by Ja son Cone, the executive director of thi s organization. "By giving the pneumonia vaccine away for free ," Cone s tate s, "pharmace uti cal corpo r a ti ons can use this as justification for why prices remain high for others, including other humanitarian organi zation s and developing countries that also can't afford the vaccine"-4 As shown in this past statement, while organizat i ons s uch as Doctors Without Borders a r e unable to see past the hi gh prices of Big Pharma , this st ill does not deter pharmaceutical companies from continuously researching and developing new drugs that could treat uncommon, but deadly diseases and donating cash and medicine to those in need.
Looking Forward
In the pa st few years, Big Pharma ha s taken blow after blow with the ri se of generic drugs and public backlash. Generic drugs have become an easier and cheaper alternative t o name-brand drugs, causing the companies of these nam e- brand drugs to lose both customers and profits. The producers of generic drugs are able to make these drugs cheaper because unlike brand -name drugs, the se generic drugs do not need millions of dollars pu t into th em for researching, developing, and marketing. Instead , after the drug patent on these brand-name drugs expire, generic drug makers on l y have to pay for the production of the drug, as the formula and ~af~ty of t?e drug ar~ already known. Big Pharma has found creative ways to combat thi s, mcludmg extendmg patents of name-brand drugs and even paying generic drug developers to delay the release of their products. Despite widespread outrage, once scrutiny d ied down , Big Pharma returned to its previous ways. However, a new obstacle seems poised to stand in Big Pharma 's way: President Donald Trump. Known for a presidential campaign of accusing drug companies of prices increases , Trump has promised to l ower consumers '. costs, especially those of Medicare. Howev er, it is not all bad news for Big Pharma. ~resid e nt Trump has also promised to s treamline the FDA drug approval process, lowenng nee- . essary costs and time for new drugs to be researched a nd approved Not on ly could this save money spen t by Big Pharm a into th e R&D process, but it co uld also save lives as a faster streamlining of drug approva l s will allow life-saving drugs to appear on the market sooner and hopefully, even cheaper. However , the real question is: Will Pre sident Trump hold true to th ese promises? Only time will tell.
References
•Aldis,William L. "Big Pharma 's Long Tentacles. " BMJ : B1itish Medical Journal , vol. 340 , no. 7743, 2010, pp. 381- 382. www.jstor.org/stable/25674047. ,, 2 Constautino, Tor. "IMS Health Study: U S. Drug Spendmg Growth Reaches 8.5 Percent m 2015 IMS Health. April 14, 20 16. Accessed February 09, 20 17 http://wv.iw.imshealth.com/en/about - us/news/imshealth-study-us-drug-spending-growth-reaches-8.5-percent-in-2015.
3Coombes, Rebecca. "Medicine and the Media: Having the Last Laugh at Big Ph arma." BMJ: British Medical Journal, vol. 334, no. 7590, 2007, pp. 396 - 397. www.jstor.org/stable/20506461.
4 Cone, ,Jason. "There is no such thing as 'free ' vaccines: Why we rejected Pfizer's donat10n offer of pneumoma vaccines." Medium. October 10, 2016. Accessed March 19, 2018. https://medium.com/ @MSF access/thereis-no-such-thing-as-free-vaccines-why-we-rejected-pfizers-donation-offer-of-pneumonia-6a79c9d9f32f# u1wlysiux
sJack Andrew. "Balancing Big Pharma's Books." BMJ: British Medical Journal, vol. 336, no. 7641, 2008, pp. 418-419. ww\.v.jstor.org/stable/20509042.
6 "Medicines in Development: Rare Diseases." Pharmaceutical Research and Manufacturers of ~n_ienc~.Apnl 18, 2016 Accessed March 19, 2018. http://phrma-docs.phrma.org/sites/default/files/pdf/med1cmes-m-development-drug-list-rare-diseases.pdf
7Swanson Anna. "Big pharmaceutical companies are spending far more on maTke~ingthan research." The Wash ington Post. February 11, 2015. Accessed March 1.8,2017. https://www.washmgtonp?st.com/news/ wouk/wp/2015/02/11/big-pharmaceutical-companies-are-spending-far-more-on-marketing-than-research/?utm term = .1eca304oflef
D::ir,n.a
Genetic Testing as a Screening Tool for Mental Health Medication
By Rachel Bringewatt
h e pa ge was s plit into three column s, neatly mark ed at the top with apital lett er s and color ed b and s
On th e left si d e of the pag e, th e gree n and was lab eled "USE AS DIRECTED." he middle yellow band read USE WITH AUTION", and t h e r ed band on the righ t re ad "USE WITH IN CREASED CAUON AND FREQUENT MONITORING." A lis t of medications was found und er each headin g . Fetzima , Zoloft , Pr ozac th e list w as ext en s ive. For Lesli e Solitario 1,wh ose h igh s cho ol daught er s truggle s with d ep r essio n an d anxiety it was "invaluable ."
Solitario 's dau ghter had tried man y kind s therapies a nd medication s . About t wo years ago, Solitar io s aid s h e de cided to clea n th e slat e a nd start fr esh in h op es of finding better care for her child . Recommendation s from friends led her to a new p sychiatri s t in F ailfax , VA. He s uggest ed h er dau gh ter und e rgo a gen et ic test t o sc r ee n for m edi cation s th at m ight be m ost effecti ve. D esp er at e for som ethin g that would h elp , Solitari o agreed .
In Sept ember 2015, Solitario 's daughter und erw en t a gen eti c t est called Ge n eSight . H er DNA w as collect e d via ch eek swabbin g and th en se nt to a lab to b e anal yzed The multiple page rep ort cam e b ack with information about whi ch antidepr ess ant s and antip sychotic d rugs woul d m os t like ly b e effective M ost of t h e m ed ication s Solit a rio 's dau ght er had tr ied we re in t h e yellow and red columns
Th e Gen eSight t es t s wer e cre at ed b y Ass ur ex Hea lth , In c., a comp any th at started in 2006 a nd is located in Mas on , Ohio
"A preci s ion medicine co mpan y pr ovidin g tr eatm e nt d ecis ion s upport to h ealthcar e p r ovid er s for
atie nts vvith be h aviora l eal th con d it ion s," t h eir web s it e2 r ea d s
Assu r ex H ealth h as four differ ent eneSight t ests ea ch t argeting differ ent gene s and m en ta l h eal th concern s . Ge n eSight Pyschotropic sc r ee n s a ser ies of pharm acoki neti c (PK) gen es as well as se r ot on in tr an s p orter an d rec eptor pharm a codynamic ( PD) genes, and sorts FDA-appro ved m ed ica ti on s p resc rib ed for d ep ress ion, anxi ety , bipolar di s ord er, p an ic diso rd er , pos ttraumatic s tr ess diso rd er , p reme n strual dyspho r ic d isorder , obsessive com p ulsive dis orde r , and sch izophren ia. " It looks at cert ai n genes an d iden t ifies wh ich medi ca tion s are m ore s u ita b le th a n oth er s," sa id Assu r ex H ea lth re pr ese n tative Mait r ey Pate l3 d u r ing a ph one int erview . "PK genes affect t he medicatio n level in the body and w ould h elp th e p h ys ician to d et er mi n e app ro p r iat e do s e PD gene s pr edict p ati en ts ' resp on se t o m edic ati on "
Gen eSight Anal ges ic, GeneS igh t ADHD , an d
GeneSigh t MTHFR are t h e three othe r t ests Genesigh t Analgesic gives color-code d effecti veness ra nkings for pain medi cation s, and Gen eSight ADHD looks at genes th at ma y influen ce h ow well d iffere n t ADHD me dications work. GeneSigh t MTHFR tests for genetic ca u ses of folate deficien cy whi ch accord in g t he Assu rex H ealth GeneSight webs it e, "m ay be m or e prev al ent amo n g d epr essed pa t ients com p are d t o n on-de p ressed p at ien ts "
Stati stics pu bli shed b y the Na ti ona l Alliance on Ment al Illn ess 4 s u ggest th at m en t al illn ess is so m et hin g with wh ich a s ign ificant p orti on of th e po p ulat io n is s tru gglin g .
"Appr oxim at ely 1 in 5 adults in th e U.S.- 43 .8 milli on, or 18.5%- expe r ien ces m en ta l illn ess in a given yea r. "
At Unive rsity of Richmond, the Counse ling and Psych ological Services (CAPS) h as b een kno vvn to have a waitli s t.
An Au gust 2 0 15 CAP S Services and Ment al H ea lth Tren d s re p ort 5 indicated that, "About one thir d of Univer s it y of Rich mo n d stu de nt s u se CAPS se r vices at lea st once before the y gr adu at e, and over t he p as t 12 yea rs, th er e's b ee n a n 9 0% in cr ease in st ud en ts seeking
mental health services at CAPS " An xiety , stress, a n d depressio n are t h e t op three most frequent concern s among coll ege stude n ts seeki n g m ent al h ealth services . When ask ed abo ut t h e u se of genetic testi ng to screen for effective medic ation, Un ivers ity of Richmond CAP S Dir ector Dr. P et er LeVin ess 6 exp ressed so m e conce rn s . "The p art t h at makes me s k ep tica l is th at for mental illness we don't know the missing piece," sai d LeViness . "We don't know what the nature of th e d is order. Cur ren t s it e s upp ort th e t est , s ightin g evide n ce of re du cti on in de pr ess ion symp toms and h ealth car e cost s for p atie n ts wh o h ave t ake n the t est p sych ia trists aren't correct ing im b alan ces t hey are tr eating symptoms."
Approximately 1 in 5 adults in the U.S .... experiences mental illness in a given year.
LeVin ess said t hat gen es se t vul nerab ilities, b ut h e does n ot know of any research that has p inpointed specific genes that cause a disorder like d epression or anxiety . The r e are b iological, psych ological, and s ocial causes of d isorde rs and cu r r ent m edi catio ns do n 't t r e at the root cause . "I t hink as a culture we over re ly on me dications," sa id LeViness, a propone n t of t alk t herapy pr ior t o pr escri bi ng med icin e. "I wo nder h ow mu ch gen et ic te s t ing h ype is d ue to an overh ype and reliance on me d icat io n ." Multiple clinical st udies posted on t he GeneSight web
"Th e cu rre nt find in gs re plicat e a p r eviou s ly publi sh ed Gen eSight clinic al
st ud y a n d d em on st rat e how depressi on out comes can b e imp rov ed wh en p har macoge nomic in for ma t io n is t ran s lat ed int o cl ini cally r elevant info rma tion, " a st ud y (H all -Fl avin , et al. 2013) con clud ed . Solit a rio h as no do ubt in h er mind th at t h e Gen eSigh t t es t was a p osit ive decis ion for h er d au ght er. "Th e last two m on th s h ave bee n way b ett er th a n what I thou ght th ey could b e," s h e sa id "I b eli eve it was a hu ge ch a n ge to hel p
References
1 So itario , Leslie " Interview v.rithLes lie Solita rio." Telephone interview by author. February 2017
2 "Welcome to GeneSight " GeneSight - Genetic Testing for Personalized Medicine Treatment Accessed March 2017 https: / /genesight com /.
3 Pa t el, Maitrey "I nterview with GeneSight " Tel ephon e in t erview by a u tho r February 2017.
4 "Mental Health By the Numbers. " NA.MI:National Alliance on Mental Illnes s Accessed March 2017. http://www.nami.org/Learn-More/Ment a lHea lt.h-By- the-N umbers
5 CAPS Ser vices and Mental Health Trends Report. UR Well , University of Richmond August 2015. Accessed March 2017. http://wellness.rich mond edu / common / pdfs /c aps / s e rvices- and -trends pdf.
6 LeViness, Pet e r. "Interview v.rithDr. LeVines s." Interview by author. February 201 7
7 Hall - Flavin, Daniel K., Joel G. Winner Josiah D. Allen, Joseph M. Carhart, Brian Proctor, Karen A. Snyder, Maureen S. Dr ews, Linda L. Eiste r hold , Jenn i fer Ges ke, and Dav id A. Mra zek. "Utility of integrated pharmacogenomic testing to support the treatment of major depres s ive d is order in a psychiatric outpatient setting .'' Pharmacogenetics and Genomic..c;23, no. 10 (October 2013): 535-48 Accessed March 2017. ResearchG a te .
n ,...n ,.. I,.. ,, c ;~ n :
Graphic/pixabay
od Dese
By Jesse Conway
he t erm "food desert" is one of recent origin but desc ribe s a growing phenomenon throughout the Unite d States. "Food desert" refers to a town or area with limited access t o fresh fruit , vegetabl es, and oth er healthy whole foods. l These areas are often impoverished and thu s devoid of nearby su permarkets and farmers' mar k ets, as low profit margins lead to a wide array of cha llenge s for incoming businesses. With limited access to the se food sou rce s, families often turn to cheaper and more processed options that are high in unhealthy fats and carbohydra t es 1 This problem worsens for households without a car or with limited access to pu bli c transportation , which is often the case for man y people living in these areas. In Richmond , Virginia, roughly 23% of its residents live \vith food insecurity, making it the biggest
In
prising. 2 Hi gh poverty rates, in combination with limited access , draw s people to cons ume higher quantitie s of processed food. 6
The implications of this gap in diet are huge , resulting in man y health iss ue s linked to obesity , suc h as heart disea se and diabetes. In the se areas, the quality of the food itself is suggested to be th e central cause of chronic disease and weight control. 6 For adults with low incomes , food insecurity is directl y associated with higher rates diseases such as hyperten s ion and diabetes. Fmther , the stress caused from food insecurity alone can increase cortisol levels , which can be a factor in obesity. 7
As more and more hospitals are looking to expand into wealthy sub urb s, rather than urban areas, th e issue of food d eserts becomes increasingly important. 10 food desert of cities it s s ize.2 Fmther , with Richmond ' s growi ng obesity problem, it is clear that nutrition and public h ealth are issues of great im-
Richmond, Virginia, roughly 23% of its residents live with food insecurity, making it the biggest food desert of cities its size.
However, due to the physical and emotio nal s tre ss of food insecurity and po verty, medi cal treatments in urban areas have grown portance, and it seems food desert s may play a sign ificant part.
In general, the places with the least access to healthy options tend to be those with the lowest incomes. In Richmond , thi s la ck of su perm arke ts -espe cially in combination with limited transportation-confines s hoppers t o inadequate corner stores and fast food chain s. 3 In some places, these deserts are so severe that even people actively looking for healthy options cannot find them. A s tud y from the Journal of Human Nutrition and Dietetics found that sma ll corner shops offered goods lik e wholemeal b read, fiuit yogurts , and other healthy options at prices twice as hi gh as those from lar ger supe rmar kets. 4 Thu s, even if these items are accessible, they are often unaffordable. For some, the most accessible h ealt hy options are less perishable frui t s and vegetabl es, like bananas and onions, which are lower in nutritional value than many other vegetables. 3
In Richmond , a lack of supermarkets in certain areas, including the East End, forces families to drive as far as s to 10 miles to find quality, health y options. With one of the highest ratios of fast food restaurants to people, Richmond 's n ea rly 30% obesity rate is not sur-
increasingly more expensive, making one problem difficult to tackle without a solu tion to the other. In all , poverty drives lower numbers of ho sp itals and supermarke ts in areas where th ey are most needed
Both access to high qu al ity food as well as affordabl e health care are nece ssary for addressing the worsening h ea lth problems faced by th ese communities. However, achieving either poses many challenges. For example, a lack of economic incentive limit s growth. Getting higher quality options accessible at low enough prices in impoveris h ed areas of Richmond, for example, is a daunting task. If the prices are not low enough, there will be no demand, and if the prices are too low, profit is impossible. Busine ss in low income areas is so difficult that, on average, one out of every five grocery stores has gone out of business. 19 However, increased access t o produce do es not mean an increa se in community health. The challenge of getting these communities to actuall y change their habit s is not always easy. 13
Although finding thi s balance may seem impossible, some businesses have been able to make it work. For example, a grocery chain in Philadelphia ha s managed to stay in business and thrive in a low- incom e ne ighbo rhood
in Richmond
for over 10 years. Since opening in 2004, the fourth-generation grocery s tore has offered the community exactly what they need simply by asking wha t they we r e missing. 11By learn ing through other successful grocery chains, efficient bu sinesses like thi s one may be able to flourish in these food deserts.
Other inventive solution s to the growing problem of food deserts have been surfacing th roughout the country, with p erhaps the mo s t creative being health food tru cks. For example, Garden on the Go, a University run food truck ou t of Ind iana, makes weekly stops to sell affordable produce to high need communities and even accepts food stamps. 18 In other cities, such as Minne apolis , lawmakers are working to in ce ntivi ze th e distribution of health foods through in vestment and quotas. 18 On an organizational level, the American Community Garden Association (ACGA)has worked to initiate the accessible Reference s
and inexpensive production of local produce in urban environments through the production and expansion of community gardens .1 8
In Richmond, th ere is an evid ent need for more creative so lutions like these. However, certain changes must be made in order to incentivize the opening of efficient superma rkets in areas suscepti ble to food insecurity. Clearly, there is not one solution to thi s growing p roblem, and with the inauguration of Mayor Levar Stoney, it \vill be interesting to see if an y progress can be achieved. Whether this change will come from direct legislative action or a comm unity effort is unknown, but it is certain that action mu s t be taken. As a community, it is esse ntial that we pay attention to how and why the se problems are perpetuated throughout this city and continue to searc h for creative ways to fix them.
2. Wise, S " Ri chmo nd has an obese city' problem ." WfVR.com. April 07, 2014. Accessed Februa1y 22, 2017. http: //w tvr .com/20 14/0 4 / 0
mond-obese-dty/.
3 . Crutchfield, Lisa. "Food Deserts: The Rest of the RVA Shopping Story." Richmond Family Mag az in e. February 25, 201 5 Accessed February 22, 2017. http://richmondfamilymagazine.com/rfm-community/food-deserts-rest-rva-shopping-sto1y/.
4. Barratt , J. "The cost and availability of h ealth y food choices in southern Derb ys hire." Journal of Human Nutlition and Dietetics 10, no. 1 (1997): 63 - 69. Accessed February 22, 2017. doi:10.1046/j.1365 - 277X.1997.00487 .x.
5. Cummins, Steven, and Sally Macintyre. "The location of food stores in urban areas: a case stu dy in Glasgow. " British Food Journal 101, no. 7 (Jan ua1y 1, 1999): 545 - 53. Accessed February 22, 20 17. doi:10.1108/00070709910279027.
6 Chan, T H. "Food and Diet. " Obesity Prevention Source April 08, 2016 Accessed February 22, 2017. https: //www .h sph.harvard.edu/obesi ty-prevention-source/ obesity-causes/ diet-and-weight /
7 Seligman, H.K. B. A. Laraia, and M. B. Kushe l. "Food In secmity Is Associated with Chronic Disease among Low- Income NHANES Participants ." Journal ofNutrition140, no. 2 (2009): 304-10. Accessed February 21, 2017. doi: 10.3945/jn .109.112573
8. Eberhardt, Mark S ., and Elsi e R. Pamuk "The Importance of Plac e of Residence : Exa mining Health in Rural and Nonrural Areas " American Journal of Public Health 94, no 10 (October 2004): 1682-686. Access ed February 21, 2017 doi:10.210 5/aj ph.94.10.1682.
9. Advis01y Board. "City hospitals move to the suburbs: 'You move o where the money is."' The Advisory Board Daily Briefing. April 14, 2015. Ac cessed February 22, 2017 https://www.advisory.com/daily-briefing/2015/04/15/city-hospitals-relocate.
10. Rice , Mitchell F. " I nner - c ity hospital closures/relocations: Race, incom e status, and l egal issues." Social Science & Medicine 24, no. 11 (1987): 889-96. Accesse d February 22, 2017. doi:10.1016/0277 - 9536(87)90282 - 6.
11. Singh , Maanvi. "Why A Philadelphia Grocery Chain Is Thriving In Food Dese1ts. " NPR May 14, 2015. Accessed February 22, 2017 http://www npr.org / sections/thesalt/ 2015/ 05/ 14/ 4064 769 68 /w h y- one -groce1y- chain - is - thriving - in -philadelphi as-foo d -desert s.
13. Wrigley, Neil, Daniel W a rm, Barrie Margetts, and Amanda Whelan. " Asses s ing t he Impa ct of Impro ve d Ret ai l Access on Diet in a ' Food Desert' : A Prelimina1y Report." Urban Studies 39, no. 11 (2002): 2061-082. Accessed February 22, 2017 doi:10.1080 /00 42098022000011362.
14. Pearson Tim , Jean Russell, Michael J. Campbell, and Margo E. Barker. " Do food de se 1ts influence fruit and vegetable consumption? - a cross-sectio nal study." Appetite 45 , no. 2 (2005): 195- 97. Accessed February 22 , 2017. doi:10.1016/j.appet.2005.04.003.
15 Bodor, J. Ni chol as , Jane C. Rice, Thomas A. Farley , Chris M. Swalm, and Donald Rose. "The Association between Obesit y and Urban Food Envi ronments. " Journal of Urban Health 87, no. 5 (2010): 771-81. Accessed Februa ry 22, 2 0 17. doi:10.1007/s11524 - 010 - 9460-6.
17. Larsen, Kristian, and Jason Gilliland. "A farmers' market in a food desert: Evaluating impacts on the p1ice and availability of healthy food." Health & Pl ace 15, no 4 (2009): 1158- 162 Accessed February 22, 2017. doi:10.1016/j.healthplace.2009.06.007.
18. Payne, Emily, Emilene Sivagnanam, Joey DeMarco, Alanna Wittet, Lisa Kaschmitter, Dani elle Nierenberg, Alexa Ahern, Lauren Nelson, Natalie
IS 183DRTHCONTROILPOTIENTD/illLY
IHIARMDNGTHIEIENVDRONMIENT?
By Missy Schrott
Dn recent year s, the "go green" mentality that more creased risk for those people who are prone to estrogenic and more people are adopting has led to concern cancer." 3 about the environmental impacts of contraceptives, Beyond cancerous risks, there is also a possibility especially birth control pills, on aquatic life and drinking that the synthetic estrogens from bi rth contro l pills in water supplies. However, there is notable controversy wastewater could impact the hormonal systems in both about how legitimate and how far-reaching these impacts humans and wildlife . 4 Research shows that chemica ls, truly are. including estrogen , have been associated with feminiz-
A primary source of concern is the detection of ing male fish. According to Environmental He alth News, hormones in drinking water and its health implications. "Male fish living in water contaminated with female In a 2008 Associated Pres s in vestigation , several pharma - hormones (or est rogen mimics) can becom e feminized, ceutica ls, including prescription hormones, were found developing female sex characteristics and behaviors." 5 in the drinking water supplies of 41 million Americans. 1 Environmental Health News also said that these Estrogen can enter water supplies through the urine of abnormalit ies in fish populations could have implications women who tak e birth control pills. for male h umans. Contaminated drinking water supplies
In one " 1 h t· 1 . 1 a· s tud y, the synthet ic •• • Severa p armaceu I CaS, lllC U Ing
estrogens in water prescription hormones were found in supplies from birth h d . k. ' 1. f .1 control pills ap- t e fill Ing WaterSUpp IeS O 41 fillpeared t o contribute lion Americans" to cancer growth.
could be contributing to reproductive problems in men , including low s p e rm counts, cancers, and infertility.
However, it is Researchers at the Univers ity of Pitt s burgh possible that people religious- ly opposed to th e found that chemicals taken from fish near untreated sewage facilities rapidly increased the growth of breast cancer cells. 2 Conrad Volz, lead researcher on the study, told Scientific American, "There is the potential for an inuse of contraceptives politicize reports about birth control and its environmental impact. For examp le, report s and statements from the Vatican, American Life League, and The Wande rer, a national catholic newspaper, emphasize
the possible negative impacts and put little focus on how likely or extreme these impacts are. 67
A j ournal by th e Association of Reproducti ve Health Professionals separates these myth s from fact, the primary finding being that "contrary t o what has been sta ted or implied by media repo1ts and anti-contraception advocates, synthetic estrogen from birth control pills is not the sole or primary source of endocrine-disrupting chemica ls in water. "8 Synthetic estrogens can also be traced back to indu stry , livestock, agriculture, and landfills. Birth control pills' contribution to waterways is "minimal or nonexistent."
Ethynyl-estradiol (EE2) is the synthetic estrogen from birth control pills that is most frequentl y cited as being harmful to the enviro nm en t. However, its levels are so diluted that the y may be negligible. According to Scientific American , EE2 levels are compa r able to a thimble full of water in an Olympic-sized pool. 9
Scientific American suggests that despite the low, diluted levels of EE2, its combination with other chemicals may induce toxic effects. When small amounts of unknown contam inant s combine in a "stew effect," it is hard to t ell what the result will be. 10 The stud ies that connect cancers and reproductive prob lem s to contaminated water s uppli es could be a resu lt of the synthetic estrogens from birth control pills that react with other trac e amounts of chemicals.
There are "greener" birth control methods that may b e worthwhile for some one who is concerned with harming the environment. A Copper Intrauterine Device is a h ormone free contraceptive that can l ast up to 10 years . Similarly, biodegradable condoms have little envi ronmental impact. 11 Th ese methods reinforce a more environmentally con sc ious approach to contraceptive
References
1 Jeff Donn, Martha Mendoza and Justin Pritchard, "An AP Investigation : Pharmaceuticals Found in Drinking Water," Associated Press, March 10, 2008, http: //hosted.ap.org/ spec ial s/interactives/pharmawater site/ ind ex .html
2 Maxine Wright-Walters, "Exposure Concentrations of Pharmaceutical Estrogens and Xenoestrogens in Municipa l Wastewater Treatment Plant Sources, the Aquatic Environment and an Aquatic Hazard Assessment of Bisphenol-A: I mplications for Wildlife and Public Health" (PhD diss., University of Pittsbu rgh, 2009).
3 "Can Birth Control Hormones Be Filtered from t h e Water Supp ly?" Scientific American, July 28, 2009, https://www scient i ficamerican com/ article/birth -control -in -water -s upply/
4 Jennifer Grayson, "Eco Etiquette: Is There A Green Choice For Bi1th Control?" The Buffington Pos t , February 9, 2011, http: // wwv..huffingtonpost.com/jennifer-grayson/eco-etiquette-is-there-a-_b_82o596.html
s http://www.envirorunentalbealtbnews.org/ehs/newscience/sex - reversal -in -fish -linked -to - chem ical-cockta il
6 Kirsten Moore Kimberly Inez McGuire, Rivka Gordon and Tracey J Woodruff , " Birth Control Hormones In Water: Separating Myt h From Fact," Association of Reproducti ve Health Professionals, August 20 11,http://www.arhp.org/publications-and-resources/contraception-journal/ august -2 011
7 Brian Clowes, "Culture Of Life 101 "What Are The Environmental Impacts Of Hormonal Birth Control? " The Wanderer, March 10, 2015, http://thewandererpress.com/catholic/news/featured - today/culture -of- life- 101-what - are - the -environmental -impacts - of- hormonal -birth - contro l/
8 Moore, McGuire, Gordon and Woodruff, " Birth Control Hormones."
9 "Can Birth Control Honn ones Be Filtered from th e Water Supply?"
10 "Can Bilth Control Hor mones Be Filtered from the Water Sup ply?"
11 Grayson , "Eco Etiquette : Is There A Green Choice For Birth Contro l ?"
Professor Editors
Assistant
Associate
Dr. Angie Hilliker
Professor of Biology
Dr. Kristine Nolin
Professor of Chemistry
Dr. Julie Pollock
Assistant Professor of Chemistry
Dr. B. Rick. Mayes Professor of Political Science
Dr. Kristine Grayson
Assistant Professor of Biology
Dr. Fernando Gomez Visiting Lecturer , Biology
Faculty Advisor
Dr. Michelle Hamm Professor of Chemistry
Design Team: McKenzie Murvin, Sanitra Desa i
Associate Editors: Maggie Michel, Cassie Gilboy, Madison Nguyen , Justin Airas, Marina Winkler, Abigal Watterson , Taylor Pak
