Vaping Is it better or worse for you than smoking?
By Madeline Ustanik
Page 12
Dear Reader,
Thanks for picking up the fifth - yes, fifth!issue of Osmosis Magazine. I am so proud of how far Osmosis has come! The articles in this issue are more relevant than ever, and ifs inspiring to see so many passionate people coming together to write about them.
We have welcomed so many new faces-shout out to my new design team - as we ll as some loya l returners. I would like to personally thank Sanitra Desai for sticking this out with me, especially the early days when it was a design team part y of two. It's going to be hard to find someone as creative and hardworking as you! Good luck in the great beyond! (Post -graduation)
Through Osmosis we hope to spread scientific literacy to the rest of campus, and not just locked it away in Gottwald. From scientific policy to vaping, we believe there's something for everyone in this issue. Happy reading, and remember to share this with a friend! Only you can prevent scientific ignorance! Your editor, Mickey
On the first Monday of October, the eight justices of the Supreme Court sat on the bench to hear the first oral arguments of the new term, Weyerhauser Company v. United States Fish and Wildlife Services. This case did not involve niche tax laws or contracts, nor did it involve hot button topics like immigration or abortion rights. Rather, it involved the lowly dusky gopher frog.
The dusky gopher frog lives in eastern Louisiana and southern Mississippi and Alabama. With less than 100 remaining and a dropping population , the species is classified as critically endangered under the Endangered Species Act of 1973. In 2010, The Fish and Wildlife Service (FWS) designated a privately owned plot of land in Louisiana as a "critical habitat" of the dusky gopher frog , despite the fact that the frog had not inhabited the land in decades and that in its current state it was not habitable. This designation requires federal agencies to ensure that "actions they plan to undertake, fund, or authorize do not destroy or adversely modify that habitat: ' The owners of the designated land, Weyerhaeuser Company, intended to develop the land for residential and commercial purposes, and they claimed that the designation would cause a $33 million diminution of value. They sued the FWS, arguing that the agency had overstepped its authority in designating the private land as a critical habitat.
The question before the Court pivots upon what the definition of "habitat" is. Justices Elena Kagan, Ruth Bader Ginsburg, and Sonia Sotomayor asked the lawyer representing the landowners, Mr. Timothy Bishop, what definition the Court should use. Should they interpret "habitat" with the more common meaning, which is defined as land that is currently habited by a species? Or should the definition of "habitat" be more scientifically oriented and defined as land that is both currently habited and potentially habited by the species? He
argued the former, saying that "habitat" should pertain to only areas in which the frog currently lives - not where it could potentially live. Additionally, he went on to say that the designated area should not be considered a habitat because the frogs spend less than a month in breeding ponds. However, this interpretation would not suit the scientific community and their work. Because they are not field biologists with dusky gopher frog expertise, the justices read amicus curiae briefs - literally "friend of the court." These briefs are filed by organizations or individuals on behalf of either the plaintiff or the defendant. They provide information or opinions by experts in different fields that allow the justices to learn more about the specific topics of the case. One of these amicus briefs, filed by a group of scientists, outlined the scientific definition of "habitat;' saying that habitat is "heterogeneous, spatially variable, and temporally dynamic:' Additionally, a habitat does not need to be occupied to be considered a habitat due to variables including "response to seasonal cycles, reproductive behavior, localized resource depletion or creation, and a search for protection:' Because of this, the FWS should be able to designate the land as an essential habitat While these definitions may be straightforward to science students, it is less clear to the Supreme Court justices or lawyers, who do not have extensive backgrounds in biology or ecology. By relying on expert opinions to reconcile science and the law, the justices receive a more holistic view in forming their op1n1ons.
The Supreme Court's ruling could have crucial effects on how th e FWS may go abou t protecting endangered species in the future. By relying on scientists opinions, the justices are able to form an opinion that is more compatible with the scientific community and the laws that are drafted using their research. While
the dusky gopher frog is only one species, the Court's opinion may set precedent on how the government will be able to approach conservation in the future. This can have large implications on research labs. Consider, for example, a lab that studies endangered salamanders. For 324 days of the year, the salamanders lay dormant under th e rocks of Westhampton Lake. Once a year th e salamanders migrate to Belle Isle for one day to breed. They can only breed here due to the temperature, resources, and lack of college students surrounding the area. Using Bishop'sargument, because the salamanders are only here for one day, the Belle Isle area would not be considered a habitat even though it is essential for them to breed. This interpretation of "habitat" would not sufficiently protect the interests of the scientists or the salamanders because it would remove the protections granted under the Endangered Species Act. This would be despite the fact that this habitat is critical to the continuation of the species.
The Supreme Court has relied on scientists in many other cases. In Association of Molecular Pathology vs. Myriad Genetics (2013), the Court ruled that isolated DNA strands cannot be patented because they are "natural;' but cDNA can be patented because it is made by humans in a lab and thus is not naturally occurring. This may influence how genetic research may be undertaken and the availability of shared information between labs. For example, if one lab wanted to research a particular gene that is patented by another, it may be restrained by the expensive license that it would have to obtain. In Massachusetts v. Environmental Protection Agency (2007), the Court found that carbon dioxide can be considered an air "pollutant" and therefore can be regulated by the EPA, having large implications in the fight against climate change.
The Supreme Court may not seem immediately relevant to many scientists, and science -related cases may be rare, but being the highest court in the land gives it the power to influence scientists and their work. It is important for the judiciary to give scientists' opinions the weight they deserve. Accordingly, scientists should exist not only within the confines of their labs but also in the courtroom. Both the scientific and legal communities are unique but are more intertwined than meets the eye. By increasing dialogue between the two disciplines, these two spheres can work more effectively.Lawyers and judges should not only strive to understand scientists' findings but also how they arrived at their conclusions. Science is not studied by one person in one lab finding a sweeping solution; instead, it involves a whole community working step by step over years to arrive at specific conclusions. Scientists and scientific journals should,
in turn, allow their work to be more readily accessible by the public. Public access to articles and adequately communicating their work in language understandable by the public would enable scientists to be more readily understood and appreciated by the government and the public . Only by building bridges between science and the law can there be a greater exchange of information and understanding, supporting a more perfect and more scientific society.
References
Brief for Scientists as Amicus Cur ae, Weyerhaeuser Com pany v. United States Fish and W ildlife Service, 17-71 U S (2018) https: //www supremecourt gov / Docke PDF/ 17/ 17-71 / 52317 20180705134216763 _ 17-71 %20 bsac%20Scientists pdf
"Lithobates sevosus " ICUN Red List. 14 October 2018 https: //www.iucnred li st.org / species / 58714 / 11828596 U.S. Fish & W ildlife Serv ce "Critical Habitat." Endangered Species 19 Ju ly 2018 https ://www .fws gov / endangered /what-wedo / critica l-habitats htm
"Weyerhaeuser Company v. United States Fish and Wildl ife Service " Oyez , 14 Oct. 2018 www oyez org / cases / 2018 / 17-71. "Weyerhaeuser Company v. United States F sh and Wildlife Service ." SCOTUSblog , 14 Oct. 2018, http ://www.scotusblog.com case-files / cases / weyer haeuser-company-v-united-states-fish-wildlife-service /
Addendum - Added on November 27, 2018 Since the writing of this article, the Supreme Court has released its opinion on this case. In a unanimous opinion, Chief Justice John G. Roberts writes that the Endangered Species Act allows the FWS to designate a habitat as "critical'' only if the land were a habitat in the first place. This makes "critical habitat" a subcategory of "habitat:' The Act does not empower the FWS to define what "habitat" is. Therefore, the Court of Appeals erred in giving the FWS the broad power to designate land as "critical habitat'' even if it was not a "habitat:' The Supreme Court thus vacated the ruling and has sent the case back down to the appellate court to retry the case in light of this opinion. The Court of Appeals must now determine what constitutes a "habitat" and whether it includes land that requires modification. This ruling does not mean the demise of the dusky gopher frog. The Supreme Court, in fact, upheld the Service's power to designate habitats that are unoccupied as "critical." The Court of Appeals will now have to decide the best way to balance science and the law to ensure proper conservation efforts in the future.
THE GENESTO SUCCESS
ARE YOU NATURALLY GIFTED?
ADRIANA GRIMES
Have you ever wondered why it seems that some people struggle in school despite working just as hard as everyone else, yet others can get away with barely studying and still have a 4.0 GPA? Well it turns out there may be some hints in your genome. There has always been the age- old debate of nature versus nurture or genetics versus environment, especially when it comes to intelligence and academic success. Though both play a role , the following studies show that much can be attributed to genetics. To figure out which specific genes could indicate academic success , you first need to know if there even is a difference in genetics for academic achievement.
Research indicates that a correlation exists between genetics and academic success. Rimf eld et. al (2017) did a large twin study examining differences in genetic and environmental factors and how they related to genetic success 1 They found that 60 % of differences in twins, academic achievements could be accounted for by ge netics 1 • These differences ranged from single nucleotide polymorphisms (SNPs) to more complicated gene-gene interactions, but in this article, it is unspecified 1 • A second study also found that academic success differences could be accounted for by genetics but to a lesser degree 2 • Selzam et. al (2017) did not use twins and did not use the same method for analyzing differences in genetics 2 • They ?---:ound genetics only accounted for between 9 and
16% of differences 2 • They referenced Rimfeld et. al (2017) and said the difference between these two numbers could be accounted for by the clifference in methods used to collect the data . 2 They mostly explain that the methods used by Selzam et. al (2017) is limited to detecting SNPs.2 Another study that accounted for environmental factors found that one third to one half of variance can be accounted for by genetics. 3 This study was looking at school engagement, which could be used as a measure for success. Specifically, success as it relates to genetic and environmental factors. This differs from Selzam and Rimf eld which looked at educational achievement. All of the above, however, indicate that genetics play a role in academic behaviors and success. In addition to general correlation, some research has shown evidence of individual genes that ha v e specific interactions and outcomes, especially related to neurotransmitters. One promising area of research is dopaminergic receptors. The dopaminergic system is known to have a multitude of effects, including memory, learning, motivation, and reward. 4 It is not surprising that this pathway has been linked to educational achievement because of its multiple impacts. These impacts are also why it is a promising research avenue. 4 The three genes Beaver et. al (2010) studied showed correlations with English, math, history, and science grades, to varying degrees. 4 All of the "risk alleles,, , or rather the alleles
of each dopaminergic receptor that are related to poor academic performance , when present, were related to poorer academic performance. 4 Despite the limitations of this study (only three genes were studied and GPAs were self-reported) these results are a strongly support that specific genes can be related to academic success. 4 Beaver et. al (2012) expanded on these results and looked at academic achievement. Academic achievement is defined as what level of schooling the participants completed (high school, baccalaureate, etc.). 5 They found that three dopaminergic polymorphisms were negativ ely correlated with higher levels of education. 5 In other words, those without the three polymorphisms were more likely to complete the highest levels of education (post -baccalaureate degreeslaw, medicine , etc.). 5 The MAOA gene is another interesting avenue MAOA is an enzyme that can metabolize serotonin. Two alleles were analyzed, one with triple repeated sequence (3-repeat) and one with a quadruple repeated (4- repeat). 6 Of the two alleles analyzed 3-repeat showed a lower activity.6 This results in more serotonin in the 3-repeat participants. 6 Increased serotonin, which is related to an increase in negative emotions such as depression, anxiety, and fear in response to stressful stimuli . 6 These emotions can impact the studenfs ability to learn and perform in academic situations. Liu et. al (2017) found that both groups had a negative relationship between academic self-efficacy and academic - related boredom. They also found
that the 3-repeat allele had a stronger correlation, indicating that serotonin levels could play a role in these two measures.
6
Further studies have examined the complicated roles of genetics and environmental factors as they relate to each other. Propper et. al (2012) examined the interactions of parenting and the genetics of both parents and children on the academic success of the child in first grade. 7 One of the most interesting things they found was that the genetics of the child could impact the parenting style of the parents, which can in turn impact academic achievement and classroom attitudes. 7 Different types of dopamine receptors change the way children react to their parents. 7 This study found that receptor types 2 and 4 evoked less sensitive parenting. 7 Less sensitive parenting then creates behaviors in their children which make them less successful in a classroom.
7
While these studies show promising leads in the fields of genetics and academic success, they also concede the explorative and superficial nature of their results. This is a relatively new field of study and all results should be regarded with caution. While preliminary results are still indicative of the need for further research could impact the way we teach, and parent children based on each individual's genetic make- up.
REFERENCES
1. Rimfeld, Kaili, Margherita Malanchini, Eva Krapohl, Laurie J. Hannigan, Philip S. Dale, and Robert Plomin. "The Stabi lity ofEducational Achievement across School Years Is Largely Explained by Genetic Factors:' Npj Science of Learning 3 (December 2018) : 1-1 0 https://doi.org/10 1038/s41539 - 018 -0030- 0
2. Selzam, S, E Krapohl, S von Stumm, PF O Reilly, K Rimfeld, Y Kovas, PS Dale, J J Lee, and R Plomin. "Predicting Educational Achievement from DNA:' Molecular Psychiatry 23 (January 2018): 161-161. http s://do i.org /10.1038/mp.20 17.203.
Maynard, B. R. K. M. Beaver M G. Vaughn, M. DeLisi, and G. Roberts "Toward a Bioeco ogical Model o f School Engagement: A Biometric Ana l ysis of Gene and Environmental Factors: Social Work Research 38 (2014): 164-76. https: //doi.org/10 1093/swr/svu018.
4. Beaver, Kevin M., Michae G. Vaughn, John Paul Wright, Matt DeLisi and Matthew 0. Howard. "Th ree Dopaminergic Polymorphisms Are Associated with Academic Achievement in Middle and High School." I n t elligence 38 (2010) : 596- 604 https://doi.org/10 1016/j.intell.2010.08 00 1.
5. Beaver, Kevin M., John Paul Wright, Matt Delisi, and Michael G Vaughn. "Dopaminergic Polymorphisms and Educational Achievement: Results from a Longitudinal Sample of Americans:• Developmental Psycho logy 48 (2012): 932-38. https://doi.org/10 1037/a0026313.
6. Liu, Yangyang and Zuhong Lu "The Relationship Between Academic Self- Efficacy and Academic - Related Boredom MAOA Gene as a Moderator:' Youth & Socie y 49 (20 17): 254 - 67. https:/ do1.org/10.l 77/0044118Xl45352 19.
7. Pro,f per, Cathi B., Michael J.Shanahan, Rosemary Russo, and W Roger Mills-Koonce. "Evocative Gene-Parenting Correlat ions and Academ c Perfo r mance at Fi rst Grade: An Exploratory Study. Development and Psychopathology 24 (2012): 1265- 82 https://doi.org/ 10 1017/S0954579412000697.
The Ellect DI leep on Pertormancein chool
By Sam Bottum
As college students, we have all heard that sleep is key to performing well in the classroom. Just how true is this? This article will delve into several studies to get to the bottom of the age- old question.
First we will take a look at a stud y conducted by Arne Eliasson et al. (2002). They conducted a study that involved surveying one thousand high school students and two hundred middle school students. They found that a vast majority (90%) of student s reported feeling drowsy during the school day. However , they found no correlation between sleep time and grade point average (GPA) (Eliasson et al., 2002). However, it is important to note that G PAs were self- reported and as such , could be subject to response bias.
Now, we' ll move on to another stud y conducted by Arne Eliasson et al. in 2009. This study was conducted specifically on college- aged student s and as such is more applicable to our uni v ersity. In terms of total sleep time (TST), there was so significant correlation between TST and GPA (Eliasson et al., 2009). However, another important aspect was in vestigated with this survey: wake time and bedtime, on days with and without class. They found that students who performed better academicall y were going to bed earlier and waking up earlier (Eliasson et al., 2009). Those in the top quintile of GPA went to bed , on average , at 12:00am on days with class, and woke up at 7:13am (Eliasson et al., 2009). By contrast, those in the bottom quintile went to bed , on average, at 12:38am and woke up at 802am (Eliasson et al., 2009). This study show s that bed / wake time are a far better predictor of
academic success than TST.
A third stud y, conducted by Royce Singleton et al. in 2009 added a third variable into the study: alcohol consumption. Two-hundred and thirty-six students, randomly chosen from a list given by the registrar, participated in an interview. These students were asked about various questions including how often they drank, how much they drank in each instance, total sleep time, and sleep schedule (Singleton et al., 2009). In order to compare this to academic performance , students released information regarding their SAT s cores and grade performance, which was given by the office of the registrar so as to avoid response bias (Singleton et al., 2009). The conclusion given was that students who drank on a more frequent basis , and consumed more in a given period, had later sleep schedules (Singleton et al., 2009). The latene ss of sleep s chedule, as shown in this study and the study describe above by Eliasson et al. (2009) show that lateness of sleep schedule is detrimental to academic performance (Singleton et al., 2009). They also made the conclusion that there is a weak negative association between total sleep time and academic performance, as was shown in the study done by Eliasson et al. (2009) (Singleton et al., 2009).
These three studies are not the only ones that show the importance of sleep on academic performance. A more recent study by Trockel et al.,
performed in 2010, showed that sleep was the most important determining factor of academic performance, outweighing exercise, diet , and several other investigated factors (Trockel et al., 2010) It is clear from all of the research performed on the topic that sleep is important to college performance. More specifically, it is of vital importance to get to bed on time!
References
Elia sso n , A., Eliasso n A , K in g, J., Gou l d, B., & Eli asso n A. ( 2 0 0 2). Associa ti on of s le ep an d aca d em ic p e r fo rm ance Sl ee p & Br eathi n g= Sch laf & At mu ng, 6 (1), 4 5 - 48 doi:10 .1007/s 11325 - 002 - 004 5 - 9 [d o i ]
Eliasson, A. H. Lettieri, C. J., & Eliasson, A.H. (2 0 10). Early to be d , early to rise! sleep habits and aca d e m ic perfo r mance in college stude nt s .Slee p & Br eath in g = Sch l af & A t m un g, 14 (1 ), 71-75 . do i:10 . 1007 / s 11325-009- 0 282 - 2 [do i]
Sing le ton R. A ,Jr & W o l fso n , A. R. (2 00 9). Alco h o l co n su mpt io n sl eep, a n d ac ad e m ic p erfor mance a mon g co llege st ude nt s.J our na l o f Studies on Alcohol and D rugs, 70(3), 355 - 363.
Trocke l, M T., Barnes, M. D ., & Egget, D L. (2000) H ealth - relate d var i abl e s and ac ad e m ic performance am o ng firs t- year c o lleg e st u d ents: I m pli ca ti ons for sleep and o th er b eh av i o r s. Jo u rna l of A m er ic an Co llege H eal t h: J of ACH 49(3), 125 - 13 1. doi :10.10 8 0 / 0 74 4848 0 0095 9 6294 [doi ]
By Dana Oriana Morcillo
A parent's greatest joy is the moment their child is born. Howev er, this moment can become confusing and even, stressful when their newborn child has different or additional genitalia than the one expected. In moments like this, an important decision lies ahead for both the parents and the physicians in treating the child with caution and more importantly, the appropriate care. Children born with disorder of sex development (DSD) introduce a new medical dilemma that extends be yond the ph ysical, but to psychological, social and ethical concerns as well.
WhatisDSD?
Disorder of sex development , or DSD, is a "congenital condition in which the development of chromosomal, gonadal or anatomic sex is atypical" (Lee et al., 2006). Before this more recent definition, DSD was also referred to as "intersex:' "hermaphroditism :' and "pseudohermaphroditism: ' Ho weve r, due to the negati v e stigma associated with these terms, the term DSD was constructed during the Chicago Consensus Meeting in 2005 in order to create an open -minded dialogue on the diagnosis, treatment , and care of DSD. Due to the more recent development of not only the term DSD, but also the field, there is limited data on its occurrence; however, it is estimated to occur ever y 1:4500 to 1:5500 births.
DSD most often manifests as congenital adrenal hyperplasia (CAH) and mixed gonadal dysgenesisboth of which result in ambiguous genitalia at birth. Howe ver, DSD acts as an umbrella term and thus encompasses a range of disorders and condition s that result in ambiguous or atypical genitalia
History of DSD
Previous to the construction of DSD, tho se born with ambiguous genitalia were commonl y ref erred to as " interse x: ' However , the concept of inter sex soon gained a negative stigma , as it b e came strongl y correlated with who the individual is, not a condition that the indi vidual has. It became a probl em of identit y, rather than a medical condition. For parents, especially, the idea of having a child who se sex was " in-between' ' or both sexes became confusing. This negative stigma associated with intersex then prevented a health y, necessar y conversation , and sometimes ev en, care of children born with DSD. This led to the development of both the term and field of DSD that has changed the mass opinion of intersex from a unique medical problem to a common one that could be treated like any other. Without the obstacles of such a stigma, ph ysicians and researchers alike have found a more open mind in the treatment and care of individuals with DSD.
Psychological, social, and ethical concerns of DSD
After the initial diagnosis of DSD, the first and foremost concern for parent s and physicians alike is what gender the child should be. This in itself begin s the dilemma as DSD activists argue about the psy chological and social dilemmas of having to "assign " a gender. Many believe that the need to have DSD treated immediately buy s into the social need for a defined gender binary. Howe ver, others believe that b y assigning a gender, the child can avoid future unnecessary psychological stress that could re sult from possible confusion and embarrassment ofDSD. Unfortunatel y, due to the recent emergence of this field, there is little substantial and long-term data that has been conducted to either support or den y these claimed effects.
Previously, the acting ph ysician would automatically assign the gender and this was considered standard practice, as it was what was believed to be in the child 's best interest and care. However, now more caution has been implemented in not only breaching the topic of DSD, but also discussing in how to best treat it. Thanks to more adv anced technology, DSD can be diagnosed early on in the pregnancy and physicians can use this diagnosis to best ad vi se parents on what gender the child will most likely identify as. For example, congenital adrenal hyperplasia is a common form of DSD that results in children with XX chromosome to have ambiguous genitalia. Ph ysicians can adv ise parent s that 90 to 95 % of these children will later on identify as female , and giv e the parents the knowledge and tools needed to make the best decision for their child.
Future of DSD
Looking forward , further research would be beneficial in better understanding what DSD is and the effect that it can ha ve on an indi vidual's psyche and well being. With the limited research available now, ph ysician s can try their best 1n guiding parents
through this difficult decision, but the lack of information can be detrimental in properly exploring and evaluating all options . This , above all, hurts the children affected by DSD. Through more comprehensive and long -term data then we can give these children the best quality of life possible.
Davidoff, Frank, and Daniel D. Federman. "Mixed Gonadal Dysgenesis:' Pediatrics, vol. 52, no. 5, 1973, doi: PubMed 4147604.
Feder, Ellen K., and Katr na Karkazis. "What's in a Name? The Controversy over 'Disorders of Sex Development:' TI1e Hastings Center Report , vol. 38, doi: 10.1353/hcr.0.0062 Houk, C.P., and P. A. Lee. "Consensus Statement on Terminology and Management: Disorders of Sex Development:' Sexual Developmen t vo l. 2, no. 4-5, 2008, pp. 172- 180, doi:10 1159/000 152032 Hyun, Grace, and Thomas F.Kolon. "A Practica l Approach to Intersex in the Newborn Per od:' Urologic Clinics of North Amer ica, vol. 31, no 3, 2004, pp. 435-443, doi: 10.1016/j. ucl.2004.04.008.
Kon, A. A. "Ethical issues in decision-making for infants with disorders of sex deve l opment:' Honn Metab Res., vol. 45, no. 5, pp. 340-343, 2015, do 10.1055/s-0035-1547269. Krone, Nils. "Congenital Adrenal Hyperplasia: Oxford Medicine Online, 2011, doi: 10.1093/med/9780 99235292.003.0616.
Lee P. A., Houk C. P., Ahmed S. F.,and I. A. Hughes. "Consensus statement on management of intersex disorders:" Pediatrics, 2006. l 18:e488-e500.
Lee P. A., Houk C. P., Ahmed S F., and I. A. Hughes "Internationa l Consensus Conference on Intersex organiz.ed by the Lawson Wilkins Pediatric Endocrine Society and the European Society for Pediatric Endocrinology. Consensus state ment on management of intersex disorders In ternationa l Consensus Conference on lt1tersex:' Pediatrics 2006. l 18:e488-e500.
Sarafoglou, Kyria kie, and S. Faisal Ahmed. "Diso r ders of Sex Deve lopment: Challenges for the Future:' The Journa of Clinical Endocrinology & Metabo lism, vol. 97, no 7, 2012, pp. 2292-2294, doi: 10.1210/jc.20 12-2178.
Sax, Leonard. "How Common Is Intersex? A Response to Anne Fausto -Sterling:' Journal of Sex Research, vol. 39, no. 3, 2002, pp. 174 -1 78, doi:10 .1 080/00224490209552139. Speiser, Phyllis W "Cong enita Adrena Hyperplasia:' Fl000Research 4.Fl000 Faculty Rev (2015): 601. PMC. Web. 18 Oct. 2018.
In2005.pathologistDr.BennetOmalu published a groundbreakingpaperonthelongtermhealthrisksofconcussionssustainedduring Americanfootball.Whileperforminganautopsyon thebrainofformerPittsburghSteelersplayerMike Webster.whohadsufferedforovera decadewith memory.judgement.andothersymptomsreminiscentof Parkinson'sDisease.unusualtissuedamage wasdiscovered. 1 Duringhis17-seasonprofessional footballcareer.Websterhadsustainedthousands ofblowstotheheadandhadsufferedfrommultipleuntreatedconcussions. 2 3 Whileinitialtestsdid notrevealanythingoutoftheordinary.specialized tissuestainsrevealedhighfrequenciesofamyloid proteinplaqueslocatedacrossthecerebralcortex. It wasconcludedthatMikeWebsterhaddiedfroma diseaseknownaschronictraumaticencephalopathy (CTE).resultingfromhisbraininjuriessustained duringhisfootballcareer. 4
Recentstudieshaveincreasedconcerns of theimpactofyouthtacklefootballonlaterneurologicalhealth. It hasbeenfoundthatplayingtackle footballbeforetheageof12leadsto earlyonsetofCTE symptomswhencomparedtothosewhodidnotstart playingtacklefootballuntillaterin life.Evenmore concerning. it hasbeenfoundthateachyearoftackle footballbeforetheageof12seemsto hastentheonset of cognitive.behavioral.andmoodproblemsby2.5 years. 6.1
Thebrainundergoesextensivegrowthduring earlychildhood.andassuch.injuryatayoungagecan havedisastrousconsequences. 8 MRIscansperformed onchildrenaged8-13haveshowedthatjusta single seasonof playingfootballcanresultsin decreasedand randommovementofwatermoleculesbetweenthe whiteandgraybrainmatter. a processthatistypically uniformandfrequentin healthybrains.Noneofthe playerstestedsufferedfromdiagnosedconcussions. furthersupportingthatrepeatedsubconcussiveblows
totheheadcanbejustasdamaging. 9
Whilerare.mostdeathsdueindirectlyor directlytofootballoccurin highschoolfootballplayers.10Arecentcasehasreignitedconcernsovernot onlythelong-termneurologicalrisksof playingfootball ata youngage.butalsooftheimmediatehealthrisks. OnSeptember30thof2018. a 16-year-oldhighschool footballplayer.whohadpreviouslybeenin excellent physicalhealth.diedaftersuffering a headinjury duringafootballgame.Theplayerhadreportedbeing unabletofeelhisbodybeforelosingconsciousness andpassingawayfromtraumaticbraininjury-induced cardiacarrestlessthantwodayslater.Thiswasdespite extraprecautions to preventheadinjury . including thepurchaseandusageofanNFL-qualityhelmet. Alarmingly.whiletheplayerhadbeenslowto getup afterbeinghitbytwoplayers.thespecificheadinjury leadingto hisdeathwasnotobvious.11.12
andMarylandhaveconsideredbanningallyouth tacklefootball.1617Whilenothinghascomeofthis yet.thedebatecontinues.andit is clearthataction mustbetakento protecttheneurologicalhealthof all children.
3.)6ordonM(2017.June06)Beforeconcussion , Mike Webster 's ShatteredLifeRetrievedfrom https,//wwwrdcom/health/conditions/mike-webster-brain-injury/ 4.)0malu. B I DeKosky S.T..MinsterR L..Kamboh. M I Hamilton R L..& WechtC.H.(2005). ChronicTraumaticEncephalopathyina NationalFootballLeaguePlayerNeurosurgery.57.128-134 doi:10.1227/01.NEU.0000163407 .92769.ED
8.)BelsonK.(2017) PlayingTackleFootballBefore12lsTiedtoBrainProblemsLater.Retrieved from https://wwwnytimes.com/2017/09/19/sportsfootbalUtackle-football-brain-youth html
9 )Bahram i, N etal (2016)SubconcussiveHeadImpactExposureand WhiteMatterTractChangesover a SingleSeasonofYouthFootballRadiology281(3)doi,101148/radiol.2016160564
13.)Laskas. J. M.. &Veasay.N.(2009September15 ) BennetOmalu . Concussions.andtheNFLHowOne DoctorChangedFootballForever.Retrievedfromhttps://www.gq.com/storynfl-players-brain-dementia-study - memory-concussions
14)Finkle.A.M(2018.October19)Stopconcocti ng unscientificexcusesfor ignoringbraininjuries fromfootballRetrievedfromhllps://chicagosuntimes.com/opinion/cte-brain-injury-nfl-footbal U 15.)Th e NFLTriedto IntimidateScientistsStudyingtheLin k betweenProFootballandTraumaticBrain Injury . (n.d. ) Retrievedfromhttps://www.ucsusa.org/intimidating-scientists-documenting-link-between-pro-football-and-traumatic - brain-injury#.W8wS3GhKhPY 16.)Feldman. J. (2018.April4). Fourstatesconsiderbanningyouthtacklefootball.Retrievedfromhttps:// www.si com/nfl/2018/04/04/four-states-consider-banning-youth-football-themmqb-newsletter 17)Belson. K (2017.September19 ) PlayingTackleFootballBefore12 lsTiedtoBrainProblemsLate r Retrievedfromhttps:/wwwnytimes.com/201709/19/sports/footbalUtackle-foolhall-brain-youth html
ORIGIN AND ETHICS OF BIOHACKING
LINDSEY PAUL
n a warm, September day in 1900, a scientist named Jesse Lazear lay dying of yellow fever in Havana, Cuba. Only 34 years old at the time, Lazear had been researching the disease as a member of the U.S. Army Yellow Fever Commission. Just days before his death, Lazear had exposed himself to mosquitos that had fed on the blood of disease - ridden patients at a Cuban hospital, purposefully infecting himself with yellow fever. Ironically , his death proved his experiment successful; only through his sacrifice was he able to confirm the mechanism of the spread of yellow fever through mosquito vectors, opening the door that led to the yellow fever prevention programs and eventual development of the vaccine. 1
In the hundred years since that historic summer day, yellow fever incidence has dropped, survival rates have risen , and the disease has been deemed preventable with vaccination. But Lazear has another legacy - his rogue self-experimentation method has slowly rev erberated throughout the scientific community and, more recently , into the general public. In a Facebook Live video in October of 2017, computer programmer and s elf-identified "community organizer " Tristan Roberts injected himself with a homemade gene therapy treatment for HIV with the help of life-extension activist Aaron Traywick. Unfortunately , the intervention did not seem to lower his viral load. 2 Four months later, Traywick stood on stage at a confer-
ence in Austin, Texas and syringed himself with an alleged cure for herpes . Although over a century has passed since Lazear s fatal experiment , the risky, public spectacles of Roberts and Traywick feel jarringl y s imilar. The difference is that today , there is a name to describe their actions: biohacking. 3
Since its first mention in a 1988 Washington Post article, the biohacking movement has taken on many definitions , with the overarching goal of disseminating information and techniques to allow people outside of the traditional scientific community to modify biological systems.4 Biohackers, then, are the members of this movement, viewing themselves a s boundary-pushers and explorers. From Kevin Warwick , who inserted an RFID tag into his arm in 1998 to contro l his electronic devices, to Josiah Zayner, a former NASA biochemist who in 2017 injected modified DNA into his arm muscles on live camera , the leaders of the biohacking movement have striven to enhance their physiological and biochemical environments with the goal of optimizing human performance , hoping to bring the ability to do so to the mas ses.5 Since its inception , biohacking has been closely intertwined with the DIYbio movement , which advocates for open accessibility and the empowerment of indi vidual s to engage in their own experimentation. 6
From 2005 to 201 O, the biohacking movement grew quickly, gaining recognition from conventiona l scienti sts as well as hobbyists outside of the academic community. 7 Within the past four ye ars , biohacking has infiltrated the main stream media. Magazines such as Men's Fitness , Shape, and Popular Mechanics have
recently featured articles advising readers on how they can "biohack" themsel v es to enhance their metabolism, sleep cycles, stress levels, and mor e 8 · 9 • 10 • 11 Unlike the radical experimentation of Roberts and Traywick, these articles offer diet advice and review up-and-coming wellness trends such a cryotherapy, intermittent fasting , meditation, and microdosing, all of whi ch are popular methods to alter one s physical and mental capabilities.
With biohacking gaining momentum so quickly, the scientific community has started to take notice: aspects of the biohacking movement are making their way into the Ph.D. curricu lum at the University of California, San Diego, and some in ventions made by biohackers in community labs have captivated the attention of traditional researchers at Harvard and other institutions. 12 13
But the recent popularity of biohacking has also caused questions to arise about just how accessible science should be. Authorities and academics have started to worry about biosecurity - how can we en sure biological materials do not get into the hands of the wrong people? How can we prevent the synthesis of threatening materials (such as ricin and anthrax) or the intentional spread of epidemics, and how can we be prepared for these risks?
The FBI has been asking the same questions . In the past few years, they have created the Biological Countermeasures Unit and have taken a "neighborhood watch'' approach, forming direct relationships with biohackers to encourage reporting and safe practices and sponsoring booths at genetic engineering and synthetic biology conference s 14 • 15 The scientific community is also cautious about potential threats. Many chemical venders will only sell potentially unsafe materials to professionals , making it extremely difficult to acquire and use these materials without the proper credentials. 16 Individual safety is also a con cern , although it is one that is harder to regulate without infringing upon indi vidual freedoms . The danger of biohacking lies in its inherent deviation from the scientific process; how can people ensure their own safety during self- experimentation wit hout aggregated data from contro lled and replicated trials? If materials are obtained cheaply, how can users e n sure their purity? Some argue that individuals have the ultimate right to decide how the y choose to manipulate their own bodies. Others warn that celebrity biohackers like Roberts and Traywick serve as dangerous examples to amateur fans , who may not understand th e potential consequences of copying their haphazard inve stigatory approach . 17 Without a standardized method of documentation or a common network for sharing data and results , biohackers have no way of anal yzing or mitigating hypothetical risks based on the findings of others in the communit y.18 It can be difficult to con s ider every possible hazard, from whether an implantable hard ware device could impact a biohacker s ability to recei ve an MRI scan to whether an untested gene therapy cou ld induce a fatal immune response. 19 For this reason, some experts argue for stronger FDA oversight and stricter regulator y require -
ments before biohackers are permitted to experiment. Today, Laz ear's sacrifices are glorified among those familiar with his story But at the time , it was not so simple. An understanding of yellow fever did not simply occur with his passing; as with any inv estigation of scientific rigor , it took years of further experimentation by his colleagues to confirm the results that his death seemed to exemplify. Did he have to die in order to further their cause? Or could the same result have been achieved another way, enabling him to continue working toward his dream of a y ellow fever -free future? Modern biohackers shou ld use Lazear's l egacy to ask themselves the similar questions, only undertaking experimentation once they have a deep understanding of their actions and motivations.
Despite its complexities, biohacking has allowed a whole generation of non-scientists to engage with the natural world in ways that even decades ago would have been impo ssible. With so many people working to understand the mechanisms of life and enrich their own biology, creative per spective s are flowing into the field This new spa ce is here specifically for dreamers and idealists who are willing to take risks on behalf of themselves and humanity, and - who knows - the next big discovery might be among their midst.
References
I. The His orical Medical Libra y of the College Physicians of Ph iladelphia. Owen , Rob ert Lat ham. Yellow fever: a compli.cati on of vario u s p u blica tions. Washington: Govt Pr nting Office, 191 l.
2. Lussenhop, J. (2017, November 21). Why I injected myself with an untested gene t herapy. Retrieved from llttps://www. b bc.com/news/world- u s-canada-4199098 l
3. Bromw ch J.E. (2018, May 22). Death of a Biohacker. The New York Times. Retrieved from ht tps://www.nytimes.com/20 18/05/ 19/style/biohacker-death-aaron-traywick h tml 4. Schrage, M. (1988, January 31). PLAYING GOD IN YOUR BASEMENT. Washington Post. Retrieved from llttps://www.washingtonpost.com/archive/opinions/l988/0l/31/playing-godin-your-basemen /6l8fl74 d -fcl -47b3-a8db-fael b8340c67/
5. Yetisen, A. K. (2018). Biohacking Trends in Biotechnology, 36(8), 744-747. https://doi. org/10.10 16/j.tib t ech.2018.02.0l l 6. Gallegos, J.E., Boyer, C., Pauwe s, .E., Kap la n, W. A., & Peccoud, J.(2018). The Open Insulin Project: A Case Study for 'Biohacked Medicines. Trends in B o ec h no logy, 0(0). h ttps://doi. org/ 10.10 16/j.tib tec h .2018.07.009
7. Ledford, H. (2010). Life hackers. Na ure; London, 467(7316), 650-652. 8. Lecovin, G. (n.d.). How to Biohack Your Met abolism. Ret rieved November 13, 2018, from htt ps://blog.nasm org/n u trition/biohack-meta b olism/ 9. Huckle, M. 2 015). Biohacking for Beginners Men's Fitness. Retrieved November 13, 2018, from file:///Users/Owner/Downlo ad s/BIOHACKJNG FOR_B.EGJNNERS.pdf
10 Malacoff, J (2018, April 9). Everyth ng You Need to Know About Biohacking You r Body. Shape Magazine Retrieve d November 13, 2018, from https://www.shape.com/health-eating/ d et -tips/what• is -b io h acki ng- n u tri t io n -science
1 1. Detw iler, J (2018, Ju ne 25). Hacked My Body So You Don' Have To. Popu ar Mec ha nics. Retrieved November 13, 20 18, from https://www.popu larmecha ni cs.com/sc ience/hea l h / a21272160/b oh a cking
12 Webb, S. (2017, October). Boo tstrapping Biology. BioTechniques, 63( 4), 152 - 156. Imps:// www.fu ture -sc ence.com/ d oi/pdf/ 10.2144/0001 14594 13 Blazesk , G. (2014, May 1). The Need for Government Oversight Over Do - It -Yourself Bio h acking, th e W ld West of Synthe t ic Bio ogy. Seton Hall University eReposi ory. Retrieved November 13, 2018 from h tt ps://scholarship.s h u.edu/cgi/viewcon t en t .cgi?referer=ht ps:// scholar.goog le.dk/ &h tpsredir = 1&art cle= 141 1&context stude n scholarship
14. Wolinsky, H. (2016). The FB and b iohackers: an un u sual relations h ip. EMBO Reports, 17(6), 793 -796. h tt ps://do i.org/lO. 5252.embr.201642 4 83 15 Shinde, S. & Meller -Herbert, 0. (2017, June 12). Biohacking. Anaes hes a, 72(7), 909. Retrieved November 3, 2 018 from https://online li.brary.wiley.com/doi/full/1 O. l ll/anae.13952
A BIOLOGICALLY MODIFIED WORLD
MAXIM ERMOSHKIN
he field of synthetic biology has recei ved more attention in the last decade to b eco me a leading emerging technology. 1 The field merges engineering concepts with the study and manipulation of biology. Synthetic biology fosters new solutions to biological probl ems by reconstructing biological phenomena as well as creating entirely new organisms. Venture capitalists and governments have dramatically increased in vestment and funding in this field because of its potential in reimagining how medicine, energy, and food are developed .
A major premise for synthetic biology is that biolog y can be understood through its construction. This is encompassed in the idea that what one can build, one can understand . 2 Constructed living unit s are more predictable as a technology than naturally occurring ones. The reason why is that living systems in nature tend to contain a lot of genetic matter that has not been prop erly characterized and identified. 3 This makes naturally occurring genomes inherently unpredictable since not all genes or their functions and interactions with other genes are known. A major goal in synthetic biology is to create minimal genomes , which invo lve the lowest number of genes necessary for a cell to function. It is much easier to modify a genome that has been reduced to its foundation so that all the genes and their interactions are known. Any additional genes that are added to the genome can be accounted for. Thus , a synthetic cell with a minimal genome might be much easier to manipulate than a natural cell since genetic modifications to such a synthetic cell could have more predictable interactions.
Applications
In many ways, biological cells can be viewed as mini- factories that can be tweaked to produce desired compounds. Thus far, synthetic biology has provided a few new avenues by which health issues can be addressed. One of the successes of synthetic biology has been the synthesis of the antimalarial Artemisinin using engineered baker's yeast, Saccharomycescerevisiae. 4 This technology has been used to compensate for shortag~es from harvesting Artemisia annua , a plant source
for artemisinin production. Engineered organisms have also been effective in detecting very low concentrations of arsenic in well water , as the bacteria can be engineered to change color or glow in arsenic environments 5 This method has been shown to be more sensitive to detecting l ow arsenic than many currently available technique s. Growing bacterial cultures and using them on paper strips is also quite cheap and simple to implement. These methods of addressing health issues are particularly advantageous in less developed countries because of increased affordability and accessibility.
Ideas
Many applications of synthetic biolog y seem to be from science fiction. There are ideas on resurrecting extinct species by reconstructing their genomes, using DNA as a form of data storage, or even using synthetic plants to grow houses. 4 One particularly interesting concept is the creation of 'mirror' organisms in which all chiral biomol ecules have been converted to their enantiomers. 4 Life on earth tends to favor one enantiomer over the other. This is clearly the case with amino acids, where the left -handed enantiomers are used almost exclusively to construct ' left -handed ' proteins. 6 A ' mirror organism' that consists entirely of 'right-handed ' proteins can be predicted to behave s imilar to its natural version . However, the mirror organism will be unrecognizable to most pathogens that infect the normal organism. This is becau s e most pathogens have evolved receptors and enzymes to match the ' left -handed ' protein s on their intended hosts. The hypothetical mirror organism would ha ve 'right -handed' proteins that no
longer match the pathogen receptors and enzymes, hence making these mirror organisms immune to many pathological mechanisms. 4 This is an outside the box way of conferring resistan ce again s t viruses and bacteria in target organisms. Other equally creative ways of looking at age old problems can be supported through synthetic biology such as in biofuel generation, environmen tal sustainability, and many others .
Ethical Concerns
There are many ethical considerations to be made given such abilit y and potential to manipulate living organisms that synthetic biology promises. Designing synthetic organisms can have unforeseen consequences on the environment. For example, reintroducing previously extinct animals or introducing purel y synthetic organisms, such as the conceptual mirror organisms, to existing ecosystems might have unpredictable consequences. Synthetic biolog y cou ld also be used as a tool for bioterrorism by creating novel, lethal pathogens for use as biological weapons. Many question whether humans are playing God by pursuing adv ancements in synthetic biology. All in all, synthetic biology is simply a tool , and the outcomes it has for the future rest upon the decisions made by those who have access to it. It can revolutionize our modern-day world and advance progress toward solving difficult problems such as antibiotic resistance. However, synthetic biology has the potential to be used in many dangerous ways and therefore needs to be monitored and regulated as it continues to develop.
References
1. Kirk, David. "Investment Fuels Cutting -Edge Synthetic Biology in UK:' SynBioBeta, 16 July 2018, synbiobeta.com / news / investment -fuels - cutting -edge -synthetic -biology - in -uk/.
2 . Roosth , Sophia . Synthetic: How Life Got Made . The University of Chicago Press , 2017.
3 Church, George. Regenesis - How Synthetic Biology Will Reinvent Nature and Ourselves. The Perseus Books Group, 2014.
5. Clarke, Tom. "Modified Bacteria Spot Arsenic:' Nature News, Nature Publishing Group, 2 Oct. 2003, www. nature.com / news / 2003/ 031002 / full/ news03029 -7 .html. Sedbrook, Danielle . "Mus t the Molecules of Life Always Be Left-Handed or Right - Handed?" Smithsonian.com, Smithsonian Institution, 28 July 2016, www smithsonianmag.com / space / must-all-molecules -lifebe -left -handed -or - right -handed - 180959956/ .
A FRESH LOOK AT LAST CENTURY'S CANDIDATE FOR FIGHTING BACTERIA
BY SAVANNAH DEL CID
umanit y ha s fought infectious bacteria for ages, but it wasn't until recentl y that humans began to distil chemicals from nature to fight bact eria , which we know as antibiotics. 1 At first, bacteria were easily treated with antibiotics, such as the well-known penicillin. However , the improper and overu se of antibiotics over the decade s has created the perfect environment for mutated bacteria to thrive despite antibiotic treatments. This has become a major concern for doctors and patients because the need to utilize methods beyond the pharmaceutical has not become widely apparent until now. 2 Decades after the development of antibiotics, humanity appears to be caught without th e proper tools to continue its battle with infectious bacteria yet again. However, headlines in the news over the
attack, phage therap y seeks to utilize the biology of the phage to attack infectious bacteria.
Some news stories might claim that phage therapy is "new." Even though the true first account of bacteriophage is up for debate amongst scholars, it should be noted that bacteriophage have been observed as early as 1896 and 1898. 3 In 1896, the British bacteriologist, Ernest Hankin , indicated that an "unidentified substance" was having antibacterial effects on a bacteria called Vibrio cholerae, which leads to cholera. 3 Hankin observed that the substance existed in the Ganges and Jumna Indian rivers and curbed cholera outbreaks. 3 In 1898 , a Russian bacteriologist, named Gamaleya, was researching Bacillus sub tilis and developed a theory concurring with Hankin. 3 It took about two decades for the theory of past few years have identified a potential solution: phage therapy It's not a new idea, but considering our rapidly
" .. . improper and overuse of antibiotics over the decades has created the perfect enviornment for mutated bacteia to thrive"
bacteriophage to be revisited wherein Frederick Twort, an English bacteriologist, hypothesized the "unidentified substance" was a virus. 3 growing knowledge of molecular biology, it could provide the way to combat antibiotic resistance.
What is phage th e rapy? Essentially , bact e ria have more enemies than just the human immune system. A class of viruses (or phage), known as bacteriophage, are specialized to kill certain strains of bacteria via a cycle of lysis. During the cycle, a virus hijacks a bacterial cell and its machinery to produce more viruses until the bacterial cell bursts and dies. For example, th e CTX phage targets Vibrio cholerae , th e bact e ria that causes cholera. While antibiotics utilized chemical
However , bacteriophage were not "officially" discovered until 1916 by French-Canadian microbiologist Felix d Herelle of lnstitut Pasteur in Paris .3
Following the declaration that bact e riophage kill infectious bacteria , d ' Herelle conducted experiments and even organized a Parisian commercial laboratory, which produced a total of five bacteriophage product lines marketed by the predeces so r of today's L'Oreal. 3 Though the prospects of using phage therapy seemed hopeful, the commercial production of antibiotics was also underway. After some experimental trials , phage therapy ' s effectiveness fell short, likely due to the
underdeveloped knowledge of molecular techniques and genetics in the early 1900s; after all, the human genome was not fully sequenced until 2003. Soon, it was evident antibiotics had the greater financial backing and public support in the western world, leaving phage therapy to the wayside for decades.
Of course , not all research into phage therapy was terminated. D' H e r elle spurred res e arch in phage therapy in the east, particularly with scientists of Tbilisi, Georgia, a city which now hosts some of the world's best phage th erapy laboratories - The Phage Therapy Center and the Eliava lnstitute. 4 In Eastern Europe and the Soviet Union, the refinement of phage therapy techniques was essential because the political climate of the late 1900s led to a limited supply of antibiotics in the eas t. In fact, the combination of the Cold War and phage therapy 's research roots in the east, created a notion that phage therapy was "un-American" compared to popular antibiotics, as revealed by influential commentary by Gunther Stent in on the 1925 novel Arrowsmith, which discussed phage therapy in a fictional context. 5
Despite the political rifts surrounding phage therapy, it s use as a potential tool against antibiotics is evident. A recent example occurred in 2015, when psychology professor Tom Patterson became ill during a trip to Egypt.6 Patterson was inf e cted by a superbug (Acinetobacter baumannii), resistant to conventional antibiotics. After monumental effort s, emergency approval from the FDA was granted and phage therapy was administered to Patterson in the US.6 Following his treatment, Patterson recovered;, and the success of his case sparked the creation of the first North American phage therapy center at UC San Diego and a TEDx talk on phage therapy in Nashville 6
However , not everyone is convinced reviving the use of phage therapy is a wise decision. Molecular Biologist Drew Smith mentions severa l key factors to consider. First, antibiotics are extremely economical in comparison to more expensive phage th e rapy and high costs cause limitations on who can afford the treatment, instigating ethical dilemmas surrounding phage therapy .7Second, phage are highly specialized to target specific bacterial strains, which lead s to the need to use cumbersome multi-phage cocktails; whereas, the same situation would only require one or two antibiotics.7 Third, due to the way phage interact with the immune system, our current execution of phage therapy results in a one -time-u se policy: if the phage enters the system again, the patient's immune system will be aggressively provoked, causing more harm than good. 7 Lastly , there
is uncertainty surrounding the phage efficacy data reported by Russia and the eas t, as well as little to no data being produced from the west, so the exact level of effectiveness for every phage is not well-known .7
Phage therapy is making a reappearance in humanity s saga with inf e ctious bacteria. Even though it originally could not be properly executed due to poor experimental results and lack of molecular knowledge, the use of phage therapy is now a more plausible solution to antibiotic resistance. Of course , there are severa l issues with cost , protocols, and practicality that need to be resolved; however, the potential for phage therapy should not be dismissed After all, our list of options to combat antib iotic resistance i s becoming rather short. Ultimately, even if phage therapy proves to be an invalid candidate against the significant scope of antibiotic resistance, science is bound to learn of mor e methods to manipulate the molecular world.
References
1 Society of Microbiology. (n.d .). The History of Antibiotics. Retrieved October 20, 2018 from https:/ /microbiologysociety .org/education-outreach/antibiot i cs-unearthed/antibiotics-and-ant ibiotic-resistanc e/ the-hi story-of-a ntibi ot ics.html
2 WHO. (2018, F ebruary 5) Antibiotic Resistance. Retrieved October 20, 2018, from http://www.who.int/news-room/fact-sheets/detail/ antibiotic-resistance
3 Sulakvelid ze, A., Alavidze, Z., & Monis, J. G. (200 1, Mar ch). Bact e riopha ge Therapy. Re trie ved October 19 2018, from http s:/ /wwvv. ncbi.nlm.nih.gov / pm c/ articles/ PMC9035 1/ # B21 4 Society of Microbiology (2016, August 09). Phage therapy. Retri eved October 21, 2018, from http s:/ / mi crobiology society.org/publication/past-issues/future-tech/article/phage-therapy-future-tech. html
5 Summers, W. C. (2012, April 01). The Strange History of Pha ge Ther apy. Retrie ved Octo ber 22, 2018, fr om https:/ /www .ncbi.nlm . nib.go v/ pmc / articl es/ PMC3442826 / 6 Kahn, L. H. (2018, October 09). Bacte rio phages: A promising a ppro ach to fighting antibiotic-res is tant b acteria. Retrie ved October 22, 2018, from http s :// th ebu llet in.or g/20 18/ 10/bact eri oph ages-a -promisi ng-a pp roach-to-fighting-antibiotic- resistant-bacteria/ 7 Smit h D. (20 18, March 28). Why Bact e riophage Therapy Won' t Solve The Problem Of Antibiotic Resistance . Ret rieved October 26, 2018, from http s:/ /www .forbe s .com/s ite s/q uora /20 18/ 03 /28/ why-bacteriophage-therapy-wont-solve-the-problem-of-antibiotic-res istance/ # 5449ea3fbf3f
CONSERVATION IN A DEVELOPING COUNTRY
MELANIELIPPERT
Amour Mohammad started farming in Pemba Is land, Tanzania in 1994 and soon became an icon for sustainable land management on the island Climate change has caused droughts , salt water intrusion into farms , and nutrient runoff from the land in Pemba . Despite this , Mohammad viewed climate change not as an obstacle, but as an opportunity to be innovative.
Mohammad originally worked for Pemba's government in 1992. He tried to get money from the government to fund his idea to create a sustainable farming model, but had no luck. Determined to develop a reproducible system to sustainability manage farms, he funded the project himself. Mohammad is now an expert on local farming pra ctices , and community members visit his farm often to learn how to implement his techniques on their own land.
As climate change persi s ted , Mohammad identified three main problems when trying to farm in Pemba These included a lack of water availability, ocean salt water intrusion, and poor soils caused by the nutrient runoff. Rather than using modern technolog y or western farming techniques , Mohammad developed his own unique methods to address these problems.
The land in Pemba is very flat, which increases nutrient runoff and salt water intrusion . To combat this, Mohammad employed raised terraces to prevent salt water from washing over his crops and to help the farmland retain its nutrients. He also created his own irrigation system so his crops could be watered even during the increasingly intense dry seasons. Additionally, he dug a solar -powered well to pump water throughout the irrigation system. Mohammad even bought cows and processed their manure to create his own natural fertilizer.
Mohammad would also grow crops for purposes other than harvesting. On his farm he had rows of bright yellow sunflowers planted between th e watermelon plant s. These sunflowers were not grown to be picked and sold. Rather , the sunflowers attracted bees, which increased the pollination and production of his waterme lon crop. Mohammad also planted a barrier of fruit trees , such as passion fruit and guavas, beside this field. He did not har vest the fruit, but instead used it as a distraction for predators like Sykes' monkeys. Instead of attacking his crops, the predators ate from the fruit trees. Mohammad has not only developed inno v ative methods to protect farmlands and produce profitable crop yields, but has also become an advocate for sustainability and the farmers in Pemba. Westerners often assume that communities in developing regions like Pemba do not understand climate change and need to be taught. But in actuality, the farmers have lots
of knowledge about climate change because they live it.
"They [the farmers ] are more intelligent than most of us; ' Mohammad emphasized. " They learn what is going on from their living:'
Mohammad explained that the people grew to understand climate change as they experienced the effects of it and saw the environment and abiotic factors changing firsthand. Thus, the people of Pemba do not view "climate change " as one entit y and often do not refer to it by that specific term, he said. In stead, they understand it to be the numerous environmental changes that they witness occurring in their daily lives and describe it as such. This mistranslation between the term "climate change;' which originated from Canadian physicist Gilbert Plass, and other countries' understandings of this word occurs in numerous parts of Africa. In a UN Africa Renewal article 1 about climate change in Africa, Ethiopian fisherman Mohammadu Bello shared Mohammad 's sen tim en t s.
"I don't know what global warming is;' Bello said in this article. "But what I do know is that this lake [Lake Chad] is dying and we are all dying with it: ' Bello went on to describe the effect s of climate change that he had experienced, such as a lack of fish, a decrease in fish size, and a recession of the lake , but never referred to them as climate change or global warming.
Mohammad emphasized that the farmers in Pemba do understand what climate change is, and many people are moving towards more sustainable farming methods. He explained that their weakness is not in understanding climate change , but rather in lacking th e
foresight to consider how it may affect the future.
Climate change has diminished the farmers' ability to increase their crop production, and most farmers ' main preoccupation is support ing their liveliho ods rather than sustaining the land for the future, Mohammad said.
Thus, many people fail to consider and foresee the future impacts of their current farming techniques and how climate change can exacerbate these effects.
"Very few people understand climate change affecting the future;' Mohammad said. Rather, "they understand the effects and impacts of climate change "now.
The people become fearful only when they feel the impact , he explained. Because of this lack of foresight, Mohammad concluded that "agriculture in Pemba is not sustainable anymore: '
He did believe, however, that there are ways to promote sustainab le farming for the future. There needs to be a strong effort to emphasize to coming generations the impacts of climate change for the future, he said. With this knowledge , Mohammad hopes that the next generations will va lue conser ving the land to help themselves and the coming generations.
Reference
1. Fleshman, M. (2007, July) Climate change: Africa gets ready. Africa Renewal. Retrieved from https: / / www.un.org / africarenewal/magazine / july-2007 / climate-change-africa-gets-ready
n 1954, the first successful kidney transplant was performed by Dr. Joseph E. Murray. Since then, organ transplantation has served as a life-saving operation, as it replaces a failed organ with a healthy and functioning organ. Recent decades have experienced great success for organ transplants due to advancement in the surgical industry as well as the availabili t y of immunosuppressive drugs that fight against organ rejection. 1 Like many medical operations, however, organ transplantation is not without its obstacles. One major problem involved in organ transplantation is that the transplants often do not last, and rejection of allografts (organs donated by humans) by the immune system frequently occurs. lmmunosuppressive drugs that prevent organ rejection certain ly exist, but such medications are only short -term solutions and do not work well against long-t erm rejection. Furthermore, there has not been much progress made to prevent chronic organ rejection. 2 Another prominent issue is the lack of organ supply in proportion to its demand. Each year, the number of patients requesting transplants significantly exceeds the number of organs available for transplantation. To put it in perspective, on average, twenty patients on the national transplant waiting list die each day, while another patient is added to the waitlist every ten minutes. 3
The types of organ rejection can be classified as hyperacute, acute, and chronic. Hyperacute rejection takes place within minutes of transplantation and occurs when the immune system's antibodies bind to the graft's antigens on its endothelial cells, leading to damage of the graft's endothelium. Hyperacute rejection is not a significant issue for allografts, as it can be prevented by matching the blood type s of the donor and recipient. Acute rejection takes place within days of transplantation and is also caused by antibodies, along with the immune system's cytotoxic and helper T-cells. The cytotoxic T cells directly target and destroy graft cells, while the helper T-cells secrete inflammatory cytokines th at damage the graft. Immunosuppressants can be used to prevent the T-cell response, although such treatment renders the immune system vulnerable to infection. Chronic rejection takes place within months or years of transplantation and is the most prominent reason for organ failure. Chronic rejection
occurs when T-cells targeting graft antigens secrete cytokines promoting the activities of fibroblasts (connective tissue cells) and smooth muscle cells, leading to graft connective tissue damage and narrowing of graft blood vesse ls. 4
No treatment for chronic rejection is currently available, and immunosuppressant treatment to prevent acute rejection has its difficulties. Immuno suppressive drugs weaken the immune system, and the patients must constantly take the drugs to prevent rejection . Furthermore, patients may receive too much or too little treatment, whi ch can lead to death or organ rejection, respectively A biopsy can be used to determine graft status, but there is a risk of bleeding . 2 A developing solution for rejection is the use ofbiomarkers, which are measurable molecules in the patient's blood and urine that can provide 1 rmation about the patient's immune system and organ functions without the risks associat-
ed with biopsies. An increase or decrease of a particular molecule could indicat e organ rejection and it s severity. Such information about the severity of rejection could help a doctor adjust drug dose to better su it the patient. However, current biomarkers are not .----- entire ly reliable, as the levels of molecules may increase only after severe organ damage has already occurred. Researchers are currently experimenting and seeking new biomarkers to be used for immune system and organ analysis. If reliable biomarkers are found in the future , doctors may be able to effectively prevent acute rejection, and perhaps even chronic rejection. 2
In addition to rejection by the immune system, another major predicament concerning tran sp l a nt patients and doctors is the shortage of available organs. This scarcity can be attributed to many factors,
including an unwillingness for an indivi l to donate his or her own (or his or her deceased family mem-
hers') organs. The be1ief that an organ donor would receive inadequate care from physicians or the unawareness of an organ shortage may influence one's willingness to donate hi s or her organ, or his or her family member's organ. The shock associated with losing one's family member may also prevent an individual from donating the family member's organ . When it comes to increasing organ supply via convincing more potential donors, dispelling the misconceptions associated with organ donation may be a wise path to take. Such misconceptions are more likely to prevent one from becoming an organ donor than other factors such as age or ethnicity. s
The strict criteria that determine whether organs can be used as allografts also reduce the number of available organs and contribute to the shortage. 6 The lack of allografts available for patients is responsible for the need for many patients to receive dialysis treatment as an alternative to organ transplantation. In 2015, it was found that the remaining lifetime of a patient receiving an allograft was seven years more than that of a patient receiving dialysis .7Thus, dialysis is not nearly as effective at increasing a patient's lifespan as organ transplantation is. Fortunately, recent efforts in increasing the number of available organs ha ve been implemented. Although organs usually come from live or brain-dead donors, organ donors that do not fall under such categories can contribute to the availability. 6 Donation after cardiac death (DCD) is another source of allografts that has recently been introduced, especially for livers and kidneys. A DCD donor is a patient who is approaching (but has not reached) brain death and whose chances of recovery are close to zero. This is different from donation after neurological death (DND), for which the donor's organs are taken after brain death. For DCD donors, the patient's organs are saved after cardiac death, when the heart has stopped beating. DCD organs may result in inferior graft function when compared to DND organs, but the organs nevertheless increase the donor pool. Whether the increase in organ availability is worth the reduction in graft quality depends on one's personal view.6 Expanded criteria donation (ECD) has also been more frequently implemented in recent years. An ECD donor is a deceased individual aged 60 or older with two of the three characteristics: high serum creatinine l evel,
history of hypertension, or cerebrovascular cause of death. Transplantations with grafts from ECD donors are more likely to fail than those with grafts from nonECD donors, but ECD donation does provide a greater quantity of available grafts and is still more likely to increase a patient's lifespan than dialysis. 8
Xenotransplantation (the use of xenografts, which are organs from members of other species) has also been thought of as a method to increase organ supply, although it is made difficult by hyperacute immune system rejection, since human antibodies react to the cells of other species. 4
While
The biomaterials used are categorized as synthetic and natural polymers. Synthetic polymers, such as polyethylene glycol (PEG), are mechanically strong, and thus are capable of supporting long-term cell cultures , but are typically not biodegradable and lack features that promote cell proliferation. Natural polymers, such as polysaccharides and proteins , on the other hand, are biodegradable and suitable for cell proliferation but are mechanically weak. The type of polymer used depends on the composition of the desired organ. The optimal biomaterials should not only be biodegradable but also nonimmunogenic, so that the bod y does not reject the printed organ. 9 increasing graft supply by introducing grafts with different criteria is certainly beneficial, another possible , " twenty patients on the national transplant waiting list die each day, while another patient is added to the waitlist every ten minutes. "
Currently, 3D bioprinted organs can only be used for drug research , but future advancements could lead to fully-functional biobut still developing, solution for the organ shortage is 3D bioprinting The original 3D printers were developed in the 1990s for printing plastics and metals , but recently 3D printers have evolved to operate more complex tasks such as bioprinting. Bioprinting utilizes the help of a computer, which assists in the deposition of live cells in printable biomaterials. This technique is capable of using large numbers of cells and can produce structures resembling human organs. 9 Three-dimensional bioprinting involves three major steps: preprocessing, processing, and postprocessing. Preprocessing is the generation of 3D models of organs or tissues using imaging technology, such as CT scans, MRI, or ultrasound . Processing involves the gathering and culturing of the patient's cells to be used for bioprinting, the suspension of the cells in bioink, and the conversion of the bioink into a 3D organ using a bioprinter. 10 The bioink is a mixture of cells and biomaterials that provide suitable living environm e nts for cells.9 Postprocessing is the maturation of the printed tissue or organ in the bioprinter 10
printed organs. 11 Blood flow, nutrient supply, and long-term survival ofbioprinted organs are among the challenges faced when it comes to bioprinting transplantable organs. 12 Future research on incorporating these elements into 3D bioprinting could potentially lead to new means of organ transplantation and significantly increase the supply of transplantable organs.
Organ rejection and graft shortage continue to be difficulties for organ patients and doctors , but there is definite hope for an improvement on these predicaments. There has already been an increase in the number of organ transplants performed in the past five years due to increased donations, and that trend may continue. 13 The incorporation of newly suggested graft categories and further research on 3D bioprinting could vastly reduce the number of patients on the transplant waitlist. Furthermore, continued research on immunosuppressive therapy and biomarkers could lead to improvements in organ rejection prevention in the future, not only for allografts but also for xenografts.
References
1 Organ Procur e m e nt a nd Tr a nspl an tation Network. (n.d.) Ret ri eved from https ://optn.transplant.hrsa.gov /learn/about-transplantation/history/
2 Arnaud , C. H. (2018 , January 29). Uncovering the hidden signs of organ transplant rejection. C&en 96(5).
3 Data (2018 ,June 28) Retrie ved from https://unos org/data/
4 Abbas A. K., Lichtman, A. H., Pillai, S., Baker, D. L., & Baker A. (2016). Basic Immunology : Fun ctions and Disord ers of th e Immun e System (5th ed .). Saint Louis, Mis souri Elsevier.
5 Sellers, M. T. , Mcginnis, H S., Alperin, M., Sweeney, J F., & Dodson T. F. (2018) Det e rrents to Organ Dona tion: A Multivariate Analysis of766 Survey Respo ndents. Jo urnal of the American College of Surgeons, 226(4) , 4 14 -422.
6 Vinson, A., Gala-Lopez, B., Tennankore, K., & Kiberd, B. (2018). The Use of Donation After Cardiac Death Organs for Simultaneous Liver-Kidney Transplant. Transp lantation, 1.
7 H eld, P. J., McCormick, F., Ojo, A., & Roberts, J.P. (2016) A Cost Benefit Analysis of Government Compensation of Kidney Donors. American Journal of Transplantation, 16(3), 877 - 885.
8 Saidi R. F., & Hejazii Kenari , S. K. (2014). Challenges of Organ Shortag e for Transplantation: Solutions and Opportunities. International J ournal of Organ Tr ansplantation Medicine, 5(3), 87 -96.
9 Xia, Z., Jin, S , & Ye K. (2018) Tissu e and Organ 3D Bioprinting. SLASTECHNOLOGY: Translating Life Sciences Innovation , 23(4) , 301-314.
10 Vijayavenkataraman, S., Yan, W.-C., Lu, W. F., Wang, C.-H., & Fuh, J. Y. H. (2018). 3D bioprinting of tissues and organs for regenerative medicine. Advanced Dru g Delivery Reviews, 132, 296 - 332.
11 GlobalData Healthcare. (2018 , September 05). Bioprinting: Th e future of organ transplant. Ret rieved from https://www.medicaldevice-n etwo rk.com/comm ent/ bioprinting-future-organ-transplant/
12 Zhang, S., & Wang, H. (2018). Curr ent Progress in 3D Bioprinting of Tissue Analogs. SLASTECHNOLOGY:Translating Life Scienc es Innovation.
13 2016 annual report (2018, J une 28). Retrieved from https://unos.org/about/annua l- report/2016 -annual -report/
When did you first learn of your interest in medicine?
I wasn't sure that I wanted to be a doctor until I was much older. My first thoughts about medicine came when I was a kid. My best friends Dad was a gastroenterologist. I used to always say that I either wanted to be a doctor or an engineer because my Dad was an engineer.
What attracted you to medicine?
There was definitely not just one factor. One of the biggest attractions to medicine, other than the ability to use my knowledge and skills to help others, is autonomy. I knew that I didn't want that presence of someone over my shoulder telling me what to do. So , I would say that autonomy was one of the big factors. How did you know it was right for you? Did you know?
I think that for most people, there is a point when you have to decide if medicine is right for you. There is a significant amount of time and energy that you need to put forward in order to get into medical school and come out a doctor. For me, this was the summer after my junior year of college when I was studying for the MCAT. I was doing a prep course and one of the instructors didn't show up for a lecture on organic chemistry. I went home that night and was reflecting on the fact that a lot of what I needed to do, I would need to do myself. I think this really hit me because the instructor had not shown up, and I had to teach myself the organic chemistry section. For the next two days, I thought about how much of my future in medicine I would need to spend not only teaching myself things, but also pushing myself to take the next step. Not having that instructor definitely made me think that this is going to be a lot of work, the rest of medicine is going to be a lot of work, and that I really needed to decide if all of the time and energy was going to be worth it. In my mind, preparing for the organic chemistry section of the MCAT was like a microcosm of the amount of work that I would need to put into medicine. Where did you go to undergrad and what did you major in?
I was a biology major at James Madison University. Where did you go to Medical School and why?
A ILOOKDINIllMl~IFLUl
An interview with:
Dr. Jeffrey Leary MD Emergency Medicine
Richmond Emergency Physicians Inc.
By Joseph McEachon
I went to MCV (Medical College of Virginia), now the VCU Medical School. As to the why, I ended up applying on the later side of the applications and interviewed at 6 different schools. I ended up with acceptances from MCV and UVA. I chose MCV over UVA mainly because the interview day just felt right at MCV. I also grew up in Richmond, so that may have subconsciously played a role. It just felt like a better fit. What other passions do you have that are either in medicine or outside of medicine? In general, I would say that I like to build things. I used to do woodworking and then I started finishing furniture. I don't do much of that anymore, mainly because I don't want to cut my fingers off and not be able to work. I pretty much stopped that in medical school. I have an entrepreneurial side of me, too. I have a patent on a small medical device that I invented. I'm also currently looking into flipping houses with a friend of mine. So outside of medicine, I'd say I'm into business things.
What is your specialty? Emergency Medicine
Where did you do your residency?
I did my residency at UVA. There were two main reasons that I chose UVA for my residency. The first, of which, was that I liked the program and the city of Charlottesville. I really liked the attendings in Emergency Medicine there and thought it would be a good place to learn. The second was that my fiancee, now wife, was in medical school in Richmond, so I was looking at places in proximity to her, and UVA was the one I liked the best.
How many years have you been in practice?
I have been in practice as an attending for eight years , since the end of my residency.
What is your practice setting/employment type?
I work in a private democratic group , Richmond Emergency Physicians , Inc., at a community hospital in the emergency department.
What kinds of other practice settings exist?
There are usually four different types: academic, freestanding ED , community-based hospitals , and rural emergency departments Rural emergency rooms rarely have other hospitals around. This essentially means that you don't have as much "back up " I worked in one for a while and you see everything. You see all ages and ailments , but you don t have access to a lot of subspecialties that you would normally have in a non-rural hospital. In contrast , in a community hospital you don 't see certain things unless your hospital is certified. For instance , you don't see as much trauma , unless you are a trauma center. You won't see as many strokes unless you are a stroke center. You won't see as many heart attacks unless you are in a hospital with the ability to do catheterizations .
What does your specialty entail?
We are experts in resuscitations and we "are jack of all trades" in everything else.
What is your main focus and expertise? Similarly, we see everything and treat everything. What does a typical day look like for you , if you can call it typical?
There probably wouldn 't be a typical day. It really depends Depending on whether it's a morning, evening , or night shift, and whether it falls on a weekday or weekend. The typical day is when you see a variety of patients every shift. I'd say when I first enter a shift , I log into the EMR (electronic medical records) and start seeing patients. Some morning shifts or night shifts can be slow , and I am just waiting for patients to come in. I spend this time finishing up previous medical charts . Most of the time, when I come into a shift, there are already a number of patients waiting to be seen , and I start seeing patients within the first five minutes of my shift. After a little while, I take reports from another doctor when their shift ends so I can carry on the care for some of their patients who are still waiting for lab reports to come back, etc. Most of the time , I have 8-10 active patients that I manage care for. One of the things that is unique to our training and specialty is triaging, or prioritizing which patients require medical attention first. For instance , patients brought in via EMS generally need to be seen first. This is not always the case, though, as many times we have patients walk into the emergency room who do not realize how sick they are It is our job to make sure the patients who need immediate help are seen first. For the most part, my patients are a mix of kids and adults , with a variety of ailments like abdominal pains , chest pains , ~strokes, and psychiatric problems.
What was the path to your specialty?
After medical school , you do a residency program which is either 3 or 4 years There isn't too big of a difference , except in the 4-year program you usually spend a little more time in the Intensive Care Unit (ICU).
What is your favorite part about Emergency Medicine or about medicine in general?
My favorite part of my job is the rare occasion that you really save somebody. Most of the time, we are saving older people or people who already have a host of chronic illnesses. We stabilize them, and they get better a while later. To me, the cases that are most rewarding are the ones that are seemingly healthy patients whose health suddenly takes a turn for the worse. For example , when a 50-year-old male who is otherwise healthy presents with some mild chest pain and suddenly goes into cardiac arrest right in front of you , we work quickly to get him back, and then two minutes later he is talking to you.
What is your least favorite part about your job?
Government mandates on healthcare are probably my least favorite. Sometimes, the government-required proof that we are using EMR can be cumbersome and detract from our job of helping patients. Also , the government is tying patient satisfaction scor e s to reimbursement. This is concerning because, often times , patient satisfaction scores are related to worse outcomes for patients rather than better It's frustrating to change the way you practice when it may not be best for the patient.
What was your most challenging/difficult case and why?
There is no doubt that some of most difficult cases are when you have a kid die in front of you. I had one patient , a young girl with a debilitating condition , who came to the ED and we lost he r We revived her and then we would lose her again , and this went on for hours. Her parents were in the room, and eventually they said that enough was enough, so we discontinued resuscitation. The mom, with tears in her eyes, tells her daughter that "she can go ride with the horses now." I was told later that the patient had always dream ed of riding a horse but was too severely disabled to be able to do that. That was ten years ago , and I can barely say
that without crying
Do you have a time that you experienced failure or struggle in medical school or residency, and how did you overcome it?
Certainly, every step of the way , there is failure. In medical school, one of the toughest things that people deal with is that fact that they used to be the shining star, and now they are in a room full of shining stars. In medical school , there is always a feeling of inadequacy. An attending ' s job is to teach students. There are always some who seem to make it their job to make you feel unprepared and inadequate , causing you study harder and become better doctors. In residency , it's a learning process the e ntire time You don't do things right , and you learn from it. Even now , as an attending, there are some times that people get sick and die no matter what you do. You can do the right thing every single time, but sometimes it's not enough and you can 't fix all of your patients.
What specialty/specialties did you originally think you were going to end up in when you entered medical school? What changed?
I thought I was going to go into pediatrics. It was not until my 4th year in medical school , when I was starting my rotation in the emergency room , that I changed my mind. I had emergency medicine in the back of my mind for a while , but it was like the second day in the ED and I knew that I liked it better than pediatrics. I didn 't ever dislike pediatrics , but I felt that I wanted to do this more.
What was your favorite part about medical school/residency?
I felt that the first time you see or do something was the coolest part. For instance, the first time that I saw a thoracotomy, I saw a live heart through somebody s chest. Somebody was shot in the chest and there were two attendings in the Emergency Room ; one was manually pumping the heart while the other was trying to stitch up a hole in the heart Really , the first time you do anything, like reduce a shoulder dislocation , is pretty neat. There is a sort of adrenaline rush to it. That was definitely my favorite part about school.
What is one skill you have that you feel has helped throughout most of your journey?
There are a lot of really smart people in the world. Not as many of them have the persistence to work for an end goal that is 7 years after you start. For emergency medicine, specifically, I think the ability to keep a calm presence in a stressful environment is important. What personalities do you think are required or necessary in Emergency Medicine?
There is a huge range of personalities in emergency medicine but all individuals in this field need to be able to multitask and work with multiple interruptions I' d say that is something that can be learned , though , it's not just a trait.
What is one piece of advice you would give to those pursuing medicine today?
I would recommend that you make sure that medicine is something that you really want to do. I know a lot of people go into it with excitement for the money, schedule , or the lifestyle, but the burn-out rate in medicine is incredibly high Particularly in emergency medicine, over 60 % of all current ED docs identify as burned out. There are many other jobs that can make a lot of money , so I would say that it's not worth it unless it is something that you really want to do.
What are the fields/aspects in medicine you feel are on rise? What fields or aspects are on the decline?
Right now , due to the shortage of physicians, it doesn't seem like there is any field that is bad to get into. I would say that some of the less technical jobs could be more easily replaced by Advanced Care Providers (ACP) , though
How has medicine affected your home life? Do you feel that you have missed out on any aspect of life because of medicine-is it possible to have a full life in your field?
I would say that it is certainly possible. In medicine, you can be as busy as you want to be, providing your student loans are paid off I would definitely say that I had a lot less time to goof off in my mid-twenties , but I still had a social life in college and in medical school. I' m married and have three kids , so I would say it is definitely possible to have a full life. You can make the priority to work as much or as little as you want. For example , my wife is a pediatrician who just resigned a couple of weeks ago to pursue a more non-clinical career in pediatrics, which will allow her to spend more time with our kids. Some fields of medicine may be harder to do that than others I would particularly say in emergency medicine, you can be as part- time as you want or as full-time as you want. Whatever you prioritize in life at a given time , you can make happen
