Tech&medicine

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

E-MEDICINE: BRE AKI NG T HE CODE r o b o ts

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FIND US ON SOCIAL MEDIA www.premedmag.org

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staff Faculty Advisors Dr. Leara Rhodes

Executive Editors Annika Carter Selin Odman Sona Rao Galit Deshe Heather Huynh Jesse Hu Lily Wang Hanna Friedlander Writers Emma Burke Grant Mercer Hamzah Ali Hallie Smith Leah Ginn Nikhil Gangasani Megan Murphy Rohit Munagala Sarah Caesar

Designers Galit Deshe Melody Modarressi Wayland Yeung Jonathan Cheaves

ANNIKA CARTER Editor-In-Chief

SELIN ODMAN Content Editor

SONA RAO Online Editor

HEATHER HUYNH Operations Editor

JESSE HU Treasurer

GALIT DESHE Design Editor

HANNA FRIEDLANDER Photography Editor

LILY WANG Photography Editor

Photographers Graham Cain Hanna Friedlander Lily Wang Nivedha Balaji Copy Editors Annika Jonker Christina Najjar Monisha Narayanan

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a message FROM OUR EDITOR

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Ahhh to Zika! A Response to the Epidemic Threat Heard Around the World

Ahhh to Zika! A Response to the Epidemic Threat Heard Around the World

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Ahhh to Zika! A Response to the Epidemic Threat Heard Around the World

Ahhh to Zika! A Response to the Epidemic Threat Heard Around the World

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Ahhh to Zika! A Response to the Epidemic Threat Heard Around the World

Ahhh to Zika! A Response to the Epidemic Threat Heard Around the World

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Ahhh to Zika! A Response to the Epidemic Threat Heard Around the World

Ahhh to Zika! A Response to the Epidemic Threat Heard Around the World

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Ahhh to Zika! A Response to the Epidemic Threat Heard Around the World

Ahhh to Zika! A Response to the Epidemic Threat Heard Around the World

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Ahhh to Zika! A Response to the Epidemic Threat Heard Around the World

Ahhh to Zika! A Response to the Epidemic Threat Heard Around the World

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Ahhh to Zika! A Response to the Epidemic Threat Heard Around the World

Ahhh to Zika! A Response to the Epidemic Threat Heard Around the World

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PreMed Magazine Presents...

The Leara Scholarship

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

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PreMed Magazine will now be offering a scholarship in each issue. Each scholarship will require a submission from you, our readers. This submission can be a piece of writing, a photograph, or a graphic design.

In each issue, our scholarship will have a different topic for these submissions. This month's topic is: What is medicine? This is a broad, very open-ended subject. Medicine has different meanings to different people -- some people come from a family of doctors while others have experienced, first hand, the life-saving abilities of medicine.

Others still may have no prior connection to medicine but are enthralled by its complexity and, thus, aspire to become physicians. Please remember that we are not looking for a dictionary definition or textbook entry -- we want you to be creative!

Remember, this scholarship is open to ALL majors, not just pre-health students!

The recipient of this scholarship will be announced in our December 4th issue. He or she will be rewarded with $500 to be spent on furthering his or her education both on and off campus.

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THE INTERNET TOLD ME

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It always happens the same way: I experience a few different symptoms, Google them, select an enticing WebMD article and diagnose myself with a terminal illness - all within a mere five minutes. If I allowed the internet to be the authoritative voice regarding my health care the numerous times that this has happened, I would be in thousands of dollars of debt due to multiple tests done in search of a cancer that isn’t there.

Though technology has advanced medicine to unprecedented heights within the last decade alone, it also is responsible for millions of inaccurate self-diagnoses and the spread of incorrect healthcare information. The errors made by these health websites may be detrimental for someone who is truly in need of sound medical advice...and that is a big problem for a society that’s only growing more technologically dependent.

BY LEAH GINN | PHOTO BY GALIT DESHE

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In 2012, the online Journal of Pediatrics published a study entitled, “Safe Infant Sleep Recommendations on the Internet: Let’s Google It.” The study, conducted by Dr. Rachel Moon and colleagues, aimed to test the accuracy of medical information found online regarding sleep safety for infants. While the American Academy of Pediatrics (AAP) has published guidelines for reducing the risks of sleep-related infant deaths, such as Sudden Infant Death Syndrome (SIDS) and suffocation, the guidelines are written for clinical professionals, and most individuals seek health care information from websites that contain less

medical jargon. The team Googled 13 phrases related to infant sleep safety and compared the medical advice written in the first 1300 search results to the AAP recommendations. Their

were only 8.5% accurate in their information! Also surprisingly, educational websites (like ebooks, peer-reviewed articles, and links ending in .edu) only had 50.2% accurate medical information. These numbers are quite scary for those of us that use the internet regularly to find healthcare information; the statistics prove just how difficult it may be to find reliable and non-contradictory advice regarding our health.

Though you may feel like you’ve been lied to for years about all of the knowledge you’ve obtained via a Google search, there is still hope for finding accurate information in the future.

Always investigate the websites that you refer to, and remember that .org and .gov sites will be the best place to look. It’s also important that the

43.5% of the 1300 websites contained information in line with the AAP’s recommendations

28.1% of the websites contained entirely inaccurate information

28.4% of the websites were not medically relevant at all findings were (somewhat) surprising: This means that over half of the medical information we find online is either inaccurate or irrelevant. They also studied the types of websites yielded by the search, and discovered that government and national organization websites (ending in .org) provided the most accurate health information, with 80.9% and 72.5% accuracy respectively. Of the 1300 websites reviewed, 246 of them were retail product review sites, which

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sites update their content, as we all know that medical information in particular is subject to quick change as research and technology progresses.

Most importantly, remember that when WebMD tells you that you only have a few months to live, this is likely not the case; by seeking the advice of a trustworthy physician, paying attention to your body and practicing healthy lifestyle choices, you may live for several more decades.

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SELEX

The Next Generation of Drug Discovery Wayland Yeung

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hat if there was a system that could discover and produce novel drugs in a matter of days?

Such an ability would greatly augment our ability to respond to crises such as sudden outbreaks.

Introducing SELEX (Systematic Evolution of Ligands by EXponential enrichment), a process developed independently by Larry Gold and Jack Szostak in 1990 that allows the discovery of high affinity binders for virtually any molecular target.

This is accomplished by in vitro evolution where binders are systematically found within a library of random molecules. Successive iterations can yield binders of increasing specificity and affinity for the target. Libraries for SELEX are composed of aptamers, nucleic acid polymers that can adopt secondary structure and act like proteins.

Here at the University of Georgia, research on this subject is being done in the lab of Dr. Ryan Hili. The lab has developed a modified version of SELEX that allows the evolution of aptamers with functional groups. An outline and explanation of this process is shown to the right.

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Notable Aptamers Pegaptanib anti-2G12 anti-HepG2 anti-IL6 anti-EGFR Fun Fact

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treatment for macular degeneration, currently the only FDA-approved aptamer a 2’-deoxy-2’-fluoro modified RNA aptamer developed by NeXstar Pharm. experimental vaccine for HIV a glycan modified DNA aptamer developed by the lab of Isaac Krauss experimental treatment for liver cancer a DNA aptamer utilizing six base pairing developed by the lab of Steven Benner experimental anti-inflammatory a Larry Gold-inspired modified aptamer developed by the SomaLogic Inc. experimental treatment for cancer an amino acid-mimic modified DNA aptamer developed by the lab of Ryan Hili

SELEX is pronounced “selects” Larry Gold, inventor of SELEX, dislikes it when people pronounce it “see-lects”

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1. SELEX starts with a library of biotinylated ssDNA template strands consisting of random sequences flanked by two constant primers regions.

2. The template strands are exposed to a premade pool of modified pentamers with a variety of sequencedefined functional groups and the two matching primer sequences. The modified pentamers bind to matching sequences on the random regions of the template while the primers bind their respective ends. Nicks are sealed with DNA ligase.

3. The dsDNA library is denatured and the biotinylated template strand is removed by streptavidin separation.

The remaining modified ssDNA strands (with R

Explanation groups) can adopt secondary structure to form the aptamer library.

4. The aptamer library is exposed to a predetermined his-tagged protein target. By random chance, small fraction of the library will bind to the target.

5. The his-tagged protein can be extracted using magnetic beads. Aptamers that bound to the protein will be extracted alongside it.

6. Because aptamers are nucleic acids, they can be amplified by PCR with a biotinyled primer and a nonbiotinylated primer. Following streptavidin separation a new ssDNA library is formed allowing additional iterations of the cycle.

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Ever since a traumatic skydiving incident that led to numerous scans and operations, Zack Lynch has been fascinated by the inner workings of the intricately complex and mysterious three-pound structure we call the brain. In his book, The Neuro Revolution: How Brain Science Is Changing Our World, Lynch, very much an optimist, mentions the current advances in the field of neuroscience and unfailingly convinces the reader of the promising future it holds. His main argument rests on the field’s capability to impact even the most distantlyrelated areas such as law and finance. In an effort to learn more about these future advances, he sought out some of the most world-renowned neuroscientists and brain researchers to learn how neuroscience can drastically alter our everyday lives.

The Neuro Revolution, a term Lynch coined to describe the fourth major revolution in human history after the agricultural, industrial and information revolutions, is exciting, mind-boggling and, sadly, quite daunting as well. A myriad of arenas in our society today will avail themselves of the new advances that will come about as a result of this new scientific revolution. In the legal system, for instance, brain-based lie detectors will enable us to identify criminals more easily by utilizing a technique known as “brain fingerprinting.” Brain fingerprinting uses an electroencephalograph (EEG) to measure the brain’s electrical activity and its changes in response to rare and common stimuli, which is then presented on a computer screen. In the marketing sector, a similar technique utilizing fMRI technology can gauge people’s emotional

THE NEURO REVOLUTION: THE NEXT MAJOR BREAKTHROUGH OF HUMANITY

BY SARAH CAESAR | PHOTO ILLUSTRATION BY GALIT DESHE

states while shopping to understand which products are most attractive to consumers.

These breakthroughs could vastly improve society but, like many other successful innovations, they certainly have their drawbacks. For instance, the use of neurolegal techniques like brain fingerprinting and fMRI might work well in open, democratic societies where CIA- and FBIlike agencies can use them to track down guilty terrorists and criminals and free the innocent.

However, in autocratic and dictatorial regimes, governments might misuse these same techniques to suppress opponents, leading to more political turmoil and unrest. A whole other arena, known as neurowarfare, also shows us the possible dark side

of this new revolution. Neurowarfare consists of the neurological methods that can be used to punish people in horrific, unimaginably gruesome ways or even perpetuate war between different countries of the world. A sector of neurowarfare consists of so-called psychotronic weapons which would be capable of altering or erasing memories.

While a lot of the aforementioned methods emulate things seen in science fiction movies, the reality of possibly utilizing these in the future makes one feel simultaneously exhilarated and uneasy.

Considering both the benefits and drawbacks, societies should make careful decisions whether and under what circumstances to utilize these innovative techniques.

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CRISPR THE FUTURE IS NOW

BY ROHIT MUNAGALA |

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ILLUSTRATION BY GALIT DESHE

GENETIC REVOLUTION

PICTURE A WORLD WHERE YOU COULD DESIGN YOUR OWN CHILDREN. A world where you had the power to manipulate your own genome to produce the best version of yourself in your progeny. Regardless of any lingering ethical qualms about gene manipulation, this “science fiction” could be a reality sooner than anticipated because of the accidental discovery of the CRISPR-Cas9 microbial gene editing system. The culmination of chance observations by scientists Yoshizumi Ishino, Francis Mojica and Ruud Jansen, CRISPR is involved in bacterial immune response to invading viruses and pathogens. Ongoing research aims to reengineer the CRISPR bacterial immune system to target and modify specific DNA sequences. Mutations introduced from CRISPR-Cas9 potentially equips us with the tools to not only control our own genes, but also to the transform our biological environment.

WHAT EXACTLY IS CRISPR-CAS? Simply put, clustered regularly interspaced short palindromic repeats, otherwise known as CRISPR, form base sequence repetitions in prokaryotes and serve as a DNA archive for their battles against viruses. Whenever a bacterium survives an attack from a foreign agent, it saves a piece of the viral DNA within their genome forming spacer DNA. Spacer DNA from encounters with pathogens form bridges between the repetitions of CRISPR and provide a pseudo-acquired immunity for the bacteria against future attack, similar in theory to vaccinations. When the pathogen invades the bacteria again,

bacteria transcribe the saved piece of virus DNA from the spacer DNA into an RNA copy known as guide RNA. The guide RNA is loaded into Cas9 (CRISPR Associated Protein 9), a DNA endonuclease enzyme that serves as genomic scissors by cleaving DNA at specific sites to add or remove genes. Guide RNA helps Cas9 by binding to sequences of target DNA, complementary to its own RNA bases, essentially binding to the virus DNA from which it was transcribed. In this way Cas9 is able to locate and cleave out foreign bacteriophage and plasmid DNA, thus protecting the bacteria against viral degradation. Scientists began to study CRISPR-Cas9 because of its precision, using it as a tool of genetic engineering. Researchers benefit from the fact that the CRISPR-Cas9 system works on live cells, can switch genes on or off, and functions with a similar mechanism on virtually every type of cell (plants, animals, and microorganisms).

Initial tests with CRISPR were able to edit artificial point mutations designed in labs, before moving on to tackling virus-based disease. A huge success came under Dr. Kamel Khalili of Temple University who used the CRISPR system to cleave HIV retrovirus DNA from live mice. Khalili incorporated the HIV genes into nearly every type of cell in the mice’s body and then injected a precise CRISPRCas system to snip off the HIV DNA via two injections to the mice’s tail. CRISPRCas was successful in eradicating the foreign DNA in more than 50% of the different mice cells. Khalili has also been successful in cutting out HIV DNA from cells taken from HIV patients and his results lead to speculation that the advancement of this technology can make fighting HIV as simple as obtaining a shot from your local clinic.

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FUTURE PROJECTS Manipulating genomes is not a new concept; we see the products of genetic engineering in the mass production of insulin, genetically modified crops, and even in glow in the dark zebra fish available for public purchase. However, gene editing has been very expensive and time consuming. CRISPR on the other hand provides a specific, cheap and easy alternative. In theory, the genomic influence granted by CRISPR allows for a high degree of control in manipulating human genomes. With expansion of the CRISPR system, we obtain the ability to not only screen for certain diseases, but proceed a step forward in correcting those mutations in the embryo. Considering over 3000 genetic diseases are caused by a single incorrect base pair, CRISPR could easily rectify small scale mutations. The interesting part about adjusting the embryo genome with the CRISPR system are the implications it has on the human gene pool.

Over generations of using CRISPR to eradicate certain mutations in the genome will stimulate a level of microevolution. The reproduction of modified humans will gradually change the gene pool, thus eliminating certain disease. Similar to how we can control the human gene pool, gradual application of CRISPR to other organisms allows for adjustments in traits that we find useful or irritating.

For example, CRISPR is being used to modify yeast as a biofuel and mutate mosquitos so they cannot transmit malaria. The precision of CRISPR as a genetic tool allows humankind to manipulate its surroundings for the betterment of the species and its potential is only limited by our creativity.

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ETHICAL ARGUMENTS AND SUBSEQUENT IMPLICATIONS The CRISPR-Cas9 system is being proclaimed as the next big thing in biomedicine and its growth as a technology will shape mankind’s outlook towards many biologic factors. CRISPR’s simplicity, elegance and precision are contributing factors to the approval its first clinical trials in the US and China to combat some terminal lung cancers. Despite all the success and potential the CRISPR-Cas9 system possesses, there are ethical controversies surrounding the genetic modification of embryos, also known as designer babies. While some argue that modifying humans to defy illness and develop superfluous cosmetic traits is unnatural, there will be few who venture into editing their genome to eliminate a prominent genetic disease running in the family, opening a door of opportunities for genetics. As the practice becomes safer and more accepted, the ethical tide may sway with advocates claiming that not using genetic engineering is unethical because it submits children to undue illness and pain when cures exist. Only time and future discoveries will tell how this plays out.

There is a low chance that we will see a genetically perfected human with perfect health, flawless skin and toned muscle build casually walking down the street in our lifetime, but whether you are skeptical or intrigued by the development of CRISPR-Cas9, it will be an interesting area to monitor in the coming decades.

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ME, MYSELFIE, AND I

BY ANNIKA CARTER | PHOTO BY GRAHAM CAIN

In fourth and fifth grade, my friends started getting cell phones (remember when the SideKick and Razr were the best?). Shortly thereafter, they started making MySpace accounts. Excited to join in on the social media craze, I created an account on my 13th birthday without my mother’s knowledge -- she definitely would have disapproved. I tried the whole social media thing -- posting statuses, taking selfies with friends, “checking in” at my favorite restaurant -- but I never got hooked. As a closet introvert, I have never been one to worry about what others think of me or to broadcast my life to the world.

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I would much rather keep to myself and my small circle of close friends. Sure, I still have that Facebook account, and I even have an Instagram (created by my freshman year roommate here at UGA), but the number of posts I make on each are pitifully low. I haven’t posted on my Facebook in years (save for the occasional profile or cover photo change) and, for the longest time, my Instagram didn’t surpass nine photos. Now, three years later, my Insta sits at a whopping 33 photos. I did not fall victim to the social media craze, but most young people have not been so lucky.

For many, social media accounts provide a way to stay connected with the outside world while simultaneously remaining removed from it.

Facebook, Instagram and Twitter all provide a platform on which someone can create a version of themselves that they are proud of -- perhaps a version of themselves very different from their actual self. And behind that computer screen, they are safe, protected by the 152 likes on their new profile picture. This new socialization brings its own pressures -- pressures to look good, better than that other girl and to be funny and interesting, so that you get more followers than that one guy. Over the years, as the number of watchers, followers, brands, advertisers and sponsors increased, these pressures only grew, creating the perfect cocktail for low self-esteem and self-worth.

of themselves. These users are particularly susceptible to the power of the “like.” But liking is a good thing, right? Well, not so much. Many use social media to get attention and, when they don’t get that attention, it can be hurtful.

This attention is often equated as self approval or self worth. Michelle Linker, a daily Instagram user, told The Guardian, “I feel anxiety over how many likes I get after I post a picture. If I get two likes, I feel like, what’s wrong with me?” Some users even delete photos that do not get enough likes. The emotional pitfalls of social media

The evidence of social media’s harmful side effects is not all circumstantial. In 2013, French researchers from the Institut Pluridisciplinaire Hubert Curien published an article describing the effects social media has on its users’ emotions.

They found that individuals who spend more time on social media sites tend to have higher levels of depression. This makes sense. Think about it -- when you scroll through Instagram, you look at pictures of your friends and celebrities, thinking, “I wish I had her makeup,” or, “Why can’t I be in the Caribbean right now like he is?” While on social media, even though you might not mean to, you are constantly comparing yourself to others. Many of us social media users fail to take into account that most of what we see is posed, staged and carefully orchestrated to give the illusion of perfection.

Social media is not real life. Celebrity stylists spend hours upon hours making their clients look perfect for that one (of one thousand) photo that makes the cut to be posted online. Even our friends and families tend to only post photos themselves at their best. Even we do.

have not been secret these past years. Essena O’Neil, an Australian teenager, quit Instagram after accumulating over 500,000 followers on the platform with her posed, model-like photos.

After quitting, she said Instagram is, “contrived perfection made to get attention.” Before quitting the platform altogether, O’Neil exposed the lie behind her beautiful photos, changing the captions to things like: “NOT REAL LIFE - I didn’t pay for the dress, took countless photos trying to look hot for Instagram, the formal made me feel incredibly alone.”

Many view their social media accounts as extensions of their personal identity. This means that every word and pixel is a piece

“most of what we see is posed, staged, and carefully orchestrated to give the illusion of perfection”

Should everyone follow O’Neil’s lead and quit social media? No. Many men and women will continue to use social media and there is nothing wrong with that. Social media is fun -- it is fun to share our lives with friends at home and overseas and exciting to scroll through our feed and see what our favorite celebrities or cats (I’m talking about you, Lil Bub) have been up to.

We need remember to occasionally unplug and take a step back. Remember what makes you you, outside of that amazing picture floating around on the internet. We need to remember that we are more than a profile, more than a status. Remember what makes you great in the real world. Because seriously, you are great.

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A NEW FACE TO AN OLD ENEMY The world confronts an old enemy today, but it has a new face disguised by false premises. This enemy targets and misleads society’s youth. Electronic cigarettes are the new forefront of the tobacco industry, outgrowing popularity for conventional cigarettes. Are e-cigarettes leading to a new revival of an old habit or are they actually helping people to quit smoking?

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Smoking conventional cigarettes has been strongly and causally associated with several adverse health consequences. The new alternative to conventional cigarettes, electronic cigarettes or e-cigarettes, is marketed as the “safe” new product that all current smokers should switch over to. Many people are under the impression that e-cigarettes are safe or that they are effective in helping people with smoking cessation. Studies by the Food and Drug Administration (FDA) show that e-cigarettes contain many toxins that are harmful in the long run.

The safety of e-cigarettes has been questioned by many health professionals. The (FDA) has conducted several studies and the results show that e-cigarettes lead to many negative outcomes.

Consumers have the misconception that, since there is no tobacco in e-cigarettes, the chances of developing cancer are very low or nonexistent.

However, tobacco is not the main ingredient in cigarettes that causes cancer. Cigarettes contain a vast number of chemicals that are proven to be harmful, and e-cigarettes contain some of these same chemicals. Since 2009, the FDA has proclaimed that e-cigarettes contain “detectable levels of known carcinogens and toxic chemicals to which users could be exposed.” For example, in e-cigarette cartridges marketed as tobaccofree, the FDA detected a toxic compound found in antifreeze that has been shown to cause cancer in humans. Studies conducted on e-cigarette liquids show that formaldehyde, another carcinogenic chemical, is released when heated. Exposure to gaseous formaldehyde over many years leads to the proliferation of cancer cells.

High levels of nicotine in e-cigarette liquids are used to garner the same effect nicotine in conventional cigarettes provides the consumer.

While many people benefit from the positive effects of nicotine, there are many negative effects from exposure to nicotine on adolescents and expectant mothers and their children. Exposure to nicotine

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during pregnancy harms the developing fetus, causing lifelong consequences for the development of the brain and functioning of the lungs in newborns. It also affects maternal and fetal health during pregnancy and can result in premature delivery and low birth weight.

The negative effects of nicotine are not limited to young children or pregnant women. Nicotine has a drastic impact on adolescent brain development.

The development of the human brain has a much longer time scale than was previously understood.

Early medical research showed that the human brain stopped development around adolescence.

From recent discoveries, it is now understood that cognitive development continues through the early 20`s. Nicotine use during adolescence and early adulthood has been correlated with lasting intellectual and behavioral impairments, including effects on working memory and attention span.

Although e-cigarettes are fairly new to society and safety studies have only been conducted in the past decade, the results seem to have confirmed hidden dangers. As future leaders of society, it is our responsibility to avoid being deceived by the new face of the old enemy and to help terminate the continual cycle of false, new alternatives.

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MAYBE YOU SHOULDN'T GO TO MED SCHOOL

Are you cut out for medical school? Many of us dream of becoming physicians, but only a few of us will achieve the dream. For some of us, the stress is too much. For others, it’s the costs. For others still, it may be an incorrect fantasy about what being a doctor is like, thanks to dramatized shows like Grey’s Anatomy.

In this interview with Nirmal Gosalia Dr. Joseph Lee describes his unique journey towards medicine and explains the important factors to explore when considering a career as a physician.

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CAN YOU TELL US A LITTLE BIT ABOUT YOUR JOURNEY TOWARD BECOMING A PHYSICIAN? My name is Joseph Lee and I was born and raised in Chicago to two Korean immigrants. I was born on the North side and went to Chicago public schools. I knew that I wanted to work with children, but I didn’t know what capacity. After four years at Northwestern, I joined a program called Teach for America. I became a 7th and 8th grade teacher in the south shore neighborhood of Chicago. I really enjoyed my experience as a teacher, but I felt very limited. I had thirty students that I had to take care of, but I felt that there were many more kids out there that I could advocate for. I thought that medicine would be the way to do that. I went to medical college for four years and now I am a pediatric resident.

IT IS CLEAR THAT YOU PUSH YOURSELF TO THINK ABOUT “WHY MEDICINE?” YOU DEFINITELY HAD THE TIME TO REFLECT ABOUT THAT QUESTION DURING MEDICAL SCHOOL, BUT DO YOU HAVE ANY REASONS WHY YOU WOULD DISCOURAGE A STUDENT FROM ATTENDING MEDICAL SCHOOL? I’ve had this conversation with quite a few undergrads and I think it’s a great question. First of all, I think that medicine is the most amazing career that anyone can have. It is such a blessing to be a physician in the United States, but I don’t think that it’s for everyone. So who are the people who maybe should think twice about going into medicine?

Sometimes when I talk to pre-meds, they have an idealistic view of medicine, maybe based on what they see on TV, that they will be saving lives every second of every day and that [being a doctor] is a very glamorous lifestyle. I would ask those students to second guess [their decision to attend medical school] because a lot of what we do is very difficult.

A lot of what [doctors] do is very repetitive and can be mundane. There’s just a lot of things that go into being a physician, such as paperwork and the calls you make outside the hospital. Those are kind of aspects that people who haven’t thought much

about medicine are really taken aback by. You do sacrifice much of your 20’s to train. You don’t have the same flexibility as a resident that most people in other careers have. We work most weeks six days a week, if not seven, and our hours are usually longer that a nine-to-five. Vacations are rare in a residency, and not when we plan. You find that you turn 30 and you’re still in training. You miss out on some of the opportunities that some of your peers have, such as purchasing a house, or a car, maybe starting your family, or having children, because of how strenuous your training is. If someone isn’t willing to make that sacrifice [medical school] is a very difficult route.

Another reason that I would have someone think twice about medicine is the burden of monetary loans that you need to take on to go to medical school. The average loan of a [medical] student can range between $200-$250,000. That’s a lot of money. I think when I first saw those numbers when I graduated, it was a little difficult. If you go into a career such as primary care, it is not easy to pay those off within one or two years.

Another reason I would discourage a student from going to medical school would be if they have any other interests or possible career options that they are considering. The reason I say that is once you enter medical school and residency training, there aren’t a lot of plan B’s. So if someone is 50% medicine, 50% any other career, they should really consider that other career first. You really want to make sure you’re going into the field that is right for you because once you enter medical school, with the exception of a few people, it is basically

"You do sacrifice much of your 20's to train." a lifetime commitment. You really want to be sure you are ready for that. I would be lying if I said that it has all been very easy and I’ve never wanted to take more time off or wanted to have more of a Monday through Friday 9-5 life. But I would say those thoughts are very rare and I have many more thoughts of feeling blessed to be in medicine and enjoy my career.

To see the full interview or others like it, visit www.DocThoughtsMed.com.

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ON THE RECORD If I could time travel into the future, my first port of call would be the point where medical technology is at its best because, like most people on this planet, I have this aversion to dying. NEAL ASHER

I fear the day that technology will surpass our human interaction.

The world will have a generation of idiots. ALBERT EINSTEIN

In the 20th century, we had a century where at the beginning of the century, most of the world was agricultural and industry was very primitive. At the end of that century, we had men in orbit, we had been to the moon, we had people with cell phones, colour televisions, the Internet and amazing medical technology of all kinds. DAVID GERROLD

Any sufficiently advanced technology is equivalent to magic. ARTHUR C. CLARKE

Technology is a useful servant, but a dangerous master.

CHRISTIAN LOUIS LANGE

If we can reduce the cost and improve the quality of medical technology through advances in nanotechnology, we can more widely address the medical conditions that are prevalent and reduce the level of human suffering. RALPH MERKLE

This is the whole point of technology. It creates an appetite for immortality on the one hand. It threatens universal extinction on the other. Technology is lust removed from nature. DON DELILLO

Technology is nothing. What’s important is that you have faith in people, that they’re basically good and smart, and if you give them tools, they’ll do wonderful things with them. STEVE JOBS

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One machine can do the work of fifty ordinary men.

No machine can do the work of one extraordinary man. ELBERT HUBBARD

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AHHH TO ZIKA! GUEST WRITERS:

LINH DINH, BSFCS IN HUMAN DEVELOPMENT AND FAMILY SCIENCE, UGA CLASS OF 2016 MICHELLE VU,PHARMD/MPH CANDIDATE CLASS OF 2018 MERCER UNIVERSITY

Would you think of a zombie outbreak to be a fascinating Halloween happenstance? Well let’s just say there’s no competition between the Walking Dead and the Zika outbreak. Zika is here and it is spreading, fast! Scientists are scrambling to respond and understand the virus. Scientific studies have reported that the Zika virus (ZIKV) is a mosquito-borne virus transmitted through monkeys, with humans being the virus’s occasional hosts. The major outbreak is threatening the lives of many throughout Africa, Southeast Asia and the Pacific islands. The good news? We know the source of this public health emergency and we’ve prepared methods of approach towards a solution such as Zika virus inactivation and genome-based vaccine developments and accessible resources such as the ZikaVR database to help catalyze vaccine discovery. The bad news? In early 2016, World Health Organization (WHO) declared Zika to be a worldwide emergency epidemic threat…Uh Oh!

Even more horrifying are the effects it has on mothers and babies: a new study looked at the brains of 45 Brazilian babies whose moms were infected with Zika while pregnant (Belluck, 2016).

Zika can cause babies -- especially those born in Latin America and the Caribbean -- to be born with abnormally small heads. The study also reveals that Zika damages parts of the brain that control movement, speech and emotion. Unfortunately, Zika has now reached Miami, a major tourist attraction and metropolis, and the CDC now recommends against traveling to Miami-Dade

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County as well as other target areas (CDC, 2016).

Even men are not safe: asymptomatic men can pass on the virus to their sexual partners and the fetus (CDC, 2016).

As of yet, there is no vaccine, but scientists are working aggressively in hopes of developing one. Symptoms of the infection are essentially similar to that of a common cold, often leading to severe fevers and headaches, rash, malaise and chills (Gupta et al., 2016). What worries healthcare professionals and individuals alike are the asymptomatic factors which could lead to potential fatalities. The pressure is on to find out how to stop this epidemic...stat. The race to create the first Zika vaccine has begun! With such a short countdown clock, waiting 3 or more years to develop a vaccine would be detrimental. But thanks to the silicon and genomic boom of the early 21st century, scientists are developing interdisciplinary, high-tech approaches that make traditional vaccine development look inefficient and antiquated.

Traditional vaccine development research is akin to grafting a new tree from a source tree: vaccine components are taken from the original virus and inactivated, conjugated or broken down. This way has worked for centuries, ever since Pasteur created the rabies vaccine. The National Institutes of Health’s National Institute of Allergy and Infectious Diseases (NIH/NIAID) Stage I clinical trial vaccine candidate was created using a traditional approach, Zika virus inactivation. However, using

H

a traditional approach can take years to develop a viable candidate (Gupta et al., 2016). Also, some viruses can not be cultivated in large quantities and handled to make these vaccines.

The sequencing of the first organism genome has paved way to a new path of vaccine discovery: genome-based vaccine development or “reverse vaccinology”. Using a viral genome and computer processing system that can screen large amounts of candidates, researchers can predict suitable protein structures, those that induce human immune-response and can be surface-exposed, to develop into vaccines (Moriel et al., 2008). In this way, researchers are using the blueprint of the source, selecting the structures of interest, and building a new model with only the desired features. Several vaccines under development, such as for malaria and anthrax, have been synthesized using genome-based methods. However, the most outstanding challenges include difficulty identifying non-protein virulent structure (e.g. polysaccharides) and incomplete information on viral genomes.

Nevertheless, researchers have innovated methods to applying reverse vaccinology to Zika vaccine development.

A study published in Nature by Gupta et al. provides a database to help catalyze drug discovery.

Generally, to synthesize an antiviral, researchers have to know the virus: its M.O. (rNA virus, DNA virus, or something new) and how its genetics relate to its viral activity. That’s why Gupta and colleagues integrated the genomics “multi-omics

platform,” creating a map terrain of the genes, proteins, and potential-therapies of Zika. Drug designers can now ask questions such as, “How is Zika similar to other viruses?” and “What drug therapies could be effective against Zika?” and use the database to discover their answers. Another powerful feature of this platform is the ability to compare different viral strains and sequences (Dengue, Yellow Fever, etc.) to Zika, a field called comparative genomics. If you are interested in bestowing a deeper understanding of Zika, more information is available on the user-friendly engine called ZikaVR.

All aspects considered, ZIKV demands an international collaborative effort with interdisciplinary approaches in order to reduce and prevent the risk of further transmission in concerned regions and non-affected countries.

Future developments and approaches include testing efficient vaccine candidates in the advent of next generation sequencing (NGS) platform that is able to decipher specific diseases (i.e. single nucleotide variants (SNVs)), mutations, epigenetic events and so on). Furthermore, the NGS data analysis tools will provide healthcare advocates with better insight of existing known variations relevant to distinct diseases, potentially providing a comprehensive basis for personalized medicine.

We, as a growing technologically advanced world, can rest a little easier knowing that researchers are indeed guiding themselves toward the development of effective therapeutic solutions and vaccines.

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BOOK REVIEW

BY NIKHIL GANGASANI

Title: When Breath Becomes Air Author: Dr. Paul Kalanithi Price: $15.00 Hardcover, $12.99 Kindle

Imagine you are close to crossing the finish line of a grueling seven year residency in neurosurgery. You have worked hard to put your medical career on a trajectory for great success. You are finally getting

ready to start a family. All of a sudden, everything changes. Your diagnosis: stage IV lung cancer.

Dr. Kalanithi splits When Breath Becomes Air into two parts: the first, his life leading up to his cancer diagnosis; the second, his life with terminal illness.

As Kalanithi grows before the reader’s eyes in the first part of the book, his potential to make a monumental impact on the world becomes readily apparent -- by his thirties, Dr Kalanithi is a resident in neurosurgery at Stanford with top awards for his research in neuromodulation. Sadly, this trajectory turns to tragedy as the hero of the story, a thirty six year old, fit physician with no history of smoking, receives a diagnosis of metastatic lung cancer. Guiding the reader through his grief with utmost honesty, Dr. Kalanithi supplements his visceral judgment with great wisdom and insightful existential commentary.

On the purpose of the physician: “...the physician’s duty is not to stave off death or return patients to their old lives, but to take into our arms a patient and family whose lives have disintegrated and work until they can stand back up and face, and make sense of, their own existence.”

Dr. Kalanithi lost his life battling cancer, but his wisdom, wit and spirit live on in When Breath Becomes Air. Just as Dr. Kalanithi’s life came to an end all too soon, so too does this beautifully crafted masterpiece.

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TELEMEDICINE THE FUTURE OF HEALTHCARE

What if it was possible to receive medical recommendations or diagnoses from a doctor without stepping out the door?

Telemedicine is a prime example of how technology has enabled the field of medicine to reach new heights and has redefined the level of potential that health professionals and organizations have to increase the quality and effectiveness of care in the United States. Telemedicine is the exchange of medical information and services through electronic communication. With the widespread digitization of everyday tasks, organizational operations, and interpersonal communication, the healthcare industry is presented with a massive opportunity to transform the way patients receive care by improving the access of care, quality of care and relationships between patients and providers through telemedicine.

Telemedicine can reach a wide population because technology is ubiquitous. Telemedicine traditionally occurs via videoconferencing but can also take form as emails, text, phone or tablet applications, websites or larger telemedicine equipment that include ancillary features such as heart rate monitors and ear inspection devices.

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Each type of communication is designed to exchange data in many forms from numerical data like weight to to images of skin conditions.

Because telemedicine is so flexible, it is a viable solution for many different types of health services. Psychiatry is the most popular use of telemedicine because there is very limited palpation involved in psychiatric care, so the doctor and patient can easily have discussions via phone or video call. Dermatology and Wound Care are the next two most common fields for telemedicine use because cameras can capture wounds and skin conditions from many angles.

There are many more areas in which telemedicine is effective, such as oncology, ophthalmology and diabetes care. Telemedicine is particularly useful in nursing homes, where patients are typically immobile and are at risk of injury while commuting to care centers, especially in rural areas where the commute is longer. Variety and accessibility are not the only advantages of telemedicine.

The benefits of using telemedicine as a means of patient care are plenty.

While some may argue that speaking

with a doctor virtually would not foster the patient-doctor relationship as well as face-toface appointments, the National Institutes of Health states that the frequency of meetings would increase with the use of telemedicine, thereby improving the communication and level of trust established in the relationship. In the long run, telemedicine reduces operating costs for hospitals and other health centers because doctors can cut travel between locations to visit their patients.

Telemedicine increases patient adherence to medical recommendations because doctors will easily be able to hold their patients accountable for taking their medications and developing healthy habits. Mobile health also increases access to health resources through information sharing; providers can announce opportunities like support group gatherings and education events verbally or through email.

While telemedicine can provide many benefits to the healthcare community and patients, it also comes with challenges. The highlyregulated environment of the industry makes implementing new technology difficult.

The extensive training required for nurse practitioners and providers to learn the system can delay operations. This potential delay is the reason why many providers are

hesitant to adopt a new system. Additionally, senior patients may have difficulty videoconferencing if they are experiencing hearing or vision loss.

The higher the quality of the videoconferencing system, the lower the rate of patient dissatisfaction and technical difficulties. High quality videoconferencing telemedicine systems can be expensive to adopt, especially those with augmented examination tools. However other forms of telemedicine, such as email, are not expensive. Government subsidies are for adopting telemedicine are becoming more common, so health centers will have more access to the resources necessary to implement telemedicine.

Overall, telemedicine is advancing the way medical practices are carried out, and while it may take time to implement, a medium for open two-way communication will benefit both patients and doctors. The role of the provider is changing because now more than ever, technology allows information on personal health to be more interoperable and accessible and fosters a better relationship between stakeholders in the healthcare environment.

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