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The COVID-19 pandemic has undoubtedly sent shockwaves through the fabric of society. As of April 26, there have been almost three million confirmed COVID-19 cases globally, with America leading at over 960,000 confirmed cases.1 American healthcare institutions are now attempting to flatten the curve, but in dealing with an outbreak of this magnitude, health infrastructure is decidedly behind the curve. The American health insurance sector has not been immune from the disruptions caused by the coronavirus pandemic. With the increasing demand for coronavirus-related care, insurers have been challenged to adapt to provide access to testing and treatment to their members. The coronavirus pandemic has created three key questions in the context of commercial insurance: how the newly unemployed will receive and fund care, how insurers will fund and cover coronavirus-related treatment, and how the cost of coronavirus treatment will influence insurance premiums next year.
Loss of Cover age Considering that approximately 56% of Americans receive their health insurance through an employer plan, access to insurance coverage is extremely fragile.2 For the ten million Americans that recently applied for unemployment in March, largely laid off due to economic ramifications of the pandemic, the employer-sponsored health insurance norm has resulted in a loss of coverage during a health crisis.3 The newly unemployed are now facing heightened economic insecurity coupled with the full burden of any upcoming health care costs. The reality of loss of coverage during a pandemic highlights existing structural problems within the American insurance market that policymakers and the public will be grappling with long after the coronavirus. The unemployed have few options to purchase coverage. The Affordable Care Act allows the unemployed to enroll for insurance on the Marketplace typically up to 60 days after their previous coverage expires, and enrollment into the Medicaid program is open year-round for qualifying 4 8
low-income individuals and families as determined by state-specific income benchmarks.4 Notably, when filing for insurance on the Marketplace, coverage and cost are determined by family size and annual income, so loss of employment does not explicitly affect the cost of a plan. The Consolidated Omnibus Budget Reconciliation Act (COBRA) is another option for insurance coverage off the Marketplace for those leaving a private company with at least twenty employees.5 COBRA allows the unemployed and their dependents to temporarily remain on their employer insurance plan with the caveat that qualified individuals may be required to independently pay up to 102% of the premium cost of the plan.6 For individuals who are ineligible for Medicaid or Marketplace subsidies, neither option provides affordable coverage.
Con cer n s f or Fu t u r e Cost s The high cost of testing and treatment related to COVID-19 that insurance plans are currently encountering has created growing concerns that insurance premiums will raise astronomically in 2021. Insurance regulators in California have predicted a 4-40% increase in commercial insurance premiums.11 Economists point to both competition between insurance plans and job benefits as two factors that will limit how much members must shoulder the spike of coronavirus costs.12 Most large insurers have ample reserves that can be used to fund COVID costs, and insurance fundamentally is intended to protect against unexpected catastrophic health events. However, the rise in health claims could put small insurers and self-insured companies in economic danger if there are no government actions toward funding the pandemic?s medical expenses. The President and CEO of insurer Blue Cross Blue Shield Association along with the President and CEO America?s Health Insurance Plans, a political advocacy group comprised of insurance organizations, wrote an open letter to Congressional leaders advocating for financial relief for insurance coverage. Requests included that Congress subsidize COBRA insurance policies for the newly unemployed by 90%, expand open enrollment on the ACA Marketplace, and provide funding to prevent health premium increases resulting from paying for the pandemic.13
Cover in g Cor on avir u s In the world of managed care insurance plans, insurers restrict access to low value care while promoting ease of access to valuable care demonstrated. It is both equitable and economically-sound to cover care that best benefits members. With a projection that 40-70% of Americans will contract coronavirus, it is evident that access to tests and treatment is not only valuable but necessary.7 For the sake of member health and the greater public health of the population, insurers are finding ways to maximize coverage of COVID-19 tests while eliminating cost sharing. While testing shortages still prevent many sick Americans from receiving COVID-19 tests, most American health insurance firms have provided full funding for the tests.8 The nation?s largest commercial insurance companies, including Aetna, UnitedHealthcare, Cigna, Anthem, and Kaiser Permanente, have removed all associated out of pocket costs for coronavirus testing.9 Insurers have also released other related-responses, ranging from Aetna?s removal of cost sharing for in-patient COVID-19 treatment to Cigna?s Express Scripts offering free delivery of medications. Several insurers, including Anthem and Cigna, are also extending coverage of prescription maintenance medications to 90-day supplies to encourage members to safely social distance at home.10
M ovin g For w ar d Ultimately, like many other coronavirus considerations, it is impossible to fully predict how commercial insurance plans will be impacted by the pandemic. Current responses by insurers and a crisis-level loss of coverage for the millions of unemployed Americans show an incomplete perspective on the disruptions from COVID-19 thus far, as the experiences of Medicaid members, Medicare members, and the otherwise uninsured are not presented here. Moving forward, questions of affordability remain on the forefront to those insured and uninsured alike as insurers look to the government for policy solutions for them, their members, and the larger public.
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Ref er en ces: 1 ?Coronavirus COVID-19 Global Cases by the Center for Systems Science.? Johns Hopkins University and Medicine, Coronavirus Resource Center. <https://coronavirus.jhu.edu/map.html> 2 Edward Berchick, et al. ?Health Insurance Coverage in the United States: 2017.? United States Census Bureau. September 2018. <https://www.census.gov/library/publications/2018/demo/p60-264.html> 3 Heather Long, ?Over 10 Million Americans applied for unemployment benefits in March as economy collapsed.? The Washington Post. April 2, 2020. <https://www.washingtonpost.com/business/2020/04/02/jobless-march-coronavirus/> 4 ?Health coverage options if you?re unemployed.? US Centers for Medicare and Medicaid Services. <https://www.healthcare.gov/unemployed/coverage/> 5 ?FAQs on COBRA Continuation Health Coverage.? US Department of Labor, Employee Benefits Security Administration, November 2015. <https://www.dol.gov/sites/dolgov/files/legacy-files/ebsa/about-ebsa/our-activities/resource-center/faqs/cobra-continuationhealth-coverage-consumer.pdf> 6 ?Continuation of Health Coverage (COBRA).? US Department of Labor. <https://www.dol.gov/general/topic/health-plans/cobra> 7 Alexandra Kelley, ?Harvard scientist: coronavirus pandemic likely will infect 40-70% of world this year.? The Hill. <https://thehill.com/changing-america/well-being/prevention-cures/482794-officials-say-the-cdc-is-preparing-for> 8 Donald Judd, et al. ?America is ramping up Covid-19 testing, but a shortage of basic supplies is limiting capabilities.? CNN Politics. March 28, 2020. <https://www.cnn.com/2020/03/28/politics/coronavirus-swabs-supplies-shortage-states/index.html> 9 ?Health Insurance Providers Respond to Coronavirus (COVID-19).? America?s Health Insurance Plans. April 2, 2020. <https://www.ahip.org/health-insurance-providers-respond-to-coronavirus-covid-19/> 10 ?Health Insurance Providers Respond to Coronavirus (COVID-19).? America?s Health Insurance Plans. April 2, 2020. <https://www.ahip.org/health-insurance-providers-respond-to-coronavirus-covid-19/> 11 Mark Pauly, ?What the coronavirus pandemic could mean for health insurance premiums.? The Philadelphia Inquirer. March 31, 2020. <https://www.inquirer.com/health/coronavirus/coronavirus-covid19-insurance-premiums-20200331.html> 12 Mark Pauly, ?What the coronavirus pandemic could mean for health insurance premiums.? The Philadelphia Inquirer. March 31, 2020. <https://www.inquirer.com/health/coronavirus/coronavirus-covid19-insurance-premiums-20200331.html>13 Letter to Speaker Pelosi, Leader McConnell, Leader McCarthy, and Leader Schumer from America?s Health Insurance Plans and Blue Cross Blue Shield Association. March 19, 2020. <https://www.ahip.org/wp-content/uploads/AHIP-and-BCBSA-Legislative-Recommendations-03.19.2020.pdf>
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Since birth, doctors, nurses, and other healthcare professionals have played a superhuman role in our lives- it is an understatement to say that they are the healers of society. Like with most heroes, it?s easy to forget that they are human too. Over time, medical dramas and other shows like Grey?s Anatomy have tried to humanize the hospitals more, relying on romances and everything dramatic. With that being said, there is a lot we are not aware of. Just because doctors are usually the ones treating ailments of all kinds does not, by any means, make them invincible. In a day and age where the decline of mental health intoxicates society, it too has managed to permeate the walls of the hospital and into the medical field. Historically, it is often hushed up- for what would it signify to society if the powerful are also powerless when it comes to mental health? Nevertheless, recent articles, reviews, and studies have gleaned that there is some truth to this; ultimately, the
?service above self ? nature of medical careers manifests in detriments to mental health. It is needless to say that healthcare professionals have been under high pressure from the very start. Take the medical school academic ?track,? for example. If you know of any undergraduate pre-meds, you probably know that they are taking a whole slew of challenging science courses, grasping any related extracurricular they can, and maintaining an immaculate transcript at the same time. If you know anyone in medical school, you know that they are probably trying to memorize hundreds of medical terms, studying for boards, and stressing from starting clinicals.1 Residency? They?re working overtime hours.2 Working as an actual professional? They must be perfect. Whether it be pressure from academics or from the job itself, it seemingly never stops- and no matter how much enjoyment comes with the job, healthcare professionals have lives at their hands. Their jobs have a margin error of zero. 7 8
per week.5 This is exceedingly more than the national average, which the U.S. Bureau of Labor Statistics claims to be 7.99 hours a day, summing to 40 hours per week.6 Many studies over the years have revealed a saddening truth: to save lives, one must let up some of their own. Unfortunately, this sacrificial mindset instilled in healthcare professionals culminates in a myriad of consequences, many relating to a decline in mental health. The most tragic result is suicide, which is most prevalent in the medical field, especially for doctors.7 Though often ?hushed up,? there are about 400 doctor suicides per year.8, 9 In a striking article in the Washington Post, Dr. Pamela Wible revealed that she has lost many colleagues and peers to suicide, though never her patients. In her own words, ?The people trained to help us are dying by their own hands.8? This goes to show that there is something fundamentally detrimental in the healthcare system? perhaps one of the factors discussed above? to mental health. Though suicide is not always the result, it appears that other mental health issues have seemed to manifest, such as depression and
Due to this pressure, many healthcare professionals put their careers above their personal lives from the start. Take the late Dr. Paul Kalanithi, for example. Renowned neurosurgeon and author of the critically-acclaimed When Breath Becomes Air, Kalanithi reflects that even in his dying days, he possessed the will to carry on his career: ?That morning, I made a decision: I would push myself to return to the OR. Why? Because I could. Because that?s who I was. Because I would have to learn to live in a different way, seeing death as an imposing itinerant visitor but knowing that even if I?m dying, until I actually die, I am still living.3? For a more recent example, consider the doctors and nurses in Wuhan, China who are risking their lives to save others in precarious conditions. Many nurses and doctors have come from distant places in China to help counter the virus, at the expense of contracting the virus themselves.4 One may argue that these noble acts are rare examples, but even in local hospitals, we see sacrifices being made. According to the American Medical Association, as of March 2019, a majority of physicians work more than 71 hours 8 8
prolonged periods of stress.10 It is an ugly truth, but an undeniable one. Such drastic consequences from the upbringing of medical professionals and their careers call for change. The question, however, is where to start. In recent years, we have seen some steps taken to alleviate the pressure, from the 1989 Libby Zion law to more recent provisions such as The Accreditation Council for Graduate Medical Education (ACGME)?s 2011 work hour limit to 80 hours a week.11 Nonetheless, a more important
step that must be taken is to bring the issue to light. Doctors should not be afraid to voice their concerns in fear of shame? if mental health struggles in the medical field are disguised, it will only prolong the problem. As Dr. Wible boldly states in her article, ?There is a way out of the pain. And it?s not death.? Being a society of initiative and not ignorance, support and not shame is the least we can do for the people who have done so much for us.
Ref er en ces: 1. Max Wilbert, "The Hardest Parts of Medical School (According to Students)," Brainscape, January 26, 2017, https://www.brainscape.com/blog/2015/06/hardest-parts-of-medical-school/ 2. Brendan Murphy, ?Survey reveals top 6 challenges faced in medical residency,? AMA, October 25, 2018, https://www.ama-assn.org/residents-students/resident-student-health/survey-reveals-top-6-challenges-faced-medical-residency 3. Paul Kalanithi, When Breath Becomes Air, (New York: Random House, 2016). 4. Helen Regan, Steve George, Sheen McKenzie, and Amir Vera, ?Nurse from Wuhan Hospital Tells CNN at Least a Dozen Medical Staff Infected with Virus,? (CNN: Cable News Network), January 28, 2020, https://edition.cnn.com/asia/live-news/coronavirus-outbreak-01-27-20-intl-hnk/h_7835609811b9838bcfa5edb776d732ea. 5. Sara Berg, ?As work hours rise, so does physician burnout,? AMA, March 22, 2019, https://www.ama-assn.org/practice-management/physician-health/work-hours-rise-so-does-physician-burnout 6. ?Average hours employed people spent working on days worked by day of week,? (U.S. Bureau of Labor Statistics, 2018), https://www.bls.gov/charts/american-time-use/emp-by-ftpt-job-edu-h.htm# 7. Pauline Andersen, ?Doctors' Suicide Rate Highest of Any Profession.? WebMD, May 8, 2018, https://www.webmd.com/mental-health/news/20180508/doctors-suicide-rate-highest-of-any-profession#1 8. Pamila Wible, ?What I?ve learned from my tally of 757 doctor suicides,? The Washington Post, January 13, 2018, https://www.washingtonpost.com/national/health-science/what-ive-learned-from-my-tally-of-757-doctor-suicides/2018/01/12/b0e a9126-eb50-11e7-9f92-10a2203f6c8d_story.html 9. Pamela Wible, ?When Doctors Commit Suicide It?s Often Hushed Up,? The Washington Post, July 14, 2014. 10. Julia Belluz, ?Doctors have alarmingly high rates of depression. One reason: medical school.? Vox, December 9, 2016. 11. Accreditation Council for Graduate Medical Education (ACGME), UPMC, https://www.upmc.com/careers/gme/license-certification/acgme
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Electronic Health Records are redefining healthcare by connecting networks of doctors together to benefit the health of a single patient. Just fifty years ago, any medical information was simply written and kept in sheets of paper in a patient?s file, labeled with the first and last name of the patient and their social security number. Left in storage with hundreds of other files, this system continued until the EHR came to the rescue. But, by 2004 with the Health Information Technology for Economic and Clinical Health Act, there was no denying a national shift to digital health records. One of the key players in this shift is Epic Systems, a company that?s revolutionizing oncological care. Epic Systems was created in 1979 with the idea of giving patients the ability to ?lead a healthier life.?1 The patient uses the MyChart program, which accesses both their personal and familial history. They can easily schedule appointments, read test results, and manage their healthcare dependent on when it's most convenient for them.1 Because it can be accessed nearly everywhere, patients can see their labs or medication even while in the hospital. Doctor ?s use the EpicCare Ambulatory program to write notes during check-ups, place orders, send prescriptions, and more.1
But Epic?s strongest feature is Epic Care Everywhere, which allows patient records to be shared between different health organizations.1 For example, information can be shared between your primary healthcare physician and any specialists you see with just a click of a button. Or, in the case of Main Line Health Oncology, oncologists are able to see their patients' labs from hospitals like Jefferson and Penn. This increases the efficiency and limits the number of redundancy in treatment. Instead of waiting for letters or having to redo blood work, the information is available in an instant online. In the module, the scans and blood work become available in as little as 24 hours. Epic also checks for abnormalities in the scans or labs, thus finding errors quickly and providing better care. In all techno-based world, Epic faces its own challenges. With online healthcare digitizing records of labs and scans as well as patient observations and notes, there rises the issue of privacy. An electronic record system could have data leaks, and some patients and doctors worry about the risk of breaches. In 2018, there were over 6.8 million healthcare data breach victims after hacking incidents. During that time period, over 300,000 individuals? data was lost due to 10 8
improper data disposal.2 How can we avoid these issues in healthcare? Some say simply avoid using electronic healthcare records at all. Federal legislation like HIPPA and the HITECH Act have added information about electronic healthcare records and encompassed more information about sharing of data between hospitals and the extent to which is it allowed.2 Epic combats privacy concerns by asserting that the patient data in EHRs and where the data goes belongs to the patient; they have total control of where their records go. But when all the records belong in an online database, is it really the patient?s control? Medicine is a people?s field? you?re constantly interacting face to face with caregivers interested in your benefit. Imagine walking into a room with your doctor and instead of having a direct conversation, a laptop is sandwiched between the two of you. The doctor spends nearly half the visit asking routine questions from a checklist and writing your responses quickly, and you leave your
visit feeling more like you just had an interview than a discussion about your health. EHRs shift the focus to efficiency rather than a person to person interactions. According to Dr. Ali and Dr. Zeger at Main Line Health Oncology, their patients often bring up complaints like ?the doctor doesn?t look into my eyes? or ?I feel unconnected to my doctor.? This is where the scribes come in? trained students who understand Epic and can quickly take notes during doctor visits. This eases some of the tension, but the nature of having an almost stenographer during your doctor ?s visit can feel somewhat odd at first. Regardless of how we feel about EHRs like Epic, the truth is that it is a multi-billion dollar industry that holds nearly 50% of United States health records and 2.5% of the global health records.3 The combined effort between electronic healthcare systems, physicians, and legislation to maintain patient confidentiality will maneuver a better future to streamlined health records.
Ref er en ces: 1. McCool, Ashley. ?What Is Epic? A Quick Overview of Modalities.? Excite Health Partners. Excite IT , November 7, 2017. http://excitehealthpartners.com/general/47772/. 2. Spitzer, Julie. ?6.1M Healthcare Data Breach Victims in 2018: 5 of the Biggest Breaches so Far. There Have Been 229 Data Breaches Affecting 6.1 Million Individuals Submitted to HHS' Office for Civil Rights' Breach Portal since the Start of 2018, According to HealthcareInfoSecurity.? Becker 's Hospital Review. Becker 's Healthcare, August 22, 2018. https://www.beckershospitalreview.com/cybersecurity/6-1m-healthcare-data-breach-victims-in-2018-5-of-the-biggest-breaches-so -far.html. 3. Glaze, Jeff. ?Epic Systems Draws on Literature Greats for Its next Expansion.? madison.com. Capital Newspaper, January 6, 2015. https://madison.com/news/local/govt-and-politics/epic-systems-draws-on-literature-greats-for-its-next-expansion/article_4d1cf67 c-2abf-5cfd-8ce1-2da60ed84194.html.
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Today, our human DNA carries a record of all the genetic transactions and mutations that have occurred since life began and spread all across the world. Imagine if we could harness this basic biological property, invented by nature ages ago, to improve the security, privacy, and interoperability of healthcare data. Having already revolutionized financial markets through cryptocurrency, here?s where blockchain technology comes into play.1
Nakamoto in 2008. Originally, blockchain was created to serve as the public transaction ledger for Bitcoin, but now has expanded to facilitate all types of inter-organizational cooperation. Blockchain is essentially multiple ?blocks? strung together. For a new block to be added to the existing chain, it must contain data that correlates to a verified transaction. Once a transaction occurs, a network of computers verifies the transaction while storing it in a ?block? and using a hashing function to create a unique code for the information. In the blockchain system, a ledger can be replicated into identical databases, where interested parties can input their information. For example, when a transaction occurs the details associated with it, such as value and assets
Wh at is Block ch ain ? Blockchain is a technology that compiles data on transactions, operations, or any types of alterable information, allowing for easy distribution and accessibility. It was conceptualized by Santoshi 12 8
exchanged, are permanently entered in all copies of the ledger, which removes the need for third-party intermediates to transfer or verify ownership.2 Therefore, this transaction would be securely and verifiably settled within seconds. In our digital world, blockchain completely transforms the way we regulate and administrate control of information.
same documentation of the ledger. A single transaction alters all copies of the record; thus, this form of documentation is more accurate and consistent. A transaction can only be recorded on the ledger if it is agreed on by all the interested parties. This level of security, along with the fact that the information is stored on various databases instead of a single server makes it difficult for hackers to compromise the data. When using traditional processes, transactions are prone to errors and often require third party intermediates to compile the data. On the other hand, blockchain uses only a single digital copy of the ledger that is shared, which reduces complications and the need for middlemen.4
Wh at ar e t h e Ben ef it s of Block ch ain ? Blockchain has already revolutionized many industries from entertainment to retail to insurance.3 Industries are using this technology to transform current business models for greater transparency, enhanced security, increased efficiency of transactions, and reduced costs. Blockchain allows for transactions to become more transparent since all interested parties have the
How Block ch ain Can Help w it h Healt h car e? One of the biggest operational burdens in the 13 8
healthcare industry is the lack of interoperability. Without an effective, cost-efficient way to exchange and process data, the quality of patient care suffers. By streamlining the administrative process, we can improve patient care coordination, reduce healthcare costs, and create stronger security for patient data.5 Blockchain can streamline medical records and enable sharing in a secure, accessible way. Imagine that you break your arm and are immediately taken to the emergency room for care. Naturally, the emergency department will contact your primary care provider to get access to your medical records. This information is then transmitted to the hospital via fax ? yes, you read that right. In an age where we have robots performing surgeries and cars that can self-drive, we still transmit medical records through fax. Although medical records are stored on electronic systems, they are still usually printed and faxed when another care provider needs it. Therefore, care providers usually have trouble accessing electrical health record among themselves without undergoing several 6 time-consuming steps. Blockchain, on the other hand, allows patients to become owners of their data, so it allows patient?s medical information to travel with them to every emergency room, pharmacy, or even specialist. Surprisingly, the convenience does not decrease
security; in fact, data stored in blockchain is more secure than current patient data in EHR. If someone were to hack into EHR, they would be able to access millions of patients?health, financial, and privacy information. However, if the EHR were powered through blockchain, that hacker would not be able to determine whose data is whose or even manipulate the data as they can with the current system because of the asymmetric cryptography that encodes the private and public keys. Improving interoperability through blockchain can transform the healthcare industry by reducing or eliminating the frictional costs of intermediates as well as improving security of patient medical data. Relative to other affluent countries, the United States spends more on health yet sees mediocre returns on this investment.7 Complex insurance rules coupled with political market distortions create massive inefficiencies that result in overburdened healthcare providers and frustrated patients. Blockchain has the power to address some of these significant inefficiencies, but concerns about the technology?s cost, implementation, and cultural adoption could affect its widespread use. But one thing is for sure ? blockchain has revolutionized the big data landscape; its wide-reaching possibilities may serve as the key foundations in the digital world for years to come.
Ref er en ces: 1. Sekhon, JagmOHaN Singh. ?The Bitcoin Blockchain/DNA Metaphor.? Medium. Medium, November 4, 2018. https://medium.com/@jna1x3/the-bitcoin-blockchain-dna-metaphor-1b168abc431e. 2. Iansiti, Marco, and Karim Lakhani. ?The Truth About Blockchain.? Harvard Business Review, August 21, 2019. https://hbr.org/2017/01/the-truth-about-blockchain. 3. Marr, Bernard. ?30 Real Examples Of Blockchain Technology In Practice.? Forbes, May 4, 2018. https://www.forbes.com/sites/bernardmarr/2018/05/14/30-real-examples-of-blockchain-technology-in-practice/#4f4c8a73740d. 4. Hooper, Matthew. ?Top Five Blockchain Benefits Transforming Your Industry.? Blockchain Pulse: IBM Blockchain Blog, June 13, 2019. https://www.ibm.com/blogs/blockchain/2018/02/top-five-blockchain-benefits-transforming-your-industry/ 5. Whitlatch, Shane. ?The 5 Key Benefits of Healthcare Interoperability.? Becker 's Hospital Review, February 27, 2019. https://www.beckershospitalreview.com/healthcare-information-technology/the-5-key-benefits-of-healthcare-interoperability.html. 6. Robert Pearl, M.D. ?Blockchain, Bitcoin And The Electronic Health Record.? Forbes. Forbes Magazine, April 10, 2018. https://www.forbes.com/sites/robertpearl/2018/04/10/blockchain-bitcoin-ehr/#1d528ca779e7. 7. ?American Health Care: Health Spending and the Federal Budget.? Committee for a Responsible Federal Budget, May 30, 2018. https://www.crfb.org/papers/american-health-care-health-spending-and-federal-budget. 8. Shashank, Abhinav. ?5 Realistic Benefits Of Using Blockchain in Healthcare - HIT Consultant.? 5 Realistic Benefits Of Using Blockchain in Healthcare - HIT Consultant, July 2, 2018. https://hitconsultant.net/2018/01/29/blockchain-technology-in-healthcare-benefits/#.Xk1ZQi2ZNar.
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After the 1998 economic triumphs of Viagra created for men and their erectile dysfunctions, American pharmaceutical companies quickly searched for a female alternative for women that suffered from female sexual dysfunction. However, no one had previously defined what sexual dissatisfaction meant to individuals or what it was defined as in biomedical medicine. The Food and Drug Administration (FDA) defined the term female sexual dysfunction (FSD) as ?an umbrella term that groups disorders to sexual response including sexual arousal, orgasmic disorders, and sexual pain?.1 After an ambiguous JAMA study of American women that did not clearly define what sexual dysfunction meant to them, 43% of woman admitted that ?they suffered from sexual dysfunction?.2 This led FDA officials to initiate drug trials for medications that could provide sexual relief and desire for women in heterosexual relationships. However, many scholars emphasized that women are not expressing biological faults, but social reasons for their uncomfortable sexual experiences. Due to these controversial practices, scholars have begun researching the biological and emotional details of
female sex and definition of sexual pleasure for individuals. Hopefully, scientific results and studies possibly offer answers to the social stigma of female satisfaction in sex and if there is a difference between the way different genders experience sex. The purpose of this literature review is to identify why women are being prescribed unnecessary medications for being unable to meet the expected norm of heterosexual sex instead of exploring emotional faults behind unsatisfactory sexual experiences. Scholarship seems to agree that pharmaceutical industries expose biased research to create corporate financial gain rather than prioritizing the health and safety of a woman?s sexual pleasure and satisfaction. In her rebuttal against the FDA?s decision to prescribe sexual arousal medication for women, McHugh described that ?many women [in the JAMA study] who experience low sexual desire have been persuaded that they might have a medical condition?.3 Similarly, McKay identified that Fibanserin, a drug that claims to improve sexual arousal currently approved by the FDA in 2015, used an outdated ?Hypoactive Sexual Desire 15 8
Disorder (HSDD) method that no longer is scientifically approved? to prove their methodology and results of their clinical trial.4 Her study concluded and questioned why the FDA has not approved drugs for men to fix issues relating to sexual arousal or desire while ?eagerly creating drugs for women with no research? since ED drugs are solely for ?increasing blood flow to the penis for men who have difficulty achieving an erection?.5 Additionally, McHugh advocated for banning pharma companies from creating medication that was not administered or tested on the opposite sex. She emphasized that female sexual dysfunction ?is the imaginary belief that female sexual dysfunction is caused by biological factors rather than focusing on social issues?.6 Thinking of these studies together, these scholars seek to answer the question of why women feel biologically inadequate regarding sex and how forced medication is making them reevaluate their sexual experiences to be caused by themselves. However, due to the discomfort of sexuality discussions outside of research, these sexual problems are solely reduced to shame which results in many drugs being used in secret to fix an imaginary sexual problem. Since women might not meet the sexual expectations showcased in popular media and culture, the majority of women believe that their heterosexual sexual experiences are not valid and therefore they must have biological difficulties.
discussing personal problems. Since sexuality and sex experiences are hidden from American culture, O?Mullan noted that ?there is a lack of consistency between word usage and universal understanding of sexual education?.7 For instance, O?Mullan?s study showcased a patient in the JAMA study named Louanne changing her sexual arousal medication whenever her husband?s ?normal sexual behavior ? was prevalent.8 She stated that many of her patients ?did not care to use the medication on their own, but for someone else?.9 Additionally, Laumann identified in their study that women who were identified as patients expressed that their lack of sexual emotions felt validated when ?it seemed to be a normalized problem expressed among other women who felt sexual distress?.10 Thus, Laumann concluded that the discussion of female sexuality in media is inaccurate and ?true sexual feelings are hidden due to ?political agendas and bias towards marginalized sexual populations?.11 Berdychevsky explained that a common finding from female sexual dysfunction research was that women who did not fit ideal sexual standards "exerted energy into the ?labor of love? and sexual experiences instead of focusing on their non-physical side of the relationship that may be lacking.12 Looking at the common finding of these studies, it seems clear that no companies explain what the definition of normal sexual behavior entails and why that is justified as the societal norm. Most studies, as shown above, have a woman?s sexual experience being defined by the satisfaction of their partner rather than on their own enjoyment.
Sexuality related issues are increasingly difficult to discuss because everyone has individual meanings for concepts and discomfort in 16 8
pleasure compared to white women?.17 Since there have been no further studies on sexual arousal or mental relationships, this data has not been analyzed to showcase ?why there is a difference in racial sexual behaviors?.18 Drawing from the conclusions of these studies, future studies on personal heterosexual relationships, a diversity of races, ethnicities, sexualities, and socioeconomic backgrounds must be examined to conduct a thorough review of that constraints that cause mental pain to women during sexual experiences. Since sex is such an important part of our evolutionary development as humans, it?s necessary to examine the pain or comfort that is associated with the completely normal and valid act. Sexual health is as valid as mental or physical
Furthermore, pharma companies deceived their target female audiences into believing that their own experiences of sexuality and life contexts were invalid and therefore need a medical solution to help ease their pain. Rather than studying the pain of being in a heterosexual relationship, capitalist companies identified the slight physical pain that women struggle with on a daily basis. Furthermore, continued focus on the biological basis of sexual behavior has little connection with a woman?s sexual difficulties and more on personal heterosexual relationships. McHugh concluded in her sexuality study that ?the conception of heterosexual intercourse is infused with patriarchal fantasies of domination and
conquest? that is completely controlled by men.13 Furthermore, McKay noted that ?women refuse to be in control of sex because it is not declared as a heterosexual norm and therefore do not experience sexual pleasure because of their discomfort in sexual stimulation with their partner ?.14 Additionally, many women who participated in McHugh?s JAMA regulated sexual studies appeared to be from high socioeconomic classes and ?white women that are heterosexual and monogamous?.15 She pointed out that future studies should include more diversity because ?diversity entails that different groups have various experiences with sex and therefore offer more complexity to sexuality?.16 Interestingly enough, McHugh noted that the minority of black women tested in the JAMA study ?tended to have higher rates of low sexual desire and experienced less
health and recognizing that sexual pleasure and wellbeing is valid for one?s individual sense of self. Through these studies, scholars are able to emphasize the emotional and social struggles of sexual satisfaction for women rather than focusing on the non-existent biological factors. O?Mullan described the unrealistic expectations that women face ?during sexual experiences compared to men? and how pharma companies exploit this stereotype.19 McHugh encouraged this step by pushing to focus more on ?personal relationships rather than biological solutions using drugs from the pharma industry?.20 Both Berdychevsky and McKay pushed women to become comfortable with ?their individual sexual desires? and focus less on the media?s high expectations of women.21 Taking all of these sources into consideration, it?s obvious that most women are forced to believe 17 8
that their sexual difficulties are due to biology and are taught to suppress their real desires and objectify themselves to fit unrealistic American norms. Due to the harsh stigma surrounding a woman?s sexuality, women aren?t trusted to be responsible with their bodies and the decisions they make surrounding their sex life. Instead, pharma companies are pushing their own agenda to declare what is best for a woman?s sexual health. Although McHugh and O?Mullan created studies that focus on heterosexual women and their sexuality, future studies should focus on identifying certain issues for reoccurring relationship problems and how to deal with these
issues in a healthy manner. With this subsequent research, women are able to be empowered and understand that it may be social problems that are causing sexual stresses and tangibly fix them. Currently, there are little to no findings on what types of personals problems impact female sex and if these sexual frustrations are resolved with relationships are improved. Therefore, future scholars can study the main constraints in relationships and improvements that can be made accordingly. By focusing on fixing relationships and showcasing sexual desires that do not fit the American norm, women can feel free to express themselves and take control of their sexuality.
Ref er en ces: 1. Liza Berdychevsky, Neil Carr. (2020) Innovation and Impact of Sex as Leisure in Research and Practice: Introduction to the Special Issue. Leisure Sciences 0:0, pages 1-20.
9. McKay, 2017.
2. Berdychevsky and Carr 2020.
12. McHugh, Maureen. ?(PDF) The Labor of Love: Enduring Pain and Disappointment ...,? August 2016. https://www.researchgate.net/publication/306128923_The_ Labor_of_Love_Enduring_Pain_and_Disappointment_in_Hetero sexual_Relations.
10. Berdychevsky and Carr 2020. 11. O?Mullan, 2017.
3. O?Mullan, Cathy, Maryanne Doherty, Rosemary Coates, and P. J. Matt Tilley. ?Using Interpretative Phenomenological Analysis (IPA) to Provide Insight into Female Sexual Difficulties.? Sexual and Relationship Therapy 34, no. 1 (October 2017): 75?86. https://doi.org/10.1080/14681994.2017.1386300.
13. O?Mullan, 2017. 14. Berdychevsky and Carr 2020.
4. Berdychevsky and Carr 2020.
15. O?Mullan, 2017.
5. O?Mullan, 2017.
16. O?Mullan, 2017.
6. O?Mullan, 2017.
17. McKay, 2017.
7. Berdychevsky and Carr 2020..
18. McKay, 2017.
8. Kimberly Mckay. ?Content Analysis of Patient Voices at the FDA?s ?Female Sexual Dysfunction Patient-Focused Drug Development Public Meeting.?? Sexuality & Culture 21, no. 2 (May 2017): 569?92. https://doi.org/10.1007/s12119-016-9405-7.
19. O?Mullan, 2017. 20. O?Mullan, 2017. 21. Berdychevsky and Carr 2020.
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Alzheimer ?s disease is the third leading cause of death in the United States.1 On a global scale, Alzheimer ?s disease is expected to afflict 131.5 million people by the year 2050.2 Despite this staggering data, as well as extensive resources directed to Alzheimer ?s disease research, no long-term treatment protocol has been established or widely implemented. So, where do we go from here?
health. The history of global health and its single-disease eradication campaigns offer key insights for Alzheimer ?s disease treatment. Single-disease eradication campaigns fortify funds and labor to garner support to target an individual disease, from smallpox to polio to AIDS.3 Historically, Alzheimer ?s has been treated as a simple disease caused by a single factor. Because of this, most treatment methods are monotherapeutic, targeting beta-amyloid plaque and tau tangles as the assailants of the condition.
One potential answer to the Alzheimer ?s epidemic is not immediately apparent: global 19 8
Under this system, however, no effective treatment regimen has emerged. Of the hundreds of drugs that have been created to combat Alzheimer ?s disease, 99.6% of them have failed to provide sustainable decreases in its symptoms or underlying problem.4 These failures elucidate that there is no single, catch-all answer to this epidemic, and surely no ?silver bullet? solution. With a global illness burden reaching the tens of millions, the lack of a restorative, standardized treatment is becoming increasingly unacceptable and inadequate.
vastly different. Smallpox?s disease eradication campaigns, however, echo the same pattern as Alzheimer ?s treatment regimens. Smallpox disease was a global affliction that had 50 million cases annually during its peak, and seemingly had a simple, ?magic bullet? answer with the 11 breakthrough of its vaccine. The World Health Organization began a global smallpox campaign in 1959, but eradication was not confirmed until 20 years later.12 The original plan to combat this epidemic aimed for mass vaccination, which ultimately fell short in its implementation.13 Instead, the shift toward ?surveillance and containment? proved much more effective. This latter campaign centered around targeted vaccination, which involved only the vaccination of communities with disease outbreaks, effectively isolating the disease and preventing its spread.14
A study conducted by Bredesen et al. at the Buck Institute for Research on Aging suggests that beta-amyloid plaque is a symptom of the disease, not the assailant.5 This research examines 100 Alzheimer ?s patients and their improvement over their course of treatment.6 This methodology consists of personalized programs that target the change agents in synaptoblastic and synaptoclastic signaling, the two factors that affect beta-amyloid plaque levels.7 Most importantly, this individualized treatment has shown to stop the progression of and mitigate Alzheimer ?s symptoms in these 100 patients over many years.8
Similar to smallpox, Alzheimer ?s disease?s spread is grouped by families and environments. Alzheimer ?s pedigree of expression cannot solely be explained by genetics; environmental causes that alter synaptoblastic and synaptoclastic signaling through inflammation, pathogens, gastrointestinal permeability, insulin resistance, nutrient or hormone deficiencies, and toxins can help predict its future occurrence.15 This suggests that instead of treating individual Alzheimer ?s patients on a case-by-case basis, hubs of Alzheimer ?s disease could be mapped and treated, similar to the targeted vaccination efforts with smallpox?s eradication.
Further, new perspectives on Alzheimer ?s have unearthed previously unknown, central qualities of the disease. Recent research has revealed it as a ?complex and multi-factorial disease,? which is exacerbated by inflammation, as well as environmental factors.9 In addition, its sub-clinical effects can be noted at least 20 years before it is diagnosed.10 This finding indicates that when the proband patient is treated, the next generation of patients in their network is likely already experiencing early cognitive decline. From this, it seems intuitive to expand the target for treatment from the individual patient to their larger community. This would create the opportunity to help patients with these sub-clinical symptoms earlier and prevent further expression of the disease. To date, however, this facet of Alzheimer ?s disease has principally been ignored. To learn how to implement this system, we should reflect on international organizations? eradication of other pervasive diseases, such as smallpox.
The shift in smallpox?s eradication campaign from mass vaccination to targeted vaccination should be employed as a guide for combating Alzheimer ?s disease. Since the next generation of Alzheimer ?s patients are already experiencing early stage, sub-clinical symptoms when the current generation of patients are being diagnosed and treated, tracking these networks would allow for preventive medicine and early treatment of the next generation of patients.16 Effective treatment of Alzheimer ?s requires a novel perspective that treats the condition as a complex, global disease and eradicates it using single-disease eradication models. While this approach rests on the notion that these recent findings about Alzheimer ?s
At first glance, Alzheimer ?s and smallpox appear 20 8
are accurate, even if Alzheimer ?s simply has an environmental and familial component, mapping these centers of disease could help in addressing patients?onset of symptoms earlier.
effort to implement an Alzheimer ?s eradication campaign may fail to help developing countries with the most pressing issues for their citizens.17 In addition, the increased surveillance required to conduct ?surveillance and containment? measures and map networks of disease also allow for potential corruption and increased biopower, which reduce individual privacy and security. With both of these potential pitfalls, however, it is important to note that these problems are characteristic of global health initiatives on a
Unfortunately, single-disease eradication campaigns have downfalls. These efforts are unable to be a ?magic bullet? solution globally, and every country will not benefit equally from them. Alzheimer ?s disease has disproportionately high rates in developed countries, so an international 21 8
fundamental level. In order to remedy these top-down problems, more holistic and bottom-up approaches to global health should be incorporated and utilized.
Single-disease eradication campaigns often begin once medicine provides a cure, and then center on access to and distribution of this cure. In the case of Alzheimer 's disease, medicine needs help from society in order to make the target of this cure smaller and more predictable. Through these methods, there lies the opportunity to formulate a pervasive care protocol that can be offered to those ?in network? and experiencing early stages of cognitive decline. From this, we can shift from curing individual Alzheimer ?s patients to curing their network, and move one step closer to the global eradication of this disease.
Alzheimer ?s disease should be treated as a global health issue. International organizations and global health communities have an obligation to address this rapidly increasing burden of disease using single-disease eradication methods. In doing so, this campaign should mimic past successes with smallpox?s eradication, and hinge on monitoring networks of the disease and catching its onset early in future generations of patients.
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Ref er en ces: 1, 5-8. Dale Bredesen et al., ?Reversal of Cognitive Decline: 100 Patients,? Journal of Alzheimer?s Disease and Parkinsonism 8, no. 5 (2018). 2. Jeffrey Cummings et al., ?Drug Development in Alzheimer ?s Disease: The Path to 2025,? Alzheimer?s Research & Therapy 8, no. 1 (December 2016): 39, https://doi.org/10.1186/s13195-016-0207-9. 3. Sanjoy Bhattacharya, ?WHO-Led or WHO-Managed? Re-Assessing the Smallpox Eradication Program in India, 1960-1980,? in Medicine at the Border: Disease, Globalization and Security, 1850 to Present, ed. Alison Bashford, 1st ed. (Hampshire, NYC: Palgrave Macmillan UK, 2007), 60?75; Michael Specter, ?The Vaccine: Has the Race to Save Africa from AIDs Put Western Science at Odds with Western Ethics?,? The New Yorker, February 3, 2003; Ebenezer Obadare, ?A Crisis of Trust: History, Politics, Religion and the Polio Controversy in Northern Nigeria,? Patterns of Prejudice 39, no. 3 (2005). 4. ?40 Years of Alzheimer ?s Research Failure: Now What?,? September 13, 2018, https://www.medpagetoday.com/neurology/alzheimersdisease/75075. 9-10, 16-17. Federico Licastro et al., ?Multi Factorial Interactions in the Pathogenesis Pathway of Alzheimer ?s Disease: A New Risk Charts for Prevention of Dementia,? Immunity and Ageing, Predictive diagnostics and prevention of chronic degenerative disease, 7, no. 1 (December 4, 2009). 11-14. ?Smallpox: Eradicating an Ancient Scourge,? in Bugs, Drugs and Smoke: Stories from Public Health (World Health Organization, 2012), 1?21.15. Dale Bredesen et al., ?Reversal of Cognitive Decline: 100 Patients.?, Federico Licastro et al., ?Multi Factorial Interactions in the Pathogenesis Pathway of Alzheimer ?s Disease: A New Risk Charts for Prevention of Dementia.?
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Health is the most important wealth, but what happens when you are already extremely wealthy? The United Arab Emirates (UAE) is one of the richest nations in the world, but makes the 20th highest rank for the most obese nation worldwide.1 The unique population includes both Emirati citizens and many non-Emirati immigrants who appear to have drastically different lifestyles. The region?s increased prevalence of obesity mainly occurs among the minority of citizens, the Emiratis (or expatriates), and are due to several factors, such as changes in food consumption, socioeconomic and demographic factors, and physical activity. One hypothesis is the significant use of immigrant maids and laborers, ultimately decreasing activity by Emirati citizens. While this critical problem may be hard to address due to the
multitude of cultural factors, it is imperative to intervene early in order to improve health outcomes later in life. Traditionally, Dubai?s people were fishermen and herders of sheep and cattle. Since the discovery of oil in the Arabian Gulf region in the mid-twentieth century, the UAE has experienced continued growth in population, per capita income and wealth.2 Along with the economic growth of the Gulf region, there have been increases in nutritional health problems and related diseases; this is often referred to as the ?health transition?, or the global increase in overweight/obesity and associated chronic diseases, in the wake of urbanization, globalization and market 2 development. 24 8
Body image and cultural beliefs unfortunately play another role in the increased obesity rates in Dubai among Emirati citizens. The significant amount of non-Emiratis has led to the use of maids and servants in the home who can be easily found on websites dedicated to hiring maids.3 This population divide has significantly contributed to the current Emirati culture and extreme wealth divide. Ideal body image and societal traditions drastically affect the ?norm? for best appearance, and truly influence lifestyle habits of people. In the Arab culture, thinness has been regarded as socially undesirable whereas plumpness is regarded as a symbol of fertility and womanhood.4 Weight gain among Emirati women is reinforced by cultural tradition that sees heavier women as more attractive. The style of looser clothing, including the abaya and shayla, also puts less pressure on women to fit into certain clothes.2 There is a perception among some parents in the UAE that being overweight is a sign of high social status, beauty, fertility and prosperity; these ideas of ideal body image and obesity surely contrast to health studies and overall outcomes.5 Is there a lack of education on health outcomes of overweight or obesity or do cultural beliefs and traditions take priority?
areas, on the other hand, can participate in active lifestyles such as fishing and agriculture. The extensive road networks, increased availability of cars, greater use of mechanized appliances, widespread use of computers, televisions and electronic gaming devices have encouraged a more sedentary lifestyle that leads to greater accumulation of body fat.5 Children are now less likely to walk to school than they were in the 1970s as both they and their parents are more inclined to take the faster and more accessible mode of transportation: the car.4 Moreover, the Emiratis, especially in urban areas, consider traveling in more expensive motor cars as a matter of social status and portrayal of extreme wealth.8 In crowded urban areas, not only is the climate hostile, but there is also a lack of sufficient open areas for children and adults to enjoy outdoor leisure activities.3 Women also face unique challenges because they must be accompanied by a male family member. Social stigma, ideal body shape, use of expatriate maids, inadequate health literacy, extreme food intake, lack of physical activity, technology and the climate are among the many factors that significantly contribute to the UAE obesity epidemic. Due to the extreme wealth in the country and little incentive to change habits, Dubai is a perfect example that wealth may not actually be so valuable. Learning from past interventions, intervening early as well as incorporating specific cultural aspects into obesity management are crucial. Continuing to strive for health in the nation by implementing programs into schools as well as jobs is critical to tackle the high rates of overweight and obesity in the UAE. As Princess Haya, the chairperson of Dubai Healthcare City said, ?good health is our right but it is also a privilege?.9 Encompassing cultural aspects of the nation, such as the use of maids, must be taken into account when planning initiatives as some factors cannot be dismissed. In reality, cars cannot be banned from the UAE, however more natural walking paths and convenient opportunities for physical activity are imperative to encourage a healthy and active lifestyle. While there already are some indoor air-conditioned football tournaments,
Food intake is arguably one of the largest contributors to the high obesity rates in Dubai and the UAE; food consumption by the majority of Emiratis is considerably higher than the body?s needs. It is common practice for people in the UAE to eat from a shared plate, which may create difficulties when estimating correct portion size.6 Over the past two decades there has been an increased consumption of fast foods and sugar-dense beverages, like soda. One study found that more than 80% of adolescents in the nation regularly drink high calorie drinks. Calories from beverages appear to be one of the major contributors to total calories, comprising 8% of total calories for adult Emirati women and up to 14% for male Emirati children.7 Urbanization and technical advances, such as cars, elevators, escalators and remotes, in Gulf countries has resulted in lack of physical activity and increased obesity in cities and towns; rural 25 8
a larger focus on creating more stadiums and other indoor activities is definitely something to consider. Intervening in the young generation is also crucial to educate and start thinking about lifestyle modifications early in life. Primary care providers and health clinics for pregnant and future mothers should educate about and encourage weight loss as well as preventative strategies. Unfortunately, annual health checkups do not exist in the same way they do in America, so future research should focus on how health
information gets communicated and enforced to the public (Singh, 2019). Future interventions may also include controlling school lunches, mandating physical activity in schools, decreasing portion sizes in fast food restaurants, educating maids on meal and food selections in grocery stores as well as providing healthier alternatives on menus. Obesity is very much a treatable and preventable disease and there is still hope for Dubai and the UAE with a proactive and motivated public health department.10 26 8
Ref er en ces: 1. Obesity- Adult Prevalence Rate. (n.d.). <https://www.cia.gov/library/publications/the-world-factbook/rankorder/2228rank.html> 2. Trainer, S. S. (2010). Body Image, Health, and Modernity: Women?s Perspectives and Experiences in the United Arab Emirates. Asia Pacific Journal of Public Health, 22(3_suppl), 60S-67S. 3. Rajan, P. B. (2018). The Growing Problem of Obesity in the UAE. Academicus International Scientific Journal, 9(18), 106-113. 4. Musaiger, A. O., Bin Zaal, A. A., & D'souza, R. (2012). Body Weight perception Among Adolescents in Dubai, United Arab Emirates. Nutricion hospitalaria, 27(6). 5. ALNohair, S. (2014). Obesity in Gulf Countries. International Journal of Health Sciences, 8(1), 79?83. 6. Ali, H. I., Platat, C., El Mesmoudi, N., El Sadig, M., & Tewfik, I. (2018). Evaluation of a Photographic Food Atlas as a Tool for Quantifying Food Portion Size in the United Arab Emirates. PloS one, 13(4), e0196389. 7. Ng, S. W., Zaghloul, S., Ali, H., Harrison, G., Yeatts, K., El Sadig, M., & Popkin, B. M. (2011). Nutrition Transition in the United Arab Emirates. European journal of clinical nutrition, 65(12), 1328?1337. doi:10.1038/ejcn.2011.135 8. Singh, Ninad, April 27, 2019, Personal Interview 9. Chaudhary, S. B. (2018, October 29). Dubai Initiates School Project Reduces Childhood Obesity. <https://gulfnews.com/uae/health/dubai-initiates-school-project-reduces-childhood-obesity-1.1922992> 10. Razzak, H. A., El-Metwally, A., Harbi, A., Al-Shujairi, A., & Qawas, A. (2017). The Prevalence and Risk Factors of Obesity in the United Arab Emirates. Saudi Journal of Obesity, 5(2), 57.
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On a sunny Saturday in February, I drove to a conference center in Montgomery County for the Juvenile Diabetes Research Foundation?s TypeOneNaiton Summit. I arrived to find myself in a crowd of hundreds of people with type 1 diabetes (T1D), supportive family members, healthcare professionals, corporate representatives, and others tirelessly working towards a cure. I was scheduled to speak as part of a panel addressing adult perspectives on T1D, but I honestly felt a strong sense of impostor syndrome in the days leading up to the conference. I was diagnosed with T1D two years ago, just after my sophomore year at Penn. Compared to the attendees who were diagnosed as children, or had been living with the disease for decades, or faced challenges with affording insulin and diabetes management technology, I was worried that my limited experience would discredit me.
a lecture coming from so-called ?experts.? Though the attendees asked us some specific questions, the structure was much more of an open discussion, with people frequently raising their hands to follow up on our answers, present a differing opinion, or offer support through their own stories. As the panel went on, a theme started to emerge among the questions ? one that I felt my experience as a college student was particularly relevant to. Many of the audience members were parents of teens with T1D who were preparing for college. They voiced a wide range of concerns about the transition. Some parents felt that their children never really internalized the fact that they had T1D, or that they failed to understand the irreversible long-term consequences of poor blood glucose management. Others explained that their children frequently experienced low blood glucose events during the night, and had trouble waking up to their continuous glucose monitor alarms. Still other parents were worried about the realities of drinking in college, and how to talk to their teens about the dangerous effects of alcohol on blood glucose.
I joined the three other panelists ? a pediatric endocrinologist, the founder of a T1D-related accessories company, and a man who had recently celebrated his 50th ?dia-versary? ? and watched the amphitheater fill to capacity. As we introduced ourselves and began fielding questions from the audience, my confidence steadily began to grow. The panel did not feel at all like an interrogation or
Managing type 1 diabetes is indeed a 24-hour job that requires constant vigilance and discipline. Many people with T1D experience markedly 28 8
poorer glucose control during their teen and
especially if they remained close to home for
young adult years; only 14% of patients between
college.
the ages of 18-30 meet their hemoglobin A1C
self-management coaching, identifying goals and
1
Transition
with
includes
needs,
reasons. Children who were diagnosed at a young
providers, was also seen beneficial when initiated
age often become accustomed to their parents
at an early age and gradually integrated over time.
playing a significant role in their T1D management,
When seeking out a new adult endocrinologist,
and are forced to assume full responsibility in a
many practices now have dedicated physicians
short period of time. Also, starting college is a
who specialize in dealing with young adults. My
difficult time for anyone, full of new social and
own endocrinologist at Penn is one example; she
academic stresses. Stress hormones are known to
has repeatedly helped me navigate the unique
raise blood glucose levels, and the risk of diabetes
challenges of T1D in the context of the everyday
burnout increases in periods of poor mental
stress of college life. Finally, the more experienced
health.
communicating
which
targets. This period is challenging for a number of
2
and
planning,
adult
care
The desire to fit in amongst peers,
parents in the room urged others to not be afraid
experiment with alcohol and partying, and eat
of giving their child a bit of breathing room.
freely without worrying about carb counting can
Beyond the regular protective instinct that comes
also lead young adults to neglect their T1D-related
with
responsibilities. Finally, they may face difficulties in
technology has advanced dramatically in recent
transitioning from being under the care of their
years. AI-enabled insulin pumps and continuous
pediatric
new
glucose monitors that push real-time data to
relationship with their adult endocrinologist. One
smartphones are valuable tools, but they can also
study found that 38% of T1D patients felt ?less
exacerbate feelings of being constantly hovered
endocrinologist
to
forging
a
3
than satisfied? with their transition to adult care.
questions
that
had
management
discussion was that parents, young adults with T1D, and endocrinologists are all on the same
the sense of unease in the room was palpable the
diabetes
over. In the end, the central message of the
These topics were all raised during my panel, and following
parenthood,
team in the daily fight against a difficult disease.
no
With proper coordination, trust, and support,
straightforward answers. Nevertheless, there was
bridging
also an outpouring of support and advice from the
the
gap
between
childhood
and
adulthood in a healthier manner is a goal that can
panelists and audience members. One point they
be achieved.
stressed was that there is no strict cutoff for the age of transition; many continued to see their pediatric endocrinologist into their early twenties, 29 8
Ref er en ces: 1. J. Iyengar, Thomas, I. H., and Soleimanpour, S. A. 2019. Transition from pediatric to adult care in emerging adults with type 1 diabetes: a blueprint for effective receivership. Clinical Diabetes and Endocrinology 5 (3) https://clindiabetesendo.biomedcentral.com/articles/10.1186/s40842-019-0078-7. 1. M. L. Marcovecchio and Chiarelli, F. 2012. The effects of acute and chronic stress on diabetes control. Science Signaling 5 (247): pt10. https://www.ncbi.nlm.nih.gov/pubmed/23092890. 3. K. C. Garvey et al. 2012. Health care transition in patients with type 1 diabetes: young adult experiences and relationship to glycemic control. Diabetes Care 35 (8): 1716-22. https://www.ncbi.nlm.nih.gov/pubmed/22699289?dopt=Abstract.
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