UGAPreMed a magazine for uga premed students
april 2013
Sustainability
photo usdagov (foter)
What’sInside? 18
04
10 In The News
Sustaining Our Doctors
Spotlight | Pharmacy
Sustaining a Healthy Future
Spotlight | Majors
Environmental Health Spotlight
Clubs in Action
Campus Kitchen Spotlight
Spotlight | Pre-Public Health Public Health Programs
04 12 06 14 08 15 09 18 10 20
Featured
The Strategic National Stockpile
Featured
You Are What You Tweet
Doctor-Patient Relationships
The Importance of Sustaining Them
Healthy Living
Sustainable Agriculture
Pharm Chat
Sustainability in Pharmacy
PreMedStaff
www.premedmag.com | facebook: premedmag | twitter: UGAPreMedMag
Writers
Kristi Haisler Sheela Sheth
Faculty Advisor Dr. Leara Rhodes Editor in Chief Shajira Mohammed Managing Editors Aashka Dave Sefali Patel
Ronke Olowojesiku
James Cheng
Kathleen LaPorte
Samantha Swygman
Business Editor Neha Gupta Assistant Editors Matt Middlebrooks Jordan Crofton Rachel Perez Design/Photo Editor Christine Byun
Abigail Shell Not pictured: Nina Paletta Erica Lee Grady College of Journalism and Mass Communication Franklin College of Arts and Sciences
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Designers Gloria Jen Lauren Foster Photographer Dina Abdulhadi
Editor’sNote I have a love-hate relationship with this time of the year. I love the perfect amount of warmth and fresh breeziness in the air, and my inner nature photographer eagerly ventures out. Sadly, I still have multiple tests each week until school ends. This year, I have realized that it is very important to find a good balance between enjoying the present and keeping the future in mind. Keeping in mind the co-occurrence of spring and exam time, we decided to make this issue’s theme about sustainability. This month’s UGAPreMed takes a look at sustainability in health and medicine through orthodox and unconventional definitions. Natalie Dixon’s article explores physician burnout so we can prepare ourselves now to face such stress in the future. Kristi Haisler and Vincent Gonzalez take a look at how you can get more involved on campus through UGA’s Environmental Health Science Major and Campus Kitchen, respectively. Our newest writer, Priya Patel takes a novel look at sustainability in health through the use of Twitter and social media. With summer break just around the corner, make sure you do not get burnt out before you become the next great person in your field. With our final issue of the semester, I would like to thank you for your support. We have even more exciting issues and events planned out for next semester. For those of you returning, see you all next semester; for those of you who are graduating, I wish you the best for your future. Keep in touch with us through Facebook.com/ premedmag and @UGAPreMedMag.
Shajira Mohammed Editor-in-Chief
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In the News
SUSTAINING OUR
DOCTORS D
id you make a New Year’s resolution this year? If so, you are among the 62 percent of Americans that make a resolution each year. Of this percentage, only about 8 percent of those people succeed in attaining their goal. At the beginning of the year, each participating person had made “permanent life changes” and was acting perfectly toward his goal. Within six months, statistics show that over half of people aban-
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don most if not all of the changes and good choices they were making. Why do people who decide, so resolutely, to change their behavior fail so quickly each year? One large source of the abandonment of New Year’s resolutions is burnout. Burnout is defined as physical or mental collapse caused by overwork or stress. In this context, I believe that burnout occurs because people make changes to their lifestyles that are too drastic to be maintained over
The Problem of Physician Burnout By Natalie Dixon
long periods of time. As a result the resolutions slowly fade out of mind. Though New Year’s resolutions may be the most well known occurrence of burnout in American society, a far more influential area exists in the medical field. Physician burnout is becoming an exceedingly common problem in the current health care system. A recent study published in The Journal of the American Medical Association Internal Medicine compared symptoms of burnout in US photo dina abdulhadi
physicians with those of the general population for the first time. The study used the Maslach Burnout Inventory (MBI) to measure the levels of burnout in both doctors and the general population. This survey measures three main burnout symptoms: emotional exhaustion, depersonalization, and sense of personal accomplishment. It was originally published 25 years ago and has been used for research concerning burnout in various fields of employment since that time. Out of the physicians surveyed in the first study, 45.8 percent showed at least one sign of burnout. Compared with the general population, the doctors had about 10 percent more chance of showing burnout symptoms. Also, the study found that physicians were nearly twice as likely to be dissatisfied with the work-personal life balance that their job allows. Some of the results seem illogical, such as the high percentage of doctors who feel a low sense of personal accomplishment. In my experience, physicians are held in very high esteem by nearly all of the population, and statistics show that they can average a salary anywhere from around $200,000 to over $600,000 annually. Therefore it seems that physicians should feel a great sense of accomplishment. According to Dr. Rob Lambert, there are several reasons for the high percentage of doctor burnout. Many are associated with the current policies regarding the healthcare system and stresses caused by them. Dr. Lambert lists his top ten reasons that he personally feels burned out. First is the drive to see a large number of patients. Many doctors are paid based on the volume of patients that they see, which forces the physician to choose between doing a thorough job with each patient and his paycheck. When the physician behaves “good” toward his patients,
such as explaining things or calling them, he is punished with a lower salary; a policy which forces the doctor to choose between compassion and his paycheck. Also, burnout symptoms can be increased by the stress of completing large amounts of paperwork while losing time that could be spent seeing patients or taking care of personal matters. The amount of rules and regulations surrounding the medical field, such as prescription of medicines, are another large cause of stress be-
PHYSICIAN BURNOUT is becoming an
EXCEEDINGLY COMMON PROBLEM
in the health care system
cause the law and its interpretation in this field are constantly changing. One violation of the rules could result in a hefty fine or loss of a physician’s medical license. On the same note, doctors must also be wary of patients who are simply seeking drugs, such as Xanax or Percocet, to feed an addiction. Another relatively recent cause of stress is media coverage of each “quick fix” for health, especially weight loss. One such example of this coverage occurs on television talk shows. These shows provide audiences with easy, believable solutions for common health problems, but many of the treatments are not backed with credible research. The shows may provide conflicting
“treatments” from one day to the next. Knowledge of these shows often causes physicians extra stress because they must now provide extra explanation as to why the treatment seen on TV will not work to solve a given problem. One of the largest sources of physician burnout is likely from a seemingly simple and commonly known source. Being a doctor, regardless of which specialty, arguably holds the most responsibility that one could have in his/her profession. Each and every day, a doctor holds his patients’ lives in his hands, some specialties more than others. Unlike most professions, a doctor cannot simply leave his work at the office; he must carry the responsibility with him wherever he goes. Over time, the immense weight of this responsibility is taxing to many physicians, leading to symptoms of burnout. Though doctors are exceedingly skilled in handling pressure, the job of a physician is an incredibly stressful one in and of itself. At any time, the doctor’s entire life can change. Any patient could have a life threatening, rare disease, and the physician must always be prepared for this possibility. If a doctor has one missed diagnosis, regardless of how many good diagnoses he has had, he will likely be subject to a malpractice suit. No matter how many years a doctor has spent performing “good medicine,” his entire reputation can be ruined by any one decision. Considering these factors, it is not a surprise that half of physicians experience symptoms of burnout. The current healthcare system in America is stressful on the doctors and may become even more so with the changes of the Affordable Care Act. Additional research is currently being done on physician burnout, and researchers hope to find ways to help doctors remain engaged in the medical process. premed magazine at uga | april 2013
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Spotlight • Pharmacy
Sustaining BY ABIGAIL SHELL
A
mid the clicking of keystrokes and roar of exclamations flooding the air during a typical day at the New York Stock Exchange, a horrified silence suddenly pervades the room. In horror, the traders stare in shock at the screens as the numbers--their breath, sweat, and lifeblood--plummet. The latest reincarnation of the infamous “Black Tuesday” has arisen in the 21st century. Though hardly novel, this anecdote nevertheless resonates with many; almost the entirety of the United States and even the international markets have been left to deal with the aftermath of this economic tsunami. Families have been displaced and markets left in chaos, but the core principles of healthcare remained unchanged: people still became ill, and doctors providedntreatment. Unfortunately, the latter may be more vulnerable than it appears. As evidenced by the rising number of drug shortages, current pharmaceutical production practices, like the turn-of-the-century economy, are not sustainable. Sustainable. Now there is a word that gets thrown around whenever someone wants to be perceived as “eco-friendly,” but its true meaning has
a healthy future
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[
]
BETWEEN 2010 and 2011, THE NUMBER OF INSUFFICENTLY PRODUCED DRUGS IN THE UNITED STATES INCREASED BY 30%
somehow fallen by the wayside. So, what does it mean? According to the Oxford English Dictionary, sustainable refers to a practice that can be upheld or maintained without depletion of resources, in other words, a circular system rather than a one-way track. In the opinion of economist Robert Gilman, traditional economic theory favors the one-way street model, and since pharmaceuticals have become big business, their production is largely governed by these same laws. Like any Fortune 500 company, major drug development firms like Pfizer and GlaxonSmithKline aim to turn a profit.
While their public relations teams emphasize their role in the research and development of innovative cures, the MBAs in the offices upstairs analyze the profitability of each drug in which they invest, determining which is the most economically profitable. Based on their investment track record, copycat, or “me too” drugs seem to claim this laurel. Due to this practice, any consumer with access to a television can, for example, witness the proliferation of the allergy medicines Allegra, Claritin, and Zyrtec, etc. Chemical analysis reveals these three drugs to contain virtually identical active ingredients, photo thomasthomas (foter)
but slight differences in formulation, packaging, or presentation allow them to be marketed individually. A rational observer can conclude that such practices are counterproductive to the companies’ stated mission--- development of innovative treatments---but because they are currently financially stable, no move has been made to wade into the murkier waters of cutting-edge research. What, then, has been the result? Two words: drug shortages. A brief trip to the FDA’s “Frequently Asked Questions” page reveals that between 2010 and 2011, the number of insufficiently-produced drugs in the United States increased by 30%. The problem is so weighty and pervasive, the American Society of Health-System Pharmacists has compiled an entire database in order to provide working pharmacists with the most reliable information regarding these shortages. Since shortages present yet more roadblocks along the diagnostic road, knowledge of their existence and reach is of paramount importance. These shortages are limited to treatments for obscure cancers or rare diseases. In all actuality, vaccines and
photo dina abdulhadi
simple saline drips are some of the more common guests on the shortage list. During my day of shadowing at Children’s National Medical Center in Washington, D.C., this summer, I saw firsthand the extra analytical steps required on the part of the pharmacist in filling doctors’ prescriptions. Drugs were interchanged; dosing was adjusted; and stocks of inaccessible medicines were placed on reserve for emergencies. Meanwhile, children, some incurably ill, lay in the surrounding beds. At that moment, I started to wonder, “Does the world really need another allergy medicine?” Truthfully, what it actually needs is a cure: a cure for allergies, a cure for Alzheimer’s, a cure for cancer. According to pharmaceutical PR, that is what they are devoting time and energy to, but their monetary actions tell a different tale. In this twisted prevarication, the self-proclaimed saviors entice the public into their candy palaces with promises of miracle cures and sweet panaceas--just what the doctor ordered. Behind the doors, however, their witchy hands delve deep into pockets and purses, extracting the green to feed their system. Just as surely as chocolate melts in the
sun, their racket is incapable of survival; the recent economic downturn is proof enough of that. Back in 2005, Dr. Marcia Angell’s mudraking book about the closed-door machinations of major pharmaceutical companies. In her exposé, she revealed how the companies’ “much vaunted pipeline [of innovative drugs] is running dry” while prices and profits remain astronomical. Her research also revealed that like Hansel and Gretel escaping the ovens of the wicked witch, the public is growing tired of the pharmaceutical industry’s unfulfilled promises. Since the public controls the voting bloc, it dictates the decisions finalized in D.C., including the regulations over the pharmaceutical industry. With the pinch in their wallets caused simultaneously by exorbitant drug prices and the recession, people want answers. In the emerging theory of sustainable economics, an answer may lie, but all parties must participate in order to succeed. Only by taking the environment, the workforce, society, products, and credit into consideration in the development of a new business plan will rhetoric come to match reality and create a system for the future.
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Spotlight • Majors
Environmental Health
By Vincent Gonzalez
Interested in countless job offers and a great starting salary, all right out of college? If so, consider the environmental health major at the University of Georgia. A part of the College of Public Health, the environmental health major is a rigorous, science major designed to prepare students for careers in environmental fields. MyMajors.com describes the major as, “A program that prepares individuals to apply mathematical and scientific principles to the design, development and operational evaluation of systems for controlling contained living environments. Students will also learn about monitoring and controlling factors in the external natural environment, including pollution control, waste and hazardous material disposal, health and safety protection, conservation, life support, and requirements for protection of special materials and related work environments.” According to the environmental health science web page for the University of Georgia, “The degree can also be used as a step to an advanced degree in many fields including environmental health, industrial hygiene, toxicology, public health, epidemiology, ecology and environmental engineering, and will
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satisfy entrance requirements for professional degree programs such as medicine, veterinary medicine, dentistry, optometry and pharmacy.” Like many science majors at UGA, students in the environmental field of study must complete basic scientific courses their first year (Chemistry, Biology, Physics). However, as upperclassmen the students are able to take classes such as water and noise pollution; solid and hazardous waste management; environmental toxicology; industrial hygiene; food microbiology; epidemiology; and public health law. The classes are typically small in size (2030), and are taught by permanent faculty members rather than graduate students. In addition,EHS students gain practical experience and problem solving skills through internships and co-ops. There are many possible career opportunities for students who choose to major in Environmental Health. The list of possible careers includes: Environmental Health Specialist, Toxicologist, Industrial Hygiene Specialist, Hazardous Waste Manager, Bioremediation Manager, Water Treatment Manager, and Ecological risk Assessor. If worried about finding a job after college, Explorehealthcareers.org states, “In the wake of recent man-made and natural
disasters, the US is placing a high priority on building up the nation’s public health workforce. Since 2002, Federal funding has increased for public health preparedness, including scholarship and loan repayment programs, workforce development grants, and funding for emergency preparedness. What does this mean for you? It means that with a degree in public health, you’ll be in high demand – and on a career path filled with advancement opportunities.” In addition, degreedirectory.org claims that, “the U.S. Bureau of Labor Statistics (BLS) reports that jobs for medical and public health social workers are expected to grow much faster than the average for all occupations over the period 2008-2018 (www. bls.gov).” The salary of a typical EHS major is nothing to balk at either. While students majoring in environmental health can expect to spend between six to nine years in school, they can also expect to make a salary of up to $150,000. The Environmental Health major at the University of Georgia offers job security, a solid salary, and opportunity for job growth. In a time when unemployment rates are incredibly high, a switch to the Environmental Health major may be the best decision one can make.
photo robert newcom (university of georgia)
Clubs in Action
CAMPUS KITCHEN
SPOTLIGHT
BY KRISTI HAISLER
A
thens-Clarke County is one of the poorest counties in Georgia, with a poverty rate of 28.3 percent. This means there are over 26,000 residents living below the poverty line, which oftentimes makes finding an affordable source of food very difficult. Despite the fact that many senior citizens go hungry, almost 40 percent of all food produced for consumption goes to waste. UGArden is committed to finding sustainable ways to feed those in need by combining food that would otherwise be wasted with food they
have gardened. Sustainability is the key to ending hunger. Campus Kitchen is a project run by the UGArden organization. Through a partnership with the Athens Community Council on Aging, it is dedicated to feeding underprivileged senior citizens in the Athens area. Georgia has the sixth highest number of hungry senior citizens, Campus Kitchen volunteers plan to change that. Volunteers gather food from fraternities, sororities, local restaurants and gardens, and recreate and redistribute it to those in need. Cam-
photo dot paul (university of georgia); illustration christine byun
pus Kitchen volunteers have the opportunity to preform numerous different tasks, from gardening, to hand delivering food, to working with others to ensure the nutritional content of the delivered food meets local senior’s needs. The project has been enormously successful; over 1200 pounds of food have been donated to those in need. Any student interested in volunteering is encouraged to email the Campus Kitchen Coordinator Sarah Jackson at sjack40@gmail. com. premed magazine at uga | APril 2013
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Spotlight • Pre-Public Health
APPROACHES TO
SUSTAIN PUBLIC HEALTH
PROGRAMS By Sharon Kim
P
ublic health is the science and art of protecting and improving the health of communities through education, promotion of healthy lifestyles and research for disease and injury prevention. It works to enhance the well-being of people in local communities and around the globe as well as working to prevent health problems before they occur. Public health has made dramatic achievements in the 20th century. They improved the quality of life: an increase in life expectancy, worldwide reduction in infant and child mortality and the elimination or reduction of many communicable diseases. In order to sustain public health, Public Health leaders need to strengthen their roles as advocates for improved population-based health in an international, global community. Sustainability is not just about achieving public health goals; it also relates to concepts such as social justice and socioeconomics. In order to keep public health sustainability tasks clear, doable and supported, it is encouraged to focus on issues, strategies, goals and resources for policies that aim to improve health and well-being. Public Health leaders should also consider linking with local groups working outside public health (e.g. transportation departments, parks and recreation departments) whose efforts complement their own.By understanding a variety of different approaches, leaders are able to function more successfully and raise the chances of maintaining a program’s efforts. There are several angles from which sustainability can be approached: policy, partnerships, establishing a community home, building members’ skills, communication and social marketing strategies.
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photo us mission geneva (foter)
P OLICIES, SYSTEMS AND ENVIRONMENTAL CHANGE STRATEGIES Policies provide long-term goals around which community members can assemble. Not only should policies be promoted but they should also be enforced and carried out. While individual approaches to behavior change are important for health promotion efforts, these changes should be induced and supported by changes in networks, environments, and social norms that support beneficial health decisions. Policy strategies can result in change on several different levels, significantly impacting social and cultural norms and values. To achieve sustainability, a policy strategy should influence everyone in its priority population. Far more people can be impacted because they are population-wide approaches rather than individual strategies. They can also be copied in several community settings and on many levels. Additionally, they are more economically sustainable long-term than other approaches. Once a policy has been implemented, few, if any, resources are usually needed to sustain resulting community improvements. In fact, policy strategies can grant constant improvements even if the institution or coalitions that helped enact them are not themselves sustained. For these reasons, a policy approach is the best way to work toward sustainable change in the community.
COALITIONS AND PARTNERSHIPS
The term “coalition” is used to describe a diverse group of individuals and organizations working together to achieve specific goals. Strong coalitions and partnerships provide a platform and process that promote buy-in and support from participating community organizations and leaders. This heightened level of support enhances the reputation of the coalition and the Healthy Communities Movement,which is a growing global effort to improve the health and well-being of individuals, primarily through policies that sustain positive, lasting changes. This increases the likelihood of new funding opportunities. They can serve as effective vehicles for exchanging knowledge and ideas. They help to limit duplication of strategies and services and demonstrate and develop community support for issues. Furthermore, they maximize the talents and resources of individuals and groups through collective action. Communication, trust and collaboration among community agencies and sectors should also be improved and community standards and norms concerning health-risk behaviors should be changed. Lastly, policies to create a sustainable change in systems and environments can be promoted.
ESTABLISHING A HOME FOR HEALTHY COMMUNITIES WORK In order to ensure long-term success, a collaborative healthy communities initiative needs to be adjusted to potential changes-e.g. in local opportunities or alliances, funding, public health needs as well as community and coalition leadership priorities. It is immensely important to consider where and how to organize a base of operations so that the initiative can proliferate during and after transformation. The community home should be able to serve as an objective broker of public health resources, solicit and administer a variety of funding sources, appeal to a variety of community-based organizations, establish an internal infrastructure and shift priorities to accommodate changes in goals and community needs. Once established, the home can serve many vital roles, such as leader and advocate, overseer of knowledge transfer and translation, convener, developer of standards, monitor and/or grantor.
BUILDING COALITION MEMBERS’ SKILLS
Coalition members need to acquire new skills, develop their capabilities, and expand their knowledge and careers. This not only benefits the coalition as a whole but it also encourages members to maintain their participation. Coalition training and skill building are implemented toward process, administrative or public health content. Administrative training include topics such as project planning, fundraising, budgeting and structuring coalitions for success. Process training include topics such as leadership training, team building, communication and project planning. Public health content includes topics such as physical activity and nutrition, current strategies to promote specific efforts around chronic disease risk factors (e.g., tobacco use, prevention, and control), understanding health equity and elements of the built environment. These skills can be learned from self-help methods or through face-to-face workshops that can aid with strategic or program planning and process training. A variety of assessment processes such as surveys and coalition-wide discussions can be used to determine the best type of training.
COMMUNICATION STRATEGIES
Coalitions should be able to form public/ decision-maker awareness and support around policy strategies by using various media to convey the policy message. Specifically, media efforts promote decision-maker
buy-in of the coalition vision, mission and plans; conveying the sense that funds and other resources are being used wisely; increasing changes that new funding or other resource-development opportunities will present and setting the stage for collaboration or coordination between organizations. It is extremely important to make sure that the message and call to action is precise and easily understood. Newsletters, social media, regular columns, periodic reports, emails and other methods should be used in order to keep community and decision-makers up to date.
SOCIAL MARKETING
Social marketing provides an action framework for generating discussion and promoting information, attitudes and values that are conducive to long-term behavioral changes in certain populations. Influencing behavior in individuals can contribute to policy changes within a community at large. When developing a social marketing plan, it is important to remember to keep the audience’s perspective in mind and consider all potential barriers to behavior change. In order for these efforts to be successful, it is crucial to know what can motivate a certain population to adopt a desired behavior. When making the choice to change, a person has to make an “exchange,” or give one thing up in return for something else. This exchange can be concrete (money) or less tangible (e.g., improvement in health, social acceptance or safety). It is important to offer something very appealing in return for the desired behavior. When planning and implementing a social marketing strategy, it is imperative to remember the “4 Ps of Marketing”: product, price, place and promotion. Looking at all of this, it can be concluded that sustainability is a deliberate process with specific action steps and is a complex goal that requires versatile approaches that reach across all areas of the community. These approaches include resource development, coalition building, social marketing, educational approaches such as mentoring and technical assistance. It is an ongoing process of prioritizing effective, feasible strategies that are likely to be maintained. Lastly, sustainability is based on collaboration. Any collective action is more than the sum of its parts, whether the focus is health, economics or the environment. Fundamentally, a broad perspective is required: a holistic view of the community as interwoven and interrelated. Using a community home approach, a coalition is most likely to have long-term success Once boundaries and limitations are discarded, the potential for every human being to live a healthier life will increase.
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Featured
THE
Strategic
National
Stockpile By Kathleen LaPorte
The United States took action last month to become more prepared for a BIOTERROISM ATTACK OR MASS PANDEMIC
T
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he U.S. received the first shipment of an anti-smallpox drug called Arestvyr in March. Delivered to the U.S. Strategic National Stockpile, the investment in this drug is part of an emergency preparedness initiative that came out of the Sept. 11 terrorist attacks. Part of an effort by Congress to increase emergency preparedness in the United States, the Strategic National Stockpile, or SNS, was developed to provide a safety net in the case of bioterrorism, widespread pandemics or disaster resulting in mass trauma and casualties. The SNS, developed in 1999, is a reserve of vaccines, pharmaceutical and medical supplies that can be quickly administered across the country during a disaster in which local supplies run out. Employed during the 2001 Anthrax threat, the Hurricane Katrina disaster and the H1N1 flu pandem-
“THE SNS HAS 12 LOCATIONS AROUND THE UNITED STATES AND IS PREPARED TO DISPATCH
12 HR PUSH PACKS TO ANY AREA OF THE COUNTRY WITHIN 12 HOURS OF REQUEST.” ic, the Strategic National Stockpile provides additional medication and supplies to area affected by large scale disasters. The Department of Homeland Security established a set of parameters and responsibilities for the SNS in 2002 that focused on public health improvement and emergency preparedness. Today the SNS is jointly managed by the Center of Disease Control and the U.S. Department of Health and Human Services, and its main goal is to provide vital medical supplies in areas of need across the country. The SNS has 12 locations around the United States and is prepared to dispatch 12-hour Push Packs to any area of the country within 12 hours of a request. During a pandemic or disaster, local or state health departments can put in a request for antibiotics and other medical sup-
plies from the SNS. The CDC or HHS authorizes the delivery, and the needed provisions are delivered to the affected area for distribution. According the CDC website, the medical supplies and vaccines stocked in the SNS are determined by, “many factors, such as current biological and/or chemical threats, the availability of medical materiel, and the ease of dissemination of pharmaceuticals. One of the most significant factors in determining SNS composition, however, is the medical vulnerability of the U.S. civilian population.” The SNS can most effectively provide for citizens in need during a disaster when local and state health departments have a plan for the distribution of vaccines and medical aid during a disaster an emergency. During disasters or terrorist attacks, it the local first
responders and health officials that can make the greatest impact on helping those affected in the area. Preparing for emergencies requires communication and joint planning from both the federal government and local officials. In order to best create a country that is prepared to sustain natural disasters, wide-spread disease or bio-terrorist attacks, local and federal officials must have a plan and be prepared. The SNS, in providing a plan of action and means of preparedness, is a significant US resource.
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13
Featured
By Priya Patel
Whoever said
“An apple a day keeps the doctor away” may not have been talking about iPhones, but nowadays it is hard to tell the difference. As smartphones and tablets become increasingly popular, so do the various applications that come with them. There seems to be an app for everything these days—from doing your math homework to choosing a restaurant. While most apps—such as games or social media— are purely recreational, they can also serve a much more didactic purpose. Twitter, the popular social media network, is a prime example of how social media can be used as an effective public health tool.
Twitter users worldwide send millions of tweets every single day, a seemingly never-ending stream of information about what people are doing and how they feel about it. For public health officials—such as epidemiologists, microbiologists, doctors, and more—this information offers a wealth of health-related data. People’s tweets can be used to ascertain a variety of things, such as disease outbreaks and the types of medicine that people are using for their ailments (i.e. “Just took another Benadryl…I hate allergies!”). This information is only useful, however, if researchers can effectively filter out misleading tweets, such as “I have Bieber fever” or “Traffic is such a headache.” Consequently, public health professionals have to employ restrictive filters in order to draw accurate conclusions from Twitter. Some researchers would say that Twitter has too much non-health related information, making it a daunting task to organize and analyze. Others would argue that this is exactly what makes Twitter so effective—it provides real information about behaviors in real time.
Not only is Twitter a valuable asset to public health research, but there are also various Twitter accounts that provide public health information to those who follow them. For example, Dr. Mehmet Oz (@DrOz), cardiac surgeon and host of the “Dr. Oz Show,” uses his Twitter to tweet about how to have a healthier lifestyle (advice on sleep hygiene, balanced diet, exercise tips, etc.). The Centers for Disease Control and Prevention (@CDCgov) gives healthy living tips and provides information about disease outbreaks around the world as well. There are even Twitter accounts for pre-medical students—such as Dr. K (@medschooladvice) and Pre-Med Princess (@PremedPrincess_)—that share advice about the medical school application process, the MCATs, and more. All in all, the recent rise in popularity of social media apps like Twitter is a good thing. With health being such an important issue in the U.S. today, Twitter provides a useful way for health professionals and researchers to gather information. Furthermore, it is important for people to have easy access to public health information through the vast number of Twitter accounts dedicated to public health. Of course, Twitter can not be used in lieu of an actual doctor’s diagnosis; however, until a truly effective way to diagnose illness without a health professional is developed, then the reliability of public health apps is largely left to the user’s discretion. When you have such a dynamic tool to promote public health and healthy living, why not tweet about it?
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illustration christine byun
THE IMPORTANCE OF SUSTAINABLE DOCTOR-PATIENT
RELATIONSHIPS BY RONKE OLOWOJESIKU
photo mercy health (foter)
“Patients have a unique story that
essentially holds the key to their
diagnosis.”
ACCORDING TO DESCARTES,
we are best defined by our thinking nature: I think, therefore I am. Spanish philosopher José Ortega y Gasset offers a different idea, that we are the summation of ourselves and our situation – “el hombre es él y su circunstancia” (man is himself and his circumstances). This past spring break, I had the pleasure of shadowing Dr. Africa Alvarez, an infectious disease physician working in the Marietta Public Health Center’s HIV clinic. Trained both abroad in Buenos Aires and stateside in New York City, Dr. Alvarez takes Ortega’s words to heart, ensuring that in the interactions with her patients, she considers not only their disease but what they are going through. She takes a genuine interest in their lives, asking about children, work life, significant others and spouses. Her patients delight in her, one praising her compassion and another not inclined to leave her current living situation for fear of losing the doctor that has become her advocate over the years. I spent the week in awe at the relationship Dr. Alvarez has with her patients and the impact she has on them. I cannot help to lament on the fact that not all doctor-patient relationships mirror that of hers, a sustainable relationship in which patient and doctor work in tandem toward a common goal. Often times today, when the word “sustainability” is
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invoked, it is usually in an environmental context. When applied to relationships, however, sustainability can be used to describe lasting person-to-person interactions in which two or more parties trust, accept and respect each other. In medicine, such a relationship between patients and doctors can be advantageous to prevent unnecessary tests and misdiagnoses. A research study published in the Archives of Internal Medicine maintains that 80% of diagnoses can be made accurately on the patient’s history. Patients have a unique story that essentially holds the key to their diagnosis. Yet, in the quick-paced nature of the world now, often times this story is not told to completion and physicians miss important details that lead to wrong diagnoses and delayed treatment. In her book, entitled When Doctors Don’t Listen: How To Avoid Misdiagnoses and Unnecessary Tests, Dr. Leana Wen discusses the case of a college student who came to the emergency room presenting symptoms associated with a hangover. However, to rule out the possibility of a brain hemorrhage, the student underwent a CAT scan and was told she would need a spinal tap. Frightened and feeling that her voice was unheard, the young female escaped from the hospital in her hospital gown. Were the additional tests unnecessary? Yes, but one cannot be too quick to blame the physicians. In an age where photo resurge international (foter)
doctors are being sued left and right, physicians at times are forced to perform what many coin CYA procedures (cover your butt) to ensure that they have covered all of their bases. However, if the student in the case above had had some sort of sustainable interaction with the physicians treating her, had she felt that she had some say in her treatment, perhaps she would not have felt the need to run away. Fostering strong and sustainable doctor-patient relationships therefore is vital in improving patient health. Communication and understanding are the keys to every good relationship, and these two aspects need to be better incorporated in doctor-patient interactions. In my shadow experience, I observed how Dr. Alvarez made herself available to her patients through email, office phone, and even through text message on her personal phone in the case of emergency. “You stood me up!” she cried in jest one day, talking to a patient of hers who had missed his appointment. She had personally called him to see what the situation was and tried to work out another time they could meet. Having a doctor thoroughly invested in a patient’s care invites the patient to work with the doctor and together, the two can provide the care most conducive to the patient’s overall well being. While at the health center, I was able to converse with photo mercy health (foter)
the patients about their experiences in the HIV clinic. One of the patients, who I will refer to as Mr. X, describes the relationship of doctors and patients as a two-way street: “Dr. Alvarez asks all these questions not because she’s nosy or anything; she just wants to know what’s going on with you so that she can help you. But she can’t do it all herself, you’ve got to do your part.” Mr. X has been a longtime patient of Dr. Alvarez. As I sat in the room with the two of them, I could sense the rich history between them. She has been with him through the worst of his disease and family trials, and he was with her during her own personal battle with serious illness and intense treatment. Mr. X willingly and openly discloses his information to Dr. Alvarez without hesitation, putting full trust in the physician who has worked tirelessly to ensure that he lives a full life. In my week with Dr. Alvarez, I saw a physician who has and continues to bend over backwards to offer the best for her patients, who takes care of her patients in all aspects. She has inspired me to work towards cultivating strong, sustainable relationships with my future patients. Ultimately, it is this type of relationship, not some new fancy diagnostic technology, which will lead to a healthier society. premed magazine at uga | april 2013
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Healthy Living
Sustainable
By Sheela Sheth
Agriculture 18 premed magazine at uga | april 2013
A revealing study of the word “sustain” can be accomplished by looking to its Latin root, sustinere, meaning “to keep in existence or maintain.” Applying photo circulating (foter)
such a notion to agriculture means farming systems should be “capable of maintaining their productivity and usefulness to society indefinitely ... [they] must be resource-conserving, socially supportive, commercially competitive, and environmentally sound.” Over the past few decades, agriculture has diverged from this ideal, instead becoming wasteful, unhealthy, detrimental to the environment, and a less sure source of income for many farmers. For proof of this unfortunate change, one only need to look to a scene in post-earthquake Haiti. The USAID sent 90,000 metric tons of crops to Haiti through the Food for Progress and Food for Peace programs. USAID had been spending $35 million annually on food aid to Haiti and spent $140 million in 2010 to address the aftermath of the earthquake. Importing food proved seemed to feel overwhelmed by the U.S.’s decision to import food in large amounts at high rates, especially given the fact that the U.S. could have bought local food for the struggling people. Unfortunately for many Haitians, though local and regional procurement would have been more beneficial for the farmers, it would also have been more costly for the U.S. The large volume of food entering Haiti led to a drop in prices and reduced the need for local production. Since most of the food aid did not even reach Haiti until months after the disaster, much locally produced food went to waste. Some Haitians claim the acts are more about expanding the U.S. economy rather than providing humanitarian support since the years of food aid to Haiti have caused no obvious economic growth in Haiti the country. How has America been able to direct so much of its food production
to Haiti, while the Caribbean nation barely generates enough food for its own people? The turn of agriculture away from sustainability is why. Rather than helping developing countries increase their crop yield and thus strengthen their economies, developed countries often prefer to capitalize on this problem by increasing their own yields through large-scale farming companies, fertilizers, and GMOs and selling surpluses on the international trade market at cut-rate prices. Besides preventing local farmers from selling their produce, this new unsustainable form of agriculture saturates soils with nutrients from fertilizers, many of which are harmful to humans. Fertilizers and pesticides negatively affect humans in several ways. Excessive exposure to pesticides, through consumption of unfiltered water or contact with contaminated soil can cause burning, itching, rashes, stinging and blistering in the eyes, skin, nose and throat. Pesticide exposure can also exacerbate respiratory problems, such as asthma. Excess fertilizer often leaches into groundwater. Nitrate, one of the most commonly used pesticides, is also the most prevalent contaminant of water. When nitrate is converted to nitrite, it reacts with amine-containing substances in food to form nitrosamines, which are carcinogenic chemicals. In the face of these negative economic and health effects, promoting sustainable agriculture can help combat the overuse of fertilizers in the production of surplus food to sell to poorer countries. Not only can sustainable farming systems ensure farmers in developing countries are arbe to make their livelihood off of an important natural, social, and economic resource,
but they can also provide a solid base of growth for these countries during times of governmental instability and domestic problems. If the US and other major players in the international market can invest in small-scale farms in developing countries, they could see an overall increase in trade and a more even allocation of the world resources. Sustainable agricultural practices have been shown to both protect the environment and improve farmers’ quality of life. Conservation tillage and pest control require less pesticide use and increase carbon sequestration. These practices additionally require less water, a scarce resource in much of the world. As the foundation of crop growth, soil quality is essential to sustaining farms. It is helpful to soil organic matter since it influences fertility, the movement of water and the growth of roots. Nutrient management is essential to sustained farming systems. As farming has evolved into a highly profitable industry, its simultaneous exploitation has brought unforeseen negative consequences that become more visible daily, Today, as markets in poorer countries try to grow, they are pushed down by the waves of cheap food sold by richer countries. A push for sustainable agriculture in these countries can help population there and in the U.S. as less fertilizers and pesticides will be used to increase the yield of crops designated for sale abroad. Alluding once more to “sustain’s” roots, small and local farms must be kept in existence to provide a foundation for developing countries to grow.
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Pharm Chat
Sustainability in Pharmacy By Erica Lee
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Every sector in the healthcare industry, including pharmacy, creates unnecessary waste. The healthcare industry is responsible for about eight percent of the United States’ carbon footprint, which is a staggering percentage for a single sector of the economy to contribute. However, the healthcare industry has recognized that an individual’s health does not have to come at the expense of the environment’s health. Hospitals and private practices continually develop new techniques to reduce their environmental impact. As well as switching from disposable
to reusable equipment and recycling, they can also join organizations like Practice Greenhealth, which is an organization for institutions in healthcare that strive to become more environmentally conscious as well as improving patient safety and care. Hospitals and private practices are not the only areas of healthcare that generate waste. Pharmacy also generates waste, although its impact is not as easy to see. It is not as easy to see the impact that pharmacy can have on the environment, pharmaceutical medicines infiltrating the water supply can be far more dangerous than a pair of latex gloves rephoto shajira mohammed
fusing to decompose in a landfill. Pharmaceuticals can enter the environment through a few different pathways. Patients can consume the drug and pass it through their body, wash off a topical medicine, or dispose of unused medications improperly. Because the human body and waste treatment plants can only remove some of the active ingredients from the drug, these chemicals eventually enter the water systems. Americans purchase billions of dollars of pharmaceutical medicines every year and release most of these chemicals into the environment. Once these chemicals enter the environment, they decimate the populations of animals that live there and cause terrible genetic defects. The Associated Press conducted a five-month study on the effects of these pharmaceuticals in Lake Mead and found reproductive problems with the fish living in the lake. Some of the male fish tested for low sperm counts, damaged sperm, and produced egg yolk proteins typically made by females, while the females of these species developed male genital organs. They also affected other animals including vultures, mussels, and algae. However, Lake Mead hosts much more than wildlife. About eight million tourists visit Lake Mead each year; five hundred thousand of whom are anglers who catch and consume these fish. Thankfully, there have not yet been any measurable effects on the humans living around and visiting Lake Mead and other similar bodies of water contaminated with pharmaceutical chemicals. The trace elements of these chemicals are not limited to natural bodies of water like Lake Mead. In the same study, the Associated Press also surveyed the drinking water supplies of major metropolitan areas to see which, if any, trace pharmaceuticals they could find. The results were sobering. There were trace elements
of pharmaceuticals in the water of almost every city that agreed to testing. Atlanta’s own water bore traces of acetaminophen, caffeine and cotinine. Acetaminophen is the active ingredient in drugs like Tylenol and other fever reducers, while cotinine is present in tobacco and an antidepressant called Scotine. New York City’s water yielded trace amounts of estrogen, heart medicine, anti-seizure drugs, relaxers, infection fighters, pain relievers, caffeine and nicotine. They also found the same chemicals in water tables and wells from pharmaceuticals that leaked from improper disposal. No water they tested was completely pure. The government also does not require testing for trace amounts of pharmaceuticals in drinking water. While scientists have proven that these chemicals are safe in small doses over a course of a few weeks or months, there is no data on how a lifetime of trace doses can affect a human. The effects the pharmaceuticals had on the fish in Lake Mead are certainly not a good indicator. Patients can help keep the chemicals in our water to a minimum by following the guidelines for their prescription. This means that they should complete the full course of the prescription, even if they think they feel better. As well as keeping chemicals out of our water supply, this will also keep many diseases from relapsing. If they do have expired or unused medications, they should follow the FDA’s has guidelines for correctly disposing pharmaceuticals. Only some medications can be safely thrown away; the rest must be disposed of by returning the medicines to a pharmacy through a takeback program or through hazardous waste removal programs. Research continually shows that unused medicines should not be flushed, which was the traditional way to discard medicines.
Even though the situation seems dire, two of the most influential organizations in health sciences are working together to fix this problem. Where others might have seen a hopeless cause, Practice Greenhealth and University of the Sciences saw an opportunity to educate the most influential people in this dilemma: the men and women behind the pharmacy counter. Together they developed sustainability training for pharmacists, pharmacy students, and other professionals in these fields. In the news release for this partnership, Anna Gilmore Hall, the Executive Director of Practice Greenhealth, said, “Pharmacies deal every day with a number of issues that touch upon sustainability, including the proper disposal of pharmaceuticals. With hundreds of thousands of pharmacists working across the country, this partnership represents a wonderful opportunity to extend sustainable practices to yet another sector of the healthcare industry.” Since January 2011 USciences and Practice Greenhealth have developed three modules related to sustainability training for hospital pharmacists and are in the process of developing three more for community pharmacists. They also have developed a public health and pharmacy course for students at their College of Pharmacy, which incorporates some of this information. Together with an informed public, the pharmacists educated by this new program will hopefully curtail the amount of pharmaceuticals leaking into our water supply and keep our precious freshwater as clean as possible. It may also open up a dialogue about other facets of healthcare that the public usually overlooks, giving the public an incentive to ensure that all aspects of healthcare are safe not only for themselves but for the environment as well. premed magazine at uga | april 2013
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