The Examiner: Rutgers Pre-Health Journal Issue 10

DECEMBER 2013 ISSUE No.

10

editors

editor-in-chief Vishal Patel

managing editors Shireen Hamza Yuli Noah

layout editors

Kristin Baresich Sailaja Darisipudi Sahitya Cherukuri Meghna Dev Nikhitha Kotha Sri Puli Hima Sathian Issac Song Evagelia Stavrakis Pujitha Talasila

Ivana Ganihong Khushbu Parikh

public relations chairs Reshma Shiwdin Erum Farooqui Anshika Verma

treasurer Kaiwal Patel

secretary Dhaval Mehta

ruexaminer@gmail.com eden.rutgers.edu/~examiner

journalists Tiwalade Adediji Kunal Bailoor Jasmeet Bawa Melanie Chen Meghna Dev Nithya Gandam Tvissha Goel Neha Kayastha Emily Moore Ronak Patel Emilie Transue Chir Wei Stephanie Yuen

letter from the editor-in-chief Dear Readers,

Welcome to the tenth issue of The Examiner – Rutgers Pre-Health Journal! We are Rutgers University’s premier pre-health media publication that is ran for and by undergraduate students with the mission of informing fellow pre-health students on current events in the healthcare field.

This issue continues our goal of being a multidisciplinary journal that attempts to bridge the current gap between the traditional sciences and the humanities. We have tried to accomplish this by presenting diverse issues relating to healthcare policies, geopolitical issues, fun columns, complex societal issues, health economics, medical school admissions, etc. to demonstrate how these seemingly unrelated topics might affect the future of the healthcare professionals.

We would like to thank and congratulate our executive staff, journalists, editors, RUSA allocations, and faculty as well as administrative advisors for contributing to this issue and ultimately to serve the needs of the Rutgers pre-health community.

We hope that you enjoy reading The Examiner, and we would sincerely appreciate your feedback on our Facebook page, Twitter, or at ruexaminer@gmail.com.

Thanks and regards,

Vishal Patel Editor-in-Chief

Exercise Pills?

Researchers isolate protein that delivers brain benefIts of exercise Ronak Patel Extensive research has long suggested that physical exercise benefits overall health and cognitive function.1 A recent breakthrough was reported by scientists from Dana-Farber Cancer Institute and Harvard Medical School in the journal Cell Metabolism.2 A neural protein produced and secreted during endurance exercise has been isolated and given to sedentary, non-exercising mice, where it activated genes that promote brain health by encouraging the growth of new neurons and synapses. The protein plays an essential role in learning and memory, but this finding could also play an important role in redefining how we exercise. How would an “exercise-ina-pill” treatment redefine the way we view and perform physical activity?

Researcher Bruce Spiegelman describes how his team discovered a protein called FNDC5, which is produced by muscular exertion and released into the bloodstream.2 This increase of FNDC5 in turn boosts the expression levels of BDNF (brain-derived neurotrophic factor) in the hippocampus, a part of the brain involved in learning and memory.2 BDNF has been established as an “important regulator of synaptogenesis and synaptic plasticity mechanisms underlying learning and memory in the adult central nervous system.”5 Having shown that FNDC5 is a link between exercise and increased BDNF in the brain, researchers investigated whether increasing FNDC5 levels in the absence of exercise would exhibit positive brain effects.

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They used a harmless virus to deliver the protein through the bloodstream to mice’s brains and raise BDNF activity. Seven days later, they examined the mouse brains and observed a significant increase in BDNF in the hippocampus.3 Much cautious research is required before a treatment for humans will become available, but the implications of this study are certainly interesting. Do most people account for the neurological benefits of exercise? Popular wisdom views exercise as a means of increasing physical fitness and enhancing positive body image, rather than a means of staying mentally sharp. Would the introduction of a drug that delivers the brain benefits of exercise be abused and substituted for the process of exercising?

Would it be misused like Adderall and other attention-boosting stimulants? Before such a treatment could be released to the public, even with tight regulation of prescription and production, many moral concerns would need to be addressed.

Although researchers are working towards understanding the exact mechanism of this protein, we should not start looking for ways to bypass exercise. The benefits of physical activity are far broader than neurological. Exercise reduces the risk of heart disease, strengthens bones and muscles, improves mental health, and increases the chance of a longer lifespan.4 No matter how far research on this topic advances, drugs will never be able to wholly substitute exercise.

GPA JUNKIES?

Nithya Gandam The magic GPA-boosting potion has yet to be discovered, but Adderall, often called “Addy” or “Speed,” is a stimulant drug prescribed to patients with Attention Deficit Hyperactivity Disorder (ADHD), and is commonly utilized among the young college population as a “study drug.” Research indicates that approximately 30% of college students have used Adderall or a similar stimulant illegally. These percentages increase in fraternities and sororities, where approximately 80% percent of students have taken them.3 At Rutgers University alone, Adderall is the 3rd most used abused drug, following alcohol and marijuana, and puts users at risk to many serious, long-term health effects.2 Adderall is intended for people suffering from Attention Deficit Hyperactivity Disorder (ADHD), but more and more people are recognizing that Adderall can also increase focus and attentiveness in people without ADHD. It is for that reason that many college students have abused the drug. Attention Deficit Hyperactivity Disorder is a fairly common brain disorder identified predominantly in children, with symptoms like impulsive behaviors, hyperactivity, and difficulty paying attention.1 ADHD symptoms are more easily recognizable in children because they attend school, and the disorder is associated with lower grades, difficulty organizing and finishing tasks, and problems in getting along with children or adults.1 The most common medications available to alleviate the symptoms associated with ADHD are stimulant drugs, like Adderall and Ritalin. Adderall is an amphetamine, classified as a schedule two drug, which means that it has a “high level of physiological and psychological dependence.”2 Other drugs that are also categorized as schedule two drugs are cocaine and oxycodone.2 Adderall use has increased by at least 200% over the last several years.3 This increase in usage can be attributed to the fact that 50% of college students can get access to Adderall or other stimulants without

a prescription, through their relatives or friends, for little or no cost at all. Students often justify their Adderall use, explaining that Adderall use significantly increases their focus, and thus, their GPAs. However, drugs taken without a prescription are illegal, and users could face prosecution. In addition, use of Adderall without a prescription can cause serious long-term health effects such as high blood pressure, delusions, difficulty breathing, seizures, depression, anxiety, and sudden death.4 The Substance Abuse and Mental Health Services Administration found that, in 2011, Adderall use sent 23,000 young adults (aged 18-25) to the emergency room. This indicated a fourfold increase in emergency room visits from the year 2005, a year in which twenty sudden deaths were linked to Adderall use.4 Using Adderall without a prescription exposes one to health risks and legal consequences. Those of you who would like to learn more or would like to ask for help, CAPS, part of the Rutgers Health Services, offers counseling, training programs, and guidance.

They can be reached via the CAPS website or by phone at 848 932 7884.

5

Victory for

Vesicle Research Emily Moore

October 7th, 2013, marked the day that Dr. James E. Rothman, Dr. Randy W. Schekman, and Dr. Thomas C. Südhof received the 2013 Nobel Prize in Physiology or Medicine “for their discoveries of machinery regulating vesicle traffic, a major transport system in our cells.”1 Vesicles, tiny structures whose protein-coated membranes encase hormones, neurotransmitters, and other essential molecules, perform vital transport functions for eukaryotic cells.2 Vesicles hold insulin, a hormone created by pancreatic cells. When we it, insulin signals the cells to absorb glucose which is essential for maintaining blood sugar levels. Malfunctioning of these vesicles can lead to metabolic diseases like Type 2 diabetes, which can be caused by problems with insulin secretion and insulin-mediated glucose transporter translocation.4 Vesicles are essential to more than just

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blood sugar control, since countless other cellular processes rely on these structures. Therefore, the contributions of these three esteemed scientists offer immense promise of improving treatment for diverse medical conditions, along with broadening the field of cell biology.

Dr. Schekman, a professor at University of California at Berkeley and a Howard Hughes Medical Institute investigator, determined that three classes of regulatory genes contribute to proper vesicle traffic control within a eukaryotic cell. One type facilitates transport from the endoplasmic reticulum, one from the Golgi complex, and one (consisting of a single gene called sec1) to the surface of the cell. Dr. Scheckman determined this through gene screen experiments, which involve intentional mutation of an organism’s genome and subsequent comparisons between the

new mutant and a non-mutated organism in order to clarify how a certain gene works.5 In this case, Dr. Scheckman mutated specific vesicle transport genes before analyzing the effects of each one. Gene screens enabled him to “systematically [unravel] the events along secretory pathways involved in vesicle traffic and in the interaction of trafficking vesicles with target membranes,” and thereby find the most Did You Know?

4 Rutgers University has crucial genes for vesicle transport. All in all, Dr. Scheckman earned his produced three Nobel Prize share of the Nobel Prize for brilliantly “[providing] a genetic basis for winners: economist Milton vesicle traffic and fusion”4.

Friedman, attorney David A. Dr. Rothman, a professor at Yale University who serves as Morse, and microbiologist Chairman of the Department of Cell Biology, studied the roles of essential Selman A. Waksman!8 proteins that help a vesicle fuse with and release its contents into a cell. One of these proteins, soluble-NSF attachment protein receptor (SNARE), formed the basis of his groundbreaking SNARE hypothesis. The SNARE hypothesis correctly suggests that target SNARES (t-SNARES) and vesicle SNARES (v-SNARES) allow for accuracy in “vesicle fusion through a set of sequential steps of synaptic docking, activation, and fusion,” and ultimately ensure that the cargo arrives at the appropriate location.1,4 In the end, the Nobel Assembly concluded that, because he expertly “dissected the mechanism for vesicle transport and membrane fusion and…proposed a model to explain how vesicle fusion occurs with the required specificity,” Dr. Rothman deserved the title of Nobel Laureate. 4 Dr. Südhof, a professor at Stanford University and a Howard Hughes Medical Institute investigator, approached the topic of vesicle trafficking from a neurophysiological standpoint.

He examined the role of calcium ions in the release of neurotransmitters, a specific form of vesicle fusion, and studied how neurotransmission is “temporally controlled.”4 In his quest to figure out neurotransmitter release in neurons, Dr. Südhof “discovered that complexin and synaptotagmin are two critical proteins in calcium-mediated vesicle fusion.”4 Only when calcium ion concentration reaches a crucial level do these proteins communicate to nearby neurons to allow vesicles to bind, ultimately leading to the release of neurotransmitter molecules.1 Basically, Dr. Südhof explained how the precise timing of our brain signals is achieved, and “how vesicle content can be released on command,” an incredible achievement that secured his place in the Nobel Prize.1 Each of the newly crowned Nobel laureates has illuminated fundamental aspects of vesicle transport that have already proven transformative for the field and for medicine. Vesicle malfunctioning can spark metabolic diseases, such as Type 2 diabetes, neurological issues such as epilepsy, and immune disorders like Familial Hemophagocytic Lymphohistiocytosis, a disorder that causes fatal hyper-inflammations. The work of these scientists has helped identify exactly what goes wrong in these conditions, and could lead to the development of effective remedies.1,4 Given that the Nobel Prize in Physiology or Medicine has only been granted to about 200 scientists since 1901 (and that the Nobel Prize is worth about a million dollars), the Nobel will prove life-changing for these three scientists.6 Dr. Südhof finds as much reward in the Nobel Prize as he does in pursuing research.

Moments after hearing that he had won the award, he stated, “I cannot tell you how much I enjoy what I do, so I will always consider it an enormous privilege to be a scientist, and…of course, this honour is very…incredibly beautiful.”7

7

The Past and Present of Unethical Research

Neha Kayastha

Any student that has ventured into the realm of research knows that there are stringent regulations to prevent unethical research. Even researchers grumbling under the burden of hours of International Review Board (IRB) paperwork recognize that these regulations are necessary, in light of the atrocities mankind has committed without them. Can information from unethical studies be ethically used?

The history of legally regulated research ethics began when the brutal abuse by Nazi doctors on concentration camp inmates came to light, after World War II. Inmates were forcefully subjected to dangerous studies, endured suffering and mutilation, and often faced pre-planned fatal outcomes.1 The Nuremberg Code of Medical Ethics was born as a response to these atrocities, and aims to protect the rights of subjects of any scientific investigations. Meanwhile, in 1932 in America, the Tuskegee Syphilis Study began when the Public Health Service started working with the Tuskegee Institute to study the natural history and progression of syphilis. The study involved 600 black men, 399 of whom had syphilis, and was conducted without informed consent of the patients. The men were told that they were receiving treatment for “bad blood,” a local term for diseases such as fatigue and anemia.

The study continued for forty years, despite the fact that these black men were not receiving proper treatment for their curable illnesses. Even after penicillin became the approved drug to treat syphilis in 1947, these men were not offered the antibiotic.2

What should be done with the data generated from these studies? An Australian study

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surveyed physicians, bioethicists, psychiatrists and scientists about the use of data from unethical experiments. The majority of the professionals surveyed said that it would be ethical to use the data if it “would save a life or improve the quality of life of an individual or members of society as a whole.” 3 In fact, a black physician who was passionate about the ethical implications of the Tuskegee study also felt that the scientific community should not let the unethical nature of the study cloud the fact that the knowledge gained from the study has contributed, and can continue to contribute, to the study of syphilis.4 Similarly, the American Medical Association states that if data from past unethical experiments can be replicated and replaced by current ethical data, then it must be done. However, if the only data available came from unethical studies, and if this data is necessary to save lives, then it may be appropriate to use it. In such a case, a disclaimer should be included in the journal article that explains the necessity of using the unethical data. The AMA has remained firm in its stance, despite a movement in 1997 by the Council on Ethical and Judicial Affairs that pressured the AMA to forbid the use of any data generated by experiments that violate the Nuremberg Code of Medical Ethics.6

Regardless of what side one takes in this debate, it serves as a reminder that there is nothing more important in research than a commitment to conducting ethically responsible studies. The brutal history of human experiments cannot be erased, but scientists can learn from the past to prevent history from repeating itself.

RE-MED Yuli Noah

CORNER

Bored in my Fundamentals of Cell Biology class, I glance around. Some students are on their laptops, browsing Facebook. Others are avidly paying attention, eating up the professor’s words to ask her vapid questions to which they already know the answers. The point of these useless questions of course is to give the image that they have a passionate interest in whatever topic is being discussed and will ultimately lead to a rapport that leads to a medical school recommendation. The professor moves on to the next slide, the quiet droning putting me to sleep. The words of a teacher are stronger than any known lullaby.

Just then, the unthinkable happens. A quick “Achoo!” draws the attention of the entire class. The professor pauses, startled. She tries to resume teaching but realizes she has made a mistake. This mistake would prove costly, but not for her. She falls into an uneasy silence.

I look around, confused. Everything has changed.

There are no more laptops out. The students who had them had already stowed them in the safety of their black Swiss Army backpacks. The comfortable quiet from a few seconds earlier had transformed into a tense, ear-piercing silence. As I looked around, I noticed that everyone’s eyes were trained on only one person. The girl who had sneezed.

That’s when it began. The obedient disciples from just a few seconds ago had left the front row and were making a swift, rehearsed formation, taking to the aisles and honing in on the seat from which the sound had emanated. As they passed by me, I saw a curious piece of metal sticking out of the pocket of one of the students. It glinted menacingly in the light. I quickly looked around, worried now. I could see the outlines of these metal instruments in all of their pockets.

The girl’s face bore a terrified look.

“No! Please! I’m allergic to dust! I couldn’t help it!”

Tears were streaming down her flushed red cheeks.

“I’ll take medication! I promise! I’ll never interrupt a lecture again!”

But the damage had been done. As they reached her, each of the students took a position so that at last they had her surrounded.

By this time, all of the other students including myself were standing on our seats and looking down upon the proceedings, our stomachs flipping over and over, struggling with the ominous feeling of what was about to happen.

The lead student, the one who achieved the highest score on the last exam, spoke.

“You interrupted our lecture. We need to know this stuff for the MCATs. How are we ever going to pass our exams and achieve a perfect GPA if inferiors like you continue to bring us down?”

PRE-MED

CORNER

By this time we all knew where this was going. My heart was racing faster than a student filling out a Scantron during an Orgo exam.

She whimpered in protest but I could see the resignation already taking the place of hope in her eyes.

“We will never get into medical school because the likes of you always bring us down. There is only one punishment that will truly put an end to your obnoxious horseplay.”

With that, he pulled a knife from his right pocket.

The students around her held her now-thrashing body still.

He said a quick prayer to the Orgo Professors to grant her good grades in her next life. Even the Curve-Killer cannot be so hard-hearted as to deny a student that much. Then he applied the knife with surgical precision to the middle of her throat. He slid it across, like he was making the incision for a thyroidectomy. But there was no anesthesia. This was not a surgical room. And the “patient” struggled for sweet life for another five seconds, during which the professor shouted random facts at her about cell signaling. She died as she lived: Learning about physiology.

“I’m calling it,” said the Curve-Killer, “1:05 P.M.”

The students quickly disbanded, some of them soaked from head to toe with spatters of blood. They left the body in the seat and returned to the front row.

That was it.

I was dumbstruck. I looked around and realized I was the only one still standing on his seat. The laptops had come back out, the statuses recommenced. The professor continued teaching, not so much because she wanted to but because she knew what they would do if she didn’t.

I would later learn that the girl’s body would be taken by a cleaning crew specifically hired for incidents like this. It would be incinerated in the Premed Furnace under McCormick Suites, her ashes joining the smoke exiting from the pipe in front of the building. Every splatter of blood would be removed. Every last record of her erased so her parents could not legitimately claim she ever went here.

There would be nothing by which to remember her. Not even a Snapchat of her final moments, celebrating her in life and then death for ten seconds of solid commemoration.

But that’s what you get when you stand in the way of premeds, isn’t it?

People who expect to become healers begin their careers as cut-throats. And their peers pay the price.

Sometimes I wonder if there could be a better way. But then someone coughs in my Biochemistry class and it starts all over again.

PRE

M E R P R NE

The Power of Prayer in Healing and Medicine

Kunal Bailoor Modern medicine today is empirical and clinical, with little room for treatment options that are considered “unscientific,” especially something as far from the medical mainstream as prayer. While the more secular and science-oriented among us may be inclined to dismiss prayer as having no place in hospitals and examination rooms, research on the subject has yielded mixed results. There is no shortage of research into the medical effects of prayer, and while some have shown that prayer may have some healing effect, others show that prayer and spirituality may be detrimental to a patient’s health.

It is undeniable that prayer factors into the consideration of patients and providers. A CBS poll found that over 75% of Americans think that prayer can heal or speed recovery, and 63% think that a doctor should join them in prayer, if they request it.1 This presents an interesting ethical conundrum: is prayer, and by extension, religion, a treatment that the doctor should provide, or is it an expression of personal belief that is unethical to force upon a physician? How do physicians feel about prayer? A survey of primary care physicians conducted by Wake

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Forest University School of Medicine found that 91% of doctors surveyed in Mississippi thought that prayer was “an important treatment modality,” but only a little over half felt comfortable recommending it.2 Nationally, the levels are lower. A study by the National Institute for Healthcare Research found that 43% of doctors actually pray for their patients, but fewer recommend that their patients pray for the purposes of healing.3 While there may be areas of the USA where physicians view prayer as a treatment rather than just a form of personal expression, the national numbers show a disconnect between the belief of the patient population in prayer as a healing mechanism and the belief of their physicians.

Studies on the direct effect of prayer on individual healing have yielded differing results; a meta-study by Hertford College found that prayer may improve in vitro fertilization implantation results for mothers, but has no clear effect on the healing process in other procedures.4

There have been studies showing that prayer can work side-by-side with more accepted modalities in Western medicine to improve patients’ health and wellbeing. A randomized trial to reduce cervical cancer burden in Appalachia showed that faith-based methods resulted in significantly greater compliance with screening guidelines.5 If faith is important to a patient, a faithbased initiative could be offered as an option, to help increase patient responsibility and adherence to suggested disease screening guidelines. Another study in the Journal of Biopsychosocial Medicine suggests that some patients see prayer as a replacement for, rather than a complement to, existing medical treatments.6 The study focused on medication adherence behavior of hypertensive patients, and found that patients who were highly spiritual were 2.68 times more likely to be “poorly adherent” with their medication than patients who did not believe in a strong connection between spirituality and healing. One reason that physicians may be reluctant to recommend

s l a t i p s o H ,

n i n a Le

Lean Process Improvement is a production practice used in business to add value to the customer by removing waste. Companies such as Nike, the Boeing Company, and Intel have all used this methodology successfully in order to significantly impact defect rates, lead times, productivity, etc. Even an award, The Shingo Prize, dubbed the Nobel Prize of manufacturing, has been established for those companies that have achieved world-class operational excellence.

How does it affect us...us being students who aspire to work in the field of medicine? A timeline of Lean Process Improvement and their adoption into companies may help.

Lean manufacturing is a

prayer as a treatment is precisely because of its potential for displacing the importance of adherence to proven treatments. The Jehovah’s Witness that refuses a blood transfusion or an organ transplant is a staple of medical ethics textbooks. In addition, many studies show no significant effect of prayer on healing, particularly on serious injuries.7 There are many variables at play in the study of the role of prayer in treatment – a greater social support system, lower stress levels, and even the placebo effect may confuse clinical outcomes. However, considering how widespread the perceived link between prayer and healing is among the American public, the medical community should be open to dialogue about how doctors should address faith and prayer.

Patel Kaiwal

management philosophy derived mostly from the Toyota Production System, which started in the 1950’s.

Companies followed in Toyota’s footsteps and adopted these Lean methodologies. In 1989, the first Shingo Prize was awarded to Globe Metallurgical. In 2002, Seattle’s Virginia Mason Medical Center experimented with Lean and from then on it has spread to hospitals throughout the country.

Currently, the best practice hospitals are the only ones using Lean. This includes the hospital around the corner, Robert Wood Johnson University Hospital. Lean began at RWJUH 2 years ago and is evolving into a culture, where all hospitalists are thinking Lean. All directors are required to take on projects whether they are doctors, pharmacists, registered nurses, etc.

Soon enough, Lean will spread throughout all of healthcare, and all members will be required to know the methodology.

One ongoing project at RWJUH involves a time-motion study of the Emergency Room. RWJUH hopes to look at the complete process to help patients come into and out of the ER as soon as possible.

This will benefit both the patient and the hospital, as the patient will be treated in a timely manner and the hospital will be able to care for more patients. Another ongoing project at RWJUH is to restructure how contracts with outside vendors are made. This will allow cost savings by comparing multiple vendors and will also provide consolidation of contracts for regions of the hospital using the same vendor. Overall, Lean Process Improvement will aide in RWJUH’s mission by adding value to patient healthcare.

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On the Origins of Public Health Melanie Chen

In some ways, public health is a modern concept of human development in science, though many of its core services are rooted in antiquity. Some of these services include health promotion, access to hospitals, engineering feats such as sewage systems, and vaccination, all of which originated in ancient societies. From the beginnings of human civilization, it was recognized that keeping the individual healthy was the first step towards protecting the health of the many.

This concept of personal hygiene was then expanded into widespread inoculation and the construction of the first public health systems like hospitals and sewage lines.

Although it is commonly accepted that the basic concepts of ‘Health Promotion’ have been developed in the last two decades, they in fact have their roots in Greek civilization. The ancient Greeks broke away from the supernatural governances of health and disease, advocating for moderate consumption and exercise as a personal, as opposed to divine, responsibility. In one of the earliest known forms of health promotion, in a guide called “A Programme for Health,” Hippocrates explains

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the ideal “balance of opposites”: “In winter, it is best to counteract the cold by eating dry, warming foods such as wheat bread and roast meat….In summer, eat smaller amounts of softer, purer food; drink smooth, white, diluted wines. Take lukewarm baths, and take only short strolls after dinner.”1 He also provides the citizens of Greece with directions for following a healthy lifestyle, which included how to keep themselves at an even temperature, eat properly, wash themselves, clean their teeth, and go on daily walks.1 According to the Ottawa Charter for Health Promotion, such concepts were crucial in establishing the foundations for modern health promotion.2

Using these Greek ideals, the Romans built free hospitals for former soldiers, called valetudinaria, which are generally regarded as the first ‘real’ hospitals that resemble what we have today. Though religious temples meant for housing the sick existed in Egypt as early as 400 BC, the Romans, like the Greeks, diverged from relying on prayers and sacrificial offerings to gods as forms of treatment. Instead, the Romans were the first people to

charge trained doctors with the responsibility of observing sick patients directly, an example of the Roman values of practicality and selfreliance.3 Construction sites around Roman hospitals were also quite advanced. The Romans understood that stagnant, dirty water housed disease communicators such as malariainfested mosquitoes. With their renowned engineering skills, they built a network of aqueducts and sewage systems that were used to drain marshland hospital sites prior to construction. These water transportation channels, the aqueducts which transported clean water to different parts of the city and the huge Cloaca Maxima sewage system which transported wastewater out, proved immensely influential in improving public health by ensuring a constant circulating supply of clean water. The basic concept of the centralized Cloaca Maxima sewage tunnels is reflected in underground sewage designs today.4

On the other side of the world, the earliest known instance of vaccination was recorded by Chinese author Wan Quan in 1549. In his work Douzhen Xinfa, Wan Quan makes the first clear reference to smallpox inoculation when the eldest son of Prime Minister Wang Tan died of smallpox around the year 1000.5 According to Wan Quan, the Prime Minister was so desperate to protect the rest of his family members that he found a holy Taoist hermit who introduced the technique of inoculation to the capital, probably by blowing pulverized powder from smallpox scabs into patients’ nostrils. Inoculation may also have been practiced by scratching matter from a smallpox sore into a healthy person’s arm.6 The Prime Minister noticed that patients grew immune to the deadly virus upon being exposed to a tiny amount of it. Throughout the centuries, the procedure for administering vaccines has been polished to include needle sterilization methods, dosage protocols, and standardized “how to” guides, but the basic principle of introducing a pathogen into the body so that the patient can develop an adaptive immunity response remains unchanged.

Global urbanization continues to challenge researchers, healthcare personnel, and policymakers to keep raising modern public health standards, but those standards remain rooted in the ideals and discoveries of ancient civilizations that thrived thousands of years ago. Understanding where the foundations of our current policies came from allows us to more greatly appreciate not only the challenges faced by our predecessors, but also the years and years of continuous improvement that have allowed us to enjoy our public healthcare today.

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THE NATIONAL HEALTH SERVICE VS. THE AFFORDABLE CARE ACT Should I Move to England?

TIWALDE ADEDIJI Although socialized health care has yet to be broadly implemented in America, the phenomenon is nothing new to our old friends across the ocean.

In the United Kingdom, the National Health Service provides a comprehensive range of health services, most of which are free, and has been publicly funded by taxpayers since 1948.4 Sixty five years later, this system is functioning considerably well. According to a study published by the Journal of the Royal Society of Medicine, the NHS ranks second on the scale of the cost effectiveness of health systems, after Ireland. 1 Additionally, a study conducted by the Commonwealth Fund found that out of eleven Western Liberal Democracies, citizens of the UK have the quickest access to general practitioners and have the lowest number of victims of medical errors (compared to citizens of France, Germany, Switzerland, Sweden, Norway, the Netherlands, the United States, Canada, Australia and New Zealand). 2

In stark contrast to this socialized system, the current US health care empire is led by the private sector—a system the Affordable Care Act is attempting to undo, in a bid to make health care affordable and accessible for every American. Yet, the country remains divided on the implementation of the ACA, with many individuals citing forced taxation as their main objection. In actuality, the paradigm shift from private sector-led health care to the socialization of the system can be seen as taking

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a page from the United Kingdom’s (and most other developed countries’) book. But how similar would health care under the ACA really be to the NHS system?

One important difference: the ACA still draws upon the services of the private sector and utilizes it as a source of insurers, while the sole “insurer” used in the National Health System is the centralized government.3,4 However, the insurance providers in the American private sector will be held to more stringent government regulations under the ACA, such as the prohibition of turning down clients with pre-existing conditions, which is a feature of the NHS.5 This has raised some eyebrows among economists and public policy analysts, as the increased government infringement upon private sector operations has always been a highly controversial matter in American politics.

Another difference: while the NHS requires no purchasing of insurance from private providers, and will treat people for free at the place of service, under the ACA, individuals will be required to have purchased insurance through companies or exchanges, and will probably have to provide a copay at the place of treatment. 3,4 However, the ACA also allows dependents to remain on their parents’ insurance plans until the age of 26, which is news that has been received favorably by students and young adults.5 This will

Laughter Is The Best Medicine Vishal Patel

ease the transition from college student to working adult, as individuals would not have to pay for their own medical insurance during this tough financial transition period. Additionally, while the ACA mandates companies to provide health insurance benefits to workers that are employees in full-time positions, there is no such mandate under the National Health System.6 Thus, it becomes apparent that the ACA embodies a protective stance towards special groups that are usually on the losing end in insurance matters, such as students, members of the labor force, children and individuals with preexisting conditions.

There is no such bias to protect against in the NHS, as all members of society are treated with an egalitarian approach.4 Despite these differences, will the implementation of the Affordable Care Act set America on a trajectory towards the cost-efficient and smooth delivery of the National Health Service? Only time will tell, but the successful precedent of the NHS since 1948 gives us reason to be optimistic about our prospects. In the short term, students and dependents can expect to benefit from the gradual implementation of the Affordable Care Act.

Humphry Davy was just your average 18th century poet, chemisty, and inventor (as average as those can be) who was known to be a bit wild and imaginative.

The discoveries he is most known for are the isolation of several alkali and alkaline earth metals and his pioneering work with electrolysis. It was Davy who was the first to isolate potassium, sodium, magnesium, boron, and barium. However, as fascinating as these breakthroughs are, one of his most comical and somewhat ironic laboratory experiments involved using nitrous oxide to cure hangovers. Davy and his associate James Watt had built a portable gas chamber in order for Davy to inhale the nitrous oxide during a hangover to test his hypothesis. Luckily, the nitrous oxide proved successful in alleviating a hangover; however Davy also observed first-hand its analgesic effects. The story goes that prior to one of his hangover experiments with nitrous oxide he had a throbbing toothache but after inhaling the laughing gas, all of his pain disappeared. He published his findings in a scientific paper but only referred to the painrelieving properties of nitrous oxide as a minor result of his experiments. It would not be until decades later that medical professionals would begin to use nitrous oxide and other similar drugs to dull pain in surgeries.

15

The Right to Life:

Physician Assisted Suicide Anonymous

Physician assisted suicide is not simply a pigeon-holed issue of giving terminally ill, suffering patients the right to die. Behind the flagship argument of those who attempt to defend euthanasia lie a bevy of problems, which show the enormous social dangers behind policies tacitly endorsing physician assistance in euthanasia. The central problem behind such policies is that it is a precursor to future cultural trends. It is empirically shown that in nations with a clear history and culture which is accepting of physician assisted suicide there is an expansion of a new human right, the right to die.

Many individuals who seek assisted suicide migrate to nations such as Switzerland, which offers assisted suicide to almost anyone willing.1,2 Switzerland recognizes that its citizens have a right to die. A recent study on two of Switzerland’s major centers for physician-assisted suicide, Dignitas and Exit, discovered that only “79 percent of the 274 people with Dignitas and 67 percent of the 147 with Exit were terminally ill; the remaining individuals were not terminally ill when they committed suicide.”1 Additionally, the study found that foreigners made up 91 percent of those who died with Dignitas.1 The implications in physician assisted suicide are twofold: first, death is a choice; second, physicians ought to be capable of assisting individuals who have chosen to die in planning and carrying out their end.

Many argue that death should be, and is, a choice that lies within the intrinsic autonomy and bodily integrity of individuals. This interpretation of autonomy has many shortcomings. Individuals are incapable of conceptualizing what death entails;

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often, they have no significant understanding of the end of their lives and of the implications of death itself. To choose to die can never be a rational decision made by an intelligent individual. When people choose to die, it is often because they are under physical and emotional strain from the medical conditions that they suffer from. A person who is terminally ill is often in shock and under emotional strain from their condition. An individual who suffers from long-term conditions or disorders often does not have emotional and personal support structures that might ameliorate the reality of their conditions.

When many people with long-term illnesses choose to partake in physician assisted suicide, they do so because their suffering under a crippling loss of autonomy and dignity makes life no longer worth living. Paraplegics who seek suicide assistance in Switzerland often cite their burdensome existence, dependence on others and their loss in quality of life.

It is hard to argue that a terminally ill individual in constant pain does not have the right to end their own life. This is recognized to this day by medical professionals within multiple disciplines, who recognize the autonomy of mentally sound patients and allow them to refuse care or sustenance when dying. Refraining from treatment, coupled with palliative care, often provides the necessary peace that these individuals desire in their last moments.

Palliative care is an ethical mediation of the patients’ rights and the physician’s obligation to do no harm, and to maintain a standard of care which preserves life and treats patients with human dignity. Often, when palliative care is performed in conjunction with

a lack of treatment, an option which a patient has the right to choose or refuse, individuals can pass-away in a painless manner, similar to that of assisted suicide.

The crucial difference between “assisted suicide” and “passive assisted suicide” is that death is not directly induced by the physician, but by the illness the patient is suffering from.

While we understand that a patient has the independent capacity and autonomy to end their own lives, we do not allow that autonomy to compel physicians to assist.

The Hippocratic Oath prevents physicians from crossing a line and becoming directly involved in the deaths of their patients.

A physician’s role, by definition, is to attempt to prolong life and increase quality of life. When quality of life decreases, there is still a reason to continue preserving life. There are multiple alternatives that a physician may use to treat a patient which do not require inducing death but still give sufficient care to suffering individuals.

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Most Common Diseases in NJ Impact of Environmental Causes

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While many people think about the genetic factors involved in diseases, people often forget to consider the great toll that environmental causes can have on people’s health. The exploitation of the environment can have negative impacts on our air, our food, and our health as we grow and develop.

In New Jersey, many residents suffer from various chronic illnesses, which are “long-lasting conditions that can be controlled but not cured” [1]. In the United States alone, chronic diseases cause about 1.7 million deaths per year which averages about 70% of all deaths.1 According to the State of New Jersey Department of Health, heart disease, cancer, asthma and diabetes are among New Jersey’s leading killers.1 Since chronic disease can often be linked with people’s habits and lifestyles, environmental factors must be considered and recognized as a reason for the increasing number of people affected by it.

The New Jersey Environmental Public Health Tracking Program is a group that collects and organizes statistics and data on health and environmental perils in regard to New Jersey residents. For instance, EPHT’s reports data such as particulate matter pollutions into the air caused by numerous vehicles on NJ roads and from industrial emissions.2 This matter hinders lung function and causes tissue damage when inhaled deeply.2 Additionally, although drinking water systems are monitored carefully, some issues impacting water quality include Arsenic, an element used in the past as a pesticide which can be found in water, has been classified as a human carcinogen.3 In addition, polluted air can contain Radon, which is a radioactive gas that can damage lung tissue and cause lung cancer.4 There are many possible environmental causes for major illnesses and the effects must be monitored closely[1] .

As stated earlier, asthma is one of New Jersey’s leading killers.1 According to the New Jersey Asthma Awareness and Education Program’s data, the average death rates due to asthma as people get older is increasing.5 In addition, according to the Centers for Disease Control and Prevention, more than 1 in 4 deaths in New Jersey are due to heart disease.6 Adults in New Jersey reported in a survey several risk factors for heart

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Meghna Dev

disease.6 It was found that about 17.1 percent were current smokers and about 9.2 percent had diabetes.6 Furthermore, a recent controversial issue in New Jersey is the idea of fracking. Fracking is a common name for “Hydraulic Fracturing”, which is a method of drilling to extract natural gas. According to environmentalists, the byproducts caused by fracking cannot be cleaned, which leads to contamination of drinking water and global warming.7 Many have been protesting to ban fracking, but some say that it could potentially help the economy and open up more sources for energy.7 The responses to this issue have been very controversial in the area. This issue led Highland Park to become the first town to ban fracking.7 All of these issues involving drinking water, air pollution, etc. affect the younger demographic and college students significantly as the health of these students are put at risk. Fracking may cause changes in the price of gas and other related costs which many college students pay for themselves. In addition, at younger ages, students can easily have significant health impacts due to contamination and various other effects.

If these issues start impacting students at a younger age, they will cause even more significant health problems as they age. Many student organizations at Rutgers are working to help the environment and as a result, hopefully prevent further potential health risks for the Rutgers community. Recently, the Rutgers University Student Assembly (RUSA) has passed a resolution opposing fracking in the Delaware River Basin.8 Rutgers students involved in these activities and organizations tackle many other environmental issues as well. For example, the Rutgers Solar Car Team competes in the American Solar Challenge to race solar vehicles and promote the idea of renewable energy.9 Students for Environmental Awareness is a student organization which works to help provide environmental education, awareness, and involvement for students.9 These are great resources for students to learn more about environmental issues, take a stand, and acquire various tools to use to educate others about the significance of environmental issues on health.

A Cloak That Covers Evil:

The Hidden Dangers of Counterfeit Medicine Chir Wei Stephanie Yuen

We pop pills without a second thought to their safety or their identity, making the assumption that they will deliver the benefits listed on the packaging. Most of the time, reality does not make any attempt to dissuade us of this assumption, but when it does, the results can be disastrous, including unwanted side effects and death.

Counterfeit medicines are referred to by the World Health Organization as “Spurious, falsely labeled, falsified, counterfeit (SFFC) medicines�.1 SFFC medicines are characterized by mislabeling, either about what contents and ingredients they contain or where they came from. These drugs can be chemically reacted with inactive substances and laced with toxic ingredients, leading to either treatment failure or death via toxic chemicals. The SFFC meds may also have altered levels of the active ingredient, leading to the above-mentioned results for the patients.

Counterfeit medicine proves a widespread systematic problem in developing parts of the world.

In Africa, up to 30% of the pharmaceuticals may be counterfeit whereas that rate is around 1% in the developed world.3 This prevalence of SFFCs in the developing world undermines public health efforts to combats epidemics such as malaria and tuberculosis.

High rates of morbidity (number of people in a population stricken with a disease) and mortality (number of deaths in a population) because of treatment failures in tuberculosis, malaria, and HIV/AIDS are linked to the large amount of counterfeit medicine available.2 Drug resistant strains in third world countries are also linked to SFFC medicine because these toxic pathogens are treated with the active ingredient intended to kill them without actually being eliminated, allowing the pathogens to develop resistance against that active ingredient.

In the US, though it is not as big of an issue, relatively speaking, counterfeit medicine is still a concern. People have received Haldol, a strong antipsychotic, when they put in orders for Xanax, Ambien, Altivan, and Lexapro. Haldol has landed consumers in the emergency room due to side effect such as muscle stiffness, muscle spasms, and difficulty breathing.5 In recent years, Adderall, a drug traditionally used to

treat Attention Deficit Hyperactivity Disorder (ADHD) as well as narcolepsy, has become a popular drug of abuse amongst college students looking for an edge over exams5. Students looking for a fix might turn to the online drug market, where they might find pills for cheap prices and without the need for a prescription5. While this may seem a convenient way to obtain medicine, the unfortunate truth is that online drug markets are rarely as strictly regulated as traditional pharmacies. In 2012, the FDA issued a warning after counterfeit Adderall pills were purchased on the Internet. While namebrand Adderall contains four amphetamine salts as active ingredients, the counterfeit pills consisted only of tramadol and acetaminophen, common pain medications that have no place in the treatment of ADHD, and could be potentially harmful if taken incorrectly3. Misusing Adderall is dangerous in its own rite, but when the drug is replaced with an unknown substance, the risk increases exponentially.

New markets are more susceptible to trading in fake medication because of their lack of regulation, whether they be international free trade zones or the internet.1 In general, strengthening legislation and industry control can lessen the problem of counterfeit medicine. Pharmacists, especially due to their familiarity with the drugs and their role as the gatekeeper of medications, can secure the distribution chain and help patients distinguish between real and counterfeit medicine.3 Doctors, pharmacists, and other health care professionals should be on the lookout for fake meds and patients should be wary and report cracked or chipped pills, medicines with unusual tastes or odors, and injections that burn at the injection site.4 You can avoid the dangers of counterfeit medicine by purchasing from licensed locations, whether in a physical pharmacy or online. Do not get prescription pharmaceutics online when they offer to sell it to you without a prescription. And, as with everything in life, use common sense. If some unlisted seller from an unlisted location with no proof of licensing on his site offers to sell you a 100-pill bottle valued at $50 for the low price of $10, ignore the offer and all others like it.

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Negative Effects Of Government Shutdown on Research

Tvissha Goel

According to Standard’s and Poor, the 17day government shutdown cost the US economy approximately 24 billion dollars. There are also other more subtle costs, especially to those in science and medicine. Research and education, relating to science, has been severely impacted and hampered due to the shutdown.2

The National Institutes of Health, comprised of many other institutes, was largely impacted by the shutdown and had to close. The National Cancer Institute was forced to furlough 80% of its workers, and many new patients. Moreover, the NIH headquarters in Bethesda, had to furlough 73% of its researchers and scientists.

Due to this halt in work, many scientists feel some of their experiments may take months to restart. In fact, George Benjamin, executive director of the American Public Health Association believes that in research “quite often something happens that is an ‘aha’ moment…we will never know when those ‘aha’ moments were missed.”

Several peer review conferences involving mutual feedback and constructive criticism among scientists, were either cancelled entirely or postponed. The NIH clinical center has resumed its admittance of patients after cancellation of patients during the shutdown.

However, for the researchers the shutdown has “resulted in a loss of momentum,” according to the NIH. 5

According to Forbes, the American Association of Medical Colleges (AAMC) was disrupted, slowing progress and in some instances stopping active research that improves health and the quality of life through new treatments and cures. Furthermore, research programs and residency trainings were halted at several teaching hospitals. Kirch, the AAMC president states “Payments for physician training at children’s hospitals also will stop, placing further strain on the nation’s capacity to train the workforce needed as the nation heads toward a critical shortage of more than 90,000 doctors by 2020.”

Hindering physician training, especially when the need for health care is expanding, may lead to an increase in the gap between the actual number of doctors and

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number of doctors needed.4

The shutdown has also impacted research of several universities. Laura Levy, the vice president of Tulane research states that “collaboration with government scientists are delayed because those colleagues are on furlough and their activities temporarily halted. Similarly, projects that require federal agency or direction will be halted.” Brad Rosenheim, an assistant professor at Tulane’s environmental sciences program, had planned to send one of his students on a research trip to Antarctica to collect sediment cores adjacent to the peninsula. However, the research station in Antarctica had cancelled the trip due to “caretaker status”. Rosenheim believes the trip is unlikely to be rescheduled due to Antarctica’s short summer duration.

“We’re geologists, so these sediments are going to be there for the next few years,” says Rosenheim. “There are people down there who have been doing time series studies for 10 or 15 years; missing a year in those time series can be very detrimental.”6

Besides having to furlough scientists, the Purdue research department had to stall experiments due to lack of funds. Departments in the College of Agriculture such as plant pathology, botany, and entomology closed due to the lack of funds.1 Many employees did not receive paychecks during the shutdown. One of the graduate students in the College of Agriculture, Anne Brown, was unable to make progress in her gene profiling experiments that involve plants. Moreover, another graduate student, Rima Thapa, believes that the shutdown is affecting her ability to conduct experiments. “Plants don’t stop growing. They need to be watered and taken care of.”

Clearly, many researchers at Purdue felt their work had been hindered and disrupted due to the shutdown.7 Evidently, the shutdown has had not only heavy monetary costs, but it has also halted the growth of scientific knowledge in several US institutions. Conferences have been canceled and experiments have been hampered.

At a critical time when scientists are greatly needed, it seems that they have been disrupted and slowed.

How Far Does the

Affordable Care Act Go? Jasmeet Bawa Maybe in Mayberry a post-racial society is reality. However, in the present day United States, this possibility remains premature.

For those that think such a societal structure has been achieved, only a few statistics are required to show the flaw in their colorblind ideologies. A glance at the incarceration rates of black men and the impoverishment of black women shows distortions in equality. Amidst the seeming injustices, which ones pertain to healthcare?

In 2008, it was estimated that approximately 46 million United States residents lacked health insurance. The Patient Protection Affordable Care Act (ACA), passed on March 23, 2010, is the biggest change in United States health care since 1965. The ACA does not take full effect until 2014. Even then, it is predicted that twenty million Americans will remain uninsured. The majority of this population consists of black men and women. A look at societal attitudes sheds light upon this inequality.

Blacks are not only over 100% more likely to be stopped by police and inspectors than whites, but also are 42.2% more likely to be found with a weapon and 25% more likely to be found with drugs. As intuitive as it might seem, incarceration affects the health of prisoners. Less intuitively, it affects black men disproportionately. The isolation of public housing and the over-policing of these “projects� lead to unjust arrests. These men then have a higher chance of developing a condition or having one they suffer from worsen. These conditions commonly include asthma, HIV, Hepatitis C, tuberculosis and hypertension.3

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Amy Katzen, a clinical fellow at Harvard Law School, articulated that the horrid conditions in prison that increase propensity for illness are not the end of health care nightmares: “The moment a prisoner is released, his or her right to government health care vanishes.” Upon being released, people from prison lack health insurance, but then further social barriers hinder them from getting back on their feet. They are not allowed cash assistance under the Temporary Aid to Needy Families, food stamps, and federal housing assistance. Referred to as “invisible punishments,” these are detrimental for groups of people who are working towards acquiring health care once again.4 Lawyer Michelle Alexander termed this phenomenon “the new Jim Crow,” but there is evidence that the old Jim Crow never left. Political structures create “glass cages” for women, limiting them with fewer opportunities for employment, that in turn result in less access to health care. Furthermore, black women are financially restricted to living in poor neighborhoods, which often have environmental contamination and nonexistent or overpriced access to healthy food, thereby resulting in or perpetuating poor health.2 Sections of the ACA indirectly suggest a solution to these detailed issues: community-based health initiatives. One resolution is the implementation of a Community Preventive Services Task Force, which examines the “health effects of interventions in domains such as education, transportation, housing and employment using methods such as Health Impact Assessments.”2 However, without effectively endorsing where the funding for these initiatives will come from, they stand as empty promise. To incite real change, local and national levels of government need to become involved.

Despite its lack of specific address to racial inequality in healthcare, it is predicted that the ACA will directly combat the issue of classism. In his study on the ACA’s projections, Jonathan Gruber summarizes that the ACA will use “government subsidies to make insurance affordable for lower income families.” Money generated from taxes will effectively help a lot of Americans, but until the same attention is provided to those affected by racism, all of America will not have better health care.5 As one piece of legislation, the ACA fails to address the multi-factorial nature of health care problems in the United States. By tailoring reform to specific groups of people in the United States and extending this analysis to other minorities and undocumented immigrants, health care reform can be truly universal.

On a local level, as of 2011, Middlesex County had over 100,000 uninsured residents. Research conducted in New Brunswick found lack of coverage predominant in the Hispanic population, as most residents are immigrants who experience fluctuating changes in income and are unfamiliar with American healthcare. 6 In the meantime, efforts of volunteers are irreplaceable. In New Brunswick, at the Robert Wood Johnson Medical Center, medical students run a clinic for the homeless and impoverished of local Elijah’s Promise Soup Kitchen and for any uninsured citizens of the city.7

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Cover Image retrieved from http://theeugenehughesblog. files.wordpress.com/2012/09/fotolia_test-tube.jpeg Page 4: Exercise Pills?

1 Cotman, C. W., & Berchtold, N. C. (2002). Exercise: a behavioral intervention to enhance brain health and plasticity. Trends in neurosciences, 25(6), 295-301.

2 Wrann, C. D., White, J. P., Salogiannnis, J., LaznikBogoslavski, D., Wu, J., Ma, D., ... & Spiegelman, B. M. (2013). Exercise Induces Hippocampal BDNF through a PGC-1α/FNDC5 Pathway. Cell Metabolism.

3 Wrann, C. (2013, October 11). Scientists Identify Protein Linking Exercise to Brain Health - Dana-Farber Cancer Institute.Dana-Farber Cancer Institute.

Retrieved October 27, 2013, from http://www. dana-farber.org/Newsroom/News-Releases/Scientistsidentify-protein-linking-exercise-to-brain-health.aspx 4 Physical Activity and Health: The Benefits of Physical Activity. (2011, February 16) Retrieved November 6, 2013, from <http://www.cdc.gov/physicalactivity/ everyone/health/> 5 Cunha, Carla, Riccardo Brambilla, Kerrie L. Thomas (2010, February 9). A Simple Role for BDNF in Learning and Memory? Front Molecular Neuroscience. Retrieved November 12, 2013 from <http://www.ncbi.nlm.nih.gov/pmc/articles/ PMC2821174/> Image retrieved from http://motionmedication.com/StockImages/Hand%20Pill%203.jpg Image retrieved from http://thumbs.dreamstime.com/z/ people-exercising-health-fitness-32803258.jpg Page 5: GPA Junkies?

1 ”Attention Deficit Hyperactivity Disorder (ADHD).”

National Institute of Mental Health. National Institute of Health , n.d. Web. 27 Oct 2013. <http://www. nimh.nih.gov/health/publications/attention-deficithyperactivity-disorder/adhd_booklet_cl508.pdf>.

2 Greenagel, Jr., Frank. “Policy Brief on Adderall Abuse.” . N.p., 9 May 2013.

Web. 27 Oct 2013. <http://media.wix.com/ ugd/15dc37_72fd12e332a8b2e854b8ef659bc48e1d. pdf>.

3 Ricker, Ronald. “Adderall: The Most Abuse Prescription Drug in America. .” Huffpost healthy leaving . 21 6 2013: n. page. Print. <http://www.huffingtonpost. com/dr-ronald-ricker-and-dr-venus-nicolino/adderallthe-most-abused_b_619549.html>.

4 Haiken , Melanie. “ADHD Drug Emergencies Quadrupled in 6 years, says Government Report .” Forbes. 13 8 2013: n. page. Web. 27 Oct. 2013. <http://www.forbes.com/sites/ melaniehaiken/2013/08/13/er-visits-from-adhd-drugsquadrupled-in-past-six-years-report-says/>.

Image retrieved from http://topnews.ae/images/Adderalldrug.jpeg Page 6: Victory for Vesicle Research 1 The Nobel Assembly at Karolinksa Instituet. (2013). The 2013 Nobel Prize in Physiology or Medicine- Press Release. Retrieved from http://www.nobelprize.org/ nobel_prizes/medicine/laureates/2013/press.html 2 Faini, M., Beck, R., Wieland, F., & Briggs, J. (2013).

Vesicle coats: structure, function, and general principles of assembly. Trends in Cell Biology, 23(6), 279-288. Retrieved from http://www. cell.com/trends/cell-biology/abstract/S09628924%2813%2900007-X 3 Cartailler, J. (n.d.). Insulin-from secretion to action.

Retrieved from http://www.betacell.org/content/ articleview/article_id/1/ 4 Zierath, J. and Lendahl, U. (2013). Machinery Regulating Vesicle Traffic, A Major Transport System in our Cells. Retrieved from http://www.nobelprize. org/nobel_prizes/medicine/laureates/2013/advancedmedicineprize2013.pdf 5 Genetic screen. (n.d.). in Scitable by nature Education (Glossary). Retrieved from http://www.nature.com/ scitable/definition/genetic-screen-200 6 Nobelprize.org. (n.d.). Nobel Prize Facts. Retrieved from http://www.nobelprize.org/nobel_prizes/facts/ 7 Smith, A. (Interviewer) & Südhof, T. (Interviewee).

(2013). “Are You Serious?” [Interview Transcript].

Retrieved from Nobelprize.org: http://www. nobelprize.org/nobel_prizes/medicine/laureates/2013/ sudhof-telephone.html 8 Rutgers University Alumni Association. (n.d.) Notable Alumni. Retrieved from http://www.alumni.rutgers.

edu/s/896/index.aspx?sid=896&gid=1&pgid=2184 Image retrieved from http://www.interactive-biology.com/wp-content/uploads/2012/07/Synaptictransmission_-3d-1024x1024.jpg Page 8: The Past and Present of Unethical Research 1 Baruch C. Cohen. The Ethics of Using Medical Data from Nazi Experiments. Retrieved from http://www.jlaw.com/Articles/NaziMedEx.html.

2 Center for Disease Control (2013). The Tuskegee Timeline. Retrieved from http://www.cdc.gov/ tuskegee/timeline.htm.

3 RW Halpin (2010). Can unethically produced data be used ethically? Retrieved from http://www. ncbi.nlm.nih.gov/pubmed/?term=Can+unethically+produced+data+be+used+ethically%3F#.

4 Charles J. McDonald (1974). The Contribution of the Tuskegee Study to Medical Knowledge.

Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2609140/pdf/jnma00485-0035. pdf.

5 American Medical Association (1998). Opinion 2.30- Information from Unethical Experiments.

Retrieved from http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/codemedical-ethics/opinion230.page?.

6 CEJA (1998). Information from Unethical Experiments. Retrieved from http://www.ama-assn.org/ resources/doc/code-medical-ethics/230a.pdf.

Image retrieved from http://upload.wikimedia.org/wikipedia/commons/3/3a/Tuskegee-syphilisstudy_doctor-injecting-subject.jpg Page 10: The Power of Prayer in Healing and Medicine “CBS Poll: Prayer Can Heal.” http://www.cbsnews.com/2100-215_162-8285.html Wilson, et. al. J Miss State Med Assoc. 2000 Dec;41(12):817-22. “Prayer in Medicine: A Survey of Primary Care Physicians.” http://www.ncbi.nlm.nih.gov/pubmed/11125643 3 “Prayer: Just What the Doctor Ordered.” The Free Library. http://www.thefreelibrary.com/ Prayer%3a+it%27s+just+what+the+doctor+ordered.-a019801524 4 Roberts, et. al. Cochrane Database Syst Rev. 2007 Jan 24;(1):CD000368. “Intercessory prayer for the alleviation of ill health.” http://www.ncbi.nlm.nih.gov/pubmed/17253449 5 Studts, et. al. Prev Med. 2012 Jun;54(6):408-14. doi: 10.1016/j.ypmed.2012.03.019. Epub 2012 Apr 3. “A community-based randomized trial of a faith-placed intervention to reduce cervical cancer burden in Appalachia.” http://www.ncbi.nlm.nih.gov/pubmed/22498022 6 Kretcy, et. al. Biopsychosoc Med. 2013 Oct 18;7(1):15 “Spiritual and Religious Beliefs – Do They Matter in the Medication Adherence Behavior of Hypertensive Patients?” http://www.ncbi. nlm.nih.gov/pubmed/24138844 7 Butler, Stuart PhD. “Is Prayer Good For Your Health? A Critique of the Scientific Research.” The Heritage Foundation. http://www.heritage.org/research/lecture/is-prayer-good-for-your-healtha-critique-of-the-scientific-research Image retrieved from http://www.ofwexcellenttips.com/wp-content/uploads/2012/11/biblepages.jpg 1 2

Page 12-13: On the Origins of Public Health 1 Greek public health. (n.d.). Retrieved from http://www.bbc.co.uk/schools/gcsebitesize/history/shp/ ancient/greekpublichealthrev1.shtml 2 The ottawa charter for health promotion. (2013). Retrieved from http://www.who.int/healthpromotion/conferences/previous/ottawa/en/ 3 Nordqvist, C. (2012, August 09). What is ancient roman medicine?. Retrieved from http://www. medicalnewstoday.com/info/medicine/ancient-roman-medicine 4 Sura, A. (2010). The cloaca maxima: Draining disease from rome. Retrieved from http://classicalstudies.duke.edu/uploads/assets/08_CloacaMaxima.pdf 5 The origin of smallpox vaccination. (n.d.). Retrieved from http://www.gilbertling.org/lp5.htm 6 Early chinese inoculation. (2013). Retrieved from http://www.historyofvaccines.org/content/timelines/diseases-and-vaccines Image retrieved from http://www.peacehealth.org/about-peacehealth/media/PrintResolution/riverbend-smart-operating-room.jpg Image retrieved from http://www.haciendapublishing.com/sites/default/files/Hippocrates.jpg Image retrieved from http://www.pitt.edu/~super1/lecture/lec37871/img044.JPG Page 14-15: The National Health Service vs. The Affordable Care Act Ramesh, R. “NHS among developed world’s most efficient health systems, says study” (2011).

The Guardian. Retrieved on October 25th 2013. http://www.theguardian.com/society/2011/ aug/07/nhs-among-most-efficient-health-services 2 “2011 Commonwealth Fund International Health Policy Survey” (2013). Commonwealth Fund. Retrieved on October 25th 2013. http://www.commonwealthfund.org/Surveys/2011/ Nov/2011-International-Survey.aspx 3 “The Requirement To Buy Coverage Under The Affordable Care Act” (2013). The Henry J. Kaiser Family Foundation. Retrieved on October 25th 2013. http://kff.org/infographic/the-requirement-to-buy-coverage-under-the-affordable-care-act/ 4 “About the National Health Service” (2013). National Health Service. Retrieved on November 7th 2013. http://www.nhs.uk/NHSEngland/thenhs/about/Pages/overview.aspx 5 “Affordable Care Act: The New Health Care Law at Two Years” (2013). White House. Retrieved on November 7th 2013. http://www.whitehouse.gov/sites/default/files/uploads/careact.pdf 6 Collins, S. and Joe Donnelly. “ObamaCare’s Definition of a Full-Time Job Needs Revising” (2013). Wall Street Journal. Retrieved on November 7th 2013. http://online.wsj.com/ news/articles/SB10001424127887223309404578611490682767344 Image retrieved from http://www.theeverlastinggopstoppers.com/wp-content/uploads/2013/10/ aff-care-act.jpg 1

Page 15: Laughter is the Best Medicine Referenced from http://www.bbc.co.uk/history/historic_figures/davy_humphrey.shtml Referenced from http://www.nndb.com/people/028/000083776/ Image retrieved from http://upload.wikimedia.org/wikipedia/commons/8/8f/Sir_Humphry_ Davy%2C_Bt_by_Thomas_Phillips.jpg Page 16-17: The Right to Life Waggoner, T. (2008, November 6). Non-terminal people increasingly seeking assisted suicide in switzerland. Retrieved from http://www.lifesitenews.com/news/non-terminal-people-increasingly-seeking-assisted-suicide-in-switzerland

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References

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Retrieved from http://www.nj.gov/health/fhs/chronic/ 2 (2013). Air Quality. In State of New Jersey Department of Health: Environmental Public Health Tracking Program. Retrieved from http://www.state.nj.us/health/epht/air.shtml 3 (2013). Drinking Water Quality. In State of New Jersey Department of Health: Environmental Public Health Tracking Program. Retrieved from http://www.state.nj.us/health/epht/water.shtml 4 (2013). Radon. In State of New Jersey Department of Health: Environmental Public Health Tracking Program. Retrieved from http://www.state.nj.us/health/epht/radon.shtml 5 (2011). Mortality. In Asthma in New Jersey (Chapter 7). Retrieved from http://www.state.nj.us/ health/fhs/asthma/documents/chapter7.pdf 6 (2013). New Jersey. In Centers for Disease Control and Prevention: Division of Heart Disease and Control Prevention. Retrieved from http://www.cdc.gov/dhdsp/programs/nhdsp_program/ nj.htm 7 Amaral, B. (2013, Septemeber 18). Highland Park Becomes First Town in N.J. to Ban Fracking.

NJ.com. Retrieved from http://www.nj.com/middlesex/index.ssf/2013/09/highland_park_becomes_first_town_in_nj_to_ban_fracking.html 8 Millicker, A. (2011, November 4). RUSA Opposes ‘Fracking’ in the Delaware Basin. The Daily Targum. Retrieved from http://www.dailytargum.com/news/rusa-opposes-fracking-in-delaware-river-basin/article_0c0495c2-069a-11e1-adbb-0019bb30f31a.html 9 (2013). Find an Organization. Retrieved from http://getinvolved.rutgers.edu/organizations/ find-an-organization Page 19: A Cloak that Covers Evil 1 Medicines: spurious/falsely-labelled/ falsified/counterfeit (sffc) medicines. (2012, May). Retrieved from http://www.who.int/mediacentre/factsheets/fs275/en/index.html 2 Tadeg, H. (2012). Substandard and counterfeit antimicrobials: recent trends and implications to key public health interventions in developing countries. East African Journal of Public Health, 9(2), 85-9. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/23139963 3 Chauve, M. (2008). The fight against counterfeit medicines in africa: experience and role of pharmacists. Comptes Rendus Biologies, 331(12), 982-5. Retrieved from http://www.ncbi.nlm.nih. gov/pubmed/19027699 4 US Food and Drug Administration, (2011). Counterfeit drugs questions and answers. Retrieved from website: http://www.fda.gov/Drugs/DrugSafety/ucm169898.htm 5 US Food and Drug Administration, (2013). The possible dangers of buying medicines over the internet. Retrieved from website: http://www.fda.gov/ForConsumers/ConsumerUpdates/ ucm048396.htm 5 Jones, T., Berger, K., & Schwappach, A. (2009, November). College students’ cheap fix. Retrieved from http://www.spokesman.com/stories/2009/nov/15/college-students-cheap-fix/ Image retrieved from http://media.npr.org/assets/img/2013/02/13/ivorycoastmarket_ wide-3278aae96d547781c1aa9f25f5273349ad301872.jpg Page 20: Negative Effects of Government Shutdown on Research 1 Colombo, Hayleigh. (2013, October 10). Purdue University weathering federal government shutdown – for now. Huffington Post. Retrieved from http://www.huffingtonpost.com/tag/ purdue-oklahoma-state.

2 Dockterman, Eliana. (2013, October 7). Here’s how much the government shutdown cost the economy. Time. Retrieved from http://swampland.time.com/2013/10/17/heres-what-the-government-shutdown-cost-the-economy/.

3 Japsen, Bruce. (2013, October 1). Government Shutdown Hits Research, Teaching Hospitals, Residency Programs. Forbes. Retrieved from http://www.forbes.com/sites/brucejapsen/2013/10/01/ government-shutdown-hits-research-teaching-hospitals-residency-programs/.

4 Kirch, Darrell G. (2013, October 1). AAMC Concerned About Government Shutdown’s Impact on Health of the Nation. Association of American Medical Colleges. Retrieved from https://www. aamc.org/newsroom/newsreleases/356256/100113.html.

5 Kliff, Sarah. (2013, October 7). This cancer patient’s treatment is on hold because of the shutdown.

The Washington Post. Retrieved from http://www.washingtonpost.com/blogs/wonkblog/ wp/2013/10/07/this-cancer-patients-treatment-is-on-hold-because-of-the-government-shutdown/.

6 Rivet, Ryan. (2013, October 15). Government shutdown puts freeze on Antarctica Research.

Tulane University. Retrieved from http://tulane.edu/news/newwave/101513_antarctica_trip_ cancelled.cfm.

7 Sohn, Jake. (2013, October 13). Student research affected by government shutdown. The Exponent Online. Retrieved from http://www.purdueexponent.org/campus/article_864143d5-d6c8-533aa590-844ac8fdc989.html.

Image retrieved from http://media.npr.org/assets/img/2013/10/10/hopkins-mouse_slide-c3253b2b3b60c25d336d7d2eae1b0f48fe7c204c.jpg Page 21-22: How Far Does the Affordable Care Act Go? 2 Leigh, W. (2012). The affordable care act and its potential to improve the health of african-american women. The Review of Black Political Economy, 39(4), 461-464.

3 Alexander, M. (2010). The new Jim Crow: Mass incarceration in the age of colorblindness. New York: New Press.

4 Katzen, A. L. (2011). African American Men’s Health and Incarceration: Access to Care upon Reentry and Eliminating Invisible Punishments. Berkeley J. Gender L. & Just., 26, 221.

5 Gruber, J. (2011). The Impacts of the Affordable Care Act: How Reasonable Are the Projections?

(No. w17168). National Bureau of Economic Research.

6 Lloyd, K., Gaboda, D., & Nova, J. (2013, June). Protecting vulnerable families from coverage & access coordination problems. Academy health annual research meeting 2013.

7 The promise clinic. (2013). Retrieved from http://rwjms3.rwjms.rutgers.edu/promise_clinic/about. html Image retrieved from http://thegrio.files.wordpress.com/2012/01/black-and-homeless-16x9.jpg

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