The Pitt Pulse - Volume III Issue I

Volume III Issue I

Featured Article

No Other Option: Health Care Reform in the United States

November 2012

In This Issue of The Pitt Pulse...

Dear Readers,

Table of Contents This Ain’t Your Mamma’s MCAT! Changes in the MCAT for 2013 and 2015 p. 3

Cover Feature:

No Other Option: Health Care Reform in the United States Side Bar: The Politics of Emergency Medicine p. 4-5 A Perspective on Planned Parenthood

p. 6

Unbridled Enthusiasm for a Growing Type of Developmental Rehabilitation: Hippotherapy

p. 7

Are You Smarter than a Pre-Med?

p.8

Games to test your knowledge!

Make sure to visit our website!

Scan the QR code or go to www.thepittpulse.com

Welcome (or perhaps, welcome back) to The Pitt Pulse! Traditionally, prehealth students have compiled this publication with the aim of sharing important topics in the prehealth world with others.

But, today, what you see before you is a newly envisioned work.

In line with our guiding principles, we will continue to inform and discuss. But with a fresh staff (prehealth and otherwise!), layout, and constructive process, the publication has felt a shift in philosophy.

Now, it emphasizes not only quality communication, but also a focus on the needs of our readers. I hope that this will lead to a more enriching experience for you, and for us.

I would like to recognize and thank the University Honors College for its continued support of our endeavors, without which this publication could not exist.

Without further ado, please help yourself to this issue; if you feel that you have been somehow educated or changed by what you have read, please pass the copy on. Alternatively, we are always open to suggestions!

Deborah Chen Editor in Chief Staff Writers Alexandra Cathcart, Natalie Ernecoff, Lauren Hasek, Rashmi Kumar, Belinda Lao, Janine Talis, Rashmi Sagaram, Zaid Safiullah Contributing Writers Rebecca Sponberg, Chase Moon Cover Art Belinda Lao

Do you have an idea you’d like to contribute to The Pitt Pulse? Do you have any prehealth questions?

Contact our editors at thepittpulse@gmail.com

Deborah Chen Editor in Chief Niaz Khan Assistant Editor

Beverly Hersh Assistant Editor

This Ain’t Your Mamma’s MCAT! Changes in the MCAT for 2013 and 2015

By Belinda Lao Staff Writer

By spring 2015, the Medical College Admissions Test will undergo rampant changes in structure and content. The most important change is the introduction of a new section focused on the social behavioral sciences: Psychological, Social, and Biological Foundations of Behavior. This addition is aimed at assessing the ability of applicants to recognize socio-cultural and behavioral determinants of health and health outcomes.

These changes are a response to recent recommendations by the Association of American Medical Colleges MR5 committee, which was appointed in 2008 to review and suggest improvements for the next generation of MCAT exams. Recommendations were based on a composite of advice from blueribbon panels, advisory groups, and over 90 outreach events, such as surveys of baccalaureate and medical school faculty, students, and admissions officers. The committee’s recommendations aim to maintain successful components of the current testing format while improving the representation of concepts that are expected to be useful for future physicians.

Since its creation in 1928, as a response to the high rates of medical school dropouts, the MCAT has served as both a measure of applicant preparedness for the rigors of medical school as well as a mental marathon of considerable strife for the majority of its examinees. Nearly all American medical schools require MCAT scores as a mandatory component of applications to be considered for admission. The current (2012) version of the MCAT is completely computer-based and can be broken down into a total of

four sections: Physical Sciences, Verbal Reasoning, Biological Sciences, and the Writing Sample. A maximum of 15 points are available for each of the first three sections, for a total possible score of 45. The Writing Sample is graded on a different, alphabetical scale, ranging from J (lowest) to T (highest).

For the 2013 and 2014 testing cycles, the revised MCAT will begin transitioning towards the integration of new sections and new concepts in preparation for its 2015 release. Students registered to take the exam in 2013 will be greeted with the traditional Physical Sciences, Verbal Reasoning, and Biological Sciences sections, but will no longer be required to take the Writing Sample. Instead, students will have the option to participate in a voluntary Trial Section that previews future questions and concepts for the revamped MCAT. Volunteers who choose to participate will take the 45-minute Trial Section at the end of their exam.

Successful completion of the Trial Section with good-faith effort will be rewarded with monetary compensation, in the form of a $30 Amazon gift card, and feedback about the examinee’s performance in comparison to other volunteers.

In an open letter from David G. Kirch, president and CEO of AAMC, the organization acknowledges that these modifications to premedical school testing reflect the changing landscape of medicine.

He suggests it will demand cultural competency and show an undeniable necessity to “promote prevention [of disease] and wellness for patients” for an increasingly diverse and aging population.

Kirch made sure to emphasize that the new focus on sociological and psychological factors of patient health will serve in addition, and not in place of, a consistently strong focus on core scientific concepts such as biology, chemistry, and physics.

So what does this mean for the current aspiring physician? We can probably consider this as parallel to recent trends in medical school admissions

and interviews towards an emphasis on identifying individuals with not only a strong background in critical thinking and scientific skills, but also good bedside manner and the ability to communicate with patients and other healthcare workers alike.

This emphasis will hopefully culminate in generations of well-rounded physicians who can interact in a manner that is progressive and conducive to providing the best possible patient care.

For students still fresh in their premedical track, you might expect to see introductory psychology and sociology courses surfacing in the coming years as recommended premedical courses, joining the ranks of traditionally recommended courses such as human physiology and genetics. Will these sweeping changes succeed at creating a more accurate determinant of physician quality? It remains to be seen, and will likely require a good number of years and many more MCAT examinees to come. v

SAMPLE MCAT QUESTIONS (ANSWERS ON BACK COVER)

1. Two cars, A and B, are moving toward one another but decelerating. During the deceleration, car A sounds its horn at a frequency of 400 Hz. Which of the following is most likely the frequency heard by car B? A. 325 Hz B. 375 Hz C. 400 Hz D. 450 Hz 2. A scientist is determining the order of a reaction. The reaction is composed of two elementary reactions as shown below. If Reaction 1 is slower than Reaction 2, what is the order of the overall reaction?

Reaction 1: A g B + C Reaction 2: 2B + D g E A. 0 B. 1 C. 2 D. The answer cannot be determined with the given information.

Questions adapted from www.mcatquestion.com

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The Politics of Emergency Medicine

No Other Option: Health Care Reform In The United States

By Natalie Ernecoff Staff Writer

It is not a secret in health care economics that reform is essential. Health care in the U.S. currently monopolizes nearly 20 percent of the GDP. This detracts from spending on other branches such as education, social welfare, and the military, that receive a comparably small percent of the GDP, with Social Security, Medicare, and Medicaid constituting over half of the federal expenditures budget. Health care spending to this degree is outrageous under any circumstances, but one would hope Americans are at least receiving high quality, cost-effective care that yields good patient outcomes. Unfortunately, this is not so.

Of First World countries, the U.S. produces far worse health outcomes (morbidity and mortality rates) than its international counterparts. Even worse, these other nations are able to provide their better care for a fraction of the spending found in the U.S. This unfortunate disparity between spending and quality of care in the U.S. is the platform upon which the need for reform rests.

Both presidential candidates have enacted health care reform plans already, albeit at different levels of government. Governor Mitt Romney, R-Mass., amended his state’s health care system in 2006, often referred to as “RomneyCare,” providing the people of Massachusetts with more coverage for less cost to the consumer than most other states. In 2010, President Barack Obama was able to pass the Patient Protection and Affordable Care Act, also known as “ObamaCare,” at the federal level. This has not yet had its full effect, as states have not yet fully embraced it (more on this, later).

There are few reform plans that are feasible, given the current climate of health care in the U.S. Despite their differences on a wide range of issues, Obama and Romney actually both approach health care reform from

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a similar angle. In this review, four key targets will be addressed: (1) an individual mandate to purchase health insurance with penalties for noncompliance, (2) a health insurance exchange program, (3) subsidies for purchasing insurance on the exchange program, and (4) Medicaid expansion. All of these ideas—described in detail below—have been enacted both in Massachusetts and in ObamaCare, though the intricacies vary.

16 percent of Americans are uninsured. Uninsured individuals generally do not go to a primary care physician, and when a medical issue arises, they utilize the ER. In these cases, hospitals typically absorb the high ER costs because while they will not refuse care, the patrons sometimes cannot pay. Using health care in this form not only yields a worse quality of life for those uninsured, but also costs a great deal more than long-term preventative care through a PCP. (See the sidebar for more information about the impact on emergency departments.) Before ObamaCare enacted the individual mandate, these uninsured individuals were able to do this without penalty.

The individual mandate, which is marketed as essential to funding an expansion in health care coverage, requires all to purchase some form of insurance. This way, insurance companies can balance their income with expenditures; income from covering healthy individuals helps offset the higher cost of those who currently utilize more coverage. At the same time, as insurance companies gain potential high-cost clients through increased coverage, they must also rely on the income of additional healthy people to balance their elevated spending. The mandate is necessary to protect against failure of the insurance-based system, as it guarantees healthy individuals will contribute to the budget, providing those with vulnerable health a source of funding.

Alternatively, under both Obama and Romney’s plans for reform, individuals can choose to forgo the mandated insurance, and instead pay a monetary penalty. These annual fees vary a bit between the candidates’ plans. In the absence of coverage, RomneyCare charges 50 percent of the lowest level insurance plan’s cost. ObamaCare, meanwhile, requires the higher of $695 or 2.5 percent of an individual’s annual income. Both penalties actually cost the individual less than insurance coverage, so those who do not want coverage are not coerced to purchase it. Even still, granting medical coverage to more individuals will save spending

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By Lauren Hasek Staff Writer

In 1986, the Emergency Medical Treatment and Active Labor Act was passed, guaranteeing that patients requiring emergency medical care could not be turned away, regardless of citizenship, legal status, or inability to pay.

While this is the closest thing to universal health care that the U.S. offers, currently 55 percent of emergency care goes uncompensated, estimated by Congress to be approximately $43 billion in 2008. This “free-rider problem” – the burden of those who receive health care free of charge because they are unable to pay – puts undue stress on the current system, where “the increasing frequency of emergency room visits for non-emergency treatment” is a direct cause of rising health costs.

Although PPACA is meant to create universal coverage, this cannot be realized for a number of reasons. While the act mandates coverage for all, the Congressional Budget Office estimates that in a decade, 30 million people will remain uninsured even though the plan will have been fully implemented. There are concerns that the penalties for going without health coverage will cost less than coverage itself, if they are enforced at all. While the expansion of Medicaid eligibility was expected to cover up to half of the uninsured, the Supreme Court recently ruled that states are not required to expand their Medicaid programs, making this coverage unlikely. While PPACA will decrease the number of Americans without medical coverage, the crisis of the uninsured is far from over. The ER will remain a key example of underfunded care, as it becomes a common primary care alternative for many Medicare and Medicaid patients.

Since physicians are only compensated for approximately 60 percent of what private insurance pays for these patients’ care, many therefore choose to only offer limited services, driving some patients to the ER alternative. While this is an immediate health care concern, very little research is being conducted to draw attention to this problem.

With such stress placed on emergency medicine,

the system could benefit from increased research that could then be translated into funding and policy initiatives to benefit ER care. Emergency medicine researchers receive less than 1 percent of NIH funding despite a 32 percent increase in ER visits over the past decade. Emergency medical care is underfunded and overcrowded; any claim that it is a replacement for insured health care is ludicrous. The PPACA does have the ability to partially alleviate the free-rider problem by increasing the number of total insured. Unfortunately, the population covered under Medicare and Medicaid expansions will still be pushed to the ER.

One fix could be to reimburse hospitals for EMTALA care. Even though this doesn’t appear to be on either candidate’s agenda, a series of independent small-scale urgent care centers and “minute clinics” are redefining health care by offering low cost, timely services, and functioning at odd hours. They are often staffed by a nurse and nurse practitioner, and accept cash and most insurance plans. A recent article from the National Center for Policy Analysis claims that one in five ER visits can be treated at urgent care centers, reducing annual health care costs by up to $4.4 billion. The use of these care centers is expected to accelerate due to the stress of implementing the PPACA over the next few years. v in the long run, while simultaneously improving quality of life for those patients who are not currently covered.

How does this fit into the current health care system? As of 2010, the majority of the insured population was under a big group plan through their employers. This type of coverage is generally perceived as high-quality care, for a reasonable cost, to individuals. Both reform plans expect this to continue, so as to minimize disruption of current good health care programs.

Individuals not under a big group plan typically use individual insurance, a small group plan, or are not insured at all. Small group plans traditionally have provided minimal coverage for a steep cost. To reduce those costs, both platforms have established exchanges.

These are programs that ensure the market is fair to those buying their own coverage outside of big groups. Exchanges provide user-friendly databases that make each plan’s benefits and costs clear to the public. The government also created minimum requirements for coverage, forcing policies to cover the basic needs of the payer at a reasonable cost. These plans are also not permitted to exclude individuals with pre-

existing conditions, as they have in the past.

Overall, the exchange programs will act to hold insurers accountable for credible policies while also improving the quality and affordability of coverage to those who are currently in small group policies or uninsured.

Despite the exchange programs, some individuals still cannot afford to enter the health insurance market. With insurance coverage mandated, the government must take these individuals into consideration, and employ an additional mechanism. Both plans offer the opportunity for individuals to receive large government subsidies, to alleviate the costs of an insurance plan. Subsidies will work to ensure these people will not be forced to sacrifice other necessities in their lives, while still receiving the care they need. Both plans grant graded subsidies to individuals and families, with the poorest receiving the most generous sums, although ObamaCare covers slightly more of the population (see table). This will not guarantee all Americans will purchase coverage, but it will improve their ability to do so in a tenuous economic environment.

In addition to making insurance more affordable, both ObamaCare and RomneyCare expand Medicaid coverage, a governmentprovided health insurance for certain impoverished individuals. Those qualified usually fit additional conditions, such as being a child, parent, disabled, or pregnant. In 2006, before Obama’s Medicaid expansion existed, Romney created an in-state expansion to cover

uninsured children in Massachusetts. When ObamaCare was implemented nationally, Medicaid eligibility expanded to reach 16 million more Americans. This expansion may still be rejected by some of the states, though nationwide acceptance could theoretically insure twothirds of the previously uninsured. States are given the option to reject additional Medicaid funds, option to reject additional Medicaid funds, thereby not expanding Medicaid coverage for their own residents. As per the recent Supreme Court decision, the federal government cannot remove states’ current funding to penalize states for not expanding coverage. Since this leaves states the option to continue with their current budgetary agendas, many Americans may remain uninsured.

Moving forward, the current health care economy is unsustainable. This is especially alarming, considering America’s care is poorer quality than other First World countries’, despite having significantly higher health care costs.

Obama and Romney both outline similar tracks for national health care reform, by decreasing cost in the long run and increasing coverage. An individual mandate with penalties will provide a strong base. Health insurance exchanges and subsidies make coverage more affordable, while Medicaid expansion will catch some of those who are still unable to purchase it. This combination of factors – as recognized by both Obama and Romney – offers what is likely the most feasible route for health care reform in the U.S. v

Federal Poverty Level (FPL) = $11,170 for single; $23,050 for family of four.

Don’t forget to cast your vote on November 6 !

You do have a say !

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A Perspective on Planned Parenthood

By Janine Talis Staff Writer

This summer, I found myself in a position I’ve been in many times before: out of school, unemployed, and bored.

Instead of moping around, watching endless reruns of “House” while slowly being absorbed by the living room couch, I decided to find something productive to do. This led me to pursue patient-based volunteer work. I ended up applying to a Planned Parenthood location in Center City Philadelphia, because it met this criterion. Many people have an opinion or view on Planned Parenthood. Politics and the media continually focus on their abortion services. Although I had sometimes considered Planned Parenthood as an abortion clinic myself, I decided to give volunteering there a chance, and the experience became much more than what I had initially expected.

Upon arrival each morning, I would sometimes pass a small group of protesters, but I never felt unsafe. I’d go upstairs, drop off my bag, grab a box of research supplies, and head back down to the Family Planning Clinic. As patients arrived, I would look through each patient’s chart to note if they met enrollment prerequisites for a research project.

Checking charts allowed me to recognize the range of services these patients were requesting. I saw people coming in for STD testing, gynecological exams, annual exams, birth control evaluation and pick-up, emergency contraceptives, and precancer screenings like colonoscopies. In fact, I did not talk to a single woman who was asking for the procedure Planned Parenthood is most often associated with: abortions. Contrary to popular belief, abortions only make up 3 percent of Planned Parenthood services

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nationwide, while contraceptive services make up 33.5 percent.

There was such a large number of individuals coming and going that I started to realize the significant position this organization holds in the community.

For many women, Planned Parenthood is the only available care center that provides them with women’s health services and birth control. Approximately 200,000 cases of invasive and 60,000 cases of non-invasive breast cancer arise in women each year, along with approximately 22,000 cases of ovarian cancer. Without the proper access to care that Planned Parenthood provides, many of these cases would go undiagnosed and untreated.

Planned Parenthood clinics have long provided easy access for women without health coverage, or those who cannot afford proper care at other facilities. For some women, whether they have a low-income household or live in a less urban area than Philadelphia, Planned Parenthood is the only place to go.

My summer at Planned Parenthood gave me the chance to revise my previously held notion of their services and impact on the community. I had the wonderful opportunity to work with an organization that not only advocates for women’s health, but also gives women in the community access to the very services needed to achieve it. One in five women in this country has taken advantage of Planned Parenthood at least once in her life. That woman may have gone for a new birth control, STD testing, or a Pap smear.

There is a chance that Planned Parenthood was the only clinic available to her. The reason behind her visit is irrelevant. More importantly, she had access to those vital services because Planned Parenthood was available. v

A Women’s Health “Did You Know...?”

Did you know if you are a full-time Pitt student, your Student Health Fee covers routine gynecologic exams, STD screenings, contraceptive consultation, and more!

Call (412) 383-1800 for more info.

Did you know a doctor can’t tell if a woman is a virgin through a physical exam? Even using a 10-foldmicroscope, doctors cannot accurately distinguish the sexually active from the inactive by the presence of a ruptured hymen. Although many people believe the hymen seals the vagina until virginity is lost, this is not the case; there is always a hole in the hymen.

Did you know as of 2012, cervical cancer screening (Pap smear) guidelines have changed!

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Previous:

Current:

Women start All women start three years after when they beginning vaginal turn 21. intercourse.

If 21-29 years If 21-29 years old, get a Pap old, get a Pap smear every smear every three years; more year. frequent testing is specifically discouraged.

For more information, consult your health care provider.

Unbridled Enthusiasm for a Growing Type of Developmental Rehabilitation: Hippotherapy

By Beverly Hersh Assitant Editor

Morgan was diagnosed with cerebral palsy at age 3, one of 10,000 children to be diagnosed with the disorder that year. Doctors had a grim outlook, telling her parents she would probably never be able to walk on her own. Not to be defeated, Morgan’s parents decided to try a novel form of rehabilitation that’s proving to be more successful than many parents could have ever anticipated.

It’s called hippotherapy. Fondly nicknamed “hippo” after the Greek word for horse, this form of rehabilitation is an allinclusive speech, physical, and occupational therapy strategy that many parents of disabled children are rushing to try. This innovative type of treatment utilizes the unique movement of horses to affect the posture, muscle tone, and balance of patients with medical disorders such as autism, cerebral palsy, sensory integration disorders, and other neuromuscular conditions.

The treatment has shown that it is capable of largely improving the impairments of a child’s mental and physical disabilities, including abnormal muscle tone, apraxia, sensory processing disorders, and gait abnormalities.

Those of us who aren’t familiar with horseback riding might be surprised at the incredible amount of strength it takes to maintain balance and posture on a moving horse. Similar muscle groups that are used for walking are used tenfold to stabilize a rider.

Hippotherapy achieves its results by employing the rhythmic and repetitive movements of a horse as compulsion to exercise these muscles.

The beneficial posture that these movements induce improves speech and communication capabilities because improved posture, as the largest factor affecting breath support, directly correlates to speech capabilities. At the same time, adjusting to compensate for the horse’s movements encourages the patient’s sensorimotor skills. For example, the patient can sit; lay forward, backward or sideways; stand in

Image by rockinghorserehab.com

the stirrups; or lay on their stomach. Patients are assisted by trained therapists who change the rider’s position on the horse to address various other therapeutic goals specific to a certain patient’s needs. Games are integrated into the riding session, such as stretching or catch, to further encourage the patient’s motor and cognitive skills.

Morgan’s cerebral palsy nearly eliminated her ability to understand her own body’s position in relation to itself and to her environment, a sense known as proprioception.

Being placed on a large moving animal triggers sensory processing that addresses not only the problem of proprioception, but simultaneously addresses deficits in tactile, visual, and auditory systems. The ability of one treatment to elicit the use of the neurological systems that are most affected by mental disabilities is what prompted Morgan’s parents to seek out the unconventional therapy.

They were lucky enough to discover Rocking Horse Rehab, an allinclusive rehabilitation center located at Essex Equestrian Center in West Orange, New Jersey.

Rocking Horse Rehab specializes in treating children with an array of mental and physical disabilities using hippotherapy, along with other occupational therapies. Over the course of five years of regular hippotherapy sessions, Morgan grew from a defeated patient, who needed constant assistance, to an encouraged youngster taking independent steps with her walker. Her mother credits Rocking Horse Rehab and

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hippotherapy for her daughter’s miraculous improvement.

What is it about hippotherapy that makes it such a successful treatment? Well, the innovation in muscle stimulation and sensory processing is a huge part of it, but so is the emotional bonding between patients and horses.

According to Rocking Horse Rehab certified pathologist Kathy Lutz, “Equine assisted therapies help students develop mindfulness, being ‘in the moment.’” The bond between horse and rider has not been thoroughly researched, but the parents of many disabled children can see a tangible difference in the way their kids interact with others as they progress through a hippotherapy program. Animal therapy is a widely accepted form of emotional rehabilitation because it encourages patients to interact with living creatures without fearing judgment or comparative resentment. Morgan’s parents have suggested that interacting with horses has taught her how to emotionally connect, something she struggles with due to the effects of cerebral palsy.

Furthermore, the interactions with animals make the therapy sessions more engaging for the patients. Morgan’s mother has said that Morgan doesn’t think of hippotherapy as “therapy,” but as an enjoyable experience she looks forward to every week. The enthusiasm that the children have for hippotherapy only enhances their progress; when patients are more excited about an activity, they are more likely to improve.

The multidimensional treatment of hippotherapy simultaneously stimulates the bodies, minds, and moods of young disabled children, making it an extremely effective therapy, and one that children thoroughly enjoy.

Morgan’s improvement was so significant that she was able to move on from hippotherapy to assisted horseback riding lessons. The developmental impact of horses has affected the lives of so many families who have chosen to try hippotherapy treatment. These success stories are little miracles that have allowed families to appreciate the power these majestic animals can bestow on kids who just want to go for a ride. v

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ARE YOU SMARTER THAN A PRE-MED? Unscramble the terms.

Match the cranial nerve names to their numbers.

I II III IV V VI VII VIII

Trigeminal Facial Optic Hypoglossal Trochlear Glossopharyngeal

IX

Accessory

X

Oculomotor

XI

Olfactory

XII

Vestibulocochlear

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MCAT ANSWERS: 1.D, 2.B

Image By Patrick J. Lynch, medical illustrator [CC-BY-2.5 (http://creativecommons.org/licenses/by/2.5)], via Wikimedia Commons

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Vagus