UChicago PULSE Issue 3.1: Autumn 2016

PULSE ISSUE 3, AUTUMN 2016

The Global-Local Divide Finding Global Health on the South Side

from the editor-in-chief Dear reader,

PULSE started off as a mere idea between premed students interested in sharing their interests in medicine, science, and society.

Two years later, I’m honored to bring you the third issue of PULSE to continue the founders’ initial aspirations – to develop an invaluable resource regarding pre-health, and to create a platform for undergraduates to explore and analyze their interests in medicine & the sciences together.

This quarter’s issue covers the scope of the entire planet. We start with a broad analysis of Zika virus worldwide and of gene editing through CRISPR and its role around the globe. Zooming in, we take a closer look at domestic issues with painkiller addiction and the Affordable Care Act. Finally, the connection between the global and local is brought into glaring focus as we examine both the bridge and divide between them in relation to HIV and AIDS activism.

Medicine is a part of so much of our lives, from lifelong aspirations and plans to the everyday details. In reading PULSE, I hope we can inspire you to share our love for science, our appreciation of medicine, and the steps we take each day to learn and apply these passions to society.

With regards, Irena Feng

pulse - autumn 2016

editors Irena Hsu Madeline Kim Shilpa Mantri Esther Wang

writers

Swathi Balaji Kiersten Crouse Sarah Nakasone Linda Phung Abhijit Ramaprasad Medha Reddy Fatima Sattar Victor Suarez

production

Purujit Chatterjee (cover design) Diana Hockett Jihana Mendu Yolanda Yu

other contributors InGenius Prep The Princeton Review

CONTENTS QUARTERLY RECAPS 2 PLANNING TO GO TO MEDICAL SCHOOL? 4

a feature from The Princeton Review WHAT’S THE CURRICULUM? 6 THE VIEW FROM THE GROUND (cover story) 7

global health, Chicago’s South Side,

and HIV activism TURNING THE TIDE ON THE OPIOID EPIDEMIC 10 A RACE TO THE FINISH LINE 12

developing a vaccine for Zika THE POTENTIALS OF CRISPR IN FUTURE MEDICINE 16 THE AFFORDABLE CARE ACT 18 INFECTION CONTROL IN HEALTHCARE SETTINGS 20 HOW TO SELL YOURSELF ON YOUR MED SCHOOL APPLICATION 21

a feature from InGenius Prep STEPPING OUT OF THE SHADOWS 22

shadowing in different medical fields:

an interview with pre-meds REFERENCES AND CITATIONS 24

table of contents || 1

AU QU TUMN AR TER

RECAPS

Light-stimulated nanotechnology and immunotherapy in cancer treatment.

The Lin group at the University of Chicago found a potential way to optimize photodynamic therapy on cancers, where photosensitizer molecules are used to create free radicals (which can damage cells) upon stimulation by light. These photosensitizer molecules were incorporated into metal organic frameworks (MOFs) of repeated metal and organic molecules, which could then be loaded with a drug to activate the immune system. The damage caused by the photosensitizer molecules and free radicals coupled with stimulation of the immune system was found to be effective against not only directly targeted tumors in mice but also untreated tumors elsewhere, an effect thought to be attributed to immune activation. The Lin group is now working on modifying MOF-mediated photodynamic therapy to treat a wider range of solid tumors, and to potentially start clinical trials next year.

New insulin product to enter market soon.

The first “follow-on” insulin product (a product modeled off one from another company) is expected to enter the market this December, possibly to be followed by a variety of similar insulins of identical protein structure. Historically, insulin as marketed has not been a single compound but rather a family of biochemically-related products that evolved over time. As patents on some products expire, drug makers are now working to develop generic insulin that would allow greater access for many diabetics. The vast majority of diabetics who use insulin currently buy from a small selection of chemically altered natural human insulin, prices of which have been consistently rising over the past few decades. The introduction of these biosimilar insulins could be a step towards a generic medication, but whether overall costs will decrease remains to be seen.

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New enzyme potentially involved in prevention of Alzheimer’s.

Scientists at the University of New South Wales have identified an enzyme, p38γ kinase, that controls how the tau protein behaves in the brain.

Tau protein plays a significant role in Alzheimer’s since tau can form tangles and clumps instead of working with normal cell functioning. The structure of modified tau (which releases toxins in the brain) is altered by another protein gone bad, beta-amyloid, which had been considered the driver of Alzheimer’s; however, more research is pointing at tau protein as the mediator of beta-amyloid toxicity.

The identified enzyme makes a different change in the structure of tau, preventing beta-amyloid from modifying tau and so interfering with the development of Alzheimer’s. p38γ kinase could shield the brain from forming clumps of tau protein and so boosting this enzyme holds potential in treatment for or prevention of Alzheimer’s.

Pill developed that stays in stomach to release drugs for extended time.

Recent drug delivery advancements have tested a multi-dose medicine capsule that could deliver oral drugs over an extended period of time. The capsule changes from a pill shape to a star shape due to pH changes once in the stomach, preventing the capsule from entering the small intestine; the capsule eventually falls apart and exits the body after a few weeks. The capsule has so far been tested in Yorkshire pigs to deliver ivermectin (anti-parasitic drug); sustained doses were observed for up to 10 days, though it remains unknown if the medication efficiency was affected by extended time spent in the stomach. This development addresses medication non-adherence where patients under treatment do not take their medicine as prescribed, often due to forgetfulness or neglect, leading to an enormous human and financial cost.

Blood stem cells depleted by deficiency of the amino acid, valine.

Researchers at Stanford University School of Medicine have shown that dietary deficiency of valine can effectively deplete the blood stem cell population in mice, allowing for successful bone marrow transplants. Bone marrow transplants (BMTs) require blood stem cell depletion to let new stem cells to grow and to prevent the body from attacking the transplant. Typically, chemotherapy or radiation is used to deplete blood stem cells, but research shows that taking valine out of the diet (the only source of valine) can achieve the same effect with much lower overall toxicity. Valine deficiency is now being explored as a potential dietary therapy for certain blood cancers, depending on whether cancer stem cells such as leukemia stem cells are vulnerable to this deficiency. The mechanism with which this effect is achieved is as of yet unknown.

Brain implant allows paralyzed patient to communicate via thought.

Zebrafish growth factor discovered to be essential in regenerating spinal cord after injury.

Traumatic stress effects different changes in brains of adolescent girls versus boys.

Genetically modified mosquitos approved to be released in Florida.

Biomarkers identified to help track progress of Huntington’s disease.

The effect of sleep fragmentation on gut microbiota.

The Brain Center of University Medical Center Utrecht has implemented the first at-home brain implant that can convert thought into other forms of communication in paralyzed patients. Electrodes are placed just underneath the skull on the brain surface to measure brain activity and send signals to another small device implanted under the skin. This device then wirelessly forwards the signal to an external computer so that the patient can communicate.

The brain implant is a compromise between superficial EEG, which remains external, and deep brain stimulation, which is much more invasive. The relative simplicity of the system makes it much more suitable for use without the constant assistance of doctors or engineers, allowing the patient more freedom in daily life.

A proposal to release genetically modified mosquitos engineered by biotech company Oxitec has been approved by mosquito control officials in the Florida Keys as a field trial. Any offspring produced by the engineered Oxitec mosquitos and wild mosquitos will not mature or reproduce, thus limiting the mosquito population as a whole in order to fight mosquito-borne diseases. Concerns regarding the study include collateral ecological damage or any potential consequences regarding mosquito bites from modified mosquitos. Oxitec aims to release only male mosquitos, which won’t bite; however, they cannot be 100% certain that there won’t be a few females released as well. The Oxitec mosquitos have been shown to reduce mosquito populations and slow down dengue transmission in locations in Brazil and Panama.

The specific location in the Florida Keys has yet to be decided.

NIH-funded research has isolated the molecule CTGFa (connective tissue growth factor a) secreted by damaged cells in zebrafish that helps regenerate severed spinal cords. Activated soon after spinal cord injury, CTGFa increased activity in specific glial cells, which are responsible for nerve cells’ structural support and form a bridge that allows new nerve cells to come and replace lost tissue. CTGFa was determined to be the key in healing capacity through tests that removed CTGFa production (resulting in failure to heal) and overexpressed CTGFa (resulting in enhanced regeneration). This discovery holds potential in regenerative treatment for humans who suffer spinal cord injuries; while this molecule alone is unlikely to have strong effect, these findings do suggest a lead for future therapies.

Researchers at Stanford University have identified multiple biomarkers in the body that can indicate the progress of Huntington’s disease.

These biomarkers are tested through a blood or urine sample and include measurements such as levels of mtDNA and plasma inflammation markers. Currently, clinical trials for patients with Huntington’s disease are long processes, slowing down study of potential therapies. The identification of these new biomarkers could allow researchers to examine the effects and proper dosages of new drugs and therapies. This study examined a previously developed drug for Huntington’s and its effect on biomarkers; it was found that biomarker readings improved after treatment with the drug, implying that the drug helped treat Huntington’s. With further development, these biomarkers can act as a guide for future clinical trials regarding this disease.

A study published in Depression and Anxiety scanned the brains of youth with PTSD and found structural differences in the insula, a part of the brain that processes emotions and empathy via cues from the body and plays a role in aligning feelings, actions, and other brain functions. It was found that in traumatized boys, the insula had larger volume and surface area compared to a control group, while in traumatized girls, the insula had smaller volume and surface area compared to a control group. This implies that boys and girls could demonstrate different symptoms in response to trauma, suggesting that different sexes could benefit from different treatment approaches; the next step is to follow traumatized youth over time to monitor how PTSD manifests itself in different ways throughout adolescence.

Sleep fragmentation for an extended period of time increased food intake, insulin resistance, and visceral white adipose tissue (fat surrounding abdominal organs) mass and inflammation. Within two weeks, the gut microbial community had changed, increasing certain families of bacteria and suppressing others. There was increased gut permeability as well, allowing products of altered microbiota in the gut to elicit inflammatory responses via circulation. Microbial function had shifted slightly and subsequently influenced systemic and adipose tissue inflammation and insulin resistance, as well as disrupted metabolic homeostasis. The study found that such effects were reversible once chronic sleep fragmentation was discontinued, suggesting interventional approaches aimed at gut microbiota could be used to treat symptoms of sleep fragmentation.

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PLANNING TO GO TO

MEDICAL SCHOOL? DO IT THE RIGHT WAY. We’ve built our program to provide you with the best tools to conquer the MCAT and get into the medical school of your dreams.

You may be wondering how much you should study for the exam. Though individual processes are different, most students should budget between 300 - 500 hours of prep time for the exam.

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common mistakes • Not putting enough thought into your personal statement • Not thoroughly researching the programs you’re applying to • Not understanding clinical hours and how your dream school ranks them • Not signing up for the MCAT soon enough • Not focusing on the things you struggle with the most • Not budgeting enough time to study

our expert recommendations • Choose a topic that is meaningful to you and will be interesting to read • Familiarize yourself with the schools you like before you apply to them • Research your dream school’s view on the importance of clinical hours • Register as soon as you are able and as soon as the list goes live online • Discover what areas you have trouble in and focus your efforts on them • Prepare 3-6 months in advance of your exam date

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autumn 2016 || 5

WHAT’S THE CURRICULUM? Much like the variety of factors that go into picking a college for undergraduate studies, the ones that are considered for choosing a medical school also play difficult roles in decision-making.

Although the competitiveness, location, and reputation of a medical school are deciding elements as to where students apply and attend, it is the curriculum that ultimately should be the guiding light towards the right fit.

Unfortunately, no one can actually learn everything there is to know about medicine within their four years at an institution. However, the questions that need to be asked are: how much is enough? And furthermore, how should that “much” be taught?

In the broadest sense, medical schools can be categorized on a scale from traditionally structured to progressively innovative. There are pros and cons to both that are relative to the applicant. Because transferring between medical schools is much more difficult than it is to do in college and is rarely done, it is crucial to find the best fit prior to enrollment.

Students who require structure about not only the material and class schedule for the week, but also the syllabus for the next four years, might find it hard to absorb knowledge through freedom of self-discovery and group-learning in medical education, as opposed to straightforward lectures in a classroom. Those who master concepts better when applied outside the classroom will often find that a traditional classroom setting with classes booked throughout significant hours of the day are too structured and don’t encourage exploration.

In a traditional education setting, the “2+2” model is practiced. The first two years of medical school focus intensely on basic sciences, and the last two years introduce clinical rotations.

Students who are successful in these types of environments usually have great memory skills, the ability to fulfill strict requirements, and comfort with letter grades and structured examinations. This system has been around for ages. However, more and more medical schools are now altering their curriculums to become more innovative due to criticism that U.S. medical education is too out-of-touch with modern healthcare needs.

A number of medical schools have joined the American Medical Association (AMA) Accelerating Change program in the aims of reforming

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BY LINDA PHUNG

their curriculum. Harvard Medical School, for example, has implemented “Pathways,” a program that emphasizes earlier clinical immersion and the sense of “flipped classrooms.”

According to The Crimson, the student newspaper, this is their way of shifting medical education from rote memorization to applied and question-based learning. “Pathways” has been the first major curriculum revolution at Harvard, a school recognized for its traditionalism, since the 1980s, symbolizing the magnitude of shifts in medical school curriculums.

Another example of less traditional learning methods can be seen at Hofstra Northshore – LLJ School of Medicine; there, students don’t just sit in lecture their first eight weeks of school, but are also trained to become emergency med-techs, where they learn “split-second life-saving skills.”

Although Hofstra Northshore is fairly new, its style of education may be a better fit for those who are prefer hands-on experiences.

Our very own Pritzker School of Medicine is also an avid participant in the AMA’s Accelerating Change program. With the implementation of a pass/fail grading system, Pritzker claims that it will “encourage cooperating among students, develop lifelong learners, and allow students to prioritize their learning and extracurricular exploration” — activities supposedly done better without worrying about numerical grades.

Mayo Clinic School of Medicine has also found that the pass/fail system stimulates a different style of thinking amongst students. For the first two years of medical school, students are graded on this system. This will allow them to get a sense of not only how much work they can handle, but also the ways in which they will be expected to display their knowledge, so that they know the ropes by third and fourth year.

Although many schools have switched their curriculum over to a more innovative model for learning, there is still a great variety of teaching styles offered by the nation’s medical schools. When using curriculum as a main deciding element, the best thing to do is to visit the schools and talk to their admissions offices.

Current students also often offer more valuable insight on what life is like within the institution.

Despite the difficulties of choosing the right medical school, and the hardships that students may endure before, during, and after, the end results can be very rewarding.

THE VIEW FROM THE GROUND: FINDING GLOBAL HEALTH ON THE SOUTH SIDE

BY SARAH NAKASONE

It wouldn’t be an

exaggeration to say

that I was born with one foot out the door and the other in the airport. The product of a military family, I’ve lived in 12 different places and wouldn’t be able to pin down a ‘hometown’ for you, should that question come up in the routine exchange of introductions.

The whirlwind of new homes, new cities, new countries even, left me with a strange love of cramped, red-eye flights to ‘somewhere’ and the haphazard packing that necessarily comes with not having enough money to check bags on a budget airline. I figured whatever I did in life, it would have to involve travel. This desire only compounded when I became interested in global health.

I was going to join Doctors Without Boarders and fight disease in some far-flung country, light years away from the

comforts of a job in an American hospital.

Or, I was going to join the Epidemic Intelligence Service, be ready to deploy to anywhere in the world for any disease outbreak at a moment’s notice.

I was going to save the world and see as much of it in the process.

I was going to judge success by the number of stamps I had on my passport.

And by all accounts, i fell into the right line of work.

By some happy accident of random conversations with teachers in high school and a rather well-stocked epidemiology section at my public library, I fell in love with HIV/AIDS activism. My interest followed the trajectory I thought the disease had taken

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“

The problems of people we will never meet are more attractive than the problems of people we see everyday.” as well — starting in the Castro District, in the heart of San Francisco, then exploding onto the world scene, burning through Africa and leaving widows and orphans in its wake. I read about how internal disagreements at UNAIDS led to the infection and death of hundreds of thousands, how US policies allowed the virus to spread throughout the continent largely unchecked, and how AIDS rates could be linked to bad condom advertisements, tribal practices, circumcision, and coffee exports. I studied the work of Peter Piot, the global health hero of both Ebola and AIDS, and Elizabeth Pisani, an epidemiologist and advocate for HIV prevention.

I got caught up in the adventure of this international problem and thought ‘Yes, finally, this is the place for me.

Here is a place where I could do some real good in the world of health.’

What was implicit in my plans, what

is implicit in most of the discussions about HIV, really, is that AIDS is an African problem.

Scientific articles explicitly ask, “Why is AIDS Worse in Africa?” and point to countries like South Africa and Swaziland, where rates of HIV positive adults have skyrocketed, reaching as high as 39% of the general population. Posters for HIV prevention feature African mothers and children in brightly colored clothes and jewelry, engendering some mix of sympathy and fascination.

Prestigious fellowships from UNAIDS, the WHO, or even the University of Chicago

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beckon to talented graduates — begging them to put their talents to use halfway around the world, to solve the AIDS problem by 2030.

There’s nothing inherently wrong about caring about HIV in Africa. There’s no denying that the disease has devastated many countries on that continent, and the people who work to solve this problem should be lauded for the heroes they are. But somewhere along this line of thinking, we forgot that AIDS is an American problem as much as it is an African problem. In the rush to examine the problem on another continent, we allowed ourselves to become complacent with it in our own backyards.

Washington, D.C.’s HIV rates rival those of many countries in Africa. Rates of testing and treatment in Mississippi and other places in the South are on par with countries like Botswana, Rwanda, and Ethiopia. But, of course, it gets worse. These statistics, as frightening as they are, actually mask the problem by including low-risk groups in their calculations. If we take them out of the equation, the problem peaks to a state of panic and emergency. In Chicago, black males who have sex with males (the medically accurate term that encompasses gay and bisexual men as well as trans women) have a one in three chance of contracting HIV. That’s a positive result when compared to the entire US — across the nation, the risk jumps to one in two.

Where are these facts in our discussion of HIV/AIDS? Why are we so willing to

be concerned about the global South’s struggles with HIV but not the American South’s? Or, God forbid, the neighborhoods that lie just a few blocks south of our university?

We’ve spun stories about HIV on the global stage that are ‘more palatable’ to listeners, and especially more palatable to funders. HIV in Africa is a story of ‘innocent victims,’ of little black babies and their mothers who need our protection. Of women who lack sexual autonomy and children who will grow up without parents.

These are important stories — don’t get me wrong. These lives matter. But somewhere along the line, we also decided that they matter more than the stories about gay men in Atlanta, about drug users in Indiana, about trans women right here in Chicago. Because we’ve judged one type of story to be ‘better’ — better for publication, better for brochures, and better for telling in general.

(The perfect example, of course, is Senator Jesse Helms, who would scream on the floor of the Senate that gay activists needed to “shut their mouths and get their mentalities out of their crotches” only to turn around and demand funding for HIV abroad.)

But beyond that,

we’ve romanticized this idea of global health work, especially when it comes to HIV. The problems of people we will never meet are more attractive than the problems of people we see (often out of the corner of our eye) everyday. We look halfway across the world and think that we can be useful because the

solutions seem simpler over there, somehow. If we can build a school for girls or increase rates of male circumcision or get more people on antiretroviral therapy, then we can end this epidemic. But when we get asked what to do in our own backyards, we just don’t know.

The problems are too big — too connected to other forces like poverty and violence that we just don’t know how to solve.

It’s sexy to embrace the glamour of international work, of expat life.

It’s less sexy to acknowledge how we have failed our own neighborhoods and that we don’t know what to do.

Spend enough time talking about anything as controversial as HIV, and eventually, someone will notice. For me, that notice came in the form of a job interview, then as a paid position researching sexual networks and HIV prevention.

I spend more time bouncing

around a free clinic and talking about gay sex then I do doing most anything these days — considerably more than I spend in class, especially. This work is about as grounded as you get. The only travel I get to do is between my dorm and 55th Street — a four-block distance that only seems long when the wind is especially bad.

It’s not what i

thought i wanted to do with my life,

and yet it is exactly what I needed, somehow.

I get to watch a community trying to heal itself. I listen to discussions on how to talk about condoms and medication, how to respect yourself, what ‘safe sex’ really means, and how to find love in the midst of it all. People tell me about their fiancées and family members’ deaths, about new jobs and prison sentences. About the hope that treatment brings,

and the constant fear it helps to combat. I get to hear a million stories, perhaps not the ones that will make the brochures, perhaps not the ones that will stir people to donate money, but a million important stories either way.

I still book as many flights as my student budget can handle and still envy people who have managed to snag a job with a healthy travel alliance. But I’m also learning that we can find global health in our own backyards. Don’t get me wrong — there are a lot of good reasons to go abroad to do health work, but you have to be ready to find them, and to articulate why exactly the work you want to do can only be done ‘elsewhere.’

And for me, after discovering an entire world in a free clinic in the South Side of Chicago, I’m not sure I’ve found a good enough reason yet.

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TURNING THE TIDE ON THE OPIOID EPIDEMIC

BY MEDHA REDDY The Center for Disease Control and Prevention reports that since 1999, the number of deaths resulting from opioid overdose has nearly quadrupled within the US. Seventy-eight Americans die every day from opioid overdoses, and 2 million people have a prescription opioid use disorder. The effects of this epidemic are devastating, not just for the individuals who are affected, but also for their families and communities. Even more unfortunate, youth are disproportionately affected by the crisis and these effects.

The origins of the opioid epidemic

can be traced to the 1990s, when practitioners were told to use aggressive pain management plans to make patients comfortable, and opioids were “heavily marketed to doctors.”

Prescribers were of the best intentions, and believed that in cases pertaining to pain, opioids would not be addictive. Sadly, this incorrect belief coupled with the loose prescribing practices gave rise to a widespread addiction.

In response to this epidemic of growing prevalence, Surgeon General Dr. Vivek Murthy has recently called on clinicians to take the pledge to help “Turn the Tide Rx” end this crisis.

Although just launched in late August of this year, the movement has already garnered the support of the President of the American Medical Association Dr. Steven Slack, the American Academy of Family Physicians, and the National Alliance of Medicare Set-Aside Professionals. While the movement does make the great stride of publicly calling for the reform in clinicians’ treatment with opioids, many feel as though it falls short of proposing practi-

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1. educate 2. screening 3. changing perception cal mannerisms to effectively resolve it. To many, this is just a symbolic stand that is only weakly backed up by continuing education.

The “Turn the Tide Rx” movement has three simple objectives. Firstly, it seeks to educate clinicians on pain treatment practices that are both safe and effective. As aforementioned, in previous decades opioids were being prescribed in higher doses than necessary, sometimes so high that it posed a threat to patient safety.

Pain management strategies have changed drastically in the recent decades. Previously, the false perception that opioids were non-addictive led to their heavy prescription in aggressive pain management plans; now practitioners’ growing awareness of opioid’s addictive qualities encourages them to pursue alternative pain manage-

ment strategies. While the effects of the addictive qualities of opioids were noted in many patients, until the early 2000s prescribers were flooded with contradictory information that prevented mass reform. In the late 1990s, the NIH established “findings from brain imaging studies in humans, along with basic cellular and behavioral research in animals, [identifying] profound disruptions in the specific brain circuits and cells that underlie addiction” while Dr. Russell Portenoy spearheaded a campaign to prioritize pain management treatment in patients due to his earlier finding that “opioid maintenance therapy can be a safe, salutary and more humane alternative” than not treating patients with chronic pain. Dr. Steven Slack, president of the American Medical Association, emphasizes the importance of practitioner

education programs by asking practitioners “when was the last time [they] looked at research on opioid alternatives? And when was the last time [they] took education to ensure [they were] prescribing safely and appropriately?”

However, education programs fail to completely resolve the moral dilemma of clinicians. The “Turn the Tide Rx” movement largely speaks to commonplace knowledge amongst physicians that opioid prescription should be guarded, further reinforced by more stringent restrictions and pharmaceutical monitoring. Yet, pain is typically considered the fifth vital sign of a patient — despite being such a subjective parameter, the patient is always considered right. While they have a moral obligation to treat the pain of a patient, physicians are also expected to balance this with avoidance of narcotic treatment. To them, it’s often difficult to distinguish between patients who are genuinely in pain and patients who are addicted to opioids. As a result, patients genuinely in pain may not get necessary opioid

too overarching and flat for the complex and tailored practice of medicine.

The second objective of this movement is to start screening patients for opioid use disorder, and to connect them with evidence-based treatment resources. Several states already have prescription drug monitoring programs that allow clinicians to track treatment of conditions requiring prescribed controlled substances. The screening acts as a preemptive preventative measure, and the presentation of resources allows patients to get help early on if they demonstrate signs of addiction.

The final objective is to change public perception of addiction. While this is a critical aspect to helping addicted patients garner the courage to address their addiction, it is unfortunately not something that can be clearly outlined in action steps. Changing public opinion on such a deep-rooted stigma is a gradual process that requires the investment of a large amount of time and resources, and there is no one given way to achieve

treatments. While the provided reference materials from “Turn the Tide Rx” help physicians set more objective prescribing conditions for opioids and suggest alternative therapies, these recommendations are

this change in opinion. Even the two leading figures of the movement have differing approaches, perhaps reflective of their differing backgrounds and roles. Surgeon General Dr. Murthy encourages mass reform

by encouraging everyone to “[treat] it as a chronic illness, not a moral failing.” American Medical Association President Dr. Slack encourages clinicians to take the lead in tackling the stigma by practicing “care and compassion, not judgment.” As a result of the campaign’s lack of action plan, physicians are given the autonomy in interpreting how this change can be achieved. While this does leave room for innovation, the lack of a comprehensive approach further delays progress in the movement.

The “Turn the Tide Rx” movement is the first step on the path to addressing the opioid crisis.

By working with clinicians who prescribe the narcotics, it hopes to better treat the mass of individuals who suffer from opioid addiction. The standardized documents it has developed for clinician prescribing and alternative treatment processes will directly impact patient pain management programs by standardizing them. Unfortunately, the change will be slow as “Turn the Tide Rx” is merely a pledge and resource, which many view as symbolic rather than an action step that induces change.

But even as a symbolic gesture, it has shortcomings due to its slow spread throughout the healthcare community, which is largely because it is a voluntary commitment that only offers access to documents summarizing what are already largely commonplace practices. Since the movement is still just in its early stages, it will be interesting to watch how Surgeon General Murthy is able to utilize his final months in office to mobilize more practitioners to take this pledge, and how the program will be implemented so that it can shape everyday prescribing promises beyond simple encouragement.

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A RACE TO THE FINISH LINE

BY SWATHI BALAJI Viruses and epidemics are ever-evolving, and with them so too are the cures and vaccines. Here we look into the development of a possible vaccine for the Zika Virus.

With every epidemic, there seems to be a race to develop a new vaccine, a desperate scramble for a solution to a global problem. The late 1940s outbreak of poliomyelitis (polio) in the United States sparked a race to develop a vaccine, resulting in the development of an injectable vaccine

by Dr. Jonas Salk, and later, an oral vaccine by Dr. Albert Sabin. More recently, the 2014 Ebola outbreak in west Africa set off a global burst of research to develop a vaccine, culminating in the development of the recombinant Vesicular Stomatitis Virus Zaire Ebola virus vaccine (rVSV-ZEBOV), which subsequently underwent testing with animal and human subjects. In April 2016, Dr. Marie-Pierre Preziosi, a medical officer in the World Health Organization (WHO), reported that it would take more than one or two years for the vaccine to enter the market, indicating that merely developing and testing a vaccine is not enough—it needs to be implemented in a timely manner as well. Thus, we come to the main question:

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how should vaccines be implemented on a global level, and are they enough?

Ebola seems to have been “replaced” with a new pandemic: the Zika Virus, with outbreaks in the Americas, Oceania and the Pacific Islands, Cape Verde, and Singapore. As with any other epidemic, there has been a race to develop multiple vaccine candidates, which include a DNA-based vaccine similar to a West Nile virus vaccine, a genetically engineered vaccine similar to the rVSV Ebola vaccine, and a live attenuated (weakened, non-disease causing) vaccine similar to the one developed for the Dengue virus. Such injection vaccination models build off of approaches to other flaviviruses (RNA viruses), including yellow fever, dengue, and hepatitis C. Though these models have traditionally been utilized successfully, there are still problems associated with them.

Since they are still being tested on animal models, it may take quite some time for researchers to even reach the final testing phases on humans; in this time-

frame, millions more could be affected by Zika. Additionally, implementing injection-type vaccines in low-income regions is highly difficult due to the lack of storage and facilitated transportation, poor hygiene, risk of infection, limited funding, and a variety of other health disparities.

Seeing these problems with injection-type vaccines, a University of Chicago student has taken a unique approach in developing a Zika vaccine by attempting to create an oral vaccine rather than an injected one. A fourth-year student in the College, Rachel Wittenberg conducted research at the University of Chicago and the Argonne National Laboratory under the guidance of Dr. Olaf Schneewind and Dr. Dominique Missiakas in the microbiology department. Working with several others, she developed an oral Zika Virus vaccine by generating a “live attenuated Bacillus anthracis spore vaccine expressing and secreting the E protein,” which is responsible for “viral fusion and entry” of the virus into the

INCREASING PREVELANCE OF ZIKA CARRYING MOSQUITOS

host. An antibody response to the administration of the live attenuated strain would indicate the successful development of immunity to the Zika Virus. The research team created a recombinant plasmid of Bacillus anthracis by deleting a few key genes and inserting the E protein of the Zika virus.

Although the live spore vaccine was able to secrete E proteins after the recombinant plasmid vaccine containing the E protein was injected into mice, the mice did not demonstrate an immune response and failed to produce antibodies specific to the E protein. Wittenberg stated that the team’s next steps in their research are to create new vaccine strains by “choosing which genes to eliminate or modify” in generating a new hybrid plasmid, which will hopefully generate an immune

response in the host.

According to Wittenberg, an oral vaccine has the ability to circumvent many logistical issues present in low-income countries since it has “potential in a low-resource context” due to ease of storage and transport, facilitated administration of the vaccine, and a lowered risk of disease transmission. Nonetheless, vaccines are only effective if a population is aware of the benefits and has access to a strong primary care infrastructure. Wittenberg emphasized how crucial it is to receive “followup care, especially [with infections] like tetanus” (which require booster shots for prolonged immunity) after taking the vaccine. Without proper access to a healthcare system, people are not well informed of infection prevention and of the availability of

vaccines.

Another problem for the implementation of both oral and injected vaccines is the inadequacy of resource allocation on a global level. Because funds are often funneled to other political issues or diseases that do not necessarily affect or threaten the majority of the population, the funding for infectious disease research barely suffices—not to mention the further lack of funds needed to implement the results of the research! President Obama requested an emergency allocation of $1.9 billion for Zika Virus research in February of this year, but with Congress delaying its response and only changing the allocation of funds in late September, the budget for Zika Virus research dwindled dangerously low for much of the year. Without enough

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funds, implementation and even development of a vaccine is difficult. As Wittenberg aptly points out, diseases with a simple solution are often not addressed due to lack of proper implementation of vaccines, high costs of vaccines, lack of education on prevention of disease, and limited awareness

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of and accessibility to vaccines.

Moreover, developing a vaccine is a long process that requires several years of extensive testing before it can be released on the market; transitioning from an animal to a human model can also pose many problems in the applicability of the vaccine, and even after all that,

the vaccine itself may not be accepted by the public due to the negative stigma associated with vaccinations in general.

In the long run, vaccines may not be enough to address the consequences of infectious diseases. What can a mother do if she contracts the Zika Virus and her baby is born

with microcephaly (abnormal smallness of the head)? What can one do if he contracts the virus and finds himself afflicted with Guillain-BarrÊ Syndrome, a possible consequence of the Zika Virus where one’s immune system attacks the peripheral nervous systema? A vaccine may serve as a temporary solution in guarding those without the disease, but a vaccination is still heavily limited in its develop-

ment, implementation amidst health disparities, and its longterm impact in actual treatment of the disease and its symptoms.

Has the race to develop a vaccine been in vain for all this time? Certainly not.

But is a vaccine enough?

Does the race need a different finish line?

Notes

a.The presence of Guillain-BarrĂŠ Syndrome in some Zika Virus victims is a positive correlation with the contraction of the virus; it does not, however, imply that Zika Virus infection causes the syndrome since the links between the virus and syndrome are yet to be discovered.

autumn 2016 || 15

THE POTENTIALS OF CRISPR IN FUTURE MEDICINE

BY VICTOR SUAREZ “Your scientists were so preoccupied with whether they could, they didn’t stop to think if they should” –Ian Malcolm Although this movie quote from Jurassic Park refers to the revival of dinosaurs through genetic engineering, science fiction is gradually becoming a reality. However, instead of reviving prehistoric creatures, scientists are uncovering the genetic tools required to save the human race. Through gene therapy, doctors will be able to edit human DNA in order to fight off diseases. With the development of CRISPR technology, gene therapy now has the potential to revolutionize the medical field. However, as scientists begin to discover how it can be done, the ethical question of what should and should not be done is now as real as ever.

CRISPR is the acronym for “Clustered Regularly Inter-

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spaced Short Palindromic Repeats.” These palindromic repeats refer to the repeated DNA fragments found in a bacterium’s genome. CRISPR is actually the technique the bacterium uses to fight off viruses. In between these repeated fragments are gene segments of previous viruses that once infected the bacteria. If the virus ever enters the bacteria again, it would be attracted to its matching segment of DNA and would bind to that matching segment, activating an enzyme in the bacteria that cuts the virus out from the bacteria’s genome.

In 2012, scientists attempted to use this CRISPR technique in more than just the bacteria’s immune system. The CRISPR associated Cas-9 enzyme can

be used as molecular scissors that target specific segments of a host cell’s DNA to either cut these segments out or replace the DNA segment. The Cas-9 enzyme binds to the correct segment with the help of a guide RNA (gRNA) that contains a sequence specific to the DNA segment the Cas-9 must target, therefore acting as a guide (as the name suggests).

After this CRISPR-Cas 9 technique was introduced, scientists worldwide were inspired by its potential. Scientists are now applying this technique in agriculture, food, animals, and in medicine. The benefits that CRISPR-Cas 9 can bring to the medical field are only limited by one’s imagination.

For example, steps toward xenotransplantation, “which involves the development of animal organs for transplantation into humans,” are making progress.

Xenotransplantation research has focused on pigs since they are domesticated and are more socially acceptable to use. Until doctors and scientists understand why we reject pig tissue, xenotransplantation is yet to become a reality. However, with CRISPR-Cas9, pig genes that release PERVs (“porcine endogenous retrovirus” that is harmful to humans) have been inactivated. The fact that the CRISPR-Cas 9 technique was used to inactivate 60 of the

PERV genes demonstrate its potential in benefitting human patients.

Ever since Broad Institute’s Feng Zhang reported success in using CRISPR-Cas9 in a human cell in 2013, ethical questions have arisen concerning whether the technique is safe to use on human patients. In June 2016, the first proposed clinical trial of CRISPR on human patients was approved by the U.S National Institutes of Health.

The research team from the University of Pennsylvania will now attempt to use CRISPR to boost the T-cells in order to fight off tumors in patients with terminal cancer. However, there are dangers in editing the genes of a patient’s cells.

Since CRISPR is still being researched, it is not perfect.

There can be mistakes in editing a cell’s genetic information.

Thus, the research team will be focusing on how the patient’s immune system responds to CRISPR-Cas9, and whether the technique leads to cuts on wrong gene locations. In order to confirm CRISPR’s accuracy, the researchers tested the technique on T-cells from healthy donors and only found one wrong cut in 148 genes. Luckily, the cut was found in a harmless location. Yet, due to the risks involved, it’s no surprise that gene therapy brings up many ethical questions.

In order to discuss these ethical questions, the International Summit on Human Gene Editing was cohosted in December 2015 by four scientific academies. They concluded that “regulatory frameworks for gene therapy” should evaluate proposed clinical trials involving gene editing in human somatic cells. This decision explains why the proposed clinical trial of using CRISPR to edit a cancer patient’s T-cells had to be approved by a regulatory framework such as the U.S Institutes

of Health. Since T-cells are somatic cells whose genetic information cannot be inherited by future generations, only the patient would be affected by the clinical trial.

Nazis. Eugenics is the process of improving a human population by promoting inheritance of beneficial traits. However, this process might suggest that some people are genetically superior

However, the Summit had a different stance on gene editing in the human germ line because these cells such as sperm, eggs, and embryos pass on genetic information to generations.

Although human germ line modification could lead to the prevention of future generations from inheriting severe diseases, there are currently too many risks involved. In a poll conducted by the Harvard T.H Chan School of Public Health, only 26% of the respondents think that “changing the genes of unborn babies to reduce their risk of developing certain serious diseases should be legal.” The majority opposition against gene editing in embryos is understandable and reflects the Summit’s own fears. The Summit concluded that no clinical trials of germ line editing could commence until gene editing is proven more accurate and safe, the general public agrees that the trial is appropriate, and the trial is approved by regulatory committees.

However, there is a major ethical question corresponding to the ability to edit the genes of future generations. Although the prevention of inherited diseases seems beneficial for the health of future generations, germ line editing could also be used to enhance human physical characteristics. The ability to improve the physical attributions of next generations is reminiscent of eugenics, a process that was perverted by

to others. If there is the risk of society believing that people are no longer equal due to genetic differences, should gene editing even be allowed?

This returns to the question that fictional Ian Malcolm posed. Are we too busy thinking about the potentials of CRISPR and gene editing, that we forget to question if it is morally correct? Regardless, research will continue and is happening right now – the Francis Crick Institute’s Kathy Niakan has already gained approval in the U.K to use CRISPR in human embryonic cells that will not come to term. We will eventually make gene editing safer and more efficient, and we will gain a better understanding of which genes influence the development of a human embryo.

However, we should also always keep in mind the question of what is morally right.

There will come the day when we can edit the human embryo efficiently. On that day, if we use human gene editing for the wrong ambitions and distort this tool to enhance those physical attributes we assume best, then we have will have gone down a wrong path.

But, if we focus on curing those with inherited diseases and use human gene editing with the ambition of saving others from disease, then we will have chosen the right moral path. This path is taken by the doctor, whose ambition is to help their patient.

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THE AFFORDABLE CARE ACT:

BY ABHIJIT RAMAPRASAD

ITS PROBLEMS AND ITS FUTURE

N.B. This article was written prior to the presidential election. The unfortunate outcome definitely puts some of the Affordable Care Act in the air, and the law’s future is quite uncertain. However, as detailed later, the law may not be as vulnerable as it seems, and attempts to repeal it may be met with fatal political backlash; indeed, there has been a definite softening in opposition rhetoric to the law in the last few weeks. Hopefully, that means that the point of this article is not moot.

The Affordable Care Act has been the most controversial law in recent memory — not only has it faced massive criticism, but many have also consistently prophesied its impending failure. As a law, it serves two purposes: to make the health insurance industry transparent so companies can no longer predatorily prey on the sick by hiking their premiums at the first sign of serious illness, and to allow many of America’s at-risk uninsured to become insured and safe. Hundreds of disingenuous arguments have been made against the ACA: sensational falsehoods about “death panels,” neoliberal arguments against the “evils of socialism/communism,” complaints about loss of “competition,” etc., all of which have served to tarnish the law in public perception. There are indeed some issues with the law, but none of them are commonly known, and they come from surprising sources. Indeed, despite the description of the law as “tyrannical,” perhaps the factor that is most hurting the law’s effectiveness right now is its weakness and difficulty in being enforced. Not helping it of course has been its startling complexity, which has sown much confusion into the minds of the public. The depths of confusion surrounding the law are truly troubling considering its wide-reaching ramifications, to the point where it has become one of the defining laws of the Obama presidency and has completely changed the landscape of healthcare and insurance. As insurance premiums (their cost for the consumer) dramatically increase next year, it is more important than ever to understand and solve the issues of the Affordable Care Act. To clear some of the smoke, I spoke with Dr. Harold Pollack, a distinguished professor at the School of Social Services Administration. To him, it was quite clear why premiums were going up, although the reasons were actually heavily counterintuitive. Rising premiums have commonly been blamed on the “lack of competition” and regional monopolies, but, according to Professor Pollack, “the problem is that there is too

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little monopoly.” This is especially a problem to states that have failed to expand Medicaid. The marketplace system, created by the ACA’s strongest critics as a continuation of the old system of insurance sale through a unified front, was meant to prevent rising costs by allowing competition, but has instead created multiple different levels of fragmentation — companies that are on the marketplaces, companies that have given up on the marketplaces, low premiums, high premiums, etc., not to mention the fragmentation in states where not all insurance providers are required to operate on the marketplace, splitting the wealthy who have always gotten their insurance from independent brokers and new insurance-holders who use the marketplace. Because of this, most insurance companies lack the leverage to deal with healthcare providers and pharmaceutical companies because they do not represent a significant enough number of individuals for these other companies to need their business, and so insurance companies must pay what these other large companies demand. Because of the illegalization of predatory practices relying on raising premiums and refusing treatment for those who became sick (the old way insurance companies made money), the pay for treatment premiums had to go up. Though initially this policy seems to mean that the ACA is costing us more, the fact is that before the ACA, insurance premiums were often giving money for nothing so if you got seriously ill, your treatment could be refused.

Now, higher premiums still guarantee treatment.

Still, premiums are steadily increasing because of these fragmentations. This is another place of confusion. Again, according to Professor Pollack, “about two-thirds of people whose premiums are rising should not feel much change because of rising subsidies covering the costs” — though he does note that for the other third, it is a serious problem. Most of the people in this group are middle class individuals and families who have too much income for subsidies but not nearly

enough to pay for the rising costs. While the ACA definitely still helped these people in other ways such as protecting them from the major dangers of predatory practices, in the material sense, the prices they pay still haven’t significantly decreased.

However, the interesting part of this issue is that it most strongly affects states that have tried to avoid the ACA and have refused to expand Medicaid. In states where the ACA has been embraced and Medicaid has been expanded, these problems are much easier to deal with and of much lesser magnitude, as Medicaid has much more leverage than individual insurance companies, and drives premiums down statewide. “Everyone was worried about stodgy old Medicaid, but it turns out that stodgy old Medicaid is far more effective than market forces at providing health insurance,” said Pollack.

Medicaid has much greater leverage than normal insurers. It pays one price and one price only, and hospitals and healthcare providers that refuse to pay lose the entirety of the potential revenue from Medicaid. How strong a cost-reducing force this is matters based on state, however. In states without expanded Medicaid and a very large insured populace, it might be possible for healthcare providers to refuse Medicaid

“

much less than what providers are charging, other insurers have leverage to pay less as well, allowing the reduction of premiums for all insurance providers. It’s clear that Medicaid is the most effective part of the ACA, but it is also one of the more controversial elements, as critics see it as “socialist medicine” that is worse than the private industry, despite the fact the Medicaid has been historically successful. Many states, especially in the southeast, continue to refuse to expand Medicaid and it is hurting their citizens, especially the middle class.

Unfortunately, expanding Medicaid is a very difficult case to make, especially to the middle class so hard hit by its constriction. Medicaid does not contain a very politically powerful demographic because of low funding, and therefore it’s a hard sell to those who do not receive the benefits of Medicaid (the middle class) to expand it. It’s a vicious cycle of lacking funding which then prevents increasing funding and thus causes lack of funding. However, it is the ACA’s path forward in the future and definitely has potential.

While representatives in the House have no real obligation to accept and negotiate the law, governors have to secure funding for state hospitals and other healthcare systems, and

The ACA is part of America now. For politicians to try and destroy it is to uninsure hundreds of thousands, and is only a loud pipe dream.” and still make money. However, in states with expanded Medicaid, refusing Medicaid means losing a huge amount of business, and if Medicaid is paying

Medicaid expansion provides a massive potential gain in funding. As the ACA becomes a more central part of America, conservative governors will

feel more and more pressure to expand Medicaid with less fear of political reprisal, meaning they will be willing to play ball.

It won’t be easy, but it also isn’t impossible. The most important part of negotiations, according to Professor Pollack, is to “give them something to take back to their voters” — some small contentious but irrelevant trifle, demonstrating token resistance to Republican voters without actually preventing Medicaid expansion. That way, the best parts of the ACA can be allowed to work without causing additional backlash, ultimately helping even the law’s enemies, making the majority of the citizenry appreciative instead of angry.

The ACA is part of America now. For politicians to try and destroy it is to uninsure hundreds of thousands, and is only a loud pipe dream. Much like the original Medicaid of Lyndon B. Johnson’s war on poverty, it will take years for the most conservative states to accept it, but it will eventually happen. Medicaid has proven its effectiveness in funding healthcare, as states that have expanded have halved the cost of Medicaid compared to states that did not expand it, and more people than ever are finally covered by insurance.

The success of Medicaid has proven the effectiveness of the ACA — it keeps premiums low, and prevents the common health insurance horror of the hidden cost and secretly massive bill. The ACA might have problems, due to its weak enforcement and still-lacking funding for Medicaid keeping the struggling middle class out of the Medicaid bracket, but the solutions are clear, and if those solutions are embraced, the post-ACA age will most definitely be better than the previous era.

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INFECTION CONTROL IN HEALTHCARE SETTINGS WHICH WAY IS THE RIGHT WAY?

BY KIERSTEN CROUSE

Infection control units oftentimes fulfill a dual purpose in a hospital. On one hand, they ensure that the hospital complies with all infection control protocols set (i.e., using gloves and alcohol wipes frequently, labeling doors with the isolation protocol that corresponds to the infection at hand, educating patients and visitors to the patient’s condition, etc.).

On the other hand, however, they play a retrospective role in the prevention of healthcare-associated infections (HAIs).

For a while, completing both of these roles was my job. As a result, after searching — for hours on end — through the medical records of patients who had suffered from HAIs, I thought I had a pretty good grasp on what to expect from the data I was collecting.

Surely, the majority of HAIs were entirely due to unhygienic facilities, tools, and the failure of personnel to properly isolate patients from the environment.

As I continued to abstract data from the records, however, I noticed – as many infection control researchers are also noticing – that our patients mainly developed HAIs after being subjected to a rigorous dose of antibiotics. With more searching, I began to be able to predict these infections like clockwork. Broad-range antibiotics seemed to lead — at least for many at-risk patients — inevitably towards one of the common multiple drug-resistant, healthcare-associated infections (such as C. diff, MRSA, CAUTI, CLABSI, etc.).

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Thus, the data revealed what I least expected: though hygiene does have a lot to do with the onset of antimicrobial resistant infections, major causes of these infections reflect the work of healthcare practitioners in administering antibiotics.

Although they obviously mean well in administering these antibiotics, the intervention of a healthcare practitioner seems to paradoxically exacerbate the problem.

The issue of rampant infections being treated widely today is not new; however, the fact that infections now originate in these supposedly safe settings and take on antimicrobial resistant forms is concerning.

The generally accepted explanation for the emergence of HAIs specifically is, as previously stated, mainly an issue of hygiene. In the most immediate way, if a patient’s environment is not sterilized after the patient is discharged, the microbes present in the room can spread to other patients. This lack of sterility turns into a greater problem when taking into account visitor traffic, as well as the spread of germs by healthcare workers.

While the emergence of multiple-drug-resistant organisms (MDROs) in the healthcare setting could potentially be explained by this phenomenon as well, researchers are now starting to point to what I also observed while doing research: the rampant and often clumsy use of antibiotics significantly contributes to the onset of MDROs. Healthcare practi-

tioners realize the potentially harmful effects of using too many antibiotics, but it is still widely accepted that the use of broad-range antibiotics is inherently useful in deterring the growth of a potentially resistant organism. In fact, treatment algorithms specifically prescribe antibiotics in a way that seems to value brute force over careful selection of antibiotics. In this way, there seems to be an inherent disconnect between the generally accepted method of treating infections and the growing need for antimicrobial stewardship.

Going forward, many propose the aforementioned idea of antimicrobial stewardship as the way to stamp out the persistent growth of MDROs present both in healthcare settings and in the outside environment. By limiting the amount of antibiotics used, and by being more thoughtful when prescribing (perhaps by going beyond the standard treatment algorithm that favors force over consideration), healthcare practitioners should see less cases of hospital-onset infections, and may eventually find the frequency of MDRO-associated infections to be lower.

Of course, it’s difficult to take a more prudent approach when brute force could eventually work as a less-complicated method. However, given the rapid growth of MDROs, it may be useful to think in the longterm when treating patients in real time.

HOW TO SELL YOURSELF ON YOUR MED SCHOOL APPLICATION BY You start writing your medical school applications years before you press submit. The best way to sell yourself to a medical school is to start thinking about your passions, interests, and future goals early. Provide yourself with the right tools to piece together a great application.

Think about your application from the perspective of an admissions officer — they read thousands of applications every year. This means that an integral part of the admissions process is making sure you can grab your reader’s attention and stand out amongst other applications — whether you’re a published poet, a varsity athlete, or the founder of your own company.

So, how do med schools evaluate applicants?

To start, you need to meet the academic requirements. A good baseline to set yourself is at least a 3.5 GPA and around a 510 on the new MCAT. That being said, your GPA and MCAT score are not everything. Most med schools will look at your application from a holistic point of view, keeping two things in mind: 1) a passion for medicine and 2) a passion for helping others.

In thinking about these parameters, you should also consider how you can tie together all of your activities, academic interests, and research experience to tell a compelling story on your application. You should have a “theme” or “persona” in mind as you write your essay, fill out your activities, and ask your supervisors

or professors for letters of recommendation. An admissions officer should be able to put down your application and have a clear idea of who you are as an applicant.

For example, if you’re passionate about a specific field, such as Alzheimer’s research, you should find similarly related experiences. Remember, not all research needs to be basic science research; you can find opportunities to help with clinical or public health research as well. You should supplement this academic interest with extracurriculars and community service to match.

If we take this example of Alzheimer’s research, volunteering with patients at a senior care center could be a great way to line up your interests with your service work.

Make sure to highlight leadership and initiative.

Other than joining an organization, you could start your own or try to gain valuable leadership experience in existing organizations.

The best way to sell yourself is to tell a clear, compelling, unique story of who you are and why you want to become a doctor. Schools are looking for candidates who want to go to med school, know why they want it, and can articulate that through their application.

If you would like to discuss your individual application to med school, you can email hannah@ingeniusprep.com!

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STEPPING OUT OF THE SHADOWS

BY FATIMA SATTAR Featuring: Aliya Moreira, Camelia Malkami

Talk to any pre-med and you’re likely to hear that they’re juggling some sort of research with volunteer hours, RSOs, and finally shadowing opportunities, all while trying to keep a stellar GPA. While it seems like, among all this, shadowing would be the last on a pre-med’s list of priorities, the experience can be very rewarding. With the insight it offers into the field of medicine, the shadowing experience greatly lends itself to reaffirming a student’s decision to continue on the pre-med track and is definitely a must for anyone aiming for med school.

PULSE recently sat down with some pre-meds in the College to gain some more insight into the world of shadowing. Aliya Moreira (’17) and Camelia Malkami (’19) spoke with us about everything to do with their shadowing experiences, from how they obtained their opportunities to exciting stories on the job to their takeaways.

What are some of the fields that you shadowed in and what did your dayto-day schedule usually look like?

Camelia Malkami (‘19)

Aliya Moreira (‘17)

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CM: I shadowed in pediatric orthopedics, so I got a taste of the pediatric side of dealing with kids and seeing the orthopedic side. I got to shadow surgeons in the OR [operating room], as well as PAs [physician assistants] in the clinic. I had a lot more patient interaction in the clinic. There were a lot of kids who came in with sport injuries, lots of sports injuries.

AM: First quarter, I was matched with a psychiatrist, second quarter with a pediatric oncologist, and third quarter with a breast cancer physician.

The psychiatrist I shadowed mostly worked with in-patients.

She saw patients with anger management, anxiety, depression, and all sorts of things. She saw mostly patients from the South Side, which was really interesting. These were people who need[ed] medication to treat their illnesses. In psychiatry, the doctor had two residents under her. The resident would

be with a patient in the room essentially just talking to the patient to get some history, symptoms, and environmental factors. What impressed me the most about her was that she saw the patients for such a short amount of time, but was still able to connect with them really well. Second quarter was a very different experience, which is why I think it’s really important to shadow in different fields. It was a much more team-based experience. This experience was really cool because I got to see the same patients every week and see more of the longitudinal effects. It was interesting to see the research, the teamwork, and even the emotional support that the doctors provide for each other.

How would you compare and contrast volunteering and shadowing?

CM: Sometimes, there’s not a whole lot you can do as a volunteer, especially when you’re working at big name hospitals.

They don’t want to have to worry about risks and liabilities. The shadowing that I did this summer while shadowing a

doctor allowed me to see more.

If you can find a specific doctor, you get to see and do more.

all, I don’t really see any huge drawbacks.

AM: It’s a lot of time and can be

How did you find your a lot more emotional than you shadowing opportunity? would expect. It’s really importCM: It was a summer internship. I went on the alumni database and emailed everyone in my hometown who was in the medical field or healthcare.

Most responded and even if they didn’t have something to offer, they would pass my email on to someone else who did. I actually got it through someone who forwarded my email.

I probably sent out about 30 or 40 emails. I enjoyed it more than going off of Handshake.

My UCIHP advisor had actually recommended me to take this route. It’s nice to directly email someone, and it’s not an application that you’re sending out.

People usually are really nice.

AM: I shadowed through the UCIHP Clinical Excellence Scholars program. They require a year of shadowing for the program, but you can also apply to just the shadowing part of the program. Each quarter they match you with a physician based on availability and your preferences.

What are the drawbacks of shadowing?

CM: Shadowing can sometimes be boring because you’re on your feet a lot. I would have to stand for hours and hours at a time. For example, I was in the OR and had to stand for a long time to see the surgery. You’re following whatever the doctor is doing, and you still get to see and experience a lot. If you’re actually interested in the field, it shouldn’t be boring. You also have to make sure you’re not a hindrance to the doctor. You’re there for the doctor and want to be as helpful as possible. Over-

ant to spend some time thinking about that and unloading that so you don’t get caught up in these moments. It’s definitely something to think about.

Don’t just schedule shadowing in between lab and class, but spend some time unloading those experiences.

How has your shadowing experience contributed to your decision to continue on the pre-med track?

CM: It’s really hard to know if you are interested in something unless you see it firsthand and see the people who are carrying it out on a daily basis. The experience definitely confirms, or maybe refutes, your decision.

It definitely teaches you about yourself and helps you realize whether you like medicine or not. Maybe you realize this specialty isn’t for [you]. For me, I wasn’t even considering surgery until this summer. I got to watch some surgeries in the OR and it was amazing. It grew my interest in surgery, which I never thought I would want to pursue. Also, it gives you a realistic image of all the good and the bad that goes on. You get a more realistic picture of what the job is.

AM: Shadowing really reinforced my decision to follow a physician’s career. It definitely opened my eyes to the realities of the field, especially psychiatry. It showed me that it was very different from what I thought. It’s hard to understand a field until you’re there. Obviously, ten weeks is not enough, but it can give you a good taste.

It definitely made me want

to be involved in psychiatry.

It changed my understanding of psychiatry. I thought it was a lot of therapy and counseling, but it was definitely more medication-focused than I had expected.

Do you have any general advice about shadowing that you want to share?

CM: Definitely take a look at the alumni database. Try to find individual doctors rather than applying to bigger organizations. Reaching out to the doctor is key. You can form a relationship with that doctor and you get to more closely pick who you want to shadow.

AM: I would definitely recommend shadowing in different fields because it shows you the harder realities of the job, not just the where you go and what you do. I definitely recommend shadowing first or second year because you have a lot more time and it’s a good time to start exploring medicine and figure out where you want to focus.

Clinical Excellence Scholars multi-year program designed to prepare students for the realities of a career in medicine while providing guided participation in relevant opportunities on campus.

UCIHP has partnered with UChicago Medicine and the Bucksbaum Institute for Clinical Excellence to develop and implement opportunities for interactions between students and physicians at UChicago. First-year scholars are accepted into the program each spring, and will begin the program beginning in the autumn quarter of their second year.

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REFERENCES AND CITATIONS AUTUMN RECAPS

Steinbach, Adriana. “Nanotechnology harnesses power of light to deliver immunotherapy for cancer.” Science Life. September 27, 2016. https://sciencelife.uchospitals. edu/2016/09/27/nanotechnology-harnesses-power-of-light-to-deliver-immunotherapy-for-cancer/ Klein, Alice. “Stopping brain protein from going rogue may prevent Alzheimer’s.” New Scientist. November 17, 2016. https://www.newscientist.com/ article/2113189-stopping-brain-protein-fromturning-rogue-prevents-alzheimers Robbins, Rebecca. “A huge change is coming to the insulin market.” STAT via The Week.

October 31, 2016. http://theweek.com/ articles/656203/huge-change-coming-insulin-market Tedeschi, Bob. “Pop-up pill could stay in stomach to release drugs for days.” STAT. November 16, 2016. https://www.statnews. com/2016/11/16/popup-pill-drug-release/ Vaughan, Christopher. “Withholding amino acid depletes blood stem cells.” Stanford Medicine News Center. October 18, 2016. http://med. stanford.edu/news/all-news/2016/10/withholding-amino-acid-depletes-blood-stem-cells. html Hamzelou, Jessica. “First home brain implant lets ‘locked-in’ woman communicate.” New Scientist. November 12, 2016. https://www.newscientist.com/ article/2112562-first-home-brain-implant-letslocked-in-woman-communicate/ Collins, Francis. “Regenerative Medicine: New Clue from Fish about Healing Spinal Cord Injuries.” NIH Director’s Blog. November 15, 2016. https://directorsblog.nih.gov/2016/11/15/ regenerative-medicine-new-clue-from-fishabout-healing-spinal-cord-injuries/ Digitale, Erin. “Traumatic stress changes brains of boys, girls differently.” Stanford Medicine News Center. November 11, 2016. http:// med.stanford.edu/news/all-news/2016/11/ traumatic-stress-changes-brains-of-boys-girlsdifferently.html Joseph, Andrew. “Field trial of genetically modi-

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fied mosquitos gets approval in Florida.” STAT. November 19, 2016. https://www.statnews. com/2016/11/19/florida-genetically-modified-mosquito-trial/ Saplakoglu, Yasemin. “Biomarker measurements may help track effectiveness of Huntington’s therapy.” Scope. November 22, 2016. http://scopeblog.stanford.edu/2016/11/22/ biomarker-measurements-may-help-track-effectiveness-of-huntingtons-therapy/ Poroyko, Valeriy A., Alba Carreras, Abdelnaby Khalyfa, Ahamed A. Khalyfa, Vanessa Leone, Eduard Peris, Isaac Almendros, Alex Gileles-Hillel, Zhuanhong Qiao, Nathaniel Hubert, Ramon Farré, Eugene B. Chang, and David Gozal. 2016. “Chronic Sleep Disruption Alters Gut Microbiota, Induces Systemic and Adipose Tissue Inflammation and Insulin Resistance in Mice.” Scientific Reports 6, Article number: 35405. doi:10.1038/srep35405

GLOBAL HEALTH ON SOUTH SIDE

Epstein, H., & Ashburn, K. (2004, February).

Why is AIDS Worse in Africa? Discover Magazine. Retrieved from http://discovermagazine. com/2004/feb/why-aids-worse-in-africa Cauterucci, C., & Bouie, J. (2016, June 17).

The First Citywide Program to Get Black Women on PrEP Is Coming to Washington, D.C. Slate. Retrieved from http://www. slate.com/blogs/xx_factor/2016/06/17/ the_first_citywide_program_to_get_black_ women_on_prep_is_coming_to_washington. html Sternberg, S., & Gillum, J. (2011, July 11).

Lack of education fuels HIV epidemic in South. Retrieved November 13, 2016, from http://usatoday30.usatoday.com/yourlife/ health/2011-07-10-HIV-AIDS-south_n.htm

OPIOID EPIDEMIC

“Understanding the Epidemic.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 2016. Web. 13 Nov. 2016.

“TurnTheTideRx | Surgeon General’s Call to End the Opioid Crisis.” TurnTheTideRX. N.p., n.d.

Web. 12 Nov. 2016.

“NIH Fact Sheets - Heroin Addiction.” N.p., n.d.

Web. 12 Nov. 2016.

“Opioids: From ‘Wonder Drug’ to Abuse Epidemic.” CNN. Cable News Network, n.d.

Web. 18 Nov. 2016.

“A Call to Action: Physicians Must Turn the Tide of the Opioid Epidemic.” AMA Wire. N.p., 2016. Web. 12 Nov. 2016.

ZIKA VACCINE

“Polio.” DISEASES and the VACCINES THAT PREVENT THEM (n.d.): n. pag. Centers for Disease Control and Prevention, Feb. 2013.

Web. “Sierra Leone Trial to Introduce a Vaccine against Ebola (STRIVE) Q&A.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 20 Apr. 2016. Web. 14 Nov. 2016.

“Looking, Hopefully, towards an Ebola-free Future.” World Health Organization. World Health Organization, Apr. 2016. Web. 14 Nov. 2016.

“All Countries & Territories with Active Zika Virus Transmission.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 05 Oct. 2016. Web. 14 Nov. 2016.

“Zika Virus Vaccines.” U.S National Library of Medicine. U.S. National Library of Medicine, 18 Aug. 2016. Web. 14 Nov. 2016.

Wittenberg, Rachel. “Developing an Oral Zika Virus Vaccine Using Attenuated Bacillus Anthracis Spore Technology.” Personal interview. 1 Nov. 2016. [Schneewind, Missiakas unpublished] “Zika and Guillain-Barré Syndrome.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 09 Aug. 2016.

Web. 14 Nov. 2016.

POTENTIALS OF CRISPR

Jurassic Park. Dir. Steven Spielberg. Screenplay

by Michael Crichton and David Kopek. Universal Pictures, 1993. Film.

Park, Alice. “A New Technique That Lets Scientists Edit DNA With Ease Is Transforming Science— And Raising Difficult Questions.” TIME 4 July

2016: 42-48. Print.

“CRISPR/Cas9 Guide.” Addgene: CRISPR/Cas9 Guide. N.p., n.d. Web. 21 Nov. 2016.

Barrangou, Rodolphe, and Jennifer A. Doudna.

“Applications of CRISPR Technologies in Research and beyond.” Nature Biotechnology.

N.p., 8 Sept. 2016. Web. 21 Nov. 2016.

Salomon, Daniel R., M.D. “A CRISPR Way to Block PERVs-Engineering Organs for Transplantation.” Ed. Elizabeth G. Phimister. The New England Journal of Medicine (2016): 1089-091. Web. 5 Nov. 2016.

“Broad Institute.” Feng Zhang | Broad Institute.

N.p., n.d. Web. 21 Nov. 2016.

Kaiser, Jocelyn. “First Proposed Human Test of CRISPR Passes Initial Safety Review.” Science | AAAS. N.p., 21 June 2016. Web. 28 Oct. 2016.

Organizing Committee for the International Summit on Human Gene Editing. “On Human Gene Editing: International Summit Statement.” Nationalacademies.org. N.p., 3 Dec. 2015. Web. 10 Nov. 2016.

Blendon, Robert J., Sc.D., Mary T. Gorski, Sc.M., and John M. Benson, M.A. “The Public and the Gene-Editing Revolution.” The New England Journal of Medicine (2016): 1406-411. Web. 21 Nov. 2016.

Digital image. Medical Literature Society at UCLA. N.p., 25 May 2016. Web. 21 Nov. 2016.

McGovern Institute For Brain Research At MIT. Digital image. Medical Futurist. N.p., 18 Oct. 2016. Web. 21 Nov. 2016.

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