UChicago PULSE Issue 8.3: Spring 2022

From The Editors-In-Chief

Dear Reader,

The temptation to create a post-pandemic retrospective - and then another, and then another - has been almost overwhelming since we assumed this role in mid-2021. In crafting this issue, we’ve had to come face to face with a brutal truth: the pandemic isn’t over, and may never be, at least in the sense of returning to a world that exists without the scars of COVID-19. What we have instead is a world coming to terms with the reality that COVID-19 has created around us, in a world that was already being marked by tremendous change and upheaval. And of course, as the world shifts, so too does the field of medicine. Every few months, as we go to compile our next issue, we find that our understanding of science and healthcare has already progressed by leaps and bounds. In this particular issue, we’ll explore everything from physician shortages to contraception, cancer treatments to chronobiology, a winding path through everything our team has on their minds as another school year comes to a close. As always, we hope you enjoy the read, and please contact us with any questions or comments.

EJ Beck and Jack Osborn

Editors in Chief

Editors Writers Cover Layout

Sophia Cariño

Fareen Dhuka

Sophie Hu

Riley Hurr

Aman Majmudar

Eva McCord

Eve Tanios

Stephanie Wu

Rachel Zhang

Sanaa Imami

Miles Kaufman

Caroline Kellogg

Adam Kunz

Karen Liao

Ayman Lone

Carlos ChavezRamirez

Neeharika Venuturupalli

Sam Goslin

Katrina Schmitt

Cancer Treatments: Past, Present, and Future

Sanaa Imami, Aman Majmudar

In 2013, Adrienne was diagnosed with metastatic, or actively spreading, ampullary cancer, a rare cancer that forms in the digestive tract. After thirteen months of aggressive chemotherapy, Adrienne’s cancer continued to metastasize; the cancer was simply not responding to the harsh treatments that wreaked havoc on her body. Perhaps Adrienne was out of options.

As with Adrienne’s case, cancer can quickly, and sometimes silently, proliferate throughout the body. Since cancer often begins abruptly and doesn’t follow the same pattern of spread and proliferation for all patients, it’s often difficult to generate effective treatment plans. This, coupled with the historic lack of specialized cancer treatment, has made it incredibly difficult for professionals to treat the disease. However, new promising forms of treatment, like immunotherapy, have revolutionized the field of oncology.

Cancer treatments are sorted into three categories: primary, adjuvant, and palliative. Primary treatment serves to eradicate cancerous cells from the body as the first line of attack against them. Common forms of primary treatment include surgery, as well as chemotherapy and radiation. Surgery is especially effective against benign tumors— tumors that aren’t actively proliferating—while other treatments like chemo or radiation can work better against certain sensitive types of cancers. Adjuvant treatment works as the second line against cancer—after primary treatment, adjuvant treatments are used to ensure that there are no remaining malignant cells in the body. These serve as precautions to ensure that cancer won’t return due to trace cells, and include additional rounds of chemo, radiation, or hormone therapy. Palliative treatment serves as relief from the toll that cancer, as well as primary

and adjuvant treatments, impose on the body, as many of them can significantly lower immune response and cause pain. Combining these three types of treatments is currently the most effective method of attacking and neutralizing cancer in the human body.

Chemotherapy is arguably the most prescribed and well-known cancer treatment today. Chemotherapy refers to a collection of drugs administered to prevent cancerous cells from replicating and metastasizing. Chemo drugs can target malignant cells in many ways. They target the DNA or RNA of mutated, cancerous cells, forcing them to stop dividing and continuing the steps of the cell cycle. Different drugs target different stages in the cell cycle; a group of drugs called alkylating agents, for example, target cells throughout all stages of the cycle by stopping DNA from being transcribed into RNA

and eventually translated into proteins. Other drugs, like nitrosoureas, can prevent proteins in cancer cells from repairing damaged DNA, thereby inhibiting DNA replication and repair.

Chemotherapy is often used concurrently with radiation therapy. Radiation therapy serves a more singular purpose. It features highly concentrated radiation beams, aimed directly at the tumor, that damage the DNA of cancerous cells, causing them to undergo apoptosis, or programmed cell death. While this form of treatment can effectively degrade the tumor, it cannot address potential metastasis—the spread of malignant cells throughout the body.

Chemo and radiation can be effective in certain stages and types of cancer, but not all of them. In fact, for certain types of cancer, once the cells have metastasized throughout the body,

This is because these primary treatments are designed to target localized cancer before the malignant cells begin to proliferate uncontrollably. To combat distant or metastasized cancer, many new treatments have emerged as potential methods. Several are undergoing the clinical trial phases with much promise. One new primary treatment is immunotherapy. Immunotherapy works much differently from other primary treatments. This treatment, rather than using drugs or radiation, primes and equips the body’s immune cells to fight against malignant cells. In general, the immune system does not recognize cancerous cells as foreign to the body, so they are seen as unthreatening; tumors also employ methods that can inactivate immune cells that try to attack them. But immunotherapy introduces new signals to the body’s immune response, so immune cells can be signaled to find and attack malignant

cell growths throughout the body. If a tumor can inactivate these immune cells even after they’ve been primed, immunotherapy introduces other molecules into the body that can bind to the tumor, restricting it from incapacitating the body’s immune response. While immunotherapies must be specialized, new formulations of immunotherapy drugs and treatments are approved quickly, making this type of treatment one of the mostpromising recent discoveries.

The field of cancer therapy has increased rapidly as new technologies and methods of treating the disease have proven to have significant potential. Adrienne was one such patient who, after several unsuccessful rounds of chemotherapy, enrolled in a clinical trial for an immunotherapy drug called pembrolizumab. The drug worked by priming Adrienne’s natural immune cells to fight against her cancer, and it worked—in just two months of treatment, Adrienne’s cancer was gone. In the future, cancer patients will have similar experiences as Adrienne, who, after two years of additional, minimal treatments to ensure all of her cancer was eliminated, is able to live life cancer-free thanks to her immunotherapy treatments. Adrienne’s story is a prime example of the efficacy of more personalized, tailored plans of treatment meant to eradicate cancerous cells once and for all.

Chronobiology and Health

Carlos Chavez Ramirez, Sophia Cariño

Have you ever pulled an all-nighter or skipped multiple meals? If so, you probably felt your body trying to restore your altered rhythms by making you feel very drowsy or hungry. Many different behaviors have been found to be regulated by endogenous rhythms. The cyclic aspect of biological functions allows organisms to align to environmental stimuli (such as cycles of sunlight or food availability in different seasons). The field of chronobiology examines the development, disruption, and evolutionary significance of these cyclic behaviors.

Chronobiologists manipulate organisms’ rhythms by putting their rooms in either strict 12-hour light/12-hour dark cycles or in constant light/darkness for long periods of time and then measuring their activity, drinking, or eating rhythms. Additionally, they can take blood samples at specific intervals over some time and measure the

concentration of different proteins over time.

Prior to the industrial revolution, human activities were limited to the range of time with daylight; however, technological advances have allowed societies to expand their active timeframes into the night. Exposure to artificial light indoors, shift work, jet lag, and different sleep patterns in weekdays and weekends are all unique phenomena that interfere with natural cycles of light exposure and sleep. The effects of these unnatural changes in circadian rhythms on physiology and cognition are summarized below.

A group of researchers restricted food availability in rats to either the light phase or the dark phase of their cycles and then measured their changes in body mass. It was found that rats fed in the light phase had higher weight gain when compared to rats fed in the dark phase (Arble et al., 2009). A theory

proposed by the authors was that there were varying concentrations of satiety hormones in the experimental groups. The authors thought their results could provide some insight into obesity treatments in humans. Although non-human animals cannot be diagnosed with depression, some depressive-like symptoms can be identified in model organisms such as rodents. In a study aiming to find relationships between circadian rhythms and depression-like symptoms in rats, researchers found that exposure to light at night alone caused an increased rate of anhedonia (lack of pleasure) and higher rates of surrendering in conditions of stress (Walker et al., 2019).

Another rodent study found that rats who were jet-lagged had significantly higher mortality levels than rats who were not subjected to time advances or delays (Davidson et al., 2006). The same research group later subjected rats to chronic

circadian desynchrony by shifting the rats’ schedules and turning the lights on 6 hours earlier each week to resemble jet lag. Rats that were subjected to circadian desynchrony showed weaker immune responses, as was shown by their lower concentrations of cytokines – proteins released by cells in the immune system that help fight infections – both in vivo and in vitro (Castanon-Cervantes et al., 2010). These altered immune responses were not due to sleep loss or heightened stress levels, since both measures were normal in rats with circadian disruptions. Both of these experiments provide some evidence for the claim that circadian desynchrony has detrimental effects in an organism’s immune system. All of the data above comes from rodent experiments, so there are some limitations to the degree to which the results can be generalized. However, several human studies have been performed showing det-

rimental effects to health based on timing of events alone. A study found that the time of administration of two anticancer drugs had significant effects on the toxicity of these drugs (Hrushesky, 1985). The varying concentrations and activities of enzymes interacting with these drugs throughout the day is likely the reason behind the different responses to these drugs. This means that hospitals could minimize the side effects of these drugs by changing their schedules of drug administration.

Neonatal intensive care units (NICUs) are branches of hospitals that provide care for premature or sick babies. Since these infants need constant care and feeding, the lights are always kept on, allowing nurses and doctors to care for them. However, this places infants in an unnatural lighting environment that could be detrimental to their health. A study in a Mexican public hospi-

tal found that by placing premature babies in a light cycle of 12 hours of light and 12 hours of darkness (by placing a cloth over their heads), the babies ate more, had a faster weight gain, better oxygen saturation, and a shorter hospital stay than those that remained in the constant light conditions (Vasquez-Ruiz, 2014). This highlights an opportunity for other NICUs to improve the well-being of premature and sick babies by performing the small change of giving them a light/dark cycle instead of constant light.

Although the studies above highlight the potential benefits of incorporating chronobiology into healthcare, it is unlikely that they will be implemented at a large scale anytime soon. Hospitals have specific schedules already established, so it would be difficult for a largescale change to occur where drugs are administered at different times (some of which could be well into the night) for each patient. In addition, it is difficult to ensure that people develop and stick to a routine on their own.

Actions at the individual level can help. People should try to have a constant sleep and meal schedule that remains the same even in the weekends. This will ensure that your endogenous rhythms are synchronized, and your body does not need to accommodate to daily changes in sleep and meal times.

References:

Arble, D. M., Bass, J., Laposky, A. D., Vitaterna, M. H., & Turek, F. W. (2009). Circadian timing of food intake contributes to weight gain. Obesity (Silver Spring, Md.), 17(11), 2100–2102.

Castanon-Cervantes, O., Wu, M., Ehlen, J. C., Paul, K., Gamble, K. L., Johnson, R. L., Besing, R. C., Menaker, M., Gewirtz, A. T., & Davidson, A. J. (2010). Dysregulation of inflammatory responses by chronic circadian disruption. Journal of immunology (Baltimore, Md. : 1950), 185(10), 5796–5805.

Davidson, A. J., Sellix, M. T., Daniel, J., Yamazaki, S., Menaker, M., & Block, G. D. (2006). Chronic jet-lag increases mortality in aged mice. Hrushesky W. J. (1985). Circadian timing of cancer chemotherapy. Science (New York, N.Y.), 228(4695), 73–75.

Vásquez-Ruiz, S., Maya-Barrios, J. A., Torres-Narváez, P., Vega-Martínez, B. R., Rojas-Granados, A., Escobar, C., & Angeles-Castellanos, M. (2014). A light/dark cycle in the NICU accelerates body weight gain and shortens time to discharge in preterm infants. Early human development, 90(9), 535–540.

Obesity and the Western Diet

Karen Liao, Eva McCord

From late-night pizza to ice cream, from impromptu grilled cheese sandwiches to grabbing drinks with friends, college affords students a newfound freedom: control, or rather a lack thereof, over what they eat.

After all, we’ve all experienced the urge to grab a cookie on our way to class, or to leave the dining hall with just one more to-go box full of fried chicken. In the midst of hectic academics, these all sound like familiar, stress-relieving activities. However, beyond weight gain–which can be a normal occurrence, regardless of one’s diet–  specifically bad eating habits expose our bodies to the risks of developing chronic diseases.

Obesity is a significant health issue in the United States. According to a Harvard Public Health study, 71.6% of adults aged 20 and over are overweight, with the metric encompassing those who are obese, and this number continues to grow. By

2030, nearly one in two adults will be obese. But why exactly are these statistics so important to address? Obesity may give rise to numerous diseases, such as certain types of cancer, cardiovascular disease, type 2 diabetes, depression, and other chronic diseases.

To circumvent this reality, more and more physicians and dietitians alike are working toward developing specific kinds of diets for those who seek to develop healthier relationships with their weight. With the Internet and various social media platforms, diet information spreads faster and is more accessible than ever before, but can often leave people confused about what is “right” or “wrong,” and more importantly, which option is best for them and their unique needs. There are countless dieting methods available to choose from, ranging from the ever-popular vegan diet to nebulous (perhaps even misleading) Internet fads. But among these diets, which

are the most effective and sustainable diets that promote a healthy lifestyle– a lifestyle that centers around a good relationship with food, the fuel of our body?

Many methods on the Internet that claim to result in significant weight loss over a curiously short period of time are often no more than a hoax; your body is only losing water weight and muscle mass, rather than losing fat. The most sustainable way to diet is to gradually lose weight over a long period of time, and to ultimately find a healthy lifestyle that will benefit and strengthen your body. According to the CDC, healthy weight loss is defined as losing around one to two pounds per week. This article will introduce two popular diets supported by science, and ultimately how to execute them in your own lives.

1. Meditarrenean Diet  The Mediterranean Diet is based on the traditional cuisines of

of Greece, Italy, and countries close to the border of the Mediterranean Sea. While there are no strict rules for the diet, it encourages the consumption of fruits, vegetables, whole grains, seeds, fish, and healthy fats. Conversely, this diet limits processed foods with added sugar, refined grains, and trans fat. Converting from unhealthy fat to healthy fat is essential for the diet. As reported by Mayo Clinic, this diet has been found to promote heart health by slowing the progression of plaque buildup in arteries and supporting healthy blood sugar levels. Healthy fats, such as olive oil, provide monounsaturated fat that lowers total cholesterol and low-density lipoprotein cholesterol level, reducing the risk of stroke and heart failure. Furthermore, NIH study shows that the diet is beneficial for brain function decline for elders, and is tied to a lower risk of dementia and cognitive impairment.

How to implement it? Consider adding tomatoes, onions, spinach, apples, almonds, walnuts, beans, chickpeas, oats, salmon, sardines, extra virgin olive oil, or avocado to your diet.

2. Intermittent Fasting

This diet doesn’t focus on what to eat, but instead when to eat. Fasting for a certain number of hours each day can help your body burn fat. Researchers from Johns Hopkins supported that in the past people were used to going without food for a longer period of time because there was no access to the Internet so people generally sleep earlier and don’t eat after dinner. The extra calories we consume between standard meals add up, leading to increased risks of both type 2 diabetes and heart diseases. Intermittent fasting is a broad umbrella term, and can effectively be customized to anyone’s needs and goals, as they are all based

choosing regular time periods to either eat or fast. There are a wide range of health benefits: thinking and memory boosts, improved blood pressure, and reduced insulin resistance to protect against type 2 diabetes according to the results of NIH clinical trials.

How to implement it? Choose a fasting period that works best for you! A popular 168 intermittent diet is to eat only during eight hours and fast for the remaining six hours.

How to choose the best diet?

There’s no one best diet– find the most suitable one to help you sustain a healthy lifestyle! It’s all about balancing between macronutrients and paying attention to what you put into your body. Foods high in protein provide amino acids essential to building and repairing tissue and maintaining muscle. Carbohydrates are the body’s primary fuel that provides energy for muscle and the central nervous system. Fats are essential for energy reserve, and they provide insulation and protection for the body’s organs. Most importantly, a healthy diet builds a positive relationship with food and nourishes your body. It is challenging for students and people who work from the office to be able to prepare their meals every day, but there are still tactics to sustain a healthy and nourishing diet.

References

https://www.nytimes.com/2020/02/10/well/live/half-of-us-face-obesitydire-projections-show.html

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5959807/

https://www.cdc.gov/healthyweight/losing_weight/index.html

https://www.cdc.gov/obesity/basics/causes.html

https://www.cdc.gov/media/releases/2021/s0915-obesity-rate.html

https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/mediterranean-diet/art-20047801

https://www.healthline.com/nutrition/mediterranean-diet-meal-plan#benefits

https://www.health.harvard.edu/staying-healthy/should-you-try-theketo-diet

https://www.healthline.com/nutrition/ketogenic-diet-101#weight-loss

https://www.researchgate.net/publication/5693223_Overweight_and_ Obesity_Are_Associated_with_Emotion-_and_Stress-Related_Eating_as_Measured_by_the_Eating_and_Appraisal_Due_to_Emotions_ and_Stress_Questionnaire

https://academic.oup.com/aje/article/158/1/85/174075

https://health.clevelandclinic.org/keto-diet-and-heart-disease

The Impact of Private Equity in Healthcare

Neeharika Venuturupalli, Stephanie Wu

The United States healthcare sector has recently seen a surge in investments through private equity (PE) in order to address the issues of underfunding. This development has created controversy wherein a number of healthcare workers have begun advocating against PE, while financial advisors are actively encouraging increased PE involvement In this article, we will explore what PE is, how it is involved in healthcare, its benefits and negatives, and how to regulate the ethics of PE. Private equity is a source of financing from private investors instead of the public markets. These investors typically buy several shares or perform a complete buyout of the companies. PE investments are attractive to companies because it offers them high amounts of liquidated financial support, as opposed to bank loans which offer increasingly high interest rates. Those who work in PE firms believe that PE investment has the ability to

transform a struggling hospital into a successful business (success defined by profit rather than quality of care) and that it can increase innovation by making the business more competitive. The competitiveness of a company is defined by its success in terms of profit and marketability to both investors and consumers. However, many healthcare workers believe that PE buyouts actually decrease the quality of care in hospitals on top of other disadvantages. So the question is, how can these large liquidated investments be harmful to healthcare? To answer this, it is important to understand how PE investments work.

It is important to remember that private equity firms are not philanthropic in nature; they will only invest in a business if they see high profit margins for themselves. PE firms work by buying large portions of shares in healthcare systems and hospitals; many firms will even completely buy out a business. Then,

these firms will work to increase the profits of these healthcare systems through methods such as mergers and acquisitions (one of the most common methods), laying off workers, shutting down departments that don’t make profits, and changing insurance reimbursement rates. However, because all of these methods prioritize profit over all else, they can significantly and negatively impact the quality of care. Hospital mergers and shutting down departments are based on finances rather than medical importance. Decreasing hospital staff causes the current employees to be overworked which can lower the quality of care. Increasing hospital revenue by working with insurance providers makes healthcare more expensive for patients.

In fact, it was found that nursing homes funded and owned by PE firms had an increase in public and private funding by Medicare but a 10% higher death rate for those

with Medicare. Nurses also had to decrease individual patient interaction time due to worker layoffs. All of these methods, while increasing profits, neglect to keep quality of healthcare in mind.

Not only does private equity investment decrease the quality of care, it is also dangerous to the hospitals and healthcare systems themselves. PE investments are difficult to track because most acquisitions and mergers are not legally required to report PE involvement to antitrust and the Federal Trade Commission (FTC). In fact, when looking into the FTC violations in particular mergers and acquisitions, there appears to be a gap in data for funding sources. This could point to PE involvement, as other investment sources would have been reported. However, since the PE involvement was never legally reported, it becomes difficult to indict and regulate PE firms.

It has been suggested that regulation of private equity firms

could lead to more ethical investments, which would benefit hospitals and the greater healthcare system in the long term. Discussions of how to better regulate PE is important because PE firms will continue to invest in healthcare. One of the few regulations currently in place is that PE firms cannot directly harm patients in order to earn a profit. However, this federal law does not take into consideration indirect harms to patient care (such as decreasing resources and increasing healthcare costs). In fact, PE firms have financial protection from the risks they take, regardless of whether they positively impacted the hospital or not. Strides are being made to enforce greater restrictions on PE firms in healthcare. According to Senator Elizabeth Warren, PE firms tend to collect assets from companies, put them in a lot of debt, and then sell. In October 2021, Senator Warren introduced the Stop Wall Street Looting Act which overall aims to

to force PE firms to put healthcare and wellbeing before their own profit gains.

Ideally, private equity investments seem to be an advantageous option. They are a significant source of funding to struggling hospitals and aim to increase their revenue and thus increase the quality of their services. Underfunding is a huge issue for many hospitals and healthcare providers, so PE firms have the capability to help the healthcare system. Regulating PE firms and making them take on more risk will hopefully push PE investment in a positive direction moving forwards.

References

Alexander, L. M., Godwin, J. R., Scheffler, R. M. (2021, May 18). Soaring Private Equity

Investment in the Healthcare Sector: Consolidated Accelerated, Competition Undermined, and Patients at Risk. American Antitrust Institute Chen, J. (2022, March 20). “Private Equity”. Investopedia

Gupta, A., Gupta, A., Howell, S. T., Yannelis, C. (2021, March 2). Does Private Equity

Investment in Healthcare Benefit Patients? Evidence from Nursing Homes. National Bureau of Economic Research

Markey, J. A., Sarola, R. M. (2022, March 24). “Private equity, health care, and profits: It’s time to protect patients”. Stat

Nahas, F., Zitter, M. (2022, February 10). “Private Equity in Healthcare: What the Experts Want

You to Know”. Kenan Institute of Private Enterprise

Villines, Z. (2021, November 10). “What is private equity in healthcare?”. Medical News Today

Warren, E. (2021, October 20). “Warren, Baldwin, Brown, Pocan, Jayapal, Colleagues Reintroduce Bold Legislation to Fundamentally Reform the Private Equity Industry”.

Elizabeth Warren

Weldon, D. (2022, February 17). “Private investments in healthcare: What CFOs need to know”.

Health Leaders

The Growing Physician Shortage

Ayman Lone, Rachel Zhang

In a country where parents often dream of their children becoming doctors, television shows romanticize medicine, and a pandemic couldn’t stay off the news for two years, one might guess that medicine would be one of the most coveted and saturated professions in the United States. This could not be farther from the truth. America is facing a problematic physician shortage that is only projected to grow in the coming years. According to current “Health Professional Shortage Area” designations, America is over 13,000 primary care specialists and 6,000 psychiatrists short of providing sufficient access to physical and mental health treatment to areas in need. If America wants to provide healthcare access to these shortage areas, granting them the same caliber of resources available in more privileged areas, the country would need over 180,000 more physicians. This gap is only expected to grow; by 2035, there is an expect-

ed shortage of up to 50,000 primary care doctors, 14,000 internal medicine specialists, and 30,000 surgeons. With an aging and growing US population, these gaps appear even more concerning. How and why is one of the most well-respected and important professional fields in America experiencing these shortages?

In the past few years, the COVID pandemic has highlighted some of the many issues responsible for our inadequate physician supply. First is the issue of physicians leaving the field, whether it be due to old age or burnout. The AAMC reports that about 40% of physicians will be 65 or older within the next 10 years. 40% of working physicians also report feeling burned out at least once a week. This statistic was recorded prior to the pandemic, and it is quite likely that an even larger proportion of doctors are experiencing burnout with the onset of the pandemic. This combination of age and stress are

both factors that go into providers working less hours, retiring early, and practicing in urban or suburban areas. To expand on that last point, rural cities and towns tend to have less medical specialists, and an older and less-affluent population. These factors tend to place a heavy burden on primary care doctors in rural America, making the speciality-location choice one of the less desirable choices for medical students. While primary care experiences the highest degree of shortages, even fewer physicians are willing to practice in rural areas; according to Kansas City University of Medicine and Biosciences, “About 20 percent of Americans live in rural areas, but barely one-tenth of physicians practice there.”

The past few issues mentioned only pertain to currently-practicing physicians and surgeons, and don’t address the barriers to entry into the profession. On top of rising medical school tuition -

around $250,000-$300,000 over 4 years – becoming a fully licensed practicing physician requires at least 7 years of training, 4 years med school plus 3 years residency at a minimum. Many aspiring doctors will pursue specialities or fellowships to push training towards a duration of more than 10 years. This kind of personal and financial sacrifice often makes the option of becoming a physician only viable to those of higher socioeconomic status, limiting the number of individuals who can even enter into the field in the first place. Couple that with the likelihood of students, after so much training and money spent, preferring more lucrative specialties in desirable cities, and you have a perfect recipe for the physician shortage, especially in rural primary care. These trends point toward a few concerning consequences, both for public health and the field of medicine. Regarding America, the shortage of doctors in rural areas

These trends point toward a few concerning consequences, both for public health and the field of medicine. Regarding America, the shortage of doctors in rural areas exacerbates the issue of unequal healthcare access which we see today. People and families living in areas that aren’t New York City, Los Angeles, or Chicago have relatively low access to treatments that require the knowledge and expertise of medical specialists, let alone primary care. Different living situations may entail different livelihoods in work and culture, but this should never be the case for our health. We all inhabit the same human bodies, and it is so crucial that America works to address the physician shortage and alleviate this growing health inequity.

Changes to medical training are already being put in place to combat this issue, but to varying degrees of effectiveness. In 2018, New York University announced that their medical school will go tuition-

free regardless of merit or need, hoping to “transform medical education nationwide.” NYU Langone Health presented the reasoning as, “Saddled with staggering student loans, many medical school graduates choose higher-paying specialties, drawing talent away from less lucrative fields like primary care, pediatrics, and obstetrics and gynecology.” However, in this past March, only 16 out of 120 of these free-tuition graduates have matched into the three aforementioned specialties. As one of the most competitive medical schools in the country, NYU attracts a highly competitive pool of students who naturally gravitate towards the more competitive and lucrative specialties, such as surgery or dermatology.

Alleviating this imbalance will take more of a persistent effort from schools, involving multiple initiatives that incentivize students to pick less popular specialities, in addition to easing the financial burden. Such efforts are being taken to increase medical school students in rural areas. Oregon Health & Science University School of Medicine (OSM) and University of Minnesota Medical School (UMMS) are just two schools that have admissions practices involving outreach and recruitment of students living in less populated towns. These schools and others also offer pathways that feature clerkships in rural hospitals, connections with rural residencies, and monthly seminars to foster a sense of community for aspiring rural physicians. Two thirds of UMMS’ Rural Physician Associate Program have gone to practice in-state and 54 out of 70 University of South Dakota (USD) Sanford School of Medicine graduates come from rural communities. Research shows that rural graduates

are more likely to practice in similar areas. These are the kinds of initiatives that will attract students to medicine, and more importantly, the practice of medicine in areas of greater need.

Hospitals are also strategizing how to address the growing need of physicians, without an actual growth in the number of physicians. This issue is what brought about the rise of Nurse Practitioners and Physician Assistants. These Non-Physician-Providers (NPP) play a role on physician-led-teams to provide various primary care-related services. Becoming an NPP requires fewer years of training and lower amounts of debt. NPPs are therefore a) more abundant, b) require less training and pay, and c) can act as primary care providers for less specialized tasks in which physicians aren’t available. Although the rise of NPPs may sound like a dream solution, the growth of these providers is one of the most controversial current

events in medicine. One discussion has involved the increase in independence and scope of practice that NPPs are granted. The American Medical Association published an article providing stats indicating increased patient satisfaction and higher vaccination rates from physician care than NPP care, portraying the NPPs growing scope of practice as a concerning trend, although this study was not peer-reviewed and may be subject to bias. The battle is also often framed as “doctors vs. mid-levels,” fought over salaries, autonomy, preference from corporate leadership, and what to call NPPs (“mid-level provider” is seen as a derogatory term compared to “advanced practice provider,” which others view as misrepresentative). A solid and agreed upon resolution for these issues is not yet clear.

In an ideal healthcare system, all residents and citizens of America would have adequate access to treatment of equal quality. Doctors would

be equitably distributed across every corner of the US, and hospitals would have all kinds of providers playing their respective roles. Nevertheless, as of now, the healthcare system is in limbo due to a growing physician shortage. There are many paths that can be taken to alleviate the issue, though, each with their own repercussions on what the future of healthcare and medicine will look like. Will there be a change in the demographic of med school matriculants? Which residency programs will become more or less programs? How will these training programs change? In hospitals, will the number of physicians return to stable numbers in all specialties, available for all treatments, or will we switch to a team-based system in which NPPs (or other physician alternates) provide basic treatments and doctors are only consulted for complex tasks? The fate lies primarily in the hands of corporate and academic leaders of healthcare and

References

Greiner, Lisa. “NYU School of Medicine Offers Full-Tuition Scholarships to All New & Current Medical Students.” NYU Langone News, NYU Langone Hospitals, 16 Aug. 2018, https://nyulangone.org/news/nyu-school-medicine-offers-full-tuition-scholarships-all-new-cu rrent-medical-students.

Heath, Sara. “Understanding Physician Shortage Issues, Patient Care Access.”

PatientEngagementHIT, Thinkstock, 28 June 2019, https://patientengagementhit.com/news/understanding-physician-shortage-issues-patientcare-access.

Heiser, Stuart. “AAMC Report Reinforces Mounting Physician Shortage.” AAMC, AAMC, 11 June 2021, https://www.aamc.org/news-insights/press-releases/ aamc-report-reinforces-mounting-physici an-shortage.

Jaret, Peter. “Attracting the next Generation of Physicians to Rural Medicine.” AAMC.org, AAMC, 3 Feb. 2020, https://www.aamc.org/news-insights/attracting-next-generation-physicians-rural-medicine.

Nielsen, Marci, et al. “Addressing Rural Health Challenges Head On.” Missouri Medicine, Journal of the Missouri State Medical Association, Oct. 2017, https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC6140198/#:~:text=Health%20Professions%2

NYU Langone Health. “Residency Match Day Results for MD Students.” NYU Langone Health, NYU Grossman School of Medicine, Mar. 2022, https://med.nyu.edu/education/md-degree/md-admissions/match-day-results.

Renfrow, Jacqueline. “AAMC Estimates 124k More Physicians Will Be Needed by 2034, with the Largest Gap among Specialists.” Fierce Healthcare, Fierce Healthcare, 15 June 2021, https://www.fiercehealthcare.com/practices/physician-shortage-continues-to-widen-now-esti mated-at-124-000-by-2034.

Robeznieks Senior News Writer .cls-1{fill:none;}.cls2{fill:#1da1f2;}Twitter logo, Andis.

“Amid Doctor Shortage, NPS and PAS Seemed like a Fix. Data’s in: Nope.” American Medical Association, AMA, 17 Mar. 2022, https://www.ama-assn.org/practice-management/ scope-practice/amid-doctor-shortage-nps-an d-pas-seemed-fix-data-s-nope.

medicine. Regardless of what actually happens, there is a way to provide equal access to healthcare for all as long as those in charge serve the best interests of public health, and not themselves.

The Bottleneck Hypothesis How Does Schizophrenia Develop?

Miles Kaufman, Fareen Dhuka, Sophie Hu

Despite years of research and millions of dollars’ worth of funding, how schizophrenia develops remains a mystery. While researchers have worked hard to uncover genetic mutations, environmental factors, and microbes that contribute to the development of the disorder, no one seems to understand how all these pieces fit together; it has remained elusive why some individuals exposed to these factors develop schizophrenia while others do not. Since no set of mutations or environmental factors guarantee the development of schizophrenia, one hypothesis is that this disorder might be caused by a “bottleneck”--when a summation of contributing factors disrupts brain development, causing schizophrenia to develop (Pearlson, 2008). This hypothesis provides a comprehensive explanation of how these factors work in conjunction to cause the disease and offers justification for many of the mysteries associated with schizophrenia,

like why the disorder presents in early adulthood.

The bottleneck theory hypothesizes that each factor associated with schizophrenia is insufficient to cause this disorder on its own, but a build-up of these factors blocks brain development and causes schizophrenia to develop. This theory suggests that the genes and environmental factors associated with schizophrenia disrupt the development of neuronal pathways and neurotransmitter interactions, and that there is a threshold amount of disruption the brain can accommodate. Once brain development has been disrupted past this threshold, schizophrenia develops. This theory provides an explanation for why no single factor or group of factors has been found to cause this disorder. The current body of research supports this theory. Since schizophrenia affects the part of the brain that develops last, many scientists have theorized that developmental

disruptions can remain dormant throughout brain development and only begin to take effect during the final stages (Thompson, 2010). Early events like prenatal infection and other pregnancy complications have been known to alter brain development significantly(Cannon, 2002), and plenty of evidence suggests that disturbances as early as in-utero contribute to an increased risk for schizophrenia (Brown, 2010). Although our brain is also resilient, and brain development often occurs in a typical fashion after minor disturbances, this plasticity likely has a limit though. Many small disturbances or a few large disturbances may disrupt brain development beyond what we are capable of recovering from, causing schizophrenia to develop.

While the bottleneck theory postulates that an accumulation of genetic factors causes disruptions in brain development, small concentrations of these genetic factors can

offer benefits. It seems that the same parts of our brain associated with language and creative thinking are associated with mutations thought to cause schizophrenia (Srinivasan, 2016). The genes corresponding to the development and function of these parts of the brain have mutated rapidly since our species diverged from Neanderthals (Srinivasan, 2016), which could explain why schizophrenia is only observed in humans. It appears that humans may have faced an evolutionary trade-off where mutations promoting creativity and language were selected for despite the inherent risk of developing disorders like schizophrenia. Many relatives of people with schizophrenia have subsets of these mutations, and they are more likely to be academically gifted or exceptionally creative, further suggesting that these genes can often be beneficial under certain circumstances (Power, 2015).

While it appears that these

mutations can have significant benefits, researchers are often perplexed how these mutations have persisted when they significantly lower the likelihood of reproduction and heritability. However, there are actually many examples of harmful genes persisting when carriers of the gene have higher than average reproductive success. One classic example is how the sickle cell anemia gene has persisted in certain populations even though it causes a deadly disease. With sickle-cell anemia, an individual with two copies of the gene is unable to transport oxygen to cells, resulting in premature death. However, an individual with one copy of the gene can transport oxygen almost as well as an individual with no copies. In addition, these heterozygous individuals have red blood cells that are inhospitable to the malaria parasite. In malarial zones, this protection is a huge evolutionary advantage, so heterozygous individuals survive more often than unaffected

individuals, which allows the sickle-cell anemia gene to persist despite its potentially harmful effects. With schizophrenia, the concept is similar. The genes that are associated with schizophrenia may be harmful in certain combinations, but the benefits they can provide in terms of creativity and brain development outweigh the potential costs of developing schizophrenia and therefore the genes persist.

Although the genetic component of schizophrenia is well established, it seems to have a slightly higher prevalence in some populations that genetics are unable to account for, insinuating that this disorder is impacted by an environmental component as well (Saha, 2005). Developed nations have higher rates of schizophrenia (Saha, 2005), which could indicate that environmental factors associated with modern living promote schizophrenia. This is further supported by evidence that urban environments have higher rates of schizophrenia than non-urban environments (Saha, 2005). These differences could be due to a host of factors, one being that more potent strains of marijuana and other drugs are found in developed countries (Leggett, 2008). Early cannabis usage is strongly correlated with schizophrenia (Evins, 2018). While our brains do produce some cannabinoids, and we have evolved to metabolize them, the human body has not evolved to handle the high levels of THC found in many modern marijuana products. Therefore, exposure to high levels of cannabinoids, especially early in life, are associated with a host of neurological issues including worse psychotic symptoms in schizophrenics (Evins, 2018). Since the cannabis industry has grown and commercial-

ized, CBD has been bred out of recreational marijuana strains while the amount of THC has increased making marijuana even more dangerous for those predisposed to schizophrenia. These changes have been most dramatic in developed nations (Leggett, 2008), providing one explanation as to why developed nations may have a higher prevalence of schizophrenia. Although marijuana consumption does not cause schizophrenia on its own, cannabis usage disrupts brain development (Hurd, 2020) and may compound with other mutations or environmental factors creating a developmental bottleneck. While more potent marijuana is simply one example of an environmental factor promoting schizophrenia, it is a good example of a disconnect between modern inventions and our biology.

The relationship between the microbiome and the development of schizophrenia is another vital aspect to understanding the bottleneck

nature of this disorder. T. gondii is a parasite that infects the brain and is often associated with higher rates of schizophrenia.Typically this parasite does not infect humans. T. gondii reproduces in the digestive tract of cats and leaves its eggs in the cat’s feces where the eggs can infect mice (Webster, 2007). The parasite then changes the brain chemistry of the mouse such that the infected animal is less anxious, less risk averse and therefore more likely to be eaten by a cat (Webster, 2007). Although this parasite evolved to mainly manipulate rodents, T. gondii can have a similar—although more subtle—effect on human brain chemistry. Evidence suggests that like their rodent counterparts, humans infected with T. gondii have slower reflexes (Kocazeybek, 2009). Not only does T. gondii affect the human brain, but it also leads to a far greater likelihood of an individual developing schizophrenia (El Mouhawess, 2020). This is thought to be due to

the effects T. gondii has on dopamine production. Since dopamine abnormalities are incredibly common among schizophrenia patients (Sutterland, 2015), scientists have hypothesized that this parasite can contribute to these abnormalities, (Kristoffer, 2019) potentially disturbing brain development much like the other factors discussed, contributing to a developmental bottleneck.

The examples of T. gondii, early marijuana usage, and genetic mutations have established how numerous factors can work in conjunction to create a developmental bottleneck in regards to schizophrenia. While this is only a theory, it provides a fairly comprehensive explanation of why this disease occurs. While speculative theories are often disregarded in science, theories like the one discussed here have the potential to both further our understanding of a disorder and provide context for diseases without clear causes.

References

Barford, E. (2013). Parasite makes mice lose fear of cats permanently.

Nature.

Brown AS, Derkits EJ. Prenatal infection and schizophrenia: a review of epidemiologic and translational studies. Am J Psychiatry.

Cannon M, Jones PB, Murray RM. Obstetric complications and schizophrenia: historical and meta-analytic review. Am J Psychiatry. 2002 Cannon TD. The inheritance of intermediate phenotypes for schizophrenia. Curr Opin Psychiatry. 2005

Caspi A, Moffitt TE, Cannon M, McClay J, Murray R, Harrington H, Taylor A, Arseneault L, Williams B, Braithwaite A, Poulton R, Craig IW. Moderation of the effect of adolescent-onset cannabis use on adult psychosis by a functional polymorphism in the catechol-O-methyltransferase gene: longitudinal evidence of a gene X environment interaction. Biol Psychiatry. 2005 May 15;57(10):1117-27. doi: 10.1016/j.biopsych.2005.01.026. PMID: 15866551. DUBEY, J.P. (2008), The History of Toxoplasma gondii—The First 100 Years. Journal of Eukaryotic Microbiology, 55: 467-475. https://doi. org/10.1111/j.1550-7408.2008.00345.x El Mouhawess, A., Hammoud, A., Zoghbi, M. et al. Relationship between Toxoplasma gondii seropositivity and schizophrenia in the Lebanese population: potential implication of genetic polymorphism of MMP-9. BMC Psychiatry 20, 264 (2020). https://doi.org/10.1186/s12888-020-02683-0

Evins, A. E. (Presenter). (2018, December 17). Cannabis Update for Patients with Schizophrenia. Lecture presented at schizophrenia Education Day 2018, Massachusetts General Hospital, Boston, MA.

Hurd, Y. L. (2020). Cannabis and the developing brain challenge risk perception. The Journal of Clinical Investigation, 130(8), 3947-3949. Insel, T. Rethinking schizophrenia. Nature 468, 187–193 (2010). https://doi.org/10.1038/nature09552

Kristoffer S. et. Al., Large-scale study of Toxoplasma and Cytomegalovirus shows an association between infection and serious psychiatric disorders, Brain, Behavior, andImmunity, 2019, ISSN 0889-1591, https://doi. org/10.1016/j.bbi.2019.01.026.

http://www.sciencedirect.com/ science/article/pii/S0889159118306998

Kocazeybek B., et al. “Higher prevalence of toxoplasmosis in victims of traffic accidents suggest increased risk of traffic accident in Toxoplasma-infected inhabitants of Istanbul and its suburbs.” Forensic science international 187.1-3 (2009): 103-108. Laruelle, M., Kegeles, L., et al. “Glutamate, dopamine, and schizophrenia: from

The Pill

Caroline Kellogg, Riley Hurr

The decision to use contraception is one that many people face and one that falls disproportionately on women. Despite the fact that 46.9 million women use some form of contraception in the U.S. alone, the prospect of deciding which contraceptive to use is an intimidating one. Aside from the large variety of options available–condoms, birth control pills, IUDs, injections, implants, and more–choosing a method of contraception is difficult because there is such a wide range of experiences with different methods of contraception. It’s all too easy to find horror stories online of other women’s experience with contraceptive methods, but how do they actually work?

The most common form of contraception in the U.S. is birth control pills. Birth control pills function by regulating hormones to reduce ovulation, thicken the cervical mucus to prevent sperm from entering the uterus, and thin the lining

of the uterus so that a fertilized egg is less likely to attach. However, as hormones are essential for regulating many essential processes in our body, the regulation of hormones can have unintended side effects. While most websites and scientific articles will already list an extensive list of known side effects such as depression, an increased risk of blood clots and stroke, nausea, and decreased libido, the personal stories of women and their own experiences with birth control reveal an increasingly growing list of side effects such as how birth control affects decision making, the partners women choose, and how it can change their entire personality. In fact, these side effects account for many women choosing to stop taking birth control pills, with percentages ranging from 30 to 60%.

There is also the issue of perceived vs. experienced side effects. As women are subject to pressure involving both their weight and

emotions, any perceived weight gain or increase in emotion becomes even more pronounced when women begin using the birth control pill. As such, these are the two most reported side effects among women on the pill, with 39% of women who experienced negative side effects with birth control citing weight gain as one of them. Women in the United States cite weight gain as one of the primary reasons why they will not start taking the birth control pill. The role that societal pressure has on women’s decisions concerning their health can therefore not be underestimated as some women opt to risk pregnancy instead of experiencing the weight gain birth control may cause. While this may seem extreme, even small changes in a woman’s weight can cause vast changes in how they perceive themselves and their self-esteem. When discussing the effects of birth control, one woman who experienced weight gain said, “It’s those pills that are ruining me,”

suggesting that weight gain caused by birth control can not just ruin someone’s body but also the person themselves. Therefore, the decision of using birth control goes beyond limiting pregnancy to how it will change the perception of oneself. Despite the fears surrounding the side effects of the pill, it has worked for many women for over 60 years. The current version of the pill was approved by the FDA in May 11th, 1960. Only seven years after its introduction, 12.5 million women were already using birth control pills worldwide. The choice to decide when to become pregnant was essential to granting women the opportunity to pursue their own goals such as education and employment beyond having a family. It is no coincidence that the introduction of the pill corresponds with the equal rights movement of the late 1960s and 70s.

With the prospect of the overturn of Roe v. Wade, contracep-

tion and most importantly access to contraception is critical to maintaining the rights that women gained since the advent of the pill. Women should have access to all kinds of contraceptives to choose one that suits their needs best and limits damaging side effects. No woman should feel that the side effects of whichever contraceptive method they choose should limit their ability to use that form of contraception and risk pregnancy. Considering that a woman’s right to have an abortion is now at risk, it is more important than ever to maintain equal and fair access to birth control methods that work for women instead of against them or otherwise risk losing the progress made in women’s rights over the last few decades.

References:

https://www.cdc.gov/nchs/products/databriefs/ db327.htm#:~:text=of%20Family%20Growth-,In%20 2015%E2%80%932017%2C%20approximately%20 65%25%20of%20women%20aged%2015,of%20contraception%20(Figure%201).

https://my.clevelandclinic.org/health/ drugs/3977-birth-control-the-pill#:~:text=Hormones%20in%20birth%20control%20pills,is%20 less%20likely%20to%20attach.

https://www.nytimes.com/video/opinion/100000005618112/birth-control-your-own-adventure.html

https://journals.sagepub.com/doi/ full/10.1177/0891243213504033

https://www.pbs.org/wgbh/americanexperience/ features/pill-us-food-and-drug-administration-approves-pill/#:~:text=Eventually%2C%20the%20 FDA%20avoided%20the,approval%20of%20the%20 contraceptive%20pill.

https://www.sciencedirect.com/science/article/pii/ S0010782498001310

An Insight Into Degenerative Brain Disease

Adam Kunz, Eve Tanois

The “punch-drunk symptom” (Dementia Pugilistica), characterized by severe physical and psychological impediments, was first described by a paper in 1928, after originally being discovered in the early 1920’s. The paper, written by Dr. Harrison Martland, was published in the Journal of the American Medical Association, and was a horrifying yet groundbreaking insight into degenerative brain disease. In collaboration with neurologist Dr. Christopher Beling, Dr. Martland performed autopsies on 309 traumatic cerebral hemorrhage cases. While doing so, he noted that 9 of these cases had no signs of skull fracture or clear physical injury to the cranial structure. This led him to conclude that the hemorrhaging was microscopic and perivascular in nature, relating these 9 cases to previous studies done by Dr. Michael Osnato and Dr. Vincent Gilberti; in which the two scientists concluded that the hemorrhaging of these peri-

vascular spaces was linked to cases of concussion. This previous study led Dr. Martland to begin monitoring a group of boxers, and after some time, he proposed a connection between the microhemorrhages and the boxers who experienced “tremors”, “slowed movement”, “speech problems”, and “confusion”. He theorized that boxers who survive serious head injuries (repeated blows to the head), develop a replacement gliosis, which linked his findings to central nervous system diseases such as strokes. Symptoms, as described above, could be seen almost immediately after impactful blows to the head and rendered the boxers in a “punch-drunk” state, hence the name. Dr. Martland’s study was revolutionary and inspired similar research over the next 75 years.

Despite the influx of brain trauma research in relation to the “punch-drunk syndrome”, only 50 cases were confirmed. There were minimal breakthroughs until 2005,

when Dr. Bennet Omalu completely revolutionized the field of brain trauma by bringing the concept of the punch-drunk syndrome, which was previously only studied in boxers, to one of the biggest stages in America: the NFL. Dr. Omalu discovered CTE (chronic traumatic encephalopathy), a variant of the “punch-drunk syndrome” in Mike Webster, a former football player, after cutting open and examining his brain postmortem. Webster had shown extreme signs of dementia prior to his death, like forgetting who he was and where he was, even self-harming. Webster’s diseased brain was where Omalu made a fascinating, yet disturbing, discovery. A focal perivascular deposition of p-tau immunoreactive neurofibrillary tangles (NFT’s) resulting in dot-like and thread-like neurites within the neocortex; comprising the brain of the ex-football player. Even more fascinating was the sheer amount of NFT’s Omalu found in Webster’s brain. There was an irregu-

lar distribution of p-tau NFT’s in the depths of cerebral sulci, near penetrating blood vessels (which serve as sources for capillaries). The NFT’s even encompassed the cerebral cortex, near the temporal neocortex, in layers 2/3 which contain excitatory neurons that serve as key factors in corticocortical connections and therefore information integration across the cortex.

These corticocortical connections are responsible for higher order processing such as consciousness, thought, emotion, and memory. The cortex is also connected to the thalamus, through cortico-thalamic pathways, linking cortical function to the thalamus, a relay station for all motor and sensory information. This link is currently being studied at the University of Chicago in the Sherman Lab, where S. Murray Sherman has proposed transthalamic pathways have a role in ongoing cortical processing. With the role of thalamus in cortical processing

being expanded, it introduces with it the possibility of diseases, such as CTE, expanding beyond our current understanding. Because research on how different pathways affect different parts of the brain is still being conducted, all the effects of CTE are still unclear. However, as mentioned previously, the deposition of p-tau has been one staple of all diagnosed CTE cases. The degradation of p-tau proteins has been found in similar diseases such as Alzheimer’s and corticobasal degeneration (CBD). These proteins are key in supporting the structure of internal microtubules, which in turn support brain cells. Genetically modified mice who lack tau protein tend to lack brain function, displaying dysfunction in the protein as a key component in brain diseases such as CTE. Recent studies suggest the deposition of tau proteins is linked to synapses, or links of oligomers, that travel across the brain and send electrical and chemical signals to cells, initiating

the deposit of tau. The triggering of these synapses has been theorized to be a result of the causes of CTE discussed previously (severe blows to the head, etc.).

Unfortunately, CTE cannot be diagnosed in a living patient as the brain must be fully removed and thoroughly studied to make a clear diagnosis. As a result, CTE can only be suspected in individuals who are at risk from repetitive head trauma. However, the research of Dr. Omalu and Dr. Martland has reached ears beyond the academic community, and changes are finally being made to ensure the health of athletes exposed to severe head trauma. The NFL has started to make rule changes to minimize head-to-head contact and have invested heavily into research and medicine to both help current players and prevent future cases. Though strides are being made on both the research front and the business front, CTE is still incurable, undiagnosable, and very dangerous to both the patient and the people around them. As a result, many scientists suggest a societal shift away from sports such as football and boxing. Sadly, this is largely unattainable due to the traction these violent sports have gained within our modern socio-economic system. This leaves us with the current social and scientific dilemma regarding CTE. How do we ensure the safety of players in a sport which inherently promotes violence? How do we diagnose a disease that we do not yet fully understand? How do we cure a disease that cannot yet be diagnosed? Here we are, living in the most crucial moment in the evolution of CTE. Yet most people would rather turn a shoulder to protect a sport they enjoy than attempt to understand the horror of this degen-

-erative brain disease. Just by reading this article, you have chosen the latter.

References:

Changa, Abhinav R, et al. “Dr Harrison Martland and the History of Punch Drunk Syndrome.” Brain, vol. 141, no. 1, 28 Dec. 2017, pp. 318–321, 10.1093/brain/awx349. “Dementia Pugilistica | Brain Injury Research Institute.”

Ellison, James. “Tau Protein and Alzheimer’s Disease: What’s the Connection? | BrightFocus Foundation.” Www.brightfocus.org, 6 July 2021

Guy-Evans, Olivia. “Cerebral Cortex Location & Functions | Simply Psychology.” Www.simplypsychology. org, 19 May 2021

Jeanne Marie Laskas. “The Football Player’s Brain That Sparked the NFL’s Concussion Crisis.” The Atlantic, The Atlantic, 2 Dec. 2015

Luo, Huan, et al. “Comparison of the Upper Marginal Neurons of Cortical Layer 2 with Layer 2/3 Pyramidal Neurons in Mouse Temporal Cortex.” Frontier Sin, 21 Dec. 2017

McKee, Ann C., et al. “The Neuropathology of Chronic Traumatic Encephalopathy.” Brain Pathology, vol. 25, no. 3, 23 Apr. 2015

Sherman, S Murray. “Thalamus Plays a Central Role in Ongoing Cortical Functioning.” Nature Neuroscience, vol. 19, no. 4, 29 Mar. 2016, pp. 533–541, 10.1038/nn.4269. Accessed 13 May 2020.

“What Is CTE?” Concussion Legacy Foundation, 6 Nov. 2018, concussionfoundation.org/CTE-resources/ what-is-CTE.

15 Tips For Your Personal Statement

Don’t underestimate the power of the medical school personal statement to make a strong, positive impression on an admissions committee. Combined with your interview performance, your personal statement can account for 60% (or more) of your total admissions score!

Medical schools want to enroll bright, empathetic, communicative people. Here’s how to write a compelling med school personal statement that shows schools who you are and what you’re capable of.

Personal Statement Topics

Your medical school personal statement is a component of your primary application submitted via, TMDSAS (for Texas applications), or AACOMAS (NB: If you are applying to medical school in Canada, confirm the application process with your school, as not all application components may be submitted through AMCAS).

These applications offer broad topics to consider, and many essay approaches are acceptable. For example, you could write about:

- an experience that challenged or changed your perspective about medicine

- a relationship with a mentor or another inspiring individual

- a challenging personal experience

- unique hardships, challenges, or obstacles that may have influenced your educational pursuits

- your motivation to seek a career in medicine

You’ll write an additional essay (or two) when you submit secondary applications to individual schools. These essays require you to respond to a specific question. Admissions committees will review your entire application, so choose subject matter that complements your original essay.

How to Write a Personal Statement for Medical School

Follow these personal statement tips to help the admissions committee better understand you as a candidate.

1. Write, re-write, let it sit, and write again!

Allow yourself 6 months of writing and revision to get your essay in submission-ready shape. This gives you the time to take your first pass, set your draft aside (for a minimum of 24 hours), review what you’ve written, and re-work your draft.

2. Stay focused.

Your personal statement should highlight interesting aspects of your journey—not tell your entire life story. Choose a theme, stick to it, and support it with specific examples.

3. Back off the cliches.

Loving science and wanting to help

people might be your sincere passions, but they are also what everyone else is writing about. Instead, be personal and specific.

4. Find your unique angle. What can you say about yourself that no one else can? Remember, everyone has trials, successes and failures. What’s important and unique is how you reacted to those incidents. Bring your own voice and perspective to your personal statement to give it a truly memorable flavor.

5. Be interesting.

Start with a “catch” that will create intrigue before launching into the story of who you are. Make the admissions committee want to read on!

6. Show don’t tell.

Instead of telling the admissions committee about your unique qualities (like compassion, empathy, and organization), show them through the stories you tell about yourself. Don’t

just say it—actually prove it.

7. Embrace the 5-point essay format. Here’s a trusty format that you can make your own:

1st paragraph: These four or five sentences should “catch” the reader’s attention.

3-4 body paragraphs: Use these paragraphs to reveal who you are. Ideally, one of these paragraphs will reflect clinical understanding and one will reflect service. Concluding paragraph: The strongest conclusion reflects the beginning of your essay, gives a brief summary of you are, and ends with a challenge for the future.

8. Good writing is simple writing. Good medical students—and good doctors—use clear, direct language. Your essays should not be a struggle to comprehend.

9. Be thoughtful about transitions. Be sure to vary your sentence struc-

ture. You don’t want your essay to be boring! Pay attention to how your paragraphs connect to each other. Good medical students—and good doctors—use clear, direct language

10. Stick to the rules. Watch your word count. That’s 5,300 characters (including spaces) for AMCAS applications, 5,000 characters for TMDSAS, and 4,500 characters for AACOMAS.

11. Stay on topic.

Rambling not only uses up your precious character limit, but it also causes confusion! Think about the three to five “sound bytes” you want admissions committee to know and remember you by.

12. Don’t overdo it. Beware of being too self-congratulatory or too self-deprecating.

13. Seek multiple opinions. Before you hit “submit,” ask several people you trust for feedback on your personal statement. The more time you have spent writing your statement, the less likely you are to spot any errors. A professor or friend whose judgment and writing skills you trust is invaluable.

14. Double-check the details. Always check for grammar, spelling, and punctuation errors. This goes for the rest of your application (like your activities list), too. A common oversight is referencing the wrong school in your statement! Give yourself (and your proofreaders) the time this task truly requires.

15. Consult the experts about your personal statement strategy. Our med school admissions counselors can diagnose the “health” of your overall application, including your personal statement. Get expert help and guidance to write an effective personal statement that showcases not only your accomplishments, but your passion and your journey.