UChicago PULSE Issue 5.3: Spring 2019

PULSE VOLUME 5, ISSUE 3. SPRING 2019.

COM B A T T I N G

THE OPIOID CRISIS

PULSE Magazine

from the editors-in-chief Dear reader,

Summer fast approaches, and break is right around the corner (after finals though, of course)!

Although we'll all scatter across the country and globe for the next few months, our common interest in medicine and health remains a unifying thread for all us readers. This quarter, our issue of PULSE revolves around another unifying subject, though in a much more sobering arena: the opioid crisis. With new developments rolling out almost faster than many of us can keep track of, from public policy to clinical practice, we bring you a summary of what we know, as well as what we don't.

The prominence of this crisis does not erase other areas of concern in health, though; likewise, PULSE moves on to also explore these other areas. Our Clinic section takes a look at the physiological with lung cancer and the mental with hypochondriasis and anxiety disorders, while our Research section broadens even more to examine aging and memory from a therapeutic perspective, and one of our writers reflects on disparities in health covered by the Asians in Medicine Conference this quarter. We wrap up this issue with a growing concern across the country: the recent measles outbreaks, an unfortunate medical blast from the past.

PULSE has been an invaluable opportunity to explore medicine beyond psets done for class and last-minute responses scribbled out for discussion. We hope you enjoy this issue of PULSE, enjoy the summer, and keep exploring what makes health and medicine important to you!

With regards, Irena Feng and Linus Park

editors

writers

production

Anya Dunaif Areeha Khalid Jui Malwankar Yifan Mao Lindsay Romano Scott Wu Allan Zhang

Swathi Balaji Sophia Cao Allison Gentry Meagan Johnson Nikki Kasal Malaika Mathias Pranati Movva Shehzaib Raees

Purujit Chatterjee (cover design) Irena Feng Linus Park

GENERAL EDITORS Swathi Balaji

other contributors Gold Standard Kaplan Test Prep The Princeton Review

PULSE Magazine

CONTENTS EDUCATION MEDICAL SCHOOL PERSONAL STATEMENT KAPLAN MCAT PRACTICE PROBLEM HOW TO MAKE THE MOST OF YOUR MCAT STUDY GROUP LESSONS LEARNED FROM "ASIANS IN MEDICINE"

2 5 6 8

POLICY NEW POLICIES ON OPIOID PRESCRIPTION A BARREN WASTELAND

10 12

RESEARCH PAINKILLERS BRAINWAVE SYNCHRONIZATION

14 16

CLINIC HYPOCHONDRIASIS IN THE MODERN AGE EARLY LUNG CANCER DETECTION

18 21

CURRENT EVENTS U.S. MEASLES OUTBREAK 2019

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MEDICAL SCHOOL PERSONAL STATEMENT

“The personal statement” or “the essay” for medical schools is typically submitted along with your AMCAS and AACOMAS applications. This personal statement is the best opportunity to speak directly to admissions officers and it presents an opportunity to give your application a voice – your voice.

Medical schools are looking for passionate, humane, and interesting individuals who can add diversity of thoughts and distinct experiences to the incoming class. So, you can convince the committee with your personal statement that you deserve a shot at an interview.

What kind of topics will you include?

In most cases, the topics you will choose should tell something about your motivation for a medical career and the experiences, situations, and ideas that have influenced your life and academic career. Considering this, you can include a life-changing personal experience with medicine, as a patient or as a person close to a patient, a relationship with mentor, the decision to pursue a medically related career. In conclusion, when brainstorming ideas for your personal statement, consider events that have strongly influenced or affected you. Start making a list of them and beginning to look for a connection between them.

Here is the main point: Whatever you say, it should not be simple!

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EDUCATION

GETTING A GREAT PERSONAL STATEMENT

Here’s a quick overview of how to structure the personal statement.

1.

Get to know yourself better.

2.

Clustering

3.

Write, write, write

The personal statement is all about you and why you want to go to medical school. So, you probably know yourself, but it will be good to come up with answers to the following questions: • Who has been the biggest influence on your life and your decision to apply to medical school?

• What work experience or extracurricular activity is most meaningful for you? What have you learned from participating in this activity?

Get a large blank piece of paper and write down a few words to describe what has led you to apply to medical school. You can also write down some interesting, sad, or memorable experiences and try to link them to your interest in medicine. Then, try to explain what you meant by each word. Is there a paper you wrote related each word? Any class you took? After you have some ideas on your paper, try to put them together and create a story.

Get a piece of paper and force yourself to start writing about anything comes to your mind. Do not worry about grammar or punctuation – just write several pages. (You can use the timer to calculate how long it takes to write one page.) Then, underline everything you like or find interesting. These words or phrases can be your beginning of your personal statement.

4. Talk, talk, talk

Talk to your friends or family about why you want to go to medical school. Ask them to write down what they think is interesting or important as you explain. By this way, you will able to get an idea what other people think is interesting in your talk and produce some materials for your start.

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THREE APPROACHES

There are many ways to structure your personal statement but here are three approaches that you can be used alone or in combination:

1.

"MY HISTORY IN SCHOOL"

2.

"MY LIFE HISTORY"

3.

"THE STORY"

Do you have high grades in college? Do you emphasize your growth during college? If so, your essay focuses on college experience. You should write about your development, specialties, and strengths.

You can also mention a specific class, professor, or experience that helped you grow during college.

Do you have any ideas that illustrate the qualities you can bring to medicine? If your whole life clearly leads up to be a physician, this can be a good choice. Do not forget concentrate your paragraphs around individual ideas when you give a summary of your life.

Are you a good storyteller? Do you have stories to tell admission officers? If so, focus on one or two stories that illustrate your key points. Just pick a couple of moments that define why you want to be in medical school.

Want to ace your medical school application essays?

Our admission experts know how to ace med school essays. Work with an admission coach to ace your med school essays.

To learn more, visit PrincetonReview.com or call us at 800-273-8439

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EDUCATION

Kaplan MCAT PRACTICE PROBLEM QUESTION Consider a biochemical reaction A –> B, which is catalyzed by A-B dehydrogenase.

Which of the following statements is true?

A. The reaction will proceed until the enzyme concentration decreases.

B. The reaction will be most favorable at 0 ºC. C. A component of the enzyme is transferred from A to B. D. The free energy change (∆G) of the catalyzed reaction is the same as for the uncatalyzed reaction

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D. Enzymes catalyze reactions by lowering their activation energy, and are not changed or consumed during the course of the reaction. While the activation energy is lowered, the free energy of the reaction, ∆G, remains unchanged in the presence of an enzyme. A reaction will continue to occur in the presence or absence of an enzyme; it simply runs slower without the enzyme, eliminating choice (A). Most physiological reactions are optimized at body temperature, 37ºC, eliminating choice (B). Finally, dehydrogenases catalyze oxidation-reduction reactions, not transfer reactions, eliminating choice (C).

ANSWER spring 2019 || 5

HOW TO MAKE THE MOST OF YOUR MCAT STUDY GROUP In order to get the most from your MCAT preparation, you should allow yourself three to six months to study. Some students prefer to study on their own while others prefer the support or solidarity of an MCAT study group.

Studying with an MCAT study group can offer you a lot of benefits including opportunities to share or learn new ideas, cover more material, lessen the chance of cramming, minimize test anxiety, and give or receive support.

Nevertheless, you should know that not all study groups are effective. Here are six tips you can follow to help ensure study group success:

Arrange a group – not a party

1

Although a lot of students may be interested in developing an MCAT study group, for the most effective studying, you should limit the size of your group to six members or less. Depending on personal study preferences or the goals of the group, you may not want to exceed four members. Whoever you form a group with, just make sure the members are committed for the long term.

Aim for balance

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For a good MCAT study group, look for members of different backgrounds and academic strengths so that the “Team” is academically balanced. This enhances the learning process for everyone. Think about it, if everyone you study with has the same arts or science academic background, then it is easy to miss out on creative ideas, approaches, or content.

EDUCATION

Share responsibilities

3

Each week, assign a different member of the group as the group facilitator. The facilitator ensures that everyone is prepared, the MCAT study schedule is followed, and non-study related topics are kept to a minimum and discussed only after the study session. This provides everyone the chance to be responsible for and maintain interest within the group.

Make the most of your time

4

With multiple people working together within a group, it may be challenging to establish meeting times that fit into everyone’s schedule. Still, in an effort to avoid relying on your MCAT study group too much, limit group study sessions to only two to three hours and make the most of your time by ensuring the group covers all the key MCAT topics.

Study before your group session

5

MCAT study groups work best when members study on their own and then participate in study sessions by asking questions concerning what they studied and sharing what they learned. Remember to respect your peers’ reasoning and do not interrupt whoever is making a presentation. A study group also helps you develop your communication and interpersonal skills, which are essential in medical school as well as your future medical practice.

Research good MCAT study techniques

6

Yet another benefit of studying with a group is improving your study habits. Your peers may have study habits that you can adapt to. And of course, they can even learn from you.

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LESSONS LEARNED FROM "ASIANS IN MEDICINE"

A CONFERENCE ON ALLYSHIP AND ADVOCACY

By

SWATHI BALAJI LINUS PARK

On Saturday, May 18th, at the Asians in Medicine Conference held at the University of Chicago, attendees were presented with these statistics about the health disparities faced by Asian Americans (AAs) and Native Hawaiians and Pacific Islanders (NHPIs). The focus of the conference, however, was not on these facts, but rather on what we can do to address these disparities, support and empower AAs and NHPIs as allies, and influence policymaking and resource allocation as advocates in Chicagoland.

At the conference, we learned about concrete ways to be advocates and improve health literacy and community education; for instance, we can use our positions—either as in-group or out-group members—to assess health needs in a culturally competent manner and improve awareness of heart disease, diabetes, and mental health in vulnerable communities. As future physicians, we also explored how our ethnicities and cultural backgrounds cause us to enter clinical settings with various biases and considered how patients may have different expectations and beliefs. For instance, patients may reject shared decision-making approaches in favor of a paternalistic model. Even though paternalism (where the doctor imposes the treatment or decision upon the patient) is no longer the model for clinical encounters in the United States, patients may still have stereotypical expectations for their physicians—especially Asian American ones—to know exactly what the next steps are. Dissonant situations where the patient and physician are not on the same page are inevitable in the clinic. By considering the seen and unseen stories of patients and supporting their rights, we can overcome our differences, build trust, and effectively serve as caregivers and advocates.

20% of Asian Americans between the age of 18 and 64 report not having health insurance or being underinsured in the past year (Asian American Health Initiative, Department of Health and Human Services, Montgomery County, Maryland, 2005).

South Asians make up 60% of the world’s heart disease patients (MASALA Study, University of California).

Asian American women have the lowest cancer screening rates and are usually diagnosed at a later cancer stage than women in other ethnic or racial groups (Asian American Health Initiative, Department of Health and Human Services, Montgomery County, Maryland, 2005).

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EDUCATION

5 WAYS TO GET INVOLVED LOCALLY: 'ALL OF US' CAMPAIGN The goal of this NIH research program is to collect as much health data as possible from at least 1 million people in order to improve research and precision medicine. By better understanding individual health differences, habits, environmental contributions, and genetics, researchers can seek to improve treatments and tailor them to the diverse needs of patients. Create an account at JoinAllofUs.org to contribute to this program.

SOUTH ASIAN AMERICAN POLICY AND RESEARCH INSTITUTE (SAAPRI) The goal of SAAPRI is to advocate for the needs of marginalized groups in the South Asian community and use research based on community needs to create equitable policies. Contact Dhara Puvar at dhara@saapri.org for more information on how to get involved and volunteer with SAAPRI.

HANA CENTER The HANA Center seeks to empower Korean American and other immigrant communities by exploring their shared history and culture and combining community resources. Meaning ‘one’ in Korean, HANA has organized numerous community educational and health care interventions to advance human rights and bring together community members. Contact Inhe Choi at inhe@hanacenter.org to learn more about how to get involved.

INDO-AMERICAN CENTER The Indo American Center supports South Asian immigrants and members of other diverse communities by helping them integrate and form connections in the United States and build a sense of community by providing them with educational, employment, and health resources. Contact Assistant Director Shikha Sharma at ssharma@indoamerican.org if you are interested in volunteering at the Indo American Center.

CENTER FOR ASIAN HEALTH EQUITY Formed as a partnership between the University and Asian Health Coalition, the Center for Asian Health Equity seeks to identify and monitor social determinants of health and conduct more research to close the gaps in knowledge on disparities faced by AA and NHPI communities. Contact Amy Wang at amy@asianhealth.org to get involved with research or volunteer at the Center.

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NEW POLICIES ON OPIOID PRESCRIPTION USE SERVE AS A CRITICAL STEP IN ADDRESSING THE OPIOID CRISIS By

PRANATI MOVVA AREEHA KHALID

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POLICY

The misuse of opioids, such as prescription pain relievers and heroin, is a serious public health concern. In fact, more than 130 people in the U.S. die from opioid overdose per day. Additionally, according to the CDC, opioid misuse presents a massive economic burden, costing the US $78.5 billion each year, and this includes the cost of healthcare, addiction treatment, and criminal justice involvement. One of the main factors contributing to the opioid addiction crisis is the fact that in the late 1990s, pharmaceutical companies did not place any restrictions on opioid prescriptions, so healthcare providers began to prescribe opioids at greater rates, not knowing the consequences that would follow.

This led to widespread misuse of and addiction to opioids. Over the years, opioid overdose rates has only continued to rise. In 2017, over 47,000 people died from opioid overdose in the US. To address this crisis, in October 2018, the Senate approved opioid legislature, titled the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act, to expand access to substance-use disorder prevention and treatment programs. This new law expands programs to treat substanceuse disorders and partially lifts a restriction preventing states from spending Medicaid funds

on addiction treatment centers.

In addition, it allows Medicare to over medication-assisted treatments in certain settings.

This law was also created to lead Medicare changes with the aim to stop overprescribing of opioid medication. The Centers for Medicare and Medicaid Services (CMS) have developed a new Medicare policy, where pharmacies will have safety alerts in place for Medicare beneficiaries filling in an initial opioid prescription or receiving high doses of prescription opioids. Other changes to Medicare will include stricter electronic prescribing of opioids and stricter management of postsurgical pain, and an initial opioid use disorder screen will be required for new beneficiaries.

While the SUPPORT Act addresses the problem of opioid misuse by restricting opioid prescriptions and provides federal support for people with opioid overdose, it does not necessarily address the needs of chronically ill patients in severe pain who require access to long-term opioid therapy.

Restrictions on prescribing opioids may lead to a decreased number of deaths due to opioid misuse; however, for patients who are already chronically and terminally ill, long-term opioid therapy may be the only solution for pain relief, and this issue has not been addressed by SUPPORT. Additionally, while this act has made strides to increase the effectiveness of prescription drug monitoring

programs which tracks which patients have been prescribed opioids along with when and how much, these drug monitoring programs do not provide sufficient information about the patient’s actual drug use, such as whether the patient is taking the drug as prescribed or if the drug is possibly being taken with other illicit substances, which may affect the potency of the drug. This limitation is important to keep in mind, especially considering the fact that according to the Quest Diagnostics 2018 Drug Misuse in America report, more than half of patients misuse their medications.

Furthermore, drug mixing is the most frequent form of misuse that has been observed. It is evident that this new law approved by the Senate as well as new Medicare regulations on opioid prescriptions is a critical step in addressing the opioid crisis; however, more work is needed in order to fully be able to resolve the crisis while simultaneously addressing long-term pain management for patients with critical pain stemming from severe medical conditions.

1.

https://healthpayerintelligence.com/news/ cms-new-medicare-part-d-policies-toaddress-opioid-epidemic

2.

https://www.drugabuse.gov/drugs-abuse/ opioids/opioid-overdose-crisis#two

3.

https://www.ama-assn.org/delivering-care/ opioids/10-ways-new-opioids-law-couldhelp-address-epidemic

4.

https://www.statnews.com/2018/11/19/ support-act-opioid-epidemic-response/

5.

https://questdiagnostics.com/dms/ Documents/drug-prescription-misuse/ Health_Trends_Report_2018.pdf

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A BARREN WASTELAND

THE ADVENT OF METHADONE TREATMENT IN OPIOID DESERTS

By

MEAGAN JOHNSON ANYA DUNAIF

“Then at some point that is indefinable and inevitable, it turns on you. It grows fangs and claws, and it wants your soul. It lies to you and tells you that you aren’t doing anything wrong. It makes you feel like you would rather die than spend another second without it...you lie, scam, break the law, and sell your soul to get barely enough to keep you out of bed.” – Ophelia R., Heroin Addiction Stories: How It Starts, And How It Ends “At one point, I went to the bathroom, and found [my boyfriend] – all six feet, two inches of him, tattooed and scarred up and tough as hell, having lived through one of the most astonishingly hard lives I’d ever heard of – curled up in the bottom of a tiny, filthy shower stall like a little escargot, sobbing and shivering in desolate agony.” – unknown, Heroin Addiction Stories: How It Starts, And How It Ends The advent of methadone treatment moderating the use of heroin and common opioids has become prevalent in the United States. Hoping to act against the growing opioid crisis, researchers and physicians have come to the notion of using another opioid to assuage the cravings of heavy drug use. In the United States, more than 130 people die after overdosing on opioids everyday.

This translates to a total economic burden of roughly $78.5 billion a year in prescription misuse and opioid related deaths, infiltrating both the health care and criminal justice system.2 Yet, in some areas of the country, the only prevalent life saving treatment is church. In this “opioid desert,” thousands of people addicted to opiods are forced to face the full impact of cutting cold turkey or spend incomprehensible amounts of money to save their own lives.

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The term “opioid desert” is coined as the barren wastelands found within the Southwestern United States ill-prepared for preventing overdose within their community, leaving citizens with opioid dependencies to their own devices.

The stories told by the thousands journey a life of redemption in a society where methadone maintenance treatments have their own destructive nature.

Methadone, just like opium or heroin, is an opioid. It manipulates the body’s response to pain sensations and lessens the symptoms of opioid withdrawal.2 Legislators in favor of methadone treatment have pushed to provide courses on prescribing opioids for chronic pain and increasing patient awareness of safe use of methadone medications. A few organizations sponsoring these courses include: The American Academy of Addiction Psychiatry, The American

Society of Addiction Medicine, and the American Osteopathic Academy of Addiction Medicine.2 Yet, some concern is placed on the passing of legislation to train rural physicians in properly administering methadone, in so-called “pop-up shops”. Methadone is habit forming and has been seen to cause potentially fatal breathing problems, compounded by a risk for sedation or coma. This synthetic opiod is even more dangerous aided by alcohol or benzodiazepines. In certain clinics, a counseling stage is a required prerequisite before methadone treatments are given. Patients are asked questions such as, “what is the nature and severity of your problem?”, and “how can you rebuild and repair your severed relationships with friends and family?” Physicians trained in providing methadone treatment may dictate whether the patient

POLICY

attendance at a clinic is necessary when each dose is administered.

Yet, if the patient is not entirely truthful about their current drug intake, methadone may activate with other drug ingredients and trigger an overdose.

The idea of finding an alternative for opioid addiction through another opioid is quite difficult to comprehend. According to the CDC, methadone overdose deaths have increased by 5.5 times between the years 1999 and 2009, with 14,000 people dying in 2014 alone.3 One major disadvantage is the lack of cost-effectiveness and travel needed to receive proper treatment. Specifically, the long winding road to recovery stops abruptly at the doorstep of Lake Isabella, California—a barren wasteland filled with low-income addicts hoping for their next saving grace. Take the story of Heather Menzel. She is a pregnant woman in her twenties who has experienced a life of petty crime, a string of toxic relationships, and homelessness. Wanting to turn her life around, Menzel opted for long-winded path to recovery, subjecting herself to 3 hour bus rides and a stiff bladder only a pregnant woman could understand. “I was big and preg-

nant,” said Menzel, who woke up Monday through Friday at 5:30 a.m. to catch the bus. “I had to ask the bus driver to pull over and pee a lot. But I made it.” In her hometown, there are thirty-two churches, hundreds of camping reservations, fishing posts, and hiking location.4 There are zero methadone clinics. With a looming due date, Menzel struggled with getting her mom to take off work in their single income household to drive to Bakersfield daily for necessary doses. The $5 bus from Lake Isabella to Bakersfield was a price far too out of reach for Menzel and for many others in the isolated town of Lake Isabella with a population of 4,000. Luckily, the director of a nearby narcotics organization took a chance on Menzel and about 20 others to invest in a daily bus service.

Soon, after countless visits to Bakersfield, Menzel was awarded the ability to receive take home doses along with a healthy baby girl, Bella. She’s currently on maintenance doses which have been reduced from 140 milligrams to a more common dosage of 39 milligrams.4 Unfortunately, there remain thousands out there who haven't had the same outcome as Menzel, which raises the question

is methadone truly the answer to the population of addicts ridden with self-esteem issues, mental illness, a general lack of opportunity, and the willingness to submit to a life of hard drugs and hopelessness? The extent of opioid addiction treatment is not limited to methadone, but spans into the administration of Buprenorphine and Naltrexone. Researchers could turn away from such controversial treatment and concentrate on counseling addicts whose environmental and social conditions may have led to drugs. Methadone is likely not the future of addiction medicine.

"Heroin Addiction Stories - How It Starts, And How It Ends." Addiction Resource. Accessed May 18, 2019. https://addictionresource.com/ rehab-stories/heroin-addiction-stories/.

National Institute on Drug Abuse. "Opioid Overdose Crisis." NIDA. January 22, 2019.

Accessed May 18, 2019. http://www.drugabuse. gov/drugs-abuse/opioids/opioid-overdosecrisis.

"Methadone: MedlinePlus Drug Information."

MedlinePlus. Accessed May 18, 2019. https:// medlineplus.gov/druginfo/meds/a682134.html.

Rinker, Brian. "A Long And Winding Road: Kicking Heroin In An Opioid 'Treatment Desert'." Kaiser Health News. July 25, 2018.

Accessed April 19, 2019. https://khn.org/ news/a-long-and-winding-road-kickingheroin-in-an-opioid-treatment-desert/.

"Long Stigmatized, Methadone Clinics Multiply in Some States." The Pew Charitable Trusts.

Accessed May 18, 2019. https://www. pewtrusts.org/en/research-and-analysis/ blogs/stateline/2018/10/31/long-stigmatizedmethadone-clinics-multiply-in-some-states.

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PAINKILLERS

OUR FUTURE PAIN-INDUCERS

By

MALAIKA MATHIAS YIFAN MAO

Like the stab from a frozen dagger, a glacial pang rushed to my head. It was almost midnight, my head was pounding, and I was stuck in the library with a paper due that night and a midterm the next day. Of all days, why had I forgotten Advil at home that day?

Our common response to headaches, joint pain, or menstrual cramps is to swallow a couple of painkillers to alleviate our pain and to feel comfortable again.

With the wide variety of drugs on the market today, it is easier than ever to pop a pill to soothe whatever physical discomfort we may be facing. And while the goal of medical professionals is to bring pain relief to those suffering physiologically, people often overlook the detrimental effects of these painkillers in favor of the momentary relief they offer, whether it be due to lack of awareness of the severity of the side effects or the mindset that the temporary respite is more worthwhile.

Painkillers are usually categorized as either opioids or non-opioid drugs, with the former prescribed exclusively for severe pain cases. Non-opioid drugs, on the other hand, are far more ubiquitous and branded as names like Tylenol, Ibuprofen, and NyQuil. This group of non-opi-

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oids can further be classified into acetaminophens and non-steroidal anti-inflammatory drugs (NSAIDs). These are commonly administered to people of all ages, toddlers included, for symptoms varying from mild fevers to severe injuries. Despite the fact that these drugs are fast-acting and allow temporary achievement of analgesia – relief from pain – alarming statistics come with these seemingly beneficial outcomes.

The number of people who suffer from the side effects of these drugs annually is significantly increasing. In 2017, the National Institute for Drug Abuse reported 70,237 deaths due to drug overdose within the United States. While this figure is easily dismissable as a statistic influenced by drug addicts, it is important to note that the second most prolific category of drug-related deaths was actually due to prescription painkillers.

What happens physiologically when we consume analgesics, and how do they affect our bodies?

First, these painkillers pass through the gastrointestinal tract, before being absorbed into the bloodstream where the soothing magic happens: excess heat is removed from the body, assisting with relieving fever symptoms and increasing the body’s overall

tolerance to pain. The drug is then transported to the liver for metabolism, where a majority of the analgesics’ time is spent, therefore causing the most damage.

The liver is responsible for the breakdown of xenobiotics – foreign substances – in the human body. Many painkillers, however, produce harmful, reactive by-products during their breakdown. In the case of acetaminophens, N-acetyl-p-benzoquinoneimine is a consequential metabolite.

Normally, this compound quickly breaks down into reduced glutathione and is secreted, causing minimal harm in the body. However, when taken in high doses or recurrently, this by-product accumulates in high concentrations in hepatocytes (liver cells) and oxidizes cellular proteins, in turn damaging the cells. As a result, hepatocytes are easily damaged by the buildup of acetaminophen analgesics, which can even lead to liver failure in severe cases.

Non-steroidal anti-inflammatory drugs (NSAIDs) such as Ibuprofen have been known to work by inhibiting cyclooxygenases (COX-1 and COX-2), offering relief from inflammation and blood clotting. However, inhibi-

RESEARCH

Model of a damaged liver, which can result from painkiller overdose.

tion of these COX enzymes also inhibits the breakdown of arachidonic acid to prostaglandin H2, the latter of which is an important molecule in several hematological processes like platelet aggregation.

Thus, NSAIDs can affect systems as far-reaching as the bloodstream.

This COX inhibition also results in failure to produce other prostaglandins, many of which are potent factors in the gastrointestinal tract. To make matters worse, many of these NSAIDs are acidic in nature, resulting in damage of intestinal mucous membranes.

These analgesics are especially detrimental in children, as their compact frame ensures that the chemicals build up in concentration in the blood more rapidly,

resulting in greater danger and more pronounced effects. Similarly, the geriatric demographic is also at greater risk of painkiller overdose, owing not only to the fact that this population is routinely administered analgesics, but because of physiological changes that occur with age that make the body more susceptible to harm by painkillers. Specifically, aging is often associated with an increase in body fat percentage – particularly adipose tissue – and a drop in lean body tissue. Hence, lipophilic medicines, such as some painkillers, spend more time in the body before they are broken down and excreted.

Regardless of the age group to which these palliative drugs are

administered, these medicines are known to foster side effects ranging from liver damage to gastrointestinal irritation. Over time, tolerance and addiction are likely to develop, and it is only a matter of time before the detrimental effects are compounded and intensified. Before letting fear creep in and shying away from painkillers altogether, check with your doctor on the safety of the dosage, the time period of the prescription, and the likelihood of addiction. By learning to safely monitor our intake of analgesics, we can avoid the threats they bring, rather than simply delaying our pain only to have one caused by painkillers themselves.

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BRAINWAVE SYNCHRONIZATION

SYNCING BRAIN WAVES TO REVERSE AGE-RELATED MEMORY ISSUES

By

SOPHIA CAO JUI MALWANKAR

Every day, every hour, we use our working memory. According to Robert Reinhart, a director at Boston University’s Visual Cognitive Neuroscience Laboratory, working memory is the fundamental building block of human cognition, also called the “workbench of the mind.” From calculating the amount of money for coffee to memorizing exam concepts, working memory allows us to hold information due to neurons being fired that generate electrical brain waves. This type of memory, though, naturally deteriorates in connection to age.

As we age, the electrical brain waves begin to unsync causing the decline of short-term memory.

From a study by University of California Berkeley researchers, older fast-moving electrical bursts known as “spindles” fail to coincide with the slower brainwaves.

As an individual ages, it becomes more difficult for the older individual to perform daily duties or remember memories.

Looking into Working Memory

Although the recession of an older individual’s memory may not be

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due to Alzheimer’s disease, working memory deterioration can still significantly impact an individual’s quality of life. Knowing this, Robert Reinhart and his colleagues tried to discover a method that could reverse age-related memory problems. Since reduced working memory is a result of uncoupled neuron activity in the brain, researchers experimented on whether recoupling brain waves could produce a positive boost on memory activity. Reinhart and his team utilized weak electrical current jolts to synchronize waves in two critical cognitive parts of the brain: the prefrontal and temporal cortex. Applying the electrical current jolts to 42 elderly healthy individuals as they looked at two identical or different images of an everyday object, the experiment was to discover whether the elderly participants could spot the difference between the two illustrations. It was determined that the elderly individuals were more accurate at discovering changes in the images after 25 minutes of electrical current jolts than before the brain synchronization. Before the brain stimulation, 60-76 yearold participants answered the

image test correctly 80% of the time, but after brain synchronization, answered correctly 90% of the time.

To gain a better understanding of the elderly’s improvement after brain synchronization, Reinhart and the other researchers also looked into the working memory of 42 young adults aged 20-29. Naturally without brain stimulation, the 42 young adults answered the memory task correctly 90% of the time. This strongly depicts the equivalence of the elderly’s’ percentage after brain stimulation and the youngsters’ percentage with their natural working memory. The research findings supported the idea that the synchronization of brainwaves improved elderly participants’ prefrontal and temporal cortex in the brain. By resynchronizing the faulty brain circuits of the elderly, Reinhart brings to attention the rapid advance of their working memory.

Game Changer Towards Memory Loss

From the experimental study, it is proposed that brain stimula-

RESEARCH

tion can return working memory function for a certain amount of time. Stated by Michael Nitsche, a neurophysiologist at Germany’s University of Göttingen, the research by Reinhart and his colleagues adds important information about the causal relevance of non-invasive brainwave alterations for age-dependent cognitive decline, and underscores that

alterations are reversible. The discovery that treatment is possible for working memory decline is so significant that brain synchronization can be a game changer for the future. As a result of this basic foundation, non-invasive treatments for Alzheimer’s disease as well as schizophrenia could be discovered in the long run.

Cohut, Maria. “Syncing Brain Waves May Fight Age-Related Memory Problems.” Medical News Today, MediLexicon International, 8 Apr. 2019, www.medicalnewstoday.com/articles/324908. php.

Gilmour, Jared. “Memory Falters with Age. Sleep Is the Culprit - and Could Be the Cure, Study Finds.” Miamiherald, Miami Herald, 19 Dec. 2017, www.miamiherald.com/news/nationworld/national/article190448734.html.

Guglielmi, Giorgia. “Zapping Elderly Brains with Electricity Improves Short-Term Memory-for Almost an Hour.” Science, 8 Apr. 2019, www.sciencemag.org/news/2019/04/ zapping-elderly-brains-electricity-improvesshort-term-memory-almost-hour.

“How 'Zapping' Your Brain Could Reverse Age-Related Memory Decline.” Advisory Board, 11 Apr. 2019, www.advisory.com/dailybriefing/2019/04/11/memory.

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HYPOCHONDRIASIS IN THE MODERN AGE By

NIKKI KASAL SCOTT WU

What is Hypochondriasis?

So you’ve got a dull headache that gets worse every time a bright light hits your eyes, and your neck’s been feeling a little stiff since you woke up this morning. Hangover? Most likely. Simple migraine?

Can’t rule that out. Whatever it is, your rational half insists it’s likely completely harmless. Yet even as you try to persuade yourself to pop some Tylenol and carry on with your day, your other half worries that your symptoms sound suspiciously similar to influenza, or even meningitis, and that maybe you should take a quick look on WebMD just to be safe.

After a brief internal argument, you finally cave and type your symptoms into the search bar. Yet instead of reassuring you that it’s just a harmless headache, the very first results displayed diagnose you with the possibility of everything from brain hemorrhage to pneumococcal infection to astrocytoma. Brain cancer? Your heart rate skyrockets and you start to feel faint. Oh my god, I didn’t even think about that.

Has my headache gotten worse? It’s definitely worse.

How fast can a tumor spread? How long until I get off work? Does my doctor take same-day appointments?

Maybe I should just head straight to the ER. If the above scenario sounds all too familiar, you might be an individual with hypochondriasis, with afflicted patients often referred to as hypochondriacs.

Interestingly, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, doesn’t classify hypochondriasis as a diagnosis anymore; instead, it’s included in the description of illness anxiety disorder.

The DSM defines illness anxiety disorder as "preoccupation with fears of having, or the idea that one has,

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a serious disease, based on a misinterpretation of bodily symptoms”.

The reason for this alteration is to remove the focus from attempts to discredit a patient’s “imagined” symptoms and instead shine a brighter light on the very real physical and mental indicators of anxiety. Dr. Jeffrey Staab, a specialist in psychosomatic and behavioral medicine at the Mayo Clinic, says that “health anxiety and body vigilance are much more understandable to patients when they realize they can have these things despite what their doctor finds”.

“We found it much easier to engage patients if we identified what the problem was instead of what it was not,” Dr. Staab adds. Hypochondriacs are hardly rare: the American Psychological Association claims up to five percent of US adults suffer from the condition. Hypochondriasis typically manifests as the all-encompassing conviction that a person has a debilitating illness, regardless of the number of times their family and doctor insist there is nothing physically wrong with them. Indeed, negative test results from a doctor’s office can even strengthen their belief that their mysterious diseases will never be diagnosed or cured. Interestingly, 60% of those affected are

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also diagnosed with another mental illness, such as generalized anxiety and major depressive disorders.

Hypochondriasis also predominantly affects men and women in their 20s and 30s and often arises following a personal medical ordeal, that of a friend or family member, or a prior mental illness diagnosis.

Types of Hypochondriacs

Accordingly to Psychology Today, hypochondriacs generally may be classified into one of three groups.

The first, obsessive hypochondriacs, obsess over minor symptoms and regular bodily functions as proof of a deadly illness (what we typically imagine when we think of a hypochondriac). Depressive hypochondriacs, the second type, are similar to the former, yet their self-diagnoses are intended to give them a deep sense of misery and hopelessness about the future of their health. Perhaps the most interesting are the somatoform hypochondriacs, whose anxiety disorder manifests via physical symptoms such as elevated blood pressure and nausea.

The last of these may manifest as frequent doctor visits, “doctor shopping” for second opinions, and requesting multiple tests. However, in today’s modern age, information-seeking hypochondriasis is increasingly merging with cyberchondria. Though the term has been coined nearly 20 years ago in the early days of internet, it is making a comeback as more and more people turn to websites such as WebMD to research symptoms and self-diagnose.

Thomas Fergus, a professor of psychology at Baylor University, believes cyberchondria reflects elements of obsessive compulsive disorder (OCD), a related mental illness. Just as people with OCD perform ritualistic behavior to quell their anxiety, cyberchondriacs keep searching online for information that will somehow relieve their fears about real or imagined symptoms. “What they’re really looking for is reassurance that nothing bad is going to happen,” Fergus says.

However, more often than not, this kind of information-seeking only makes the disorder worse. Chief

among the reasons for this is the inherent unreliability of online information. While a Mayo Clinic article may generally be trusted, hypochondriacs turn to every information source they can find: this includes everything from said article to medical forums with people sharing home remedies and experiences.

"A lot of the stuff on the Internet, especially on health-related bulletin boards, is pure impression and anecdote," says Arthur Barsky, Harvard MD and author of Worried Sick: Our Troubled Quest for Wellness. "They just don't have a lot of scientific validity."

Ultimately, this wealth of conflicting information ends up breeding mistrust between a patient and their doctor: if a patient believes their medical provider is somehow withholding the (likely inaccurate) information they are reading online, they may start second-guessing the doctor’s judgment and decisions.

Rather than assuaging the hypochondriac’s concerns, each consecutive doctor’s visit only causes their suspicion and fear to snowball, worsening their condition.

The Future of Treatment

Traditional hypochondriasis treatment used to be focused on identifying the patient’s source of trauma responsible for the condition, which could be difficult at best and downright impossible at worst. “If we can’t find it, and the patient can’t find it, it can become a speculative wild goose chase for trauma”, says Dr. Staab.

However, a new approach to diagnosis is focusing more on treating hypochondria similarly to other anxiety disorders with cognitive behavioral therapy (CBT). CBT helps patients learn to recognize unhelpful and intrusive thoughts and replace them with more rational thoughts and behaviors in order to better cope with anxiety-inducing situations. Studies have shown this type of therapy to be effective in reducing hypochondria-related anxiety for at least a year and can be repeated as needed.

Cyberchondria, unfortunately, complicates the issue of treatment, since it’s intrinsically tied to our everyday use of modern technology as a byproduct

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of the phenomenon of digital health progress. With sleep trackers, nutrition logs, symptom checkers, online genetics tests and more, we have revolutionized our approach to preventative health in the past twenty years. However, the fact that this wealth of information is being interpreted by people with no formal medical training can lead to false interpretations of data and premature jumping to conclusions.

So what can we do? In addition to the courses of treatment discussed previously, it’s important for cyberchondriacs to actively manage their condition by recognizing that the internet is a double-edged sword, and every bit of true information is accompanied by ten falsehoods. Stick to reliable sources such as Healthline and MedPage Today when looking up symptoms, or better yet, realize that extensive research is likely only going to make the anxiety worse. The philosophical principle of Occam’s Razor states that the simplest solution is more often than not the right one: in hypochondriac terms, that headache is far more likely to be from a hangover than from a brain tumor.

Brody, Jane E. “A New Approach to Treating Hypochondria.” The New York Times, The New York Times, 18 June 2018, www.nytimes.com/2018/06/18/ well/a-new-approach-to-treating-hypochondria.html.

“How to Overcome Being Cyberchondriac?” The Medical Futurist, 11 Sept.

2018, www.medicalfuturist.com/how-to-overcome-being-cyberchondriac.

“Hypochondria: a Word Desperately in Need of a Makeover.” National Elf Service, 14 Apr. 2013, www.nationalelfservice.net/mental-health/anxiety/ hypochondria-a-word-desperately-in-need-of-a-makeover/.

“Internet Makes Hypochondria Worse.” WebMD, WebMD, www.webmd.com/ balance/features/internet-makes-hypochondria-worse.

Neal, Brandi. “Here's What Cyberchondria Is (And How To Tell If You Have It).” Bustle, Bustle, 7 May 2019, www.bustle.com/p/what-is-cyberchondriathis-kind-of-health-anxiety-is-fueled-by-dr-google-17015236.

“Psychiatry and Psychology.” Mayo Clinic, Mayo Foundation for Medical Education and Research, www.mayoclinic.org/medical-professionals/ psychiatry-psychology/news/dsm-5-redefines-hypochondriasis/ mac-20429763.

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EARLY LUNG CANCER DETECTION

THE EVOLUTION OF LUNG CANCER SCREENING

By

SHEHZAIB RAEES ALLAN ZHANG

In 2017 alone, 1.88 million people died from lung cancer, the largest tally for deaths across all types of cancer, even though it is only the fifth most prevalent form of cancer. In fact, although the proportion of lung cancer deaths have decreased by nearly 50% from 1990 to 2016 in men and 23% from 2002 to 2016 for women in the U.S., lung cancer has been the leading cause of cancer-related deaths for decades, with a sum greater than next three most common cancers combined (breast, prostate, and colorectal cancers). With a survival rate of only 18.1%, the third lowest among all types of cancer, lung cancer has proven itself to be one of the greatest detriments to human health.

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The most evident reason as to why lung cancer is so deadly is because it is almost undetectable in its early stages without invasive biopsies or radiation reliant screening techniques. Moreover, when symptoms are observable, metastasis in local and distant regions has most likely already occurred. Lung cancer presents itself as a challenge to physicians in all areas of medicine, as it has a comparatively high recurrence rate following curative surgical resection procedures of 30-55% in patients with non-small cell lung cancer (NSCLC) and obscured symptoms despite rapid spreading and metastasis that prevent proper diagnosis. Although surgical removal is the only curative procedure for early stage NSCLC tumors and chemoradiation therapy for small cell lung cancer (SCLC), none of these methods are viable without proper screening and visualization of the tumors.

However, screening for lung cancer has never gained the same traction as other forms of cancer; almost all adults are recommended to undertake

colonoscopies for colorectal cancer between 45 and 75 years of age, females should begin an annual mammogram routine at age 40 and switching to every 2 years after age 55 to check for breast cancer, and men are recommended to consult with their physicians starting at age 50 regarding prostate cancer. Nevertheless, lung cancer screening never became a prominent countermeasure to prevent early state disease, even to the point where patients with extensive pack-year – a metric to quantify a person's cigarette smoking – histories would not even receive an X-ray recommendation. Two of the most apparent flaws with screening techniques, however, are false positives and overdiagnosis. False positives can be misinterpretations of data or errors within the testing mechanism that produce positive test results in patients or test subjects who do not have the condition. An overdiagnosis is a diagnosis of a condition that will produce no negative symptoms, and although it is correct in nature, the diagnosis

Figure 1. Cancer deaths attributed to various types. Tracheal, bronchus, and lung cancer contributed more than twice the amount of the deaths than the next leading type in colon and rectum cancer and is the leading form of cancer death in high and middleincome countries. Data sourced from Institute for Health Metrics and Evaluation.

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can cause patients to experience stress and undergo unnecessary treatments that can harm their well-being. Given the devastating potential of lung cancer, a reliable screening test had to be found by researchers, which means it would not only have to accurately diagnose early stage lung cancer, but also be reliable enough to prevent false positives and overdiagnosis.

In the 1970s, X-rays were the most prominent form of screening, which posed a serious problem in terms of overdiagnosis and a lack of mortality reduction. Studies conducted by the Mayo Clinic and Johns Hopkins used sputum cytology tests and chest X-rays as prevalence checks, split the participants into two groups, then conducted chest X-rays and follow-up sputum cytology tests every 4 months in the experimental group as opposed to the regular annual check for the control group. Both studies not only showed no reduction in mortality across both groups, but the experimental group showed increased overdiagnosis, with 585 cancer diagnoses in the experimental screening group and 500 in the control group.

These overdiagnoses resulted in patients undergoing unnecessary invasive procedures, such as follow-up biopsies that require general anesthesia and place the patient in a risky environment, especially given the lack of positive return on the exam.

In fact, the chest X-rays and sputum cytology test are by nature inaccurate; although X-rays can detect large cancerous lesions and represent their location relatively well, visualizing small tumors is extremely difficult and require extensive invasive workups to be differentiated from other non-cancerous lung conditions. Sputum cytology screens have a false negative rate of almost 40%, and although they have a false positive rate of only 1%, they detect less than 50% of peripherally located tumors compared to 71% of those more centrally located.

Computed tomography (CT) scans then entered the fray as the technology used in this screening test became more readily available. CT scans consist of several imaging slices throughout the area of interest, whereby a chest CT scan typically consists of 1mm image slices throughout the whole thorax that are reconstructed via computer software. The most

Figure 2. X-ray of chest of patient with known emphysema presenting with cough. The lesion identified with arrows, a slight grey patch, differentiated from normal physiological structures in the right hilum (medial, or central, side of lungs) was determined to be a carcinoma through CT-guided biopsy. Image sourced from Saint Vincent’s University Hospital.

common form of lung cancer screening is a low dose CT scan (LDCT), which utilizes less than 25% of the typical amount of radiation in regular CT scan and does not require the use of intravenous iodine contrast dye.

Following the X-ray trials in the 70s, the Mayo Clinic began an LDCT trial with 1,520 patients that had extensive 20+ pack-year histories. Of those patients, 74% were diagnosed with lung nodules, which are comparatively benign lung masses that have the potential to represent cancerous lesion, but also arise from infectious diseases such as pneumonia and tuberculosis or even old age. However, only 4% of those individuals developed lung cancer, which signaled that a large amount of overdiagnosis were made and the mortality rate was similar to the previous Mayo Clinic trial with X-ray screening. This study also had an exorbitant number of false negatives; almost 26% of patients had lung nodules that were not detected on the initial, or baseline, scan.

Therefore, no clear evidence was provided to evaluate whether CT scans are the preferable screening method when compared to X-ray screening.

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Figure 3. CT scans of normal chest and chest with right lung cancer. The tumor is clearly visualized as a large white mass within the right lung (left side on the scan) that is distinct from normal physiological structures. Image is sourced from UF Health Jacksonville.

However, a trial began in the Cornell University Medical Center involving 1,000 high-risk and notably asymptomatic patients. The Early Lung Cancer Action Program (ELCAP) produced the first results that indicated CT scans were a more viable alternative to chest radiography. In the findings, the experimenters showed that 80% of participants found to have lung cancer had stage 1 disease, which proved that CT scans can readily detect early stage lung cancer. This is especially important given that the curability rate for stage 1 lung cancer is 80-90% and the survival rate for localized lung cancer over a 5-year period is 60%, compared to a 6% survival rate for distant late stage disease. The ELCAP study was not without concern, however, as there was no control group to which the results could be compared, but it showed that chest CT scans can improve mortality rates for individuals with elevated risks of lung cancer by detecting early stage disease.

In 2002, the National Lung Screening Trial began, a study with 53,454 participants at high risk for lung cancer, which means patients at least 55 years of age with a 30+ pack-year history who have recently stopped smoking. This study sought to finally show that LDCT scans could readily reduce the mortality

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rate while simultaneously preventing overdiagnosis.

The patients were split into two groups: LDCT and chest radiography and information were gathered through December 31, 2009. The results indicated that although the false positive rate remained drastically high (96.4%), there was a relative reduction in mortality rate of 20% in the LDCT group patients, which thoroughly proved the effectiveness of CT scan screening. Although the potential for overdiagnosis remained high, the overall mortality rate for all causes also significantly declined by 6.7%, which indicates that LDCT screening has the potential to not only reduce patient mortality rates via detection of early stage lung cancer, but also provides information in other areas that allows physicians to see a more holistic overview prior to diagnosis and therefore reduces the chances of risky invasive procedures or point out other underlying thoracic conditions.

As screening technologies and techniques continue to improve, the issues of false positives and overdiagnosis will slowly fade, and more precise data will be gathered to prevent the spread of lung cancer. More advances in healthcare policy have occurred in recent years to accompany those technological changes.

In 2013, the U.S. Preventative Services Task Force

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issued a groundbreaking recommendation, suggesting that all people who meet the high-risk criteria for lung cancer should contact their physicians to begin annual LDCT scans in order to detect the potentially life-threatening disease. Trials to revise the criteria and guidelines for LDCT screenings are still being made and will open the door for more readily available screenings as more data regarding the adverse effects of smoking continue to be discovered through medicinal trials.

“Cancer Screening Guidelines | Detecting Cancer Early.” Accessed May 15, 2019. https://www.cancer.org/healthy/find-cancer-early/ cancer-screening-guidelines/american-cancer-society-guidelines-for-theearly-detection-of-cancer.html.

“CAT Scan (CT) - Chest.” CAT Scan (CT) - Chest. February 14, 2018. Accessed May 15, 2019. https://www.radiologyinfo.org/en/info.cfm?pg=chestct.

“Facts & Figures 2019: US Cancer Death Rate Has Dropped 27% in 25 Years.”

American Cancer Society. January 8, 2019. Accessed May 15, 2019. https:// www.cancer.org/latest-news/facts-and-figures-2019.html.

“Lung Cancer.” Mayo Clinic. November 16, 2018. Accessed May 15, 2019. https://www.mayoclinic.org/diseases-conditions/lung-cancer/diagnosistreatment/drc-20374627.

“Lung Cancer - CXR.” Lung Cancer Case Study. Accessed May 19, 2019. http:// www.svuhradiology.ie/case-study/lung-cancer-cxr/.

“Lung Cancer Screening.” Lung and Esophageal Cancer Care Programs.

Accessed May 19, 2019. https://ufhealthjax.org/cancer/lung/screening.aspx.

“Non-Small Cell Lung Cancer Survival Rates.” Non-Small Cell Lung Cancer.

February 4, 2019. Accessed May 15, 2019. https://www.cancer.org/cancer/ non-small-cell-lung-cancer/detection-diagnosis-staging/survival-rates. html.

“Small Cell Lung Cancer Treatment.” National Cancer Institute. Accessed May 15, 2019. https://www.cancer.gov/types/lung/patient/small-cell-lungtreatment-pdq.

“What Is Overdiagnosis?” April 20, 2017. Accessed May 15, 2019. https://www. ncbi.nlm.nih.gov/books/NBK430655/.

Aberle, Denise R., Amanda M. Adams, Christine D. Berg, William C. Black, Jonathan D. Clapp, Richard M. Fagerstrom, Ilana F. Gareen, Constantine Gatsonis, Pamela M. Marcus, JoRean D. Sicks, and National Lung Screening Trial Research Team. “Reduced Lung-cancer Mortality with Low-dose Computed Tomographic Screening.” The New England Journal of Medicine. August 04, 2011. Accessed May 15, 2019. https://www.ncbi. nlm.nih.gov/pubmed/21714641/.

Finigan, James H., and Jeffrey A. Kern. “Lung Cancer Screening: Past, Present and Future.” Clinics in Chest Medicine. September 2013. Accessed May 18, 2019. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4102106/.

Marcus, Pamela M., Erik J. Bergstralh, Richard M. Fagerstrom, David E. Williams, Robert Fontana, William F. Taylor, and Philip C. Prorock.

“Lung Cancer Mortality in the Mayo Lung Project: Impact of Extended Follow-up.” OUP Academic. August 16, 2000. Accessed May 18, 2019. https://academic.oup.com/jnci/article/92/16/1308/2905917.

Members of the U.S. Preventive Services Task Force. “Final Recommendation Statement.” Lung Cancer: Screening. Accessed May 15, 2019. https://www.uspreventiveservicestaskforce.org/Page/Document/ RecommendationStatementFinal/lung-cancer-screening.

Pennell, Nathan, M.D. “Why Lung Cancer Is the Deadliest Cancer, and Why It Doesn't Have to Be.” Healthcare. June 30, 2016. Accessed May 15, 2019. https://health.usnews.com/health-news/patient-advice/ articles/2015/06/30/why-lung-cancer-is-the-deadliest-cancer-and-why-itdoesnt-have-to-be.

Roser, Max, and Hannah Ritchie. “Cancer.” Our World in Data. July 03, 2015.

Accessed May 15, 2019. https://ourworldindata.org/cancer#cancersurvival-rates.

Tan, Winston W., M.D., and Syed Huq, M.D. “Non-Small Cell Lung Cancer (NSCLC) Workup: Approach Considerations, Laboratory Studies, Chest Radiography.” Non-Small Cell Lung Cancer (NSCLC) Workup: Approach Considerations, Laboratory Studies, Chest Radiography. April 22, 2019.

Accessed May 15, 2019. https://emedicine.medscape.com/article/279960workup#c11.

Uramoto, Hidetaka, and Fumihiro Tanaka. “Recurrence after Surgery in Patients with NSCLC.” Translational Lung Cancer Research. August 2014.

Accessed May 15, 2019. https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC4367696/.

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U.S. MEASLES OUTBREAK 2019:

FROM AN ELIMINATED DISEASE TO RENEWED THREAT

By

ALLISON GENTRY LINDSAY ROMANO

In the 1950’s, nearly all children in the U.S. contracted measles before the age of fifteen. The development, distribution, and implementation of an effective vaccine throughout the late twentieth century led to the elimination of measles from the United States in 2000; however, in past months, there has been a significant increase in the amount of measles cases recorded, with a total of 764 cases recorded in 2019 as of May 3.

Measles is a viral infection in the host’s nose and throat where any contact with surfaces containing infected droplets may lead to infection. This disease is extremely contagious, and can spread through the air, transmitted through sneezing or coughing.

Infection can remain a threat for as long as two hours after the infected person was present. Symptoms include fever, sore throat, inflamed eyes, and severe coughing, and an individual may be contagious for up to four days before a distinct rash appears on the skin. Due to the contagious nature of the infection, it is extremely difficult and expensive to quarantine infected individuals, as the proto-

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col requires getting in contact with every person possibly exposed to the infected individual.

There is an elevated risk of contracting measles for individuals who are unvaccinated, as they have no immunity developed against the infection. Those who have been exposed to the weakened live virus in vaccines have developed immune responses which can decrease the chances of infection.

The vaccine for measles is usually combined with the vaccinations for mumps and rubella, known as the MMR vaccine. It is suggested that children receive the first dose of this vaccine around 12 to 15 months of age and the second dose from 4 to 6 years of age.

Subsequent doses are suggested for adults who show no sign of immunity or during outbreaks of the infection.

The more recent outbreaks within the U.S. have arisen due to unvaccinated travelers who brought the disease back from foreign countries where measles is more prevalent. In cases where the infected individual returns to a community of other unvaccinated individuals, there may be

contagion which is widespread and difficult to contain. Cases such as these include a major outbreak in the fall of 2018 in an Orthodox Jewish community in Brooklyn, New York, which began after an unvaccinated child caught the disease after a trip abroad, and the infection spread throughout the neighborhood. The Brooklyn outbreak has become so severe in several areas that four zip codes are mandating MMR vaccinations for all people in the area, with potential fines up to $1,000.

As of May 3rd, there have been reported cases of the measles in 23 states, including outbreaks in major cities such as Los Angeles, where five cases have been reported and are being contained.

One of these cases included a student at UCLA, where the infected individual attended classes for four days before being quarantined. Officials are working to manage the situation by notifying all individuals on campus who may have come into contact with the student at that time. In areas of higher population concentrations, it is vital that the disease be contained quickly so that it will

CURRENT EVENTS

CDC Media Statement: Measles Cases in the U.S. Are Highest since Measles Was Eliminated in 2000 | CDC Online Newsroom | CDC." Centers for Disease Control and Prevention.

Accessed May 2, 2019. https://www.cdc.gov/ media/releases/2019/s0424-highest- measlescases-since-elimination.html.

"Infographic: Measles & Rubella Initiative - A Global Partnership to Stop Measles and Rubella." Centers for Disease Control and Prevention. January 27, 2014. Accessed May 2, 2019. https://www.cdc.gov/globalhealth/ immunization/infographic/mri.htm.

Feldman, Sarah, and Felix Richter. "Infographic: 2019 Is Proving A Bad Year For U.S. Measles Outbreak." Statista Infographics. Accessed May 2, 2019. https://www.statista.com/chart/17629/ united-states-measles-cases/.

McKay, Betsy, and Melanie Grayce West. "U.S. Records Highest Number of Measles Cases in 25 Years, CDC Says." The Wall Street Journal. April 24, 2019. Accessed April 27, 2019. https://www.wsj.com/articles/ new-york-citys-measles-outbreak-growsincludes-two-pregnant-women-11556136301.

This chart shows the increase in measles cases in the U.S. as of April 25, 2019, and illustrates that the amount of cases in merely the first half of this year have exceeded the total seen in previous years.

not lead to further infections or hospitalizations within the area.

The recent outbreaks are also being linked to a spread of misinformation about vaccinations, which has been spread through social media and telephone hotlines developed by groups such as the “Anti Vaxxer� movement.

Groups with anti-vaccination platforms have been present in the public sphere ever since vaccinations were introduced, due to growing fears about sanitation and general distrust of medical professionals. This unease was heightened by speculation that vaccinations could potentially lead to autism in children, and while this conjecture was proven faulty in 2011, suspicions within public opinion still remain. The influence of these anti-vaccination groups have led to many parents deciding to not vaccinate their own children, leaving the children exposed

to the infection with no immunity and increasing the likelihood for rapid contagion.

The ongoing rise in measles cases throughout the United States is alarming and highlights the importance of widespread vaccinations for the protection of the general public as well as for prolonged immunity against the infection. The continual spread of misinformation about vaccinations may lead to detrimental effects for the public, leaving unvaccinated populations more vulnerable to infection. The vaccination of both children and adults has been proven to be the most effective way to combat the disease. As the outbreaks continue, sources such as the CDC have suggested that individuals ensure that their vaccinations are up-to-date in order to ensure some protection against further outbreaks.

McKay, Betsy, Melanie Grayce West, and Brianna Abbott. "Spread of Measles Accelerates, With U.S. Cases Rising to 465 So Far This Year." The Wall Street Journal. April 08, 2019. Accessed May 1, 2019. https://www.wsj.com/articles/ number-of-measles-cases -in-u-s-rises-to-465so-far-this-year-11554734849.

"Measles." Mayo Clinic. September 07, 2018.

Accessed May 16, 2019. https://www. mayoclinic.org/diseases-conditions/measles/ symptoms-causes/syc-2037485.

"Measles | History of Measles | CDC." Centers for Disease Control and Prevention. Accessed May 1, 2019. https://www.cdc.gov/measles/about/ history.html.

"Measles | Cases and Outbreaks | CDC." Centers for Disease Control and Prevention. Accessed May 1, 2019. https://www.cdc.gov/measles/ cases-outbreaks.html.

"The Anti-vaccination Movement." Measles & Rubella Initiative. September 13, 2018. Accessed May 16, 2019. https:// measlesrubellainitiative.org/anti-vaccinationmovement/.

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THE PRE-MEDICAL STUDENTS’ ASSOCIATION the university of chicago FACEBOOK /uchicagopmsa WEBSITE pmsa.uchicago.edu