UChicago PULSE Issue 4.2: Winter 2018

PULSE VOLUME 3, ISSUE 2. WINTER 2018

THE ARTIFICAL WOMB

from the editor-in-chief Dear reader,

Happy 2018! As the new year gets into full swing, we hope you're all excited to read another new issue of PULSE! This quarter, we've got quite the collection of articles spanning a range of topics, from debating the ethics of organ donation in our Policy section to considering the CDC word ban in the context of HIV/AIDS under Current Events, and so much more in between. In this issue, like every issue of PULSE, we attempt to paint a bigger picture of medicine and expose the interplay between research, health, and policy in our society.

This winter issue also presents a series of reviews placing recent research in a social framework including questions about how artificial wombs might affect ethics and policy, what connections lie between gut bacteria and cancer, and the impact of virtual reality on healthcare. We discuss how policy impacts medicine and health and how health and medicine should impact policy, with gene editing, vaccines, and more!

The world advances a bit every day, in every direction; PULSE aims to pick out some of the highlights and present them in their own light for your perusal. We hope you enjoy!

With regards, Irena Feng

editors

writers

production

Bushra Akbar Swathi Balaji Purujit Chatterjee Anya Dunaif Kalina Kalyan (general) Amber Keahey Jui Malwankar Ariel Pan Linus Park Medha Reddy Fatima Sattar

Daksh Chauhan Annagh Devitt Yassmin Elbanna Hannah Jacobs-El Kalina Kalyan Nikki Kasal Sarah Nakasone Olivia Paraschos Alessandra Veinbachs Scott Wu Edward Zhou

Purujit Chatterjee (cover design) Irena Feng Bonnie Hu Olivia Shao

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other contributors Gold Standard Kaplan Test Prep The Princeton Review

CONTENTS EDUCATION ANATOMY OF A MED SCHOOL APP HOW TO MAKE YOUR MCAT PREP PERSONAL KAPLAN MCAT PRACTICE PROBLEM WHY MCAT SUMMER IMMERSION IS WORTH IT

2 6 7 8

POLICY THE OREGON HEALTH INSURANCE EXPERIMENT ETHICS OF ORGAN DONATION NEGLECTED TROPICAL DISEASES: THEN AND NOW

10 14 18

RESEARCH THE BIOETHICS AND SOCIAL IMPLICATIONS OF

THE ARTIFICIAL WOMB THE ROLE OF GUT BACTERIA ON CANCER TREATMENT AUGMENTED REALITY IN HEALTHCARE

22 24 26

CURRENT EVENTS WHY CENSORSHIP AT THE CDC WILL COST LIVES WHO HAS THE RIGHT TO EDIT YOUR DNA? THE NUMBER-ORIENTED PROBLEM OF THE MEDICAL WORLD THE PLUMMET OF PUBLIC HEALTH

30 36 39 42

RECENT DEVELOPMENTS

48

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ANATOMY OF A MED SCHOOL APP Medical schools share a general application process, but individual schools can vary significantly in how they evaluate candidates. Here’s what you need to know about your primary and secondary med school applications to stay on track.

APPLYING TO MEDICAL SCHOOL Most U.S. medical schools participate in the American Medical College Application Service (AMCAS), a centralized, third-party organization that administers and processes medical school applications. The majority of medical schools admit students on a rolling basis, which means that spaces in the program are offered to qualified students until all the spots are filled.

Primary Application •

•

•

• •

First, you'll submit a single application, usually through one of three centralized online application services: • AMCAS (for MD admissions) • TMDSAS (for Texas Medical Schools) • AACOMAS (for DO admissions) Your primary application provides medical schools with enough information to make an initial screening of applicants. A completed primary application includes: • your transcripts (undergraduate transcripts plus any for grad or post-bacc work) • MCAT scores • information about your most meaningful experiences (academic, research, clinical, and extracurricular activities • a short personal statement • letters of recommendation (though some schools ask for LORs as part of the secondary application only) Each medical school sets its own final deadline for applicants submitting information through the application service. Regardless of these deadlines, our med school admission experts recommend you submit your application as early as possible. Applications that are submitted early in the cycle are reviewed first and therefore have a better chance of acceptance at almost all schools.

Procrastinators, take note: these application services are serious about their deadlines. If an application is late, you'll get it back without a refund.

If any of your chosen schools have interest, they will invite you to submit a secondary application.

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EDUCATION

Secondary Applications • • • •

After reviewing your AMCAS file, the admissions committees at your med schools will either reject you or send you a secondary application. Some schools send all of their applicants a secondary. Others go through an initial cut that is usually based entirely on GPA and MCAT scores.

Unless you've decided not to apply to that school, you should complete and return each secondary application as you receive it. Most med schools will reject any application that arrives after the deadline.

Secondaries typically include a variety of essays on assigned topics. You could be asked to discuss your favorite novel, describe a leadership role you've taken, or detail your greatest academic achievement.

You will also be asked to submit letters of recommendation if you did not do so through AMCAS. If the cost of sending back secondaries is prohibitive, you can call the school and request a fee waiver.

If you were eligible for a waiver from AMCAS, for example, you will probably be eligible for a waiver from individual schools.

Interviews • • • • •

Once the committee reviews your secondary med school application, they will do one of three things: reject you, invite you to the campus for an interview, or hold your application until after the first round of interviews. Final decisions are usually made after the interview.

The standard U.S. interview season is between September and February (occasionally March).

Med school interview policies and formats vary. At some schools you'll interview one-on-one, and at others you'll interview by panel.

The interview is another opportunity to stand out to med schools! Practice with our list of classic medical school interview questions, found online.

A school might decide that they want to see what the rest of the applicant pool looks like before they admit you. If a med school puts you on a "hold list," you can send in supplementary material (a short one-page description of recent academic or extracurricular achievements) to bolster your application.

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After applications and interviews...

Alternate List Once all the med school class places have been filled, additional qualified candidates are placed on the alternate list and are granted space only as accepted students decline their acceptance. While it’s rare, some students do drop out of the program in the initial days which can open up additional places.

MED SCHOOL APPLICATION SERVICES Most U.S. medical schools participate in AMCAS. But there are other application services you may need to be aware of depending on the types of med schools you are applying to and their locations.

WANT TO GET AN EDGE OVER THE CROWD? Our admissions experts know what it takes it get into med school. Get the customized strategy and guidance you need to help achieve your goals.

For more than 35 years, students and families have trusted The Princeton Review to help them get into their dream schools. We help students succeed in high school and beyond by giving them resources for better grades, better test scores, and stronger college applications. Follow us on Twitter: @ThePrincetonRev.

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EDUCATION

AMCAS

TMDSAS

AACOMAS

WHAT IS IT?

American Medical College Application Service

Texas Medical & Dental Schools Application Service

American Association of Osteopathic Medicine Application Service

WHO USES IT?

Applicants to most allopathic medical schools

Applicants to medical, dental, and veterinary schools in Texas

Applicants to most osteopathic medical schools

IMPORTANT DEADLINES

May 2: AMCAS opens and begins accepting transcripts June 1: AMCAS begins accepting application submissions June 30: AMCAS sends first batch of processed applications to med schools August 1: Submission deadline for Early Decision Programs

May 1: TMDSAS opens August 1: Submission deadline for Early Decision September 29: Submission deadline for application to medical, dental, and vet programs

The application cycle opens in May and closes the following April.

$160 for the first school, $38 for each additional school

$150 flat fee for all applicants regardless of the number of schools applying to

$195 for the first school, $40 for each additional school

FEES

Deadlines vary by college so be sure to confirm deadlines for the schools to which you are applying.

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HOW TO MAKE YOUR MCAT PREP PERSONAL Preparing for the MCAT exam can feel stale, disinteresting, and at times restrictive.

Pouring over pages of facts and formulas for hours can easily become frustrating.

Enter your MCAT personal notes!

Writing personal notes while studying for the MCAT is a very important part of the review process. Your notes ensure that you avoid making the mistake of over-studying or under-studying. In addition, note taking maximizes the benefits of your content review, practice problems, and full-length MCAT practice tests. But, of course, you must first know how to take personal notes.

Practice Problem Notes

Practice problems are useful for applying information from your content review. However, practice problems also help you identify which concepts you may not completely understand along with techniques for arriving at an answer faster. This is why you should always read answer explanations thoroughly. Usually, that explanation will not only direct you to its corresponding chapter but also include intuitive reasoning and the process of elimination.

These are great time-saving tips that you should add to your notes.

Full-length Practice Test Notes

Content Review Notes

For each chapter you read during your content review, you should develop one to two pages of notes by asking yourself the following questions: • Do I know this already?

• Is this related to something else I read?

• Is this really relevant to the MCAT? Your answers to these questions will help you focus note taking on the most relevant as well as new information. For example, if you notice a derivation of the Ideal Gas Equation, include that derivation in your notes if it is something new to you. Also, take note of keywords and concepts that you want to retain.

Taking notes after taking a full-length MCAT practice test is essential. These notes will help you avoid repeating costly mistakes on future practice tests as well as the real exam. For this reason, you must review your full-length practice test notes before taking the next practice test.

Early in your MCAT preparation, you should read your notes from your content review, practice problems, and full-length practice tests two to three times per week. Then, in the weeks leading up to your test day, you should read your notes every day. Research shows that reading your notes every day improves information recall.

These notes will be your most precious review tool in the days leading up to the real MCAT. Good luck!

Gold Standard has over 25 years’ experience helping students through their MCAT preparation. All our resources at www.MCAT-Prep.com, from online courses to practice tests, are based on problem-based learning.

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EDUCATION

Kaplan MCAT PRACTICE PROBLEM QUESTION Which of the following terms refers to the burden or degree of disease associated with a given illness?

A. morbidity B. mortality C. second sickness D. chronicity

THINK YOU’RE READY FOR TEST DAY? Find out with this fun and FREE way to tackle practice MCAT questions from Kaplan Test Prep. Register to receive one sample question a day for the next three months. You’ll get: • A new MCAT-style question each day to test your knowledge and skills • Complete explanations and expert strategies with every question • Compete against your friends to see who’s really ready for test day To get started go to: https://www.kaptest.com/mcat/mcat-practice/free-mcat-practice-question-a-day

A. Morbidity refers to the burden of illness, or the severity or degree of illness.

Mortality, choice (B), refers to deaths caused by a given illness. Second sickness, choice (C), is a term used to describe the exacerbation of health outcomes due to social injustice. Chronicity, choice (D), refers to the duration of a disease, not its severity or significance for the patient.

ANSWER winter 2018 || 7

WHY MCAT SUMMER IMMERSION IS WORTH IT When you’re a pre-med, every second of your time is valuable. Make this summer count by achieving your MCAT score goals. Our MCAT Summer Immersion programs are perfect for maximizing your score in an on-campus, focused prep experience. Not sure if an MCAT boot camp is right for you? Here's why intensive summer prep is a smart choice.

1. MAINTAIN A HEALTHY WORK/LIFE BALANCE

3. KEEP YOUR OPTIONS OPEN

2. GET PEACE OF MIND

4. PREP FOR THE FUTURE

Prepping for the MCAT during the summer means you can focus on grades, extracurriculars, and research during the school year. Use your break from school to ramp up your study schedule (and boost your score).

With 370 hours of instruction, MCAT Summer Immersion is our most rigorous MCAT prep program. Dive into summer knowing that you WILL maximize your score, or take it again for free if you're not satisfied.

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Our six-week program will get you ready for MCAT test dates in August and September. You can apply to medical school in the current admissions cycle or save your score and apply next year.

Don’t have a summer or fall MCAT date? Our program will help you build the strong foundation you need to take the MCAT at a later time.

EDUCATION

MCAT Summer Immersion is a six-week, on-campus MCAT prep experience designed for the most dedicated and high-achieving students. You’ll live and breathe the MCAT so you’re ready for your July, August, or September test date. For more information or for help deciding which city is right for you, call our enrollment advisors at 1(888)-501-7612.

5. SAY GOODBYE TO BAD HABITS

7. LEARN FROM THE VERY BEST

6. BOOST MEMORIZATION

8. GET MOTIVATED

A new environment can help you achieve a new level of focus. Instead of building (and breaking) your own study schedule, follow a proven MCAT schedule that covers content review, practice tests, and strategy.

There's even built-in study time to practice or get one-on-one feedback on the test-taking tips you're learning in class.

Cognitive science studies show that a change in study location can greatly improve retention and recall. Try switching up your daily routine in our locations in Orlando, San Diego, or Austin – perfect for committing key topics to memory!

Instead of learning from one MCAT instructor who does it all, you’ll learn from a team of specialists in each of six MCAT subjects. Prep for orgo questions with an Organic Chemistry expert and for CARS passages with a CARS expert.

You’ll be surrounded by high-achieving MCAT students who are just as dedicated to maximizing their score as you are. Together you’ll live and breathe MCAT for the summer, holding each other accountable and celebrating each other’s successes.

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THE OREGON HEALTH INSURANCE EXPERIMENT EFFECTS OF EXPANDING MEDICAID By

DAKSH CHAUHAN MEDHA REDDY (Editor)

The question of the type of healthcare America should have is a long-standing one that has baffled politicians and medical professionals alike. While some have proposed expanding existing subsidies, like Medicaid – which provides eligible people with free health coverage – and transitioning into a single payer system like Canada, others question whether increased spending is the most effective way to solve the problems associated with the current system. The main concern of the skeptics is whether expanded coverage for all will even improve health outcomes for the nation and prevent financial losses to sick days.

This is one of the questions that the Oregon Health Insurance Experiment, a 2008 study done by the Oregon Health Study Group, headed by Dr. Katherine Baicker (then Professor at Harvard and the current Dean of the Harris School) and Dr. Amy Finkelstein (professor at MIT), aims to answer.

Right before the Obama administration took control of the White House and shifted its focus to increasing healthcare coverage for all, the Oregon state government began an expansion program of its Medicaid program for low-income adults. However, due to limited funds, not everyone could be enrolled.

A lottery-based system was instituted by the Oregon government, which allowed for a good randomized setting. About 90,000 Oregon residents put their names in the lottery, and about 30,000 were given a chance to enroll. Of the 30,000 who were given a chance to enroll, about 10,000 successfully enrolled.

For the purposes of analysis, the individuals who received the insurance through the lottery were the

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treatment group, and ones who did not were the control group. Two years after the lottery, Baicker and Finkelstein looked at variables like blood pressure, cholesterol and results from depression screenings to calculate the effect of the Medicaid expansion.

After analyzing the data collected from the group of 20,000 Oregonians, half of whom received Medicaid and half of whom did not, the Oregon Health Study Group found that there was no significant difference between the groups for most of the clinical outcomes, including cholesterol levels, glycated hemoglobin levels and blood pressure. Even the ten-year risk of cardiovascular events, calculated with the Framingham risk score, was not significantly affected with Medicaid coverage. However, the group with Medicaid was almost 30% less likely to be diagnosed with depression compared to the control, a notable difference attributable to depression screening through the patient health questionnaires.

The study also discovered that people with Medicaid were also much more likely to have received a higher number of prescription drugs, and make more visits to a doctor in a year. Overall, following the expansion, it was noted that people on Medicaid spent $1,172 more on average compared to the control group.

Hence, the Oregon Health Insurance Experiment was important in showing that increasing public funded coverage does not significantly improve health outcomes of patients. Enrolling in Medicaid did not lead to better controlled blood pressure or cholesterol levels compared to the control group. Even though the government was spending more by expanding

POLICY

Medicaid to 10,000 more people, patients were not getting healthier. The only clinical outcome which was better for people enrolled in Medicaid compared to those in the control group was diagnosis of depression. Although the Medicaid expansion did improve diagnosis of depression, the mere possession of health insurance provides a degree of financial security which makes it unclear whether the outcome can be solely attributed to the services provided with Medicaid.

But given these results, we must ask if spending more money to insure a greater population is worth the increased financial security on a larger level. Forbes writer Avik Roy, an author exploring Medicaid's failure to improve health outcomes in his recent work How Medicaid Fails the Poor, called on this study in 2013 to make a case against the Patient Protection and Affordable Care Act. He argued that if Medicaid is only able to provide increase financial security, it does not make “sense to pour about a trillion dollars into a health care system that everyone agrees is deeply dysfunctional, when some of that money could be returned to Americans’ paychecks instead.” Others used the study to argue that even lowered financial strain is worth the greater mental peace of mind. The New Republic writer Jonathan Cohn, an outspoken supporter of universal health care and the writer of Sick: The Untold Story of America's Health Care Crisis – and the People Who Pay the Price, stated in an article that improved mental health in itself could save money and costs associated with lack of productivity. “Not only might better mental

health save some money, given the costs to society of lost productivity and activity…It should also save lives,” stated Cohn in his article. His assumption, clearly, is that peace of mind in itself is a positive outcome that would reflect when looking at clinical outcomes.

But saying that we should not increase funding for Medicaid because it does not objectively make its users healthier or lower the losses to lack of productivity significantly is morally wrong. Just because a formulaic cost-benefit analysis shows that the amount of money spent by the government is not yielding the returns or reducing the money lost to sick leaves doesn’t mean that we should leave millions of currently uninsured Americans in a depressed state, something that will definitely reflect in their performance and physical health over time. In addition, greater financial stability of the American citizens is in itself a positive outcome that can warrant greater spending on Medicaid expansions, because financial stability leads to better mental health and lower risk of depression as shown by the Oregon Health Insurance experiment. However, we must spend wisely on government subsidized insurances like Medicaid and make sure that they carry out their function as

Increasing public funded converage does not significantly improve health outcomes of patients.

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TABLE: CHANGE IN FINANCIAL HARDSHIP WITH MEDICAID COVERAGE VARIABLE

MEAN VALUE IN

CHANGE WITH MEDICAID

CONTROL GROUP

COVERAGE (95% CI)

P VALUE

Any out-of-spending (%)

58.8

-15.30 (23.28 to 7.32)

<0.001

Amount of out-of-pocket spending ($)

552.8 ± 1219.5

-215.35 (-408.75 to -21.95)

0.02

Catastrophic Expenditures (%) 5.5

-4.48 (-8.26 to -0.69)

0.02

Any Medical Debt (%)

56.8

-13.28 (-21.59 to -4.96)

0.002

Borrowed money to pay bills or skipped payment (%)

24.4

-14.22 (-21.02 to -7.43)

<0.001

SOURCE: BAIKER. THE OREGON EXPERIMENT. THE NEJM 2012.

good health insurance, something that Baicker herself discussed during her congressional testimony.

In her 2013 congressional testimony before the US House Committee on Energy and Commerce, Baicker voiced her view that a good health insurance should provide people care and protection from significant financial losses but at the same time not let people consume services of questionable value. She pointed out that balancing costs well is therefore crucial for a good insurance program, and that Medicaid as a program does not do it well, referring specifically to two big issues. First, Medicaid only provides limited protection from financial catastrophes, prompting most people to seek supplemental coverage in the form of programs like MediGap or Medicare Advantage. However, people using supplemental coverage, as mentioned in her testimony, had “too much insurance” or spending in areas of questionable benefit.

This was her second issue with Medicaid, because “too much insurance" ultimately led to greater spending on the Medicaid program. In an interview with the Chicago Maroon, she noted how people began using significantly more services, many with questionable value, with a higher frequency than expected under Medicaid because people now had access to a resource that was not free before. For instance, it was noted that Medicaid patients made significantly more visits to their physicians and bought more prescription drugs than the control group in the study. While it was expected that the number of physician visits and the amount of money spent on prescription

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drugs would increase to some degree, the study didn’t see any significant improvements in clinical outcomes. This suggests that not all the services being used produced a positive outcome and why, as the study noted, people on Medicaid spent much more on health services than ones without. This is an example of what Baicker would call “too much insurance.”

Baicker instead proposes changing the current structure of Medicaid to tackle the cost-based issues associated. Medicaid is a program that needs overhaul to hit the middle ground between spreading financial risk and making sure that services being consumed will actually benefit the users. The key aspects include changing the out-of-pocket cost sharing system of Medicaid to provide greater financial stability and restricting “first-dollar coverage,” or coverage of questionable value to the users. To reduce out-ofpocket spending, Baicker argued that out-of-pocket payments to medical providers and for drugs should be capped, so users will not have to endure catastrophic costs of the system without any other form of coverage. Similarly, Baicker suggests a complete ban or an institution of surcharges to effectively restrict coverage for questionable treatment.

An alternative solution to alleviate these identified problems of the existing healthcare system would be to institute caps on the amount certain procedures or services cost. Those prices would change with inflation and technological improvements in the future, but they would help lower the overall spending significantly by preventing healthcare providers

POLICY

and corporations from charging excessively for their products. While this idea of instituting price ceilings may seem radical in the current system, per capita spending on healthcare in the US is by far the highest.

This is not because Americans use more care than citizens of other nations, but because the costs of procedures and services themselves are very high. For instance, a heart bypass surgery in the US costs about $75,000 on average but about $15,000 in the Netherlands. While we should not drastically bring down the price of services without looking at how it would impact health systems, ongoing research, and technological funding, we must begin somewhere in order to prevent the already high health care prices from growing further and depleting taxpayer money.

The path to improving Medicaid and alleviating the problems in the current healthcare system will be long and hard, but at the same time advancements and studies like the Oregon Health Insurance Experiment are enlightening us more about what could and would not work. This study showed that going single-payer or fully putting the load of insurance on the government may not even produce the expected

benefits in full. It has shown us what areas in the existing Medicaid system could be improved, so that it can perform its role as a health insurer in a more cost-effective manner.

Baicker, Katherine et al. “The Oregon Experiment – Effects of Medicaid on Clinical Outcomes.” The New England Journal of Medicine 368.18 (2013): 1713-1722. PMC. Web. 14 Feb 2018.

Roy, Avik. “Oregon Study: Medicaid 'Had No Significant Effect' On Health Outcomes vs. Being Uninsured.” Forbes, 2 May 2013. Web. Cohn, Jonathan. “What Oregon Really Told Us About Medicaid.” The New Republic, 12 May 2013, newrepublic.com/article/113195/oregon-medicaidstudy-good-bad-and-ugly. Web. “Baicker HEC Testimony June 2013.” 2013. Web. Chauhan, Daksh. “Dean Baicker, Whose Medicaid Research Has Been Politicized, Discourages ‘Cherry-Picking Results’.” Chicago Maroon. 16 Nov 2017. Web.

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THE ROLE OF DEATH IN SAVING LIVES

ETHICS OF ORGAN DONATION By

ANNAGH DEVITT BUSHRA AKBAR (Editor)

Organ donation poses the greatest challenge to medical ethics today: determining the line between life and death. This line, muddied by policy, religion, culture, and even the biases present in the medical field, determines who can and cannot donate.

The intersection of so many perspectives have led to policies that conflict on basic medical ethics.

There are two types of people who can donate organs: those alive and those dead. Living donors give non-vital organs such as a kidney, a lobe of the lung, or a piece of the liver. Comparatively, these cases do not raise as many ethical concerns because the individuals involved are fully aware and consent to the procedure. Yet, even with full autonomy, ethical questions are raised with respect to the motives

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of donation. Take Zell Kravinsky, a millionaire known for his opulent generosity. Not only did Kravinsky donate the vast majority of his $45 million in wealth, he also donated one of his kidneys to a complete stranger. His family was so opposed to the idea that he had a friend cover for him while he went under so his family would not stop the surgery. Such a stunt is enough to prompt questions as to whether the real estate mogul is in the right mental state to freely consent to such a procedure. Kravinsky’s mother even accused the hospital of using her son for his organs without regard for his wellbeing.

However, Kravinsky’s generosity did not end there. He has gone on record that he would donate his second kidney, a proctedure that would cost him his life. Despite his willingness, no doctor has agreed

to the surgery, believing it is not ethically right to end someone’s life – matter how willing they might be – for the sake of their organs.

Although doctors and ethicists alike asserted that Kravinsky’s proposed procedure was as good as murder, similar circumstances are justified among donors by brain death (DBD). DBD and DCD (donors by cardiac death) are two subsets of deceased donors, patients who are declared medically dead yet whose hearts are kept beating so that their organs can be suitable for donation. These “heart adapted across the 50 states and in numerous countries that deals with the rights of these donors. In particular, many countries have addressed the issue of consensual organ donation from deceased donors.

POLICY

European countries are caught between two extremes, so-called opt-in and opt-out systems.

Germany, an opt-in country, requires that its citizens register in order to become an organ donor.

While this ensures that all organ donations are the wish of the patient, it also means that many citizens who might donate do not, leading to one of the lowest consent rates at 12% in Europe.

In contrast, Austria has one of the highest rates at 99.98% through an opt-out system. Otherwise known as presumed consent, Austria’s system has numerous ethical failings. For one, such a system removes the freedom of the individual; it negates the patient’s autonomy. Presumed consent could also disproportionately affect the poor. A study led by economist Jim Andreoni found that economic pressures on low-income individuals can negatively impact their ability to prioritize tasks and do small chores, such as mailing a letter to opt-out of the organ donation registry. By assuming consent, some Austrian citizens, the poor in particular, who do not want to be organ donors will have their rights violated. Another system, mandated choice, offers a happy median between these two extremes. Adopted in the majority of American states, mandated choice determines through a yes or no question whether one wants to

be an organ donor or not. It takes the guesswork out of one’s will.

Yet, in all of these systems, one issue still remains: the consent of the family. Physicians often resort to the family’s wishes despite the will of the patient. In opt-in countries, the will of the patient remained strong because organ donors needed to go out of their way to be registered. But for opt-out countries, families could argue that their loved one did not know or agree to organ donation, and so the patient’s will can more easily be eroded. For the patient’s

wishes to be respected, many states adopted first-person consent laws dictating that hospitals only need the consent of the patient, through a driver’s ID or other donor document, to take the organs. But again, this system is not without fault, as seen through the hypothetical case of Derek Polaski as published in the American Medical Association Journal of Ethics.

Derek Polaski is a registered organ donor who has been pronounced brain dead as a result of a motorcycle crash. His wife arrives at the hospital after his death and sees

Payne, Scott. “Organ Donation Card.” Flickr, 1 July 2013.

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him hooked up to a respirator, breathing and warm but nonetheless dead. The wife refuses to let the doctor remove her husband’s organs and says things such as, “I'm his wife. You have to give his body to me, and I don't want it all cut up and mutilated. I won't let you do it." While the husband’s ID does indicate he wished to be an organ donor, he might not have made such a decision if he had known what his wife’s reaction would be like. However, it is not possible to know whether Mr. Polaski would have made a different decision given the specifics of the situation. The nuance involved in such sensitive situation makes it impossible for any policy to accurately uphold the wishes of the patient.

Even when the circumstances around an organ donation are ideal – the family and patient both fully understand the situation and consent to it freely – ethical dilemmas will still ensue. 14-yearold Nicholas Breach was in such a situation; he was terminally ill and decided along with his parents to be an organ donor after his death.

However, as Nicholas grew more

and more sick, it became evident that the tumors in his brain would only affect the brain stem and not the higher brain, which is responsible for consciousness. Although Nicholas would still die as a result of the tumors, the slight difference in their placement meant he could no longer be an organ donor through brain death. He did still have the opportunity to donate his organs but through a much less effective process: non-heart beating donation (NHBD).

NHBD requires that the donor be removed from life support and be without a heartbeat for at least two minutes (or as much as 10 minutes in some districts).

Although minimal, the extra time it takes for one’s heart to stop beating means that a process called ischemia will occur more quickly.

Once ischemia starts, organs lose oxygen and are more likely to be unsuccessful in transplants. When harvesting organs from brain dead donors, however, a respirator is used throughout the procedure, which means the organs will not lose as much oxygen and will have a higher rate of success in transplants. Unfortunately, many of

Nicholas’s vital organs were lost to ischemia and he could only donate his eyes. Had he been a brain dead donor, all of his organs would likely have been salvaged.

Nicholas's wishes were not wholly fulfilled due to a technicality on what constitutes death, known as the dead donor rule (DDR). DDR states that organs can only be removed from dead patients (the reason why no physician would agree to remove Kravinosky’s second kidney), where dead patients either have no heartbeat or are declared brain dead. In the United States brain death can only occur if an individual has sustained “irreversible cessation of all functions of the entire brain, including the brain stem.” Such a distinction creates an incongruous condition of death. Consider, for example, two versions of Nicholas’s case, one where his whole brain is destroyed and one in which only his brain stem is affected. No ordinary onlooker would be able to visibly distinguish between the two cases; the patient would just appear to be in a vegetative state hooked up to a respirator. However, in the eyes of

EVEN WHEN CIRCUMSTANCES AROUND AN ORGAN DONATION

ARE IDEAL… ETHICAL DILEMMAS WILL STILL ENSUE.

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POLICY

the law, the patient with brain stem failure is kept alive by the respirator and to remove the organs would be an act of murder. But the patient with whole brain failure is dead and the respirator acts only as a tool to pump oxygen to the organs, so to remove the organs would be ethically sound.

The disparity between these two extremely similar cases fuels a growing crusade in the medical community and beyond, that these medically dead patients are actually alive. The movement points to numerous examples where individuals, previously declared brain dead, have survived for years afterwards, with one boy even undergoing puberty. If patients were brain dead, they simply would have decomposed; at least that is what doctors told the parents of Jahi McMath. The new face of the movement, 13-year old Jahi McMath was pronounced brain dead after a botched tonsil removal surgery. Yet, despite her

prognosis, Jahi often moves and even physically responds to verbal commands. Such responsiveness is previously unseen in the medical field, though some critics argue that it is just simple spinal reflexes.

Nevertheless, such circumstances have allowed ethicists and doctors alike to espouse long-held doubts about brain death, particularly that the death of the brain is not necessarily the death of the individual.

The ethics of organ donation are complicated because life and death are complicated. The “noble lies” that surround organ donation, from the autonomy of the patient to the legitimacy of the dead donor rule, are often hard to grapple with because doing so places scrutiny on the practices that save tens of thousands of lives per year, and could inadvertently scare people away from donation. While there is likely no right answer to these moral questions, simply ignoring them breeds ignorance that harms patients and practitioners alike

Aviv, Rachel. “What Does It Mean to Die?” The New Yorker, 5 February 2018.

Davidai, Shai, et al. “The meaning of default options for potential organ donors.” PNAS, 30 July 2012.

“Donation after Death.” Donate Life, 2014, www. donatelife.gov.

“Donation Process.” CORE: Center for Organ Recovery Education, 2018, www.core.org.

Dubner, Stephen J., host. “Are the Rich Really Less Generous than the Poor?” Freakonomics, 24 May 2017.

Finger, Erik B. “Organ Preservation.” Medscape, 26 November 2015, emedicine.medscape.com.

GM., Abouna. “Ethical issues in organ transplantation.” NCBI, January-March 2003, www.ncbi.nlm.nih.gov.

Greenberg, Gary. “As Good as Dead.” The New Yorker, 12 August 2001.

Kerridge IH., Saul P., Lowe M., et al. “Death dying and donation: organ transplantation and the diagnosis of death.” Journal of Medical Ethics, 2002.

Moskop, John C. “Organ Donation: When Consent Confronts Refusal.” AMA Journal of Ethics, February 2003.

Organ Donation, Organ Donor Registry. Health Resources Services Administration and U.S. Department of Health and Human Services, 2018, www.organdonor.gov.

Rady, Mohamed Y., et al. “Organ donation after circulatory death: the forgotten donor?” BMC, 29 September 2006.

S., Repertinger, et al. “Long survival following bacterial meningitis-associated brain destruction.” NCBI, July 2006, www.ncbi.nlm. nih.gov.

Sade, Robert M. “Brain Death, Cardiac Death, and the Dead Donor Rule.” PMC, 12 June 2012, www.ncbi.nlm.nih.gov.

Saunders B. “Normative consent and opt-out organ donation.” Journal of Medical Ethics, 2010.

Shaw, David. “Presumed consent to organ donation and the family override.” Journal of the Intensive Care Society, 18 May 2017.

Strom, Stephanie. “An Organ Donor’s Generosity Raises the Question of How Much Is Too Much.” The New York Times, 17 August 2003.

Thaler, Richard H. “Opting in vs. Opting Out.” The New York Times, 26 September 2009.

Truog, Robert D. “The Ethics of Organ Donation

by Living Donors.” The New England Journal of Medicine, 4 August 2005.

UNOS. United Network for Organ Sharing, 2017, unos.org.

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NEGLECTED TROPICAL DISEASES THEN AND NOW By

Nikki Kasal Ariel Pan (Editor)

For the average American doctor, the epidermal lesions and discolored patches of skin that signify the condition of leprosy are far from a typical sight.

Neither would he or she expect to treat droves of patients complaining of eye infections induced by river blindness, or sporting the swollen limbs of someone suffering from the disease elephantiasis, caused by a number of parasitic worms (particularly Wuchereria bancrofti). Despite their lack of prevalence in the developed world, these serious conditions form a subset of illnesses termed by the World Health Organization (WHO) as NTDs, or neglected tropical diseases. The WHO describes NTDs as “a diverse group of communicable diseases that prevail in tropical and subtropical conditions in 149 countries,” largely limited to impoverished regions in Africa and Asia. Though many countries have turned their focuses to the treatment of chronic (and profitable) conditions like cancer, these NTDs still pose a serious threat, affecting more than one billion people and costing developing economies billions of dollars in

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treatment and lost productivity each year.

Among the more well-known members of this group is leprosy, or Hansen’s disease. A chronic infectious disease characterized by lesions of the skin and, in severe cases, visual impairment, leprosy can be treated quite effectively with multidrug therapy (MDT). As its incubation period can run anywhere from five to twenty years, this disease is notoriously difficult to track. Even in spite of this, its high morbidity is undeniable; indeed, the WHO reported 216,108 new cases in 145 countries in 2016. As part of its 2016-2020 Global Leprosy Strategy aimed at avoiding leprosy-induced disability, the WHO partnered with Japanese non-profit The Nippon Foundation and later Swedish pharmaceutical company Novartis in order to provide MDT free of charge to all patients until 2020. This initiative has proven fruitful: over the past 20 years, over 14 million leprosy patients have been cured. Online data collection programs have also made great strides in detection of the disease: 2,810 additional cases have been identified from 2015

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to 2016. “This increase is due to the excellent work of national programs and is directly linked with active case-finding,” says Dr. Erwin Cooreman, head of the Global Leprosy Program in New Delhi, India.

Another subset of NTDs is devoted to parasitic illnesses, such as dracunculiasis. Known best by its common name of guinea worm, this infection is caused by drinking water contaminated by fleas carrying the guinea worm larvae. This worm grows to maturation in the victim’s tissues before bursting through the skin, causing immense pain along with blistering and fever. The parasite must be extracted from the lesion inch by inch over a period of months; breaking the worm while it is still embedded in the body may prove lethal to the host. Despite its severe pathology, incidence is relatively low, with fewer than 30 cases reported in 2017. This number has fallen

from over 3 million cases located almost exclusively in Sub-Saharan Africa just thirty years ago, largely thanks to a global eradication campaign spearheaded by the WHO and the American Center for Disease Control (CDC).

However, not all diseases have been contained as successfully as guinea worm. Trachoma, a bacterial eye infection, is currently the world’s leading cause of preventable blindness. Largely localized to Sub-Saharan Africa, the acute form of this disease caused an excess of half a million people to require surgery in 2017. However, the WHO has made it a goal to eradicate trachoma by 2020, and Ethiopia in particular has achieved improved disease detection through the compilation of the world’s first trachoma database with the Global Trachoma Mapping Project.

Despite these significant recent advances, NTDs

Seidlitz, Serge. “Neglected Tropical Diseases.” Financial Times, Financial Times, 17 Apr 2017. https://www.ft.com/content/857c2092-ed20-11e6-ba01-119a44939bb6.

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Issa, Jabez, and Kanjan Mehta. Neglected Tropical Diseases. 2015. http://sites.psu.edu/khanjanmehta/category/research-ethics/.

have not historically been treated with the same degree of attention. Part of this can be attributed to the fact that despite their high morbidity, they have a relatively low mortality, accounting for fewer than 200,000 deaths annually. Therefore, they do not attract much funding for researching new drugs or initiating public health efforts, according to Dr. Evan Secor of the Division of Parasitic Diseases and Malaria at the CDC. However, a much larger part of the reason lies in the fact that they mostly affect people living in remote areas across Africa and Asia with limited to no access to healthcare. This means that sufferers could go years without seeking the

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proper treatment and documentation of their condition. Another aspect of this can be attributed to the localization of incidence to areas of poverty, with inadequate access to clean water or sanitation fueling the prevalence of many of these diseases.

Focusing on the U.S. in particular, its past response to this public health challenge has largely remained restricted to research and surveillance carried out by the National Institutes of Health (NIH) and the CDC. However, in the past ten years, efforts have risen remarkably, starting with the allocation of funds

by Congress to the U.S. Agency for International Developmentâ&#x20AC;&#x2122;s (USAID) NTD Program in 2006. This

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program now spans 25 countries, helping to target seven diseases, including trachoma and elephantiasis, through a “rapid-impact package” consisting of drug treatments and personnel to support the efforts of endemic countries. Globally, the WHO’s 2012 Roadmap for Implementation aims to control and eliminate specific diseases by 2020, with one goal being the eradication of guinea worm by 2015.

Though this has yet to be achieved, an incidence of only 25 cases in 2016 is already a drastic decrease from the thousands of cases observed only five years prior.

However, countries still face challenges in NTD control, particularly in regards to the United States administration. Its budget request for the control of NTDs dropped from $100 million in 2017 to $75 million in 2018, bringing into question the government’s dedication to the public health effort.

In addition to the altruistic motivations of helping improve the lives of fellow humans, developed countries need to continue in their attacks against such diseases due to the illnesses’ potential to spread beyond the regions in which they are currently prevalent. “Some of these diseases are going to become our problem soon,” says Michael Pollastri, chair of the Department of Chemistry at Northeastern University. “It’s just a matter of time. With increased travel and continued climate change, they’re going to move north from the tropics. Dengue fever has already reached Miami and so has the West Nile virus.”

Taking these shifting climate and political situations into consideration, it is now more important than ever to commit to the eradication of these neglected tropical disease and leave them in the annals of history.

Ensor, Charlie. Assignment For. “Why The World Ignores Diseases Of Poverty.” The Huffington Post, TheHuffingtonPost.com, 16 Jan 2018, www. huffingtonpost.com/entry/why-the-world-ignores-diseases-of-poverty_ us_5a57ae31e4b0a57f282c6568.

Gardner, Tom. “The Biggest Cause Of Preventable Blindness Just Won't Go Away.” The Huffington Post, TheHuffingtonPost.com, 8 Jan 2018, www.huffingtonpost.com/entry/ethiopia-trachoma-blindness_ us_5a4d3c08e4b0b0e5a7aa95cb.

Ibelle, Bill. “Why You Should Care About Rare Tropical Diseases.” News at Northeastern, Northeastern University, 10 Jan 2018, news.northeastern. edu/2018/01/why-you-should-care-about-rare-tropical-diseases/.

“Leprosy.” World Health Organization Thailand, WHO Southeast Asia Regional Office, 11 May 2014, www.searo.who.int/thailand/factsheets/fs0026/en/.

Moloo, Ashok. “Neglected Tropical Diseases.” World Health Organization, World Health Organization, www.who.int/neglected_diseases/diseases/en/.

Simmons, Ann M. “Guinea Worm, River Blindness and Elephantiasis Are among the World's Neglected Tropical Diseases. A Battle Is on to Wipe Them Out.” Los Angeles Times, 14 Dec 2017, www.latimes.com/world/la-fgglobal-neglected-tropical-diseases-20171214-story.html.

“The U.S. Government and Global Neglected Tropical Disease Efforts.”

The Henry J. Kaiser Family Foundation, 3 Nov 2017, www.kff.org/ global-health-policy/fact-sheet/the-u-s-government-and-global-neglectedtropical-diseases/.

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THE BIOETHICS AND SOCIAL IMPLICATIONS OF THE ARTIFICAL WOMB By

ALESSANDRA VEINBACHS ANYA DUNAIF (Editor)

In the United States, premature birth is the leading cause of infant mortality, causing approximately one-third of all infant deaths.

However, as of right now, the only treatment option for premature infants is the use of a ventilator, and even as little as a few hours on a ventilator can cause permanent damage to their underdeveloped lungs.

In April 2017, Dr. Alan Flake and his team of physician scientists at the Children’s Hospital in Philadelphia published the results of their study on the “Bio Bag,” an artificial womb that Flake’s team hopes could save premature babies. The “Bio Bag” is a sac filled with synthetic amniotic fluid and placed on a heating pad.

Attached are two tubes; one brings in oxygen and essential nutrients required for the developing fetus, while the other removes carbon dioxide. The goal of this “Bio Bag” is to mimic conditions found in the womb, allowing the premature infant to continue developing as it would have in the womb, thus preventing complications and deaths that would occur as a result of underdeveloped organs.

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In the study, Dr. Flake and his team used the most recent model of the “Bio Bag” to allow eight premature lambs to finish development outside of their mother’s wombs. After reaching term, the lambs were placed on a ventilator for twelve hours. Seven of the lambs were euthanized immediately following and used for organ studies. One was kept alive so that its postnatal development could be monitored. All of the lambs appeared to have developed normally when compared to their peers that were carried to term in the mother’s womb.

While use of the “Bio Bag” in humans could drastically raise premature infant survival rates, it could also have far-reaching implications on the way that we as a society view pregnancy. One technical concern would be the way we define developmental stages.

Fetuses are defined as unborn children while babies are children who have already been born, but if a child is transferred from the womb to the artificial womb, is it a baby or a fetus? Would we define the birthday of this child as the day it is transferred from the natural

womb to the artificial one or the day it leaves all wombs, artificial or not?

Additionally, the use of the artificial womb in humans could cause lawmakers to rethink abortion laws and timeframes. The time at which abortions are legal varies greatly by state, but in general, such laws are based on the idea of viability, or the likelihood of the fetus being able to survive outside of the womb. With the use of the artificial wombs in humans, the fetus could be viable as early as 23 weeks after conception. This would mean that the time frame in which abortions are legal would be reduced. While only 1.2% of all abortions are performed after 21 weeks of gestation, the restricted time frame would affect some groups of women more than others. Women of lower socioeconomic status, for example, have abortions later in their pregnancies due to the fact that it takes them longer on average to gather the money required for the procedure.

Younger women, including teenagers, are also more likely to obtain abortions later in the pregnancy due to obstacles such as fear of

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parents’ reactions or difficulties detecting the pregnancy. Another possibility could be that women desiring to abort pregnancies after a certain time point would be required to transfer the fetus to an artificial womb. After development, the baby would then be put up for adoption. But in a country where there are already 400,000 orphans, would this be a good solution?

On a deeper ethical level, the quality of life of the child would need to be taken into account.

Little is known about the sensations the premature infant might experience during and after the time it is transferred from the natural womb to the artificial womb. If the transfer or the experience in the “Bio Bag” is painful or stressful, this might not be an ethical solution. What if the “Bio Bag” is unable to prevent or reverse complications of premature births?

Being able to save a premature infant does not necessarily mean that we should. There are disagreements on whether or not it would be better to allow the infant to die or prolong its suffering. Is forcing it to develop in the artificial womb

and live a life in which constant medical monitoring or treatment is needed really a better option?

These are just a few concerns raised by bioethicists and scientists, and many more are likely to come up as the future of the “Bio Bag” becomes more certain.

Dr. Flake is currently working in conjunction with the FDA to gain approval to move on to the next steps: additional animal trials and, eventually, human trials. Further animal trials are at least three years away, however, and much more research and information are required before any conclusions can be reached about the ethicality of the artificial womb.

“Definition of Fetus.” MedicineNet. Flake, Alan W, et al. “An extra-Uterine system to physiologically support the extreme premature lamb.” Nature, 25 Apr 2017.

Klugman, Craig. “Woolgathering: It's a Bag, It's a Baby, It's an Artificial Womb.” Bioethics, 8 May 2017.

Planned Parenthood. Abortion After the First Trimester.

Roberts, Michelle. “Premature lambs kept alive in 'plastic bag' womb.” BBC News, BBC, 25 Apr 2017.

Stein, Rob. “Scientists Create Artificial Womb That Could Help Prematurely Born Babies.” NPR, NPR, 25 Apr 2017.

Swetlitz, Ike. “Brave New Wool? Artificial Womb Sustains Premature Lambs for Weeks.”

Scientific American, 25 Apr 2017.

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THE ROLE OF GUT BACTERIA ON CANCER TREATMENT By

YASSMIN ELBANNA LINUS PARK (Editor)

In the past ten years, cancer therapy has drastically evolved.

Multiple studies on how to improve immune response to tumors have produced different responses to a wide array of options. Researchers are now finding how to individualize various therapies to patients with the intent of yielding more favorable results. However, the key to shaping protocols to each individual diagnosis is understanding what makes us unique in the first place. How do gut bacteria play a role in the development of cancer and how can researchers use that to their advantage in finding a treatment?

Microscopic organisms, often referred to as “microbes, are living organisms that are too small to be seen without a microscope. The term describes many different types of life including bacteria, archaea, fungi, protists, viruses, and microscopic animals.

Microbes, while having a similar structure as other cells, lack membrane bound organelles and a nucleus; instead, they possess a control center referred to as a plasmid containing genetic infor-

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mation in a single loop of DNA. The human body is home to a wide variety of microbes, which influence many of our bodily functions.

The microbiome is linked to a range of health concerns from mental health to acne. As we grow up, our microbial profiles change alongside us. Disruptions in the bacteria in our guts, due to a change of diet or excess use of antibiotics, may translate in conditions such as autism or, more notably, cancer. Some microbes cause inflammation in the lining of the gut, which appears to increase cancer risk. Others have a more direct influence, as in the case with H. pylori bacteria, which may cause infections in the stomach leading to various stomach cancers. More specifically, the H. pylori infections lead to inflammation, which damages the inner layer of the stomach, allowing for a higher risk of cancer in the lower stomach or different lymphomas.

Despite the fact that these bacteria are a major cause of stomach cancer, surprisingly, two in three adults worldwide infected with the bacteria will not develop cancer. Therefore, we can infer that

other factors play a role in separating those who develop cancer carrying the bacteria and those who don’t. This factor primarily relies on the individual’s diet.

Nitrites found in cured meats, some drinking water, and vegetables can be convert strains of the bacteria leading to higher risk of stomach cancer. More studies have established a connection between the microbe and cancer.

In the past year, two recent studies published in Science have linked the body’s microbiome to cancer immunotherapy. These studies emphasize the importance of antibiotics on the body’s response to immunotherapies, specifically those that inhibit proteins PD-1 and PD-L1. One study found that patients treated with antibiotics for unrelated infections did not respond as effectively to their cancer treatment as expected. This raised the question over whether antibiotic use should be limited for those on other regimens or if the microbiome itself should be changed to produce better outcomes to therapy.

One study conducted at MD Anderson by Wargo and a team

RESEARCH “Bacteria.” Wikipedia, Wikimedia Foundation, 13 Feb. 2018, en.wikipedia.org/wiki/Bacteria. EscherichiaColi NIAID.jpg

of epidemiologists sought to answer the question of how the rate of tumor growth relates to gut microbes. The experiment utilized fecal samples from more than 100 people with advanced melanoma before they began treatment with anti-PD-1 immunotherapy drugs. The research found that the patients with more diverse gut microbes had a higher likelihood of responding to their treatment.

Tumor growth was also reduced in mice treated with fecal transplants of those with better responses to the immunotherapy.

A recent study affiliated with the University of Chicago conducted by Ayelet Sivan and her group also reported a specific genus of bacteria in the gut that enhances antitumor responses to drugs that target PD-L1. The published research, “Commensal Bifidobacterium promotes antitumor immunity and facilitates anti–PD-L1 efficacy,” set out to understand the mechanisms underlying immune response, specifically that of cancer. By comparing the melanoma growth in mice harboring the commensal bifidobacteria to those without,

the study observed significant differences in their antitumor immunity. Oral administration of the bacterium alone also improved tumor control to the same extent PD-L1-specific antibody therapy did, and the combination of the two completely abolished tumor outgrowth. This data suggested the manipulating the bacterial microbiome in the gut could guide cancer immunotherapy.

The early stage results of this research give us some insight into how our bodies react to cancer treatment, but the next step is an even harder one to take. To utilize these findings, researchers need to investigate treatments to utilize the gut bacteria to facilitate patients’ response to cancer treatments.

However, the risk of not providing the necessary antibiotics for a patient with an infection is far greater than the potential effect treatments such as targeted therapy may have on the cancer or response to cancer. This research allows us to understand the natural properties of the body that play a role in our health, although it still is possible it isn’t the most efficient route to take in the pursuit

of discovering various treatments.

Despite the fact that there are possibilities that the current level of research does not provide the most efficient method in discovering the perfect treatments for cancer, understanding the role of gut bacteria and its dynamic within the human body certainly plays a role in the understanding of our gut bacteria themselves.

“Bacteria that can lead to cancer.” American Cancer Society, www.cancer.org/cancer/cancer-causes/ infectious-agents/infections-that-can-lead-tocancer/bacteria.html.

“Cancer treatment response may be affected by gut bacteria - National Library of Medicine - PubMed Health.” National Center for Biotechnology Information, U.S. National Library of Medicine, www.ncbi.nlm.nih. gov/pubmedhealth/behindtheheadlines/ news/2017-11-07-cancer-treatment-responsemay-be-affected-by-gut-bacteria/.

Sivan, Ayelet, et al. Science (New York, N.Y.), U.S. National Library of Medicine, 27 Nov. 2015, www.ncbi.nlm.nih.gov/pmc/articles/ PMC4873287/.

The Microbiome and Disease, learn.genetics.utah. edu/content/microbiome/disease/#cancer.

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AUGMENTED REALITY IN HEALTHCARE By

Scott Wu Swathi Balaji (Editor)

The same technology that revolutionized the smartphone gaming industry by introducing Pokémon Go in the summer of 2016 has begun to transform the healthcare industry. Augmented reality (AR), which superimposes computer-generated images onto technology users’ views of the real world, creates a hybrid between virtual reality and users’ normal perceptions of their immediate environment. While AR technologies such as Google Glass are already on the radar of the general public, companies such as Medsights Tech, HoloAnatomy, and Orca Health may soon become household names due to their ability to improve physician performance and transform procedures. While some AR technologies assist caregivers in ordinary tasks such as finding veins for intravenous fluid injection, other technologies have the breathtaking potential to improve physician efficiency in the operating room, create three-dimensional reconstructions of tumors, and simulate vision for visually impaired patients.

Furthermore, AR technology provides realistic train-

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ing opportunities with minimized risk for students in several fields of medicine.

The most significant impact of the introduction of AR technology in mainstream healthcare is its potential to revolutionize operations. By allowing surgeons to view internal anatomic structures from simple external scans that do not involve harmful radiation from X-rays, AR creates a convenient mechanism for surgeons to visualize isolated structures

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before they operate. These structures are not limited to bones or connective tissue, but also include tumor masses that may potentially need to be excised by the surgeon. MedSights Tech, an AR software company, has created a software that uses AR to generate three-dimensional reconstructions of tumors. The software allows physicians to not only determine the precise location of a tumor within the body, but also identify the volumetric proportions of the tumor and its shape. Dr. Stefano Bini, a practicing orthopedic surgeon at the University of Californiaâ&#x20AC;&#x201C;San Francisco and medical technology advisor, maintains that the ability of augmented reality to reconstruct internal body structures in three-dimensional space is exceptionally beneficial to surgeons: â&#x20AC;&#x153;Adding accessible images to the space that [surgeons] are working in,

visualizing structures through augmented reality, and being able to handle three-dimensional reconstructions is crucial, especially to orthopedic surgeons.â&#x20AC;?

Developments in AR technology can also simulate vision for patients suffering from vision impairment.

EyeDecide, a medical smartphone and tablet application, allows doctors to input data on cataract and plaque build-ups, which is subsequently analyzed by the application. EyeDecide then simulates a view of reality for the visually impaired patient, which can be used to decide whether the patient should pursue corrective surgery. AR technology, such as EyeDecide, allows physicians and patients to have a mutual understanding of symptoms and communicate on the same level about viable treatment paths, thereby strengthening the doctor-patient relationship.

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As a training tool, AR technology also provides students with unprecedented opportunities to watch and participate in medical procedures while minimizing the associated risks. AR technology allows students to see precisely what the doctors see.

Usually, only a few lucky medical students have the opportunity to participate in rare medical cases and observe complicated procedures; however, Microsoft HoloLens is one of the many technologies that aims to expand visual and hands-on access to these rare cases. Partnering with Case Western Reserve University and Cleveland Clinic, Microsoft HoloLens has developed a digital anatomy curriculum that creates three-dimensional holographic images of actual patients. This curriculum allows students to study various bodily systems such as the organ system or nervous system as well potential surgical techniques that may be used to ameliorate issues in the operating room. Dr. Stefano Bini describes the importance of utilizing AR as teaching aids by stating, “We can now create experiences for students and allow them to manipulate various structures…. This practice makes students and residents quicker and more accurate in the operating room.”

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Implementing AR devices in medical education can revolutionize surgical training. Handheld devices, which are paired with augmented reality headsets to augment the vision of students, can rival actual surgical experience in improving psycho-motor surgical skills. Osso VR, a training platform with several visual and handheld AR devices, is leading the way in this category of AR technology. By catering to nearly all skill levels and allowing students to access realistic training remotely while being able simulate nearly any surgical procedure, Osso VR showcases the breadth of opportunities and benefits offered by AR technology. Osso VR co-founder and CEO Dr. Justin Barad, a practicing pediatric orthopedic surgeon, characterizes this shift in the approach to teaching as a revolution in medical education: “Virtual and augmented realities give us the opportunity to teach and learn in ways that are exponentially better than methods and technologies that have previously existed and may completely change what we currently consider the standard in medical education.” This revolution in medical education also comes with little risk in the protection of patient information and health records. Images and reconstructions can all

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be shared and handled without attachment to names or other potential patient identification information, thus minimizing risks of HIPAA (Health Insurance Portability and Accountability Act of 1996) violations.

Although augmented reality has several benefits in clinical settings for physicians, students, and patients, current barriers to the universal implementation of augmented reality devices are mainly centered around cost and supply. Because product development and prototype testing require careful analysis and input from various fields, the time it takes for an augmented reality device to transform from a blueprint to a widely used tool spans several years. Despite active support for this burgeoning field from investors, costs of this development constitute another barrier for both providers and purchasers alike.

While AR technology promises to turn multiple industries upside down, its transformation of healthcare is perhaps its most revolutionary impact. AR

has changed how surgeons visualize internal masses and transformed how physicians understand their patientsâ&#x20AC;&#x2122; visual perception of the world. AR technologies can also improve medical education by providing hands-on experiences for students and increasing access to rare clinical cases. From patient to surgeon and medical student to physician, AR truly augments a broad variety of healthcare domains and will continue to influence the forthcoming era of healthcare.

The author wishes to thank Dr. Stefano Bini and Dr. Justin Barad for their comments and input.

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"LOOK PRETTY AND DO AS LITTLE AS YOU CAN" WHY CENSORSHIP AT THE CDC WILL COST LIVES By

SARAH NAKASONE AMBER KEAHEY (Editor)

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CURRENT EVENTS

It was an article that in quieter political times would have made the front page of every major news source and lead to weeks of back and forth on talk radio, cable news shows, and the errant political podcast.

As it was, the Washington Post’s article, “CDC gets list of forbidden words: Fetus, transgender, diversity” barely made it into the print copy of its own newspaper.

Here’s what got lost in the noise of everything else happening in Washington DC: on December 15, 2017, Juliet Eilperin and Lena Sun, Washington Post reporters whose beats include national affairs and public health respectively, broke shocking news from a recent meeting at the CDC. Their sources claimed that policy analysts had been told by senior CDC officials that there would be certain words that would not be permitted when preparing budget documents for the next fiscal year. These words were “vulnerable, entitlement, diversity, transgender, fetus, evidencebased, and science-based.” In a couple of cases, alternate phrases were offered. For example, instead of evidence-based and science-based, the proper wording was to be “the CDC bases its recommendations on science in consideration with community standards and wishes.”

The article makes no mention of from where this directive came (the White House, the Director of the CDC, the Office of Budget and Management, etc.). However, given the current administration, few health officials expected that this order, whomever made it, was in any sort of good faith. In fact, after a year during which President Trump had pulled out of the Paris climate accords, slashed funding for the EPA, and fired the entire AIDS council, this latest move could be seen as a continuation of a war on science and public safety.

Later reporting seemed to suggest that the instructions at the budget meeting stemmed from career CDC officials and not political appointees. As new details emerged, the controversial move began to be rebranded as a swing toward survival and rather than censorship. The Department of Health and

Human Services (HHS), for instance, is now staffed by people who do not agree with many programs run by the CDC. The top Trump advisor on health care, Katy Talento, has made repeated claims that birth control causes cancer and miscarriages and Valerie Huber, the chief of staff to the Assistant Secretary for Health at the HHS, was formerly president of an abstinence-only education association. Wouldn’t it be best to avoid any word that might throw up red flags for people like this? Given last year’s budget, which championed a 1.2 billion-dollar funding cut from the CDC and a 5.8 billion-dollar one from the National Institutes for Health, why shouldn’t the CDC be doing everything possible to remain as non-offensive and funded as possible?

I followed this story with the sort of fascinated horror and deep-seated sorrow that has characterized many of my feelings toward actions at both the Department of Health and Human Services and Centers for Disease Control over the over the past year. It became the default topic around my family’s dinner table over Christmas break, a conversation that pitted my siblings and I against each other and generally ended with tears on my end and accusations of hysteria on theirs. After all, I was reminded, the EPA had been rebranding satellites monitoring climate change as ones needed for “weather” to save their program funding from being cut, so why was this any different?

I’ve worked at the intersection of HIV activism and public policy for the past two years. I’ve seen the human cost the epidemic has left on Chicago and it is ultimately these experiences that leave me most concerned about what is happening at the CDC. Because on one hand, yes, a funded CDC is better than one bereft of money. But if that funding comes at the expense of self-censorship, we will build up a public health crisis the likes of which we already have historical precedent. Using America’s HIV epidemic as the context for these recent political developments, it becomes all too obvious that silence from our public health agencies will – and has – cost lives.

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When AIDS Was Funny

The video starts with the same eerie music you would expect of a low-grade horror film, the sort of sounds that, despite their clichéd use, have become part and parcel of American fear. Except this time, it isn’t a horror film: it’s archival footage of White House press briefings from Scott Calonico’s documentary short, When AIDS Was Funny. Using audio clips spanning the earliest years of the AIDS epidemic in the US, viewers hear Larry Speakes, Ronald Reagan’s then press secretary, make a series of homophobic jokes in response to questions about the growing crisis. He is met by laughter and amusement among the press pool. Overlaying the press audio is a bright, chirping, video game score sound that accompanies a growing tally of AIDS fatalities. The number of deaths seems to multiple with each laugh.

It was the misfortune of all those touched by AIDS that the epidemic emerged during the Reagan years. Given that the disease was first diagnosed in self-identified gay men, AIDS was originally called “GRID” or “Gay Related Immune Deficiency.” The disease’s moniker and its victims gave the federal government a motivation to write it off as a non-issue – God’s judgment on sinners. By all accounts, Reagan had no personal animosity against the LGBTQ+ community, but his ascendance to political power had been tied to the rise of Jerry Fallwell and his moral majority, a group that believed it was engaged in a battle for the soul of America, with birth control and queerness representing two of its major foes. Whatever Reagan’s personal convictions, he wasn’t about to rebut the people who had catapulted him to office.

So in 1981, when the first 159 cases were diagnosed, Reagan said nothing.

And in 1982, when there were 771 AIDS cases and 618 deaths and the CDC began to worry that the US’ blood supply was infected, Reagan said nothing.

And in 1983, when there were 2807 cases and 2118 deaths and AIDS discrimination cases appeared in the courts, Reagan said nothing.

And in 1984, when there were 7239 cases and 5596 deaths and researchers pleaded before Congress for funding, Reagan said nothing.

And in 1985 when there were 15,527 cases and 12,529 deaths and the surgeon general released a report on safe sex practices to stop the epidemic

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just to be shouted down by other cabinet members, Reagan said nothing.

And in 1986 when there are 28,712 cases and 24,559 deaths and Reagan’s own friend wrote in the New York Times that “everyone detected with AIDS should be tattooed in the upper forearm, to protect common-needle users, and on the buttocks, to prevent the victimization of other homosexuals,” Reagan said nothing.

It wasn’t until 1987, 50,378 cases and 40,849 deaths later that Reagan made his first public statement on the epidemic.

This may seem a strange thing upon which to harp – after all, at this time, the CDC was underfunded

and immigration officials were beginning to bar anyone entering the country who tested positive for AIDS. Why aren’t those things more important than what Reagan may or may not have said officially?

It’s worth remembering, though, that in the early days of the epidemic, AIDS was chronically underreported and Reagan’s refusal to so much as name the disease contributed in no small part to the silence and ensuing hysteria wielded against those who contracted the disease. It was the silence that permitted ignorance and apathy across the county because if the president couldn’t be bothered to care, then why should anyone else? As Don Francis, one of the first epidemiologists at the CDC put it,

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“[The response from Washington] set a precedent for other conservative, high-level governors and the like to say: "Well, the highest levels of the White House don't necessarily think we should put money into HIV/AIDS; then why should we? And it's also embarrassing to talk about sex and needle exchange and needles and school education about abstinence and sex and choices, etc., and I don't like that anyway. And since Ronald Reagan didn't like it, then I'm not going to do anything either."

The Hidden Epidemic

“If you wouldn’t mind commenting on the surveillance of partners, tracking of contacts, that sort of thing. What – what are we legally able to do? And I don’t want to say the quarantine word, but I guess I just said it.”

– Rep. Betty Price, October 2017

In this day and age, you would not expect to have to explain to people that no, quarantining is not a viable option for fighting the US’ AIDS epidemic and, no, the legality of it isn’t really relevant because

the morality of it is so clear-cut. But apparently you do have to explain these things to Georgia State Representative Betty Price, wife of the former HHS secretary Tom Price.

We would like to think we have made progress in the fight against AIDS, but comments like this show how much farther we have to go. As do statistics.

Coinciding with the 36th anniversary of the public consciousness of AIDS, The New York Times Magazine published an article entitled “America’s Hidden H.I.V. Epidemic.” The article details a community that might as well be back in the early days of the plague, before the life-saving medications, before we considered HIV to be a treatable, chronic disease.

The article’s byline, which reads “Why do America’s black and gay bisexual men have a higher H.I.V. rate than any country in the world?” would be shocking in and of itself. But the body of the article is worse. It turns out that this “higher HIV rate” means that one in two, 50%, of black men who have sex with men (MSM) will contract HIV at some point in their lives.

Plus, given that black MSM tend to be diagnosed later in their illness and take longer to get treatment, the

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disease all too often proves deadly.

Just try googling “HIV in Atlanta,” the city that is considered the epicenter of black HIV cases. Results like “Atlanta’s Third World HIV Epidemic,” don’t exactly inspire hope.

And of course this is an issue of racial bias in the health care system. Of course this is an issue of lack of access to health care, mass incarceration and stigma.

But it is also an issue of silence.

The first official notice to the world that HIV existed came in the CDC’s Morbidity and Mortality Weekly Report (MMWR). The article made note of a strange disease that had appeared in “five young men, all active homosexuals.” The lack of race implies that all the victims were white, and they were. But there were two other cases that weren’t included in this report: an African American man who identified as gay and a Haitian man who did not. When asked about these omissions, Dr. Michael Gottleib, the article’s author offered the following, “Until recently, I wouldn’t have thought it mattered. But in retrospect, I think it might’ve made a difference among gay black men.”

Representation in an epidemic, especially the AIDS epidemic, is no small matter. Recognition would have meant more outreach by the federal and state agencies (once they got around to tackling the problem), not to mention more of a voice and standing for HIV/ AIDS advocacy organizations and even access to the cultural and financial power of the LGBTQ+ community.

Time matters too. The American Foundation for AIDS Research put out a report last year entitled “HIV and the Black Community: Do #Black(Gay) Lives Matter?” It contains one of the most sobering quotes I have read: “We are going to eventually end AIDS in the United States, but I fear it’s not going to happen for black M.S.M. We have waited too long.

With so many black gay men already infected, the horse is already out of the barn.”

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Where From Here?

In so many ways, the history of AIDS is a history of silence and shame. It is the story of a president who refused to discuss the crisis and, in doing so, ensured that it would be much worse than it had to be. It is the story of communities who go forgotten and ignored as HIV advocacy organizations claim success. This recent censorship of the CDC is, like the atrocities that came before it, just a new chapter in an already familiar tale.

But it would be a mistake to think that is the only way to see the issue of censorship at the CDC. Because the story of AIDS is also the story of organizations like ACT UP and TAG who took to the streets to demand access to lifesaving drugs and, in doing so, rewrote the rules at the FDA, saving countless lives. It is the story of millions across the US who took to the streets last summer to save Obamacare, a health care law that ensures many who are diagnosed with HIV can still get health insurance. And it is the story of people, who I will not name but have been lucky enough to meet, who refuse to rest while their communities are still at risk. People who were convinced that they would die when they were diagnosed with HIV decades ago, and who believe their continued existence to be nothing less than a miracle.

If you can live through one miracle, they tell me, then you can certainly effect another.

The word ban at the CDC should be terrifying.

But it is also heir to so much hope – so many actions that should make us believe that ordinary citizens can stand up, act up, push back, and affect meaningful change.

When the news about the CDC came out, I listened to Vito Russo’s speech about what hope means in the context of so much loss: “AIDS is really a test of us, as a people. When future generations ask what we did in this crisis, we're going to have to tell them that we were out here today.

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And we have to leave the legacy to those generations of people who will come after us.”

We are still in the crisis; we still have a legacy to leave.

Let it not be a legacy of silence and censorship.

amFAR. “HIV and the Black Community: Do #Black(Gay)Lives Matter?”

Washington DC: amFAR, 2016. Accessed February 14, 2018. http://www. amfar.org/uploadedFiles/_amfarorg/Articles/On_The_Hill/2016/BlackGay-Men-and-HIV.pdf. amFAR. “Thirty Years of HIV/AIDS: Snapshots of an Epidemic.” amFAR. N.d.

Buckley, Jr., William F. “Crucial Steps in Combating the Aids Epidemic; Identify All the Carriers.” New York Times. March 18, 1986.

“CDC gets list of forbidden words: Fetus, transgender, diversity.” New York Times, December 15, 2017.

Domonoske, Camila. “CDC Denies Banning Words; Rights Group Projects Disputed Terms Onto Trump D.C. Hotel.” NPR, December 20, 2017.

Engber, Daniel. “There Is No Ban on Words at the CDC.” Slate, December 21, 2017.

Fleming, Molly. “US politicians asks whether you can legally ‘quarantine’ HIV patients.” Independent. October 21, 2017.

Image citations Manuscripts and Archives Division, The New York Public Library. "Kissing Doesn't Kill (With additional text: "Corporate greed, government inaction, and public indifference make AIDS a political crisis.")" New York Public Library Digital Collections. Accessed February 14, 2018. http:// digitalcollections.nypl.org/items/510d47e4-1020-a3d9-e040-e00a18064a99 Manuscripts and Archives Division, The New York Public Library. "All People with AIDS Are Innocent (Poster)" New York Public Library Digital Collections. Accessed February 14, 2018. http://digitalcollections.nypl.org/ items/510d47e3-539d-a3d9-e040-e00a18064a99 The National Library of Medicine. "AIDS Is Still a Crisis (Post Card)" The National Library of Medicine Digital Collections. Accessed February 14, 2018. https://collections.nlm.nih.gov/catalog/nlm:nlmuid-101457372-img “Wojnarowicz in 1988” Digital image. The Guardian. May 12, 2016. Accessed February 14, 2018.

Geiling, Natasha. “The Confusing and At-Times Counterproductive 1980s Response to the AIDS Epidemic.” Smithsonian. December 4, 2013.

“Interview Don Francis.” Frontline: The Age of AIDS, PBS, last modified May 30, 2006, https://www.pbs.org/wgbh/pages/frontline/aids/interviews/ francis.html.

Richard Lawson. “The Reagan Administration’s Unearthed Response to the AIDS Crisis Is Chilling.” Vanity Fair. December 1, 2015.

Russo, Vito. “Why We Fight.” Speech, Washington DC, May 9, 1988. ACT UP. http://www.actupny.org/documents/whfight.html.

Villarosa, Lina. “America’s Hidden HIV Epidemic.” New York Times Magazine.

June 6, 2017.

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WHO HAS the RIGHT TO edit YOUR DNA? CRISPR RESEARCH CONTINUES EVEN AS PATENT DISUPTES HEAT UP By

EDWARD ZHOU FATIMA SATTAR (Editor)

Even long before Watson and Crick discovered that the genetic code of life was found in DNA, humans have dreamed of making themselves smarter, faster, stronger, and ever more perfect. For some, that dream has predominantly taken shape as the eradication of disease and adverse effects of aging; for others, the desire to live longer, change one’s appearance, or the acquisition of increased strength or smarts has been the primary driver. Such a dream to pursue perfection is probably literally baked into our DNA – in a Darwinian universe where survival of the fittest demands that we find the best possible mates so that our own genes will continue on, considerations such as height or intelligence still abundantly characterize the only place today where we have evolutionary control: finding a partner and reproducing. On a societal scale, eugenics programs from ancient Sparta to pre-World War II Germany, as tasteless and immoral as we now find them, have characterized the desire of entire communities to strive for an improved iteration of the human species.

Genetic modification, long an obsession in our literature and media and a topic of intense research in our laboratories, has society-spanning implications – with an impact as large and unpredictable as the wildest imaginations of our authors, filmmakers, and even scientists. And yet, a future with genetic modification – the ability to precisely control our own, and indeed any genetic code – has become an issue that we will have to contend with in our modern-day

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society, whether we like it or not.

The ability to rewrite our own genetic code is already here. It’s called CRISPR – short for Clustered Regularly Interspaced Short Palindromic Repeats – and it can change DNA, with high specificity, in any part of almost any genome.

The first mention of CRISPR is credited to Francisco Mojica. Working at the University of Alicante in Spain, Mojica first coined the term during his 19932005 research. In 2011, Emmanuelle Charpentier, working with Umea University and the University of Vienna, discovered how CRISPR could selectively target DNA, and shortly after, researchers at UC Berkeley and at Vilnius University in Lithuania published papers separately but almost simultaneously, demonstrating that CRISPR/Cas9 could be programmed to cleave DNA at any location. In 2013, the Broad Institute, funded by MIT and Harvard, fatefully extended Cas9 DNA editing to eukaryotic cells – confirming that research which had previously been limited to prokaryotic organisms could in fact work on humans.

The claim of control for the rights to the CRISPR patent now rests between two groups, with the Broad Institute of Harvard and MIT on one side, and UC Berkeley and the University of Vienna on the other.

As opposed to most patent disputes which settle out of court due to the complex and extremely expensive nature of litigation, the legal battle for control of CRISPR patents has been intense and dramatic on

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both sides. With the potential for CRISPR technology to literally reshape the landscape of medicine, not one but multiple Nobel prizes almost certainly on the line, and the profits of what may be a multibillion or multitrillion dollar industry at stake, neither side is backing down. Already, various companies have been spun off in order to monetize and continue developing the technology, with several, such as CRISPR therapeutics (UC Berkeley) and Editas Medicine (Broad Institute), publicly traded and valued at billions of dollars.

Although a preliminary ruling given by the U.S. Patent Trial and Appeal Board sided with the Broad Institute, citing the Broad Institute’s specific applications to eukaryotic cells, UC Berkeley has contested the decision, and the outcome of these patent wars is far from certain. And it’s not just a dispute in the US – in Europe and Asia too, patent battles rage on.

Furthermore, CRISPR is ultimately just one method of gene editing, and other methods could certainly be proposed as research continues. Even within CRISPR technology, current patents are for a variation known as CRISPR/Cas9, and other variations, such as CRISPR/Cpf1, which are currently under active

research, do not fall under such restrictions. If these variations prove to be more effective, more ownership questions will surely arise.

CRISPR technology has already reached a degree of sophistication that has allowed researchers to identify the most promising diseases to be early treatment targets As we wait to see how this legal battle will play out, CRISPR technology has already reached a degree of sophistication that has allowed researchers to identify the most promising diseases to be early treatment targets of this new technology – commonly those that are a result of mutations which are simpler and easy to correct. One such treatment targets a mutation in the MYBPC3 gene, involved in the potentially fatal disease hypertrophic cardiomyopathy. Another aims to target sickle-cell disease, and the University of Pennsylvania has made plans to apply CRISPR to melanoma, multiple myeloma, and sarcoma. Several clinical trials are scheduled to begin shortly in the

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US, but in China, where a much more relaxed control policy for such new technologies prevails, experiments using CRISPR technology in humans have already been conducted. One of the first, conducted at Sichuan University, modified immune cells to be more resilient to a patient’s lung cancer.

If CRISPR trials are successful, personalized medicine may one day become commonplace, and the ability for humans to alter their genetic sequence to contain exactly the traits they want may become a matter of course. What implications will such freedom and responsibility have on science and society?

A, Jenny. “Advances in Precision Medicine in Multiple Myeloma.” The Myeloma Crowd. March 07, 2017. Accessed February 16, 2018. https:// www.myelomacrowd.org/advances-in-precision-medicine-in-multiplemyeloma/.

“CRISPR: A game-changing genetic engineering technique.” Science in the News. July 31, 2014. Accessed February 16, 2018. http://sitn.hms.harvard. edu/flash/2014/crispr-a-game-changing-genetic-engineering-technique/.

“CRISPR fixes disease gene in viable human embryos.” Nature News. Accessed February 16, 2018. https://www.nature.com/news/crispr-fixes-diseasegene-in-viable-human-embryos-1.22382.

“CRISPR gene-editing tested in a person for the first time.” Nature News.

Accessed February 16, 2018. https://www.nature.com/news/crispr-geneediting-tested-in-a-person-for-the-first-time-1.20988.

“CRISPR Timeline.” Broad Institute. January 06, 2017. Accessed February 16, 2018. https://www.broadinstitute.org/what-broad/areas-focus/projectspotlight/crispr-timeline.

“Editas Medicine, Inc.” EDIT Editas Medicine, Inc. Stock Quote. Accessed February 16, 2018. https://finviz.com/quote.ashx?t=EDIT. Jay P. Kesan and Gwendolyn G. Ball, “How Are Patent Cases Resolved? An Empirical Examination of the Adjudication and Settlement of Patent Disputes “ (February 2006). University of Illinois Law and Economics Working Papers. Working Paper 52. http://law.bepress.com/uiuclwps/art52.

Mullin, Emily. “CRISPR in 2018: Coming to a human near you.” MIT Technology Review. December 23, 2017. Accessed February 16, 2018. https://www.technologyreview.com/s/609722/crispr-in-2018-coming-to-ahuman-near-you/.

“The Current CRISPR Patent Dispute, Explained.” Cal Alumni Association.

May 01, 2017. Accessed February 16, 2018. https://alumni.berkeley.edu/ california-magazine/just-in/2017-04-27/current-crispr-patent-disputeexplained

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THE NUMBER-ORIENTED PROBLEM OF THE MEDICAL WORLD By

OLIVIA PARASCHOS JUI MALWANKAR (Editor)

There is an epidemic in the medical field that is not nearly as discussed as it should be: the ever-growing physician shortage. This shortage has only increased in past years, and although various solutions have been proposed, the dialogue on this issue appears to have diminished at this point without further evaluation and action. A report published by the Association of American Medical Colleges (AAMC) has projected that by 2025, there will be a shortage of between 34,600 and 88,000 doctors, and this quantity will only increase by 2030: hitting a high of between a 40,800 and 104,900 physician shortage. Meanwhile, a 2016 AAMC report measured the number of active US physicians at 860,939, just a 2% increase from the 799,501 physicians active in 2010. While this does show that there is an absolute increase in physicians throughout the US, this growth does not prove to be enough to support a growing and aging population; instead, the AAMC has projected a growth in physician demand of 17% by 2025. There are, however, plenty of actions that can and need to be taken in the future in order to alleviate such a progressively damaging issue.

The depth of this shortage has been found to greatly fluctuate depending on medical specialty and region of the country. Although the state median of active DO’s and MD’s is 257.6 per 100,000 people according to the AAMC 2017 AMA Physician Masterfile and population estimates from the U.S. Census Bureau, there is a wide range within this calculated average of this ratio depending on the state – it ranges from around 185 to nearly 450 for every 100,000 people. These lows and highs – Mississippi and Massachusetts respectively – highlight the great health disparities within different regions of the US.

For those interested, the estimate for Illinois falls at around 280 physicians per 100,000 people, which is slightly above the median. As for the breakdown between MD’s and DO’s, a majority of the active physician population falls under the MD category; nevertheless, the proportion of MD’s to DO’s also greatly varies by state. The different shortages in types of medical professions also seems to vary greatly, with general surgeons and psychiatrists ranking among the most understaffed fields. According to the AAMC, the field of psychiatry has even shown a drop in activity in recent years, falling 1.4% in just 5 years, from 38,289 in 2010 to 37,736 in 2015.

These projections, although numerically concerning, cannot be fully understood without grasping what exactly these numbers mean for the patient population. This problem, although commonly referred to as a physician shortage, is actually more of a failure to meet growing demands once greater care is spent looking at the details of the problem. The obvious concern is that of a growing elderly population, as older people tend to require a greater number of physician visits. This greater number of visits in turn requires a higher supply of available physicians, and the current supply is nowhere near close to

The problem is actually more of a failure to meet growing demands once care is spent looking at the details of the problem. meeting the demand; the increase in life expectancy only serves to exacerbate this issue further. As for the general adult population, they are most likely to suffer from this physician shortage due to not only

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the 80 million aging baby boomers, but also a greater instance of prevalence of obesity and diabetes, and an expanding insurance system. While more individuals get access to healthcare, there are more patients for physicians to care for, and this care of the US population needs to become a more urgent priority in the administrative sector than it currently is. There also is an issue with the physicians themselves, in that many physicians are turning away from a clinical path due to unhappiness with an increasing technological expectation. This expectation, due to the HITECH Act passed in 2009 requiring a greater level of electronic data entry, is believed to detract from the primary hands-on work required of a physician and is causing many physicians to leave the clinical field of medicine. However, this overall problem of a numerical shortage is not as cut-and-dry as it seems, and there are also factors that serve to reverse the impact of the shortage. On this other side of the spectrum is the main argument that not all medical care needs to be provided by physicians, and that with improving technology there begins to become less of a need for direct care from physicians. Nevertheless, due to the

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sheer capacity at which the negative factors impact the physician shortage, indirect physician care is not nearly as effective as it should be.

One of the main solutions that has been enacted over the years is an increase in graduates from medical schools. However, this plan is not effective as a short-term aid; from 2002 to 2016 there has been a gradual increase of 25%, but the problem in this stems from the principle that graduates still need to complete a residency in order to become full-fledged physicians. So, although the number of graduates of medical schools have increased, the residency slots also have to increase by that much to be fully effective. Other proposed solutions include simpler regulations for foreign medical school graduates to practice in the US, a more comprehensive team-based care strategy, and a better use of technology. Telemedicine, which is a way to provide medical care from a distance, is just one of the technological advances that is being implemented to try and appeal to the growing demand for physician care; despite being initially created to reach patients in rural locations, it is now seen as a potential tool to reach urban populations

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with healthcare shortages as well. Perhaps the key to adequately addressing the problem of the physician shortage is in a multi-pronged approach. Regardless of whether a multi-pronged approach is utilized, the main goal in lessening this shortage should be to address the root of the problem by training more physicians, especially in areas and specialties that have been on the decline. Through all of these implementations, perhaps future projections will be lessened and eventually the US will no longer suffer from a physician shortage at all.

AAMC. Physician Supply and Demand Through 2025: Key Findings. www.aamc.org/download/426260/data/ physiciansupplyanddemandthrough2025keyfindings.pdf.

Bodenheimer, T. S., and M. D. Smith. “Primary Care: Proposed Solutions To The Physician Shortage Without Training More Physicians.” Health Affairs, vol. 32, no. 11, 1 Jan. 2013, pp. 1881–1886, https://www.healthaffairs.org/ doi/abs/10.1377/hlthaff.2013.0234.

Japsen, B. (2016, December 31). U.S. Faces Doctor Shortage Despite Specialist Growth. Retrieved February 12, 2018, from https://www.forbes.com/sites/ brucejapsen/2016/12/30/u-s-still-faces-doctor-shortage-despite-specialistgrowth/#639e0d381aa7.

Loria, Keith. “Physicians leaving profession over EHRs.” Medical Economics, 24 Jan. 2018, medicaleconomics.modernmedicine.com/medicaleconomics/news/physicians-leaving-profession-over-ehrs.

Mann, Sarah. “Research Shows Shortage of More than 100,000 Doctors by 2030.”AAMCNews, 14 Mar. 2017, news.aamc.org/medical-education/ article/new-aamc-research-reaffirms-looming-physician-shor/.

Marcus, Mary Brophy. “New report predicts “troubling” shortage of doctors in the U.S.” CBS News, CBS Interactive, 20 Mar. 2017,www.cbsnews.com/ news/doctor-shortage-us-impact-on-health/.

Moawad, Heidi. “Can the looming physician shortage be stopped?” Medical Economics, 22 May 2017, medicaleconomics.modernmedicine.com/ medical-economics/news/can-looming-physician-shortage-be-stopped. image citations Association of American Medical Colleges, “The Complexities of Physician Supply and Demand: Projections from 2013 to 2025,” March 2015.

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THE PLUMMET OF PUBLIC HEALTH: By

HANNAH JACOBS-EL PURUJIT CHATTERJEE (Editor)

introduction Vaccines have played a pivotal role in reducing and eliminating the prevalence of infectious diseases such as smallpox, measles, and whooping cough for the past three centuries. Their use has saved millions of lives worldwide and continues to do so today. However, many individuals are beginning to question the usefulness and effectiveness of vaccines, due to both the low prevalence of many diseases and skepticism surrounding their safety. By assessing the development of vaccine policy and anti-vaccine movements, one can begin to plan a solution on how to prevent these infectious diseases from resurfacing. history Vaccines

1796: Founding of Vaccinology in the West by Edward Jenner with the creation of the first smallpox vaccine in 1798.

1971: Measles-Mumps-Rubella (MMR) vaccine created. The widespread use of the vaccine drastically reduced the disease rates; by 1981, the number of reported measles cases was 80% less than the previous year.

1988: Mass polio immunization began, reducing the number of polio cases worldwide from 350,000 in 1988, to 37 in 2016.

1989-1991: Measles epidemic in the United States results in tens of thousands of measles cases and hundreds of deaths.

1994: Vaccines for Children Program (VFC) imple-

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mented by the Omnibus Budget Reconciliation Act of 1993. This federally funded program provides vaccines to children at low cost, removing potential financial barriers.

1994 National Vaccine Plan in the United States implemented in order to develop new and improved vaccines, ensure safety and effectiveness of vaccines, better educate the public and health professions on the benefits and risks of immunizations, and achieve better use of vaccines to prevent disease, disability, and death.

2000: Measles declared eliminated in the United States. (â&#x20AC;&#x153;Eliminationâ&#x20AC;? refers to the absence of continuous disease transmission for greater than 12 months).

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DEVELOPMENT OF IMMUNIZATION POLICY AND THE MOVEMENT history Anti-Vaccine Movements 1905 Jacobson v Massachusetts: Following a smallpox outbreak, the Board of Health in Cambridge, Massachusetts mandated that all city residents be vaccinated against smallpox in 1902. A man named Henning Jacobson refused to comply on the grounds that the law violated his right to care for his own body; the city filed criminal charges against him in response. The case moved to the Supreme Court and in the 1905 case, Jacobson v.

Massachusetts, the Court found in the state’s favor claiming the state could enact compulsory laws to protect the public in the event of a communicable disease. This was the first U.S. Supreme Court case concerning the power of states in public health law.

1930s Thimerosal Controversy: Thimerosal is a mercury compound that has been used as a preservative in vaccines since the 1930s. Fear erupted surrounding potential harmful effects of mercury when levels exceeded FDA guidelines, and the public began to hypothesize a link to autism (there was no evidence supporting this correlation). The FDA called for the reduced or eliminated use of

thimerosal in vaccines, and it is no longer used in most childhood vaccines.

1998 Andrew Wakefield Study: Andrew Wakefield, a British medical researcher, published a study in the Lancet linking the MMR vaccine to autism.

Wakefield claimed that the vaccine contained a live virus that damaged children’s’ brains, which he believed led to the “autism boom” in the 1980s.

However, no reputable study confirmed his findings, and current studies have disproved his theory.

Contrary to his hypothesis, autism rates decreased as MMR vaccination rates increased, and autism rates were shown to be lower in vaccinated groups versus unvaccinated groups. It was later revealed that Wakefield had been paid by attorneys seeking to file a lawsuit against vaccine manufacturers; the Lancet formally retracted his paper in 2010, and Brian Deer found that he may have committed research fraud by falsifying data about his child subjects’ conditions in 2011. Despite this, many still believe in a link between vaccines and autism.

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current vaccine policy Current immunization policies are created in order to maintain the high level of immunization rates that the United States has experienced in the last decades. With the increasing number of communities opting out of vaccines, the effectiveness of these programs is becoming more crucial in maintaining a safe state of public health.

2010 National Vaccine Plan This plan was implemented in order to address current issues that the 1994 National Vaccine Plan did not address, while also continuing the development and improved ability of vaccines. This plan has five broad goals, all aiming to achieve optimal prevention of infectious diseases through immunization, as well as to enhance all aspects of vaccinations.

Strategic Multi-Attribute Ranking Tool for Vaccines (SMART Vaccines Tool) A piece of software that helps triage new vaccines for development, it prioritizes vaccines based on health, economic, scientific, business and demographic considerations, as well as public concerns. This software, if implemented, would aid in the faster and overall simpler creation and distribution of vaccines.

Public Health Campaigns Public health campaigns change the public behavior through interventions and education in order to alter risky behavior and improve decision making. The “Infection: Don’t Pass It On” campaign started in

2015 and specifically focused on the influenza virus and immunization. They focused on communicating and educating the public on how to reduce the spread of infection through the use of advertisement (posters, videos, brochures, etc.).

A study by the Health Development Agency (HDA) found that behavior change is an effective mode of achieving policy goals. Specifically, they saw that mass media campaigns have been effective in broader health promotion, as it informs the general public, sets the agenda for a public debate, and encourages policy changes to create a supportive environment.

Affordable Care Act (ACA) The ACA expanded access to health insurance and the provision of clinical services, including vaccinations. It improved access to these services by making federally purchased vaccines available to all 50 states, broadening the national vaccine infrastructure and eliminating some of the financial barrier for lower-income individuals.

current anti-vaccine movement The current anti-vaccine movement has many similarities to the older movement. However, the development of social media has created a collectively increasing distrust in the effectiveness and safety of vaccines due to the ease of communication and information sharing.

Autism Increase Over the last decade, there has been an increase in autism cases in the United States, and many have hypothesized a possible link to vaccines, especially given Wakefield’s now-discredited article. Health care professionals and scientists are unsure whether it is actually increasing, whether there is an increase in diagnosis and reporting, or a change in the definition and criteria, although some studies have found it is most likely due to diagnostic changes.

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Religious Beliefs The main religious oppositions to vaccines are based on ethical predicaments associated with using human tissue cells to create vaccines, as well as beliefs that the body is sacred and should not receive certain chemicals or blood/tissues from animals.

Many believe in healing by God or natural means.

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2010 NATIONAL VACCINE PLAN Goal 1

Goal 2

Goal 3

Goal 4

Goal 5

GOAL

IMPLEMENTATION

ACHIEVEMENTS

Develop new and improved vaccines

Develop priority for vaccine targets

New vaccines in the market, improvements in the flu vaccine

Enhance the vaccine safety system

Enhance timely detection & verifcation of vaccine safety signals

Effectivce U.S. safety system, rapid aqquisition and anlysis of safety data

Support communications to enhance informed vaccine decision-making

Increase awareness of Comprehensive approaches to promote vaccines, vaccine-preventable vaccine uptake, efforts to better underdiseases, and the benefits, stand and increase public confidence risks of immunizations

Ensure a stable supply of, access to, and better use of recommended vaccines

Eliminate financial barriers, create an adequate and stable supply of recommended vaccines, improve electronic health records & technology

Increase global preven- Improve global surveillance tion of death and for vaccine-preventable disease through safe and diseases effective vaccination

Distrust and Social Media A prominent argument surrounding immunizations is the belief that vaccines are simply a way for pharmaceutical companies to increase their revenue, causing a certain level of distrust. However, vaccines actually only make up 2-3% of this trillion-dollar industry, and is not a major source of revenue; in fact, they would make more money creating drugs to cure diseases than creating vaccines to prevent the diseases.

Reducing financial barriers (near-universal coverage for children under the ACA), high vaccine coverage rates for pediatric vaccines, improving access to vaccine providers Progress against global elimination goals

Social media sites such as Facebook and Twitter make it increasingly easy for anti-vaccination supporters to spread ideas and gain support. Thus, the anti-vaccination movement is not only able to grow but has the resources and support to act on their beliefs. One study assessing the effects of social media on anti-vaccination attitudes found that mistrust in government and general paranoia were key attitudes of those in support of the anti-vaccination movement.

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current news Over the past few years, there has been an increasing number of preventable disease outbreaks in the United States. The CDC believes that the recent increase in spreading of infectious diseases is caused by an increase in communities with pockets of people who are not vaccinated.

Confirmed Measles Cases, California 2000 - 2014 (California Department of Public Health)

Orange County, California The measles outbreak in Orange County, California in 2014 saw approximately 131 confirmed cases , the largest outbreak in the state in two decades. Of the 82 cases with verified vaccination states, 70% were unvaccinated and 30% were vaccinated.

A state law passed in 2016, Senate Bill 277, was one of the strictest vaccine laws in the nation, eliminating a loophole that allowed families to opt out of state immunization laws by saying vaccinations conflicted with their personal beliefs.

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Religious Communities In 1994, there were measles outbreaks in Christian Science communities in Missouri and Illinois, where 190 cases of measles were reported between April 16 and May 19. More recently, in 2005, there was a measles outbreak in a religious community in Indiana caused by an unvaccinated teen returning from an overseas trip.

Minnesota 2017 There were 73 confirmed measles cases in Minnesota alone in 2017 (this exceeds the total number cases in the US in 2016, which was 70), 69 of which included unvaccinated persons; the median patient age was 21 months. This outbreak first afflicted Somali-American communities when they discovered Wakefieldâ&#x20AC;&#x2122;s study linking autism and vaccines, causing vaccination rates to plummet in these communities.

CURRENT EVENTS

looking forward Vaccine policy has been constantly changing, and it is inevitable that sentiments surrounding these policies are ever-changing, as well. The national increase in preventable disease outbreaks and slow decrease in vaccine trends shows that there need to be changes in order to maintain the current health standard in the United States. Addressing the unique beliefs behind this movement is crucial to improving the state of healthcare. Due to the unique natures of anti-vaccine supporters, with reasons for support ranging from religious belief to distrust in the government, vaccine policy must tailor to the particular groups that they are trying to reach in order to successfully prevent the spread of vaccine-preventable diseases. Enhanced education can be done through improving communication between health care providers and patients, as well as utilizing social media in order to create an open dialogue. Policy can adapt by focusing on the pockets and tailoring policy to specific areas and addressing the specific needs of unique groups. By focusing on the states and areas with low vaccination rates and high preventable disease outbreaks, organizations can begin focusing their energy on the larger problem.

This current anti-vaccine movement is not the first and certainly will not be the last movement that healthcare has to face; if a policy is not created that takes these into account, there will be an increasing number of unvaccinated pockets and, in turn, an increase in vaccine preventable diseases.

2010 National Vaccine Plan: Protecting the Nation's Health through Immunization. Washington, D.C.: U.S. Department of Health & Human Services, 2010. Print.

“A Brief History of Vaccination.” Immunisation Advisory Centre, 4 Apr. 2017, www.immune.org.nz/vaccines/vaccine-development/brief-historyvaccination.

“About VFC.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 14 Feb. 2014, www.cdc.gov/vaccines/programs/ vfc/about/index.html.

Baker, Jeffrey P. “Mercury, Vaccines, and Autism: One Controversy, Three Histories.” US National Library of Medicine, National Institutes of Health, Feb. 2008, pp. 244–253.

“Cultural Perspectives on Vaccination.” History of Vaccines, www. historyofvaccines.org/content/articles/cultural-perspectives-vaccination.

“Do Vaccines Cause Autism?” History of Vaccines, www.historyofvaccines.org/ content/articles/do-vaccines-cause-autism.

Graham, Jordan. “Vaccination Law Passed after 2014 Disneyland Measles Outbreak Increased Immunizations in Orange County.” Orange County Register, Orange County Register, 15 May 2017, www.ocregister. com/2017/05/15/more-orange-county-schools-have-herd-immunity-afterstate-vaccination-law-inspired-by-disneyland-measles-outbreak/.

Haelle, Tara. “Majority Of Autism Increase Due To Diagnostic Changes, Finds New Study.” Forbes, Forbes Magazine, 8 Jan. 2015, www.forbes.com/sites/ tarahaelle/2015/01/05/majority-of-autism-increase-due-to-diagnosticchanges-finds-new-study/#b6eb5327c369.

“History of Anti-Vaccination Movements.” History of Vaccines, www. historyofvaccines.org/content/articles/history-anti-vaccinationmovements.

Holland, Jeremy. “How the Anti-Vaccine Movement Is Damaging Big Pharma's Reputation – Polecat.” Polecat, 5 May 2017.

Howard, Jacqueline. “More Measles in Minnesota than All of US Saw Last Year.” CNN, Cable News Network, 2 June 2017, www.cnn.com/2017/06/02/ health/minnesota-measles-outbreak-bn/index.html.www.cdc.gov/mmwr/ volumes/66/wr/mm6627a1.htm.

Institute of Medicine (US) Committee on the Review of Priorities in the National Vaccine Plan. “1994 National Vaccine Plan Goals, Objectives, and Anticipated Outcomes.” Initial Guidance for an Update of the National Vaccine Plan: A Letter Report to the National Vaccine Program Office, U.S. National Library of Medicine, 1 Jan. 1970, www.ncbi.nlm.nih.gov/books/ NBK214672/.

Lam, Bourree. “Vaccines Are Profitable, So What?” The Atlantic, 10 Feb 2015.

“Measles Outbreak – California, December 2014-February 2015.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 20 Feb. 2015, www.cdc.gov/mmwr/preview/mmwrhtml/ mm6406a5.htm?s_cid=mm6406a5_w.

Measles: Questions and Answers, Immunization Action Coalition.

“Measles (Rubeola).” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 3 Mar. 2017, www.cdc.gov/measles/about/ history.html.

“Measles (Rubeola).” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 5 Feb. 2018, www.cdc.gov/measles/casesoutbreaks.html.

Mitra, Tanushree, et al. Understanding Anti-Vaccination Attitudes in Social Media. Association for the Advancement of Artificial Intelligence, 2016.

“Poliomyelitis”. World Health Organization, 18 April 2017, http://www.who.int/ mediacentre/factsheets/fs114/en/.

Rao, T. S. Sathyanarayana, and Chittaranjan Andrade. “The MMR Vaccine and Autism: Sensation, Refutation, Retraction, and Fraud.” Indian Journal of Psychiatry, Medknow Publications, 2011, www.ncbi.nlm.nih.gov/pmc/ articles/PMC3136032/.

SMART Vaccine Tool. US Department of Health and Human Services, 28 Mar. 2016, www.hhs.gov/nvpo/about/resources/smart-vaccine-tool/index.html.

“Vaccines for Children Program (VFC).” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 24 Apr. 2014, www.cdc.gov/vaccines/programs/vfc/index.html.

“VHA Seasonal Influenza Manual: Infection: Don’t Pass It On A Campaign for Public Health.” U.S. Department of Veterans Affairs, July 2014, www. publichealth.va.gov/docs/flu/va-flu-manual.pdf.

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RECENT DEVELOPMENTS FDA APPROVES BLOOD TEST FOR CONCUSSION By

KALINA KALYAN

It is estimated that 1.6 – 3.8 million sports- and recreation-related concussions occur in the United States each year. Concussions due to sports and recreation activities and repeat concussions are extremely prominent, and they are currently diagnosed through a CT scan using a series of X-rays to obtain cross-sectional images of the skull and brain. However, a new form of technology has been developed: blood tests.

Blood tests for concussions work quickly through testing levels of two proteins, UCH-L1 and GFAP. Elevated levels of these proteins are suggestive of a certain type of brain damage normally only found through a CT scan. Thus, concussion blood tests serve to determine which patients need a CT scan to confirm the damage and which patients do not require further treatment.

These blood tests are groundbreaking in that they provide hospital staff an efficient and accurate way to better treat those who have potentially incurred a concussion. Additionally, these blood tests are significantly more compact and less expensive than CT scanners, and can be used both inside the continental US and outside in order to treat our active duty military overseas.

NEW STUDY USES MOBILE TECHNOLOGY TO TRACK HEART PROBLEMS Recent advancements in technology, ranging from wearables like the Apple Watch to smartphones with health-tracking apps, are becoming more prevalent in making a difference in healthcare; equipped with the ability to provide long-term data for individual patients, these advancements integrate health care into everyday life – a difference that could mean the world for patients with undiagnosed heart problems.

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Many chronic heart conditions, such as atrial fibrillation, are underdiagnosed since office visits with a primary care doctor can only provide snapshots of a patient’s health status. Mobile tracking can help with the diagnosis, reveal triggers for disease, and assist in a patient’s care; the Health eHeart study looks at a wide range of individuals, varying from age to sex to geographical location, in order to compile a large database for future research recruitment.

Health eHeart focuses on cardiac research, but the implications of mobile health-based research relative to other conditions range far and wide. The appeal for research participants to join this and other similar studies lies in community service, assisting in broad research projects to advance general knowledge; for researchers, in the global reach of mobile platforms – and the causes they might serve.

CURRENT EVENTS

WINTER 2018 BLOOD TEST DEVELOPED FOR EARLY CANCER DETECTION CancerSEEK is a blood test, or liquid biopsy, developed to measure the DNA in the blood, shed by dying tumor cells, and analyze the DNA for different genetic mutations commonly found in cancer; it also seeks to test for proteins expressed in specific tumor types. A preliminary trial on patients already diagnosed with canccer examined eight types: breast, colorectal,

esophageal, liver, lung, ovarian, pancreatic, and stomach cancer.

The trial revealed that CancerSEEK could detect 70% of the patientsâ&#x20AC;&#x2122; cancers and narrow down the location of the tumor to specific organs about 80% of the time. The rate of false positives was negligible, at less than 1%. The test requires further fine-tuning to better detect stage 1 cancers, to maximize its use in early cancer

detection for different types of cancers as well.

Next, CancerSEEK aims to run a clinical trial on patients with no history of cancer, over a period of 5 years. With this development and other advances in liquid biopsies, a trend towards non-invasive measures of cancer detection is beginning to appear.

INFECTION BY ZIKA COULD ASSIST IN BRAIN CANCER TREATMENT

OBESITY LEVELS DRIVE UP HEALTH CARE COSTS

Zika virusâ&#x20AC;&#x2122; role in microcephaly may be due to its ability to increase cell death in neural progenitor cells, which are precursors of brain cells; researchers have used this relationship to investigate how Zika may play a role in combating glioblastoma, one of the most aggressive forms of brain cancer in adults. They found that Zika infection severely damages cancer cell growth and morphology at 48 hours post-infection, eventually leading to cell death. Analyzing Zika-infected brain cancer cells revealed the presence of digoxin, a molecule that has previously been implicated in tumor death in skin and breast cancer; this suggests that by genetically modifying Zika to eliminate the effects of infection and retain the ability to synthesize digoxin, Zika virus could hold potential for future glioblastoma treatments.

A policy analysis study on the relationship between health care spending and obesity-related illnesses has demonstrated an association between adult obesity and health care costs, varying by state. Overall, national medical expenses devoted to obesity-related illnesses increased by 29% from 2001 to 2015. The study reports by payer type, including private insurance companies, Medicare, and Medicaid; differences between states are explained by obesity prevalence, health care access, and treatments and prices of health care.

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ulse p THE PRE-MEDICAL STUDENTSâ&#x20AC;&#x2122; ASSOCIATION the university of chicago FACEBOOK /uchicagopmsa WEBSITE pmsa.uchicago.edu