The Great Vaccine Battle by UMiami Scientifica Magazine

Issue 18

February 2021

The Great Vaccine Battle

Contents Health The Great Vaccine Battle The Silent Killer

Impacts of Unsafe Sun

Ethics 6 11

Exposure

#skincare #edutok How TikTok is the Frontrunner for Skincare Education

The Silent Science A History of Public Health

Milestones in Healthcare

14 16

Racial Disparities that Plague Clinical Trials

News 18

A Need for Diverse Representation in Research

The Husband Stitch

COVID-19 Behind Bars

Health Disparities in Colon Cancer Screenings

Sex ed in america

FDA Changes the Face of Packaged Foods

The Supreme Court Battle Over Reproductive Healthcare

UThrift: Do Good, Feel Good

Roll the dice

How the Nutrition Facts Label is getting a reality check

Cover art by Megan Buras

Research Nobel Prize Winners of 2020

The Dark Side of Blue Light

Printing the Future of Surgery

The Human Microbiome

A Real Way to Stop The Spread

Profiles

The Great Vaccine Battle

Eye-Opening Research

Tearing Down Stigmas

Research Profile on Sasha Milbeck

How our eyes have been sacrificed by screen time

Research Profile on Krishna Louis

p. 6

In this issueâ&#x20AC;&#x2122;s feature piece, The Great Vaccine Battle (p. 6), Christina Paraggio and Marissa Maddalon explore the rising tide of vaccine hesitancy in the U.S. and how this dangerous trend could hamper the effectiveness of COVID-19 vaccines.

The Importance of Contact Tracing

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l e t t e r f r o m t h e e d i to r

Anuj Shah Microbiology and Immunology Class of 2021 Editor-in-Chief, UMiami Scientifica

Serving as the editor-in-chief of Scientifica has been one of the greatest privileges of my lifetime. The chance to lead our team and create impactful stories has given me new insight into the immense influence science has on our everyday lives, and I’m excited for the central role journalism will play in my life moving forward. My time as editor came during a tumultuous period in our country’s history, one in which science was disputed more than ever and a pandemic that has killed over 400,000 continues to rage on. However, witnessing the incredible journalistic talent of the magazine’s staff has filled me with hope for a better future, one where scientific progress and human well-being are treated as one and the same. Above all else, it has been an extraordinary joy and honor to work with such talented fellow team members. I’ll deeply cherish the memories I made with them, and I’ll miss my fellow seniors and our incredible advisor, Roger Williams. The team’s work on this public health-centered issue truly represents the best of what this magazine has to offer: in-depth writing and research, gorgeous artwork, and an impressive array of diverse voices. I’m excited to hand over the reins to our new editorin-chief, Anam Ahmed. Anam quickly established herself as a natural leader and creative talent, and I can’t wait to see the new heights to which she and the team will undoubtedly take the magazine.

letter from the e d i to r i a l A dv i s o r Every new year brings with it changes and a desire to achieve more than we have in the past. This issue focuses on a variety of public health topics ranging from sex education to the current pandemic affecting our nation. I am confident that the magazine will speak for itself, so instead, I wish to focus on the greatest change-maker to this magazine. This issue will unfortunately be the last with our current Editor-inChief, Anuj Shah, who will be matriculating to the Miller School of Medicine to begin his journey to becoming a physician. Under Anuj’s leadership, the magazine has continued to evolve and flourish, and he has led and motivated his fellow peers to keep to our demanding publication schedule and launched our special infographic issue during his tenure. I have had the pleasure of not only working with him on this magazine, but also instructing him and serving as his academic advisor in our Microbiology and Immunology Undergraduate Major, and I am very proud of him and his many accomplishments. Even Roger I. Williams Jr., M.S. Ed. though he will be leaving us, I am confident he has left the magazine in good hands with his successor, Anam Ahmed, and I wish Anuj well in his future endeavors. Please enjoy this issue and continue to strive Director, Student Activities Advisor, to be the very best version of yourself. Happy New Year, and be safe. Microbiology & Immunology

Editorial Advisor, UMiami Scientifica

s c i e n t i f i c a C o r e s ta f f Anuj Shah Shravya Jasti Abigail Adera Aaron Dykxhoorn Megan Buras Sneh Amin Mac Clifton Amirah Rashed Anam Ahmed Ainsley Hilliard Kimberley Rose Austin Berger Sofia Mohammad Victoria Pinilla Roger Williams, M.S. Ed

Editor-in-Chief Magaging Editor Copy Chief Design Director Art Director Director of Photography Webmaster Secretary Core Associate Distribution Manager Director of Creative Writing Director of Public Relations Director of Community Outreach Board of Advisors Liason Editorial Advisor

S c i e n t i f i c a 2 0 2 1 Board of Advisors Barbara Colonna Ph.D. Senior Lecturer Organic Chemistry Department of Chemistry Richard J. Cote, M.D., FRCPath, FCAP Professor & Joseph R. Coutler Jr. Chair Department of Pathology Professor, Dept. of Biochemistry & Molecular Biology Chief of Pathology, Jackson Memorial Hospital Director, Dr. Jonn T. Macdonald Foundation Biochemical Nanotechnology Institute University of Miami Miller School of Medicine Michael S. Gaines, Ph.D. Assistant Provost Undergraduate Research and Community Outreach Professor of Biology Mathias G. Lichtenheld, M.D. Associate Professor of Microbiology & Immunology FBS 3 Coordinator University of Miami Miller School of Medicine Charles Mallery, Ph.D. Associate Professor Biology & Cellular and Molecular Biology Associate Dean April Mann Director of the Writing Center Catherine Newell, Ph.D. Associate Professor of Religion Leticia Oropesa, D.A. Coordinator Department of Mathematics *Eckhard R. Podack, M.D., Ph.D. Professor & Chair Department of Microbiology & Immunology University of Miami Miller School of Medicine Adina Sanchez-Garcia Associate Director of English Composition Senior Lecturer Geoff Sutcliffe, Ph.D. Chair Department of Computer Science Associate Professor of Computer Science Yunqiu (Daniel) Wang, Ph.D. Senior Lecturer Department of Biology * Deceased

s ta f f

SECTION EDITORS ETHICS NEWS RESEARCH HEALTH PROFILES

Amirah Rashed Snigdha Sama Alexandria Hawkins Marissa Maddalon Setareh Gooshvar

COPY EDITORS Nikhil Rajulapati Giovanna Harrell Amrutha Chethikattil Greg Zaroogian Yashmitha Sadasivuni Aarohi Talati Sneh Amin Avery Boals Kylea Henseler Jeffrey Caldwell Sophia Meibohm Yazmin Quevedo Abdullah Abouradi Christian Rivera

DESIGNERS Megan Buras Megan Piller Varsha Udayakumar Anam Ahmed Cherri Chen Natalia Jimenez Meera Patel Alejandra Rinaldi Aaron Dykxhoorn

WRITERS Christina Paraggio Marissa Maddalon Isik Surdum Meera Patel Megan Piller Caitlin Dowell-Esquivel Natalia Perez Baez Aarti Madhu Alexia Vignau Raghuram Reddy Setareh Gooshvar Nikhil Rajulapati Isabella Lopez Ainsely Hillard Yashmitha Sadasivuni Sadie Shireman Amirah Rashed Lily Scmutter Christian Rivera Brandon Dinner William Goodman

PhotograpHers Dhara Patel Avery Boals Raghuram Reddy Sneh Amin

Artists Natalia Jimenez Cherri Chen Anam Ahmed Megan Buras Varsha Udayakumar Megan Piller

The Great Vaccine Battle by Christina Paraggio and Marissa Maddalon Illustration & Design: Anuj Shah

6 | Health

Scientists defeated the odds to make a COVID-19 vaccine in record time. But, anti-vax movements are threatening the vaccine’s effectiveness.

nti-vax. Vaccine hesitancy. We’ve all heard of it, but it’s more relevant now than ever. With the flu season and a pandemic upon us, it is crucial that we are all aware of exactly what this movement is, where it comes from, and how it has the potential to seriously impact the community this season. Although controversy surrounding vaccinations has been around since their conception, most experts consider the start of the modern anti-vaccination movement to be the early 1980s when the NBC network released the documentary DPT: Vaccine Roulette which claimed a link between the diphtheria pertussis and tetanus (DPT) vaccine and negative health outcomes like brain damage and juvenile seizures. The content of the documentary has been heavily criticized and deemed inaccurate by scientists, but misinformation spreads like wildfire, especially when disguised as hard-hitting journalism. In 1998, the Lancet journal added fuel to this proverbial fire, publishing a now infamous and redacted article detailing a connection between the MMR vaccine and autism. The author of this article, Dr. Andrew Wakefield, was stripped of his title after it came to light that he had falsified the data to support this claim. Nevertheless, in the late nineties, the vaccine hesitancy movement gained its celebrity face, Jenny McCarthy, who claimed that it was the routine vaccinations that led to her son’s autism diagnosis around age 2. Using her platform, McCarthy began to advocate for parents to opt out of standard vaccinations, and the anti-vax movement continued to gain momentum. Fast-forward to 2014: an unvaccinated child causes a measles outbreak after visiting Disneyland. This incident alone led to a combined 125 cases in the United States, Canada, and Mexico. It is especially interesting to note that 66% of the pediatric patients involved in the outbreak had been excused from the MMR vaccine due to “personal belief.” There have been other cases of measles carriers leading to outbreaks all the way up through 2019, and the unvaccinated population comprises a significant proportion of the case load each time. In 2019, the Vaccine Safety Handbook from the group Parents Educating and Advocating for Children’s Health was disseminated through Orthodox Jewish communities in New York, containing unfounded claims of vaccines causing autism and containing monkey, rat, and pig DNA. Vaccine rates dropped in this population as a result, and the effect was not limited to the United States. There was a 72% increase in measles cases in the Haredi community of London, a devout Orthodox subgroup, that same year. The rabbi in charge of the Haredi Health Forum voiced concerns about the information coming from anti-vaccination groups in the United States, aware of the negative impact it may be having on the community. What is at the heart of all of the claims against vaccination?

Misinformation. The bottom line is that vaccines are safe and effective at preventing infections. In 2013, a thorough study was conducted to investigate the alleged link between vaccines and autism and no evidence was found to support the claim. Vaccine development is a lengthy process involving several rounds of clinical trials that only commence once compounds have demonstrated efficacy and safety in the lab. However, as with any medical procedure, there can be sideeffects. This is not cause for alarm, since all are described as mild and can be attributed to the responses of a healthy immune system to the introduction of a foreign body, which is precisely what a vaccine is. So, if the anti-vax movement is based on misinformation, why do we have a reason to be concerned now? Firstly, because 2019 marked the third consecutive year that the national rate of vaccinations has decreased, and this demonstrates a threat to the public health and safety of the general population. Secondly, we are in unprecedented times, facing both the SARS-CoV-2 pandemic and heading into flu season. The anti-vax movement has had a marked impact on adherence to standard immunizations, including those for the flu. A January 2020 survey conducted by the American Academy of Family Physicians showed that 61% of adults in their 20s and 30s agreed with some principles of the vaccine hesitancy movement. This survey also showed that, of the 60% of parents whose child has missed at least one flu shot, 20% were influenced by anti-vax concerns. With flu season around the corner, it is of the utmost importance that people adhere to the recommended vaccination schedule. Since the presentation of the flu is similar to that of COVID-19, experts anticipate that unvaccinated patients exhibiting these symptoms would be tested for both viruses. This depletes testing resources for both disease processes, and can lead to processing bottlenecks increasing wait times on results. Also, as we have seen this past year, there is a limited amount of resources in hospitals and healthcare systems. Increases in flu cases would put a strain on medical equipment and beds, which would be detrimental to the health system as a whole.

Characterizing and combatting the antivaccine movement in the United States Data: AAFP, Gallup, CDC, Pew Research Center

Last but not least, a simple flu shot drastically reduces the risk of being infected with both COVID-19 and the flu, and helps to protect the community as a whole. After the global spread of COVID-19 and its unprecedented shock to many peoples’ lives, the phrase “back to normal” seemed like a faraway reality. Now, labs and pharmaceutical companies’ vaccines have undergone clinical trials and are expected to work on a widespread level against the coronavirus. With hope riding on the widespread distribution of a COVID-19 vaccine and successful public immunization, an important question has arisen—how effective will the COVID-19 vaccine be if people are hesitant to receive it? Vaccines are one of the safest and most effective public health prevention tools. Through their use, diseases like smallpox, measles, polio, rubella, and others that have previously caused complications and death have been largely eliminated in the U.S. and in other parts of the world. One purpose of vaccines is to allow a population to reach herd immunity, a state at which a large portion of the population acquires immunity to the virus, causing a decrease in the transmission rate and an eventual reduction to the spread. Herd immunity for COVID-19 requires between 70% to 80% of the population to have some degree of protection, either from a vaccine or from a previous infection. However, experts have suggested that more of this immunity may have to come from people receiving the vaccine rather than just previously being infected with COVID-19, since cases reinfection are possible and have been widely documented. In the United States, despite strategies such as lockdowns and social distancing to decrease COVID-19 transmission rates and mitigate the impact of the virus on the public, transmission is widespread. Clearly, high rates of vaccine coverage against COVID-19 are needed to control the spread of the virus and decrease mortality and morbidity as the pandemic continues. Recently, the Food and Drug Administration (FDA) Emergency Use Authorization (EUA) of two COVID-19 vaccines, the PfizerBioNTech and Moderna vaccines, brought hope to frontline hospital

Historically, vaccine hesitancy has led to local outbreaks

4155

cases of measles in a 2018 outbreak in Israel, with over half occurring in orthodox Jewish communities

9120

cases in a whooping cough 2010 outbreak in California after higher-than-average vaccine exemption requests

1282

cases of measles in the U.S. in 2019, the highest in nearly three decades; the majority occurred in unvaccinated individuals

Amid misinformation, concern over childhood vaccination is increasing Parental attitudes toward childhood vaccinations

2001 2019 8 | Health

“It is extremely important or very important that parents get their children vaccinated.”

“It is not at all important that parents get their children vaccinated.”

“I have heard a great deal about the possible disadvantages of childhood vaccinations.”

“Vaccines are more dangerous than the disease they are designed to prevent.”

94%

39%

84%

79%

11%

staff and other essential workers. The phase 3 vaccine trials that were conducted were designed to assess efficacy and safety, and the FDA had said that once a vaccine was shown to be safe and at least 50% effective, it could be approved for use in the U.S. The good news? The Pfizer-BioNTech and Moderna vaccines each boasted an effectiveness of over 90%. Although these vaccines might not be completely effective against a coronavirus infection, it is still very likely that the vaccine will reduce the severity of the disease, which translates to fewer people hospitalized or in the ICU, a lifeline for overworked healthcare workers and overcrowded hospitals. Although other vaccine candidates are likely to follow in coming months, the picture isn’t entirely positive— more than a quarter of Americans have expressed vaccine hesitancy despite the serious potential consequences of a COVID-19 infection, citing concerns arising from lack of trust, political affiliation, misinformation, and concerns about scientific integrity. Dr. Maria Alcaide, one of the investigators on the University of Miami team for the Moderna COVID-19 vaccine trial, sheds light on the vaccine development and trial and her thoughts on vaccine hesitancy. Both Moderna and Pfizer used a vaccine development technique that utilized mRNA, molecules that are naturally present in our body. The mRNA incorporated into the vaccine coded for a protein called spike that studs the surface of the SARS-CoV-2, the virus that causes COVID-19. Dr. Alcaide speaks extensively about the vaccine’s ability to be manufactured and distributed rapidly when needed, and the promising results the vaccine has shown through multi-phase clinical trials, including a large-scale Phase 3 efficacy trial. For the Moderna vaccine, this trial involved over 30,000 participants in many sites across the U.S., with half receiving a vaccine and half receiving a placebo. The participants were followed over time and received the same recommendations for preventing COVID-19, and efficacy was then measured by looking at how many people got infected with COVID-19 in both groups. By December, Moderna had published the promising news that most of the infections were within the placebo group only, indicating that the vaccine had over 90% efficacy and

appeared safe without any major side effects. In addition, the Moderna vaccine sports a much more manageable storage temperature, which may make it easier to distribute compared to the Pfizer vaccine and other vaccine variants. With the Moderna vaccine’s recent FDA authorization, the focus has now shifted to making sure it is effectively distributed and utilized across the country. As the vaccine continues to undergo production and distribution, there is still the looming question of whether people are going to be willing to receive the vaccine. According to Dr. Alcaide, vaccine hesitancy—much of it based on misinformation, fear, and a lack of trust and knowledge—is likely to impact public receptiveness to the COVID-19 vaccines, the vaccine effectiveness, and the development of herd immunity. As the pandemic has continued, rising anti-vaccine sentiments and rhetoric towards the COVID-19 vaccine have led U.S. citizens to become less confident about vaccine safety, especially due to public figures spreading misinformation regarding the particularly short timeline that the creation of the COVID-19 vaccines followed. Over the past year, misinformation has spread online amid rising COVID-19 infection rates, with various tactics from minimizing the threat of the disease to claiming that vaccines cause severe illness or aren’t effective. Additionally, some do not trust the government and as a consequence, do not trust a federally funded vaccine, while others believe that the pharmaceutical industry is corrupt and is attempting to make a coronavirus vaccine too quickly, making the new vaccine with lower quality, increased risks, and uncertain side effects. This wide spectrum of vaccine hesitancy and vaccine refusal has led to alarmingly low levels of confidence in a COVID-19 vaccine, despite the widespread destruction and death the disease itself has caused. According to a study done by the Pew Research Center, as of September, only about 51% of U.S. adults said that they would definitely or probably get a vaccine for COVID-19 if it were available, dropping from the more hopeful 72% in May. Only 21% said they would definitely get a coronavirus vaccine if it were available. Dr. Alcaide also describes how vaccine hesitancy could impact certain

U.S. public opinion surrounding COVID-19 vaccine continues to fluctuate “If a vaccine to prevent COVID-19 were available today, would you get it?”

Deﬁnitely not 11% Probably not 16%

May 2020

Probably 30%

Three important facts to help reduce worry about the new COVID-19 vaccines

Deﬁnitely 21%

Deﬁnitely not 24% Deﬁnitely 42%

Sept 2020 Probably not 25%

Deﬁnitely not Definitely not 18% 18%

Probably not 21% Probably 30%

Deﬁnitely 29%

Nov 2020

Probably 31%

1. The vaccines can’t give you COVID-19, and they don’t use any actual components from the virus. 2. There may be some side effects, like achiness and fever, but there are normal with vaccines like the COVID-19 and flu vaccines. 3. These vaccines were tested in tens of thousands of people before scientists concluded that they were safe and effective.

ethnic minority groups. Higher infection rates, increased severity of infections, and higher mortality rates of COVID-19 have been documented among African Americans and Hispanics, groups that have been historically wronged and exploited by government-funded research studies and clinical trials. Due to increasingly skeptical attitudes, the anti-vaccine movement and vaccine hesitancy surrounding the coronavirus could be extremely detrimental. Developing a vaccine, although a monumental achievement, may not be enough. The real struggle may lie in attempting to convince people to actually receive the vaccine, not only in the U.S., but around the world. According to Dr. Deborah Jones Weiss, a University of Miami researcher studying vaccine hesitancy and behavioral medicine, increasing vaccine acceptability requires a concerted effort. One important aspect is the behavioral medicine component, which focuses on the central role of behavior in personal health and utilizes healthrelated behavior changes to prevent disease, an approach that could be vital in encouraging people to receive the vaccine. Additionally, Dr. Jones mentions the concept of the adoption of novel ideas, an approach that utilizes well-known adopters who receive the vaccine early on to show that it is safe and important to receive. Dr. Jones emphasizes her work with health promotion in Australia, where she appeared on

TV and received a tetanus injection to encourage others to adopt that behavior. Another example of the importance of early adopters can be seen in Zambia, where the president of Zambia, Kenneth Kaunda, publicly had an HIV test to encourage others to do the same. Improving health literacy, the degree at which individuals can understand basic health information and make decisions, is another key component in changing public sentiments about the COVID-19 vaccine and eradicating fear due to misinformation and lack of knowledge. As a whole, it’s clear that targeting vaccine hesitancy and increasing vaccine acceptability requires a broad-spectrum behavioral change program and is vital in our country’s path to achieving herd immunity. There has always been and always will be hesitancy surrounding vaccines. We have seen the impact of vaccine hesitancy and the anti-vaxxer movement in the past, and time will only tell its impact on the success of the COVID-19 vaccine. When strategizing for vaccine acceptance among Americans, it’s important that we focus on behavioral approaches and teaching the public about the safety of vaccines and the rigorous scientific process required to produce and authorize them. Despite the struggles that are undoubtedly ahead in boosting public morale and convincing people to stick to maskwearing and social-distancing guidelines, one thing is for sure—the more people that get vaccinated, the better.

How does the mRNA vaccine against COVID-19 work? What is messenger RNA (mRNA)? mRNA molecules naturally occur in our body. Think of them as the intermediate step between DNA/ genes and proteins!

The mRNA in the COVID-19 vaccine teaches our body how to make a harmless piece of a protein called spike protein, which sits on the surface of the virus. mRNA

DNA

mRNA

protein

Our bodies’ immune cells notice that the fragment doesn’t belong there, and they start preparing an immune response, which includes antibodies against the virus.

spike protein fragment

Once injected into our arm muscle, the mRNA is picked up by cells and used to make a bit of the spike protein fragment, which the cells express on their surface. muscle cell

Now, if you are exposed to the virus, your body will have a defensive response ready to make sure you won’t get infected!

immune cells

10 | Health

antibodies

The Silent Killer Impacts of Unsafe Sun Exposure

s a result of the ongoing pandemic, many people have become more aware of their personal health. However, one dangerous exposure that young people are not paying enough attention to is something they are exposed to almost every day—the sun. Over 90% of skin aging is caused directly by the sun, and extensive ultraviolet (UV) exposure is the cause of many skin cancers through a slow but cumulative process. Exposure to UV rays causes DNA damage in skin cells, and although some of this damage can be repaired, much of it cannot. The consistent buildup of damages leads to mutations that trigger rapid multiplication of skin cells, potentially causing tumors. Of course, there are benefits to sun exposure, including stress reduction, better sleep, and strengthening of bones and the immune system. However, the recommendation is only 10-15 minutes of exposure without sunscreen twice a week. Those who live in South Florida likely experience hours of direct sun exposure daily, and much of that exposure is without the proper protections. A study done by Healthy People 2020 found that only 10.1% of young adults regularly wear sunscreen when outside for more than one hour on a sunny day. This lack of sun protection can be explained as young adults often do not recognize the impacts that excessive sun exposure has on their health due to no immediate threat beyond a sunburn. While one sunburn is not enough in most people to trigger mutations that may lead to cancer, a consistent lack of responsible behavior when exposed to the sun causes long-lasting damages that accumulate through the years. Young adults are especially at risk. Research has shown that multiple sunburns during adolescence and childhood can more than

by Isik Surdum Illustration: Megan Buras Design: Meera Patel

double the risk of developing melanoma in the future. In recent years, many young adults have developed self-care or skincare routines, and suncare should be added and prioritized.. In fact, sunscreen should be applied daily to both face and body, even when not spending time outdoors. Sun protection is needed because the sun’s UV rays can travel through windows and still have the potential of harming skin while inside the home. A sunscreen with a sun protection factor (SPF) of at least 30 is recommended, and it should offer both UVA and UVB protection. Another common misconception is that once applied, sunscreen lasts the whole day. In reality, sunscreen should be reapplied every two hours, and even earlier if exposed to water. Other than sunscreen, there are other ways to protect your skin from the sun. Wearing protective clothing that covers up vulnerable areas along with seeking shade when possible also helps greatly with protection. Sun exposure should also be limited between the hours of 10 a.m. and 4 p.m., as the sun’s rays are strongest at this time. While tanning is very popular in the summer, it is greatly damaging to your skin especially when consistently done over years. While the danger of the sun does not seem imminent, it is one of the most overlooked factors when it comes to protecting one’s health.The sun and its UV rays make up the most consistent external exposures people experience throughout their lives. It is of utmost importance to educate and encourage everyone, especially young adults, to practice sun safety and make it part of their daily routines.

“...over 90% of skin aging is caused directly by the sun...” 11

#Skincare #EduTok How TikTok is the Frontrunner for Skincare Education

t was only 10 months ago when the world took a turn and people started to spend their time indoors developing new hobbies. Some of these hobbies included taking on home-improvement projects, working on self-care, and scrolling endlessly through the TikTok “For You” page. As the most downloaded app on the Apple Store and with 800 million active users, TikTok has played an important role in advocating for healthy skincare. Despite spending the majority of the time inside and away from the dangers of ultraviolet (UV) light, skin care has become a trend amongst Gen Z. In particular, TikTokers “Skincare by Hyram” and “J.C. Dombrowski” educate their followers on products they should try or avoid, and ingredients to stay away from. These self-declared skin care specialists create short videos that take a heavy topic, such as skin damage, and make it into an interesting and honest review of products they have tried. Followers invest their time in the influencers’ content, change their skin care routine, and will tag the influencers in their own videos to receive some helpful, educational, and honest feedback through the “duet” feature. The popularity of these videos greatly affects the sales of certain products. For example, CeraVe is an inexpensive drugstore skin care brand that TikTokers have shed positive light on. After many raving reviews from influencers, CeraVe’s parent company, L’Oréal, reported more than a 40% sales growth towards the end of March in the United States. This growth was under its Active Cosmetics Division which was driven particularly by the brand CeraVe. Another brand, The Ordinary, experienced a spike in sales when a bottle of its cult favorite Niacinamide 10% + Zinc 1% acne serum sold out every three seconds at the start of the lockdown. These sales were due to influencers having this product in their skin care routine, resulting in many wanting to see the hype behind the serum. Evidently, TikTok has bolstered brands’ sales since the beginning of lockdown. While products from CeraVe and The Ordinary flourished, there are other brands that suffered from influencers’ videos. When it comes to reviewing products, the skinfluencers of TikTok do not stray away from bashing brands that incorporate harsh ingredients such as high doses of parabens and/or alcohols, witch hazel, essential oils, and fragrances, to name a few. A particular brand, St. Ives, has received a lot of backlash from their popular scented scrubs that ultimately lead to long-term skin damage due to the walnut shards, fragrances and alcohol present in them. Combining these ingredients results in sensitivity, redness, and inflammation that is never good for

12 | Health

by Meera Patel

the skin. With any scrub, not just the St. Ives Scrubs, there is the risk of over-exfoliating the skin which ultimately ruins our epidermis, better known as our moisture barrier, which keeps our skin healthy from dehydration and irritants in the air. The harsh ingredients these skincare fanatics discuss are astringents that need to be avoided to maintain protected and healthy-looking skin free of dryness and sensitivity. TikTok has become a forefront in skin care education and proves to be a resource to convey public health messages like the importance of skin health. As you scroll through TikTok, you can find countless information about the products that favor your skin type, all while avoiding the ingredients that strip your skin of its protective moisture barrier.

“It was only 10 months ago when the world took a turn...”

If you’re looking for an affordable skincare routine as recommended by TikTok skinfluencers take a look here: Step 1: Cleanser Try CeraVe’s Cleansers *Check out CeraVe’s website for cleansers for specific skin types* Step 2: Face Mask (optional) Step 3: Toner (optional) Step 4: Treatment (this includes serums) Try The Ordinary’s Hyaluronic Acid 2% + B5 (hydrating) Try The Ordinary’s Niacinamide 10% + Zinc 1% Serum (acne, improves skin texture) *Check out The Ordinary’s website for more specific skincare needs* Step 5: Moisturizer Try CeraVe’s Daily Moisturizing Lotion Step 6: Sunscreen (a must) Try La Roche-Posay Sunscreen Anthelios Clear Skin Dry Touch Sunscreen

“...A sunscreen with at least SPF 30 is recommended, and it should offer both UVA and UVB protection...” “...While the danger of the sun does not seem eminent, it is one of the most overlooked factors when it comes to protecting one’s health...” “...skin care has become a trend amongst Gen Z...”

“...TikTok has become a forefront in skin care education...”

THE SILENT SCIENCE by Megan Piller

“healthy mind in a healthy body,” which broadens the scope of focus in ublic Health. When asked to define this term you may be both science and medicine to include all aspects of mental and physical tempted to reference the extensive coverage of the ongoing health. The development of hospitals to care for soldiers, sewers to COVID-19 pandemic, conjuring channel waste away from town, and up images of overwhelmed doctors “The field of public health allows us to aqueducts to filter water and ensure begging Americans to stay home, take scientific advances and make them its fair supply during the peak of social distance, and wear masks; you the Roman empire cleared the way accessible to the general population, might even describe scientists working for the development of a broad new resulting in better quality of life tirelessly to create an effective vaccine science that instituted advancements for both individuals and society as for this deadly virus. Despite the focus addressing the interaction between a whole. The coronavirus pandemic on public health’s role in the ongoing human health and environmental has shed light on the importance pandemic, this field is not just a conditions. of working together across fields, lifeline, with prevention measures and These advancements continued across sectors, and across borders. other practices instituted only in times into the nineteenth century, during The skills required in the field of of immense crisis and loss. Instead, which England underwent the “Great public health—especially our reliance the field of public health is incredibly Sanitary Awakening.” During this on interdisciplinary collaboration— expansive. According to Charlestime, political leaders and health are proving more important today Edward Amory Winslow, the founder officials built upon the foundation than ever in our lifetimes. The extent of the Yale School of Public Health, of the ancient Romans, involving of illness, economic hardship, and broad goals of this field include the promotion of health through social disruption brought upon the “preventing disease, prolonging infrastructure improvement. Edwin world by COVID-19 is such that it has life, and promoting health through generated never-before-seen attention Chadwick, the pioneer of the sanitary the organized efforts and informed movement, promoted the idea that to our common fragility stemming choices of society, organizations, filth both causes and transmits from health risks. There is much talk public and private communities, disease. His idea inspired a change about a new normal. We have a unique and individuals.” Public health has in the way society viewed health, opportunity to build a better normal. been woven into the very fabric causing a shift from an isolationist We owe it to those who have suffered of our healthy, high-functioning view to one of shared responsibility. to apply the lessons we have learned society. It influences the food we eat, This view of shared responsibility thus far.” the conditions that we work in, the emphasizes that each individual manner in which we raise our families, citizen should hold one another Julio Frenk, M.D., Ph.D. and everything that falls in between. accountable for the creation of Public health, though a relatively young science, has roots in ideal environmental and social conditions. Additionally, the Public ancient societies with the Roman writer Juvenal coining the phrase Health Act of 1848 was adopted in England and Wales, implementing

14 | Health

A History of public health proactive standards for sanitation, health, and environmental also included improved family planning services that focused on quality. John Snow, the father of epidemiology, was encouraged by the affordable and accessible health care, especially for young women, improving health and sanitation standards and conducted the world’s and mental health counseling. The expansion of this field further first epidemiological study. This study resulted in his monumental included a transition from sanitation and passive disease management discovery: cholera mortality was directly linked to contaminated water to proactive global surveillance and offensive health practices. This sources. His field-defining research not only gave rise to an incredibly expansion can best be reflected in the passing of the Social Security important branch of public health dealing with Act in 1935 which opened the door for states the distribution and determinants of disease, to implement and maintain advanced public “I sincerely believe that but also brought attention to the importance health services and properly train public health Public Health’s most of access to a clean water supply, an issue that personnel. significant contribution is present today. In the final stretches of the The twenty-first century, a period where to society has been the nineteenth century, Louis Pasteur’s germ theory we have seen many deadly, pervasive health improvement on maternal of disease stated how microorganisms known as threats including H1N1, Ebola, and COVID-19, and child health. So many “germs” can cause disease, revolutionizing the will not be defined by the fear that these threats families have been saved by way the spread of disease and even its prevention have inspired. Rather, public health in this education, technological was addressed. This theory gave public health century will surely be characterized by the advancements, and a solid scientific foundation and encouraged ability of our scientists, doctors, and leaders to continued research. the creation of national and local health continue to adapt to the ever-growing threats to We still have a long departments. our global health. As our technologies advance, way to go in reducing This movement towards personal health we use artificial intelligence to predict and health disparities. for and hygiene and federal involvement in health track the spread of disease. Interventions are example, maternal inspired public health officials to establish increasingly expansive, and vaccinations as and infant mortality many important national health programs and well as desperately needed health resources disproportionately affects institutions. These programs and institutions are distributed to developing countries. Public Black women and babies.” focused directly on the prevention of adverse health officials not only respond to but also health outcomes on a national and local level. proactively address crises. Now more than ever, Cynthia Lebron, Ph.D., MPH In 1906, the Food and Drug Act was passed by we must trust in our public health officials Congress which expanded the scope of public and put into practice in our own communities health to include the production, regulation, and sale of food. This act the century-defining discoveries that paved the way to our current was responsible for minimizing adverse health outcomes through the healthy, developed lifestyles. Public health as a field will continue implementation of stricter nutritional standards and the reduction to test the limits of our scientific knowledge and push past the of food insecure families. Public health efforts even expanded to boundaries of the understood to create solutions for problems we are include maternal and child health, with a particular focus on neonatal not yet aware exist. and maternal medicine. The expansion of maternal and child health

Milestones in Healthcare by Caitlin Dowell-Esquivel Design: Aaron Dykxhoorn

he history of healthcare has shaped the system we have today. The United States healthcare system has transitioned from a focus on environmental healthcare issues and medical science advancements to the premise that healthcare is a right, placing an economic burden on the present system. During the 1850s to 1900s, healthcare was primarily focused on epidemics and was largely a public health issue, not a medical care issue. An epidemic, also known as antigenic drift, occurs when there are minor changes in the virus, such as the yearly flu. There was a lack of understanding about how the environment and living conditions impacted health. People did not understand how unsafe food and contaminated water supply could impact your health, which led to an outbreak of cholera. Additionally, the first health insurance plan was offered by Franklin Health Insurance Company of Massachusetts. During this time, ambulatory health care services were faith-based. This religious affiliation is still seen today in cities like Miami, Florida, where the Mercy Hospital is Catholic, Mount Sinai Hospital is Jewish, and Baptist Hospital is Baptist. Furthermore, wealthy people were treated at home and poor people were treated in clinics. For instance, when President Lincoln was shot at Ford’s Theatre, he was not taken to the hospital, but was instead taken across the street to Petersen House. In the United States, doctors were not employed by hospitals; rather, they practiced independently, a division that still exists in the

present day. Additionally, the first group practice, the Mayo Clinic, was established in 1887. Through group practices, which are commonplace today, doctors can work together more efficiently and learn from one another. From the 1900s to the 1940s, medical science became the new focus of healthcare, and environmental health, such as water, sewage, food, and urban living areas, was regulated. During the 20th century, there were three pandemics: the Spanish influenza in 1918, the Asian influenza in 1957, and the Hong Kong influenza in 1968. A pandemic occurs due to an antigenic shift, when there are drastic changes to the surface antigens on a virus leading to the emergence of a novel virus. Influenza, commonly referred to as the flu, is a viral respiratory infection affecting the lungs, nose, and throat. All three of the major 20th century pandemics occurred due to a new strain of the influenza virus. There are two critical steps of transmission for a pandemic: step 1, animal-to-human, and step 2, human-tohuman. A major pandemic was the 1918 influenza, referred to as the Spanish flu, that spread throughout the world in five months. The rapid transmission rate of the Spanish flu was impacted by World War I, when there was a lot of travel throughout the world, among other factors. This pandemic resulted in an estimated 30 million deaths worldwide. Just like with COVID-19, there were control efforts implemented in the United States, including gauze masks and laws forbidding people from spitting in public. The measures taken to prevent the spread of the 1918 influenza are similar to the

“According to the Trustees of Medicare, Medicare may become insolvent by the year 2026. Will Congress take action?” 16 | Health

measures taken to prevent COVID-19. However, unlike COVID-19, the 1918 influenza disproportionately affected children and pregnant women. Moreover, it wasn’t until later that more advanced medicines and surgical procedures were developed, such as insulin in 1921 and penicillin in 1941. Also during the 1900s to 1940s, hospitals began to transform from welfare facilities that cared for sick patients to organizations of medical science. During this time there was a managed care health system, known as a capitated system, where a doctor would receive a set amount of money from the employer per member per month. The doctors then must work under this set income to keep the workers healthy. This capitated system was primarily a prevention health model as (1) owners wanted to keep their workers healthy, (2) workers wanted to stay healthy to receive an income, and (3) doctors wanted to keep the members healthy to avoid costs on their end. This was the start of the present Health Maintenance Organization (HMO) system. As seen through the managed care system, incentives impact health-related behaviors which in turn impact health outcomes. Owners are incentivized to keep workers healthy to continue producing products, workers are incentivized to be healthy to receive income, and doctors want to keep the workers healthy to prevent costs on their end. In contrast to the capitated model, in the United States there is also an alternative model, an indemnity model, in which health professionals are paid each time a patient is treated by a doctor. During the 1940s to 1980s, healthcare became a right, not a privilege. The United States legislature became proactive, enacting the Hill-Burton Act in 1946 in which the government matched funds raised in the community to construct more hospital beds. Additionally, as a result of the World War II casualties, the government supported medical research resulting in advanced antibiotics, trauma burn care, and an increased use of technology in hospitals. Furthermore, World War II changed health insurance. For example, active military obtained health insurance, and wage freezes lead to employers finding alternative incentives like providing health insurance to lure employees to join their company. Bolstered by unions, this era was the birth of employerbased health insurance in the United States, and the government aided in this process by giving tax exemptions for companies with

employer-based health insurance. In 1965, Medicare, the national health insurance for those over the age of 65, and Medicaid, the national health insurance for the indigent and medically indigent, were implemented. This implementation resulted in an increased use of hospitals, as Medicare and Medicaid were covering the medical expenses. In the 1980s, it was estimated that 23% of hospital admissions were unnecessary, and that 17% could have been outpatient care. Additionally, hospital usage was further increased by cost-plus reimbursement contracts, contracts in which the hospital is reimbursed for the costs incurred during the hospital procedure and stay, as well as an additional fee which is a percentage of the total procedure. The higher the cost of the procedure, the higher the rate of return, resulting in increased earnings for hospitals. This period was considered a golden age for hospitals. From the 1980s to the present, there have been financial constraints and resource limitations in hospitals. The U.S. National Health Expenditure’s percentage of the Gross Domestic Product (GDP) in 1940 was 4.5% and in 2020 is 17.9%. The price of healthcare is accounting for a much higher percentage of the economic pie. In comparison to healthcare, defense expenditures account for 3.3% of the GDP and education accounts for 3.4% of the GDP. This problem is compounded by the fact that the aging population is the fastest growing population in the U.S. at a rate of 3.3% growth per year. The increase in the aging population is important as Medicare is funded by current workers paying for current retirees. If the current workers are growing at a modest rate to pay for current retirees, there will be fewer workers funding more retirees. According to the Trustees of Medicare, Medicare may become insolvent by the year 2026. Will Congress take action? Will they cut benefits and raise the age of eligibility, raise taxes to pay for these expenses, or allow for fewer reimbursements to physicians and medical professionals? One thing is certain—the next decade will be instrumental to the future of healthcare in the United States.

“One thing is certain—the next decade will be instrumental to the future of healthcare in the United States.”

I would like to extend my sincere appreciation to Dr. Steven G. Ullmann, who inspired me to write this article. For those interested in learning more about healthcare, I recommend taking his course in Health Sector Management and Policy (HMP 270).

Racial Disparities that Plague Clinical Trials A Need for Diverse Representation in Research by Natalia Perez Baez

18 | Ethics

Design: Aaron Dykxhoorn

hey were promised free medical care. They were promised effective treatments for their diseases. They were promised transparency. However, they received quite the opposite. They were deceived by so-called physicians. They were provided with placebos and ineffective medications disguised as “promising treatments,” even though approved treatments for the disease were already in the market. They were left to succumb to neurological consequences among others on their own—side effects that ranged from blindness, heart disease, bone deterioration, nervous system collapse, and even death. They were misled about their condition, leading to the unintentional infection of their wives, children, and peers, and generating a widespread outbreak of a fatal communicable disease in their community. This is the heartbreaking story of the infamous Tuskegee Syphilis Study in Alabama, where 600 Black men were deceived and overtly rejected healthcare in the name of ‘‘medical advancement’’ from 1932 to 1972, according to the principal investigators. The 600 men were incentivized to join the study in hopes of receiving treatment for their critical disease, syphilis, when in reality the researchers were solely interested in witnessing the long term effects of syphilis when left untreated. They withheld medication from the participants for the duration of the study, setting them up to develop severe health problems. It was not until private details about the study leaked 40 years later that Tuskegee University and U.S. Public Health Service felt pressured to terminate it as a result of the overwhelming public outrage. This example, along with many others that plague the country’s past, has elicited ‘‘historical trauma’’ in minority communities: a trauma rooted in fear and mistrust of research and medical institutions. Maria Braveheart, a Native American social worker, coined “historical trauma” as the internalization of traumatic experiences endured by national, religious, racial, or ethnic groups as a result of colonization, genocide, war, or other forms of political, social, and medical subjugation, either historically or in current times. This trauma is not something a community forgets overnight, especially when many of the survivors and their descendants are still facing the consequences to this day, like in the case of Tuskegee. Undoubtedly, current mistrust in medical research stems from cruel historical events and is then simultaneously reinforced by systemic public health issues—a combination of factors that ultimately results in the disproportionate participation of minorities in clinical trials. Other influences that the National Institute of Health (NIH) attributes to the skewing of demographics in clinical trials includes persistent racial disparities in health settings, limited access to health care, and negative encounters with health care providers. A lack of cultural diversity and competence among physicians also significantly contributes to the growing skepticism, especially among African Americans. The NIH also claims that minorities are least likely to be provided with information regarding available trials, further discouraging them from participating. However, the lack of participation of minorities shouldn’t fall on their shoulders. In her biological anthropological study at Mayo Clinic, Dr. Eseosa T. Ighodaro found that institutions have not been allocating sufficient time and effort to recruit ethnic and racial

“Undoubtedly, current mistrust in medical research stems from cruel historical events and is then simultaneously reinforced by systemic public health issues—a combination of factors that ultimately results in the disproportionate participation of minorities in clinical trials.” minority individuals. The inability to develop more authentic and transparent conversations with them has made it, and continues to make it, all the more difficult to overcome this barrier of unequal participation. In 2018, the U.S. Food and Drug Administration (FDA) released an eye-opening report that reveals the significantly disproportionate participation of minorities in clinical trials. Although increased emphasis has accelerated the inclusion of minorities in trials, it is clear that not enough is being done. The report disclosed that 83% of clinical trial participants are nonHispanic White, while only making up 67% of the U.S. population. In contrast, Black/African Americans make up 13.4% of the U.S. population, but are only 5% of trial participants; and Hispanic/ Latinos represent 18.1% of the U.S. population, but account for less than 1% of trial participants. Why is this so problematic to clinical practice? Because one size does not fit all: treatment responses are unique to every individual. Studies that limit the inclusion of diverse participants fail to account for numerous confounding variables that can influence the effectiveness of treatments and test interventions, variables

like socioeconomic differences, various exposure to environmental toxins, and distinct added societal stressors. When utilizing data on patients that is not generalizable or applicable to them, ethical concerns arise. Warfarin, for example, is a drug whose dosage requires cautious fine-tuning to ensure safe reactions from patients. In the mid-2000s, efforts to research warfarin’s interpatient variabilities among different ethnicities ramped up after witnessing clear differences in the responses to it. Ever since, several studies have thoroughly investigated and optimized the specific dosages recommended for individuals of African, East Asian, European, or Latino descent, dosages which vary greatly among each ethnicity. The fact that warfarin is the most widely prescribed anticoagulant for preventing embolisms and thrombosis made it all the more critical to research, especially since administration of an inappropriate dosage of warfarin would put a patient at a higher risk for bleeding or succumbing to a thromboembolism. Why did it take so long to figure out? Because of the lack of representative data. Prior to these studies, the grand majority of participants included in clinical trials had been White males. It was not until 1993 that Congress passed the NIH Revitalization Act that mandated minorities and women to be included in clinical trials as a result of their blatant exclusion in prior studies. The increasing encouragement to diversify participant populations has precipitated discoveries of treatments targeting minorities—discoveries that would have otherwise been overlooked. However, this issue remains a shortcoming that researchers are continuously battling with today, even in the current COVID-19 treatment studies. The New York Times recently reported on the lack of inclusion of racial and ethnic minorities in the COVID-19 vaccine trials conducted by Pfizer, AstraZeneca, Moderna, and Novovax, among several others. They claim that only a mere 3 percent of participants are of African American descent, for example. Recruiting racial and ethnic minorities as volunteers during a time characterized by heightened mistrust and awareness of racial injustices has been a daunting task. Yet minorities’ participation in these trials has never been more urgent. Considering that Black individuals, like Latinx and Native Americans, have experienced not only the highest rates of COVID-19 infection, but also of COVID-related hospitalization and mortality, shouldn’t research institutions make it one of their top priorities to increase

20 | Ethics

diversity among clinical trial participants to ensure generalizability? There are no clear-cut solutions for how to resolve this issue, but undoubtedly, it is an issue that must be addressed urgently. In order to ensure minority recruitment and participation in clinical trials, increased efforts on behalf of the medical community is required but also increased trust from minorities. The mistrust and stigma attached to medical institutions is one of the most influential factors for minorities—and it must be confronted. How? By engaging with community educational programs that can act as bridges with minorities to increase their awareness and access to clinical trials. By endorsing diversity initiatives that will address mistrust concerns head on by organizing webinars and town halls, for example, to make clinical information widelyavailable to minority communities. By establishing transparent and honest channels of communication between investigators and potential participants that may be hesitant about enrolling. Medical institutions must also train and advocate for their medical and research professionals to truly strive towards creating a more nurturing, safe, and informative scientific environment to adequately cultivate minority relationships and confidence. Clearly, this is no small feat for the scientific community, but it is one that must be overcome for the proper advancement of medicine for all mankind.

The Husband

t has become a cautionary tale whispered between soon-to-be mothers. This feared and painful extra stitch to tighten the vaginal opening after childbirth is rumored to be a judgment call made by physicians behind the backs of teary, sleep-deprived, and tormented new mothers. The “Husband Stitch” is an unnecessary extra stitch to repair the natural tearing that occurs during childbirth or the cut from an episiotomy. It results in a painful future for the mother, and a tighter opening for the husband’s sexual pleasure. Though there are no studies looking at the prevalence of the Stitch, the stories of women, filled with feelings of pain and betrayal, show the gravity of the issue and the deep-rooted sexism in medical care. A newborn baby’s head is about eleven and a half centimeters wide and passes through a two to three centimeter vaginal opening. Hormones, contractions, and dilations do their parts to make this slightly bearable, but tearing still results in up to 79 percent of child births. To combat complications that come with the tearing, episiotomies were developed in the 18th century. Dr. Fielding Ould developed the procedure, as he believed that manually cutting the women’s vagina was less harmful than the forced tearing that occurs during childbirth. This new technique was only to be performed for dangerously long labors to save the lives of both the mother and child. However, by 1980, episiotomies were performed in the majority of vaginal births. These routine procedures came under fire as new research showed that they caused more harm than good, leaving many women with severe tissue trauma, chronic pain, infections, and a variety of other long-term negative outcomes. As episiotomy rates fell to 11.6 percent in 2012, a novel feared procedure echoed through hospital halls: the “Husband Stitch.” Stories of the “Husband Stitch” live on through the pain of victims and the testimonies of their witnesses which have proven it to be far from some sort of healthcare myth. “It was there that the obstetrician, after injecting me with a general anaesthetic, dared to ask my husband (man to man), ‘How tight do you want her?’,” author and activist Sheila Kitzinger relived in her autobiography, A Passion for Birth. When

by Aarti Madhu Illustration & Design: Anam Ahmed her husband was taken aback by this question she was “duly sutured and then handed back to him with these words: ‘I’ve sewn her up good and tight.’.” The “husband stitch” is misogyny at its worst. A sedate woman, who has just endured the tribulations of a brutal child birth, is blatantly taken advantage of, and for what? The pure sexual pleasure of a man. A physician that was supposed to care and preserve a mother’s dignity, and bring into the world a new life, puts his sexist ideals in front of patient care. The term itself, the “husband stitch,” screams at the intersection between healthcare, the objectification and disrespect women face, and furthermore, the overall discrimination that minorities can face. Crude remarks and literal genital mutilation are happening now, behind the closed doors of our own hospitals. Women are left with infections, swelling, bleeding, uterine prolapse, constant pain, and feelings of betrayal and mistrust. Studies have shown that women who experience an assisted vaginal delivery—which often requires an episiotomy and in turn comes with the fear of the “husband stitch”—are more likely to feel uninvolved in making decisions about their labor. Women are unsure of what will happen to them during labor, what to expect afterwards, and are worried that a trusted physician will leave them with an experience less beautiful than they perceived it would be. Black women, specifically, were found to be the most affected, an outcome that eerily aligns with extremely high maternal mortality rates of Black mothers in America. The “husband stitch” is becoming more rare throughout America, thanks to brave victims sharing their stories and the returned acknowledgement by physicians. As students and future working professionals, we must work to rid ourselves of harmful ideals, practices, and biases, and ultimately work and educate ourselves to combat the injustices faced in every field. Whether people believe the Stitch is now just a remnant of an outdated practice, or a rumor being spread through the maternity ward, it is important to remember that these practices still happen today, and that their implications are scarring—both literally and figuratively.

COVID-19 Behind Bars

by Alexia Vignau Illustration & Design: Megan Buras

wo weeks after the first case of coronavirus was diagnosed in Rikers Island jail complex in New York City in March of 2020, more than 200 additional cases were diagnosed. Mirroring this was the rapid outbreak in the Chicago Cook County prison, with 350 prisoners and staff testing positive for COVID-19 in early April. These case studies of rapid transmission are symptomatic of a larger public health problem associated with imprisoned populations. Due to the COVID-19 pandemic, long standing challenges with prison congestion and disease transmission are forcibly being brought into the limelight. The United States, compared to its peer nations, disproportionately relies on incarceration and arrest as a response to criminal offense. According to one estimation from June 2020, U.S. prisons (with about 2.2 million inmates) “represent an estimated 24% of the world’s proportion of incarcerated individuals.” This statistic is staggering especially when contextualized with repeated public health recommendations to curb transmission, which are made virtually impossible by “overcrowding, insufficient sanitation, poor ventilation, and inadequate healthcare in prisons.” Despite efforts by the United States Bureau of Prisons (the largest correctional system in the U.S.) to manage the spread via mandating and disseminating face masks and personal protective equipment (PPE), halting inmate prison transfers and implementing policy for self-isolation of infected staff, a woeful lack of preparation to face the pandemic challenge remains evident. These shortcomings are reflected in the U.S. COVID-19 inmate case rate, which is 5.5 times that of the general U.S. population.

22 | Ethics

In addition, due to shifts in recent prison demographics as a result of longer sentences, the average prison age has risen, putting more prisoners in the “at risk” bracket for severe infection and death. According to Dr. Laura Hawks and colleagues at Harvard Medical School, even more unsettling is that “about half the people incarcerated in state prisons have at least 1 chronic condition… [in] percentages far greater than those for the population at large, even when comparing similar age groups.” Unsurprisingly, therefore, the crude death toll in prisons calculated in June 2020 with a rate of 39 deaths per 100,000 prisoners was higher than that of the U.S. population rate of 29 deaths per 100,000 people. Recidivism creates a revolving door of inmates into and out of their local community. Repeated incarceration and eventual release into society causes the challenges with prison transmission to negatively affect local community health as well. This is bolstered by the Chicago Cook County outbreak case study. As explained by Eric Reinhart and Dr. Daniel Chen, this “jail-community cycling” was reflected in how the COVID-19 “case rate in Chicago [was] significantly higher in ZIP codes with higher rates of arrests and released jail inmates from the Cook County Jail.” This study highlights how prison health is correlated to general community health and further emphasizes the underlying need for prison reform and decreased recidivism and associated prison crowding. This issue goes beyond COVID-19. Prison congestion and disease transmission going hand in hand is no revolutionary conclusion. The global pandemic has simply called for more focus on public health and social issues experienced by an often overlooked population and manifested by a system unequipped to handle the extent of its constituents. Lowering rates of recidivism remains one of the biggest challenges of the prison system and yet bears the possibility to confer long term solutions that go beyond the current pandemic. Decreased recidivism is facilitated by reintegration of former prisoners into society. This is no simple feat as prisoners upon release face challenges which range from finding housing and employment to reestablishing relationships with family and friends. It is very difficult for former prisoners to obtain jobs (particularly ones with any sort of health benefits), especially as there are laws that prevent former felons from attaining jobs which require licenses (i.e. barbers, public sector employees), as well as discrimination by potential employers. The challenge to secure a stable job contributes to the vicious cycle of prison return as well. One study of 259 ex-offenders in New York by the Manhattan Institute found that the rate of recidivism was inversely correlated with employment, with more speedy employment after prison release

the better. Job instability, inadequate insurance, compounded with increased health challenges and the prison system experience even after release, all ultimately circle back to struggling and overcrowded penitentiaries. In order to break the cycle, it is necessary to provide these former inmates with resources to help them reincorporate into society. Prior to the rapid onset of COVID-19, one bound towards reform was made by President Trump in 2019 via the First Step Act. This act was made to try to decrease prison population size while keeping the general public safe. This included reducing sentences for many criminal offenders via the reauthorization of the Fair Sentencing Act of 2007 and developing a “risk assessment system” where prisoners could be placed in prerelease custody if they completed recidivism reduction programming. This programming includes drug treatment and vocational training. As of August 2020, the Bureau of Prisons has released a memo for this programming (which had been stagnated due to COVID-19) to recommence with social distancing protocol. The efficacy of these novel reforms as well as the economic effects COVID-19 will ultimately have on their funding are still unknown. In essence, the public health issue surrounding COVID-19 “behind bars” is one that is actually rooted in social issues revolving around prison infrastructure and overcrowding as well as a flawed criminal justice system. Longitudinal solutions may involve reducing prison counts by increasing resources to decrease repeat criminal offenses through prison programming and job securing assistance. COVID-19’s effects on prison populations and their associated communities call on society to implement reforms so that the repercussions of present and future public health crises can be minimized.

“In essence, the public health issue surrounding COVID-19 “behind bars” is one that is actually rooted in social issues revolving around prison infrastructure and overcrowding as well as a flawed criminal justice system.”

Health Disparities in Colon Cancer Screenings by Raghuram Reddy Illustration & Design: Megan Buras

id you know that children living in subsidized housing are four times more likely to be in fair or poor health than those who live in owner-occupied homes? Or, that homeless patients are twice as likely to report psychological problems compared to community health center patients? How about the fact that viral suppression rates for HIV/AIDS are significantly lower for Blacks, American Indians, and Pacific Islanders as compared to non-Hispanic Whites? All these statistics demonstrate the existence of health disparities, which refer to a segment of the population that suffers from poor health outcomes and bears a disproportionate burden of a certain health concern when compared to the general population. Measures of health inequalities are in the form of statistics such as infant mortality rates and life expectancies. These disparities are apparent when assessing rates of illness and death caused by heart disease, cancer, diabetes, HIV/AIDS, COVID-19, asthma, obesity and more. Social determinants of health, which include living conditions, transportation, public facilities, income level, and educational attainment, are correlated with better or worse health outcomes. One of the most studied diseases to better understand disparities is colorectal cancer (CRC), the second leading cause of cancer-related deaths for people in the United States. The death of Chadwick Boseman, star of Black Panther, has prompted further CRC research in African American men. Compared to any other racial group, African American men have the lowest 5-year survival rate for CRC, which is largely attributed to the disparities present in CRC screening. As per a study published in JAMA Surgery, CRC incidence is also highest among African American men, indicating the need for programs to ensure that their screening rates increase to at least the levels of their white counterparts. The U.S. Preventive Services Taskforce recommends all average-risk adults to undergo CRC screenings, beginning at the age of 45. There are several barriers that patients face in CRC screening, including a lack of information and mistrust in providers. Inaccurate information about colon cancer and CRC screening can prevent a person from going through with a much-needed colonoscopy. Mistrust of the healthcare system serves as a lethal barrier to health. The extremely unethical Tuskegee study and other examples of traumatic mistreatment in clinical research have had a tremendous generational impact on Black communities, contributing to their hesitancy in trusting medical organizations and professionals. Procedure costs and transportation to the clinics and hospitals are other obstacles for CRC screening. Many private insurances do not

24 | Ethics

cover these sorts of medical procedures. To combat this, physicians should meticulously note risk factors for CRC, which would make it more likely for the patientâ&#x20AC;&#x2122;s insurance to cover earlier screening. The national campaign led by the National Colorectal Cancer Roundtable seeks to reach screening rates of â&#x20AC;&#x153;80% in every community.â&#x20AC;? Patient navigation can help improve completion rates for scheduled CRC screenings through social support (i.e. calling them on the phone to talk about their day and make an appointment with a doctor), which can help them overcome barriers to healthcare. One unique initiative that has been started by Dr. Charles Rogers and his team is the #CuttingCRC trial. #CuttingCRC is a barbershop-based intervention, framed after the theory of planned behavior (TPB), where care related to masculinity and CRC screenings are targeted. Barbers are utilized as motivational interviewers to help spark behavioral change and improve rates of CRC screening. Participants also have the chance to win prizes such as gift cards, an iPad, or a TV. Due to a suspension of noncritical medical procedures like CRC screening during the COVID-19 pandemic, these rates of these important procedures have fallen drastically during recent times. The pandemic will widen the gap in health disparities, so it is vital for healthcare professionals to work towards reversing these trends that can harm marginalized communities in the years to come. As conscientious members of society, it is not enough for us to simply be aware of these inequalities. Acknowledgement is just the first step; we can volunteer as a patient navigator or as part of current initiatives to make a difference! We must come together to achieve health equity by creating policies, implementing evidence-based interventions, increasing diversity in the workforce, and increasing access to healthy food and healthcare to help disenfranchised groups.

Groundbreaking research. Innovative discoveries. Revolutionary solutions. Explore the fascinating and fierce frontiers of science. frostscience.org/powerofscience Supported by

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SEX ED

by Setareh Gooshvar and Nikhil Rajulapati Design: Megan Buras

IN AMERICA

26 | News

Sex Education Mandates by State

Sex education mandated but not required to be medically accurate

Sex education mandated and required to be medically accurate

Sex education not mandated but required to be medically accurate if taught

Sex education not mandated

others have no sex education requirement pregnancies and STIs. By presenting at all. When a state does enact guidelines, abstinence as the sole morally viable option ex-education for many of us has likely state officials usually dictate the type of to practice sex (or lack thereof), these been approached as a taboo topic, one information included and leave districts and programs fail to provide individuals with rife with scare tactics and tirades in middle schools to their own jurisdiction in terms of accurate information regarding sexual health. and high school classrooms. However, the which curriculum to adopt. With only two Additionally, these programs fail to discuss truth of the matter is that the more we hide main approaches to sex education: abstinence- contraceptive methods as viable options for proper sex education behind these tactics, only and comprehensive sex education, it prevention and tend to include them in the the more we harm our young population. The is expected that much of the disseminated conversation solely to emphasize failure state of sex education in America is abysmal rates. On the other hand, and largely engulfed in the comprehensize sex education politics of abstinence-only “Due to the fact that sex programs present medically sex education and thirdaccurate and evidence-based party-created curriculums. education is not a federally information in regards to The Guttmacher mandated institute, it is up to the contraception and abstinence. Institute on Sex and HIV Some programs also include states to enact laws” Education reports that information regarding safeonly “24 states and DC sex practices and healthy mandate sex education relationships and lifestyles. for youth” and that only “13 states require information follows the former approach. While abstinence-only programs are found that the information taught in sex education Abstinence-only programs promote in the majority of schools across the country, be medically accurate.” Due to the fact that the idea that abstinence from sex is the only most Americans don’t support this form of sex education is not a federally mandated morally acceptable option and the standard education. According to the Pew Research institute, it is up to the states to enact laws. As for youth, thereby making it the only safe Center, over 85% of individuals believe that a result, some states have offered only broad and effective way to prevent unwanted comprehensive sex education should be guidelines around sex education while many

> 85% of individuals believe

In 2017

1/3

comprehensive sex education should be provided over abstinenceonly programs.

of federal funding for teen sexual health education programs was for abstinence education.

provided instead of abstinence-only programs. Regarding funding, the federal government has served as a strong incentive for schools to teach abstinence-only curriculums since the early 1980s. This is exhibited in the current federal funding streams for sex education which include: Title V Abstinence-Only-Until-Marriage (AOUM) established in 1996, which specifically mandates that information about contraceptives and condoms may not be provided unless used to emphasize failure rates, and Sexual-Risk Avoidance Education (SRAE) established in 2012. Although there are a few funding streams that include mandates for medically accurate information (Personal Responsibility Education Program and Teen Pregnancy Prevention Program) and a single stream that is inclusive of LGBTQIA+ youth (Division of Adolescent and School Health), they are by far the exception. In terms of tangible dollar amounts, the Sexuality Information and Education Council reported that in 2017, one-third of federal funding for teen sexual health education programs was for abstinence education. Perhaps the emphasis on abstinence-only education can be justified if there are positive outcomes among the youth that experience these curricula. However, there is no strong body of evidence that teens who undergo abstinence-only education have a delayed first sexual encounter or a reduction in the number of partners they have. In a nine-year congressional study published in 2007, youth from four of the programs implemented by the Title V AOUM program were tracked. The

study found that abstinence-only education not only had no effect on the sexual behavior of youths but also found that they were no more or less likely to engage in unprotected sex than other youth. Another study found that in the states that stress abstinence-only programs, there is a higher rate of teenage pregnancy and births in comparison to comprehensive sex-education programs, even after social status and position is accounted for.

When teens are given information in a medically accurate and open format, they are at a

50%

lower risk of teen pregnancy.

only 9 states and DC include LGBTQIA+ sex education in their curricula. It is often the rule, and not the exception, for queer youth to be completely left out of the conversation. As Dr. Sara C. Flowers, the vice president of education for Planned Parenthood, stated, “This can result in a lot of misinformation about their identities, bodies, and health— leaving them without the skills or resources they need to have healthy relationships or safe sex, if and when they make that decision.” Leaving queer youth out of the conversation about their sexual health impacts them in spheres of influence beyond sex education. It is incredibly common for queer youth to “report disproportionate experiences of depression, bullying, and feelings of unsafety at school—and these experiences are even more common among LGBTQ+ youth of color.” It is far too common for LGBTQIA+ youth to be marginalized, ignored, or erased and it has been proven to lead to a diminished state of health in all aspects. Therefore, not only is it critical that we present sex education in a medically accurate and objective light, focusing on an individual’s health and their personal right to choose the when, where, and how, but we must also further broaden and diversify the information presented to the youth of today. At the end of the day, by providing people with accurate information, health outcomes are better, teen pregnancies and birth rates are decreased, and the use of contraceptive protection is increased. All in all, it is only to our benefit to reform the state of sex education in America in order to affirm and include young people in such a way as to empower them to thrive.

“It is far too common for LGBTQIA+ youth to be marginalized, ignored, or erased and it has been proven to lead to a diminished state of health in all aspects.”

28 | News

On the other hand, those states which instituted comprehensive sex education programs proved to be effective in delaying sexual initiation among teens and increasing teen use of contraceptives when engaging in sexual intercourse. In fact, when teens are given information in a medically accurate and open format, especially regarding contraceptives, they are at a 50% lower risk of teen pregnancy than those in abstinenceonly programs. Additionally, over 40% of the programs that address both abstinence and contraception have been found to delay the initiation of sex and reduce the number of sexual partners. Of course, when considering the impacts of abstinence-only and comprehensive sex education, it is critical to understand that both are usually taught from a heteronormative stance. This is exhibited by the fact that

FDA Changes the Face of Packaged Foods How the Nutrition Facts Label is getting a reality check

by Lily Schmutter

ew scientific research, public input, and the ever-changing study of nutrition have all given rise to the FDA’s “New Nutrition Facts Label” education campaign, effective 2021. Spearheading the first substantial update to the label on packaged foods and drinks in twenty years, the FDA hopes to enable greater opportunities for informed food choices and healthy lifestyle habits. The revision of the label’s design and information will bring awareness to consumers of the vast benefits of proper eating and its link with preventable disease outcomes. Manufacturers earning over $10 million in sales annually were required to switch labels by January of 2020, while those making less than the $10 million mark have until the beginning of 2021 to comply. The FDA is increasing the campaign’s visibility through ads, videos, social media, and user-friendly downloadable materials, working alongside the food manufacturers in this collaborative public health effort. The first order of business is a “refreshed design”—at the top of the remodeled label will be a bolder type for calories, as well as larger font for serving sizes and serving quantity per container. While the triedand-true label design will remain intact, these significant upgrades will encourage those at home to become more conscientious eaters, with all the information in their hands. For the quantities of potassium, iron, calcium, and Vitamin D, manufacturers are obliged to not only present to the consumers a Daily Value percentage, but also the actual amount of these vitamins and minerals printed. The footnote describing the significance of the percent Daily Value will now be enhanced for further clarify nutritional advising.

Design: Alejandra Rinaldi The label will also see many changes in terms of presenting macronutrients, vitamins, and minerals. “Added sugars” will be included in both grams and percent Daily Value. As the obesity epidemic and the prevalence of cardiovascular risk are on a steady incline, clear definitions of sugar content in the food we eat are substantial improvements to the labels. Vitamin D and potassium are now required to be on the label, alongside calcium and iron. Furthermore, the Daily Values of sodium, dietary fiber, and Vitamin D will be adjusted upon updated research from the Institute of Medicine. The percent Daily Value is a significant feature of Nutrition Facts as the primary guide for nutrition information in the context of total daily diet, and thus this change will be vital for the proper eating habits of consumers at large. As the quantities of food and drink consumed have been largely altered from when they were last defined in 1993, the new labels are now legally required to display an accurate representation of serving sizes. Shifting away from the declaration of what people should be eating, reference amounts will be more realistic on the 2021 labels to reflect actual eating habits of the population. Package servings are also seeing modifications to more practically express how much people eat in one sitting, so the nutritional information will likely represent the entire package or bottle on the new label. As the face of the American diet has transformed considerably over the past decade, the role of nutrition in chronic disease outcomes continues to be inextricably linked. The FDA hopes that the installation of the updated Nutrition Facts label will spark change across the nation, with more informed food choices at the forefront of the war against illness as we enter the new year.

The Supreme Court Battle Over Reproductive Healthcare Why looming Supreme Court decisions may soon put public access to abortion and the healthcare rights of marginalized populations at risk 30 | News

by Isabella Lopez Illustration & Design: Anam Ahmed

he confirmation of U.S. Supreme Court Justice Amy Coney Barrett has made national headlines and has sparked both controversy and debate over women’s healthcare and reproductive rights. It is well known that her past rulings, along with those of the other Supreme Court justices, will likely ultimately influence and impact current legislation under review, such as a challenge to the Affordable Care Act (ACA) under California vs. Texas and 18 cases regarding abortion rights. While individuals of diverse beliefs and backgrounds hold differing opinions regarding the ethical and moral implications of abortion, it is important to evaluate how new rulings made by Barrett and the conservative majority on the court may lead to further racial inequities and health disparities among women of color (particularly those that identify as Black and/or Latinx). The current legislation and cases under review by the Supreme Court will have wide-ranging consequences on racial and ethnic minorities, those in lower socioeconomic classes, and disabled individuals. In particular, it’s important to focus on how past and future rulings will shape the current political and medical climate regarding reproductive healthcare and the social issues that accompany it. Several news outlets, like the Women’s Media Center (WMC) and the Center for American Progress, and organizations dedicated to fighting for social justice issues (such as the National Partnership for Women & Families) have highlighted the detrimental effects that disbanding the ACA will have on the financial stability of those who depend on it. Their research shows that striking down parts of or the entire ACA could pave the way for massive loss of insurance coverage, which would pose greater maternal and reproductive healthcare limitations to groups who already have barriers to these services. On top of that, it would come at a time when the economic repercussions of the COVID-19 pandemic are already hitting the American people the hardest. Already facing unemployment and pre-existing health conditions (some even chronic), marginalized groups have the most to lose from the repeal of the ACA, a decision that is likely to create greater restrictions to adequate healthcare and reproductive services, and further exacerbate the wage gap between ethnic and racial minorities (notably Black,

Latinx, American Indian, and Alaskan Native people) and non-Hispanic white groups. Numerous publications within public health journals and from national agencies such as the CDC from the past decade have highlighted an important point about the prevalence of abortions in the United States: women of color and/or of lower socioeconomic class have higher rates of abortions (particularly in the second trimester) and higher rates of unplanned pregnancies compared to their white, wealthier female counterparts. This is reflective of countless healthcare inequities, including lower access to contraceptives within minority communities due to a number of factors, such as systemic differences in quality of healthcare, unstable life situations, cultural or linguistic barriers, or frustration and dissatisfaction with prescriptions that lead to infrequent or ineffective use and practice. Regardless of one’s political affiliation, the wide-ranging impacts of these potential decisions on our country are undeniable, as is the disproportionate effect it will have on women of color and individuals from lower socioeconomic backgrounds. The impact of rulings such as abortion restrictions and healthcare coverage repeal on women of color, lower socioeconomic backgrounds, and younger age should be better dissected and considered, as their health rights and economic stability is what is ultimately threatened and targeted. While arguments over the moral justifications of abortions and and other aspects of reproductive rights will unfortunately continue to be debated among various religious and third-party interest groups, it is crucial for the American people to consider how future restrictions on healthcare will disproportionally affect minority groups.

by Ainsley Hilliard Design: Natalia Jimenez

s you walk across campus on Wednesday afternoons, you’ve likely passed a tent filled with colorful clothes billowing in the wind or heard the shouts of “free clothes, UThrift!” If you walk up to the stand, you will find stylish tops, shoes, and accessories. All these items come from student donations through a club called UThrift. UThrift is a fairly new organization on campus that began in the fall of 2017 as a Student Government ECO Green Committee Initiative. It hosted its first pop-up in the spring of 2018 on United Nations Day, and quickly grew from there. In 2019, UThrift did everything from pop-ups and collaborations to workshops and clothing drives. This spring, UThrift received an organization designation from the Committee of Student Organizations. Its most recent event was the Swap and Strut fashion show, featuring no sew masks, DIY denim workshops, the standard clothing swap, and student models showing off their favorite thrifted items. But UThrift does more than provide an on campus thrift swap; it also hosts engagements with philanthropic organizations on and off campus, spending a day volunteering with the organization and learning about its mission. UThrift hosts at least one engagement a semester. Last spring, the club volunteered with the Miami Rescue Mission to help organize their store, fold clothes, and sort through donations. This past fall, UThrift hosted a collaboration with Lambda Theta Alpha and Lucha Latina to host a clothes drive for refugees and immigrants at the Lake Worth Center for the U.S. Committee for Refugees and Immigrants. The event was a raging success, bringing in over a hundred donations for families at the facility.

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What are clothes made of?

“Globally, we consume 80 million new pieces of clothing a year, 400% more than we consumed twenty years ago.”

The primary goal of UThrift is to provide a free thrifting platform that aims to mitigate the environmental and social effects of the fast-fashion industry. Fast-fashion refers to the practice of creating clothing designs that quickly go from the runway to stores to keep up with trends, allowing shoppers to purchase trendy clothing at an affordable price. However, behind fast fashion are numerous negative environmental and social effects. Globally, we consume 80 million new pieces of clothing a year, 400% more than we consumed twenty years ago. The constant creation of new clothing contributes to 10% of global carbon emissions, 16% of global pesticide use, and 20% of global water waste. In total, the average person in the U.S. generates 82 pounds of textile waste a year, which adds up quickly. In 2017, the U.S. generated 16.9 million tons of textile waste, which is roughly 46 Empire State Buildings (the Empire State Building weighs 350 thousand tons). Inside the clothes themselves are over eight thousand chemicals, including crease resistant agents, flame retardants, and plasticizers. When it comes to what our clothes are made of, the situation remains dire: 65% of clothes are made of synthetics, aka spandex, polyester, nylon etc. These products are petroleum-based, making them non-biodegradable, unsustainable, and contributors to long-term pollution. Now that we have established the environmental impacts, it is time to look at the other ugly face of fast fashion: exploitative labor practices. To start off, some basic economics: how does one make a product profitable? The product has to sell at a higher price than overall production costs. Thus, the lower the cost of production, the more profitable the product is. In the fast fashion industry, a common method of cutting production costs is to find the cheapest labor possible. Some companies look overseas for factories, such as in India, Bangladesh, and Pakistan, where female workers are not paid a livable wage. Others look no further than Los Angeles, where 85% of garment factories have labor violations. Many companies, including Fashion Nova, Forever 21, Charlotte Russe, and Urban Outfitters, take full advantage of these factories, where the average hourly wage is five to six dollars. American sweatshops are alive and well in the U.S. because there is always a demand for cheap labor as a means to make a profit. But these companies are in trouble, as more people are becoming aware of these shady practices, and they arenâ&#x20AC;&#x2122;t putting up with it. Shoppers are switching from buying fast fashion to going thrifting. With more consumer knowledge of the problems fast fashion creates, the world of shopping is changing. Shopping vintage became a trend in the 1950â&#x20AC;&#x2122;s and was broadcasted by pop-culture references beginning in the 1980â&#x20AC;&#x2122;s. The secondhand market also saw increased sales after the financial crisis of 2008. Today, millennials and Gen Z are the main thrift shoppers, with one in three Gen Z-ers shopping secondhand in 2019. Over the past three years, the resale industry has grown three times faster than the classical retail and in three more years, the resale market is projected to be worth $51 billion, almost double of what it is now ($24 billion). So, the next time you want to go shopping, think thrifting.

Roll the Dice Roll both the dice, Because we’re playing Monopoly. And the only way to go higher Is if you already have the highest Number possible. Get a 12, and you can go again. Or at least, That’s how I’ve seen it played. Because second chances are given Before some even get their first. There’s an empty bowl Spinning like a top On the road swishing in the black green Water around it - water, i say, Because sewage sounds badand it Keeps spinning because There is nothing else to wail Like an ambulance’s siren While another mother Goes into labour, There is no penny To spin instead And there won’t be Neither baby nor mother To wail after.

34 | Creative Writing

So we sit in elegant Pantsuits and printed ties To discuss poverty reduction But the world is so large With few pockets full And fewer hospital beds

So we sell hope instead and Tell them we will listen and That we will be there, But only until we close borders And can’t throw a stage And some props where A lifeguard in red and white Jumps into an empty pool to Save a poor child.

by Yashmitha Sadasivuni Design: Natalia Jimenez

There are skyscrapers and Floating trains painted like Bright bright futures But our banker is a double agent That will rescue the first-timers That are holding cards that Someone else has been playing with Even before history Entered textbooks. The banker matches their shy smiles With grinning loans And everyone awws for a round But we all laugh internally Because oh what a child, That loan will help pay off the rent To old colonialists So you sprint to catch up But you can’t, You can’t catch up because The banker said In small, loud script, That you can’t build your own In the way you want. Come on, kid. Roll the dice, again.

by Sadie Shireman and Yashmitha Sadasivuni

ublic health is an oft forgotten, unacknowledged, underfunded, underappreciated, and ultimately ignored field, but with the pandemic, that perspective might have begun to shift. Google Trends show that the popularity of the term ‘public health’ itself had grown by 70% from February to March of this year. But public health was already an overloaded field to begin with, so what are its most pressing concerns outside the context of a pandemic? Public health has always been concerned with reducing the burden of disease from the conception of the field. For years, western capitalistic enterprises have exploited many countries with weak economies and poor public health infrastructure. Economies were set up by colonialist powers for resource extraction, and post-colonial economic development has been stunted by very poor health outcomes encouraged by international norms. While sociopolitical factors such as these have transformed the focus of public health over time, many of the goals—reducing maternal and infant mortality, reducing rates of infectious disease, ensuring accessible clean water and food for everyone—have remained steadfast and are generally outlined in the United Nations Millennium Development Goals (MDGs). One country in particular with some of the worst health outcomes in the world is Sierra Leone. The small West African country that achieved independence from the UK in 1961 has the worst maternal mortality rate on the planet—where women have a 1 in 17 lifetime chance of dying due to pregnancy-related complications. The country also suffered from the highest number of fatal cases during the 2014-2016 Ebola outbreak, to which the country also lost 7% of its health workforce. Now with COVID-19, the country’s already weak public health system is seeing yet some challenges. Over the years, Sierra Leone has been receiving foreign aid and loans from the International Monetary Fund (IMF), but this lending comes with strict conditionalities that require recipient countries to adopt policies which often prioritize short-term economic objectives over investments in public systems. For instance, the IMF’s economic reform program requires the Sierra Leonean government to keep spending low, which in turn requires caps on public-sector wage bills. The country already spends only 12 USD per capita on health, and its health workforce density of 2.2 per 10,000 population is dwindling due to emigration of health personnel for better prospects and working conditions. In fact, in 2010, when the country launched its Free Health Care Initiative for children and pregnant women to reduce the high infant and maternal mortality rates and achieve the corresponding MDGs, IMF staff “stressed the need to carefully assess the fiscal implications” and favoured “a more gradual approach to the [associated] salary

increase in the health sector.” Partners in Health (PIH) is a global health organization whose mission is to provide a preferential treatment option for the poor. PIH began working in partnership with the government of Sierra Leone amidst Ebola, and is one of the few organizations that had to raise funds independently to fill gaps created by donors and lenders that were too rigid on how funds must be spent—even refusing to finance medical evaluations or the construction of permanent infrastructure. In fact, only 5% of resources appropriated for the emergency Ebola response were channeled through the government. There needs to be a shift towards long-term solutions for chronic problems in healthcare systems that prevent countries from being able to tackle situations like the ongoing pandemic. And in line with its principles of finding long-term solutions, Partners in Health is currently working to build the Maternal Center of Excellence in the Kono district of Sierra Leone. This would be a hospital run by Sierra Leonians to address the problems Sierra Leonians face—after all, communities have the best understanding of their own needs. The goal of this hospital is to reduce the number of preventable deaths related to pregnancy, and will address many health concerns in the community that high maternal mortality causes. University of Miami’s Partners in Health Engage Miami— one of the many teams for a grassroots organization network that supports Partners in Health through fundraising, advocacy, and community building and education—is also currently raising funds for the Maternal Center of Excellence. This pandemic has shown the large range of sacrifice human beings are willing to commit to. From healthcare workers who have given their lives to try and save their patients to Congress members who have called the virus fake and then been the first to receive the vaccine to college students who have ignored public health advisories and spread the disease to new bounds. As a world we are exhausted and scared, but are we bereft enough, compassionate enough, hopeful enough? Are we committed enough to fight for public health for others once the risks to ourselves have gone? Will public health be returned to the backburner, forgotten and underfunded, even as women die of preventable deaths? Will we ignore systematic racism, an epidemic in its own right, as soon as this pandemic has been mitigated? We would like to leave three points on your mind as we close out these musings on public health. The first being, the way we see loans and foreign aid requires us to see health as a human right, rather than an act of philanthropy. Second, if we want better health outcomes for everyone, we need to fundamentally shift the perspective on public health. The public must be aware that poverty is fundamental to poor health outcomes, and many places had circumstances of poverty imposed on them by other countries. Finally, what we know about public health we have learned from years of recorded human suffering and success. Many of the circumstances we all have found ourselves in could have been prevented if the world cared to listen to both communities and academics.

Nobel Prize Winners of 2020

by Amirah Rashed

Illustration & Design: Anuj Shah

he Nobel Prizes in the sciences represent groundbreaking discoveries that help us make generational leaps in our knowledge of scientific phenomena. This year, the prizes embodied the truly vast scale of science, from microscopic viruses and molecules inside bacteria to the macrocosm of our galaxy and the black holes both

inside of it and beyond. In addition to scale, the scientists’ profound work shows the importance of research for both the short term and long term—the implications of Nobel laureates’ findings stretch from human health and the treatment of diseases to interstellar travel and the very future of our species.

CHEMISTRY The prize in Chemistry was awarded to Emmanuelle Charpentier and Jennifer A. Doudna, who developed the now wellknown method of genome editing using CRISPR/Cas9 genetic scissors. Back in 2006, at the University of California, Berkeley, Doudna and her colleagues found repetitive sequences in the genome of vastly different bacteria, which they termed clustered regularly interspaced short palindromic repeats (CRISPR). Interestingly, these genetic sequences in bacteria seemed to actually originate from viruses, indicating that bacteria that had survived various viral infections actually added parts of viral genetic codes into their own DNA, evidence of an ancient immune system present in bacteria. Around the same time, Emmanuelle Charpentier’s studies of the pathogenic

Bacteria have been constantly fighting viruses and other pathogens on Earth for billions of years, and were forced over time to evolve defense mechanisms in their immune systems to cut out foreign genetic material.

36 | Research

bacteria Streptococcus pyogenes led to some unexpected discoveries. The first was that the CRISPR system in that particular bacteria only required a single CRISPR-associated (Cas) protein to cleave any virus DNA. In addition, she found that a previously unknown molecule, trans-activating crispr RNA (tracrRNA) allows for the maturation and activation of the bacteria’s CRISPR/Cas9 complex, which was key to the functioning of this powerful bacterial immune system. After meeting, Charpentier and Doudna were able to simplify the components of the genetic scissors and were able to reprogram the scissors to recognize any DNA molecule at a predetermined site, not just DNA in viruses as it did in its natural form, leading to a vast expansion in the capabilities of the CRISPR/Cas9 system. The implications of CRISPR/Cas9 are huge and allow for genome editing for a variety of purposes, everything from creating more drought- and pest-resistant plants to developing treatments for cancers and finding cures for inherited diseases. Though there are undoubtedly many ethical challenges that will arise due to the technology, the potential of this tool to improve human lives and facilitate further discovery is undeniable. cut site

guide RNA

Cas9 protein

host DNA sequence

Charpentier and Doudna were able to utilize this ancient bacterial defense system, called CRISPR/Cas9, in other cells and organisms. This introduced the possibility to delete genes, introduce mutations, or insert entirely new genes into existing DNA.

PHYSICS The prize in Physics went to three scientists who all contributed to further illuminating one of the universe’s biggest mysteries: the black hole. In 1965, using Einstein’s general theory of relativity, Roger Penrose proved that black holes can form and described them in detail as the one exception in which all known laws of nature cease to hold true. In his paper, he described in detail the mathematical support for idea that a black hole creates a singularity, where all matter collapses inward to an infinitesimally small point The work of Reinhard Genzel and Andrea Ghez and their respective groups of astronomers has confirmed the presence of a heavy, invisible object at the center of the Milky Way which changes the orbit of surrounding stars. In the 1920s, American scientist Harlow Shapley was the first to identify a mysterious region at the center of the Milky Way galaxy, which was later named Sagittarius A*. In Chile, Genzel and his team use the Very Large Telescope facility, VLT, on

Paranal mountain. In the U.S., Andrea Ghez and her team use the Keck Observatory, located on the Hawaiian mountain of Mauna Kea. For over thirty years, they developed new techniques to track the positions of about thirty stars in Sagittarius A*. They noticed stars move most rapidly within a radius of one light-month from the center, inside which they move like a swarm of bees. In contrast, the stars that are outside this area follow their elliptical orbits in a more orderly manner. The orbits of the stars observed by both teams is the most convincing evidence of the existence of a supermassive object, a black hole, at the center our galaxy.

Milky Way Sagittarius A*

Scientists used large telescopes and other scanners in observatories to study the center of our galaxy, the Milky Way, and eventually found the presence of a supermassive black hole, known as Sagittarius A*. The mass of this black hole is so great that nearby stars are slingshotted at speeds of up to 16 million miles per hour by the gravitational force of the black hole. How can black holes, which have such enormous masses compressed into an infinitely small point, exist? In fact, they form when a massive star collapses in on itself due to its large mass. Though we’re still learning more about the nature of black holes, studying these supermassive objects can teach us more about how galaxies form and evolve.

PHYSIOLOGY AND MEDICINE The prize in Physiology or Medicine was jointly awarded to three scientists, Harvey J. Alter, Michael Houghton, and Charles M. Rice, for their discovery of the Hepatitis C virus. Prior to this discovery, there was still a large number of unexplained cases of chronic hepatitis, despite the discovery of Hepatitis A and B viruses. Alterâ&#x20AC;&#x2122;s work at the U.S. National Institutes of Health led the search towards this mysterious cause of chronic hepatitis. His study of the occurrence of hepatitis in blood transfusion patients demonstrated that blood from patients that were known to be negative for Hepatitis A and B could still transmit this mysterious new disease to chimpanzees, and the infectious agent had the characteristics of a virus. This form of hepatitis became known as â&#x20AC;&#x153;non-A, non-Bâ&#x20AC;? hepatitis. Michael Houghton continued the search for this form of hepatitis by collecting DNA fragments from nucleic acids found in the blood of infected chimpanzees. Houghton and his team inferred that some of these fragments would be from the unknown virus.

Using serum from infected patients, they identified cloned viral DNA fragments that encode viral proteins and found one positive clone, which was later found to be derived from a novel RNA virus belonging to the Flavivirus family. The last step was to determine whether this virus alone could cause hepatitis. This was carried out by Charles Rice, who generated an RNA variant of Hepatitis C virus that included the newly defined region of the viral genome, devoid of the inactivating genetic variations. When injected into the liver of chimpanzees, the virus was detected in the blood, and symptoms of the disease as seen in humans were observed. With the cause of these cases of transfusionmediated hepatitis identified, blood tests for the virus were created to prevent post-transfusion hepatitis. The development of antiviral drugs now means that Hepatitis C is a curable disease, and efforts are underway to lay the groundwork for eradicating Hepatitis C altogether.

Starting around 1975, a new chronic hepatitis causing long-term liver damage and cirrhosis was observed, puzzling both physicians and researchers.

Researchers collected blood from two types of infected patients, humans and chimpanzees, and were then able to clone the viral DNA collected from samples and confirm the identity of the virus as a type of hepatitis.

This monumental discovery of Hepatitis C allowed for the future development of new antiviral treatments, and eventually allowed scientists to make Hepatitis C a curable disease.

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The Dark Side of Blue Light| How our eyes have been sacrificed by screen time

by Lily Schmutter Illustration & Design: Varsha Udayakumar

ince the dawn of the COVID-19 pandemic, “home base” has taken on a new meaning. Living spaces have become working and learning centers, and daily commutes have become virtually nonexistent. Along the way, the screen has become our closest companion, and our eyes have fallen victim. Computer Vision Syndrome has been defined as the consequence of this digital eye strain, as new research arises concerning the long-term effects of screen exposure so overtly present in society today. Its symptoms? Headaches, blurred vision, dry eyes, and pain in the neck and shoulders. The consequences of heavy electronic use translate to permanent retinal damage alongside enduring vision problems like macular degeneration. Nearly all visible blue wavelengths pass through the cornea and lens before reaching the retina. While sunlight is the main source of blue light, it is also found in a plethora of manmade origins such as fluorescent and LED lighting, flat-screen TVs, and most notably in digital handheld devices. These rays, having shorter wavelengths and more energy, have the capacity to impose unfocused visual “noise” which affects contrast and prematurely ages the eyes. When too much time is spent in direct contact with screens, two central eye systems are affected: binocular vision and tear film. Binocular vision primarily facilitates the visualization of objects on the screen by allowing the eyes to converge. The closer the eyes are to the screen, the more reduced their ability to converge because their muscles are directly disturbed and become less efficient over time. The tear film protects the eye via a thin fluid layer, ensuring that functionality is preserved. When we blink, the tear film’s surface is smooth and replenished. Since we blink less when peering over at screens, the extent of protection is hindered, and to compensate the eyes are forced to focus more. In addition to the light’s silent attacks on our vision, research has found that it can often have a powerful effect on sleep patterns. Exposure to light subdues the secretion of melatonin, a hormone that regulates circadian rhythms, especially at night. The body’s biological clock functions in cycles defined by the amount of light and dark the body is exposed to throughout their days. Circadian rhythms control the timing of many essential physiological processes, including brain activity, hormone production, and cell regeneration. Light during bedtime is a large contributor to lack of sleep and disruption of this natural rhythm, as the system that regulates the distinction between day and night becomes confused when artificial light is introduced. According to a Harvard research study that compared 6.5 hours of blue light exposure to green light, blue light was found to suppress melatonin and shift circadian rhythms for twice as long. Late shift workers and night owls should

40 | Research

be wary of their exposure to indoor light as well, as fluorescent light bulbs and LEDs are an added contributor to blue light above what is already being emitted in excess from our screens. According to Dr. Robert Oexman of Sleep to Live Institute, our environment should be dimly lit with minimal blue light exposure before bedtime so that the body can begin the natural process of melatonin development and encourage its sleep-wake cycle. So, what can be done to protect our eyes from blue light? The most simple way is to reduce screen time. While that is easier said than done nowadays, we can at the very least attempt to rest the eyes by taking frequent breaks during the daily routine. Try the 20-20-20 technique: every 20 minutes, focus your eyes on an object 20 feet away for at least 20 seconds. While it can help prevent eye strain,

The 20-20-20 technique: every 20 minutes, focus your eyes on an object 20 feet away for at least 20 seconds.

it also simply serves as a constant reminder of awareness about blue light exposure. In addition, powering down our devices 30 to 60 minutes prior to bed could be worth the while for better sleep outcomes. Nutritional supplementation of the carotenoids that compose macular pigment, the primary blue-light absorbing tissue, is also recommended. For considerably long computer uses, consider investing in a pair of high-quality blue-light blocking glasses. With yellow-tinted lenses, the harmful blue rays are counteracted, contrast is increased, and digital eye strain can be eased. Antireflective lenses are helpful in complementation with the tint, as the coating offers an added layer of comfort and protection by reducing glare and blocking blue light on both sides of the lenses. There are a multitude of affordable screen filters available on the market for computers, tablets, and smartphones, which decrease the amount of blue light given off from these devices. Opthamologists are currently evaluating intraocular lenses, or IOLs, which replace

the cloudy lens of cataracts patients with powerful blue and UV light blocking capabilities. In September of 2018, Apple included a Screen Time tracking feature as part of its iOS 12 updateâ&#x20AC;&#x201D;a powerful initiative to inspire individuals to curtail their relationships with their smartphones. Device exposure data displayed shockingly high percentages as millions across the globe entered quarantine, receiving unwelcomed default alerts each and every week. In the midst of the pandemic, these reports have become a badge of shame. Now that the fine line between work and personal life has become eternally blurred, our devices have become a constant, and the detriment to our eyes is sizable. Combatting the effects of heavy blue light exposure is a vital consideration that we must all adopt into our daily lives. Using our devices with intent will be substantial in the prevention of both short- and long-term effects on the strength of our eyes. This means adopting a balanced approach; neutralizing screen time with outdoor activity or in-person interactions will encourage a sense of mindfulness in us all during these trying times. As we protect our eyes, we can hope to have a promise in sight for what lies ahead.

blue light glasses|

Printing the

Future

Surgery by Christian Rivera

Illustration & Design: Varsha Udayakumar

hree-dimensional printing is gradually transforming itself from a thing of science fiction to a tangible reality in the field of medicine, especially in plastic surgery. With this relatively new technology, surgeons are better able to meet the needs of the patient, whether it be for reconstructive or aesthetic purposes. In recent years, there has been a massive spike in the popularity and demand of plastic surgery. According to the American Society of Plastic Surgeons (ASPS), a total of $16.5 billion was spent on cosmetic procedures in 2018 within the United States. Icons like Justin Jedlica, famously known as the â&#x20AC;&#x153;Human Ken Doll,â&#x20AC;? have generated international buzz for undergoing over 700 cosmetic surgeries. Due to the increasing demand, biomedical engineers and surgeons are researching new and improved ways of maximizing outcome accuracy and patient satisfaction. Not unlike other medical specialties, the world of plastic surgery is transitioning to more advanced forms of technologyâ&#x20AC;&#x201D;enter 3D printing. The concept of creating three-dimensional objects from digital models materialized during the 1980s when Chuck Hull, inventor and co-founder of 3D Systems Corporation, was the first to be granted a patent in 1986 for the stereolithography apparatus (SLA). This machine works by creating solid layers of cross-linked polymers from an insoluble photopolymer liquid that is subject to focused beams of ultraviolet light. Once all layers have been shaped, the prototype should look identical to its pre-drawn digital counterpart. It was through this process that the very first object was 3D printed: an eye wash cup. While this form of 3D printing is the oldest, it pioneered a new, innovative tech industry that would cascade across different fields beyond industrial manufacturing. During the early 2000s, the applications of 3D printing were extended to the medical field, initially through custom prosthetics and

42 | Research

dental procedures. Over the years, 3D printing, while still premature, has expanded the range of opportunities for patients requiring organ transplants, reconstructive therapies, or extremely difficult surgical treatments. This is primarily due to its ingenious interplay with stem cell research. Stem cell technologies lie within the core of restorative medicine. The general process of stem cell therapy involves (1) extracting stem cells from samples of tissue, (2) genetically manipulating and mixing the cells with growth factors, (3) culturing the cells in a lab setting using a scaffold, and (4) implanting the finished product into the patient. Now, with 3D printing, this process can be conducted with more fidelity. Using computer-aided design (CAD) software, a 3D model is created from CT scans. After the computer model is created, the 3D printer uses biocompatible materials and stem cells to meticulously grow, develop, and mold the substrate into a real-life replica within a span of a few days. By the end of its preparation, the final product should be geometrically and functionally identical to its digital sketch. Some biomedical technology companies, like MirrorMe3D, have already implemented 3D printing into their services. MirrorMe3D specializes in FST scans, which is an acronym for Facial Soft Tissue. All it takes is a couple of selfies from different angles, and MirrorMe3D will transpose these pictures into an advanced imaging software that converts them into a 3D model. Many plastic surgeons have started using this facial recognition technology for preoperative consultations with patients. 3D busts encourage better communication between doctors and patients, and they give patients a realistic representation of what their appearance would look like post-operation. While the current literature available on the operational uses of 3D printing in plastic surgery is limited, it is still very promising. Recent studies from 2016 and 2017 demonstrate that it poses as a viable tool for general reconstructive surgeries by expanding the options for patient customization and decreasing the amount of time spent in the operating room due to fewer complications. Physicians can even utilize surgical tools that were constructed from the 3D printer itself. Such findings give meaning to the excitement behind 3D printing technologies and their potentially revolutionary role in personalized medicine. Despite the clear benefits of 3D printing, its applications are still considerably premature. While media outlets and government representatives often propagate thrilling expectations for this technology, 3D printing is not a feat that can be accomplished overnight. It will likely take several years before this technology becomes readily available to plastic surgeons throughout the nation. Arguably, the largest hurdle for this biotechnology is the average cost of a 3D printer. Whereas everyday-use 3D printers are priced around $300-$1,000, those with advanced functionalities specialized for medicine can run for at least $10,000, making them very difficult for general hospitals to obtain. In addition, there are several copyright issues, federal regulations, and other legal formalities that will have to be considered before these machines can be used everywhere. Certain places in the US have banned 3D printing due to the illegal production of firearms and master keys, leading to a rise in covert biological operations conducted by independent researchers within their own homes. Regardless of the barriers to entry for 3D printing technologies, the implications traverse a distant yet possible reality that one would typically find in sci-fi movies. Once universalized, 3D printing will expand the capabilities of medicine and redefine what it means to be a plastic surgeon in the 21st century.

Image acquisition via CT, MRI or ultrasound

Creating 3D models from DICOM files using CAD softwares

Material and component selection

Cell type selection

Bioprinting

Static or dynamic incubation

Implantation

the the Human Human Microbiome Microbiome

BY BRANDON DINNER ILLUSTRATION & DESIGN: CHERRI CHEN

How microorganisms interact with humans and can be exploited for practical healthcare purposes Overview Inside your body, trillions of microorganisms play key roles in human physiology and homeostasis. In fact, over half of the cells in the human body are prokaryotic cells, which form the microbiota. As such, less than 45% of our cells are actually coded by the human genome. Our lives would be incredibly challenging without our microscopic friends. So, what is the scope of these microorganisms, and why should we care? Simply put, these organisms are involved in nearly every aspect of our lives, from digestion to immune response to behavior. Understanding the human microbiome is vital to tackling some of society’s most critical issues in disease diagnosis and treatment, and has the potential to revolutionize healthcare in the coming century.

The Human Microbiome The human microbiota, or the microbiome, refers to the community of commensal, symbiotic, and pathogenic microorganisms in the body. The entire genome sequence encoded by said microbiota has been discovered to contribute to both normal human functions and pathology. It is composed of bacteria, fungi, yeast, viruses, and archaea, with highly specialized niches corresponding to particular body regions. The nearly 40 trillion prokaryotic organisms that comprise the majority of cells in our body participate in metabolic functions, contribute to the education of the immune system, protect against pathogenic microorganisms, and thus affect many of our physiological functions both directly and indirectly. Many large scale projects have been launched and funded to characterize the

44 | Research

diversity of microbial composition in the human microbiome. One study, the Human Microbiome Project (HMP), reported the results of 16S ribosomal subunit profiling on 242 healthy adults from the United States with samples representing eighteen body habitats across five major body areas. Furthermore, research indicates that two healthy individuals may have very different microbiomes. For instance, the gut microbiome is specifically influenced by multiple factors including mode of

Personalized Medicine The information gained from studies that began in the 1960s and have continued through the Human Microbiome Project and beyond has significantly expanded our knowledge of human physiology and has led to great strides in personalized medicine, a field in which medical treatment is tailored to the individual. New research indicates that dysbiosis, or an imbalance in “normal” microbiome composition of an individual, is correlated with many diseases such as diabetes, inflammatory bowel disease, pancreatic ductal adenocarcinoma, and others. Detection of microbiome dysbiosis in our organs can be used as a primary diagnostic to improve specificity of diagnosis, reduce disease risk, and optimize early detection and treatment. Via innovative shotgun metagenomics, which sequences bacterial

DNA isolated from whole microbial communities, scientists can define organisms present in an individual’s microbiota at a species level and thus retrieve a detailed description of bacterial composition. Sequencing of a complete bacterial genome can now be performed on a lab bench for about a hundred dollars per sample. Rapidly declining costs promise to fundamentally alter the clinical paradigm by improving our ability to track, identify, and understand disease-causing agents. The microbiome also serves as a modulator of traditional disease therapies. Gut microbiota play an important role in drug transformation, affecting their efficacy. For example, acetaminophen (the brand name drug tylenol) may compete with the gut bacteria-generated p-cresol for O-sulfonation resulting in acetaminophen glucuronidation, which can cause toxic effects in the liver. This may explain variability in analgesic response as well as differences in adverse events due to the accumulation of its toxic metabolite, called NAPQI. Other studies indicate that Bacteroides bacteria are responsible for antitumor effects of CTLA-4 blockade, commonly used for cancer immunotherapy. Irinotecan (CPT11), a chemotherapeutic used for colorectal cancer, can undergo beta-glucuronidation by gut bacteria, resulting in a metabolite that causes severe diarrhea. These examples highlight the importance of understanding gut microbiota composition when predicting drug responses in individuals. Acknowledging the role of the microbiome will allow doctors to prescribe more precise, effective, and individualized therapeutics, while decreasing the probability of adverse reactions. Human microbiome research will continue to open doors to new target-specific approaches to health improvement. Traditional approaches to targeting microbial populations within the microbiome have employed antibiotics, which are essential for the treatment of pathogenic infections. However, antibiotics have unintended effects on microbial community structure, making them a poor option as a precise therapy to target the microbiome. Novel approaches to the specific target of the microbiome include the use of probiotics, prebiotics, and dietary interventions. Early probiotics lacked precision in targeting a biological function and were found to offer little effect on gut microbiota compared to placebo. Next-generation probiotics, on the other hand, will be developed to alter microbial metabolism in a targeted, disease specific manner. A multicomponent probiotic was recently shown to modulate the gut microbiome and suppress hepatocellular carcinomas in mouse models. Prebiotics, which are mainly composed of oligosaccharides (short-chain carbohydrates), specifically fermented and metabolized by gut microbes, aim to modulate the gut in a way to positively impact human health. Early prebiotics focused on promoting the growth of a single or group of beneficial bacteria, but failed to account for how this could disrupt the balance in the microenvironment and inhibit the growth of other important microorganisms. Research on next-generation prebiotics promises to model the metabolic interactions of organisms in the microbiome to better understand overall effects on the community and host physiology. Diet significantly impacts the microbiome, as it is the primary nutrient source for microbes. With advances in research on microbiome composition and microbe interactions with individual human hosts, diets can be tailored-made to promote healthy microbiomes and thus healthy humans.

What’s in Store for the Future? Research on individual microbiome composition and approaches that target specific microbial pathways tailored to an individual’s microbiota will ultimately change the way we practice medicine in the coming century. The development of next-generation prebiotics and probiotics, as well as personalized dietary therapies, will form the new frontier in the field of personalized medicine. This is a very exciting time, and we are already beginning to see a shift in medicine from over-prescribing medicine to recognizing the importance of dietary supplements and foods that can feed our microbiomes. The human body—and its microbiome—is so incredibly complex and resilient; soon the topic in medicine may change from “what can we use to heal you?” to “how can you heal yourself?”

A Real Way to Stop The Spread The Importance of Contact Tracing By William Goodman Design: Aaron Dykxhoorn

46 | Profiles

he declaration heard ‘round the world: on March 11, 2020, the World Health Organization classified the COVID-19 crisis as a pandemic. Two days later, a national emergency was declared in the United States. For citizens, it has been more than ten months of living through this global crisis with new mandates, health advice, and media reports. For the average Joe, sifting through the surplus of information released regarding COVID-19 can be quite overwhelming, leading to confusion and even danger in cases of false information. Symptoms of infection vary greatly in patients; however, the disease remains consistent in its immensely high rate of transmission. This high rate of infection is one of the most important virulence factors the coronavirus possesses, leading to its unfortunate tour around the globe. This realization by scientists around the world has led to the crucial task of contact tracing. Contact tracing is the process of identifying, monitoring, and supporting individuals who have been exposed to COVID-19. Such individuals are told to quarantine to prevent the further spread of the virus. Quarantining is the practice of separating individuals who have had this close contact with COVID. On average, quarantine lasts for two weeks and individuals are told to get tested once their isolation has concluded. A negative test and a confirmation of good health with dissipating symptoms permit infected persons to return to their normal life. In the event where an individual who has been reported to have close COVID-19 contact consistently tests negative, they are released from quarantine restrictions. However, if this hypothetical individual was reported by a family member or a roommate, they are encouraged to remove themselves from the infected person’s immediate area. During her interview, Marie Darcy, a physician assistant and avid COVID-19 contact tracer, clearly painted the importance of a wellorganized contact tracing system. In the interview, Ms. Darcy began by discussing the standard questions directed towards newly diagnosed patients. Beginning with their symptoms, she asks questions like “Are you experiencing symptoms? If so, what symptoms?” and “When

did your symptoms start?”. After the timeline of viral infection is established, Ms. Darcy transitions to identifying close contacts. She will ask the individual to write down the activities they have participated in since the onset of the virus, as well as a list of names of whom they have been in close contact with. The CDC defines close contact as “someone who was within 6 feet of an infected person for at least 15 minutes starting from 2 days before illness onset (or, for asymptomatic clients, 2 days prior to positive specimen collection) until the time the patient is isolated.” After the full names and numbers of these “at-risk” persons are documented, public health staff contact these individuals, letting them know they have potentially been exposed to the virus. It is standard to COVID-19 contact tracing practice to keep the identity of the person who tested positive undisclosed to their contacts. Ms. Darcy states with confidence that contact tracing is the most effective method, along with hand washing, social distancing, and face covering, to help decrease transmission rates. She also brought up a unique lens on the power of quarantining— when one quarantines, they are completely isolating the virus, preventing it from adapting and mutating. Ms. Darcy received her certification from Johns Hopkins University, through a course available to all and of no cost on Coursera. com. She raved about this opportunity, as this online, self-paced course can create an army of COVID-19 tracers. In addition to giving a person the ability to fight the pandemic, getting certified provides a job opportunity. In the United States, the average salary of a contact tracer is $19.96 per hour. John Hopkins has made the criteria to get hired for this position available to millions, and with increasing numbers of individuals tracking the disease, the total number of deaths will hopefully decrease. The surplus of data that tracing provides gives vital information to public health officials, accurately migrating their efforts. Cities across the US suffer unique amounts of new cases, therefore requiring different responses. Using the locations provided by contact tracers, hot spots around the states are documented and mandates are put in place accordingly. These hot spots are those that pose the highest

“For the average Joe, sifting through the surplus of information released regarding COVID-19 can be quite overwhelming, leading to confusion and even danger in cases of false information.”

risk to the community, places where five or more cases have been tracked from non-related individuals. From nursing homes to major industrial factories, data from these hot spots are crucial in decreasing transmission. Contact tracing is only effective when involved individuals are truthful and cooperative. It is understandable that people will have mixed feelings about divulging their daily routine and the names and contact information of others. And clearly, quarantining is not a fun way to spend 14 days. However, the purpose lies in prevention; when push comes to shove, this data saves lives. Contact tracing saves lives.

EYE-OPENING

RESEARCH By Brandon Dinner Design: Aaron Dykxhoorn

What One UM Student is Doing to Help Glaucoma Patients Research profile on Sasha Milbeck 48 | Profiles

lthough our lives have all changed due to COVID-19, this has not stopped one outstanding student from pursuing her dreams. On a Friday afternoon, I sat down with Sasha Milbeck, a Junior Global Health Studies major at UM, via Zoom to learn more about her achievements—both in academia and in research. At the time of the interview, Sasha phoned in from Washington D.C., where she is working at the National Center for Health Research. There, she analyzes clinical trials and FDA research to help make the public better aware of the safety of different medical devices and pharmaceutical drugs in a more digestible way. Born and raised in a suburb outside Milwaukee, Wisconsin, Sasha grew up in a home speaking mostly Russian and learned English when she went to school. Her earliest memory of an interest in science, and where her passion arose, was in elementary school where she had the opportunity to conduct science experiments without needing to understand English. She mentions that her experiences in grade school have sparked her interest in advocating for science and early education for kids, a field that focuses more on hands-on activities that any kid, regardless of what language they speak, can understand. Leveraging her interests in education and biology, Sasha has been working with Science Made Sensible in Miami to teach biology topics to high schoolers at Miami-Dade Public Schools. Sasha hopes to prove that science, especially when conducting field observations, can transcend language; she is already making great strides. When she isn’t performing cutting edge research or studying for classes, Sasha is travelling the world (she went backpacking in Israel and Jordan for a month), cooking, and serving up mean cups of Joe. Sasha worked as a barista at a local coffee shop for four years and says she can make an amazing latte. Sasha, if you’re reading this, Scientifica would love to cash in your coffee offer! Curious about research, Sasha joined an Ophthalmology and Neuroscience lab as a Freshman at the Miller School of Medicine with her now research mentor, Dr. Sanjoy Bhattacharya. The lab focuses on mass spectrometry and comparing proteins, lipids, and other metabolites between healthy and diseased optic nerve samples. She describes working with Dr. Bhattacharya as an incredibly meaningful experience, and continues in the lab today. Sasha attributes her motivation to conduct research in this area to her longtime interest in the brain and nervous system, the fact that the optic nerve can be used as a model for multiple sclerosis and spinal cord research, and Dr. Bhattacharya’s open communication and support. In May of 2020, she completed a project with the lab and published a paper on lysophospholipids in the optic nerve and optic nerve degeneration in glaucoma patients. In glaucoma, one of the key pathologies is optic nerve degeneration which causes a patient to lose vision. As the nervous system is one of the only systems in our bodies incapable of regeneration, Sasha works to find ways to rebuild the optic nerve, or maintain it, so that the patient won’t lose vision. In her paper, she discovered using mass spectrometry of optic nerve samples from the Bascom Palmer Eye Institute that several classes of phospholipids were significantly decreased in human glaucoma optic nerves. Analyzing

available genomic data, she found that this could potentially be the result of impaired protein enzymes. As with any novel research, challenges are often experienced. Sasha described that her most challenging experience in the lab was when she worked full time in the lab over the summer doing western blots, and not a single one produced reliable results. Western blots take three days to perform, and going into it, she expected everything to run smoothly. After experiencing frustration from these attempts with no avail, she had a conversation with Dr. Bhattacharya. She learned that when working with diseased samples, you have to put your expectations aside and failure can be a part of the process. Good research takes time, sometimes years, and Sasha learned that patience is extremely important when conducting research. In the process of her failed procedures, though frustrating, she gained more experience and mastery of the protocol; she is now able to teach other people how to perform western blots. When she returns to the lab in person, Sasha plans to write a comparative paper summarizing the differences in optic nerve protein and lipid levels between human and mouse models. Working in the lab, Sasha learned about what goes into writing grants and papers, western blotting, and mentions that she had learned more about neuroscience and optic nerves than she had in any of her classes. She also developed skills in analyzing scientific research and developing perseverance, patience, and teamwork. She very much enjoyed the collaborative nature of the lab and how helpful the graduate students were in assisting her with her project. For any undergraduate student interested in getting involved with research, Sasha suggests talking to professors you had classes with, and reaching out to Dr. Gaines and the Office of Undergraduate Research. Above all else, Sasha recommends that students show their interest, never be afraid to voice their research interests to their lab professors, and above all else, make the most of their time in college. As she puts it, “try as many things as you can because now is the time to do it; after college we might not have the opportunity again!”

“Try as many things as you can because now is the time to do it; after college we might not have the opportunity again!” 49

Tearing

Down Stigmas Research profile on Krishna Louis By Setareh Gooshvar

50 | Profiles

Design: Aaron Dykxhoorn Photography: Anuj Shah

rishna Louis is a senior at the University of Miami studying Exercise Physiology with a minor in Sports Medicine. She holds many leadership positions as the treasurer for the Competitive Club Cheer team and as Peer Education Co-Chair for It’s On Us. One of her other passions, however, is her mission to tear down walls surrounding mental health and HIV/STD awareness. Through her work, Krishna seeks “to bring awareness to mental health and make this sensitive and occasionally uncomfortable topic more known and more easily talked about.” As a black woman, she grew up being told to always be strong and independent. However, she mentions that this is a stigma often faced by black women—never to be dependent on anyone and to always be “strong.” Therefore, she wants to put a stop to this stigma and bring awareness to the mental health challenges that black women face. Krishna tackles this issue within the University of Miami community as a Youth Lead Presenter from the National Alliance of Mental Illness. Through this role, she delivers presentations for the Ending the Silence program, which helps audience members learn about the warning signs of mental health conditions as well as what steps to take if they detect symptoms of a mental health condition. During these presentations, Krishna shares her own personal experiences regarding mental health and works to stop the stigma surrounding such issues. Her achievements include being a youth panelist for newly elected Miami-Dade mayor, Daniella Levine Cava, in “What People with Mental Illness Want You to Know,” where she shares her experience with anxiety. She mentions her desire for others to understand that anxiety is not an illness that can be easily controlled, and that it can manifest itself daily and in many different forms. By sharing her impactful story, she hopes it will provide a light at the end of the tunnel and hope for others who may be “stuck in a dark place.” Krishna has also been a youth panelist for the PBS National “Well-Beings Tour” and prepared a segment on “People Living with a Mental Health Challenge: Anxiety During Mental Health Awareness Week” for the National Alliance of Mental Illness headquarters. She does all of this with the goal of sharing her story and “reaching out to the community to ‘End the Silence’ on mental health by being an advocate and voice for young people who may have a mental health challenge.” However, Krishna’s incredible contributions to public health do not stop there. Not only is Krishna active within the mental health community, she is also a certified HIV testing counselor under the Florida Department of Health, which manifests in the work she does at Promote2Prevent, a clinic for adolescent counseling, testing, and treatment. Her responsibilities include offering free HIV and STD testing for people of ages ranging from 13 to 29 at the UHealth Bachelor Children’s Research Institute. The motivation for this work comes from Krishna’s awareness of Miami-Dade County’s dire HIV situation. As the county with the highest CDC reported annual rate of newly diagnosed HIV infections throughout the nation, Miami-Dade is in desperate need of the type of help Krishna and her colleagues are providing. This situation motivated Krishna to act to “promote practicing safe sex to prevent the increases in cases of sexually transmitted diseases and HIV among at-risk youth,” a job that she has continued to perform during the COVID-19 pandemic. Throughout all of her hard work and effort, Krishna has learned volumes about the public health aspect of HIV and STDs, which

she finds to be extremely useful information for her future. As an aspiring healthcare professional, she has learned to embrace a broader perspective and attitude toward the more difficult aspects of medicine, a skill that came through her experience of having to tell young adults and teens about their positive HIV status. She mentions that it “is very traumatizing not just for me, but for the patient. The rest of their life changes with just one simple phrase, ‘you are positive for HIV.’” By practicing empathy and recognizing that receiving this news is incredibly difficult, she has grown as both a person and budding healthcare professional. Regarding her future goals, Krishna knows that working in the Promote2Prevent clinic has provided her the platform to strengthen her communication and people skills. Furthermore, her valuable work with mental health campaigns and insight into the mental health issues present within her community will allow her to continue to fight stigmas surrounding those topics. Tying in her degree from the University of Miami, she aspires to be a Physician Assistant, and will undoubtedly excel in the medical field as a compassionate and empathetic individual.