Frontiers March 2014 by Frontiers: Washington University Review of Health

March 2014 Washington University Review of Health frontiersmag.wustl.edu

At WUSTL, research is no longer a monopolized field for hard-core science students.

Frontiers Magazine

March 2014

WE ARE ACCEPTING APPLICATIONS FOR WRITERS AND ILLUSTRATORS FRONTIERSMAG@GMAIL.COM

Frontiers Magazine

WHO IS BEHIND

Executive Board:

Editors:

Writers:

Illustrators:

Executive Director: Amee Azad

Aashka Dalal

Katelyn Mae Petrin

Margaret Flately

Co-Editor-in-Chief: Rachel Hoffman

Christina Ge

Charlie Chen

Co-Editor-in-Chief: Olivia Sutton

Amrita Hari-Raj

Megan Kerstein

Director of Finance: Alex Wess

Iqra Khan

Richard Hongyi Li

Director of Design: Sydney Meyers

Katelyn Mae Petrin

Apoorva Ram

Webmaster: Tony Wang

Sandy Tadros

Neha Prasad

Public Relations: Mahendra Reddy

Adam Lowenstein Sanji Suresh

March 2014

CO NT EN TS 4

Reflection in Practice

â&#x20AC;&#x153;Edutainmentâ&#x20AC;?: Promoting HPV Awareness

St. Louis: Moving from Brain Drain to Brain Gain

Redefining Entrepreneurship - The Innovative Medical Solution

The Roots of Drug Discovery: Traditional and Complemetary Medicine

The Image of the Doctor: Television and Reality

Microbes and Me

The Health and Fitness Smartphone Apps for You

Are We Even Making a Difference?: Sustainability in Practice 3

Frontiers Magazine

Reflection in Practice

RR Katelyn Mae Petrin

Reflection. You’re familiar with it, in its various forms. Your face in the mirror, your thoughts on a page; as the Latin suggests, little pieces of you are bent back on themselves and aligned on a surface for convenient viewing. Reflection often seems like arbitrary testing or busy work, the sort from which it would be nice to be freed in higher education. However, since the 1983 introduction of a book titled “The Reflective Practitioner,” reflective practice has become “A Thing” in education—of all types—across the United States. The idea that thinking improves practice has morphed into a cohesive body of theory. Many educational programs now teach reflection. However, there is a gap. More and more people argue that U.S. medical schools should teach reflective practice as if it were just as important as the names of our bones. But while researchers have conducted many studies, few have found significant quantitative evidence that reflection improves medical practice. Some report correlation between reflective coursework and increased GPA or scores; others claim that students who reflect on their anatomical coursework demonstrate better recollection of structure and functions. On a whole, though, the evidence has been scant and questionable. So why do medical educators and professionals continue to argue that reflection is crucial to the medical education? Stephen Lefrak, director of the Humanities in Medicine program at Washington University School of Medicine (WUSM), said that reflective practice is “best able to teach doctors how to get patients to reflect, and to talk to patients.” Lefrak favors analyst-guided reflection and has run several programs over the course of his career that focus on providing a space for reflection free of fear and administrative interference. “It was certainly useful,” he said. “How do you deal with the experience of the medical profession as a student? It’s hard to do. Reflection is crucial for the doctor’s mental health.”

Lefrak said he laments the medical community’s disinclination to encourage reflection as part of a physician’s work. Some medical schools have begun to work with Medical Humanities programs similar to the one Lefrak leads. Medical Humanities explores what Lefrak calls “the existential part of illness”—as opposed to pathology itself. Some have called reflection “a medical humanities approach” to the health profession. Perhaps these programs might one day provide a doorway into reflective practice. Right now, though, they are neglected by medical schools. Robert Patterson, head of WUSTL’s Writing Center, offers an explanation from the perspective of a writing teacher: putting things down in words creates coherence. “It allows you to realize, ‘hey, the way I’m thinking about ballet and what I’m getting out of it is really similar to the things I’m getting out of EMT work’, and that lets you better understand what drives you,” Patterson said. And more than that, it pushes you to ask the question, “why did they want me to learn in these ways?” This, he said, allows people to take so much more out of an educational experience. You may see, then, why reflection might be used in medical practice despite a lack of empirical evidence, why researchers push to find more tangible demonstration of its impacts and why doctors believe that it needs more incorporation into medical curriculae. Reflection has the potential to improve the least tangible, least measurable parts of a blooming physician: the ways they think, the ways they understand themselves, and, as doctors, the ways that self-knowledge changes how they interact with patients. It’s not just for the physician, though. Maybe you are pre-med and will write reflections in medical school a few years from now; maybe you are in the B-school and will run into other forms of reflective practice; maybe you refuse to ever write something that resembles a class reflection ever again. But it is worth it, for a bit, to step back and think about thinking. How often do you sit back and try to find coherence between what you love? What could you gain from slowing your life, writing down some thoughts, and looking at the reflection of your day, only to see it from angles you had never noticed before?

March 2014

“edutainment”:

promoting hpv awareness Charlie Chen

17,000 primary schools. 500,000 girls. one vaccine. On March 10, the South African Departments of Basic Education and Health began providing free human papillomavirus (HPV) vaccines to girls between the ages of 9 and 10.The vaccines will help protect against HPV infection as well as other health problems the infection may cause, such as cervical cancer. The cost of such an endeavor is attracting concerns. The HPV vaccines Gardasil and Cervarix are among the most expensive immunizations in the world. Pricing of Gardasil in South Africa is estimated at 770 rand ($70) per injection. Cervarix costs 700 rand ($64.50) per injection. In the US, a single injection of either vaccine cost $130, but it is up to either the individual or insurance company to cover the cost.

in South Africa. A major lead came from Mary Kawonga, a public health medicine specialist at the University of the Witwatersrand. “Mary suggested that we look into doing animations and comics, since this nonprofit called Soul City was really successful in getting their message across in South Africa,” Lo said. The Soul City Institute for Health and Development Communication does research on multimedia “edutainment,” which combines the use of television and radio dramas to create a platform for promoting health and social change.

“We decided to contact Soul City, who referred to the nonprofit Right to Care, an organization that raises awareness for HIV/AIDS and cervical cancer in South Africa, who put us in contact with the Department of Public Health,” Lo said. After collaborating with art students to design the film and comics, Lo and Saxena plan to travel to South Africa, where they hope to bring their educational initiative to the schools that are beginning vaccinations. As they wait for their final approval from the South African Department of Public

A far more pressing issue lies in raising the overall awareness of cervical cancer.While parents take their children less 5 years old for standard vaccines,“older children don’t access healthcare because they are healthy, or at least think they are,” said Dr. Greta Dreyer, a Gynaecologic Cancer Clinician at the University of Pretoria and the Steve Biko Academic Hospital. “The only way to reach them is through schools.” It is this last issue that Washington University in St. Louis students Hannah Lo and Anchal Saxena hope to address through the design of an HPV vaccine awareness program. Their CGI U Commitment to Action, the HPV Educational Resources Outreach Program (HERO), will use animated films and cartoon strips to increase awareness of HPV in an effort to encourage participation in the vaccination program. Lo said the idea emerged from many email conversations with public health workers

“Soul City’s success with a multi-media platform among South African children (encouraged us) to design a similar project using cartoons and animations to deliver information about the HPV vaccine,” Saxena said. Seeing successful examples of multimedia campaigns in raising health awareness, Lo and Saxena began to seriously consider acting on their common interest in global health to make a contribution to improving health equity.

Health, the two reflect on the progress they have made so far. “I think some of our successes would be the great amount of support we have received from doctors and public health workers in South Africa,” Saxena said. “I also think our acceptance to CGI U is another success and has definitely helped motivate us to work harder.”

Frontiers Magazine

St. Louis: Moving from Brain Drain to Brain Gain Megan Kerstein

Brain Drain. As nefarious as this phrase sounds, it represents a real problem for the greater St. Louis community. Brain Drain, also called human capital flight, is the movement of educated and professional individuals from one geographic location to another for better pay or working conditions. In the case of St. Louis, many recent graduates from Washington University in St. Louis (WUSTL) and other St. Louis colleges and graduate schools leave the city for larger cities, such as Chicago, New York, and Los Angeles. The problem of Brain Drain is particularly apparent when it comes to the medical field. Robert Fruend, Chief Executive Officer of the St. Louis Regional Health Commission, spoke about the state of community health in St. Louis. According to Fruend, St. Louis is actually a model city when it comes to community health. St. Louis city and county were selected by the Centers for Medicare and Medicaid Services to participate in a pilot project called “Gateway to Better Health.”Through this program, St. Louis receives $30 million in federal funds each year to provide primary, specialty, and urgent care for uninsured adults in the St. Louis metropolitan area. Many of these adults do not qualify for Medicaid, the federal program for that allows low-income families and individuals to receive medical care. Since St. Louis does not have a public hospital to treat uninsured patients, Gateway funds several community health centers where patients can seek treatment. Fruend also discussed the Patient Protection and Affordable Care Act (PPACA) and how it will affect the Gateway program. One of the many goals of the PPACA is to expand healthcare coverage of millions of Americans by means of expanding Medicaid. More people will qualify for Medicaid as qualifying income thresholds are raised. After intense debate over the constitutionality of the PPACA, the Supreme Court determined that individual state legislatures can decide whether they wish to expand Medicaid. Missouri opted not to expand Medicaid, creating problems for programs like Gateway. Federal funding of Gateway will be siphoned away to other states’ Medicaid programs. With funding removed, the future of Gateway and the health of St. Louis is uncertain. Further, many doctors and other healthcare 6

professionals now flee from St. Louis and the state of Missouri. They instead go to states that have expanded Medicaid because these states have more funds available to compensate health care professionals.Thus, St. Louis is on the verge of a largescale physician shortage. There are potential solutions to the problem of Brain Drain. A group of WUSTL alumni, all sharing a love of St. Louis and a willingness to work for change, stuck around in St. Louis after graduation.They formed a group called “Brain Drain.”This collective hopes to retain more young professionals in the St. Louis area by discussing ways to make St. Louis more appealing to this group.To start off, the group created a project called CityPulse, which studies the demographics of different neighborhoods in St. Louis by using mounted cameras. The data will give the group a better idea of where people are and what they are doing. For instance, in a neighborhood with high levels of bicycle traffic, that neighborhood can become more bike-friendly by adding bike lanes. In this way, CityPulse seeks to improve neighborhoods in St. Louis by tailoring developments to community-based needs. Improvements are evident in places such as Washington Avenue in downtown St. Louis, where vacant buildings have been renovated. The street is now known for its vibrant nightlife and the abundance of loft-style housing. With similar neighborhood improvements, St. Louis will become a more livable city and likely retain more professionals. One recent WUSTL alumni, Audrey Chan, originally from the San Francisco

Bay Area, made the decision to stay in St. Louis. “During my years of undergrad I felt that I had not yet fully experienced what St. Louis has to offer as a city, and so that was a factor in my decision to stay,” Chan said.“Second, the different job prospects were a major factor. For me, St. Louis has more opportunities in my field versus going back to the Bay Area where WashU has not quite yet established the reputation it deserves. I would have to compete with graduates from Stanford and Berkeley that are more well-known there. Third, I like the people and the culture of St. Louis. People are very well-connected and it’s a great place to build up a network.” Within WUSTL, some initiatives are already in place to encourage students to gain exposure to St. Louis. For example, the Gephardt Institute, offers the Goldman Fellows Program, which offers a $3500 stipend to students who spend the summer in St. Louis working on a community-based project. The program exposes students to the St. Louis community outside of WUSTL, hopefully sparking long-term interest in the city. Other long-term community service initiatives, such as Pre-O program Leadership Through Service, also provide additional exposure to the St. Louis area, allowing students to explore all that the city offers. Brain Drain is not inevitable. St. Louis college students are at a fork in the road. We can choose to change the city by using the tools available to us and sticking around after graduation.

March 2014

Redefining Entrepreneurship— The innovative medical solution Richard Hongyi Li There is a new social entrepreneurial movement afoot that seeks solutions to some of the world’s most challenging medical issues. Medical entrepreneurship is among the very best hopes we have for accelerating the pace of medical innovation and industrial progress. For many people living with Parkinson’s disease, the mere act of chewing and swallowing can be a challenge. The tremor caused by the disease currently has no cure in the market—all treatments only moderate symptoms. While traditional medical research and industry rendered no effective solutions to tackle the tremor symptom, an untraditional research organization offer a solution. Lift Labs, a San Francisco startup company, has developed a gadget, Liftware, which can help stabilize tremors of people with Parkinson’s and related disorders. The Liftware counteracts on tremor when patients are eating—tests proved “a reduction of more than 70 percent in tremors when using the spoon.” In a news release, Life Labs founder Anupam Pathak said that soon after he figured out how to make the hardware active tremor cancellation, he introduced the technology to the lab, producing the first prototype of Liftware. All it took was an edge-cutting entrepreneurial idea to bring the already-mature technology to the medical industry. What makes Lift Lab and its products unique is their representation of a new model for developing medical solutions— a pathway distinct from the traditional research model, where research is affiliated with an institutional lab and nourished by funding grants.Though it started with an NIH grant, Lift Lab was mainly supported and funded by $1 million from “angel investors,” investors who specifically fund small startups or entrepreneurs. This type of funding proved crucial for the survival of Liftware: the flaws in the traditional research model would have killed the project even before it hit the market.

The traditional research model for medical innovation, as we know it today is obsolete and nearly broken. Why? Two words: inefficient and ineffective. First of all, too much time writing grants makes the current research pathway extremely inefficient. For instance, in 2007, a U.S. government study found that “university faculty members spend about 40 percent of their research time navigating the bureaucratic labyrinth.” Such frustration is becoming one of the major obstacles in medical research and innovation. Moreover, the old medical research model is ineffective because it is, by design, risk averse. Grant proposals that win funding are usually those that seek out small, incremental discoveries—it is the very nature and policy of the grant-making bodies to look for ideas that build on existing knowledge. Breakout ideas are not able to happen under this incrementalist research model since they might be too “difficult and long to achieve” via limited funding. The money goes to the projects that are so close to the “product” that nothing is possibly “wasted.” This is where and why the neoentrepreneurial movement comes in. Through corporate modes of research funding, medical researchers with “good, even radical, ideas” now have a chance to transform their “ideas” into prototypes of medical solutions more viable through the investments from angel investors and markets. Liftware was “lifted” in such way. In the past decade, so were many other devices.

Andrew Brimer and Abigail Cohen created a portable and low-cost spirometer, empowering patients to connect with their doctors in tracking and managing lung diseases through seamless integration with mobile devices. In an interview, Cohen talked about the project’s origins. She said it all came from an idea to make treatment and prevention of lung diseases cheaper and more accessible. “Statistics indicated that an estimated 300 million people in the world suffer from asthma, and the number is expected to grow,” Cohen said.“People living in the developing world have a much more difficult time… and we want to use our expertise to help.” Sparo Labs was born out of a Washington University class called The Hatchery, which is taught by Cliff Holekamp, a senior lecturer in entrepreneurship and director of the entrepreneurship platform atWashington University.“[Sparo Labs] are great examples of the talent that is bought in from around the world to Washington University and that is contributing to the startup culture in St. Louis,” Holekamp said in a St. Louis Business Journal article.

This entrepreneurial pathway for medical innovation has been proven so effective and viable that even undergraduate college students can take advantage of it.

The new model stimulates students’ passion to get involved in undergraduate research program. At WUSTL, research is no longer a monopolized field for hard-core science students. With the entrepreneurship-integrated model, it also draws the attention and participation of students from other areas of study. Not only are scientific hypotheses tested, but business marketing ones as well. It is the integration of entrepreneurship and traditional research model that unites students across the campus and areas of their study.

At Washington University in St. Louis (WUSTL), two senior engineering students have developed a new product for asthma monitoring and managing. It has given millions of patients in developing country new hope. Sparo Lab founders

In this worldwide, academic, social and, most importantly, entrepreneurial movement, innovations transform to medical solutions is vastly accelerated and simplified. After the entrepreneurship hits the academia, all it takes is a good idea. 7

Frontiers Magazine

The Roots of Drug Discovery:

Traditional and Complementary Medicine Apoorva Ram

Your doctor hands you the prescribed medicine. You choke the red liquid down and hope that it will help you. Extensive evidence backs the medicine, and it is documented to treat your symptoms. He tells you the name: Dragon’s Blood. He instructs you to drink it three times a day, and your symptoms should disappear. Dragon’s Blood is a deep red resin extracted from Dracaena cochinchinensis, or “Yunnan Dragon’s Blood.” Since the first century AD, Dragon’s Blood, an herb used in traditional medicine in many cultures, has been used to treat inflammation, stomach ulcers, and more. Research shows that certain resin components induce activities in the body that are current therapy methods for neurodegenerative diseases.The components that cause these effects are being investigated as possible therapeutic agents for neurodegenerative disorders. Drug discovery is a complex process that requires intense laboratory and clinical testing. One major strategy for drug discovery is utilizing the already-existing medical knowledge base in traditional and alternative medicine.The World Health Organization defines traditional medicine as “the sum total of the knowledge, skills, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness. Washington University School of Medicine (WUSM) conducts many clinical drug trials, including drugs intended to treat hyperlipidemia, diabetes, depression, and more. Aside from a strictly medical perspective, however, students in many fields find interest in drug discovery traditional medicine, from those involved in anthropology to those involved in pre-health studies. Traditional medicine is practiced across the globe, and countries often use methods originating from other geographical areas as well. Although many forms of traditional and complementary medicine exist around the world, one major contributor to the pharmaceutical industry is Ayurveda, a form of traditional Indian medicine.

Ayurveda has been used to diagnose and treat disease since 1000 BC. Recently, Ayurveda and other forms of traditional medicine have become increasingly popular as a holistic alternative to patient treatment. Ayurvedic knowledge provides detailed descriptions about the use of more than 1500 herbs as well as a diagnosis system for more than 5000 signs and symptoms. Using this methodical and well-documented healthcare system provides many opportunities for bioprospecting, or the search for clinically useful molecules in microorganisms, fungi and plants. Compounds extracted from herbs used in traditional medicine have a relatively safer usage than many other drugs, as they have been used for years. Many promising new discoveries have arisen through Ayurveda, some of which are summarized in Table 1. The World Health Organization (WHO) published a traditional medicine strategy in 2013 that will extend from 2014-2023. The plan highlights the three major strategies for approaching traditional medicine. First, WHO suggests that member states construct national policies recognizing the potential of traditional medicine. Second, that they create safe, proper and effective forms of traditional medicine through regulation and development of the existing sources. Finally, that they integrate traditional health care systems with conventional systems to promote universal health coverage. The World Health Organization’s report on traditional medicine attests to its importance and potential in our world today as both a source of new medicinal drugs and a relatively lowcost solution to certain public health issues. Increased regulation of drug development has caused a rise in the price of newly discovered drugs and longer development times due to safety risks. Traditional and alternative medicine provide sources of information that researchers have been utilizing to develop treatments for many diseases. Traditional medicine can provide useful and innovative drugs, and it remains advantageous despite the seeming prevalence of conventional or westernized medicine. Traditional medicine has not been forgotten yet.

March 2014

Sarpagandha

Rauwolfia serpentina

Bakuchi Psoralens

Kutaja

Holarrhena alkaloids

Hypertension

Vitiligo

Amoebiasis

Control nerve impulses in the heart and blood vessels to lower blood pressure.

Used with UV light for repigmentation.

The bark of this plant has proven useful in decreasing symptoms.

Velvet Bean Mucuna pruriens

Parkinsonâ&#x20AC;&#x2122;s disease/ spermatogenic loss M. pruriens cotyledon powder acts as a neurorestorative and controls the symptoms of Parkinsonâ&#x20AC;&#x2122;s disease. M. pruriens regulates apoptosis in germ cells.

Bhumyamalaki Phyllanthus amarus

Ashwagandha Withania somnifera

Antiviral/ Jaundice

Cancer

Decreases the oxidative stress in the liver.

Bioactive withanolides can enhance apoptosis and inhibit invasion and generation of osteoclasts, cells that resorb bone.

Frontiers Magazine

The Image of the Doctor: Television and Reality Katelyn Mae

Doctor House. Doctor Cox. Doctor Lecter. These names, these titles—they have weight. Some of it is their pop culture clout: they are fun, they are snarky, they say it like it is (even if one of them does eat people, and another is a space alien). But there is something more than that. “Doctor.” We know who they are. Stories about doctors are not exactly a new thing. Doctor Faustus gave way to Doctor Frankenstein, and so on. But like any story that doesn’t die, the doctor fable has changed, reflecting the culture around it. In the doctor drama’s early days, doctors were beacons of hope and perfection and excellence. In the last decade or so, though, their stories have been about medical success at the expense of personal qualities—or in the case of Hannibal Lecter, culinary success at the expense of a few patients. 21st century television’s doctor is a man of contradictions.They’re usually a certain sort of man: conflicted, tortured, talented. They usually have nothing outside their work except random skills they somehow picked up through unquestioned access to superior education; however, they might also have a conflicted decade-old relationship or two, if it serves the plot.They heal the patient, though.The shows’ mantras: these characters are rarely good people, but they are always good doctors. But what does it matter? Certainly, there is a lot of talk about how “doctors on TV” might change medical practice (for better or worse). Pop culture analysts have suggested a few trends: maybe television doctors raise people’s expectations too high; maybe they give them too many ideas of bizarre diseases they definitely do not have; maybe they give real doctors a bad name. Lots of theories, lots of paranoia— it just depends on whom you ask. Some psychologists have found evidence that primetime doctors make people hate their physician. Others have found that the most television can do is make you think your doctors are ugly and immoral, but mostly okay otherwise.

Using quantitative data to form these connections is inconclusive at best, outright misleading at worst. However, as pop culture scholar J.R. McLeod writes, “Television has the power to manipulate and to certify, to selectively inform, and to selectively manipulate emotion. All of these effects operate at a level of cultural immersion.” So how might doctor shows reflect our culture of care and the doctors who offer it? Despite their supposed medical prowess, these tv doctors overlook a serious part of medical responsibility. When researchers cataloged 50 episodes of “House” and “Grey’s Anatomy” for their bioethical dilemmas, they found that, in 57 percent of cases, the doctors committed blatant bioethical violations—not just ignoring consent altogether, but also lying outright to their patients to achieve consent. Here, we see a certain sort of trend: in every story every week, doctors do the job. They have the knowledge. They’re the best. No matter how nasty they are, they have something the patients need, and they hold life in their hands. But they break the rules, they disregard others, they endanger lives and flout ethics. Their patients often do not even have a choice in their care. Thus, these television doctors become absolute powers, unchecked even by the law. Being a doctor becomes a power symbol more than it is a profession. This power can extend to the real world, too. Individual experiences with doctors reflect these very real dynamics of power and representation. “Doctors get away with shots in the dark,” said Livvy Bedford, a Yale undergraduate. “When they try something that doesn’t work, there’s no accountability. At one point, I had a test for my stomach condition. I watched the pH test dip down to the number that qualifies for diagnosis. And when I walked into my doctor’s office, she said, ‘Yeah, you don’t have acid reflux.’ No explanation, no test—one sentence. And I wanted to ask: what happened? Why did I see those numbers?”

March 2014

The problem for her, Livvy said, is not necessarily that misdiagnoses like this can happen; it’s that “you can’t question what the doctors are doing, especially when you’re younger. I think we have this lone wolf image of doctors who act on their own, like in ‘House.’ That’s more harmful than anything.” Situations like Livvy’s are not uncommon.The National Center for Policy Analysis reports that a believed 10-20 percent of diagnoses are incorrect. Beyond that, 28 percent of surveyed cases were lethal misdiagnoses. Livvy has since been diagnosed and treated for acid reflux by a different doctor. It is well known that our health care system does not work as well as it could. However, the structure of the health care system—the way it valorizes doctors as free agents, grants them the power to act independently of each other and sometimes even their patients—prevents

In NBC’s “Hannibal” Dr. Hannibal Lecter accepts his homicidal tendencies. Here Dr. Hannibal Lecter is chowing down on Web MD showing the inferiority of Web MD in the face of an actual doctor’s opinion.

its own reform. Here lies the juncture between media image and reality. Misdiagnosis can be expected. Imperfect systems are not unusual. The relationship between the patient and the doctor, though, and the resistance of doctors and the health industry to revising a relationship that so empowers them—that’s McLeod’s cultural immersion, an image of “health care” created and perpetuated in culture, then reflected outwards through television. Television says: the doctor has the power, the patient has none.And society doesn’t tell anyone otherwise. Perhaps this is something we—whether we are audience, patient, or future doctor—should think about changing

Frontiers Magazine

Microbes and Me Neha Prasad

We are—on both the cellular and genetic level—more bacteria than human.There are 100 times more genes in our bodies coding for the microorganisms in our intestines than our own human genes. Imagine the potential for opening new doors to medical discovery through manipulating the ecosystem of microorganisms flourishing within us. When we eat natural probiotic foods like soy-based foods, yogurt, or pickled foods, we introduce additional microorganisms into our intestinal microsystem. Manufactured probiotic products, such as Greek yogurt, Dannon’s Activia, and Yoplait Original, are frequently advertised as a way to improve health. Companies boast that probiotics can improve digestive health and the immune system, but not all manufactured products can support their claims.

to the number of bacteria in the product. Since true probiotics must contain live and active cultures of bacteria, the manufacturing, shipment, and storage must accommodate for the bacteria’s sensitivity to the environment. Due to these specific conditions, strict regulation is needed to ascertain the nutritional value of probiotics.

gut microbiota plays as significant of a role in malnutrition and obesity as does diet.

Among other responsibilities, the US Food and Drug Administration (FDA) assures the safety of foods and drugs, but it holds probiotics to a different standard.When it comes to foods and drugs, the FDA must substantiate “health claims,” but probiotic manufacturers are allowed to make unregulated, nonspecific statements describing how their supplement maintains normal functioning of the body. Thus, probiotics are advertised to “improve general digestion” without the FDA’s endorsement. Categorization governs what kind of regulations the FDA requires for a certain product. Probiotics, however, can be squeezed to fit at least four categories, adding to the challenge of controlling the quality, characteristics, and risks of probiotics. As a result of the lax FDA policy, marketing standards are not well-regulated. To ensure the efficacy of probiotics, several aspects must be moderated: the identification of bacteria hosted in the product, the shelf life and acceptable methods of storage to ensure bacteria viability, and a dosage that correlates

The mechanism by which probiotics affect our microbiota is still being explored. Recent research has indicated that manipulating intestinal microbiota could lead to a potential cure for severe acute malnutrition (SAM) and obesity. SAM accounts for 35 percent of deaths in children under the age of 5, and is characterized by a very low weight for height. Dr. Jeffrey Gordon at Washington University School of Medicine is a pioneer researcher in the field of microbial ecology. His experiments involve the transplantation of human microbiota into sterile mice to assess the effectiveness of various diets. When mice were given the same diets, the batch with microbiota transplanted from SAM children in Malawi exhibited extreme weight loss compared to mice with microbiota transplanted from healthy individuals.This shows that the gut microbiota plays as significant of a role in malnutrition and obesity as does diet. Research in this field may determine how to change the current treatment for SAM. Overall, there is great potential in the study of microbiota, ranging from effective probiotics to treating life-threatening illnesses. While the FDA still needs to reevaluate how it regulates probiotics, you can extend a warm welcome to the bacteria in your yogurt as they settle into their new home-your intestines.

March 2014

The Health and Fitness Smartphone Apps for You Adam Lowenstein

Since 2005, anyone with access to the Internet could attempt to diagnose an illness without leaving home.WebMD marked a milestone in healthcare technology that has been duplicated and adapted in the decade since. Today, there is a seemingly unlimited supply of websites one can log onto in order to find medical advice. Physician and scientist Daniel Kraft discussed this phenomenon in his 2011 TED Talk, “Medicine’s future? There’s an app for that.” Upcoming innovations will allow for seamless communication between the doctor and patient. Not only will doctors have the ability to utilize robot technology for remote procedures, but individuals can also take advantage of new gizmos and gadgets to take control of their health. According to the Pew Internet and American Life Project, less than one-fifth of United States adult smartphone users have at least one health app, but many more students take advantage of the hard rectangle in their pockets. In fact, half of a 50-person undergraduate population surveyed at WUSTL actively uses apps to follow their fitness. The apps that are most pervasive on campus are MyFitnessPal, RunKeeper, and Charity Miles: MyFitnessPal by MyFitnessPal.com (Price - free): As one of the highest-rated health and fitness apps in the iTunes Apps Store (known as “Calorie Counter & Diet Tracker by MyFitnessPal”) in addition to the Google Play Store (“Calorie Counter - MyFitnessPal”), MyFitnessPal acts as an all-in-one health tracker.The app’s ability to integrate social media with more than 350 various types of cardio and weight-training exercises gives students everything they need for their exercise regimen.

RunKeeper By FitnessKeeper, Inc. (Price - free): Also a strongly-rated app, RunKeeper (“RunKeeper - GPS Track Running Walking Cycling” in iTunes and “RunKeeper - GPS Track Run Walk” in the Google Play Store) keeps students active by pushing them to personal milestones when running, walking, and biking. It also integrates with 70 other apps and services, including MyFitnessPal, “to get deeper insight into your overall health,” according to their description. RunKeeper’s creators know what their users want. Charity Miles By Charity Miles (Price - free):Why not donate to charity while exercising? By just downloading Charity Miles and choosing a charity, users can help the organization raise $1 million by walking, running, or cycling. No money comes out of any user’s pocket. These three health and fitness apps seem to be popular among those who are active. If these apps are too complex, an app to consider is “Moves” by ProtoGeo, a very simple app that counts the number of steps taken each day. In addition,“Moves” provides minutes cycled and miles ran as well as the user’s location. Students can even connect phones wirelessly to their shoes with “Nike+ Running.” Soon, they will be able to connect their devices to any article of clothing. With Generation Y as the first group to take full advantage of the digital age, it is evident that college students are proactive when tackling their fitness ventures. With the ability to track data from caloric intake to hours slept, one can track fitness data more easily than ever before.

Frontiers Magazine

Are We Even Making a Difference?: Sustainability in Practice Sanji Suresh

After receiving his undergraduate degree, my brother spent a year helping provide clean water to people living in an underserved village in Rajastan, India. However, setting up water filtration systems in the village was only half the battle. The real trouble was convincing the locals that purchasing clean water was vital for their health, even though it was a more expensive alternative to the readily available fluorine-laden water. Intensive education measures and constant persuasion were necessary to ensure that these resources were not in vain. If an entire year of constant interaction with the villagers was needed to convince them, would the effectiveness of such an endeavor have changed had the project run for just one week, or even three? The abridged form of international medical activism has become a fad on college campuses. Washington University in St. Louis (WUSTL) hosts a number of medically-oriented trips that attempt such activism through groups such as Global Brigades, Engineers Without Borders, GlobeMed and China Care. These clubs share a similar component in their missions: providing awareness and potential solutions to issues affecting international communities. Just a few examples include playing with orphans after their surgery, innovating cheap and sustainable technology for use in under-resourced hospitals, and working toward preventing water-related ailments. How are these initiatives best implemented within communities that find Western healthcare methods foreign? According to Brian Redline, Internal Co-President of GlobeMed at WashU, “local voices and vision must drive community change.” Four GlobeMed interns work with their partner in Uganda for 8-10 weeks each summer, helping their partner implement local solutions to local issues. The sustainability of the benefits from projects is also dependent on how locals decide to utilize resources and ideas after volunteers leave.Without the consent and input of the community, ventures such as these would not be possible and would not succeed long after the trip ends. Claire Edelman, president of WUSTL’s chapter of Global Brigades, said that “Global Brigades strategically selects communities in which to begin working and does so upon the consent of that community.” Global Brigade’s national organization also addresses their model for sustainability. According

to their website, “the brigades alone aren’t enough. Projects need community members and local technicians to design and perpetuate them outside of brigades” (http://www.globalbrigades.org/model). Organizations also focus on creating tangible change in the communities where they work. Engineers Without Borders president Charles Wu said he was confident about how the group’s innovations were benefitting the local communities, as the group “goes back each year to check on previous years’ efforts in order to create sustainable projects.” In contrast, China Care volunteers work with a larger international organization, Half the Sky, which is theWUSTL group’s backbone. According to Delia Shen, co-president of China Care, sending students abroad is “more effective in raising awareness and exposing students to the international/global health problems abroad” than anything else. Students are educated about the issues plaguing the underprivileged in China in order to act as “ambassadors” when returning to St. Louis. The outcome-based approach and the education-based approach are two distinct methods of tackling change, both positive in their own right. While the outcome-based approach aims to confront international issues through visible change, it must be able to maintain the those changes by promoting community awareness and involvement in tackling the issues, especially after volunteers leave. On the other hand, the education-based approach utilizes the ties international organizations already have with communities. Thus, change is on-going through this approach even if that change is not necessarily brought about by WUSTL volunteers. The takeaway is this: creating change does not end with a week-long excursion to a foreign country. Many WUSTL organizations’ missions are not complete until “progress” and “change” can be supported by visibly higher standards of living in their selected communities. Efforts and benefits should not only be visible but also sustainable, and sustainability shows itself in different ways.

(http://globemed.org/approach/) (http://www.globalbrigades.org/model) (http://ewbwashu.org/about_us.html)

March 2014

globemed global brigades engineers without borders china care

length of trip

number of students sent

trip locations

areas of impact

approach

8 - 10 weeks

3-5

naigobya, uganda & iganga, uganda

maternal health, water, sanitation & hygiene, nutrition, income generation, communicable disease prevention, and capacity building

“partner: partner students with grassroots organizations to address health disparities,” “learn: educate and train student advocates for global health equity,” and “ignite: build a movement of people who believe in health and justice for all.”

7 - 10 days

15 - 40

ghana & honduras

medical, dental, water, medical, public health, microfinance, environmental, human rights, and architecture

“system of collectively implementing health, economic, and education initiatives to strategically meet a community’s development goals”

1 - 2 weeks

7-8

ethiopia & guatemala

water supply, sanitation, civil works, structures, energy, agriculture, information systems

“improve their quality of life through the implementation of environmentally sustainable, equitable, and economical engineering projects while developing internationally responsible engineers and engineering students”

2 weeks

10 - 12

beijing, china

fundraising, advocacy, mentoring, and visiting beijing’s china care home

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