#Premeded

As with similar Twitter chats, this will be an hour-long discussion about issues and questions related to pre-medical education as well as medical school and clinical practice every week. The day and time will be Wednesdays at 9 PM EST.

Here are some ground rules:

1. At the beginning of the chat, please introduce yourself, and tell us a little about yourself. Remember, the people who are there one night may not be there the next!

Ex. Saroj, pre-med, neuroscience enthusiast, Indian cooking maven.

2. Topics will be decided before each chat, but will likely branch out to other topics as the chat progresses.  Bring your chosen topics and questions to the table.  If they aren’t discussed one night, all efforts will be made to incorporate it into subsequent chats.

3. Be respectful and courteous to the other participants.  Your online persona should be one that you wouldn’t mind showing to adcoms and employers down the road.

4. HIPAA does not disappear when you move from the classroom or clinic to the computer. Keep your tweets HIPAA-compliant.  If you don’t know what HIPAA is, ask one of us.  One of the later chats will likely cover HIPAA as well.

5. While you may have a great book or MCAT prep class, do NOT advertise on the #premeded chat.

6. If you can’t make one of the chats, don’t worry! We know all too well that pre-med schedules can be hectic (and usually are). You can access the transcripts either on our Twitter page (@Premeded) or Facebook page (http://www.facebook.com/premeded).

Looking forward to chatting with all of you!

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Twitter basics

I realized that some of you who are joining the Twitter chat may be new to Twitter, so here are some basics that may help:

1.  To participate in the chat, just write your tweet and include #premeded somewhere in the tweet so that it gets included in the conversation.

Ex. Organic chemistry is so cool. #premeded.

2.  To respond to someone, type “@” followed by the Twitter handle of the person to whom you are responding.

Ex. sospokesaroj: No, neuroscience is far cooler. #premeded

premedstudent: @sospokesaroj In what universe? #premeded

3.  To follow what others are saying in the conversation, you can either:

a)  Go to twitter.com, click on “#discover”, and search for “premeded”.  All tweets in the conversation should show up in real-time.

b)  Use your Twitter client to set up a separate area to view all tweets with the #premeded hashtag.  In Tweetdeck, just clicking on the hashtag sets up a new column automatically.

If you have any other questions about how to participate in the chat, don’t be afraid to ask!

Social Media and (Pre) Medical Education

I joined Facebook back in 2004, only months after the site was launched. The internet, though I didn’t realize it at a time, was still a very disconnected place. Social media was fundamentally in its infancy, with Facebook joining only a few other social networking sites (MySpace and Friendster come to mind). Twitter and many other social media sites were just thoughts at that stage. Aside from Facebook, the only way I connected with other people was through AOL Instant Messenger, if even that.

Eight years and some 900 million Facebook users later, social media has exploded onto the scene. Rare are the websites that DON’T have a share button that allows users to share the site with users on many different social media outlets. Early on, I used Facebook exclusively to keep in touch with close friends. In contrast, I created this blog to disseminate information. Soon after I started blogging, I discovered Twitter and the medical community that was burgeoning there. I then began to explore using social media for learning more about healthcare and medicine.

People are slowly recognizing the vast potential of social media, especially in the context of healthcare. Not only is it poised to be an important tool in clinical practice, but also in training new generations of physicians. There is a hashtag #meded for a Twitter conversation that takes place weekly, where participants discuss medical education, any problems observed, and potential solutions. It, along with the #hcsm (Healthcare Social Media) Twitter conversation, represents a great forum to propose innovative ways to improve the field of medicine and medical education. I think for students, especially, it is an incredible asset. One can get a very broad perspective of medical education in general, and can reach out to others who are encountering similar problems and situations on their way to a career in medicine.

Speaking for myself, I am pre-med. When I will shed the “pre” part is unknown at this time, but that’s an entirely different topic. I am working, but I am still thinking about entering medical school down the road. I love Twitter, and I use it in part to connect with doctors and students, and to keep abreast of issues that are going on in both the education side and the clinical practice side. I tend to lurk in the background for both the #meded and #hcsm conversations, observing and learning, but not directly participating. I have learned a great deal, but this is information that will probably come in handy further down the road, when I officially start on the road to becoming a physician. What would be nice right now is a similar community for pre-meds.

There is a somewhat more cohesive community that exists on the Internet to provide a resource for pre-meds, as well as medical students and practicing physicians and other healthcare professionals to pose questions and get answers: Student Doctor Network. This is something that has been around for years, and many students have embraced. I have used this multiple times and I think it’s fantastic. However, it is somewhat static, compared to Twitter at least. Yes, people post answers, but it’s not quite the same. Twitter has the feel of a conversation among friends. The rapid-fire exchange of questions and answers feels more natural, and more human in some ways.

Now of course there is a community of sorts on Twitter. There are many pre-meds who have taken to Twitter for one reason or another, and who sometimes connect with other pre-meds along the way. Yes, we all come together to bond, complain, rage, and sometimes exult about classes, the MCAT, and medical school applications. Yet it would be nice to have a way to discuss issues that plague pre-meds from freshman year to the post-graduate years. Ideally the conversation could be fostered and archived under a hashtag. The resulting posts/tweets can be accessed readily later.

There are so many questions that arise for pre-meds even before they reach college. Which school should I apply to? Should I opt for a combined BA/MD program, or go the “traditional” route? In college, the questions can range from the general (What should my GPA be? What about my MCAT? Where should I do community service? Which doctor should I shadow?) to the painfully specific (What the heck is a racemic mixture? How much acid-base chemistry can one expect on the MCAT? What is the average GPA of students accepted to medical school X?). Pre-med is a label that encompasses a wide range of students from at least the age of 17 or 18 to those who are often in their mid to late 20s, if not older (as is the case for many non-traditional students). A social media community dedicated to pre-med issues would be a wonderful way to not only allow these questions to be answered and grievances aired, but it represents a great opportunity for mentoring of younger students by older ones who have had more experience. Having pre-medical advisers, medical school admissions staff, and medical school professors potentially join these conversations would add much needed perspective about what lies on the other side of that seemingly impervious wall called medical school admission.

I’ve been talking about Twitter quite a bit, because that’s what I tend to use most of the time, but other social media tools can be used as well. Facebook’s potential as a teaching tool is being explored in the context of medical education. However, there are some who have reservations with regard to its use in this context, especially if educators are involved, as outlined in this great blog post by Anne Marie Cunningham of Cardiff University in the UK. Blogging, though considered antediluvian by some nowadays, represents another opportunity to detail experiences and forge bonds with others who are in similar situations, and get answers from those who have walked down the same path.

Think of how great it might have been for you to have a community right at your fingertips, where most (if not all) of your pre-med questions can be answered, and readily at that? It’s something that I definitely wished I had early on. While SDN has its benefits, at least on Twitter, there is a greater sense of openness and trust that enhances the learning experience in that context. I have communicated with students and doctors, and they have been wonderful sources of insight. I consider many of them to be friends and invaluable sources of information. It would be wonderful to see universities embrace social media as a powerful source of information and a teaching tool not only for pre-meds, but for all students. Social media participation should be encouraged, but it would be nice to see classes being offered to students that taught them about using social media wisely and managing their online reputation. Perhaps professors can get in on the act and provide information to their students on the social media groups, sites, and hashtags where conversations about topics that are being covered in their class. The possibilities are endless.

Thoughts? Comments?

Social Media as a Tool for Patient Empowerment in Developing Countries

When I was in India recently, I spent time with one of my relatives. While I was there, he came down with a minor cold, and walked to the doctor’s office just down the road. I stayed at home until he came back. When he did return, he had with him a packet of various pills all mixed together. None of them were labeled, nor did they come with a set of instructions. He didn’t know what any of them were, just that his doctor gave them, so he took them.

A week later, I found myself talking to the servant that had come to clean our apartment. Her son had been ill for sometime, and I knew something about the condition from which he had been suffering, because someone had explained to me earlier. Yet when I talked to her soon after she had come back from meeting with her son’s physician, the way she tried to explain his condition to me struck me as completely inaccurate, given the condition in question.

In other instances, I have seen relatives sitting in the doctor’s office. Oftentimes they don’t say anything, and don’t ask anything, instead simply nodding in agreement. Yet when they were out of the office, the questions and doubts start flying. Usually the condition in question remained nebulous even after the appointment, or the procedures were not explained fully. Other times, they would take a decidedly cynical stance when it came to evaluating the doctor’s suggestions, believing that they were more interested in extorting as much money as possible instead of actually treating the condition.

To my eyes, at least in developed countries, patients seem to be more empowered in the context of the doctor-patient relationship. In the ideal scenario, the patient and doctor work together for a solution, with the patient actively engaging the doctor with questions and concerns, and the doctor giving the due attention and compassion. The patient may also have access to additional information through the internet.

Yet in developing countries, including India, many patients still to cling strongly to the doctor-patient hierarchy. What the doctor says, goes, in most cases. In areas with dense populations, few physicians, or a combination of the two, giving the patient the time they deserve can be a formidable task. Among those with less education, a lack of basic medical literacy can further complicate matters.

I recently attended NYMCSPAD (New York Medical College Student Physician Awareness Day). The theme for the day was Social Media in Medicine. All of the speakers–who are very active in social media applied in healthcare and medical education–discussed their personal experiences using social media, as well as advice on how to effectively use social media. One of the points that really stuck out is that patients who continue to ascribe to the “traditional” doctor-patient hierarchy are likely to be left behind. I thought back to my relatives and other people I know who are still content being passive, and not actively taking charge of their care.

There is no denying that social media has taken hold globally. Its value as a tool for patient education and empowerment is slowly being realized in the United States as well as in other countries. Patients, in many cases, vet their doctors by searching for them on social media sites to learn more about them and what they do. Social media is also being embraced in developing countries among physicians, medical students, and public health workers alike. However, I still believe there is still more work to be done to promote patient empowerment in those countries.

The doctor-patient hierarchy–though in many cases a cultural mainstay especially in developing countries–presents a very real barrier when it comes to tightening and improving the healthcare system. According to the World Health Organization, patient empowerment can allow for a more efficient use of resources. Poor medical literacy is another barrier that makes patient empowerment that much difficult among patients who are unsure about the particulars of their own health. While for many in developed countries, information is quite literally at one’s fingertips thanks to smart phones, the same is not necessarily true for the majority of people in developing nations.

While the knee-jerk reflex for many is to develop an app that can be used on smart phones, it doesn’t solve the whole problem, especially considering that smart phones aren’t as pervasive a presence in most of the world as they are here. In India, there are about 20 million smart phones available, but given that there are just over a billion people in India, it represents a very small percentage of the population. However, there are over 900 million cell phones in use. Similar trends are true for other developing nations, with cell phones being available to at least 50% of the population in many cases. Cheap cell phones are often readily available to the majority of the population. I have often observed the very poorest toting a cell phone.

Facebook, Twitter, and other social media platforms are all useful in their own right. Among social media tools, Twitter seems particularly well suited as a way to improve medical literacy and increase patient empowerment in developing countries. While most users use Twitter through Twitter apps and clients on their smart phones and computers, even those with cell phones can send and receive tweets. Before I got my first smart phone back in 2009, I used my regular cell phone to tweet.

So who would these patients tweet or follow? Doctors, medical organizations, medical schools, and other research institutions are just a few that come to mind. The issue with developing nations on the whole is elevating the patient so that they are on an equal playing field with their doctors. They need to feel like they can ask questions of their healthcare providers, that they can trust these providers, and be well-informed about their health and any prescribed treatment. While part of this can be solved by trying to impress upon the patient that the doctor is a partner in their healthcare, part of it can also be solved by improving the patient’s medical literacy.

Medical literacy has been of particular interest to me ever since I took a class on immigrant health for my public health program. A lack of medical literacy can contribute to a whole litany of problems, including early deaths. The issue in many developing countries is not only the lack of medical literacy but the lack of literacy in general. Combining this with the fact that many still cling to preconceived notions and superstitions can further complicate things. Here, the use of a non-written medium, such as Youtube, can be used to effectively transmit information about various aspects of healthcare. The use of video allows for not only circumventing text entirely, but easily adapting the content to the local languages and cultures. Given the likely poor access to technology in poorer communities, the onus is on physicians and public health officials to make this information available to them.

This is something I have thought about for a while, but revisited with renewed interest after attending NYMCSPAD. Do you know of programs currently utilizing these and other approaches that have been conducted to date? What are they? Do you have any other thoughts on how to promote patient empowerment in these regions? Comment away!

The Cost of The Flu

As the weather warms up, flowers start to bloom, and allergies kick in (sigh), it’s fair to say that the flu season is (pretty much) behind us. However, it’s important to understand the financial cost of each flu season.

I got an email from someone at FrugalDad (http://frugaldad.com) with a link to an infographic that very clearly lays out the costs of preventing/treating the flu. What stuck out to me was the pretty significant difference in cost between vaccination versus enduring a bout of the flu and all the costs that can come with it. Bottom line: vaccination not only saves you a lot of the physical agony that can come with suffering from the flu, but it can save you a lot of money as well.

Source: FrugalDad.com

Early Puberty in Girls: What We Know and What The Government Has Done (Or Not)

Can you imagine puberty occurring at around the age of 6, or even younger?

It’s happening.

Puberty is the inevitable rite of passage that everyone will go through. There are changes in shape and mood, in appearance and outlook. Its onset at around age 10 or 11, and continuation into one’s mid-teens is considered normal, with most processes wrapping up by the time high school graduation rolls around.

Early onset of puberty in girls is starting to become the new norm, and has been profiled in a recent New York Times article. Girls as young as 4 or 5 have been sprouting pubic hair and demonstrating signs of budding. At that age, most children are barely capable of putting on clothes by themselves. They are only starting to learn how to navigate their way around their social circles, and falling into the routine of school, play, and homework.

Ladies, can you imagine having to contend with the mood swings and physical changes while dealing with the mean little girls who pull your hair and call you names. Can you imagine dealing with all of that while the boys still are considered “icky” and have “cooties?”

The risks are not surprising. There is a higher risk of drinking, substance abuse, eating disorders, depression, and engaging in risky sexual behaviors. The question is, how do we protect our girls?

While there are some means of slowing down these changes through pharmacological means, preventing early onset altogether is probably the best approach. There are several potential causes, among them family problems/stress, obesity, and exogenous hormones/xenoestrogenic compounds. While the first two causes can be controlled to some extent, the last one is not necessarily something that can be controlled by the average consumer.

Hormones are chemical compounds that are produced in one site (endocrine gland) and are transported to other target sites via the blood. We are exposed to hormones through our food supply, at least in cattle, where hormones are sometimes given to boost growth. Xenoestrogens (literally foreign estrogens) are compounds that occur outside of the human body, but mimic the effects of estrogen in the human body. Many plastics can be sources of xenoestrogens, notably ones that contain a substance called bisphenol A (BPA). A Twitter follower directed my attention to her blog post, which is a wonderfully informative piece on the role these hormones/hormone mimics may be playing. While some measures have been taken on the part of states and select companies to eliminate BPA from their products, it remains a ubiquitous substance, and it is believed that well over 90% of the U.S. population has at least trace amounts of BPA in their bodies. In the New York Times article, Frank Biro (a researcher in the field) believes that based on existing data that demonstrates that endogenous estradiol levels are very low in girls with early breast growth, nonovarian sources of estrogen are likely the culprit. Perhaps these could be estrogen/estrogen-like chemicals occurring outside of the body.

Research demonstrates that many xenoestrogens, including BPA, are active at nanomolar/picomolar concentrations (1). In rats, early exposure to BPA has been correlated with an early onset of puberty, as well as increased problems with fertility, including a condition resembling polycystic ovarian syndrome (2-3). One of the mechanisms of BPA’s xenoestrogenic activity was demonstrated in non-human primate endometrial cells, where BPA co-administered with estradiol decreased the expression of endometrial progesterone receptors (4). The presence of many endocrine-disrupting compounds has been discovered in the urine of young girls, and a correlation between prenatal BPA exposure and behavioral problems among girls has been shown, though the latter results should be taken with a grain of salt given the modest sample size (5,6). Nonetheless, the fact that any correlation was shown is cause for concern at the very least, and warrants further study.

According to the Milwaukee-Wisconsin Journal Sentinel, after lobbyists from the plastics industry met with officials in the Obama administration in early 2010, BPA was left out of an Environmental Protection Agency action plan drawn up to regulate chemicals identified as dangerous. Recent efforts to regulate or ban endocrine-disruptors such as BPA, or research endocrine-disrupting chemicals have stalled at different stages:

1. In the 111th Congress, Senator Chuck Schumer (D-NY) sponsored bill S.753.IS, called the “BPA-Free Kids Act of 2009.” It died in the Senate.

2. The same bill was sponsored in the House (H.R.4456.IH) by former Representative Anthony Weiner (D-NY). It died in the House.

3. Representative Louise Slaughter (D-NY) sponsored the “Environmental Hormone Disruption Research Act of 2009″ (H.R.4160.IH). It died in the House.

4. The “Ban Poisonous Additives Act of 2011″ was introduced in the Senate by Senator Dianne Feinstein (D-CA). It has yet to be referred to committee.

5. As of January 25, 2011, the “Ban Poisonous Additives Act of 2011″ that was introduced in the House by Rep. Ed Markey (D-MA) has been referred to committee, but nothing has transpired since then.

The apathetic attitude of the government towards endocrine-disrupting agents can only spell disaster for future generations. Though research to date does strongly suggest that these are dangerous substances that can cause dramatic effects in the way the body functions, more research is needed to further understand how they may be affecting normal development. This necessitates government support. The fact that many politicians appear far more passionate about regulating women’s health rights, rather than protecting our children from a very real public health threat, is appalling and a sign that our priorities need serious rethinking.

I hope that things change. I hope that politicians will realize that addressing public health issues should always trump entertaining the whims of corporations. I hope that the government won’t continue to bow to pressure from industry lobbyists, and will eventually recognize the danger of these substances and pass the appropriate legislation to fund research and ban them from commonly-used products. If I have daughters, I want them to grow up in a world I know is safe, so that they can enjoy being girls, and won’t start the trek towards womanhood at the behest of foreign chemicals, but when they are good and ready.

1. Wozniak AL, Bulayeva NN, and Watson CS. Xenoestrogens at Picomolar to Nanomolar Concentrations Trigger Membrane Estrogen Receptor-α–Mediated Ca2+ Fluxes and Prolactin Release in GH3/B6 Pituitary Tumor Cells. Environ Health Perspect. 2005; 113(4): 431–439.

2. Fernández M, Bourguignon N, Lux-Lantos V, Libertun C. Neonatal Exposure to Bisphenol A and Reproductive and Endocrine Alterations Resembling the Polycystic Ovarian Syndrome in Adult Rats. Environ Health Perspect. 2010;118(9): 1217–1222.

3. Nah WH, Park MJ, Gye MC. Effects of early prepubertal exposure to bisphenol A on the onset of puberty, ovarian weights, and estrous cycle in female mice. Clin Exp Reprod Med. 2011;38(2): 75–81.

4. Aldad TA, Rahmani B, Leranth C, Taylor HS. Bisphenol-A exposure alters endometrial progesterone receptor expression in the nonhuman primate. Fertil Steril. 2011;96(1):175-179.

5. Wolff MS, Teitelbaum SL, Windham G, Pinney SM, Britton JA, Chelimo C, Godbold J, Biro F, Kushi LH, Pfeiffer CM, Calafat AM. Pilot Study of Urinary Biomarkers of Phytoestrogens, Phthalates, and Phenols in Girls. Environ Health Perspect. 2007;115(1):116-21.

6. Braun JM, Kalkbrenner AE, Calafat AM, Yolton K, Ye X, Dietrich KN, Lanphear BP. Impact of Early-Life Bisphenol A Exposure on Behavior and Executive Function in Children. Pediatrics. 2011;128(5):873-882.

Ten years later…where do we stand?

I feel like I’ve written or told this story a hundred times before. I’m not even sure if it made out into some tangible form, or if I replayed the events in my head from time to time over the last decade. Every passing September makes my heart ache. I was thankfully not directly affected by the tragedy that day, but it affected me nonetheless.

I remember that September 11, 2001 had started off as a bright day. Bright enough to coax me out of bed, and out of the house, on my way to high school. It was only the second week; classes had not yet lost their novelty. The first two classes passed unremarkably. Even if you asked me, I wouldn’t be able to remember what those classes were. My third class, though, I will never forget.

It was science research, a class devoted to introducing students to lab techniques and research skills. It was a little past 9:40 AM, and several of us were gathered around the desk to the far corner of the room, talking about whatever high school sophomores talk about. One of the girls came running in a little after class started, and exclaimed that planes had hit the World Trade Center. She was someone who had a tendency to be a little silly, if not outlandish, and so I didn’t believe her at first. Who would want to? It was when the wood shop teacher walked in from next door, solemn and silent, that we realized that something indeed was wrong.

We were shepherded into his classroom, where a TV had been wheeled in, blaring the news. There we stood or sat, transfixed, watching smoke billow out from the angry, blazing gashes that had torn through each World Trade Center tower. I remember some students crying, some were talking out loud. Others were anxiously calling their parents who worked at or near the World Trade Center. I don’t remember what I felt exactly, probably because at that moment, I felt empty. I had no idea how to react, because what had happened was so beyond the scope of what was possible, that my mind and body were blindsided. I watched, as though in a trance, as the smoke continued to pour out, and the voices of the news anchors danced nervously around, unsure quite how to react themselves. Gone was the notion that the United States was, somehow, impervious to outside forces. Wars were supposed to be few and far between, fought oceans away, not in my own backyard. Any impression of peace and stability was quickly and mercilessly eviscerated.

I remember that a good friend of mine was sitting next to me, palpably frightened, though perhaps only comforted by the fact that she had discovered that her mother was not in harm’s way. We were sitting together when, at 9:59 AM, the South Tower began to collapse. Forever etched into my memory is the sound of the small scream that escaped my friend’s lips at the moment the roar of the flames and the crunching sound of failing structural beams became one, as everything screamed towards street level. For me, that was the sound that marked the boundary between what once was, and what is now. Innocence, and innocence lost. The start of a terrible new chapter, but everyone was too frightened to willingly turn the page.

I remember that when I left the school that day and looked west, the sky was now covered with a faint, gray haze. “Smoke from the Twin Towers, most likely,” said a friend of mine.

Later that night, I remember sitting on my bed, thinking about the the day’s events, and of what happens now. I was thinking about the thousands upon thousands of bodies scattered throughout the site: some dead, some barely clinging on, and the rest working to save them. Death was not something I was familiar with, let alone on such a scale and in such close proximity. That was the first time that I openly wept that day.

I was scared, not only for future attacks from beyond our borders, but attacks from within. Hate crimes had started almost as soon as word had gotten out that the terrorists were mostly Arab Muslims. Anyone who looked potentially Arab and/or Muslim was a target, including my family, my friends, and me. I heard stories about not only Muslims, but Sikhs and Hindus being taunted, beaten up, and in some cases, gunned down. All paid the pound of flesh that they did not owe. While the incidence of those crimes died down almost as quickly as they had appeared, the simmering anger against Muslims was still present.

Ten years later…

Ten years later, Osama is dead, along with thousands of people with terrorist leanings. So is Saddam, and hundreds of thousands of Afghani and Iraqi civilians. So are thousands of US soldiers.

Ten years later, Muslims (and to some extent many South Asians) are still vilified. Every opportunity to throw stones seems to be taken by people who don’t understand that the sins of the few should not fall on the shoulders of the whole group, and that just because the color of our skin is the same as another group, doesn’t mean we are the same. If you don’t believe me, look at any news story that involves a Muslim, and read the comments from the readers. It is shameful.

Ten years later, The first responders, who put aside family and other responsibilities to toil at the smoldering remains of the World Trade Center, have had to pay a huge price for their sacrifice. Many have developed significant respiratory issues, others have developed cancers that normally occur far more rarely. For this, they have received little, aside from empty words of support and promises, as they face further death and disability. Slowly, steps are being taken in the right direction to provide compensation, but they deserve far more than that.

Ten years later, we receive word of another “credible” threat though “unconfirmed.” I truly hope that nothing happens. Yet, this is just another stop on the paranoia roller coaster many of us in the United States have been riding since 9/11. At this point, I feel like the way in which news outlets cover stories about terror threats, acts of violence, and other similar events has moved so far beyond “the boy who cried wolf” that every threat, credible or otherwise, has become background noise to me. It shouldn’t, but it has. This is what fear-mongering does. It saturates and obliterates any ability to discern what is worth worrying about, and what can be put aside.

Ten years later, I worry that I have descended into a kind of cynicism. I want to believe that, as a country, we have grown closer post-9/11, and that we can look past everything and come together for the sake of peace and stability. Then I see the politicians railing against equality, diversity, and drive while championing xenophobia, a widening income gap, and ignorance. They fancy themselves patriots. The patriots who fought for our country over 200 years ago (yes OUR country) were fighting for freedom and equality for all. How quickly the definition of patriotism has changed! This only fuels my cynicism. If you want to meet a patriot, talk to some of the first responders who didn’t ask those they saved if they were immigrants, followed a different faith from theirs, or worked in a different income bracket before deciding whether or not to save them.

Ten years later, and I’m still admittedly worried.

Ten years later, and I still mourn the loss of life.

Yet…

Ten years later, what was Ground Zero–a smoldering pile of ashes, rubble, pain, and death–has slowly blossomed into something beautiful and full of hope. Even though I am in Manhattan very often, the last time I had visited Ground Zero was in 2008. It takes my breath away now, to see what has literally risen from the ashes. From 9/11 to now, we have been beating the terrorists everyday by living, building, and thriving. Yet we cannot truly win until we hearken to a more basic, but universal set of principles. That is to say, all are equal, and all should have the opportunity to pursue their dreams. Freedom, knowledge, and well-being are not objects that can or should be rationed, but rather, are undeniable facets of human nature that should be tapped, and never stifled for any reason.

The Persistence of Myth: Why Anti-Vaccination Sentiment Still Persists Post-Wakefield

On May 14, 1796, Edward Jenner tested his hypothesis that inoculation with cowpox can confer immunity against smallpox. The success of this experiment earned him the title, “Father of Immunology” and set the stage for the development of new vaccines.

On February 28, 1998, Dr. Andrew Wakefield published a paper in the prestigious journal The Lancet that would have significant public health ramifications. In his paper, he and his colleagues claimed that the measles mumps rubella (MMR) vaccine was linked with an increased incidence of bowel disease and autism among children.

These represent perhaps two of the most important dates in the history of vaccines. One that heralded the start of the age of vaccination. The other that appeared to herald the end of the public’s trust in vaccinations.

In the time since Jenner’s discovery, there has always been some underlying concern about vaccines as the vaccines themselves and the regimens in which they were included changed. The advent of thiomersal (thimerosal in the U.S.), an ethyl mercury-based preservative that was introduced in the 1930s, and the increase in the number of vaccines provided at certain points during infancy and early childhood have both been believed to be linked to the increase in the number of cases of autism. Yet it was Wakefield’s paper that seemed to provide confirmation that the MMR vaccine, and perhaps vaccines in general, were somehow responsible.

Fast-forward 12 years almost to the day, The Lancet paper that had spurred a passionate movement against childhood vaccinations was retracted. In the years leading up to the retraction, Dr. Wakefield had experienced a dramatic fall from grace, as evidence emerged that the data for the study was obtained under deceptive and unethical grounds, where the children involved were subjected to unnecessarily invasive procedures. His medical license was ultimately revoked.

Autism cases have been increasing, but the link to vaccines has not been independently verified in follow-up trials after the controversial Wakefield study. While the reason for the increase is not known, it is likely that it is probably more a function of our understanding of autism symptoms than a true increase. Even after thiomersal was removed from most vaccines (except influenza) and some have moved away from vaccinating their children, cases continue to rise. Yet people continue to vocally support Wakefield’s research despite the fact that it was discredited, believing that he was still a hero, exposing the “evils” of vaccination. Celebrities like Jenny McCarthy, whose own son is autistic, continue to champion the cost even at grave public health risk. She and then-boyfriend Jim Carrey released this statement in light of the retraction. There is still a feeling of “us” versus “them” where “them” refers to the pharmaceutical companies who produce the vaccines. It is understandable that parents of autistic children would want to pin the blame on someone or something, but once that something that seemed so irrefutable is taken away, it is difficult for them to deal with that reality. However, when people like McCarthy continue to peddle this false evidence and perpetuate false notions, there are far greater dangers that lie ahead.

As the anti-vaccination movement gained speed among parents, the incidence of measles, mumps, and rubella increased nationwide when, previously, there had been few if any cases reported. Now, clusters are becoming increasingly prevalent among infants all over the U.S., some leading to death. These are deaths that could have been easily prevented had parents chosen to vaccinate their children. Instead, they felt that the supposed risk of autism outweighed any benefit of vaccinations.

The retraction was over a year ago, and the effects are still being felt today. Unfortunately, the retraction came too late, and thousands of well-meaning parents have already been duped and set events into motion that have brought about the rise of previously preventable illnesses. With respect to the rise in autism cases, rather than continuing to point fingers and hold tightly to theories that have been soundly discredited, our energies should be devoted to understanding the condition, possible causes (verified by sound research), and potential safe therapies. In the meantime, continued efforts need to be made to educate the public about the benefits of vaccination. The risks of choosing not to vaccinate are, infinitely more dangerous than the risks of vaccination.

Japan: past experiences and current hopes

I fell in love with Japan at the age of 3, after watching the Sesame Street special “Big Bird in Japan.” I wanted to visit from the time I saw that special, and got my wish four years later, when my family and I took a trip to Japan. I fell in love all over again, in the way only a 2nd grader can: completely.

At the time, I remember being surrounded by a vast array of colors, the bright lights of Osaka and Tokyo, people whose manners and etiquette made New Yorkers come across as cavemen. I was floored by the modernity when I first got to Japan. Even in the early 90s, Japan was a hub of technological achievement, especially epitomized for me in a smooth, seamless journey on the shinkansen (bullet train) from Osaka to Tokyo. In Nara, I was introduced to the ancient, as it resided alongside the modern. The Todai-ji temple was a glorious site to behold, with its pagoda architecture, giving it the appearance of having wings. Inside, it housed a 50 ft. massive bronze statue of the Buddha which, for someone who was still somewhat below 4 ft. at the time, was an unbelievable marvel. Marbled through modern Japan remained an ancient sense of etiquette, propriety, wisdom, and duty, which was clear in our interaction with the people.

In the years since then, I have kept my love affair with Japan alive, even though I haven’t gotten to set foot on Japanese soil since my first trip. I took two years of Japanese in high school, an Asian religions class in college that covered Zen Buddhism, and have devoted some of my spare time to learning more about the culture.

When I heard about the tsunami in Japan, my heart sank. Yes, Japan had been subject to many natural disasters in the past decade or two, from snowstorms to earthquakes, but none were remotely of the same magnitude as this. As pictures and news stories started to pour in, I began to see just how destructive it had been, and how far-reaching the effects were. Sleepy fishing villages were torn apart and turned upside down, while Tokyo was strewn with debris and rubble. Countless thousands were dead, with thousands more left homeless and alone. Ultra-modern Japan had been brought to its knees by nature. With the added threat of radiation leakage from damaged nuclear reactors, Japan faces a new threat that could have ramifications for decades, if not more.

In the face of disaster, whether at the hands of nature or man, the people are often thrown into chaos, and turn inconsolable, enraged, and sometimes violent. It is a normal reaction to suddenly abnormal and adverse circumstances. What struck me as unusual about Japan is how little of that there appears to be. Yes, there is grief and frustration, but paramount to those feelings was a resolute sense of duty, a duty to rebuild both cities and lives. The so-called “Fukushima 50″ have gained international attention for their extreme dedication to keeping the nuclear reactors at the Fukushima I Nuclear Plant from melting, while subjecting themselves to levels of ionizing radiation that are several orders of magnitude above what would otherwise be safe.

Perhaps this reaction isn’t entirely unusual. The Japanese people, after all, were on the losing end of World War II and the only country to become a victim of nuclear warfare that had horrific consequences for Hiroshima and Nagasaki. Yet, they were able to recover from that level of destruction through resolute determination, and so it would only make sense for them to put their collective energies solely towards the business of recovery and rebuilding. Duty and industriousness was something I got to see as a tourist in Japan, and are qualities that persist now. It is reflective of the hardy culture that has endured for centuries, through dynastic upheavals and wars, and will likely help them endure for many more centuries.

My thoughts and prayers are with the Japanese people.

Concierge Medicine

I came across this article in the New York Times about Internet medical practices. It’s something I’ve been very interested in, especially in light of the recent push for health care reform amidst increasing cost of care with fewer doctors available to provide services, notably primary care.

It seems as though medicine has been dogged about maintaining the old ways, and while it embraces technology in the context of new treatments, little has changed as far as the way practices are run. With devices like the iPhone and Android-based phones, with its multitude of apps, some practices have found ways to use these and other technologies to their advantage. This has resulted in automation of many processes that would normally be handled by an army of administrative assistants, cutting costs, and saving time that can then be spent with patients.

While not everything can be done online (auscultation, palpation, neurological tests, etc.), some things such as monitoring blood pressure (as referenced in the article) can be done relatively easily over email. It certainly beats the usual method i.e. go to the clinic, wait for hours, get maybe 10 minutes with your primary care doctor, and maybe a prescription if warranted, all for the sniffles. I find this incredibly frustrating, and I’m pretty sure I’m not alone. So, if there is a way for me to stay home, communicate with my doctor, and get the same care (if not better), then I’m all for it.

It would be incredibly cool if some of the more specialized areas could also save time by doing some of their tests through an Internet-based medium, as well as implementing similar measures to reduce overhead costs. Of course this would only apply to a few areas, perhaps psychiatry, some aspects of neurology, and select others. Nonetheless, it is worth considering, and perhaps could be done relatively easily, given the ability of devices like the iPhone to be used to monitor things like heart rate already.

What do you all think?

Upheaval in the Middle East?

It would seem that the events in Tunisia have sparked a call to action across the Middle East, most recently in Egypt. There are also signs that Jordan may be the next to join the fray. While it is encouraging to see people seeking to oust the old guard in favor of something more akin to a democracy, my concern is that fringe elements may try to pander to the people’s need for change by injecting their questionable views into the mix in the hope that they may take root.

I hope that change does come to the region with little chaos, and heralds in an age of greater strides in technology, social reform, and entrepreneurship. I mean, the Arab world has given us a lot that we take for granted nowadays, so who knows what else may come from that region. It would be very cool to see what ideas come to the surface if they are given the chance to shine.