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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?
For those of you who know me know that I am, simply put, neuro-obsessed. Here’s where I try to justify that.
Think about the human body and how incredibly complex it is. Think of all the chemicals that course through your bloodstream to regulate this organ or that, that allow you to grow and mature. Think of the electrical and structural precision that is needed to keep your heartbeat normal. Think of the myriad events that go on to maintain normal digestion even when you are unaware that it is going on.
Now think of the brain and think of the fact that it regulates all of it. A three-pound (give or take a few ounces), gelatinous and convoluted mass of neural tissue sitting comfortably in your cranium regulates all of it. I think that’s pretty cool, right?
Consider this a kind of (grossly simplified) neuroscience primer from someone who has neither an M.D. nor Ph.D (so take it for what it’s worth).
Humans are programmed to experience fear, because fear is a useful response to noxious stimuli. Yet, there are those fears that are more irrational that others.
I suffer from ligyrophobia. Ligyrophobia is defined as the irrational fear of loud noises. Balloons popping, fireworks, thunder, explosions, dogs barking, and (even at one time) vacuum cleaners used to scare me beyond words. Of course, now it’s greatly improved for the most part. It may seem silly, being scared of loud noises, and it is. I’ll be the first to admit it. My mother blames it on the fact that she went into labor when a car backfired right next to her. I’m not too sure about that, but there is something to be said for traumatic events setting one up for a lifetime of phobias.
The suffix “phobia” itself derives from the Greek, meaning “fear.” A host of prefixes can be attached that denote the specific fear. Agoraphobia is a fear of open spaces (or conversely, leaving one’s home), agora referring to the ancient Greek, open-air marketplace. Arachnophobia is a fear of spiders. The list goes on, with some of the fears being especially off-beat. Fear of hippos. Fear of wrists. My personal favorite is fear of peanut butter getting stuck to the roof of your mouth. Arachibutyrophobia. Try saying that ten times fast.
Emotional memories, especially fears, are generally encoded in the amygdala. The amygdala (from the Latin for “almond” because of its shape) sits in the middle of the brain, and is also encircled by the hippocampus, another important memory-related structure. Yet it is interesting because fear itself is not totally dependent on memory, per se. In an experiment conducted during the turn of the 20th century, it was observed that in a Korsakoff’s patient, pricking her hand would result in her being less likely to shake the researcher’s hand, but she couldn’t pinpoint why that was the case. In Joseph LeDoux’s lab at NYU, rats who were conditioned to associate a 30 second tone with a small shock to the foot. Eventually, rats would freeze and/or display other typical fear responses to the tone alone. Some rats were given amygdalar lesions and lost the conditioned response that they had to the tone, and reacted as though there was no association at all. The response to shock, though, was unchanged.
The amygdala is hardwired to pair variables together, usually sights, smells, sounds, and certain touches to events, positive and negative. Perhaps in phobias, there is a a tendency to overextend and associate seemingly innocuous objects with a negative response. fMRI studies have confirmed the link between amygdalar activation and phobic responses in humans (in this case, with arachnophobes).
So is there a way to really cure phobias? Not really anything much more than strength of will and perhaps therapy. Some fears are easier to overcome than others. It has taken me years to get over some of mine, but will probably take many more to get over it completely. For me, ligyrophobia is something I have had for as long as I can remember. Getting rid of something so rooted in your psyche is a challenge, a challenge which I don’t mind taking. It helps a little, to know the biological underpinnings for why we fear, it makes fear less nebulous and more conquerable. It also helps to have a strong support system, friends, family, and loved ones usually make any task a lot easier.
“There is nothing to fear but fear itself,” Franklin D. Roosevelt once said. Certainly misplaced fears should be avoided, but I don’t think there we should ever attempt to fear nothing, because fear is after all a much-needed survival response. Some spiders, sharks, lightning (at least, close-range), and other things are obviously dangerous, and should be feared and avoided to a degree. I think Ellen DeGeneres summarized this and other points in one of her monologues the best, and I’ll leave you with that.
Dear Readers,
I figure after 3500+ views in a little over a month, I should probably welcome all of you who read my blog. Welcome, bienvenidos, bienvenue, welkom, swaagat, swaagatham, and (insert welcome of choice here). 
I’m so glad to see this blog has started to blossom and attract numerous viewers. I hope you are finding the posts informative and maybe even entertaining. I will try to keep the topics varied and interesting, so that everyone can find something to read and enjoy on this site.
Thank you so much for your support, kind words, and even criticisms. Here’s to hoping this blog continues to thrive!
Love,
Saroj
I will tag this with the tags for the aforementioned post. If you want the password, you will have to comment on this post and I will email it to you.
We all dream. In fact, over a lifetime, we spend about six years dreaming. Six years! Imagine what you could do over six years of your life.
So my question is, should dreams be treated solely as the product of neurotransmitters and REM during sleep? Or should they be interpreted as something deeper, steeped with meaning? For someone like me, who is both an aspiring doctor with a fondness for neuroscience and a deeply spiritual person who deals in the abstract, it’s a bit of a debate.
Neuroscience hasn’t gotten around to providing a concrete biological definition of dreaming, but there are theories being thrown around. This is the best summary I can come up with:
During sleep, your brain goes through periods called rapid eye movement (REM), where (if one were to do an EEG) the resulting brain waves during those periods look remarkably similar to those from wakefulness. Scientists have postulated that several neurotransmitters are involved in creating the dream state, while a host of others are suppressed. The result is a situation similar to wakefulness, but also a state of virtual paralysis so as to prevent the sleeper from acting out the motions in his or her dreams. Curiously enough, a chemical called dimethyltryptamine (DMT) is suspected to have a large role in creating the dream state. Among other things, it is a psychedelic agent. Need I say more?
Yet of course, there are others who treat dreams differently. Sigmund Freud and Carl Jung published numerous case studies where they analyzed patients’ dreams. They, as well as several psychologists downstream, held that dreams reflected the interplay between the conscious and the unconscious. The unconscious allowed thoughts inaccessible to the conscious to bubble to the surface during dreams. Dreams, therefore, could be interpreted to get at the underlying emotions.
So who’s right? The neuroscientists or the psychologists? I’d like to think both are right.
Yet interpreting dreams is an inexact science that is open to many, often wrong, interpretations. Is it really worth it? Sometimes it helps to give some degree of closure or clarity, since dreams have a tendency to just be downright strange, if not emotionally charged. That’s of course, if you can get at an interpretation that achieves that end.
Then there are the prophetic dreams. Some say they’re religious experiences, some say they’re random events. Others argue it’s the brain putting 2 and 2 together into some logical conclusion that turns out to be right in real life. I, however, am not sure. I’ve had a few of these, and I can’t describe them any other way other than inexplicable.
Why do some people experience dreams differently from others? I have talked to my friends about my dreams, and find that among many of my friends, I tend to have very vivid dreams replete with the whole range of sensory experiences: color, touch, smell, sound…heck sometimes music. Others I know tend to have consistently bizarre, and often humorous dreams. Others still have violent dreams. Perhaps it’s a function of our individuality, including how we deal with experiences that we may have had in our day to day activities that have since sunk into our subconscious.
So will we ever solve why we have dreams, and how to deal with them? Probably not, but what say you, the reader? How do you deal with dreams? Any interesting ones?
I interviewed with a doctor yesterday for a research position, and found myself saying the following words:
“I have been working in labs for the past 7 years…”
Good Jesus…and I don’t have a Ph.D yet?
Nonetheless, getting into a medical school involves an unwritten rule: that you will sell your soul for a certain period of time to a research lab of your choosing. There you will be the willing and able slave of your PI, and do whatever he/she orders. That’s not really the reason I do research though.
I’m fortunate to have had a research program in my high school, which introduced students to the various techniques and concepts that one normally encountered in labs. While it was, in essence, a breeding ground for new Intel entrants, it was also where I realized I loved research.
My first project looked at the possible xenoestrogenic effects of polystyrene leechate. While I didn’t get statistical significance with my work, it was enough to make me extra wary of getting my coffee in a styrofoam cup. There was something thrilling about having my own project, tweaking the parameters, working with the specimen, seeing the results. Oh seeing the results is the best part. For better or worse, I think ego drives a better part of the scientific community to do what it does, but sometimes people can make the leap from getting thrilled at seeing their name in a journal article to getting thrilled at seeing their discovery in a journal article.
Needless to say, since then, I’ve been around the block. I’ve worked in many labs, and I’ve loved all the experiences I’ve had. Some were obviously better than others. In terms of the projects that were covered, I think all were fantastic. In terms of how I gelled with both the lab setting and the people? Sometimes there was something left to be desired. Here is how I categorize all the labs I have worked in, names and locations have been left out to preserve anonymity (but if you know me you will probably be able to guess which one is which):
1) The lab with the lone, hermit grad student, and the PI. The grad student is like a mother hen around her work and is reluctant to bond with new students. The PI kind of does his own thing. The equipment is so-so. The work is mostly benchwork, molecular biology stuff.
2) The lab with no grad students, just a sweet…albeit absentminded PI. The work is interesting, animal-related, but the lab space is dreary, old, and has no windows. Most of the equipment and office furniture is decades older than I am.
3) The lab teeming with students, but the PI is kind of abrasive at times. When he is not talking about science, though, he can be borderline personable. No one really bonds terribly well despite efforts at achieving that end. The lab is well-lit, and the equipment is mostly new. The work is bench work.
4) The lab with students from all walks of life. The PI mostly remains in the shadows, but the older students take you under their wing. Bonding happens readily, and bonds remain well past the research stint. The lab is cutting-edge, and scenic. The work is animal-related, but it is a marriage of a lot of disciplines and a lot of cool techniques.
Most labs probably fall into these categories, or some variant of it. Needless to say, I liked lab 4 the best. Science is important, but sometimes the best labs are the ones that both produce the great discoveries and foster the best bonds. Contrary to popular belief, social connections are important to scientific progress. Being a hermit isn’t what being a scientist is about.
Science has unfortunately taken a back seat in this country. We have let science and math education falter and wither, and are sitting back passively as the world passes us by. This needs to change…maybe by fostering research among students more aggressively. It’s a way to generate interest at the trench level, so to speak, instead of speaking solely in theory.
So obviously I want to be a doctor, and this will help me to better understand medicine, in some senses. Yet I genuinely enjoy the research process in of itself. You can call me a nerd if you want to, but come on, there’s something cool about being in a lab with other people who are all striving to learn something new and interesting, and taking matters into their own hands by designing ways to reach that goal.
And to think Sarah Palin derided fruit fly research as something inconsequential? Seriously, she’s missing out. :p
http://news.yahoo.com/s/afp/20081106/ts_afp/healthsciencestemcelljapan
This made me very happy. The theory, to date, has always been that neurons are differentiated to the point that they cannot replicate in the event of any sort of damage. Hence, if you lose a neuron, you can’t replace it. This has been the problem in dealing with diseases and conditions that are characterized by targeted or widespread loss of certain neural pathways: Parkinson’s and dopaminergic neurons in the substantia nigra, Alzheimer’s and acetylcholinergic neurons, heck ecstasy use and 5-HT (serotonin) pathways, etc. etc.
The results of this study are promising: they were able to generate functioning tissues (not just cells) from stem cells. Besides serving as another way to study neurological conditions, perhaps without so much of a need for rat or other models, the fact that functioning neural tissue can be generated means that several diseases characterized by a loss of neural tissue may be able to be cured.
Now to deal with the matter of funding stem cell research more strongly…
This one deals with those fruit fly comments Sarah Palin made not too long ago…
It’s the classic developmental cliche: the disenfranchised youth. Gone are the marionnette strings and off they go, puttering about, trying to establish their views on the world without the influence of parents. Faith, whether it’s in religion or anything else, tends to fall by the wayside. Cynicism reigns supreme. So does faith have a place in the minds and hearts of the youth, or is it better suited for the later years, when the tumultuous waves of adolescence and young adulthood have subsided?
Ok I’m pretty religious myself…more like spiritual, but this isn’t a call for people to flock to religion per se. It’s about having something that anchors you to some reality, to some constant, to some truth… For me, that’s spirituality and science (two seemingly irreconcilable entities, but they work surprisingly well together). For another person, it may be economics (ok not sure about that in the current economic climate but who knows). To not have anything to hold on to seems almost inhuman. To be apathetic means to not fulfill a core aspect of our being human: to believe in something.
Faith gives direction and faith gives strength. Faith in a politician could both settle our own nerves and give that person the strength they need to see their mission through. Faith in a set of ideals lends credence to those ideals. Faith can be misplaced, but that’s part of the learning process; knowledge and experience is key to well-placed faith. Faith should never be forced onto another person or onto one’s self, it is something that is personally grown and nurtured, not force-fed.
In this election, we cannot afford to be apathetic…we have to have faith. Our collective faith was misplaced eight years ago, and again four years ago, but not anymore. We cannot sit on the sidelines and cite our lack of interest, or a lack of faith as a reason to not vote. Not now, especially not now. I’m not saying vote for Obama or vote for McCain. I’m saying get excited about someone or something in this process, this is about redeeming our country from eight years of ignorance and rash decisions that have cost us our place in the eyes of the world.
The youth are finally getting swept up in the urgency of the moment, they have found grounding in the messages of our candidates, but still it seems as though most are seemingly uninterested, thinking that this decision is still not that important, thinking that politics are still beyond their scope of interest or caring. It’s time to drop these notions and join the fray. Pick an issue you feel strongly about, pick a candidate who sees your vision for a successful America as their own, and have faith!
