American Medical Student Association

Once a week, this section will be updated with a new article or book recommendation, video, song, or news story that features some enlightening aspect of medical technique, philosophy, progress or history. Topics will vary between every branch of medicine past, present, and even hypothesized.

As interview dates approach for medical or graduate schools, you'll need to make sure that you're up-to-date on current events and understand the social contexts of your field of interest. If you're not sure where to start, hopefully this page will help. If you have any ideas for a submission, send them to PittAMSA@gmail.com!

 Week 10: 04/14/08 - 04/18/08: If you know me personally, you've probably heard me gush at some point about the DaVinci telesurgical system. This device utilizes four surgical, robotic arms (1 for a camera, 2 for grasping/cutting, and 1 more for a student/teacher to assist) that are controlled remotely from a virtual reality-like panel that can be located as near as next to the patient's bed or as far as across the world. Not only do the small robotic arms allow for incredible precision cutting by converting large manual movements into fine motions by the "robot," but the thinness of the arms also allows for small incisions that make recovery less painful and infection less probable.

The idea for the DaVinci came from the United States army, which found that soldiers were far too often dying of preventable complications (e.g., excessive bloodloss in the absence of a care provider) and unfortunately, surgeons are hard to coax to the battlefield. The army's hope, subsequently, was that engineers might construct a telesurgical device (a machine allowing the performance of surgery from a distance) with a remote-operated receiving unit in tanks positioned on site. After about 10 years of research, the first operational DaVinci became available and as you'll learn from the video, they're being used all over the globe.

A couple summers ago, I had the opportunity to meet one of the inventors (in a long and ongoing list of contributors to its continuing development), Dr. Randall Wolf, at the University of Cincinnati and tried out the DaVinci for myself (see below). By operating the pedals at my feet, I could change instruments, instrument functionalities, or opt to adjust the camera zoom.

As Dr. Wolf explained, the DaVinci as it exists today has imperfections in need of improving despite its amazing capabilities (e.g., most people, including myself, report a liberating sense of becoming ambidextrous when using the system, even if they weren't otherwise before or afterward). For instance, in any kind of surgery, it can sometimes be difficult for a surgeon to identify what tissue s/he's encountering but palpating the area (feeling it with the hands) can help. With the present model of the DaVinci, unfortunately, not only is the surgeon deprived of using his/her hands to feel the operating site, but the resistance offered to pressure by the tissue in question can be hard to ascertain (meaning that hazardous penetration can become more likely). A system is currently being developed to address this issue.

On the plus side, the DaVinci allows surgeons to reach areas that they could never get to with their hands and as an improvement upon former endoscopic surgical tools, the DaVinci provides for 3D vision with the use of 2 cameras as opposed to resorting to flat-panel 2D perspectives that forfeit a sense of distance. Use of the DaVinci has also consistently demonstrated better results in patients with certain conditions (e.g., atrial fibrillation, prostatomegaly or similar prostate problems requiring its removal). Indeed, new promising results and ideas for possible functions are turning up all the time. In terms of its suitability for its original function, however, they're still too large to fit in most tanks, but developers are constantly working in the lab to make them smaller.

Week 9: 04/07/08 - 04/11/08: *The following story is credited to www.newscientist.com

 

Some paintings are meant to be appreciated in silence – but not this one. It is called Unravelling Boléro, by Canadian artist Anne Adams, and is a bar-by-bar representation of the popular classical music piece Boléro by Maurice Ravel.

The painting also provides a scientific window into the creative mind.

When Adams completed Unravelling Boléro in 1994, her brain was starting to be affected by a neurodegenerative condition called primary progressive aphasia. It later robbed Adams of speech, and eventually took her life.

In its early stages, however, the condition seemed to unleash a flowering of neural development in a brain area that integrated information from different senses. In part, Unravelling Boléro may be a beautiful symptom of a terrible disease.

Repetitive patterns

This is the view of a group of neurologists led by William Seeley and Bruce Miller of the University of California, San Francisco.

And here's the jaw-dropper: Ravel is thought to have suffered from the same condition, which may have drawn him towards repetitive patterns such as the themes that cycle through Boléro. Adams was unaware of this, and of her own condition, while working on her painting.

Adams started out as a scientist, teaching chemistry at the University of Toronto, before moving to Vancouver in 1966 with her husband Robert Adams, a mathematician. Later, after raising four children, she retrained as a cell biologist, gaining a PhD.

But in 1986, life took an unexpected turn. Expecting to nurse her son Alex through a long recovery after he was involved in a car crash, Adams gave up scientific work and began to explore her artistic talents.

Alex soon recovered, but his mother never looked back. "Anne had decided what she was going to do and just went after it," her husband recalls.

Music in the detail

In Unravelling Boléro, each of the vertical figures represents a bar of music, with its height corresponding to volume, and the colour representing the pitch of Adams' favourite note within the bar.

Like the music, the theme repeats and builds until a change of colour to orange and pink, representing the key change that precedes Boléro's dramatic conclusion. "Every last detail has some meaning," says Seeley.

At this time, Adams had no obvious symptoms of aphasia. But in retrospect, MRI scans taken from 1997 to monitor a benign tumour on her auditory nerve suggest that regions of her frontal cortex involved in processing language were already starting to degenerate.

"It was pretty subtle," says Miller, who is not surprised that her radiologists failed to spot it.

By 2000, however, Adams' speech was becoming laboured. She was diagnosed with primary progressive aphasia in 2002 by Dean Foti, a neurologist at the University of British Columbia. After finding out about her paintings, he referred her to Miller, who has shown that some patients with progressive aphasia develop a passion for creating art.

This may be caused by enhanced function in parts of the brain that are normally held in check by the dominant frontal regions affected by the disease.

Connected senses

Adams was a particularly remarkable example. Brain imaging reveals that regions involved in integrating information from different senses were unusually well developed. Miller suggests that these areas may have sprouted new neural connections as her language centres began to deteriorate.

Adams did not perceive colours when she heard musical notes – a condition known as synaesthesia. But her creative blurring of the boundaries between the senses has rubbed off on Seeley, who now thinks of Boléro and the painting it inspired almost as parts of a whole. "I've 'listened' to them together and the synchrony is spooky," he says.

Although Adams was unable to communicate with Seeley and Miller verbally, she was fascinated by the neurologists' findings. "She actually brought in a scientific paper and showed it to me," says Seeley. That paper, published in the European Journal of Neurology (DOI: 10.1046/j.1468-1331.2002.00351.x), suggests that Ravel suffered from the same condition as Adams.

As well as losing language, patients with progressive aphasia can develop repetitive behaviours. Could the repeating themes of Ravel's Boléro and Adams' interest in the piece be early signs of their neurodegenerative conditions? It's a fascinating idea, but impossible to know for sure.

Today, Unravelling Boléro hangs in Miller's office – a fitting location for a painting that has contributed to our understanding of the neural roots of artistic creativity.

Journal reference: Brain (DOI: 10.1093/brain/awm270)

Week 8: 03/31/08 - 04/04/08: *The following story is credited to ABC News.

A UCLA scientist says he has developed an anti-germ lollipop that can help fight cavities.

Americans spent an estimated $85 billion on oral health care last year. Still, 79 percent of children will have a cavity by age 17.

Dr. Wenyuan Shi, a medical microbiologist at UCLA, believes Americans are taking the wrong approach to fighting tooth decay. In response, he has combined ancient Eastern medicine and modern technology, and created a candy solution.

"This is really an anti-germ lollipop. … It can prevent and protect you from tooth decay," Shi said. "We really recognize the power of those Asian wisdoms."

Shi took 2,000 herbs, such as those available in a Chinese remedy store, and conducted more than 50,000 experiments, looking for a natural enemy to cavity-causing bacteria.

"To our great surprise, we're left with licorice," Shi said.

Licorice root actually does contain an anti-cavity compound. First, it must be soaked to draw out its potency. Then when the liquid evaporates, what's left is a cavity-blasting powder component, he said.

ABC News correspondent Lisa Fletcher visited Shi's lab to take a look at bacteria samples with and without the licorice powder.

Shi says the safe and natural powder, when put into lollipops, could revolutionize dental health around the world.

He hopes they will help underprivileged kids, the elderly and those in developing nations to protect their teeth. His proposed regimen would be two lollipops a day for 10 days, four times a year.

Even with the lollipops though, Shi says don't stop brushing. "It's important for a lot of reasons beyond cavity fighting," he said.

Eager to get in on his discovery, major oral health companies are in discussions with Shi. Even pet food manufacturers are calling, hoping to add the powder to their products.

"Being a scientist, the most enjoyable experience I have is when what we do will actually benefit society," Shi said.

Shi chose a lollipop because of its universal appeal. Because they're all natural, they also don't need Food and Drug Administration approval.

Shi is still doing more studies, but he said the lollipops are already selling under the brand name Dr. John's.

Week 7: 03/24/08 - 03/28/08: *The following synopses were taken from thirteen.org

ROLLING was named best documentary at the Independent Film Project conference for works in progress, held in New York City. The film was also one of 14 new American films chosen by the Independent Film Project for screening at the European Film Market, which was held in conjunction with the Berlin Film Festival.

While Berland and her cinematographer both shot footage for ROLLING, the documentary is primarily filmed by the three participants via video cameras mounted on their chairs: Buckwalter, a clinical psychologist paralyzed at 17; Wallengren, a TV writer with five children who suffered from ALS (Lou Gehrig’s disease), which stole his mobility and, finally, his ability to speak and breathe; and Elman, who was the business manager for a department at the UCLA School of Medicine until multiple sclerosis put her in a chair.

In the film, Buckwalter calls himself a “proud gimp” and says, “My blessings don’t stop it from hurting.” Each participant captures the joy of living as well as the pain. Buckwalter films himself practicing with his band, Siggy, camping with his wife and friends, stressing aching shoulders by repeatedly lifting himself in and out of his car, and during a frustrating doctor’s visit.

Elman, the divorced mother of a daughter in medical school, is seen advocating for Californians for Disability Rights and a bill called the “V. Elman Community Living Act,” which would make it easier for the disabled to live at home.

Wallengren is seen deftly coaching his sons’ basketball team, dealing with awkward comments from well-meaning people at a birthday party, and using dry humor to deflect difficult situations.

“Even though the film started out as a way of understanding the experience of being in a wheelchair, in the end, it’s really about life,” says Berland. “It’s not about feeling sorry for someone with a disability.”

Copies of the film will be available in the spring. Please send a request via the feedback tab on the bottom of the page or leave a comment and we will add you to an email list to receive notifications about the film’s availability.

Statements about ROLLING

"If we want to create a patient-centered health care system, we need to better understand the perspective of the patient. How do you really understand someone's viewpoint? One option is to give them a camera." -- Filmmaker, Gretchen Berland

"Something as small as getting back into my chair can be a pretty big victory. I'm not always sure people can see that. That's why I took the camera." -- Associate Director, Vicki Elman

"Because most people can walk and run and climb, and since I can't, I'm defined as disabled, not only defined as disabled, I'm expected to act and feel disabled. For many years I did the same, but what they don't see now is that I'm a survivor." -- Associate Director, Galen Buckwalter

About the Filmmaker

Gretchen Berland is a physician who uses her experience in documentary production and journalism to highlight issues that are critical to understanding and improving health care. She has spent the last 10 years giving video cameras to participants. ROLLING is her third project to use this approach.

Berland received a B.A. (1986) from Pomona College and an M.D. (1996) from Oregon Health and Science University. Prior to attending medical school, Berland worked for the PBS television series NOVA and MacNeil/Lehrer Productions. She completed her internship and residency at Washington University Medical Center in St. Louis, Barnes Hospital (1996-1999). Berland was a fellow of the Robert Wood Johnson Clinical Scholars Program at the University of California, Los Angeles (1999-2001). Since 2001, she has been an assistant professor in the Department of Internal Medicine at Yale University School of Medicine.

 
The documentary can be viewed here: http://www.thirteen.org/rolling/experience/thefilm

Week 6: 03/17/08 - 03/21/08: In a new trend in physical rehabilitation that's already reached several medical centers around the country, physical therapists are utilizing the Wii gaming system to assist their patients with range-of-motion exercises targeting specific muscle groups. Healthcare professionals have been excited about introducing the Wii into their therapy because it allows them a more engaging means to treat patients with broken bones, sprains, strains, spinal cord injuries, brain injuries, and stroke and has the potential to benefit them in terms of balance, coordination, and muscle strength. Likewise, patients have responded very positively by saying that it makes their recovery a more social and exciting process. While a competitive element and the fact that games typically encourage player progression may helps, however, it's not been shown that these same factors won't significantly discourage less skilled players. Research has yet to be performed on the successes of these methods.

One telemedical researcher at UPMC's Department of Rehabilitation Science and Technology, Dr. JongBae Kim, has been considering the piloting this research in Pittsburgh. As a person with a disability himself, he spoke to me at the American Telemedical Association's (ATA) national conference in Seattle about the Wii's potential benefits for not only rehabilitation, but exercise. As we discussed, however, only certain games could work and specific kinds of games would need to be made to maximize the usefulness of the Wii in the context. Games typically used, at present, for what's being called "Wii-hab" include bowling, racing, boxing, cooking, golf, and generally anything where arm movement is a central feature of the game. While this trend seems to be growing fast, no one expects that video games will replace standard physical therapy regimens.

Week 5: 03/10/08 - 03/14/08: My sources for the following review include the academic journal, Nature, as well as Reuters, Slate.com, MIT, and UC Berkeley.

"Imagine a general brain-reading device that could reconstruct a picture of a person's visual experience at any moment in time, and perhaps even provide access to the visual content of phenomena such as dreams and imagery."

Since the 1899 publication of Freud's Die Traumdeutung (literal translation: "Dream-reading"), the content of dreams has received increasing attention from the scientific community. The attention has not always equated to popularity, however; one criticism consistently leveled against dream studies is that methodology suffers from overly-subjective inputs and a lack of raw data. With the help of scientists at the University of California, Berkeley, however, those issues may not be so relevant in the near future.

These scientists have recently developed a computational model that utilizes functional MRI (fMRI) data to decode information from an individual's visual cortex – the part of the brain responsible for processing visual stimuli. Such a device would make it possible to track attention and perhaps, in the near future, to reconstruct a picture of a person's visual experience from measurements of brain activity alone.

They've not reached that point yet, but they can predict what photographs their volunteers are looking at with up to 92% accuracy. For the first step, they calibrated their experiment by having two members of the team look at 1,750 photographs while being scanned by fMRI. "The content of the photographs included animals, buildings, food, humans, indoor scenes, man-made objects, outdoor scenes, and textures," they wrote. For the second stage, the two researchers looked at 120 new images while the fMRI machine was on. The research team then tried to figure out which photograph each one had been looking at.

They got the right answer 92 percent of the time for one researcher and 72 percent of the time for the second. When they worked with a set of 1,000 images, accuracy dropped only a bit, the Berkeley team reported.

Previous research has shown that fMRI can pick out brain activity associated with viewing different images. But so far it has only been possible to identify very basic images, from fixed categories, such as a face or a house. The process also depends on prior knowledge of the associated brain activity.

Now the Berkeley team has shown that brain imaging can reveal much more complex and arbitrary images, without prior knowledge of brain activity. "It is going to be particularly powerful in the field of visual perception and possibly the field of decoding motor responses," says John-Dylan Haynes of the Max Planck Institute for Human Cognitive and Brain Sciences in Leipzig, Germany.

This research hints that scientists might one day be able to access dreams, memories and imagery, says Haynes, providing the brain processes dreams in a way that is analogous to visual stimuli. "The difficulty is that it's very hard to set up models for other types of complex thoughts, such as memories and intentions," Haynes says.

So maybe Freud's desire to decipher the contents of dreams isn't immediately upon us, but we've arguably entered into a scientific era in which the notion's conceivable.

What's might be next with this technology:

1) Quadriplegics issuing commands to computers via brain scan.

2) Watching or analyzing another person's dreams.

3) A general brain-reading device that could reconstruct a picture of a person's visual experience at any moment.

I enoucourage to you watch the available clips further detailing this procedure at the following link:

http://health.discovery.com/search/results.html?query=gretchen&go.x=0&go.y=0

These three brief clips are taken from a show entitled Surgery Saved My Life on Discovery Health that detailed Dr. Kareem's objectives, issues, and strategies in Gretchen's treatment. They may be a little slow to load depending on your connection, but after giving them several seconds and pressing play, they should work.

Dr. Kareem is scheduled to present and speak with us in the fall of 2008.

Week 3: 02/25/08 - 02/29/08: Of all the medical books with a storyline I've ever read (and I've read quite a few!), this is by far the best. The House of God, written by psychiatrist Stephen Bergman (pen name Samuel Shem), mimics the creative and hilariously bittersweet narrative style of Catch-22. Comprised of a cast of mischievous yet down-to-earth characters, this inspired, fictional novel explores the bliss and despair that infamously (and, in other ways, secretly) characterize the lives of medical interns in the United States. Set in a progressive hospital in the late '70s, the novel's protagonist and narrator, Roy G Basch, MD, struggles to tackle problems of self-identity, how to save his patients, salvage his relationship, choose a specialty, and maintain a sense of gratification for the pursuit of medicine amidst failures and hardship all at the same time. Meanwhile, it becomes apparent to him that everyone seems to exhibit their own brand of Crazy, including himself.

A chief informant for the television show Scrubs (especially the first episode), The House of God comes highly recommended by many medical schools (in fact, for many, it's required reading). As comedic and insightful as this book is, it's just as accessible to all kinds of audiences. You certainly don't need a degree in medicine to read it, but you may want one after you do.

Week 2: 02/18/08 - 02/22/08: The following article was found at http://scientificblog.newsvine.com/ :

A 'broken heart' is not just a period of emotional sadness. In some cases it is a traumatic physical event.

Takotsubo cardiomyopathy is informally known as 'broken heart syndrome' because it often occurs due to an emotional or physical shock. It almost always happens to women and patients are typically in a critical state during the first 48 hours.

"These patients can be difficult to manage for emergency physicians and cardiologists alike," says Brown University cardiology fellow Richard Regnante, M.D. "They may be in cardiac arrest, cardiogenic shock, or severe heart failure. They may require advanced life support with airway management and medications to support blood pressure."

Based on electrocardiographic tracings and blood tests for heart damage, patients seem to be having a heart attack but cardiologists find no blockages in the coronary arteries.

A recent study monitored 40 patients diagnosed with Takotsubo cardiomyopathy at two major hospitals in Rhode Island over a period of nearly 2½ years. 95% were women and 60% experienced stress before coming to the emergency room.

Unfortunately, the types of stress were not consistent. There is no easy correlation between a bank robbery and a colonoscopy.

"We don't know why some women develop this syndrome after what appears to be minimal stress, while other women experience severely stressful events but don't develop Takotsubo cardiomyopathy," said Regnante. Possible other causes were a blood clot temporarily blocking a major artery, then dissolving before being detected.

It may just be that something is fundamentally different about women and men and how they handle stress, love and depression.

In this Virginia Commonwealth University study, Love Beats Depression for Women, Not Men, the researchers wrote:

Supportive, loving relationships offer women protection against major depression but don't seem to play a role in male depression

So we may be in the realm of Neuroscience rather than Cardiology. Lovesickness is mental trauma was the theme of a report for The Psychologist magazine outlining the mental relationship between love and depression.

But the physical symptoms are also evident. Ilan S. Wittstein of the Johns Hopkins School of Medicine in Baltimore studied 19 patients who seemed to have heart attacks after stress situations but had healthy arteries and found that all but one were women and most were older. They all had stress hormone levels (like adrenaline) two to three times as high as the actual heart attack victims and seven to 34 times higher than normal.

"Our hypothesis is that massive amounts of these stress hormones can go right to the heart and produce a stunning of the heart muscle that causes this temporary dysfunction resembling a heart attack," Wittstein said. "It doesn't kill the heart muscle like a typical heart attack, but it renders it helpless."

So love may make you helpless in ways you never expected.

Week 1: 02/11/08 - 02/15/08: This ABC news special reviews a system that very well could usher in the future of telemedical technology. Over the past few years, scientists have designed a device that non-invasively senses electromagnetic waves emitted from animal brains (subsequent to your focused versus meditational concentration) and converts them to signals in computer circuits. In effect, it's by virtue of nothing more than a combination of voluntary thought and self-awareness that people are influencing binary systems and perhaps soon enough, commanding a host of helpful devices covered by their insurance plans. Implications are especially exciting for handicapped individuals who exhibit difficulty manipulating objects in their daily environment. If you'd like to learn more beyond internet and article searches, you'll be interested to know that Pitt and CMU recently teamed up to advance this technology in the field of prosthetics. Check out the following link to see the progress they've recently achieved with a monkey that can now control a robotic arm to feed itself.