The Lack of Patient Credibility

Swathi Mettela

MHC Science Forward

Professor Kowach

24 October 2016

The Lack of Patient Credibility

It is well established in academia that pain is one of the most difficult phenomena to communicate via language. When this idea is brought into a hospital setting, it poses a serious issue concerning efficiency of modern medicine.

Not only is communicating pain difficult, but it is even more tricky for females and minorities. A 2013 qualitative study examined what females suffering from chronic muscular pain face when trying to communicate with their physicians. Ten women of different ages and ethnicities were interviewed about their experiences having a “medically unexplained disorder.” For some physicians, seeing truly is believing. Unfortunately, not all pain is not visible whether it be through the naked eye or through a microscope. The study portrayed themes of trying to seem “normal.” The women reported that they tried not to come off as too weak or too healthy so as to comply with the expectations in clinical medicine. They also noted problems with credibility, assertiveness, appearance, and dignity. Trying to communicate a subjectively painful, but otherwise undetectable problem with their bodies left these women powerless and unsatisfied with their care. (Werner)

In 2009, the United Kingdom received 5.5 million responses to the English GP Patient Survey. The purpose of the study was to find ways to make medical care more patient-centered. However, a research study in 2013 uncovered that one some physicians made changes to their approach after seeing the results of the survey. Many expressed doubts regarding credibility of the responses. Physicians feared that some people may have political influences or ulterior motives reflected in their responses, disregarding that the sole purpose of the survey was to improve care in the medical facilities. While this caution is within reason, it nearly impossible to develop a truly patient-centered medical environment if a physician does not trust patient feedback. (Asprey)

Systematic differences such as economic status, upbringing, and ethnicity all play a role in how questionnaires like the English GP Patient Survey are completed. Some people have higher expectations for medical care than others. It was reported that medical practices with a higher number of young patients, ethnic minorities, and lower class families had more negative responses in patient surveys (Ahmed). Although there are studies supporting that patients can complete health related surveys without expectations of care influencing their responses, systematic differences such as class and ethnicity are difficult to address with objectivity (Weinick).

Citations:

Ahmed, F., Burt, J., & Roland, M. (2014). Measuring patient experience: concepts and

methods. The Patient-Patient-Centered Outcomes Research,7(3), 235-241.

Asprey, A., Campbell, J. L., Newbould, J., Cohn, S., Carter, M., Davey, A., & Roland, M.

(2013). Challenges to the credibility of patient feedback in primary healthcare settings: a

qualitative study. Br J Gen Pract, 63(608), e200-e208.

Gee, G. C., Ryan, A., Laflamme, D. J., & Holt, J. (2006). Self-reported discrimination and

mental health status among African descendants, Mexican Americans, and other Latinos in the New Hampshire REACH 2010 Initiative: the added dimension of immigration. American Journal of Public Health,96(10), 1821-1828.

Weinick, R. M., Elliott, M. N., Volandes, A. E., Lopez, L., Burkhart, Q., & Schlesinger, M.

(2011). Using standardized encounters to understand reported racial/ethnic disparities in patient experiences with care. Health services research, 46(2), 491-509.

Werner, A., & Malterud, K. (2003). It is hard work behaving as a credible patient: encounters

between women with chronic pain and their doctors.Social science & medicine, 57(8), 1409-1419.

Targeting Genetic Disorders with CRISPR

Scientists have the ability to genetically engineer all organisms including bacteria, animals, and plants. A method of DNA editing called CRISPR, which stands for clustered regularly interspaced short palindromic repeats, allows scientists to edit DNA quickly and more efficiently (Stovicek 2015). CRISPR is found naturally in most bacteria and archaea and is part of their immune system (Horvath 2010). CRISPR is a set of DNA repeats that are separated by variable sequences called spacers (Horvath 2010). These spacers have the same DNA sequences of viruses or other foreign invaders that have invaded the organism before. When the same virus attacks again, RNA, which is transcribed from DNA and contains CRISPR, will go to the virus and cut up the part of the virus’ DNA that is complementary to the DNA sequence in a spacer, killing the virus (Gratz 2013). If a new virus attacks, a new spacer is created in case the organism needs to fight off the same virus again. Many researchers are interested in CRISPR because if it is manipulated, sections of DNA can be cut at precise locations and undesired DNA can be eliminated. Desired DNA can be inserted at precise sections. There is so much potential in using CRISPR. It is being researched for uses in medicines and gene therapy (Xue 2016). Even germline gene therapy, which is currently forbidden, can become a reality if CRISPR is deemed safe to use.

CRISPR is a very recent discovery in genetic engineering. It was first identified in 1987 in Escherichea coli, and later became known as being part of the immune system (Gratz 2013). CRISPR RNA can break the double helix of foreign DNA at a specific location that corresponds to DNA sequences in spacers. To manipulate this system, researchers need to change the sequences of spacers to complement DNA sequences that they want CRISPR RNA to cut. Instead of changing the genome of an organism, they can change the sequences of CRISPR RNA. In one experiment, when spacers were deleted, the cell lost its resistance to the viruses that it used to be resistant to and when spacers were added, the cell gained resistance against viruses it never encountered (Barrangou 2007). Fortunately, CRISPR can be used in eukaryotes even though it is naturally found in most bacteria and archaea, probably due to the similarity in genomes. Experiments have shown that CRISPR can be used in yeast cells and human stem cells (Gratz 2013). Plants can also be genetically modified using CRISPR (Bortesi 2014).

Figure 1- Editing and correction of gene with CRISPR in mouse with DMD

There have been significant advancements in using CRISPR for gene therapy. There were three studies on treating mice with Duchenne muscular dystrophy (DMD), which is caused by a mutation (Xue 2016). As shown in Figure 1, in the experiments, CRISPR was manipulated to remove the mutation in DNA. It was injected into the mice via a virus vector for somatic gene therapy. The mutations were corrected and the mice were observed. The mice regained some muscle control (Xue 2016). The ratio of muscles that do not have the mutation increased, which showed that the corrected gene is being expressed (Xue 2016). These experiments show promising results, but not all genetic disorders are caused by a single mutation. There can be complex causes to these disorders. In addition, editing cells can have unknown consequences in cellular functions and in how different cells communicate (Xue 2016). Edited cells may also work too well compared to unedited ones. It may not necessarily be good if edited cells have greater fitness and can survive longer than unedited ones. The same disadvantages apply to germline gene therapy using CRISPR, although the problems magnify because they are inheritable. Researchers do have the ability to manipulate stem cells, but it is strictly forbidden to provide germline gene therapy so they cannot research the use of CRISPR on germline gene therapy. Like many treatments, CRISPR has advantages and disadvantages that researchers need to explore. As researchers uncover more facts about CRISPR, perhaps gene therapy using CRISPR can become a regular treatment.

Works Cited

Barrangou R, Fremaux C, Deveau H, Richards M, Boyaval P, Moineau S, Romero DA, Horvath P. Science 2007; 315: 1702-1712.

Gratx SJ, Cummings AM, Nguyen JN, Hamm DC, Donohue LK, Harrison MM, Wildonger J, O’Conner-Giles KM. Genome Engineering of Drosophila with the CRISPR RNA-Guided Cas9 Nuclease. GENETICS 2013; 194: 2019-1035.

Horvath P, Barrangou R. CRISPR/Cas, the Immune System of Bacteria and Archaea. Science 2010; 327: 167.

Stovicek V, Borodina I, Forster J. CRISPR-Cas system enables fast and simple genome editing of industrial Saccharomyces cerevisiae strains. Metabolic Engineering Communications 2015; N/A: 13-22.

Xue HY, Zhang X, Wang Y, XIaojie L, Dai WJ, Xu Y. In vivo gene therapy potentials of CRISPR- Cas9. Gene Therapy 2016; 23: 557-559.

Conservation Approaches to Oil Paintings: From Centuries Ago to the Contemporary

Much of the world’s most well-known artwork are oil paintings – from da Vinci’s Mona Lisa to van Gogh’s The Starry Night. Although these pieces were created centuries ago, their original imagery and overall condition have stayed intact and pristine as a result of the extensive work done by conservators and restorers throughout the many years. As technology has advanced, conservation approaches have been altered and public perception has changed.

18^th and 19^th Century Painting Conservation Controversies

Due to concerns surrounding the handling of valuable artwork and doubt over conservators’ capabilities, the art conservation field has always been one at the center of controversy. Partridge cites events from late 18^th century involving public distrust over museum conservators, i.e. when the National Gallery was subject to committee inspection by the government to satisfy public inquiry into how artwork was cleaned, managed, and handled. This kind of scrutiny had an effect on the way conservators at that time regarded artwork, exemplified through the practices of Giuseppe Molteni (1799–1867). Molteni was a painter in addition to a restorer at the National Gallery. He often “corrected” works to reflect contemporary trends and boost appeal to collectors at that time (Partridge). Though he left works pristine, it was often not true to the original image. Leonardo da Vinci’s Last Supper has had a similar fate at the hands of excessive restorers. Its decay began not many years after its completion, mainly because early restorers had mistaken the mural’s medium for oil paint (it is tempera). Restorers like Michelangelo Bellotti had already covered it with oil and varnish, drastically altering da Vinci’s original work and accelerating its decay in appearance. Now, there is more regulation as to what constitutes as restoration. Works are preserved to maintain its original state, and not necessarily reflect the trends of the art market and art collectors.

Artwork restored by Molteni

Restoring a Damaged Oil Painting Today

James Bernstein, an intern conservator at the Worcester Art Museum, details his experience restoring a torn, cracked, and faded painting. He starts by first testing the reactions of the paint to various solvents, then identifying which mediums he can use to make the paint adhere to the canvas and prevent further cracking. He also uses delicate Japanese tissues to cover up tears in the paintings as well as help with paint adhesion. The tissue is applied in a very intricate manner such that it does not interfere with existing paint yet still manages to work itself into the canvas. In terms of cleaning the painting, he uses a fiberglass brush to remove dirt, a scalpel to remove any impurities and clumps, and lastly a vacuum cleaner to pick up remaining traces of dirt and fiber glass.

Bibliography

Anderson, Jaynie. “The first cleaning controversy at the National Gallery 1846-1853.” Appearance, Opinion, Change: Evaluating the Look of Paintings. London: UKIC, 1990. 3-4. Print.

Bernstein, James. “The Treatment of an Extensively Damaged Oil Painting on Canvas.”Bulletin of the American Institute for Conservation of Historic and Artistic Works, vol. 14, no. 2, 1974, pp. 93–104. http://www.jstor.org/stable/3179326.

R. J. Van Asperen De Boer. “On a Rational Aspect of Van Eyck’s Painting Technique.”Studies in Conservation, vol. 18, no. 2, 1973, pp. 93–95. http://www.jstor.org/stable/1505462.

Keck, Sheldon. “Some Picture Cleaning Controversies: Past and Present.” Journal of the American Institute for Conservation, vol. 23, no. 2, 1984, pp. 73–87. http://www.jstor.org/stable/3179471.

Partridge, Wendy. “Philosophies and Tastes in Nineteenth Century Paintings Conservation.” Studying and Conserving Paintings: Occasional Papers on the Samuel H. Kress Collection. London: Archetype Publications, 2006. 19-30. Print.

The Cyberknife System and Prostate Cancer: Research Demonstrates a Positive Impact on Toxicities, Biochemical Survival, and PSA

Ariana Gopal

The objective of this week’s paper is to evaluate the effects of the Cyberknife system on a specific type of cancer.  Literature reviewed in the past, specifically on cancers effecting the nervous system, indicated that the use of the Cyberknife for cancer treatment should extend to various types of cancers, such as those of the lung or prostate.  The impact of the Cyberknife system on prostate cancer was specifically evaluated in this assignment.

One of the main concerns that comes with performing radiosurgery on cancer patients is the fact that an incredibly high dose of radiation sent to a target area can negatively impact the normal tissues and organs that surround that area.  In the case of prostate cancer, these sensitive organs could be the rectum and/or the bladder. One of the articles this week specifically discussed the feasibility of using the Cyberknife to target the prostate while leaving the healthy, sensitive tissues surrounding it unharmed (King et al., 2003).  It was mentioned that the Cyberknife system is able to track daily position changes made by the patient during radiation delivery and ultimately correct or this (King et al., 2003).  The system’s ability to correct for this comes from gold “seeds,” or fiducial markers placed within the prostate gland trans-rectally via a urologist (King et al., 2003).  This is what ultimately makes it feasible to deliver a high dose of radiation to a target area while sparing the healthy surrounding tissues, supporting the accuracy of the system (King et al., 2003).

Figure 1: Representative treatment plans (axial and coronal views) from a patient to be treated with the Cyberknife system. Tumor coverage is 95%. (Friedland et al., 2009)

Numerous articles discussing the treatment of prostate cancer with the Cyberknife have been published since the theoretical accuracy of the system has been established.  For example, a study conducted in 2015 sought to evaluate the biochemical disease-free survival and impact of Cyberknife treatment on PSA levels for 437 patients with prostate cancer (Davis et al., 2015).  Genitourinary and gastrointestinal toxicities reports were minimal in the patient population (Davis et al., 2015).  Median PSA decreased from 5.8 ng/mL to 0.88, 0.4, and 0.3 at 1, 2, and 3 years post treatment (Davis et al., 2015).  Two-year biochemical disease-free survival was considered significant at 96.1% (Davis et al., 2015).

Additional research conducted in this field has shown that patients treated with the Cyberknife for prostate cancer experienced low grade toxicities, and a biochemical recurrence rate of 20%, none of which were patients at low or intermediate risk (Koh et al., 2014).  Additionally, research performed in 2009 reported that 82% of patients with prostate cancer and treated by the Cyberknife maintained their sexual functioning post treatment (Friedland et al., 2009).  Lastly, in a study evaluating the clinical outcomes of the Cyberknife system on low and intermediate risk prostate cancer at a median of 51 months post treatment, no biochemical failures were reported, and most toxicities returned to baseline after a follow up of 2 months, none of which were reported as grade 3 genitourinary and gastrointestinal toxicities (Kim et al., 2016).

As demonstrated in the research above, the Cyberknife system demonstrates a positive impact on reducing PSA, having a high correspondence to biochemical disease-free survival, and maintaining sexual function.  Although toxicities did exist among the various patient populations, a majority of them were considered low grade.  The research here clearly shows promise for the Cyberknife system with respect to the treatment of individuals with prostate cancer.

References

Davis, J., Sharma, S., Shumway, R., Perry, D., Bydder, S., Simpson, C. K., & D’ambrosio, D. (2015, December 04). Stereotactic Body Radiotherapy for Clinically Localized Prostate Cancer: Toxicity and Biochemical Disease-Free Outcomes from a Multi-Institutional Patient Registry. Cureus.

Friedland, J. L., Freeman, D. E., Masterson-Mcgary, M. E., & Spellberg, D. M. (2009, October). Stereotactic Body Radiotherapy: An Emerging Treatment Approach for Localized Prostate Cancer. Technology in Cancer Research & Treatment, 8(5), 387-392.

Kim, H. J., Phak, J. H., & Kim, W. C. (2016, June 17). Hypofractionated stereotactic body radiotherapy in low- and intermediate-risk prostate carcinoma. Radiation Oncology Journal Radiat Oncol J.

King, C. R., Lehmann, J., Adler, J. R., & Hai, J. (2003, February). CyberKnife Radiotherapy for Localized Prostate Cancer: Rationale and Technical Feasibility. Technology in Cancer Research & Treatment, 2(1), 25-29.

Koh, D., Kim, J., Kim, H., Chang, Y., & Kim, H. J. (2014, March). Clinical Outcomes of CyberKnife Radiotherapy in Prostate Cancer Patients: Short-term, Single-Center Experience. Korean Journal of Urology Korean J Urol, 55(3), 172-177.

Cannabis Part II: Further Explication of Pros and Cons

A study published in the Society for the Study of Addiction’s journal tested behavioral effects of the cannabinoid agonist WIN on adult and pubertal rats. The study tested both long-term and short-term effects of the cannabinoid. As seen in the figure, the results showed that cannabinoid treatment on both pubertal and adult rats caused decreased percentages in object and social discrimination (Schneider et al., 2008). Therefore, it is clear that the cannabinoid has the ability to hinder social abilities as well as memory and recognition.

Percentages of Object and Social Discrimination, Vehicle Group vs. WIN Group, per trial.

Furthermore, a study published in the European Journal of Pharmacology analyzed the influence of pre-exposure to the cannabinoid agonist CP 55,940. In one of the experiments, “rats were pre-exposed to CP 55,940 or a vehicle for 14 days and were subsequently trained to self-administer morphine intravenously (1 mg/kg per lever press) for 14 days. Rats pre-exposed to CP 55,940 self-administered a significantly greater number of morphine infusions than vehicle pre-exposed rats” (Norwood, 2003). This information can be interpreted into the real world of drug use and show that cannabis can act as a gateway to other drug addiction.

Cannabis can also pose a hindrance to neurological health by affecting serotonin receptors. A study published in The International Journal of Neuropsychopharmacology examined the effects of long-term cannabis use on responsivity of 5-HT_1A and 5-HT_2A receptors. These receptors have been shown to have links to depression. The experiment yielded “data [that] imply that chronic cannabinoid treatment may up-regulate 5-HT_2A receptor activity while concurrently down-regulating 5-HT_1A receptor activity, a finding similar to that sometimes observed in depression” (Hill, 2006).

Despite what seem to be overwhelmingly negative results about cannabis and its effects on health, there are some studies that show that cannabis has some useful and beneficial properties. For example, a study published in the British Journal of Pharmacology states that although cannabis has been associated with myocardial infarction, the cannabinoid HU-210 “prevented the drop in left-ventricular systolic pressure (HU-210: 1425 mm Hg; P<0.05 vs control: 1243mm Hg; and P<0.001 vs AM-251: 1143mmHg)” in rats with myocardial infarction. This study has the potential to disprove the idea that cannabis can cause myocardial infarction.

Furthermore, various cannabinoids are used to treat pain in patients who require strong pain relieving medications. A study published in the Society of Cannabis Clinicians’ Journal found that “inpatient adults with painful HIV neuropathy in 25 subjects in double-blind fashion to receive [who] either smoked cannabis as 3.56 % THC cigarettes or placebo cigarettes three times daily for 5 days (Table 18.1) … had a 34 % reduction in daily pain vs. 17 % in the placebo group (p = 0.03). The cannabis [group] also had 52 % of subjects report a >30 % reduction in pain scores over the 5 days vs. 24 % in the placebo group (p = 0.04) (Table 18.1)” (Russo, 2013). Therefore, cannabis also provides some benefits to people’s health by acting as a pain relief medication.

There is a very divided debate in the US about whether cannabis should be legal to sell and use. This is unsurprising considering the wide variety of studies published that discuss the health effects of cannabis. While many articles show that cannabis can adversely affect physiological health, some articles prove the health benefits of cannabis and show it to be a natural remedy for pain.

Works Cited

Norwood CS, Cornish JL, Mallet PE, et al. Pre-exposure to the cannabinoid receptor agonist CP 55,940 enhances morphine behavioral sensitization and alters morphine self-administration in Lewis rats. European Journal of Pharmacology. Vol 465, p 105-114. 2003.

Schneider M, Schömig E, Leweke FM. Acute and chronic cannabinoid treatment differentially affects recognition memory and social behavior in pubertal and adult rats. Society for the Study of Addiction: Addiction Biology Vol 13, p 345-357. 2008.

Wagner JA, Hu K, Karcher J, et al. CB1 cannabinoid receptor antagonism promotes remodeling and cannabinoid treatment prevents endothelial dysfunction and hypotension in rats with myocardial infarction. British Journal of Pharmacology. Vol 138, p 1251-1258. 2003.

Hill MN, Sun JC, Tse MTL, et al. Altered responsiveness of serotonin receptor subtypes following long-term cannabinoid treatment. The International Journal of Neuropsychopharmacology. Vol 9, p 277-286. 2005.

Russo EB, Hohmann AG. Role of Cannabinoids in Pain Management. Society of Cannabis Clinicians. Vol 18, p 181-197. 2013.

Medical Insight of Living in Space from Research at the International Space Station

One of the main premises behind building, operating, and conducting research on the incredibly massive and expensive International Space Station was to learn more about how humans, and life in general, respond to long-term living in space. The ISS was built with manned space missions in mind, and the extensive research in astronauts’ health and wellbeing aboard is used to aid in the technical aspects and training of proposed missions like the one to Mars. The following is a report on recent research solely conducted on astronauts aboard the ISS, as it is the most accurate and credible source of insight into the living conditions of humans in future space missions.

Eight Russian astronauts aboard the ISS for six months participated in a study on the effects of long-term microgravity exposure autonomic cardiovascular and respiratory control (Baevsky et al., 2007). Several medical tests, including blood pressure, heart rate, heart rate variability, and respiratory frequency, were conducted before, during, and after the mission. The study concluded that the average heart rates of the astronauts remained relatively constant before and after the mission, while the average respiratory frequency and blood pressure decreased in seven of the eight astronauts during the space mission with a statistical significance (p-value<0.05).

A common complication for ISS astronauts is the susceptibility to eye injury and vision loss because of microgravity’s effect, or lack thereof, on the human eye. A study conducted on seven astronauts aboard the ISS attempted to find out what these effects were, by taking complete eye examinations, including OCT and MRI scans, of the astronauts before and after their missions (Mader et al., 2011). Among the results, five astronauts were diagnosed to have developed disc edema, the swelling of the optic disc, and globe flattening, the distortion of the front of the eye, and six reported decrease in near vision.

The ISS has a 6 to 10-day rotating food menu, consisting of pre-dehydrated, nutrient-packed meals.  Eleven astronauts aboard the ISS for six months were the subjects of a study on the metabolic and nutritional effects of long-term reliance on the ISS’s food system and of living in microgravity (Smith et al., 2005). The body weight of the astronauts decreased by 5%, the urinary concentration of 80HdG rose by about 35%, indicating increased DNA damage, the vitamin D status indicator decreases by about 25%, and the general energy intake by calorie was about 80% of the WHO’s recommendation for adults.

Though muscle atrophy in space has counter measures such as exercise and diet, bone loss and damage are much less preventative and more dangerous to one’s long-term health. A study on 23 astronauts aboard the ISS used blood and urine tests taken during the astronauts’ missions to determine the risk of bone loss by excess iron and oxidative damage (Zwart et al., 2013). The study concluded that ferritin, an acute phase protein released in response to inflammation, is a good indicator of bone damage since ferritin concentration in blood was found to have a correlation with superoxide dismutase (oxidative damage), with a correlation coefficient of -0.32. The correlation coefficient between ferratin concentration and the total bone mineral density in the astronauts was -0.47.

Figure 1: Visual representation of the sleep cycles of three astronauts who participated in the study. The x-axis is the standard clock time aboard the ISS in hours, and the y-axis shows the day. The grey bars display the sleep time and the white circles show the simulated minimum body temperature in response to the circadian rhythm.

One of the seemingly less serious problems astronauts aboard the ISS face is irregular sleep cycles, but it is one of the most important for such a high-stakes and focused role. Since the Sun sets around 16 times in the 24-hour day aboard the ISS, astronauts’ circadian cycles are thrown off from humans’ natural tendency to sleep in the dark and wake up in the day. In one study, 21 astronauts aboard the ISS recorded sleep logs and took questionnaires in order to compare their sleep cycles during the mission with the control on Earth (Flynn-Evans et al., 2015). One in five sleep episodes was characterized as circadian misaligned, when the astronauts went to sleep in the brightest time aboard and woke up at the darkest time aboard. During these sleep episodes, the astronauts slept about 1 hour less per night, 24% of astronauts used sleep medication compared to 11% during normal sleep episodes, and use of other medication was 63% compared to 49% during normal sleep episodes. Figure 1 displays data taken from three astronauts, with the sleep cycles in grey and circadian temperature, simulated body temperature responses to circadian rhythms, in white dots.

Works Cited

Baevsky, Roman M., Victor M Baranov, Irina I. Funtova, et al. “Autonomic cardiovascular and respiratory control during prolonged spaceflights aboard the International Space Station.” Journal of Applied Physiology. 103, no. 1 (July, 2007) [Cited 25 October 2016].

Dijk, Dirk J., David F. Neri, James K. Wyatt, et al. “Sleep, performance, circadian rhythms, and light-dark cycles during two space shuttle flights.” American Journal of Physiology. 281, no. 5 (November, 2001) [Cited 25 October 2016].

Mader, Thomas H., Rober C. Gibson, Anastas F. Pass, et al. “Optic Disc Edema, Globe Flattening, Choroidal Folds, and Hyperopic Shifts Observed in Astronauts after Long-duration Space Flight.” Ophthalmology. 118, no. 10 (October, 2011) [Cited 25 October 2016].

Smith, Scott M., Sara R. Zwart, Gladys Block, et al. “The Nutritional Status of Astronauts Is Altered after Long-Term Space Flight Aboard the International Space Station.” The Journal of Nutrition. 135, no. 3 (March, 2005) [Cited 25 October 2016].

Zwart, Sara R., Jennifer LL Morgan, Scott M Smith, et al. “Iron status and its relations with oxidative damage and bone loss during long-duration space flight on the International Space Station.” The American Journal of Clinical Nutrition. 98, no. 1 (July, 2013) [Cited 25 October 2016].

Lina Mohamed-Assignment 4

Lina Mohamed                                                                                    October 24^th, 2016

MHC 20301- Paper Assignment 4                                                                Professor Glen Kowach

Continued Search for Alternative Medicine: Herbal Medicine

Herbal Medicine is ancient and has been used in so many cultures all over the world for years. Herbal medicine utilizes herbs and natural ingredients to treat many minor and major illnesses and diseases such as premenstrual syndrome, indigestion, insomnia, liver problems and even heart disease. Herbal medicine is pretty harmless which makes it superb for self-treating. Sales for pain killers are just going up and this is good for business but bad for the health of the United States citizens. Alternative medicine is never advertised and its rarely ever taught or practiced. If people learned of this alternative medicine, sales of pills would go down drastically. Over time, our bodies get so used to taking these prescription pills and they become ineffective as they develop resistance to them. However, herbal medicines is a safer way to combat symptoms for many illnesses and cure them in a way that is not damaging to the body because that is what pills do.

Today, about 25% of drugs are still derived from trees, shrubs, or herbs. For the most part, modern medicine has veered away from using natural elements in drugs because of the patent issue and economic reasons. However, before the 1970s, people were being conditioned to rely on synthetic, man-made drugs to provide quick relief without worrying about side effects or the actual problem. Herbal medicine and natural alternatives are beginning to make quite a comeback as concerns arise about the side effects of all these excessive pharmaceutical drugs. As organic food and raw lifestyles become more popular, natural medicine should follow these new health-conscious trends. If herbs have been used since the beginning of civilization, why not use them now in our daily lives?

Around the world, herbal medicine is much more prevalent especially in developing countries. Herbal medicine began to be eliminated from drugs, not because of their ineffectiveness, but because there was not much data to back up the effects of herbs. However, even in Europe, herbal medicine is much more readily accepted for methods of treatment. There is nothing concrete prohibiting the use of herbal medicine. “The result is that many herbal medicines are outside of the “system”.” (Alternative Medicine, p. g. 255). This further proves that our pharmaceutical companies in the United States are simply looking for economic prosperity rather than the health of the people.

Herbal medicine can easily replace so many prescription medications and over-the-counter drugs. However, will this be advertised in the United States anytime soon? Probably not. People have remedies for the common cold, flu, anxiety, stress, bronchitis, some allergies, PMS, and other conditions normally treated by prescription drugs. For example, types of hepatitis and cirrhosis can be treated with milk thistle seed extract, hawthorn as a heart tonic (stimulant/refresher), chamomile, passionflower, lavender, green teas for anxiety/stress and this list goes on and on. Natural medicines are effective and hopefully people recognize this and begin incorporating them into their lives to lead healthier lives. Holistic medicine is the future.

-Alternative Medicine: The Definitive Guide (2nd Edition)– June 6, 2002 Retrieved from Google Scholars: https://books.google.com/books?hl=en&lr=&id=OyrhatOdk9gC&oi=fnd&pg=PA270&dq=natural+alternatives+to+painkillers&ots=68fhOAE58y&sig=-malo2jqTO8ylS5N_CVlAN-PFSo#v=onepage&q=natural%20alternatives%20to%20painkillers&f=false

-(Dahlgreen, 2015) Many believe Alternatives are effective. YouGovUK. Retrieved from:

https://yougov.co.uk/news/2015/03/06/many-believe-alternative-medicine-effective/

-(2011) Prescription Painkiller Overdoses in the US. CDC. Retreived from:

http://www.cdc.gov/vitalsigns/painkilleroverdoses/

-(J.E. Chrubasik, B.D. Roufogalis, S. Chrubasik, 2007) Evidence of effectiveness of herbal anti inflammatory drugs in the treatment of painful osteoarthritis and chronic low back pain.  Wiley Online Library. Retrieved from:

http://onlinelibrary.wiley.com/doi/10.1002/ptr.2142/abstract

-(Ullman, 1988) Homeopathy Medicine For The 21^st Century. The Futurist. Retrieved from:

http://crawl.prod.proquest.com.s3.amazonaws.com/fpcache/943614fc1c15f8962b8e86ff8603fffc.pdf?AWSAccessKeyId=AKIAJF7V7KNV2KKY2NUQ&Expires=1477266797&Signature=%2F925B7VJ%2FgV1kwnxH5DTa9%2FbfLM%3D

Chagas Disease: What is it and How is it Being Treated?

Chagas Disease is caused by the parasite Trypanosoma cruzi.  The parasite is transmitted to animals and humans through insects and is found only in the Americas, predominantly in rural areas of Latin America. Currently there are roughly 6 to 7 million people infected with Chagas disease, mostly in Latin America (CDC, 2010). The disease presents itself in two separate phases. First, there is an acute phase that lasts for two months. During this phase, the parasites are circulating through the blood, but no serious symptoms are present yet. There might be swelling of the eyelids or skin lesions in some people during the acute phase. After the acute phase comes the chronic phase. During this phase, the parasites have moved to the heart and digestive muscles. Some people encounter cardiac and/or digestive issues as a result. As the disease progresses, many die from cardiac failure or sudden death from the nervous system shutting down (WHO, 2016).

Currently, there are two drugs available to treat the disease, benznidazole and nifurtimox. Both of these drugs are very effective when treating acute stage Chagas, but less so during chronic stage (Montgomery et al., 2014). Chagas disease is now spreading beyond rural areas and into non-endemic regions, creating a serious public health issue (Fig. 1).  Early detection and treatment of asymptomatic patients are rarely practiced (Rassi, 2010).

The parasite is transmitted by the triatomine bug. This insect will usually live in walls are roofs where there are cracks. The bugs feed of of human blood and are most active at night. They usually bite a very exposed part of the body, mainly the face, and then the bug defecates by the bite, infecting the person with the parasite (WHO, 2016). The life cycle of the triatomine bug and the transmission of Chagas Disease can be seen in Fig. 2. The WHO also suggests that those who are at a higher risk for contracting the disease should take precautions such as spraying cracks in the home with insecticides, improving overall condition of home, using bednets, good hygiene, and screening during blood transfusions, organ donations, and pregnant women and newborns. By taking these preventative measures, a reduction in transmission can occur, and those who are infected and are screened can get treatment, which will be more effective during the acute stage.

Figure 1: Areas affected by Chagas Disease

Figure 2: Transmission and Life Cycle

Works Cited:

Montgomery*, Susan P., Michelle C. Starr, Paul T. Cantey, and Morven S. Edwards. “Neglected Parasitic Infections in the United States: Chagas Disease.” Neglected Parasitic Infections in the United States: Chagas Disease. He American Society of Tropical Medicine and Hygiene, 16 Feb. 2014. Web. 23 Oct. 2016.

“Chagas Disease.” World Health Organization. World Health Organization, Mar. 2016. Web. 23 Oct. 2016.

“Prevention & Control.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 02 Nov. 2010. Web. 23 Oct. 2016.

Rassi, Anis, Jr., and Jose Antonio Marin-Neto. “Chagas Disease.” The Lancet. N.p., 17 Apr. 2010. Web. 23 Oct. 2016.

El-Sayed, Najib M., and Peter J. Myler. “The Genome Sequence of Trypanosoma Cruzi, Etiologic Agent of Chagas Disease.” Science. N.p., 15 July 2005. Web. 23 Oct. 2016.

Digital Powerhouse: How Technology Takes Hold of the 21st Century

Since its inception, digital technology has proven to be a catalyst in growth and success across all fields of business. In the post-WWII era, the countries quickest in recovering their economies and rebuilding their gross domestic product had the highest amounts of technological usage (Comin, 242). The introduction of products such as the cellphone and computer initiated a new way of accessing information as well as communicating with other individuals within the click of a button. Now, present day society is constantly inundated with technology: from e-readers to virtual reality headsets to smart-TVs to endless more gadgets and gizmos. As of 2011, there are approximately 1.97 billion Internet users (Cher Ping Lim, 60), with that number growing exponentially as time progresses. This equates to a mass network of people interacting directly with media, other individuals, or both 24/7. While this may sound terrifying to the average consumer, for media companies, this provides a perfect platform to target their consumers with brand-new content to both share and dissipate at a lightening rate across the Internet. Individuals have become so engrossed in technology that it has changed from being a want to a need, and that need is both immediate and permanent. Consumers are actively searching out the content that they want to see, using search engines such as Google and Yahoo to find the news that they want to read (De, 1939). Since technology has now become the primary medium by which information is collected and shared, consumers are now accustomed to finding the news they want, all within the span of a nanosecond.

Figure 1. Technology usage separated by media.

Additionally, consumers are now demanding rather than requesting some element of technology incorporated into every aspect of their lives. As a result, businesses must fight to stay relevant in an ever-expanding industry of the latest apps and new digital enhancements that provide both new and original functionalities for the user (Ahearne, 298).

Nevertheless, it is important to know that there is some novelty in traditional methods of information gathering. In fact, one study concluded that students prefer utility over accessory when it came to the question of whether or not libraries should integrate technological components (i.e. self-search kiosks, e-reader compatibility) into their services (Cassidy, 390). The main argument was that as long as libraries were able to fulfill their main purpose—to provide students with access to information about any and all topics—then it did not matter whether or not technology was involved in the process. This is a lesson that media companies should also take note of; that the technological revolution should not downplay the essence of a company’s mission, but rather supplement it. The Wall Street Journal should not change its mission to solely focusing on maintaining its online database with secondary components because its main purpose is to inform readers about the events happening in the world.

In a world of .coms and hashtags, balancing traditional practices with new technologies is a precarious act that could make or break a company. The businesses that are able to carefully integrate the two realms together are the ones that have been the most successful in their trajectories in the new age of digital. Soon, online will be the only way that we get our news, respond to loved ones, and share our thoughts about the world. In this way, technology becomes a double-edged sword; both a fountain of possibility and an abyss of mindless chatter. For communication to grow and for media to stay up-to-date, it must be able to decipher and analyze how exactly technology can be used to its full potential.

Works Cited:

1. Comin, D., & Hobijn, B. (2011). Technology Diffusion and Postwar Growth. NBER Macroeconomics Annual,25(1), 209-246. doi:1. Retrieved from http://www.jstor.org/stable/10.1086/657531 doi:1
2. De, P., Yu (Jeffrey) Hu, & Rahman, M. (2010). Technology Usage and Online Sales: An Empirical Study. Management Science,56(11), 1930-1945. Retrieved from http://www.jstor.org/stable/40959565
3. Cher Ping Lim, Yong Zhao, Jo Tondeur, Ching Sing Chai, & Chin-Chung Tsai. (2013). Bridging the Gap: Technology Trends and Use of Technology in Schools. Journal of Educational Technology & Society,16(2), 59-68. Retrieved from http://www.jstor.org/stable/jeductechsoci.16.2.59
4. Ahearne, M., Srinivasan, N., & Weinstein, L. (2004). Effect of Technology on Sales Performance: Progressing from Technology Acceptance to Technology Usage and Consequence. The Journal of Personal Selling and Sales Management,24(4), 297-310. Retrieved from http://www.jstor.org/stable/40471971
5. Cassidy, E., Britsch, J., Griffin, G., Manolovitz, T., Shen, L., & Turney, L. (2011). Higher Education and Emerging Technologies: Student Usage, Preferences, and Lessons for Library Services. Reference & User Services Quarterly,50(4), 380-391. Retrieved from http://www.jstor.org/stable/20865428