What Will Medical Technology Look Like in 2025?

Take a trip to the future of medicine in these excerpts from TED Talks. What might 2025 hold? Patient-specific pluripotent stem cell lines stored in the freezer until they’re needed for regenerative therapy. Medical devices embedded in clothing that send signals when something goes wrong. Patients taking ownership of their own bodies and their own data. And nanotechnologies to detect and treat cancer. The brave new world may also be a healthier world. From Induced pluripotent stem cells. A new resource in modern medicine: Pluripotent stem cells possess a remarkable unlimited self-renewal capacity and offer unparalleled in vitro differentiation potential. This provides a unique model system not only to study early human development but also gives renewed hope in terms of developing cell therapies and regenerative medicine. S. Yamanaka, a medical doctor and researcher, reported the possibility of reprogramming somatic cells to so-called induced pluripotent stem cells via the ectopic expression of four transcription factors, namely Oct4, Sox2, Klf4 and c-Myc. This Nobel Prize winning work has since revolutionized stem cell research and paved the way for countless new avenues within regenerative medicine. This includes disease modeling in a patient-specific context with the ultimate aim of individually tailored pharmaceutical therapy. Additionally, genetic correction studies have rapidly increased in basic science and thus there is hope that these can be effectively and efficiently translated into clinical applications. Addressing the medical...

How A Five Sentence Doctor’s Note Helped Facilitate The Opioid Epidemic

All it took was one-hundred words to kill over hundreds of thousands of Americans. A new report from the New England Journal of Medicine tells the story of how this short doctor’s note helped facilitate today’s American opioid epidemic: We found that a five-sentence letter published in the Journal in 1980 was heavily and uncritically cited as evidence that addiction was rare with long-term opioid therapy. We believe that this citation pattern contributed to the North American opioid crisis by helping to shape a narrative that allayed prescribers’ concerns about the risk of addiction associated with long-term opioid therapy. In 2007, the manufacturer of OxyContin and three senior executives pleaded guilty to federal criminal charges that they misled regulators, doctors, and patients about the risk of addiction associated with the drug. Our findings highlight the potential consequences of inaccurate citation and underscore the need for diligence when citing previously published studies. Since opioids were not widely used forty years ago, so doctors did not have much data to support addictive properties. The New England Journal of Medicine performed a bibliometric analysis of the validity of the 1980 letter. There were 608 scholars that cited the letter as proof since 1980. 72% cited that addiction was rare among those prescribed opioids; however 81% of scholars did not mention that the patients were hospitalized when they receive the prescription. Because so many scholars cited the letter...

Is It Time Yet To Redefine Medical Education?

The ins and outs of medical education are hard to imagine as an outsider to the field. However, once you are in it, it’s a rabbit hole with not escape. Even as a lowly first year medical student, I am often embroiled in engaging articles or scintillating conversations about the state of medical education. What have we done that has worked well in the past? Is it working at its optimal capacity right now? What kind of scope do we have to improve it for our future generations of doctors? From the times of apprenticeship as the primary way of learning the art of medicine to the current paradigms of systematized education by the 2+2 model (2 years of basic science education followed by 2 years of clinical education), we have definitely come a long way. However, like everything in the world, the new establishment comes with its own set of drawbacks. While I am engaged in the day and night struggle to ingrain those molecular biomarkers of immunology or those atypical antipsychotics commonly prescribed for schizophrenia, the context of it all often seems out of reach. I constantly question myself: How does this all apply to a patient? This imagination process is often unfortunately left to the individual student, pending future patient contact in 2 years time. So what can really be done to improve the current setup...

The Devil You Know: A Day In The Doctor’s Office

An excerpt from Dr. Fizzy’s new book: The Devil You Know, available now! “Jason Burnham?” I call out. A man in his late twenties rises reluctantly to his feet. Damn, he’s handsome—he’s got a soldier’s solid build with firm muscles lining his arms and visible under his T-shirt. I can tell by the look on Mr. Burnham’s face that he isn’t terribly thrilled that I’m the one who’s going to be examining his testicles. I’m sure he’d prefer a male doctor. Still, I think it’s melodramatic the way he acts like a man being led to the electric chair as I take him to the newly cleaned examining room. “Mr. Burnham,” I say to him. “My name is Dr. McGill. Would you please change into a gown for me?” Jason Burnham nods miserably. Examining testicles is not my forte. I’ve gotten better at it since my patient population has become primarily male, but I’m nowhere near as good at that as I am at, say, finding the cervical os. Testicles just seem so… delicate. Obviously. But I’m getting better. As far as I can tell, the key to doing a good testicular exam is not accidentally saying something dirty during the exam, which is extra challenging when your patient is so damn attractive. I’m going to work on that today. I return to Mr. Burnham, who is now sitting miserably...

How To Write The Best Recommendation Letter

When you apply to study at any institution you will usually be asked to provide a few recommendation letters from people who know you well. This is more to see what character trades you have and how people perceive you. It is important for the institution to get to know you apart from your academic record. Your character is just as important as your grades and this is part of the process to get acceptance. The question then remains, how do you get these great recommendation letters for your application? Here are some tips you can apply to get these recommendation letters. Be honest and open If you need a recommendation letter for residency, you have to be open and honest with your professors and ask them straight out. By sharing your needs with them, you place the ball in their court. Explain to them how the residency application process works and that this is a requirement. Also mention whatever you would like to have on your recommendation letter. You do not want to tell them how to word it, but just mention a few achievements to refresh their memory. This probably won’t be news to your professors as many students ask for a recommendation letter. Remind them When you are asking for recommendation letters, remind your professor of some of the outstanding work you’ve done. If you have...

Do Teaching Hospitals Offer Better Mortality Rates?

There are many misconceptions about teaching hospitals, but the easiest mistake to make is to assume that because residents with less experience are involved at the hospital it means that patients will receive a lower standard of care. However, a new study published in JAMA shows that what may sound like a logical conclusion does not hold up. When researchers in the Boston area, led by Laura G. Burke, MD, MPH, Instructor in Emergency Medicine at the Harvard T.H. Chan School of Public Health, set out to examine this very question, they found that data from previous studies was, in many cases, decades old. To gather new data, the researchers looked at hospitalizations from 4,483 different hospitals across the U.S, taking only data from 2012-2014. The researchers then examined the mortality rates for specific medical conditions and surgeries, such as stroke, heart failure or hip replacement. In their analysis of 21.5 million hospitalizations of Medicare patients, the researchers found that the 30-day mortality rates were significantly better at major teaching hospitals, even when patient data was adjusted for age and the severity of illness, or when the hospital data was adjusted for size of hospital, etc. The 7-day and 90-day mortality rates were also better at the major teaching hospitals when compared to non-teaching hospitals. Because of their close association with medical schools, teaching hospitals may be at the...

Taking Sick Days in Medicine

As my regular readers may have noticed, I tend to write about what I know. I think it’s the best way for me to choose what to write about because then I don’t feel like a phony, which is something I sometimes feel just as a by-product of being a student of medicine. Another way in which I feel like a bit of a phony is when I get sick and have to miss school. It’s especially tough on rotations because you feel like you’re letting everyone down, as if the whole team is somehow there for you when in reality they would function completely the same without you (although they may miss your positive attitude/humor/white coat pocket snack stash). For example, I get migraines often and they are only partially managed with medication. Sometimes the meds just don’t work or I’m not able to take them in time. Once I went a whole month without them because there was a snafu with the pharmacy and I couldn’t refill them. During that time I was so nervous I would get a migraine and have to call in sick that the whole time I was filled with anxiety over the mere possibility. Even if I do actually take the sick day I just sit at home feeling nauseas and ill, arguing with myself over whether I am sick “enough” for...