Monday, February 3, 2020

02-2020, Cancer Module Blog, Word Count: 450+


What was new was learning about the uncanny intelligence of cancer cells of using strategies like the exploitation of the Programmed Death PD-1 and CTLA proteins.  Cancer cells can synthesize proteins to press the “off” button on your T cells.  And yet, the unanswered question remained, do cancer cells synthesize the MHC identifier proteins?

The MHC helps the immune system identify which cells are foreign.  Thanks to the education provided by a previous institution, the term “triple negative” breast cancer was often heard in the treatment of minority patient populations, especially African Americans.  Ateoliumab is indicated for such difficult cancers that lack the conventional pharmacological targets.  As Dr. D. explained, having those receptors “is a good thing.”  If your choice is to have a cancer that has receptor targets used by existing medication, your chances are better than if you do not have those pharmacological targets.  
When Dr. Chuck Miller from the School of Public Health was expected to lecture, there was an expectation of rehashing from what Dr. Oz and other TV docs  already said on television: Don’t smoke. Quit toasting your bread and synthesizing deadly acrylamide.  Eat salmon.  Sip kale shakes. Don't scramble your eggs on non-stick pans; opt for PFOA-free pans. But no.  Consume fewer calories.  The American public is not ready to hear this.  They would much rather listen to the magical powers of some herb or vegetable.  Then Walmart and Target will sell that ingredient as a shake or pill.  
Two oral presentations on medications used for cancer were presented with fellow group members.  First was Doxorubicin, a medication used for lymphoma and a notorious side effect of producing radical oxygen species that can develop into cardiac disease.  The other was on hydroxyurea, a cancer drug and also used for sickle cell anemia.  For some, the entree to the disease was because of the interview given by R&B artist T-Boz who cried when remembering the excruciating pain she endured as a child with sickle cell anemia.  The study mentioned how challenging it was to treat the disease in sub saharan African because of the lack of resources, such as equipment to conduct Transcranial Doppler ultrasound to assess for stroke risk.  Furthermore, the prevalence of malaria is a concern for clinicians who cannot prescribe anything to relieve pain that can also compromise the immune function.    







Thanks to previous work at a retinopathy clinic, Benvacizumab was a familiar drug.  The physicians provided ocular injections of Avastin.  When studying the diseases, the patient literature informed the patient that normal blood cells are stronger and do not spill, possibly because of the tunica media and de novo synthesis.  But the sprouting blood vessels for diabetic patients are weaker and tend to spill.  Because of excess spilling, the vision is compromised.  Fluorescein angiography was a diagnostic tool to access the extremity.  Occasionally, some patients vomited after receiving the iodine.  
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Happy Black History Month!

Google Doodle celebrated the heroic gamechangers of the Woolworth Sit in: Joseph McNeilFranklin McCainEzell Blair Jr., and David Richmond.  They were  brave to envision a world in which everyone could sit together.  In their time, they were criticized for being disruptive troublemakers.  All of them struggled to find gainful employment after their act of nonviolent protest because of their "bad" reputations.  Then, more student activists at Howard University who participated in walk-outs were also called disruptive by university administrators. This was surprising because wouldn't the faculty members of a historically black college support their students engaged in advocacy?  I am very grateful to the disruptive changemakers, because I would not be able to enter Tulane University if it wasn't for their sacrifice to endure the violence, discomfort, denigration, and vilification.  

Celebrating Black History Month at Tulane School of Medicine has to be done on your own.  My classmate made a presentation, but that was closest to what can be called an acknowledgement of the injustice in healthcare, using the example of Serena Williams; I was able to speak about what physician advocates like Dr. Hines and her state legislation  have done to address the inequity and also a study on the poor listening skills of most physicians heard from the podcast "An Arm and a Leg." The inadequate rapport and support from physicians has been identified as a factor in the inequity.   Thanks to my research in addiction disorder, the injustice extended further to women receiving inequitable treatment.  We didn't get to honor "Anarcha, Lucy, and Betsey " and their bravery for being the first American patients of gynecology in the era before anesthesia. Their bravery to endure horrifying, unimaginable pain led to the development of the speculum, a critical tool used for cervical examination and synonymous with HPV prevention.  Their contribution to preventative health had more profound effect and saved more women than anything achieved with an NIH grant.  We didn't get to learn about the strategies used by leaders like Mary Seacole and Dr. Jocelyn Elders.  Mardi Gras, king cake, beads, and parades got more attention than healthcare inequity.  

Downtown New Orleans is a location with a high density of tobacco users; because secondhand smoke has been linked to numerous incurable diseases, including diabetes, attending Tulane SOM carries a high cancer, cardiac, diabetic, and autoimmune risk and there are no safe walking paths to follow Dr. Vivek Murthy's recommendation to "Step it Up," to inhibit the thinning of the cerebral cortex, followed by horrific NBME scores. A mere walk across the street to the library involves breathing in the tobacco of six smokers all smoking near the entrance.  Perhaps the university administrators should have considered how selecting a location would have harmed the health of low-income students. It has a nice, comfortable veneer of "integration" or the allure of the "proximal effect" - by having the poor so close to idealistic schools, how quickly we will solve poverty.  To borrow the phrase from Chana Joffe-Walt, this is a "Nice, White" solution.   But a quick walk from the School of Medicine to the Tidewater building will dismiss any sense of the Optimism of Dr. Pangloss. It is easy to elevate the supposed valiant intentions of the university of selecting a location that others would call dangerous and not even consider the separate and unequal experiences.  Such a location may have unintended consequences of spreading social determinants of inequality to the low-income students and university staff members.  Students with resources will not be affected;  Those who do not will experience the same challenge of literally navigating through the tough neighborhood which is plagued with poor public transportation, inadequate green spaces, and not having easy access for groceries.  Adding more individuals to experience poverty is not resolving poverty, but amplifying the worst aspects.  This is not a solution. Solutions without measurable evaluations are not solutions, but delusions.   

Instead of placing a university in the middle of a poverty-stricken area, a better way to "help the people" would be using legislation.  The price of cigarettes here in Louisiana is about the same as a fast food meal. Improving public transportation by those actually take public transportation (drivers lack appreciation about the static aspects of space and should be recused from these decisions), expanding affordable housing, and after-school programs would have been more effective than electing to build a university in middle of the police siren-blaring CBD area.  It would have saved money on hiring front desk security and variety of lock technology to sequester the university property from "the people" it was supposed to help.  A lot of aspects of Louisiana resemble a past era for anyone who comes from a more progressive state.  Patient autonomy and privacy are also considered not that big of a deal in Louisiana.  Witnessing the "chipping away" of rights here fuels anxiety.  It can make anyone want to grab a microphone, "Dear People of Louisiana: You deserve more. It doesn't be like this."  The use of waiting periods and mandatory "patient education" were already covered in national news of how restrictions were made on women's healthcare in certain states.  But here's the info not covered in any of Tulane University promo literature: those practices are not restricted to elective termination of pregnancy; those practices are used for other situations in Louisiana to remove patients from making decisions about their own bodies, as well.  And, no one thinks it's that big of a deal.

Given the disparity of substance use,  a research mentor who can combine interests in addiction and pharmacology is being sought.  Despite the affirmations from members from the last year cohort, research is not encouraged in MS program ; it's encouraged for the Ph.D program.  Anyone who wants to be a candidate in the Research Scientist program will have to supplement the research component independently to correct the deficiency.   The prompt for the Ph.D program reads,  " you are required to write an essay that describes your significant research experiences. In this essay, please specify your research supervisor’s name and affiliation, the duration of the experience, the nature of the problem studied, and your contributions to the research effort." The MS program is really meant for pre-health "enhancers" rather than "career changers." A lot of the research presentations from the faculty members were very interesting but the MS curriculum does not include  research practicum or working with a research mentor.  




Word Count: 450+

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