In the wake of a seismic shift in the political environment in the United States, with a new presidential administration and the promised rapid repeal of the Patient Protection and Affordable Care Act (ACA), medical students across the country are making their voices heard. Health professions students have unified under an ancient, fundamental ethical principle set forth in the Hippocratic Oath: “primum non nocere,” or “do no harm.” Repealing the ACA, these students have argued, “will cause immeasurable harm to patients.”

student protest

Students join a demonstration outside the Capitol Building in Washington, DC. Image courtesy Micah Johnson

Since its signing in 2010, the ACA has provided health insurance to nearly 30 million Americans and reduced the uninsured rate to a historical low of 11 percent. It has barred insurance companies from discriminating against patients with pre-existing conditions, allowed young adults to remain on their parents’ insurance plans for an extended period, and expanded coverage for preventive, mental and women’s health care. Furthermore, because implementation of the ACA has required a radical restructuring of the health insurance marketplace, immediate repeal would severely destabilize the health care economy, hurting patients and hospitals.

Recognizing these dangers, medical students have acted urgently to forge a coalition called #ProtectOurPatients. Under this umbrella, students published an online petition urging Congress to consider the consequences of an ACA repeal. To date, the petition has amassed more than 4,500 signatures and sparked collaboration among students from medical schools and congressional districts nationwide, and with several large national organizations, including Doctors for America, the National Physicians Alliance, the American Medical Student Association and Physicians for a National Health Program.

students phonebanking

Medical students campaign by phone-banking. Image courtesy Maria Phillis

Several Johns Hopkins medical students have been integral in the organization, planning and implementation of these efforts, which they say are driven not by politics, but by a concern for the well-being of patients. They have been collaborating on efforts to circulate petitions, draft op-eds, hold phone-banking sessions to call legislators and more to make their voices heard as the future of medicine in America. Justin Lowenthal, one of the Johns Hopkins organizers, explained to me why this work was so important. “Though early in our training, each of us already has stories of patients we have helped care for and whose lives have been saved or health improved due to the coverage expansion under the ACA. Politics aside, it is very important to many of us that these gains are not lost,” he says.

On Jan. 9, Lowenthal was joined by Johns Hopkins medical students Maria Phillis and Marc Shi for a day of activism and lobbying in Washington, D.C., organized by the #ProtectOurPatients coalition. A passionate group of students started the day outside the Department of Health and Human Services, “to make known our desire that the ACA be saved and to thank HHS for all its work in the implementation.” Then, they migrated to Capitol Hill, where they spent an hour calling on Congress to save the ACA. The demonstration was powerful, with coordinated chants, poster displays, three minutes of silence for the 30 million at risk of losing their coverage, stories from patients and medical students about the good the ACA has done, and a roll call of senators.

L"With the threat of patients’ lives on the line, students at Johns Hopkins and nationwide have mobilized to take a stand, united by the core value of a health care system that improves health and quality of life for all Americans.”ater, students fanned through the Senate office buildings to meet with senators and legislative aides from both parties, delivering their petition and discussing the request to improve rather than replace the ACA or, at the very least, ensure that any replacement occurs simultaneous to repeal and offers similar or better coverage. Phillis says some of the meetings were “very warm and productive,” while others were “more frustrating.” Her favorite moments from the day included speaking with Ohio Sen. Sherrod Brown’s staff and meeting a number of prominent senators during a Facebook Live event. Remarking on an opportunity she won’t soon forget, Phillis “talked to Elizabeth Warren live on the video feed about the importance of maternity care coverage in the ACA.” On the same day, other students, including Ilan Caplan, coordinated a day of phone banking in Baltimore as part of a national effort among medical schools across the country to draw attention to the repeal of the ACA.

With the threat of patients’ lives on the line, students at Johns Hopkins and nationwide have mobilized to take a stand, united by the core value of a health care system that improves health and quality of life for all Americans.

If you are interested in getting involved in the #ProtectOurPatients campaign, please contact Justin Lowenthal at jilowenthal@jhmi.edu or Maria Phillis at mphill58@jhmi.edu.


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Benjamin Ostrander

Benjamin Ostrander is a third-year medical student who strives to keep life infinitely interesting through creativity with words, food, music, medicine and more.

The United States spends more money on health care than any other country - $2.9 trillion in 2014, or about $9,110 per personThe United States spends more money on health care than any other country — $2.9 trillion in 2014, or about $9,110 per person. Spending continues to increase. With the arrival of the new Trump administration, the debate on health care costs is heightening. In preparation, let’s take a closer look at U.S. health care costs and what these numbers actually mean.

In a recent study published in JAMA in December 2016, “US Spending on Personal Health Care and Public Health,” the authors attempted to systemically quantify U.S. health care spending by breaking it down into categories, such as disease condition, age, sex and type of care. The study primarily focused on “personal health care spending,” which they defined as “the total amount spent to treat individuals with specific medical conditions,” but it also examined federal government spending on public health, including disease prevention, health protection and health promotion.

The authors first examined which medical conditions led to the most personal health care spending in 2013. Diabetes topped the list, with $101.4 billion and a spending increase of 6.1 percent between 1996 and 2013. About a third of diabetes spending was on ambulatory care, a third on inpatient care and 14 percent on pharmaceuticals. Coming in second was ischemic heart disease, with low back and neck pain third. Hypertension, falls, depressive disorders, oral disorders, sensory organ diseases, skin disease and pregnancy rounded out the top 10. Notably, cancer was not included in the top causes of spending because it was broken down into 29 individual types.

The top 5 leading conditions in public health spending were HIV/AIDS, lower respiratory tract infections, diarrheal diseases, infectious diseases and hepatitisThe greatest amount of personal health care spending was for those between 50 and 74, after which total spending declined as the population size decreased. In contrast, excluding the newborn and infancy period, per-person spending increased with age. Women 85 and older had the highest spending per person, largely due to nursing facility costs.

Overall, health care spending increased approximately 3 to 4 percent per year for most age groups between 1996 and 2013, with the highest annual growth in the categories of emergency care (6.4 percent) and prescription drugs (5.6 percent). For newborns to 19-year-olds, the highest rate of growth was for attention-deficit hyperactivity disorder. For young and middle-aged adults — ages 20 to 44 — diabetes spending had the top growth rate. For older adults — ages 45 to 64 and those over 65 — annual spending for hyperlipidemia showed the highest increase.

relatively low spending related to lifestyle modifications, like diet, exercise or smoking, that are key risk factors for diabetes, heart disease and other leading causes of health costs, morbidity and mortalityFor me, one of the most interesting take-home messages from this analysis was that the top conditions for public health spending are very different than the conditions with the highest personal health care spending. The top five leading conditions in public health care spending were all infectious diseases — HIV/AIDS first, followed by lower respiratory tract infections, diarrheal diseases, a miscellaneous category of infectious diseases and hepatitis. In contrast, relatively little public health spending is on lifestyle modifications, such as diet, exercise and smoking, that are key risk factors for diabetes, heart disease and other leading causes of U.S. personal health care costs, morbidity and mortality. Public health care spending on tobacco ranked eighth, and spending on obesity ranked 22nd.

As our nation forges on its re-evaluation of health care policies, this discrepancy should be addressed. Overall, this paper is valuable for systemically analyzing health care costs. Its findings, particularly on which conditions contribute the greatest costs in both personal and public health care, should help to guide future health care policy.


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Alisa Mo

Alisa Mo is an M.D./Ph.D. student who's passionate about the intersection of neuroscience, genomic medicine and society. She’s also a pianist and enjoys cooking.

Major depressive disorder (MDD) afflicts more than 250 million people worldwide and is the most common source of disability for Americans. In addition to counseling and talk therapy, there is a veritable alphabet soup of medications, from amitriptyline to venlafaxine, currently prescribed to treat MDD. Each class of antidepressant acts on an individual or combination of receptors and enzymes in order to adjust the levels of neurotransmitters. However, for various reasons, the currently available antidepressant drugs are not effective for up to 70 percent of patients. In fact, MDD refractory to current medical therapy is one of the primary reasons depression is a leading public health issue in America, which has lead to a continued interest in novel pharmaceuticals aimed at better treating this disorder.

The United States spends more money on health care than any other country — $2.9 trillion in 2014, or about $9,110 per person.The company Allergen is currently testing a compound, rapastinel, which acts via a novel mechanism involving the NMDA receptor. The NMDA receptor is better known for its role in memory development and neural synaptic plasticity, but it has also been shown to be a promising target for treating MDD. So far, rapastinel has shown fast and promising results in a group of patients who had not benefited from traditional antidepressants. In a phase II clinical trial, just one dose of rapastinel induced reductions in patients’ standardized scores of depression within 24 hours, with the results lasting up to a week. Compared to traditional antidepressants, which generally take effect over the course of four to six weeks, rapastinel was able to achieve a nearly twofold improvement in patients’ reported mood within one day, without adverse side effects.

Ketamine is another surprising agent that appears to alleviate depression. In clinical studies, ketamine improved mood within minutes to hours — again, significantly faster than the time of onset for common antidepressants. In addition, for some participants, ketamine’s effects on mood lasted over a week post-administration of a single dose. However, ketamine has an increased risk for abuse due to its dissociative, sedative and often addictive side effects. For this reason, one of ketamine’s metabolites, a structurally related form called hydroxynorketamine, is currently being tested in mice and has been found to positively affect mood in the absence of the adverse effects elicited by ketamine.
In addition, another compound (CPG3466B), similar in molecular composition to ketamine, also resulted in positive results in mice subjected to two standardized tests of depression symptoms within a few hours’ onset. Although additional studies will be required to determine the compounds’ efficacy in humans, the ability to remove the negative and addictive aspects of ketamine in animal models is a huge step toward making the drug a less risky alternative to antidepressants already on the market.

Did You Know Compared to traditional antidepressants … rapastinel was able to achieve a nearly twofold improvement in patients’ reported mood within one day, without adverse side effects.While there are several novel drugs in the pipeline of animal clinical trials, recent studies have also determined the benefits of new, less traditional therapies for human patients with depression and other mental illnesses. In a joint study involving Johns Hopkins and New York University, 80 cancer patients were given synthetic psilocybin, a hallucinogenic agent typically found in “magic mushrooms.” Two-thirds of the participants felt their moods lifted and their depression and anxiety symptoms subsiding after taking psilocybin. Based on these promising results, researchers are continuing to look into psilocybin as a potential therapeutic option for a variety of disorders and illnesses, but they stress that the dosing and administration will need to be closely supervised by a medical professional in a health care setting.

It is both promising and exciting to see how quickly the fields of neuroscience and medicine have moved to investigate and develop diverse, less traditional therapeutic avenues for patients suffering from debilitating depression. Given the prevalence and severity of MDD and its significant burden on both individual and public health, any positive result from a new therapy is a new hope on the horizon.


 

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Adela Wu

Adela Wu is passionate about making connections between ideas and people, and seeing how her interests in literature, creative writing and medicine play out in that theme. In addition, she also enjoys river and sea kayaking, having recently whitewater kayaked the Shenandoah River rapids.

In Outliers, Malcolm Gladwell observes that in many different fields, it seems to require roughly 10,000 hours of deliberate practice to become an expert. By my most conservative estimate, Willard Standiford has spent 119,250 hours practicing medicine. He retired at the end of 2016, 50 years after beginning his career as a pediatrician.

pediatrician examines a child with a stethescopeI met Dr. Standiford last January, on the first day of my longitudinal ambulatory clerkship. Designed to run alongside the Genes to Society organ systems curriculum, the longitudinal clerkship enables Johns Hopkins medical students to develop a deep relationship with a single physician and patient group. For 12 months, we spend one afternoon a week in the same clinic working with the same physician to see patients and practice our craft. Nearly every Tuesday of 2016, I scarfed down lunch, topped up my coffee and caught a ride with several classmates to Dr. Standiford’s Columbia office. Then we went to work.

Our practice was structured according to the credo of medical education: “See one, do one, teach one.” First, you observe and ask questions. Then, you practice under supervision. Finally, you teach others, clarifying and solidifying your own knowledge in the process. I began by watching. I had learned the physical exam on adult patients. As it turns out, there are different considerations when the patient may begin wailing at any moment. (Tip: Listen to the heart and lungs before you stick a tongue depressor in their throat.) Within a few weeks, I was seeing patients on my own. I spoke with and examined them, and then I communicated what I learned to Dr. Standiford. The two of us returned to the room for Dr. Standiford to fill in the holes and discuss the treatment plan with our patients and their families.

“Thank you for letting me take care of your family,” he would say. And then, he would extend a flat palm and ask the child for a high-five, with eyes sparkling and the corner of his mouth turned up in his broad smile.Dr. Standiford invited me to be a part of every interaction with a patient. During well-child checkups, we worked side by side to examine the patient together. Dr. Standiford always began with the hands. He took the patient’s right hand in his while I took the patient’s left, inspecting the skin, nails and joints. Our eyes and fingers moved up to our respective shoulder joint, and then to the face and eyes.

After looking in the right ear, he handed me the otoscope to look in the left one. When we reached the heart, our stethoscopes roved over the patient’s chest in a pattern that must have seemed random to child and parent, but which was actually a coordinated effort to listen to all four heart valves without tangling stethoscopes.

We must have made a curious sight: the 80-something pediatrician in jeans and a flannel shirt, and the 20-something medical student in a too-crisp white coat, both huddled around a young patient. It’s a scene that would not be out of place 50 or even 100 years ago: the apprentice learning from the master doctor. There was so much he could teach me. Fifty years of accumulated knowledge and skill; 50 years of explaining illness to parents, counseling healthy habits and comforting frightened children — for a 24-year-old, it’s difficult to conceptualize spending two lifetimes refining a single art.

As our year together, and Dr. Standiford’s practice, drew to a close, families began to say goodbye. For five or six Tuesdays in a row, virtually every parent I met lamented Dr. Standiford’s retirement. They teased him about what he would do with all his free time and thanked him with heavy voices for watching over their children. “Thank you for letting me take care of your family,” he would say. And then, he would extend a flat palm and ask the child for a high-five, with eyes sparkling and the corner of his mouth turned up in his broad smile.


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Infectious, oncologic and rheumatic conditions were all likely suspects for this puzzling disorder. Read more about how pediatrician Willard Sandiford faced the medical mystery plaguing his patient.

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Carson Woodbury

Carson Woodbury relishes a good detective story. Drawing early inspiration from Scooby-Doo’s Mystery gang, he fell in love with the natural world and all its enigmas — from Herodotus to developmental genetics. He is a second-year medical student, an aspiring mountaineer and an avid reader of The Baltimore Sun. His dream job is chief medical officer of a starship.

Today, adult women have a wide variety of choices of birth control methods, including daily pills, implants, IUDs and others. However, there is still no equivalent method of birth control for men, who have historically been limited to withdrawal, condoms and sterilization, placing the burden of pregnancy prevention on females.

blue and pink pillsA recent study, co-sponsored by the United Nations and published in The Journal of Clinical Endocrinology and Metabolism, aimed to change this by testing the safety and efficacy of a new male contraceptive. The study was a phase II clinical trial and included 320 healthy men. The men were injected with a combination of testosterone and norethisterone — a derivative of a female hormone found in many birth control pills — with the expectation that the additional testosterone would send a signal to the brain to shut down testosterone production due to already sufficient levels. As a result, sperm production would also drop significantly, rendering the men temporarily sterile.

Initial results were very promising and suggested that the drug was quite effective. The contraceptive was 96 percent effective in preventing pregnancy in the men’s monogamous partners, and after the men stopped receiving shots, most returned to fertile sperm counts within an average of 26 weeks. However, the men reported a number of negative side effects that were deemed to be too serious to continue the trial. Negative side effects reported by the participants included acne, increased libido, emotional disorders, injection site pain and muscle pain. One man developed severe depression, and another tried to commit suicide, although this was later determined to be unrelated to the study. Several men dropped out early, and later, two independent committees decided to cut the study short.

This caused a row of controversy, as women pointed out that many of the reported side effects were similar or less detrimental than the side effects of many female birth control options already on the market. However, to understand whether these effects were truly minor or not, it is critical to objectively compare them with the available data on female contraceptive use.

The contraceptive was 96 percent effective in preventing pregnancy in the men’s monogamous partners, and after the men stopped receiving shots, most returned to fertile sperm counts within an average of 26 weeks. In the male birth control trial, 4.7 percent of men experienced mood swings and 2.8 percent experienced depression. On the other hand, when using an IUD, which was approved by the FDA in 2015, 5.2 percent of women reported mood swings and 5.4 percent reported depression. Besides these side effects, the women also experienced abdominal pain, ovarian cysts, headaches, acne and heavy menstrual bleeding. IUDs can also, in rare instances, cause sepsis or perforate the uterus. Similarly, hormonal birth control pills have long been known to cause headaches, nausea, cramps, yeast infections, mood swings and weight gain. Most recently, a study of more than 1 million women, published in JAMA Psychiatry, found that women who used combination hormonal birth control were 23 percent more likely to be prescribed antidepressants.

Thus, it appears that the FDA-approved female contraceptives currently on the market have side effects that are just as bad, if not worse, than those experienced by patients during the injectable male birth control trial. But given that there is no urgency for pharmaceutical companies to develop male birth controls, the field is content to wait until safe and effective methods of contraception are developed. Currently, there is a highly promising nonhormonal method being studied, called Vasalgel, a gel polymer that is injected in the vas deferens of the male. The vas deferens is a narrow tube that carries sperm. The polymer forms a physical barrier and prevents the passage of sperm through the vas deferens. This promising approach is reversible since a second injection can dissolve this polymer, effectively restoring the flow of sperm, and may be a first step toward removing some of the burden of pregnancy prevention from females. A male contraceptive pill, on the other hand, is likely still decades away.

Sources:


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Monika Deshpande

Monika Deshpande is passionate about science communication. When she was a postdoc at the National Institutes of Health, she was involved in several publications, such as The NIH Catalyst and NIH Research Matters. She is adept at interviewing scientists and showcasing their achievements, and is able to write for scientific and nonscientific audience.

When I turned 11, the only thing I wanted for my birthday was a letter from Hogwarts, the magical school from the world of Harry Potter, telling me that I was a wizard. To my dismay, no such letter arrived but little did I know what the future had in store.

mentoring groupEleven years later, I was admitted to the Johns Hopkins University School of Medicine, which unfortunately isn’t Hogwarts — can anything compare? — but is still an extremely magical school. I see quite a few similarities between Hogwarts and Johns Hopkins, beyond the fact that sometimes medicine can seem like magic. Both are highly esteemed, and both require some sort of expensive dress code — are robes cheaper than white coats? But one of the biggest similarities I see is in mentorship.

Similar to the four houses of Hogwarts, each student entering the school of medicine is placed in one of four colleges — Nathans, Sabin, Taussig or Thomas — each named after prestigious Johns Hopkins scientists, technicians and physicians. Each college serves as the student’s “home base,” a physical location in the Anne and Mike Armstrong Medical Education Building, where four highly decorated lounge areas are partitioned off and filled with couches, ping pong tables, refrigerators and lockers. The college system also serves as a fundamental foundation to the medical school’s strong mentorship model. Each college is further split into “molecules” made up of five students and a faculty member. These molecules serve as a space for discussion, learning, growth and, most importantly, mentorship from the faculty member and peers. Furthermore, the same faculty member’s previous molecules from years two through four combine to create a macromolecule, with a total of 20 students.

student success is supported by many people across the school, creating a very rich and interconnected atmosphere.I’m blessed to have been placed in Taussig College and in a wonderful, invaluable molecule. My classmates and I have had numerous vigorous discussions in our molecule meetings and also had supportive one-on-one time with our mentor. My macromolecule has allowed me to meet older students and learn from their experiences. In addition, in Taussig, each first-year student is assigned a second-year “TausSib” who can provide advice and act as a general soundboard for any questions or concerns.

Beyond the Colleges Advisory Program, mentorship is still plentiful. Early in the year, first-year students are assigned to small peer-advising groups outside their molecules. Later, first-years also have an opportunity to sign up for the student preceptor program, in which they are paired with fourth-year students. My student preceptor has been absolutely amazing and has given me early exposure in learning to interview patients in real-life settings at the hospital.

Just like in Harry Potter, learning at Johns Hopkins is almost always supplemented by the communities built by the colleges and peers. Therefore, student success is supported by many people across the school, creating a very rich and interconnected atmosphere. As I turn the corner into my second semester of my first year, I can’t help but look ahead and think of ways I can give back to the community as a mentor myself for future incoming students.


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Pranjal Gupta

Pranjal Bodh Gupta is a first-year medical student who arrived at Johns Hopkins from Vanderbilt University where, over the course of four years, he danced in numerous cultural showcases. Throughout these shows, he learned various routines, including a Japanese fisherman dance (“Soran Bushi”), Indian Bollywood dance, Korean pop, Japanese drumming dance (taiko) and Indian Bhangra. As a side hobby, Pranjal made short films and majored in chemical engineering. His latest adventure includes learning medicine and trying to gain social media fame.

In November, I talked about the at-times-excruciating wait for interview invitations. Now that it’s mid-January, the bulk of interviews are over. Several flights later, I’m settled back in Baltimore, excited to sleep in my own bed rather than a hotel, an Airbnb or a couch. The past two months have been wonderfully exciting and inevitably draining. While for the most part, they went smoothly, massive amounts of travel will always be littered with perks and mishaps.

airplaneLessons I’ve learned:

  • If a city has two airports, always double-check which airport you are supposed to go to. Returning a rental car to the wrong airport at 5 a.m. is not fun, rushing to the correct airport via Uber and missing your flight by 10 minutes is frustrating, and subsequently paying several hundred dollars to catch the next flight out is downright painful.
  • Hotels are human too. One hotel accidentally upgraded me to club status. This led to free dinner on the club floor, a call to make sure the room was “to my satisfaction” and a waived hotel charge; I’m somewhat convinced they thought I was a hotel reviewer — oops? Another hotel accidentally gave me a room that needed maintenance and ultimately upgraded me to a room with a balcony (in sunny Southern California). As Alexander Pope said, “To err is human.” The good news is, as a hotel guest, you’re likely going to benefit from that error — appreciate it!
  • Programs are also human! Programs make scheduling mistakes, coordinators miss emails and program directors are insanely busy. They also recognize that you’re human. If you need to leave an interview day early for whatever reason, whether it be getting to the next interview or just catching a more affordable flight out, let the coordinator know! More often than expected, the interview day ends earlier than what is written on the schedule, and you can catch that earlier flight, saving yourself time and money.
  • quote: space your interviews out and take time to recharge. Otherwise, the interview season will be significantly less enjoyable. Signed: Ruchi DoshiBook flights that are flexible. Everyone I know, myself included, had to rearrange interviews and change flights more than once. Sometimes interview invitations come in late, and sometimes someone else on the trail may need to swap interview dates for personal reasons. Thankfully, Southwest Airlines allows you to change flights for free. I have friends who used other airlines and were required to pay as much as $200 in fees. On this note, I strongly recommend signing up for some sort of travel rewards credit card, as well as paying the $85 for TSA PreCheck — trust me, when you get to the airport late, it quickly becomes worth it.
  • Schedule breaks. Interviewing back to back gets very tiring very quickly. If you factor in pre-interview dinners, two to three interviews per week becomes exhausting and leads to burnout. Space your interviews out and take time to recharge. Otherwise, the interview season will be significantly less enjoyable.
  • Make friends on the interview trail. You’re all interviewing together — in fact, I interviewed with someone I knew or met on the trail at every single interview, including the first one — it turns out that it’s quite a small world, even among college students! Crashing on a couch with a friend who lives in the area is another, cheaper option and usually fun. Plus, you get an insider’s view to whatever city you’re looking to move to.
  • Have fun! I got to spend time in some really cool cities I had never visited and at times took an extra night to explore new downtowns or simply spend a little time at the beach. I managed to eat some good food and spend some time with good company throughout the interview process.

Ultimately, while I enjoyed the experience, I’m glad interview season is over. I’m not a fan of wearing suits (really, aside from Barney Stinson, who is?), and while it’s fun to see friends on the interview trail, among the travel, time changes and nerves, it becomes exhausting. Now “all” that’s left is to create a rank list and wait for the official end of this process — Match Day 2017.

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Ruchi Doshi

Ruchi Doshi is a third-year medical student pursuing her M.P.H. She is also an avid cook and baker who loves everything Bollywood.

At the proverbial watercooler in teaching hospitals across the world, one hears remarkably similar refrains: “This patient is back again,” “I have no idea why my experiment failed this time” and, most universally, “I’ve only slept three hours in the past two days!” Medical trainees often view sleep deprivation as a badge of honor, one that demonstrates in a quantifiable manner just how hard we are working. But time and again, adequate sleep has been shown to be vital for human health and performance, and researchers are continuing to learn how to best optimize sleep time and uncovering the associated benefits.

sleepy traineesNearly a third of all Americans suffer from some form of sleep disturbance with widely varying etiologies, both endogenous (e.g., familial insomnia and stress) and exogenous (e.g., employment interference). This number jumps to 50 percent among populations of medical and graduate students, and with it, the concomitant health concerns: increased mental stress, increased susceptibility to illness and decreased focus and attention. Unsurprisingly, survey respondents all pointed to similar explanations for their poor sleep — the stress of high-level academics and the vast time commitment required by training in the field. Although these challenges are often par for the course, by understanding some basic principles about sleep, medical trainees can maximize the efficiency of their little time available.

To gain a better understanding of how to tackle the challenges of sleep deprivation in medical/graduate school, there is no better authority to speak with than Mark Wu. Having completed both medical and graduate school himself, Wu currently serves as a sleep neurologist at The Johns Hopkins Hospital and as the lead investigator of a basic neuroscience lab that studies the molecular mechanisms underlying sleep regulation. I sat down with Wu to discuss the ways in which trainees can get the most out of their limited time during the most sleep-stressed points in their careers.

Wu first clarified an important distinction: Sleep deprivation — that slow-moving, drained feeling one has after many hours without rest — can result from a reduction in either the amount of sleep or the quality of sleep. The former is more commonly reported, likely because intense work and academic requirements leave students with little time to sleep. However, the latter can be equally impactful and often more difficult to discern. A loss in sleep quality can arise for various reasons, including disconnection between sleep time and the circadian rhythm (e.g., sleeping during the day during night shift work), stress, caffeine intake and alcohol.

bell-quote_010617To avoid the health and performance deficits that result from sleep deprivation, Wu made two major recommendations. First, guard your sleep time. We all have busy schedules, and as our responsibilities and social lives become cluttered, too often we carve out time that should be spent resting. He advises picking and maintaining consistent times to go to bed and wake up. Doing so optimizes the time available to sleep and increases your ability to have both the right amount and quality of sleep.

Second, pay attention to sleep hygiene. No, this doesn’t mean showering before bed. In fact, sleep hygiene refers to a number of behavioral interventions that may contribute to more effective sleep. For trainees, these should include a consistent sleep period (preferably during the night), regular exercise, and avoiding both naps and caffeine in the afternoon, as both may lead to sleep fragmentation and a reduction in the restorative quality; alcohol will do the same.

Although academics and work requirements will inevitably tax our ability to enjoy a good night’s rest, by optimizing both the time spent sleeping and sleep quality, we can counteract some of these restrictions and better avoid those groggy, ill feelings that are associated so strongly with sleep deprivation. Plus, as Wu is quick to point out from experience, as stressed out about sleep as we may be now, it’s a walk in the park compared to raising that first new child.


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Benjamin Bell

Benjamin Bell studies sleep and circadian rhythms in mice and flies, and is fortunate the mice understand his semi-nocturnal work schedule. When not actively in the lab, you can find him thinking about research and science-writing on his motorcycle, on the hiking trails, or at any local concert venue.

Within the medical field, naming a surgical instrument is often considered the epitome of success. Such a major contribution not only cements the lucky surgeon’s name in history books for decades to come, but also means that his/her name will interminably roll off the tongues of future physicians who appreciate that innovation and its use on a daily basis.

To think of the lives saved by one’s own innovation is quite profound, but many medical trainees and physicians have no idea

Kelly clamp

The Kelly Clamp

who to credit for the amazing innovations they are lucky enough to use each day, many of whom are former Johns Hopkins employees. In researching the origins of the interesting names behind some of my favorite surgical instruments, I gained an appreciation for the vital role played by numerous Johns Hopkins physicians in the development of common surgical tools.

One such instrument is the surgical clamp. Surgeons use clamps for nearly everything — to stop a bleed by closing off a vessel or often as extensions of their own digits. Two clamps that are constantly called for are named the Kelly, after Howard Kelly, and the Halsted, for William Halsted. These two men made up one-half of the team of Johns Hopkins physicians often referred to as the Founding Four, who were famously recruited to the hospital based on their impressive qualifications and medical careers by the trustees who funded its construction.

One of Hopkins Founding Four, Howard Kelly

Howard Kelly

Kelly was a gynecologist and served as the first head of gynecology at The Johns Hopkins Hospital. Besides pioneering surgeries in the field of gynecology, he was responsible for introducing radiation as a cancer treatment, which was the basis of the clinic he pioneered at Johns Hopkins. The version of the short, curved clamp that physicians commonly call the Kelly is one his many contributions to the field of medicine. The Kelly clamp is one of the most common instruments used in and out of surgery.  This little instrument is a mainstay in many medical and surgical toolkits.

Halsted contributed a slightly different version of the clamp, used instead for small bleeders. Halsted was the first head of The Johns Hopkins Hospital’s Department of Surgery and is best known as the first physician to pioneer radical mastectomies for treating breast cancer. His lesser-recognized contribution, the Halsted clamp, sometimes called the hemostat or mosquito, is a smaller, thinner, straight clamp and is used to cut off blood flow at smaller vessels than can be clamped by the Kelly. This simple yet intricate instrument allows us, as surgeons, to be able to stop bleeding, all while doing the least amount of damage to surrounding tissues.

Another famous Johns Hopkins physician, not far removed from the Founding Four himself, is Harvey Cushing, an accomplished neurosurgeon who trained under Halsted during his surgical residency at The Johns Hopkins Hospital. Cushing has a number of diverse medical conditions, syndromes and tools named after him, and even brought blood pressure measurement to America from Italy in the early 1900s, pioneering the field of medical diagnostics as a whole. But the Cushing vein retractor, a tapered, teardrop-shaped surgical tool, is perhaps his most important contribution to the field of neurosurgery. Used by surgeons to delicately move blood vessels during surgery, the Cushing vein retractor has made possible such intricate neurosurgical and other procedures where lymph nodes need to be removed overlying large blood vessels.

These are only a few examples of surgical instruments invented by and named for Johns Hopkins physicians that have revolutionized the field of surgery as it is known today. The role of The Johns Hopkins Hospital and its employees as leaders in surgical innovation first started in the late 1800s, with the establishment of the hospital itself. This spirit of medical innovation has continued to be a priority and point of pride, as the hospital continues to provide patients with the best and most recent standards of care in a constantly changing world.


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About the Author

Diana Cholakian

Diana Cholakian is a fourth-year gynecology and obstetrics resident at Johns Hopkins. When she’s not in the OR, she enjoys biking, hiking, and running around the city.

As 2016 draws to a close and many of us look forward to spending time with family and loved ones, one cannot escape the joyful jingles that herald this season. Whether you celebrate Christmas, Hanukkah, or Kwanzaa, the holidays that mark the end of the calendar year give us pause to reflect on the blessings associated with giving and receiving.

Of the myriad gifts that will be exchanged this season, time remains one that stays in high demand but comes in short supply. As Martin Luther King Jr. once famously remarked: “Life’s most persistent and urgent question is, ‘What are you doing for others?’”

We give of ourselves—often sacrificing time away from family, friends and other pursuits—in the hopes of bringing healing to othersWithin the context of medicine, as physicians, we “do for others” by offering our skills and services to care for patients. We give of ourselves—often sacrificing time away from family, friends and other pursuits—in the hopes of bringing healing to others. These acts of giving—encoded in the Hippocratic Oath and over the course of years of training through medical school and residency—are emphasized as an instrumental part of the physician’s professional creed. Distinct and separate from this form of giving, however, is another kind of giving: volunteering.

Giving one’s time through volunteerism requires a conscientious effort and willful presence in today’s fast-paced, time-starved world. Less fortunate individuals often depend on the selfless acts of volunteers who give countless hours throughout the year toward greater goals, such as community building and development. Through a cadre of service groups, volunteers give to others by bringing hope to those filled with despair and by helping to improve the lives of individuals within disadvantaged communities.

Since moving to Baltimore from New Haven, where I completed medical school, I’ve sought opportunities to become engaged within the Baltimore community at large. My experiences training in both cities have given me a nuanced perspective of the baffling tensions between “town and gown,” so to speak.

Giving one’s time through volunteerism requires a conscientious effort and willful presence in today’s fast-paced, time-starved world. As a result of their lived experiences and interactions with the institutions, most people living within these communities believe that the academic achievements of esteemed institutions, such as Johns Hopkins and Yale University, have historically been inconsistent with the pace of development of the surrounding, less affluent communities where these erudite towers of learning are situated.

Strained relationships between academic institutions and local communities  are nothing new, however. They date back as far as the infamous Battle of St. Scholastica in 1335, during which a bar fight led to a group of townspeople killing multiple scholars at the University of Oxford.

Fast-forward several centuries later, and institutions like Johns Hopkins have since recognized the need to invest in the surrounding communities as a whole. Johns Hopkins specifically has developed a community engagement inventory, which catalogs multiple community partnerships and programs, and champions volunteerism within Baltimore and its surrounding neighborhoods.

mlk commemoration event flyerAt the end of each year, Johns Hopkins recognizes from among its more than 55,000 employees, individuals who best uphold the spirit of volunteerism and giving back to the community. It was humbling to be chosen this year as one of eight honorees from across the university and health system who will be recognized at the 35th Martin Luther King Jr. Commemoration on January 13, 2017 for outstanding commitments to volunteer community service. Upon meeting the other awardees, I found it inspiring to hear about their contributions to Baltimore and the ways in which Hopkins employees are working to improve the quality of life in their communities.

I was selected to receive the award based on a need I identified while serving on medical school admissions committees and from speaking with many high school and college students applying to college and medical from underrepresented communities. Several students confessed to struggling with putting together a strong application, and, in particular, drafting compelling, error-free essays, which are a critical component of the application process. Together with a few colleagues, I started a free essay writing and review service, which has helped more than 400 students since 2011.

It has been an intrinsically rewarding experience helping these students over the years. Being recognized for this work is a humbling reminder of my responsibility to continue striving to help others; that making a difference matters; and that every day is a time for giving. May this season of giving compel each of us to continue making a difference in our communities and to give to others in the coming years.


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About the Author

Charles Odonkor

Charles Odonkor is a resident in physiatry (physical medicine and rehabilitation) and an Armstrong Institute fellow. An old soul and a dreamer, he is awed by the sacred and explores the world via the lens of a rich Afropolitan heritage.