Gene Editing Under Fire
CRISPR/Cas9 gene editing is the hottest new technology being used by molecular biologists and geneticists around the world. The method, first developed in prokaryotes in… Read More »Gene Editing Under Fire
New Statin Guidelines Herald a New Era of Preventive Medications
In medicine, we would like to believe that treatment decisions are black and white, evidence is clear cut and uncertainty is a bygone impediment, squashed… Read More »New Statin Guidelines Herald a New Era of Preventive Medications
Making Our Voices Heard in a New America
On Nov. 9, 2016, our country awoke on the precipice of a new beginning. The recent presidential election was historic in many ways, but one… Read More »Making Our Voices Heard in a New America
Partnering Toward Discovery Seminar Series: HIV-Positive to HIV-Positive Transplants
Organ transplants are lifesaving operations for HIV-positive patients with kidney and liver failure — but only if they can reach the top of the waiting… Read More »Partnering Toward Discovery Seminar Series: HIV-Positive to HIV-Positive Transplants
An iPad Game Helps Children with Amblyopia Improve Their Vision
“She needs to see an eye doctor,” the pediatrician told the parents of a preschool child. I, a first-year medical student at the time, was… Read More »An iPad Game Helps Children with Amblyopia Improve Their Vision
Community Engagement Through Volunteering
Medicine means a lot of things to different people — patient care, research, education, lifelong learning — but to me, one of the most meaningful… Read More »Community Engagement Through Volunteering
Seeing Clearer but Not Farther: Disease Through the Eyes of a Young Medical Student
The day after my cardiology exam, my grandfather had a heart attack. Heart attack — what a terrifying phrase. The heart transcends normal anatomical description.… Read More »Seeing Clearer but Not Farther: Disease Through the Eyes of a Young Medical Student
Kid in a White Coat
I am no stranger to medical institutions. I’ve spent time in hospitals and clinics all throughout my life — shadowing physicians, working in the operating room as an administrative intern and now as a first-year medical student. However, while walking through the busy corridors of The Johns Hopkins Hospital, I feel distinctly different. Of course, this could be attributed to a variety of things, such as growing older and finally beginning a formal medical education, but the biggest difference for me comes from a short white coat with my name emblazoned on the left.
In our field, the white coat inevitably carries a strange and amazing sense of power and responsibility. Although we knew very little about medicine, since the day my peers and I received our white coats, we’ve been viewed differently in the hospital setting. While wearing the white coat, complete strangers confide in you, often sharing extremely personal stories, hopes and fears perhaps hidden even from immediate family. Suddenly, you are seen as a figure of authority and are, accordingly, faced with a sense of responsibility to provide the highest level of care for the people around you. The implications of this transformative power are incredible but also daunting.
Just over half a year ago, I was a senior in college and often joked with my friends about how we were “pretending” to be adults that were ready for the real world once graduation arrived. Now, I walk through The Johns Hopkins Hospital wearing an article of clothing that boldly proclaims something quite different — that I am an adult, ready to take care of the real world. The cognitive dissonance is glaring. I don’t feel any different on the inside than I did as the young college student only a few months earlier. How is it possible that I am suddenly responsible for taking care of others’ physical and emotional well-being when I am only just now learning how to take care of myself? I understand that as a new medical student, especially one coming directly from college without having taken any gap years, these sentiments are completely normal, but the nagging feeling that I am an imposter is still very real.
Regardless of these feelings, my medical training so far has been a privilege and incredibly rewarding. And now, several months in, I’m starting to learn that the solution to alleviating the dissonance lies in perspectives. It’s important to remember that medical training is a journey — one that will continue throughout my entire career — and that’s it’s OK to not always know exactly what I’m doing right now. Rather than letting imposter syndrome undermine my confidence, I can choose to see it as an opportunity to continuously challenge myself to learn and grow. Embracing my strengths and finding the courage to accept my weaknesses with confidence will, hopefully, help me work toward a satisfying and fulfilling career as a physician — even if some days, I still feel like just a kid in a white coat.
Applying for Residency: Interview Season
The last time I wrote about applying to residency, fourth-year medical students were just about to hit the submit button on the Electronic Residency Application System. Several long weeks later, the interview season has begun.
The irony of the phrase “hurry up and wait” becomes acutely painful for students during the weeks between submitting residency applications and receiving interview invitations. Applying for residency is much like applying for a job — you put together a CV, send it out to several prospective employers and hope that they are interested enough to invite you for an interview. For the past several weeks, fourth-year medical students have been eagerly waiting for those interview invitations and, after receiving them, have been busy scheduling flights, booking hotels and preparing to explain why they are an excellent fit for each program.
However, before the craziness of scheduling interviews — which requires students to strategically accept the maximum number of interviews, while allowing for adequate time to travel between cities — there is the wait. Thanks to peers applying to the same specialty and websites such as Student Doctor Network, students know almost immediately when their dream schools start sending out invitations — and are in for an unpleasant moment if they do not receive one. Thus commences the anxious wondering: Will there be a second round of interview invitations? Why did I not get invited in the first round? Is there anything I can do or say to the program to garner one of those coveted invitations? By the time I get an invitation, are there going to be any interview spots left? Unfortunately, there are no satisfactory, cut-and-dried answers to any of these questions.
By and large, though, most students will receive or have already received invitations to interview at their dream schools, and indeed, many are now weeks into the interview process. Aside from the nervousness that accompanies each interview, there is also an underlying hum of enthusiasm and excitement. The attendings and residents at each program are potential mentors; the other interviewees, future colleagues, or perhaps even future co-residents. At each interview, there is a tantalizing glimpse into the world that everyone has worked so hard during medical school to have the privilege to enter. Additionally, each interview allows the applicant a peek at how that specific program’s rounds work, what the hospital culture is like and what the program values. Similarly, programs use the interview process to find applicants with aligned goals who they think will not only learn from their institution, but also thrive in their particular environment and form part of a cohesive team.
The past few weeks have been both exciting and trying, filled with emotional highs and lows. Charles Dickens once penned, “It was the best of times, it was the worst of times …” While he was referring to London and Paris during the tumultuous French Revolution, somehow, it resonates well with this part of the application process to residency.
At the Vanguard of the Psychedelic Renaissance
A priest, a minister and a rabbi walk into Johns Hopkins Bayview Medical Center to ingest psilocybin, the active ingredient in hallucinogenic mushrooms. Although this probably sounds like the beginning of a great joke, new advancements in the field of psychedelic medicine are no laughing matter.
After nearly 50 years of prohibition, academic studies and clinical trials have recently begun to examine illegal and psychedelic drugs as treatment tools for a variety of physiological and psychological conditions. Of these, marijuana has been at the forefront, based on growing evidence of its beneficial applications as a treatment for diverse pathologies, including glaucoma, seizures and chronic pain. This has led to an increased acceptance of the plant in the medical pharmacopeia, and indeed, its legalization for medical use has increased from four to 25 states since 2000. Similarly, ketamine, a dissociative anesthetic conventionally used in veterinary medicine, has shown remarkable efficacy in recent trials for treating depression. The psychoactive compound MDMA, or Ecstasy, is being utilized in conjunction with psychotherapy to treat patients with post-traumatic stress disorder, with remarkable results. The success of this combination has been so dramatic that the Food and Drug Administration recently fast-tracked the MDMA-assisted psychotherapy phase III clinical trials that are already underway in hopes of determining an acceptable medical use of the drug by 2021.
This recent resurgence in psychedelic studies is exciting but not necessarily surprising for two researchers at Johns Hopkins Bayview. Roland Griffiths and Matthew Johnson have been examining the powerful effects of psilocybin in a variety of contexts for over a decade, and both are optimistic about its future applications as an accepted pharmaceutical. In collaboration with a small group of researchers from several universities around the world, Griffiths and Johnson have demonstrated that psilocybin-assisted psychotherapy can help induce and maintain behavioral changes, such as quitting nicotine or cocaine, as well as psychological changes, including reduction in depression symptoms and end-of-life anxiety associated with terminal cancers. In both cases, preliminary trials have demonstrated efficacy rates over 80 percent, which were maintained for at least one year.
The first psilocybin study Griffiths completed in 2006 examined the concept of the “mystical experience” in volunteers. The majority of study participants experienced significant feelings of “unity ... an interconnectedness of all things ... sacredness of life,” and over 60 percent reported it as the most meaningful experience of their lives. In further studies, Griffiths showed a consistent correlation between individuals’ self-reporting of this mystical experience and the success of their treatment. Strikingly, those with the most success quitting smoking or resolving symptoms of depression all reported high levels of this mystical aspect. To better understand this phenomena, Griffiths and Johnson are now recruiting religious leaders to engage in a study where they will use psilocybin in a therapeutic setting and report exclusively on its effects to their own deeply held beliefs. Griffiths believes the benefit will be twofold: These participants will be better able to communicate the mystical experience to researchers, and may also enrich their own congregation and vocation in a new and powerful way.
Psychedelic researchers are quick to distinguish that these positive effects in clinical settings do not mean the drugs are suddenly safe to use by anyone, anytime. Instead, they advocate strongly for controlled consumption, with a well-trained clinician guiding the patient through the experience to highlight positive growth and outcomes.
Originally made illegal during the Nixon administration, psychedelics have been placed on the Schedule I list for having “no medicinal value” for nearly 50 years. But as a remarkable body of evidence to the contrary is collected by researchers like Griffiths and Johnson, the country must begin to more seriously discuss how to best incorporate these substances into the medical field so their positive effects may reach the patients who need them.