MEDICINE HEALTH RESEARCHPRE-MED TIPSSTETHOSCOOPthe

Cornell Pre-Medical Society

CORNELL UNIVERSITY Fall 2013

The StethoSCOOP is brought to you by the Cornell Pre-Medical Society’s Publication Committee. The StehoSCOOP’s mission is simple: to educate pre-med students at Cornell about relevant issues, news, and events. The Cornell Pre-Medical Society aims to be the

hub of all things pre-med on Cornell University’s campus, as well as to promote the union of all pre-medical student organizations on campus.

Devon McMahonRachel Chuang, Ariel WamplerAnn LeiErin Barlow, Sachidhanand Jayakumar, Christine MathewDevin MassaroChristine Chow, Rachel Chuang, Angela Goscilo, Sachidhanand Jayakumar, Grace Lin, Mei Xin Luo, Devin Massaro, Christine Mathew, Zoe Memel, Ariel WamplerMika GaugerWinnie Chu

STETHOSCOOPthe

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Peaceful Hearts Doctor - Banksy

TABLE OF CONTENTSMedicineThe Lack of Nutrition Education in American DoctorsThe Present State of Electronic Health RecordsOsteopathic Medicine: A Fit for Your Goals?I Need a Doctor: The US Physician Shortage

HealthMore is Not Always Better: The Overuse of Medicine in our SocietyThe Developing Threat of Cancer in Low-Income Countries

Pre-Med TipsRethinking the MCATPrelims, Assignments, and Papers, Oh My!

ResearchDon’t Go to Bed Angry: A Study in SleepA Self-Control Center in the Brain May Inspire New Drugs

At Cornell

Biographies

References

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“There is no

like hope,no incentive so great,

and no tonic so powerfulas expectation of something tomorrow.”

-Orison Swett Marden

medicine

The Lack ofNutrition

Educationin American

Doctors

et’s play a game. Pretend you are asked to join a world where 80% of the chronic diseases we suffer from are eliminated. Cancer, obesity, diabetes, and

heart disease are a rarity. Medical costs are at an all time low and insurance companies cannot deny you based on a pre-existing condition. Let’s pretend that food is not seen as an “evil” substance, destined to make you overweight, but is used to energize and empower you. Billions of dollars are saved every year and the average life span and quality of life are dramatically higher. My question to you is: would you join? Most people would automatically say yes. Who would not want a healthy population at half the cost? My second question is why isn’t this imaginary world our reality? Our society has put a man on the moon and created unbelievably advanced technology, yet our population is still riddled with chronic diseases. There is something wrong with our world and I believe the key to making this hypothetical fantasy attainable is one thing – nutrition. Multiple studies have found that an integration of nutrition and preventative medicine into the medical field would cause both chronic and acute diseases to dwindle in numbers. However, the people most responsible for our nation’s health, our doctors, are lacking in even the most basic nutrition education.

By: Zoe Memel

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Physicians train extensively for over four years, leading one to think that this laborious endeavor would include the basics of nutrition and preventative medicine. However, during the time I spent volunteering at a public hospital in Brooklyn last summer, I found that doctors not only spent minimal (if any) time discussing the importance of nutrition with their patients, but also did not know much about nutrition themselves. As a passionate nutrition major at Cornell University, I was shocked at the little emphasis nutrition has within our current medical system, and decided to investigate the cause of it. The first, and greatest cause is due to a lack of integration of

nutrition and medicine during medical school. In the past, medical schools were not required to have nutrition courses within their curriculum, and many to this day still do not. Doctors learn how to treat the disease and cure the present ailment, but are not trained to help the patient prevent the disease. Prevention techniques are a significant topic to look over when one in two American adults is currently suffering from a chronic disease.2

A recent survey found that 96% of internists and 84% of the cardiologists who were asked about basic facts regarding low-fat diets and cardiovascular health gave incorrect answers.3

This study illustrates how little doctors emphasize proper eating habits and health as a means to improve their patients’ well-being. When asked where nutrition ranks in terms of a doctor’s priority when talking to a patient, the Chief of Cardiology at Northwestern University’s Feinberg School of Medicine responded “a new diagnosis, an evaluation of lifestyle, new medicines, perhaps recent procedures and then diet issues.”4 With the estimated time of a patient-to-doctor encounter averaging less than eight minutes, doctors have to prioritize what they discuss during a visit, and nutrition is usually the first thing to be nicked. Currently, the majority of health insurance companies reimburse physicians through a fee-for-service system where doctors get rewarded for performing excessive tests and prescribing high cost drugs, not for taking the time to discuss healthy behavioral changes. One can only wonder if the lack of support for preventative measures is correlated with an underlying fear among doctors of losing profits.The frightening deficiency of nutrition integration

within the health field has not gone unnoticed. Fifteen years ago, a committee of the National Research Council identified deficiencies in U.S. medical school education and “recommended that nutrition become a required course in every U.S. medical school, with a minimum of 25 hours of core curricular time.”5 Congress then passed the National Nutritional Monitoring and Related Research Act of 1990 that charged federal agencies to identify ways to “assure that students enrolled in U.S. medical schools and physicians practicing in the U.S. have access to adequate training in the field of nutrition and its relation to human health.”6 Yet, more than two decades later, nutrition education in

U.S. medical schools remains inadequate, according to a 2010 study published in the Journal of Academic Medicine. The fact of the situation is that on average, only 27% of schools meet the minimum standard of nutrition training. This lack of emphasis on both nutrition and preventative medicine, built over decades of disregard for an education within the

nutrition health field, has now left doctors with not only an inability to properly treat their patients, but also has created a negative stigma against changing one’s lifestyle as a means to prevent disease. Using lifestyle changes as a tool to reverse the adverse effects of an illness is a much slower process than a quick, high-priced medication. Many doctors have disregarded the belief that patients can empower themselves and change habitual behaviors.As Dr. Dean Ornish, president and founder of the non-

profit Preventive Medicine Research Institute stated, “If you ask [a doctor] ‘Do you teach it?’ they say, ‘No, who has the time?’ This is real-world medicine. We need to do it better”. Why waste both the time and energy working with a patient on altering their dietary patterns and exercise routines when angioplasty or medication can improve their high blood pressure faster? Both tactics provide doctors with a greater monetary benefit and are less time consuming methods.

This backwards mentality of simply fixing the problem,

not the cause, has only turned our nation into one flooded with medical debt and destined for debilitating chronic disease. Yes, there has been progress over the past decade as more and more schools are finally starting to incorporate nutrition programs and preventative medicine within their curriculums. However, it is not enough. There needs to be a push by Congress to emphasize nutrition within the core curriculum of all U.S. medical schools. Patients should be empowered to help themselves by changing their lifestyle behaviors as opposed to relying solely on expensive medicines to do a job they could fix. The good news is that the imaginary world I proposed is

one not too far out of reach. However, as we wait aimlessly for nutrition to become a more integrated part of our medical schools’ curriculum, I encourage you to help evoke change. Educate yourself; take a nutrition class and exercise, because at the end of the day, your health is not something to treat lightly. While the majority of the medical field lags behind in their use of preventative medicine, it is our responsibility as a society to take action. In the spring, I will begin the process of applying to medical

school. The admission rates are so low these days that, to be honest, my selection criteria is quite low. However, the one thing I will require in any medical school I attend is the integration of nutrition within the curriculum. At the end of the day, if I am unable to prevent chronic disease in my patients, my position as an agent of change is worth so little. I personally choose the imaginary world discussed above. My only hope is that everyone will choose to join me.

“I found that doctors not only spent minimal (if any) time discussing the importance of nutrition with their patients, but also did not know much about nutrition themselves.”

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The Present State ofELECTRONIC HEALTH RECORDS

magine that you went on a spring break trip with your friends to Florida. While swimming in your friend’s pool, you mistakenly dive into the shallow end and

get knocked unconscious. When you are rushed to the ER of the local hospital, your friends alert the physicians that they know you have a heart problem from when you were younger but are unsure of the details. Now, the doctors must spend precious minutes trying to contact your family/practitioner to learn what possible drug interactions or risks your condition could cause, rather than treating you.Although the preceding situation represents an extreme

example, it demonstrates the startling information delays that medical records present in our “advanced” health care system. These delays are detrimental not only in emergency situations, but also in everyday trips to the doctor. In response to this concern, the Obama administration passed the Health Information Technology for Economic and Clinical Health Act (HITECH Act) in 2009 to promote a nationwide adoption of the Electronic Health Records (EHR) model by healthcare organizations. What exactly is an EHR though? And how is it different from the normal patient charts that most doctors used just a decade ago?According to the CDC, an EHR is an electronic system

that compiles a patient’s total history and concerns, clinical notes, medications and allergies, and lab/imaging data into one centralized database. EHRs thus represent all of the patient data normally found in the ubiquitous manila files of doctors’ offices with the added analytical capabilities of an electronic database. Although this might not seem to have a large impact on the way doctors perform their daily jobs, I was able to observe the benefits of this system firsthand during the week that I spent

shadowing a gastroenterologist at Albany Medical College this past summer. Five years ago, the hospital adopted the Soarian Clinicals EHR system to coordinate patient care in every department. This decision became especially useful in a specialized field like gastroenterology, where most patients are admitted on a referral basis. In one particular instance, Dr. Jesse Green (the doctor who I was shadowing) showed me the case of a newly accepted patient who already had an extensive patient file from his previous heart valve complications and surgeries. The EHR system not only showed scanned cardiologist notes from every past procedure the patient had, but also displayed echocardiogram videos from recent tests. By viewing this information beforehand, Dr. Green noted how he was able to save time by focusing more on the current concerns of the individual, rather than the patient’s past history. As Dr. Green concluded the appointment, the EHR system also reminded him of any adverse drug interactions that might occur between the GI drugs he was electronically prescribing and the heart medications the patient was already taking. Safety measures such as these are infinitely more efficient than any paper record. Based on the limited adoption of EHR systems so far, most surveyed physicians have found a range of benefits similar to those experienced by Dr. Green: 74% reported an “enhanced overall patient care” and 25-50% reported a variety of job efficiency improvements (preventing repetitive lab tests, increased flexibility of viewing patient files, etc.). This positive reception obviously requires that the settings in which databases are used have the necessary electrical and technical infrastructures to prevent any crashes, a fair assumption to make at the current pace of technological innovation.

By: Anand Jayakumar

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However, the initial success of EHR systems is misleading because most of the electronic systems in place today are specialized contracts between IT companies and hospitals. This works well on a small scale for individual health groups, but fails to provide a truly national platform for the secure access of patient data. The main factors preventing this higher level of

advancement are the decentralization of the Health IT model and privacy concerns of the consumer population. Both of these factors are tied to the lack of specification in the HITECH Act. Although the law promises monetary incentives for the “meaningful use” of the new system, it does not demand that a specific database type has to be adopted by all hospitals that wish to do so. This has been great for increasing the flexibility at each hospital, but has resulted in hundreds of different electronic systems that are incompatible with each other. If you have ever experienced the frustrations that can arise when simply sharing files between Windows and Apple computers, you can imagine how inefficient such a system might be on a nationwide level. These non-uniform standards extend to the security practices of each IT company as well, where patient data is only protected to the level that technology insiders believe is necessary. Especially with the recent news of the NSA scandal and the almost commonplace hacking that companies experience, it is not surprising that Americans would be hesitant towards even greater intrusions into their personal medical information. One simple change that could address both problems

would be the approval of a corollary to the current HITECH Act to standardize the communication and privacy requirements of IT platforms. Such an act would push reform in the EHR sector while involving the government as little as possible in the choices for

adoption. This hands-off approach is important because it maintains the power that hospitals currently have to tailor contracted systems to their administration’s specific needs. One realistic option to base this standard on would be the VistA platform (used by Veterans Affairs Hospitals), a well-regarded system that many physicians become familiar with at some point in their medical education. A corresponding privacy agreement could then be offered in this uniform system to the patients of all participating providers. This agreement should allow people to set limits on what information type (ranging from general chronic conditions to more sensitive family history disease risk factors) and which individuals (ranging from direct family to any certified healthcare provider) their records could be accessible to. Allowing for such detailed control is important considering recent patient surveys that show a range of consumer preferences for data sharing, depending on the sensitivity level of their health records (Caine and Hanania, 2012). Patients who are still wary of their records being exploited by insurance companies or other organizations could choose to opt out of data sharing entirely. This would legally confine their data to onsite server storage only, hopefully encouraging them to still participate in the system. Although the preceding idea of centralization to achieve

consistency might seem like too simple of a solution, the reality is that there is just too much fragmentation for EHRs to currently satisfy their full potential. Having an accurate health record is only useful for the patient if the correct individuals (such as an ER doctor) can access the data and if unwanted parties (such as nosy insurance companies) are blocked from doing so. If these basic requirements cannot be guaranteed, it might even be better to stick with the reliable old medium of paper.

“The reality is that there is just too much fragmentation for EHRs to

currently satsify their full potentional.”

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OSTEOPATHICMEDICINE:

By: Christine Mathew

A Fit forYour Goals?

ome people believe that DOs are not “real” doctors, but did you know that DOs have the same practice rights as MDs? The DO degree stands for “Doctor

of Osteopathic Medicine” and entitles accredited doctors to treat the same illnesses, work in the same facilities, and practice in the same specialties as MDs.The difference in the two degrees is a matter of philosophy.

Osteopathic medical schools instill in their students a holistic approach to health care, allowing patients to achieve a high level of wellness. Osteopathic physicians place much emphasis on health education and preventative medicine, empowering patients “to strive toward the body’s natural, optimal state of structure, function, self-healing and health.” This explains their success in primary care, as pointed out in a recent Forbes article. The writer of the article describes, “at least one osteopathic college is ranked in the top 10 in the United States for primary care. That is quite good, especially considering that there are only 26 osteopathic schools and well over 100 medical schools.”Perhaps the most commonly misunderstood aspect of

osteopathic medicine is osteopathic manipulative treatment (OMT). Dr. Brian F. Degenhardt, an osteopathic physician who integrates OMT into his practice on a daily basis, explains that he “spend[s] a great deal of time explaining the role of this treatment modality in health care.” Using OMT, DOs are trained to use their hands as a tool for diagnosis, treatment, and prevention of injuries. Osteopathic physicians manipulate muscles and joints using techniques such as resistance, application of pressure, and stretching. In this way, they stress the integration of the neuromusculoskeletal

“Osteopathic physicians... [empower] patients “to strive

toward the body’s natural, optimal state of structure, function, self-

healing, and health.”

7

S

osteopathic medical colleges. These organizations play key roles in medical licensing exams and residency.In terms of medical licensure, allopathic schools use the

United States Medical Licensing Examination (USMLE) and osteopathic schools use the Comprehensive Osteopathic Medical Licensing Examination (COMLEX). There are more ACGME residency positions and specialized programs than AOA residency positions. Osteopathic students have the option of taking the USMLE and applying to ACGME residencies, which traditionally use the USMLE for their applications. However, allopathic students do not have the same opportunity to take the COMLEX and apply to AOA residencies. Most osteopathic students opt to take the USMLE, as it allows them to apply to a broader range of programs.As a prospective medical school applicant, the osteopathic

philosophy greatly interests me. I find it difficult to understand why allopathic schools do not follow a similar model in caring for their patients, given the close relationship between the mind and body. I would encourage anyone who believes in a stronger role for preventative medicine in health care to consider applying to osteopathic medical schools. Attacking the root of an illness can make a far more significant impact than prescribing quick fix medications. As Dr. Degenhardt suggests, “Appreciating the unique characteristics of the osteopathic profession should help in directing premed students to apply to a system of medicine that best supports their motivations and skills.”

system with the rest of the body. OMT complements drugs and surgery, and may replace them in some cases. Not surprisingly, allopathic and osteopathic schools use

difference application systems. Allopathic schools use the AMCAS application, which most premedical students are familiar with. Prospective applicants to osteopathic medical schools use the AACOMAS application. In comparison to allopathic schools, osteopathic schools tend to stress candidates’ interest in the osteopathic philosophy and clinical experience. As a result, they tend to place less emphasis on GPAs and the MCAT score than allopathic schools. In addition to their holistic approach to the application, osteopathic schools also accept replacement grades for repeated coursework. On the surface, this causes osteopathic schools to appear “lenient” in terms of admissions standards, contributing to the myth of the osteopathic profession being less prestigious than the allopathic profession.However, the osteopathic curriculum overlaps with the

allopathic curriculum with minor variations depending on individual colleges. In addition to general course requirements, DO students spend a minimum of 200 hours learning about the history and philosophy of osteopathic medicine, as well as OMT. Another important difference is that the two schools are

accredited by separate organizations. The Accreditation Council for Graduate Medical Education (ACGME) is responsible for accrediting allopathic schools, while the American Osteopathic Association’s (AOA) Commission on Osteopathic College Accreditation (COCA) accredits

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The US Physician Shortage, and a Possible Non-Physician SolutionBy: Ariel Wampler

his summer, as battles over the Patient Protection and Affordable Care Act (ACA, also known as Obamacare) raged on Capitol Hill, a key issue facing our nation and

the medical community began to emerge in media coverage. The concern? That the US does not have enough doctors to care for its population, especially one that is rapidly aging and experiencing unprecedented rates of chronic disease, and that this scarcity is only going to get worse. The first question to answer, whenever a “crisis” is reported to be

at hand, is to verify whether or not the situation is actually dire. Economists attempting to confirm the presence of a shortage can examine several different variables. Data on waiting times for appointments, physician fees billed to insurers, and overall physician incomes can provide valuable insight to this effect. Since 2003, physicians’ incomes have, on average, grown 1-2% faster than inflation, suggesting that a dearth of doctors does exist. Another method involves calculating the rate of return on investment (ROI) into a medical education. Analyses of this kind have found that medical school holds a very high ROI, upholding the presence of a shortage. Furthermore, the US ranks 27th in the number of practicing physicians per 1,000 population out of 34 developed countries. Given that US citizens typically have poorer health than those in other nations, it arguably has an even greater need for doctors. The Association of American Medical Colleges (AAMC)

estimates that this shortage of physicians will reach 90,000 by 2020 and 130,000 by 2025. This shortage will largely be driven by the aging of the baby boomers, since the elderly tend to receive more medical care and suffer more chronic conditions such as hypertension, arthritis, and diabetes. The Centers for Medicare and Medicaid Services estimates that 52.2 million aged people will be enrolled in Medicare by 2020, a 31% increase from 2011. Additionally, in accordance with provisions of the ACA, 25 states have thus far elected to expand eligibility for Medicaid. This is expected to lead to coverage of an addition 8.7 million low-income Americans by the end of 2014. Since the launch on Oct. 1, 2013, about 106,000 people have enrolled in plans via health insurance exchanges created under the ACA, and hundreds of thousands more are expected to follow. Moreover, the AAMC anticipates that nearly one-third of currently practicing physicians will retire by 2020, as demand for physicians is predicted to spike.

I NEED A DOCTOR:T

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The shortage is real. But what happens when a severe lack of physicians occurs? First, physicians may stop seeing patients whose insurance plans do not reimburse as well as others. This would disproportionately affect the poor and elderly, who are covered by Medicare and Medicaid. Evidence of such “patient-dumping” is already apparent. The average Medicare reimbursement to physicians for visits is 81% of the average payment by private insurers, and Medicaid reimburses doctors even less – about 58% of the average private insurer payment. In a 2012 survey, 23% of physicians answered that they would no longer accept patients of insurers who pay poorly. A 2012 study which used callers posing as mothers attempting to schedule an appointment for their child showed that offices refused to see 66% of callers claiming to have Medicaid, versus refusing only 11% of those claiming private insurance. A study with similar methodology published in 2011 revealed that, on average, “Medicaid-covered” children had to wait 22 days longer than “privately-insured” children before there was an “opening” for the doctor to see them. Doctors outside of the emergency room are already permitted to turn away the uninsured. But for those newly insured through Medicaid and who hope to finally be deemed worthy of care, a continuing shortage could mean relegation to a second-class citizenry.A second effect of the shortage, one particularly relevant to

pre-medical students, is that medical schools may become more selective. This is because the number of medical school applicants fluctuates over time, being highest when physician income is the highest – which occurs when physicians are lacking – while the number of slots for first-year medical students is relatively constant. AAMC data reveals that from 2001-2012, the number of admitted students to US medical schools rose by 19%, but the number of medical school applicants increased by 30%. The same data showed that average MCAT scores and GPAs of both applicants and matriculants (admitted students) also increased. Physicians are noticing the change – when interviewed, a pediatric plastic surgeon and Cornell alumnus remarked, “If I were applying today instead of 15 years ago, I would never have gotten in.” Lastly, the shortage may induce long wait times and

potentially higher co-pays, causing people to go to the doctor less often than they should, although ACA regulations on insurance companies may blunt co-pay increases. This could negatively impact the health of individuals with conditions that require regular monitoring and/or treatment adjustment, such as hypertension, diabetes, asthma, mental illness, and pregnancy. In the case of diabetes, there is strong evidence that frequent contact with one’s physician allows faster achievement of treatment goals and improved patient outcomes. Unless the physician shortage is alleviated, the oft-touted cost savings and health gains possible through a greater focus on preventative care are unlikely to materialize.The principles of economics assert that it is possible to

alleviate a shortage by increasing the supply of physicians in the workforce. Medical schools have been crafting several innovative responses to meet the need for more practicing doctors. The AAMC has called upon US medical schools

to increase their enrollment by 30%, and institutions are on track to meet that goal by 2016. This will be achieved by both increasing the class size at current medical schools and establishing new medical schools. From 2005 to 2012, the number of US-accredited medical schools increased from 124 to 141. The 16 medical schools in New York state enrolled 120 more students this fall than last year. International medical graduate programs, such as one in UCLA, recruit foreign-educated physicians and help them to compete for residency slots. Additionally, a handful of medical schools, such as Texas Tech University and Mercer University, now have 3-year programs for students committed to practicing family medicine. All in all, medical schools are doing their part to meet the high demand for doctors.However, without a corresponding increase in the number

of graduate medical education (GME) positions, also known as residencies, all that these efforts will produce is hundreds of medical school graduates saddled with $150,000 or more in debt. The primary source of funding for residencies comes from Medicare, but the number of federally-funded residencies has been capped since 1997. Unless Congress votes to increase funding for residencies, newly-minted MDs will be unable to complete their training and become practicing physicians, and millions of people across the US may not receive adequate medical care. The needs to be met are staggering – to be prepared for the demands of 2020, the AAMC has projected that the number of GME spots must be increased by 15%, representing an additional 4,000 physicians to be educated every year. Unless the number of residency positions is increased, efforts of medical schools to educate more MDs will be meaningless. However, given the current political landscape, it is unlikely that Congress will approve the additional funding. Two bills designed to address residency funding, HR 1180 and HR 1201, were referred to a subcommittee in March 2013, and neither have come up for a vote. During debates over the ACA, Congress refused a proposal to fund an additional 15,000 residencies, and a 2014 budget seeks to reduce GME funding by $11 billion over the next decade – the exact opposite of the direction the US needs to be going. An alternative method for alleviating at least the primary

care shortage, involves nurse practitioners (NP) and physicians’ assistants (PA). Physician’s Assistants typically complete 27 months of both clinical and classroom training in an accredited program after obtaining their bachelor’s degree, are required to pass a certifying exam, and must complete 100 hours of continuing medical education every 2 years. Nurse Practitioners must first receive a Bachelor’s

“Physicians may stop seeing patients whose insurance plans do not reimburse as well as others. This would disproportionately affect the poor and elderly.”

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of Science in Nursing degree, and at least 2 additional years of study to achieve a Master’s degree and sufficient clinical training. These non-physician clinicians, sometimes called “physician extenders,” have been shown to have patient outcomes, effectiveness, and safety equivalent to that of primary care physicians. An alternative method for alleviating at least the primary

care shortage, involves nurse practitioners (NP) and physicians’ assistants (PA). Physician’s Assistants typically complete 27 months of both clinical and classroom training in an accredited program after obtaining their bachelor’s degree, are required to pass a certifying exam, and must complete 100 hours of continuing medical education every 2 years. Nurse Practitioners must first receive a Bachelor’s of Science in Nursing degree, and at least 2 additional years of study to achieve a Master’s degree and sufficient clinical training. These non-physician clinicians, sometimes called “physician extenders,” have been shown to have patient outcomes, effectiveness, and safety equivalent to that of primary care physicians. Not all of the tasks that a physician performs necessarily

require an MD and several years of residency training. Every year, thousands of people go to the doctor with a cold or the flu, which typically does not involve medical treatment – does a clinician need to have gone to medical school to tell a patient to rest, drink fluids, and come back if symptoms fail to subside within a few days? Anyone who has shadowed in a pediatrician’s office can verify that ear infections and strep throat are two of the most commonly seen conditions in children. Diagnosis is simple in both cases – a short ear exam, or a throat swab plus rapid antigen test or culture. Treatment is likewise straightforward – antibiotic ear drops in the first case, oral amoxicillin (that iconic pink, bubble-gum flavored syrup) in the second. Currently, 32 states do not permit nurse practitioners

to prescribe medications without physician approval. But if certain medications could be prescribed independently by NPs, and all insurance companies reimbursed NPs for providing care, it would lead to a much more efficient allocation of health practitioners’ time. If these laws were changed, physicians might be able to devote more time to patients with serious or complex conditions, instead of being overburdened with work for which they are overqualified. Regrettably, the American Medical Association and many other physician organizations oppose giving NPs more autonomy, claiming that the shorter training of NPs makes them more likely to put patients’ health at risk. However, this has not been borne out by the evidence, as mentioned above – in fact, NPs may communicate with patients even better than primary care physicians do. Furthermore, data have indicated that NPs could be more likely than primary care physicians to care for Medicare and Medicaid patients, and to practice in a federally designated primary care shortage area. Finally, the types of services that NPs and PAs provide could be reimbursed at a lower rate than what physicians now receive, allowing the US to trim health care costs without compromising access or quality of care.

It is unfortunate that so many physicians are fighting expansion of NP and PA scope of practice, when doing so is obviously against patients’ best interests and wishes. A 2011 survey showed that 16% of US adults waited 6 or more days to see a primary care physician when they needed care. Another survey, conducted in 2012, showed that only 25% of patients with a cough would wait a day to see a doctor, when they could see a NP or PA on the same day. Forcing patients to wait for care can result in more costly and unnecessary hospitalizations, delayed cancer diagnoses, and even death. Additionally, patients are increasingly discontented with how little time their physicians will see them for - 55% of doctors in 2012 reported spending less than 16 minutes with each patient. These results are important, especially as patient preferences and satisfaction are valued more highly. Refusing to allow NPs independent prescribing and practice privileges ultimately limits access to quality primary care, especially for those with great need and few resources. Physicians who may contest changes out of self-interest should not fear competition from NPs and PAs – there will always be more patients to see, and their care to bill for, even if other providers absorb a portion of their clientele. On this issue, doctors – even prospective pre-medical

students – should take a stand, and recognize that the well-being of patients matters far more than preserving high physician incomes and prestige. The Hippocratic Oath charges physicians to “first, do no harm.” Sometimes doing no harm to patients means yielding care to a competent NP or PA with the time to fully tend to them, rather than squeezing them in for cursory consults with an MD. If physicians and physicians in training stand behind scope of practice reforms that enable NPs and PAs to take full advantage of their training and skills, they could do more to improve access to primary care than even the ACA. In the end, a dose of humility may be just what the doctor ordered.

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“It is

that is real wealth,not pieces of gold and silver.”-Mahatma Ghandi

health

MORE IS NOT ALWAYS BETTER

By: Rachel Chuang

he overuse and misuse of antibiotics in treating certain illnesses is a common topic of science courses. We are familiar

with the story: antibiotics that are incorrectly and ineffectively used against viral infections, such as colds and flus, cause more antibiotic-resistant bacteria to evolve. Antibiotic resistance has been named one of the most significant public health problems in the world today. This crisis is largely driven by public attitudes

about the purpose of medicine. The public tends to believe that if you are sick, you should go to the doctor and the doctor should prescribe a quick fix. If a patient leaves the office empty-handed without any prescriptions, certain questions may arise. Is the doctor doing his or her job? Was the appointment a waste of time?

TThe Overuseof Medicine in Our

Society“The allocation of resources to

superfluous treatments stunts growth in other public health areas and

education efforts.”

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treatments stunts growth in other public health areas and education efforts. How can we prevent the overuse of health care and change

public opinions toward the application of medicine? In a world geared towards action and “doing something,” how do we escape that mentality when considering the well-being of ourselves and our loved ones? One initiative geared toward addressing this issue is the Do No Harm Project,2 which was started at the University of Colorado School of Medicine. Its mission is to promote doing “as much as possible for the patient and as little as possible to the patient.” Physicians and trainees are encouraged to write vignettes, or reports, about unnecessary medicinal interventions. These reports are then published online, or submitted to journals for review. Other doctors recommend considering benefit-harm tradeoffs and benefit-cost tradeoffs. However, guidelines for utilizing cost-benefit trade-offs are currently not well-defined within the United States. For example, some treatments that are covered by Medicare in the U.S. are not covered in the United Kingdom, as the magnitude of benefit was found to not be worth the cost.4

In conclusion, the common belief that “more is better” is no longer applicable in terms of health care policies and treatments. Both physicians and patients are becoming more aware of this concept. However, implementing change within the health care system to allocate money more effectively, and to prevent harm to patients due to the use of unnecessary medicines remains a challenge.

The World Health Organization reports that more than 50% of all patients overuse, underuse, or misuse prescription and non-prescription drugs.5 This pattern is not only seen in the United States, but also in developing countries, where less than 40% of patients are treated according to recommendations. Such issues stem from the public’s lack of knowledge about medicinal use and the unrestricted availability of over-the-counter medicines. Many people receive information about drugs from TV and magazine advertisements by pharmaceutical companies, rather than clinical guidelines.In September of 2012, the American Medical Association

published a paper on reducing the overuse of certain widespread but unnecessary treatments, including antibiotics for viral upper respiratory infections (URIs) and the over-transfusion of red blood cells.3 The organizations defined “overuse” as treatments that provide limited or no benefit to patients, and may instead cause more harm than good. The paper states that overuse “may result from many factors including payment incentives, time pressures... a culture that has a bias toward ‘doing something’ rather than not, and an inclination to use technology to solve clinical challenges.” Overuse of medicine can both endanger the health of patients and affect health care costs and policies. The United States spends about $8,000 per capita on health care, which is 50% higher than is spent in many other developed nations. Furthermore, unnecessary health care services are estimated to cost $210 billion annually in the United States.1 The allocation of resources to superfluous

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THREAT OF CANCERBy: Christine Chow

A

The Developing

In Low-Income Countries

lthough cancer is mostly thought of as a disease of developed countries, the majority of new cases of cancer are in

developing countries, and with each year, the percentage of new cases occurring in developing countries increases. As of 2009, the percentage of new cases in developing countries was already 55%. Even though developed countries still have a higher rate of cancer, the quantity of people and population growth rate in developing countries has lead to a greater overall number of cancers in the developing world. Not only do developing countries face increasing incidences of cancer, but they also face lower survival rates. For example, 85% of cervical cancer deaths are from developing countries due to lack of screening through the Pap smear.So why is cancer growing as a health issue?

One reason is actually the improving standard of living. Along with a better economy and more money, people can smoke, eat unhealthy foods, and buy more alcohol. Because these habits create physiological problems, they also increase the likelihood of cancers such as lung cancer, liver cancer, and a variety of cancers in the case of obesity. Besides this negative impact of a country’s economic progression, the positive effect of extending the average lifespan also adds to the growth of cancer in these countries. By virtue of having a longer lifespan, people have

more chances to contract cancers as they get older. Even after surviving or avoiding infectious diseases, people are still prone to hereditary or non-transferable diseases such as cancer. A third reason for the overall increase in cancer in developing countries comes from the infectious diseases that still exist despite the great progress in prevention. Compared to higher-income countries, low-income countries have a much higher rate of cancers related to a viral agent. In these countries, infectious agents, such as H. pylori, HPV, and Hepatitis B, indirectly or directly cause 25% of the cancers. For all of these reasons, the types of cancers prevalent in developing countries differ greatly from cancers prevalent in developed countries. Along with the growth in cancer rates in

developing countries, the absence of enough drugs, human resources, examinations, and hospitals, combined with lower survival rates, contribute to the impact of cancer. Because of these expenses, people in developing countries cannot access the necessary drugs. Even if they had the money, the physical distance people would need to overcome to obtain these drugs could prevent access. Sometimes these drugs are not in the same country, in which case, hospitals would need to overcome regulatory or legal barriers. Furthermore, the correct usage of these drugs would require an adequate amount of human resources, such as doctors, nurses, and pharmacists. Because not many people in these countries are trained in medical professions, people may not be aware of these drugs, much less know the correct dosages and usages. Along with this lack of human resources is the dearth of preventative examinations. Examinations can be a quick way to inform people of early stages of cancer or help doctors recognize physiological problems, yet often times these base-level tools are not available. Lastly, one of the biggest obstacles to treating cancer in developing countries relates to all of the previously mentioned issues – the

“Low-income countries have a much higher rate of

cancers related to a viral agent. In these countries,

infections agents... indirectly or directly cause 25% of

the cancers.”

17

not necessarily difficult. For example, raising awareness in developed countries about these problems can help non-profit organizations recognize the necessity of addressing cancer. Increased awareness could help fill the gap in infrastructure in these developing countries. Educating people about the symptoms of cancer, nearby health facilities, and the causes of cancer can help rectify the issue. Of course, many methods of awareness and education exist, so finding the best way can be difficult. Nevertheless, these actions would improve the lives of many people.

lack of hospitals. Without new and major hospitals, doctors do not have the infrastructure necessary to organize equipment and drugs or set up appointments with patients. In addition to the barriers that developing countries generally face, each country and each person faces additional unique difficulties in dealing with cancer. While many organizations try to assist these countries

in creating a base level of health, cancer, a less recognized problem, has become an increasingly important issue that is also intertwined with infectious disease. More actions should be taken to address these issues, and these actions are

18

“Medicine heals doubtsas well as diseases.”

-Karl Marx

pre-medtips

By: Grace Lin

RETHINKING THE MCATPremedical students are very familiar with the Medical College Admissions Test, or MCAT. However, the MCAT was last updated in 1991. Given the vast changes to healthcare since then, is the test still a good predictor of who the best physicians will be?

When medical school admissions committees looked into what made candidates most successful, they decided that there needed to be a more standardized measure of those qualities than the current MCAT. As a result, the format of the Medical College Admissions Test will change beginning Spring 2015. This format will likely be upheld until at least 2030. The changes reflect the understanding that being a successful physician requires more than just knowledge of the hard sciences. Social and cultural aspects of medicine are just as important, especially in an increasingly diverse population of patients. For instance, many of the top diseases and causes of death in the United States – such as smoking, obesity, and cardiovascular disease – can be linked to behavioral issues and socioeconomic status. According to Ana Adinolfi, Cornell’s College of Arts and Sciences health careers advisor, “[Committees were] adding

in social sciences, thinking about having future doctors who are well informed about what’s going in the world, how to interact with people…that part was missing from the standardization of the medical school application process and medical schools would have to teach students that after they were admitted.” It is important for future doctors to be not only academically but also culturally competent and aware. Addressing

emotional needs and making patients feel cared for is a large part of being a healer. Intrapersonal and interpersonal skills are necessary to develop a rapport with patients coming from very different backgrounds. The MCAT’s new social behavior section will ideally test for these qualities.

New MCAT 2015 sections:•Biological and Biochemical Foundations of Living Systems•Chemical and Physical Foundations of Biological Systems•Psychological, Social and Biological Foundations of Behavior•Critical Analysis and Reasoning Skills

Pre-2015 MCAT sections:•Physical Sciences•Verbal Reasoning•Biological Sciences•Writing Sample

Science sections will be revised to reflect updates in medical knowledge, and there will be a greater emphasis on biochemistry, which will be helpful upon entry to medical school. Statistics will also be added to the MCAT. Overall, passages will be more medically relevant. For instance, questions could relate to torque and skeletal movement, or blood pressure, as opposed to classic problems involving roller coasters or pendulums. Each new section will be longer than its old counterpart, bringing the total testing time up to 6 hours and 15 minutes (from 3 hours and 20 minutes).

WHY THE CHANGE?

WHAT IS NEW?

21

The change will mostly affect students taking the MCAT in Spring 2015, who will later apply to medical school and matriculate in Fall 2016. Students considering a gap year should keep in mind that MCAT scores are only valid for two to three years depending on the school.

The last administration of the current MCAT will take place in January 2015. The new MCAT will be administered beginning Spring 2015

Traditional applicants will be able to take the MCAT after completing the majority of their coursework, typically at the end of junior year. The most obvious impact that the new MCAT will have is on the classes students choose to take. Adinolfi recommends taking statistics, biochemistry, and psychology or sociology (preferably both).AAMC will release a 2015 MCAT practice test and The

Official Guide to the MCAT 2015 Exam to aid students in preparing for the test. They encourage students to continue to take the classes relevant to what will be tested on the MCAT, but, even further, to understand how each core science relates to the others. “After 2015, [the MCAT] will be more about competencies and less about coursework,” says Adinolfi. How else can you prepare? It seems tricky to prepare

for a test that is still developing. Companies like Kaplan are working on developing 2015 relevant material for prep classes, but it is not known when these classes will be offered. The decision to enroll in an MCAT prep course requires self-reflection on study habits and the ability to maintain a quality study schedule. Just like the old MCAT, it is important to understand

that the new MCAT is not asking its takers to reiterate everything they have learned in their coursework. The admissions committee can look to transcripts for that aspect. Rather, the MCAT tests the ability to think critically and creatively solve problems – valuable attributes for future doctors. The practice of medicine is integrative, so applying learned concepts are good steps to prepare for the test of becoming a doctor.

WHO WILL BE AFFECTED?

WHEN WILL IT HAPPEN?

HOW TO PREPARE

22

OH MY!By: Angela Goscilo

Prelims,Assignments,and Papers,

23

I f there is one thing that all Cornellians share, it is stress! Whether it is a result of managing coursework, beating the curve or getting that perfect seat in Olin, we all

create stress for ourselves. In these situations, we all must be proactive and work to reduce our stress. In fact, there are many ways of doing so from modifying your diet to taking up new hobbies.

1. Enjoy What Cornell has to OfferThere is much more to Cornell than the stacks of the library. Between various clubs, sport teams and volunteer groups, there are plenty of ways to get involved. Getting involved is a way to meet to new people and immerse yourself in Cornell culture. Cornell has over 1000 clubs1, visit the Cornell Student Organization website and see which ones match your interests. Take time to check off the 161 things to do at Cornell, none of which include studying through the night in Uris!

2. ExerciseStudies have shown that those who exercise see numerous health benefits including reduction in stress.6 Although beginning an exercise routine may seem daunting, it has numerous rewards. Exercise has been proven to increase the concentration of neurotransmitters, like endorphins levels, which help to improve one’s outlook.6 Physical activity also helps to take the stressors of the day off your mind. Did you ever notice that when you are working out you aren’t concerned with your upcoming prelim or assignment? Exercise can act as a form of meditation.

3. Get More Sleep Amount of sleep and stress are significantly related. The Division of Sleep Medicine at Harvard University reported that a study done in 2001 determined that only 11% of college consistently sleep well.2 What’s more is that the American College Health Association found that only 7.3% of students felt fully rested on all seven days of the week.3 Sufficient amount of sleep is critical for proper brain cognition. In addition, there are many negative consequences of sleep deprivation. Try to get 7 to 8 hours of sleep per night.

4. Eat a Well Balanced DietEating junk foods, foods that are high in fat and refined sugars, make us feel groggy and sluggish. These foods do not provide sustained energy. Balanced diets promote health and can leave us feeling stress free. Snack on foods such as raw veggies, nuts and oranges, which are all proven to reduce stress.5 Also, incorporating foods like oatmeal, spinach and avocados can have positive effects on one’s mental state.

6. Try YogaYoga is a practice that teaches individuals how to achieve a state of peace through various poses and breathing techniques intended to promote self-awareness. There are many varieties of yoga, each which serve a similar purpose. All of the Cornell Fitness Centers offer yoga classes.

9. Take a BreakWhile it may seem that hours of studying will lead to success, it is always beneficial to take a much earned break. Walk outside, meet up with a friend or take a short nap! College is supposed to be the best four years of our lives, so get out there and enjoy it. Learn to balance studies with valuable experiences.

10. Dance in the RainBe silly- dance in the rain, sing in the shower and make funny faces. Dancing can reduce the level of chemicals that create stress. Similar to the effect of exercise, this can act as an antidepressant.

5. Maintain Your Sense of HumorRemember to laugh and how to have fun. While Cornell may be overwhelming at times, take a moment for yourself. Studies have proven that laughter can reduce stress through relief of tension. Laughing increases and then “cools down” the stress response systems in the body.4 This cycle leads relaxed feelings.

7. Talk About It When you are stressed out for any reason, try talking to someone. Whether it is a friend, professor or professional, talking it out can greatly help to relieve stress. Cornell offers many different resources, such as EARS,7 where students can seek assistance. Also consider keeping a journal to write down how you are feeling. Writing down your feelings can help you to feel better and determine what is the real cause of your stress.

8. Focus on One Thing at a TimeWe face countless stressors on a daily basis, which when put together seem incredibly overwhelming. Take a step back and prioritize what you need to get done. Handle one task at time. Most people find that focusing on one task leads to more productive work than focusing on everything.

In short, we all have stress and it is important that we learn how to manage it. There are many different strategies that can be used to reduce these feelings of anxiety. Whether you take up a hobby, join a club or run outside, make time for activities that make you feel good.

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25

“If we knew what it waswe were doing,it would not be called

would it?”-Albert Einstein

research

26

By: Devin Massaro

A Study in Sleep

27

Don’t Go toBed Angry

P more quickly and had more restful sleep. Interestingly, high PA reactivity only affected the ease with which one is able to fall asleep. Lastly, they found that those people with both high trait PA and PA reactivity had a much harder time falling asleep and getting restful sleep. In other words, people who are more naturally more enthusiastic and outgoing have an easier time falling asleep and end up getting a more restful sleep. Also, if one is not optimistic about the hassles in life, one will have a harder time falling asleep (restfulness of sleep is not affected). Lastly, if one is enthusiastic yet pessimistic, the negative effects mentioned before will be even worse.Dr. Ong and his colleagues have shed

some light on this important issue. While they showed that those with high trait PA are lucky enough to easily catch the elusive gift of a good night’s sleep, the study also revealed that the key to sleep is a positive outlook. So when you are down after a long day of work and maybe a bad grade, don’t let it get to you. If you keep a positive outlook, you may be able to catch those Zs you need and come back the next day ready to take on the world - or just Organic Chemistry. So remember, keep your chin up, put your head down on the pillow, and drift on off to dreamland.

reactivity, in contrast, is the way a person is affected by and deals with the little hassles and victories in daily life. It is essentially a measure of optimism. So, if someone has high PA reactivity, they are more easily affected by hassles in daily life and more pessimistic. Dr. Ong and his colleagues set out to

explore the relationship between both of these aspects of PA and how they are linked to sleep. They began with three hypotheses: (1) that higher levels of trait PA would be related to an easier time falling asleep, better overall sleep quality, and greater morning rest; (2) that greater PA reactivity would be related to poor sleep quality, less morning rest, and a harder time falling asleep; and (3) that the effects of high PA reactivity would be exacerbated if one also had high trait PA.Dr. Ong used a very simple yet elegant

method to test his hypothesis. Using data from the Midlife in the United States Survey (a nationwide survey lasting one year), he used a multilevel modeling approach to compute estimates of daily PA reactivity by examining the unique relationships between the number of daily events and daily PA for each person. The results of this study were in accordance with the hypotheses of Dr. Ong and his colleagues. They found that people with high trait PA fell asleep

eople disagree on many things: the future of our country, the best sports team, and whether or not

there was enough room for Leonardo DiCaprio to fit on that door at the end of Titanic. But whether you are a Republican or Democrat, Giants fan or Eagles fan, or have never even seen Titanic, you would agree that sleep is absolutely wonderful. Sleep recharges us after the daily grind and allows us to live out our dreams. This extraordinary gift can be very elusive, however, which is why Cornell Human Development Professor Anthony Ong, PhD wants to find a way to catch it. Research has shown that there are negative health effects, especially those pertaining to mortality, associated with a lack of restful sleep. Research has also shown that one potential factor contributing to a good night’s sleep is positive affect. Based on this research, Dr. Ong and his colleagues recently conducted a study linking positive affect and sleep in an effort to help people fall asleep and get quality sleep.First, what is positive affect? Dr. Ong

studied two variants of positive affect (PA): trait PA and PA reactivity. Trait PA is a person’s characteristic and stable level of positive emotions or feelings. Those with high positive affect are typically enthusiastic, outgoing, and active. PA

“If one is not optimistic about the hassles of daily life, one will have a harder time falling asleep.”

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A Self-Control Center Found in the Brain May

Inspire New DrugsBy: Mei Xin Luo

The significance of this study goes beyond just a scientific revelation that demonstrated the apparent linkage in the DLPFC and vmPFC. Instead, this sort of discovery may become the gateway to the production of drugs to prevent the breakdown of judgment when it comes to exhibiting self-control. Since the need to make “good decisions” and to summon the more sensible side of ourselves is such a significant part of living in the modern world today, this scientific finding has the potential to become a profitable market. The creation of such drugs may appear futuristic and

even controversial to some, but they will be an extension of similar drugs, such as anti-depressants, that are already widely accepted in the pharmaceutical industry. Though there is potential for these drugs to be created based on the results of this study, experts are still skeptical. In theory, drugs of this type can be manufactured, but Hare says that it would be difficult to target that specific region of the brain without affecting neighboring regions. Drugs are not the only way in which self-control can be

regulated; in fact, there have been previous experiments that sought to induce control through minor electrical stimulation. In a study done in 2010 by Bernd Figner, transcranial magnetic stimulation, which makes use of small electric currents, was used to impede activity in the DLPC, leading subjects to make more impulsive decisions. This technology could also be used to achieve the opposite and to increase the activity of the DLPC to establish self-control. This technology formulates a way by which the brain can be trained to act in a certain way, given a dilemma. If a demand for the regulation of self-control grows in the near future, we may see more active research done to resolve the specificity issue in drugs rather than this form of electrical therapy, as they are more convenient and economical. This drug would also be capable of revolutionizing the dieting culture, given that it would ensure that dieters remain committed to the regimen – a common problem for which nobody has yet produced an effective solution.

ow often does a dieter run into the problem of self-control when confronted with a slice of Vanilla Bean Cheesecake? How frequently do shopping

addicts choose to give into their impulse of purchasing the latest style of cashmere sweater? Many would admit that their willpower often falters when presented with an opportunity to satisfy their immediate desires, rather than exert self-control. Yet a new scientific study shows that this tendency is not completely arbitrary; in fact, some individuals are more susceptible than others to give into their temptations. This lack of self-control can be in part explained by decreased activity in the dorsolateral prefrontal cortex (DLPFC) of the brain. Scientist Todd Hare presented dieters with a variety of

food choices while they were inside a functional magnetic resonance imaging (fMRI) scanner. Participants ranked each food on a scale based on taste and healthiness. On the basis of these rankings, researchers selected the food that was given a neutral rating. Researchers then presented the neutral food item with each of the other foods and asked participants to select one to eat. Researchers then separated the participants into the self-control (SC) or no self-control (NSC) groups based on the choices each person made. Self-controllers were those who took both the taste and healthiness of the food item into account, while non self-controllers only took the taste of food into account, thus favoring the most liked and unhealthiest item. The fMRI data acquired from these two groups, interestingly

enough, showed that the ventromedial prefrontal cortex (vmPFC) was activated in both groups, implying that it is important in decision-making. However, there was only significant recorded activity in the dorsolateral prefrontal cortex region among self controllers, leading researchers to conclude that this portion of the brain is responsible for incorporating what they call “higher order factors,” such as health, into the decision. This trend in self-controllers is opposed to only the incorporation of taste in the vmPFC in non-self controllers.

H

“Instead, this sort of discovery may become the gateway to the production of drugs to prevent the breakdown of judgment when

it comes to exhibiting self-control.”

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30

AT CORNELLIn Photos:Medicine, Health, Pre-Med, and Research

31

AT CORNELL

DEVON MCMAHONBiological Sciences and College Scholar Program - Arts and SciencesClass of 2015This is Devon McMahon’s second semester as Editor-in-Chief of the StethoSCOOP. She is also a global health minor and involved in many clubs related to research and global health. On campus, Devon is a research assistant in the Linster and Young lab. She has studied global health in Peru and South Africa, and plans to study abroad next semester in Nepal. After graduating from Cornell, Devon hopes to attend medical school. In her free time, she enjoys spending time outdoors and relaxing with friends and family.

CONT

RIBUT

ORS

ARIEL WAMPLERHuman Biology, Health, and Society - Human EcologyClass of 2015In addition to writing and editing for StethoSCOOP, Ariel Wampler is the outreach chair and a writer for Cornell’s student health magazine The Student Body, a volunteer at the Ithaca Free Clinic, an Active Citizen for Alice Cook House, and a PATCH mentor. She formerly worked as an undergraduate research assistant with the Laboratory for Rational Decision-Making, and as a laboratory assistant at an epigenetics lab at Harvard Medical School. Her lifelong dream is to become a physician, and she is pursuing a Master’s in Public Health as well as an M.D.

Her interests extend into social justice, medical ethics, health policy and educational policy, neuroscience, psychology, and philosophy. Outside of academia, Ariel enjoys the classics of Western literature, baking elaborate desserts, hiking, skiing, and various crafts.

ERIN BARLOWBiology and English - Arts and SciencesClass of 2016Erin aspires to earn an MD and become a physician in emergency medicine, a surgeon, or a medical examiner–she’s not sure which. In the meantime, she divides her time between classes, research on spinal cord injury in mice, and her various clubs. In addition to being a writer and editor for StethoSCOOP, her hobbies include reading, baking, knitting, and sword fighting with the Ring of Steel club.

ANN LEINutritional Sciences - Human EcologyClass of 2016Ann is a Los Angeles native and global health minor who aspires to alleviate malnutrition and disease in impoverished communities. She fulfills her graphic and layout design cravings with not only The StethoSCOOP, but also The Thread, the Big Red Sports Network, and The Student Body. She is also an avid fan of Jamaican Me Crazy coffee, yoga, and naps.

RACHEL CHUANGBiology - Arts and SciencesClass of 2016Rachel is particularly drawn to the areas of cell biology, global health, and education issues. On campus, she enjoys volunteering her time with Givology, Global Dental Brigades and Project Generations. Rachel currently works in the Lab of Ornithology to develop curriculum materials for 2nd to 7th graders. In her free time, she enjoys drinking green tea and watching movies.

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SACHIDHANAND JAYAKUMARBiological Sciences - CALSClass of 2015Sachidhanand Jayakumar (you can call him Anand) is a Biological Sciences major at Cornell concentrating in neurobiology and behavior. After graduating from Cornell, he plans on going to medical school somewhere on the east coast. Anand is particularly interested in researching the progression of neurodegenerative diseases and has done projects at the NYS Dept. of Health, Albany Medical College, and the Linster lab. He has been involved on campus as the treasurer of Learn To Be, a REACH tutor at a local school, an editor of the StethoSCOOP magazine. For fun,

Anand likes to go to the gym or play sports of any kind. He is particularly interested in martial arts and currently practices Aikido at Cornell.

DEVIN MASSAROHuman Development - Human EcologyClass of 2015Devin is interested in everything neuroscience related. He has yet to decide on a specific facet of medicine to pursue after graduation. Devin is the Publicity Chair for StethoSCOOP; when he is not writing for the journal, he is spending time with friends. Devin is also a member of Phi Sigma Pi Honor Fraternity and enjoys doing service work on campus. He hopes to one day move to California and escape the incessant cold of the Northeast.

CHRISTINE MATHEWHuman Biology, Health, and Society - Human EcologyClass of 2015Aside from writing for the StethoSCOOP, Christine volunteers in the Emergency Department at Cayuga Medical Center and works as a Student Assistant at Uris Library. Her interests include human physiology, nutrition, health policy, and bioethics, among others. After graduating from Cornell, she hopes to attend medical school closer to her home in Bergen County, NJ. In her free time, she enjoys reading, drawing, running, swimming, and spending time with family and friends.

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CHRISTINE CHOWBiological Sciences - Arts and SciencesClass of 2016In addition to her interest in learning more about the intricacies of biology and the advancements within the field of biology, Christine want to understand how aspects of biology relate to everyday matters. Other than school-related activities, Christine enjoys trying new types of food and eating her favorite snacks while studying for classes.

ANGELA GOSCILONutritional Sciences - Human EcologyClass of 2015Angela is a dietetics student in the College of Human Ecology. In the future, she aspires to be a healthcare professional delivering care with a strong nutritional focus. This is her second semester writing for StethoSCOOP. Angela divides her time between classes and various clubs. She is also a Marketing and Promotions Intern with Cornell Dining Nutrition. Angela also enjoys running, playing tennis, baking and spending time with friends in her spare time.

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MEI XIN LUOBiology and English - Arts and SciencesClass of 2015Raised in New York City, Mei is an English and Biology major. She wants to blend her two passions into a career in scientific journalism in the future. Her outside activities include being an Arts & Sciences student ambassador, interning for an online magazine, and writing short stories. Her dream is to one day publish a collection of short stories.

GRACE LINBiology - Arts and SciencesClass of 2016Grace is especially interested in nutrition and medicine from the perspective of public health and global sustainability. An aspiring physician, she may pursue an MD/MPH following her undergraduate education. She currently researches in the O’Brien lab and is involved in service work on campus.

ZOE MEMELNutritional Sciences - Human EcologyClass of 2015Born and raised in sunny California, Zoe has always been a strong believer in fresh foods and plenty of outdoor activity. Zoe is currently a junior at Cornell University and is studying the field of nutritional sciences with a particular interest in health care inequality. Besides writing for the Stethoscoop, Zoe is the teaching director of an organization on campus called Cover Africa, the lead undergraduate coordinator in a Weight-Gain prevention Lab, a residential advisor for Clara Dickson Hall and a public service scholar. In her spare time she enjoys cooking with friends, running,

yoga and watching movies.

MIKA GAUGERHuman Biology, Health, and Society - Human EcologyClass of 2015Mika is a pre-med student, aspiring to study Pediatrics and Internal Medicine. Mika is also on the SpringFest planning board. This summer, she will be a student field technician for the Cornell Small Grains Research project in the H.H. Love Lab.

CONTRIBUTORS+

REFERENCESOctober 15, 2013.6. Available at: http://www.oecd.org/els/health-systems/oecdhealthdata2013-frequentlyrequesteddata.htm. Accessed October 15, 2013.7. Available at: https://www.aamc.org/advocacy/campaigns_and_coalitions/fixdocshortage/. Accessed October 14, 2013.8. Available at: http://www.cdc.gov/chronicdisease/resources/publications/aag/aging.htm. Accessed October 15, 2013.9. Available at: http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/MedicareProgramRatesStats/SummaryMedicareMedicaid.html. Accessed October 15, 2013.10. Available at: http://www.npr.org/2013/10/11/231104643/faq-where-medicaid-s-reach-has-expanded-and-where-it-hasn-t. Accessed October 15, 2013.11. Available at: http://www.reuters.com/article/2013/09/18/us-usa-healthcare-spending-idUSBRE98H11T20130918. Accessed October 14, 2013.12. Available at: http://www.npr.org/templates/story/story.php?storyId=245343964 . Accessed November 15, 2013.13.Available at: https://www.aamc.org/advocacy/campaigns_and_coalitions/fixdocshortage/. Accessed October 14, 2013.14. Medicare Payment Advisory Commission Reports to the Congress: Medicare Payment Policy, 2000-201215. Zuckerman S, Williams AF, Stockley KE. Trends in Medicaid physician fees, 2003-2008. Health Aff (Millwood). 2009;28(3):w510-9.16. Available at: http://www.medscape.com/features/slideshow/compensation/2013/public. Accessed October 14, 2013.17. Decker SL. In 2011 nearly one-third of physicians said they would not accept new Medicaid patients, but rising fees may help. Health Aff (Millwood). 2012;31(8):1673-9.18. Bisgaier J, Rhodes KV. Auditing access to specialty care for children with public insurance. N Engl J Med. 2011;364(24):2324-33.19. Available at: https://www.aamc.org/data/facts/applicantmatriculant/. Accessed October 15, 2013.20. Morrison F, Shubina M, Turchin A. Encounter frequency and serum glucose level, blood pressure, and cholesterol level control in patients with diabetes mellitus. Arch Intern Med. 2011;171(17):1542-50.21. Association of American Medical Colleges. A Snapshot of the New and Developing Medical Schools in the United States and Canada. 201222. Available at: http://nypost.com/2013/09/17/ny-medical-schools-increase-enrollment/. Accessed October 15, 2013.23. Available at: http://www.kitsapsun.com/news/2013/jun/11/latin-american-doctors-fill-us-physician/#axzz2hkNf6opG. Accessed October 14, 2013.24. Available at: http://www.medpagetoday.com/PublicHealthPolicy/MedicalEducation/41651. Accessed October 15, 2013.25. Available at: http://www.premedlife.com/1/post/2013/04/6-medical-school-trends-to-watch-for-in-2013.html. Accessed October 15, 2013.26. Available at: https://www.aamc.org/advocacy/gme/71178/gme_gme0012.html. Accessed November 15, 2013.27. Available at: https://www.aamc.org/advocacy/campaigns_and_coalitions/fixdocshortage/. Accessed October 14, 2013.28. Available at: http://beta.congress.gov/bill/113th/house-bill/1180. Accessed November 2, 2013.Available at: https://www.govtrack.us/congress/bills/113/hr1201.

CoverPHOTO: http://www.flickr.com/photos/thomashawk

The Lack of Nutrition Education in American DoctorsKung HC, Hoyert DL, Xu JQ , Murphy SL. Deaths: final data for 2005. National Vital Statistics Reports 2008;56(10). Available from http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_10.pdf2, 3, 5, 6. Deardoff, Julie. A Nutrition Gap in Modern Medicine. Chicago Tribune.PHOTO: http://www.flickr.com/photos/sanofi-pasteur,

The Present State of Electronic Health RecordsCaine, K. and Hanania, R. (2012). Patients Want Granular Privacy Control Over Health Information in Electronic Medical Records. J. American Medical Information Association, 20, 7-15.HealthIT (2012). The Benefits of Electronic Health Records. Retrieved from http://www.healthit.gov/providers-professionals/ benefits-electronic-health-records-ehrs.Jamoom, E., Beatty, P., Bercovitz, A., Woodwell, D., Palso, K. and Rechtsteiner, E. (2012). Physician adoption of electronic health record systems: United States, 2011. NCHS data brief, 98.Mandl, K. D. and Kohane, I. S. (2012). Escaping the EHR Trap – the Future of Health IT. The New England Journal of Medicine, 366 (24), 2240-2242.PHOTO: http://sunvalleymag.com/Blogs/Body-Soul/Summer-2013/Take-Control-of-Your-HealthElectronically/files.jpg

Osteopathic Medicine“About Osteopathic Medicine.” American Osteopathic Association. American Osteopathic Association, 2013. Web. 15 Oct. 2013.Degenhardt, Brian F., D.O. “Osteopathic Manipulative Medicine: Optimizing Patient-focused Health Care.” The Advisor 21.1 (2000): n. pag. American Association of Colleges of Osteopathic Medicine. Dec. 2000. Web. 1 Nov. 2013.“What Is Osteopathic Medicine? .” American Association of Colleges of Osteopathic Medicine. American Association of Colleges of Osteopathic Medicine, n.d. Web. 17 Oct. 2013.Wu, Patrick, and Jonathan Siu. A Brief Guide to Osteopathic Medicine, For Students, By Students. Publication. American Association of Colleges of Osteopathic Medicine, 10 Apr. 2012. Web. 15 Oct. 2013. Salzberg, Steven. “Second Thoughts On Osteopathic Medicine.” Forbes. Forbes Magazine, 29 Oct. 2010. Web. 15 Nov. 2013.PHOTO: http://www.flickr.com/photos/usdagov

I Need a Doctor1. Feldstein PJ. Health Policy Issues, An Economic Perspective. Health Administration Press; 2011. 2.Available at: http://www.medscape.com/features/slideshow/compensation/2013/public. Accessed October 14, 2013.3. Explanation of method: This takes into account the costs of tuition, books, and the income that could have been earned during medical school and residency, and compares what could have been earned by investing those funds into the stock market to income earned as a future physician (discounted to the present). 4. Feldstein PJ. Health Policy Issues, An Economic Perspective. Health Administration Press; 2011. 5. Available at: http://www.forbes.com/sites/theapothecary/2013/05/28/are-u-s-doctors-paid-too-much/. Accessed

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Accessed November 2, 2013.29. Iglehart JK. The residency mismatch. N Engl J Med. 2013;369(4):297-9.30. Available at: http://www.aapa.org/your_pa_career/becoming_a_pa.aspx. Accessed November 2, 2013.31. Available at: http://explorehealthcareers.org/en/Career/75/Nurse_Practitioner#Tab=Requirements. Accessed November 2, 2013. 32. Horrocks S. Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors. BMJ. 324(7341):819-823.33. O’Grady ET. Advanced Practice Registered Nurses: The Impact on Patient Safety and Quality. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr. Chapter 43. Available from: http://www.ncbi.nlm.nih.gov/books/NBK2641/ 34. Heller ME, Veach LM. Clinical Medical Assisting: A Professional, Field Smart Approach to the Workplace, A Professional, Field Smart Approach to the Workplace. Cengage Learning; 2008.35. Available at: http://kff.org/other/state-indicator/nurse-practitioner-autonomy/. Accessed November 2, 2013.October 15, 2013. 36. D. Blumenthal and M. K. Abrams, “Putting Aside Preconceptions—Time for Open Dialogue Among Primary Care Clinicians,” New England Journal of Medicine, pubished online May 16, 2013.37. Desroches CM, Gaudet J, Perloff J, Donelan K, Iezzoni LI, Buerhaus P. Using Medicare data to assess nurse practitioner-provided care. Nurs Outlook. 2013.38. Available at: http://www.sj-r.com/breaking/x1039452481/Doctors-block-Statehouse-bills-to-expand-nurse-dentist-roles.39. C. Schoen, R. Osborn, D. Squires, M. M. Doty, R. Pierson, and S. Applebaum, New 2011 Survey of Patients with Complex Care Needs in 11 Countries Finds That Care Is Often Poorly Coordinated, Health Affairs Web First, Nov. 9, 2011.40. Dill MJ, Pankow S, Erikson C, Shipman S. Survey shows consumers open to a greater role for physician assistants and nurse practitioners. Health Aff (Millwood). 2013;32(6):1135-42.41. Available at: http://www.npr.org/blogs/health/2012/05/24/153583423/whats-up-doc-when-your-doctor-rushes-like-the-road-runner. Accessed October 15, 2013.42. Available at: http://www.medscape.com/features/slideshow/compensation/2013/public. Accessed October 14, 2013.43. Available at: http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=92. Accessed November 2, 2013.

More is Not Always BetterCaverly, T. J., Combs, B. P., Moriates, C., Shah, N., & Grady, D. (2013). Too Much Medicine Happens Too Often: The Teachable Moment and a Call for Manuscripts From Clinical Trainees. Jama Intern Med. Retrieved from http://archinte.jamanetwork. com/article.aspx?articleid=1741887 Do No Harm Project. (n.d.). General Internal Medicine. Retrieved from http://www.ucdenver.edu/academics/colleges/medicalschool/ departments/medicine/GIM/education/DoNoHarmProject/ Pages/Welcome.aspxJoint Commission and American Medical Association. (2012). Proceedings from the National Summit on Overuse. Retrieved from http://www.ama-assn.org/resources/doc/cqi/overuse-proceedings-paper.pdfLipitz-Snyderman, A., & Bach, P. B. (2013). Overuse of Health Care Services: When Less Is More … More or Less. Jama Intern Med, 173(14), 1277-78. Retrieved from http://archinte.jamanetwork.com/ article.aspx?articleid=1691771

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Medicines: rational use of medicines. (n.d.). World Health Organization. Retrieved from http://www.who.int/mediacentre/ factsheets/fs338/en/PHOTO: http://shaninarce.wordpress.com/2013/05/28/beautiful-sandys-fitness-shoot; http://oracletalk.com/wp-content/uploads/2013/07/Screen-Shot-2013-07-10-at-4.21.51-PM.png

The Developing Threat of Cancer in Low-Income CountriesBryant, John H., and Phillip Rodes. “Variations among Developed Countries.” Encyclopedia Britannica Online. Encyclopedia Britannica, n.d. Web. 16 Nov. 2013. <http://www.britannica.com/ EBchecked/topic/482384/public-health/35553/Variations-among -developed-countries>.“Cancer in Developing Countries.” International Network for Cancer Treatment and Research. INCTR, n.d. Web. 14 Oct. 2013. <http://www.inctr.org/about-inctr/cancer-in-developing- countries/>.CanTreat International. “Scaling up cancer diagnosis and treatment in developing countries: what can we learn from the HIV/AIDS epidemic?” Annals of Oncology 21.4 (2010)): 680-682. Web. 14 Oct. 2013. <http://annonc.oxfordjournals.org/content/21/4/680. full>.“Data comparing more and less developed countries.” World Cancer Research Fund International. WCRF International, 2008. Web. 14 Oct. 2013. <http://www.wcrf.org/cancer_statistics/developed_ countries_cancer_statistics.php>.Frenk, Julio. “Cancer is on the rise in developing countries.” HSPH News. Harvard School of Public Health, Fall 2009. Web. 14 Oct. 2013. <http://www.hsph.harvard.edu/news/magazine/shadow- epidemic/>.“Myth 2 - Cancer Is A Disease Of The Wealthy, Elderly And Developed Countries.” World Cancer Day. n.p., n.d. Web. 14 Oct. 2013. <http://www.worldcancerday.org/myth-2-cancer-disease- wealthy-elderly-and-developed-countries>.Silberner, Joanne. “Part III: An Ounce of Prevention.” Public Radio International. PRI’s The World, 05 Dec. 2012. Web. 14 Oct. 2013. <http://pri.org/stories/2012-12-05/part-iii-ounce-prevention>.Silberner, Joanne. “Part IV: The Infectious Connection.” Public Radio International. PRI’s The World, 06 Dec. 2012. Web. 14 Oct. 2013. <http://pri.org/stories/2012-12-06/part-iv-infectious- connection>.PHOTO: http://www.an-hua.org/sites/default/files/image/fotos/malaria_-_anhua_08.jpg

Rethinking the MCATAdinolfi, Ana. Personal interview. 1 Nov. 2013.Association of American Medical Colleges. “The MCAT 2015 Exam for Students”. <https://www.aamc.org/students/applying/mcat/ mcat2015/>.Kaplan MCAT Team. MCAT 2015: What the Test Change Means for You Now. Kaplan Publishing: New York, NY.PHOTO: http://www.news.cornell.edu/picture-cornell/picture-cornell-oct-1-2013

Prelims, Assignments, and Papers, Oh My! Student Organizations. Retrieved from www.orgsync.rso.cornell.eduSleep and Memory. Retrieved from http://healthysleep.med.harvard. edu/need-sleep/whats-in-it-for-you/memory.American College Health Association. National College Health Assessment: Reference Group Data Report. 2007. 31Mayo Clinic Staff. Stress relief from laughter? It’s not a joke. Retrieved from http://www.mayoclinic.com/health/stress-relief/ SR00034.WebMD Staff. (23 April 2012). Diet for Stress Management Slideshow: Stress Reducing Foods. Retrieved from http://www.

webmd.com/diet/ss/slideshow-diet-for-stress-management.Mayo Clinic Staff. Exercise and stress: get moving to manage stress. Retrieved from http://www.mayoclinic.com/health/exercise-and- stress/SR00036. Counseling. Retrieved from http://ears.dos.cornell.edu/reachingears. html.

Don’t Go To Bed AngryOng AD, Exner-Cortens D, Riffin C, Steptoe A, Zautra A, et al. (in press). Linking stable and dynamic features of positive affect to sleep. Ann Behav Med DOI: 10.1007/s12160-013-9484-8

PHOTO: http://www.bumc.bu.edu/gms/files/2010/07/BUSMClass1940-HistologyLabFall1936.jpg; http://i.huffpost.com/gen/1264028/thumbs/o-SLEEPING-COUPLE-facebook.jpg

A Self-Control Center Found in the Brain May Inspire New DrugsJan Peters, Christian Büchel, The neural mechanisms ofinter-temporal decision-making: understanding variability, Trends in Cognitive Sciences, Volume 15, Issue 5, May 2011, Pages 227-239, ISSN 1364-6613, http://dx.doi.org/10.1016/j.tics.2011.03.002. (http://www.sciencedirect.com/science/article/pii/S1364661311000374)

Figner, B., & Knoch, D. (2010). Lateral prefrontal cortex andself-control in intertemporal choice. Nature Neuroscience, 13(5), 538-539. Retrieved from http://www.nature.com/neuro/journal/v13/n5/abs/nn.2516.html

PHOTO: http://www.thesweetestoccasion.com/2010/04/homemade-dessert-buffet-wedding-reception-ideas/

At CornellPHOTOS: Winnie Chu and Ann Lei

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