Search This Blog

Loading...
Provided by SEO company.

Wednesday, April 2, 2014

Selected works, part III: Anti-vaccine hysteria and the subsequent effect on public health

Class: Eng 101
Assingment: Report the Conversation-- Desribe a topic that is of high discussion in your intened career
Grade: 92/100

The Rise in Anti-Vaccine Hysteria and the Subsequent Effect on Public Health
Joshua A Pillow
Brigham Young University- Idaho
In February of 1998, Dr. A. J. Wakefield was the main author of an early print article in The Lancet that argued for the causative correlation between the Measles-Mumps-Rubella vaccine, commonly known as MMRV, and Regressive Developmental Disorder, also known as Autism-Spectrum Disorders or ASD. (Wakefield et al. 1998) Both within and without the medical community people started questioning the safety of vaccines; this questioning has led to lower vaccination rates, decreased herd immunity and a decreased effectiveness of vaccines. However, not long after the original publication of his findings, Dr. Wakefield’s work was questioned. Two articles were published in The Lancet which pointed out multiple flaws in the original report, including the fact that Dr. Wakefield’s test subjects were possibly self-referred and may not have even had autism, that Dr. Wakefield’s subjects were at an age where ASD symptoms first appear, and that he considered normal digestive behaviors of children to be symptoms of Inflammatory Bowel Disease, or IBD. Eventually, it was found that Dr. Wakefield falsified data in his study to deliberately discredit the MMRV as he was attempting to patent his own MMRV. The Lancet eventually published a retraction of his study, and many of the co-authors of the paper later retracted their statements and findings. While the fallout resulted in Dr. Wakefield losing his medical license, it has also included thousand deaths directly attributed to preventable diseases and massive outbreaks of diseases that were once extremely rare.
            Most of the concerns and controversy around vaccine safety are related to the relationship between the effect of live viruses used in vaccines and Autism-Spectrum Disorders. In the original report that Dr. Wakefield published in The Lancet, Dr. Wakefield argued that the live, though weakened viruses found in the MMRV vaccine were causing gastrointestinal distress, which could cause peptic acid and bile to leak out of the small intestine and into the bloodstream. (Wakefield et al. 1998) He further argued that the digestive enzymes would then travel to the brain, eventually leading to retrograde Autism-Spectrum Disorders and other neurobehavioral issues. This argument was quickly brought under harsh scrutiny; Dr. Wakefield contended no workable model for how digestive enzymes might cause the retrograde neurobehavioral issues. In a 1998 article published in The Lancet in regards to Dr. Wakefield’s original report, it was noted that reproduction of Dr. Wakefield’s study failed to reproduce his findings of MMR vaccine traces found alongside IDB symptoms in young children. The article read that “…other researchers, using more sensitive and specific assays, have not been able to reproduce these findings.” (Chen & DeStefano 1998 p.612) Further on, it reads: ‘There is no report of detection of vaccine viruses in the bowl, brain, or any other tissue of any of D. Wakefield’s series.” (p.612) The article did not argue that Autism-Spectrum Disorder could never be caused by vaccines, but that there has yet to be any reproducible evidence or workable models for how it might work. Another article published in The Lancet in May of 1998 argued in part that the supposed evidences of IBD in the twelve test subjects were not evidence of any form of IBD. It noted that such symptoms as stomach aches, diarrhea and indigestion are quite normal among children. It also notes that evidences collected through colonoscopy are normal for young children. It read that “…lymphoid nodular hyperplasia in the terminal ileum… is not unusual in children. Walker-Smith et al. have described this condition as ‘benign lymphoid hyperplasia’ due to the frequency of its demonstration in asymptomatic children.” (Richmond & Goldblatt 1998 p.1354)  Even though Dr. Wakefield claims that MMRV-induced IBD has happened with children, several physicians argued against him, stating that IBD-like symptoms are not unusual in children and his evidence was in fact not evidence at all; likewise, Dr. Wakefield’s claims of MMRV-induced IBD, and IBD-induced ASD have been thoroughly discredited and repudiated.
            Many medical professionals question Dr. Wakefield’s findings because it is unclear whether or not his test patients actually had ASD, and if they did have ASD, was it caused by the MMRV? In a correspondence published in The Lancet in May 1998, A. Rouse of the UK Department of Public Health questioned Dr. Wakefield and the credibility of his test subjects. He writes that there is a questionable relationship between Dr. Wakefield and an autism advocacy group referred to as the Society for Autistically Handicapped, writing that “…information from parents referred in this way would suffer from recall bias” (Rouse 1998 p.1356) Dr. Wakefield denied any connection between his research and the society, claiming he never heard of the society. (Wakefield 1998 p.1356) Dr. Wakefield refused to state form where the children were referred. In his original paper Dr. Wakefield noted that all of his test subjects were tested by a psychiatrist who confirmed their diagnoses (p.1356); however, ASD diagnosis can be difficult, and the DSM-IV used at the time did not include as wide of criteria for ASD as is currently included under DSM-V. In order to give a definitive diagnosis, a therapist, either psychiatrist or a psychologist, must spend a significant amount of time with the child and get to understand him or her. Without definitive sources of referral, Dr. Wakefield had failed to prove beyond any doubt that his twelve test subjects actually had ASD, by either DSM-IV standards or DSM-V criteria.
Another area that has been a hot-topic in the arena of vaccine safety is between Thimerosal and ASD. Thimerosal is an organic compound that contains mercury and is an effective antifungal and antibacterial. Because it was considered safe in small doses, it was used in vaccines for the purpose of preservation until 2002 when it was recommended that Thimerosal be removed from all childhood vaccines. The recommendation came after multiple studies failed to definitively prove that trace amounts of mercuric compounds are completely safe. (Grinker 2005 p. 545) Many people, including Robert Kennedy Jr., have claimed that these studies and subsequent recommendations on Thimerosal are proof that the government knew Thimerosal caused autism, stating that there are supposedly hundreds of scientific studies claiming causative correlation between mercuric compounds and ASD (Kennedy 2005); however, there has never been cited any peer-reviewed study showing causative coloration between mercuric compounds and ASD. In fact, there have been many reports showing that there has been no connection between Thimerosal and ASD. Despite the removal of Thimerosal from childhood vaccines and declining vaccination rates, multiple scientific studies have shown increased ASD diagnoses, suggesting there is no correlation between vaccination and ASD. (Gerber & Offit 2009) Despite this, the myth of vaccine-induced ASD continues. In a report on Paul Offit’s book Autism’s False Prophets, Richard Grinker writes “[it] is as if these reports never happened.” (Grinker 2005 p.545) Richard Grinker writes that many people ignore the evidence that is around, instead choosing to lie and support a debunked mentality that vaccines and Thimerosal are causing ASD. Even with mounting evidence that Thimerosal is not connected to ASD, many still believe and push the idea, leading to a disturbingly large cleavage between what is supported by scientific evidence and what is perpetuated by popular media.
One of the more ignored facts in the vaccine debate is that many of the supporters of the pseudo-science that pushes the idea of vaccine-induced ASD have been found to have ulterior motives, most usually financial gain. There is a lot of money to be made from fear mongering and scaring people away from truth. Jenny McCarthy, who has no formal scientific training, has become one of the most outspoken opponents to vaccination in the last several years. She claimed in her book Louder than Words: A Mother's Journey in Healing Autism, that her child was given a vaccine that then caused the child to develop autism, but is now claiming her child is okay—she claims that methods of questionable scientific value have cured her child’s autism. (McCarthy 2007) Many in the medical community believe that her child’s diagnosis of Autism was inaccurate as the symptoms he showed, such as sudden-onset seizures, are not symptoms of autism, but actually Landou-Kleffner Syndrome, which is often mistaken for ASD. Despite her obvious lack of scientific credibility, the doubt around her story’s validity and a preponderance of evidence against her claims, many in the popular media continue to give her credence in her claims. What is often not mentioned is that the methods used to “cure” ASD are often extremely expensive, sometimes costing over ten thousand dollars. Many in the anti-vaccine camp actively attack “big pharma” for being profit-driven, although this is easily repudiated, as the evidence shows vaccination is a low-profit area for everyone involved. (Paul 2009 p.693) Ironically, many of these alternative practitioners who are against “big pharma” stand to make massive profits themselves. (This is similar to the workings of the overall natural health industry, which is its self a multi-million dollar industry.) There is a vast network of people, mostly alternative practitioners like Traditionalist Chiropractors and Acupuncturists, and even a few Osteopathic and Allopathic physicians who, despite well-established evidence against it, practice therapies that are intended to cure Autism. This is considered by some in the medical field to be a violation of the Hippocratic Oath, as it is understood in the medical community that there is no cure for ASD; further, many of these treatments can be painful and traumatizing for young children. Still, many practitioners continue with these controversial treatments. Still, physicians such as Robert Grinker do not necessarily blame the parents of autistic children, noting that for many parents, it’s difficult to simply sit and wait, and pseudo-cures may be very psychologically comforting. (Grinker 2008 p.546) In his paper, Robert Grinker notes that many of the physicians who work to support anti-vaccine theories and their subsequent cures are being paid for their activities by those who profit from the supposed cures. Robert uses the example of Mark Geier, who he notes is not an expert in either autism or vaccination, who does research in his basement, funded by two anti-vaccine activists, an anti-vaccine lawyer (who uses Geier’s findings in his arguments), and a “business partner” of Geier who profits from Geier’s work. (p.545) The idea that ASD is curable stands in direct contrast to the current scientific understanding. While a few fringe practitioners peddle the idea that ASD is curable, usually for financial gain, those who stay within the bounds of reason and science do not peddle what is often called pseudo-science.
As the debate around vaccines has evolved, many in the anti-vaccine camp have questioned the overall effectiveness of vaccines and have questioned if they are even necessary. For many people, it doesn’t seem inherently safe to put live viruses into a human body, and many question whether or not it is necessary. This mentality that has been beneficial to anti-vaccine camp, giving them a flammable fuel they can use to further their ideologies. Most of the questions however come from a lack of proper education on vaccines to the parents. First, while many vaccines do contain viruses, some do not. For example, many influenza vaccines do not contain actual influenza viruses; instead, they contain inert microorganisms that have been modified to mimic the surface protein structure of the influenza virus, which in turn causes the immune system to treat it as the disease and create antibodies.  Second, the argument against so many vaccines is also scientifically flawed, as the human body is not overwhelmed by vaccines, and even a newborn’s immune system can handle hundreds of pathogens at once (Gerber & Offit 2009 p.459) While the body does have a small immune system at a young age, immunity is only available from exposure. The Center for Disease Control recommends 14 vaccinations for children beginning at a few months and progressing to the early teens. (Center for Disease Control 2014) This is because disease is non-discriminatory—it can affect anyone at any age. President Franklin Roosevelt had Polio (one of the 14 diseases children should be vaccinated against) as a child, which led to his inability to walk as an adult. In a report for The Journal for Specialists in Pediatric Nursing, Dr. Lisa Miller, MD and Joni Reynolds, RN write that “Infant immune systems are capable of responding to these routine exposures… Infants and children build effective antibodies to vaccine antigens and are then able to develop internal defenses against a variety of infectious diseases…” (Miller & Reynolds 2009) Immunizations give the body a safer way to be exposed to disease antigens, which in turns protects the body from these very diseases. As more people become immune to diseases, those diseases become less prevalent. Vaccinations work over 99% of the time, making it one of the most successful medical procedures ever. The most striking example is Smallpox. Smallpox was once one of the most deadly disease found in the human race until the 1970s. After a world-wide immunization blitz, Smallpox was totally eradicated, with the exception of a small sample that is kept in a secure lab.  Because these vaccinations give the body exposure to disease antigens without the inherent risk associated with direct disease exposure, the body is capable of building a strong defense against the antigens, therefore proving the necessity, usefulness and effectiveness of vaccines. Because vaccines give the body a means of safe exposure, their effectiveness is evidenced in such things as the eradication of Smallpox, and near-eradication of Polio.
            For many of the pro-vaccine camp, the trend of decreasing vaccination rates have been disturbing. Because of the decrease in vaccination rates, the heard immunity effect is being lost. This is evidenced in the trend of disease outbreaks that were only recently considered rare. According to CDC statistics, In Idaho alone there have been 77 confirmed cases of whooping cough since 2007, with two already this year. In Europe, there have been tens of thousands of cases of Measles; there have been over ten thousand cases of Rubella in Western Europe. This is not random. During the aftermath of Dr. Wakefield’s studies, MMRV rates dropped significantly worldwide. Not long following this drop came an increase in Measles and Rubella cases, focused mostly in Europe. One of the biggest issues faced is that those who under immunize their first child are more likely to under immunize subsequent children. An article in Pediatrics finds that the 18% of under immunization is parental beliefs against vaccines related directly and solely to safety. (Gust et al. 2004) Because heard immunity depends on a vaccination rate above 90%, this puts those who are under vaccinated at greater risk. In a report published by The Lancet in January 1998, it’s noted that in Hungary, where immunization rates have stayed over 95%, there has not been a confirmed case of Pertussis since 1975. (Gangarosa et al. 1998 p.357) This stands in sharp contrast with the US, where vaccination rates have dropped off under 90%, and Pertussis has increased from 1.2 per 100,000 to just over 2 per 100,000, (p.357) which in medical terms is a large enough increase to cause concern. There are even more grizzly statistics: according to the CDC, there have been over a hundred thousand infections leading to over a thousand preventable deaths from under immunization (CDC 2014) Even though those who are immunized themselves are in little harm from outbreaks; there is a large portion of under immunized who are at an increasing risk of disease as the number of preventable diseases continues to rise under the influence of the anti-vaccine movement.
            As the anti-vaccine debate rages, there are those who align themselves with science, and there are those who align themselves with hysteria. While the evidence has conclusively proven time and time again that vaccines are safe and do not cause ASD, there continues to be a loud minority who claim to know better. Many times, the popular media lends ear to the latter group, leading many in the public to be misinformed and weary of what is a safe and many times life-saving treatment, the effect of which causes those who cannot be vaccinated at all to be put at higher risk. The outlook does seem bright, however. Slowly, vaccination rates are continuing to increase, reaching closer to the threshold of heard immunity. Many people are learning to trust their doctors and learning to recognize legitimate scientific inquiry. The debate is slowly shifting, and will continue to shift away from ASD and towards other minor concerns, such as the right to religious refusal of immunizations. Hopefully, there will be a time when the anti-vaccine movement is lowered to a point where it loses its influence completely. That certainly seems the path it’s taking now, and in the minds of many experts, that is the path it should take.
           















References
Autism, inflammatory bowel disease, and MMR vaccine. (1998). The Lancet, 351(9112), 1355.
Chen, R., & DeStefano, F. (1998). Vaccine adverse events: Causal or coincidental? The Lancet, 351(1903), 611.
Freed, G. L., Clark, S. J., Butchart, A. T., Singer, D. C., & Davis, M. M. (2010). Parental vaccine safety             concerns in 2009. Pediatrics, 125(4), 654-659. doi:10.1542/peds.2009-1962
Gangarosa, E., Galazka, E., Wolfe, C., Phillips, L., Gangarosa, R., Miller, E., & Chen R. (1998). Impact of anti-vaccine movements on pertussis control: The untold story. The Lancet, 351, 356-361.
Grinker, R. R. (2009). Offit paul: Autism's false prophets: Bad science, risky medicine, and the search for a cure. Journal of Autism & Developmental Disorders, 39(3), 544-546. doi:10.1007/s10803-008-  0679-y
Gust, D. A., Strine, T. W., Maurice, E., Smith, P., Yusuf, H., Wilkinson, M., . . . Schwartz, B. (2004). Underimmunization among children: Effects of vaccine safety concerns on immunization status.    Pediatrics, 114(1), e16-e22. doi:10.1542/peds.114.1.e16
McCarthy, J. (2007). Louder than words: A mother's journey in healing autism (Reprint ed.). New York City: Penguin Books USA.
Miller, L., Joni. (2009). Autism and Vaccination—The current evidence. Journal for Specialists in Pediatric Nursing, 14(3), 166-172. doi:10.1111/j.1744-6155.2009.00194.x
Plotkin, S., Gerber, J. S., & Offit, P. A. (2009). Vaccines and autism: A tale of shifting hypotheses. Clinical             Infectious Diseases, 48(4), 456-461. doi:10.1086/596476
Wakefield, A., Murch S., Anthony A., Linnell J., Casson D., Makil M., . . . Walker-Smith, J. (1998). Ileal-            lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. The Lancet, 351(9103), 637.
Kennedy, Robert Jr. (2005) Dangerous Immunity Retrieved from http://www.robertfkennedyjr.com/articles/2005_june_16.html
Center for Disease Control (2014) 2014 Recommended Immunizations for Children from Birth through age 6 Retrieved from http://www.cdc.gov/vaccines/parents/downloads/parent-ver-sch-0-6yrs.pdf

Center for Disease Control (2014) Morbidity and Mortality Weekly Reports for 1 Feb 2014 Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6305md.htm#fig1

Monday, March 24, 2014

Selected Works II: Psychiatry-- because psychologists are dumb

Class: Eng 101
Assignment: What I want to be 
Grade: 92/100

Neuropsychiatry: Because Psychologists are losers
In May 2009, I was hired into the management training program at a local grocery store. I felt on top of the world. No longer would I be without a job, and the job I had was full of promise; however, in July 2011 my personal “cloud nine” fell to earth. I lost my job at the store, which was on its way to closing. I had no Idea what I would do, and my mind was too clouded for me to think of any viable options. I quickly took a job at Chick-Fil-A, hoping to work my way up to manager; meanwhile, my mind continued to wander, searching for something that felt correct, which I knew wouldn’t be Chick-Fil-A. As my mind continued to wander, I kept coming back to something I had only considered in passing beforehand: Neuropsychiatry.
                I have always had somewhat of a passive interest in Neuropsychiatry: from the time I was undergoing treatments as a child for learning disabilities, to my treatment for MDD and anxiety as a teenager, I always felt drawn to the field. The psychiatrists I’ve dealt with had left huge impressions on me about how wonderful psychiatrists truly are.  All three of my psychiatrists were been wonderful, caring, and intelligent people-- exactly how I had always envisioned myself as an adult.  Dr. Otto, the
first psychiatrist who treated me, was much kinder than I had expected. He took the time to explain everything about the neurology of ADD, and we was intuitive enough to know that I was smart enough to understand it. Dr. Pam, who was completing her fellowship under Dr. Otto, immediately came across as a sweet and gentile person. She would ask so many questions, wanting to know more about me than just my learning disabilities; she even gave my mom and me advice on how to get rid of some pests that had found their way into our house. Dr. Oh was the first doctor who was able to find the right treatment for my MDD and social anxiety. Instead of just drugging me up like most psychiatrist would do, he took almost an hour talking with me, getting to know all of me, and was smart enough to know what drugs to use when and when to use alternative means, such as psychotherapy. As I came to know my doctors, and began reflecting on the qualities that they put out, I began to feel like I should be just like them; I felt that I should use my natural intuition and caring nature to help others like they do. I began more and more to want to be a psychotherapist.
                As I began to think about what exactly I wanted to do, I thought of several ideas, including child/adolescent psychotherapy and addiction therapy. For a long time, I felt that I should pursue an undergraduate, graduate and Ph.D. in phycology; it gave me a clear road, and It was easy to accomplish. All I would need to do was get started by going to school. Graduate programs were aplenty enough, and I didn’t really need a Ph.D. to practice addiction medicine. I began researching different psychology programs across the country, and I began to educate myself on the different types of psychologists that existed.  But as I continued my learning and thought about exactly what it was I wanted to accomplish, I realized I was looking in the right direction, but I was a bit off; I am better suited for psychiatry. I wanted to treat people medically, and have means available to me that psychologists don’t, such as pharmaceuticals. While often confused, I learned that psychology and psychiatry differ in two fundamental ways: psychology is the general study of behavior, and can include things such as family counseling; inversely, psychiatry is strictly the study of abnormal behavior, and doesn’t include general counseling. Also, a psychologist is someone with a degree in psychology; a psychiatrist is, as mentioned earlier, a physician. A psychiatrist is either an MD or DO, meaning he has completed four years of medical school, and then completed a residency in psychiatry, possibly followed by a fellowship in some sub-specialty like forensics or addiction medicine. The main advantage of being an MD is I would get to use medications in my treatments. Medications were a vital part of my own treatments, and as such, I am a big believer is the use of medications is the treatment of psychiatric and neurological disorders. When I had my first appointment with Dr. Oh, he put me on a regiment of Prozac and Welbutrin.  The effect took some time, but as they slowly built up in my system, I began to notice changes in the way things affected me. I slept better; I felt happier; I enjoyed being around my friends again. Because of my experience with the positive effects on these medications, I’ve become a big believer in the place pharmaceuticals have in healing of both mind and body, for conditions such as MDD are both a psychological and neurological.
As I continued researching psychiatry, I began making a mental checklist of the things I needed to accomplish before, and during, my undergraduate years. Because of the difficulties involved in Medical school, physical, emotional and mental, the admissions committees for most med schools want to make sure the people they select are genuinely interested in medicine as well as genuinely capable of handling medical school. There are almost three applicants per one medical school opening every year, so the admissions committees don’t want someone who couldn’t make it taking the place of someone who could. One of the things medical schools look at is clinical exposure: how much time has an applicant actually spent around people in a medical setting? Another aspect they look at is research. Almost all medical schools are large parts of the medical research community, and it’s vital that the students conducting the research have experience with how those kinds of things are done. Another
aspect of the application is community involvement. Long gone are the days of physicians who are simply physicians; todays doctors must be active, vitals pieces to the community as a whole. When admissions look at med school applications, they want the applicants to show that they genuinely want to be a part of a community and not simply to be the doctors of a by-gone era when doctors were above, and better than those they treated; likewise, they want applicants to be capable of being modern doctors. They want people who have real experience with the things doctors do.
In order to be a competitive applicant, I immediately began looking for ways to gain clinical exposure. One of the most common methods is shadowing. I had a friend who worked the E.R. at the local hospital, so I took an opportunity to shadow him during one of his shifts. While most of the patients we saw were, one could say boring cases, I did some first-hand experience with a patient showing the signs of psychosis. He had attempted suicide, and eventually had to be tied to his bed. During my time, I also saw the ugly side of medicine in regards to mental health. While my friend is a more than competent physician, he, and the nursing staff, treated the psychosis patient with complete apathy.  I later learned this is usually the case, and even some psychiatrists can behave similarly. While this startled me, I came away knowing even more that I needed to be different. While I certainly don’t have delusions of grandeur, I feel like the man in the starfish analogy-- I can’t help them all, but to the ones I do help, it makes a difference. As I reflect on the little experience I gained from that, I know that it will be useful to me as I pursue my dream of making the difference in people’s lives.
Aside Shadowing, I have the opportunity to fulfil other med school requirements here at BYU-I. BYU-I offers me the availability of all my non-academic prerequisites nearby. One of the classes I am required to take for my Neurobiology degree is a research course, which will also give me research hours I can put on my application. Likewise, there is a lot tons of opportunity on campus for me to shadow            
physicians at the Student Health Center, and various physicians around the Rexburg area. On top of that, the school offers many groups, clubs, and service opportunities that I can use to put on my application to medical school. These opportunities, as I use them, add experience that will help me prove to admissions committees that I am able to meet and exceed the demands of medical school, and a career as any time of physician.
The most important aspect of a med school application is academics. More than anything, admissions committees want to know that those whom they accept can handle the rigors of med school. Once a person fails out of Med School, they don’t get another chance; likewise, they took the spot of someone who may have made it all the way through. In order to have a good shot at being accepted, I would need to maintain a minimum GPA around 3.8 or so, and an MCAT of around 35. The average GPA for my first choice med school, the Florida State University College of Medicine, is a 3.6 and an MCAT of 29; however, that includes minority students who get in with less-competitive applications, but have affirmative action to back them up. My intentions are to graduate with a 4.0, making myself even more distinguished from the competition. While that seems far-fetched, I know it’s possible. My acquaintance  Kate recently graduated from BYU-I with a 4.0, and know of others that have as well. I’ve also chosen to take tougher classes to fulfil the academic prerequisites. Instead of taking application of physics to fulfil my physics requirement, I am taking a calculus-based physics. Admissions weigh the difficulty of courses when considering applications, and a calculus-based physics class will certainly be worth more in that light than a 101 physics course. Irrespective of exactly which courses I take, I still have to maintain a high GPA. While I intend to graduate with a 4.0 GPA, I cannot be so fixated on that goal that I lose hope simply with one grade that what could have been a 3.9 instead becomes a 2.9.



Perhaps keeping in mind my experiences as a youngling will be what it takes for me make it all the way through medical school and residency. It was my own treatments that encouraged me to pursue Neuropsychiatry after all. I know that I would be happy being the type of person my psychiatrists are. Pushing through my clinicals, putting in hours of community work, hours of research, and rigorous academics certainly are not appealing in and of themselves, but they are the means to an end: Dr. Joshua Aaron Pillow, MD

Friday, March 14, 2014

New Series: Selected works

So, since I never write anymore, I'm gonna do something that I think is awesome. It's called Selected Works. Basically, I'm gonna post my essays for school that I think are pretty awesome. Feel Free to critique.

Selected Works, Episode I
Angiogensis Inhibitors 
Class: Bio 199
Assignment: 700-900 word essay on the documentary "cancer warriors"
Grade Received: 99/100

The History and Development of Endostatin as an Angiogenesis Inhibitor
Joshua A Pillow
Brigham Young University- Idaho
                When the US military developed its first nuclear submarine, they were faced with the problem of how to store blood long-term. At the time, human blood could not be stored for more than three weeks, which was significantly shorter than the 6 months that nuclear submarines were to be deployed. The military recruited several physicians to research the viability of reconstituted RBCs. While the experiment with reconstituted RBCs was successful, one of the physicians working on the project, Dr. Judah Folkman, made an observation, and that observation has led to possible improvements in the treatment of cancer: Angiogenesis Inhibitors.
                While working on the RBC project with the US military, Dr. Folkman added tumor cells to the thyroid gland that was being experimented on. He observed that the cells did not grow any larger. Thinking that they might be dead, he extracted the cells and put them in a mouse, where they immediately began to grow again. Dr. Folkman was curious about what would cause this. As he continued through his career as a surgeon, he noticed that every time he would remove a tumor from a patient, the tumor would be unusually bloody and be surrounded by blood vessels. This lead Dr. Folkman to hypothesize that cancer cells produced a protein that causes blood vessels to form around the tumor, giving it enough blood to grow rapidly. This idea was almost universally rejected. In order to prove that angiogenesis (the process of growing new blood vessels) was real, he devised an experiment. He placed a small sample of a tumor in the cornea of a rat’s eye. Because the cornea contains no blood vessels, this would prove that the presence of blood vessels around tumors was not coincidence. Not long after planting the tumor into the rat’s cornea, blood vessels began growing into the cornea towards the tumor. Immediately, the doubters turned into colleagues.
                The next task then turned to identifying the individual protein complex that caused the angiogenesis. It took over ten years before the protein was identified. They proved that it was the correct protein by placing a packet of it in a rat’s cornea, simulating the effect of a tumor cell, causing angiogenesis. Now that the researchers knew what was causing the angiogenesis, they needed to identify a way of combating it. They thought about bone marrow: because bone marrow contains blood vessels early on, but quickly loses all of its blood vessels, they figured that the answer to angiogenesis inhibitors must be hidden in the proteins of bone marrow. Researchers spent countless hours scraping bone marrow from bovine bones, and searching for an angiogenesis inhibitor. Eventually, they found one. The then placed a packet of the protein that caused the angiogenesis inside a cornea along with a packet containing the inhibitor. Blood vessels began growing, but stopped once they reached the inhibitor packet.
                Next came the search for an angiogenesis inhibiter that worked more often. One researcher found one in a drug that was used a few decades earlier, Thalidomide. When Thalidomide was metabolized and then placed in a chicken embryo, the blood vessels in the chicken embryo bypassed the area when the Thalidomide was placed, proving that it is an angiogenesis inhibitor. Researchers then turned to developing new inhibitors, and eventually landed with Endostatin. Like other angiogenesis inhibitors, Endostatin differs from traditional chemotherapy in that it isn’t a poison- it simply stops the tumors from growing new blood vessels, limiting their ability to grow.            
                Endostatin when into stage I trials. There were thousands of people who signed up to receive the treatment. One of those picked was Duane Gray, who had advanced stage lung cancer. Duane, as well as 14 other participants in the stage I trial, were removed after their cancer grew beyond the guidelines set for trial. Sadly, he passed away from his cancer in 2009.

                Through all three phases of the trials, Endostatin proved to be only marginally effective as a monotherapeutic treatment for various cancers; however, it did prove extremely valuable in one criteria: unlike traditional chemotherapy, the cancer cells were unable to mutate a resistance to the Endostatin, which has always been a major cause of the overall ineffectiveness of traditional chemotherapy. Research on Endostatin still continues, and has expanded to include various other fields such as autoimmune diseases like arthritis and Crohn’s Disease. 

Next week: Selected Works, Episode II: Neuropsychiatry: Because Psychologists are Losers

Thursday, January 2, 2014

Provo

Update:im in provo until tomorrow, then I go to rexgurg friday.S






Sunday, August 25, 2013

Narcissism is glorious. Let us all bask in my epic infallibility!

I did one of these a few years back, and I figured why not. I'll see how many I actually do. I'm not doing 100 facts about myself at 2am

1) I hate when people try and make themselves sound like something they're not. (Like that idiot Chiropractor who called himself a physician.)
2) I used to wonder why MDs didn't respect Chiropractors. The more time I spend around the medical field, I understand.
3) I believe that most forms of healing have a place, as long as they actually work.
4) I injured my right knee 4 years ago when I was hit by a car on my bike.
5) I was bed-ridden for about a week.
6) I recently have started having problems with that knee. It's getting worst. I can barely walk sometimes.
7) It needs an MRI; however, I'm poor and have no insurance.
8) I'm not bothered by profanity in some cases. I actually feel like it can be used correctly, and "substitute" words don't convey the same meaning.
9) That said, I hate when people can only use profanity to make a point.
10) My first favorite band was the Beach Boys.
11) My first favorite song was the old theme song to "All Things Considered"
12) My Second favorite band was Backstreet Boys
13) Then Lincoln Park
14) Then Aerosmith
15) then Metallica
16) Now it's Megadeth
17) I'm not sure how I feel about Megadeth's new album. I like some of the songs, but I can't stand the pseudo-enlightened political dribble.
18) Dave Mustaine used to have really well thought-out lyrics, especially when it came to political songs. I miss those days.
19) Old Dave (1990): Brother will kill brother/ spilling blood across the land. Killing for religion/ something I don't understand. Fools like me/across the sea/ they come to foreign lands! Ask the sheep/ do you still believe/ do you kill on God's command?
20) New Dave: Sentenced to work a dead-end 9-5/ trapped in a dingy corporate cubicle heel. Then go to work on the midnight shift/ any chance you get selling gas at the corner Shell. 3-letter groups listening in on you/ courtesy of Big Brother.
21) Those facts aren't about me
22) That second song has a pretty cool chorus.
23) My current roommates has made me lose a lot of respect for homosexuals. The way they treat non-gays is actually pretty disgusting.
24) Back to music: I'm not shocked that I enjoy metal. I was raised on classical, and I always gravitated towards the darker and more aggressive forms. I can't really get into romantic era; I love the baroque era.
25) My favorite classical works: Night on Bald Mountain, Winter and Summer from the Four Seasons, Adagio for Strings, Fantasia on a Theme, Firebird Suite and Rites of Spring.
26) Yes, I find that previous fact ironic.
27) Growing up, all I listened to was classical, blues, jazz, oldies and some soul. Then one day my sister played a Metallica CD when my parents weren't home.
28) I hate small Dogs
29) I love big dogs.
30) Before realising I needed to go into medicine, I wanted to be a cop.
31) I couldn't decide between doing SWAT or being a K-9 Handler.
32) I think Siberian Huskies are the most beautiful animals ever, followed closely by the German Shepherd.
33) I would make an excellent businessman, but I hate business.
34) I am a character in a horror book.
35) It was written by my friend Tom as a "creative writing exercise."
36) It's called 'The Daily Death: How I Killed my Coworkers in 30 Days."
37) He was working with me at Food Lion at the time. Every day he would write about the fictional death of one of us.
38) I died after getting struck by lightning during a concert.
39) I'm worried about not fitting in socially at BYU-I.
40) I'm extremely introverted
41) My experience with YSA also tells me I have very little in common with my peers in the church.
42) Best I can figure, the total crap I've dealt with over the past few years has changed me a lot, and I find other's lack of maturity about life annoying.
43) I don't think facing homelessness multiple times is something a lot of people deal with as an adult. It's not an easy thing to go through.
440 I once almost chewed out a missionary because of an off-handed comment he made about how I don't let small things get to me anymore. I wanted to badly to tell him about all the crap I've dealt with since last year and ask hi how he would react to it.
45) I wasn't having a good day that day obviously.
46) I really miss playing Baseball and Football
47) If it wasn't for my knee I would try out for one or both at BYUI
48) I'm looking at a few guitars. As soon as I have the money, I wanna get these, in this order: King-V Soloist 7-String Soloist 

I'm done. Goodnight

Friday, August 23, 2013

Re: Kate

I've actually been meaning to update my blog, and Kate's comment finally got me doing it. So here's the skinny:

I am on the Winter/Spring track; however, I plan on staying in Rexburg year-round. I declared Physics as my major, but I will be changing it to Biology/ Neuroscience. (This damn 120 credit ceiling sucks.) I have narrowed down my apartment to either Arbor Cove or Georgetown. I am --hopefully-- going to ship my stuff with my friends Mike and Kat. They're on the Fall/Winter track, and they have an apartment in IF. They are renting a POD and Kat told me if there is room I can put some stuff in there. She also said that there will be room since their stuff is mostly wedding presents. I am planning to fly into SLC on the January 1st, and I've gonna spend a couple of days in Provo with my sister Cherryl until the 3rd. From there I will either hitch a ride or take the SLE to Rexburg.

I have a heckuva hill to climb once I get there. Med school applications are done in may of your junior year, and you have to complete all your pre-med courses by that semester, which means I have to have the following done in no more than 5 semesters:
6 credits of Math
6 credits of English
8 credits of Biology, w/ lab
8 credits of Inorganic Chemistry w/ lab
8 credits of Organic Chemistry, w/ lab
3 credits of Bio-Chemistry, w/ lab
6 credits of Physics, w/ lab
3 credits of Spanish (not required but encouraged)
3 credits of Psychology (Not required, but is part of MCAT)

Yeah.  The good news is math and english are covered by my foundations classes, and  Bio as well as InorgChem are part of the Neuroscience major.

I'm gonna have to do fast-track, or change to Fall/Winter track. The latter is actually better, as I would then be graduating in April instead of July. (Med Schools usually matriculate early-mid July.)

So for the right now, I quit GFS. I walked out. I refused to be insulted by them only offering my 9 hours a week. Goodbye.

I start at Winn-Dixie in 7 hours. I'm really not looking forward to it. WD usually caters to the most difficult of shoppers. (think ratchets)

I have considered not working until November when UPS does their annual temp jobs. I know they'll rehire me. Plus, I'm moving out next week, so I don't have to pay rent the rest of the year. I am so glad to be moving out. I will never live with gay people again. I know that sounds bad, but they are absolutely the worst to live with. I'd rather live with a bunch of drama-ridden girls.


Well, my somnolent hallucinations have progressed to the point of my keyboard looking and feeling round, so I think I should go to sleep.

Deuces

Tuesday, July 23, 2013

Stress

I don't know how to deal with all of this.

Working at GFS cost me my job at Jersey Mikes. Now GFS is cutting hours and I am making less that I made at JMS before. I barely break even at the month. I have no money is savings. If I continue down like this I'll only have maybe a 50 bucks to my name when I go to Idaho in January. I can't do that. I can't completely transplant to a new place where I know almost no one and depend completely on money that I won't even be getting until the second week I'm there. If I continue to live where I'm at now I will have to keep paying 400 a month in rent. If I move in with the Hawthorns, I won't have to pay rent (though I would still, though not 400) but I'll be living in an environment that isn't good for me. I don't wanna move to Idaho with my stuff infested with roaches and everything smelling like smoke. It took me three months to get that smell out of my suits last time, and I was only there for a month. Between my 4 suits, my ties and dress shirts I have over 1300 dollars invested. I don't want those things ruined. I don't even know how I'm gunna get my stuff out to Idaho. I know no one out there who I could ship it to ahead of time, and it would cost too much to take in a suitcase on the plane. Hell, I don't even know how the heck I'm supposed to get from wherever I fly to the school.

I had my first dental checkup in 5 years today. 16. I have 16 cavities, three of which may require a root canal. the total cost to do all these fillings, assuming I don't require any root canals is 2600. If I need any root canals, it'll be close to 2000 each.  My parents said they're gonna pay for my dental work, but they don't know it's gunna be that much. I know they can't afford it. On top of that, My upper teeth are shifting back. The dentist wants me to go see an orthodontist. Not only is that several thousand more that I don't have, I lose the ability to say my teeth are naturally aligned straight.

Sarah is over in New Mexico; she's been there since may. It's slowly killing us. It's not that we need to see each other to be together as, we only have phone calls right now. When she was only on the other side of the state we had skype; now, we have nothing. On top of that, the time difference and terrible reception are making our phone conversations, the only thing we have, agonizing. Add in the time difference and it's even worst. By the time she's ready to call I'm ready to go to bed, and I don't really feel like having a conversation, which leads to bitter feelings and fights. With skype and when we're in person, silence isn't awkward, but it is on the phone. Unfortunately, when it's midnight, and I'm tired and stressed silence is my default.

All of this actually isn't a lot, except I don't have any of my coping mechanisms.

I used to read. But my bishop wants me to read an incredibly boring and ill-written book. I feel like I'm reading a damn dictionary every time I pick it up. I used to breeze through books like they're on fire. NOw every time I pick up a book I want to read, I remember I'm supposed to be reading something else, and decide I'll just not read at all.

I used to bike. But my mountain bike requires several hundred dollars in new parts, and is currently in several pieces. My road bike needs both derailleurs and the bottom bracket replaced, which is another thousand or so that I don't have. I can ride it around town, but I can't take it out on US1 and just ride till my feet fall off like I used to.

I used to play guitar when I was stressed, but I had to sell my Jackson (electric guitar) to pay rent several months back. I thought I could just use my Epiphone electric for the time. Well, the truss rod inside the neck is broken and I can't find any replacement necks that will fit. All I'm left with is my two acoustics, which work alright, but I can't play most of the stuff I wanna play. You just flat out can't play just anything on an acoustic guitar.

I used to enjoy listening to music. But when I hear good songs, It makes me wanna go play 'em. See above.

I used to play baseball and football. Now everyone I played with has either moved away or quit playing.

I used to be able to deal with stress.