QUILL & SCOPE

VOLUME III SPRING 2010

New York Medical College

QUILL & SCOPE
PUBLISHED ANNUALLY BY THE STUDENTS OF NEW YORK MEDICAL COLLEGE


VOLUME III. SPRING 2010.


EDITORS IN CHIEF
Edward Hurley
Jenny Lam

SENIOR GRAPHIC DESIGNERS
Annabelle Teng
Dennis Toy


SENIOR WEBMASTER
Michael Smith

MANAGING EDITORS
Linda DeMello
Navid Shams
Gavin Stern

WEB COMMUNICATIONS
Kevin Cummings

EXECUTIVE FACULTY ADVISOR
Gladys Ayala, MD

EDITORIAL BOARD
Gladys Ayala, MD
Diana Cunningham, MLS
Kenneth Lerea, PhD
Stephen Moshman, MD
Padmini Murthy, MD
Sansar Sharma, PhD
Noorjahan Ali
Debasree Banerjee
Christine Capone
Edward Hurley
Sean Kivlehan
Jenny Lam
James Naples
Annabelle Teng
Dennis Toy


Research
Humera Ahmed
Jonathan Drake
ART EDITORS
Becky Lou
Allison Navis
WEB DESIGN
Calley Levine


Quill & Scope is an annual NYMC student publication dedicated to promoting awareness of the personal, social, economic,
and ethical issues con-fronting the modern physician. It was founded in 2008 by medical students Christine Capone and Sean
Kivlehan. The articles selected for publication have been chosen for their literary or artistic merit. They do not necessarily
represent the opinions or views of the editors, faculty, or New York Medical College.

All rights reserved. No part of this publication may be reproduced, stored in electronic format, or transmitted in any form
without the express permission of New York Medical College.

Inquiries concerning reproduction should be directed to:
Gladys M. Ayala, M.D., M.P.H.
New York Medical College Administration Building/Office of Student Affairs
40 Sunshine Cottage Road Valhalla, NY 10595
gladys_ayala@nymc.edu

STAFF EDITORS
Commentary
Loren Francis
Janet Nguyen
Rajdeep Pooni
Aditya Sarvaria
Alex Trzebucki


International Medicine
Stuart Mackenzie
Yin Tong
Michael Weinreich

Poetry & Fiction
Alanna Chait
Marissa Friedman
Danielle Masor


Community Health
Chris Ours
Sarah Pozniak

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N E W Y O R K M E D I C A L C O L L E G E

40 SUNSHINE COTTAGE ROAD, VALHALLA, NEW YORK 10595
TEL 914-594-4500 FAX 914-594-4565 PAUL_WALLACH@NYMC.EDU

PAUL M. WALLACH, M.D., F.A.C.P.
VICE DEAN FOR MEDICAL EDUCATION

Hi
HRU?
K
School?
KGoingtomall
Havefun.ILY.
LY2TTYL

Ourfamilyrepresentstheposterchildrenforthefamilycellphoneplan:fiveindividuals,fivephonesnowwith
unlimitedtexting.ThatdecisionfollowedamonthwhereIwaschargedfor1800textmessagesmadebyone
memberofourfamily;thats60aday!Istillfindithardtobelievethatsheisabletosendthatmanytexts,but
withoutadoubt,textmessagingisapartoftodayscommunicationsystem.Whiletextmessagingisperfectly
OKfortheoccasionalmessage,Iamconcernedthatrelyingontextingforamajoramountofcommunication
furthererodesourabilitytocommunicateeffectivelyinthemoreformalwrittenorspokengenres.

Effectivecommunicationremainsacentralskillforphysicians,healthcarepractitioners,andhealthscientists.
Highqualitywrittencommunicationcontributesextensivelytoourprofession.Inwriting,wecapturetheclinical
courseofourpatientssothatotherhealthcareproviderswhocometoseethesamepatientunderstandour
thinkingaboutthepatient.Inwriting,wesharescientificandotherscholarlyfindingswithcolleaguessothat
ourworkcanbeevaluatedbypeersandsothatotherscanbenefitfromtheresearch.Inwriting,wesharethe
storiesofourfieldandcontributetothefabricofmedicine.Thesestoriesaddtotherichnessofmedicineasan
art,captureexperiencesthathavemovedus,andleavealegacyforthosewhofollow.Wespeakaboutour
successesandourfailures,aboutourpatientsandourteachers,aboutourhopesandourfears,aboutwhatwe
learnwhenphysiciansbecomepatients,aboutourrelationships,aboutwhatitmeanstobeadoctor.Similarly,
theartisticexpressioninphotography,drawing,andothervisualartsalsocaptureourexperiencesrichly.

IwashonoredtobeaskedtowriteanoteofintroductionforthisissueofQuill&Scope.Herein,ourstudents
communicatebeautifullyabouttheirexperiencesasphysiciansintraining.Theyhavewrittenreviews,poetry,
commentaries,essays,clinicalexperiences,andscientificpapers.Theyhavepresentedartworkthatspeaks
thousandsofwords.Iamproudoftheworkproductsofourstudentsthatarepublishedhere,acknowledge
theirefforts,andwishthemgreatsuccessinthefuture.

Ithankthemforchoosingtocommunicatesoeffectivelythroughthisvenueandencourageotherstosimilarly
expressthemselves.Wewillallbericherforit.CongratulationstoeditorsJennyLamandEdwardHurley,and
FacultyExecutiveAdvisor,Dr.GladysAyala.

GTG.TTYL.
Myverybest,

PaulM.Wallach,MD
ViceDeanforMedicalEducation

1860~2010 BUILDING ON THE EXCELLENCE OF OUR PAST

Sir William Osler is regarded as the pre-eminent physician of the 20th century and ideal medical practitioner
because of his humanism, his view that the practice of medicine is an art based on science, his thoughts on education,
and his philosophy of life. Osler had a lifelong devotion to books and libraries. His influence and legacy, not only in the
areas of clinical, educational, and literary spheres, remains strong and lives through his vast writings. Osler states that: "a
library represents the mind of its collector, his fantasies and foibles, his strengths and weaknesses and preferences....The
friendships of his life, the phases of his growth, the vagaries of his mind, all are represented.

As a foreword to this 3rd edition of the Quill and Scope, which coincides with NYMCs Sesquicentennial Anni-
versary, I have chosen to highlight some of Sir William Osler quotes that contemplate the importance of culture, of read-
ing literature and non-science books, and the value of studying the humanities to the lifelong study of medicine.

Taken from The Quotable Osler, edited by Silverman, Murray, and Bryan, 2003:

No. 25: Books influence character. Carefully studied, from such books come subtle influences which gives stability to character and
help to give a man a sane outlook on the complex problems of life.

No. 26. Culture is helpful to physicians. A physician may possess the science of Harvey in the art of Sydenham, and yet there may be
lacking in him those finer qualities of heart and head which count for so much in life....medicine is seen at its best in men whose fac-
ulties have had the highest and most harmonious culture.

No. 150. Cultivate your hearts and your heads. Be careful when you get into practice to cultivate equally well your hearts and your
heads.

No. 179. The practitioner also needs culture. One cannot practice medicine alone and practice it early and late, as so many of us have
to do, and hope to escape the malign influences of her routine life. The incessant concentration of thought upon one subject, however
interesting, then there's a man's mind in a narrow field. The practitioner needs culture as well as learning.

No. 611. Without reading, a physician sinks to a low-level trade. A physician who does not use books and journals, who does not
need a library, who does not read one or two of the best weeklies and monthlies, soon sinks to the level of the cross-counter pre-
scriber, and not alone in practice, but in those mercenary feelings and habits which characterize a trade.

No. 613. Reading benefits the mind. There is no such relaxation for a weary mind as that which is to be had from a good story, a
good play or good essay. It is to the mind what sea breezes and the sunshine of the country are to the body -- a change of scene, a
refreshment and a solace.

No. 631. Expand your interest. Every day do some reading or work apart from your profession. I fully realize, no one more so, how
absorbing is the profession of medicine; how applicable to it is what Michelangelo says "there are sciences which demand the whole
of a man, without leaving the least portion of his spirit free for other distractions;" but you will be a better man and not a worse prac-
titioner for avocation.

With great pleasure and honor I introduce you to the third edition of the NYMC Student Journal, the Quill and
Scope. This literary journal showcases the work of many students. Through these original articles, commentaries, poetry
and artwork we can cultivate our hearts and minds as Osler still teaches us today, more than 150 years after his life.

Congratulations to Jenny Lam and Edward Hurley for their dedication and hard work as editors-in-chief, they
have taken this journal to the next level. Congratulations to the entire editorial staff, everyone that contributed their time
and efforts in making this successful, and especially to the students that contributed a piece of themselves in their schol-
arly work.

My sincerest good wishes to all the readers, new and old, of the NYMC Student Journal,


Gladys M. Ayala, M.D., M.P.H.
Senior Associate Dean for Student Affairs
Executive Faculty Advisor
Sifting through the 1880s Chironian, the student publication of then New York
Homeopathic Medical College, offers a fascinating glimpse into the hallowed halls of
the school founded on 20
th
Street and 3
rd
Avenue. Its old, time-worn pages reveal how
the driving force of medical students has changed little: an insatiable appetite for
knowledge, humanistic desire to alleviate suffering, and the belief in just and equita-
ble healthcare.


The year 2010 marks New York Medical Colleges 150
th
anniversary. In honor of such a historical
milestone, Quill & Scope dedicates this third volume to the faculty and alumni who tirelessly
helped shape the College into the premier academic medical institution it is today.

Since its founding in 2008, Quill & Scope has served as a forum for the discussion of the personal,
ethical, political and socioeconomic facets of medicine that are not often discussed in the class-
room or on the wards. Topics explored in the past two issues include healthcare disparities, contro-
versies of vaccination, military medicine, bioterrorism and international aid. It showcases the wide
range of literary, artistic and academic endeavors of burgeoning healthcare professionals as they
reflect on todays ever-evolving medical environment. Through editorials, commentaries, essays,
poetry, and artwork, we hope to demonstrate that the practice of medicine continues to be founded
on empathic and patient-centered care.

The theme of Quill & Scope Volume 3 is as a retrospective on the transformations that have oc-
curred over the years, beginning with the insights of Dr. Weg, a distinguished alumnus trained at
Flower Hospital, to the advances of women in medicine and the construction of new buildings in
the current campus location in Westchester. Readers will also find timely articles on health-care
policy and universal health care, the influence of social networking on human rights movements, as
well as the impact of information technology on the management of diabetes.

The Quill & Scope has an annual distribution of 1,500 copies to students, alumni, deans, faculty
and the Board of Trustees. With a staff of 30 students, more than 25 contributors from all four
classes, and a faculty review board, the student medical journal has grown tremendously since its
inception and established a presence at the College. We are grateful to our dedicated editors, the
editorial review board, our advisor Dr. Ayala, generous donors and the student body, without
whose support the journal would not have been possible.

It is with great pride that we present to the New York Medical College community this collection
of literary and artistic pieces by our fellow medical students, and we hope to continue in the tradi-
tion of excellence first set by our predecessors many years ago.


Edward Hurley & Jenny Lam
Editors-in-Chief
EDITORS INTRODUCTION
CONVERS ATI ON
Sitting Down with Dr. John Weg: Pulmonary Medicine Pioneer 2
Recently, the Quill & Scopes Jenny Lam and Edward Hurley spoke with pulmonary medicine pioneer
Dr. John Weg, Class of 1959, about his career, medicine in general and his time at New York Medical
College.
COMMENTARY
Women in Medicine 6
Marissa Friedman
The 150
th
Anniversary of New York Medical College inspires a reflective look into the journey of
women in medicine. In a time when women did not receive the same rights as men, a few courageous
women pushed to open the field of medicine for all to study. One of these women, Dr. Clemence Sophia
Lozier, founded the first womens medical school in New York City, New York Medical College for
Women. In 1918 this school became incorporated into the original New York Medical College, to be-
come the co-ed school known today. Despite small growth in the numbers of women physicians
throughout most of the 20
th
century, women currently account for half of medical students in the United
States.
Planck Versus Poe: Scientific and Poetic Approaches 8
Anita Kelkar
P A M Dirac wrote that "In science one tries to tell people, in such a way as to be understood by every-
one, something that no one ever knew before. But in poetry, its the exact opposite." Dirac's quote con-
fronts us with the question: Do both the scientific and poetic approaches ultimately enjoy equal success
in expanding human knowledge?
Antidepressants Misrepresented 12
Steve Rockoff
In a January 2010 study conducted at the University of Pennsylvania, investigators determined that for
patients who had less than very severe depression, antidepressants have no measurable effect on de-
pressive symptoms when compared to placebo. This resounding statement was widely circulated by
every major national media outlet. If true, it has powerful implications for the millions of Americans
who are currently prescribed antidepressants. The commentary at hand highlights several glaring flaws
in the design and conclusions of these researchers meta-analysis, in an attempt to portray their findings
in a less alarming and more realistic light.
An Examination of Three Model Healthcare Delivery Systems 18
Gavin Stern
The United States is just now beginning its journey into a universal healthcare delivery system. On
March 30, 2010, President Obama signed into law the Health Care and Education Reconciliation Act of
2010 (H.R. 4872), which completed the work of the Patient Protection and Affordable Care Act
(H.R. 3590) signed on March 23, 2010. The effects of this legislation are phased in over the course of
this new decade, but the final product is far from certain. Implementation could be legislated away with
one election cycle. This article examines three model healthcare delivery systems that the United States
could look towards on its march to universal coverage: those of France, Germany, and the Netherlands.
Homeopathy 24
Charles Volk
For the first 50 years of NYMC's history, the school taught a form of medicine called 'homeopathy'.
What is this form of medicine and what would it be like to go to a homeopathic medical school? The
author shares his experiences in the world of alternative medicine and the time he spent in a homeo-
pathic academy learning about energy medicine, impossibly diluted compounds, how the germ theory is
wrong, how science is incorrect, and how miasms are at the core of all human suffering.
Our Valhalla: Thirty-Eight Years of the New NYMC 29
Gavin Stern
Our Valhalla describes the history of the New York Medical College Valhalla campus, now nearly 40
years old. The article details how the campus evolved into its present form, including events leading to
the closing of Flower & Fifth Avenue Hospital. Research for this article included consultation with fac-
ulty, articles from the New York Times, and archived yearbooks. Photographs were collected from the
Health Sciences Library and are interspersed throughout the issue.

I NTERNATI ONAL MEDI CI NE
A Lesson from Iran: Improving Rural Primary Health Care in The United States 34
Navid Shams
In 1979, about a third of Irans population was living in rural areas that were mostly out of contact with
health services. In the times of change that followed the revolution, primitive infrastructure and lack of
resources challenged the development of a rural primary health care program. Successful implementa-
tion of novel techniques, such as the use of front line health workers, led to political commitment, the
programs expansion, and much improved health status indicators. The program is now considered the
foremost example among rural primary care systems. Consequently, Iranian experts have recently begun
aiding in the development of a similar program in Mississippi, a state with some of the worst health sta-
tistics in the country.

Social Networking Tools in the Modern Era of Human Rights Protection 37
Odessa Balumbu, Richard Fazio, Mera Geis, and Michael Karsy
Human rights are fundamental liberties that should be guaranteed to all human beings. These include
things such as access to education and health care, food security, freedom from persecution and access
to shelter, safety and security. Human rights promotion and international development have become
popular philanthropic efforts and new technology is helping younger generations participate more easily.
Whether through activism, fundraising or volunteering, there are many ways to make a difference. Pro-
moting the awareness of and access to human rights is a job everyone can and should be a part of.

Another Look: Medical Cooperation and the Israeli-Palestinian Conflict 42
Danielle Masor
P A M Dirac wrote that "In science one tries to tell people, in such a way as to be understood by every-
one, something that no one ever knew before. But in poetry, its the exact opposite." Dirac's quote con-
fronts us with the question: Do both the scientific and poetic approaches ultimately enjoy equal success
in expanding human knowledge?

Njinga 46
Stuart Mackenzie
This piece is based upon my experiences over the course of 18 months in Lusaka, Zambia with the Cen-
ter for Infectious Disease Research in Zambia (CIDRZ). I worked with patients in HIV/AIDS clinics
across the country, coordinating community health initiatives and assisting in small business develop-
ment for HIV support groups. In this setting, the limits and discrepancies in access to health care, nutri-
tion, employment and education were stark and sobering, but it wasnt necessary to venture into the
heart of a compound to witness the risk factors faced by most Zambians. A simple commute to work was
enough to see the effects of poverty and the threat of disease. My work and time in Zambia has im-
pressed upon me the importance of understanding a patients life and context outside of the clinic, in
order to treat them effectively within the clinic.
COMMUNI TY HEALTH
Cancer Education and Awareness Program: Education and Its Role in the Prevention of Cancer 50
Sukhpreet Singh
As U.S. healthcare accelerates into an era of science fiction, we find that most diseases are treatable via
technological intervention. This has, unfortunately, reduced the role of the physician as the patients
teacher and advocate in the clinical setting. The Cancer Education and Awareness Program attempts to
tackle one of the worst diagnoses a patient can receive, and dispel the misconceptions the general popu-
lation has about the prevention of disease. We do this by reaching out to high school students in the local
community, and through the method of storytelling, we teach them the science behind the disease. This
allows them to be able to appreciate a more tangible aspect of disease that seems generally out of their
reach. CEAP has tried to bring back the role of the physician as an educator by taking this role straight
into a high school classroom. We hope this will allow our target audience to learn about the relevant
consequences of their decisions now, and to impact their health in the future.

POETRY & FI CTI ON
Alanna Chait - Life Fuel 53
Daniel Waintraub - For Only A Moment 54
Navid Shams - Resident 56
Andrei Kreutzberg - Medamorphosis 57
Poonam Kaushal - Vitality 58
Jordan Roth - The Shell 60
Linda DeMello - Its Gonna Be All Right 61

ORI GI NAL FI NDI NGS
Telemedicine Management of Diabetics in an Underserved Community 64
J. Paul Nielsen and Pranav Mehta, M.D.
Information technology via telemedicine offers the potential for cost-effective and active management of
type 2 diabetes mellitus for people in high-risk underserved communities such as Harlem, NY and the
Bronx, NY. Telemedicine is the use of telecommunications technology for medical diagnostic, monitor-
ing, and therapeutic purposes to communicate information instantaneously from one location to another,
such as from a patients home to a hospital. We compared the baseline Hemoglobin A1C levels to the
levels recorded after the patient was enrolled in the Housecalls telemedicine program for at least 3
months. The initial results indicate that the Housecalls program is effective in improving compliance and
management of diabetes. The initial success of the program is encouraging and demonstrates a great po-
tential for the use of telemedicine in monitoring chronic disease.
Can Cycles of Neddylation and Deneddylation Provide Points for Possible Therapeutic
Intervention? 67
Nadia Nocera
Neddylation plays a critical role in proteosomal degradation and the progression of the cell cycle. Inter-
fering with the process of neddylation and deneddylation could provide points of therapy by promoting
cell death or cell cycle arrest in cells that are undergoing rapid proliferation, such as in tumors. The cy-
cle of neddylation and deneddylation is essential for cellular processes, and if it is inhibited or amplified
in some way, this may disturb the proliferation of tumor and with further research, it may be used as a
target for cancer therapy.
Diagnosis: Recurrent Ascites and Lower Extremity Edema in a 67-year old Female 72
Lea Alfi
In this clinical vignette, a third year medical student explores what may be ailing a 67-year old woman
with ascites and lower extremity edema.

MEDI CAL S TUDENT RES EARCH FORUM
Resilience in the Third Year of Medical School: A Prospective Study of the Associations Between
Stressful Events Occurring During Clinical Rotations and Student Well-Being 76
Paul S. Nestadt, et al

Wait List Death and Survival Benefit of Kidney Transplantation among Extra-renal Transplant
Recipients 77
James Cassuto et al

Racial Differences in Bronchopulmonary Dysplasia Severity for Neonates with Mitochondrial Su-
peroxide Dismutase Polymorphism 78
Edward Hurley et al.

Using Fluorescence in situ Hybridization (FISH) to Examine the Prevalence of ETS Gene Fusions
in a Large Prostatectomy Cohort. 79
Christopher J. LaFargue et al.

Use of EGFR Genetic Analysis to Potentially Expand Treatment Options for Patients With Vulvar
Squamous Cell Carcinoma 80
Susan L. Boisvert et al.

Arachidonate 5-Lipoxygenase Expression in Papillary Thyroid Carcinoma Correlates with Inva-
sive Histopathology and Promotes Extracellular Matrix Degradation via MMP-9 Induction 81
Nicolas T Kummer et al.

ART AND PHOTOGRAPHY
Eliott Lee - Administration 5
Ian Hovis - A young Ghanian woman captured in a balancing act on the streets of Accra 33
Katrina Bernardo - If They Knew 48
Ava Asher - Man Huddled and Man Leaning 49
Anna Djougarian - Transformation of the Medical Student 52
Linda DeMello - Skull Rock 55
Luke Selby - Spring Break at Night 59
Radeeb Akhtar - Untitled Nude 63
Sabrina Perrino - Ocean Beach Pier 75
Julie Grimes - Wendell Park 82
Ann Tran - Infinity 83
In 1959, Dwight D. Eisenhower was president. Gas cost about 30 cents a gallon. To mail a let-
ter, which people did in 1959, only cost four cents for a stamp! That same year, Dr. John Weg
graduated from New York Medical College. After a five decade long career, he is still involved
in research and teaching at the University of Michigan, where he is an emeritus professor in the
Internal Medicine Department. A pioneer in the field of pulmonary medicine, Dr. Weg re-
ceived a Medal of Honor award from NYMC in 1990. Recently, the Quill & Scopes Jenny
Lam and Edward Hurley spoke with Dr. Weg about his career, medicine in general and his time
at NYMC. An edited transcript follows:

Q&S: What motivated you to go into medicine?
Dr. W: Ive always been the type of person who wants to take care of people. Even in grammar
school I would tell my friends that I wanted to be a doctor some day.

Q&S: How has pulmonary medicine specifically changed since you started medicine?
Dr. W: When I started, tuberculosis was the major problem for pulmonary disease. It was really
wide spread. Many people unfortunately were put inside the sanitarium for months if not years.
We started to try and ventilate people who had other kinds of lung disease like chronic obstruc-
tive pulmonary disease (COPD) and the machines we had were not really adequate. We had an
iron lung, which was great for polio because the person couldnt fight against the machine, but
somebody with COPD or severe asthma would fight against that machine and you couldnt ad-
just it, so we had to use pressure control ventilators which made you almost literally had to sit
there and adjust the machine as their compliance and resistance changed in order for them to get
an adequate breath. It was an exciting time. You didnt have everything handed to you on a
platter where the machine did everything automatically or almost automatically. I liked that.
That was interesting.

Q&S: Could you give us an overview of your career in terms of the mix of patient care,
research, teaching, and administration that you have done?
Dr. W: How do I spend my time? Probably close to half of my time was spent taking care of
patients and much more than half of that was spent in the intensive care unit (ICU), which was a
respiratory care unit, which then became a critical care medicine unit. When people get very
sick they almost always need a ventilator for whatever reason they get sick, whether it be a dia-
betic coma or something else. So the sicker you are, the more likely you are to require a ventila-
tor. That was a subset of sick people.
I finished my training with the Air Force as head of the pulmonary and infectious disease unit.
Then I worked at Jefferson Davis hospital in Houston, which is part of the Baylor Medical
School and opened the intensive care unit there, which was the first in Houston. It was phe-
nomenal. We went from scratch, to teaching nurses how to do things when they come in to see
the patient on each of the trips.

Sitting Down with Dr. John Weg: Pulmonary Medicine Pioneer
2
And then when I came to the University of Michigan in 1971, it was the same study all over.
We tried to open an ICU. I brought a nurse with a masters degree in pulmonary medicine from
Houston, [she] provided a course for the nurses at the University of Michigan. And the same
way, we had the nurses assigned and I would come in on different shifts to make sure they were
doing what was correct, but more importantly to give them support so they would have it when
they needed it.
Mixed into all of that would be the research on how to provide better care in the intensive care
unit whats a better way to ventilate. Then another area that I spent a fair amount of time in
was improving diagnosis of pulmonary embolism. We have been conducting studies in that area
and Im not the PI of it all, but I was the one in Michigan for over 25 years now. Looking at dif-
ferent ways of diagnosing, and looking at combinations of things that provide the most efficient
diagnosis at the least cost and least invasiveness for the patient. I still am working on some of
that.

Q&S: You have done extensive research in venous thrombo-embolism. How would you
describe the change in approach to this pathology since you started?
Dr. W: You made the diagnosis on the physical exam, the chest X-ray, EKG, and blood gases,
but as it turns out none of those was very helpful because they were not specific. Then in the
late 1960s we began using ventilation perfusion scans. Then one of the first multi-center stud-
ies I was involved in was trying to evaluate how good that was in making a diagnosis. It turns
out it was not very good. It can only assure you that there was a pulmonary embolism or not in
roughly a quarter of the patients. In the others it was not specific enough to say if it was a PE or
not.
And then from that we moved on to do CT Pulmonary Arteriography and that is very accurate
and very specific. However, what we realized there is a lot of radiation involved. Most recently
we looked up Magnetic Resonance Angiography, which has no radiation. You dont have to
worry about the die causing problems with allergies but we found roughly a quarter of the stud-
ies were not good enough to be interpreted as to whether it was a PE or not. We went back to
look at the ventilation perfusion scans. The test was actually much better than we had thought.
Ventilation perfusion scans got a new life.

Q&S: With all of these progressions and improvements in technology, do you think the
quality of medicine has been hurt at all? For example, would people depend more on the
ventilation perfusion scans and then miss something that could have been diagnosed in the
physical diagnosis?
Dr. W: I think that is always a concern. Your really have to start with the basics. The most im-
portant thing is to get a very good history from the patient, in real detail and take the time to do
it. If you end up using the wrong test for the wrong patient then that usually leads to a wrong
answer. All these tests are good only after you get an adequate, accurate history of the patient in
great detail. Select from that whats most likely to be right and then move forward. If you go
right to the test, as some people do, you generate lots of costs, considerable radiation, and you
expose some people that really arent going to benefit from the test.

Sitting Down with Dr. John Weg: Pulmonary Medicine Pioneer
3
Q&S: What do you think has been the greatest discovery or invention since you gradu-
ated from medical school, in the medical realm?
Dr. W: I think there have been many contributions to a whole variety of areas. I think one large
area is in visual images, whether its a chest X-ray or a CT or magnetic resonance. They really
improve, if theyre selectively used, our ability to diagnose without first deciding to do some-
thing like a laparotomy to find out whether someone has an intra-abdominal problem. I think
theyve made a major improvement in the diagnostic area.
In other areas, just speaking of the things that Ive been talking about, the need to adequately
anti-coagulate patients with warfarin and then with heparin has improved greatly from when I
first started. We really didnt understand how to monitor the use of warfarin and we werent
doing the right tests because we didnt know what to do. So we moved from just looking at a
prothrombin time to looking at something called an international normalized ratio (INR). With
heparin, we now have a short acting one. Now whether any of that would be the greatest, I dont
know. You can make a great case for the antibiotics. And I dont think the ones I mentioned are
at all inclusive.

Q&S: Can you compare and contrast the difference between the campus here, and I as-
sume you went to the Flower Hospital?
Dr. W: Flower Hospital [was] right in Central Park, as well as part of the medical school. If
you went more than a block east from there or less, you were in a very low socioeconomic area
with considerable rates of crime. There was no campus, we just had two buildings: the hospital
and the one building of the medical school that were hooked together as one. There were no
amenities. The students would find housing in the neighborhood, some was nice, some was not
so nice more was not so nice and then others like myself commuted because I was married
and we had children at the end of the first year. So I commuted from the Bronx for a little
while, then I commuted from Flushing. The [Valhalla] campus is gorgeous. Its really ex-
panded.

Q&S: Whats your theory behind sarcoidosis? Do you think its viral, bacterial, or purely
autoimmune? Do you have a theory behind what causes sarcoidosis?
Dr. W: The short answer is I have no idea. Years ago we looked at a group of patients with sar-
coid. I started doing sarcoid when I actually went into the Air Force, to see whether theyre re-
active to the atypical mycobacterium differently and they did all react. We postulated whether
there was over-reaction to one of these atypical bugs, but it didnt go anywhere. I was on the
NIH committee that looked at extensive studies, at viral studies, and they didnt find anything. I
didnt do any of those studies but we looked at multiple people that were going to do research.
It seems to be an altered immunity, but an altered immunity to what I dont think we know.
Sitting Down with Dr. John Weg: Pulmonary Medicine Pioneer
4
Eliott Lee
Administration
Women in Medicine
Marissa Friedman
Looking across the rows of seats in the Cooke Auditorium at my fellow female medical stu-
dents, I cannot help but feel a sense of accomplishment and gratitude. Especially as we begin to
celebrate New York Medical Colleges 150
th
anniversary, I am reminded of how lucky I am to
be alive in this day and age, when women actually have the opportunity to pursue a career as a
physician.
New York Medical College has played an important role in promoting the presence of
women in medicine. Only three years after the founding of the original college in 1860, the as-
sociated New York Medical College for Women was founded by Dr. Clemence Sofia Loz-
ier. She was one of the first women in the United States to practice medicine, and is credited
with being the pioneer of womens medical education. Dr. Lozier first started as a teacher,
opening a primary school for young women. Having a passion for helping others, she became
inspired by the story of the first female medical doctor in the United States, Elizabeth Black-
well. Blackwell graduated from Geneva Medical College in upstate New York in 1849. After
hearing this, Lozier decided that she too wished to have a medical degree and tried to attend the
same college. However, the medical college in Geneva decided that one woman physician was
enough, and refused to admit Lozier as a student. Eventually, Lozier attended medical lectures
at Central New York College at Rochester, and was finally admitted to Syracuse Eclectic Col-
lege, where she graduated in 1853.
1

When Lozier returned to New York City to practice medicine, she was met with great suc-
cess, despite the fact that she was a woman. She did however continue with her teaching roots
and desire to educate women by holding various health-related lectures out of her own
home. These lectures on familiar medical fundamentals, such as anatomy and physiology be-
came packed with women. Lozier realized that there was a strong desire by women to learn
medicine, and that prompted her to eventually create the New York Medical College for
Women, the first school of its kind in New York City and the lower New York area.
Although the College had an all-male faculty and only seven female students in its first
class, it was responsible for some remarkable accomplishments. This includes the graduation of
Elizabeth Stowe in 1867, as the first female physician to receive a medical education in New
York City. When Stowe returned to her native country, she became the first female physician in
Canada. This was followed by the graduation of Dr. Susan Mckinney in 1870 as the first Afri-
can-American graduate in New York State and only the third in the nation.
2
This was undoubt-
edly amazing considering that this was going on far before women had not yet even received
the right to vote.
As a matter of fact, at that time, the American Medical Association did not allow female
doctors to become members. In addition, most hospitals did not permit women to obtain intern-
ships, and thus the only hospital available to women for training was the Womens hospital as-
sociated with New York Medical College. It was not until 1918 that other hospitals such as
Bellevue opened up its doors to female medical students
1
. It was also in 1918 that the New
York Medical College for Women officially closed and transferred its students to the original
6
and previously male-only New York Medical College, thus transforming it into a place for both
men and women to receive a medical education. Around this time, the AMA started to allow
women to become members.
3
Despite the groundbreaking headway that began at the end of the 19
th
century, the percent-
age of woman physicians remained low throughout most of the 20
th
century. By 1890, only 5%
of physicians in the United States were women. This only increased to approximately 17% dur-
ing the 1980s. Despite the small numbers, likely due to social constraints that categorized
women as homemakers and a view that the medical profession was a mans job, women still
made remarkable contributions to the medical field.
Dr. Gerty Cori is a name that may sound familiar to first year students as one of many No-
bel laureates thrown on the screen during a lecture for Biochemistry. What many students
might not realize is that Gerty Coris accomplishment goes far beyond just the discovery of the
role of phosphorylase in glycogen metabolism. She was the first woman to receive the Nobel
Prize in Medicine in 1947. This act contributed not only to solidifying the fact that women
could be renowned physicians, but also brilliant physician scientists.
4
This brings me back to my first year lecture hall, where I look around and notice that there
seems to be an equal amount of male and female faces. Actually, since the turn of the 21
st
cen-
tury, a great change has started to occur within the medical profession. In 2002, 25.2% of all
U.S. physicians were women, almost double the 1980 figure
5
. Still, by far the biggest change is
occurring now in medical schools across the country. According to the Association of Ameri-
can Medical Colleges (AAMC), the total number of women entering medical schools has in-
creased each year since 1982. Moreover, the percentage of women in medical school classes
has increased from less than 31.4% in 1982-1983 to 49.6% in 2003-2004. In 2008-2009,
women represented 48.8% of the students receiving M.D. degrees. This was the highest num-
ber of female medical school graduates to date.
5
This increase in the number of women in medi-
cal school is evident even here at New York Medical College where the class of 2010 is com-
prised of 54% females and 46% males
2
. As I begin my own journey in medical education, I am
very proud to attend a school such as New York Medical College that played such an important
role in allowing women to pursue careers in medicine. Furthermore, I cant help but pay hom-
age to the brave trailblazers such as Dr. Blackwell and Dr. Lozier, who made it possible for
women like me pursue a dream of becoming a physician.
R E F E R E NC E S
[1] Cazalet S.History of the New York Medical College and Hospital for Women.2001.Accessed 30 Dec.
2008.http://www.homeoint.org/cazalet/histo/newyork.htm
[2] About NYMC:History.New York Medical College Website. 2009.Accessed 30 Dec. 2008.http://
www.nymc.edu/AboutNYMC/History.html
[3] Womens History in America.Womens International Center. 1995.Accessed 30 Dec. 2008. http://
www.wic.org/misc/history.htm
[4] Women in Medicine: An AMA Timeline.American Medical Association.2004.Accessed 30 Dec. 2008.http://
www.ama-assn.org/ama1/pub/upload/mm/19/wimtimeline.pdf
[5] U.S. Medical School Applicants and Students 1982-83 to 2009-2010.Association of American Medical
College. 2009.Accessed 30 Dec. 2008.http://www.aamc.org/data/facts/charts1982to2010.pdf
Marissa Friedman: Women in Medicine
7
Planck Versus Poe: Scientific and Poetic Approaches
Anita Kelkar
The British theoretical physicist, Paul Adrien Maurice Dirac, wrote that "In science one
tries to tell people, in such a way as to be understood by everyone, something that no one ever
knew before. But in poetry, its the exact opposite."
1
This leads to the inevitable question: Do
both approaches suggested in Diracs statement enjoy equal success in expanding human
knowledge?
2
First it is necessary to explain the individual approaches of science and poetry.
From there I hope to discover if an expansion of human knowledge actually occurs from these
approaches. However, the phrase "human knowledge" is ambiguous and can mean different
things. Human knowledge can refer to the knowledge obtained by humans about the world
around them or it can represent knowledge about themselves. After taking into consideration
every aspect of Dirac's statement, I hope to come to a conclusion of whether both approaches
stated in the quotation enjoy equal success in expanding all aspects of human knowledge.
"In science one tries to tell people, in such a way as to be understood by everyone, some-
thing that no one ever knew before." According to Merriam-Webster science is defined as the
"systematic acquisition of knowledge". This definition is the basis of the scientific method,
which is the core of every researchers methodology. A researchers approach to a possible
study begins with a review of background litera-
ture that will ultimately culminate in a hypothe-
sis. This is followed by a methods section and
the actual experimentation, analysis, results and
conclusions. Hence, when one is trying to relay
scientific discoveries, one must provide data and
statistical analyses to support ones statement.
This scientific approach has ultimately led to the
evidence based medicine movement that dictates
our approach to diagnoses and treatment today,
Along with quantitative evidence of her discov-
ery; the researcher must further prove that the
conclusion is generalizable under all similar con-
ditions. Generalizable information is an essential
component for patient treatment. For example, if
a certain cancer drug is proven to remain efficacious for all situations under all circumstances
then the acceptance factor of that drug increases. Since there is no room for the statement to be
denounced, it must be accepted.
It is also important to explain this "systematically obtained knowledge" in such a way that it
is understood precisely and unambiguously. The foremost goal of the scientific approach is for
newly discovered information to be understood by all and accepted. The information must be
easily understood by the audience, which requires the information to be worded in accordance
to the ability level of the information receiver. This can be seen in the information dissemina-
tion that occurs after a groundbreaking scientific discovery has occurred. When new discoveries
are made in cancer research, the description of the discoveries written in JAMA will be more in
8
In the clinical sci-
ences, lack of knowledge
dissemination or accep-
tance can have grave
consequences"
-depth and the language more technical than when the same discovery is relayed to AP Biology
students in high school. The expressed information must be clear, precise and have no room for
doubt or misinterpretation. It is only after the information has been conveyed in a precise man-
ner, will the audience understand what is being said.
The successful dissemination of scientific information requires the public to accept what is
being said, for the public has gained knowledge only when the new information has been ac-
cepted. In the clinical sciences, lack of knowledge dissemination or acceptance can have grave
consequences. A prime example of this can be seen in the controversy regarding the supposed
link between the MMR vaccine and autism. One of the authors of the Wakefield study that ini-
tiated the link between vaccines and autism has recently stated There is now unequivocal evi-
dence that MMR is not a risk factor for autism -- this statement is not spin or medical conspir-
acy, but reflects an unprecedented volume of medical study
3
. Even before this statement, de-
spite the volumes of data and scientific knowledge disproving the link between autism and vac-
cines, millions of parents refused to accept this knowledge as true. Hence parents had been ulti-
mately committing a harmful disservice to not only their children, but a disservice to the health
of the public.
The scientific approach for expanding human knowledge requires precision, clarity, evi-
dence and generalizability of the information conveyed. Ultimately, regarding the expansion of
the human knowledge, the strength of the scientific approach lies in the fact that information is
presented in a clear, logical and unambiguous fashion, and is supported by analytical evidence.
The second part Diracs statement requires the analysis of a poet's approach in extending
human knowledge. Since poetry attempts to convey the poets ideas that may not be necessar-
ily something new or unique or even easily understood, this method can be considered as al-
most polar opposite of the scientific approach,. In po-
etry instead of tangible and scientific facts, the
"human knowledge" that is addressed, is the knowl-
edge about human beings themselves. Poetry is de-
fined as writing that formulates a concentrated
imaginative awareness of experience in language cho-
sen and arranged to create a specific emotional re-
sponse through meaning, sound, and rhythm.
3
The
poetic approach can be divided into two areas: one
being how the poet states what she wants to say and
the other is the content being of what she says. Each
poet has his own unique style and is not required to
conform. How then can one say that a poetic approach
expands human knowledge? Unlike a scientist, a poet
does not necessarily write for the purpose of disseminating new information. A poet writes to
express his own emotions, describe an experience, provide inspiration; a poets intent is limit-
less. Since the poet is not necessarily conveying a set message, the reader is free to interpret a
poem in a way that appeals to himself. Unlike science where misinterpretation of conveyed in-
formation can have serious consequences, poetry is open to many interpretations; interpreta-
tions that the author may not have initially intended. One of the differences in interpretation can
be due to the fact that it may be difficult for a person to understand an emotion they have yet to
Anita Kelkar: Scientific and Poetic Approaches
9
A poet writes to
express his own emo-
tions, describe an ex-
perience, provide in-
spiration"
experience. For example in Edgar Allan Poe's "A Dream" a heartbroken lover might see the
plight of unrequited love, while a widower might see solitude and loneliness in it. A poet often
makes a reader introspective and in doing so helps the reader explore the different facets of his
being. Poetry has the ability to reveal to us, the reader, what is hidden and often what we refuse
to see about ourselves. It may not be rash to say that poetry may be the mirror to ones soul.
Human knowledge is surely expanded by the poetic approach. The poetic method forces one
to extend his imagination and enter the crevices of his own soul. Poetry evokes emotions and
reactions, which subsequently give one insight into her thought processes. Not only does it rein-
force feelings that may be already present, but poetry also provides a passage to emotions that
one might not have yet experienced. It allows the reader to feel the poet's pain, loneliness, love
or lust, or touch the tip of emotions that one has yet to embrace. The poetic approach expands
human knowledge by ultimately developing or heightening one's self-awareness. If this method
can expand this version of human knowledge, then this process to self-discovery is extremely
critical as well.
After discussing both approaches of two distinctly different fields it is clear that the each
method is successful in its own right. The scientific, objective approach induces a growth of
knowledge regarding the observable physical world of humans while the subjective poetic ap-
proach focuses on self awareness. Both approaches are equally successful in expanding their
angle of the already nebulous concept of human knowledge. Although the types of human
knowledge ascertained are distinctly different, the approaches are not mutually exclusive. The
scientific approach grants us information of our physical surroundings, and the interpretation of
this knowledge helps us to gain insight about ourselves and our existence. Conversely, knowl-
edge from self-discovery is necessary to discover our capacity and capability to deal with the
outside world. Hence I must end here, for the only thing that remains certain can be summa-
rized by the writer Samuel Coleridge, During the act of knowledge itself, the objective and
subjective are so instantly united, that we cannot determine to which of the two the priority be-
longs."
4


R E F E R E NC E S
[1] P.A.M. Dirac, H Eves Mathematical Circles Adieu (Boston 1977).
[2] International Baccalaureate Theory of Knowledge Essay Topic
[3] Merriam Webster Online Dictionary
[4] P. Baker, D. Clements. Does the MMR Vaccine cause Autism? http://www.dukehealth.org/health_library/
advice_from_doctors/your_childs_health/mmr_vaccine_and_autism. (2007)
[5] Samuel Coleridge., Chapter XII of Biographia Literaria (1817)
Anita Kelkar: Scientific and Poetic Approaches
10
PEERS OF OUR PAST

Outside of the basic sciences building (1975)
Students were assigned an individual module
desk where they would study, use their micro-
scopes, and conduct experiments (1977)
Grasslands housing complex (1980)
11
Antidepressants Misrepresented
Steve Rockoff
In the first week of 2010, a study performed by researchers at the University of Pennsyl-
vania made waves as it circulated through every major national news outlet. The study, a meta-
analysis of six independent studies conducted at various points in the past 20 years, was con-
ducted in order to determine the relative benefit of antidepressant medications over a placebo,
for depressed patients with a varied range of baseline symptom severities.
1
The results of the
study led to the publication of articles in various medias with titles such as U.S. News & World
Reports Do You Really Need That Antidepressant? and USA Todays Study: Antidepres-
sant lift may be all in your head.
2, 3
Indeed, the conclusion that the researchers came to was
that in cases of mild or moderate depression, some of those common antidepressants were no
more useful than a mere sugar pill.
I was fairly troubled when I perused through the various articles and stories that covered
this study, seeing that in many cases, the media was up to its usual old tricks of sensationalizing
and misrepresenting the most recent hot medical study of the week. Sending a message to the
American people that trivializes the effects or usefulness of antidepressants is a very precarious
game, and as I shall imminently elaborate, even more unfortunate when that message is based
on a study with several inherent flaws.
The class of drugs known as antidepressant
medications (ADMs) encompasses a multitude
of compounds whose members are often pre-
scribed for a wide variety of psychiatric disor-
ders. One of these is major depressive disorder, a
multi-factorial mood disorder that most likely
arises due to a complex interaction of biological,
psychological, and social factors including drug
and substance abuse. Depression is a disorder
that can range from having mildly intrusive to
severely debilitating effects on a patients
life. The most characteristic psychological
symptoms of depression are low mood, low self-esteem, loss of interest & pleasure, excessive
rumination, and feelings of worthlessness. These are more often than not accompanied by the
physical symptoms of insomnia, drastically decreased appetite, weight loss, headaches, and fa-
tigue.
4

The identification and treatment of depression is of great interest to the American peo-
ple. While the lifetime prevalence of depression in most countries falls between 8-12%, the
United States has roughly 17% of its population afflicted.
5
Antidepressants are the third-most
widely prescribed class of drug in the US, with an estimated 10% of women and 4% of men
taking them.
2
Unfortunately, it is widely agreed in the medical community that not only is de-
pression under-diagnosed, but that diagnosed patients are often under-treated! The investiga-
tors actually had a praiseworthy motive for the study at hand; their literature search revealed a
12
Not only is depression
under-diagnosed diag-
nosed patients are often
under-treated!"
marked paucity of pharmacological studies in which participants had baseline scores below 23
on the Hamilton Depression Rating Scale (HDRS), the minimum score for very severe depres-
sion. Bearing in mind that the majority of ADM patients may be considerably below a score
of 23 (it was shown that 71% of participants in a recent survey had HDRS scores less than 22),
the investigators task at hand of examining those who were less depressed would seem very
worthwhile.
6

It is important to bear in mind that in the world of depression treatment, antidepressants
share the throne with psychotherapy. Or at least, ideally they do. In the modern worlds quick-
fix, medicated society, too often psychotherapy is overlooked or unwanted. Indeed, from 1996
to 2005, the use of ADM in the U.S. doubled, while the use of psychotherapy declined.
7
When
in reality, the various forms of psychotherapy (which include cognitive behavioral therapy,
group therapy, and psychoanalysis) may have just as much, if not more, to offer than ADMs in
terms of treatment.
This past summer, I worked in the Behavioral Health Center (BHC) of Westchester Medical
Center under the supervision of B-2 inpatient unit physician Dr. Jay Draoua. I spent the bulk of
my days observing or participating in the evaluations and treatments of the admitted patients,
many of which had depression. As a rule, my current personal standpoint as an idealistic bur-
geoning medical student is still one that prefers to avoid pharmacological treatment as much as
possible, especially when other forms of treatment are available. This means that for psychiat-
ric disorders such as depression, in addition to the helpful standbys of exercising, eating
healthy, and pushing ones self into socialization, I highly advocate psychotherapy as a thera-
peutic tool. With the patients I have observed in the BHC, antidepressants have been highly
useful in the stabilization of recently admitted patients; however, antidepressants are not sup-
posed to be advertised as a long-term solution to for depression. As I have witnessed, to truly
treat depression, one must examine the core of the patient, explore the roots of the underlying
issues or events that triggered their pain, and have them come to an understanding with their
illness. The patient has to approach an appreciation and respect for themselves. Only then can
you put depression beyond the reaches of remission, something that antidepressants are not able
to do.
However, as I mentioned, antidepressants do have substantial merits of their own. The idea
is to normalize certain neurotransmitters in the brain that are involved in regulating mood, thus
potentially alleviating the altered levels which are sometimes associated with depression. This
can provide immeasurable benefits for the patient on their road to recovery. Often, patients
must be brought to a higher level of functioning before any meaningful psychotherapy can even
begin. In other cases, they can stabilize a mildly or moderately - affected patient from re-
lapsing into a severe episode. Perhaps most often, they can provide a subtle boost in function-
ing for men and women going about their daily lives and work, without which they would be
increasingly burdened by whichever depressive affliction haunts them.
For these reasons, I feel somewhat offended by the way in which this studys results are pre-
sented by the authors and the media. As I perused the content of this meta-analysis, I built a list
of several troubling concerns I had regarding the methods involved, and how the results were
portrayed.
Steve Rockoff: Antidepressants Misrepresented
13
To begin with, the literature search which was conducted by the investigators to find studies
for their meta-analysis reached all the way back to 1980. Out of the over 2000 studies they
searched, their exclusion criteria (for studies without placebo controls, or ones examining spe-
cial subpopulations, etc.) narrowed the number of studies they included in their final meta-
analysis down to just six. Of these six, three of them compared the ADM imipramine to pla-
cebo, and three compared the ADM paroxetine to placebo. Imipramine belongs to an older
class of drugs developed in the 1950s, the tricyclics (TCAs), a highly effective group of antide-
pressants which are still used for treatment-resistance depression when other drugs fail, though
they can sometimes cause mania or hypomania on a maintained dosage.
8, 9
Today, the TCAs
are less popular due to the advent of antidepres-
sant drug classes with less severe side effects,
such as the selective serotonin reuptake inhibi-
tors (SSRIs). A 2007 ranking of the most com-
monly prescribed ADMs in the U.S. put
imipramine at thirteenth with 1.524 million,
which is less than one-third of the twelfth-
ranked nortriptyline and a mere fraction of the
top four ranked ADMs (which all top 20 mil-
lion on their own).
10
Using such a rarely-
prescribed and antiquated drug to represent the
whole range of ADMs and their supposed inef-
fectiveness on mild depression is just poor
practice, in my opinion. The investigators
make note of several of their studys limitations, but this is not one of them. It is quite a shame
that they have allowed ADMs to be presented to the public this way, with half of their data
coming from this particular drug.
Paroxetine, a SSRI and the fifth-most prescribed ADM in the U.S. in 2007, was the other
drug used in the studies. However, compared to the three SSRIs that were more popular
(sertraline, escitalopram, and fluoxetine), paroxetine is associated with several concerning side
effects such as weight gain, increased risk of suicidality, and high risk of withdrawal syn-
drome.
11, 12, 13
Again, not a drug most representative of the antidepressants Americans would be
likely to use. Neither one of the two ADMs used on patients in the meta-analsyis are popularly
used as first-line agents for depression. Even if they were used as the first treatment, as they
were in these studies, it is well known (and even taught to us in first year Behavioral Sciences
in medical school) that very often the first-line of treatment is not effective, and that two or
three classes of ADMs may be tried before finding one that the patient responds to.
Another area of concern to me was that the investigators set a minimum criterion of a 6-
week treatment duration period for symptom scores when selecting studies to include. In fact,
the average treatment duration for the six studies was only a little over eight weeks, which
seems to be an alarmingly short time to stop the recording data for a depression study. ADMs
are renowned for their need to take several weeks in order to begin to take effect. Two to three
weeks is usually the minimum standard, and for an ADMs effect to take even longer than that
is by no means rare. In particular, the rate of symptom improvement can greatly vary by drug
and by person. Imipramine in particular has been shown to have a slower rate of symptom im-
provement than other drugs in the treatment of depression, and even though it can lag behind its
Steve Rockoff: Antidepressants Misrepresented
14
Often, patients must be
brought to a higher level of
functioning before any
meaningful psychotherapy
can even begin."
peers after six weeks of treatment, its effect is by no means over a continued improvement in
symptom score is still observed beyond that six week mark.
14
The investigators findings seem
to, unfortunately, only apply to acute treatment, not the continuous or maintenance ADM treat-
ment that millions of Americans find themselves on.
Further flaws in this recent study can be found in the types of patients who were chosen to
be excluded from this meta-analysis. Almost 600 studies were stricken from inclusion because
the depression patients were dysthymic or were from a special sub-population (i.e. a certain eth-
nicity). Dysthymia is a mood disorder which is best described as chronic depression, but at a
lesser intensity the patient must have the symptoms of a depressed mood for at least two
years, but without the presence of a major depressive episode. The very definition of dysthy-
mia, which is to have a less severe depression, seems to suggest that its patients would suit
perfectly for the present meta-analysis, which has a great interest in patients who score lower on
a depressive symptom scale. If the proposed trend of less-severely depressed patients showed
an equal response to placebo was also discovered in dysthymic patients, which would contrib-
ute greatly to the investigators current conclusions. However, it has been well shown over the
years that the three main classes of ADMs (SSRI, TCA, and monoamine oxidase inhibitors)
have a noted pharmacological effect over placebo in the treatment of dysthymia patients, espe-
cially in the short term.
15
It should also be noted that the results of this meta-analysis do not
apply to inpatient populations or children, two sizable groups which were also excluded from
the study.
My last criticism of the meta-analysis at hand is the use of the depression symptom scoring
criteria. All six studies involved used the Hamilton Depression Rating Scale (HDRS), in which
patients scoring 8-13 have mild depression, 14-18 are moderate, 19-22 are severe, and
greater than 23 are very severe. The results of the current analysis demonstrated that there
was a small effective difference between ADM and placebo when the patients had a baseline
below a score of 23. In addition, the National Institute for Clinical Excellences standard for
significant difference between ADM and placebo (meaning the HDRS difference is 3 or
greater) was not met until patients had a baseline of 25 or greater.
Most media articles reporting this study emulate the claim that ADMs only work if one is
severely depressed, i.e. has a HDRS score of 23 or greater. However, taking the ratings on
the HDRS scale literally is very misleading. Resistance to the use of HRDS labels by mental
health practitioners is nothing new. The Hamilton concept of severe, I think many psychia-
trists would think of as moderate, said Dr. Mark Olfson, a professor of clinical psychiatry at
Columbia University.
16
The Hamilton scale, developed in the 1960s, is widely used because of
tradition in the field, but in reality it suffers from a sort of grade inflation that can classify pa-
tients in very misleading, and especially more severe, ways.
The authors of this meta-analysis recognized some of the limitations of their study, particu-
larly the caveat about the psychometric measuring properties of the HDRS. However, many of
the items I noted above were not spoken for. I would agree with the authors call for more stud-
ies examining patients with a wide range of baseline depression severities, as their claim that
there is relatively little data on lesser depressed patients responses to antidepressants appears to
be valid. I would hope, though, that with future studies to be done, they could rectify some of
my current critiques regarding the methods of analysis, and accurately present their conclusions
to the public and media.


Steve Rockoff: Antidepressants Misrepresented
15

R E F E R E NC E S
[1] Fournier J, DeRubeis R, Hollon S, Dimidjian S, Amsterdam J, Shelton R, and Fawcett J. 2010. Antidepressant
Drug Effects and Depression Severity: A Patient-Level Meta-Analysis. JAMA, 303[1]: 47-53.
[2] Kotz, D. Do You Really Need That Antidepressant? USnews.com. 6 Jan 2010. Accessed 12 Jan 2010. http://
www.usnews.com/health/blogs/on-women/2010/01/06/do-you-really-need-that-antidepressant.html
[3] Rubin, R. Study: Antidepressant lift may be all in your head. USAtoday.com. 5 Jan 2010. Accessed 12 Jan
2010. http://www.usatoday.com/news/health/2010-01-06-antidepressants06_ST_N.htm
[4] Depression. 2008. National Institute of Mental Health. Accessed 12 Jan 2010. http://www.nimh.nih.gov/
health/publications/index.shtml
[5] Andrade L, Caraveo-Anduaga JJ, Berglund P. 2003. The epidemiology of major depressive episodes: Results
from the International Consortium of Psychiatric Epidemiology (ICPE) Surveys. Int J Methods Psychiatr Res, 12
[1]: 321.
[6] Zimmerman M, Pasternak MA, and Chelminski I. 2002. Symptom severity and exclusion from antidepressant
efficacy trials. J Clinical Psychopharmacology, 22[6]: 610-614.
[7] Yan, J. 2009. Antidepressant Use Rises in 10-Year Period. Psychiatric News, 44[17]: 8.
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296300.
[10] "Top 200 generic drugs by units in 2007."Drug Topics. 18 Feb 2008. Accessed 12 Jan 2010. http://
drugtopics.modernmedicine.com/drugtopics/Top200Drugs/ArticleStandard/article/detail/491194
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[12] Barbui C, Furukawa TA, Cipriani A. 2008. Effectiveness of paroxetine in the treatment of acute major
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Placebo in the Treatment of Depression. JAMA, 249[22]: 3057-3064
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Steve Rockoff: Antidepressants Misrepresented
16
Building the Westchester County Medical Center (1978) Early photograph of Sunshine Cottage
Fifth Avenue Hospital, in Manhattan (1976), and home of
New York Medical College. It was closed in 1979.
Rear of Basic Sciences Building, 1979
yearbook (1966 on doors is not explained)
17
FUTURE FOUNDATIONS
An Examination of Three Model Healthcare Delivery Systems
Gavin Stern
The United States is just now beginning its journey into a universal healthcare delivery sys-
tem. On March 30, 2010, President Obama signed into law the Health Care and Education
Reconciliation Act of 2010 (H.R. 4872), which completed the work of the Patient Protection
and Affordable Care Act (H.R. 3590) signed on March 23, 2010. The effects of this legislation
are phased in over the course of this new decade, but the final product is far from certain. Im-
plementation could be legislated away with one election cycle. This article examines three
model healthcare delivery systems that the United States could look towards on its march to
universal coverage: those of France, Germany, and the Netherlands.
France: Government-run Universal Insurance
In 2000, France had the best healthcare system in the world, according to the World Health
Organization.
1
The basic French system - Scurit Sociale - covers Hospital care, ambulatory
care and prescription drugs along with minimal coverage of outpatient eye and dental care
2

and nursing home benefits.
1
This is a mandatory system.
Complementary insurance covers individual cost
sharing, and is usually provided by the employer. More
recently, the Couverture Maladie Universelle (CMU) is
provided to individuals who cannot afford the public
system due to unemployment
2
, estimated at 0.4% of the
population. Another system LAide Medicale dEtat
(AME) covers Illegal residents. In general, poorer
patients are exempt from cost-sharing.
2
Therefore, one
could infer that that none go without basic health insur-
ance in France even noncitizens.
1

The French medical system is not nearly as government-centralized as, for instance, the
United Kingdom, which has a socialized system. Rather, the government of France finances
basic healthcare via legislation that creates the annual prospective global budget for the public
health expenditures, which funds the Scurit Sociale and CMU and is financed through na-
tional income taxes and the General Social Tax a supplementary income tax (7.5%) intro-
duced in 1991 to help offset health care costs; 5.25% of which helps pay for the health care sys-
tem. Further, Complementary insurance reduces financial burden on individual cost sharing.
Ninety-two percent of the population carries the complementary insurance, roughly half of
which is funded by employers.
1

France controls healthcare costs with financial leverage. For instance, individual co-
payment for a drug is linked to effectiveness. Drugs with proven therapeutic effects are basi-
cally free, while those of dubious or limited use are cost-shared to a greater extent. While indi-
viduals may visit any physician, reimbursements are better when one starts with a gatekeeper
general practitioner: Visits to the gatekeeping general practitioner are subject to a 30% co-
insurance rate, while visits to other GPs are subject to a 50% co-insurance rate.
2
This is a new
18
None go without
health insurance in
Franceeven nonciti-
zens."
concept, introduced via the Douste-Blazy law in order to reduce large budget deficits. Overall,
the practice of medicine in France is a self-regulating market. A reference price determines
what the public system will reimburse. Technology reduces paperwork and increases efficiency:
patients carry Scurit Sociale cards containing microchips storing their comprehensive medi-
cal information, allowing physicians immediate access to a patients record. Physicians are
private employees, mostly self-employed and paid on a fee-for-service basis.
1

Out of pocket spending for healthcare is still an issue in France, as patients visiting physi-
cians and dentists pay full price and are later reimbursed for costs by the public health insurance
and complementary insurance. Out of pocket expenses were 6.9% of total health expenditures
in 2005.
1
However, some conditions are completely reimbursed, including cancer, diabetes and
other chronic conditions includ[ing] all pharmaceuticals [and] experimental drugs. Pricing
and reimbursements are negotiated between the health insurance funds and unions representing
providers. The supplemental insurance plans are not allowed to compete by lowering health
insurance premiums,
1
which may have the effect of reducing competition but is done for the
purposes of solidarity. To reduce the effects of moral hazard, there are additional co-payments
per office visit, with an annual ceiling of 50 Euros. The French system in totality does not pro-
vide the same level of expertise to all income levels, as doctors and dentists may charge above
this reference price based on their level of professional experience.
2
The wealthy, then, can
afford more skilled practitioners despite the French principle of solidarity. However, the ability
for skilled physicians to set a higher price also provides an incentive to achieve that higher level
of skill a capitalist tenet.
Is the French healthcare system a good deal? Healthcare spending in France was 11.1% of
GDP in 2005, much lower than 15.3% in the United States.
3
Per capita spending in 2003 was
$2903 in France compared to $5635 in the United States. There are proportionally more physi-
cians in France: 3.4 to 2.3 per 1000.
4
French infant mortality was 4.3 deaths per 1000 births
compared to 7.2 per 1000, and life expectancy at birth was 82.2/74.6 (female/male) compared
to 79.4/73.9 in the United States.
5
Clearly, the French system performs better. However, US
implementation of the French system would be difficult because it requires a strong central gov-
ernment (France is arguably a single-payer system). A system of government-regulated insur-
ance coverage (more like that of Germany or the Netherlands) might be a more reasonable long-
term goal for the United Statess
Germany: Social Insurance and Sickness Funds
The healthcare system of Germany consists of governmentally independent sickness funds,
along with a separate private insurance system. Sickness funds are autonomous, not for profit,
nongovernmental bodies regulated by law, which act as the collectors, purchasers, and payers
in both health and long-term care insurance in Germany.
6
This system of more than 200 sick-
ness funds is the oldest system of social insurance in the world.
7
The notion is that these
funds will compete against one another, encouraging greater efficiency and reduced cost.
In 2006, 88% of Germans were covered by the sickness fund system. Only 0.22% of Ger-
mans were uninsured. A special state program covered 9.7% as government employees, and
2% purchased private health insurance.
7
Individuals with income levels of less than 48,000
annually (75% of the German population) are required to enter into the public program. 75% of
Gavin Stern: An Examination of Healthcare Systems
19
people with income above this level remain in the public system by choice. This helps to dem-
onstrate that the public healthcare system of Germany is considered to be satisfactory even for
those with greater income levels, as private insurance enrollment is very low. After 2009,
health insurance will be mandatory in either the social or private health insurance scheme.
6

Before that, insurance was optional for individuals with yearly income over 48,000.
The sickness funds are financed by employee and employer contributions of (on average)
8% and 7% of income, respectively. The unemployed are still expected to make a contribution.
Patients may incur cost sharing or copayments of up to 2% of household income. This figure
is cut in half for those declared chronically ill. This system of contribution also changes in
2009, in that all contributions will be centrally pooled by a new national health fund, which
will allocate resources to each [sickness fund] based on an improved risk-adjusted capitation
formula.
6
This should help to evenly spread the risk of more ill, more needy, more expensive
patients on particular sickness funds. However, this does show a trend towards more centralized
control via the government.
The sickness fund program is more comprehensive than other social health programs dis-
cussed in this analysis including, dental, inpatient, and preventive care along with
prescription drugs and rehabilitative treatments and disability payments to those who cannot
work.
7
Patients receive incentives to utilize gen-
eral practitioners in a family physician care
model. The German system encourages cost ef-
fectiveness as sickness funds and physicians col-
laborate on price control. Physicians maintain their
autonomy to practice and are generally paid by a
mixture of fees per time period and per medical
procedure.
6
Physicians are compensated by sick-
ness funds via their regional physician associa-
tions.
8
It should be noted that, unlike the United
States system, physicians are encouraged to col-
laborate and lobby, similar to the French system.
Healthcare spending in Germany was 10.7% of
GDP in 2005, lower than 15.3% in the United
States and 11.1% for France.
3
Per capita spending in 2003 was $2996 in Germany, much lower
than $5635 in the United States. Germany and France had the same per capita number of physi-
cians at 3.4 per 1000, higher than 2.3 per 1000 in the United States.
4
German infant mortality
was 4.6 deaths per 1000 births in 1999 (7.2 per 1000 in the US) while life expectancy at birth in
1998 was 80.5/74.5 (female/male) compared to 79.4/73.9 in the United States.
5
The German
healthcare model receives generally good reviews, with 66% of Germans approving of the sys-
tem in 1996,
5
and 11% disapproving.
8
The German system would be difficult to implement in
the United States because it involves a large degree of government control. The sickness funds
do not operate capitalistically (as in the Netherlands) but rather as a nonprofit, indirect exten-
sion of government.
The German healthcare system significantly outperforms that of the United States, with re-
sults comparable to France but with less expenditure as a percentage of GDP. American imple-
Gavin Stern: An Examination of Healthcare Systems
20
The notion is that
these funds will compete
against one another, en-
couraging greater effi-
ciency and lower cost."
mentation of the German system is feasible because the sickness funds are analogous to private
insurance companies. However, the German system requires these funds to be not-for-profit,
and they now pay into a single national fund. Employers would have to contribute to the sys-
tem, a policy that United States has been trending away from. While a system similar to that of
Germany could practically evolve in the United States by capping insurance company profits,
the political reality is that it would be attacked as anti-capitalist. The healthcare system of the
Netherlands might be more palatable.
The Netherlands: Multi-Payer Private Competition With Government Regulation
The Dutch healthcare system has been referenced as a possible route to universal healthcare
coverage in the United States.
9
The Health Insurance Act (2006) established a system of gov-
ernment-regulated private insurance companies. As in the United States, insurers retain their for
-profit status. However, in the Netherlands the Supervisory Board For Health regulates these
companies. The emerging American model may benefit from the Dutch example of increased
regulation.
The Dutch government does not exert
direct control over healthcare treatments
(no rationing). Rather, insurance compa-
nies are obligated to accept anyone who
applies for the government-mandated
standard insurance package. Each policy
must include basic services: medical
care hospitals and midwives, hospitali-
zation medical aids, medicines, mater-
nity care, ambulance and patient transport
services as well as limited remedial,
speech, and occupational therapy. Nurs-
ing care, home care, chronic and mental
illnesses are covered under the separate
Exceptional Medical Expenses Act. All
working adult citizens of the Netherlands
are obligated to purchase a standard in-
surance policy. The government pays for
the health policies of children (under 18 years of age). The government also subsidizes indi-
viduals who cannot afford such a policy, defined as greater than 5% of income, by providing an
allowance proportionate to income. Nevertheless, an estimated 1.5% of Dutch citizens remained
uninsured as of 2007.
10
The lack of 100% coverage remains a consequence of blunted govern-
ment intervention, an issue that the United States will also be left with.
Individuals, employers, and the government finance the Dutch system. Individuals pay
6.5% of the first 30,000 of annual taxable income. The rate is reduced to 4.4% for the un-
employed. Purchasers of these policies retain free choice, in that they may change policies once
per year. Citizens also benefit from lowered prices as insurers compete for business. This com-
petition-based model also forces increased efficiency and cost reduction. Physicians operate on
a fee for service basis. General practitioners receive a capitation payment for each patient on
Gavin Stern: An Examination of Healthcare Systems
21
All working adult citizens
of the Netherlands are obli-
gated to purchase a standard
insurance policy Neverthe-
less, 1.5% of Dutch citizens
remained uninsured as of
2007."
their practice list and a fee per consultation, a vast improvement over American reimburse-
ment for primary care services. Physicians maintain their autonomy, in that they are not em-
ployees of the government. The billing process is simplified via Diagnosis Treatment Combina-
tions (DTCs). DTCs incorporate all the costs of treatment and diagnosis, so that individuals do
not receive billings for every minute detail in a single office visit.
10

Insurance companies charge a flat rate premium, which is based on the policy itself not
the risk of the insured as in the American system. The cost of these annual premiums was
1,050 on average in 2006. Government-mandated deductibles have been in effect since 2007,
and the insured pay the first 150 of any health care costs in a given year. However, costs to
the individual remain low, as out of pocket payments as a proportion of total health expendi-
ture are around 8%. Payments are collected centrally and distributed among insurers based on
a risk-adjusted capitation formula in order to equilibrate risk.
10

Healthcare spending in the Netherlands was 9.2% of GDP in 2004, lower than the United
States, France, and Germany.
3
Per capita spending in 2003 was $2,976. The Netherlands em-
ployed slightly fewer physicians per capita (3.1 per 1000) than Germany and France, but still
outperformed the United States.
4
Dutch infant mortality was 4.3 deaths per 1000 births, and life
expectancy at birth was 82.1 for females and 76.8 for males rates almost unanimously equal
or better than all countries compared in
this analysis.
11

This system is far from perfect. Al-
though the Dutch system encourages com-
petition and free choice, four insurers
control 90% of the market. Additionally,
the basic healthcare package does not
cover what Americans might consider to
be essential services, such as dental care,
eyeglasses, alternative therapies, and cos-
metic surgery (in some cases of disfigure-
ment). Citizens still have to pay extra for
these services. Indeed, 90% [of citizens]
buy supplemental packages.

The Future of The United States:
Of the healthcare systems examined in this analysis France, Germany, and the Nether-
lands the Dutch model is most compatible with the emerging healthcare system adopted by
the United States in 2010. The Dutch model produces the best results at the lowest price, with a
high degree of freedom and coverage while retaining capitalistic principles. The United States
would do well to follow the path of mandated coverage and strong government regulation of
insurance companies. There is some optimism that the United States may be moving in this di-
rection. Those who support such a system and the benefits outlined herein will need to be vigi-
lant of insurance companies that defend profit, of misplaced political accusations, and a politi-
cal movement to repeal this reform or declare it unconstitutional.

Gavin Stern: An Examination of Healthcare Systems
22
The United States would
do well to follow the path of
mandated coverage and
strong government regulation
of insurance companies."

R E F E R E NC E S
[1] International Health Systems: France. (2008, August 6). The Henry J. Kaiser Family Foundation. Retrieved
April 22, 2009, from http://www.kaiseredu.org/topics_im_ihs.asp?imID=4&parentID=61
[2] Durand-Zeleski, I. (2008). The French Health Care System. Descriptions of Health Care Systems: Denmark,
France, Germany, the Netherlands, Sweden, and the United Kingdom. Retrieved April 22, 2009, from http://
www.commonwealthfund.org/~/media/Files/Resources/2008/Health%20Care%20System%20Profiles/
LSE_Country_Profiles%20pdf.pdf
[3] Anderson, G., & Frogner, B. (2008). Health Spending In OECD Countries: Obtaining Value Per Dollar. Health
Affairs, 27(6), 1718-1727. Retrieved April 10, 2009, from http://content.healthaffairs.org/cgi/content/
abstract/27/6/1718
[4] Grol, R. (2006). Quality Development in Health Care in the Netherlands. The Commonwealth Fund, 21, np.
Retrieved April 10, 2009, from http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2006/Mar/
Quality-Development-in-Health-Care-in-the-Netherlands.aspx
[5] Rodwin (2003). The Health Care System Under French National Health Insurance: Lessons for Health Reform
in the United States. American Journal Of Public Health, 93(1).
[6] Busse, R. (2007). Descriptions of Health Care Systems: Germany. Retrieved April 10, 2009, from
www.allhealth.org/briefingmaterials/CountryProfiles-FINAL-1163.pdf
[7] The Century Foundation (2008). National health insurance: Lessons from abroad. New York City: The Cen-
tury Foundation Press
[8] Green, D., Irvine, B., & Cackett, B. (2005). Health care in Germany. Retrieved 4/17/2009, 2009, from http://
www.civitas.org.uk/pubs/bb3Germany.php
[9] de Ven, W. v., & Shut, F. (2008). Universal Mandatory Health Insurance In The Netherlands: A Model For
The United States?. Health Affairs, 27(3), 771-781 . Retrieved April 10, 2009, from http://
content.healthaffairs.org/cgi/content/abstract/27/3/771
[10] Klazinga, N. (2008). The Dutch Health Care System. Descriptions of Health Care Systems: Denmark,
France, Germany, the Netherlands, Sweden, and the United Kingdom. Retrieved April 22, 2009, from http://
www.commonwealthfund.org/~/media/Files/Resources/2008/Health%20Care%20System%20Profiles/
LSE_Country_Profiles%20pdf.pdf
[11] United States Central Intelligence Agency (2009). The Netherlands CIA World Factbook. Retrieved April 9,
2009, from https://www.cia.gov/library/publications/the-world-factbook/geos/nl.html
Gavin Stern: An Examination of Healthcare Systems
23
Homeopathy
Charles Volk
In 1860, the incoming class to the New York Homeopathic Medical College sat down to
become specialists in their chosen form of medicine, homeopathy. At the time it was a com-
pletely reputable form of medicine, equal to or better than the more conventional medicine of
the day. Indeed, a homeopathic physician would often garner a larger salary in the western
United States than a physician who used the strong laxatives and heavy metals that were used in
conventional medicine of the time. The US was very welcoming of homeopathy, founding the
American Institute of Homeopathy in 1844. The conventional physicians, in response to the ho-
meopaths, made their own institute a couple of years later: The American Medical Association.
The homeopaths gave conventional medicine a name to differentiate themselves and their
form of medicine. They called conventional medicine allopathy, and although the term is an-
tiquated, it seems to have stuck. This is actually a rivalry in medicine that has been going on
since the time of Hippocrates. Theres an idea that if a person has a condition, a physician can
do one of two things:
1) Give them a compound that causes
an opposite problem. For example: If a per-
son has diarrhea, give them something that
causes constipation. You give them some-
thing that would cause opposite suffering;
allopathy.
2) Give them a compound that causes a
similar problem. For example: If a person
has diarrhea, give them an extremely small
dose of something that causes diarrhea.
Similar suffering; homeopathy.
New York Homeopathic Medical College continued to churn out homeopathic physicians
for many years. However, by the end of the 19
th
century, new discoveries, an increasing trust in
the scientific process, and disagreements among homeopathic practitioners were starting to
sound a death knell for homeopathy in the United States. The curriculum at New York Homeo-
pathic Medical College had integrated new discoveries in medicine and science since its charter
class, and once medical education in the US became more homogenized around the turn of the
20
th
century, its classes largely resembled those found at any contemporary Allopathic medical
school. By 1910, as the popularity of homeopathy in the US dwindled and confidence in Allo-
pathic medicine increased, New York Homeopathic Medical College changed its name to New
York Medical College and the degree it offered to an Allopathic Medical Doctor. A little less
than a century later, homeopathy enjoys a resurgence in the US, with a half dozen schools in the
country. However, while the homeopathic medical education of the past encompassed new dis-
coveries in its teaching, modern homeopathy has taken a completely different angle.
24
While homeopathic medi-
cal education of the past en-
compassed new discoveries in
its teaching, modern home-
opathy has taken a com-
pletely different angle."
My experiment with homeopathy started with a book on natural health for dogs and cats. In
the book, the author introduced many natural ways to keeps pets healthy, but the one he es-
poused the most was homeopathy. I started looking further into it and became fascinated with
what I saw. After experimenting on myself and on willing family and friends (my dad still takes
the homeopathic remedy I got him for his bursitis), I was hooked. I found out about a homeo-
pathic medical school in Minneapolis, Minnesota, and after a year of college was accepted into
the class of 2009.
The first day of class started at 8AM on a frigid Minnesota January morning. The building I
walked into was rented out to practitioners of the entire spectrum of complementary medicine.
It felt like stepping back in time; herbs smoldering, strange esoteric compounds being displayed
and archaic rituals being performed to heal diseases I didnt even know existed. And there, at
the end of the top floor hallway, was my homeopathic medical school classroom.
It seemed like the room hadnt changed much since the late 1800s: old woodwork, ancient
blackboards, and colossal iron radiators. I took a front corner seat close to a power outlet (for
my laptop) which had the unintended side effect of allowing me to see both the faces of my
classmates and the professor at the same time. More on this later.
The room eventually filled up with the other 30 students, and I noticed that I was the young-
est person there by at least ten years. After some administrative stuff, we were all asked one-by-
one to stand in front of the class and tell everyone how we were called to homeopathy. I was
incredibly uncomfortable with this, as I didnt feel called to anything. The term evokes a cer-
tain amount of fait accompli of the universe; that my decision to study homeopathy could only
be explained by supernatural means. What it really reminded me of was Catholic school. Once
it was my turn, I just got up and explained how I thought homeopathy was very interesting, and
how I thought I could really delve into the subject to come up with knowledge to make people
better. I specifically left God told me to out of it.
The first teacher brought my hopes up slightly, talking about what anyone in medicine could
agree on, but the next teacher then started talking deeply about philosophy. He claimed that you
have to be a philosopher to get homeopathy, and you could only be a great homeopath if you
tweak your worldview. The phrase tweak your worldview was said to me dozens of times,
and it grew old very quickly.
Im not really one for extended philosophical musings. Nights wiled away in a heated dis-
cussion about our role in the universe just never really held too much interest for me. I always
found that learning about the natural world was always far more interesting than debating on
existentialism. I always felt that I existed because billions of years of evolution had by chance
created me. If it hadnt, I wouldnt be around to think about it. So, I guess my worldview is that
of things exist that I can interact with or detect, better known as the materialistic world-
view.
The greatest problem with modern medicine and science is that it only believes in the ma-
terialistic worldview, the teacher says.
Charles Volk: Homeopathy
25
So it begins.
He claimed that homeopathy is spiritual energy. Later, another instructor claimed it was
energy medicine somewhere in the realm of electromagnetism. Another invoked quantum
mechanics (but couldnt explain it, of course). If one read 100 authors books on homeopathy,
one would get 100 different mechanisms for its action. It seems to be one of those disciplines
that constantly lie in the gaps of scientific knowledge. If one gap is closed by legitimate re-
search, itll move on to another.
I think it behooves me here to take a little foray into exactly what are homeopathics?
Homeopathic remedies are made by a certain process of dilution and shaking to potentize
them. Let me take you through making one, step by step: First get your original product, for ex-
ample, venom from the Bushmaster snake. Take one drop of the snake venom and put it in 99
drops of a water/ethanol mixture. Shake this
mixture 40 times, then take one drop of that
mixture and put it into 99 drops of water. Shake
40 times. Repeat with 28 more dilutions and
shakes, and you have the remedy Lachesis 30C.
The 30C means 30 1/100 dilutions.
Now, you are probably thinking that there
cant be anything left of that snake venom. In
fact, the mathematics of dilution (thanks,
Avogadro!) state that there cannot be anything
left of the original compound after twelve
1/100 dilutions, but the practitioners of home-
opathy claim the more they dilute it, the better
it seems to work. The basic idea is that it
causes the opposite reaction of the toxin or herb
in its full dose. For example, if one would take the belladonna herb and rub it on ones skin, it
would become very red, hot, and painful. The belladonna remedy helps remove afflictions with
similar symptoms, like sunburn. Although occasionally, some herbs are used for the same con-
ditions that their full strength counterparts are used for. It seems to be that if an herb has a large
alternative medicine following, a homeopathic preparation of the herb does the exact same
thing, just better.
Homeopathics are prescribed in an extremely convoluted and seemingly contradictory fash-
ion. Sometimes they operate in the opposite fashion from the large dose. Sometimes they have
the same effect. Sometimes you are supposed to find the constitutional type a person is, and
that remedy is the only thing that will heal them. I figured my confusion was only due to na-
ivet, and would disappear when I had learned more about it.
Luckily, they also offer combination remedies, which have a number of different homeo-
pathic remedies in them that are commonly used for whatever disease. It takes much of the
guesswork out of it (have the flu? Use flu!), though they are supposedly less effective than the
Charles Volk: Homeopathy
26
There are currently no
scientifically accepted tri-
als that show homeopathy
has any effectiveness be-
yond placebo, and in fact, a
general tendency towards
placebo response."
single remedies. No one could seem to explain why. My guess was that it would put homeo-
paths out of a job.
I should also mention that with the exception of some occasional small, poorly constructed
drug efficacy studies, there are currently no scientifically accepted trials that show homeopathy
has any effectiveness beyond placebo, and in fact, a general tendency towards the placebo re-
sponse as methodological controls get more precise. There are individual trials that have shown
the effectiveness of homeopathics, but none have been reproducible. However, there is some
lab-based evidence that shows some cellular response to ultra-diluted compounds similar to ho-
meopathics, as well as an immense amount of anecdotal evidence for its effectiveness. (A com-
plete discussion of the evidence for and against homeopathy is beyond the scope of this essay. I
would direct readers to the article on homeopathy in the Skeptics Dictionary at http://
www.skepdic.com/homeo.html)
A little later into the discussion on that first day, I raised my hand, What was all that about
germs not causing disease?
They dont, the teacher answers.
My vantage point at the front corner meant I could see
peoples faces and reactions whenever a barrage of ques-
tionable information began. The sheer number of people in
that class that had a look of Well, of course they dont.
Everyone knows that was disheartening in a way I cant
quite describe. The instructor backed it up by saying,
Viruses and bacteria are scavengers of diseased tissue. A
miasm (literally meaning evil spirit. Seriously.) has to
cause disease first, and only then can the microorganisms
cause tissue damage. If you roll this around in your head
for a while, it makes a weird sort of sense, but then I re-
member a man named Louis Pasteur proved that microor-
ganisms, not miasms, caused disease over 150 years ago.
Were way past arguing the accuracy of the germ theory in
the 21
st
century.
The lead instructor also said that homeopathics can cure bad luck. Another claim was that
heredity is mostly energy (the teachers percentages were about 5% DNA and 95% energy).
There was a point in there somewhere about rocks causing disease, which was then paralleled
with the Christian idea of original sin. Again, my incredulousness was only matched by the
agreeing nods of my classmates as they listened to his lecture.
Soon enough, the very idea of the scientific method came under attack. He claimed that the
entire idea of scientific theories was wrong. The average life of a scientific theory is five
years, All the scientists just go running from one theory to another, and You know, theory
comes from the Greek word for theater. Actually, theory comes from the Greek word for
spectator or observer. I called him out on that after class and he claimed that, spectator is
Charles Volk: Homeopathy
27
Soon enough,
the very idea of
the scientific
method came un-
der attack."
what I meant. despite it completely changing the meaning of his damning appraisal of science.
The teacher made an announcement (actually several) to those people who were perhaps
having some trouble believing any of this (me). It was that we should Put off our reasoning
minds for awhile and make a space for homeopathy. This is not something that I have much
experience doing. It begs the question, When is it okay to start thinking again? I dont know
about most peoples minds, but I dont stop thinking. My mind just doesnt work that way.
And why would I want it to anyway? So, homeopathy only makes sense only if you suspend
any part of your brain that determines sense?
What became the last straw for me was a students response to something the teacher said:
Yeah, that makes sense, because I can put a thought into a crystal and give that to some-
one, and that will heal them.
Though I may be in the majority of people in the general population in thinking this is ut-
terly ludicrous, I was in a definite minority in this room. I simply couldnt take the barrage any-
more. During a break, I went up to talk to the lead instructor. He could see that I was not com-
fortable here and was having a hard time. He laid it out for me that he could never prove that
homeopathy was effective by my standards, He also said that it didnt bother him if it wasnt
real and that even if it was just by a placebo effect, he was still helping.
There is definitely something to be said for the placebo effect, but I realized I have ethical
issues with being in a profession that considers no real treatment just as worthy of charging for.
And, I have a problem with a $20,000 tuition bill and spending four years of my time learning
something that may not even be true.
In the end, I spent 5 full days at the homeopathy academy. It was one of the most marginal-
izing, confusing, degrading, and surreal experiences of my life. A few months after this experi-
ence, I began allopathic pre-med studies and havent looked back.



28
Charles Volk: Homeopathy
Homeopathy only
makes sense if you sus-
pend any part of your
brain that determines
sense?"
Our Valhalla: Thirty-Eight Years of the New NYMC
Gavin Stern
Just before 9:00a.m., first and second year medical students migrate from their on-campus apart-
ments to class. Some sneak into the cafeteria to grab a bagel or coffee. Others were in the library the
whole time, pre-studying under the glow of skylights. Along the way, the students pass snippets of his-
tory that line the walls: paintings of founders and deans long gone, sketches of an old homeopathic
medical college perched above a grocery store, the silvery names of honored graduates, and of course
photographs of Flower Hospital the very first built by a medical school in the United States. Arriving
just a little late via the commuter lot, I pass under the Tree of Hippocrates planted at Flower & Fifth
Avenue Hospital in 1972 and then transplanted to Valhalla in 1979. I stop under the tree, which now
towers over the rear entrance of the Basic Sciences Building, and consider this Valhalla campus must
have a history, as of yet untold. Indeed, the journey of New York Medical College is a testament to per-
severance through difficult times, doing the best with what you have, and never giving up on doing bet-
ter


The basic sciences building was completed in 1972, intended as temporary quarters for New
York Medical College. At that time, the College operated two campuses (and trained two medi-
cal school classes) while departments slowly transferred from Manhattan to Valhalla. Early stu-
dents at the Valhalla campus would complete their training a year ahead of their Manhattan
counterparts, as the B classes of 1975 and 1976 operated under an experimental three-year
curriculum. Lectures, labs, and study modules were all located in the Basic Sciences Building
students and faculty alike crammed into clusters of rooms separated by inter-labs. Most stu-
dents actually hailed from New York. In their yearbook tribute, the Class of 1975B Pioneers
described the rigors of the transition period: unpaved roads, mountains of mud, a lack of fur-
nishings, off-site faculty, a difficult housing situation, and one extraordinarily leaky roof. The
modern Medical Education Center was only a dream.
One cannot discuss the history of
the Valhalla campus without explaining
the circumstances surrounding the clo-
sure of Flower & Fifth Avenue Hospi-
tal. The move to Westchester occurred
during a period of financial turmoil in
New York City, as massive cuts in re-
imbursement threatened the survival of
many hospitals and medical schools in
the 1970s. Flower & Fifth Avenue
Hospital and its owner, New York
Medical College, were struck particu-
larly hard. Seeking financial stability,
New York Medical College signed an
affiliation agreement with Pace College
(now Pace University) in 1973, nearly merged with Metropolitan Hospital in 1977, and even
considered a move to Queens. Ultimately, NYMC would affiliate with the Archdiocese of New
York, at that time a major provider of healthcare in New York City. The Archdiocese guaran-
We went to the brinkand
came back.
Dr. John Connolly, the
president of New York Medical
College when interviewed by
the New York Times in 1983
29
teed NYMCs debt of $10 million (1978 dollars) and took over appointments to the College
board, in a sponsorship arrangement that endured for nearly thirty years. In an extremely con-
troversial move, the Archdiocese closed the storied Flower & Fifth Avenue Hospital and con-
verted it into a continuing care facility, the Terrance Cardinal Cooke Health Center.
By 1978, the School of Medicine
transferred its main operations to the Val-
halla campus. The Graduate School of
Basic Medical Sciences followed suit,
while control of the Graduate School of
Nursing was relinquished to Pace, now a
University due to its affiliation with the
School of Medicine. New York Medical
College maintained affiliations with many
city hospitals, but it also gained a new
one on campus the Westchester County
Medical Center.
Due to a push by the American Medi-
cal Association for all residency programs
to have a university affiliation, and un-
willingness for many physicians to practice without an academic appointment, Westchester
County endeavored to bring a medical school to the suburbs. In 1968, the county offered New
York Medical College land on the Grasslands Reservation along with favorable rental terms on
former Grasslands Hospital buildings. The National Institute of Health provided much of the
funding to build the Basic Sciences Building. The next step was to build an academic hospital.
By 1977, the Westchester County Medical Center was completed on the site of an old apple or-
chard, along with a new stretch of parkway to service it. The hospital went private in 1998 and
was joined by the Maria Ferrari Childrens Hospital in 2005.
Many of the current campus buildings were
originally part of Grasslands Hospital Center,
which predated Westchester Medical Center:
Munger Pavilion, which now houses most clini-
cal departments, was an adult tuberculosis hospi-
tal while Sunshine Cottage was a pediatric hospi-
tal. Animal imagery can still be seen in the archi-
tecture of Sunshine Cottage, although most of the
statues are gone. Elmwood Hall, another former
Grasslands Hospital building, served as the ad-
ministration building in the decade before Sun-
shine Cottage was available. Vosburgh Pavilion
has a previous life as a psychiatric facility (notice
the fenced-in courtyard and small workrooms).
New York Medical College owned the Mental
Retardation Institute (Cedarwood Hall, now the Westchester Institute for Human Development)
but sold it to the county government when it proved financially unsustainable. The MRI is
Gavin Stern: Our Valhalla
Flower and Fifth Avenue
Hospital is no more. In its
wake stands a new hospital, a
new home. An era has ended
only to mark a rebirth in
Westchester.
1979 yearbook, Odyssey
Compared to the way
it was back then, the
school is currently a
thriving metropolis
Dr. Daniel Peters,
Class of 1984
30
distinguished in holding the first lecture of the Valhalla campus, as outfitting of the BSB audi-
toriums was behind schedule.
Today, on-campus housing is considered a staple of the NYMC experience, but for two dec-
ades Grasslands Housing was reserved primarily for second-year students. Private investors had
planned to build 1,000 subsidized apartments, but protests from Westchester residents forced a
substantial reduction, as reported by the New York Times in 1971. With few on-campus op-
tions, many first-year students lived in dormitories at Manhattanville College, Briarcliff in
Tarrytown. Vosburgh Pavilion doubled as temporary dormitory even as psychiatric patients
were still being admitted nearby. In 1981, Vosburgh
Pavilion changed its mission and instead housed new
Graduate School of Health Sciences, later renamed
the School of Public Health, and finally to the School
of Health Sciences & Practice by 2008.
Plans to replace the basic sciences building came
and went over the decades. A 1984 Master Plan
outlined the construction of a Clinical Research and
Education Center, located between the Basic Sci-
ences Building and the Institute for Human Develop-
ment. The new building was to include a student cen-
ter, five-hundred seat auditorium, library, dining fa-
cilities, and laboratory space. Munger Pavilion was
to be overhauled, while Vosburgh Pavilion would
have become a permanent dormitory by renovating
the rooms previously used for psychiatric admissions. The plan also called for administrative
offices to move from Elmwood hall (near the prison) to the statelier Sunshine Cottage which
actually did occur. However, a projected cost of $50 million (1984 dollars) proved too ambi-
tious to accomplish these goals all at once.
Improvements to the College instead occurred incrementally over the ensuring decades: the
Blue Auditorium stayed blue, but somewhere along the line Orange Auditorium was reno-
vated into Terrance Cardinal Cooke. Courtyards that graced the center of each academic depart-
ment were swallowed up to feed the BSBs appetite for interior space (this explains why some
offices have windows, but no view). Farmland occupied the rear of the College and was tended
to by prisoners this too disappeared but a historic building on the estate was transformed
into the Alumni House. The cafeteria expanded into the space once occupied by a much smaller
bookstore, which in turn moved into the former instrument shop. A gargantuan, convex televi-
sion fixture disappeared from the center lobby. Wall panels and bright red paint covered previ-
ously exposed brick and steel. Slowly, private investment expanded the number of Grasslands
apartments, with the final building completed in the mid-1990s along with a student center
(rededicated in 2008). Finally, medical students and their families could live, mingle, work out,
and barbeque on campus. But one component of the modern NYMC was still missing.
After nearly three decades of tinkering with the Basic Sciences Building, New York Medi-
cal College finally built its elusive dream building in 2001, thanks to a massive fundraising ef-
fort. The $32 million Medical Education Center included a proper lobby, the larger Nevins
When I came here in
1971, it was a little
flowerpot. It has since
grown into a beautiful
garden
Delroy Chang, staff
Gavin Stern: Our Valhalla
31
auditorium and updated study modules. The Health Sciences Library extended underneath the
new structure and, capped with skylights, doubled in size. Previously segmented into ten small
rooms, the anatomy lab moved into a single space on the top floor. Most of the old BSB class-
rooms were renovated into laboratories and offices, but vestiges can still be found: cardiac
simulators now occupy two of the old cadaver labs, as does the graduate school conference
room. The physiology library remains virtually unchanged as a former classroom, while Blue
Auditorium also provides a window into the past. Desks and microscopes once filled the open
space now enjoyed as a student lounge.
Previously trafficked by thirty years of medical students, the original entrance and lobby is
difficult to find but its there. Half of it houses the extended security station. The rest is hid-
den behind a brick wall next to the MEC but one can still find the marks where a doorframe
and heaters were attached. Indeed, current students may never realize where their ancestors
once toiled but they were there, too. Thirty years after the odyssey began, the modern NYMC
was born. It was now our Valhalla.









Contributors:
Dr. Elliot Perla
Dr. Daniel Peters
Delroy Chang
Sean Manning
Anonymous faculty
Every yearbook staff since 1972


Gavin Stern: Our Valhalla
32
Ian Hovis
A young Ghanian woman captured in a balancing act on the
streets of Accra
A Lesson from Iran:
Improving Rural Primary Health Care in The United States
Navid Shams
Around the time of the Islamic Revolution (1979), 23 million of the total 60 million Iranians
lived in extremely poor and underdeveloped rural areas.
1
Wide-spread poverty was the result of
an imbalance of previous industrialization, modernization and economic development efforts
that favored urban areas.
2
As a result, over 50% of the rural population had low health status.
Recognizing this, the new Ministry of Health made rural health a priority in order to work to-
ward the constitutionally-guaranteed right to health care for all citizens.
3

Before the Revolution
Improving rural health posed a significant challenge due to the primitive infrastructure and
lack of various types of resources. For instance, even though medical graduates were required
to spend 2 years in the rural Health Corps, about 87% of the medical practitioners still worked
in one of the 5 largest cities. This left very few physicians in the rural regions
(physician:population ratio of 1:15,000).
4
Even the 400 Health Corps stations were only able to
provide minimal care to 20,000 of the 55,000 villages.
4
Moreover, of the 700 doctors who
graduated medical school every year, about half would leave to find work in other countries.
3

This led to importation of physicians from India, Pakistan and the Philippines, which was met
with resistance by rural residents who preferred Iranian auxiliary health workers to non-Iranian
physicians.
5
Also, the small health sector budget (about 3% of total government spending) was
mostly used on expensive projects, such as building large city hospitals that the rural population
didnt have access to.


These factors led to the poor health status in rural regions. Infant and child mortality rates
were twice that of urban areas. Life expectancy was approximately 10 years lower in both the
male and female rural population. Also, child malnutrition rates were high and important facili-
ties such as sanitary drinking water were only present in 20% of rural homes.
3

An imbalanced distribution of economic resources also contributed to the difficulties. In
1977, 48% of the population lived in isolated villages with less than 1,000 inhabitants each. The
government had not given financial support to provide these areas with roads, utilities, hospi-
tals, or schools,
6
never mind the supporting facilities that physicians (Iranian or imported)
would need to actually use their specialized skills in these rural areas.
Building On Past Experience
With social and economic considerations in mind, the government set out to establish a new
rural primary health care (PHC) program. Fortunately, studies had recently been carried out in
Iran that involved training local young people with primary education to become front line
health workers (FLHW).
7
In each location, a male worker (Behdashtyar) was in charge of com-
munity health (surveillance) and environmental sanitation, whereas the female worker
34
(Behvarz) was in charge of maternal and child health, family planning and general patient care.
Because they were locals, the FLHW developed close relationships with community members,
which allowed for accurate collection of health information that was recorded in individualized
household log books. Implementation of the system led to significant declines in infant (IMR)
and under 5 mortality rates (U5MR) before the revolution.
7
That success as well as the rela-
tively inexpensive nature of the new primary care and prevention program led to the systems
expansion throughout rural and eventually urban areas during the 80s and 90s.
The focal point of the new system is the Health House (khane behdasht). Each is staffed
by the two FLHW, who serve about 1500 people. This number is large enough to give the
Health House wall chart enough data to identify village level disparities and trends (in births/
deaths, marriage/divorce, disease, etc.) and small enough to allow monitoring of immunizations
with household-specific active follow up.
1
The population is drawn from one main village and
several satellite villages with similar culture and social structure. Satellite villages had to be
within one hour walking distance of the main village. In addition to the Health Houses, mobile
teams consisting of a doctor, lab technician and a Behvarz, make monthly visits to remote vil-
lages to provide support and refer patients to Rural Health Centers (RHC). The RHC completes
the network by supervising several Health Houses and mobile teams. Along with the doctor and
technician, the RHC has a member from various specialties (i.e. environmental health, disease
control, oral health, nurse, etc.).
3

An Ideal(istic) Solution?
The Iranian government has identified and implemented an effective strategy to reach its
rural health goals. The ease of access to a friendly and agreeable FLHW allows for constant and
continuous interaction between the health system and the community. This has led to the pro-
motion of healthy attitudes and behaviors, such as the encouragement of breastfeeding and
awareness about environmental hygiene and sanitation improvements.
4
It has also catalyzed the
movement toward universal immunization of children and correct treatment of children suffer-
ing from diarrhea and acute respiratory infection.
8
These improvements were essential to the
decrease in IMR and U5MR from 122 and 191 per 1,000 live births in 1970 to 28.6 and 35.6
per 1,000 live births in 2000.
9
Considering this success it is not surprising that groups in the United States have looked to
the Iranian system in hopes of improving rural health. Recently, a group from Mississippi
signed an agreement with Irans Shiraz University to form the Mississippi/Islamic Republic of
Iran Rural Health Project. Despite having the 3
rd
highest medical expenditure per capita, Missis-
sippi has the highest level of childhood obesity, hypertension, and teenage pregnancy in the
United States.
10
Furthermore, IMR among non-whites in the Mississippi Delta region are com-
parable to that of third world countries. Ostensibly, a strong primary care network, which is sin-
cerely lacking, can use the states pre-existing resources to improve these figures. However, the
stigma against bringing in experts from a less than popular country, coupled with the already
present distrust between the communities and public health officials, due to previous scandals
(i.e. the Tuskegee Syphilis experiment), pose significant challenges. Despite these challenges,
the concept of improving health has a way of opening doors. In fact, the first Mississippi
Health House is set to open in January 2010 and 15 other communities have already ex-
pressed interest in opening their own. The unique program has also caught the eye of Harvards
Navid Shams: A Lesson from Iran
35
School of Public Health, which will assist in monitoring the project. The involvement and coop-
eration among various groups is impressive and holds exciting potential for the project in the
coming years.
Conclusion
With political commitment to a needs-driven development of the PHC program, Iran has
made great strides towards minimizing health disparities between the rural and urban popula-
tion. Several key aspects (i.e. access to health services, collection of data, community participa-
tion and cooperation, unity and reach of the network, and a focus on prevention) cast a positive
light on the system. Using these strengths, the implementation of similar programs can surely
improve health statistics in various settings from Iran to Mississippi and beyond.

R E F E R E N C E S
[1] Couper I. Rural primary Health Care in Iran. South African Academy of Family Practice 2004 46(6):37-39
[2] Hooglund E. Land and revolution in Iran, 1960 1980. Middle East research and information projects reports.
1980, 87(1):3-6.
[3] Aghajanian A. Mehryar AH. Ahmadnia S. Kazemipour S. Impact of rural health development programme in
the Isalmic Republic of Iran on rural-urban disparities in health indicators. Eastern Mediteranian Health Jour-
nal. 2007 13(6):1466-1475
[4] Ronaghy H. Najarzadeh E. Schwartz T. Russel S. Solter S. Zeighami B. The Front Line Health Worker: Selec-
tion, Trainig, and Performance AJPH 1976 66(3):273-7
[5] Zeighami B. Zeighami E. Mehrabanpour J. Javidian I. Ronaghy H. Physician Importation A Solution to De-
veloping Countries Rural Health Care Problmes? AJPH 1978 68(8):739-742
[6] Amani M. Zandjani H. The Principles of population policy with special reference to Iran. Genus 1977 33(1-2)
141-150
[7] Barzegar M. Djazayery A. Evaluation of Rural Primary Health Care Services in Iran: Report on Vital Statis-
tics in West Azarbaijan. American Journal of Public Health (AJPH) 1981 71(7):739-742
[8] LeBaron S. Schultz S. Family Medicine in Iran: The Birth of a New Specialty International Family Medicine
2005 37(7):502-5
[9] Unicef. At a glance: Iran (Islamic Republic of) http://www.unicef.org/infobycountry/iran.html
[10] Lamb, Christina. Deep South calls in Iran to cure its health blues. The New York Times. December 20, 2009
Navid Shams: A Lesson from Iran
36
Social Networking Tools in the Modern Era of Human Rights Protection
Odessa Balumbu, Richard Fazio, Mera Geis, and Michael Karsy
Where after all do universal human rights begin? In small places, close to home - so close and
so small that they cannot be seen on any map of the world. Yet they are the world of the
individual person; the neighborhood he lives in; the school or college he attends; the factory,
farm or office where he works. Such are the places where every man, woman, and child seeks
equal justice, equal opportunity, equal dignity without discrimination. Unless these rights have
meaning there, they have little meaning anywhere. Without concerted citizen action to uphold
them close to home, we shall look in vain for progress in the larger world.
Remarks by Eleanor Roosevelt at the United Nations, March 27, 1958
1
The technological advances employed during each major period of historical social change,
whether it be the printing press or internet, have been at the forefront of organizing and foster-
ing activism. From the drive of Eleanor Roosevelt in the passage of the United Nations Univer-
sal Declaration of Human Rights on December 10
th
, 1948, to the modern creation of online
blogs and social networks championing a particular social cause, the field of human rights pro-
tection has undergone vast change. Modern technologies have only supplemented the unremit-
ting passion and drive that encourages social movements to improve the human condition
worldwide.
Social networks have become a mainstay used for an enormous variety of interest groups in
the promotion of an ever increasing number of causes. Websites like Facebook, Myspace,
Linkedin, and Wayn have grown from solely social networks used to connect individuals to be-
coming tools used to raise awareness, organize activism and create a permanent constituency
devoted to a particular cause.
2,3,4
In fact, specific applications have been designed and marketed
for these networks to allow any user to raise funds for their favorite non-profit organization.
5

Other flavors of networking also exist, such as microblogging through Twitter, which allows
individuals to rapidly dispatch very short messages to many others and has been successfully
utilized in a variety of recent, real world cases.
6
Social bookmarking, such as Delicious, Stum-
bleupon, and Reddit, allows individuals to quickly generate a public bookmark of websites
geared towards any theme, thus being able to focus attention across the enormity of the web
onto humanitarian issues and causes. Many other forms of social medial tools exist, including
video-sharing (YouTube), photo-sharing (Flickr), podcasting (Blog Talk Radio), mapping
(Google Maps), social voting (Digg), lifestreaming (Friendfeed), wikis (Wikipedia), and virtual
worlds (Second Life), all with various capabilities and untapped potential.
7
Numerous organizations representing different platforms, from political parties and bio-
medical research foundations to humanitarian agencies, utilize social networking tools to pro-
mote their cause. A website such as Facebook boasts over 400 million members globally and
serves as the largest social networking medium in the North America and Europe.
8
It is unclear
how many distinct social causes exist within Facebook, but their impact on grassroots organiza-
tion and fundraising has been importantly cited in political campaigning and voting patterns.
9,10

Despite the wide range of online tools for social networking, most large-scale organizations
(e.g. Christopher and Dana Reeve Foundation, Michael J. Fox Foundation, Bill & Melinda
37
38
Gates Foundation) arguably utilize only a limited portion of available online resources. These
mostly include tools to allow individuals to send general online petitions to congressmen, do-
nate to the foundation or passively follow the activities of the organization. Furthermore, de-
spite the immense potential of social networking tools in the biomedical sphere, most discus-
sions involve the ethics of such tools and their misuses, such as medical students posting unpro-
fessional content on social sites.
11,12,13,14
Instead, many grassroots organizations and humanitar-
ian agencies (e.g. Genocide Intervention Network, STAND, Amnesty International) seem to
have utilized the capabilities of online networking tools most effectively towards their respec-
tive causes. These groups have generated tools to allow for local, self-organization in an effec-
tive way.
One of the first cases of online social networking arose serendipitously around U.S. citizen
Eric Volz.
15
In 2006, Volz was falsely accused and imprisoned in Nicaragua under doctored
charges of rape and murder.
16
Working in Nicaragua as the editor of the magazine El Puente,
Volz was prosecuted under suspicious circumstances. Although eye-witness accounts, cell
phone usage, and credit card receipts placed him two hours from the scene of the crime; never-
theless, the government of Nicaragua proceeded to try him. The cause of his ordeal was later
attributed to a strained geopolitical situation between Nicaragua and the U.S., in which Volz
was entangled
15
. During Volzs one-year ordeal, a website was created from his mothers liv-
ing room simply as a way to keep friends and family informed of his condition.
17
A phenome-
nal world-wide movement emerged where the website received on average 140,000 visits a
month with many asking how they could help
15
. A Spanish version of the site was also cre-
ated.
18
These websites helped to organized numerous telephone calls to the U.S. State Depart-
ment which implemented screening to direct calls to the Nicaraguan embassy and website,
eventually resulting in a crash of the embassy webserver at one point. Volzs ordeal was de-
scribed in a video narrative posted on Youtube, the first cited event where the site was used to
champion a human rights cause as oppose to solely entertainment
15,19
. In addition, this video
also resulted in a propagandized video placed on the site by the Nicaraguan government vilify-
ing Volz.
20
In fact, the story of Volzs online support led to mainstream media stories on this
situation, helping to garner further support and eventually aiding in Volzs release and deporta-
tion from Nicaragua.
21
Currently, the site is now used to generate support for other human
rights abuses in Nicaragua and elsewhere.
The Volz case highlights the first self-organized social movement supported by online tools.
The power and widespread reach of social networking tools was illustrated quite clearly. How-
ever, despite the great benefit of an online medium to support his cause, Volz cites several ex-
amples where social networking acted detrimentally to his case in an unexpected way. The in-
creasing publicity of Volzs court case resulted in the case becoming extremely politicized and
perilous in Nicaragua for any judge to overturn the decision. Furthermore, the Nicaraguan gov-
ernment saw Volz as a more valuable bargaining chip when negotiating with the U.S. on diplo-
matic and trade issues
15
. Misinterpretation of information generated from Volzs site, Youtube
video and online following was propagandized by the Nicaraguan media to vilify him often as
wealthy American extorting the Nicaraguan justice system
20,22
. Additionally, during multiple
instances throughout the ordeal, the Volzs family was extorted by various individuals threaten-
ing his life in exchange for money. In spite of these drawbacks, Volz still tours the country
supporting the power of online social networks in organizing individuals towards a common
Michael Karsy et al.: Social Networking Tools in the Modern Era of Human Rights Protection
goal and using his site to raise awareness of ongoing human rights abuses in Nicaragua
15
.
One of the most creative organizations to utilize the collective power of the internet and so-
cial networking to advocate for humanitarian issues has been the Genocide Intervention Net-
work (GI-Net). Formed in 2005 by Mark Hanis, a descendent of Holocaust survivors, GI-Net
was designed to create a permanent anti-genocide constituency which could rapidly be mobi-
lized.
23
Two key lessons Hanis learned from elder Holocaust survivors during his upbringing
were to never forget and never let such a situation happen again
15
. GI-Net has been involved in
a variety of activities through their website, including the creation of advocacy and divestment
tools, and mobilizing constituents.
Research by GI-Net in collaboration with genocide scholars have identified eight ongoing
areas of genocide or ethnic cleansing occurring globally, namely Iraq, Sudan, Chad, Central Af-
rican Republic, Democratic Republic of Congo, Somalia, Sri Lanka and Burma.
24
Educational
tools remove any excuse for not knowing about genocide but beg the question: how can geno-
cide still occur despite better global awareness? One possibility is that there is zero political
cost to an absent Congressional vote against genocide. In response to this, GI-Net created Con-
gressional report cards depending on how Congressmen voted for anti-genocide legislation.
25,26

The effect on Congress was dramatic and effective. Multiple members of Congress called im-
mediately after the formation of the webtool and in response to a deluge of phone calls and e-
mails from constituents, to inquire about how to improve their scores
19
. Some wrote op-ed
pieces in their constituents districts.
27
The combined effort greatly improved the awareness of
Congressmen and the public about the ongoing genocide. In addition, the lobbying was impor-
tant in the passage of a variety of legislation to protect the people of Darfur, including the Su-
dan Divestment and Accountability Act signed into law in December 2007.
28,29
In response to
improving interaction with Congressmen during the passage of bills, GI-Net helped to establish
the genocide hotline (1-800-GENOCIDE) where constituents could call, enter their zip code
and automatically be transferred to the White House, their senators or representatives.
30
While
Hanis states that GI-Net has been an important tool towards mobilizing activists in genocide
intervention, he stresses that personal interaction with Congressmen still remains a key method
of supporting ones cause. These tools demonstrated the capability of online networks to foster
rapid and widespread mobilization of constituents in order to allow individuals to collectively
increase the power of their voice.
In addition to advocacy, GI-Net and its student wing Student Anti-Genocide Coalition
(STAND) have helped to organize targeted divestment against companies that do business in
Sudan, which supports the ongoing genocide. While U.S. businesses are not allowed to operate
in Sudan due to anti-terrorism legislation, stocks of companies operating in Sudan are ex-
changed on the U.S. stock exchange and can receive investments from mutual fund companies.
GI-Net and its collaborators helped to identify and publish an online list of companies involved
in investments which funneled money into military equipment purchases while avoiding com-
panies that were involved in infrastructure development and delivery of aid to the people of
Darfur. Next, GI-Net and STAND provided online resources which encouraged the self-
formation of student and grassroots groups that lobbied states, cities and universities to divest
their pensions and funds from these companies. Harvard University and the UC Regents be-
came two of the most publicized cases where divestment was successfully accomplished, al-
though it was by no means simple.
31,32,33,34
Michael Karsy et al.: Social Networking Tools in the Modern Era of Human Rights Protection
39
Grassroots movements and student groups have also been able to expand from lobbying to
broad fundraising campaigns using social networking tools. STAND helped to create and or-
ganize the STANDFast Project through its website and student chapters, resulting in annual
fundraising efforts by groups all over the country. These efforts have helped to raise more than
$500,000 over the course of three years.
35
In fact, the Genocide Awareness and Prevention
Group (GAAP) at New York Medical College (NYMC) has been involved in these efforts and
has helped raise over $1500 in the past two years.
36
Recently, a new tool has been developed
by social entrepreneurs involving the ability to donate via text messaging to a number of regis-
tered charities.
37
Texting PROTECT to 90999 allows any person to donate $5 to GI-Net di-
rectly from their cell phone bill.
38
In fact, this tool alone was cited for raising over $25 million
dollars for Haiti after its 2010 earthquake.
39
These and other tools have helped to organize the
fundraising of many small groups of interested people over a large area, which otherwise would
have been impossible.
New technology has rapidly changed the way that human rights issues are addressed both
locally and globally. The benefits and negative effects of social networking on human rights
protection and other important issues were not anticipated. In todays era, where thousands of e
-mails or Tweets can be fired off regarding one cause or another, there is an increased immunity
to the impact of social networking due to the large volume of messages which can be sent on a
daily basis. Despite this, online networking continues to play an important and developing role
in social issues. These tools serve to supplement rather than replace organization on a face-to-
face level. Social networking has allowed for greater participation on a variety of issues and
has forever changed the landscape in the fight for social causes.

R E F E R E N C E S
[1] Roosevelt, E. Quotations by Eleanor Roosevelt. The Eleanor Roosevelt Papers. 28 June 2008. George Washington
University. 25 February 2010. http://www.gwu.edu/~erpapers/abouteleanor/er-quotes/
[2] Watson, T. Facebook Generation: Will social networks change the nature of philanthropy? 18 June 2007. The
Huffington Post. 25 February 2010. http://www.huffingtonpost.com/.
[3] Guynn, J. SOCIAL NETWORKING/ Changes in Facebook/ Web plan hopes to boost activism. 25 May 2007. San
Francisco Chronicle. 25 February 2010. http://articles.sfgate.com
[4] Mansfield, H. MySpace: Where pop culture meets social activism. 26 February 2008. National Press Club. 25
February 2010. http://www.slideshare.net.
[5] Causes on Facebook. 25 February 2010. http://apps.facebook.com/causes/about
[6] DigiActive Team. The DigiActive guide to Twitter for activism. 13 April 2009. DigiActive. 25 February 2010.
http://www.digiactive.org
[7] Mishra, G. Digital activism & the 4Cs social media framework. 10 May 2009. DigiActive. 25 February 2010.
http://www.digiactive.org
[8] Facebook. 25 February 2010. http://www.facebook.com/press/info.php?statistics
[9] Thewall, M. and Wilkinson, D. Public dialogs in social network sites: What is their purpose? Journal of the Ameri-
can Society for Information Science and Technology 61:2 (2010): 392-404.
[10] Zhang, W.W., Johnson, T.J., Seltzer, T. and Bichard, S.L. The revolution will be networked the influence of social
networking sites on political attitudes and behavior. Social Science Computer Review 28:1 (2010): 75-92.
[11] Guseh, J.S., Brendel, R.W., Brendel, D.H. Medical professionalism in the age of online social networking. Journal
of Medical Ethics 35:9 (2009): 584-586.
[12] Jain, S.H. BECOMING A PHYSICIAN: Practicing medicine in the age of Facebook. New England Journal of
Michael Karsy et al.: Social Networking Tools in the Modern Era of Human Rights Protection
40
Medicine 361:7 (2009): 649-651.
[13] Chretien, K.C., Greysen, S.R., Chretien, J.P., and Kind, T. Online posting of unprofessional content by medical
students. Journal of the American Medical Association 302:12 (2009): 1309-1315.
[14] Emery, C. Medical students using Facebook and Twitter can get expelled. 22 September 2009. MedPage Today.
25 February 2010. http://www.medpagetoday.com
[15] The Human Rights Center UC Berkeley. Human rights on and off the internet: Social Networking. 5 May 2009.
UC Berkeley. 25 February 2010. http://fora.tv/
[16] Celizic, M. Will Nicaragua ever set Eric Volz free? 21 December 2007. MSNBC. 25 February 2010. http://
today.msnbc.msn.com
[17] Friends of Eric Volz. 25 February 2010. http://www.friendsofericvolz.com
[18] Amigos de Eric. 25 February 2010. http://www.amigosdeeric.com
[19] Am American wrongfully imprisoned in Nicaragua. 21 March 2007. Friends of Eric Volz. 25 February 2010.
http://www.youtube.com/watch?v=8YChhOHrFA4&feature=related
[20] Evidence against Eric Volz. 30 March 2007. Nicaraguan Films. 25 February 2010. http://www.youtube.com/
watch?v=sSo3sb73CZY
[21] Details of release. Friends of Eric Volz. 25 February 2010. http://www.friendsofericvolz.com/
Details_of_Release.html
[22] Rogers, T. Gringo justice in Nicaragua. 18 December 2007. Time World. 25 February 2010. http://www.time.com/
time
[23] About us. Genocide Intervention Network. 25 February 2010. http://www.genocideintervention.net/network
[24] Areas of Concern. Genocide Intervention Network. 25 February 2010. http://www.genocideintervention.net/
areas_of_concern
[25] Darfur Scores. 25 February 2010. http://www.darfurscores.org/
[26] Trageser, C. OP-ED: Darfur: How do local reps stack up? 24 November 2006. Willamette Week. 25 February
2010. http://blogs.wweek.com/
[27] Reichert, D. OP-ED: U.S. must do more for people in Darfur. 15 September 2006. Seattle Post-Intelligencer. 25
February 2010. http://seattlepi.nwsource.com/
[28] Stolberg, S.G. Bush Signs Bill Allowing Sudan Divestment. 1 January 2008. New York Times. 25 February 2010.
http://www.times.com
[29] S. 2271: Sudan Accountability and Divestment Act of 2007
[30] Genocide Intervention Networks advocacy hotline receives 25,000th caller. 15 May 2009. Genocide Intervention
Network. 25 February 2010. http://www.genocideintervention.net/press_release
[31] Harvard Divest. 25 February 2010. http://www.harvarddivest.com/
[32] Harvards Sort-of Divestment 2 July 2007. Inside Higher Ed. 25 February 2010. http://www.insidehighered.com/
[33] UC Divest Sudan. 25 February 2010. http://www.ucdivestsudan.com
[34] UC Regents vote to divest from companies with business ties to Sudan government and acts of genocide. 16
March 2006. UC Newsroom. 25 February 2010. http://www.universityofcalifornia.edu/news/
[35] STAND. 25 February 2010. http://www.standnow.org/campaigns/standfast
[36] Previous events. 6 June 2009. Genocide Awareness and Prevention. 25 February 2010. http://www.nymc.edu/
Clubs/Gaap/index.htm
[37] Mobile Accord. 25 February 2010. http://www.mobileaccord.com/
[38] Mgive. 25 February 2010. http://www.mgive.com/Partners.aspx
[39] Dowd, K. Text Haiti to 90999 Passes $25 Million. 20 January 2010. DipNote - U.S. State Department Official
Blog. 25 February 2010. http://blogs.state.gov
Michael Karsy et al.: Social Networking Tools in the Modern Era of Human Rights Protection
41
Another Look: Medical Cooperation and the Israeli-Palestinian Conflict
Danielle Masor
The Controversy
There has been much debate and controversy surrounding the war in Gaza of last
year (December 28 2008- January 18, 2009), and it is often portrayed in a slanted, if not biased,
manner. Indeed, I came across one such article in last years issue of Quill and Scope entitled
The Humanitarian Crisis in Gaza: A look at the health infrastructure before, during and imme-
diately after the December-January attacks. The article described the affects of last years con-
flict on Gazas health care infrastructure and the health of its population. However, while doing
so, it presented a highly politicized and biased view of the conflict, and critical facts about the
events in Gaza were omitted.
Critical Facts
I would like to establish some key facts about the Gaza conflict that were not mentioned in
last years article. Then, I hope to focus on a more uplifting aspect of the Israeli-Palestinian
conflict: Israels medical aid to its Palestinian neighbors and the world beyond.
In terms of critical facts, the article did not mention what precipitated the war in Gaza; it
made no mention that Palestinians have fired over 12,000 rockets at southern Israel over the
past eight years, terrorizing towns closest to Gaza, such as Sderot.
1,2
Over 90 percent of Sderot
residents have experienced a Palestinian Kassam explosion at some point.
3
Over one million
Israelis live within firing range of these deadly homemade rockets that are stuffed with shrap-
nel and nails to inflict the maximum damage possible.
4
An entire generation of children in
Sderot has grown up with the fear of constant rocket attacks. Thus, in order to protect its own
citizens, Israel had no choice but to engage Gaza and root out its vast terrorist infrastructure.
Moreover, while discussing the high death toll and injury rate in Gaza, the article omitted
the fact that Hamas, the internationally recognized terrorist organization that runs Gaza, makes
widespread use of human shields. Whereas the Israeli population hides in underground shelters
when there is warning of a rocket attack, the authorities in Gaza have been known to hide guns
in schools, mosques, or hospitals, and use human shields to protect themselves.
5
Alan Der-
showitz, a professor at Harvard Law School, succinctly summarized the situation, This is the
Hamas dual strategy: to kill and injure as many Israeli civilians as possible by firing rockets in-
discriminately at Israeli civilian targets, and to provoke Israel to kill as many Palestinian civil-
ians as possible to garner world sympathy.
6
In fact, the Israeli Defense Force (IDF) went to
great lengths to avoid civilian casualties. The IDF announced exactly where it would strike with
radio broadcasts, over two million leaflets, over 100,000 cell phone calls, and specific warnings
before attacks.
8,9
In conclusion, the Gaza conflict is complex, and it is part of a broader Israeli-Palestinian
conflict that is exquisitely complicated and multi-dimensional. Moving beyond the Gaza con-
flict, now, I would like to show that there is more than strife between Israelis and Palestinians.
Turning to the medical arena, I hope to show how Israels advanced medical system has bene-
42
fited its Palestinian neighbors, and how Israeli non-profit ventures have saved the lives of many
Palestinians and others.

The Reality
Israels involvement in the administration of health care to Palestinians began over forty
years ago. In 1967, Israel was attacked by its neighbors and after winning this brief, Six-Day
War, Israel assumed control of the Golan Heights, West Bank and Gaza. Interestingly, it also
assumed responsibility of the health of the Palestinians. As Dr. Theo Dov Golan, former Direc-
tor General of Israels Ministry of Health notes, During that period (1967-1994), Israel has
presented annually dramatic documented achievements to the World Health Organization
(WHO). This included the total eradication in the Palestinian population of poliomyelitis,
neonatal-tetanus and measles. Also, Israel dramatically reduced the death rate of Palestinian
newborns from over 60/1000 to 19/1000 within those 27 years of Israel's presence.
9

To this very day, thousands of Palestinians are referred to Israeli hospitals for life-saving
treatment. The Israel-based NGO, the Peres Center for Peace, has established the Saving Chil-
dren project, facilitating referrals to and treatment of Palestinian infants and children in Israeli
hospitals for sophisticated treatments and diagnostic procedures not available in the West Bank
or Gaza. The costs are covered entirely by the Peres Center (which receives funding from pri-
vate sourcesincluding several regional Italian governments). Since its inception in 2003,
Saving Children has received some 6,560 referrals from the West Bank and Gaza.
10

Outside the NGO circuit, Palestinians from the West Bank and Gaza are referred to several
hospitals in Israel. Before the Gaza conflict, for example, Barzilai hospital, located only twelve
miles from Gaza, received numerous Palestinian patients on a daily basis. As Dr. Ron Lobel,
Barzilais deputy director noted in a 2008 interview: We treat hundreds of Gazans here each
year Even if they're terrorists, they're treated like any other person being brought into the
emergency room - we make no distinction between treating Israelis or Palestinians. While the
Palestinian Authoritys Health Department pays for a majority of the cases, Israel foots the bill
for many others. Of course, it gets complicated, and many Gazans are stopped at the Erez secu-
rity crossing before they can access Israeli health care. In 2004, a female suicide bomber who
claimed she had surgical plates in her legs blew herself up at the crossing after bypassing the
metal detector, killing four Israelis, prompting increased security measures.
11,12
Save A Childs Heart (SACH)
Perhaps the most uplifting of all the examples of the medical relationship between Israelis
and Palestinians, is the Israeli-based humanitarian organization, Save a Childs Heart (SACH),
which was founded in 1995 by Dr. Ami Cohen. The goal of SACH is to provide and improve
pediatric cardiac care for children from developing countries regardless of nationality, religion,
color, gender or financial situation. To date, over 2,100 children (49% from the West Bank,
Gaza, Iraq and Jordan, 40% from Africa, 7% from China, Sri Lanka, and Vietnam, and 4%
from Moldova and Russia), ranging from early infancy to 18 years of age, have been success-
fully treated.
13
Their cases include numerous congenital heart defects, such as tetralogy of Fal-
lot, and acquired conditions, such as rheumatic heart disease.
43
Danielle Masor: Medical Cooperation and the Israeli-Palestinian Conflict
SACH medical personnel travel throughout the Middle East, Africa, and beyond to evaluate
potential patients with portable echocardiography technology and the cooperation of local cardi-
ologists. If it is decided that an operation is necessary, SACH flies the child (and a family mem-
ber, for younger children) to Israel for treatment. Surgery is performed at the Wolfson Center in
Holon, Israel, not far from Tel Aviv. Children are hosted pre- and post-operatively at the nearby
Childrens Home. SACH also runs teaching missions, sharing knowledge and expertise with
colleagues in China, Ethiopia, and Mauritania, to name just a few. A total of 14 such teaching
missions have been conducted to date. Moreover, SACH conducts training programs to foster
more independent centers of competence in the developing world, and 50 visiting physicians
have been trained under its auspices.
14
SACH is funded by private donors, including Christian charities, and its remarkable 70-
person staff, including its chief surgeon, contribute their time without receiving any payment
from SACH.
What I find so uplifting about SACH is that it operates without regard to politics. SACH
gives its all to save the life of any childwhether he or she is Palestinian or Iraqi. One particu-
larly touching story, which emerged against the context of the war in Gaza, detailed how a little
Palestinian girl, Noor, and her mother, Wafaa Huseini, managed to get out of Gaza and make it
to the Wolfson Center for surgical correction of a debilitating patency between Noors right and
left ventricles. The eleven person medical team included Jews, Christians, and Muslims. It did-
nt matter what was going on in the world outside, all that mattered was saving Noors life.
I spent some time looking at the on-line photo gallery of children presently at the SACH
Childrens Home either awaiting or recovering from heart surgery.
16
Yuquing, 13, is from
China. Kinsley, 3.5 years, and Erica, age 5, are from Ghana. Hezhan and Rezhna, both smiling
very broadly in their photos, are from Iraq. Salam, 9 months, is from the West Bank. Daria is
Romanian, and Aisha, grinning to ear-to-ear, is from Zanzibar. These pictures concisely convey
the humanitarian efforts of Israelis, and stand in sharp contrast to the often politicized, one-
sided criticism of this small nation.
Further research led me to similar ventures. Eye From Zion, for instance, is an Israel-based
non-profit working to restore sight to hundreds throughout the developing world, mostly with
the relatively simple removal of cataracts.
17
The Midwives Coexistence Project is a group of
Palestinian and Israeli midwives who work together toward peace to assist pregnant Israeli and
Palestinian mothers with safe and natural births.
18
In conclusion, it is easy to simplify the Israeli-Palestinian conflict and ignore the complex,
subtle reality on the ground, of which Israeli-Palestinian medical involvement is but one dimen-
sion. It is also easy to forget that Israel is a nation of only 7.2 million people, with a landmass
the size of New Jersey. Despite its small populace, and vast security concerns, it remains the
only democracy in the Middle East. And despite its small size, it sent one of the biggest interna-
tional aid teams, 220 strong, to Haiti in the wake of the recent earthquake that claimed an esti-
mated 200,000 to 250,000 lives. Israel set up a huge, makeshift hospital which could accommo-
date up to 500 people, and included an operating room for complex surgeries.
19,20
Several Hai-
tian children were born in the Israeli hospital. The first mother to deliver there told the doctor,
Dr. Shir Dar, that she would name her son Israel.
20,21

Danielle Masor: Medical Cooperation and the Israeli-Palestinian Conflict
44
R E F E R E N C E S
[1] Gaza Facts. The Israeli Ministry of Foreign Affairs. Accessed 12 Jan. 2009. http://www.mfa.gov.il/
GazaFacts
[2] Facing Rocket Attacks in Southern Israel (Video) NY Times Online. 5 Jan. 2009. Accessed 17 Jan. 2010.
http://video.nytimes.com/video/2009/01/05/world/middleeast/1194837360056/facing-rocket-attacks-in-
southern-israel.html
[3] Bedein D. Trauma: The Unreported Casualty of War. Therapy Today. Jun. 2009. Accessed 17 Jan. 2010.
http://www.britannica.com/bps/additionalcontent/18/43444006/Trauma-the-unreported-casualty-of-war
[4] Gaza Facts. The Israeli Ministry of Foreign Affairs. http://www.mfa.gov.il/GazaFacts
[5] Montaner, C. Gazas True Disproportion Washington Post Global. 12 Jan. 2009. Accessed 17 Jan. 2010.
http://newsweek.washingtonpost.com/postglobal/carlos_alberto_montaner/2009/01/
gazas_true_disproportion.html
[6] Dershowitz, A. Hamas War Crimes. LA Times. 10 Jan. 2009. Accessed 17 Jan. 2010. http://
www.latimes.com/news/opinion/la-oe-dershowitz10-2009jan10,0,2587090.story
[7] UK Commander Challenges Goldstone Report. UNWatch.org. 16 Oct. 2009. Accessed 15 Jan. 2010.
http://www.unwatch.org/site/apps/nlnet/content2.aspx? c=bdKKISNqEmG&b=1313923&ct=7536409
[8] Cooper, A., Brackman, H. The Threat of the Human Shield Strategy Hamas Uses Extends Beyond Israel,
Gaza. US News & World Report. 19 Jan. 2009. Accessed 17 Jan. 2010. http://www.usnews.com/articles/
opinion/2009/01/09/the-threat-of-the-human-shield-strategy-hamas-uses-extends-beyond-israel-gaza.html
[9] Golan, T. The Big Why. Israel21c.org 19 Sept. 2004. Accessed 17 Jan. 2010. http://www.israel21c.org/
opinion/the-big-why
[10] The Peres Center For Peace http://www.peres-center.org/SectionProject.asp?cc=01140201
[11] Berg, R. Israels Dilemma Over Sick Gazans. BBC News. 30 Apr. 2008. Accessed 17 Jan. 2010 http://
news.bbc.co.uk/2/hi/middle_east/7375439.stm
[12] Authors Note: No current information found on Palestinian patients at Barzilai post Gaza operation.
[13] Save A Childs Heart http://www.saveachildsheart.org/89-en/Sach.aspx
[14] Save A Childs Heart http://www.saveachildsheart.org/89-en/Sach.aspx
[15] Dyson, J. Heart of Gold: Loving Hands Reach Out In the Nightmare of Mid-East Politics to Repair the
Hearts of Dying Children. Readers Digest. July 2009. Accessed 17 Jan. 2010. http://
www.saveachildsheart.org/sip_storage/FILES/2/1832.pdf
[16] Children Currently in Israel. saveachildsheart.org Accessed 17 Jan. 2010. http://
www.saveachildsheart.org/265-2086-en/Sach.aspx?pos=1
[17] Israels Eye From Zion Restores Sight in Developing Countries. Israel Ministry of Foreign Affairs. 17 Nov.
2009. Accessed 18 Jan 2010. http://www.mfa.gov.il/MFA/Israel+beyond+politics/
Eye_from_Zion_restores_sight_developing_countries_17-Nov-2009.htm?DisplayMode=print
[18] Stein, H. Giving Birth to Peace. Israel21c.org. 6 Jan. 2010. Accessed 18 Jan. 2010. http://
www.israel21c.org/social-action/giving-birth-to-peace
[19] Mozgovaya, N. Israeli Team to Halt Haiti Search Efforts Monday. Haaretz.com. 18 Jan. 2010. Accessed
18 Jan. 2010. http://www.haaretz.com/hasen/spages/1143165.html
[20] Cohen, E. Slow Medical Care is One More Thing For Quake Victims to Survive. CNN.com. 17 Jan. 2010.
Accessed 18 Jan. 2010. http://cnn.mlogic.mobi/cnn/archive/archive/detail/432499/full/
frg;jsessionid=0C33EA7110AA24035D01EFE52DD36DBF.live7i
[21] Dr. Besser Assists in Haitian Babys Birth. ABC News.18 Jan 2010. Accessed 18 Jan. 2010. http://
abcnews.go.com/Video/playerIndex?id=9591907
45
Danielle Masor: Medical Cooperation and the Israeli-Palestinian Conflict
Njinga
Stuart Mackenzie
Its been getting darker each day I wake, and the dawns chill is no motivation to leave the
house. Yet the coffee soaks in, the Cape Dove chants, Work harder, work harder, and I know
its time to leave.
Outside, the 55-pound bulk of my Atlas bicycle sits, gently decaying into the mornings
mud. Its slowly leaking front tire is in need of a trip to the filling station. As I ease back the
warped steel gate of our plot, the subdued quiet of home vanishes with the speeding black ex-
haust of a passing sedan. Kabulonga is fully awake and scores of Zambians line the roadside,
hoping for a lift from a passing vehicle or picking their way to work through the collected pud-
dles.
Few, if any, of these pedestrians are coming from the homes along Kudu Road, but thats
where theyre headed. Each morning, maids, guards, nannies and garden boys leave the ram-
bling shantytown compound of Mtendere, warding off the cold with bright pieces of chitenge,
and making their way to work in upscale Kabulonga. Sidewalks are not a luxury afforded to the
poor, and the growing stream of cars forces these unseen labourers further into the mud.
As I urge my cheap, over-built Indian bike further down the road, its bearings creak with
each revolution, and the eyes that turn my way are a mixture of amusement and confusion. A
white man, a mzungu, on a bicycle is an unusual sight around here, and few of these Zambians
would believe that I actually prefer riding my bike to driving to work. You can be sure that not
a single one of them would be caught dead in the street if they could afford anything with
wheels.
Cresting the hill towards Kalingalinga, a bike bell rings frantically and I look up from my
bars to see a man speeding in the wrong direction. Without swerving, he brushes past a group of
school children, the youngest of which is yanked backwards by the hand of an older sibling.
Theres no apology from the cyclist, no indignation from the children, just another close call on
a Tuesday.
Pulling into the filling station, I wait by the air compressor as a taxi driver fills the tires of
his robin-egg blue taxi. Both of the right wheels are small spare tires and the car leans percepti-
bly to the passenger side. A small grey hatchback roars through the parking lot, scattering
women selling bananas, and it pulls up next to the taxi. When the opportunity presents itself,
this man goes to take the air hose, paying no attention to me or my bicycle, but the paleness of
my skin makes him falter. He looks uncomfortable as I reinflate my front tire, and he brusquely
takes the hose from me.
As I leave the filling station and enter Kalingalinga Compound, a group of street kids run,
chasing after the bike, screaming their only English at the top of their lungs, Hello! How are
you? A passing bus conductor, passing literally six inches from my elbow, laughs from his
perch on his bus window. He yells something in Nyanja, but its too fast for me to understand.
46
This stretch of road is what I love about starting each new day. The crowd of people, pro-
duce, and vehicles, complete with swerving bicycles and the shouts of bus conductors,
Hospital, hospital! are a heady reminder of the rich colour of Zambian life. This scene is also
a stark reminder of the gross gradations in lifestyles that its participants enjoy. Those drivers of
second-hand Chinese cars, the ones without a back window with the muffler held up by clothes
hangers, will travel further this morning than the woman selling tomatoes will in a month. A
hollering conductor packs those who can spare a few cents into a crowded mini-bus, although
theyll be back amongst the masses in just a few kilometres. Across from the bus stop, an old
woman with a hammer and rheumy eyes bears hazy witness to this chaos as she pounds frag-
ments of granite into stone dust and gravel.
As a white foreigner, I am normally excluded from such everyday Zambian experiences, but
on a bicycle, I manage to straddle the divide, if only for the fifteen-minute commute. Weaving
through the bus stop, Im careful not to take too much liberty with these testy drivers, and I
dodge a weaving old man clutching his carton of maize beer.
Im quickly forced back into the mud by the swerve of a minibus that sees a potential cus-
tomer on the side of the road. Coming too close to the refuse-choked ditch, I am furious and I
yell at the perspiring driver as I pass. He stares back blankly, and Im unable to tell if he just
doesnt understand me, or doesnt care. Another passenger crammed aboard the minibus jumps
out off the shoulder, and the bus flies 100 meters down the road before jamming on its brakes at
a backup. Undeterred, the driver steers his vehicle onto the rutted shoulder and bumps along
past the jam, honking incessantly at any pedestrian foolish enough to get in the way.
The last stretch to my office is the least developed of the route, but it is the realm of paper-
boys who chase the slow traffic with morning news. A big man in his Mercedes cant consider
slowing down for the teen chasing him, desperate to collect the money hes owed. The closer I
get to work, the thinner the pedestrian traffic becomes, and the potholes fade from the road sur-
face.
Its not necessary to lock my bike, all the guards know who rides the big black Eagle, and I
run in for my notebooks. Ten minutes later, Im in the passenger seat of a brand new Land
Cruiser, and the driver has the air conditioning on. Its not hot, but we have air conditioning, so
we use it. Pulling out onto the road, the driver turns back towards the compounds and our first
clinic. Speeding through the potholes, he honks at a mother and child, reminding them to stay
off the dry road. I was just here twenty minutes ago, but this time, I know there will be no chil-
dren asking me how I am, and the conductors will mouth wordlessly as we pass.
Stuart Mackenzie: Njinga
47
Katrina Bernardo
If They Knew...
Ava Asher
Man Huddled (Top)
Man Leaning (Bottom)
Cancer Education And Awareness Program:
Sukhpreet Singh
"Time is a great teacher, but unfortunately it kills all its pupils." -- Hector Berlioz
I remember this place, a high school auditorium filled with restless and inattentive teens. I
was here last year to do a presentation on preventing skin cancer. These presentations had become
mundane and rehearsed acts to an uneducated audience. To our surprise, the school principal asked
us back to present again because the school was so impressed by our work and the impact that it left
on the students. I guess mediocrity passes for excellence in some places.
After our presentation, I was greeted with a familiar but awkward smile, Hey, do you re-
member me? I replied, having no idea who he was, Yes, of course, I do. How are you? Without
further guesswork, he reminded me how we had met, and I recalled his name, David. As we talked
further, he said, You know you saved my life right? I replied amusingly, How is that, David?
After I had given my presentation the year before, David noticed an odd spot on his back,
and it fit the categorization of melanoma that we had taught. He saw a dermatologist, and he was
told that he was lucky to have come in when he did. Based on pathology reports, the mole was start-
ing to show signs of turning into an aggressive cancer. I realized that these seemingly mundane and
rehearsed acts do have the ability to make a remarkable difference in people's lives.
In medical school, we spend most of our time as students reading textbooks and memorizing
minutiae for exams. The cost of this is that we lose perspective and awareness of our ability to make
a difference right now, along with the impact we'll make in the future. Medicine is a privileged pro-
fession. Even our slightest intervention carries long term significance. We manipulate the human
body, and in our best attempts, we cure our patients. Even at our worst, we alleviate human suffer-
ing. However, we forget the most amazing skill we have to prevent disease before it afflicts our
patients. We fight all sorts of ailments with interventions, but we minimize the importance of pre-
vention through education. This galvanized my efforts of cancer prevention education.
Cancer has been stigmatized over the years by most as an unpreventable death sentence.
This reflects a lack of knowledge of behavioral contributions to cancer. It is this lack of understand-
ing that not only causes an increase in morbidity and mortality, but also consequently makes the job
of the physician harder. It is due to these reasons that we as physicians also have a significant roles
as educators.
We join the field of medicine because we believe in its ability to cure, but even more than
that, to prevent disease. It was with that same philosophy that I started the Cancer Education and
Awareness Program (CEAP) last year on campus. I had a vision, one that I hope to accomplish
within the next few years at NYMC. With my organization, I aim to dispel the misconceptions
about cancer, and to provide markers for early detection in the general community as tools for pre-
vention.
There have been similar programs started in foreign countries to reach populations that are
impoverished in HIV/AIDS education. These programs found great success because they were able
to approach their subjects through a story telling method, which is the model for our presentations.
An article published by Mukoma et al. Process evaluation of a school-based HIV/AIDS interven-
Education And Its Role In The Prevention Of Cancer
50
tion in South Africa outlines the specifics of their processes, including their successes and fail-
ures.
1
When designing our program, I wanted it to not only incorporate a story telling approach, but
to be able to address a much broader population. In his study of rural smokers of Illinois and popu-
lations of urban cities, McLafferty et al. found that urban dwellers are more prone to cancers due to
smoking.
2
It is nonetheless important to be able to disseminate information to every part of the
population; disadvantaged, advantaged, rural or urban.
Unfortunately, no programs in the United States have been able to reach an appreciable
scale to do a publishable study. That is one of our goals. We want to be able to show that we are
able to reach not only the students in our demographic, but also their parents by emphasizing the
need for them to share this information. We aim to provide a comprehensible and scientific Power-
Point presentation to kids between the ages of 14-18. This age group is easily accessible through
high schools, and according to the American Lung Association, the average age of onset of smoking
amongst teenagers is 13 years old.
After we had defined our objectives and outlined a clear mission statement, we sought sup-
port amongst the faculty and students. We knew we would not be able to launch this off the ground
until we had other people sharing our vision. The success of the project owes itself to the support
from faculty members, such as Dr. Wu, and the shared vision of my fellow classmates. It is with all
of their help that we have taught nearly 800 students this year, nearly half my intended goal for the
entire year. It is through these students that we reach their families and friends, thus, the real num-
bers are forever growing as information always disseminates. I will have realized my greatest ac-
complishment if I have been able to reach out to another David.
As we continue to expand on the NYMC campus as a student club in the upcoming years,
we aim to provide a curriculum for other cancers beyond our current lung cancer presentation. At
the end of this year, we intend to incorporate a curriculum for skin cancer as well. I also intend on
making CEAP an independent non-profit organization that will be incorporated into other graduate
schools in the area. Our greatest strength is in our numbers.
To recapitulate the words of Berlioz, the passage of time is a great teacher with its undeni-
able consequence death. As physicians, we bear the responsibility to not let our patients learn
through time and to make their own mistakes, but to teach from the mistakes of others to allow them
to live more fruitful lives. As long as we continue to believe that we have the ability to change the
course of events by our own interventions, in this case to prolong life, we will make a difference
without fail. That is why we must take on the roles of teachers and educate others before time does
it for us.


REF ERENCES
[1] Mukoma, W., Flisher, A.J., Ahmed, N., Jansen, S., Mathews, C., Klepp, K.I., Schaalma, H. (2009): Process
evaluation of a school-based HIV/AIDS intervention in South Africa. Scand J Public Health, June, 37, Suppl 2:
37-47.
[2] McLafferty S., Wang F. (2009): Rural reversal? Rural-urban disparities in late-stage cancer risk in Illinois.
Cancer, June 15, 115(12): 2755-64.
Sukhpreet Singh: Cancer Education and Awareness Program
51
Anna Djougarian
Transformation of the Medical Student
Life Fuel
Alanna Chait
We are a people of loss.
Umbilical cords sever like freshly cut grass;
fluid evaporates as quickly as these words;
hemorrhages pilfer life fuel;
hemosiderin-laden ecchymoses burst like fallen sunsets;
arteries and ardor retreat with each battle;
leaky membranes displace ions like Adam from the garden;
neoplasias obliterate self;
bodies dwindle with each cut;
disoriented immune systems cloud illusion and reality.
We are a people of loss.

We are a people of replenishment.
Undying receptors cling like desperate lovers;
protein transporters home as pigeons to their nests;
bone springs from primordial roots;
zymogens save us from ourselves;
souls emerge from finely sculpted blastulas;
ATP pumps birth energy and motion;
liver cells replace defeated neighbors;
vessels vitalize broken hearts;
despair breeds strength and conviction.
We are a people of replenishment.

Within loss, gain;
within death, birth.
53
For Only A Moment
Daniel Waintraub
Inspiration seems to only last a moment
As if thats all its worth
Striking a chord, hitting the spot, enlightening the mind
And once again back to the earth

It only lasts for so long, before it leaves us again
Like a quick lightning strike, or an uniquely caring friend
Time and time again we encounter this being
This thing they call inspiration, which allows us to see

Its too bad it only settles for a second, in our flashy, fleeting minds
For if it would last a moment longer, it would be a moment longer to find
Some of those elements of life, which we all fail to perceive
Those which are important or significant, before we are ready to leave

Sadly though, its a fact and it is true
That a free gift such as this is one taken for granted, one we tend to eschew
Like a wave in the ocean, it comes and goes
Where it will take us, only g-d really knows

It may spur us into a mental frenzy of motion
Lifting us to elated heights for a moment, like an effective potion
However, we run from this moment, tend to close it out of our minds
But we fail to realize, we only get such an opportunity so often, before we run out of time

We could conquer this world, if wed hold onto that spark
Allow it to set in, lighten our minds, and eventually drag us out from the dark
We could finally see that which is not seen, and hear that which is not heard if we grasp it
so tight
Amazing how the effect of one moment, could grant one the gift of sight

But man is prone to escaping, from any moment of thought
For he fears any sort of change, and this is what he has been taught
That this world is for the benefit, of our kindly physical being that we own
Ignore the open passageways, which permit us to look to the unknown

Search for your body, and your heart and soul you shall ignore
For they are not important, so they you will deplore
So recognize the following, as a tool for the common man
It will come upon you at some time, and it will not ever be planned
54
Daniel Waintraub: For Only A Moment
A spark of inspiration, for the lost souls of our age
A spark of inspiration, pushing you to finally turn the page
To the next chapter of life, whichever one that may be
But if you dont hold on to that moment, that next page, youll never see
Whatever it might be, that could cause such a flare in the mind
Dont neglect this sudden feeling, for you dont know what you may find
Failing to retain inspiration, is something we all have done
Well continue to believe we have everything, when really all we have isnone

It can only be to ones avail, that sudden enlightenment which we feel
And only if we hold onto it, and use it, will we be able to unveil that which is real
So, the next time that you feel it, dont let it go for naught
For it might lead to something special, like that thing we callthought
55
Linda DeMello
Skull Rock
Joshua Tree National Park
Twentynine Palms, CA
Resident
Navid Shams
Reminiscent, I close my eyes and think about us
and our first years in the field of medicine.
You, scarecrow, that sacred defender
of its solidarity, ugly
cousin of the man named malpractice.

Those early days,
surely that was the way
it wasnt going to be.
So easy. So hopeful for a few days,
as I entertained forged synapses,
met a socialite threshold, burning diesel,
then they arrived by email,
all electric, and it all changed.
Unlike memories, habits developed die hard.

Now, while listening to you whine,
me and a malbec drift away,
rediscover simplicities,
a couch and a convo,
wondering about what could have been,
dental school, anything really.

Then I return to you, agitated and in need
of advice, looking for the selfless few,
escaping to tv and lethargy.
Troubled. Test and toast, shot, shot,
black out, we all open up.
Passed out, cubbied, hunched over and lonely,
coming home covered in an odor,
pungent in the way only sterility can be.
Wide-eyed,
just to stare down a microscope.

The multiple stresses of a traditional approach.
A sacrificed anatomy but at least you made the mark.
A slave now and when will I hear that canary sing?
Maybe never, hopefully soon, probably tomorrow.
Dates, another thing I learned not to share with reality.
Either way Im happy, like the only crow hidden in your shade,
reaping the spoils others avoid.
56
Medamorphosis
Andrei Kreutzberg
Some call it a prison
A locked in boxed in metal edge razor
Cortisol crazy, relentless and furious
Balancing on the edge of a knife from oblivion

Wishing-hoping-pleading,
Suffering one more day for mysterious reasons
Sacrifice! sacrifice!
Youth gives way to hunchback isolation and paper cuts

The soul cries out for pleasure and repose
But the narcissist longs for perfection,
Perfection is beauty, perfection is joy,
Only perfection can halt the millstone

The mirror must shatter
Striving-stomping-screaming,
Giving up moon dreams and settling for safe ground
But charity knows not mediocrity.

A prison? Nay, a cocoon!
A soul forged, fast paced, trial by fire frenzy
A dark burning chrysalis: god spun, hope inspired, endurable

The chalice of knowledge blisters and purifies
What a beautiful metamorphosis:
Earning each angel feather one wrong answer at a time
57
Vitality
Poonam Kaushal
He plays in the sun-sparkled sandbox each day,
building small mounds of a castle along where his shovel and pail lay.

With his mother watching fondly as the child giggles with pleasure,
She looks at her son with ardor not made to measure.

He plays in the sun without concern or care,
His mother leisurely watches not realizing an unseen danger lurks somewhere.

A sudden splash of something lands on his arm,
He looks at it curiously without feeling a need to be alarmed.

From its globular being, it drips and oozes without letting go of its hold,
The child wonders what is of such a thing that is not so easy to mold.

With great resistance, small drops evade the elastic splotch,
Landing swiftly onto his delicate calf, he continues to watch.

He doesnt feel any different but suddenly becomes fatigued and lazy
The oozing moving slowly down his arm starts to make him feel queasy.

As he searches for a sign of meaning, his color starts to wane,
He turns toward his mother who covers her face as she sobs in pain.

The splotch that moved slowly to his hand causes him a new sensation of discomfort,
He gently rests his head on his hand using the remaining energy he had to exert.

He tugs and pulls and feels a little stuck,
And after finally pulling free, he finds, sticking to the oozing splotch, a hair tuft.

The sun is not bright, the clouds have it covered,
A dark dismal gloom ensues making him wonder where he has faltered.

The boy cries and sobs,
Thinking all that was good has left, leaving nothing more than this blob.

Just as abruptly as this blob came, while the boy shed almost all his tears,
He suddenly felt his hand covered by another of younger years.

Smaller eyes looked up at him curiously, filled with light
He looked at them with wonder, forgetting momentarily about his plight.
58

Poonam Kaushal: Vitality
Smiling happily, she held up his shovel and pail
And as his eyes gazed over the baby he saw a tuft of hair no longer there.

Confused and bewildered he sat and saw,
that the despair and gloom that burdened was replaced by the light from her eyes filled with awe.

It was not his mothers worry or oncologists medicine that gave him strength,
but a younger child reminding him that his own vitality will help him go the length.


World Cancer Day is on February 4
th
, 2010.

A tribute to all of the children with cancer, and to those with cancer who help other children
newly diagnosed with cancer each day.
59
Luke Selby
Spring Break at Night
The Shell
Jordan Roth
Here it is another day
In the land where doctors roam.
Im in search of peace more than answers
Because its been so long since I felt at home.

Here comes the team
Without a knock on the door.
In their haste to save time
I am left wanting more.

No real connection
I have come to expect.
Trapped in this crumbling shell
Their words are more direct.

I hear my case retold each day
But none of them knows my story.
About when I ran, and laughed and played
Lived and led, about my days of glory.

Distant stares and scribbled notes
Tell me more than they know.
I wish I could tell them what Ive learned about life
And whats most important at the end of this road.

They funnel out in a line
But one hesitates to leave.
He best keep on moving or
He is sure to face reprieve.

The light filters in through the window
And with it a smile greets me.
And for a second I remember
Life, love, humanity.

His hand holding mine
Our eyes meet with a glow.
Perhaps for just this moment in time
This place feels like home.
60
Its Gonna Be All Right
Linda DeMello
She lost her job.
After ten years, they told Marie they had to let her go. The economy is bad, they said.
Well compensate you for the rest of the month. Were really sorry.
My God. What was she going to do now?
The hospitals sterile staircase ascended above her, leading to the gray door of the third
floor. She held on to the cold railing so tightly that her knuckles were white. Panic clutched the
strings of her heart, yanking them hard. Her husband died two years ago in a construction acci-
dent, leaving her a mourning single mother of one. She tried her best, but no matter what she
did, fate continued to mercilessly shove her down onto her knees.
And now she had failed her son.
She climbed the stairs and finally entered into the bright dcor of the childrens unit.
Drawings hung in picture frames ferocious tigers, fire-breathing dragons, and princesses in
pretty dresses. Christmas decorations covered the hallways, lights glowing and tinsel glittering
as Frosty the Snowman hummed through the air. Conversation was abound, adults chatting
and children laughing. The snake of dread constricted Maries throat as tears burned the back of
her eyes.
Everything was falling apart.
Forcing herself onward, she winded through the lively hallways, feeling like a black
shadow amidst the vibrant energy. Siblings chased each other as the staff dodged them, grin-
ning in delight. As doctors and nurses passed her, their jovial faces faltered, recognizing that
something was wrong. She wanted them to stop looking at her, to stop proving that she was
weak and helpless, especially now that she had nothing left to give.
Especially now that there was nothing more she could do for the most precious person in
her life.
Her hands began to shake. She clenched them into fists. She plowed onward towards
room 309, ignoring the greetings and the smiles. Her eyes filled, and she lifted her head up in a
vain attempt to prevent them from spilling. When she finally arrived, she opened the door to her
five-year-old sons room.
He sat there, a beacon of light in the dark, wearing a Santa hat and playing with a fire
truck. Machines surrounded him, sending out a cacophony of noise that had kept her up many
nights. Joey looked up at her and his face lit like a ray of sunshine, for she had arrived earlier
than usual. He wore his favorite pajamas, the ones with fire trucks all over them. He wanted to
be a fireman when he grew up.
And all Marie could think of was how his future had disappeared before her eyes,
61
chased away like chalk paintings in the rain.
Mommy! Joey exclaimed, his fragile face filled with happiness. Youre here!
Yes, baby, Im here, Her voice cracked and she loathed the sound. She moved over to
his bedside, trembling, regretting that she hadnt picked up a gift for him, even if it was just a
Hersheys bar.
Joeys smile faded when he noticed her tears. Mommy, whats wrong?
She shook her head, managing a smile through the blur of misery. Oh, nothing.
Mommy is just being a silly girl.
He didnt believe her. Like any child who knew far more than he should, she couldnt
fool him. He lifted the fire truck and placed it in her hands, his beautiful dark eyes filled with
sympathy. Here, mommy, you can have my truck. Itll make you feel better.
Her walls came crashing down, crumbling apart at the sight of his favorite toy in her
hand. Im sorry, honey, she murmured hoarsely, apologizing for losing her job, for losing all
hope of continued treatment, and for losing the battle against his cancer. Im so sorry.
Joey stood up, wobbly on his feet, and he wrapped his frail arms around her, showing
her courage and strength beyond anything she could imagine. Its gonna be all right, mommy.
Its gonna be all right.
Linda DeMello: Its Gonna Be All Right
62
Radeeb Akhtar
Untitled Nude

Telemedicine Management of Diabetics in an Underserved Community
J. Paul Nielsen and Pranav Mehta, M.D.
Introduction
Information technology via telemedicine offers the potential for cost-effective and active
management of type 2 diabetes mellitus for people in high-risk underserved communities such
as Harlem, NY and the Bronx, NY. Adults with type 2 diabetes mellitus have heart disease
death rates about 2 to 4 times higher than adults without diabetes, and the risk for stroke is 2 to
4 times higher among people with diabetes.
1
Telemedicine is the use of telecommunications
technology for medical diagnostic, monitoring, and therapeutic purposes to communicate infor-
mation instantaneously from one location to another, such as from a patients home to a hospi-
tal.
2
Conventional diabetes management involves a patient diagnosed with type 2 diabetes melli-
tus seeing a physician in an outpatient setting for monitoring, and meeting with a diabetes edu-
cator who recommends lifestyle and dietary changes. If these lifestyle interventions are not
adequate to bring the blood glucose levels under control, the physician may recommend phar-
macological interventions such as treatment with metformin or another medication to increase
insulin sensitivity and secretion.
The New York City Health and Hospitals Corporations (NYC HCC) Housecalls program
supplements conventional diabetes management by providing free tele-glucometers to patients
diagnosed with type 2 diabetes mellitus. These glucometers transmit the patients daily blood
glucose measurements back to the hospital and alert the medical staff to any needed changes in
the treatment regimen. Utilizing only an existing phone line and a tele-glucometer rigged to
plug into a phone line, clinicians have the opportunity to monitor the daily glycemic status of
patients without having to see the patient in clinic.
The use of telemedicine to assist residents of East Harlem with controlling their blood glu-
cose levels can function in meeting the two main goals of Healthy People 2010: increase the
quality and years of healthy life and to eliminate healthcare disparities.
3
A previous study on
Army diabetics has indicated that telemedicine leads to better glycemic control and fewer com-
plications than conventional treatment in controlling diabetes.
4
Using a home telemedicine sys-
tem to deliver care to patients with type II diabetes resulted in a 16% reduction in Hemoglobin
A1C levels (from 9.5 to 8.2%) and a 4% mean weight reduction (from 214.3 to 206.7 pounds)
during a 3-month period of monitoring.
4
Our study aims to quantify the improvement experienced by NYC HCC diabetics treated at
placed on the Housecalls telemedicine monitoring program and compares them to NYC HCC
patients treated via the conventional approach of medication and lifestyle recommendations
combined with regularly scheduled outpatient medical visits.
Methods
The patients analyzed were NYC HCC patients that were newly diagnosed with type 2 dia-
64
betes mellitus. Hemoglobin A1C levels from before the patient was enrolled in the Housecalls
program served as baseline reference values. Hemoglobin A1C serves as a stable mean value
of a patients constantly changing blood glucose levels averaged over a multi-week period. We
compared the baseline Hemoglobin A1C levels to the levels recorded after the patient was en-
rolled in Housecalls for at least 3 months.
Results
The initial results indicate that the Housecalls program is effective in improving compliance
and management of diabetes. Of the patients with an HbA1c level measured within 3 months of
start of program and 3 months after enrollment, 19 of 22 (86%) had a decrease in HbA1c, while
the remaining 3 patients had no change in HbA1c.
Discussion
The initial success of the program is encouraging and demonstrates a great potential for the
use of telemedicine in monitoring chronic disease. One of the largest problems in providing
care to patients of underserved areas is loss to follow up, and telemedicine offers a cheap and
effective solution to reduce such losses. The costs of providing the tele-glucometer would be
largely offset by the reduced expenses of treating diabetes complications if this method is in-
deed effective in improving long term glycemic status. The initial results are encouraging and
certainly warrant more detailed and in-depth analysis of this simple tool.


J. Paul Nielsen and Pranav Mehta, M.D.: Telemedicine Management of Diabetics
65
R E F E R E N C E S
[1] Improving Reproductive Health. United Nations Population Fund. 2006. Accessed 1 Mar. 2007. http://
www.unfpa.org/rh/index.htm
[2] Johri A. Innovations at Work: Reaching Out with RCH Services. State Innovations in Family Planning Ser-
vices Project Agency, Uttar Pradesh. 1999. Accessed 2 Feb. 2007. http://www.policyproject.com/pubs/
countryreports/INDinnov.pdf
[3] Claeson M, Bos ER, Mawji T and Pathmanathan I. 2000. Reducing Child Mortality in India in the New Mil-
lennium. Bulletin of the World Health Organization, 78: 1192-1199.
[4] Tewari J. USAID/India Strategic Objective Close out Report. Organization for Economic Co-operation and
Development. 2005. Accessed 28 Jan. 2007. http://www.oecd.org/dataoecd/55/14/36104395.pdf
[5] Gudipati D. Healthcare Delivery Systems in Rural India: Meeting the Changing Needs of Rural Populations.
Carnegie Mellon Heinz School Review. 2006. Accessed 1 Mar. 2007. http://journal.heinz.cmu.edu/articles/
healthcare-delivery-systems-rural-india
[6] Rosa FW. 1967. Impact of New Family Planning Approaches on Rural Maternal and Child Health Coverage
in Developing Countries: India's Example. American Journal of Public Health and the Nations Health, 57[8]:
1327-1332.
[7] Costello A, Osrin D and Manandhar D. 2004. Reducing Maternal and Neonatal Mortality in the Poorest Com-
munities. British Medical Journal, 329: 1166-1168.
J. Paul Nielsen and Pranav Mehta, M.D.: Telemedicine Management of Diabetics
66
Can Cycles of Neddylation and Deneddylation
Provide Points for Possible Therapeutic Intervention?
Nadia Nocera
Introduction
The process of ubiquitination serves as an important signaling mechanism in many biologi-
cal processes such as protein trafficking, DNA repair, protein-protein interactions and proteoly-
sis.
1
Ubiquitin is a small polypeptide that is covalently linked to the lysine residue of target pro-
teins by a multienzymatic system consisting of E1 (ubiquitin-activating), E2 (ubiquitin-
conjugating), and E3 (ubiquitin-ligating) enzymes. E3 ligases include

cullin-based ubiquitin li-
gases, in which the cullin acts as

a scaffold for the assembly of a multisubunit ubiquitin ligase

complex that contains a RING-box protein and a cullin-specific

substrate adaptor protein.
Cullin3 (Cul3) forms a complex, which controls cyclins, transcription factors, and cellular path-
ways.
1
All cullins require an attachment of the ubiquitin

homologue neural-precursor-cell-
expressed and developmentally

down regulated 8 (Nedd8) at a specific lysine residue near its

C
terminal end to activate its ubiquitin ligase function. After protein is tagged with ubiquitin, it is
targeted to the proteosome, where it is degraded.
Because these components in the cell cycle (E1, E2, E3, Cullins, Nedd8, etc.) are essential
in controlling proteolysis, null function or increased production of any of these proteins may
lead to unregulated cellular processes and possibly to tumorigenesis. Knowing the functional
details of these interactions could lead to clues for therapeutic targeting.
What is Nedd8 and what is its function?
Cullin family proteins organize ubiquitin ligase (E3) complexes to target numerous cellular
proteins, such as those involved in cell proliferation and proteasomal degradation. Cullins di-
rectly interact with Roc1, a Ring finger protein. The Cullin-Roc1 complex comprises the core
module of a series of ubiquitin E3 ligases, which confer substrate specificity and therefore regu-
late the degradation process.
2
Cullin family proteins; Cul1, Cul2, Cul3, Cul4A, Cul4B, and
Cul5, have been shown to be modified by Nedd8 (a ubiquitin-like protein) in mammalian cells.
3
Neddylation of cullins is critical to cullin function and is required to facilitate processive trans-
fer of ubiquitin from E2 to E3 to the target protein.
4

Nedd8 is a highly conserved, 81- residue protein that is attached to cullins by a process
termed neddylation.
1
Neddylation occurs through the action of a neddylation cascade similar to
that used in the ubiquitin system. The first step in neddylation is the formation of a thiol-ester
bond via the C-terminal glycine residue of Nedd8 with APP-BP1/Uba3, a heterodimeric E1-
activating enzyme.
1
The process is completed by the formation of an isopeptide bond, linking
the carboxyl-end of Nedd8 Gly-76 to the e-amino group of a conserved cullin lysine residue.
5

Neddylation results in mononeddylation of cullin substrates.
Ubiquitination activities of cullin-RING ligases (CRLs) require neddylation to control their
E3 ligase activity. Studies focusing on the relationship between neddylation and E3 ligase func-
67
tion
6, 7
suggest that Nedd8 plays a direct role in the activation of the E3 ligase function in ubiq-
uitination. Inactivation of the CRL ligase activity requires the COP9 signalosome (CSN) that
removes Nedd8 from cullins, a process called deneddylation.
8
Although the significance of
Nedd8 in cullin complex activation has been established, it is not yet clear what the mechanism
of Nedd8 action is.
Neddylation and deneddylation provide means to maintain homeostasis
It has been found that deneddylation by CSN protects cullins from degradation and that
Nedd8-conjugated cullins are unstable and depleted in vivo.
8
CSN has been implicated in a
wide range of biological processes including plant photomorphogenesis, yeast mating path-
ways, signal transduction, the regulation of DNA repair, and cell cycle regulation.
9
CSN inhib-
its ligase activity and negatively regulates the cell cycle by promoting deneddylation of cullins.
The regulation of Cul1 and Cul3 by neddylation and deneddylation was examined by gener-
ating CSN-null mutants of D. melanogaster.
8
Cul1 and Cul3 were found to be depleted, as
shown in Western blots with lysates prepared from CSN-null larvae and CSN double-stranded
RNA (dsRNA) treated S2 cells. The depletion was primarily due to the absence of unneddy-
lated Cul1 and Cul3.
8
Although this study showed that neddylated cullins were degraded in the
absence of CSN, the protective role of CSN remains debated. A different demonstrated that
although the CSN complex was inactivated, both the percentage of neddylated cullins in cells,
and the cullin substrates themselves, increased.
7
Further research is required to elucidate the
role of cullins.
Cul1 was found to accumulate in D. melanogaster, with the Nedd8-null allele present in the
eye and wing discsindicating that Nedd8 may have a role in down regulating the levels of
Cul1 and Cul3 proteins.
8
This suggests the efficient degradation of neddylated cullins, unless
the conjugated Nedd8 is removed by CSN. It therefore appears that neddylation and deneddyla-
tion provide a means to maintain normal cellular levels of activated CRLs and prevent exces-
sive ubiquitin ligase activity.
8

Neddylation and deneddylation may provide points for therapy
Because of the apparent role of neddylation in the function of cullin, blocking this process
may provide some real therapeutic benefit in cancer patients, by promoting cell death or cell
cycle arrest in excessively proliferating cells. Furthermore, because of the requirement that
cullins undergo deneddylation in addition to neddylation, blocking Nedd8 removal could se-
verely interfere with cell viability. Specifically, the inhibition of cullin deneddylation through
small molecule inhibitors would be expected to lead to defects in the cells ability to ubiquiti-
nate numerous cullin-based E3 targetsultimately leading to defects in cell proliferation.
10

However, it remains to be determined whether cancer cells have a greater rate of deneddylation,
as compared to normally proliferating cells. If research reveals this to be the case, there could
be a therapeutic window for small molecule inhibitors of the CSN protease.
E1, E2 and Nedd8 form a complex
Recently, a study conducted by Huang and colleagues
11
found a unique N-terminal se-
quence on the E2 protein that helps form a complex to stabilize E1 and Nedd8. In this complex,
Nadia Nocera: Cycles of Neddylation and Deneddylation As Possible Therapeutic Intervention?
68
three E1 domains pack to generate a large central groove, which cradles ATP, molecules of
Nedd8, and E2 substrates together. E1 activates Nedd8 through adenylation and forms a bond
with Nedd8, transferring the protein to E2. E2 then transfers Nedd8 to E3, which joins Nedd8
with Cul1. NEDD8 is in the center of the complex, with its C terminus tethered within a chan-
nel focused on the thioester bond.
11
A network of charged and polar side-chains contacts E1s
catalytic cysteine and Nedd8s C terminus. Mutational analyses showed that these residues con-
tribute to E1, E2 and Nedd8 complex formation.
11
It was also demonstrated that deleting the tail
from E2 significantly hinders the ability of E2 to transfer Nedd8 to E3, thereby decreasing the
transfer of Nedd8 to Cul1.
12
Therefore, a decrease

in the transfer of Nedd8 to Cul1 would lead
to increased stability and negative regulation of the cell cycle.
The discovery of this unique E2 tail is very intriguing for researchers because it may pro-
vide one way to target the process of neddylation in cancer treatment. Scientists now know the
exact shape and function of the E2 tail, and the E1 groove within which it fits. Novel drugs that
are designed to disrupt the tail, the groove, or both might block the ability of the Nedd8 path-
way to accelerate the replication of cancer cells.
12

Research reveals a new substrate for Nedd8
Although it is known that neddylation plays an important role in ubiquitin-mediated prote-
olysis by modification of cullins, it was found that cullins are not the only substrates targeted
for Nedd8 modification. In a study focusing on the neddylation of a breast cancer associated
protein, it was found that BCA3 (breast cancer associated protein 3), a non-cullin protein, is
also a Nedd8 substrate.
13
BCA3 has recently been found to be over-expressed in both breast and
prostate cancers. Although BCA3 does not have an inherent relationship to cancer, it can act as
a tumor suppressor when modified by Nedd8.
13
A yeast two-hybrid screen was performed in a human placental cDNA library using SENP8
(a Nedd8-specific protease) as baitan interacting plasmid encoding BCA3 was identified.
13

BCA3 was tagged and was found to be modified by Nedd8. It thus appears that neddylation
may occur through Nedd8s association with eleven lysine residues on BCA3 because when
these residues were replaced by arginine, neddylation did not occur.
In the cell, BCA3 is localized within the nucleus. It has been reported to be a Kyo-T2 bind-
ing protein, which was shown to regulate the DNA binding protein Recombination Signal Bind-
ing Protein-Jk (RBPJk) and to participate in transcription regulation of NFkB (nuclear factor
kappa B).
14
NFkB is a family of proteins that turn on genes involved in apoptosis and cell pro-
liferation. When NFkB is over expressed, it can protect cells from undergoing apoptosis, so the
more NFkB that is expressed, the more resistant a cell is to death.
15

In the study focusing on the neddylation of breast cancer associated protein, investigators
examined whether BCA3 could act as a transcription regulator of NFkB, as well as whether the
neddylation of BCA3 is required for its transcriptional inhibitory activity.
13
To investigate this,
several lysine residues on BCA3 were mutated, whereby they were replaced with an arginine.
One mutant had a single lysine mutated, while in two other mutants contained ten lysine re-
placements. Of interest, researchers found that each of these mutants inhibited NFkB activation,
with the exception of a BCA3 mutant in which all 11 lysine residues had been replaced. The
Nadia Nocera: Cycles of Neddylation and Deneddylation As Possible Therapeutic Intervention?
69
latter mutant was also unable to undergo neddylation, demonstrating that BCA3 must be neddy-
lated to inhibit NFkB activation.
13
The same study revealed that BCA3 binds to p65, one of the
two proteins that make up NFkB, in order to regulate NFkB. Therefore, Nedd8-modified BCA3
binds to p65 and recruits a histone deacetylase (SITR1) to suppress NFkB-mediated transcrip-
tion.
13
The aforementioned study describes a cancer-promoting (or demoting) pathway.
13
Interfer-
ing with this pathway may provide a possible way to diminish the number of factors that pro-
mote tumorigenesis. With further study, researchers may soon be able to design drugs that
block the removal of Nedd8 from BCA3, or alternatively, promote the addition of Nedd8 to
BCA3. By increasing the amount of Nedd8-modified BCA3, there would be a decrease in
NFkB. Decreasing NFkB would render cancer cells less resistant to chemotherapy and more
able to undergo apoptosis.
Conclusion
Through their control of cullins, cycles of neddylation and deneddylation have proven to be
important processes in the cell cycle. Neddylation of cullins activates their ubiquitin ligase ac-
tivity, subsequently allowing cullins to control the cell cycle via the ubiquitination of cellular
proteins involved in cell proliferation. In contrast, the inactivation of cullins is achieved by
deneddylation through the COP9 signalosome. Another substrate for Nedd8 is the BCA3 pro-
tein, found to be a tumor suppressor when modified by Nedd8. When Nedd8 is removed from
BCA3, oncogenes are no longer suppressed, resulting in resistance to apoptosis and excessive
cell proliferation. Because of Nedd8s critical roles in the cell cycle and modification of tumor
suppressor genes, developing a way to control cycles of neddylation and deneddylation could
prove to be an effective cancer therapy.
R E F E R E N C E S
[1] Wimuttisuk, W., Singer, J.D. The Cullin3 ubiquitin ligase functions as a Nedd8-bound heterodimer. Mol.
Biol. Cell 18, 899909. 2007
[2] Kamura, T.; Koepp, D. M.; Conrad, M. N.; Skowyra, D.; Moreland, R. J.; Iliopoulos, O.; Lane, W. S.;
Kaelin, W. G., Jr.; Elledge, S. J.; Conaway, R. C.; Harper, J. W.; Conaway, J. W. Rbx1, a component of the
VHL tumor suppressor complex and SCF ubiquitin ligase. Science 284: 657-661, 1999.
[3] Osaka, F.; Kawasaki, H.; Aida, N.; Saeki, M.; Chiba, T.; Kawashima, S.; Tanaka, K.; Kato, S. A new
NEDD8-ligating system for cullin-4A. Genes Dev. 12: 2263-2268, 1998.
[4] Wu, K., Chen, A. and Pan, Z.Q., Conjugation of Nedd8 to CUL1 enhances the ability of the ROC1-CUL1
complex to promote ubiquitin polymerization. J. Biol. Chem. 275 41, pp. 3231732324. 2000
[5] Pan, Z.Q., Kentsis, A., Dias, D.C., Yamoah, K., Wu, K. Nedd8 on cullin: building an expressway to protein
destruction. Oncogene 23, 19851997. 2004
[6] Read, M.A. et al. Nedd8 modification of cul-1 activates SCF((TrCP))-dependent ubiquitination of IB. Mol.
Cell. Biol. 20, 23262333. 2000
[7] Kawakami, T. et al. Nedd8 recruits E2 Ubiquitin to SCF E3 ligase. EMBO J 20, 4003-5012. 2001
[8] Wu et al. Neddylation and deneddylation regulate Cul1 and Cul3 protein accumulation Nature Cell Biology
7, 1014 - 1020 2005
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[9] Bosu, D. R., Kipreos, E. T. Cullin-RING ubiquitin ligases: global regulation and activation cycles. Cell Di-
vision, 3:7 doi:10.1186/1747-1028-3-7. 2008
[10] Nalepa, G., Harper, J. Therapeutic anti-cancer targets upstream of the proteasome. Cancer Treatment Re-
views. Volume 29, Supplement 1, Pages 49-57. May 2003
[11] Huang DT, Hunt HW, Zhuang M, Ohi MD, Holton JM, Schulman BA: Basis for a ubiquitin-like protein
thioester switch toggling E1E2 affinity. Nature, 445(7126):394-398. 2007
[12] Structural Insights for Therapeutic Targeting of an E2 Function and Neddylation in Proliferation Control.
Cancer Biology and Therapy. 10, 924-925. 2004
[13] Gao,F.; Cheng, J; Shi, T; Yeh E.T. H. Neddylation of a breast cancer-associated protein recruits a class III
histone deacetylase that represses NFB-dependent transcription. Nature Cell Biology - 8, 1171 1177. 2006
[14] Oakley, F. et al. Basal expression of IB is controlled by the mammalian transcriptional repressor RBP-J
(CBF1) and its activator Notch1. J. Biol. Chem. 278, 2435924370. 2003
[15] MD Anderson Cancer Center News Release. New Path from Estrogen to Survival in Breast Cancer Cells
Described. http://www.mdanderson.org/departments/newsroom/display.cfm?id=6C70D16C-C98D-4342-
9AE00B3BF82715AD&method=displayFull&pn=00c8a30f-c468-11d4-80fb00508b603a14
Nadia Nocera: Cycles of Neddylation and Deneddylation As Possible Therapeutic Intervention?
71
Diagnosis: Recurrent Ascites and
Lower Extremity Edema in a 67-year old Female
Lea Alfi
Symptoms
I feel so bloated. The 67-year-old female could feel herself getting hot as she tried to ma-
neuver herself into an upright position. She had gone through this 3 months prior, and won-
dered why it was happening to her again. Her abdomen was now completely distended. She ex-
plained that her ascites had been drained 3 months ago, and she promised that she had been so-
ber. Exasperated, she brought herself to her feet. She had no one in the room with her, and
looked apologetic as her eyes scanned the room, eventually resting on a distant roof gar-
den.
As her eyes fell to her legs, she explained how they had gradually ballooned over the past
12 weeks, despite her use of diuretics. With the swelling methodically moving up from her feet
to her thighs, her slender frame was now completely hidden. She was exhausted; she said she
had never felt so tired in her life. She could not get up quickly enough to reach the restroom,
and the uneasy decision was made to place a Foley catheter. She looked down over her belly,
unable even to see her feet, bewildered by her own condition.
Investigation
My resident assigned me this patient, emphasizing that it would be a great way to cement
my understanding of hepatic pathophysiology, a textbook case of cirrhosis. My patient was a
67-year old female with a past medical history including cervical cancer (status post radiation)
15 years prior, with a resultant rectovaginal fistula, and a 40-year history of alcohol depend-
ence. She was single, and gravida 0. She was a non-smoker, and denied any IV drug use in the
past.
Her labs revealed a normocytic anemia; she had started folate and multivitamins during her
last admission. This explained some of her fatigue, but was there some underlying chronic dis-
ease? The private attending following her planned a bone marrow biopsy. The medicine team
did not work up the anemia right away, instead focusing their attention on the worsening ascites
and lower extremity edema.
Records from the patients last hospitalization included a CT scan demonstrating a cirrhotic
liver. No liver biopsy had been performed. There was no documentation as to whether the cir-
rhosis was of viral or toxic etiology, or possibly both. GI was consulted, and serology was sent
for hepatitis panels. Her liver function tests were abnormal, as expected. My resident was fairly
certain that this was another routine case of cirrhotic decompensation triggered by alcoholic
hepatitis, but her AST: ALT ratio (aspartate aminotransferase: alanine aminotransferase) was
not 2:1. Moreover, I felt the patient had no reason to lie about her sobriety, since she had been
forthcoming about her alcohol history. Hepatitis B and C virology returned negative.
The patients serum albumin was low, at 2.0 grams per deciliter (normal being 3.5-5 g/
72
dl). She wasnt spilling any protein into her urine, ruling out a nephrotic syndrome. Her low al-
bumin was most likely due to a combination of chronic malnutrition and alcoholic hepatitis. Re-
nal was consulted and SPA (serum poor albumin) treatment was initiated to pull the escaping
fluid back into her intravascular space. SPA was of negligible benefit, with the patient still in
overt pain and discomfort. My resident and intern performed a therapeutic tap. The paracentesis
removed 3 liters of ascitic fluid, alleviating, but not resolving, the patients abdominal disten-
tion.
My resident assigned me with calculating the serum-ascites albumin gradient (SAAG), an-
ticipating that it would support a cirrhotic etiology for the ascites. The SAAG was 1.0; by defi-
nition, a SAAG greater than or equal to 1.1 would have suggested portal-hypertension related
ascites. However, the patients SAAG was less than 1.1, meaning my patients ascites were
possibly nonportal-hypertension related. My resident held firm to his belief that the ascites were
portal-hypertension related, noting that a SAAG of 1.0 could be considered borderline. More-
over, as cirrhosis was the cause of eighty-one percent of portal-hypertension related ascites, he
reasoned that this was likely the case with our patient. However, because our patient had known
cirrhosis, meaning an expected SAAG beyond 1.1, and her SAAG was still less than 1.1, I won-
dered if we should spend more time considering other etiologies for her ascites.
The physicians aphorism played in my mind, If you hear hoof-beats, look for horses, not
zebras, reminding me of the practice of pursuing more common, rather than exotic, diagnoses.
However, as a medical student with a paucity of clinical experience and a relative excess of
time, looking for zebras and following stringent SAAG cutoffs was more intuitive, and interest-
ing, than looking for horses. Alternative diagnoses included peritonitis, pancreatitis, vasculitis,
bowel obstruction or infarct, hypoalbuminemic states (nephrotic syndrome or a protein-losing
enteropathy), or Meigs syndrome.
In the absence of any amylase or lipase elevations, I eliminated pancreatitis. Peritonitis did
not fit, as the ascitic fluid showed PMNs, white blood cells indicative of acute infection, to be
less than 250, and a white count less than 500. Moreover, she was afebrile, and had no abdomi-
nal tenderness. There was no evidence of any vasculites or bowel obstruction. This left hypoal-
buminemia or Meigs syndrome. However, based on the failure of SPA treatment, it didnt
seem as if her ascites could have been solely due to a hypoalbuminemic state. Meigs syn-
drome typically presents as a triad: ascites, pleural effusion, and ovarian tumor. A possible two
out of three seemed reasonable, so I texted my resident, What about Meigs?
Resolution
Renal had re-initiated daily diuretics to drain the remaining fluid and lessen the patients
lower extremity edema, the standard furosemide 40 and spironolactone 100. The patients pri-
vate attending, an oncologist, had ordered a slew of tumor markers: AFP (alpha-fetoprotein),
CEA (carcinoembryonic antigen), CA-125 (an antigen on nonmucinous ovarian cancers), and
CA-19-9 (a monoclonal antibody against certain GI carcinomas). In reviewing her days labs,
her CA-125 had returned; it was elevated. This threw weight behind Meigs, or any gynecologic
malignancy. As a transvaginal ultrasound was scheduled, I left the team for my next rotation.

Lea Alfi: Diagnosis: Recurrent Ascites and Lower Extremity Edema in a 67-year old Female
73
A few days later, I re-visited my patient. She told me how horrible the transvaginal ul-
trasound had been, and said she had been told it was to test for ovarian cancer. She showed me
the soaps and lotions a friend had brought her, sliding them under my nose, and pointed out the
bouquet of cattails she had added to her windowsill garden of sunflowers. I reassured her, and
wished her good luck. She kissed me on the cheek and thanked me. As I left her room, I did not
know whether she had a benign fibroma or a malignant tumor, or whether the CA-125 was lead-
ing us astray. I wondered whether our path to diagnosis had been achieved, not knowing ulti-
mately to what the hoof-beats belonged.
Five months later, I did a double take as I saw my former patient being admitted. From
afar, I could see that her face had become unsettlingly gaunt, her belly more distended, and her
legs unusually swollen juxtaposed against her twig-like arms. She was no longer my patient,
and I was no longer on the medicine team. The medical record number that I had once typed by
memory had receded from my mind. And unfortunately, I was unable to learn her final diagno-
sis before she was moved to another floor.
Lea Alfi: Diagnosis: Recurrent Ascites and Lower Extremity Edema in a 67-year old Female
74
Sabrina Perrino
Ocean Beach Pier

.
Resilience in the Third Year of Medical School: A Prospective Study of the Associations
Between Stressful Events Occurring During Clinical Rotations and Student Well-Being
Paul S. Nestadt, MS III; Margaret E.M. Haglund, M.D.; Marije aan het Rot, Ph.D.; Nicole S. Cooper, Ph.D.; David
Muller, M.D.; Steven M. Southwick, M.D.; Dennis S. Charney, M.D.
New York Medical College, Valhalla, New York; Columbia University, New York, New York; Mount Sinai School of
Medicine, New York, New York; Yale University School of Medicine, New Haven, Connecticut.
Purpose. The third year of medical school exposes students to many stressful and potentially
traumatic events. These students witness patient suffering and death, personal mistreatment, and
poor role modeling by physicians. Such experiences may explain increases in anxiety and de-
pression during medical school, and could contribute to a decrease in future physician empathy.
However, to date this has not been studied.

Methods. The present study prospectively measured stressful clerkship events occurring during
the 2006-2007 academic year in third-year medical students of the Mount Sinai School of
Medicine (n = 125), using baseline measures and surveys completed monthly. Students labeled
stressful events traumatic if they met the trauma criteria of the Diagnostic and Statistical Man-
ual of Mental Disorders, fourth edition. The authors measured anxiety, depression, and post-
traumatic stress symptoms at the beginning and end of the year and twice during the year. At
year's end they also measured students' personal growth.

Results. Class participation varied from 106 (85%) at baseline to 82 (66%) at endpoint. Most
students (101; 81%) completed at least one monthly survey. Many students reported exposure
to trauma as well as personal mistreatment and poor role modeling by superiors. Trauma expo-
sure was positively associated with personal growth at year's end. In contrast, exposure to other
stressful events was positively associated with endpoint levels of depression and other stress
symptoms. Students who had experienced higher levels of childhood trauma were found to be
more vulnerable to the psychopathogenic consequences of third year trauma, whereas students
with higher levels of current social functioning were more resilient to these stresses.

Conclusions. Trauma exposure was common but not associated with poor outcomes by year's
end, which suggests that students were resilient. In fact, it appears that exposure to patient re-
lated traumatic events throughout the third year may aid in student personal growth. However,
unprofessional behavior by resident and attending physicians might have adverse effects on the
well-being of students.
CL I NI CA L S CI ENCE: F I RS T P L A CE
76
Wait List Death and Survival Benefit of Kidney Transplantation among Extra-renal
Transplant Recipients
James Cassuto
1
, MS II
4
; Roy Bloom
2
, M.D.; Peter Reese
2
, M.D.; Matthew Levin
1
, M.D., Ph.D.; Seema Sonnad
3
,
Ph.D.; Kim Olthoff
1
, M.D.; Abraham Shaked
1
, M.D., Ph.D.; Ali Naji
1
, M.D., Ph.D.; Peter Abt
1
, M.D.
Hospital of the University of Pennsylvania, Philadelphia, PA
1
Division of Transplantation,
2
Renal Electrolyte and
Hypertension,
3
Outcomes Research,
4
New York Medical College, Valhalla, NY
Purpose. The number of surviving extra-renal transplant recipients who develop end stage renal
disease is increasing, adding a drain on the limited pool of kidney grafts. With current interest
in balancing equity and utility, we sought to evaluate kidney transplant benefit in extra-renal
transplantation compared to primary isolated (KA1) or repeat primary kidney (KA2) trans-
plants.

Methods. Renal waitlist and transplant survival benefit for kidney after lung (KALu), kidney
after heart (KAH), and kidney after liver (KALi) were compared to KA1 and KA2. Multivari-
ate Cox regression models were constructed with UNOS data for patients listed and trans-
planted between 1995 through 2008.

Results. Deaths per 100 waitlist years were 8.9 for KA1, 5.8 for KA2, 26.5 for KALu, 19.6 for
KAH, and 25.2 for KALi. The risk of death on the wait list for an extra-renal transplant was
compared in an adjusted analysis to KA1: KA2 (p<0.001, HR=0.85, CI=0.82-0.88), KALu
(p<0.001, HR=3.73, CI=3.06-4.54), KAH (p<0.001, HR=1.93, CI=1.68-2.21), and KALi
(p<0.001, HR=3.02, CI=2.78-3.27). Compared to remaining on the waitlist, kidney transplanta-
tion was associated with a five year survival benefit amongst all groups, with extra-renal trans-
plant recipients demonstrating the largest survival benefit. Following transplant, patient sur-
vival was greatest for KA1, but similar among KA2, KALi, and KAH, and inferior for KALu.

Conclusions. Extra-renal transplant recipients with ESRD have an increased risk of wait list
death and greater survival benefit from kidney transplantation compared to KA1 and KA2.
These groups should be considered in the development of kidney allocation algorithms.

CL I NI CA L S CI ENCE: S ECOND P L A CE
77
Racial Differences in Bronchopulmonary Dysplasia Severity for Neonates with Mitochon-
drial Superoxide Dismutase Polymorphism

Edward Hurley, MS II; Kristen Aland, B.A.; Johanna Calo, M.D.; Lance A Parton, M.D.

Department of Pediatrics, New York Medical College, Valhalla, New York

Purpose: Oxidative stress, along with genetic factors and mechanical ventilation, has been im-
plicated in the susceptibility of preterm infants to bronchopulmonary dysplasia. Manganese su-
peroxide dismutase is an important enzyme for quenching reactive oxygen species. It catalyzes
the conversion of the superoxide anion to hydrogen peroxide in the mitochondria. The enzyme,
which is coded by genomic DNA, requires a mitochondrial targeting sequence to gain entry. A
well-studied single nucleotide polymorphism (SNP) in the mitochondrial targeting sequence
causes a replacement of alanine by valine, resulting in less efficient transport into the mitochon-
dria. For a subset of the subjects, we examined two other MnSOD SNPs. One SNP
(rs11575993) causes a change in amino acid from a leucine to a phenylalanine and the other is
an intronic SNP (rs2842958) that has been associated with other lung conditions such as COPD.

Methods: We hypothesize that the MnSOD rs4880 SNP is associated with susceptibility to
BPD. Infants (N=87) were enrolled who weighed <1 kg at birth and had no congenital or chro-
mosomal abnormalities. DNA was isolated from buccal mucosal swabs and allelic discrimina-
tion was performed using a specific probe with Real-time PCR. BPD is defined by the need for
oxygen at 36 weeks PMA. Chi square analyses and ANOVA were performed with P<0.05 de-
noting statistical significance.

Results: There were significant differences in birth weights and gestational ages, but not in ra-
cial distributions between BPD and Non-BPD infants. The genotype distributions were not sta-
tistically different between BPD and Non-BPD infants (P=0.23). We found significant differ-
ences between the genotype distributions of this SNP when we analyzed Caucasian (N=21,
P=0.027), but not Hispanic or African-American infants. Significantly more intraventricular
hemorrhage was found among infants with BPD compared to Non-BPD.

Conclusions: Caucasian ELBW preterm infants who progress to BPD are more likely to con-
tain the minor allele for the MnSOD rs4880 SNP, which results in less efficient transport of su-
peroxide anion into the mitochondria. This association was not seen in Hispanics or African-
Americans, and cannot be explained by differences in birth weight or gestational age. We ex-
amined the two additional MnSOD SNPs (rs11575993 and rs2842958) in the Caucasian sub-
jects but found no significance.
CL I NI CA L S CI ENCE: THI RD P L A CE
78
Using Fluorescence in situ Hybridization (FISH) to Examine the Prevalence of ETS Gene
Fusions in a Large Prostatectomy Cohort.

Christopher J. LaFargue, MS I; Raquel Esgueva, M.D.; Sven Perner, M.D.; Veit Scheble, M.D.; Glen Kristiansen,
M.D.; Mark A. Rubin, M.D.

Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, NYC, NY.
Department of Urology, University Hospital of Berlin, Berlin, Germany.

Purpose: Approximately 40-60% of PSA screened prostate cancers harbor gene fusions between the
5 region of the hormone regulated TMPRSS2 gene and the 3 region of members of the ETS family
of transcription factors, most commonly ERG. Prostate cancers possessing ERG rearrangements rep-
resent a distinct sub-class of tumor based on previous studies reporting associations with histomor-
phologic features, characteristic somatic copy number alterations, and gene expression signatures.
More recently, additional 5 fusion partners of ERG have been discovered; most notably SLC45A3
and NDRG1. The purpose of this study was to examine the frequency of these particular gene fu-
sions in a large scale prostatectomy cohort and to determine whether any relationship existed with
pathologic parameters or clinical outcome.

Methods: A cohort of 614 prostate cancer patients who underwent radical prostatectomy was used.
Various parameters such as age, preoperative PSA levels, PSA relapse (biochemical recurrence),
Gleason grade, and tumor stage were recorded for each case. Tissue microarrays were constructed
from the formalin-fixed paraffin-embedded tissue blocks from each patient. A break-apart FISH as-
say was employed allowing an evaluator to determine whether or not a particular gene was disrupted.
Two differently colored DNA probes flanking the gene of interest were simultaneously hybridized to
5 micron sections of each TMA and were evaluated using a fluorescence microscope. Four gene sets
were used: ERG, TMPRSS2, SLC45A3, and NDRG1. A sample negative for rearrangement showed
two green and red overlapping signals in each nucleus, with each overlapping pair corresponding to
one allele. A sample harboring a rearranged gene showed a split, or break-apart, of the signals. In
this case, each nucleus would contain a green-red overlapping signal (normal allele), and a single
green and single red located apart from each other (disrupted allele). A case was considered positive
for gene fusion if it possessed rearrangements of both ERG and the particular 5 partner.

Results: Of the 614 patients in the cohort, 540 could be evaluated by FISH. Similar to previous re-
ports, ERG rearrangement occurred in 53% (254/540) of the cases. Of these 254 cases, 78% were
shown to be fused with only TMPRSS2, 6% with only SLC45A3, 11% with both TMPRSS2 and
SLC45A3, and 5% with an unknown partner. From these unknown cases, one was identified as be-
ing fused to NDRG1, a novel 5 partner recently discovered. Using various statistical methods, this
study did not find any association with pathologic parameters or clinical outcome.

Conclusions: While most studies have assumed that all ERG rearranged prostate cancers are fused
with TMPRSS2, we showed that a significant percentage is SLC45A3-ERG. Additionally, the dis-
covery of concurrent rearrangement of TMPRSS2 and SLC45A3 within the same case suggests that
there must be additional molecular complexity which has been previously unappreciated. This study
has important clinical implications for the development of diagnostic assays to detect ETS rearrange-
ments in prostate cancer. Incorporation of these assays which detect the less common ERG rear-
ranged fusions could further increase the sensitivity of the current PCR-based approaches.
BA S I C S CI ENCE: F I RS T P L A CE
79
Use of EGFR Genetic Analysis to Potentially Expand Treatment Options for Patients
With Vulvar Squamous Cell Carcinoma

Susan L. Boisvert MS I, Whitfield B. Growdon MD, Sara Akhavanfard MD, Esther Oliva MD, Dora C. Dias-
Santagata PhD, Sakiko Kojiro, Neil S. Horowitz MD, A. John Iafrate MD PhD, Darrell R. Borger PhD and Bo R.
Rueda MD

Massachusetts General Hospital, Boston, Massachusetts 02114, USA

Purpose. Invasive vulvar cancer represents 5% of gynecologic cancers and it is estimated that 3,580
new cases and 900 deaths will be reported in the United States for 2009. Treatment for vulvar
squamous cell carcinoma (VSCC) has changed little over the years and surgical incision and inguinal
lymph node dissection remain the standard of care. This standard of care treatment is associated
with significant morbidity and recurrence; therefore, understanding the molecular mechanisms of
this malignancy has the potential to expand treatment to include targeted therapies. While it is clear
that molecularly-targeted therapies play a major role in an adjuvant setting in other epithelial tumors,
there is little understanding of the underlying etiology of vulvar carcinoma. Molecular alterations in
a subset of patients leading to Epidermal Growth Factor Receptor (EGFR) gene activation have been
shown to confer therapeutic response to targeted therapies in a number of cancers of epithelial origin.
Therefore, the purpose of our study was to evaluate genetic alterations in the EGFR gene that could
be used to expand clinical management of VSCC through the inclusion of molecular targeted thera-
pies.

Methods. A cohort of 51 patients seen at the Massachusetts General Hospital Cancer Center from
1994-2007 with primary VSCC was selected and represented all FIGO stages. Assessment of the
following was completed: EGFR protein levels using immunohistochemistry (IHC), EGFR muta-
tional analysis using PCR and EGFR gene amplification using fluorescence in situ hybridization
(FISH). EGFR gene amplification and protein expression were correlated with a variety of clinical
prognostic variables (age, stage, recurrence, lymph node status and survival).

Results. A high level of EGFR protein expression was observed in 31% of VSCC patient samples.
Common activating mutations in the tyrosine kinase domain of EGFR were not broadly identified in
this cohort. Chromosomal analysis using FISH demonstrated amplification of the EGFR gene in
12% of patients. Decreased survival was observed in patients with additional copies of EGFR. Gene
amplification was an independent prognostic variable, even when controlled for age, stage, grade,
lymph node status and high-risk HPV status

Conclusions. Our data demonstrates that a subset of patients with squamous cell carcinoma of the
vulva present with EGFR gene amplification that is HPV-independent and associated with poor
prognosis. Given the association of EGFR amplification with response to targeted therapies in other
tumor types, EGFR amplification status in patients with VSCC may identify patients who will bene-
fit from small molecule tyrosine kinase inhibitors that target the EGFR pathway. This investigation
compliments an ongoing Dana Farber Harvard Cancer Center prospective clinical trial for patients
with VSCC. Early correlative data from a patient on trial who exhibited a partial response to 6
weeks of therapy demonstrated EGFR gene amplification. This case reinforces the possible clinical
implications of this translational investigation and the application of small molecule inhibitors in the
treatment of vulvar squamous cell carcinoma.
BA S I C S C I ENCE: S ECOND P L A CE
80
Arachidonate 5-Lipoxygenase Expression in Papillary Thyroid Carcinoma Correlates
with Invasive Histopathology and Promotes Extracellular Matrix Degradation via MMP-9
Induction

1
Nicolas T Kummer MD-PhD Candidate Year VII (MS III)
2
Cordon Iacob MD,
2
Stimson Schantz MD,
1
Raj K Tiwari
PhD,
1
Jan Geliebter PhD

1
NYMC, Department of Microbiology and Immunology, Valhalla, NY;
2
New York Eye and Ear, Ear Infirmary, New
York, NY

Purpose: Papillary thyroid carcinoma (PTC) is the most common thyroid and endocrine malignancy,
accounting for ~80% of all thyroid cancer. Aggressive disease results in poor prognosis, however
little is known about the pathogenesis of aggressive PTC. Evidence suggests arachidonate 5-
lipoxygenase (ALOX5) promotes tumorigenesis of various carcinomas. Here we investigate the role
of ALOX5 in the pathogenesis of aggressive PTC, with hopes of identifying new therapeutic targets
and disease markers.

Methods: To investigate the correlation between invasive PTC and ALOX5 expression, fold differ-
ences in ALOX5 mRNA were calculated between pairs of matched PTC and normal thyroid tissue
and correlated to a Tumor Invasive Score (TIS, based on histopathology). mRNA was quantified by
real-time RT-PCR and significance was determined by Spearman correlation coefficient. To deter-
mine the effects of ALOX5 on PTC pathogenesis; cell proliferation, MMP protein expression, and
invasion were investigated in a PTC cell line transfected with an ALOX5 expression vector, or an
empty vector control. In follow-up, ALOX5 induction of MMP-9 secretion was verified by western
blot analysis of conditioned media from the transfected cells, and cells conditioned with 5-HETE (a
metabolic product of arachidonic acid and ALOX5). To determine if ALOX5 enhances invasion via
MMP-9 activity, invasion assays were repeated with the transfected cells and the addition of MMP-9
inhibitors.

Results: Mean expression for ALOX5 in PTC and matched normal tissue were 3.39 (SE 2.09) and
0.27 (SE 0.10) copies/GAPDH (respectively P=0.002). The fold increase in ALOX5 mRNA expres-
sion between matched samples significantly correlated with TIS (Spearman correlation coeffi-
cient=0.74, P=0.0007). Transfection of an ALOX5 expression vector into the PTC cell line conferred
a 3.12 fold increase in invasiveness compared to the empty vector control (P<0.001), and was re-
versible by ALOX5 inhibition. Serum free conditioned media of the transfected cells demonstrated a
2.00 fold increase of MMP-9 (P=0.03) compared to the empty vector control, determined by MMP
protein array, and confirmed by western blot analysis. Additionally, MMP-9 levels increased in a
dose dependent manner in response to 5-HETE, determined by western blot analysis. Inhibition of
MMP-9 activity, by either chemical inhibition or by an inhibitory antibody, abrogated the ALOX5
mediated increase in invasion.

Conclusions: Current evidence characterizes ALOX5 primarily as anti-apoptotic in cancer. Here we
demonstrate that ALOX5 correlates with tumor invasiveness and contributes to PTC pathogenesis by
enhancing invasion via MMP-9 induction. These findings signify a new paradigm for ALOX5 in
tumor pathogenesis which may be exploited for diagnostic and therapeutic advantages in aggressive
PTC.
BA S I C S C I ENCE: THI RD P L A CE
81
Julie Grimes
Wendell Park

Ann Tran
Infinity
Tribute to Generosity

The editors and staff of the Quill & Scope would like to thank the generous
donors whose financial and moral support have made this publication possible.

-Jenny Lam & Edward Hurley



Dr. Karl P. Adler Dr. Ralph A. OConnell
Dr. Gladys Ayala Dr. Norman Levine
Dr. Muhammad Choudhury Dr. Sansar C. Sharma
Diana Cunningham, MLS, MPH Department of Admissions
Dr. Joseph T. English The Student Senate
Weston Foundation Anonymous




84

Radeeb Akhtar (radeeb_akhtar@nymc.edu); NYMC class of 2013, BA in Psychology from New York
University. He is the inventor of the NYMC_ART club born 2009. He is pursuing international medicine
through the MD/MPH program. A very active, introspective, and not-your-typical medical student. He
enjoys creating art and hopes that he can continue it throughout a medical career. You'll often find him
figuring out ways in which to save the world.

Lea Alfi (leaalfi@gmail.com), class of 2011, graduated from Yale University in 2006 with a B.A. in
Psychology and spent one year teaching the second grade in Manhattan before entering medical school.
She is currently enjoying her clinical rotations, and she is looking forward to choosing a specialty.

Ava Asher (ava_asher@nymc.edu), class of 2012, graduated from University of Oregon in 2006. She is
leaning toward family medicine, and is interested in health care reform. She originally wanted to be an
art teacher, got lost and found herself in 2nd year of medical school.

Katrina Bernardo (katrina_bernardo@nymc.edu), class of 2012, is a native of New York and can't wait
for third year rotations to begin.

Alanna Chait (Alanna_Chait@nymc.edu), class of 2012, is a 2004 graduate of Columbia University,
where she majored in Psychology, English, and Comparative Literature. Before entering medical school,
Alanna conducted research in child psychiatry and performed with several opera companies. Alanna is
interested in psychiatry and pediatrics, and she plans to incorporate writing and singing into her medical
career.

Linda DeMello (linda_demello@nymc.edu), class of 2013, is an executive board member of American
Medical Womens Association, a member of the Blood Drive Committee, and a managing editor for
Quill & Scope. When she doesnt have her head in the textbooks, she writes fiction and spends as much
time as possible with her husband. She loves to run, drinks coffee by the gallon, and she still doesnt
know what kind of doctor she wants to be when she grows up.

Anna Djougarian is a graduate of the Macaulay Honors College at CUNY Hunter with a BA in Psy-
chology. She loves friends and family, sunny days, cooking, dancing, learning new things and frequent
"The Office" study breaks.

Marissa Friedman (marissa_friedman@nymc.edu), class of 2013, graduated from New York Univer-
sity in 2007 with a B.A. in psychology. She is expected to receive a Masters in Health Administration
from Hofstra University. She is also the first year representative for the NYMC chapter of the AMA,
and is involved with the Medical Society of the State of New York, Medical Student section.

Julie Grimes, class of 2012, graduated from Boston College in 2007 with a degree in Psychology.
When she's not studying, she enjoys playing her trombone, being outdoors, and spreading Red Sox love
in the heart of the evil empire.

Ian Hovis, class of 2012
Michael Karsy (Michael_karsy@nymc.edu) is a year four MD/PhD candidate in the Department of Ex-
perimental Pathology. He is currently the treasurer of the Genocide Awareness and Prevention (GAAP)
club at NYMC. He is a Leo, enjoys reading, and long walks on the beach.

Poonam Kaushal (poonam_kaushal@nymc.edu), class of 2011, graduated from the University of Cali-
fornia, Irvine with a B.S. in Neurobiology is interested in pediatrics and hopes to aid underserved chil-
dren and influence health policy in the future.

CONTRIBUTORS
Anita Kelkar (anita_kelkar@nymc.edu), M.D. class of 2011, received her Master of Public Health de-
gree from Dartmouth College and her B.S. in Psychology from Virginia Commonwealth University. She
is interested in cardiovascular medicine, and hopes to pursue a career in the field after finishing medical
school.
Andrei Kreutzberg (akreutzb@gmail.com) is a second year medical student. His interests include mu-
sic, nutrition, running, and psychiatry.

Eliott Lee, class of 2012, received his B.A. from Case Western Reserve University in 2003. After col-
lege, he tried out numerous paths including stock broker, english teacher and law student before settling
on medicine. He enjoys travel and photography and hopes he'll find more time for both in the future.

W. G. Stuart Mackenzie (stuart.mackenzie@gmail.com ) class of 2013, was born and raised in Canada,
and a graduate of both the University of Toronto and Boston University. Having spent time working in
Internal Development and Infectious Disease, he is excited to read other NYMC students' perspectives
on International Medicine.

Danielle Masor (danielle_masor@nymc.edu), class of 2013, graduated from Swarthmore College with
majors in French Literature and Economics. While slowly finding her way to the medical field, she has
worked in the insurance and non-profit sectors, among others. Danielle loves kids and is considering
pediatrics, although she has not yet done a rotation in this field.

J. Paul Nielsen (jonpaul_nielsen@nymc.edu), MD/MPH, is proud to have contributed to the 3
rd
edition
of Quill and Scope. Paul is pursuing a career in radiology. In addition to writing about chronic and in-
fectious diseases in NYC, Paul enjoys playing guitar, snowboarding, and basketball.

Nadia Nocera (nadia_nocera@nymc.edu), class of 2013, is a 2009 graduate of Brown University where
she majored in biology. She is currently a member of AMSA, the surgery club, the blood drive commit-
tee and the NSF foundation, which is a not-for-profit organization focused on providing health and edu-
cation assistance to rural communities. Her current interest is to pursue reconstructive surgery.

Sabrina Perrino, class of 2012, earned a B.S. and M.S. in Biology from the University of California,
San Diego. She proudly participates on the executive boards of the NYMC Pediatrics Club, the Latino
Medical Student Association, and La Casita de la Salud. After the sun goes down in Valhalla, she exe-
cutes culinary masterpieces while listening to neo-soul, and plots how to get back to San Diego for resi-
dency.

Steve Rockoff (steve.rockoff@gmail.com), class of 2013, graduated from Northwestern University in
Evanston, Illinois after studying psychology and biomedical engineering. He has developing interests in
Internal Medicine and Psychiatry. Some of his favorite pastimes include watching baseball, eating
sushi, and playing tennis.

Jordan Roth (Jordan_roth@nymc.edu) is an M.D. candidate for the class of 2010. He is looking for-
ward to graduation and launching into an exciting career in Family Medicine. His passions in medicine
include improving health care access and health education for the underserved, global health and mis-
sion work, addiction medicine, and caring for families across the lifespan. As a native of the Pacific
Northwest, he loves enjoying the outdoors with his beautiful wife Lauren.

Luke Selby (Luke_Selby@nymc.edu) is a third year student who, in his very limited free time, enjoys
hiking, running, outdoor photography and SCUBA diving. These photos were taken on his honeymoon
in Belize in April 2009.
Navid Shams (Navid_Shams@nymc.edu), class of 2013, is interested in Pediatrics and the Infectious
Disease specialty. His passion for poetry began when reading and reciting Persian poems as a child in
Iran. He has an undergraduate degree in Creative Writing and Biology from Carnegie Mellon Univer-
sity. Prior to medical school, he attended Boston University for a Masters in Public Health, with concen-
trations in International Health and Epidemiology.

Gavin Stern (gavin_stern@nymc.edu) is a MD/MPH student in the Class of 2013, majoring in health
policy and management. He studied English, biopsychology, and biology at the University of Michigan
and is an alumnus of the Michigan Daily. Though a native of New York and alegal resident of Florida,
he identifies most closely with Michiganders. His high school experience as an ice cream man has led
him to choose the field of pediatrics.

Sukhpreet Singh (Sukhpreet_Singh@nymc.edu) attended the University of California, Irvine and re-
ceived her B.S. in Developmental and Cell Biology with a minor in Chicano/Latino Studies. Having
grown up in a country where medical care is hard to come by (and also at an expensive cost), she discov-
ered the power of preventative medicine through the forum of teaching. Having worked with a similar
project at her alma mater at UCI, she decided to organize a program based on the same principles, but
with a more grand vision at New York Medical College.

Ann Tran (ann_tran@nymc.edu), class of 2012, graduated from Hunter College with a degree in An-
thropology. She is involved with the pre-medical mentoring program at NYMC and is considering a ca-
reer in Family Medicine.

Charles Volk (charles_volk@nymc.edu) is a first-year medical student. He is originally from Bis-
marck, North Dakota and did his undergrad at the University of Minnesota - Twin Cities. He is the 2013
Scribe President, and is also active in PNHP, the NYMC community garden, and a med student blue-
grass band. He is currently an officer under the Navy HPSP scholarship and lives on campus with his
wife, Katrina.

Daniel Waintraub (daniel_waintraub@nymc.edu), class of 2013, graduated from Yeshiva University in
2009 with a B.A. in Biology prior to embarking on his path through New York Medical College. His
interests include writing, guitar, pretending to do work in the library (or elsewhere), mellow music, run-
ning, fiction novels, day dreaming, and a well done mac and cheese. He is greatly looking forward to
making it through medical school with his sanity intact.
QUILL & SCOPE STAFF

Humera Ahmed (humera.ahmed@gmail.com), class of 2012, received her B.A. in English from Boston
College in 2007. In the intervening two years before medical school, she spent time researching the
safety and efficacy of novel, catheter-based approaches to the treatment of cardiac arrhythmias. Follow-
ing in the footsteps of her idols: Paul Farmer, MD and Sanjay Gupta, MD, Humera hopes to touch the
world by avidly pursuing her passions for medicine, literature, social justice, and travel.

Alanna Chait (alanna_chait@nymc.edu), class of 2012, received her B.A. in Psychology and English
and Comparative Literature from Columbia University in 2004. Following graduation, she conducted
research in the Department of Child Psychiatry at Columbia University, where she co-authored several
papers and developed a music program for children with special needs. In addition to her Quill and
Scope position, Alanna participates in PsychSIGN and is interested in pediatrics and psychiatry.

Linda DeMello (lindardemello@gmail.com), class of 2013, is an executive board member of the
American Medical Womens Association, a member of the Blood Drive Committee, and a managing
editor for Quill & Scope. She graduated magna cum laude from the University of Massachusetts Dart-
mouth in 2007 with a BS in Biology and a minor in Biochemistry. She worked in clinical laboratories
for six years in several hospitals across southern New England before her acceptance into NYMC. When
she doesnt have her head in the textbooks, she writes fiction and she spends as much time as possible
with her husband. She loves to run, drinks coffee by the gallon, and she still doesnt know what kind of
doctor she wants to be when she grows up.

Jonathan Drake (jonathan_drake@nymc.edu), class of 2013, received his B.S. in Zoology from the
University of Massachusetts Amherst in 1993. Following graduation, Jon worked for nine years in oph-
thalmology research, including seven years at the University of California San Francisco, and two years
at Miyata Eye Hospital in Japan. He then shifted to neuroscience research while receiving masters de-
grees at Boston University School of Medicine and at the University of Massachusetts Boston, and
while working in neuropsychology and neuropathology at the Framingham Heart Study. Jon plans to
pursue neurology as a specialty, and enjoys rock climbing, windsurfing, cooking, and traveling in his
spare time.

Loren Francis (loren_francis@nymc.edu), class of 2013, received her B.S. in Applied Mathematics and
Biology from Brown University in 2009. She is a member of the Pediatrics Interest Group and the soon-
to-be famous flag football team Valhallabackers. When not studying, she enjoys reading, spending time
outdoors, and baking anything chocolate.

Marissa Friedman (marissa_friedman@nymc.edu), class of 2013, graduated from New York Univer-
sity in 2007 with a B.A. in psychology. She is expected to receive a Masters in Health Administration
from Hofstra University. She is also the first year representative for the NYMC chapter of the AMA,
and is involved with the Medical Society of the State of New York, Medical Student section.

Edward Hurley (edward_hurley@nymc.edu), class of 2012, graduated magna cum laude from the
University of Massachusetts-Amherst with a dual major in Journalism and Philosophy. Prior to medical
school, Edward spent nearly a decade as a journalist both in newspapers and in online media. When not
studying, he enjoys spending time with his beautiful wife, Sarah. Edward is considering either pediatrics
or geriatrics as he adores kids and older folks but is lukewarm about people in the middle.

Jenny Lam (jenny_lam@nymc.edu), class of 2012, received her B.A. in Biological Sciences from
Columbia in 2007. She is currently interested in a number of fields in internal medicine, namely endo-
crinology, gastroenterology and hematology. She enjoys the performing arts, cooking, tennis, and
bringing people together.

Calley Levine (calley_levine@nymc.edu), class of 2013, graduated from the University of Pennsyl-
vania in 2009 with a B.S.E. in Computer Science & Graphics and a minor in Psychology. She is cur-
rently a member of NYMC's Student Senate.

Becky Lou , class of 2013.

W.G. Stuart Mackenzie (stuart.mackenzie@gmail.com), class of 2013, was born and raised in Can-
ada. He is a graduate of both the University of Toronto and Boston University. Having spent time
working in International Development and Infectious Disease, he is excited to read other NYMC stu-
dents' perspectives on International Medicine.

Danielle Masor (danielle_masor@nymc.edu), class of 2013, graduated from Swarthmore College with
majors in French Literature and Economics. While slowly finding her way to the medical field, she has
worked in the insurance and non-profit sectors, among others. Danielle loves kids and is considering
pediatrics, although she has not yet done a rotation in this field.

James Naples (jnaples513@gmail.com), class of 2012, grew up in CT and graduated from Boston
College in 2008 with a degree in Biology and Chemistry. He enjoys spending time outdoors, running,
and being active. While he is keeping his options open for the future, he is very interested in oncology.
He hopes to practice as a clinician and also stay in touch with laboratory research and academic
medicine.

Allison Navis (allison_navis@nymc.edu), class of 2013, was born and raised in Los Angeles. She
graduated from Boston University in 2007 with a BA in both Neuroscience and French. Upon gradua-
tion, Allison moved to New York City where she worked in finance while also pursuing her interests in
the arts. Allison currently lives in Brooklyn and is a first-year medical student at NYMC.

Janet Nguyen (janetnguyen14@yahoo.com), class of 2013, graduated from University of San Fran-
cisco with a B.S. in Biology. Following graduation, she worked at Genentech Inc. in Quality Control
Stability. After dabbling in the industry, Janet joined the Research Institute of California Pacific Medi-
cal Center where she performed research on a novel gene therapy technique to treat monogenic dis-
eases, such as Sickle Cell Disease. During her spare time, she enjoys cooking, watching TV and spend-
ing time with her family and friends.

Chris Ours (christopher_ours@nymc.edu), class of 2013, is just a city boy, born and raised in south
detroit. He took the midnight train goin' to New York, class of 2013. He graduated from The College of
William and Mary with a B.S. in Biology and Philosophy. In Williamsburg, Virginia, he did research
on germline stem cells of Drosophila melanogaster and worked as an Emergency Room scribe for over
two years. At NYMC, he serves on the 1st and 2nd year curriculum committee and has helped out on
the SPAD fundraising committee. When not neck deep in notes, he enjoys cooking, mysteries, and ter-
rible television medical drama.

Sarah Pozniak (sarah_pozniak@nymc.edu), class of 2013, graduated from Boston University in 2006
with a B.A. in American Studies. After graduation she worked for three years as a medical assistant to
a primary care physician in Cambridge, Mass. She likes pilates, running and reading The New Yorker.
Sarah is interested in primary care.

Rajdeep Pooni (rajdeep.pooni@gmail.com), class of 2013, is a graduate of UC Davis, where she stud-
ied both biological sciences and English literature. Her diverse interests include healthcare, literature,
and traveling.

Aditya Sarvaria (aditya_sarvaria@nymc.edu), class of 2012, is from Murfreesboro, TN. He received
his B.A. in Biology from Wake Forest University.

Navid Shams (navid_shams@nymc.edu), class of 2013, is interested in Pediatrics and the Infectious
Disease specialty. He has an undergraduate degree in Creative Writing and Biology from Carnegie
Mellon University. Prior to medical school, he attended Boston University for a Masters in Public
Health, with concentrations in International Health and Epidemiology.

Mike Smith (smithixy@gmail.com), class of 2012, graduated from Boston College in 2008 with a
degree in Biology. In addition to his duties at Quill and Scope, he also designed the website for
Student Physician Awareness Day. In his spare time, Mike enjoys sports, music, eating, and American
Idol.

Gavin Stern (gavin_stern@nymc.edu), class of 2013, is a MD/MPH student in the Class of 2013, ma-
joring in health policy and management. He studied English, biopsychology, and biology at the Uni-
versity of Michigan and is an alumnus of the Michigan Daily. Though a native of New York and a le-
gal resident of Florida, he identifies most closely with Michiganders. His high school experience as an
ice cream man has led him to choose the field of pediatrics.

Annabelle Teng (annabelle_teng@nymc.edu), class of 2012, graduated from University of California
San Diego in 2005 with degrees in Anthropological Archaeology and Biochemistry/Cell Biology. Prior
to medical school, she spent close to three years working on immunology and allergy research in
Yokohama, Japan. She enjoys cooking/baking, salsa dancing, karate, oil painting, and learning foreign
languages.

Dennis Toy (dennis_toy@nymc.edu), class of 2012, graduated from University of Chicago in 2007
with an A.B. in Biological Sciences. As an undergraduate he worked for several years as a student
docent at the Smart Museum of Art. In addition to art and medicine, his interests include paleontology,
which has given him the opportunity to go on several excavations. His favorite dinosaur is the
diplodocus. When not playing video games, Dennis enjoys running and playing tennis.

Yin Tong (yin.tong.ak@gmail.com), class of 2013, graduated with a BS in Human Development from
Cornell University in 2008. She grew up in Beijing and Alaska as a misguided snowbird (summers in
Beijing, winters in Alaska) and served as the executive editor of Cornell's Ivy Journal of Ethics. At
NYMC, she is a first year coordinator for Big Sib Lil Sib, helps out on the SPAD PR committee and is
a tour guide. She enjoys skiing, reading, sleeping and cultivating an irrational fear of birds, clowns and
occasionally, the dark.

Alex Trzebucki (trzebucki@gmail.com), class of 2013, graduated from Davidson College with a B.S.
and biology and pursued graduate studies in Biomedical Science at Tufts University School of Medi-
cine. Alex has conducted AIDS research at Albert Einstein College of Medicine, cardiothoracic re-
search at Columbia University, and was a member of the Cardiothoracic Transplant Team at Colum-
bia. Alex was the managing editor of a school newspaper and is an avid photographer, filmmaker, and
urban explorer.

Michael Weinreich (michael_weinreich@nymc.edu), class of 2013, grew up in Poughkeepsie, NY.
He received his undergraduate degree from Cornell University.


LEND A HELPI NG HAND. . .
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