All's Fair in Love and Warfarin?

During our orientation week, we were discussing how medical studies were often biased against underrepresented minorities. I was well aware of how drug companies will sometimes choose to only study genetic lines that they see as more "profitable." For the most part, this doesn't bother me too much. I get upset when I think that some people's lives are put in danger because drug companies haven't done enough research on how the drug differentially reacts with the large variance in human genotypes. Warfarin, an anti-coagulant, is a good example. But it's technically a free market, and there is a lot of genetic variation in the human population--I understand that you can't study everyone.

That being said, I was enraged when my thoughts on this topic were put succinctly by a female professor at the University of Illinois. I found this article on the blog io9.com. It's a pretty good blog, and they post enough science and medical articles to be interesting for anyone interested in science and medicine:

University of Illinois anthropologist Kathryn Clancy, who studies medicine and gender, told me that her "sexapocalypse to celebrate" will come when gender bias is drained out of medical studies. She imagines a world where:

Gender bias no longer influences pharmaceutical priorities or federal funding, and when we accept a wider interpretation of normal variation in human form and function. Issues like why black women have higher mortality rates for breast cancer, or why postpartum hemorrhage seems to strike so randomly yet is so deadly, or the black box of transgender reproductive health, all would be resolved before cures for erectile dysfunction or baldness. Finally, we would do away with all the underfunded, misunderstood syndromes – polycystic ovarian syndrome, chronic fatigue syndrome and premenstrual syndrome, to name just a few – and start to identify the origins of these clusters of symptoms.

In Chicago it is certainly true that black women have a higher mortality rate from breast cancer than white women. I actually helped my aunt--who works with public health at the University of Illinois at Chicago--with a project that would help inform black women where they could go to get free mammograms. It's one of the things that I would like to do more with in the future.

But to be honest, I'm also quite upset that no one seems to be working on a female Viagra. Either people assume that it wouldn't make as much money (which may or may not be true) or they assume that there isn't any need for it. Either way, the lack of adequate care for women, of all races, in this country is pretty substandard. It's not just "silly" things like female viagra, or spending more money on male problems--it's larger care situations where women are regularly put at a disadvantage. Whether it's the government putting up legislation to make birth control inaccessible for poorer women, or the fact that female heart attacks are less successfully diagnosed than men's, there's still sexism in health care.

Bllllech! (enGROSSed* by Dermatology)

Traditionally, Chicago Medical School tries to practice systems-based teaching. It's redundant, but after you learn what the heart looks like (physically), what it does (physiologically), and what hormones can do to it (chemically), you (hopefully) now a lot about the heart simply by going to class and being semi-attentive.

Systems-Based teaching has fallen apart after our first two exams: Pharmacology is covering autonomic nervous system; Microbiology is introducing itself; and finally, Pathology is teaching us about skin.

Now I could go on another rant about Dermatology. I think it's worthless. I've seen a dermatologist once, and it was interesting but also pretty useless. I also feel like most of the serious derm conditions (i.e., skin cancer...) are mostly white people problems. I know I should care, but it's just that unless it's a condition I have or a condition that one of my friends or relatives has, I don't care nearly as much as a "doctor" probably should (I don't know why I threw quotes around the word doctor. Suspicious...)

So my feeling towards Dermatology are pretty negative (also, somehow, racist). People keep telling me that sometimes dermatology is really important and not superficial. And while I respect this point, it doesn't seem like enough for me.

This has recently changed. I was told that 1) Dermatology has the most medical conditions/illnesses of any specialty and 2) Dermatology offers insight into internal medicine illnesses.

skin disorders can be manifestations of systemic disease.


*Title is totally derived from the great Alice Lee, a fellow compatriot of CMS

Ambiguus

In the wise words of our anatomy professor, Dr. Manion:

"If you really don't know exactly what something does, you probably shouldn't take it out."

...and that's why you have tonsils.

Did you know?

There are sexual headaches. That's right--the human body can get a headache from having sex. Sex headaches. And I have to know that. I did not want to know that.

Discomforting

For the last two weeks in anatomy lab we have been sawing through a human head. It's discomforting. At first we were just sawing through the occipital and temporal bones. But then we started skinning the face. At first I found it amusing that our body, Debbie, was still very attractive with only dermis covering her face. But then we cut through her, straight down--through the chin, lips, nose, forehead. Between the eyes. Still pretty. But then we took a hand saw to her face. When we opened her mouth we looked around her palate. She was missing teeth. A lot. She only had 22. Most people have 32-36 (wisdom teeth are obnoxiously removed). I noted a cavity that hadn't been filled. No fake teeth had been added to her alveolar plate.

Someone suggested that perhaps Debbie was homeless. That did not sit right with me.

So I forgot about it.

It's really interesting, getting to know someone on a rather intimate level. Debbie, this entire year, has seemed very real to me. I have enjoyed getting to know her. But it has made me think. I'm thinking about the patients I might one day have. I'm thinking about all the information they'll give me that I'll have to file away under "TMI" and all the information I will be legally obligated to write down. And then there will be things I will want to forget but can't. I am sure even in this I will be happy I chose the profession. People are fascinating. I could observe people all day. I am excited for that part of medicine. What I am worried about is that I may one day be able to handle discomforting information much more readily than I do now. And if I no longer feel  can I still be capable of empathizing? Because whenever something bad happens to someone, the natural response is to imagine how you would feel if you were them--mirror neurons fire away and all that jazz. That's why when you see someone break their ankle, you're suddenly much more aware of the weight pressing down on your feet.

Which is why I should be wincing in pain as my lab partners hack at Debbie's skull. But I no longer feel like something is horribly wrong when I probe through her nerves and vessels, peel away connective tissue, rub my fingers on exposed bone. I feel like a serial killer.

Now that's discomforting.

Eczema... Psioriasis

I aced the "Essentials of Clinical Reasoning" (ECR) exam on dermatology. I aced it. And yet... I still have no idea what's causing the skin around my nose and under my eyes to flake. I'm not sure if the white patch above my shin is an autoimmune response or simply a response to irritation from all the wool socks I wear. I know that eczema runs in my family. But the one time I saw a dermatologist, he told me I had psioriasis alba. So no matter how much I try to clinically reason with myself, I still fall short of any conclusive self-diagnosis. Moral? Good grades are not congruent with applicable knowledge.