PhD vs MD

 

Broad Street; M.D. vs Phd.

Broad street is a very interesting road, full of lively locals and interesting visitors, it is never a dull time driving down it. When you approach Shriners Hospital and Temple Hospital on the left, youcan see an equally impressive building on the right. This is the MERB, or Medical Education and Research Building for Temple. It is basically the hub for neuroscience research. Broad street now becomes more of a divide then just a physical one. On the left (when you are heading South, heading towards William Penn) the Shriners building along with the Temple Hospital are very impressive. They also represent the M.D.’s, that is, the medical doctors, the students who went to college and opted to enter med-school. Very honorable. These type of doctors, as opposed to the doctorates, are what I call learners or practitioners. They are the ones who learn the knowledge, memorize all the information and practice what they know on people, usually the public. On the other hand, on the right, you have temples neuroscience building. This structure is also very impressive (as an inpatient at shriners I actually used to sit and watch out the window while they built this building). This building is filled with the Phd’s. These doctors I call the discoverers. They are the ones who (usually in the scientific community at least) do the research and experiments. They are the ones who discover new information and turn it over to the M.D.’s to put into practice. I learned all this by speaking with Dr. (Mickey) Selzer, the man who has an M.D. and a Phd., as well as runs the entire six floor of the building, funded by Shriners and Temple.

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On Understanding

On Understanding

I have come across a very important and relevant fact of the idea of understanding things. We do not simply understand something and be done with it. We say we understand something, maybe something for one of our classes, or something we see on TV. We tell ourselves that we understand and in a sense we may be right. What I think is important to realize is that understanding something isn’t a yes or no concept it is not black or white. Rather there is a spectrum, or varying degrees of understanding. For example, while reading Six Easy Pieces by Richard Feynman, I came across many instances of Feynman admitting that physicists do not understand some phenomena, like what energy is, why it is conserved, the relationship between gravity and the quantum world, and even gravity in general. These areas of physics and astronomy are not new and it took my by surprise when Feynman said that we do not understand them. Upon further reading of Feynmans explanations it soon became apparent as to what he meant. You see there are different levels, or degrees of understanding. You can understand how something works, say for instance, an fMRI machine. I have done a good amount of research on this topic interning at FI. I know that an MRI machine is essentially a giant magnet that aligns the nucleus of hydrogen atoms into an equilibrium state. A radio wave then quickly blasts the atoms out of equilibrium into a higher energy level. As the radio wave stops the atoms come back down into equilibrium, a stable energy level, giving off energy. This energy is read by the machine which creates a picture. Now for any regular person this seems to be a pretty good understanding. But what about the engineer making the MRI machine. He might need to know a little more about what it is he’s doing. I am useless to the engineer building the machine because my level of understanding is not complete. It is partial. I might even say it is merely fractional of the engineer. This is why Feynman once said, “that which I cannot create I do not understand”. A perspective I like to look at this idea of understanding from is that of a child. Recall the wonderment of a child, asking why, why, why endlessly. I have no began judging my own comprehension on how many why’s I can answer about a certain subject. Going back to the MRI machine I think I would be able to answer only a few why’s at most. I do not understand magnetism well at all and I do not understand electromagnetic radiation, let alone radio waves well either. I really do not know how an MRI machine works, I only know how its major parts work. I think eventually, down the endless chain of why’s we will always hit a dead end where we must admit to our tiny inquirer that we do not know the next why and must subsequently admit we don’t know and that is just the way it is.

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Who Are You?

Sometimes in order to understand yourself it is necessary to talk to your self, or better yet type to yourself, in order to figure out what is going on inside. Just like writing a paper or novel it can be advantageous to jot down your thoughts, feelings, goals, hopes and dreams in order to better connect with your true self. I am 21 years old and after stripping off all the labels that have been put on me, for instance, student, son, brother, PA resident, wheelchair user, former hockey player, avid writer, etc., I am not sure at all who I am. All of these descriptions are just that, they describe me, they describe the person who I am. Interestingly, many of those labels do not describe who I was or who I will be. Either way you see it, we are not just labels stuck to a person for a certain amount of time. We are much more deeper then that, but that deepness and complexity of who we are makes it that much harder to know ourselves. How different do you act when you are interacting with different people? For example your spouse, your brother, your mother, you mother-in-law, your waitress or even your state representative. Now each separate person calls for a different circumstance, is it that hard to imagine that each situation calls for a different you? You may say that this is the common practice of “switching hats” if you will and maybe you are right. I am not expert in consciousness, psychology or sociology but I have 21 years of experience under my belt and I think that counts for something. I also think that the analogy of different hats does not express the reality of the always changing you. I have heard of the seven years fact, that you replace all of your bodies cells within seven years and I don’t think it is that huge of a problem and I am fairly certain it is untrue. Nevertheless, seven years is such a long time to wait for a “real new” you to emerge, just look at how fast people, not to mention children change from year to year. We are not our past and we are not our future. I will be someone different tomorrow albeit only very slightly different. The fact is that your brain changes everyday, with each new lesson and each new experience changing ourselves into someone different. Who will you be tomorrow and the next day and the next day…?

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Literature Review of Stem Cell Transplantation for SCI

For most of medical history the spinal cord has been a place of mystery and uncertainty with injuries resulting in little or no improvement in the patient’s condition. In fact, often times surgery would damage the spinal cord even further leaving the person worse off than before. Perhaps it is not surprising then that the earliest known medical text, discovered in Egypt and dating back to 2000BCE, described injuries to the spinal cord as ‘an ailment not to be treated’. With the exception of the last hundred years or so, doctors and surgeons have achieved little insight into treating spinal cord injuries. These types of approaches persisted for many years along with the assumption that the spinal cord and central nervous system as a whole were unable to regenerate. This all changed in the early 1900’s when Santiago Ramon y Cajal and his team discovered that the spinal cord was actually able to heal and regenerate itself, if only to a degree. Ever since this landmark discovery the race to ‘cure’ damaged spinal cords had begun. However, it would take one more discovery to set the medical world down a promising and realistic path to end chronic spinal cord injury once and for all. In 1981, Martin Evans, of the University of Cambridge, became the first person to identify embryonic stem cells. The implications of this discovery were sufficient enough to land Evans the Nobel prize and researchers and scientists alike have been studying the possible uses of embryonic stem cells ever since.

To understand how embryonic stem cells and stem cells in general have the potential to heal spinal cord injuries (SCI), an adequate understanding of an SCI necessary. An SCI occurs when a part of the spinal cord is damaged, usually through contusion or compression. The spinal cord is just as sensitive to trauma as the brain is and any insult to it can cause a significant loss of function. At the actual site of the spinal cord lesion many processes are taking place at the cellular and molecular level. The primary lesion can cause acute ischemia as well as inflammatory swelling that can cause secondary lesions which are often more damaging than the initial injury. Furthermore, axonal and synaptic destruction, cell death through excitotoxicity, the deregulation of ion balance and the blocking of action potentials all contribute to the chaotic and devastating environment of an SCI. Additionally, astrocytes begin to form glial scars at the lesion immediately following the injury. Glial scarring can actually promote axonal regeneration by isolating the nerve tissue from swelling. Unfortunately, because few axons can grow past the scar tissue, glial scarring can also inhibit neuroregeneration. Stem cells however, can potentially bridge this glial scar and reconnect the electrical signals from the brain to lower parts of the body. They can also minimize the inflammation and swelling rendering secondary lesions obsolete. These two issues have been at the heart of stem cell research associated with SCI and in recent years experiments around the world have shown incredible promise. In this paper an overview of the research on the major types of stem cells being researched to treat spinal cord injury is discussed.

Shwann Cells

Shwann cells (SC) are the main glial cell of the periphery nervous system (PNS) where they are able to help regrow and reconnect the axons of damagaed nerves. This is why SC are the most widely studied type of adult cell for neuroregeneration. Many in vivo experiments on animals have shown how these exceptional cells are able to repair damaged nerves in the PNS. When a nerve is damaged SC’s migrate to the broken axons where they produce and activate neurotrophic factors (NTF) such as nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF). These NTF are crucial for neuronal survival, axon growth and the production of extra cellular matrix. In addition to helping repair and stabilize damaged nerves in the PNS, extensive research has shown that SC’s also produce myline sheaths that surround axons and enable them to send electric impulses quickly and efficiently. It was natural for researchers to wonder how these PNS glial cells would behave in the CNS and if they would have any rehabilitative use following trauma. After further research the answer was a definitive yes. In fact, scientists made an incredible discovery when they found that Schwann cells actually migrate to the CNS following severe trauma where they aid in many endogenous processes. The problem seems to be that there is not nearly enough of them to give the spinal cord any real shot of recovering on its own. The other major problem is that Oligodentrocyte and Astrocytes (glial cells in the CNS) begin to produce molecules that form the glial scars which axons cannot grow across, even with the help of SC’s. SC’s have shown great potential but there needs to be additional approaches that can inhibit the activity of the glial cells scar forming molecules.

Olfactory Ensheathing Cells

Olfactory ensheathing cells (OEC) are a specialized glial cell that is produced in the olfactory epithelium where neurogenesis occurs throughout life. Like their name suggests, OEC’s ensheath and surround the axons of sensory neurons in the olfactory system. There is an extraordinary amount of data that has been produced since 1997 including over 100 papers on the transplantation and potential nervous system repair of OEC’s. It turns out that the excitement for treating damage to the CNS and SCI’s in general is well warranted. OEC’s have a phenotype close to that of the SC, except that they are unique in a few ways. They can behave like SC’s by mylinating and helping to grow axons, but they exist in the CNS as well as the PNS. At first this may not seem like a big deal but to researchers this is an invaluable fact. Because OEC’s exist in the CNS and the PNS they can reach their full potential for healing and repairing a damaged spinal cord. This is in contrast to the Shwann cell, which only exists in the PNS unless it is called on during incidents of trauma. At the cellular level the biological environment ( proteins, bacteria, cells, etc.) dictates how molecules interact. A big problem with some of the earlier stem cell experiments was that even though stem cells have the ability to become any cell, they didn’t know what to become because they were in a completely new environment (ie. A spinal cord). Shwann cells may not be repairing CNS damage as well as they could be for this very reason. The fact that OEC’s behave naturally in the CNS (and spinal cord) means that scientists don’t need to do much in terms of coaxing them to do what they want them to do, they already ‘know’ where they are and what they need to do. Of course the biggest deficit associated with SCI’s is paralysis but many people aren’t aware that SCI’s effect just about every organ and process below the level of injury. OEC’s have been proven by many studies to recover locomotor function even in spinal cords that have been completely transected. In addition to motor recovery OEC’s seem to be especially good at restoring bowel and bladder function as well as phrenic nerve activity which could potentially help get some SCI patients off respirators. OEC’s are very promising and are undoubtedly going to have a role in curing SCI’s although it is not exactly clear how.

Mesenchymal Stem Cells

 

Mesenchymal stem cells (MSC) are found abundantly in bone marrow which is why they are sometimes referred to as bone marrow stem cells. Both of these names are rather misleading as they don’t describe this cells function or potential well at all. The (MSC) is really just a multi-potent stromal cell that has the ability to differentiate into several types of cells depending on the signals it receives from the local cellular environment. The word mesenchymal, coming from the word mesenchyme which means embryonic connective tissue, gives an adequate description of what kinds of cells these MSC’s can turn into. They can turn into bone cells, cartilage cells, blood cells, and fat cells. In recent years these processes have all been reproduced successfully in the lab in culture and in animals. Researchers have also found MSC’s in all kinds of places including the placenta, the umbilical cord and its blood, amniotic fluid, corneal stroma and dental pulp. The goal of some of the early research on CNS MSC transplantation was to see how safe they were and how they would react in an area such as the spinal cord. Fortunately when the MSC’s were injected there was very little backlash from the immune system which is very important considering how much of a burden immunodepressants can be. In addition, because these MSC’s are stromal cells, which means they naturally form supportive structure in the body, researchers are hoping that they will grow into a type of axonal scaffolding through the glial scar enabling nerve signals to be reconnected. Research into how this might work and how to induce this to happen if it doesn’t automatically is ongoing. Scientists have also discovered that when the spinal cord is damaged severely many cells are destroyed leaving spaces were there should be none. This is another area where MSC’s could possibly provide structure and stability where few other cells could.

A Realistic Interpretation of the Data

 

Many studies have shown that stem cells seem to be an effective way to repair a damaged spinal cord after an injury has occurred, however there are some troubling confounds within the data as a whole due to the nature of the spinal cord. While it is advantageous that scientists are using a several different types of stem cell to repair spinal cords, it can also make it difficult to ascertain what exactly is going on. Additionally, there are different methods for getting the stem cells to go where they should and act like they should which complicates things further. Moreover, the different kinds of injuries a spinal cord can suffer make every case, including ones that are run in the same experiment, unique and therefore difficult to judge quantitatively. These three factors, the multitude of stem cells used, the differing treatment methods and the fact that every SCI is unique make comparing data from study to study a complex task which must take into account each variable separately. Perhaps the only facet of stem cell-treated spinal cord injury studies that does not change is the spinal cord itself.

A Not-So-Miracle Cure

While many, if not dozens of various stem cell treatment and therapy programs have produced very promising data it is paramount that we interpret the data in a reasonable and practical way. It is crucial that we limit emotion and desire from skewing the reality of what the results have shown thus far. Stem cell therapies clearly offer tremendous hope for people suffering from spinal cord injuries but the data needs to be evaluated critically and rationally, and not read blindly . For example, even though many companies, universities and hospitals have achieved tremendous success in rehabilitating rodents, primates and even humans after an SCI, reasons to be skeptical are abundant. One main reason being that the overwhelming majority of stem cell therapy models aimed at repairing damaged spinal cords have the researchers inject or transplant their stem cells into the test animals spinal cord immediately following the injury. Now this methodology could potentially be useful for improving functionality of individuals who suffer SCI’s in the future, but for the tens of millions of people who have already suffered a SCI this data has little relevance. Obviously the faster you deliver the stem cells to the damaged spinal cord the better and more significant results you will see. Furthermore, like breaking a bone, there are many ways a spinal cord can be damaged. For example, a spinal cord can be crushed, sliced, or compressed. In addition, SCI’s happen at all different levels of the spinal cord with varying intensity and damage from one patient to the next. It follows that a one-size fits all ‘cure’ is not a realistic solution. There will be no miracle vaccine to treat SCI. Rather, it is more likely that there will be a number of different methods for restoring function and feeling below the level of injury specifically tailored to reach the best possible outcome for each individual case. Another huge issue with a lot of the data coming out about SCI rehabilitation is the degree of function that these animals and in some cases humans regain after their stem cell therapy treatment. Of course any improvement in function for an SCI patient is wonderful but the data needs to be taken for what it is. Lots of data that has gotten published claims extraordinary results and in some ways it is but for some this might be an over glorification. For example, there have been numerous stem cell therapy studies done on animals who have suffered a SCI that claim the animal can now move its once paralyzed limbs voluntarily. While this may be true, it is important to find out to what degree has this animal recovered. Is the animal back to walking, running and jumping or is it just twitching it’s foot randomly? Many people who suffer from SCI have some degree of function below their level of injury but it is not substantial enough to be a substitute for a wheelchair. We need to look closely at what the data are telling us so that we understand exactly what the implications are for ourselves personally as well as future individuals. It is also important to remember that, while doing potentially life changing research, the vast majority of companies producing data for stem cell treated spinal cord injury are for profit. This means that even though some of their data may truly be remarkable it will almost always be in their best interest to over inflate and exaggerate their results for the better, whether it be to build brand awareness, build awareness about SCI as a whole or to secure additional funding.

The entire field of stem cell therapy has improved tremendously in the last two decades. Research going on around the world, whether it be in an animal model or in actual human clinical trials, is getting closer and closer to a treatment for people suffering from an SCI. Although it seems like little breakthroughs are being made every day there are still many questions to be answered and a lot of work to be done. Researchers need to identify which cell(s) are able to interact most effectively at the cellular level inside the spinal cord. Researchers also have to study better methods of decreasing inflammation directly following an SCI as well as inhibiting glial scar formation molecules from being activated. Next, they need to investigate which technique of cell transplantation gives the cells the best shot at repairing the spinal cord. Lastly, and perhaps most importantly there needs to be a better understanding of how these different types of cells interact with each other and how best to combine them into a comprehensive treatment. Because each cell type can only repair part of the complex biology of the spinal cord there will need to be some type of combination of cells. Extensive research like this may be a few years away and there may be single cell type treatments that show promise but if there is ever going to be a wide ranging cure for SCI it will have to come from a treatment of several cells working in unison.

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How strong would a magnetic field have to be to kill you?

Originally posted on Gravity and Levity:

There’s a great joke in Futurama, the cartoon comedy show, about a horror movie for robots.  In the movie, a planet of robots is terrorized by a giant “non-metallic being” (a monsterified human).  The human is finally defeated by a makeshift spear, which prompts the robot general to say:

“Funny, isn’t it?  The human was impervious to our most powerful magnetic fields, yet in the end he succumbed to a harmless sharpened stick.”

The joke, of course, is that the human body might seem much more fragile than a metallic machine, but to a robot our ability to withstand enormous magnetic fields would be like invincibility.

But this got me thinking: how strong would a magnetic field have to be before it killed a human?

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Unlike a computer hard drive, the human body doesn’t really make use of any magnetic states — there is nowhere in the body where important…

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A Day in the Life

Originally posted on Untold Stories:

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It’s seven o’clock and Tierkidi refugee-camp is buzzling of early morning activity. It’s food distribution day, and Nyaboth (16) is patiently waiting for the queue in front of her to get smaller.

No one knows the exact number of refugees in the Gambell-region. But we are at least looking at 250.000. More than a quarter of a million people who are dependent on the food that World Food Program is distributing.

The line is moving slow, but Nyaboth isn’t in a hurry as long as she gets what she came for. Four hours later, she has collected all the items her family is entitled to this month. The previous four hours were more boring than exhausting. Now the tough part comes. The 16-year old has to get 150 kilos of flour, maize, oil, lentils and soap back to her tent a couple of kilometres away.

−I have to sell some…

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Crowdfunding Disability: Pay for the Change That You Want to See in the World

Originally posted on Matan Koch's Blog:

From those studying the medicinal benefits of centipede venom to those researching the existence of life bearing extrasolar moons, scientists have turned to crowdfunding for issues which have captured the popular imagination but have been overlooked by a traditional grant process.  Without commenting on the value of individual projects (one questionable project has funded a review of frog sounds in the Amazon), I’m fascinated by the phenomenon of crowdfunding allowing people to put their money where their passion is.

It’s a cliché that everything in our society costs money, but that doesn’t make it less true.  Rather than lament a reality that I can’t even see a way around, (after all, whether it’s rent, utilities, food, or equipment, most money for expenses goes to people who themselves have bills to pay) I love the idea that crowdfunding gives society the opportunity to pay for the things that they deem valuable…

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Exploring the Natural World

I am disappointed, if I’m being perfectly honest, at my current situation and the lack of spontaneity it allows me. I need to do extra planning for almost everything I set out to do. Luckily for me and the millions of other people who use wheelchairs, there has been a huge cultural and architectural transformation throughout the United States in the last quarter century. Unfortunately, it seems that the latter has proven much easier to change than the former but that’s a different story, one in which I am not currently concerned with (partly because I have spent a long time thinking about how to change the stigma and view of individuals with disabilities and partly because I have no idea how to change it). So, with the ADA legislation, there are many, many more places I can go to and activities I can participate in. There is one area of travel that I have not yet figured out how to over come. Of course there are many places I cannot really traverse practically (or at least without significant help) including: mountains with rocky or snowy inclines, beaches, dense jungles, etc. The limits I have to deal with in regards to exploring nature and immersing myself in the beautiful and diverse natural landscapes of Earth is definitely one of my major sources of despair. It’s a shame because there are so many incredible places to be explored and yet they are out of reach for me at the moment. Many places such as the Rocky Mountains, the Appalachian Mountains and the Grand Canyon offer accessible hiking trails and accessible transportation. This is fantastic and I think it is a great time to be disabled because of all the options made available. One problem though, is that the more accessible they make the park, or mountain or whatever, the more the landscape is ruined. The more paved roads and bathrooms and signs and parking lots they build the less natural the scene looks. In addition, I don’t want to just scratch the surface of these places, I don’t want to take the bunny slope down, I want to experience the wilderness deeply and fully, I want to be completely overwhelmed by the majesty of our planet, ideally alone. Perhaps this level of intimacy will have to wait for now.

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Reflection on Death

When a person dies it is a solemn reminder of how fragile life really is. Because we cant tell the future and we cant be sure when a disaster or tragedy will strike life is always precious, always fragile because of the very fact that we don’t know what tomorrow will bring. Our very mortality ensures that no moment can ever be re-lived no day will happen twice and this is what gives our lives immeasurable value and joy. It is the very knowing that our days are numbered that gives each day meaning. When a person dies we are forced into the sudden realization that life is finite. Time ceaselessly marches on. Things happen all the time, everywhere, but it’s different when theres a death. The permanence of death is ominous and often overwhelming. We feel like we have to care deeply when someone dies, because we can’t just let death go like the rest of the things that happen go. Death has to be sad, tragic and terrible. How could it not be anything but sad? If we don’t grieve and feel sorrow then no one will. The universe is completely indifferent, it could not care any less. If we don’t care, then no one cares and that can be hard to come to terms with. Death doesn’t have to be sad but it usually is especially when it happens to someone close to us. When it happens to someone we are not so close to it can serve as a sobering reminder of what really matters.

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Brief History of the Discoveries of the Atom

Originally posted on A Few Things I've Been Thinking About:

Man has questioned his world and reality for as long as he has been around. One of the oldest questions ever asked was, “What, in it’s most basic form, is the nature of matter?”. We must travel back to ancient Greece for the first recorded answer. Philosophers debated on whether or not matter was indivisible or infinitely divisible. Around 460 BC, philosophers such as Democritus and Leucippus believed that matter was made up of tiny, indivisible parts, which is where we get the term ‘atom’ from, Greek for indivisible. Still, other thinkers such as Plato and Aristotle held that matter could be broken down an infinite number of times and no such indivisible atom existed. Back then there was really no experimental way of proving who was right so the winner was usually the best debater which in this case was Aristotle. Twenty-two thousand years of humanity would pass before…

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