Coffee Break: Funding Medical Education, A Human Ancestor, Tardigrades to the Rescue, Trashing the Earth, Plus MAHA and Measles

Part the First: Financing Professional Education in the United States.  College costs too much in the United States.  Professional School costs way to much.  Up until the present – who knows what will happen next as the broad attacks on American universities continue – graduate education at the PhD level in traditional disciplines in the natural sciences, social sciences, and humanities has been funded at the student level by teaching and research assistantships in which those programs worth the effort will graduate PhD candidates who will not have accumulated large debts as a consequence of getting their doctorates.  The overhang from undergraduate debt can be large, however.

We can and we should and we must do better.  However, that we have not is not the point right now.  A fair and just solution will have to await a political revolution, which is coming.  The proposed changes in federal student loan programs that allow students from families without generational wealth to attend medical school will prevent these students from becoming doctors.  This is not acceptable.

The Association of American Medical Colleges is not one of my usual sources, to say the least, but this covers the current situation on the ground fairly well: Proposed changes to federal student loans could worsen the doctor shortage.  I am particularly concerned because my day job is devoted increasing the number of rural medical students who will become primary care physicians (Internal Medicine, Family Medicine, General Surgery, Pediatrics, Obstetrics & Gynecology and Psychiatry) and then return home to practice medicine.  Most of these students do not have generational wealth.  Many are first-generation college students who persevered by working their way through college to get to medical school.  Pulling the rug out from under them will do nothing but keep them from going to medical school.

This proposal in bad faith will not decrease the number of students going to medical school.  But those students will be among those who got to medical school in the first place because college was a matter of course for them and they never had to concern themselves with paying their own bills – rent, living expenses, tuition and otherwise.

When I began my current position it became clear that the easiest path to medical school was to choose one’s parents wisely, with the children of doctors (and other professionals) being overrepresented in our student population.  A recent look at our admissions data showed that students in the so-called “Top-20” based on scores on the Medical College Admission Test had 13 parents with an MD or PhD and average family income three times the median for the state.  None was a first-generation college student.  The so-called “Bottom-20” had three MD or PhD parents and a family income below the average.  Most of them were first-generation college students.  In the end, however, there was no difference in how these two groups performed in medical school, and the residency programs each group joined were equivalent.

We can return to the first group as the primary source of our future doctors, but somehow I do not believe that rich, urban America needs more “aesthetic dermatologists.”  On the other hand, a dermatologist who treats farmers and farm workers for skin cancer in rural America and an OB-GYN who cares for women and mothers and delivers babies where prenatal care has been unknown for years will be doing God’s work on Earth.

And yes, I know that urban America has a population of medically underserved that is obscenely large.  I can see that from my window.  That is the fault of how we (fail to) provide healthcare in America and is not due to a local shortage of physicians, which has become the default state in much of rural America.  Oh, and medical school indebtedness is real, but doctors in America are members of the one profession that can afford it, for now.  That is, as long as they begin with a Honda instead of the Range Rover and a house instead of the McMansion.

Part the Second. Science Is Cool.  Our Denisovan ancestor, Dragon Man, was one interesting looking fellow.  But we could have guessed that, even if the illustrator has a somewhat fanciful view of the subject.  And he came to science in an interesting way:

Qiang Ji, a palaeontologist at Hebei GEO University in Shijiazhuang, China, obtained the specimen from an unnamed man in 2018. The man – who Ji suspects discovered the artefact himself but failed to report it to authorities – claimed that his grandfather unearthed the fossil in 1933 during bridge-construction work over Long Jiang (which means dragon river), and buried it in an abandoned well, where it remained until a deathbed confession… In 2021, Ji and his colleagues determined that the ‘Dragon Man’ fossil represented a new archaic human species, which they crowned Homo longi.

Does the identification of Homo longi and other Denisovans mean anything?  That depends on one’s view of science.  We can never know too much of the natural world, and often the most obscure research leads to a revolution in science or the practice of science.  Is there something in the genome of Homo longi that could explain resistance to disease, for example?  Perhaps. As we have discussed before, research on how jellyfish glow in the dark (GFP) has revolutionized cell biology.  And now those who work on pluripotent stem cells, which will eventually provide the means to fight any number of conditions and diseases, are now able to track the cells in a living organism.  Without the label, the stem cell would look like any and all others.  A big thank you to the late Paul Allen.

Part the Third: Science is Really Cool.  Ever since I had a (now retired) colleague who kept an aquarium full of water bears who happily lived in the mosses at the bottom of the tank I have been fascinated by tardigrades.  They are absolutely adorable and practically indestructible.  And they have much to teach us, if we will pay attention.

Having previously gone through seven weeks of radiation and chemotherapy for a tonsil tumor, I am paying attention to recent results of research on tardigrades that may lead to practices that will reduce radiation damage to healthy tissue during the course of treatment using modern radiation oncology.  From a short news item from the National Institutes of Health, which still exists according to my email:

• Researchers found that a protein made by tiny creatures called tardigrades can protect mouse and human cells from radiation damage.
• The findings hold promise for reducing the harmful side effects of radiation therapy to treat cancer.

Modern medical and radiation oncology “resolved” my tumor but three years later, but some things linger:

High doses of radiation can damage the DNA inside cancer cells, which destroys the cells and shrinks tumors. But radiation treatments can harm healthy cells as well, which can lead to severe side effects. These effects can be especially challenging for patients with head and neck cancer… Oral tissues can become inflamed after radiation therapy for head and neck cancer, making eating difficult.

The first thing to go (within a few days) during even highly focused radiation of the oropharyngeal space is the sense of taste, which makes eating a difficult and unnatural chore.  The salivary glands are also damaged by radiation and “dry mouth” can follow.  This can lead to dental problems such as cavities long after one’s “cavity prone” years.  My sense of taste returned, except that chocolate is not the same as before (no great loss and probably a healthy outcome).  Dry mouth, especially at night, remains uncomfortable, and a few months ago I had two cavities filled for the first time in about thirty years.  And eating bread and cheese without something to drink is an iffy proposition. But overall, no complaints thanks to modern clinical oncology!  And now on to tardigrades, who apparently have no kryptonite and make Superman look weak:

In the hope of protecting healthy tissue during radiation therapy, an NIH-supported research team took inspiration from miniature creatures called tardigrades, or water bears. These tiny eight-legged animals are less than a millimeter in size, barely visible to the naked eye. They can survive in a wide range of extreme environments, from the ocean’s depths to the vacuum of outer space. They also can endure high doses of radiation that would kill most other organisms.

The scientists focused on a damage-suppressing protein found in tardigrades called Dsup. Dsup interacts with DNA strands and keeps them from breaking. The researchers envisioned a novel approach in which Dsup could be precisely delivered to healthy tissues before radiation treatment to curtail radiation damage.

And how did these NIH-supported scientists deliver Dsup to cells?

The researchers created nanoparticles that encased messenger RNA (mRNA) with instructions for making the Dsup protein. They showed that the nanoparticles could ferry the mRNA into mouse or human cells and trigger broad production of Dsup (thank you Dr. Robert Malone). To see how long Dsup production would last in the body, the scientists injected the nanoparticles into the oral or rectal tissues of mice. The protein’s production peaked about 6 hours after injection, then declined. Four days after the injection, little or no Dsup could be detected.

To test protection against radiation, the nanoparticles were injected into healthy mice about 6 hours before exposure to a radiation dose that’s similar to what cancer patients receive. A control group of mice received radiation but no nanoparticles. The nanoparticle-treated mice showed much less DNA breakage after radiation treatment than the non-treated mice. Additional experiments found evidence that the protective effects of nanoparticles remained limited to the injection site. As such, the particles are unlikely to have the unwanted effect of protecting nearby tumor cells.

Are these results ready for translation to the clinic?  Certainly not yet.  But radiation oncology has made immense progress over the past few years.  Radiation (protons) from a mini-particle accelerator (I couldn’t help but be fascinated by the process while bolted down to a table in a fitted mesh mask that prevented my head and neck from moving more than a millimeter) can be focused to a small area and tuned to a certain depth.

But collateral damage is inevitable.  And it could be these little creatures will provide an answer to radiation side effects.  Twenty years ago, I would have had surgery followed by cisplatin and relatively unfocused radiation.  The side effects would have been grim, including likely structural damage due to the surgery and damage to my kidneys, hearing, and vision caused by the cisplatin.  Twenty years from now, a patient in my predicament might retain his sense of taste during radiation and not have his salivary glands damaged irreversibly.  And all because NIH funded the research on strange little animals.  The paper is here if you can get over the paywall.  I do wonder, will NIH even fund mRNA research that leads to such an advance?

Another general article on tardigrades is here, and it includes mention of how delivery of functional mRNA was tested using the jellyfish protein – GFP – mentioned in Part the Second.  It is safe to say that without the tool that is GFP none of this research would have been feasible.

Part the Fourth: Another Episode in the Ongoing Series Called “We Are Not a Serious People.”  This time the culprit is “Fast Fashion”, described in Fun Ways to Ditch Fast Fashion for a Sustainable Wardrobe.

In Chile’s Atacama Desert, a mountain of more than 59,000 tons of clothing can now be seen from space. This so-called garment graveyard comprises fast-fashion discards inherited from the U.S., Europe and Asia. In 2024 activists, designers and NGOs organized Atacama Fashion Week—with a fashion show atop the garment graveyard—to draw attention to this growing problem.

The article is definite coffee break material, while it describes just another way we are trashing the planet for no reason other than it seems convenient and a good way for some to make a lot of money:

The HVTP (Hudson Valley Textile Project, a natural-textile supply chain that aims to break free from the global fashion industry) is one part of a growing effort to mitigate the harms of the global fashion industry, in which millions of low-paid garment workers around the world endure unsafe working conditions to churn out huge amounts of clothing and textiles year after year. The pull on the planet’s natural resources is immense: Annual textile production uses up enough water to fill at least 37 million Olympic-size swimming pools. Cotton agriculture alone uses 2.1 percent of the world’s arable land. And because roughly 60 percent of global textiles now contain plastic derived from fossil fuels, it is estimated that more than a third of the microplastics in the oceans today were shed from clothing.

The fashion industry is also responsible for up to 10 percent of global greenhouse gas emissions—more than the aviation and shipping industries combined. If apparel consumption continues to grow at its current rate, by 2050 the industry will be using more than one quarter (McKinsey) of the world’s carbon budget. The problem becomes even worse when you consider that most clothes make a quick trip to the landfill, where they’ll emit greenhouse gases such as methane.

These numbers reflect a growing appetite for fast fashion, a business model that brings trendy designs to the masses as quickly and cheaply as possible. As clothing consumption rises, the consumer tends to shoulder the blame. But what’s enabled things to get this bad is a lack of regulation.

One is reminded of the late, great Herbert Stein of fifty years ago: “If Something Cannot Go on Forever, It Will Stop.”  The coming world will get smaller whether we like it or not.  We could go ahead and stop this nonsense now.

Part the Fifth. Measles, of All Things.  This brings us to another coffee break article that can only make one want to scream.  I had rubella (German measles) and rubeola (14-day measles) in the first grade.  As far as I know these two unpleasant interludes caused no lasting damage to me.  The same is not true of all of us, though, as recounted in this article from The New York Times: “I Feel Like I’ve Been Lied To’: When a Measles Outbreak Hits Home”.

This is particularly interesting as the story of one rural physician, Don Edwards, who is now practicing what can only be described as alternative medicine, including vitamin A (cod liver oil) as a treatment for measles:

Edwards had never seen a measles case until earlier this year, but he’d helped vaccinate hundreds of children against the virus. He spent the first decade of his career as the only doctor in rural Garza County, Texas, practicing medicine in the same tradition as his grandfathers. “I was 100 percent by the book, just following the company line,” he said, which meant he saw patients in 10-minute blocks, recommended all vaccines on schedule and kept prescribing more medications to a population that seemed to only get sicker.

It wasn’t until 2011 that Edwards experienced what he called a “divine appointment,” and began questioning the core tenets of American medicine. He came to believe that his patients weren’t suffering from diseases so much as experiencing symptoms of bad diets and societal rot, and that the human body was almost always capable of healing itself with hydration, movement, nutritious foods and spiritual peace. He moved to Lubbock and started his own practice, Veritas Medical, named after the Latin word for truth. He began selling supplements and started a weekly podcast, “You’re the Cure,” on which he often hosted guests who questioned the safety of vaccines.

Instead of seeing 50 patients a day, Edwards scheduled his intake appointments for up to two hours, so he could learn about the root causes of his patients’ problems and offer dietary plans and what he called “peace consultations.” His new practice filled with hundreds of patients who shared his disillusionment with mainstream medicine, including a few dozen Mennonites who lived an hour from Lubbock.

Thus, Dr. Edwards change in his medical practice to include the tropes of MAHA predates the damascene conversion of Casey Means MD by about fifteen years, and more recently on the current absolutely unnecessary measles outbreak:

Most of Edwards’s patients showed some initial improvement with supportive care — which is what he offered to Kiley and his family as they began to recover. He gave all four children intravenous fluids and vitamins to bolster their immune systems for the weeks and months ahead. Edwards also continued to prescribe breathing treatments for patients in more severe distress, which sometimes helped ease their symptoms.

And all the while, Edwards continued to release his weekly podcast, hosting a rotation of authors, doctors and activists who minimized the danger of measles and spoke instead about the benefits of being unvaccinated and the risks of rare vaccine injuries.

“The body’s designed to kill measles,” Edwards said, as it spread into New Mexico and Oklahoma.

“I would encourage you to seek a higher authority, a spiritual authority, and let peace guide you,” he said, as the disease stretched into Kansas and Nebraska.

“Don’t be scared of anything,” he said, when the total number of reported measles cases rose above 1,000, almost all among people who were unvaccinated, as the virus continued to spread in Colorado, Pennsylvania and finally into the remote corners of North Dakota, arriving in the state for the first time in 14 years.

We have seen this show before.  Dr. Edwards is not wrong that we are an unhealthy society in too many ways to count sometimes.  But the body is not designed to kill measles.  The immune system has evolved to combat infectious disease, but not for every disease every time.  And unless this nonsense about the measles vaccine ends, the lives of thousands will end unnecessarily.  Herd immunity against measles requires that >90% of the population be vaccinated, or like me and many others of a certain age, have had the measles and recovered.  There is no treatment for measles aside from supportive care.

And the disease still kills.  Mother Nature doesn’t care about our beliefs, and this curve could reverse itself if vaccination rates against measles and other diseases continue to decline below the threshold for herd immunity.

See you next week on Independence Day in America.  Until then, stay safe.