2024 Edition
“We need to live in a culture that values and respects and looks up to and idolizes women as much as men.”
Emma Watson
The Editor's Take: Thanksgiving Dinner
Hello AMWA UTD! I am excited for you all to read your writers’ latest articles! This month, we bring you articles on the high cost of motherhood, value-based healthcare, recent developments in Alzheimer’s and dementia, and seasonal affective disorder. We also have two Hot Button articles tackling controversial issues in medicine.
As we leave spooky season behind us and enter November, most of us are likely eyeing Thanksgiving break and the prospect of a break from classes and exams and instead spending time with family and enjoying good food. However, for individuals struggling with body image, body dysmorphia, or disordered eating, the holidays can also be a scary time. The indulgent Thanksgiving dinner spread, while delicious, can trigger food guilt, a feeling of shamefulness that accompanies eating what one feels like they “shouldn’t” eat.
Food guilt is often rooted in the societal appearance ideal, which in the U.S. has long promoted being thin for women and being lean and muscular for men. The positive body movement has made strides to combat this ideal, but progress takes time. The resulting societal pressure, often perpetuated by traditional and social media, can engender fear of gaining weight and body dissatisfaction. Studies have shown that as much as 69-84% of women and between 10-30% of men experience body dissatisfaction. Body dissatisfaction is a major contributing factor to disordered eating.
Dieting culture especially preys on people’s insecurities and dieting influencers often foods “good” or “bad”. Assigning morality to food is harmful and contributes to food guilt - we feel guilty when we eat foods that we view as “bad”. In turn, food guilt can even increase the likelihood of overeating and can cause anxiety, sadness or depression. Luckily, there has been a turning tide among dieting influencers to destigmatize foods and promote balanced diets that include your favorite treats, but it takes time to undo and repair unhealthy relationships with food and poor body image.
So if you find yourself feeling guilty or shame as you enjoy (or try to enjoy) Thanksgiving dinner, please be gentle with yourself. It is okay to feel food guilt, but try not to let it weigh heavily on your mind and ruin your enjoyment of the day. Each and every one of you are beautiful the way you are.
As always, if you would like to submit your own piece of writing, have ideas, or questions, email me at Zoe.Du@utdallas.edu
-Zoe
The High Cost of Motherhood
By: Gauri Guruprasad
When it comes to healthcare costs, giving birth in the U.S. is one of the most expensive experiences a person can face. A routine vaginal delivery without insurance can cost around $13,000, while a C-section can cost up to $22,500 (Health Care Cost Institute). These numbers don’t even account for prenatal care, lab tests, anesthesia, and any unexpected complications along the way. For uninsured mothers, costs can range from $10,000 to $30,000 or more, depending on the hospital and state. For many families, these numbers can be financially devastating, especially when childbirth should be a time of celebration, not financial strain.
Having insurance certainly helps, but it doesn’t eliminate all costs. On average, insured mothers can still expect to pay out-of-pocket expenses between $1,000 and $5,000, according to the Kaiser Family Foundation. This includes deductibles, co-pays, and often many non-covered services. High-deductible insurance plans—some of the most common plans available—mean that families might end up covering large portions of their hospital bills themselves. This situation is even more difficult for women of color and low-income families, who face additional obstacles to accessing affordable, high-quality maternal care (Kaiser Family Foundation).
The financial pressure surrounding childbirth often leads to difficult choices. Some families may consider skipping or delaying crucial prenatal visits to save money, while others turn to home births as a less expensive alternative to hospital deliveries. However, these choices can increase health risks for both the mother and baby. Data from the CDC reveals that uninsured women are less likely to receive adequate prenatal care, which can lead to higher rates of complications, including low birth weight and preterm birth (Centers for Disease Control and Prevention). This disparity is a reminder of the urgent need for accessible and affordable maternal healthcare that serves all families equally.
Ultimately, the rising costs of childbirth in the U.S. call for significant policy reform. Every parent deserves to start their journey without financial strain, and the system should support them in making that possible. Accessible, affordable maternity care must be a right, not a privilege, in one of the wealthiest countries in the world. No family should be forced to choose between their financial well-being and their child’s health, and now is the time to address these barriers.
The Rise of Value-Based Healthcare: What Does it Mean for Future Providers?
By: Riya Ramani
In recent years, the healthcare landscape has been undergoing a significant transformation, shifting from traditional fee-for-service models to value-based healthcare (VBHC). This paradigm shift prioritizes patient outcomes over the volume of services provided, reflecting a broader recognition of the need for sustainable, efficient healthcare delivery. As future healthcare providers, understanding this transition is crucial for adapting to a changing environment that increasingly emphasizes quality over quantity.
Value-based healthcare is a model that aligns provider reimbursement with patient health outcomes. Unlike fee-for-service systems, where providers are paid for each service rendered—often leading to unnecessary procedures and rising healthcare costs—VBHC focuses on achieving better health outcomes at lower costs. This shift is grounded in the belief that healthcare should be patient-centered, aiming not just to treat illness but to improve the overall health and well-being of patients.
The impetus for this transformation can be traced back to several factors, including rising healthcare costs, an aging population, and growing consumer expectations for high-quality care. Legislative changes, such as the Affordable Care Act (ACA) and the Medicare Access and CHIP Reauthorization Act (MACRA), have also played a crucial role by promoting value-based initiatives and incentivizing providers to improve care quality.
The adoption of value-based care has steadily increased among healthcare providers. According to recent data, approximately 40% of healthcare payments are now tied to value-based models, a significant rise from previous years. Primary care providers are often at the forefront of this movement, implementing innovative care delivery models that prioritize comprehensive, coordinated care for patients.
Technology is a pivotal enabler of value-based healthcare, facilitating improved data collection and analysis. Electronic health records (EHRs), telehealth services, and patient engagement platforms are critical in tracking patient outcomes and streamlining care coordination. Furthermore, the recognition of social determinants of health (SDOH)—factors such as socioeconomic status, education, and community environment—has become increasingly integral to value-based care. Understanding and addressing these determinants can lead to more effective interventions and improved health outcomes for patients.
One of the primary advantages of value-based care is its potential to enhance patient engagement. By encouraging shared decision-making and empowering patients to take an active role in their health, providers can foster a more collaborative relationship with patients. This shift not only leads to higher patient satisfaction but also improves adherence to treatment plans, ultimately resulting in better health outcomes.
Value-based care also emphasizes improved care coordination. With multidisciplinary teams working together, providers can ensure that patients receive comprehensive care tailored to their individual needs. For example, managing chronic conditions such as diabetes requires a team approach, involving primary care providers, specialists, nutritionists, and social workers. By fostering collaboration among these professionals, VBHC can lead to more effective management of complex health issues.
The focus on patient outcomes is evident in numerous studies highlighting improvements in specific health metrics. For instance, patients with chronic conditions under value-based care models have shown reduced hospital readmission rates and lower overall healthcare costs. These results underscore the effectiveness of prioritizing value in healthcare delivery.
Financial considerations are also paramount. While value-based care presents opportunities for improved patient outcomes and satisfaction, it also carries potential risks. Providers must be prepared to manage financial incentives and penalties based on patient outcomes, requiring a comprehensive understanding of the financial implications of their care decisions.
As future healthcare providers, adapting to the principles of value-based care will be essential. This shift entails a fundamental change in responsibilities, moving from a focus on volume to a focus on value. Providers must develop new skills, including data analysis, effective communication, and care coordination, to navigate this evolving landscape successfully.
Latest Research on Alzheimer’s and Dementia Studies
By: Sahaana Anand
Did you know that one in three elderly Americans die due to Alzheimer’s disease or other forms of dementia? Alzheimer’s Disease is defined by the Mayo Clinic as “a brain disorder that causes a gradual decline in memory, thinking, behavior, and social skills, making it the most common cause of dementia”. Despite decades of research and inquiry, there is still no definite cure for this disease, though there is a lot of work being done so that we can create a clear understanding of all the “hows” of this disease.
As of the latest published research, there are currently more than 75 genes associated with risk of developing Alzheimer’s. Because Alzheimer’s is a progressive disease, the severity and presence of symptoms worsen/increase over time. Subsequently, it is important to detect predisposition and increased risk of the disease ahead of time. More research is constantly being conducted to enhance early detection.
Our knowledge of the genetics of Alzheimer's disease has improved recently, especially with regard to the APOE4 gene variant, which has been identified as a major risk factor. Studies indicate that individuals who are APOE4 homozygotes (carry two copies of the allele) frequently experience early onset Alzheimer’s, exhibiting Alzheimer's-related brain abnormalities as early as age 55 and with symptoms appearing around age 65. These abnormalities and symptoms, including amyloid-beta accumulation and cognitive impairment, manifest 7-10 years earlier in these individuals compared to people without the APOE4 mutation. Researchers believe that APOE4-related Alzheimer's may be a genetic subtype of the illness, and future diagnostic and treatment approaches that prioritize early intervention for APOE4 carriers may be influenced by this knowledge.
The Brain and Behavioral Sciences department at UT Dallas has great programs to get involved with the research towards this Alzheimer’s. As one of my neuroscience professors said, all science is important science, as every piece of theory and findings is important to the contributions of overall understanding and development of treatments for issues at hand. To keep up with the latest updates in scientific literature and research, whether it be in this field or others, I have a few recommendations! Other than making it a part of your routine, there are several online platforms that can send you notifications of articles to scan through. A few of my favorites are: Browzine (database of University of Cambridge that provides free access to journals and scientific literature with categories organized), JournalTOCs (largest and free collection of scholarly articles that will notify you of multiple publications as desired), and of course, just any local news app that you can subscribe to.
Seasonal Affective Disorder
By: Sahasra Guvvala
For many of us, October is the start of autumn, specifically colder weather and multicolored leaves. This month brings many emotions along with it, like the happiness of a pumpkin spice cookie or even the stress during the middle of a midterm exam. One common emotion, though, associated with the changing seasons is sadness. If you’ve noticed yourself becoming gloomier with the shorter days, you’re not alone. Studies show that many others experience lower energy levels and mood changes when there’s less natural sunlight. Extreme symptoms can even lead to signs of Seasonal Affective Disorder.
Seasonal Affective Disorder, or SAD for short, is a form of depression that usually appears during the fall and winter months. Mayo Clinic states that the onset of these symptoms is generally brought on by shorter days and less sunlight, leading to a disruption in the body’s circadian rhythm. This can also affect serotonin and melatonin levels. Some signs that follow this disorder include oversleeping, appetite changes, weight gain, and tiredness. SAD is more commonly observed in women, and women are more likely to brush off possible symptoms for a case of “winter blues” or a seasonal funk.
It is important to take note of what you’re experiencing because mood swings and sluggish energy can mean more than just having a bad week. If you find your symptoms becoming more severe as the season progresses, it might be worth checking in with your healthcare provider or telling someone you trust. SAD can also be accompanied by many other underlying conditions, such as depression, anxiety, or even bipolar disorder, so it never hurts to schedule a routine checkup and express your concerns! It can help to know that SAD can come from family genetics, lower vitamin D levels, and even how far away you live from the equator. If not taken seriously, SAD can have a serious effect on social skills, emotional withdrawal, substance abuse, mental health problems, and even suicidal thoughts.
As October fades into November, make sure to take care of yourself and put yourself first. Even if you don’t have SAD or other conditions, it is important to stay healthy and not let negative emotions overcome you. It can be difficult to prioritize mental health during the hectic time of midterms, schedule planning, and the holidays, but always remember to step back and take a deep breath in when you’re feeling overwhelmed. Take some time for yourself, either by taking a walk, indulging in a bubble bath, or even letting yourself sleep in. Embrace this season with kindness toward yourself, and remember that seeking support is a strength, not a weakness.
Hot Button: Ozempic - Instagram vs Reality
By: Gauri Guruprasad and Sahaana Anand
If you have been on TikTok or Instagram recently, you have probably seen #ozempic or #wegovy in many trending posts. Ozempic, Wegovy, and Mounjaro are name brand medications that are in a class of injectable drugs known as GLP-1 RAs (glucagon-like peptide-1 receptor agonists) and were originally developed for blood sugar level management in adults with type 2 diabetes (Ozempic). Although it is primarily known as a weight loss drug, it is only approved to treat type 2 diabetes. Thus, it is often prescribed “off-label” to people wanting to lose weight, which in turn leads to a growing number of self-proclaimed “Ozempic influencers” who promote the drug by sharing their journeys on social media. Ozempic and its counterparts have also been advertised on television and even at medical spas, where you could get semaglutide (generic Ozempic) injections along with Botox touch-ups.
The science behind Ozempic and similar drugs is fascinating. GLP-1 RA drugs mimic the action of glucagon-like peptide-1, a hormone that is regularly made in our bodies, by binding to GLP-1 receptors in the body to elicit a biological response. The GLP-1 hormone affects our blood sugar and appetite regulation, so people who take GLP-1 drugs tend to feel full for longer and they even slow down stomach emptying. However, these drugs can also cause side effects such as nausea, dizziness, and fatigue. Additionally, once you stop taking the drugs, your appetite returns, often with a vengeance. Most people will regain the weight they have lost if they do not make lifestyle changes to maintain the weight loss. These drugs are far from the permanent fix that Ozempic influencers advertise it as, because they do not have the understanding of the basic biological effects of the drugs.
The use of medications like Ozempic for weight loss has been at the center of controversy. The advertising of GLP-1 medications like Ozempic on social media, particularly through celebrity endorsements, has encouraged a "quick fix" approach to weight loss that completely disregards major health hazards. There is a common pattern for influencers to overlook possible adverse effects by portraying these medications as simple fixes. As a result, many people consider Ozempic to be a safe over-the-counter alternative when it actually needs regular medical supervision. Additionally, this representation heightens toxic body ideals, particularly for young people who are easily influenced and may feel under pressure to use drastic weight-loss techniques in order to meet the beauty standard. Additionally, shortages have been caused by the explosive growth in demand for off-label use in weight reduction, which has limited access for diabetics who depend on these drugs to control blood sugar and associated symptoms. Social media's approach to these drugs underscores the need for responsible health communication that prioritizes informed use over trends.
All in all, with its ability to effectively treat obesity, type 2 diabetes, and maybe other illnesses including cardiovascular disease, Ozempic and other GLP-1 medications constitute a revolutionary development in medicine. These medications offer a novel strategy to control weight, treat metabolic health conditions, and improve the quality of life for those with obesity-related health problems by affecting appetite and metabolism. However, their widespread use has also raised moral and practical questions, such as the restriction of diabetic patients' access to these medications and the promotion of these medications as easy, risk-free ways to lose weight. GLP-1 drugs have the potential to revolutionize healthcare by addressing both established and new health needs, but optimizing their beneficial effects will need ethical use, fair access, and public awareness of the dangers and advantages. By taking a balanced and nuanced approach, people will be able to maximize the advantages of GLP-1 medications while reducing any potential ethical and social consequences.
Hot Button: Texas’ New immigration Check Law in Hospitals
By: Riya Ramani and Sahasra Guvvalai
As of November 1, 2024, Texas hospitals must now inquire about patients' citizenship status, as mandated by Governor Greg Abbott’s Executive Order GA-46. This policy aims to quantify healthcare costs tied to undocumented individuals, with Texas seeking federal support to offset these expenses. However, the order raises public health and financial concerns within the healthcare community regarding access and funding implications.
The primary goal of GA-46 is to track uncompensated care costs for undocumented residents, a significant expense for Texas taxpayers. With around 18% of Texans being uninsured, Governor Abbott argues for federal aid to ease this financial strain on state-funded providers. By documenting these expenses, Texas hopes to bolster its case for federal financial relief.
This mandate aligns with efforts in states like Florida, where similar measures exist to gauge the cost of healthcare for undocumented individuals. Florida's results show around 8% of patients declined to answer citizenship questions. Texas officials have stated that data collected will be anonymous and used solely for cost analysis, not for tracking or enforcement, adhering to federal privacy laws.
Critics argue that although patients aren’t required to answer, asking about immigration status may deter care-seeking among immigrants, even legal residents. This hesitancy could reduce preventive and emergency care access, negatively impacting public health. In Florida, similar policies reportedly led to fewer hospital visits from immigrant communities despite assurances of privacy.
Public health experts warn of increased risks from delayed care, especially for contagious diseases. Research indicates early intervention prevents disease spread, while barriers to care exacerbate public health issues. During COVID-19, for instance, delays in care elevated transmission risks. Experts worry GA-46 could create a similar dynamic, with individuals delaying essential care out of fear, potentially escalating public health risks.
Financially, delayed care often shifts costs to more expensive emergency services. The Kaiser Family Foundation estimates that avoidable emergency care costs in the U.S. total $409 billion annually, partly due to untreated conditions worsening over time. This contributes to higher overall healthcare costs, impacting hospitals and patients alike.
Rural hospitals, in particular, may be disproportionately affected. Texas has numerous rural hospitals, many of which are already financially strained and which serve high numbers of uninsured residents. Health advocates argue that GA-46 could place additional pressure on these facilities, increasing uncompensated care and risking service cuts or closures. With an estimated 26% of Texas’ rural hospitals at closure risk, this policy could further threaten rural healthcare access.
Health equity concerns also arise. Texas is home to over 1.6 million undocumented individuals, many from racial and ethnic minority groups who already face barriers to care. If GA-46 discourages these individuals from seeking care, it may deepen health disparities. Advocates argue for policies that foster inclusive, accessible healthcare environments, noting that equitable preventive care access could ultimately reduce emergency care costs.
Supporters of GA-46, however, believe that transparent data on healthcare costs for undocumented residents is necessary to address fiscal challenges. They argue that tracking these costs will help Texas better understand the financial demands undocumented patients place on the system, enabling more informed policy decisions and fund allocation.
The effects of GA-46 will depend on its impact on hospital visitation patterns and financial outcomes for Texas’ healthcare system. While the focus on cost transparency and federal reimbursement is intended to address fiscal concerns, public health implications remain significant, particularly regarding healthcare access in immigrant communities. Organizations like the Texas Hospital Association and immigrant advocacy groups stress the importance of informing patients of their rights under this policy to mitigate fears and maintain access to essential care.
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