2023 Edition
"When we speak, we are afraid our words will not be heard nor welcomed, but when we are silent, we are still afraid, so it is better to speak."
Audre Lorde
The Editor's Take: Breast Cancer Awareness Month
Hello AMWA UTD! In this edition of the newsletter, your writers bring you articles on Tackling Disparities, Avoiding Stress and Burnout with the MCAT, a spotlight on EPIC Medical Clinic, and the Gender Differences regarding Multiple Sclerosis. We also bring to you our paired articles - The Sex Talk You Never Had and What's Poppin'. Also, take a look at our Spotify Playlist as you prepare for midterms this month!
In October, we acknowledge Breast Cancer Awareness Month and PA Week. Breast cancer is when malignant cells form in the tissues of the breast with multiple types of breast cancer that affect both men and women. It is detected through annual mammography and other breast exams to determine the stage of the cancer.
Breast Cancer Incidence in the U.S. (National Breast Cancer Foundation, Inc.)
1 in 8 women will develop breast cancer in their lifetime
It is estimated that in 2023, approximately 30% of all new female cancer diagnoses will be breast cancer
On average, every 2 minutes, a woman is diagnosed with breast cancer in the U.S.
While breast cancer is a leading cause of death for women, there has been a 40% decrease in mortality over the last three decades (National Breast Cancer Foundation, Inc). This can be attributed to early diagnosis, awareness, and improvements in treatment. However, there is still a long way to go in order to tackle the disparities that limit patients from getting the right resources and education. This includes poor access to quality and affordable care and socioeconomic inequalities.
To get involved and spread breast cancer awareness, check out the 2023 Komen Dallas North Texas More Than Pink Walk on October 21, 2023.
National PA Week is from October 6 to October 12. The field of physician assistants began with Dr. Eugene Stead. In a field that nurses and primary care physicians primarily dominate, physician assistants help expand the medical field and make it more accessible to patients. They conduct physical exams and provide diagnoses and treatments. The PA education is intense but rewarding as the curriculum is considered a 'condensed version' of medical school and lasts an average of 26.5 months.
Spend time with these articles, and as always, if you would like to submit your own piece of writing, have ideas, or questions, email me at Tanya.Baiju@utdallas.edu.
- Tanya
Tackling Disparities in Healthcare
By: Riya Ramani
Health disparities, also known as health inequities, are receiving increased attention from healthcare providers, legislators, and federal organizations. Health disparities include health and healthcare quality discrepancies among diverse groups, including race and ethnicity. Age, sexual orientation, access, and socioeconomic variables all play essential roles. Disparities in access to medical care between racial and ethnic groups are caused by cost, healthcare access, primary care availability, and bias.
The disparities based on race and ethnicity offer moral and ethical difficulties to the healthcare system. According to cardiology research, African Americans were less likely to obtain crucial cardiac treatments even when their clinical parameters matched those of white patients. These inequalities highlighted questions regarding the impact of culture on treatment decisions. Despite advances in healthcare technology, access remains unequal, affecting social justice, opportunity, and overall well-being. The economic ramifications are essential, as poor health among certain groups hurts the nation's prosperity.
The Malone-Heckler Report, released in 1985, highlighted substantial health inequities. It revealed a long history of unequal access to medical treatment and identified specific illnesses, such as cancer and heart disease, contributing to excess mortality among minorities. "Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare," published by the Institute of Medicine in 2003, revealed racial and ethnic discrepancies in healthcare. It emphasized the impact of bias and discrimination even when equal access was provided, and it proposed an integrated model to explain these differences.
Health insurance coverage disparities continue among various demographics. Uninsured individuals obtain fewer preventative interventions, have lower health outcomes, and die at a higher rate. The economic cost of health disparities in the United States is projected to be over $1.5 trillion over three years.
Despite improvements since the Malone-Heckler Report, issues remain in the awareness of health inequities. Implicit biases in healthcare continue to exist despite efforts to improve cultural competency training. The changing landscape of healthcare reform, cost-conscious care, and performance-based payment structures presents new problems.
Tackling health inequities is critical for social justice, ethics, and the country's general prosperity. Recognizing and addressing these gaps is a moral necessity and crucial for a healthier and more equitable future for all Americans.
The Sex Talk You Never Had: Uterine Fibroids
By: Hafsa Mohammed and Gauri Guruprasad
The first time I heard about uterine fibroids was a frightening time. My friend was experiencing some health issues and became concerned about possibly having a fibroid, as her symptoms matched. Thankfully, it turned out to be a false alarm, but my curiosity led me down the rabbit hole of learning more about this surprisingly common ailment, which we all most likely have not heard of or do not know much about.
Uterine fibroids, otherwise known as myomas or leiomyomas, are benign enlargements of the uterus that are not cancerous but may bring upon a host of other issues for those afflicted. The tumors differ in size and number. Many women experience abdominal and/or uterine swelling that resembles pregnancy. In 25% of women, fibroids may be accompanied by pelvic pressure and menstrual irregularities (Stewart 2001). In other cases, fibroids may not pose symptoms in patients and are only discovered through pelvic exam or ultrasound. Although it has been noted that fibroids may cause infertility, it is rarely the case and is almost always treatable. In pregnant patients with fibroids, the location and size of the fibroids may cause the need for a Cesarean birth or premature delivery. In worst-case scenarios, it may even cause miscarriages. There are different theories at play to ascertain what could cause fibroids. One such theory is that fibroids develop from misplaced cells in the womb as a fetus, and the growth is promoted through estrogen and progesterone throughout life (ACOG 2022).
Fibroids can grow in various places in the uterus and are grouped into three categories as such:
Submucosal fibroids grow in the uterine cavity.
Intramural fibroids grow in the uterus wall.
Subserosal fibroids grow on the outside of the uterus.
Fibroids can be detected through routine gynecological exams, ultrasounds (sound waves form a picture of the uterus), saline infusion sonography (salt solution injected into the uterus to create an ultrasound image), MRI, x-rays, and CAT scans (NIH).
Uterine fibroids can be treated. People with uterine fibroids often have no symptoms or issues, so they do not even need treatment. For people afflicted with fibroids, pain medicine may be helpful for occasional pain. Birth control pills could help control heavy bleeding and painful periods but may cause fibroids to grow larger. Intrauterine contraceptive devices (IUDs) reduce heavy and painful bleeding but are not recommended for people with large fibroids that could block the uterine cavity.
Additionally, gonadotropin-releasing hormone agonists (GnRHa) block hormones that cause ovulation and reduce fibroids' size. However, these medications can have side effects that mimic the symptoms of menopause, so they are only meant to be used temporarily (NIH). There are also fascinating trends/discrepancies about the demographic population affected by uterine fibroids. Black women are at risk for developing more severe and early uterine fibroids than White women. This could be due to the difference in exposures across life that may have contributed to the disparity (Katon, Ph.D., MS, and Plowden, MD, MPH). However, it is important to remember that this condition is treatable, and some conditions may not cause too much affliction.
While uterine fibroids can be difficult to deal with, treatments are available to ease the symptoms or completely get rid of the fibroids. Since the economic impact of fibroid treatment is significant, there are active research projects to try to find the pathophysiology of fibroids to find ways to avoid them as well as avoid surgical intervention (NIH). The future of uterine fibroid treatment looks lush with new possibilities and evidence-based therapies to reduce the risk of fibroids.
MCAT: Avoiding Stress and Burnout
By: Alyssa Chiev
Preparing for the medical college admissions exam is often a months-long process that can leave many aspiring physicians stressed and burnt out. Practicing a full-length exam takes about an entire day, more specifically, seven hours and thirty minutes, and each individual practice section takes about 90 minutes. It is often difficult to find large open intervals of time to fit studying into, making time management crucial. After managing to fit studying into a schedule, it is important to prevent burnout.
Time Management is Key to Avoiding Stress
Managing time is key to success. Although this is obvious, it is often forgotten by many premeds. It is easy to overload your schedule with jobs, research, and classes, leaving little to no time to study for MCAT or free time for yourself. Although these commitments would look good on a medical school application, it is equally important to recognize when they affect studies and overall well-being. After all, the main two factors medical schools look at are GPA and MCAT scores.
Some popular MCAT prep packages, such as Blueprint, have a feature that designs a study schedule based on preferences and availability, making it quite useful. However, most third-party prep does not have this, so designing a realistic schedule is challenging. When designing a schedule, remember to include not only time for studying but also time for breaks.
Burnout
The MCAT is a marathon, not a race. It is easy to be burned out multiple times within the months of studying for the exam. Taking two days off a week from studying will be highly restorative. Not only are breaks restorative, but taking care of yourself also is. According to Blueprint, some ways you can prevent burnout is:
Get enough sleep. At least seven hours a night is ideal. Anything less would affect your studying. Not getting enough sleep can affect memorization, recall, critical thinking skills, and more. It will seriously affect the body's circadian rhythm and accumulate sleep debt.
Exercise regularly. Regular exercise during a study period can be highly beneficial. Exercise is a stress reliever and could be considered an investment of time rather than a waste of time.
Effective Studying
When studying for the MCAT, it is challenging to see significant improvements. To effectively study, staying present and avoiding distractions while studying is essential. Checking Instagram, text messages, and other social media is not an efficient use of study time. It is far more efficient to study less focused than it is to study more distractedly. And for exams like the MCAT, stamina usually plays a factor in a score not improving. That is why taking breaks now and then is beneficial because overloading yourself with practice exams can impact you for the worse.
The medical college admissions exam is brutal; preparation takes up to months. The exam requires good stamina and knowledge within the four sections that it tests: chemistry and physics, critical analysis and reasoning skills, biological foundations, and psychology and sociology. The exam does not only require knowledge but stamina, considering that it is about eight hours long. It's easy to be stressed and burnt out, but recognizing when you will get to that point will, in the end, save you more time when it comes to studying and help your overall well-being.
EPIC Medical Clinic: Emancipating Healthcare One Patient at a Time
By: Hafsa Mohammed
At least one weekend of the month, I volunteer at EPIC Medical Clinic, a free clinic in East Plano that serves the surrounding community. A few weeks ago, a patient came in for long-term muscle pain. She had arrived in America not so long ago on a student visa and was at a loss in adjusting to the new environment and find care. After her consultation, the doctor gleaned the necessary background information from the patient, and we ran a pregnancy test. And lo and behold, the patient had tested positive. However, with her lack of insurance, finding resources to aid her throughout her pregnancy was difficult. Our MA lead and the doctor worked with the patient one-on-one to direct her to resources for receiving care.
This story may not seem as exciting or full of pizzazz as some medical dramas portray healthcare to be, but it is a very real story of what happens at our clinic. Not to say there aren’t any cool cases, but many of our patients come in with ailments they could not find treatment elsewhere. One of the biggest needs in healthcare is the lack of care for the uninsured population. What has drawn me and several other healthcare professionals to the clinic is that the care provided isn’t doused in the underlying knowledge that healthcare is transactional, but all of it was done free of charge through the dedicated team of volunteers.
As part of the Collin County Coalition of Charitable Clinics, EMC is a weekly free clinic open on the weekends that serves uninsured patients from the DFW metroplex. It was established in 2008 in partnership with the East Plano Islamic Center to provide much-needed care to members of the community. The clinic is open every Sunday from 9 am to 12 pm for all types of care (excluding medical emergencies and government paperwork) and Every Saturday for the GYN (Women’s Health) clinic. What is unique about EMC is that we have an extensive network of medical specialties that see patients for free. The various specialties offered are:
Internal Medicine
Family Medicine
Pediatrics
Oncology
Nephrology
Gynecology
Psychiatry
Neurology
Orthopedic
Pulmonary Medicine
Patients only pay for lab fees, which are heavily discounted when ordered through the clinic. The clinic has saved over $400,000 for patients since its opening regarding doctor’s visits and lab fees. All of this wouldn’t be possible without the help of our dedicated team of volunteer doctors, MAs, leads, directors, etc.
In 2020, the clinic opened a Women’s Well Clinic focusing on gynecological issues. Many women tend to ignore issues that are brought up due to difficulty finding care and paywalls that restrict them from receiving treatment. Dr. Hina Cheema, M.D., is one of the recurring doctors who see patients in the GYN clinic. Through her and the amazing team of doctors, EMC can see 24 to 28 patients weekly and is expanding to support more of the community. Many patients who come to the clinic have little to no knowledge of the healthcare system. EMC does its best to guide patients to the appropriate resources and bridge them to other volunteer organizations with adjacent goals.
“What I love about EMC is that we’re giving people what they need. No politics, no money involved, no strings attached. We’re just giving people what they need. And that’s beautiful”
- Faiz Mustafa, MA lead at EMC
*All statistics are pulled directly from EMC’s reports
Relevant Links:
https://form.jotform.com/201684543243049 (Book an Appointment)
https://www.epicmedicalclinic.org/ (EPIC Medical Clinic website)
https://services.madinaapps.com/donation/clients/epicmasjid/paymentOptions;jsessionid=AFA06F80CE0B3C3D028A89B45CB12FFE/147 (How to Donate)
Gender Differences Regarding Multiple Sclerosis
By: Gauri Guruprasad
There are so many different organizations and Fun Runs advocating for Multiple Sclerosis awareness. However, I had no idea about how important this disease actually was until I learned it disproportionately affects women and is increasing in prevalence.
Multiple sclerosis (MS) is a rare autoimmune disease that affects the brain and spinal cord (the central nervous system). MS causes degeneration of myelin (protective sheath) on nerve fibers. This causes communication issues throughout the central nervous system, leading to mobility issues, spasticity (loss of muscle tone), paresthesia (numbness and tingling), and vision distortion. Most people experience symptoms starting in their 20s to 40s, but late-onset multiple sclerosis (LOMS) can cause symptoms starting at age 50.
Diagnosis occurs when someone has had one or more attacks (sudden onset of symptoms listed above) and an MRI scan showing specific changes in brain tissue (Hopkins). More specific tests can also be done, including evoked potentials (which indicate if the electrical signaling in your brain is impaired), blood tests, and cerebral spinal fluid analysis (which checks for chemical and cellular abnormalities).
There are some interesting disparities in the diagnosis of MS in people. Most importantly, MS disproportionately affects women, with the MS prevalence ratio being 2.3-3.5:1 for women compared to men (NIH). This marked increase in MS for women most likely reflects changes in environment/nutrition (NIH). The disparity also continues with latitude, with people in higher latitudes in the Northern Hemisphere being disproportionately diagnosed. These disparities could have many factors, specifically environmental factors such as smoking (female smokers have increased) and month of birth, which correlate to specific seasonal viruses or the amount of maternal UV exposure. Men and women generally respond differently to their environment, so this disparity makes sense. However, there is not much evidence about the symptomatic differences between men and women with MS. Though women typically get diagnosed earlier and show less progressional disability than men (NIH).
MS, unfortunately, cannot be prevented infallibly, as genetics and age play a huge factor. Some ways to live a healthier life can possibly prevent the disease. Make sure you get enough vitamin D in your diet and move somewhere lower in latitude, as studies show that “if a person is born in a northern climate area and moves close to the equator before the age of 15, they will have a lower risk of getting MS” (Bottaro). In addition, quit smoking, engage in physical activity, and have healthy gut flora by regularly eating probiotics since the gut affects the health of the immune system (Bottaro).
While the disease is rare, it is important to know about diseases that are increasing in prevalence and disproportionately affect women, as we are more susceptible. Take action to avoid this disease by living a healthier life. Next time you see people raising awareness about MS near you, I hope you can join the mission.
What's Poppin': Alleviating The Medical Debt
By: Alyssa Chiev and Riya Ramani
More than 100 million Americans are affected by medical debt, which costs over $195 billion. Medical concerns account for 66% of all bankruptcies in the United States, and medical debt keeps afflicting the disadvantaged, including the uninsured, chronically ill, disabled, and/or minority communities. On the other hand, those with insurance might become victims of medical debt due to high deductibles, disputes between providers and insurance plans over coverage, and expensive healthcare expenses. However, our existing system does nothing to prevent or mitigate this problem in the future.
Over the last five years, more than half of US individuals have suffered medical debt, with 25% owing more than $5,000 and 13% owing more than $10,000. In the last five years, 69% of African and 64% of Hispanic Americans have had medical debt. African Americans are 50% more likely than white adults to owe money for healthcare. People of color are also more likely to be uninsured and to have a lower income, making them more likely to incur medical debt. Furthermore, they have a higher incidence of chronic illness, requiring additional care.
Along with persons of color, uninsured Americans are the second hardest afflicted by medical debt. In the last five years, 71% of uninsured and 61% of insured individuals have incurred medical debt. The problem is exacerbated further in the South and Midwest, where state governments refuse to expand Medicaid, leaving thousands of low-income Americans uninsured. However, the strongest predictor of medical debt is illness. People with chronic conditions require more medical care than the average American, which raises more medical bills. With 52% of Americans suffering from at least one chronic illness, chronic illness is one of the leading causes of medical debt.
Furthermore, medical debt adds to financial hardship and can prevent individuals from paying for necessities like rent, utilities, and food. Medical debt also limits credit availability and hurts credit scores. Medical debt can permeate an individual's life, causing financial difficulties in almost every aspect.
According to the New England Journal of Medicine, there are many solutions to tackle the accumulating medical debt within the United States. If Medicare were to apply the Affordable Care Act's regulation to all hospitals, this would notify patients that financial assistance is available and make the documentation process much more efficient for those who need assistance. It would also strengthen the rules surrounding charging low-income families.
Another method that was addressed was debt forgiveness programs. By leveraging the fact that medical debts are often sold as discounts, policymakers can design programs that provide relief to families with medical debt rather than relying solely on charitable donations. An additional proposed solution is to adopt nationwide Medicaid, reduce the frequency of eligibility checks, lower the maximum out-of-pocket expenses for those with private insurance and Medicare Advantage plans, and implement an out-of-pocket spending limit for individuals enrolled in traditional Medicare. These proposed measures aim to make healthcare more affordable and accessible, particularly for low-income individuals, while also providing financial protection for those using government healthcare programs.
The most popular solution that has been proposed for decades but still seems somewhat controversial is universal healthcare. Universal healthcare is considered the ultimate solution for alleviating medical debt but remains controversial in the United States due to ideological differences and cost concerns.
More than a hundred million Americans are affected by medical debt. These medical debts affect certain groups harder than others. Although there are many proposed solutions, it is, in reality, challenging to implement any of them, given the political divide and cost concerns in the United States. These solutions include strengthened regulations, debt forgiveness programs, coverage expansions, and universal healthcare. With many Americans struggling with medical debt, policymakers and the public must continue to explore and advocate for practical solutions to relieve the burden of medical debt on those who need it most.
Sources
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3540621/
https://www.ama-assn.org/delivering-care/patient-support-advocacy/reducing-disparities-health-care
NIH. “What Are the Treatments for Uterine Fibroids?” Eunice Kennedy Shriver National Institute of Child Health and Human Development, U.S. Department of Health and Human Services, www.nichd.nih.gov/health/topics/uterine/conditioninfo/treatments. Accessed 22 Sept. 2023.
Katon, PhD, MS, Jodie G, and Torie C. Plowden, MD, MPH. “Racial Disparities in Uterine Fibroids and Endometriosis: A Systematic ...” Fertility and Sterility, www.fertstert.org/article/S0015-0282(23)00060-2/fulltext. Accessed 23 Sept. 2023.
https://pubmed.ncbi.nlm.nih.gov/11214143/: official govt resource outlining brief summary of uterine fibroids
https://pubmed.ncbi.nlm.nih.gov/27335259/: gives demographic information
https://www.womenshealth.gov/a-z-topics/uterine-fibroids: answering commonly asked questions about uterine fibroids
https://academic.oup.com/edrv/article/43/4/678/6422392: comprehensive review of uterine fibroids
https://www.princetonreview.com/med-school-advice/mcat-study-guide/mcat-study-schedule
https://blog.blueprintprep.com/medical/4-key-tips-to-avoid-mcat-or-usmle-step-1-study-burnout/
https://www.aha.org/fact-sheets/2023-06-12-fact-sheet-medical-debt
https://www.nejm.org/doi/full/10.1056/NEJMp2306942
Bottaro, Angelica. “Can You Lower Your Risk of Developing MS?” Verywell Health, Verywell Health, 2 Mar. 2022, www.verywellhealth.com/can-you-prevent-multiple-sclerosis-5207758#:~:text=It%20cannot%20be%20totally%20prevented,your%20diet%20and%20quitting%20smoking.
“Multiple Sclerosis (MS).” Johns Hopkins Medicine, www.hopkinsmedicine.org/health/conditions-and-diseases/multiple-sclerosis-ms. Accessed 24 Sept. 2023.
https://www.nationalbreastcancer.org/breast-cancer-facts/
https://www.nationalbreastcancer.org/blog/disparities-in-breast-cancer-threaten-progress-for-all/
As always SPOT ON writers! I wrote an analysis essay on Nancy Mairs on being a cripple and her dry sense of humor when talking about adjusting to living with MS is poignant gender factor is a big deal for diagnoses