Stanford to M.D.

Two friends sharing their passion for medicine.    

[stanfordtomd]

Going Green in the Lab

From the desk of Lauren...

Since joining the Schiffman Lab at the Huntsman Cancer Institute, I have been increasingly interested in reducing the waste in the lab. Timed perfectly with the Climate Change Conference currently taking place in Paris, TheScientist hosted a webinar yesterday about going green in the lab. It was a great opportunity to hear about the green initiatives Genentech, Harvard, and My Green Lab have implemented which I will try to highlight here so we can all bring them to our own labs!

Recycling Bins: the obvious starting point in office spaces, but in labs it’s hard to get contractors to take recycling due to safety concerns. Harvard’s solution? Show companies a good history of separating out biohazard waste and carefully rinse or remove all labels to avoid handling concerns. Make it harder for things to accidentally make it into recycling by not placing them by fume hoods or where hazardous materials are generally used.

Freezer temperature: it has become standard to use -80C for no other reason other than we could make a freezer to go this low. All the experts agree that real damage doesn’t start happening until around -60C, so they recommend setting freezers to -70C. Making this change reduced ~25% freezer energy costs at Genentech.

Reuse rooms and events: avoid ordering superfluous materials and solutions, but having a room and garage sale type days for extra equipment hanging around the lab is a great way to repurpose things your lab won’t need. Also is great for reusing unrecyclable things like styrofoam shipping materials.

Biosafety cabinets: minimize the time the sash is open by closing the sash between experiments. This saves Harvard over $200,000/yr in HVAC costs and reduced each lab’s energy intensity by an average of 608 CFM/day.

Additionally, minimizing the time the UV light is turned on saves energy. Cleaning these bulbs regularly is essential for them to have any effect whatsoever, and even then the maximum effect is within 15 minutes (ASU). Thus we should limit use of the UV light to the 15 minutes immediately preceding and following hood use. The CDC has actually released that the use of UV light in biosafety cabinets is not recommended or necessary. Just using 70% ethanol to disinfect the hood is sufficient for sterility. There’s some great literature about this one, including from the NIH, but for the best analysis I’d check out this article. “Use of a UV light in excess of an hour or overnight is massive overkill.”

PCR and centrifuges: the last idea I’d like to implement in our lab addresses the costly maintenance of cool temperatures in PCR thermocyclers and centrifuges. Only run PCRs during the day so it doesn’t remain cooling throughout the night or just ask someone who is staying late to take it out when it finishes. Similarly, store just the rotor in a 4C fridge instead of having the whole centrifuge working all day and night to maintain that temperature.

Check out more about Harvard’s sustainability campaign at: http://green.harvard.edu/ and watch the free Go Green webinar here!

[stanfordtomd]

Lauren: for the burgeoning young ethologist in you. Simple, but a great glimpse into an inquisitive mind and a life dedicated to one's passions.

[stanfordtomd]

Learning Impacts How We See

From the desk of Tegan...

I recently read an article about how our learning can actually impact how we see. You can check out the article here.

They say that “top-down” processing has an impact on what we actually see. This means there are connections that influence neurons in the visual cortex. One example given in the article was our ability to read words that are missing letters, we are able to do this based on our past experiences.

The brain has both “top-down” and “bottom-up” interactions however, with learning, top-down interactions are favored. This study supports not only the fact that we interpret the present using our past experiences and knowledge, but that the way we see our surroundings is impacted by top-down signalling. This means our brains may not be accurately representing our surroundings but instead attempting to predict them.

“Your assumptions are your windows on the world. Scrub them off every once in a while, or the light won't come in.” - Isaac Asimov

This article brings up a traditional problem in philosophy, the problem of perception. If it is possible that how we perceive reality is flawed or influenced by our experiences, do we even actually have access to reality or more generally what is reality? The Stanford Encyclopedia of Philosophy has a good article that outlines the problem of perception in the history of philosophy and various attempts for philosophers to deal with the problem if you would like more info.

[stanfordtomd]

Cord Blood Banking

From the desk of Lauren...

Cancer. Probably the most feared word. Fortunately, childhood cancer is relatively rare (1/285) and survival rates are increasing, but cancer remains a completely devastating disease. As such, parents in the delivery room are pressured to “protect” their new children from cancer by banking cord blood. I have never been more shocked than by the information about this practice. So, after some research, here is what I have collected  about what cord blood is, what medical uses it has, and the difference between private and public banking.

What is cord blood?

This is the blood remaining in the placenta and umbilical cord after childbirth. Its value comes from the hematopoietic stem cells that differentiate to generate all types of blood cells. It is difficult to obtain samples, which can only be stored effectively for about 20 years.  

What can it be used for?

Companies love to spout that 80+ diseases may be treated with stem cells. Well that’s not the whole truth. If the problem is genetic, then putting back more of your own cells is not going to solve the problem. So the diseases treated with your own stem cells are very few (10) and rarely seen. These are disorders like Hodgkin Lymphoma, which carry a 95% cure rate, and to begin with are only present in .014% of children.

Treatment using others’ stem cells.

This category is slightly larger (13 diseases), but more importantly it covers much more common cancers like leukemia, which accounts for 34% of childhood cancers.

Notice above the categories were stem cell treatments. Cord blood is not the only source - stem cells can also be obtained from peripheral blood and bone marrow.

How can we store cord blood?

Private Banking

Companies charge an arm and a leg to store the cord blood for your private use.

Public Banking

Collection is free to donate, but not saved for a specific person. The banks are regulated by the FDA and screened. Unfortunately, this testing has shown us that collection of cord blood is a very precarious process, only 40-60% of donations can be used. In comparison, private bank samples are known to have smaller volume, lower cell counts, and an even higher incidence of bacterial contamination than public banking. Private companies are NOT required to inform you of the viability of your sample, so there is at least of 50% chance that you are paying thousands of dollars to store a unusable sample.

Related Donor Cord Blood Program

Fortunately, there is a solution for families in which there is an older sibling who has a transplant-treatable disease. In this case there is a 25% chance that the newborn will have a match. Cord blood storage in these programs is free!

My Conclusion

Cord blood is a resource we should use for medical treatments. Even if you remove money from your assessment and you look exclusively at the likelihood of using your own sample, it does much more good to donate it to a public registry like Be The Match Registry. The notable exception is in the case of an older sibling with a transplant-curable disease.

Unfortunately, private companies prey on new parents who want to protect their children with misleading, accusatory advertising.

Cost estimate for private cord blood banking: $1,374,246 per life year saved.

Read scientific articles about cord blood here:

Cost-Effectiveness of Private Umbilical Cord Blood Banking

Private Cord Blood Banking: Experiences and Views of Pediatric Hematopoietic Cell Transplantation Physicicans

References:

Abdullah Y. Cord blood banking: what nurses and healthcare providers should know. MCN Am J Matern Child Nurs.

2011 Nov-Dec;36(6):344-50.

American Cancer Society. Cancer Facts and Figures 2014 Special Section: Cancer in Children & Adolescents.

Atlanta: American Cancer Society; 2014.

Effinger, K. “Cord Blood Banking: Yes, No, Public, Private. What’s the Risk?” Cancer Epidemiology. Stanford

University. Jan 13, 2015. Lecture.  

Kaimal AJ, et al. Cost-effectiveness of private umbilical cord blood banking. Obstet Gynecol. 2009 Oct;114(4):848-55.

Thornley I, et al. Private cord blood banking: experiences and views of pediatric hematopoietic cell transplantation

[stanfordtomd]

Lauren: Introduced by my favorite guy, Professor Sapolsky, with “a third of my students absolutely hate it, a third don’t get it, and a third tell me it changed their lives”. I fall in the third category! Mind blown.

[stanfordtomd]

Tegan: I work as a scribe in the Emergency Department and the other day, the doctor I was working with was explaining a patient’s EKG to me. He pulled this diagram up to show how the different leads correlate with the anatomy of the heart.

[stanfordtomd]

Cool Science: Scotch Tape Makes X-rays

From the desk of Tegan...

Something you never knew about scotch tape?  It can produce x-rays!

This doesn't mean that you need to be wary of radiation coming off of tape when you are using it on a daily basis; the tape has to be in a vacuum for there to be any discernible effect. But scientists at UCLA were actually able to generate a finger X-ray from the energy released by their sticky tape machine.

This type of energy release is called triboluminescence and it can be seen as a release of light. Triboluminescence is poorly understood, but it occurs when two surfaces are moved relative to one another and it has been suggested that it may have to do with separation of opposite charges. Scientists are baffled as to why this amount of charge built up on the peeling tape, but more research will follow to investigate the potential to trigger nuclear fusion! Kind of gives you a whole new respect for tape!

Here is the Nature news article with links to videos of the research.

[stanfordtomd]

Response to “We Are Athletes”

A Discussion on Collegiate Athletics from Tegan & Lauren….

Lauren: Earlier this week we shared an incredible video from a current Stanford Athlete, you can check it out here. While normally this is not the topic of our blog Tegan and I, both former Division I athletes, thought we would like to add our two cents about collegiate athletics.

Tegan: I watched the video three times in a row. The final time I only listened. Each time I got chills and her words really hit home. For me, she hit the mentality of an athlete right on the head. We always expect ourselves to succeed, at everything. But when we don’t we never give up. We try again, figure out another way, work harder, and fight until we succeed. “Fall seven times, stand up eight.” -Chinese Proverb. We feel that we should be perfect and this can take its toll on our mental health because you feel you cannot show weakness or ask for help. However, we all struggle, and needing help is human. Stanford athletes are especially prone to feeling pressure to be perfect due to being the “Ivy of the west” alongside highly competitive Division I athletics.

Lauren: The decision for me to attend Stanford University was to me a no-brainer - attend the most academically rigorous university in the world and play the sport I loved in the best conference? Sign me up! Athletes are in the unique situation where you push yourself to the limits not only in physical capabilities, but also mental concentration and dedication. It is an incredible working environment to be a part of where everyone is working at 100%. That kind of effort goes into every part of my life now. I find what inspires that kind of passion in me and I work at it like all those hours on the field.

Tegan: The athlete mentality is something that not necessarily everyone understands. However, employers of all types are beginning to appreciate it. If you google “why you should hire a college athlete” you get articles from Forbes, LinkedIn, and more. It has to do with everything from time management, to dealing with failure, to putting the team first. Here is one such article that I thought summed up some of the great qualities that come from being a student athlete. Many of these qualities are applicable to becoming a physician as well.

Lauren: There are a lot of great articles about why athletes are great hires, but it all boils down to this: all those qualities that made you great at your sport, they make you a great asset to your workplace as well. If you know your passion is medicine, well first off Tegan and I agree it’s pretty awesome, but even if it’s not go after it! And we want to hear about it! We want this blog to be a place where people come together to learn from each other!

[stanfordtomd]

Through the Application Process: Secondary Season

From the desk of Tegan…

Hello! It has been a while. Lauren was busy graduating with her B.S. in Biology (CONGRATULATIONS!!!!) and I was enjoying the brief lull in the application process. However, we were working on our resources section as well, check it out!

I am now in the midst of many, many, MANY secondary questions. The secondary application is where each school gets to ask you anything they like. Many schools have short answer questions and some have a single essay. Some have no additional questions they just require some background information and maybe a list of your letters (you can check out the questions we have collected here). One thing they all have in common? A fee. Applying to medical school is not cheap.

However, with the secondaries, you get a chance to express yourself a little more than you do than in the confines of the primary. This part is great because with some schools you feel like they might get to see who you are as a person a little bit more than they do from the primary. There is also quite a bit of overlap between schools (but with different word and character counts of course).

Lauren’s addition to conclude...

Because this is the portion of your application that is important to let medical schools get to know you at a deeper level, it is important to dedicate a lot of time to writing out the responses and submit them in a timely fashion. It’s also a good idea to keep track of what information you send to each school, because in your interview anything you have sent them is fair game!

Check back soon for an article we are working about medical school interviews!

[stanfordtomd]

Was shown this amazing video today by a current Stanford athlete. It gave me chills and definitely hit home, so we wanted to share

This is her description on youtube (she choreographed and wrote everything):

“This dance was inspired by the struggles that athletes go through but rarely show externally because of the pressure and expectation to always appear strong. I hope by sharing this, that people will be more willing to speak out about their struggles and know that they’re not alone.” -Hannah Levy

[stanfordtomd]

Through the Application Process: Submitted!

From the desk of Tegan…

On the evening of June 4th, I SUBMITTED my primary application! Its feels a bit like how I imagine sending your child off to college feels. You have been with you app and working on it for at least a month always editing, tweaking, and changing… then you hit that one button, and BOOM you’re an empty nester. This is a great relief though after what feels like 60478350853708580 drafts of my personal statement, it was finally ready (or ready enough).

I’m enjoying what will be a brief respite though, the deluge of secondaries will soon arrive! Based on some google research, it seems that the average number of medical schools individuals apply to is about 15, ranging anywhere from 10-25. The majority of medical schools send secondary applications to everyone who applies. This means LOTS of secondary questions to answer! I suggest having a document where you save the questions and answers to all of these because a lot tend to be similar and sometimes you come up with a fantastic answer that you can possibly tweak and use again. However, there are some that do screen your primary prior to sending a secondary (the UC’s and Vanderbilt). For these schools, you have at least made it through the preliminary round!

As I get secondaries, I will add info about them to the Secondary Applications document in our resources section.

[stanfordtomd]

Through the Application Process: Resources

From the desk of Tegan...

Where to begin? So, this is my second time going through this application process and although it is quite painful, this time around I feel like I somewhat know what I am doing. The first time I applied was June of 2013, which was when I graduated from Stanford.

Lauren and I wanted to share all the resources we have collected (me through 2 rounds of applying and Lauren through being way more on top her schmidt than I am). We have a resources tab in the navigation (see above) and have posted many of our resources here via google drive. Whenever we find new resources, they will be posted there as well.

A little about the application generally…

First of all, you can begin filling everything out online in early May and it usually opens for submission first few days of June. In terms of content, there are the standard sections (general info, your parents, your childhood, felonies, etc). Then you have the pleasure of meticulously typing in all of your classes EXACTLY as they appear on your OFFICIAL transcripts. If you mess something up, it could delay your application up to something absurd like 10 weeks, hence why everyone recommends ordering an official transcript for yourself. Next is the “activities section” where you can list up to 15 activities. For each activity, you estimate your number of hours and have 700 characters to describe it. For 3 of your up to 15 activities that you deem “most meaningful” you get and additional 1325 characters to explain why it changed the very core of who you are (AAAAH!). Finally, there is the personal statement.

Currently I am in the slaving over my personal statement stage… how many drafts can one possibly do? Anyone who has written a personal statement for anything already knows that it can be agonizing. How are you supposed to show someone who you are in 5,300 characters including spaces? Not only are they supposed to feel as if they know you after reading those characters, you are also supposed to be so AWESOME that they remember YOU above everyone else. Good luck!

You can see how this can be pretty intimidating. Something to keep in mind, that advisors and beyond say over and over again: your personal statement will not make or break your application. Yes it can help and yes it can probably hurt as well, but it will not be the reason you are or are not accepted to a medical school.

I will compile notes we have on all aspects of the personal statement here. For most people, the problem is getting started, one of the best things you can do is start stream of consciousness. Just START writing. Because staring at that blank word doc is the scariest part of the process. We also have some questions that you can get started with. These are used as exercises to get you started and get you thinking, so when I was made to do them, we got 3-5 minutes each question and just typed/wrote whatever came to mind (check them out here).

As I make my way through the application process, I will post updates :)

Here is a list of the resources we currently have: 2015 compiled MSAR Data spreadsheet, personal statement exercises, AMCAS application worksheet, a general application timeline, and more. Make sure to check it out!

In the wise words of Dory "Just keep swimming, just keep swimming, just keep swimming swimming swimming"

[stanfordtomd]

Professional Modesty

From the desk of Lauren: Happy New Year! Stanford has Cured Alzheimer's!

This is the headline that was all over my Facebook feed to start off my 2015.

Admittedly I have become so calloused to these outrageous claims from the banners all over the internet like “5 tips to losing that belly fat” or “use this cream to stop aging” that I immediately knew that this article could not be anything other than another example of sensationalized journalism.

So surprising to me, then, was that over the course of the next several weeks that my Facebook friends kept sharing it on their newsfeed unironically, even my fellow Stanford students.

Granted, this is some exciting new research that could have some amazing therapeutic implications, but it certainly cannot be touted as a magical cure just yet.

I would encourage everyone to read the actual journal article here.

This is part of how unhealthy the pressure has become to get the next big scoop. Headlines have become more and more hyperbolic. Which brings me to the paper and subject of our first post.

False-Positive Results in Cancer Epidemiology: A Plea for Epistemological Modesty

This article is a great plea to the scientific community to “practice some epistemological modesty when interpreting and presenting their findings”.

Of course scientists want their work to yield meaningful, positive results. And they push themselves and their graduate students very hard to produce publishable results on a short timeframe. This pressure has partly been generated by the publishability of certain results. A journal mostly publishes studies showing “positive” work, as in disproving the null hypothesis. Thus scientists naturally only follow up on experiments that are heading in that direction.

Fortunately, we are beginning to address this foundational problem. Ultimately, we need to know what experiments have shown no statistical significance so other labs don’t continue to chase the dead end. A new journal has been created for this exact purpose and I’m excited to see how it gains traction. Check it out here: Journal of Negative Results. Also Journal of Negative Results in Biomedicine, edited by Bijorn R. Olson of Harvard University.

Even though this paper was specifically addressing false positive correlations in cancer epidemiology we should all, across the whole scientific community, take heed of their advice – self-monitor our results and practice some professional modesty.

“Most people say that it is the intellect which makes a great scientist. They are wrong: it is character.” – Albert Einstein

[rachelfershleiser]

I was thinking this week about how much my own brain has changed regarding beauty. I went almost 40 years without seeing anyone presented as beautiful unless they met a really narrow standard. I never saw fat women presented as beautiful. I think Tumblr, specifically, has actually healed my brain. It’s exposed me to so many types of beauty. And I realized that I have widened my own standards to include myself.

Rainbow Rowell On The Power Of Fan Fiction (via rachelfershleiser)

[mymedlife]

Just a glimpse of four years worth of textbooks and notes. This doesn’t include all the books I borrowed from the library, which would probably make another tall book stack.

[theoneadays]

This must of been shared pre-PDF era. 

[mymedlife]

Lawl, this pic was taken this afternoon. 

[stanfordtomd]

So true! This is why you befriend people the year above you! Hand-me-downs.

[cluelessmedic]

Tetralogy of Fallot

Pulmonary Stenosis

Right Ventricular Hypertrophy

Ventricular Septal Defects

Overriding Aorta (overrides a VSD)

most common cause of cyanotic congenital heart disease

signs - clubbing, loud ejection systolic murmur (radiates to back), cyanosis

surgery at 6 months, may give temporary shunt to increase pulmonary blood flow (subclavian artery–>pulmonary artery)

[stanfordtomd]

Hello World!

Why did we decide to start a blog?

1. Because we are nerds…

“The secret of genius is to carry the spirit of the child into old age, which means never losing your enthusiasm.” -Aldous Huxley

We both love learning and have a fascination when we learn new things that seems to be somewhat rare in our peers. For us there is an excitement that comes along with learning why leaves change color in the fall, neuroethics of brain-machine interfacing, or the politics of cord blood. We wanted to share this excitement. And not just with our roommates, who halfway through our rants tend to get this look on their faces like oh dear, please let this be over soon.

#nerdnation

2. We feel we have a somewhat different perspective...

“We walk the same path, but got on different shoes, live in the same building, but we got different views” -Drake

Both of us are planning on becoming doctors, but neither of us is taking the “traditional route”. Tegan has already applied once before (June 2013), but nothing worked out. She is applying again and working on her application currently. Lauren wants to run a lab as well as practice someday, and so is planning on working in a research lab for a couple years when she graduates this June.

#followyourownpath

What will be on this blog?

Good question. We are going to figure that out as we go along. Overall the idea is to share things we find fascinating, things we think need to be discussed, and things we have learned that we feel will be useful to others. Also, seeing as we both love to read and we both collect quotes, you’ll notice there is a books section (along the top navigation bar) and I’m sure you’ll be seeing quite a few quotes along the way.