Ode to a Dreamer of Dreams

Dear Dr. Sacks,

Like the late Carl Sagan, you have a gentle way of magnifying everything into brilliant resolution and reminding us of our place in the universe. I always look forward to reading your books and opinion pieces, as you put which things matter into perspective. Last month, I was quite delighted to read of your love for the physical sciences, also beautifully described in Frank Wilczek’s A Beautiful Question. Beauty can truly be found in any field or context and Wilczek’s coverage of the concept reminds me of that Gerard Manley Hopkins’ poem, “Pied Beauty,” in which the author pronounces, “Glory be to God for dappled things.” As Adam Frank puts it, “Science — under all its theories, equations, experiments and data — is really trying to teach us to see the sacred in the mundane and the profound in the prosaic.”

Indeed, few experiences prove as humbling as observing the heavens. The night sky brings to mind the opening lines of a personal favorite: “Let us go then, you and I/ When the evening is spread out against the sky/ Like a patient etherized upon a table.” Meanwhile, consciousness continues to prove an elusive idea, as you mentioned. Is it a purely biological phenomenon or does it extend into the philosophical and spiritual realms? I think the most beautiful aspect of our universe is the sense of infinite mystery surrounding it; as Anaïs Nin explains it, “The possession of knowledge does not kill the sense of wonder and mystery. There is always more mystery.”

From your stories of patient case studies to your descriptions on the benefits of musical therapy, your words offered comfort and solace amidst adversity and uncertainty. When I was struggling with my own medical challenges (though nothing as serious as your struggles), I found works such as William Ernest Henley’s “Invictus” and Dylan Thomas’ “Do Not Go Gentle Into That Good Night” to be particularly uplifting and encouraging, and perhaps you will, too. I think the practice of medicine allows one to grow closer to his fellow brethren and fulfill the insightful words of Countee Cullen: “Your grief and mine/Must intertwine/Like sea and river/Be fused and mingle/Diverse yet single/Forever and forever.” I only hope I will fulfill my role with the same patience, compassion, dignity, and grace that you exemplify in your daily life. As one chapter closes and another begins, I wish you laughter and joy in the company of friends and family, exchanges of love among kindred spirits, courage as you confront your final battles, and peace and contentment in the knowledge that you have touched more lives than you know. From the deepest parts of my being, I thank you. Stay gold, dear Captain, our Captain.

Warm regards,

Nita Jain

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Top Ten Favorite Scientists

I was recently asked to make a list of my top ten favorite scientists, and after some deliberation, these are the people I chose:

Feynman

  1. Richard Feynman: While Feynman made outstanding contributions to our understanding of quantum physics and to the Manhattan project, he is perhaps most remembered for his teaching as evidenced by the still-beloved Feynman Lectures on Physics. Feynman even rejected a job offer from the Institute for Advanced Study, a research center whose staff boasted luminaries like Albert Einstein and Kurt Gödel, because there were no students there to teach.
  2. Marie Curie: Curie conducted pioneering experiments into the nature of radioactivity and also discovered radium and polonium, receiving Nobel Prizes in both chemistry and physics for her efforts. Upon observing radium’s destructive effects on her own healthy tissue, she reasoned that radium could also be used to destroy infected tissue, giving birth to the idea of radiation therapy.
  3. Isaac Newton: From his work on optics to his laws of motion and universal gravitation, Newton was a central figure in the scientific revolution. He developed the reflecting telescope as well as differential and integral calculus to explain the elliptical orbits of celestial bodies all before his 26th birthday.
  4. Rosalind Franklin: Franklin’s X-ray diffraction data was arguably the most important puzzle piece in the discovery of DNA’s double helical structure. She also contributed to our molecular knowledge of viruses, including tobacco mosaic virus and the poliovirus.
  5. Nikola Tesla: While Tesla is perhaps best known for developing the alternating current motor, the Serbian-American innovator also experimented with X-rays, performed short-range demonstrations of radio communication two years before Marconi, and invented the high-voltage transformer known as the Tesla coil.
  6. Clair Patterson: Not only did geochemist Clair Patterson calculate an extremely accurate estimate for the age of the Earth using lead dating, but he also served as an activist after discovering the toxic effects of lead on human health. His persistent campaigning eventually led to a ban on the use of lead in consumer products.
  7. Linus Pauling: Pauling made incredible insights into the nature of the chemical bond, including the prediction of secondary structures such as the alpha helix and the beta sheet. Pauling also developed the concepts of electronegativity and orbital hybridization and remains the only person to have received two unshared Nobel Prizes – for Chemistry in 1954 and for Peace in 1962.
  8. Michael Faraday: It has often been said that Michael Faraday was the greatest discovery of eminent chemist Humphry Davy. Faraday established the principle of electromagnetic induction, created the first electrical generator, and even initiated the first Christmas Lectures series in 1825 to teach science to children.
  9. Louis Pasteur: Best known for his namesake process to prevent bacterial contamination, Pasteur was instrumental in disproving the idea of spontaneous generation. His work on the germ theory of disease also led him to create vaccines for anthrax and rabies.
  10. Craig Venter: When the Human Genome Project began in 1990, progress initially got off to a very slow start. In 1998, Craig Venter dramatically sped up the process using a technique known as whole genome shotgun sequencing. As we now enter the era of genomic medicine, the variable uses of the sequenced human genome are steadily unfolding.

If I were to make a longer list, I would probably include a lot more notable physicists, including Albert Einstein, James Clerk Maxwell, Max Planck, and Alan Guth. Copernicus, Galileo, Cecilia Payne, Annie Jump Cannon, and Henrietta Swan Leavitt all helped advance our understanding of the cosmos. I would also have liked to acknowledge the many scientists who were involved in atomic theory, such as Democritus, James Dalton, Niels Bohr, Ernest Rutherford, and J.J. Thomson. Mendeleev classified the elements periodically, and Carl Woese classified life on Earth. Gregor Mendel founded the field of genetics, and Meselson and Stahl performed an experiment that supported the hypothesis of semiconservative DNA replication. Along with Pasteur, both Robert Koch and Ferdinand Koch helped found bacteriology and establish the credibility of the germ theory of disease. Alexander Fleming accidentally discovered the first antibiotic in the form of penicillin, and Jonas Salk developed the first successful polio vaccine. On the computer science front, Ada Lovelace, Hedy Lamarr, and Tim Berners-Lee made significant contributions, the latter of whom is responsible for having developed the algorithms on which the World Wide Web depends. Polymaths Archimedes, Leonardo da Vinci, and Benjamin Franklin advanced our knowledge of the sciences as well as other diverse fields.

This list is just one person’s opinion, so I invite you to share yours. Who would you include in your top ten favorite scientists? Leave your suggestions in the comments below!

Why Medical Research?

More than a body of knowledge, science is a way of thinking based on empirical observation. William Lawrence Bragg once said, “The important thing in science is not so much to obtain new facts as to discover new ways of thinking about them.” Science makes use of that wonderful blend of curiosity, skepticism, and imagination to create and innovate. In practice, medical investigators combine innovation and efficiency, and this dualistic aspect of medical research is what draws me most to the field. After obtaining my bachelor’s degree in biochemistry & molecular biology, I plan to pursue an MD-PhD program in order to train in both clinical medicine and research methodology.

If I had to describe the focus of medical research in one word, I would say communication: the internal dialogue within a patient’s body. Almost all pathology can be traced back to a failure to communicate. Cells can go deaf and fail to respond to certain chemicals such as insulin, as is the case in type 2 diabetes or they can go mute and fail to release insulin at all, as is the case in type 1 diabetes. Cells may misinterpret messages, send incorrect signals, or act at inappropriate times, all of which have pathogenic potential. As a research assistant, I investigated specific cancerous interactions between scaffolding proteins and cAMP-dependent protein kinase (PKA), which is involved in many cellular processes from neurotransmitter metabolism to gene transcription, illustrating the interconnectedness inherent in the human body. This interconnectedness poses both opportunities and challenges in the field of medicine, for the targeting of a common substrate can offer therapeutic solutions for several related conditions but may also result in wide-ranging biological responses, underlying the need for treatment that addresses the source of the problem without causing too many additional side effects. The development of new therapeutics warrants an equally multifaceted approach, requiring collaboration between researchers and clinicians. For this reason, I intend to continue my education in translational and clinical research to help move novel drugs from the bench to the bedside.

Through research, I realized my love of discovery and innovation. My work in the laboratory has given me the skills to solve problems, optimize processes, and develop more efficient tools. Research has also given me an appreciation for the meticulousness that should characterize both experimental design and data interpretation in order to ensure the most accurate and precise results possible. Most importantly, research has taught me to embrace failure as an opportunity to learn and identify existing areas where improvements can be made. Scientific research thrives on criticism, debate, and the application of new ideas. Of course, medicine still has many unknowns: cause and effect relationships are often unclear and diagnoses of exclusion are sometimes difficult to treat. While medicine still has its limitations, remarkable progress has been made in the past few decades, and I hope to take my place as an agent of that continual innovation.

Brainstorming the Existence of a Mythical Country

The Constitution of the United Citizens of Andalucía,

An Autonomous Community of Spain

Area: 88,000 sq. kilometers, Population: 1,000

  • Economics

Free market, fair trade, and laissez-faire economic policy. Production and export of wheat, barley, and other textiles as well as the development of hydroponics drive the economy. Carbon capture and sequestration methods are used to mitigate the effects of fossil fuel emissions of both global climate change and ocean acidification. Citizens fall into tiered tax brackets based on annual household income.

  • Politics

In our democracy, government is civil service. The prime minister serves an executive role and enables the goals of the bureaucrats below to come to fruition. Candidates for prime minister must be official citizens of Andalucía, aged 60 or younger to ensure sound decision-making abilities. Leaders are chosen based on proficiency on civil service exams and popular vote in public elections, held every four years. Prime ministers may not serve more than two four-year terms in order to ensure a democratic political system that is responsive to the will of the people and adaptable to the changing environment.

  • Education

Education from kindergarten through undergraduate is mandatory; tuition expenses for these years are covered by the state for all citizens. Scholarships are available for vocational, graduate, and professional education beyond the undergraduate years.

  • Criminal system

Criminals are tried and convicted by a jury of their fellow citizens in accordance with the severity of their offenses. The death penalty, capital punishment, and any variants thereof are strictly prohibited by law. The highest offenses are punishable by corporal punishment and court-mandated community service designed to improve infrastructure and transportation systems, including building of roads, construction of public buildings such as schools and libraries, and the development of diverging diamond interchanges to regulate traffic flow in a timely and efficient manner.

  • Medical system

Universal healthcare is provided to all citizens. Medical school expenses are covered by the state for those students that are eligible. Eligibility is based on academic proficiency in the life sciences, as assessed by competency exams that are administered subsequent to obtainment of an undergraduate degree. After successful completion of medical studies, physicians must pass a series of state-mandated board examinations in order to obtain licensure to practice.

  • Religion

Inhabitants are free to practice religion according to their own personal beliefs. Furthermore, the government does not sanction state-sponsored religion nor does it promote any one religious system over another. Agnosticism and atheism are not stigmatized. In this manner, peace and understanding are promoted among inhabitants of the state.

Compiled List of Medical Reads

Student Dr. Diva

Hey everyone! As promised, here is the list of compiled suggested medical reads from everyone. I don’t know about you, but I want to buy all of these books and start reading right now! Thank you to everyone that sent me suggested books – this list came from all of you! Take a peek, enhance your library, and learn even more about the amazing and fascinating medical world. At the very bottom of the list is a section titled “Textbooks/References” for pre-meds and medical students. Enjoy!

Why medicine?: And 500 Other Questions for the Medical School and Residency Interviews – Sujay Kansagra, M.D.

Everything I learned in Medical School: Besides All The Book Stuff – Sujay Kansagra, M.D.

Baby Doctor: A Pediatrician’s Training – Perri Klass, M.D.

Intensive Care: The Story of a Nurse  – Echo Heron

The Immortal Life of Henrietta Lacks – Rebecca Skloot

When the Air Hits…

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Imagination in health and medicine? 11 fresh ideas from the TEDMED stage

TED Blog

Nassim Assefi hosted TEDMED2014, Photo: Sandy Huffaker Jr. Nassim Assefi directed the stage program for TEDMED 2014, a conference which brought out unexpected ideas in medicine—like how one can help cancer patients with a pink tutu. Photo: Sandy Huffaker Jr.

Prosthetics as sculpture, the maternal benefits of breast milk, Cuba’s radical approach to free medical education. These are just a few of the subjects tackled at TEDMED 2014: Unlocking Imagination, hosted last week simultaneously in San Francisco and Washington, DC, with a stage program directed by TED Fellow, physician, novelist and activist Nassim Assefi. On two stages over three days, 2,000 conference-goers and 80 speakers and performers gathered for an idea exchange on a vast range of subjects relevant to innovation in health and medicine.

A medical edition of the TED conference that was founded in 1995 (it’s now independently owned), we asked Assefi what made this TEDMED different from those in the past. “This was the most diverse TEDMED conference…

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A Beautiful Mind, A Dysfunctional Synapse

The dopaminergic projection pathways in the midbrain also play a crucial role in the development of schizophrenia. The midbrain has two distinct dopaminergic projection pathways: the nigrostriatal pathway and the mesolimbic pathway. The former is involved in motor control and is associated with Parkinson’s disease, the second most common neurodegenerative disease (after Alzheimer’s disease), while the latter is involved with addiction and reward behaviors and is therefore implicated in the development of schizophrenia.

The nigrostriatal pathway is compromised in Parkinson’s disease, which is often treated with L-DOPA, the precursor to dopamine, in order to stimulate the biosynthesis of dopamine within nerve terminals (dopamine is not administered because it cannot cross the blood-brain barrier). However, this increased biosynthesis of dopamine often leads to overstimulation of the mesolimbic pathway, which also utilizes dopamine, manifesting in schizophrenia-like side effects. Similarly, antagonists of the D2 dopamine receptor (called neuroleptics) used in the treatment of schizophrenia often result in side effects resembling Parkinson’s disease due to the unintended suppression of the nigrostriatal pathway. Abnormalities in other neurotransmitters, such as norepinephrine and glutamate, may also contribute to schizophrenia.

Knowing Neurons

JohnForbesNashJr2_300 John Forbes Nash, Jr.
Image courtesy of Princeton University.

“I felt like I might get divine revelation by seeing a certain number; a great coincidence could be interpreted as a message from heaven.”

– John Nash in “A Brilliant Madness”

John Forbes Nash Jr. was a 20-year-old graduate student when he came up with the mathematical theories that would win him the Nobel Prize in Economics 50 years later. His mathematical insight into game theory is often over-shadowed by accounts of the eccentric behavior, paranoia, and delusions that characterized his schizophrenia. Paranoid schizophrenia manifests in clinical terms as fixed beliefs that are over-imaginative and accompanied by experiences of hauntingly real perceptions of something not actually present. These hallucinations often take the form of auditory or visual disturbances and can be accompanied by a lack of motivation and clinical depression. In his own words in the documentary “A Brilliant Madness,” Nash…

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