the dual decree_spring 2013

10
A day after Pi Day and two before St. Patrick’s Day, March 15th was just another Friday for most. But for this year’s graduating medical students, it was Match Day, marking an important transition from medical school into a lifetime of discovery, learning, and healing. More than 150 fourth-year medical students from University of Maryland, including our own Paz Luncsford and Kavita Gandhi, gathered in Davidge Hall to receive sealed envelopes containing their residency match results. Before the scheduled ceremony, your humble authors assembled alongside our former classmates and their families. Soon to graduate medical school, these students were our peers with whom we studied, laughed, cried, agonized, and even occasionally went outside, just two short years ago. Now they waited excitedly and anxiously for the distribution of match results couldn’t come fast enough. Most students at least wore a calm face, having received assurances earlier in the week that they had matched, but where they would end up was a surprise. The families also had their own hopes and wishes, weighing their children’s professed goals and desires along with their ulterior motives. One MS IV mother said that she had her future grandchildren to think about, as well as convenient air or rail travel between here and wherever “there” would be. Another MS IV’s parents were festively content, as all of their daughters’ top choices were far closer than Baltimore to their home in the Southeast. All in attendance, however, were proud that their loved ones had made it to this day, regardless of the ultimate outcome. Surprisingly or not, your authors, too, experienced various emotions this day. We were of course happy to see most of our former classmates successfully completing medical school and entering into advanced medical training. Yet, the day was and would continue to be bittersweet, as we watched from the sideline. This sentiment was also echoed in the MD/PhD students who were matching with a different group of students than with whom they had originally started medical school. Traditionally, family members entered Davidge Hall alongside their soon-to-be grads to partake in the ceremony. As class sizes have grown, this has created a substantial crowding issue in need of a solution. For the first time in the history of UMSOM, family members and friends were restricted to the SMC Student Center ballroom to watch a video live-feed of the ceremony; only students and faculty members were allowed in Davidge Hall. Though the change was arguably sensible on paper, it deprived students of being with their loved ones when they learned their fates. The live-feed sounded muffled, which elicited more than a handful of audible complaints and head-shakes from those family members who had decided to stay put in the SMC ballroom. As the ceremony participants assembled in Davidge Hall and the ceremony proceeded, the several hundred remote audience members strained in total silence to make sense of words coming from the heads of the Offices of Medical Education and Student Affairs. We watched with pride as the live-feed showed our own Director Donnenberg and Associate Director Keegan posing with Kavita and PJ in the first row of Chemical Hall for a photo op. Finally, the first names were read. Luckily, although the opening speeches had been almost entirely indecipherable, the name of each matching student was just clear enough for the families to make out. As names were called, each student walked to the podium, showered with cheers from both audiences, live and remote. After MARK KVARTA, GS II AND PETER LI, GS II THE ENVELOPE, PLEASE: ON MARCH 16, 2013, MARK KVARTA (TOP LEFT) ATTEND- ED MATCH DAY TO SUPPORT HIS FORMER MEDICAL SCHOOL CLASSMATES OUTSIDE OF DA- VIDGE HALL. PAZ LUNDSFORD ENTERS CENTER STAGE TO RECEIVE HER ENVELOPE (TOP RIGHT). KAVITA GANDHI CELEBRATES HER PEERS AS SHE AWAITS HER TURN (BOTTOM LEFT). MSTP STUDENTS MEET UP WITH ASSOCIATE DIRECTOR ACKSAH KEEGAN (BOTTOM RIGHT). D UAL D ECREE THE UNIVERSITY OF MARYLAND MEDICAL SCIENTIST TRAINING PROGRAM Baltimore Volume IV � Issue 2 � Spring 2013 MSTP MATCHES COAST-TO-COAST FOR RESIDENCY TRAINING (continued on page 3)

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University of Maryland Medical Scientist Training Program Newsletter

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A day after Pi Day and two before St. Patrick’s Day, March 15th was just another Friday for

most. But for this year’s graduating medical students, it was Match Day, marking an important transition from medical school into a lifetime of discovery, learning, and healing. More than 150 fourth-year medical students from University of Maryland, including our own Paz Luncsford and Kavita Gandhi, gathered in Davidge Hall to receive sealed envelopes containing their residency match results.

Before the scheduled ceremony, your humble authors assembled alongside our former classmates and their families. Soon to graduate medical school, these students were our peers with whom we studied, laughed, cried, agonized, and even occasionally went outside, just two short years ago. Now they waited excitedly and anxiously for the distribution of match results couldn’t come fast enough. Most students at least wore a calm face, having received assurances earlier in the week that they had matched, but where they would end up was a surprise. The families also had their own hopes and wishes, weighing their children’s professed goals and desires along with their ulterior motives. One MS IV mother said that she had her future grandchildren to think about, as well as convenient air or rail travel between here and wherever “there” would be. Another MS IV’s parents were festively content, as all of their daughters’ top choices were far closer than Baltimore to their home in the Southeast. All in attendance, however, were proud that their loved ones had made it to this day, regardless of the ultimate outcome.

Surprisingly or not, your authors, too, experienced various emotions this day. We were of course happy to see most of our former classmates successfully completing medical school and entering into advanced medical training. Yet, the day was and would continue to be bittersweet, as we watched from the sideline. This sentiment was also echoed in the MD/PhD students who were matching with a different group of students than with whom they had originally started medical school.

Traditionally, family members entered Davidge Hall alongside their soon-to-be grads to partake in the ceremony. As class sizes have grown, this has created a substantial crowding issue in need of a solution. For the first time in the history of UMSOM, family members and friends were restricted to the SMC Student Center ballroom to watch a video live-feed of the ceremony; only students and faculty members were allowed in Davidge Hall.

Though the change was arguably sensible on paper, it deprived students of being with their loved ones when they learned their fates. The live-feed sounded muffled, which elicited more than a handful of audible complaints and head-shakes from those family members who had decided to stay put in the SMC ballroom. As the ceremony participants assembled in Davidge Hall and the ceremony proceeded, the several hundred remote audience members strained in total silence to make sense of words coming from the heads of the Offices of Medical Education and Student Affairs. We watched with pride as the live-feed showed our own Director Donnenberg and Associate Director Keegan posing with Kavita and PJ in the first row of Chemical Hall for a photo op. Finally, the first names were read.

Luckily, although the opening speeches had been almost entirely indecipherable, the name of each matching student was just clear enough for the families to make out. As names were called, each student walked to the podium, showered with cheers from both audiences, live and remote. After

Mark kvarta, GS II and Peter LI, GS II

the enveLoPe, PLeaSe: on march 16, 2013, mark kvarta (top left) attend-ed match day to support his former medical school classmates outside of da-vidge hall. paz lundsford enters center stage to receive her envelope (top right). kavita gandhi celebrates her peers as she awaits her turn (bottom left). mstp students meet up with associate director acksah keegan (bottom right).

Dual Decreethe university of marylanD meDical scientist training program

Baltimore � Volume IV � Issue 2 � Spring 2013

mstp matches coast-to-coast for resiDency training

(continued on page 3)

As this is my inaugural col-umn in The Dual Decree, it is only appropriate that I begin by thanking all of our schol-ars for the warm and gracious reception that you have given Dr. Keegan and me. I am tru-ly thrilled to assume my new role, aiding you in your jour-ney as aspiring physician sci-entists. I am aware and a bit in awe of the esteem in which you hold Dr. Rogers and un-derstand that transitions can be difficult. However, thanks to your patience; to wise ad-vice from Jane, Dr. Rogers,

the MSTP Student Tran-sition Committee and the MSTP Admissions and Ad-visory Committee; and to the efforts of Dr. Keegan, I think we’re all beginning to get ac-quainted and comfortable.

Now that we’ve been work-ing together for about four months, I’d like to share with you some of my early impres-sions. First of all, it’s crystal clear that the program is thriving. Our MS1 and MS2 students are mastering the massive body of information that medical school demands they know, and they are per-forming very well on exams. They have also been very im-pressive, leading and partic-ipating in the discussions in our Molecules to Medicine series. They are lining up their summer rotations (if they hav-en’t already decided on a lab) and balancing life and school. Our GS1 students have ad-justed well to the altered pace and diverse demands of graduate school. The GS2 and GS3 students are begin-

ning to gain momentum in their research while trying not to forget everything they learned in the first two years. The students in the advanced graduate years are holding up well to the challenges and pressure of trying to conclude their research and line things up for reentry to medical school. The MS3 students are fully immersed in the world of patient care, while the MS4 students are racing toward match day and graduation. In sum, you are the epitome of vibrancy and achievement.

Our program is only as good as our students, and right now we’re focused on the task of recruiting our next outstand-ing class. The applicants have been simply fantastic. The challenge now is to help them realize that they belong here. Of course, no one is better equipped to do so than you. I cannot emphasize enough how reliant we are on you to reach out to the accepted ap-plicants through e-mail, Face-book, and calls to extol the

benefits of our program. If you have made a connection to any of these students, please make an effort to build upon it.

As we recover from recruit-ing season, it will soon be time to review our current organization, procedures and curriculum. In 2014 we will be submitting our training grant renewal application and this year is our final opportunity to implement any advances, incremental or monumental, that will enhance your expe-rience and our prospects for continued funding. Please let me know of any ideas you have to continue our tra-jectory toward continuous growth and improvement.

Finally, I’d like to remind ev-eryone that my door is open. Unless I’m away, I spend ev-ery Monday and Wednesday from 2 PM to 4 PM in the MSTP office. Please pop in to say hi and share your thoughts and concerns or, if you prefer, e-mail me to be sure I’m avail-able. I look forward to spend-ing more time with each of you.

Directors’ Decree

MIchaeL donnenberG, MdMStP dIrector

mstp ms ivs :on graDuation anD moving forWarD

Dual Decreethe university of marylanD meDical scientist training program

Baltimore � Volume IV � Issue 2 � Spring 2013

edItor-In-chIef:Kristi Chakrabarti

Layout edItor:Elise Ma

coPy edItor:Carolyn Rosinky

Photo edItor:Alexander Tsai

contrIbutInG edItorS:Monica Charpentier

Adam FischPatrick KernsAparna Kishor

contact us: [email protected] views expressed herein are solely those of the authors and do not necessarily repre-sent the views of the University of Maryland School of Medicine or any affiliated institution.

Spring 20132 the Dual Decree

intrascope

Kavita is filled with a mix of emotions as she begins the next chapter of her life. “I am so excited to be moving to the west coast. I’ve been dying to do that for my whole life. But now I’m going to be a resident, I’m a little nervous about that,” she says. But she thinks taking on challenging rotations as an MS IV prepared her well for residency. After finishing Match Day and defending her thesis, Kavita can finally close the MSTP door and begin to open a new one. “It’s surreal to be here,” she says. “It’s been nine years. I can’t believe I’m leaving.”

pJ is looking forward to starting residency and joining her husband in North Carolina. “I’ve spent the majority of my life in Maryland, so I can’t wait to see what life is like in another part of the country,” she said. For PJ, it was important to attend a program that had strong academics and well-balanced residents, which she feels she has found at Wake Forest. “Things have worked out wonderfully, and since Match Day we have found a [...] home which we are buying and closing on soon!”

(continued from page 1)MATCH DAY

3mdphd.umaryland.eduSpring 2013

Minding the MD/PhD Gender Gap

The Women’s Physician Scientist Interest Group has officially become part of the University of Maryland MSTP this academic year. A few years ago, when I attended the National MD/PhD Conference in Keystone, CO, I was struck by the lack of female students present at the conference and the issues that female physician scientists face, which were discussed in specific breakout sessions. Only then did I realize that the University of Maryland MSTP is an anomaly among other MSTPs as the majority of our students are women! While we are extremely well supported here, I wanted to make sure that we are ready to tackle these issues once we venture off this campus, and thus I started the Women’s Physician Scientist Interest Group.

Truth be told, our former director, Dr. Terry Rogers, had always been acutely

aware of the gender issues that exist in various MSTPs and urged students to start activities with other Women’s Physician Scientist Interest Groups a long time ago. I was so sheltered here on campus that I never took the necessary steps to get the group started until after the Keystone conference. Beyond the obvious childbearing responsibilities, women physician scientists also face a slew of challenges that were previously discussed in the Summer 2012 Dual Decree issue, including: the challenge of work/family balance, the lack of role models, and the feeling that women must “outperform” their male counterparts or be “very aggressive.” At the time the interest group was formed, the PNAS article documenting science faculty members’ gender biases was also published, highlighting that both male and female faculty members favored male target students despite identical credentials (Moss-Racusinet al., PNAS 2012). All faculty participants were likely to offer female students less mentoring and a lower salary.

The goal of the Women’s Physician Scientist Interest Group is to ensure that our students have ample interaction and discussions with successful role models and career mentors to to ensure our success as women physician scientists. Furthermore, through meeting and interacting with other female students who are facing similar struggles, we hope to create a stronger sense of community among women physician scientists so we can work together and identify specific issues that need to be addressed as we enter the next phase of our careers.

Since its inception, the Women’s Physician Scientist Interest Group has invited Dr. Miriam Laufer to speak with our students and discuss the delicate work/family balance issue. We also had a joint event with the Women’s Physician Scientist Interest Group from Johns Hopkins MSTP at which we had a chance to meet other female students and learn how Dr. Cynthia Bearer navigated her career, including how to negotiate a salary and climb the academic science ladder. This spring, we are holding a spring happy hour to bring our students together. In May, we will be hosting Dr. Carol Greider, Nobel laureate and former UMB GPILS lecturer, and Dr. Mary Amanios, who both work on tolemerase and cancer genetics, at our joint WPSIG event with the Hopkins group. I hope to see many of you at these events!

handshakes, hugs, depositing $5 in a green Leprechaun’s cauldron, and receiving a fancy letter opener and an autographed copy of Dr. Colgan’s Advice to the Young Physician, most students elected to return to their seats or off to the hallway with their envelopes still sealed. Some, though, opened their envelopes immediately while still at the base of the stairs, to mounting cheers and applause, and screamed their match selection in delight. Kavita matched at Oregon Health and Sciences University in Emergency Medicine. PJ matched to Wake Forest University in Internal Medicine.

At some point, your authors learned that it would be incredibly easy to join the main ceremony across the street. Sneaking in at the conclusion of the matching class’s performance of the “Harlem Shake,” we joined our friends in person. The festive excitement was far more palpable and infectious. “Everyone is so happy. The energy is so high. It’s a good experience and a great event,” Kavita described of the atmosphere surrounding Match Day.

As the number of remaining envelopes dwindled, relief and celebration began to replace the feeling of anxious excitement. Most laughed at their classmates’ antics or chosen entrance music as they each had their minute in the spotlight in turn. As soon as the last envelope was called, the crowd broke into deafening standing ovation and cheers for Paul Goleb who collected his envelope, the aforementioned gifts from the Alumni Association and Medical School, as well as roughly $800 in accumulated cash from the green cauldron. All cheered for various reasons: for Paul and the expectation that he would buy the first round of libations, for the end of the tense ceremony, for the approaching completion of medical school, and for the beginning of a new chapter in their lives.

JeSSIca ShIu, GS Iv

21%

50%

37%

60%

women in science represent:

of full professors in science

of doctorates in science earned in the United States

of national MSTP students

of UMB MSTP students

source: aamc source: shen, h. (2013) “inequality quantified: mind the gender gap.” nature. 496(7439):22-24.

4 the Dual Decree � Spring 2013 � mdphd.umaryland.edu

start:

MT ROYAL AVE

S CHARLES ST

LIGH

T ST

N CH

ARLES ST

WASHINGTON MONUMENT via Charles St.

STUDENT CENTER @ Lombard/Greene

UNIVERSITY OF MARYLAND

INNER HARBOR via Harbor Bridge Walk

E. PRATT ST

FORT AVE

HARBOR BRIDGE WALK

PhotoS: aLexander tSaI, MS IIrouteS ProvIded by MonIca charPentIer, GS III

»

the Dual Decree � Spring 2013 � mdphd.umaryland.edu 5

CON

STELLATION

PLAZA

ANN

ST

S BROAD

WAY

INNER HARBOR via Harbor Bridge Walk

FELL’S POINT via Thames St.

FORT MCHENRY via Constellation Plaza

LANCASTER ST to S CAROLINE ST

FORT AVE

four MILeS up Charles Street Hill and through Washington Monument Park.

SIx MILeS along the waterfront promenade of Inner Harbor and Fell’s Point.

nIne MILeS to & around Fort McHenry.

*routes start & end at umb map is not to scale

B’more Fit :Lace up your running shoes and take on these scenic routes through our historic, waterfront city.

Compartment Syndrome: 0 Me and My Knife: 1

This is the story of how

I saved my toe nail,or, I should say, of how I think I saved my toe nail. The coming days will tell the full story, but at this point I am happy with my treatment.

The story goes like this (and pathophysiology follows):I went for my first run in about seven weeks on New Year’s Eve with a fellow runner who took me for the longest run I had ever been on: 16.2 miles. After about six miles my toes hurt a little bit. As we headed home, I had a feeling that I had big subungual hematomas, or pockets of blood beneath my nails.I took a picture when I got home (Fig 1) and was relieved to discover that the right great toe was bleeding (Fig 1 A). It continued to have minimal serosanguinous drainage for 24 hours, and by Post-Run Day 1, the right toe was feeling much better. Normal color had returned by Post-Run Day 3. Even though things were looking up on the right side, my left great toe concerned me, for the hematoma was much more posterior (Fig 1 B, dashed circle) and by Post-Run Day 1 had started to bleed under the skin posterior and medial to the nail bed. On Post-Run Day 2, I was concerned enough about the left toe to attempt needle decompression of this area (Fig 1 C, lateral part of dotted line – towards the viewer’s left) as a mechanism to relieve the pressure. I was able to express about 100 microliters of serous fluid with some immediate pain relief. However, the pain came back in full as the needle puncture closed and the fluid pocket refilled, building pressure back up. On Post-Run Day 3, the area around the dotted line (Fig 1 C) reached a maximum swelling and erythema due to the blood collection immediately under the skin. Although I did not believe it infected, the posterior aspect of the nail bed was quite tender and was subtly altering my gait. Therefore, I made an incision with my straight razor along the dotted line and expressed 1-2 mL of bloody fluid with immediate relief of symptoms. Prior to incision, I sterilized the toe and razor with rubbing alcohol. I then dressed the incision with antibiotic ointment and wrapped my toe with sterile gauze.

Compartment syndrome is actually an extremely common phenomenon most of us have already encountered.

If you spend a night at the Shock Trauma Center (STC) or even a local Emergency Department you may meet a patient who, as the story usually goes, passed out intoxicated somewhere and awoke “some time” later unable to move his feet. He probably has tremendous pain in his lower legs, especially if you try to

move them. His feet are likely pale, cool to the touch, and may give the patient some odd “asleep” sensations. His pulses may be present, weak, or absent. This very sad situation is a surgical emergency; the compartments in his legs must be cut open immediately or he will lose them both and possibly die.

Compartment syndrome can also occur in other situations. Post-stroke cerebral edema is another serious form of this disease. Shin splints are a more familiar example, while priapism a less common one.Each of these scenarios has in common two things: increased pressure and reduced (or lost) blood flow to the affected tissue. Compartment syndrome means there is increased pressure in a closed “space” within the body, and this pressure compresses capillaries, preventing blood flow to target tissue. This loss of blood flow leads to tissue death, which leads to edema (swelling) and inflammation. The edema leads to increased pressure, which leads to further diminished blood flow, further tissue damage, etc.So how high does the pressure have to rise to compress capillaries and shut off blood supply? We start to worry about compartment syndrome at pressures above 20 mmHg. By pressures of 30 mmHg, we’ve exceeded the pressure in the capillaries. Understanding what pressures occur in the body, where in the body they occur, what a normal range is, and how alterations affect hemodynamic stability will soon become second nature.

Kn o w i n g when to

cut, and more i m p o r t a n t l y when not to cut, can be an e x c e p t i o n a l l y difficult and multidisciplinary decision. From my discussions with Dr. Sharon

Henry, who runs the Skin & Soft Tissue Surgery service at the STC, this is particularly true with soft tissue and skin infections. Particularly in the acute form, the edema and inflammatory exudate produced by a NASTI (Necrotizing Acute Skin and soft Tissue Infection) can result in compartment syndrome. Whether you are evaluating a patient in the Emergency Department, on the Medicine floors, or scrubbing in at 0200 for an Acute Care & Emergency Surgery (ACES) patient, you will face this beast multiple times in your clinical years. So did I do the right thing? Was I being a cavalier, wanabee-yahoo-cowboy surgeon? Well, the proof is in the pudding. See Figure 2A: the left great toe after incisional decompression is healing well with the nail reattached at the posterior and medial nail bed; it remains uninfected. The right toe, on the other hand, has looked relatively normal for days. So perhaps I have learned something in medical school after all. Compartment syndrome, this time I claim my victory over thee! We shall meet again…

A

C

B

fig 2a: the left toe post-incision. much relief! fig 2B: the right toe bears the tell-tale yellow of hemoglobin breakdown from trace blood that did not drain.

JoSh LIeberMan, MS III

Spring 20136 the Dual Decree

fig 1: my toes, post-16.2 mile new year’s eve run

a B

Hsp70, a prototypical molecular chaperone, binds AU Rich Element (ARE)-containing mRNA 1000-fold better than its canonical peptide substrate. We used fluorescence anisotropy to determine the binding affinity between recombinant Hsp70 and nucleic acid and peptide probes. These two panels of data show (A) binding of Hsp70 to a fluorescently-tagged ARE-containing RNA substrate has a Kd of 12 nM, on the order of other ARE-binding proteins (closed circles). Over this titration range, Hsp70 does not interact with DNA of the same sequence (open circles). In (B), the binding isotherm of recombinant protein with a fluorescently-tagged heptameric peptide substrate with the sequence indicated reveals that the Kd of this interaction is 27 μM. Given that Hsp70 is critical to the cellular stress response, its high affinity for ARE-containing mRNA targets raises many questions surrounding the mechanism and significance of this interaction as well as the relationship between the peptide chaperone functions of the molecule and its RNA-binding activity.

A few changes have been made to the MSIII and MSIV curriculum that apply to all students. MSTP students transitioning from graduate to medical school will see the addition of two new 4-week blocks during MSIII clerkships. Independent scheduling of clerkships allows for greater flexibility in the return to clinical years. It is still advised to discuss plans with MSTP directors and Dr. Neda Frayha during the Fall semester prior to your intended return to medical school.

froM the bench of aParna kIShor, MS III

7mdphd.umaryland.eduSpring 2013

Kd = 12 ± 2 nM0.5 nM Fl-ARE[38]

Kd = 27 ± 5 μM5 μM Fl-NLLRLTG

featured figure

4-week blocksfamily medicine

psychiatry

neurology

surgical selective*elective*

6-week blocksob/gyn

pediatrics

8-week blockssurgery ‡medicine‡

4-week blockssub-internships (2) #

electives (2) #°area health education center (1)

MS III MS IV

Changes to Medical Clinical Curriculum Begin with the Class of 2015

* newly-added blocks offer options to explore specialized fields (such as Emergency or Ophthalmology) not typically seen in MSIII.

# one block in either of these must be in the Dept. of Medicine.

° one block may include the MSTP Research Selective.up to 3 months of Elective Credit may be earned through the

Physician Scientist Elective or other programs.‡ length-reduced blocks

Curriculum includes Fall, Winter, and Spring Breaks, as well as a Summer Break before returning for MSIV.

2 to 3 months may be unscheduled to prepare for Step 2 or to interview for residency programs.

minimum mstp ms iv requirements:

rePorted by MonIca charPentIer, GS III

In February, Dina Check made headlines when she sued New

York City to allow her child to attend public school, from which the child had been barred because she had not been vaccinated. Because Mrs. Check’s decision to not vaccinate her child was rooted in her Catholic faith, she believed she should be granted a religious exemption from state laws requiring that children be vaccinated against diphtheria, pertussis, tetanus, polio, measles, mumps, rubella, hepatitis B, chicken pox, Haemophilus influenza type B, and pneumococcus. Christopher P. Vogt, a theologian at St. Johns University, gave his opinion in the media that nothing in Catholic teachings prohibits vaccination. Additionally, Check had immunized her other children but said that she now regrets doing so.

The case will be resolved in a New York court, but it raises the question of why all states require that children be vaccinated before attending public schools, and whether the widespread practice of granting exemptions is ethical. Currently, three types of exemptions are granted: medical, religious, and philosophical. Medical exemptions require a doctor’s note detailing the rationale and whether the exemption should be permanent or temporary. Rules for granting religious and philosophical exemptions vary between states but often require only parental statements of “I don’t believe in vaccines” or something similar.

The primary argument against vaccination mandates is that they infringe on individual autonomy. We accept that individuals should be able to refuse medical care and parents should be able to make decisions regarding their children’s healthcare. However, in the case of non-vaccination, the health risks extend beyond the individual child.

Vaccines protect the individual, but also contribute to public health. Immunizing individuals decreases the number of hosts for the pathogen and acts like a firebreak. A population possesses “herd immunity” when its immunity to a disease increases to a certain threshold so the pathogen

can no longer spread through the population. This is valuable because no vaccines are 100% effective and some vaccinated individuals can still catch and die from these diseases. Herd immunity provides protection in addition to that of the vaccine itself by reducing pathogen exposure.

Thus, the principles of Beneficence and Justice are served by mandates to vaccinate school-age children because of the protection that public school students enjoy through immunization and the herd immunity effect. Justice is also served by protecting children from the parent’s decision to not vaccinate, a decision often based on misinformation such as the discredited notion that the MMR vaccine causes autism. Additionally, Nonmalfeasance is served by not requiring students to attend schools with unvaccinated children who pose a health risk to them.

The counter-argument voiced by many who support the choice not to vaccinate is that the diseases we vaccinate against are rare while vaccines carry a small risk of adverse events. It is true that because of use of these vaccines, many diseases have been greatly reduced in the population, but increasing incidence of non-vaccination has created outbreaks.

In the 1980s there were 11,000 hospitalizations and 123 deaths due to measles outbreaks. There were measles outbreaks in 2006 in Boston and 2008 in San Diego even though the disease was declared eradicated in 2000. In contrast to the risk of measles, the risk of the MMR vaccine is that for every 3,000 to 4,000 children vaccinated, one child will experience “a small increase in risk of febrile seizures,” according to the CDC.

Weighing these factors, most states have decided that parents are free to choose whether to vaccinate, but they must if their children are to attend public schools. This compromise may protect the school community from the risk that unvaccinated children pose, but it fails to protect the child from the parent’s decision to deny them protection from disease. Furthermore, the process of awarding religious or philosophical exceptions to anyone who asks risks making these mandates useless.

While our nation values religious freedom, surely that respect ends when individuals’ beliefs threaten the health of their and the community’s children. In the case of Jehovah’s Witnesses, for example, it is legally acceptable and ethically required to give children life-saving blood products over the objections of the parents.

A reasonable proposal by the Pediatric Infectious Diseases Society is that exemptions based on personal belief should not be allowed. If they are allowed, the parents should be required to attend a counseling session, to provide detailed information on their beliefs regarding vaccination, and to reaffirm this decision yearly after meeting with a counselor. The proposal advocates that during outbreaks of vaccine-preventable diseases, unvaccinated children should be barred from attending school (a provision already in force in Maryland).

puBlic schools anD manDatory vaccinationPatrIck kernS, GS Iv

MEDICS on ETHICS

Spring 20138 the Dual Decree

“Vaccines protect the inidividual, but also contribute to public health.”

inthespotlight

Cai X, Kallarackal AJ, Kvarta MD, Goluskin S, Gaylor K, Bailey AM, Lee HK, Huganir RL, Thompson SM.Nature Neuroscience. Published online 17 March 2013 doi:10.1038/nn.3355.Local potentiation of excitatory synapses by serotonin and its alteration in rodent models of depression.

publications

presentationsKristi Chakrabarti, MS II

Monica Charpentier, GS IIIAmerican Association of Cancer Research

Annual ConferenceWashington D.C.April 6-10, 2013

Kyle Wilson, GS III Society for Interventional Radiology

Annual Conference New Orleans, LAApril 12-19, 2013

resiDency matchesmarch 15, 2013Doctoral Dissertation

march 28, 2013

congrats!

frontiers of nmr in Biology Keystone symposium

I had the opportunity to attend the Frontiers of NMR in Biology Keystone Symposium with Dr. Michael Summers’s Lab. The

biannual meeting was held in Snowbird, Utah this year, with Dr. Summers as the keynote speaker. There were a variety of people from all over the world. I attended many different seminars and learned very interesting and innovative NMR techniques, such as NMR urine biopsies. I was also able to meet Kurt Wüthrich, a chemist/biophysicist and a Nobel laureate in chemistry.

I did a poster presentation on my HIV-1 Capsid Inhibitor project, and I also gave a “Lightning Talk,” a one-minute oral presentation on my project that helped advertise my poster and attract more viewers. Interested people came to my poster and gave me constructive feedback and advice about future directions for my project.

The meeting was held at the Snowbird Resort, located in Little Cottonwood Canyon. The schedule included a break in the afternoon, which allowed time for relaxation and skiing. The meeting was a great experience and a lot of fun.

9mdphd.umaryland.eduSpring 2013

Kavita GandhiPh.D. EPID EpidemiologyVariation in the Circumsporozoite Pro-tein of Plasmodium falciparum: Impli-cations for Vaccine Design

Kavita GandhiEmergency MedicineOregon Health and Sciences University

Paz LuncsfordInternal MedicineWake Forest Baptist Medical Center

JoShua brown, MS I

Spring 201310 the Dual Decree

Karl Deisseroth,mD, phD

stanforD univerisity

First to successfully express microbial opsins on neurons

roBert innis,mD, phD

national institute of mental health

Branch and Section Chief of the PET Neuroimaging Sciences

noBel laureate

carol grieger,phD

Johns hopKins

Discovered how chromosomes are protected by telomeres and the enzyme telomerase

mary armanios,mD

Johns hopKins

Expert on telomere-mediated disorders

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Affix Mailing Label & Postage

april 17Adam Fisch (GS III)

may 1 Josh Lieberman (MS III)

april 16

& april 23

Molly Hritzo (MS I) & Andrew Wescott (MS I)

Faculty Leader: Bruce Kreuger

(tmt)

(m2m)

translational meDicine topics

molecules to meDicine

dates & reminders april 4, 2013 @ 4 pm Physician Scientist Seminar with [HSFII Rm. 341] * Robert Innis, MD, PhD

april 22, 2013 @ 4 pm Max Lecture with [HSFII Auditorium] * Karl Deisseroth, MD, PhD

may 7, 2013 @ 6 pm WPSIG event with [HSFII Rm. 341] * Carol Greider, PhD & * Mary Armanios, MD

may 16, 2013 MSTP Graduation Reception [Student Center]

may 17, 2013 Graduation

august 1, 2013 MSTP Retreat [Engineer’s Club]

april 16 & 23 @ 12pm Molecules To Medicine [HSF II, Rm. 400]

april 17 & may 1 @ 12pm Translational Medicine Topics [HSF II, Rm. 341]

&

april 22, 2013 @ 4 pm Max Lecture with [HSFII Auditorium] * Karl Deisseroth, MD, PhD

may 16, 2013 MSTP Graduation Reception [Student Center]

august 1, 2013 MSTP Retreat [Engineer’s Club]

april 17 & may 1 @ 12pm Translational Medicine Topics [HSF II, Rm. 341]

MSTP Graduation Reception

MSTP Retreat