Monday, November 16, 2009

I need better theories

As I begin to become interested in particular topics in my studies, there are several topics that spark further exploration. (oh yeah, I'm taking online courses at University of Minnesota School of Public Health, and I'm giggling only because I can say Minnesota with a stellar Fargo accent, stellar)

The 20s and 30s represent prime childbearing years for low-risk pregnancies in white women. But while white teen pregnancies are considered extremely risky, studies show that African American teen mothers experience a survival advantage compared to infants whose mothers are older. As African American women enter their 20s and 30s, infant mortality rates increase.

The Weathering Hypothesis suggests that African American women may begin to deteriorate due to socioeconomic disadvantage. It is unclear why these disparities exist, but various social determinants are offered as possible explanations.

Reflecting on what other factors could play a part in this, I researched further and discovered there are several genetic differences between white and African American women. On average, African American women enter puberty and begin menstrual cycles much earlier than white women. The high-risk associated with white teen pregnancies may be because of the lack of fertile development, while most African American teens have reached fertile maturity much earlier and have already surpassed the high-risk pregnancy window during their pre-teen years. These facts suggest that it is possible that for African Americans, prime childbearing years could naturally peak in their teen years. [Don't be impressed, when I researched further, I discovered several other explanations shooting down this theory]

And so far, my world of theories are continuously being rejected. I think it's because I'm way too optimistic when it comes to health.

For example, we now know that some long-term smokers get COPD earlier than others. When speaking to a physician about possible genetic effects, I suggested that perhaps some guys have a gene that makes their lungs more elastic and resilient. The physician laughed and said "There's no superman gene. There must be patients with genes that make them more at risk for the disease." My immediate thought was, what a pessimist, but as I find out more about the approaches made to find these facts, the question is always, "Who's more at risk?" and never "Who's in the clear?"

Now that I've finally grasped that without prevention, every relevant person has a chance of being at risk, perhaps now my theories will have more worth. Of course, as I understand, it is common to have even the most profound trial findings shot down several times in one's career.

Why Epi? Why Now?

It's crunch time. For the admissions office, not me. I'm in the waiting game with no apparent timeline. Since, I've applied, I received various promises from one school that I will hear back in: 5-7 days, 2 weeks, 1 month from the app deadline, and now, the beginning of December. The other school has me waitlisted, which is just an excuse to have me wait longer.

Many of you are curious why I decided to make a career switch of this magnitude. As I learn more about Public Health, the combination of curiosity and passion has led me to create a list of all of the things I want to accomplish while on the road to a PhD in Epi.

Head-to-Head Trials

When Big Pharma finally breaks down and funds head-to-head-trials, they have all these dodgy ways of weighing data to their favor. I want to create an organization that funds head-to-head trials, while taking into account the strengths and weaknesses of each drug as documented by their pivotal trials. Clinical trial models should use treatment guidelines for measurements, any AEs that require special monitoring and other factors.

Associations
There is so much data already out there that we can use for retrospective trials. An example that has already been done makes an association between rib injuries and pneumonia. Rib injuries can cause patients to breath shallowly to avoid further pain, but shallow breathing can lead to a build up of bacteria in the chest causing pneumonia and other bacterial infections. Findings like these can prevent additional ailments in patients.

Unusual exposure
I feel that a fair number of trial proposals from physicians stem from undocumented evidence observed in the several patients they see everyday. I want to explore fields that might not be followed as often in medicine, and interview people who may have exposure to a specific group of patients that aren't seen by a physician everyday. An example could be interviewing trainers who help overly obese patients lose weight dramatically. The process of losing excessive weight is especially interesting, because the body does what it can to maintain the weight that the person is, so when they begin to waste rapidly, it would be interesting to know what the body does to cope and if these processes can be arranged into stages...


Regulate Big Pharma

Last year, the FDA put all of these regulations into place to align Big Pharma with better practices, but I'll tell you right now, they failed. Keeping sales reps from giving doctors flashy pens will not solve the manipulation behind sales. The first thing I learned in Marketing class at Drexel was that health care is an inelastic market. Even though Big Pharma does us a favor by creating medications that save lives, something should be done to remind them this business is for the lives.

-Keeping patients from getting a better approved drug, because the company's other less effective drug hasn't run it's life cycle yet--worse than a flashy pen.

-Paying doctors (key opinion leaders) millions of dollars to advocate a drug and pretend that all their patients flourished on the medication--worse than a notepad with the logo on it

-Redefining the disease state to fit the medication's needs and brainwashing sales reps into believing it--worse than a flash drive

Obviously, this is more of a health policy thing, but this is something I care about.

Stop and give yourself a pat on the back
Thanks to epidemiology, awful diseases have been controlled and even eradicated, and yet there are new diseases, new strands of old diseases, and several other things to keep epidemiologists at work. One question that I'm trying to answer through retrospective research is if we eradicated malaria, would there be a dramatic increase of anemic patients? How would we best prepare for this? Would it make sense to fight both synchronously?

There are several other efforts, I'd love to find out more about in general. I saw this film called "The Final Inch" about UNICEF trying to eradicate polio in the world, and it made me want to get involved. There are other diseases and ailments (HIV, diabetes, autism, malaria) where I'd like to know more about the current efforts people are taking to control or find the root of.

At the end of my career, I'd like to say, "Because of my contribution to public health, we know the cause of blank disease, we've eradicated blank disease, and we are living in a much safer environment, due to the data we've found stating blank." You get the idea. It may be difficult for me to be solely responsible for these things, but I hope to find correlations in the data that will lead to any of these great events.

Right now, I have to just get into an MPH program.