Health Humanities & Medical Sociology

Substance Addiction: A Disease, Not a Matter of Free Will

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by Zijun Zhou, July 27, 2025

In the 21st century, social technology and cultural advances have brought new challenges. One of the most serious is drug addiction, now a major public health and social issue. The latest statistics from the Addiction Group (2024) show that nearly 50 million Americans suffer from a substance addiction or substance use disorder (SUD) each year, but less than 10% receive appropriate treatment. Further, more than 70% of alcohol-dependent people have never sought professional help. Addiction is also deeply intertwined with broader mental health challenges, including a significantly elevated risk for suicidality. While not all of the 13 million adults and 3.4 million adolescents in the United States affected by suicidal thoughts each year necessarily have a diagnosed substance use disorder, research robustly demonstrates that individuals with SUDs face a substantially increased risk of suicide mortality (Sugue, 2024). For example, a large case-control study conducted across eight integrated healthcare systems in the United States found that all categories of substance use disorders, including alcohol, tobacco, and other drug use disorders, were significantly associated with an increased risk of suicide mortality, even after controlling for comorbid mental health and physical health conditions. This methodological rigor is critical, as it provides strong evidence that Substance Use Disorder is not merely an epiphenomenon or symptom of other psychiatric conditions, but rather a powerful and independent driver of suicide risk. This finding offers a solid evidentiary foundation for the article’s central thesis: that addiction is itself a primary pathological process. The study emphasized that the risk is particularly pronounced for individuals with multiple substance use disorders, and that women face a relatively higher risk compared to men (Lynch et al., 2020). This strong association further underscores that substance use disorders likely contribute significantly to suicide risk, particularly among individuals experiencing suicidal ideation and broader mental health crises. Such findings emphasize the importance of addressing addiction as a critical public health concern.

Despite the mounting scientific evidence, a consensus on the nature of addiction remains elusive in both academic and public spheres. A landmark event in this debate occurred in 2014, when the esteemed journal Nature published an editorial, Animal farm, which claimed that the view of addiction as a brain disease was not particularly controversial, at least among scientists (Animal Farm, 2014). This assertion, however, provoked a swift and strong backlash, culminating in a letter signed by 94 international addiction scholars who contested this one-dimensional portrayal. They argued that substance abuse cannot be divorced from its social, psychological, cultural, political, legal and environmental contexts: it is not simply a consequence of brain malfunction. This public debate highlights the complexity of the issue. Therefore, this article’s support for the disease model is not intended to dismiss these vital critiques. Rather, it is to argue that, while fully acknowledging the importance of these psychosocial and environmental factors, the neuroadaptive changes that occur in the brain during addiction are so profound, pathological, and dysfunctional that the disease framework remains the most robust scientific model for understanding its compulsive nature and for guiding effective intervention.

Addiction is a chronic disease characterized by drug seeking and use that is compulsive or difficult to control despite harmful consequences (National Institute on Drug Abuse, 2018). Unlike the traditional concept of addiction as a weakness of will or an individual’s choice, the occurrence and development of addiction are driven by complex neurobiological mechanisms. These neurobiological mechanisms fundamentally undermine voluntary control by profoundly restructuring the brain’s reward system. This restructuring pathologically heightens the motivational value of the drug while diminishing the perceived value of natural rewards. As a result, the individual experiences intense, cue-driven cravings that can overwhelm rational thought. This is compounded by severe disturbances in emotion and stress regulation that create a deeply negative affective state during abstinence, driving a powerful compulsive need to use the drug to escape from this distress. These issues are further exacerbated by significant impairments in executive function, which compromise the prefrontal cortex’s ability to control impulses and weigh long-term consequences, weakening the brain’s inhibitory control system against relapse. The clinical manifestations of addiction are usually accompanied by tolerance and withdrawal symptoms, and its essence is continuous and repeated drug seeking and use. Tolerance and withdrawal symptoms may be present, and the essential elements include continuous and repeated drug seeking at the cost of normal rewards. It is not the result of one’s own choice.

Critics often argue that addiction is not a real disease because they believe that the brain is designed to change throughout life naturally. They support this by pointing out that the growth stages of children and adolescents and learning throughout adulthood are based on similar changes in the cerebral cortex and limbic system (Lewis, 2017). However, this view ignores the changes in brain structure and function that addiction demonstrably causes, which form the core basis for defining it as a disease. These extensive alterations exemplify an abnormal state affecting brain structure and function, accompanied by clear behavioral symptoms, consistent with established medical criteria for a disease (National Cancer Institute, 2011). Indeed, addiction manifests precisely through such pathological changes. For example, a defining feature of drug abuse is the pathological ‘hijacking’ of the brain’s natural reward system and emotional regulation circuits. This hijacking itself represents a fundamental disruption of normal brain function, an abnormal state directly initiated when all addictive drugs drastically increase dopamine release in key brain regions. Dopamine is the central neurotransmitter of the brain’s reward system and is primarily responsible for regulating feelings of pleasure, motivation, and reinforcement learning. However, a drug-induced surge in dopamine is not a physiological adaptation like normal learning, but rather an extreme and abnormal neurochemical event that profoundly alters neural circuits. In addictive behaviors, drugs cause a sharp rise in dopamine levels in key regions such as the nucleus accumbens and the striatum by stimulating dopamine neurons. This abnormal dopamine release alters neural circuits deep in the brain from the ventral tegmental area (VTA) to the nucleus accumbens. Further, it extends to regions such as the limbic system and orbitofrontal cortex (Leshner, 1997). Together, these regions regulate emotions, decision-making, and impulse control. Unlike the gradual changes of natural learning, this overwhelming, drug-induced flood of dopamine fundamentally corrupts the brain’s decision-making architecture, which is a hallmark of a disease state.

While these changes begin with the limbic system, the effects of addiction extend further to higher-order regulatory regions. The ventromedial prefrontal cortex (VMPC) in drug addicts exhibits significant functional impairments.The behavior of people with an addiction is highly similar to that of patients with VMPC damage: both groups often deny or are unaware of their problems (Bechara, 2005). Moreover, when faced with a choice that offers an immediate reward, they tend to ignore the possible long-term negative consequences, including the loss of their job, family, or even reputation. VMPC damage usually includes the medial parts of Brodmann Area (BA) 25, lower 24, 32, 11, 12, and 10. Although patients may retain normal intelligence, memory, and other cognitive functions, they show significant deficits in emotional and social behavior and long-term decision-making abilities, which is highly consistent with the characteristics of drug addiction (Bechara, 2005). Compared with non-addicts, drug addicts (such as cocaine-dependent individuals) have significantly lower resting-state functional connectivity (RSFC) between the frontal hemispheres. This change is particularly pronounced in areas related to the dorsal attention network, including bilateral prefrontal, medial prefrontal, and posterior parietal regions (Kelly et al., 2011). This weakening of RSFC reflects the persistent impairments in executive function, attention control, and behavioral regulation in people with an addiction. This not only makes them more prone to relapse in the face of environmental cues (for example, encountering people who used to take drugs together, going to places associated with past drug use, or seeing items and equipment related to drugs), but also weakens motivation for long-term goals and impulse control (Mennis et al., 2016).This phenomenon reveals that addiction is not only a functional abnormality of a single neural circuit but also the result of impaired collaboration among multiple brain regions.

From a neurobiological perspective, the development of addiction can be divided into three recurring stages: Binge and Intoxication, Withdrawal and Negative Affect, and Preoccupation and Anticipation. This cyclical model, driven by profound neural adaptations within specific neural circuits, clearly reveals the progressive pathophysiological process of addiction as a chronic, relapsing brain disease, rather than a simple issue of willpower or choice. Each stage involves the activation of specific neurobiological circuits and is accompanied by clinical and behavioral characteristics (Koob & Volkow, 2016; Volkow, Koob, & McLellan, 2022). Exploring each of these stages in turn reveals how the disease progresses and systematically hijacks the brain’s circuitry.

During the Binge and Intoxication stage, addictive substances significantly increase dopamine levels by triggering their release in the brain’s reward circuitry. This process bypasses natural reward mechanisms, directly stimulating dopamine transmission in key regions such as the nucleus accumbens and prefrontal cortex, resulting in reward effects from drug use that far exceed those of natural stimuli (Kalivas & O’Brien, 2008). This direct and overwhelming stimulation of the reward pathway represents an initial pathological transformation and an early manifestation of the disease state of addiction, as it disrupts the brain’s normal regulatory processes, disproportionately amplifying the incentive value of drugs. Dopamine signaling not only reinforces the immediate response to drugs but also links drug use to specific environmental cues through conditioned learning. As usage frequency increases, dopamine cells gradually become less responsive to the reward but more sensitive to cues predicting the reward, thereby intensifying drug cravings (Koob & Volkow, 2016). This neural adaptation marks a pathological hijacking, reflecting addiction as a disease where patients’ behavior is increasingly driven by external cues rather than autonomous choice. This neural adaptation marks a pathological hijacking, reflecting addiction as a disease where patients’ behavior is increasingly driven by external cues rather than autonomous choice, thereby setting the stage for the painful withdrawal of the second act.

The Withdrawal and Negative Affect stage is characterized by a critical shift from reward-system dominance to the recruitment of brain stress and antireward systems. This transition is initiated by counteradaptive mechanisms, specifically the opponent process, a neurobiological response that counteracts the drug’s initial rewarding effects. In addition, this process becomes dysregulated; it fails to return to its homeostatic baseline and instead establishes a new, pathological state known as allostasis (Koob & Le Moal, 2008). This allostatic state represents a chronic deviation of the brain’s reward set point, sustained by the extended amygdala’s overactivation of the antireward system (Koob & Le Moal, 2008). The hyperactivity of this system, mediated by neurotransmitters like corticotropin-releasing factor, is responsible for the profound negative emotional states of withdrawal, such as anxiety and irritability (Volkow, Koob, & McLellan, 2022). Consequently, the motivation for drug use is fundamentally altered. It shifts from a volitional act to seek pleasure to a compulsive behavior driven by the need to temporarily alleviate this persistent, aversive internal state (Koob & Volkow, 2016). This shift from choice to compulsion is a core pathological feature of the disease. At this juncture, the motivation for drug use has fundamentally shifted from chasing pleasure to escaping pain—a critical turning point that marks the transition from voluntary use to compulsion.

Regarding the Preoccupation and Anticipation stage, its core feature is dysfunction in the prefrontal cortex and its associated circuits. This stage is primarily associated with significant impairment in executive function, including reduced impulse control, self-regulation, and decision-making abilities. Due to abnormal regulation of dopamine and glutamate signaling in the prefrontal cortex, addicts struggle to resist impulses when exposed to drug-related cues. Additionally, prolonged drug use has led to significant neuroplastic changes in the brain. These changes are concentrated at the molecular level, such as the accumulation of deltaFosB and brain-derived neurotrophic factor (BDNF). These molecular-level changes not only reinforce compulsive drug-taking behavior but also significantly increase the risk of relapse (Kalivas & O’Brien, 2008). Research has shown that short-term withdrawal (e.g., 12 hours) significantly increases an individual’s reactivity to cues, accompanied by enhanced activation of the medial prefrontal cortex (mPFC) and orbitofrontal cortex (OFC). This change is associated with intense craving and withdrawal symptoms (Goldstein & Volkow, 2011; Volkow, Koob & McLellan, 2022). The effects of long-term abstinence on prefrontal cortex activity highlight the complexity of neuroadaptive changes in addiction. While some studies suggest reduced activity in certain prefrontal regions during prolonged abstinence, possibly due to adaptive behavioral strategies, the overarching pattern remains one of significant dysfunction. Such complexity underscores the difficulty addicts face in resisting drug-related cues, reinforcing the importance of understanding impaired cortical function in the chronic relapse cycle of addiction. Due to impaired executive function in the prefrontal cortex, addicts often struggle with decision-making to inhibit drug use, leading to a vicious cycle of repeated drug use. This significant functional impairment of the prefrontal cortex, including imbalances in neurochemical signaling and persistent molecular-level adaptive changes, constitutes the core pathological manifestation of addiction as a chronic brain disease. A key example of such a change is the accumulation of the protein deltaFosB, which acts as a long-lasting molecular switch that structurally rewires neural circuits to reinforce compulsive drug-seeking (Nestler et al., 2001). It directly undermines an individual’s ability to engage in rational assessment, inhibit inappropriate impulses, and maintain long-term goals, rendering self-control exceptionally challenging at the physiological level, thereby contributing to the chronic nature of the disease and its high relapse rate. At this point, the brain’s accelerator (the craving system) is stuck on full throttle, while the brakes (executive function) have failed, trapping the individual in a cycle of relapse that is physiologically difficult to escape.

The profound impact of environmental and social factors on the neurobiologically vulnerable individual—as underscored by the disease model of addiction—is vividly illustrated by the case of Vietnam War veterans. Vietnam War veterans experienced widespread heroin addiction due to the high levels of stress and availability of drugs in the war environment. However, after returning home, many were able to quit relatively successfully due to the disappearance of the war environment and related cues (Leshner, 1997). This case powerfully demonstrates the significant influence of social and environmental factors on addiction, highlighting the need for holistic treatment strategies that address not only neurobiology but also the psychological context in which addiction occurs.

While the end of the war created a positive environmental shift for many, more recently, the COVID-19 pandemic provided a stark counterexample of how social upheaval can catastrophically worsen the addiction crisis. In the wake of the pandemic, U.S. drug overdose deaths surged dramatically, increasing by over 30% in 2020 and surpassing 106,000 in 2021, with opioid-related fatalities showing the most significant rise (Tanz et al., 2022; Spencer et al., 2022). This trend was starkly illustrated at the state level; in New York, a recent report by the New York State Office of the State Comptroller (OSC) found that the increase in opioid overdose deaths in New York between 2019 and 2021 was approximately 68% (OSC, 2022). A perfect storm of factors drove this crisis. On one hand, the pandemic created a widespread mental health crisis, increasing feelings of anxiety, loneliness, and despair, which fueled the demand for substances. On the other hand, lockdowns and social distancing measures severely disrupted access to treatment and recovery support services, leaving vulnerable individuals isolated (Hulsey et al., 2020). This was compounded by an increasingly toxic illicit drug supply, where lethal synthetic opioids like fentanyl became more prevalent (Melamed et al., 2022). This modern-day example powerfully underscores the complex interplay between the neurobiological disease of addiction and large-scale environmental stressors. These cases powerfully illustrate a central tenet of the modern disease model: the neurobiological vulnerabilities established by the disease process are dramatically amplified or mitigated by the external environment. A purely neurobiological focus, therefore, is insufficient. A truly comprehensive strategy must be bimodal, simultaneously targeting the internal pathophysiology of the brain and the external social context of the individual.

Viewing addiction as a disease shapes healthcare policies, treatment approaches, and social attitudes, directly influencing societal outcomes. This disease-oriented perspective provides a clear scientific basis for developing effective treatment protocols, reducing stigma towards individuals with addiction, and guiding evidence-based policy-making. For instance, it supports legislative changes such as improved insurance coverage for addiction treatment and shifts from punitive measures toward rehabilitation. Economically, addiction imposes significant burdens on society; the annual social cost of tobacco, alcohol, and illicit drug abuse in the United States reaches approximately $700 billion (Volkow et al., 2022). This figure is projected to rise due to the ongoing opioid crisis, with opioid-related disorders and overdoses alone accounting for around $1.5 trillion in losses in 2020, including healthcare expenditures, lost productivity, and criminal justice expenses (Lines, 2024). Additionally, over 25% of arrests in the United States involve drug-related offenses (Lines, 2024). Addressing addiction comprehensively as a public health issue, then, is both economically and socially essential.

From a policy and legislative perspective, treating addiction as a disease has driven changes in healthcare and insurance systems. For example, the Mental Health and Substance Abuse Equity Act (MHPAEA) requires that substance abuse treatment be covered under the same insurance as general healthcare services. The implementation of this law has significantly improved patients’ access to treatment. Although there has been a slight increase in spending on substance abuse treatment per insured person, the impact on overall healthcare costs has been relatively small, demonstrating the economic viability and social value of insurance policies with equality at their core (Busch et al., 2014). Moreover, treating addiction is less costly and more effective than incarcerating addicts. Leaders in the police and justice sectors are increasingly recognizing that sending addicts to prison only perpetuates social problems, while directing resources to treatment and rehabilitation services can improve public safety (Williams, 2015). Despite its existence, enforcement has been challenging, leading to persistent coverage disparities. Federal agencies issued final rules in September 2024 to strengthen enforcement (U.S. Department of Labor, EBSA, 2024), but these new rules were immediately challenged by industry lawsuits, ultimately leading the agencies to suspend enforcement in May 2025 pending review (APASI, 2025). This policy uncertainty highlights the ongoing challenges of translating scientific consensus into stable and effective societal responses. Nevertheless, the view of addiction as a disease remains the fundamental driver for promoting fairer insurance coverage and shifting from punitive to rehabilitative criminal justice reforms.

Moreover, considering addiction as a disease may also reduce social stigma, so that more addicts can actively seek help rather than refusing treatment out of shame or fear. Currently, more than 70% of alcohol-dependent people have never sought professional help, and views of addiction as a moral failure or a weakness of the will undoubtedly exacerbate this phenomenon. In contrast, defining addiction as a disease can lead society to invest more resources in treatment, rehabilitation, and prevention services, rather than simply punitive policies. For example, the Patient Protection and Affordable Care Act (ACA) has promoted the inclusion of substance abuse services in basic health benefits, which has greatly improved the accessibility of addiction treatment, further illustrating the important guiding significance of the disease definition for public policy.

Viewing addiction as a disease provides the essential foundation for critical policy and social reforms. Such a perspective underscores the value of evidence-based treatment strategies over punitive approaches, which not only reduces stigma and encourages more individuals to seek necessary care but also promotes public safety by breaking the cycle of addiction-related crime. Ultimately, addressing addiction as a chronic disease rather than a moral failing allows for a more compassionate, effective, and economically sustainable societal response.

In summary, neurobiological evidence clearly indicates that addiction is a brain disease rather than a simple lack of willpower. Addictive substances create lasting changes in brain circuits, disrupting neurotransmitter regulation (e.g., dopamine) and impairing critical functions controlled by areas such as the prefrontal cortex. These persistent physiological alterations undermine self-control, rational decision-making, and the proper assessment of natural versus drug-induced rewards. However, this biological model is not deterministic; as the experiences of Vietnam veterans demonstrate, environmental context and social support are powerful modulators of these neurobiological vulnerabilities. The cyclical and relapsing nature of addiction underscores its chronicity and complexity. Just like other chronic diseases, a short-term cure is a relatively rare outcome; instead, relapses are more common. Recognizing addiction as a disease, one that involves a complex interplay of biology and environment, thus fosters deeper understanding and enables society to respond with greater empathy and effectiveness.

References:

APA Services Inc (APASI). (2025). Challenges to mental health parity law leave uncertainty for mental health and substance use disorder care.

APA Services (2025). https://www.apaservices.org/advocacy/news/challenges-mental-health-parity-law

Bechara, A. (2005). Decision making, impulse control and loss of willpower to resist drugs: A neurocognitive perspective. Nature Neuroscience, 8(11), 1458–1463. https://doi.org/10.1038/nn1584

Busch, S. H., Epstein, A. J., Harhay, M. O., Fiellin, D. A., Un, H., Leader, D., Jr., & Barry, C. L. (2014). The effects of federal parity on substance use disorder treatment. The American Journal of Managed Care, 20(1), 76–82.

Di Chiara, G. (2002). Nucleus accumbens shell and core dopamine: Differential role in behavior and addiction. Behavioural Brain Research, 137(1–2), 75–114. https://doi.org/10.1016/s0166-4328(02)00286-3

Goldstein, R. Z., & Volkow, N. D. (2011). Dysfunction of the prefrontal cortex in addiction: Neuroimaging findings and clinical implications. Nature Reviews Neuroscience, 12(11), 652–669. https://doi.org/10.1038/nrn3119

Hulsey, J., Mellis, A., & Kelly, B. (2020, September). COVID-19 pandemic impact on patients, families and individuals in recovery from substance use disorders. Addiction Policy Forum.

Kalivas, P. W. (2009). The glutamate homeostasis hypothesis of addiction. Nature Reviews Neuroscience, 10(8), 561–572. https://doi.org/10.1038/nrn2515

Kalivas, P. W., & O’Brien, C. (2008). Drug addiction as a pathology of staged neuroplasticity. Neuropsychopharmacology, 33(1), 166–180. https://doi.org/10.1038/sj.npp.1301564

Kelly, C., Zuo, X.-N., Gotimer, K., Cox, C. L., Lynch, L., Brock, D., Imperati, D., Garavan, H., Rotrosen, J., Castellanos, F. X., & Milham, M. P. (2011). Reduced interhemispheric resting state functional connectivity in cocaine addiction. Biological Psychiatry, 69(7), 684–692. https://doi.org/10.1016/j.biopsych.2010.11.022

Koob, G. F., & Le Moal, M. (2008). Addiction and the brain antireward system. Annual Review of Psychology, 59(1), 29–53. https://doi.org/10.1146/annurev.psych.59.103006.093548

Koob, G. F., & Volkow, N. D. (2016). Neurobiology of addiction: A neurocircuitry analysis. The Lancet Psychiatry, 3(8), 760–773. https://doi.org/10.1016/s2215-0366(16)00104-8

Leshner, A. I. (1997). Addiction is a brain disease, and it matters. Science, 278(5335), 45–47. https://doi.org/10.1126/science.278.5335.45

Lewis, M. (2017). Addiction and the brain: Development, not disease. Neuroethics, 10(1), 7–18. https://doi.org/10.1007/s12152-016-9293-4

Lines, L. (2024). Economic impact of addiction. EBSCO Information Services, Inc. https://www.ebsco.com/research-starters/economics/economic-impact-addiction

Lynch, F. L., Peterson, E. L., Lu, C. Y., Hu, Y., Rossom, R. C., Waitzfelder, B. E., Owen-Smith, A. A., Hubley, S., Prabhakar, D., Williams, L. K., Beck, A., Simon, G. E., & Ahmedani, B. K. (2020). Substance use disorders and risk of suicide in a general US population: A case control study. Addiction Science & Clinical Practice, 15(1), 14. https://doi.org/10.1186/s13722-020-0181-1

Melamed, O. C., deRuiter, W. K., Buckley, L., & Selby, P. (2022). Coronavirus disease 2019 and the impact on substance use disorder treatments. The Psychiatric Clinics of North America, 45(1), 95–107. https://doi.org/10.1016/j.psc.2021.11.006

Mennis, J., Stahler, G. J., & Mason, M. J. (2016). Risky substance use environments and addiction: A new frontier for environmental justice research. International Journal of Environmental Research and Public Health, 13(6), 607. https://doi.org/10.3390/ijerph13060607

National Cancer Institute. (2011). Disease. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/disease

National Institute on Drug Abuse. (2018). Understanding drug use and addiction DrugFacts. https://nida.nih.gov/publications/drugfacts/understanding-drug-use-addiction Nestler, E. J., Barrot, M., & Self, D. W. (2001). ΔFosB: A sustained molecular switch for addiction. Proceedings of the National Academy of Sciences of the United States of America, 98(20), 11042–11046. https://doi.org/10.1073/pnas.191352698

Nature. (2014). Animal Farm. 506(7486), 5–5. https://doi.org/10.1038/506005a

New York State Office of the State Comptroller (OSC). (2022). Continuing crisis: Drug overdose deaths in New York. https://www.osc.ny.gov/reports/continuing-crisis-drug-overdose-deaths-new-york

Spencer, M. R., Miniño, A. M., & Warner, M. (2022). Drug overdose deaths in the United States, 2001–2021 (NCHS Data Brief No. 457).

Substance Abuse and Mental Health Services Administration. (2014). Leading change 2.0: Advancing the health of the nation 2015–2018.

Sugue, M. (2024). Current addiction statistics: 2024 data on substance abuse & trends. Addiction Group. https://www.addictiongroup.org/resources/addiction-statistics/

Tanz, L. J., Dinwiddie, A. T., Snodgrass, S., O’Donnell, J., Mattson, C. L., & Davis, N. L. (2022). A qualitative assessment of circumstances surrounding drug overdose deaths during the early stages of the COVID-19 pandemic(SUDORS Data Brief No. 2).

Volkow, N. D., Koob, G. F., & McLellan, A. T. (2022). Neurobiologic advances from the brain disease model of addiction. In Evaluating the brain disease model of addiction (pp. 25–34).

Routledge. U.S. Department of Labor, Employee Benefits Security Administration (EBSA). (2024). Statement regarding enforcement of the final rule on requirements related to MHPAEA. https://www.dol.gov/agencies/ebsa/laws-and-regulations/laws/mental-health-parity/statement-r egarding-enforcement-of-the-final-rule-on-requirements-related-to-mhpaea#t1

Williams, T. (2015). Police leaders join call to cut prison rosters. The New York Times. https://www.nytimes.com/2015/10/21/us/police-leaders-join-call-to-cut-prison-rosters.html

The Possible Anti-depressant Effects of Magic Mushrooms

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By Maisha Pathan, March 9, 2024

Depression is a debilitating condition that affects up to 17.8% of American adults as of
2023 (Witters). Although there are countless treatment options in the form of antidepressants,
and therapy, sometimes, these treatments may still not be enough to provide relief for those
suffering from depression. Shrooms, also known as magic mushrooms may be an emerging
answer to those seeking an alternative. This unorthodox form of treatment called
psilocybin-assisted therapy (PAT) is gaining popularity, and the results are significant enough to
be brought to the public’s attention. In PAT, the patient is given a dose of the psychedelic
psilocybin, also known as magic mushrooms, in a controlled setting while their assigned
therapist stands by to monitor the experience. Despite its low toxicity and even being safer than
nicotine and aspirin, the stigma surrounding psychedelics causes people to hesitate even
considering this as an option, on top of which it’s still a controlled substance by the government
(Lowe et al. 20). However, research obtained from clinical trials shows that in a controlled
environment and administered by a trusted professional psilocybin has a powerful impact on
depressive symptoms, and many participants report improvement in their condition after their
sessions. For the people struggling with treatment-resistant depression, severe depression, or
anyone who finds that medication and therapy aren’t helping them: psilocybin-assisted therapy
could be a viable option for treating depression and should be offered alongside therapy and
medication.


Historically, psilocybin mushrooms have been in use for centuries, prominently in the
Aztec empire around the 15th century. The substance was referred to as “god’s flesh” in Nahuatl
and used in religious and healing rituals (Nichols 679). However, it wasn’t until 1957, when
Albert Hoffman a chemist who (also created LSD) isolated psilocybin from a Mesoamerican
psilocybin mushroom, and published its effects, that magic mushrooms entered modern
American society (Nichols 680) . Although the substance was then used in psychedelic therapy,
it became popularized for its recreational use during the 60’s aided by the hippie movement,
until the USA passed the Comprehensive Drug Abuse Prevention and Control Act of 1970,
which marked it as an illicit drug along with LSD and other psychedelics. Despite these
restrictions, psilocybin continued to be used recreationally by citizens and has been gaining
more traction in media.


Major depressive disorder is a serious depressive disorder that can have a lasting impact
on the brain. This damage essentially rewires the brain which can keep the person in their
depressive state for a prolonged amount of time. The compounds that makeup psilocybin can
sometimes reverse, or rewire, the damage depression does to the brain. According to an article
published by Healthline, a medical information website, depression can shrink regions of the
brain governing memory (hippocampus), emotion (amygdala), and cognitive functions
(prefrontal cortices). As a result of shrinking, function in these brain regions such as emotional
regulation and interest, memory, and concentration are also diminished (“5 Ways Depression
Can Physically Affect the Brain”). Psilocybin, specifically psilocin comes into play here due to
its role as a subtype of serotonin receptor. It activates a serotonin receptor called the 5-HT2A
which increases serotonin levels similar to SSRIs (2-Minute Neuroscience: Psilocybin, 0:16). In
a study conducted by researchers at Weill Cornell Medicine, an fMRI was used to show how the
activation of the 5-HT2A serotonin receptor by psilocin affected the brain landscape. The results showed that on psilocin, the brain lowered energy barriers between different regional
connections in the brain which allowed regions of the brain that were typically not stimulated to
be activated. Due to the flattening of the brain’s energy landscape, new connections could be
made between different brain regions, enabling neuroplasticity and promoting neurogenesis,
which is generation of new neurons. This opens up space that allows the brain to rewire itself,
and if the psilocybin is taken in a clinical setting such as in a PAT session, old patterns of
thinking can be replaced with new, expansive thought patterns which can reverse the effects of
depression on the brain by fostering new connections (Kuceyeski).


The structure of PAT is what makes it so successful and extremely safe in treating
depression. It’s is controlled by doctors and therapists in a clinical setting and is spread
throughout three stages: a preparatory stage, an administration stage, and an integration stage
(Schuitmaker 2). Each stage of PAT plays a significant role in how effective the treatment will
be for the patient while maintaining the environment in a controlled setting.


In the preparatory stage, participants attend several psychotherapy sessions to set their
goals and intentions for their experience. This creates the set and setting. Although individuals’
experiences on psilocybin vary from person to person an important factor to the experience is set
and setting. An article analyzing PAT in medicine by Cureus, a peer-reviewed medical journal,
explains that set refers to a patient’s goals and intentions for their psilocybin experience and is
discussed with their therapist so that it could be used to guide the individual and keep them on
track. The setting refers to the patient’s mental, physical, and emotional state prior to and during
the treatment. Attending these preparatory therapy sessions helps the therapist assess when and
where treatment should take place (Ziff et al. 7).


Once the patient is prepared, the next stage is “administration” which the Yale Manual for
Psilocybin-Assisted Therapy of Depression details. Typically, on the day of administration, the
patient is taken to a homey, welcoming room, where they lie down on the couch, put on
headphones, run a musical playlist, and wear a blindfold. The dose of psilocybin provided can
vary but typically is less than 1 gram and based on what the participant can handle. The music,
lying down, and blindfold work together to create a relaxing environment where the patient can
feel safe. They know that if they need any support they have their therapist right there next to
them. These measures create a controlled environment for the patient, minimizing possible
adverse reactions like anxiety or paranoia which can lead to nausea or vomiting. Once the patient
is settled and has consumed their psilocybin dose, the drug slowly takes effect, guiding them on a
journey into the depths of their mind. The therapist only guides the patient when needed based on
the goals and intentions set in the preparatory sessions, and otherwise does not interfere with the
psilocybin trip (Guss et al. 45-50).


The day after administration takes us to the third stage, “integration.” Integration
consists of several sessions through the following weeks during which the therapist asks the
patient about their experience, what they saw, felt, learned, what they’d like to take away from
their experience, and how to integrate that into their lives (Guss et al. 51-60). Although all three
stages of psilocybin-assisted therapy are equally as important, integration ensures that the
positive experiences are incorporated into the patient’s life and have a lasting effect while the
negative experiences if any are worked through. This structuring makes the therapeutic
administration of psilocybin safe and maximizes the benefits the substance can provide a
patient.

The effectiveness of psilocybin-assisted therapy as a treatment is evident in a number of studies.
In an article published by Johns Hopkins Medicine, the efficiency of using psilocybin to treat
major depression is explored through two studies conducted under their Psychiatry and
Behavioral Sciences department. The results found from both studies showed that using
psychedelic therapy by giving each participant a dose of psilocybin followed by psychotherapy
significantly reduced the symptoms of depression in both studies. Half of the participants in the
first study entered remission from depression at the end of the four-week follow-up. In the
second study, participants with a long history of depression on antidepressants were provided two
doses of psilocybin in a few weeks. They took a GRID-Hamilton Depression Rating Scale before
and after. The results showed that 67% of the participants showed a reduction in their symptoms
after a week, and four weeks after treatment, 54% of participants in the study were in remission
(“Psychedelic Treatment with Psilocybin Relieves Major Depression, Study Shows”). In another
study conducted by the Psychiatric University Hospital of Zurich, 52 participants suffering from
major depressive disorder were treated with psilocybin-assisted therapy. Half of them were given
psilocybin while the other half, 26 individuals were given a placebo. The results showed that
psilocybin significantly decreased depressive symptoms in those who had it, more than those
who received a placebo along with their therapy sessions. By the end of the study 14 out of 26,
met the criteria for remission from depression on the Montgomery–Åsberg Depression Rating
scale. In comparison to the placebo group in which the treatment was technically seven required
therapy sessions, 4 out of 26 met the criteria for remission demonstrating that psilocybin was the
driving force for the symptom reductions (Rotz 7-10).


In one clinical PAT trial conducted by NYU School of Medicine, the participants were four
cancer patients struggling with depression and anxiety. At the end of their participation which
spanned 26 weeks, each patient demonstrated a significant reduction in their depressive
symptoms which resulted from the experiences they had during their trips.
Many people suffering from depression who participated in psilocybin-assisted therapy
clinical studies report having positive experiences that aided in reducing their depressive
symptoms. Chrissy, a 50-year-old female with stage 4 breast cancer stated “[The psilocybin
experience] brought my beliefs to life, made them real, something tangible and true – it made my
beliefs more than something to think about, really something to lean on and look forward to,”
(Malone et a. 4). Although Chrissy knew that she was still going to pass, she was able to accept
and even look forward to the time she had left. In a separate trial by the Faculty of Medicine at
Al-Hikma University, ten participants struggling with depression were treated their with
psilocybin-assisted therapy. During an integration session with their therapist, a young adult
known as Participant 1 stated, “My whole thought pattern changed. I was so relieved. My head
had never been clearer. I was so happy the day after cried to my trip buddy about how I could see
again…. I was on three different anti-depressants, valium, and sleeping pills. This stopped within
2 weeks of my first dose,” (Hisham et al. 3). Many other participants from the same study
reported the experience was mind-expanding, and gave them a more positive outlook in life. The
experiences of the participants in this particular study are consistent with the neuroplasticity
effect psilocybin can have on the brain which allows it to create new connections and eradicate
old, negative thought patterns.


Psilocybin-assisted therapy has proven to be a worthwhile treatment venture for many of the
patients who participated in treatment for their depressive disorders. It’s important to note that psilocybin in this case is being used for treatment, not for recreation or self-exploration and
because it is being used for treatment by entrusted clinics it poses a relatively low risk, if at all to
those who receive it. However, that is not to say that this should be an option for everyone.
Studies have shown that people who are genetically predisposed to psychotic disorders such as
Schizophrenia can be triggered if exposed to any psychedelic substances such as psilocybin, in
the case where if they hadn’t been exposed to the substance they would not have developed any
form of psychosis (Ziff et al. 8). This is however, managed under psilocybin-assisted therapy as
before being able to receive it, all patients must undergo medical health screening to ensure it
will be an appropriate option for them. Many of the clinical studies on PAT usually begin with a
large pool of participants, which is slowly trickled down to a very small number via medical
health screening. The doses of psilocybin provided by these clinics are also quite moderate, and
typically less than even 1 gram which is the starting dose for recreational users. Years of research
and studies have gone on to show that psilocybin-assisted therapy can bring profound
improvement to depressive symptoms, especially for those who have exhausted all other options
such as medications and therapy. Age, health, and environment are all factors to consider when it
comes to PAT and it should be offered based on a mutual decision between the patient and their
mental healthcare provider. Although psilocybin-assisted therapy is not currently offered as an
official treatment and can only be accessed by participating in clinical trials, this may change
soon. In 2018, the FDA granted psilocybin-assisted therapy “break-through therapy” status
which means they will prioritize reviewing it soon for approval meaning it could soon be widely
offered for treatment (Coleman). For those struggling with depression who haven’t found relief
from any of the current treatment options, or are interested in trying psilocybin-assisted therapy,
this may be good news. Still, as in all cases, it’s important to do your own research to determine
whether this is the right option for you.

Bibliography

  1. Alshaikhli, Hisham, et al. “Effectiveness of Psilocybin on Depression: A Qualitative Study.”
    Electronic Journal of General Medicine, vol. 18, no. 3, Apr. 2021, p. em296,
    https://doi.org/10.29333/ejgm/10862.
  2. Coleman, Theara, and The Week US last updated. “The Legal State of Psychedelic Therapy in
    the US.” The week, 25 June 2023,
    theweek.com/drugs/1024449/the-state-of-psychedelic-therapy-in-the-us. Accessed 26
    Oct. 2023.
  3. Guss, Jeffrey, et al. “The Yale Manual for Psilocybin-Assisted Therapy of Depression (Using
    Acceptance and Commitment Therapy as a Therapeutic Frame).” Yale Manual for
    Psilocybin-Assisted Therapy of Depression , Aug. 2020,
    https://doi.org/10.31234/osf.io/u6v9y. Accessed 4 Nov. 2021.
  4. Kuceyeski, Dr. Amy. “Psychedelic Drugs Flatten the Brain’s Dynamic Landscape.” WCM
    Newsroom, Weill Cornell Medicine, 2022,
    news.weill.cornell.edu/news/2022/10/psychedelic-drugs-flatten-the-brain%E2%80%99s
    dynamic-landscape    .
  5. Lowe, Henry, et al. “The Therapeutic Potential of Psilocybin.” Molecules, vol. 26, no. 10, Jan. 2021, p. 2948, https://doi.org/10.3390/molecules26102948.
  6. Malone, Tara C., et al. “Individual Experiences in Four Cancer Patients Following Psilocybin-Assisted Psychotherapy.” Frontiers in Pharmacology, vol. 9, 2018, p. 335252, https://doi.org/10.3389/fphar.2018.00256. Accessed 26 Oct. 2023.
  7. Nichols, David E. “Psilocybin: From Ancient Magic to Modern Medicine.” The Journal of Antibiotics, vol. 73, no. 10, May 2020, pp. 679–86, https://doi.org/10.1038/s41429-020-0311-8.
  8. Neuroscientifically Challenged. “2-Minute Neuroscience: Psilocybin.” YouTube, YouTube Video, 5 May 2020, www.youtube.com/watch?v=XBEas8MGzd0.
  9. Rotz, Robin, et al. “Single-Dose Psilocybin-Assisted Therapy in Major Depressive Disorder: A Placebo-Controlled, Double-Blind, Randomised Clinical Trial.” EClinicalMedicine, vol. 56, Feb. 2023, p. 101809, https://doi.org/10.1016/j.eclinm.2022.101809.
  10. Schuitmaker, Nicole. “Psilocybin-Assisted Therapy: A Scoping Review of Participants’ and Facilitators’ Experiences in Qualitative Studies.” Research, Society and Development, vol. 12, no. 9, Sept. 2023, p. e12312943308–e12312943308, https://doi.org/10.33448/rsd-v12i9.43308. Accessed 26 Oct. 2023.
  11. Witters, Dan. “U.S. Depression Rates Reach New Highs.” Gallup.com, 17 May 2023, news.gallup.com/poll/505745/depression-rates-reach-new-highs.aspx#:~:text=In%202023%2C%2029.0%25%20of%20Americans. Accessed 19 Aug. 2023.
  12. Ziff, Shawn, et al. “Analysis of Psilocybin-Assisted Therapy in Medicine: A Narrative Review.” Cureus, vol. 14, no. 2, Feb. 2022, https://doi.org/10.7759/cureus.21944.
  13. “Psychedelic Treatment with Psilocybin Relieves Major Depression, Study Shows.” Www.hopkinsmedicine.org, 4 Nov. 2020, www.hopkinsmedicine.org/news/newsroom/news-releases/2020/11/psychedelic-treatment-with-psilocybin-relieves-major-depression-study-shows#:~:text=In%20a%20small%20study%20of. Accessed 26 Oct. 2023.
  14. “5 Ways Depression Can Physically Affect the Brain.” Healthline, 24 Oct. 2018, www.healthline.com/health/depression-physical-effects-on-the-brain#reversing-the-effects. Accessed 26 Oct. 2023.

Healthcare’s Youngest Victims: Inequality in Pediatric Healthcare and How We Can Fix It

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 by Cameron Takmil, February 24, 2024

Millions of children visit the emergency room every year with cuts, bruises, and a myriad of other diagnoses. Many are turned away from necessary treatments for seemingly nothing except one thing – race. While seemingly trivial, disparities across racial and ethnic lines persist, underscoring a critical need for systemic reform. Recent research spearheaded by experts at Northwestern revealed that healthcare inequities are widespread, affecting non-white minorities profoundly in pediatric care. 

The most concerning disparity was in pain management. When comparing kids of color to their white counterparts, they were not given proper medication at the same rate (Godoy 2024). 

These disparities manifest in other ways, including but not limited to diagnostic imaging, surgical complications, emergency care wait times, and treatment for developmental disabilities. Children of color often get the short end of the stick in these circumstances, receiving less than optimal care. UCLA researchers determined that white pediatric patients were more likely to receive sepsis treatment, compared to their black counterparts who also were less likely to be given full diagnostic testing through automated sepsis-alert systems (Li et. al 2022).

Premature infants of color tend to have increased rates of morbidities with regard to bronchopulmonary dysplasia, intraventricular hemorrhage, and necrotizing enterocolitis (Fanta et. al 2021). Those same infants generally had a lower birth weight, were born more prematurely, and had a higher mortality rate compared to white infants.

Differences lie not only in physical health, as mental health has seen its fair share of disparities amongst pediatric patients. Post-diagnosis, Latino and Black children receive medication and treatment at a lesser rate than White children (Fanta et. al 2021). Underdiagnosed and undertreated, patients of color were less likely to be evaluated on evidence-based mental health care and be given the correct medication all in all.

These inequalities persist despite the families having insurance, pointing towards the idea that these disparities are caused by other factors (Godoy 2024). Nevertheless, Hispanic and Black populations were much less likely to be uninsured, which is another hindrance in access to ubiquitous healthcare (Zhang et. al 2019).

The source of these inequalities stems from decades-long structural racism. Race-based residential segregation, institutional racism, and concentrated poverty have led and in many cases today, continues to worsen quality of housing, safety, and healthcare access and quality. A Harvard study found that in nearly all of the largest urban areas in the United States, two-thirds of non-Hispanic Black children and more than half of Hispanic children lived in areas graded as low- or very low opportunity (Slopen, Heard-Garris 2021). On the other hand, fewer than 1 in 5 Asian or White children live in low- or very low opportunity neighborhoods, clearly more affluent than their minority counterparts.

Government programs that have kept many afloat are slowly falling to the wayside, exposing vulnerable populations to even worse conditions. The Special Supplemental Nutrition Program for Women, Infants and Children, or WIC, served nearly half of the U.S’s infant population, and over six million children overall (Center for Health Journalism 2024). WIC has been able to improve birth metrics such as birth weight, preterm birth, and infant mortality rates. Despite being seemingly essential, the refusal by Congress to adjust its budget has put close to a million Americans at risk of losing their benefits.

These disadvantages extend into overall health as “toxic stress” – a term used by researchers at the Dana-Farber Cancer Institute – leads to negative consequences in physical and psychological health. Their study discovered that adversity during childhood was associated with poorer neurocognitive, neonatal, and cardiovascular health (Umaretiya et. al 2022). Due to red-lining – residential segregation policy in the 20th century – environmental risk is increased in more impoverished areas, posing a risk of safety and exposure to its residents (Samuelson 2024). Pediatric patients of color who live in these areas with higher density of housing code violations are more likely to be admitted and return to the ED due to asthma and related complications  (Fanta et. al 2021). 

If that was not enough to overcome, this prejudice has been baked into society with false, harmful, and misleading stereotypes, which many internalize, whether consciously or subconsciously. Minority parents, especially Hispanic parents, frequently report that healthcare providers do not dedicate sufficient time to understand their child’s needs, respect their parenting expertise, or align with their child-rearing preferences (Flores 2005). These same populations also reported that topics such as community violence, household smoking, alcohol usage, issues paying for the child’s basic needs, and spouse/partner support were discussed more frequently than white parents.

These sentiments extend far beyond healthcare, as anti-minority beliefs have come to the forefront in the past years. According to a recent national survey, “51% of whites think that blacks are prone to violence, whereas only 16% of whites think that whites are prone to violence” (Flores 2005). In the doctor’s office, we see much of the same, as the prevalence in which community violence was discussed quadrupled and tripled for Hispanic and Black patients respectively. Similar trends were found with regard to substance use, even in families where average income exceeded $75,000 (Flores 2005). 

This gap in communication and understanding only exacerbates the feeling of marginalization and can lead to decreased satisfaction with care and impaired patient-provider communication. These same minority populations have been reported to have higher levels of distrust of their provider, mainly due to implicit and explicit discrimination (Umaretiya et. al 2022). Such interactions might not only perpetuate discrimination but also detract from providers’ ability to educate, inform, and aid these patients.

It is not all hopeless, though, as there is a pathway for solutions to reduce the gap between patients of color and white patients. Addressing and solving disparities in pediatric healthcare is a multifaceted challenge that demands an in-depth and multidisciplinary approach. The strategies to promote health equity in pediatrics can be categorized into three levels: individual, institutional, and structural as demonstrated in research (Fanta et. al 2021). 

At the individual level, healthcare professionals can make up ground by engaging in continuous professional development focused on understanding and mitigating the impact of interpersonal racism, discrimination, and bias on pediatric health inequities (Fanta et. al 2021). It is crucial to educate providers on not only their explicit biases, but more importantly their implicit biases that they might not be aware of. Through this, a mindset of cultural humility and openness, being other-oriented, and recognizing the impact of power dynamics on building trusting relationships with patients and their families can be cultivated. 

These shortcomings of healthcare are not only the responsibility of the providers to ameliorate, as the onus is on institutions to invoke change themselves. Diversifying the workforce can enhance the relatability and effectiveness of the patient-provider relationship (Fanta et. al 2021). This could help patients feel more comfortable with providers who might be more apt to understand their plight. 

In a broader sense, addressing structural disparities requires moving outside of the healthcare system and advocating for policy reform aimed at eliminating inequities in critical social determinants of health. These determinants include healthcare access and quality, economic stability, education, neighborhood and built environment, and social and community context (Fanta et. al 2021). A study from Dana-Farber notes that adopting universal and systematic social determinants of health – coined as SDOH in their paper – screening within pediatric care can identify key areas where interventions can be most effective (Umaretiya et. al 2022). Identifying the specific root causes on a patient-to-patient basis will allow for much more optimized solutions.

Something as simple as integrating SDOH screens into each visit, within national pediatric protocols, can help identify mechanisms driving disparities and opportunities for intervention (Jindal et. al 2024). Developing multilevel health equity interventions that address identified pathways, such as access to care, patient-health-care-system interaction, and the impact of toxic stress, is crucial (Umaretiya et. al 2022).

It will be imperative to focus on improving the various systems that lead to poorer healthcare outcomes for pediatric patients of color. Efforts to dismantle the underlying racism that perpetuates pediatric racial and ethnic health inequities must focus on policies within multiple interdependent systems. This includes challenging housing policies that sustain poor housing, limiting access to resources like high-quality education and healthcare, and increasing exposure to environmental risk factors (Jindal et. al 2024). Enhancing family resilience through evidence-based psychosocial interventions can also play a role in mitigating the effects of toxic stress (Umaretiya et. al 2022).

To effectively reduce and solve disparities in pediatric healthcare, a concerted effort from all stakeholders—healthcare providers, institutions, policymakers, and communities—is required. This involves addressing not only the immediate healthcare needs of children but also the broader structural and social determinants of health that contribute to disparities. By implementing these strategies at the individual, institutional, and structural levels, we can move closer to achieving health equity in pediatrics, ensuring that all children have the opportunity to thrive and reach their full health potential.

Bibliography

  1. Godoy, M. (2024, January 18). Kids of color get worse health care across the board in the U.S., research finds. NPR. https://www.Godoy.org/sections/health-shots/2024/01/18/1225270442/health-inequities-pediatrics-kids-of-color-disparities
  2. Li, E., Ng, A. P., Williamson, C. G., Tran, Z., Federman, M. D., & Benharash, P. (2022). Assessment of Racial and Ethnic Disparities in Outcomes of Pediatric Hospitalizations for sepsis Across the United States. JAMA Pediatrics. https://doi.org/10.1001/jamapediatrics.2022.4396 
  3. Fanta, M., Ladzekpo, D., & Unaka, N. (2021). Racism and pediatric health outcomes. Current Problems in Pediatric and Adolescent Health Care, 51(10), 101087. https://doi.org/10.1016/j.cppeds.2021.101087 
  4. Zhang, X., Carabello, M., Hill, T., He, K., Friese, C. R., & Mahajan, P. (2019). Racial and Ethnic Disparities in Emergency Department Care and Health Outcomes Among Children in the United States. Frontiers in Pediatrics, 7. https://doi.org/10.3389/fped.2019.00525 
  5. Slopen, N., & Heard-Garris, N. (2021). Structural Racism and Pediatric Health—A Call for Research to Confront the Origins of Racial Disparities in Health. JAMA Pediatrics. https://doi.org/10.1001/jamapediatrics.2021.3594 
  6. The Health Divide: Pediatric care is worse for kids of color; federal nutrition program faces worrying shortfall | USC Center for Health Journalism. (n.d.). Centerforhealthjournalism.org. Retrieved February 10, 2024, from https://centerforhealthjournalism.org/our-work/insights/health-divide-pediatric-care-worse-kids-color-federal-nutrition-program-faces 
  7. Puja J. Umaretiya, Robert J. Vinci, Kira Bona; A Structural Racism Framework to Guide Health Equity Interventions in Pediatric Oncology. Pediatrics May 2022; 149 (5): e2021054634. 10.1542/peds.2021-054634, https://publications.aap.org/pediatrics/article/149/5/e2021054634/186711/A-Structural-Racism-Framework-to-Guide-Health
  8. Pediatric care for non-white children is universally worse across U.S. (n.d.). News.northwestern.edu. Retrieved February 10, 2024, from https://news.northwestern.edu/stories/2024/01/pediatric-care-for-non-white-children-is-universally-worse-across-u-s/ 
  9. Glenn Flores, Lynn Olson, Sandra C. Tomany-Korman; Racial and Ethnic Disparities in Early Childhood Health and Health Care. Pediatrics February 2005; 115 (2): e183–e193. 10.1542/peds.2004-1474 https://publications.aap.org/pediatrics/article/115/2/e183/67379/Racial-and-Ethnic-Disparities-in-Early-Childhood 
  10. Jindal, M., Barnert, E., Chomilo, N., Gilpin Clark, S., Cohen, A., Crookes, D. M., Kershaw, K. N., Kozhimannil, K. B., Mistry, K. B., Shlafer, R. J., Slopen, N., Suglia, S. F., Nguemeni Tiako, M. J., & Heard-Garris, N. (2024). Policy solutions to eliminate racial and ethnic child health disparities in the USA. The Lancet. Child & Adolescent Health, 8(2), 159–174. https://doi.org/10.1016/S2352-4642(23)00262-6 

Struggles of Organ Donation: Microcosm of American Healthcare

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by Cameron Takmil, December 2, 2023

In the last year alone, over 42,000 transplants were performed. Yet, 17 people a day of the 100,000 people on the national transplant waiting list die without the transplant they so desperately hope for (HRSA). Those who are fortunate to survive on life-sustaining treatments will likely find themselves without a transplant due to the shortcomings of the process as a whole.

Inequalities in organ transplantation can be sourced back to the frequency in which certain populations require new transplants altogether. African Americans and Hispanics disproportionately suffer kidney failure as well as organ failure as a whole — both over one and half times more likely compared to whites. This disproportionate rate of organ failure can be attributed to increased rates of general comorbidities that stem from poor healthcare access and health education (Harvard Health). 

Dr. Jessica Kendrick, a kidney specialist and researcher at University of California, outlined the two main factors that affect African Americans (UC Health)). “The two most common factors are diabetes and hypertension,” both of which also affect African Americans disproportionately, Kendrick said. She cited socioeconomic barriers as the underlying cause for these disparities in not only African Americans but disadvantaged minority populations as a whole. Organ failure is a culmination of poor health and is much more treatable if one is well-educated on their health and has consistent primary care access — something that many cannot say they have.

Geography plays a role as well, as those who are situated in more impoverished areas will have to battle food insecurity and poor quality of diet (NPR). In turn, they are more likely to develop fatty liver and have a need for a liver transplant. But, in rural and low-affluence areas, completing the rigorous testing necessary to land on a donor list becomes a tall order. The first steps in the transplant process is often one that many fail to even reach or surpass. The extensive work-up and evaluations necessary to get on the waiting list bogs down the many who are already struggling to get their routine check-ups. In 2023, over 1,500 Americans were omitted from the transplant list due to being too sick to receive a transplant, adding on the already 50,000 that die from liver disease every year (NPR).

Costs are not limited only to the surgery itself, as post-operative care and medication can be a toll on the already struggling. Dr. Mary Simmerling, an assistant professor at Cornell University with a PhD in bioethics, highlights this in one of her pieces regarding the implications of organ transplantation. “Even if there were a sufficient supply of suitable organs for transplantation, the reality is that the uninsured, underinsured and the poor do not currently have an equal opportunity to fully realize the benefits of organ transplantation because they do not have equal access to very expensive and necessary post-transplant immunosuppressant medications,” Simmerling states. 

Even those with Medicare are not safe from these expenses as coverage for these post-transplant medications and services only lasts three years – at 80 percent (Centers for Medicare Services). With the cost of nearly 2,000 dollars a month and close to 400 dollars after Medicare, those living off minimum wage salary can expect this to eat a sizable portion of their monthly income and even eclipsing their income if they are unable to obtain coverage (Simmerling 2007).

Recently, in 2022, Medicare introduced a “Part B Immunosuppressive Drug Benefit”, which is an extension of the partial coverage that allows for one to be covered continuously. While a step in the right direction, the caveat is that this only covers the exact medication for immunosuppressants but not additional medication that help treat possible complications arising from the immunosuppressant drug regimen or from surgery (i.e. organ rejection). This is simply not enough to ensure patients won’t be run up with charges if any complications come about post-surgery. 

Sentiments around donating organs have not helped either, as many are hesitant to donate due to a myriad of reasons. A study done by a group of Case Western researchers found that African-Americans’ tendency to donate was related to their lack of trust in the healthcare system. 38.6% of the African-American participants agreed with the statement that “if doctors know I am an organ donor, they won’t try to save my life”, a sentiment that is rooted in historically poor healthcare access and education (Siminoff 2006).

Lack of access can also be attributed to poor procurement by organizations responsible for retrieving and regulating donor organs. Organ procurement organizations, OPOs, facilitate the organ donation and procurement process, making organs available for transplant. Across the board, black families that were potentially interested in donating received less information than their white counterparts, a factor that makes minority families reluctant to donate (Forbes).

Today, there are 56 OPOs, all responsible for handling their respective donor service area (Scienceline). Only until recently have OPOs been responsible for being more transparent about their efficacy and process of procurement. Some estimate that almost 30,000 organs are not correctly retrieved due to inefficiencies and shortcomings of the current systems. These same estimates project that 25,000 additional lives could be saved. Dorry Segev, a professor of surgery at Johns Hopkins, brought up the point that “some OPOs are prioritizing their organs-procured-per-donor rate, ignoring potential donors where only one organ can be procured”. This limits the amount of organs procured, limiting the access down the line for all (Scienceline).

In the words of Elizabeth Warren, “Right now, [United Network for Organ Sharing] is 15 times more likely to lose or damage an organ in transit as an airline is to lose or damage your luggage,” said the Massachusetts’ senator. “That is a pretty terrible record,” (NPR).

Under the Biden administration, promises have been made to double the budget for OPOs and organ procurement programs as a whole, but it will take time to see if that will come to fruition (USA Today).

Plenty of solutions have been proposed, ranging from organs generated stem cells to compensating donors for their donation. Unfortunately, stem cells research is decades away from providing safe and effective generated organs that can replicate the function of human organs. Small scale studies have been successful in creating “miniature” organs, but are still far from creating human-scaled organs (Mayo Clinic).

Some have brought up the potential of allowing the sale of organs, which in theory would increase the available organs for transplantation. A study done at Stanford in 2018 explored the possible implications of allowing the sale of organs, specifically kidneys. The researchers estimated that a donated kidney would equate to $75,000 and the overall value being $1.3 million when considering the extension of lifespan. According to the study, “The study’s calculations showed a positive net benefit, in monetary terms, of $12.4 billion for low-income people overall. The researchers also calculated that the number of transplants per year would increase from 17,500 to 31,000 — enough to supply kidneys for yearly additions to the waitlist.” The proportion of transplant receipts who were considered non-affluent would go from a mere six percent to 30, a fivefold increase (Scope). Nevertheless, while promising, this experiment would be difficult to translate into the real world, due to the reluctance of legislators.

The dilemmas of organ transplantation reflect the greater issues of society today, as a multitude of problems today have coalesced to create the obstacles we face today. In a country that boasts the largest GDP in the world, there should be no reason anyone has to die waiting for their new chance at life.

Bibliography

  1. organdonor.gov, H. R. S. A. (2023). Organ Donation Statistics. Figures of Organ Donation. https://www.organdonor.gov/learn/organ-donation-statistics
  2. J. Kevin Tucker, M. (2021, February 3). What’s behind racial disparities in kidney disease? Harvard Health. https://www.health.harvard.edu/blog/whats-behind-racial-disparities-in-kidney-disease-2021020321842  
  3. Smith, T. (2023a, June 23). Why is chronic kidney disease risk higher for black people?. UCHealth Today. https://www.uchealth.org/today/why-chronic-kidney-disease-risk-higher-for-black-people 
  4. NPR.org. (2023, May 24). One man left Kansas for a lifesaving liver transplant, but the problems run deeper. https://www.npr.org/2023/05/24/1177589739/one-man-left-kansas-for-a-lifesaving-liver-transplant-but-the-problems-run-deeper 
  5. Centers for Medicare & Medicaid Services. (n.d.). Part B – Provider. https://www.cms.gov/partbid-provider 
  6. Journal of Ethics | American Medical Association. (2007, June). Beyond scarcity: Poverty as a contraindication for organ transplantation. https://journalofethics.ama-assn.org/article/beyond-scarcity-poverty-contraindication-organ-transplantation/2007-06 
  7. National Center for Biotechnology Information. (2007). The ethics of organ transplantation: How comprehensive the ethical framework needs to be. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1831604/ 
  8. Awan, O. (2023, February 22). Disparities of organ donations in America and how to rectify them. Forbes. https://www.forbes.com/sites/omerawan/2023/02/22/disparities-of-organ-donations-in-america-and-how-to-rectify-them/?sh=49f5d8904692 
  9. Scienceline. (2020, January). Organ donation in the US is broken, and we know who is to blame. https://scienceline.org/2020/01/organ-donation-in-the-us-is-broken-and-we-know-who-is-to-blame/ 
  10. NPR.org. (2022, August 17). Damaged and diseased organs: The agency overseeing transplants faces intense scrutiny. https://www.npr.org/sections/health-shots/2022/08/17/1118009567/damaged-and-diseased-organs-the-agency-overseeing-transplants-faces-intense-scru 
  11. USA Today. (2023, March 26). Organ transplant system overhaul: UNOS. https://www.usatoday.com/story/news/health/2023/03/26/organ-transplant-system-overhaul-unos/11522346002/ 
  12. Mayo Clinic Proceedings. (2011). The Ethics of Organ Donation by Living Donors. https://www.mayoclinicproceedings.org/article/S0025-6196(11)61602-9/fulltext 
  13. Scope Blog | Stanford Medicine. (2018, November 28). Compensation for kidneys would help the poor, study finds.  https://scopeblog.stanford.edu/2018/11/28/compensation-for-kidneys-would-help-the-poor-study-finds/ 

Why Genetically Modified Foods are Nothing to Fear and Should be Explored to the Full Extent

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by Ramizah Tayiba, October 21, 2023

The United Nations Food and Agricultural Organization (FAO) reported that over 795 million people are malnourished globally, 98% of whom are from developing countries. With the global population expected to rise to 9.7 billion by 2050 (UN), it will be challenging to produce enough food for the current population, let alone the expected growth in population (UN Department of Economic and Social Affairs). 

It is also worth mentioning that food production has become increasingly complicated with the decrease in arable land and crop yield. The FAO found that the amount of arable land available for food production per person is expected to decrease from 0.242 hectares to 0.18 hectares. Furthermore, a 2016 study found that the current rate of increase in crop yield is 1.7% when it needs to be 2.4% to meet the demands of population growth (Oliver.) 

With such damming numbers, it is clear that agriculture and food production need to develop in order to meet expected demands and make up for losses due to climate change-induced disasters and a decrease in soil fertility. Several promising technologies have been developed in order to remedy the situation but none are perhaps more controversial than genetically modified organisms. 

Genetically modified foods, or genetically modified organisms (GMOs), are organisms whose genetic material is engineered in a laboratory to express a certain trait obtained and transferred from another organism. An example of this is when antifreeze protein genes found in winter flounder fish are transferred to tomato crops to increase the plant’s frost tolerance.

With such control over the outcome of crop yields, GM foods certainly have great potential. Genetically modified foods hit the market in 1994 and their ethics and safety have been fiercely debated ever since. Opinions about GMOs range from believing such technology is the cure to world hunger, malnourishment, and the impending threat of climate change to believing such technology can lead to long-term health consequences. 

Interestingly, according to a Pew Research study, the debate on GMOs seems to have a wider gap between the public and scientific sentiment than any other controversial topics such as vaccines and nuclear power. Surprisingly, only 37% of the American public are of the opinion that GMOs are safe to eat compared to 88% of AAAS scientists who think GMOs are safe to eat (Pew Research Center). Such a range of opinions demonstrates the conversation surrounding this technology is distorted and misleading. 

Despite the fact that genetically modified foods are not the silver bullet to all of the world’s food problems, the research and the application of this technology are incredibly important as it has the potential to aid in the very necessary fight to revolutionize farming, aid in the fight to end malnutrition, and contrary to popular belief, there is sufficient research stating it is not dangerous to humans health and harbors no long term consequences. 

The biggest objections to GM foods stem from the fear of their long-term health effects. The process of genetically modifying foods can seem mystifying and even sinister to some as the technique is thought to be playing against nature and the natural order. Anti-GMO advocates have voiced their fears of potential long-term diseases for humans and animals from GMOs. 

Such a lack of awareness regarding the biological techniques involved in genetic engineering breeds uncertainty and fear in this technology which is then reflected in polls. The Pew Research Center found that Americans who believe that GM crops are safe for consumption are in the minority (37%). Fears surrounding the health effects of GM foods exist in large amounts and extend beyond the United States. A 2016 survey conducted in China found that 47% of respondents viewed GM foods as a form of bioterrorism and a threat to safety. Furthermore, an overwhelming 60% of survey respondents in Poland opposed the production and distribution of genetically modified foods (Evanega et al). 

It is understandable that new technology will be questioned due to concerns regarding health, however, research conducted over the past decades has confirmed that genetically modified foods pose no more health risks than their non-GM counterparts. The United States Food and Drug Administration (FDA), which subjects all foodstuffs through rigorous safety inspections, has officially stated that a genetically modified crop poses the same level of health threats as any traditionally grown crop (Rudolph). 

GM crops can also be engineered to be more nutritious. One promising project developed by Swiss and German researchers, “Golden Rice,” involves transferring specific genes from corn and harmless bacteria to increase the amount of beta carotene, a key ingredient to make vitamin A in the human body, in rice crops. Such a crop would be greatly beneficial in a world where, according to the World Health Organization, a vitamin A deficiency causes a quarter to half a million cases of childhood blindness, especially in Southeast Asia and Africa. This GM product which has been made available, partly due to Biotech companies waiving the patent rights, is economically effective and efficient for mass distribution as it enhances the specific nutrients lacking in the consumer, resulting in more nutrients in less volume (Jamil). “Golden Rice” is one of several GM foods that are in development that have the potential to enhance the nutritional value of food without increasing the quantity, further demonstrating the usefulness of this technology and supporting the belief that research and investments in this field should continue. 

Another advantage of genetically modifying crops in a laboratory is having the capability to engineer the crop to be repellent to certain pests eliminating the need for pesticide use. According to a study published by the National Library of Medicine, GM foods and biotechnological techniques have reduced the use of chemical pesticides by 37% (Klümper et al). Research has shown that some pesticides have negative health effects on humans with a greater effect on farmers and pesticide applicators due to greater exposure. Short-term effects of pesticides can include rashes, blisters, nausea, dizziness, and diarrhea. Long-term or chronic effects can include cancer, birth defects, neurological and development toxicity, and reproductive harm (Californians for Pesticide Reform). Additionally, the pesticide has adverse effects on the environment as its use can contaminate surrounding bodies of water, soil, and vegetation while also posing a threat to non-target wildlife and plants such as fish, birds, and insects, that are crucial for a functioning ecosystem (Aktar et al). While pesticides do repel pests from crops, it is still imperative that an alternative method of crop protection is adopted to protect consumers from the health effects of pesticides. GM foods provide such a solution as biotechnological techniques can engineer crops to repel incoming pests without the use of pesticides. 

One such widespread example is the utilization of BT, or Bacillus thuringiensis. These crops include the common corn, cotton, potato, and tobacco. Such crops are engineered to carry the genes of the bacteria Bacillus thuringiensis which is found in soil and is toxic to certain harmful insects, specifically, insects from the Lepidoptera, Coleoptera, Hymenoptera, Diptera, and Nematoda order upon ingestion. The genetic modification of crops to include the BT bacteria within its DNA sequence eliminates the need for pesticide use, minimizing pesticide exposure to farmers (Abbas). Such success stories demonstrate the great potential of GM foods, which help to ameliorate fears and further strengthen the argument that such technology should be explored to the full extent. 

It is also worth noting that more realistic voices from the fight to end world hunger correctly point out that global malnutrition is not necessarily caused by a lack of food, but rather not being able to afford food. Most of the world’s malnourished reside in developing countries with unstable or weak economies where being able to afford nutritious food is beyond the economic capabilities of most. Such a problem requires an economic solution not agro-technical As mentioned, the world doesn’t suffer from a lack of food. In fact, global grain production alone can provide 4.3 pounds of food per person, per day (Jamil). While this food exists, it does not mean that it is secure. The decrease in nutrient-rich soil and the constant threat of climate change have led to farming irregularities, disrupting food production in many parts of the world. 

According to the UN Environment Programme, 23 hectares of arable land is lost to drought or desertification, not including the land lost to urbanization. In Georgia for example, 60% of the nation’s arable land has been rated as low or middle quality for food production, while 35% is rated as too degraded to produce food (UNEP.) In addition to losing land for agriculture, food production is also threatened by climate change. According to the United States Environmental Protection Agency, climate change threatens global agricultural productivity as it causes irregular precipitation patterns, warmer temperatures, and water shortages which complicates farming (US EPA). 

While it is important to acknowledge that poverty is the main cause of world hunger and not lack of food, it is equally important to acknowledge the current food supply is under threat by climate change, desertification, and urbanization, and therefore new methods of farming need to be adopted to withstand climate change induced consequences and to maximize crop yields in smaller farming areas. GM foods can be a promising tool to ameliorate some of these problems. 

According to a study published by the National Library of Medicine, GM technology has increased crop yields by 22%, with most of its concentration based in developing countries (Klümper et al). Another study that lists the agricultural benefits of GM foods, states that between 1992-2012, there was an increase of more than 370 million tons of crops in the United States, one-seventh of which has been attributed to genetically modified foods. The study goes on to state that between 1996-2013, an estimated additional 138 million tons of soybeans, 274 million tons of corn, 21.7 million tons of cotton lint, and 8 million canola have been produced through biotechnology. To produce equivalent amounts of this food without the use of biotechnology would require an increase of 11% of arable land, further demonstrating the efficiency of GM foods (Zhang et al). This example demonstrates that GM technology has the potential to withstand the threat of arable land loss as it can produce larger crop yields in a smaller farming area without adding additional stress to the environment. 

In addition to being engineered to produce larger crop yields, GM technology can also create drought-resistant plants. Droughts have become increasingly prevalent due to climate change which threatens current and future agricultural productivity. Genetically engineering crops to be more resistant to water shortage and drought can protect crop yields from dry seasons. Researchers have developed a method of creating drought-resistant crops that involves inserting genes from the soil bacterium Bacillus Subtillis, which activates a protein that alleviates the damaging effects of drought into crop DNA. These genetically modified crops are more tolerant to water shortages than non-GM foods which ensures their ability to grow despite potential threats of droughts (USDA). 

Given the immense possibilities of genetically modified foods, it is imperative that research and application of this technology continue to overcome the challenges surrounding the food supply and world hunger. All technology has limitations. In the case of GM food, it is by far not the quick fix to all the world’s food problems and cannot alleviate the economic obstacles that exist between people and food. Despite its limitations, GM foods still remain an invaluable tool in the very necessary fight to revolutionize farming and agriculture as it results in more nutritional foods in smaller quantities. It is unfortunate that GM technology is still viewed by the public as unsafe despite the fact that the overwhelming scientific consensus not only agrees on its safety but champions its widespread use. Given the plethora of benefits that this technology provides, it is important that acceptance and development of GM become commonplace and that it is paired with other new and sustainable practices to protect the world’s current and future food stock.

Bibliography 

1. Klümper, Wilhelm, and Qaim, Matin. “A Meta-Analysis of the Impacts of Genetically Modified Crops.” PLoS ONE, vol. 9, no. 11, 2013, https://doi.org/10.1371/journal.pone.0111629. 

2. Zhang, Chen, et al. “Genetically modified foods: A critical review of their promise and problems.” Food Science and Human Wellness, vol. 5, no. 3, 2016, pp. 116-123, https://doi.org/10.1016/j.fshw.2016.04.002. 

3. Aktar, Md., et al. “Impact of pesticides use in agriculture: their benefits and hazards.” Interdisciplinary Toxicology, vol. 2, no. 1, 2009, pp. 1-12, https://doi.org/10.2478/v10102-009-0001-7. 

4. Abbas, Mohamed. “Genetically engineered (modified) crops (Bacillus thuringiensis crops) and the world controversy on their safety.” Egyptian Journal of Biological Pest Control, vol. 28, no. 1, 2018, pp. 1-12, https://doi.org/10.1186/s41938-018-0051-2. 

5. Klümper, Wilhelm, and Qaim, Matin. “A Meta-Analysis of the Impacts of Genetically Modified Crops.” PLoS ONE, vol. 9, no. 11, 2013, https://doi.org/10.1371/journal.pone.0111629. 

6. Russell, A. “GMOs and their contexts: A comparison of the potential and actual performance of GM crops in a local agricultural setting.” Geoforum, vol. 39, no. 1, 2008, pp. 213-222, https://doi.org/10.1016/j.geoforum.2007.04.001. 

7. Evanega, Sarah, et al. “The state of the ‘GMO’ debate – toward an increasingly favorable and less polarized media conversation on ag-biotech?” GM Crops & Food, vol. 13, no. 1, 2021, pp. 38-49, https://doi.org/10.1080/21645698.2022.2051243.

8. Jamil, Kaiser. “Biotechnology – A Solution to Hunger?” UN Chronicle, https://www.un.org/en/chronicle/article/biotechnology-solution-hunger. 9. Rudolph, Cameron. “Are GMOs Safe?” Michigan State University, 15 Aug. 2018, https://www.canr.msu.edu/news/are-gmos-safe. 

10. “World Population Projected to Reach 9.8 Billion in 2050, and 11.2 Billion in 2100.” Department of Economic and Social Affairs, https://www.un.org/en/desa/world-population-projected-reach-98-billion-2050-and-112-b illion-2100. 

11. Bent, Elizabeth. “Not All GMO Plants Are Created Equally: It’s the Trait, Not the Method, That’s Important.” Phys Org, https://phys.org/news/2015-04-gmo-equally-trait-method-important.html#:~:text=The%2 0so%2Dcalled%20%22fish%20tomato,present%20in%20the%20fish%20genome. 

12. “Climate Impacts on Agriculture and Food Supply.” United States Environmental Protection Agency, https://climatechange.chicago.gov/climate-impacts/climate-impacts-agriculture-and-food supply#:~:text=Climate%20change%20can%20disrupt%20food,result%20in%20reduced %20agricultural%20productivity. 

13. “Every Minute, We Lose 23 Hectares of Arable Land Worldwide to Drought and Desertification.” UN Environmental Programme, 12 Feb. 2018, 

14. https://www.unep.org/news-and-stories/story/fridayfact-every-minute-we-lose-23-hectare s-arable-land-worldwide-drought. 

15. Oliver MJ. Why we need GMO crops in agriculture. Mo Med. 2014 Nov-Dec;111(6):492-507. PMID: 25665234; PMCID: PMC6173531. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6173531/

16. “Pesticides and Human Health.” Californians for Pesticide Reform, https://www.pesticidereform.org/pesticides-human-health/#:~:text=Examples%20of%20a cute%20health%20effects,disruption%20of%20the%20endocrine%20system. 

17. “Public Opinion about Genetically Modified Foods and Trust in Scientists Connected with These Foods.” Pew Research Center, 1 Dec. 2016, https://www.pewresearch.org/science/2016/12/01/public-opinion-about-genetically-modif ied-foods-and-trust-in-scientists-connected-with-these-foods/. 

18. Mcfadden, Johnathan. “Drought-Tolerant Corn in the United States: Research, Commercialization, and Related Crop Production Practices.” Economic Research Service U.S. DEPARTMENT OF AGRICULTURE, 13 Mar. 2019, https://www.ers.usda.gov/amber-waves/2019/march/drought-tolerant-corn-in-the-united-s tates-research-commercialization-and-related-crop-production-practices/.

Religion and Herbs: Women and Childbirth in Ancient Greece

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by Ayesha Azeem, April 12, 2023

In recent years, there has been a large shift in medical research towards a focus on birth and early childhood, especially on environmental factors that can affect fetal health. This area of interest in obstetrics, however, is not something new and was actually demonstrated in Ancient Greek medicine, albeit with some misunderstandings. While Ancient Greek medicine got some things right – the main objectives of the Hippocratic oath, medical terminology, and human dissections﹣ a lot of it needed improvement. Specifically, Ancient Greek doctors and scientists hyperfocused on the differences between male and female anatomy rather than recognizing their overwhelming similarities, and this translated into their care of patients. The majority of medical care for women focused on menstruation and childbirth, mainly because female fertility played a large role in societal expectations of women living in Ancient Greece. 

Ancient Greek Culture and Women’s Reproductive Health

The emphasis on the childbirthing process in women’s medicine stems from the roles and expectations of women in Ancient Greek society. The practice of marriage in Ancient Greece existed primarily with the aim of birthing a legitimate heir, and the suspicion of infertility was a common cause of divorce (Dasen). Women were expected to produce sons that would grow up to become good citizens, contribute to the family’s bloodline, inherit their father’s property, and oversee the care of their parents in old age (Wise). This importance was emphasized through the worship of gods like Artemis, Elieithyia, Aphrodite, Zeus, and Demeter for their healing powers or association with childbirth (King). Artemis was worshipped in particular to seek assistance in labor and a safe birthing process, as she was known as the protector of young women, specifically as they transitioned from girl to woman and began motherhood (King). 

In addition to reliance on religion, midwives were available to assist women through the arduous process of giving birth. Childbirth was mainly handled by other women as midwives in ancient society, and men were rarely present during this moment, except as physicians (Dasen). Midwives were referred to as maimai or latrine and received training to help safely deliver children from other midwives or doctors (King). It was believed that Artemis herself was a midwife, and assisted her mother in giving birth to her twin Apollo (King). Despite this, childbirth was extremely dangerous due to a lack of understanding of female anatomy.

Medical Practices in Ancient Greece

The Ancient Greek practice of medicine focused their research mainly on gynecology, and this was reflected in their writings and medical treatment of mothers through the birthing process. Hippocratic writings on women’s medicine primarily concentrated on menstruation as a factor for disease. In Diseases of Women I, women are categorized based on whether they have given birth before. Women who have never been pregnant were believed to become more seriously ill from difficulties with menstruation compared to women who had children because they were denser and more robust (Hippocrates 9). Women were considered to be more porous and have softer flesh because they did not exert themselves physically as often as men, who were fitter (Hippocrates 13). Generally, diseases in women stemmed from menstruation, regardless of whether her symptoms were related to her sexual health or not. For example, if a woman was having trouble breathing, this was said to be due to her uterus suffocating her (Howe). Hippocratic writers believed that the uterus could move around inside a woman’s body and cause disease, a condition known as “wandering womb” that resulted in women experiencing “hysteria,” or suffocation caused by the womb (Zeltzer). The most common treatment prescribed to women during this time was to ‘dampen’ their uterus to keep it in place, either through sexual intercourse or pregnancy (Howe). 

Once pregnant, Ancient Greek physicians recommended several practices to ensure the birth of a healthy newborn. Pregnant women were told to participate in passive exercise on a stool or take a short walk to prevent the fusion of bones due to lack of use (Sonarus 20). Physicians like Sonarus also advised pregnant patients to eat neutral foods that were not greasy, fat, or pungent vegetables; avoiding pungent foods would ensure that the ‘seed’ is not ‘softened’ (Sonarus 20). They were also encouraged to avoid intercourse for the duration of their pregnancy, as doing so would agitate the uterus and cause the seed to discharge (Sonarus 20). Women who did not follow these rules would have a fetus that is weak and malnourished, according to Sonarus (Sonarus 21). Pregnant women also wore amulets, with the belief that wearing objects with special powers would protect them and their child from harm. These amulets were made from different materials, like aetites, the “eagle-stone” or the “pregnant stone,” because they resembled embryos (Wise). The eagle-stone was wrapped in the skin of sacrificed animals and worn throughout the pregnancy, not to be removed until delivery because doing so would cause the prolapse of the uterus (Wise). 

Other rituals were performed during birth to hasten delivery or protect the mother and child from potential dangers associated with the birthing process. Such rituals included placing a Jericho rose in a bowl of water during labor, as the rose would unfold when exposed to moisture and ensure that the labor pains are brief (Wise). Despite these practices, complications in pregnancy were incredibly common. 

If complications in pregnancy arose, the woman was solely to blame for having a problem with her body. If a woman could not get pregnant, it was because her cervix or uterus was misshapen due to an imbalance of the humors in her body (Howe). Once a woman was pregnant, miscarriage was common, likely due to a lack of accurate knowledge surrounding women’s bodies. Women were blamed for having miscarriages as well, and Hippocratic writers cited an unhealthy or slippery uterus as the most common cause (Howe). Other causes included if a woman was beaten, fainted, was frightened, lost control over herself, or ate something she was not used to (Howe). The lack of hygienic precautionary measures, cesarean sections, and treatments like antibiotics or blood transfusions meant that any complications in childbirth that arose would likely lead to the death of the mother, infant, or both (Wise). Artificial abortion was rejected by ancient physicians with the reasoning that the natural creation of an embryo should be preserved and protected; Sonarus, however, supported abortion if there was a medical need for it (Sonarus 6). Despite this, Sonarus supported contraceptives over abortion, and recommended measures like pomegranate peels, the flesh of dried figs, and honey water to abort the fetus or avoid pregnancy altogether (Sonarus 24). 

Conclusion

The process of childbirth was one of the most significant moments experienced in the lives of Greek women, as this marked the transition from girlhood to womanhood. Through pregnancy and birth, women were able to contribute to the continuation and success of Ancient Greek society. The incredible value placed upon pregnancy and birth can be seen through the Hippocratic works published with guidelines for women to follow throughout their childbearing, the presence of amulets and rituals to ease the process and ensure the protection of the mother and infant, and the worship of gods and goddesses specifically for conception and pregnancy. Because it was deeply valued, childbirth came to be seen as the sole objective of a woman’s life, and medical care focused solely on this part of female anatomy and health. While pregnancy and childbirth is an integral part of women’s health, women were solely viewed through this lens in Ancient Greek society, evidenced by Ancient Greek physicians’ ‘expert’ advice during this time in a woman’s life.

Works Cited

Dasen, Véronique. “Childbirth and Infancy in Greek and Roman Antiquity.” Core, https://core.ac.uk/download/pdf/79426554.pdf. Accessed 26 Nov 2022.

Hippocrates. Diseases of Women I. Accessed 26 Nov 2022.

Howe, Keelin. “Pregnancy & Childbirth in Ancient Greece.” Women in Antiquity, 31 March 2017, https://womeninantiquity.wordpress.com/2017/03/31/pregnancy-and-childbirth/#:~:text=Eileithyia%2C%20commonly%20associated%20with%20Athena,goddess%20of%20midwifery%20and%20childbirth. 

King, Katherine. “Who to Trust When Giving Birth in Ancient Greece, Gods or Midwives?” Australian Archaeological Institute at Athens, 5 May 2021, https://aaia.sydney.edu.au/who-to-trust-when-giving-birth-in-ancient-greece-gods-or-midwives/.

Sonarus. Sonarus’ Gynecology. Translated by Owsei Temkin, Johns Hopkins, 1991. 

Wise, Susan. Childbirth Votives and Rituals in Ancient Greece. 2007. University of Cincinnati, PhD dissertation.Zeltzer, Naomi. The “Cure” is the Affliction: Pregnancy and Childbirth as Healing and Harming in Ancient Greek Gynecology. 24 May 2021. Vassar College, Senior Capstone Project.

Ignorance is NOT Always Bliss: An Experience with Healthcare During Pregnancy

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by Ayesha Azeem, December 19, 2022

Mary’s Interview

One of the most significant events in a woman’s life is when she goes through her first pregnancy, an experience that changes her life forever. This experience can be further complicated by one’s culture and its respective social norms that may affect women negatively. I interviewed Mary [pseudonym given to protect her identity] in both English and Urdu about her experiences with pregnancy and the healthcare she received during all three of her pregnancies, one of which was experienced in her home country, Pakistan. Mary was only 22 years old when she got married and found out she was pregnant soon after. When asked about how she felt when she found out about her pregnancy, Mary described how little she knew about morning sickness, and because at-home pregnancy tests are not easily accessible in Pakistan, Mary had to make a doctor’s appointment to confirm her pregnancy. Mary describes the first emotions she felt after hearing the news as being excited and nervous: she was excited to have her first child and finally start the family she always dreamed of, and nervous because she truly did not know what to expect. However, Mary’s experiences with pregnancy arose in less-than-ideal circumstances that proved to make the duration of pregnancy very difficult for her: while Mary was living in Pakistan with her in-laws, her husband was in the United States, working two jobs to support his new family, his brothers, and his mother. Thus, Mary was understandably terrified when she heard that she was pregnant: she did not expect to have to live through this without her husband by her side. While Mary recounts her mother-in-law taking very good care of her – accompanying her to doctor’s visits, supervising her diet to ensure that Mary received the nutrients necessary for a pregnant woman, and preventing her from completing any household chores – she did not feel adequately prepared or supported without her husband. 

Lack of Knowledge About Pregnancy

Mary describes her experiences with prenatal care in Pakistan as disastrous. There was very little communication from the doctor; Mary would have monthly ultrasounds, would be told that her baby is breathing, and receive an injection at the end of every visit to “help with weakness.” Mary explains that the injection was very painful and was something she didn’t truly understand, as all of her questions would go unanswered during the visit. Unfortunately, Mary had very little knowledge of reproductive health and pregnancy; when she first experienced morning sickness, she thought she had food poisoning, and did not realize she was pregnant until she went to the doctor. Mary also did not know how to take care of herself during her pregnancy, as no one had told her that intense exercise was ill-advised. Mary recounts playing cricket with her cousins one day when she started bleeding from her vagina. Rather than panicking and rushing to the hospital, Mary simply assumed that her period had begun; it was not until she had asked her mother-in-law for a pad that Mary realized the severity of the situation. Thankfully, her mother-in-law’s quick judgement saved Mary’s fetus from further harm. 

Unfortunately, the education system and healthcare system had failed Mary so horribly that she had never learned about the birthing process until the actual day of her delivery – she spent this day in a panic, trying to figure out how she would survive. After Mary had given birth, the obstetrician had unknowingly left a dangerous blood clot unaccounted for in Mary’s cervix, leaving Mary with excessive bleeding. The obstetrician removed the clot after a week via an emergency operation, but while the physical symptoms were removed, this event effectively scarred Mary psychologically. 

Following the birth of her first child, Mary fell into a deep depression. This was not postpartum depression, but instead due to the almost instantaneous change in her mother-in-law’s behavior once her grandson was born. Previously very caring, Mary’s mother-in-law’s attitude toward her was now unwaveringly cold. She became very cruel, constantly hurling verbal abuse and treating her like a common housemaid rather than the wife to her oldest son. 

Arrival to the United States

When Mary arrived in the United States, she expected that things would change drastically in her life and reproductive experiences. Mary hoped that she would now receive the supportive care she dreamed of from her husband. However, her expectations were never met. Mary’s husband was far from living the American dream, working long evening shifts as a taxi driver in an attempt to make ends meet for his family in America as well as abroad in Pakistan. Mary found herself more alone than ever before. Whereas she had her mother-in-law to take care of the house throughout the duration of Mary’s pregnancy, Mary now had to do everything herself during her second and third pregnancies. Not only did she have to cook food and maintain the house, but Mary also had to attend doctor’s appointments by herself as her husband was often catching up on his sleep. Whereas Mary always had her brothers and father to accompany her when she left the house, Mary now had to learn how to be independent after a life of depending on others. Without the right support from her mother-in-law, mother, or husband to help her throughout her experiences, Mary often felt lonely, and it was not long before she relapsed back into depression. 

Differences in Healthcare Between the United States and Pakistan

While her personal life was exceedingly difficult, Mary found a light at the end of the tunnel: the vast difference in healthcare quality in the United States compared to Pakistan. Here, Mary found that her obstetrician was willing to listen to her complaints and work on finding solutions together, actually allowing Mary to be heard. Mary described the healthcare she received in America to be very progressive and professional; her doctors informed her of their concerns every step of the way and educated her on several things she knew nothing about, reflective of the poor health education she received in Pakistan – Mary took classes on breastfeeding, the child birthing process, and taking care of her child after birth, learning more in a few months than she had ever learned in Pakistan. 

A Desire to Learn

Unfortunately, Mary’s experiences in both Pakistan and the United States are common for many women in both countries. As Mary explained in the interview, she did not have an adequate amount of knowledge regarding reproductive health and pregnancy, and thus often made mistakes in taking care of herself. 

In the article titled “‘I Thought I was Dying:’ (Un)Supportive Communication Surrounding Early Menstruation Experiences,” the researchers conclude that women who menstruate hold a desire for knowledge about the health and practical information regarding menstruation, and that there is inadequate communication within close relationships regarding menstruation and reproductive health for young women (Rubinsky, Gunning, & Cooke-Jackson, 2018). The same can unfortunately be said for pregnancy; many women express a desire to know more about the pregnancy process and how they can take care of themselves. 

Unfortunately, in Pakistan, there is restricted access to programs that focus on advancing knowledge on female sexuality and reproductive education. In many schools across the country, health classes cover every topic other than reproduction, because it is seen as “vulgar” to speak about such topics in a co-ed classroom. This leads young women to develop negative attitudes towards their bodies and reproductive health as they learn through social cues that their sexuality is meant to be secretive and cannot even be shared with their parents (Rubinsky, Gunning, & Cooke-Jackson, 2018). Further, women like Mary are often unprepared when they become pregnant, not knowing what to expect or how to take care of themselves. Their mothers do not provide the right knowledge to them because their own mothers never did, leading to a chain of dangerous ignorance that partially explains the high maternal mortality rate seen today in both countries. 

The Treatment of Women in Pakistan

This negligence of women’s reproductive health stems from a systemic disregard for women, who are often deemed to be “inferior” in Pakistan’s society, even today. Women in Pakistan are held to different standards than men, as they are expected to compromise more in relationships, leaving their personal lives for a permanent devotion to their husband and his family. In the event of a divorce, regardless of the cause, the ex-wife is often put under intense scrutiny and is blamed for not being a “good enough wife.” 

Women’s experiences with mental health, menstruation, and other aspects of reproductive health are often disregarded, and women who speak up about their trauma are carelessly labeled as overdramatic attention-seekers. These women are cast aside and deemed to be ungrateful of the many blessings they have, such as having a husband and children with no long-term medical conditions – effectively staining their reputations in response to speaking up about the trauma they have faced. 

In Pakistan, women are expected to act similar to how Professor Lobel characterizes an “ideal woman” in her lecture on autoimmune disorders – suffering in silence, not asking questions, and always being compliant. Women who are vocal about the issues they face – whether it is personally or in a healthcare setting – are treated poorly for standing up for themselves. 

Gender Roles and Mental Health

Further, women’s emotional experiences with pregnancy and other health concerns are often affected by the lack of support they receive from their families, especially their husbands or significant others. Like Mary, many women are expected to carry out familial duties and are part of a family system in which others depend on them. These women often prioritize the health of other family members above their own, proving to be very harmful for women who are pregnant and need to take care of themselves. 

As stated in the article titled “Emotions and Mental Health During Pregnancy and Postpartum,” the strains associated with balancing work and family life with reproduction and child care are major stressors that affect women’s emotional states during pregnancy and after childbirth (Lobel & Ibrahim, 2018). In Pakistan, most women are expected to work as housewives, regardless of the amount of education they’ve had, with a lifelong commitment to caring for their children and their husbands who come home from work each day. Because of these sociocultural norms that also exist in the United States, male partners are often excused from the responsibilities that revolve around child care and household chores, even when their female partners are pregnant or otherwise unable to complete these duties. These expectations substantially prevent pregnant women from getting the rest and prenatal care they need to ensure their good health as well as their fetus’s. 

The Patient-Provider Relationship

Women often receive inadequate care when they visit healthcare providers, specifically obstetricians. As Professor Marci Lobel and Lisa Rosenthal state in the article titled “Explaining Racial Disparities in Adverse Birth Outcomes: Unique Sources of Stress for Black American Women,” power plays an important role in the patient-provider relationship, and women often report feeling dissatisfied and powerless when interacting with gynecologists and obstetricians, as the medical field of reproduction is often characterized by control over women’s bodies (Rosenthal & Lobel, 2011). This is especially true for the healthcare system in Pakistan, in which physicians often dominate the patient-provider relationship and make health decisions without informing the patient and obtaining consent. As Mary stated in her interview, she would be given an injection to combat “weakness” every month with little say in the matter. The patient-provider relationship in Pakistan makes it difficult for patients, especially female patients, to vocalize their concerns about their health and receive answers to the questions they want to ask. 

In addition, it is quite difficult to access quality healthcare in Pakistan, as there is no national health insurance. While there are government-funded hospitals, the care given at these facilities are often not the best and patients still have to pay fees. Private hospitals are often considered to provide the best care one can receive in Pakistan, but even at these facilities, the quality of care could be much improved. Mary described her experiences with visiting a doctor in a private practice, and recounted that even though her obstetrician had won multiple awards and was considered the best in her hometown, the care Mary received was subpar at best. This was because the doctor neglected to treat Mary as an actual human being and decided to instead take control over the decisions Mary was meant to make. 

Furthermore, there are very few pharmacies in Pakistan like CVS or Walgreens in the United States that have standardized rates for medications, allowing physicians to charge patients as much as they like without much retaliation. Thus, patients often delay seeking medical care, especially obstetric care, for fear of not being able to afford all the fees associated with the visits. This delay in seeking patient care due to cost, coupled with the lack of advanced technology in Pakistan, contribute to Pakistan having one of the highest maternal mortality rates in the world. 

Looking to the Future

As Mary’s experiences indicate, much work is needed to improve the healthcare experiences of women who go through pregnancy and other reproductive events in their lives, both in the United States and in Pakistan. Rather than completely medicalizing patient care, we as a society need to work to mitigate the causes that lead to the many complications women face during pregnancy and childbirth, including lack of knowledge, lack of support, and unbalanced power relationships in healthcare. Many of the sociocultural norms in both Pakistan and the United States affect the way in which women see themselves and prioritize their health, which can later affect the lives of their children. Equal treatment of women, both personally and professionally, is essential to improvements in mental and reproductive health outcomes, and can only be done when sociological efforts are made to change the way women are perceived by their loved ones as well as in public. 

References

Rubinsky, V., Gunning, J. N., & Cooke-Jackson, A. (2020). “I thought I was dying:” (Un)supportive communication surrounding early menstruation experiences. Health communication, 35(2), 242–252. https://doi.org/10.1080/10410236.2018.1548337

Lobel, M. & Ibrahim, S.M. (2018) Emotions and mental health during pregnancy and postpartum. Women’s Reproductive Health, 5(1), 13-19. 10.1080/23293691.2018.1429378

Rosenthal, L., & Lobel, M. (2011). Explaining racial disparities in adverse birth outcomes: Unique sources of stress for Black American women. Social science & medicine (1982), 72(6), 977–983. https://doi.org/10.1016/j.socscimed.2011.01.013

Nine Minute Medicine? Your Brain on Music

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by Aviram Nessim, October 22, 2022

The intense rise and fall of chords, flow of rhythm, intricate melody, and extensive variation of tonality as instruments play a unique tune — these are the typical sounds an individual hears while actively listening to music. Music, or sounds amalgamated to produce beauty of form and harmony, is a ubiquitous companion to people’s everyday lives. It is a universal human relic, confirmed to have originated approximately 35,000 years ago (Smithsonian, 2021). At present, the average American listens to over 32 hours of music on a weekly basis, and there are good reasons for why (Lupis, 2017). Music has an extraordinary capacity to stimulate emotions and alter mood. Its sheer power can have profound biological effects both internally and externally: it can affect blood pressure and heart rate internally, and cause spine-tingling, chills, and even sadness externally (Manning-Schaffel, 2017). 

In 2020, a study conducted by the British Academy of Sound Therapy (BAST) exposed 7,581 subjects to various intervals of music (encompassing driving rhythm and fast tempo) to investigate whether music can be prescribed for specific mood states. The study concluded that just nine minutes of music was sufficient enough to emotionally stimulate virtually every subject (Westmore, 2020). For every 10 subjects, 9 reported improved energy levels and 8 reported an enlivened outlook on life. In thirteen minutes of exposure, 8 of every 10 subjects reported elimination of negative thoughts as well as decreased muscle tension. In the same timeframe, a whopping 9 out of 10 subjects reported having increased levels of focus as well as enhanced performance throughout the work day.  

With such powerful analgesic effects, how precisely is music able to stimulate the body? Music primarily activates specific neural pathways located within the auditory, limbic, and prefrontal brain regions (McCollum, 2019). These parts of the brain are synchronized; levels of physiological activity are influenced through the release of neurotransmitters such as dopamine, endorphins, oxytocin, and cortisol. Thus, regions of the brain that register rewarding stimuli, altruistic acts, and subjective enjoyment are activated (Sachs et al., 2019). By influencing levels of activity within the brain, the body effectively responds, undergoing transient changes in physiology, which, in turn, can have the same mood-enhancing qualities on the psyche as over-the-counter remedies that target anxiety, insomnia, and stress (Landau, 2018).

Regardless of one’s ailment, music therapy, or usage of “singing, music play, improvisation, songwriting, and music-assisted imagery that address the emotional and developmental needs of individuals of all ages” is an effective therapy that should continue to be widely implemented within the medical community (Yale New Haven…). By utilizing neuroscience, music is a powerful, restorative analgesic that has withstood the advances of modern medicine. A seemingly unlikely therapeutic, music is admired for alleviating the dreadful effects of neurodegenerative diseases such as Alzheimer’s, Lewy Body, and Parkinson’s by serving alongside the current array of prescribed therapies. In patients with Parkinson’s Disease (PD), between 45% and 68% of people with PD will sustain a fall each year (Pelicioni et al., 2019). However, upon exposure to targeted music therapy, a study found that over a 16-week period, 47 subjects with PD reported an improvement in velocity, cadence, and stride length, as well as a significant decrease in the occurrence of falls (Malhas, 2018). According to Wang et al. (2022), rhythmic auditory stimulation (that is, an application of targeted music therapy) allows for a variation between the “on” and “off” dopaminergic states, suggesting that upon an auditory stimulation of familiar music, the release of dopamine serves as an integral player in improving spatio-temporal parameters as well as overall parkinsonian gait (Erra et al., 2019).   

Besides the aforementioned emotional capabilities music has on daily life and health, music is also being utilized as a vehicle for social change to bring communities together. Choral repertories such as bands, chorus, and common musical groups have been around for thousands of years and, through an infectious beat, audacious gimmick, or catchy chorus, propagate messages of motivation, inspiration, and self-empowerment to inspire and alter the status quo of its listeners (Perrot, 2020). The unprecedented nature of the COVID-19 pandemic raised important questions about the role of music in society, namely as a medium for coping with the crisis. As the world went into lockdown, communal initiatives were undertaken to provide solace and comfort. Andrea Bocelli performed a solo Easter concert from an empty Milan cathedral, John Legend streamed live concerts from his residence, and cellist Yo-Yo-Ma spearheaded the #Songsofcomfort campaign to offer tranquility amid the time of crisis. Upon an 2021 analysis of Indian civilians who were in lockdown, those who regularly listened to music reported decreased feelings of depression, fear, and worry (Hennessy, 2021). In the streets of Dnipro, Ukraine, local musicians are commonly found performing in the streets for passers-by to penetrate the horrors of the war with soulfulness and defiance. By serving as a literal and figural “instrument,” the universality of music’s affective potency is able to be showcased in its ability to help people manage an unprecedented life stressor.

The utilization of music is imperative and advantageous in one’s mental wellbeing. Music is more than entertainment; it binds humanity together in a way that language sometimes fails to proffer. It is a social communication system that, irrespective of listening idiosyncrasies, has united humanity for tens of thousands of years. By continuing to implement it into daily aspects of life, music can help drive us towards a more cooperative society and a far more connected world.

References

Malhas, A. (2018, July 30). Beat it! Learning to walk to music reduces falls for Parkinson’s patients. Parkinson’s News Today. https://parkinsonsnewstoday.com/news/beat-learning-walk-music-reduces-falls-parkinsons-patients/  

Erra, C., Mileti, I., Germanotta, M., Petracca, M., Imbimbo, I., De Biase, A., Rossi, S., Ricciardi, D., Pacilli, A., Di Sipio, E., Palermo, E., Bentivoglio, A. R., & Padua, L. (2019). Immediate effects of rhythmic auditory stimulation on gait kinematics in parkinson’s disease on/off medication. Clinical Neurophysiology, 130(10), 1789–1797. https://doi.org/10.1016/j.clinph.2019.07.013  

Hennessy, S., Sachs, M., Kaplan, J., & Habibi, A. (2021). Music and mood regulation during the early stages of the COVID-19 pandemic. PLOS ONE, 16(10). https://doi.org/10.1371/journal.pone.0258027 

Landau, E. (2018, January 23). This is your brain on music. CNN. https://www.cnn.com/2013/04/15/health/brain-music-research/  

Manning-Schaffel, V. (2017, July 21). Why some songs make us cry. NBC News. https://www.nbcnews.com/better/health/why-do-certain-songs-make-us-cry-ncna784801  

Lupis, J. C. (2017, November 13). We listen to music for more than 4 1/2 hours a day, Nielsen says. Marketing Charts. https://www.marketingcharts.com/industries/media-and-entertainment-81082 

Pelicioni, P. H., Menant, J. C., Latt, M. D., & Lord, S. R. (2019). Falls in parkinson’s disease subtypes: Risk factors, locations and circumstances. International Journal of Environmental Research and Public Health, 16(12), 2216. https://doi.org/10.3390/ijerph16122216 

Sachs, M. E., Habibi, A., Damasio, A., & Kaplan, J. T. (2020). Dynamic intersubject neural synchronization reflects affective responses to sad music. NeuroImage, 218, 116512. https://doi.org/10.1016/j.neuroimage.2019.116512 

McCollum, S. (2019, September 5). Your brain on music: The sound system between your ears. The Kennedy Center. https://www.kennedy-center.org/education/resources-for-educators/classroom-resources/media-and-interactives/media/music/your-brain-on-music/your-brain-on-music/your-brain-on-music-the-sound-system-between-your-ears/ 

Smithsonian National Museum of Natural History. (2021, April 27). Musical instruments. The Smithsonian Institution’s Human Origins Program. https://humanorigins.si.edu/evidence/behavior/art-music/musical-instruments  

Perrot, S. (2020, November 18). Reperforming, reenacting or rearranging ancient Greek scores? The example of the first delphic hymn to Apollo. https://hal.archives-ouvertes.fr/hal-03013279/document   

Wang, L., Peng, J. L., Ou-Yang, J. B., Gan, L., Zeng, S., Wang, H. Y., Zuo, G. C., & Qiu, L. (2022). Effects of rhythmic auditory stimulation on gait and motor function in Parkinson’s disease: A systematic review and meta-analysis of clinical randomized controlled studies. Frontiers in Neurology, 13, 818559. https://doi.org/10.3389/fneur.2022.818559 

Westmore, L. (2020, February 21). Music as medicine – The musical recommended daily allowance. The British Academy of Sound Therapy. https://www.britishacademyofsoundtherapy.com/musical-daily-allowance/?utm_source=THE%2BBAST%2BNEWS&utm_campaign=012e2b3618-EMAIL_CAMPAIGN_2020_01_29_09_30&utm_medium=email&utm_term=0_41f7445393-012e2b3618-596333309 

Yale New Haven Children’s Hospital (Ed.). (n.d.). Arts for healing. Yale New Haven Children’s Hospital. https://www.ynhh.org/childrens-hospital/services/support-services/child-life/arts-for-healing  

Interview With a Female Fibroids Patient: How One Woman’s Story Speaks Volumes About the US Healthcare System

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by Vineeta Abraham, May 6, 2022

Disclaimer: This paper was written for Dr. Marci Lobel’s Psychology of Women’s Health class in Spring 2022. This paper is intended to analyze the real experiences of a woman suffering from health issues. It should be noted that the use of the word “female” in this paper refers to the sex assigned at birth rather than the gender of “women” in general. Name of the interviewee has been changed for confidentiality.

In discussions of menstrual health, we often neglect to pay enough attention to the less apparent changes occurring in our reproductive organs. While one may focus their knowledge of reproductive processes in the female body on the phenomena of menstruation, reproduction, and menopause, there are other symptoms and diagnoses that can impact a female’s menstrual health. 

I was fortunate to have been able to interview Sarah [pseudonym], a 53-year-old registered nurse living on Long Island, about her recent experiences with uterine fibroids, which she identified as noncancerous growths in the uterus. Sarah has been married for 25 years and has three children ages 21, 18, and 16. She is originally from India and moved to the United States in 2003 after receiving her bachelor’s degree in nursing. She follows a Protestant-Christian religious practice and works overnight shifts at Queens Hospital Center. 

Sarah reported finding out about her uterine fibroids at the age of 51, about two years before this interview was conducted. She was lucky enough to have received the diagnosis before experiencing any serious side effects or symptoms. She claimed, “I went in for a regular check-up at my doctor’s office. We had been discussing my anemia for a few visits, so she recommended that I consult with my gynecologist to rule out fibroids.” Unfortunately, the opportunity for a “rule-out” never came. I asked Sarah whether she looked into treatment options upon hearing of her diagnosis of fibroids. She responded grimly, “Yes. The only treatment option is surgery to remove [the fibroids]. That or ablation, which is to block blood supply to the fibroids to shrink them.” Unsurprisingly, Sarah was not eager to undertake such invasive treatment, so after a few weeks of contemplation, she carefully declined. “Temporarily,” she clarified in our discussion. “I won’t be getting any further treatment unless serious complications arise.” She described how having uterine fibroids was not impacting her day-to-day activities any more than other related health concerns that previously existed before this diagnosis. For example, Sarah described how, although 53, she has not yet reached menopause, which is a great cause of concern for her. She also suffers from menorrhagia, which she described as having “severe anemia.” In an afterthought, she added that the fibroids may be adding to this.    

I then asked Sarah about any support or lack thereof she had received from friends and family regarding her diagnosis. She explained that the least support seems to come from her husband: “I asked him to ask around or look into other solutions, if he knows any other doctors, to ask if there are options other than surgery.” He did not follow through with the task, but Sarah did not comment any further on this. On the other hand, she claims better support came from other women, friends or co-workers who had either experienced similar problems or knew of others who had. Sarah described often talking with these women about gynecologist recommendations or side effects in her hunt for more information. When asked if she had felt any financial boundaries inhibiting her from receiving treatment, she said she did not think so, and does not think it would be an issue if she decides to get treatment in the future. 

I also made sure to ask Sarah about how living with this physiological health concern has impacted her mental or psychological health. Fortunately, Sarah replied that she did not experience any psychological differences as a result of her diagnosis. She explained that she is not particularly stressed about having fibroids, as it “doesn’t run in the family, doesn’t give [her] any side effects, and there are no hormonal changes.” She claimed that her lack of distress is one of the reasons she is okay with waiting before jumping into treatment. 

Much of what Sarah discussed with me in our conversation relates to topics discussed in Dr. Marci Lobel’s Psychology of Women’s Health course. For example, Sarah was clear in her explanation of limited options presented to her in terms of treatment for her uterine fibroids. The option of invasive surgery – and not much alternative – seems drastic and frightening for patients like Sarah. This reminded me of a concept discussed in the “Introduction and Overview” reading excerpted from the Physical Health, Illness, and Healing textbook, in which the authors explained how doctors show “more interest in restricting [women’s] reproductive potential than in treating their illnesses.” Although Sarah has decided she will not be having any more children, she described that she is not comfortable with getting rid of all her reproductive organs, an option presented to her through the discussion of surgery. She mentioned that although she may not want to have kids, she needs those organs to produce hormones for the rest of her life (she also demonstrated a distaste for taking external hormone supplements). The thought of invasive surgery comes with many risks and potential side effects, and is therefore understandably less appealing to women who are caretakers or full-time employees – or, like Sarah, both. 

Perhaps this is one of the many reasons Sarah has decided to wait on the decision to treat her fibroids. As she mentioned multiple times in our conversation, Sarah’s fibroids are not an obvious hindrance to her day-to-day routine. In the midst of her hectic work schedule and household responsibilities such as childcare, home maintenance, or cooking, her fibroids are therefore being metaphorically “pushed to the backburner.” This information came as no surprise to me after hearing Dr. Lobel’s lecture on women’s cardiovascular health on February 1, 2022 during which she described how there is often a delay in women seeking healthcare services. Dr. Lobel attributed this delay to factors such as having various other responsibilities or a general lack of knowledge. Sarah’s own testimony relates closely with this concept, as she claimed that her hesitancy to receive treatment came from her desire to learn more information instead of jumping hastily into a decision. This idea of not receiving adequate information was also discussed in the “Introduction and Overview” article, in which the authors described how female patients sometimes receive less information than male patients or report feeling dissatisfied with the communication they had with their healthcare providers. This could come from providers being biased and assuming that male patients are better able to understand their diagnoses or treatment options compared to their female counterparts. However, this lack of strong communication can cause women to feel disrespected or underserved, further discouraging them from seeking healthcare services in the future. True to this idea, when I asked Sarah when the last time was that she went to her provider to check on the status of her fibroids, she responded, “about a year [ago].” Sarah admitted to understanding that the fibroids could grow exponentially in that time frame, and claimed that she will go in for a checkup soon, although she did not clarify when that would be. 

In Sarah’s defense, she has made attempts to remedy her lack of knowledge regarding her diagnosis and treatment options. Sarah described going to her husband primarily to help with the situation. “I asked him to ask doctors that he associates with about other options or if they knew of good places to go for the surgery or ablation.” Sarah’s husband also works in a hospital, and she wished to take advantage of his access to multiple healthcare providers and professional opinions. However, she was disappointed to find that he soon forgot about her situation and never followed through with an inquiry. The lack of support Sarah received from her husband was a theme discussed in Dr. Lobel’s lecture on autoimmune disorders, where she discussed how social support from family and friends can play a large role in the recovery process for female patients. In Sarah’s situation, lack of support from the husband has been a contributor for the delay in her treatment, which may lead to more serious consequences if her fibroids grow.

On the bright side, Sarah claims that she has received better support from her friends and co-workers. Dr. Lobel’s lecture mentioned the benefits of having a support group for patients to connect with individuals who have similar diagnoses or experiences. While Sarah did not attend a formal support group for her diagnosis, she was able to discuss her diagnosis with female friends and co-workers who have experienced reproductive complications. These discussions resulted in sympathy and advice in the form of treatment alternatives or gynecologist recommendations that helped Sarah to feel less alone in her journey. While Sarah, unlike many of the women we learned about in lecture, did not report having serious psychological effects as a result of her diagnosis, she was grateful for the support she received from her friends. This type of support, as we’ve learned, can help women feel less alone in their journey of recovery. 

As seen in our lectures and readings, many of the factors impacting Sarah’s experiences are not unique to her. Female patients are often put in difficult circumstances in which their reproductive organs and menstrual health are endangered, often being placed in situations that male patients and physicians cannot personally relate to. Because of this, it is easy for women to feel isolated or unsure about their treatment options. Women are also disproportionately placed in social frameworks that label them as caretakers or being tasked with other social responsibilities, which adds to the delay in proper treatment. This delay can put them in riskier situations as their conditions may either worsen or become more complicated without proper resources. As in Sarah’s case, there may also be circumstances in which treatment options are available but not ideal, which can also lead to delays and uncertainty in patients. Healthcare services should therefore strive to improve their communication and flexibility in treatment options for females with menstrual and other health related complications. Female patients should feel well supported by both their providers and their social structures throughout their healthcare journeys.