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RPS/MSS/YPS Newsletter December 2011
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1. YPS Spotlight Interview with Sara Brenner, MD, MPH

2. Mobile Health and Preventive Medicine in the United States

3. Preventing Cancer With Diet - Words from Dr. Andrew Weil, Integrative Medicine Guru

4. WANTED: Practicum Rotation Descriptions! We Need Your Help!



1
. YPS Spotlight Interview with Sara Brenner, MD, MPH
         By Samuel Peik, MD, MPH

1) How did you get interested in Preventive/Occupational/Environmental Medicine?

As an undergrad, I studied genetics and philosophy and considered a career in either basic science research or theology. Not wanting to abandon one for the other, I thought medicine might be a good way to marry my love of science and my passion for the humanities. So I applied to medical schools relatively late in the game just before moving to Sydney, Australia to finish my last semester studying biotechnology. During medical school at the University of Iowa, I was impressed with the quality and compassion of physicians and the medical community, but my philosophical side became increasingly dissatisfied with what I was seeing and experiencing in the health care system. By my third year of medical school, I knew that the conventional, well-worn path of most clinicians was not for me. Medicine, as practiced in the U.S., focuses almost exclusively on diagnosis and treatment of disease. I was frustrated that >90% of the illnesses and diseases we treat are preventable — our medical education, residency training, and physician payment systems must shift in focus from fixing derailed trains to keeping trains on the tracks in the first place. Serendipitously, I came across the specialty of preventive medicine through a scholarship announcement forwarded to me by one of the medical school Deans. It was in 2005 – the first year ACPM was offering two stipends for medical students to attend their annual meeting. I was selected to attend, and it changed the trajectory of my life. For the first time, I met physicians whose passion was to increase the emphasis, investment, and incentives for prevention and wellness. I fell in love with the specialty immediately, and spearheaded the medical student section of ACMP the following year.

2) Where did you do your training? Can you share some of your thoughts about that program?

After a prelim year in internal medicine at Evanston Northwestern (Chicago), I moved to Albany to specialize in general preventive medicine at the New York State Preventive Medicine Residency Program (http://www.albany.edu/sph/pmrhome.php) and was supported by the American Cancer Society through the cancer prevention track. I absolutely loved the program, the program director and supporting staff, and my fellow residents. The location was close enough to D.C. to commute easily for Federal health policy initiatives and offered a great deal of flexibility and customization to each resident’s unique career goals. I would highly recommend the program and would be happy to talk to any interested applicant about it in further detail.

3) What do you do now? How did you end up with that job you have now?

After training in internal medicine, preventive medicine, and public health, I took my initial career–launching position beyond residency as the first physician on faculty at the University at Albany College of Nanoscale Science & Engineering (CNSE). My research focus areas include nanomedicine, occupational and environmental health & safety, and bioethics. I am also designing and developing cutting–edge "NanoHealth" initiatives and programs in collaboration with colleagues in academia, industry, and government.

My interests fall in a few different, but complimentary domains – Nanomedicine, preventive medicine and public health, and bioethics. My research in nanomedicine aims to develop novel nanotechnology applications in the life sciences, particularly medicine and public health. Regarding preventive medicine and public health, I am leading health and safety research initiatives related to nanoparticle and nanomaterial exposures in the workplace, consumer marketplace, and environment. In this way, I am addressing gaps in our understanding of the safety and risk associated with the unique characteristics of nanoscale materials by incorporating theory from many disciplines such as physics, engineering, biology, genetics, medicine, public health, epidemiology, and environmental science. As part of these efforts, I am advancing risk assessment and reduction strategies for occupational exposures, monitoring of materials that may impact population health and public safety, and the development of industrial practice standards for product safety.

My research team of graduate students, undergrads, and research staff at the CNSE is working proactively with collaborators and partners to develop monitoring and surveillance techniques to assess the environmental and ecological impact, as well as the biopersistence of engineered nanomaterials in New York’s Capital Region. We are building a framework to employ custom–tailored strategies to mitigate potential risks associated with nanotechnology-based products that are currently on the market as well as those under development. As a professor, I also participate in teaching and service to the University. I have developed and am currently teaching two courses at CNSE: ‘Societal Implications of Nanotechnology’ which will combine science with philosophy, ethics, and public policy, and ‘Intro to Clinical Nanomedicine’ which integrates anatomy, physiology, and current applications of nanotechnology in medicine.

In March 2011, SEMATECH-ISMI and CNSE announced a partnership to launch a groundbreaking NanoHealth & Safety Center, a pioneering global consortium to proactively explore occupational and environmental health and safety for nanoelectronics research and manufacturing. I currently serve as the Chair of the center’s joint steering committee. The NSC aligns both ongoing and new programs and initiatives of SEMATECH, ISMI and CNSE, along with a host of global corporate partners, to form the world’s leading nanotechnology health and safety research and development enterprise. With funding in excess of $10 million over the next five years, international experts from industry, academia, and government are addressing emerging critical challenges in nanotechnology such as: occupational health and safety, including exposure to nanoparticles in the workplace; environmental health and safety, to assess the impact and life cycles of nanomaterials; resource utilization, to study decreasing water, energy and chemical usage while increasing efficiency; and proactive collaborative research and development, from new device materials and processing fluids to manufacturing processes and tools. Expansion of the center’s research portfolio – from genotoxicology to exposure assessment to epidemiology – has grown rapidly to include over a dozen faculty at CNSE and collaborating universities in less than a year.

More info on NanoHealth & Safety research below:

CNSE Faculty profile: http://cnse.albany.edu/AboutUs/FacultyStaff/Faculty/SaraBrenner.aspx

Safeguarding the Promise of Nanotechnology (Medgadget): http://medgadget.com/2011/08/safeguarding-the-promise-of-nanotechnology.html

NanoHealth & Safety Center launch (YNN News clip): http://capitalregion.ynn.com/content/top_stories/533607/100-nanohealth-jobs-coming-to-region-as-industry-grows/

Nano Meets Public Health (NanoNow): http://www.nanotech-now.com/columns/?article=365

4) Can you describe what made you decide to enter the field of nanotechnology, particularly at a public/private partnership setting?

I couldn’t resist the challenge, the opportunity, the chance to blaze a new trail and do things that hadn’t been done before. While I hadn’t previously considered a career in academia (I was headed to D.C. to do health policy work), fate intervened, and I decided to join the faculty at CNSE with the charge of developing new programs, collaborations, curricula, and initiatives in health and medicine. This was particularly appealing because it afforded the opportunity to do a multitude of things at once – teach, build a research program, interface with the community, innovate, advocate for proactive health interventions and corporate responsibility, collaborate with people from diverse backgrounds from multiple sectors, and challenge myself in mind-boggling ways. The learning curve has been steeper than I ever imagined it could be!

5) Do you have any advice for medical students considering PM or OEM?

Think non–traditionally. Keep your eyes open for opportunities off the beaten path as well as those that directly present themselves, and then take advantage of every singe one, even if it doesn’t seem relevant at the time. Don’t lose sight of your passion and purpose while you are shaping and guiding the evolution of what "medicine" means to you, as well as informing the future form and function of our health care system.

Also, don’t lose perspective through the process of medical training. Hold tight to the people and outside activities that have special meaning and purpose in your life. I spend time with family and friends whenever possible — I love socializing over good food and wine or through activities. The main passion I have outside of work is fitness. Running is my primary addiction, although I also teach swing and ballroom dance. I started running marathons during medical school, which progressed to running ultra–marathons (up to 50 miles) and ultra–relays (up to 200 miles). Since moving to upstate New York I have also picked up trail running, adventure racing, and snowshoe racing. I also continue doing occasional music gigs like weddings and jazz ensembles for events. My right brain is always looking for a way to break loose through creative writing, art, and photography.

6) Do you have any advice for current PM residents?

For those already in preventive medicine, you’re already on a less traditional path, so first I would say nice work! I would then say to take it even further – take risks, embrace big challenges, think differently. In order to achieve the maximum potential reduction in health care costs, morbidity, and mortality, every aspect of the health care system must realign, from individual patient care to federal health policy. A quote from the late Steve Jobs sums it up brilliantly: "Here's to the crazy ones. The misfits. The rebels. The troublemakers. The round pegs in the square holes. The ones who see things differently. They're not fond of rules. And they have no respect for the status quo. You can quote them, disagree with them, glorify or vilify them. About the only thing you can't do is ignore them. Because they change things. They push the human race forward. And while some may see them as the crazy ones, we see genius. Because the people who are crazy enough to think they can change the world are the ones who do."

7) Where do you see nanotechnology in 5 years? 10 years?

Technological advancements, including an ever-increasing number that are enabled by nanotechnology, stand to revolutionize health care as they have computers and other electronics. The emerging science, engineering, and application of nanotechnologies to biological systems are undergoing rapid expansion in the U.S. and abroad. The last few years have yielded unprecedented advances in biotechnology, including chip–based detection methods and human genome sequencing. Nanotechnology applications in medicine and public health will lead to revolutionary advances in targeted drug delivery, imaging, diagnostics, implant technology, regenerative medicine, anti-cancer therapies, infectious disease control, and personalized medicine. Not only does the future hold promise of advances in medical interventions and treatments, but also for the early detection and prevention of disease and illness. Examples of current medical applications include novel chip–based technologies for diagnostics and high–throughput screening, nanopharmaceuticals, BioMEMS, protein nanoarrays, nanogenomics, nanofluidics, engineered nanostructures for cell and tissue scaffolds, nano-enabled devices for optics, and quantum dots for imaging.

To take full advantage of and propel these emerging applications, a new generation of clinical researchers will be needed. In March 2011, CNSE and SUNY Downstate Medical Center announced a partnership to launch the world’s first program for research physicians in nanomedicine, the MD/PhD Program in Medicine & Nanoscale Science or Engineering. This is a program that I developed and now direct with colleagues at both institutions. The MD/PhD program is a first-of-its-kind, dual degree program that provides world-class education and training in both medicine and nanoscale science and engineering, which will enable nanomedicine innovations designed to transform and enhance the prevention, diagnosis, and treatment of disease. The program uniquely prepares a new hybrid generation of research physicians who are capable of driving nanotechnology applications in medicine and redefining the standard of health care.

MD/PhD program in nanomedicine: http://cnse.albany.edu/PioneeringAcademics/GraduatePrograms/Nanomedicine.aspx

With these extraordinary opportunities will come momentous challenges in navigating and defining the ethical, societal, and public policy aspects of how, when, where, and why to deploy new life-changing technologies. I look forward with great anticipation to playing a role in the new world of 21st century health care


2. Mobile Health and Preventive Medicine in the United States
        By Julielynn Wong, MD, MPH
        Rotating ACPM Pfizer Health Policy Resident

Mobile health or mHealth can be defined as the application of mobile technologies to healthcare. mHealth encompasses a diverse array of products and services, including; cellphones, wireless sensors, consumer devices, and medical applications. While many innovative mHealth solutions have been piloted in the past decade, only a few have evaluated and demonstrated positive clinical outcomes. This article will focus on several mHealth solutions that pertain to the specialty of preventive medicine, target the U.S. population, and have shown evidence of clinical effectiveness.

The major mHealth applications relevant to preventive medicine specialists in the U.S. relate to; (i) lifestyle modification (ii) remote monitoring of patients (iii) collection of community and clinical health data, and (iv) patient education. Several innovative mHealth strategies are described below.

In peer-reviewed published randomized clinical trials1,2, WellDoc’s mobile and web-based personalized, real-time, diabetes patient coaching system and provider decision support program, led to significantly reduced A1c levels.

A poster abstract3 described how the use of Asthmapolis weekly email reports by asthma patients (n = 27) over a period of 3 months led to statistically significantly increased improvements in the asthma control scores and statistically fewer number of symptomatic days. Asthmapolis employs the Spiroscout device, which is a GPS wireless medication sensor that attaches to a rescue inhaler. With the Asthmapolis mobile app, users can map and track their symptoms, triggers, and use of rescue and controller medications, receive text message reminders when inhaler doses are missed, review personalized asthma maps and charts to reveal patterns of medication use and to identify locations that cause their symptoms to worsen.

Interim analysis4 described in a press release showed that Vitality’s Glowcap increased medication compliance from 71% to 98% in hypertensive patients compared to controls (n = 139). Glowcap is a Internet-linked packaging that fits over standard pill bottles and alerts patients with light and sound cues when they are due to take their medications. This device has an embedded wireless connection and notifies the patient via automated calls about missed doses, routine progress reports, and refill reminders. Vitality also offers an optional social network that shares and promotes medication adherence. In scaled settings, each Glowcap costs $10 per pill bottle.

Text4Baby was launched in February 2010 and has over 131,000 users nation-wide. This free service provides expectant and new mothers with weekly text messages on pregnancy and infant care health tips, including; the prevention of birth defects, breastfeeding, car seat safety, drug and alcohol use, physical activity, vaccinations, nutrition, dental health, smoking cessation, community prenatal and infant care services, and much more. These messages are timed accordingly to a woman's pregnancy due date or her infant’s actual date of birth. At the American Public Health Association Annual 2011 meeting, researchers presented survey data5 that showed that 63.1 percent of users reported that Text4Baby helped them recall an appointment or immunization shot that they or their infants needed.

For preventive medicine physicians, the mHealth sector contains powerful technologies that can complement and even transform population-based healthcare. Cellphone-based solutions in particular, are highly scalable due to the widespread use of mobile phones across the U.S. As well, monitoring and documenting the clinical benefits of mHealth is greatly needed, which is another area in which preventive medicine specialists can make a significant impact. The practice of preventive medicine and mHealth technologies will likely become increasingly intertwined in the future.

Julielynn Wong, MD, MPH is a Health Policy Fellow at the American College of Preventive Medicine. She has no financial relationships with any of the products and services described in this article.


References

  1. Quinn CC, Clough SS, Minor JM, Lender DM, Okafor M, Gruber-Baldini A. WellDocTM mobile diabetes management randomized controlled trial: change in clinical and behavioural outcomes and patient and physician satisfaction. Diabetes Technol Ther. June 2008;10(3):160-8.
  2. Quinn CC, Shardell MD, Terrin ML, Barr EA, Ballew SH, Gruber-Baldini A. Cluster randomized trial of a mobile phone personalized behavioural intervention for blood glucose control. Diabetes Care. Sept. 2011;34:1943-1942
  3. Van Sickle D, Magzamen S, Truelove S. Online feedback about remotely monitored inhaled bronchodilators improves composite measures of asthma control. Am J Respir Crit Care Med. 2010;181:A3127.
  4. June 23, 2010 Press Release: Wireless medication adherence study conducted at the Partners Center for Connected Health shows promising initial findings. Available at: http://mobihealthnews.com/8067/wireless-medication-adherence-study-conducted-at-the-partners-center-for-connected-health-shows-promising-initial-findings/. Accessed December 1, 2011.
  5. November 1, 2011 Press Release: San Diego researchers first to report positive impact of Text4Baby program. Available at: http://www.text4baby.org/index.php/news/180-sdpressrelease. Accessed December 1, 2011.


3. Preventing Cancer With Diet - Words from Dr. Andrew Weil, Integrative Medicine Guru

According to the Integrative Medicine guru, Andrew Weil, MD, to help reduce your risk of some types of cancer, try the following:

  1. Avoid polyunsaturated vegetable oils, margarine, vegetable shortening, all partially hydrogenated oils and all foods that might contain trans-fatty acids (such as deep-fried foods).
  2. Minimize or eliminate consumption of foods with added sugar.
  3. Increase omega-3 fatty acid intake by eating more cold-water oily fish, freshly ground flaxseed and walnuts.
  4. Reduce consumption of animal foods and try replacing them with plant-based proteins such as whole soy products.
  5. Use hormone-free, organically produced products whenever possible.
  6. Eat plenty of fresh fruits and vegetables.
  7. Eat shiitake, enokidake, maitake and oyster mushrooms frequently.
  8. Drink green tea daily.


4. WANTED: PRACTICUM ROTATION DESCRIPTIONS! WE NEED YOUR HELP!

Did you do an interesting rotation that improved your practicum year???

Did you do one that you thought was not as beneficial???

What about a global health experience???

Please send us a short description of your practicum rotation experiences (past, present, future) and your opinion of them (overall, was it useful or not; what can be done to improve the rotation; what did you like about it, etc). Don't forget to include details like the name of the site, name of your preceptor and their contact info, and whether or not you thought the experience was worthwhile (and why). Please do this in short paragraph as we are just working on the basics for now. Pleasesend the descriptions by email to acpmrps@gmail.com.

Your time and dedication to improving the Preventive Medicine residency experience is greatly appreciated!



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