“Of all the forms of inequality” Dr. Martin Luther King Jr. once said in a 1966 press conference, “injustice in health is the most shocking and the most inhumane.”
In honor of King’s impact on public health, Duke’s dean of Trinity College Dr. Gary G. Bennett delivered a powerful address Jan. 12 at the Trent Semans Center. Entitled ‘You have to Keep Moving Forward: Obesity in High-Risk Populations,’ Bennett discussed America’s Obesity Epidemic, and its disproportionate effects on Black women.
“More than 40% of the American population has obesity,” Bennett began. Incidence rates among Black women are the highest and have been since the epidemic began in 1955. “These disparities have not closed, and in many cases, they’ve widened over the years,” Bennett said.
Raisi-Estabragh 2023
Type two diabetes, hypertension, and cardiovascular disease are just some of the health risks associated with obesity. Compared to other racial groups, Black women are more likely to suffer from these conditions, as well as die from their effects. Furthermore, it appears that the efficacy of treatment options is significantly lower for patients of African descent.
But why do such disparities exist in the first place? According to Bennett, they can be attributed to a range of internal and external factors. “There certainly are physiological variations that are worth noting here, which is perhaps a challenge in all of obesity research.”
Research published in the journal Nature in 2022 found that, while there are different forms of obesity, that have shared ‘genetic and biological underpinnings.’ Environmental factors are also driving disparities. Black women are “exposed to more obesogenic environments, food desserts,” Bennett explained. With limited access to affordable and nutritious food, options for healthy eating are slim.
But perhaps most interestingly, Black women also have a range of sociocultural factors at play. “There are fewer within-group social pressures to lose weight,” Bennett maintained. Other sociocultural factors include higher body image satisfaction and higher weight misperception. “This is problematic in some ways,” he continued. While it protects against certain eating disorders and low self-esteem, “It does challenge your ability to achieve weight loss.”
For Black women, obesity is a complex public health issue that needs to be addressed.
But how? Frommedication to surgery, there are myriad potential treatment options. According to Bennett, however, the real key is lifestyle intervention. “It really is the foundation.” Comprised of three parts: reduced calorie diet, physical activity, and self-monitoring, lifestyle intervention is able to reach the widest range of participants.
Like other treatment options, the lifestyle intervention route shows racial disparities in its outcomes. Because of this, Dr. Bennett’s work focuses on developing methods that are designed with Black patients in mind.
At the forefront of his research is a new online intervention called iOTA, which stands for Interactive Obesity Treatment Approach. “This is a digital obesity approach that we designed specifically for high-risk populations.” The platform personalizes weight loss goals and feedback, which assist in program retention.
In addition, participants are equipped with coaching support from trained medical professionals. “This IOTA approach does a bunch of things,” Bennett said. “It promotes weight loss and prevents weight gain, improves cardiometabolics,” along with a host of other physical benefits. Results also show a reduction in depressive symptoms and increased patient engagement. Truly incredible.
Scholars like Bennett have continued the fight for public health equity- a fight advocated for by Dr. King many years ago. For more information on Bennett and his work, you can visit his website here.
As a woman, I am familiar with the gynecologist. In fact, thinking about it right now, I may need to create an appointment for one soon. However, I am not just a woman; I am a black woman, and in addition to being familiar with what the gynecologist is, I am also familiar with the dangers of the gynecologist. I know that if I were to become pregnant, I would be three times more likely to die by pregnancy-related causes compared with my white counterparts. This phenomenon is not new; in fact, it is a symptom of the racism within American Gynecology. The founding of this system is not pretty, or pure; it is ugly and distasteful, and during her lecture, historian Deirdre Cooper Owens explains it perfectly.
Dr. Deirdre Cooper Owens and I after her wonderful lecture
Cooper Owens is an associate professor of History and African studies at the University of Connecticut, and earlier this semester, she gave an insightful talk on how slavery and modern American gynecology are interconnected.
The controversial “father of gynecology” was J. Marion Sims, who experimented on enslaved women in Alabama. When talking about the racism in gynecology today and in the past, Sims mainly gets the blunt end of the stick. However, it was not just Sims; it was much bigger than him, Cooper Owens said.
Dr. Samual Cartwright was the first doctor for the Confederacy. Through his experiences with enslaved people, he believed that black people did not feel pain. Furthermore, he created a theory that if an enslaved person ran away or thought about running away, then they had a mental illness. Through the use of a spirometer (a medical tool still used today), he noted that black people have smaller lung capacity than white people. His findings were used to prove that there was a biological difference between races, which is not true.
This idea separated people and placed them in a hierarchy where white people were perceived as superior and black people inferior. The thought of this is damaging in itself, but back then, and sometimes now, they used this ideology as an excuse for the pain they caused African Americans.
Ephriam McDowell, for instance, removed a tumor from the ovaries of a white woman. From this, he then decided to “perfect” this surgery on five black women; four were enslaved, and one was freed. From this group, one person died, and other than that, there is no record of the women’s personal lives.
Dr. Francis M Prevost performed C-sections on enslaved people. These experiments did not take the pain of these women into account; due to the fact that he believed black people did not feel pain, but they did and still do. Now one would hope that a black woman’s relationship with C-sections has improved, but, from 1832 until two years ago, Louisiana was the state where a black woman’s body was used the most for a C-section. Today, that state is Mississippi.
John Peter Mettauer performed experiments on a white woman and a black woman. After the experiment, he claimed that the white woman was cured, but the black woman was not. As a result, he operated on the black woman eight times and claimed that if she did not have intercourse, she would have been cured. However, he failed to take into account that the woman was enslaved and had no control of her body autonomy. So how could she say no to both unwanted sexual encounters and to him?
Lastly, there is James Marion Sims, who is notorious for his contributions to American gynecology. However, such contributions were based on the bodies of enslaved women who had no choice. He used these experiments to advance his techniques and deepen his understanding of gynecology. In fact, it even went to the point where he built a hospital for the sole purpose of experimenting on enslaved women.
J. Marion Sims with his assistants and the victims of his experiments
While the acts and experiments that these men conducted were atrocious, they raised a question for me, why black women? At that time, black people were viewed as an inferior race; they were not equal in physical components and intelligence compared to white people. Therefore, if they are genetically different, why experiment with black women to find cures for white women? When asking that question, the answer is obvious; they knew there was no difference, so they chose to ignore it. They chose to continuously bring harm to these women, and until recently, they were rewarded for it.
Image provided by Harvard T.H. Chan School of Public Health
I learned a lot from this lecture, but if I had to choose only one thing that stuck with me, it would be that the victims of these heinous acts were only referred to as enslaved persons with no name and no story. The only story that was told was the point of view of those committing the acts.
I hope one day, the mortality rate of black women giving birth will decrease to the point that it is simply unheard of. Still, for society and our health system to reach that point, we must understand American gynecology’s true history.
If you weren’t outside enjoying the sun on Wednesday, April 19, you were probably milling around Penn Pavilion, a can of LaCroix in hand, taking in the buzz and excited chatter of students presenting at the 2023 Fortin Foundation Bass Connections Showcase.
Open floor presentations at the 2023 Bass Connections Showcase
This annual celebration of Bass Connections research projects featured more than 40 interdisciplinary teams made up of Duke faculty, graduate students, undergraduate students, and even partners from other research institutions.
Research teams presented posters and lightning talks on their findings. You might have heard from students aiming to increase representation of women in philosophy; or perhaps you chatted with teams researching physiotherapy in Uganda or building earthquake warning systems in Nepal. Below, meet three such teams representing a wide variety of academic disciplines at Duke.
Building sustainable university-community partnerships
As Bass Connections team member Joey Rauch described, “this is a poster about all of these other posters.” Rauch, who was presenting on behalf of his team, Equitable University-Community Research Partnerships, is a senior double-majoring in Public Policy and Dance. His interest in non-profit work led him to get involved in the team’s research, which aims to offer a framework for ethical and effective university-community research collaboration – exactly what teams do in Bass Connections. The group looked at complicated factors that can make equitable relationships difficult, such as university incentive structures, power dynamics along racial, socioeconomic, and ethnic lines, and rigid research processes.
Senior Joey Rauch with his team’s 2nd-place poster!
Along the lines of rigid research, when asked about what his favorite part of Bass Connections has been, Rauch remarked that “research is oddly formal, so having a guiding hand through it” was helpful. Bass Connections offers an instructive, inclusive way for people to get involved in research, whether for the first or fourth time. He also said that working with so many people from a variety of departments of Duke gave him “such a wealth of experience” as he looks to his future beyond Duke.
For more information about the team, including a full list of all team members, click here.
Ensuring post-radiation wellness for women
From left to right: seniors Danica Schwartz, Shernice Martin, Kayle Park, and Michelle Huang
The project has been around for three years and this year’s study, which looked at improving female sexual wellness after pelvic radiation procedures, was in fact a sister study to a study done two years prior on reducing anxiety surrounding pelvic exams.
As Huang described, graduate students and faculty conducted in-depth interviews with patients to better understand their lived experiences. This will help the team develop interventions to help women after life events that affect their pelvic and sexual health, such as childbirth or cancer treatment. These interventions are grounded in the biopsychosocial model of pain, which highlights the links between emotional distress, cognition, and pain processing.
For more information about the team, including a full list of all team members, click here.
From dolphins to humans
Sophomores Noelle Fuchs and Jack Nowacek were manning an interactive research display for their team, Learning from Whales: Oxygen, Ecosystems and Human Health. At the center of their research question is the condition of hypoxia, which occurs when tissues are deprived of an adequate oxygen supply.
Sophomores Noelle Fuchs and Jack Nowacek
Hypoxia is implicated in a host of human diseases, such as heart attack, stroke, COVID-19, and cancer. But it is also one of the default settings for deep-diving whales, who have developed a tolerance for hypoxia as they dive into the ocean for hours while foraging.
The project, which has been around for four years, has two sub-teams. Fuchs, an Environmental Science and Policy major, was on the side of the team genetically mapping deep-diving pilot whales, beaked whales, and offshore bottlenose dolphins off the coast of Cape Hatteras to identify causal genetic variants for hypoxia tolerance within specific genes. Nowacek, a Biology and Statistics double-major, was on the other side of the research, analyzing tissue biopsies of these three cetaceans to conduct experiences on hypoxia pathways.
The team has compiled a closer, more interactive look into their research on their website.
And when asked about her experience being on this team and doing this research, Fuchs remarked that Bass Connections has been a “great way to dip my toe into research and figure out what I do and don’t want to do,” moving forward at Duke and beyond.
For more information about the team, including a full list of all team members, click here.
If you’re a doe-eyed first-year at Duke who wants to eventually become a doctor, chances are you are currently, or will soon, take part in a pre-med rite of passage: finding a lab to research in.
Most pre-meds find themselves researching in the fields of biology, chemistry, or neuroscience, with many hoping to make research a part of their future careers as clinicians. Undergraduate student and San Diego native Eden Deng (T’23) also found herself plodding a similar path in a neuroimaging lab her freshman year.
Eden Deng T’23
At the time, she was a prospective neuroscience major on the pre-med track. But as she soon realized, neuroimaging is done through fMRI. And to analyze fMRI data, you need to be able to conduct data analysis.
This initial research experience at Duke in the Martucci Lab, which looks at chronic pain and the role of the central nervous system, sparked a realization for Deng. “Ninety percent of my time was spent thinking about computational and statistical problems,” she explained to me. Analysis was new to her, and as she found herself struggling with it, she thought to herself, “why don’t I spend more time getting better at that academically?”
Deng at the Martucci Lab
This desire to get better at research led Deng to pursue a major in Statistics with a secondary in Computer Science, while still on the pre-med track. Many people might instantly think about how hard it must be to fit in so much challenging coursework that has virtually no overlap. And as Deng confirmed, her academic path not been without challenges.
For one, she’s never really liked math, so she was wary of getting into computation. Additionally, considering that most Statistics and Computer Science students want to pursue jobs in the technology industry, it’s been hard for her to connect with like-minded people who are equally familiar with computers and the human body.
“I never felt like I excelled in my classes,” Deng said. “And that was never my intention.” Deng had to quickly get used to facing what she didn’t know head-on. But as she kept her head down, put in the work, and trusted that eventually she would figure things out, the merits of her unconventional academic path started to become more apparent.
Research at the intersection of data and health
Last summer, Deng landed a summer research experience at Mount Sinai, where she looked at patient-level cancer data. Utilizing her knowledge in both biology and data analytics, she worked on a computational screener that scientists and biologists could use to measure gene expression in diseased versus normal cells. This will ultimately aid efforts in narrowing down the best genes to target in drug development. Deng will be back at Mount Sinai full-time after graduation, to continue her research before applying to medical school.
Deng presenting on her research at Mount Sinai
But in her own words, Deng’s most favorite research experience has been her senior thesis through Duke’s Department of Biostatistics and Bioinformatics. Last year, she reached out to Dr. Xiaofei Wang, who is part of a team conducting a randomized controlled trial to compare the merits of two different lung tumor treatments.
Generally, when faced with lung disease, the conservative approach is to remove the whole lobe. But that can pose challenges to the quality of life of people who are older, with more comorbidities. Recently, there has been a push to focus on removing smaller sections of lung tissue instead. Deng’s thesis looks at patient surgical data over the past 15 years, showing that patient survival rates have improved as more of these segmentectomies – or smaller sections of tissue removal – have become more frequent in select groups of patients.
“I really enjoy working on it every week,” Deng says about her thesis, “which is not something I can usually say about most of the work I do!” According to Deng, a lot of research – hers included – is derived from researchers mulling over what they think would be interesting to look at in a silo, without considering what problems might be most useful for society at large. What’s valuable for Deng about her thesis work is that she’s gotten to work closely with not just statisticians but thoracic surgeons. “Originally my thesis was going to go in a different direction,” she said, but upon consulting with surgeons who directly impacted the data she was using – and would be directly impacted by her results – she changed her research question.
The merits of an interdisciplinary academic path
Deng’s unique path makes her the perfect person to ask: is pursuing seemingly disparate interests, like being a Statistics and Computer Science double-major on the pre-med, track worth it? And judging by Deng’s insights, the answer is a resounding yes.
At Duke, she says, “I’ve been challenged by many things that I wouldn’t have expected to be able to do myself” – like dealing with the catch-up work of switching majors and pursuing independent research. But over time she’s learned that even if something seems daunting in the moment, if you apply yourself, most, if not all things, can be accomplished. And she’s grateful for the confidence that she’s acquired through pursuing her unique path.
Moreover, as Deng reflects on where she sees herself – and the field of healthcare – a few years from now, she muses that for the first time in the history of healthcare, a third-party player is joining the mix – technology.
While her initial motivation to pursue statistics and computer science was to aid her in research, “I’ve now seen how its beneficial for my long-term goals of going to med school and becoming a physician.” As healthcare evolves and the introduction of algorithms, AI and other technological advancements widens the gap between traditional and contemporary medicine, Deng hopes to deconstruct it all and make healthcare technology more accessible to patients and providers.
“At the end of the day, it’s data that doctors are communicating to patients,” Deng says. So she’s grateful to have gained experience interpreting and modeling data at Duke through her academic coursework.
And as the Statistics major particularly has taught her, complexity is not always a good thing – sometimes, the simpler you can make something, the better. “Some research doesn’t always do this,” she says – she’s encountered her fair share of research that feels performative, prioritizing complexity to appear more intellectual. But by continually asking herself whether her research is explainable and applicable, she hopes to let those two questions be the North Stars that guide her future research endeavors.
At the end of the day, it’s data that doctors are communicating to patients.
Eden Deng
When asked what advice she has for first-years, Deng said that it’s important “to not let your inexperience or perceived lack of knowledge prevent you from diving into what interests you.” Even as a first-year undergrad, know that you can contribute to academia and the world of research.
And for those who might be interested in pursuing an academic path like Deng, there’s some good news. After Deng talked to the Statistics department about the lack of pre-health representation that existed, the Statistics department now has a pre-health listserv that you can join for updates and opportunities pertaining specifically to pre-med Stats majors. And Deng emphasizes that the Stats-CS-pre-med group at Duke is growing. She’s noticed quite a few underclassmen in the Statistics and Computer Science departments who vocalize an interest in medical school.
So if you also want to hone your ability to communicate research that you care about – whether you’re pre-med or not – feel free to jump right into the world of data analysis. As Deng concludes, “everyone has something to say that’s important.”
Imagine a robot small enough to fit on a U.S. penny. Or even small enough to rest on Lincoln’s chest. It sounds preposterous enough. Now, imagine a robot small enough to rest on the chest of Lincoln – not the Lincoln whose head decorates the front side of the penny, but the even tinier version of him on the back.
Before it was changed to a Union Shield, the tail side of pennies contained the Lincoln Memorial, including a miniscule representation of the seated Lincoln statue that rests inside. Barely visible to the naked eye, this miniature Lincoln is on the order of a few hundred micrometers wide. As incredible as it sounds, this is the scale of robots being built by Professor Itai Cohen and his lab at Cornell University. On February 22, Cohen shared several of his lab’s cutting-edge technologies with an audience in Duke’s Schiciano Auditorium.
Dr. Itai Cohen from Cornell University begins his presentation by demonstrating the scale of the microrobots being developed by his lab.
To begin, Cohen describes the challenge of building robots as consisting of two distinct parts: the brain of the robot, and the brawn. The brain refers to the microchip, and the brawn refers to the “legs,” or actuating limbs of the robot. Between these two, the brain – believe it or not – is the easy part. As Cohen explains, “fifty years of Moore’s Law has solved this problem.” (In 1965, Gordon Moore theorized that roughly every two years, the number of transistors able to fit on microchips will double, suggesting that computational progress will become exponentially more efficient over time.) We now possess the ability to create ridiculously small microcircuits that fit on the footprint of a few micrometers. The brawn, on the other hand, is a major challenge.
This is where Cohen and his lab come in. Their idea was to use standard fabrication tools used by the semiconductor industry to build the chips, and then build the robot around the chip by folding the robot into the 3D shape they desired. Think origami, but at the microscopic scale.
Like any good origami artist, the researchers at the Cohen lab recognized that it all starts with the paper. Using the unique tools at the Cornell Nanoscale Facility, the Cohen team created the world’s thinnest paper, including one made out of a single sheet of graphene. To clarify, that’s a single atom thickness.
Next, it came to the folding. As Cohen describes, there’s really two main options. The first is to shrink down the origami artist to the microscopic level. He concedes that science doesn’t know how to do that quite yet. Alas, the second strategy is to have the paper fold itself. (I will admit that as an uneducated listener, option number two sounds about as absurd as the first one.) Regardless, this turns out to be the more reasonable option.
Countless different iterations of microrobots can be fabricated using the origami folding technique.
The basic process works like this: a seven nanometer thick platinum layer is coated on one side with an inert material. When put in a solution and voltage applied, ions that are dissociated in the solvent will absorb onto the platinum surface. When this happens, a stress is created that bends the device. Reversing the voltage drives away the ions and unbends the device. Applying stiff elements to certain regions restricts the bending to occur only in desired locations. Devices about the thickness of a hair diameter can be created (folded and unfolded) using this method.
This microscopic origami duck developed by the Cohen Lab graced the covered of Science Robotics in March 2021.
As incredible as this is, there is still one defect: it requires a wire to an external power source that attaches onto the device. To solve this problem, the Cohen lab uses photovoltaics (mini solar panels) that attach directly onto the device itself. When light is shined on the photovoltaic (via sunlight or lasers), it moves the limb. With this advance and some continuous tweaking, the Cohen lab was able to develop the world’s smallest walking robot.
At just 40 microns by 70 microns by 2 microns thick, the smallest walking microrobot in the world is able to fold itself up and walk off the page.
The Cohen Lab also achieved “BroBot” – a microrobot that “flexes his muscles” when light is shined on the front photovoltaics and truly “looks like he belongs on a beach somewhere.”
The “BroBot,” complete with “chest hair,” was one of the earlier versions of the robot that eventually was refined into the world record-winning microrobot.
The Cohen Lab successfully eliminated the need for any external wire, but there was still more left to be desired. These robots, including “BroBot” and the Guinness World Record-winning microrobot, still required lasers to activate the limbs. In this sense, as Cohen explains, the robots were “still just marionettes” being controlled by “strings” in the form of laser pulses.
To go beyond this, the Cohen Lab began working with a commercial foundry, X-Fab, to create microchips that would act as a brain that could coordinate the limb movements. In this way, the robots would be able to move on their own, without using lasers pointed at specific photovoltaics. Cohen describes this moment as “cutting the strings on the marionette, and bringing Pinocchio to life.”
This is the final key step in the development of Ant Bot: a microrobot that moves all on its own. It uses a hexapod gate, meaning a tripod on each side. All that has to be done is placing the robot in sunlight, and the brain does the rest of the coordination.
“Ant Bot,” one of the most advanced of all microrobots to come out of the Cohen Lab, is able to move autonomously, without the aid of lasers.
The potential for these kinds of microrobots is nearly limitless. As Cohen emphasizes, the application for robots at the microscale is “basically anything you can imagine doing at the macroscale.” Cleaning surfaces, transporting cargo, building components. Perhaps conducting microsurgeries, or exploring new worlds that appear inaccessible. One particularly promising application is a robot that mimics that movement of cilia – the microscopic cellular hair responsible for countless locomotion and sensory functions in the body. A cilia-covered chip could become the basis of new portable diagnostic devices, enabling field testing that would be much easier, cheaper, and more efficient.
The researchers at the Cohen Lab envision a possible future where microscopic robots are used in swarms to restructure blood vessels, or probe large swathes of the human brain in a new form of healthcare based on quantum materials.
Until now, few would have imagined that the ancient art of origami would predict and enable technology that could transform the future of medicine and accelerate the exploration of the universe.
We live in a country where 80% of both Democrats and Republicans believe that the other political party “poses a threat that if not stopped will destroy America as we know it.” Lovely.
A 2020 study found that only 3.5% of voters would avoid voting for their preferred candidate if that candidate engaged in undemocratic behavior. In 2022, 72% of surveyed Republicans said that Democrats are more immoral than other Americans, and 83% of Democrats said that Republicans are more close-minded than other Americans. Political polarization is apparently increasing faster in the U.S. than in other democracies, but Americans aren’t just divided along political lines. Other aspects of identity, like religious beliefs, can spawn discord as well. In the U.S., 70% of atheists think religious organizations “do more harm than good,” but 44% of Americans still think that you must believe in God “in order to be moral and have good values.”
Most Americans agree that polarization is a problem. But what can be done about it? The Trent Center for Bioethics, Humanities, and History of Medicine recently hosted a conversation between two people who have spent much of their careers engaging with many different beliefs and perspectives. A recording of the talk can be found here.
Molly Worthen, Ph.D., Associate Professor of History at UNC and a freelance journalist, grew up in a “secular, totally nonreligious home,” but courses she took in college made her realize that “for a huge swath of humanity, over the course of our history,” religion has helped people find meaning and community. She has explored religion extensively through her work as a historian, author, and journalist. Worthen says she has “way too risk-averse a temperament to be a full-time journalist,” but one advantage of journalism is that it provides “an excuse to ask people questions.”
Emma Green, a journalist at The New Yorker, has also covered religion in her writing and spent time engaging with people and communities who hold a wide variety of beliefs. Green believes that “the most interesting stories are often about the debates communities are having within themselves.” These debates aren’t just about religion. In communities of all kinds, people with different and often opposing beliefs navigate disagreements with their best friends, neighbors, and family members as they engage with polarizing issues and try to find ways to coexist.
The process of interviewing people with differing worldviews and beliefs can bring challenges, but both Worthen and Green have found that those challenges are not insurmountable. “If you do your homework and you really make a good-faith effort to learn where a person is coming from,” Worthen says, “they will tell you their story. They will not shut down.”
Worthen has spent time with a community of Russian Orthodox Old Believers in Alberta. It was an opportunity to make a “concerted effort to really get inside the worldview of someone very different from myself.”
Green has also spent time talking to and learning from religious communities. She published an article about Hyattsville Mennonite Church in Pennsylvania, which had been welcoming gay members for over a decade and had originally been “disciplined” by the Allegheny Mennonite Conference for its open acceptance of homosexuality. A decade later, the Conference gathered to determine whether the Hyattsville church should be allowed to rejoin the Conference or be removed from it altogether. (A third option, according to Green’s article, was to dissolve the Conference.) Green was struck by how the Mennonite community approached the dispute. They followed the formal “Robert’s Rules of Order,” but they also sang together in four-part harmony. The central dispute, Green says, was “about whether they could stay in community with one another.” Ultimately, the gay members were allowed to stay, though Green says that some people left the congregation in protest.
Polarization is a word we hear a lot, but why is it that we seem to have such a hard time finding common ground when it comes to important—or even seemingly unimportant—issues? Worthen points out that there seems to be a new survey every few years showing that “humans are generally impervious to evidence” that goes against our existing beliefs.
“Barraging a human with evidence doesn’t really work,” Worthen says. According to her, theologians and philosophers have long said that “we are depraved, irrational creatures, and the social science has finally caught up with that.”
This hesitancy to even consider evidence that conflicts with our existing beliefs has implications on public trust in science. Too often, “believing in science” takes on political implications.
According to Pew Research Center, only 13% of Republicans have “a great deal” of confidence in scientists, compared to 43% of Democrats. “Many people on the left think of the universities as belonging to them,” says Worthen, leading to a greater sense of trust in science. “There is a desire on the left to want science to line up” with their political views, Green agrees, but good science isn’t inherently aligned with a particular political party. Science involves uncertainty and “iterative self-correction,” Worthen says, but even acknowledging uncertainty can spawn controversy. And when science doesn’t perfectly align with someone’s political or ideological beliefs, it can make people uncomfortable. For instance, Worthen believes that “the retreating date of viability” for fetuses and better fetal imaging technology is “provoking… discomfort on the left” in conversations about abortion.
Similarly, evidence from evolutionary biology can be hard to reconcile with deeply held religious beliefs. Worthen describes an interview she did with Dr. Nathaniel Jeanson. He has a Ph.D. from Harvard in cell and developmental biology, but he is also a Young Earth creationist who believes the earth was created by God in six days. There are “plenty of conservative Christians who understand those days as metaphors,” Worthen says, but Jeanson takes the six-day timeframe described in the Bible literally. In Worthen’s article, she says that Jeanson “dutifully studied evolutionary biology during the day and read creationist literature at night.” One thing Worthen admired in Jeanson was his willingness to be “honest about who we are”: not very open to new evidence.
“I think very few humans are anti-science,” Worthen says. “It’s more that humans are selectively pro-science.”
It isn’t just politics that can cause people to distrust science. Green points out that people who have had frustrating experiences with traditional healthcare may look for “other pathways to achieving a sense of control.” When patients know that something is wrong, and mainstream medicine fails them in some way, they may turn to alternative treatments. “That feeling of not being understood by the people who are supposed to know better than you is actually pretty common,” Green says, and it can fuel “selective distrust.”
It can be helpful, Worthen says, for a clinician to present themselves as someone trustworthy within a larger system that some patients view as “suspect.”
Distrust in public health authorities has been a recurring theme during the Covid pandemic. Green recalls interviewing an orthodox Jewish man in New York about his community’s experiences during the pandemic. Many Orthodox Jewish communities were hit hard by Covid, and Green believes it’s important to recognize that there were many factors involved. Even well-meaning health officials often lacked the language skills to speak dialects of Yiddish and other languages, and the absence of strong, pre-existing relationships with Orthodox communities made it harder to build trust in the middle of a crisis.
Worthen spoke about vaccine hesitancy. “For most of the population who has gotten the [Covid] vaccine,” she says, “it’s not because they understand the science but because they’re willing to ‘outsource’” their health decisions to public health authorities. It is “important not to lose sight of… how much this is about trust rather than understanding empirical facts.”
Finally, both speakers discussed the impacts of social media on polarization. According to Green, “information ecosystems can develop in social media and become self-contained.” While “there are a lot of people out there who are quacks who purport to be experts,” social media has also created public health “stars” who offer advice and knowledge to a social media audience. Even that, however, can have downsides. “There isn’t a lot of space for uncertainty, which is a huge part of science,” Green says.
Worthen, meanwhile, believes that “social media is one of the main assets destroying our civilization…. I would encourage everyone to delete your accounts.”
Polarization is pervasive, dangerous, and difficult to change. “As a journalist, I basically never have answers,” Green says, but maybe learning from journalists and their efforts to understand many different perspectives can at least help us begin to ask the right questions. Learning to actually listen to each other could be a good place to start.
The healthcare industry and academic medicine are excited about the potential for artificial intelligence — really clever computers — to make our care better and more efficient.
The students from Duke’s Health Data Science (HDS) and AI Health Data Science Fellowship who presented their work at the 2022 Duke AI Health Poster Showcase on Dec. 6 did an excellent job explaining their research findings to someone like me, who knows very little about artificial intelligence and how it works. Here’s what I learned:
Artificial intelligence is a way of training computer systems to complete complex tasks that ordinarily require human thinking, like visual categorization, language translation, and decision-making. Several different forms of artificial intelligence were presented that do healthcare-related things like sorting images of kidney cells, measuring the angles of a joint, or classifying brain injury in CT scans.
Talking to the researchers made it clear that this technology is mainly intended to be supplemental to experts by saving them time or providing clinical decision support.
Meet Researcher Akhil Ambekar
Akhil standing next to his poster “Glomerular Segmentation and Classification Pipeline Using NEPTUNE Whole Slide Images”
Akhil Ambekar and team developed a pipeline to automate the classification of glomerulosclerosis, or scarring of the filtering part of the kidneys, using microscopic biopsy images. Conventionally, this kind of classification is done by a pathologist. It is time-consuming and limited in terms of accuracy and reproducibility of observations. This AI model was trained by providing it with many questions and corresponding answers so that it could learn how to correctly answer questions. A real pathologist oversaw this work, ensuring that the computer’s training was accurate.
Akil’s findings suggest that this is a feasible approach for machine classification of glomerulosclerosis. I asked him how this research might be used in medicine and learned that a program like this could save expert pathologists a lot of time.
What was Akhil’s favorite part of this project? Engaging in research, experimenting with Python and running different models, trying to find what works best.
Meet Researcher Irene Tanner
Irene Tanner and her poster, “Developing a Deep Learning Pipeline to Measure the Hip-Knee-Ankle Angle in Full Leg Radiographs”
The research Irene Tanner and her team have done aims to develop a deep learning-based pipeline to calculate hip-knee-ankle angles from full leg x-rays. This work is currently in progress, but preliminary results suggest the model can precisely identify points needed to calculate the angles of hip to knee to ankle. In the future, this algorithm could be applied to predict outcomes like pain and physical function after a patient has a joint replacement surgery.
What was Irene’s favorite part of this project? Developing a relationship with mentor, Dr. Maggie Horn, who she said provided endless support whenever help was needed.
Meet Researcher Brian Lerner
Brian Lerner and his poster, “Using Deep Learning to Classify Traumatic Brain Injury in CT Scans”
Brian Lerner and his team investigated the application of deep learning to standardize and sharpen diagnoses of traumatic brain injury (TBI) from Computerized Tomography (CT) scans of the brain. Preliminary findings suggest that the model used (simple slice) is likely not sufficient to capture the patterns in the data. However, future directions for this work might examine how the model could be improved. Through this project, Brian had the opportunity to shadow a neurologist in the ER and speculated upon many possibilities for the use of this research in the field.
What was Brian’s favorite part of this project? Shadowing neurosurgeon Dr. Syed Adil at Duke Hospital and learning what the real-world needs for this science are.
Many congratulations to all who presented at this year’s AI Health Poster Showcase, including the many not featured in this article. A big thanks for helping me to learn about how AI Health research might be transformative in answering difficult problems in medicine and population health.
How does parenting change when infant and child mortality affects every family in society? Recent history may provide an answer. For the entirety of the 19th Century, child mortality was ubiquitous. In the year 1880, nearly 35% of children born in the United States passed away in their first five years. The medical literature that explores the common diseases and public health inadequacies, though expansive, often fails to address the central humanistic questions surrounding such widespread death. How were these children mourned? How did grieving families move on? And how has this mourning changed in the context of the past hundred years of medical advancement?
These guiding questions drove Dr. Perri Klass, Professor of Journalism and Pediatrics at NYU, to pen her recently published book, “The Best Medicine: How Science and Public Health Gave Children a Future.” A distinguished clinician, author, and medical historian, Klass explored prominent art and literary works from this era of high infant and child mortality at the recent Trent Humanities in Medicine Lecture at the Duke School of Medicine, titled “One Vacant Chair: Remembering Children”.
Dr. Perri Klass, MD
Throughout the lecture, Klass guided the audience through famous portraits, poems, and prose produced in the 18th Century that memorialized children who had died at a young age. Perhaps the most famous fictional account of childhood death in the 19th century emerged in Uncle Tom’s Cabin by Harriet Beecher Stowe. The emotionally wrenching death scene of young Eva, who succumbed to tuberculosis, struck a chord with virtually all those who read the novel. Published in 1852, Uncle Tom’s Cabin would go on to be reproduced in theaters across the country for several decades, the death scene becoming a ubiquitous anchor that often brought the audience to tears. Klass further described how Beecher Stowe drew from her personal experience, the death of her son Charlie from cholera only a few years prior to the writing of the book, to create this powerful literary scene.
“Uncle Tom’s Cabin.” Published in 1852 by Harriet Beecher Stowe.
Beecher Stowe was not the only author whose personal experience impacted their art. Charles Dickens, deeply impacted by the death of his children, had created a slew of sentimental yet mortal child characters in his stories. One of the most prominent examples, young Nell from “The Old Curiosity Shop,” was published in installments and developed a strong following. Dickens ended the series with the death of twelve-year old Nell, much to the outrage of international readers.
Perhaps it’s no surprise that parents chose to memorialize their deceased children through literature and art. Wealthy families would often contract famous portrait artists were often contracted to depict their dead children. Some, including the Rockefellers and the Stanfords, channeled the deaths of their children and grandchildren into resourced academic institutions.
For grief to drive philanthropy and art is not a new phenomenon, but the sources of grief that drive such artistic and financial overtures today have changed considerably. Klass sought to bridge this knowledge gap and pull closer the history to which society has the privilege of being oblivious. Maybe, even, it would even inform how we cope with the mortality of young people today.
“How do we situate ourselves in a world where infant and child mortality is so low?” Klass asked at the beginning of her presentation.
The past does not reveal one clear answer, but it does provide a tapestry of options, many lost in our modern collective memory, for mourning, for celebrating, and for memorializing.
As a senior at Duke University in 2010, Dr. Quinn Wang was simply Quinn, an undergraduate English major on the pre-med track, wondering how to combine her love for medicine with her love for English. This is how her senior thesis was conceived – Through the Lens of Medicine: Landscapes of Violence in Cormac McCarthy’s Blood Meridian (1985), All the Pretty Horses (1992), and No Country for Old Men (2005) – which ended up winning the English department’s award for “Most Original Honors Thesis.”
Dr. Quinn Wang
Fast forward 12 years, and Wang can now call herself a double Dukie, having completed medical school here. She went on to complete ophthalmology residency at UCSF and this past Saturday, November 5, came back to her alma mater as part of the Duke Medical Ethics Journal’s Medicine, Humanities, and Business celebration to talk to an eager audience at Schiciano Auditorium about her path from Duke until now.
She began her story during the infamous year of 2020, when she was forced to stop seeing patients at her private practice in California’s Bay Area due to COVID-19. Restless and anxious about how her patients were doing, she tried to keep up with them as best she could, but of course there were limitations. And then, a few months in, one of her patients went blind.
This tragic moment sparked a frustrating realization by Wang that in the tech capital of the world – San Francisco – there was still no good way to test people’s eyesight from home to prevent what should have been preventable. She decided to put together something herself, guided by the one question she thought was most important to answer until COVID-19 abated and people could come into clinics again – “how do we make sure people don’t go blind?”
Wang took common visual eye-testing tools used in clinics, and with some simple Photoshop editing and a little bit of code, turned them into a series of easy multiple-choice questions that could be answered from home. This simple but powerful transformation turned into Quadrant Eye, a start-up she co-founded with software engineer Kristine Hara.
A common visual tool used to test eyesight is the Snellen chart
The Quadrant Eye journey has taken her from running a private practice as an ophthalmologist to taking the plunge into business by applying to and getting selected for Y Combinator, which calls itself a “graduate school for startups”. YC invests $500,000 into a selection of early-stage startups twice a year. Then, for three intense months, they provide support to get startups off the ground and in good shape to present to investors for funding. At YC, Hara worked on turning Quadrant Eye into an app, and Wang renewed hundreds of prescriptions.
Quadrant Eye
Ultimately, though, the most significant place Quadrant Eye has led Wang to is a journey of self-mastery that applies to any human endeavor, from building a startup to doing research to just getting up every morning. As she describes, startup life entails always learning new things and always messing up – which, for someone who professes that “I don’t like to do things I’m not good at” – can be challenging. She candidly admitted that she, like everyone, has bad days, when sometimes all she can do is throw in the towel and end work early. “I have more doubts than I care to admit,” Wang says, but at the end of the day, “we’re all climbing our own mountains”. Pushing through requires “superhuman effort” but it’s worth it.
And as for that English thesis? Wang describes how Quadrant Eye’s very first investor – “let’s call him Charlie” – asked her all the requisite questions investors ask early-stage startups (think Shark Tank). But he also asked her for something non-traditional – all fifty or so pages of her undergraduate honors thesis she had written ten years back. Apparently, he had seen a mention of it on LinkedIn and was intrigued. A few weeks later, Wang received a phone call that he was interested in investing – and he admitted that her thesis had played a part. To him, the uniqueness and quality of her thesis showed that Wang could problem-solve, communicate well, and think creatively, and Wang herself agrees. “My English thesis showed me that I can do hard things,” she said, and if Quadrant Eye is any indication, clearly, she can.
“After COVID-19,” senior Cynthia Dong (T’23) remarks, “so much of what was wrong with the medical system became visible.”
Duke undergraduate Cynthia Dong, Class of 2023
This realization sparked an interest in how health policy could be used to shape health outcomes. Dong, who is pursuing a self-designed Program II major in Health Disparities: Causes and Policy Solutions, is a Margolis Scholar in Health Policy and Management. Her main research focus is telehealth and inequitable access to healthcare. Her team looks at patient experiences with telehealth, and where user experience can be improved. In fact, she’s now doing her thesis as an offshoot of this work, researching how telehealth can be used to increase access to healthcare for postpartum depression.
Presenting research on telehealth
In addition to her health policy work, however, Dong also works as a research assistant in the neurobiology lab of Dr. Anne West, and her particular focus is on the transcription mechanism of the protein BDNF, or brain-derived neurotrophic factor.
While lab research can be clearly visualized by most people (think pipettes, rows of benches littered with bottles and plastic tubes, blue rubber gloves everywhere), health policy research is perhaps a little more abstract. When asked what the process of research through Margolis is like, Dong says that “it’s not team-based or individual – it’s a lot of both.” This looks like individual research on specific topics, talking to different stakeholder groups and people with certain expertise, and then convening for weekly team meetings.
With other Margolis Scholars
For Dong, research has been invaluable in teaching her to apply knowledge to something tangible. Doing that, you’re often “forced to understand that not everything is in my control.” But on the flip side, research can also be frustrating for her because so much of it is uncertain. “Will your paper get published? Is what you’re doing relevant to the research community? Will people invest in you?”
In that vein, research has humbled her a lot. “What it means to try to solve a societal problem is that it’s not always easy, you have to break it down into chunks, and even those chunks can be hard to solve.”
After graduation, Dong plans on taking a couple of gap years to be with family and scribe before ultimately pursuing an MD-MPH. Because research can be such a long, arduous process, she says that “It took me a long time to realize that the work we do matters.” In the future, though, she anticipates that her research through Margolis will directly inform her MPH studies, and that “with the skills I’ve learned, I can help create good policy that can address the issues at hand.”
