Tag: medicine

What brings seniors Deney Li and Amber Fu together? Aside from a penchant for photoshoots (keep scrolling) and neurobiology, both of them are student research assistants at the lab of Dr. Andrew West, which is researching the mechanisms underlying Parkinson’s in order to develop therapeutics to block disease progression. Ahead lie insights on their lab work, their lab camaraderie, and even some wisdom on life.

(Interview edited for clarity. Author notes in italics.)

What are you guys studying here at Duke? What brought you to the West lab?

DL: I am a biology and psychology double major, with a pharmacology concentration. I started working at a lab spring semester of freshman year that focused on microbial and environmental science, but that made me realize that microbiology wasn’t really for me. I’ve always known I wanted to try something in pharmaceutics and translational medicine, so I transitioned to a new lab in the middle of COVID, which was the West lab. The focus of the West lab is neurobiology and neuropharmacology, and looking back it feels like fate that my interests lined up so well!

AF: I am majoring in neuroscience with minors in philosophy and chemistry, on the pre-med track. I knew I wanted to get into research at Duke because I had done research in high school and liked it. I started at the same time as Deney – we individually cold-emailed at the same time too, in the fall! I was always interested in neuroscience but wasn’t pre-med at the time. A friend in club basketball said her lab was looking for people, and the lab was focused on neurobiology – which ended up being the West lab!

What projects are you working on in lab?

DL: My work mainly involves immunoassays that test for Parkinson’s biomarkers. My postdoc is Yuan Yuan, and we’re looking at four drugs that are kinase inhibitors (kinases are enzymes that phosphorylate other proteins in the body, which turns them either on or off). We administer these drugs to mice and rats, and look at LRRK2, Rab10 and phosphorylated Rab10 protein levels in serum at different time points after administration. These protein levels are important and indicative because more progressive forms of Parkinson’s are related to higher levels of these proteins.

AF: For the past couple of years, I’ve been working under Zhiyong Liu (a postdoc in the lab). There are multiple factors affecting Parkinson’s, and different labs ones study different factors. The West lab largely studies genetic factors, but what we’re doing is unique for the lab. There’s been a lot of research on how nanoplastics can go past the blood-brain barrier, so we are studying how this relates to mechanisms involved in Parkinson’s disease. Nanoplastics can catalyze alpha-synuclein aggregation, which is a hallmark of the disease. Specifically, my project is trying to make our own polystyrene nanoplastics that are realistic to inject into animal models.

What I’m doing is totally different from Deney – I’m studying the mechanisms surrounding Parkinson’s, Deney is more about drug and treatments – but that’s what’s cool about this lab – there are so many different people, all studying different things but coming together to elucidate Parkinson’s.

How much time do you spend in lab?

DL: I’m in lab Mondays, Wednesdays, and Fridays from 9 to 6. All my classes are on Tuesdays and Thursdays!

AF: I’m usually in lab Tuesdays and Thursdays from 12 to 4, Fridays from 9 to 11:45, and then whenever else I need to be.

Describe lab life in three words:

DL: Unexpected growth (can I just do two)?

AF: Rewarding, stimulating, eye-opening.

Lab life also entails goats and pumpkins

What’s one thing you like about lab work and one thing you hate?

DL: What I like about lab work is being able to trouble-shoot because it’s so satisfying. If I’m working on a big project, and a problem comes up, that forces me to be flexible and think on my toes. I have to utilize all the soft skills and thinking capabilities I’ve acquired in my 21 years of life and then apply them to what’s happening to the project. The adrenaline rush is fun! Something I don’t like is that there’s lots of uncertainty when it comes to lab work. It’s frustrating to not be able to solve all problems.

AF: I like how I’ve been able to learn so many technical skills, like cryosectioning. At first you think they’re repetitive, but they’re essential to doing experiments. A process may look easy, but there are technical things like how you hold your hand when you pipette that can make a difference in your results. Something I don’t like is how science can sometimes become people-centric and not focused on the quality of research. A lab is like a business – you have to be making money, getting your grants in – and while that’s life it’s also frustrating.

What do you want to do in the future post-Duke? How has research informed that?

DL: I want to do a Ph.D. in neuropharmacology. I’m really interested in research on neurodegeneration but also have been reading a lot about addiction. So I’ll either apply to graduate school this year or next year. My ultimate goal would be to get into the biotech startup sphere, but that’s more of a 30-years-down-the-road goal! Being in this lab has taught me a lot about the pros and cons of research, which I’m thankful for. Lab contradicts with my personality in some ways– I’m very spontaneous and flexible, but lab requires a schedule and regularity, and I like the fact that I’ve grown because of that.

AF: The future is so uncertain! I am currently pre-med, but want to take gap years, and I’m not quite sure what I want to do with them. Best case scenario is I go to London and study bioethics and the philosophy of medicine, which are two things I’m really interested in. They both influence how I think about science, medicine, and research in general. After medical school, though, I have been thinking a lot about doing palliative care. So if London doesn’t work out, I want to maybe work in hospice, and definitely wouldn’t be opposed to doing more research – but eventually, medical school.

What’s one thing about yourself right now that your younger, first-year self would be surprised to know?

DL: How well I take care of myself. I usually sleep eight hours a day, wake up to meditate in the mornings most days, listen to my podcasts… freshman-year-Deney survived on two hours of sleep and Redbull.

AF: Freshman year I had tons of expectations for myself and met them, and now I’m meeting my expectations less and less. Maybe that’s because I’m pushing myself in my expectations, or maybe because I’ve learned not to push myself that much in achieving them. I don’t necessarily sleep eight hours and meditate, but I am a little nicer to myself than I used to be, although I’m still working on it. Also, I didn’t face big failures before freshman year, but I’ve faced more now, and life is still okay. I’ve learned to believe that things work out.

Nursing’s Trial by Fire: COVID-19 and the Path Forward

By Vibhav Nandagiri

On October 12, 2022

In Medicine, Policy, Science Communication & Education

The list of professions that have been pushed to the brink during the pandemic is ever-expanding. However, the sea change that swept over nursing in the past three years rivals that of almost any occupation, said panelists in a Sept. 28 event hosted by Duke University School of Nursing.

Already one of the most overworked professions, the pandemic only seemed to magnify nursing’s enduring problems, according to panelist and journalist Lauren Hilgers. A few months into the pandemic, nurses around the country began quitting in droves due to both burnout and undervaluation by their employers. As the front lines dwindled, hospitals working at full capacity needed to meet patient demand by any means necessary.

Enter travel nursing agencies, independent staffing organizations that matched nurses from across the country with hospitals dealing with acute labor shortages. Already increasing in popularity in the lead-up to the pandemic, demand for travel nurses in recent times has exploded. As this fundamental change in the make-up of the nursing labor pool occurred, people started to take notice.

In February of 2022, an article was published in the New York Times titled “Nurses Have Finally Learned What They’re Worth”. In the piece, Hilgers chronicles the major trends in the nursing workforce over the past three years. Hilgers describes the unique proposition facing the nurses who chose not to quit: remain as a staff nurse on their current salaries or sign up with a traveling agency and uproot their lives, albeit for higher pay. And the pay bump was substantial. Certain travel nurse jobs paid up to $10,000 a week, many times what staff nurses were earning. These nurses would often stay at a hospital anywhere from a couple of weeks to months, providing much-needed relief to healthcare systems. However, as the practice spread, questions soon began to emerge about the disparities in pay between staff and travel nurses, the sustainability of travel nurse programs, and, moreover, how the American healthcare system enabled travel nursing to rise to such prominence in the first place?

These questions served as the foundation of the Dean’s Lecture Series event, “The Value & Importance of the Nursing Health Care Workforce for U.S. Health and Wellbeing”. Moderated by Dean Vincent Guilano-Ramos PhD, the event featured Hilgers alongside a panel of distinguished speakers including Solomon Barraza, CCRN, cardiac ICU nurse at Northwest Texas Hospital, Benjamin Smallheer, PhD, Associate Professor at the School of Nursing, and Carolina Tennyson, DNP, Assistant Professor at the School of Nursing.

From left to right: Solomon Barraza, Lauren Hilgers, Vincent Guilano-Ramos, Benjamin Smallheer, Carolina Tennyson. Photo by Andrew Buchanan.

“Nursing is the largest segment of the healthcare workforce…yet what we contribute to the health and wellbeing of our country is invisible,” mentioned Dean Ramos at the discussion’s outset.

Smalheer agreed, adding that nurses today are contributing to patient care in ways that were vastly outside of their scope of practice just twenty years ago. A unique combination of technical proficiency, aptitude during crisis response, and ability to provide feelings of care and comfort, Hilgers describes nursing as one of, if not the only, profession in healthcare that considers the “entirety of a patient.”

A frequently cited statistic during the panel presentation referenced results from a Gallup poll indicating that nursing was rated as the most trusted profession for the 20th year in a row. While nurses were always aware of their influence and worth, getting healthcare systems to agree proved to be a much larger effort, one that only grew in importance as COVID-19 progressed.

“The pandemic has hardened us,” explains Smallheer. No longer were nurses willing to tolerate slights against their treatment as a profession. And they had tolerated plenty. Barraza, one of the protagonists of Hilgers’ piece, described the relentless search for purpose amidst constant burnout, especially during the pandemic’s heaviest waves. From finding efficient triage methods during a surge of cases to celebrating patient discharges, Barraza actively sought out ways to be “consistent when there was no consistency.” A charge nurse located in a region with severe labor shortages, Barraza had seen the influx of travel nurses firsthand every week. What ultimately kept him from traveling across the country in the pursuit of a more lucrative job, however, was the relationships he had forged within the hospital. Nurses, students, patients-they had all left an indelible mark on Barraza and enabled him to push through the long and grueling hours. Tennyson reinforced Barraza’s story by claiming that “you can be burnt out and still find value in a profession.” This seemingly contradictory duality may have proved sufficient to retain nurses during the pandemic, but as for long-term solutions, the panelists agree that significant change must occur at a systemic level.

Hilgers (pictured right) spent months speaking to nurses around the country, including Barraza (pictured left). Photo by Andrew Buchanan.

One of the central tensions of Hilgers’ article is that between the hospital and the worker. The explosion of travel nursing during the pandemic was but a manifestation of decades of undervaluation by hospitals of nurses. In order to undo this narrative and enact concrete change, Tennyson argues that nurses must be represented in more interdisciplinary professional spaces, from healthcare administration to policy to business. Hilgers restates this idea more broadly, saying that nurses “need to have a seat at the table” in reshaping the healthcare system post-COVID-19.

Much of this work begins at the level of the educational institution. Smallheer and Tennyson spoke at length about how nurses can better be prepared to navigate the ever-changing healthcare workforce. They both highlighted a few of the Duke School of Nursing’s novel instructional methods, including early exposure to complicated patient cases, extensive practice with end-of-life scenarios, and recognition of overstimulation points in the field. Also important for nurses-in-training and existing nurses, according to all panelists, was collective action. Through supporting state and national nursing associations, writing to local politicians, and speaking to healthcare administrators, they argued that nurses will be better equipped to voice their demands.

Christine Siegler Pearson Building at Duke University School of Nursing

As the panel reached its closing stages, one of the main talking points centered around changing the narrative of nursing as solely a burnout profession. Hilgers in particular remains critical of the portrayal of nurses, and more broadly those involved in care work, in popular media. She strongly advocates for authentic storytelling that including the voices of actual nurses, nurses such as Barraza. Ramos describes Barraza as someone who “represent[s] the best in nursing,” and the panelists maintained a strong desire to see such stories of resilience and passion spotlighted more frequently.

There is no simple formula to reform the nursing profession in the United States. However, through a combination of effective storytelling, more current educational standards, greater interdisciplinary involvement, and collective action, the panelists of the Dean’s Lecture Series firmly believe that lasting change is possible.

Post by Vibhav Nandagiri, Class of 2025

Poetry and Pedagogy: The Push for Humanities Education in Medicine

By Vibhav Nandagiri

On March 16, 2022

In Art, Medicine, Science Communication & Education

“If language shapes inequitable systems, then their disruption relies in part on our ability to effectively wield language in subversive ways”
Dr. Irène Mathieu, MD

Dr. Mathieu reading from her award-winning 2017 book *orogeny*

Buried within a smattering of bullet points and data nuggets, these evocative words flashed across the slide deck of Dr. Irène Mathieu, MD. As Assistant Professor of Pediatrics at the University of Virginia School of Medicine and an award-winning poet, Mathieu thinks medical students could benefit from a stronger background in the humanities. Over the course of her guest lecture, “Playing Between the Lines: Poetry by a Pediatrician,” Mathieu dropped many such pieces of wisdom linking the study of language, and more broadly the humanities, with the practice of medicine. She shared this wisdom through a variety of methods, including original poetry, anecdotes from her life, and the latest research into the field of narrative medicine. The lecture was organized by the Trent Center for Bioethics, Humanities, and History of Medicine and hosted by Dr. Sneha Mantri, MD, MS, Assistant Professor of Neurology at Duke University School of Medicine.

Published in 2016 and co-authored by Dr. Charon, “The Principles and Practice of Narrative Medicine” is considered as one of the influential works in the field.

The field of narrative medicine, hardly twenty years old, can trace its roots to Columbia University, when a group of physicians and scholars, spearheaded by Dr. Rita Charon, MD, PhD, sought to change the discourse surrounding traditional medical training. Emphasizing various humanities-based approaches, narrative medicine seeks to increase the propensity of physicians to perceive strife, uncertainty, and complexity in the pursuit of caring for complex illnesses. In her discussion, Mathieu cited multiple studies that detail the positive impact of an exposure to the humanities on the empathy, wisdom, tolerance for ambiguity, and resistance to burnout in medical students. More recent studies have shown that narrative medicine experimental training programs have similar impacts.

Like many of her contemporaries, Mathieu sees the utility in narrative medicine to impact not only the personal lives of physicians, but also the systems in which they interact. By approaching treatment through the lens of narrative medicine, she believes that physicians can better reimagine health systems into more equitable entities. In her pursuit of greater health equity, Mathieu identified two concepts that every physician should strive to possess: structural competency and critical consciousness. Structural competency, a term coined by her colleagues in an influential 2014 paper, proposes a model of patient engagement that goes beyond the realm of cultural awareness and further into understanding upstream, systemic issues such as zoning laws, food delivery systems, and health insurance. Critical consciousness, the ability to recognize the inherent contradictions and inequities within society, complements the structural competency framework. By consistently engaging in critical reading and reasoning, future physicians will be better able to reflect on the “power, privilege, and the inequities embedded within social relationships”.

While Mathieu recognized the power of narrative medicine, she also acknowledged how poetry has never had its proper place within the prose-heavy field. In her eyes, however, incorporating poetry into narrative medicine frameworks makes a lot of sense. For one, it allows a deeper level of vulnerability and dynamicity that literary fiction and theory cannot provide. More practically, however, poetry tends to err on the shorter side of literature (Mathieu calls them “multisensory micro-stories”), offering a less time-consuming alternative for busy medical students and residents.

For most of Mathieu’s life, her passion for poetry and medicine developed on parallel tracks. It wasn’t until her undergraduate years that she began to think of poetry more externally and started to seek out opportunities for publication. Around the same time, through her work in various global health initiatives, she witnessed the power words and policy can possess over the healthcare needs of entire populations. She identified a need for a humanities education, replete with poetry and theory and fiction, as critical to increasing equity within the healthcare system. When Mathieu assumed her latest role at UVA, on the eve of publishing her third poetry collection, the critically acclaimed Grand Marronage, she was given the opportunity to integrate her poetry within the university medical curriculum. Today, Mathieu has a secondary appointment as Assistant Director of the Program in Health Humanities at UVA’s Center for Health Humanities and Ethics. The parallel pathways of her life had converged.

Mathieu’s three books: *the galaxy of origins* (2014), *orogeny* (2017), and *Grand Marronage* (2019)

As Mathieu revealed during her presentation, much of her poetry has little to do with her daily medical practice. Rather, she views poetry more along the lines of an escape. This escape takes the form of a critical reflection, by connecting the quotidian with themes of family and love, excess and presence. Mathieu’s poetry has the rare ability to walk readers through her complete narrative process, from the barest of sensory details to the ambiguities of emotion.

Perhaps there is no more fitting an ending to this article than an invitation to join Mathieu’s narrative world. After all, no amount of prose can substitute for a real poem. Below is a particularly striking excerpt of Mathieu’s artistry from the first stanza of her poem, “the forest fire of family trees”:

the problem is we don't know
that many ways of doing things
for instance, neither of us can
fry an egg without public radio
chattering in our ears, & there
are worse blueprints for a home,
like what my grandfather taught
my uncle. we think we know
people until we see the way
they eat a banana, totally unlike
how we peel and devour the fruit,
only instead of eating a banana
it's something way bigger,
like loving another person.

Post by Vibhav Nandagiri, Class of 2025

What are Healthcare Researchers Doing to Address Health Equity?

By Meghna Datta

On February 4, 2022

In Medicine

“Community engagement” and “health disparities” are some of the most trending terms in healthcare right now, but what are people actually doing about them? On Wednesday, February 2, panelists in healthcare sat down as part of Duke’s Research Week to talk about ways in which they and their organizations were actively addressing health disparities by focusing on communities. (View the session)

Dr. L. Ebony Boulware, professor at the Duke University School of Medicine and director of the Duke Clinical and Translational Science Institute, set the stage by defining health equity for the vast number of us that might only have read about it in a mission statement or an article but weren’t exactly sure how it was conceptualized. To work towards health equity, she said, means that “everyone has an opportunity to attain their full health potential regardless of any socially defined circumstance.” These circumstances could range from poverty to structural racism, but the main theme was that community engagement is a key player as we think about how best to achieve equity.

Slide taken from Dr. L. Ebony Boulware’s presentation.

COVID-19 is a great example of why health equity matters, as we ponder whether the pandemic could have turned out any different if more people had access to vaccines, personal protective equipment, and the capacity to socially distance. Dr. Michael Cohen-Wolkowiez, a professor of Pediatrics at the Duke University School of Medicine, and Dr. Giselle Corbie-Smith, a professor at the UNC School of Medicine gave a pertinent example of their work addressing the health disparity on our minds right now– access to COVID-19 testing – and the RADx program out of the NIH that is funding work to address this problem.

But even before COVID-19, attaining health equity was a tough goal to address for virtually every country in the world. Health equity isn’t just a nicety, it affects how long we are alive. And while progress in terms of life expectancy differences is improving, much work remains to be done to close the myriad gaps that remain. Dr. Tyson Brown, associate professor of Sociology at Duke, highlighted his research into structural racism to stress the fact that structural racism is toxic for population health and disproportionately affects people of color.

Slide taken from Dr. Tyson Brown’s presentation.

Dr. Schenita Davis Randolph, a registered nurse and professor at the Duke School of Nursing, zoomed in a little to highlight what true community engagement looks like. As part of her lab’s research to improve uptake of pre-exposure prophylaxis (PrEP) treatment to address HIV in Black women, they designed an intervention for beauty salons, known to be trusted venues for health promotion in the Black female community. But “how do we use community engagement so it’s not just a checkmark?” This, among other pressing challenges to community engagement in addressing health disparities, is what Dr. Keisha Bentley-Edwards, developmental psychologist and professor at the Duke University School of Medicine, talked about.

As the panel discussion came to a close, a key message emerged. As Dr. Davis remarked, both disparities and the communities that are hurt by them are complex, and so until we take a multi-faceted approach to understanding them, we continue to grasp for the ultimate goal of health equity.

But while these disparities are complex, they are certainly not unsolvable. Dr. Corbie-Smith emphasized that “we have a clear understanding of of how health disparities work.” All that’s left to do is solve them, and Dr. Bentley-Edwards highlights this move from awareness to solutions as a challenge to achieving health equity. Perhaps most significantly, though, it’s important to move from inertia to action. While there are seemingly thousands of ways in which communities in the U.S and around the world face barriers to health access, it’s important to do something – however small. As Dr. Bentley-Edwards concluded, by everyone working within their sphere of influence to close the health equity gap, that sphere becomes bigger and bigger and the gap becomes smaller and smaller.

LowCostomy: the Low-Cost Colostomy Bag for Africa

By Camila Cordero

On January 11, 2022

In Biology, Biomedical Engineering, Cancer, Engineering, Environment/Sustainability, Global Health, Medicine, Students

It’s common for a Pratt engineering student like me to be surrounded by incredible individuals who work hard on their revolutionary projects. I am always in awe when I speak to my peers about their designs and processes.

So, I couldn’t help but talk to sophomore Joanna Peng about her project: LowCostomy.

Rising from the EGR101 class during her freshman year, the project is about building a low-cost colostomy bag — a device that collects excrement outside the patient after they’ve had their colon removed in surgery. Her device is intended for use in under-resourced Sub-Saharan Africa.

“The rates in colorectal cancer are rising in Africa, making this a global health issue,” Peng says. “This is a project to promote health care equality.”

The solution? Multiple plastic bags with recycled cloth and water bottles attached, and a beeswax buffer.

“We had to meet two criteria: it had to be low cost; our max being five cents. And the second criteria was that it had to be environmentally friendly. We decided to make this bag out of recycled materials,” Peng says.

For now, the team’s device has succeeded in all of their testing phases. From using their professor’s dog feces for odor testing, to running around Duke with the device wrapped around them for stability testing, the team now look forward to improving their device and testing procedures.

“We are now looking into clinical testing with the beeswax buffer to see whether or not it truly is comfortable and doesn’t cause other health problems,” Peng explains.

_{Poster with details of the team’s testing and procedures}

Peng’s group have worked long hours on their design, which didn’t go unnoticed by the National Institutes of Health (NIH). Out of the five prizes they give to university students to continue their research, the NIH awarded Peng and her peers a $15,000 prize for cancer device building. She is planning to use the money on clinical testing to take a step closer to their goal of bringing their device to Africa.

Peng shows an example of the beeswax port buffer (above). The design team of Amy Guan, Alanna Manfredini, Joanna Peng, and Darienne Rogers (L-R).

“All of us are still fiercely passionate about this project, so I’m excited,” Peng says. “There have been very few teams that have gotten this far, so we are in this no-man’s land where we are on our own.”

She and her team continue with their research in their EGR102 class, working diligently so that their ideas can become a reality and help those in need.

Post by Camila Cordero, Class of 2025

The COVID-19 ‘Endgame’ Depends on Where You Live

By Meghna Datta

On October 20, 2021

In Business/Economics, Global Health, Medicine, Statistics

In February of 2020, no one could have fathomed that the very next month would usher in the COVID-19 pandemic – an era of global history that has (to date) resulted in 5 million deaths, 240 million cases, trillions of dollars lost, and the worsening of every inequality imaginable.

And while scientists and governments have worked together to make incredible advances in vaccine technology, access, and distribution, it goes without saying that there is more work to be done to finally put the pieces of an exhausted global society back together. On Tuesday, October 12^th, the Duke Global Health Institute (DGHI) brought together three leaders in global health to discuss what those next steps should be.

The panel discussion, which was moderated by Dr. Krishna Udayakumar of the DGHI, was titled “The COVID-19 Endgame: Where are we headed, and when will we get there?” The panelists were Dr. Ann Lindstrand, who is the World Health Organization’s unit head for the Essential Program on Immunization; Dr. Ayoade Alakija, who is the co-chair of the African Vaccine Delivery Alliance and founder of the Emergency Coordination Center in Nigeria; and Alberto Valenzuela, who is the Executive Director of the Pan American and Parapan American Games Legacy Project.

Dr. Lindstrand began by setting the stage and highlighting what are undoubted successes on a global level. 6.5 billion doses of the vaccine have been administered around the world, and the vaccines have impressive effectiveness given the speed with which they were developed. Yet undergirding all of this is the elephant in the room that, sitting in a 1^st-world country, we don’t think about: high-income countries have administered 32 times more doses per inhabitant compared to low-income countries.

This vaccine inequity has been exacerbated by already weak health security systems, vaccine nationalism, and lackluster political commitment. And while the WHO is slated to enormously ramp up supplies of vaccines in Q4 of 2021 and Q1 of 2022, it doesn’t mitigate the damage to the socioeconomic welfare of people that COVID-19 has already had. Dr. Lindstrand outlines the three waves of socioeconomic impact we will see, but expressed concern that “we’re already beginning to see the first wave pan out.”

Dr. Alakija took this discussion a step further, asserting that COVID-19 is poised to become the disease of low-income countries. “If you’re living in the US or EU,” she remarked, “You’re heading into the ‘Roaring 20s’. If you live in the Global South, COVID-19 is going to become your future.”

To this point, Dr. Alakija emphasized that the only reason this is the status quo is because in her eyes, the world failed to do what was right when it should have. In her home country of Nigeria, she highlighted that out of a population of 210 million people, 5.1 million people have received the vaccine – and of those 5.1 million, just 2 million — one percent — have been double-vaccinated. “It really is a case of keeping those down further down, while giving booster doses to those that have already been vaccinated,” she said. “We don’t have diagnostic data, so people are slipping underwater and the world has no idea.”

It’s worth noting that Nigeria houses some of the megacities of the world, not just in the African continent. So according to Dr. Alakija, “we don’t solve this with a medical lens, we solve this with a whole-of-society lens.” We must, she argued, because in an interconnected world, no one exists in isolation.

Alberto Valenzuela’s work is a great example of this. In 2019, his team led organizing efforts for the Pan American Games in Lima, relying on extensive partnerships between public organizations and corporations. In 2020, though, as the world shifted, the government called on the team to transition into something much different – COVID-19 relief efforts in the country.

The results are staggering. In just 5 weeks, the Pan American and Parapan American Games Legacy Project built 10 hospitals in 5 regions of the country. The implementation of 31 vaccination centers throughout the country resulted in a tripling of the number of people vaccinated per day in Lima. To him, this work “proves what’s possible when private and public sectors merge.” In other words, remarkable things happen when all of society tackles a societal issue.

So where do we go from here? Perhaps the biggest thing that stood out was the need to empower low-income countries to make decisions that are best for them. In Dr. Alakija’s words, “we need to lose the charity model in favor of a partnership model.” Dr. Lindstrand pointed out that there’s a deep know-how in the Global South of how to roll out mass-vaccination efforts – but only when we “lay down our organizational hats” can we move to what Dr. Lindstrand termed “more coordination and less confusion.” Valenzuela emphasized the need to integrate many sectors, not just healthcare, to mobilize the COVID-19 response in countries. But above all, Dr. Alakija said, “there will be no endgame until we have equity, inclusion, and health justice.”

Post by Meghna Datta, Class of 2023

The Duke Dentist and her Research: Saving Children’s Teeth, One Tooth at a Time

By Camila Cordero

On October 4, 2021

In Biology, Medicine

Walking into our small meeting room with green scrubs and a white lab coat on, our special guest set her bag down in the front and stated “I fixed 60 teeth today and haven’t sat down since this morning.” To us, it sounds like a nightmare, but to Dr. Martha Ann Keels, working in her clinic and conducting dental research is a dream come true.

Born and raised in North Carolina, Dr. Keels has kept her roots as she studied here at Duke. As a Duke undergrad, she received her bachelor’s degree in Chemistry and a minor in Art History, later choosing to become a pediatric dentist at UNC. It wasn’t long until she returned back to Duke to volunteer at Duke’s Children Hospital, and in 1986, she became the first pediatric dentist to get privileges to practice at Duke. She continues to run her own clinical practice alongside Duke Health System to this day, working for over 30 years!

“I get to feel the satisfaction that something I used my hands for helped alleviate pain in children,” Keels said. “I also get to watch them grow as they come in over the years. It feels super rewarding.”

With her passion and dedication, not only does she help those that enter her office, but she also conducts research on the side, wanting to help dentists all over.

Dr. Keels currently has her hands dirty with a major research project she has been working on for the past nine years. According to the National Institute of Dental and Craniofacial Research, 42% of children between the ages of two to eleven years old have at least one cavity in their primary teeth, and 23% of those children are untreated. With how high these numbers are, she and a group of other researchers are trying to develop tools that allow pediatricians and pediatric dentists to be able to identify high risk factors of cavities in children and care for them before they do occur; tools like questionnaires, surveys, and ‘top 5 predictors…’.

Table of percentages of children with cavities corresponding to age, sex, race, and poverty (National Institute of Dental and Craniofacial Research)

By observing a group of 1,300 children ever since birth, they have been analyzing all aspects of each child: collecting saliva, looking at biofilm (more commonly known as plaque), physical deformities in their teeth, and even social factors like parents’ dental experience.

Despite the children still being fairly young, Dr. Keels reveals that a surprising amount of information has been found. “No one has ever looked at tight teeth– when your teeth are closely spaced– but we are seeing that it puts a child at high risk of cavities,” Keels said. She also adds that they have also begun to identify which types of bacteria help with reducing chances of getting a cavity, as well as bacteria that bring a high risk of creating a cavity.

This also goes hand in hand with the microbiomes in our mouths. Dentists first believed that the microbiomes of the child’s caregiver affected the child’s microbiome, in the sense that their microbiomes would be similar from the beginning. Dr. Keels’s study says otherwise. It’s being shown that a child’s microbiome starts off as its own, unique microbiome, and it is over time that it begins to become similar to their caregiver’s microbiome.

With the vast amount of information already collected, Dr. Keels and her team continue to persevere, now wanting to push the study for another five more years. They want to start working with adolescents, wanting to also analyze mental states and how that might affect their dental hygiene and risks of cavities.

Maybe in the near future, as you speak to your dentist at your next appointment, and they bring up a list of risk factors for cavities, who knows? That list or table could be coming from the one and only Dr. Martha Ann Keels.

Post by Camila Cordero, Class of 2025

Trust-Building, Re-Visited History, and Time Pertinent to Achieve Health Equity for Black Americans

By Cydney Livingston

On September 1, 2021

In Cancer, Genetics/Genomics, Lecture, Medicine

Along with being a beautiful person and leading a productive life, Henrietta Lacks is the mother of modern medicine. Her scientific child was born without Henrietta’s consent through the clinical breakthroughs and medical miracles achieved with the help of her cervical cells – HeLa cells – stolen without her knowledge when she sought healthcare. Ironically, the same treatments developed from the cells of this Black woman are inaccessible for many Black Americans contemporarily. Though Ms. Lacks passed away from cervical cancer at the premature age of 31, her unique cells have become immortal. Her story lives on as a pertinent reminder of the importance of building trust between medicine and the Black community. In honor of her birthday, expert panelists met to both celebrate Ms. Lacks and discuss the path forward in trust-building, equity, and reckoning with our history to change the narrative of healthcare for Black Americans.

The panel honored Henrietta Lacks through discussion of the path forward for biomedical research and Black communities. The panel was hosted in August in remembrance of Ms. Lacks’ birthday on August 1st.

The panel, which took place on Tuesday, August 31, began as a conversation between Nadine Barrett (Ph.D.), Robert A. Winn (M.D.) and Vanessa B. Sheppard (Ph.D.). Among their many other titles and positions, Barrett is Director, Center for Equity in Research, Dukev CTSI and Associate Director of Equity, Community and Stakeholder Strategy, Duke Cancer Institute, Dr. Winn is the Director of the Virginia Commonwealth University (VCU) Massey Cancer Center, and Sheppard is the Associate Director of Community Outreach Engagement and Health Disparities at VCU Massey Cancer Center. The trio were joined by Reuben Warren (D.D.S., M.P.H., Dr. P.H., M.DIV.), Director of Tuskegee University’s Bioethics Center, along with a handful of other contributors including Veronica Robinson – Henrietta Lacks’ great-granddaughter and a registered nurse who represents the Lacks family on the NIH panel that reviews applications to conduct research using the HeLa genome.

A screenshot of panelists who took part in Tuesday’s conversation.

Winn began by referencing the U.S. 1932 public health service study that took place in Tuskegee, Alabama. The experiment exploited Black men in Tuskegee when an effective form of treatment for syphilis was discovered 15 years into the study but withheld from participants “to track the disease’s full progression.” In 1972, 40 years after the study began, it was the associated press, not the scientific community that finally led to the experiment’s demise and the issue of an apology from the U.S. President.

As Warren pointed out, the issue with the study was less about the treatment and more about the dishonesty, the falsifying information, and lies. “Stop calling them poor, stop calling them all sharecroppers,” Warren said of the Black men who participated in the study, “They were far more than that.” “[The study] was an issue of trust, not an issue of ignorance,” he continued. Unfortunately, when talking about this story, Winn said that Black Americans “don’t always talk about the power of us standing up and saying not again.”

Bioethics violations have been a continuous part of the biomedical research enterprise in the U.S., and race and racism have been part of scientific inquiry, which continues to be of great concern, Warren said. Often, rather than putting preventative protections in place, bioethics regulations have come as a reaction to extreme violations of justice. Thus, Warren laid out a central theme of the panel that “You build trust by making yourself trustworthy and that takes time.” Rather than initiating transactional research with Black communities when the scientific and medical community needs something, Warren offered that they should start when they want to help with something.

Dr. Rueben Warren presenting examples of bioethics violations in the history of biomedical research, with most examples stemming from the United States

As Sheppard said, “[Black people] have earned a mistrust” for medical communities. This is largely hinged on Barrett’s argument that the American systems from health to education to criminal justice “are working as they were designed” – to ensure that the very inequalities that exist today came to be. Using the analogy of a marathon, Barrett said while white men in the U.S. started the race 450 years ago, Black men and women only began running this race hundreds of years later. “Those who start the race are going to…ensure that they thrive,” Barrett said. This has led to Black people dying disproportionately from often treatable diseases, Sheppard said, continuing to add that these sorts of disparities were front and center for the world to see during the COVID-19 pandemic.

In the creation of our structural inequalities, the system created “two bookends: Black and white.” But there has to be a narrative that keeps this story alive. “In order to create the change, we have got to do the work to change the narrative,” said Barrett.

Nadine Barrett (Ph.D.), Director of Health Equity and Disparities at Duke Cancer Institute

Robinson pointed to the importance of history, paralleling Warren’s comments that in focusing on health equities we are fully focusing on the future in a way that ignores the past and does not deal with “what really brought us into health disparities” in the first place. Robinson said that we “can no longer sweep [conversations on the historical injustices of medical racism] under the rug.” She continued to say that the reason why Tuesday’s conversation and the ongoing dialogue that is sure to follow is so powerful is because “we are no longer victims in our own legacies” by taking over conversations at the table rather than being the topics of discussion at the table.

Mistrust in the Black community for systems of medicine and healthcare are based on hundreds of years of action. Hesitancy – from Covid-19 vaccinations to participation in clinical trials for cancer research – amongst Black Americans “aren’t us saying no,” said Robinson, “We’re saying something happened.” Sharon Ribera Sanchez, Founder-Director of Saving Pennies 4 A Cure, is a cancer survivor and advocate for people of color to engage in clinical trials because of the difference they can make in medical developments that draw on more diverse and robust data.

But there is a bigger conversation than just having more Black folks take place in research and clinical trials, Winn said. “How are you going to look at my biology without looking at my history?” he asked, referencing the genetic implications of environmental conditions and stressors from socially constructed race that impact DNA.

The dialogue, which was opened and closed with a prayer, also spoke to the importance of establishing regular, ongoing, transparent relationships between the Black faith community and the medical community. This should happen, not just in times of crisis, because “mass hysteria is prime for miscommunication,” Ralph Hodge, pastor of the Second Baptist Church in South Richmond, Virginia, said.

“Today was a big way of us looking back at the past, looking at where we are at now, and moving forward to the solutions,” said Barrett. This comes by letting communities know that we care, said Winn, along with “doing things with our communities, not through them.”

A key factor in deconstructing this issue and achieving health equity is time. Time to reflect on the past in order to avoid reliving it; time to generate innovative solutions to the problems at hand; and time to invest in Black communities – to learn from them, support them, and earn their trust not because they can offer science something, but because science has something to offer them.

The Diversity Problem in Science

By Meghna Datta

On February 1, 2021

In Medicine, Policy, Responsible Conduct

With COVID-19 being a fixture of our lives for nearly a year now, science has been a staple in the news. Along with science, though, a long-overdue conversation about the state of race relations in America has taken center stage, which makes diversity in science a critical topic to delve into. COVID-19 has highlighted not only a national crisis in healthcare response, but also longstanding health disparities across racial and socioeconomic groups that have only been exacerbated by the pandemic.

On Wednesday, January 27, Dr. Gowthami “Gow” Arepally, known for her work as Professor of Hematology at the Duke School of Medicine, led a talk called “The Diversity Problem in Science” that aimed to highlight not only the obvious problems in research but the urgency with which everyone, from the individual to the collective level, should aim to address the problem within their spheres of influence. Dr. Arepally is not only known for her work in the medical school but also as a valuable mentor for colleagues, undergraduates, and high school students — a point that was highlighted as an important way non-URM (under-represented minority) scientists can make a difference.

Underrepresentation in science starts early, Arepally says. For example, while discrepancies in graduation rates between Black/Hispanic students and their white/Asian peers are not bad in high school, they get progressively worse through college and beyond. In 2016, 18% of degrees nationally were awarded overall in STEM fields — but this number drops to 12% for Black students and 15% for Hispanic students. As of 2015, Black applicants have lower medical school acceptance rates than peer applicants – 34% versus 44% for their white counterparts. And the numbers get worse further into medical school; Black students and Hispanic students each represent less than 6% of medical school graduates, while a staggering 80% of graduates are either white or Asian.

This perpetuates a cycle going into the workforce that discourages young underrepresented minority (URM) students from entering STEM, seeing a lack of role models that look like them. As of 2016, only 39% of full-time faculty at medical schools were female, and a mere 4% of faculty were Black. This results in barriers to NIH research that further hold URM scientists back. Between 1999 and 2012, 72% of NIH awards were given to white scientists and 24% were given to Asian scientists, but only 2.4% of these awards were given to Black scientists.

This is a story that is shocking when told through statistics but is all too familiar, as an experience, for minority students and researchers interested in pursuing careers in the sciences. However, there are concrete ways to counter the problem. As Dr. Arepally pointed out, NIH Diversity Supplements for existing NIH grants can be obtained from the high school to faculty level as an added source of support for URM researchers. Medical societies themselves can be sources of diversity initiatives, such as Dr. Arepally’s society, the American Society of Hematology, which boasts one of the most aggressive minority recruitment initiatives. Within Duke, many pipeline programs exist for researchers to support URM students and new researchers and faculty.

Most importantly, it’s important for individuals to enact change on a personal level. Whether it means educating oneself on underrepresentation, advocating for the advancement of other URM trainees and colleagues, or committing to the success of URM students through pipeline programs, individual steps can add up.

And as Dr. Arepally highlighted, these steps, however small, are important to prioritize. Increasing diversity in medicine, for example, can help address existing health disparities. URM physicians are more likely to address the care of minority populations, while minority patients are more likely to choose URM populations. And the existence of more URM physicians improves the cultural competency of all trainees. Sex diversity, too, has a positive effect on the quality of science in collaborative groups. The impacts of diversity extend to role-modeling for younger students, who may be at a crossroads in terms of determining a future career. In this way, current measures to increase diversity can foster a cycle of more diverse students entering STEM and being supported there, for generations to come.

Diversity in science is not only good for science and scientists, Arepally says, but for all of us. Science should reflect the society it serves, and with more diversity in science, breakthroughs will be applicable and accessible to every person — not just the majority.

Post by Meghna Datta

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