23andMe

Genetic testing is a powerful diagnostic technique – and it’s getting cheaper as sequencing costs so much less than a decade ago.  But is it any good for prediction?

23andMe started back in 2006 and offered genetic testing, specifically SNP analysis* of certain parts of your genome.  All you had to do with send them some saliva, and $$$ of course.  In return, they sent you a list of diseases and genetic traits that you might be predisposed to.

Well, the FDA cracked down on them, for selling a medical product/service that wasn’t validated.  Over the past decade, 23andMe has worked hard to test its reliability for just a handful of genetic disorders and gotten them past the FDA.  They stopped giving health information and only gave customers the raw data for everything else.

I don’t particularly care to know what I’m genetically at risk for.  I can probably just tell my family history.  Besides, so many diseases are based more on environmental factors (like not exercising, eating crappy food, etc) that I question the accuracy of the results that 23andMe used to offer.  However, I do think it’s interesting that 23andMe is collaborating to conduct research studies**.

It is incredibly useful and powerful to be able to get sequencing data from a large group of people and try to find genes that are associated with disease.  I really hope this company goes more towards these types of efforts in the future!

*https://en.wikipedia.org/wiki/SNP_genotyping

**http://www.fiercebiotech.com/medtech/23andme-kicks-off-genetic-study-for-depression-bipolar-disorder

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Racism, politics, and more

Probably like everyone else in the U.S., I’ve been thinking about this topic a lot this week.

Racism is clearly still a problem here.  In big cities as well as small ones.  Across the entire country, not just in the South or former Confederate states.   You’ll find them of all ages.  All genders.  And I might even venture to say all races.  (I might get vitriol for saying this, but I don’t think minority communities are exempt from racist views).

So what do we do?  I’m not sure.  I’ve never been on the receiving end of such hateful remarks, but I imagine my classmates who are minorities probably have.  Do they just bite their tongues and leave when a patient refuses to be seen by them? Or do they stay and try to convince the patient that black/Asian/Hispanic doctors and medical students are just as competent?  I should probably ask them what they do.

I’m not convinced shaming racists, yelling at them and calling them derogatory names back is going to do anything to change their views.  If anything, it will solidify in their minds that they are right.  Calling all Republicans (whether or not they voted for Trump) racist/sexist/neo-nazi and white supremacist sympathizers isn’t going to endear them to the rest of us.  At the same time we can’t allow them to spew such hate towards a huge proportion of Americans.  We can’t condone their actions.

There’s a picture floating around the Internet of a young lady getting within inches of a young guy’s face and angrily flipping him off.  He’s holding a Confederate flag and looks away from her, cringing with almost a disgusted expression.  Is that the answer?  Maybe it would convince one or two young malleable minds to reconsider.  But I really really don’t think so.  I just wish I could come up with a better option.

Apathy

All the medical students in my class seem so excited.  About every rotation.  About every procedure.  About every new thing they see or learn on the wards.

I just can’t do it.  I can’t seem to feign interest in ob-gyn.  I can’t stand the OR. Quite honestly I can’t muster up enough energy to care about medical school right now.  Not even my grades.

Is it apathy? Boredom? Disinterest? I don’t know.

I don’t hate patients or anything like that.  I feel bad that they are in the hospital.  But beyond that I just can’t bring myself to care.  I hope they don’t feel like I’m cold-hearted or mistreating them.

On dragons

After watching Game of Thrones, dragons have been on my mind.  It’s really interesting how so many different cultures have dragons in their art or mythology.  They share many of the same features too!  Makes you wonder what animal they were basing their respective creatures on.  Here’s a few I found on the internet!

Drake_på_en_medeltida_vävnad,_Nordisk_familjebok

Dragon on medieval tapestry

 

Metal_dragon_half_frontal_view

Japanese dragon

 

Drachenbrunnen in Schleiz

Dragon fountain in Schleiz

 Images from Wikimedia Commons:

By Nordisk familjebok – Nordisk familjebok (1907), vol.6, p.816 [1], Public Domain, https://commons.wikimedia.org/w/index.php?curid=920625
By Chris 73 / Wikimedia Commons, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=600293
By Doris Antony, Berlin – Own work, GFDL, https://commons.wikimedia.org/w/index.php?curid=28553292

Marijuana legalization

I have believed for a long time that marijuana should be decriminalized.  Alcohol has far greater consequences, yet it is legal.  When was the last time you heard of someone high on weed punching a guy, getting in a car crash, or overdosing?  Sure it might happen, but definitely less often than with alcohol.

Marijuana-related crimes tend to be possession or distribution of the drug.  If we made marijuana legal, police could stop wasting resources arresting and jailing these people.  Instead, they can focus more or respond to violent crimes.  Furthermore, if the government made pot legal and taxed its purchase, they can use that money towards their budget deficits.  Let’s be honest.  How many cities or states have a surplus right now?

Impostor syndrome

According to Wikipedia, impostor syndrome is “a concept describing high-achieving individuals who are marked by an inability to internalize their accomplishments and a persistent fear of being exposed as a “fraud”.

Ever since I started medical school, I have felt this way.

It’s interesting because in college, I did well without much work or stress.  I figured I was coasting along since I picked easier classes, had some good luck, and relying on some kind of innate “talent” or “brains”.

That stopped as soon as medical school began.  Everyone else was so smart – they were at the top of their classes in college, learned much more quickly than me, and just knew everything.  Our grades were pass or fail, determined by a cutoff relative to the class average.  I was doing so poorly I thought I should just drop out and pick another profession.  One that I knew I could be good at.  The only reason that didn’t happen was because I couldn’t think of any.

Being diagnosed with bipolar disorder during medical school didn’t help.  Now it became more than just “what if they find out I’m not smart?? I don’t deserve to be here”.  Thoughts like “what if they found out I’m crazy too? Now they’ll really kick me out!” started entering my mind.

I know it’s all irrational.  I know it’s common.  I just wish I could make it go away.

Black Swan

No I’m not talking about the movie (which I absolutely loved!)

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I’m referring to the black swan events – events that are a surprise and have a major effect.  Unexpected outliers.  But ones that we try to rationalize away as something we could have predicted.

My therapist once had asked me what some of the black swan events in my life had been.  It caught me off guard, and I sputtered out something like getting into med school.  Of course the rest of the session ended up being about my poor self-esteem and impostor syndrome.

Later that day, I thought about it more and realized that perhaps the most important black swan was my diagnosis of bipolar disorder.

My initial episode was unfortunately a manic episode with some mixed features, which landed me in the hospital because no one knew what was going on and ended up with me having to take a leave from medical school.  Definitely a major disruption in my life.  Bipolar disorder isn’t super rare, but it certainly isn’t terribly common compared to depression.  Who knows what the stats are amongst medical professionals, because of course there’s plenty of stigma and no one’s going to admit to having bipolar disorder (or any other psychotic illness) in our field.  In retrospect, I probably was hypomanic in the weeks/months leading up to my diagnosis.  People just didn’t notice, because no one was looking for it.  You know, like a black swan.

I’m sure there are other examples in my life that I could find if I dug hard enough.  But I think the lesson is more that these events aren’t necessarily predictable, and will happen to everyone.  It only matters in how you respond to it.

image source: By Ing.Mgr.Jozef Kotulič – Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=1097939