When I was in medical school at the University of Utah, I made it a point to read all of the books written by Dostoyevsky, Tolstoi, Henry Miller, Victor Hugo, and Asimov. I also read The Rise and Fall of the Third Reich. I went to the library on lower campus to check out the reel-to-reel PBS documentary on WWII. It became a ritual to feed the tape/film through the projector. I was disappointed that medical school was turning me into an ATM machine to put out drugs after pressing diagnostic buttons. I naively believed a doctor should be a renaissance person, and that literature would make me a better doctor. This is why read with delight the article below. I hope you enjoy it, too.
Hugo Rodier, MD
As programs face cuts, the U. wants a new ‘medical humanities’ degree they say could help train better doctors
The program would focus on bioethics, art and literature as tools to train empathetic caregivers. By COURTNEY TANNER | The Salt Lake Tribune December 31, 2024
“Literature is filled with examples of all sorts of doctors: Dr. Jekyll, Dr. Frankenstein, Dr. Faustus, Dr. Zhivago, even Dr. Dolittle. And it turns out that reading those books — and the study of humanities in general — can be instructive for real doctors, too. At least that’s the kind of the thinking behind a new program being pitched at the University of Utah. Two professors at the U. are pushing for the school to launch a bachelor’s degree called “medical humanities,” where students who want to go to into the medical field will study the classics of writing, the arts, philosophy and ethics — all with the intention of making them better, more holistic health care providers. “If you think of health care as humans giving care to humans, you need to think of the humans in that equation,” said Gretchen Case, the director of the U.’s longstanding Center for Health Ethics, Arts, and Humanities, as she pitched the new program to the school’s Academic Senate earlier this month.
“The health and ethics center has existed at the state’s flagship institution with various name changes but a singular mission since 1989. It is focused on bringing insights from the humanities and arts into the medical world of science, an intersection that Case sees as natural and beneficial, teaching healers to act with compassion, according to the center’s mission statement. The U. already has a minor in medical humanities; it also is currently the only traditional public university in the state with an associated medical school. Now, Case said, she would like to see the program expanded into a full degree for students to major in to train the next generation of doctors. “Softer skills, like close reading, analyzing a text, listening, asking questions, connecting with people, she said, are often developed in the humanities classroom. And they go a long way in building a foundation for health professionals, along with the science they learn in chemistry or biology, when working with patients with complex illnesses. That includes telling someone they have a life-changing diagnosis, studying a patient’s symptoms, thinking creatively about how to treat an illness and generally communicating with kindness. Essentially, viewing an X-ray uses the same skills as interpreting art.
“A degree would include classes on bioethics (the ethics of medicine and biological research), studies on human nature, examinations into bias and a look into art. This year, for example, Case taught a class titled “Art in Medicine/Medicine in Art,” and one of her students created artwork on a physician’s white coat. Sydney Cheek-O’Donnell, a theater professor, has also worked on a research project using theatrical techniques to improve nonverbal communication with health care patients.
“The hope would be to start the program in fall 2025, as a collaboration between the Department of Philosophy and College of Humanities. It passed unanimously in the Academic Senate, though it will still require final approval from both the U.’s board of trustees and the greater Utah System of Higher Education. It comes at a difficult time for higher education in Utah, with schools tasked by state lawmakers to make cuts to “inefficient” programs. There are fears that that means the liberal arts will be targeted for elimination; expanding with a new major now is a risk. “But Jim Tabery, the other professor overseeing the new degree, said there is demand for it in Utah, which doesn’t have any school offering degrees in this field while roughly 130 universities nationwide do, mostly on the East Coast. That includes medical humanities programs at Harvard University, the University of Chicago, Brown University, Rice University, Northeastern University and more. “The Intermountain West is a desert in this field,” Tabery said. But across the county, “these degrees are going up exponentially in the last 10 to 20 years.” He also sees it as a narrative against cutting the liberal arts, showing that those studies have an important place in all careers — including in the high-demand medical field. And it’s a way to make a degree that is interdisciplinary and collaborative across several departments. In his job, Tabery is the perfect example of someone with a career that crosses both fields, working in both the Department of Philosophy and the Department of Internal Medicine. He examines the debate around genetics, including the use of DNA results in the criminal justice system and who has been harmed by genetic research. Tabery believes the new degree would help give students an edge in applying to medical school, particularly if they pair it with a traditional science degree. “It makes for an extremely attractive candidate.”
“Case, who has sat on the admissions committee for the U.’s medical school, said the people who review applications are “absolutely” looking for humanities degrees and see those as a positive. Those studies show the committee, she said, that students can think and adapt, be empathetic and work well with people. At some point, she said, the arts and humanities were divorced from the clinical and science skills necessary to be a doctor. But she says that was a detriment. And in the 1970s, researchers in the U.S. started trying to bring them back together with medical humanities programs. Katharine Coles, one of the members of the U.’s Academic Senate and a renowned poet, said she has sent poetry students to medical school who have done exceptionally well and made for caring doctors. There is no reason doctors can’t have heart and love good literature; they should be warm and welcoming. “This is great,” Coles said during the discussion. “I’m delighted that you’re doing it.”
“Currently, the program has received dozens of letters of support from faculty willing to teach classes, Tabery said. He also noted the degree applies to students who don’t want to be doctors necessarily, but who want to work in the medical field as communicators, journalists, researchers or maybe the next novelist to create a famous doctor character.”
The liver converts fructose into lipids to fuel tumors.
- Nature 04 December 2024
“Fructose aids tumor growth, but cancer cells usually lack the enzymes needed to metabolize this sugar. The liver converts dietary fructose to lipids that enter the blood, and cancer cells use the lipids to make membranes for proliferation. It is well established that tumor cells consume more of the sugar glucose than do non-proliferating normal cells, a phenomenon known as the Warburg effect. Another sugar, fructose… is an alternative potential fuel for tumor growth.”
Comment: Dr. Warburg won the Nobel Prize in 1931 for this work.
Endothelial inflammation in COVID-19
Disrupted endothelial function underlies the multiorgan complications of COVID-19
J. Science 28 Nov 2024, Vol 386, Issue 6725, pp. 972-973
“The vascular endothelium forms a crucial interface between tissues and the blood stream and maintains normal blood flow. In its homeostatic state, the endothelium resists blood clotting, vasoconstriction, and inflammation and maintains selective barrier functions. This tightly regulated suite of properties can shift rapidly to unleash a series of functions vital to stanch blood loss from wounds or mobilize innate and adaptive immune defenses to repair injury and fight pathogenic microorganisms. But endothelial cells can, if overexuberant, aggravate disease. Infection with severe acute respiratory syndrome coronavirus 2 has highlighted how altered endothelial functions contribute to multiorgan health effects during the acute phase of COVID-19 and potentially to the longer-term consequences associated with Long Covid.”
Comment: try taking arginine and beet juice to improve endothelial function. Get off processed foods and fix your microbiome. The latter imbalance led to Long Covid.
Lifestyle interventions for cardiometabolic health
J. Nature Medicine volume 30, pages 3455–3467 (2024)
“Unhealthy lifestyle behaviors such as poor diets and physical inactivity account for most of the cardiometabolic disease (CMD) burden, including type 2 diabetes and cardiovascular diseases. Much of this burden is mediated by the effects of unhealthy lifestyle behaviors on overweight and obesity, and disproportionally impacts certain population groups—including those from disadvantaged socioeconomic backgrounds. Combined lifestyle interventions (CLIs) have the potential to prevent CMD, but their implementation, reach and effectiveness in routine practice are often limited. Considering the increasing availability of effective but expensive pharmaceutical options for weight loss, we review the short-term and long-term benefits and cost-effectiveness of CLIs on overweight, obesity and associated CMDs, in controlled studies and in routine care. We discuss the effective components of CLIs and the many challenges associated with implementing them and outline future directions for research and implications for policy and practice to improve lifestyle behaviors and cardiometabolic health at the population level.”
Comment: The American Heart Association has advised to try TLC first, before medications. Tender Loving Care as discussed above? No, but it would help, too. They meant “Therapeutic Lifestyle Changes.”
A core microbiome signature as an indicator of health
J. Cell Volume 187, Issue 23, p6550-6565.e11November 14, 2024
“The gut microbiota is crucial for human health, functioning as a complex adaptive system akin to a vital organ. To identify core health-relevant gut microbes, we followed the systems biology tenet that stable relationships signify core components. By analyzing metagenomic datasets from a high-fiber dietary intervention in type 2 diabetes and 26 case-control studies across 15 diseases, we identified a set of stably correlated genome pairs within co-abundance networks perturbed by dietary interventions and diseases. These genomes formed a “two competing guilds” (TCGs) model, with one guild specialized in fiber fermentation and butyrate production and the other characterized by virulence and antibiotic resistance. Our random forest models successfully distinguished cases from controls across multiple diseases and predicted immunotherapy outcomes through the use of these genomes. Our guild-based approach, which is genome specific, database independent, and interaction focused, identifies a core microbiome signature that serves as a holistic health indicator and a potential common target for health enhancement.”
Comment: all health problems improve when we rebalance our microbiome.
Dietary-timing-induced gut microbiota diurnal oscillations modulate inflammatory rhythms in rheumatoid arthritis
J. Cell Metabolism Volume 36, Issue 11p2367-2382.e, 5November 5, 2024
“Rheumatoid arthritis (RA) is a chronic autoimmune condition characterized by inflammatory activity with distinct rhythmic fluctuations. However, the precise mechanisms governing these inflammatory rhythms remain elusive. Here, we explore the interaction between dietary patterns, gut microbiota diurnal oscillations, and the rhythmicity of RA in both collagen-induced arthritis (CIA) mice and patients with RA and highlight the significance of dietary timing in modulating RA inflammatory rhythms linked to gut microbiota. Specifically, we discovered that Parabacteroides distasonis uses β-glucosidase to release glycitein from the diet in response to daily nutritional cues, influencing RA inflammatory rhythms. We validated the daily fluctuations of P. distasonis-β-GC-GLY in patients with RA. These findings underscore the crucial role of dietary timing in RA rhythmicity and propose potential clinical implications for novel therapeutic strategies to alleviate arthritis.”
Comment: I wrote a book about my experience improving all rheumatoid conditions by rebalancing the microbiome after I cured myself of Ankylosing Spondylitis. See below.
Increased fiber intake reduces rheumatoid arthritis risk
Healio Minute, March 12, 2024
“Individuals with higher cereal fiber intake are less likely to develop rheumatoid arthritis, according to data published in Nature Scientific Reports. The researchers additionally concluded that the Dietary Inflammatory Index score is a “crucial intermediary” in this relationship, highlighting the role of diet in preventing and managing RA.”
Comment: fiber, a prebiotic, feeds our microbiome.
