WUHC March 2015 Newsletter

Wharton Undergraduate Healthcare Club

The Politics and Healthcare Issue

The Vaccine Debate

Page 4

Dr. Zeke Emanuel on Immortality

Page 8

Vaccines: Insights from Dr. Jonathan Moreno Page 9

Newsletter

March 2015

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Dear readers,

Welcome to the Wharton Undergraduate Healthcare Club Newsletter! This first edition of 2015 contains a lot of other new firsts. We are excited to introduce our first-‐themed issue: “Politics and Healthcare”; a lot has been going on in politics of late and we can’t wait to share them with you! We will strive to do our best to continue to keep you up-‐to-‐date on current events and health care, academic and professional opportunities, and opinions on trends of the future.

Check out our new regular features: news around Penn’s campus, insights from a faculty member, and a section on YOUR personal health. Let’s not forget that while you are all building the foundations for your future careers that will no doubt improve the health of many people, your own health, at this very moment, is important too!

Sincerely,

Nirupa Galagedera

Keep your health in CHECK

1. Breathe! Drop your pencil

or phone, close your eyes, and take a couple of deep breaths. We promise your Newsfeed will still be there in 20 seconds.

2. Have you made someone smile today? Chances are it’ll make you smile too. Get the good kind of contagion in your life.

3. Better yet, ask someone how his day is going...and actually listen to the answer. Enjoying a conversation can help relieve stress and being a good listener is a big part of that.

Letter from the Committee Chair

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The Medicine Precision Plan Initiative: A Step Towards Individualized Medicine?

By Puja Upadhyay

During this year’s State of the Union Address, President Obama introduced America to the Precision Medicine Initiative, a $215 million investment in the President’s 2016 Budget. The plan is focused on the concept of precision medicine, which aims to eliminate the “one-‐size-‐fits-‐all” approach towards disease prevention and treatment and instead incorporate individual differences according to people’s genes, environments, and lifestyles.

The plan has allocated its $215 million budget to four different organizations that will each focus on an individual area relating to the larger precision plan project:

1. $130 million to the National Institutes of Health (NIH) for development of a voluntary national research cohort of one million or more volunteers

2. $70 million to the National Cancer Institute (NCI), part of the NIH, to scale up efforts to identify genomic drivers in cancer and apply that knowledge in the development of more effective approaches to cancer treatment

3. $10 million to the Food and Drug Administration (FDA) to acquire additional expertise and advance the development of high quality, curated databases to support the regulatory structure needed to advance innovation in precision medicine and protect public health

4. $5 million to the National Coordinator for Health Information Technology (ONC) to support the development of interoperability standards and requirements that address privacy and enable secure exchange of data across systems.

"FACT SHEET: President Obama's Precision Medicine Initiative." The White House. The White House, 30 Jan. 2015. Web. <http://www.whitehouse.gov/the-‐press-‐office/2015/01/30/fact-‐sheet-‐president-‐obama-‐s-‐precision-‐medicine-‐initiative>.

One of the goals of this project, as demonstrated by the substantial $130 million share of the investment, is to create a national, patient-‐powered research bio bank that would contain medical records and genetic information for perhaps a million or more Americans. Instead of creating a new database of patients from scratch by enrolling new volunteers, the goal is to pull together existing studies into one giant database. Scientists and researchers could use the database for studies that could potentially find new disease-‐gene associations and eventually incorporate genomic and molecular information into routine medical care.

There are, however, opponents to several aspects of Obama’s Precision Medicine Initiative. Some have questioned whether it is feasible to combine medical records from various different sources, especially if crucial data is missing or if it was collected in different ways. Others question how useful the bio bank and the focus genomic medicine. Thus far, genomic medicine has been successful in areas such as finding genes for underlying rare diseases and treating cancer patients, but will it garner further discovery in other areas of medicine? Another criticism towards Obama’s plan points out that the funding for a project that hopes to revolutionize medicine is rather “underwhelming.” For example, the NIC, which will receive $70 million of the total $215 million, had a budget of $4.9 billion in 2014 (Forbes).

However, people in support of the new initiative explain that this is just the first step to a worthwhile project. National attention and federal funding, no matter how much, are huge steps in the field of precision medicine. Let’s hope the new initiative will aid in providing clinicians with the tools, knowledge, and treatments to treat their patients in the most effective manner.

Kaiser, Jocelyn. "Obama Precision Medicine Plan Would Create Huge U.S. Genetic Biobank." AAAS.org. American Association for the Advancement of Science, 29 Jan. 2015. Web. <http://news.sciencemag.org/biology/2015/01/obama-‐precision-‐medicine-‐plan-‐would-‐create-‐huge-‐u-‐s-‐genetic-‐biobank>.

Salisbury, Meredith. "Obama's Not-‐So-‐Daring Precision Medicine Plan." Forbes. Forbes Magazine, 5 Feb. 2015. Web. <http://www.forbes.com/sites/techonomy/2015/02/05/obamas-‐not-‐so-‐daring-‐precision-‐medicine-‐plan/>.

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The Vaccine Debate

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Pro By Didja Hilmara

Over the years, vaccines have saved millions of lives by preventing numerous cases of disease. Common illnesses of the 20th century including rubella, diphtheria, smallpox, polio, and whooping cough, are now prevented by vaccination. Firstly, it is important to understand the scientific basis of vaccines. Vaccines contain a weakened form of a particular disease that is then injected into the body. The body then produces antibodies, proteins that identify the foreign disease-‐causing substances, to fight off the disease. Should the disease ever attack the body in the future, the antibodies will return to fight them off. According to the Centers for Disease Control and Prevention, vaccines are generally safe; adverse reactions to them are significantly rare.

Anti By Mayher Uppal

The CDC’s mandate for certain vaccines causes a great deal of uproar among anti-‐vaccine activists. Although commonly overlooked by most vaccine users, many side effects of vaccines can be extremely harmful and cause various ailments. Some of the most common vaccines that employers and schools require of all their constituents contain serious side effects. The MMR (measles, mumps, and rubella) and dTAP (diphtheria, tetanus and pertussis) vaccines have been associated with seizures, coma, and permanent brain damage.

The claim with the most media coverage has been that vaccines cause autism, championed by celebrity mother Jenny McCarthy.

Feature

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Contrary to the belief of several anti-‐vaccination advocacy groups, there is no credible scientific correlation between vaccination and certain disorders.

Of especially great importance is ensuring vaccination for children. Childhood immunization helps to protect not only the vaccinated children, but also those individuals within a community who cannot be immunized due to age-‐related or other medical reasons. For example, if an unvaccinated child goes into the pediatrician’s office where there is an unvaccinated baby (since the baby fails to meet age-‐based criteria for immunizations), the baby is unfairly placed into harm’s way.

Immunization is also a cost-‐effective health tool because it limits the amount of unnecessary doctor’s visits, hospitalizations, and premature deaths that would occur to individuals not immune to vaccine-‐preventable diseases. Ultimately, vaccinations are an affordable and essential component to our overall health and that of future communities.

McCarthy has been extremely public with her warnings to parents against vaccinating their children, claiming that vaccines are linked to the onset of autism, OCD and ADHD. She has called for safer vaccines from vaccine companies that are made with less toxins. As it is, many vaccines contain aluminum and formaldehyde, both of which are extremely dangerous if excess amounts enter a person’s system.

In addition to the medical ramifications that result from government mandated vaccines, there have also been claims that they result in infringement on basic rights. Certain religions also oppose vaccination. This conflict between state mandated actions and religious preferences deeply angers many Americans. Some view that government mandates on what vaccines are required of its citizens is an invasion of privacy and personal medical choices. Opponents of the vaccinations feel that what happens to our bodies should be our choices.

Are the images on the previous page familiar?

Those political cartoons, as well as other as content, can be found on our blog at: http://wuhcpenn.org/category/blog/.

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Second Open Enrollment Period Comes to a Close By Edward Jing

The second Open Enrollment Period to sign up for a health insurance plan in the Marketplace opened on November 15, 2014 and ended on February 15, 2015. Some individuals were granted additional time if they qualified for special enrollment periods outside of the Open Enrollment Period. Alternatively, if they experienced “qualifying life events” — such as moving to a new state or experiencing certain changes in income or family size — they were also granted an extension.

During the second Open Enrollment Period, 11.4 million Americans signed up for a healthcare plan, with over a million people signing up in the last nine days, according to CQ Roll Call. On the final day, Department of Health and Human Services Secretary Sylvia Burwell said that “we had more consumers sign up that we’ve ever had, last year or this year.”

Continued on page 7…

Increased Research Funding By Jack Cahn

In 2008, the United States government cut federal research and development funding as part of across-‐the-‐board budget cuts caused by budget sequestration. As a result, universities

began to struggle with funding their research operations — especially given that federal funding typically plays a large role in financing research.

President Obama’s 2016 budget proposal seems to be moving in the opposite direction. It is redirecting funding towards research and development and will enable universities to spend more money on research and development initiatives.

In terms of funding for science and cutting edge-‐technologies, the budget provides the Department of Energy Office of Science with over $5.3 billion

and the National Science Foundation with over $7.7 billion. It also provides $755 million for the National Institute of Standards and Technology laboratories. The budget increases funding for these three agencies by $0.7 billion over last year’s levels.

http://physicsworld.com/cws/article/news/2009/oct/28/high-‐payoff-‐energy-‐research-‐receives-‐us-‐cash-‐boost

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For more information:

https://www.healthcare.gov/glossary/open-‐enrollment-‐period/

https://www.healthcare.gov/glossary/qualifying-‐life-‐event/

http://www.huffingtonpost.com/2015/02/20/obamacare-‐deadline-‐extension_n_6720496.html

http://www.huffingtonpost.com/2015/02/19/obamacare-‐deadline-‐extension_n_6709208.html

http://obamacarefacts.com/sign-‐ups/obamacare-‐enrollment-‐numbers/

http://www.gallup.com/poll/180425/uninsured-‐rate-‐sinks.aspx

Second Open Enrollment Period, continued from page 6

In a recent development, federal officials announced on February 20, 2015 that taxpayers facing fines for not being enrolled in a health insurance plan when they file their tax returns will be able to enroll in a Marketplace plan from March 15, 2015 to April 30, 2015. The extension, which helps taxpayers avoid the $95 per person fine, is designed to help cover more uninsured Americans and mitigate backlash, according to Jeffrey Young of the Huffington Post.

According to a January 7, 2015 Gallup Poll, the uninsured rate among U.S. adults for the fourth quarter of 2014 was 12.9%, down from 13.4% in the third quarter and 17.1% a year ago. In addition, the poll indicates that “the uninsured rate has dropped 4.2% since the Affordable Care Act’s requirement for Americans to have health insurance went into effect one year ago.”

Increased Research Funding, continued from page 6

Funding increases will also promote innovation in the United States. The Budget proposes $12.3 billion in spending on the Department of Defense’s Science & Technology program and invests $1.5 billion in the National Nanotechnology Initiative. These efforts will help spur growth in the growing fields of information security and nanotechnology, both of which are posed to be leading areas of research in the coming years.

Obama’s budget modifications will also have a profound effect on the community here at the Penn as well, specifically in the context of healthcare funding. Implementation of President’s Obama’s proposal would mean an additional $31.3 billion in support of biomedical research at the National Institute of Health. The NIH is one of Penn’s largest sources of funding. This funding proposal is a $1 billion dollar increases over 2015 funding levels.

Finally, Obama’s Budget invests over $3 billion in promoting STEM education. Taken as a whole, this budget proposal has the potential to greatly improve research and development initiatives at major research universities.

http://blog.ehealthinsurance.com/2013/03/when-‐is-‐the-‐new-‐health-‐reform-‐open-‐enrollment-‐period/

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On Penn’s Campus... Dr. Zeke Emanuel on Immortality

By Thomas Buckingham

On February 5th, Professor Ezekiel Emanuel was hosted by the Philomathean Society for a talk entitled the “American Obsession with Immortality: A Talk with Ezekiel Emanuel.” The talk centered on his latest article in The Atlantic, “Why I Hope to Die at 75.” Ezekiel Emanuel is the Vice Provost

for Global Initiatives, the Diane S. Levy and Robert M. Levy University Professor, and Chair of the Department of Medical

Ethics and Health Policy at the University of Pennsylvania. Outside of Penn he was the founding chair of the Department of Bioethics at the National Institutes of Health, in addition to serving as a Special Advisor on Health Policy to the Director of the Office of Management and Budget and National Economic Council. Dr. Emanuel’s talk focused on a discussion of the article and was opened up to questions by the audience.

Emanuel’s introduction of the concept of “hoping to die at 75” was mainly an assertion about the importance of quality over quantity. Emanuel talked about how “things fall apart” as people age more and more, both physically and mentally. He addressed the concern of many that lots of people over the age of 75 are happy, with an argument that as a person ages, they learn to be happy with smaller things and slower lives. He goes on to explain that happiness is not what we should be concerned about, but rather the contributions we make, and that by age 75, your ability to contribute is diminished. From there he cited a study that found that people peak twenty years into their career, and then begin to decline. He stressed that by setting the end of his life at 75, he could realistically work to accomplish all of the contributions he wants to make within that timeframe.

Emanuel admitted that 75 was chosen “mildly out of the air” but gave statistics on the prevalence of Alzheimer’s disease, particularly that one in three Americans over 85 have the disease, in order to justify the number. With this he has created a self-‐imposed deadline as opposed to accepting one set by others. With deadlines people are prone to procrastinate, however, he discussed how this sets up a timeline for him to make the contributions he wants to leave behind. After this he opened the talk up to discussion to questions from the audience. The questions ranged from his opinion euthanasia to how he came to write the article for The Atlantic. The talk, arranged by the Philomathean Society, was a highly engaging look into the opinion of a Penn professor who has helped shape the American healthcare system.

http://www.ezekielemanuel.com

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The Vaccine Debate: Insights from Professor Jonathan Moreno By Nirupa Galagedera

Dr. Jonathan Moreno is one of fifteen Penn Integrates Knowledge professors and a David and Lyn Silfen Professor of Medical Ethics and Health Policy, History and Sociology of Science, and Philosophy. He has served on numerous bioethics commissions at the national and international level, and was a member of President Barack Obama’s 2008 transition team. The American Journal of Bioethics has called him “the quietly most interesting bioethicist of our time.” Read on as we add his expertise to the growing debate on vaccines.

As with most issues pertaining to medicine, science, and technology, the discussion surrounding whether or not to vaccinate a child is not far removed from the core principles of bioethics. According to Dr. Moreno, beneficence is the bioethical principle of most relevance to the vaccine dilemma. Beneficence, the principle of providing benefits for others (including preventing harm), is a key factor people must take into consideration in regard to vaccines. While some parents attest to their right to make individual choices in their own lives, as well as in their children’s lives, Dr. Moreno points out that many do not fully understand how far reaching the consequences of their decisions are.

He says the “majority attempting to protect the minority” is a driving factor for pro-‐vaccination proponents. For immunity to be reached, approximately 90% of the pertinent population must comply with immunizations for optimal effectiveness.

He argues that upholding the principle of beneficence does not necessarily imply that respect for autonomy must be sacrificed. Incentives, as long as they include options and thus are free from suggestions of coercion, may be a necessary public policy tool.

In recent times, especially after the implementation of the Affordable Care Act, many professionals have questioned if the allocation of resources spent on prevention versus those spent on treatment will be altered. Dr. Moreno notes that vaccines are both prevention and treatment, and thus will continue to play a role in health care policy debates.

“People simply forget what it’s like to have epidemics today,” Dr. Moreno states. The generational gap has spurred part of the growing divide between the two sides. This rift in views partially stems from the fact that older generations can recall a time, or are at least less removed from the time, when vaccines were lauded as the primary means of epidemic control.

Continued on page 10…

http://www.jonathandmoreno.com

Faculty Interview

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Dr. Moreno, continued from page 9

As recently as the 1990s, the public became increasingly aware of multiple drug resistant tuberculosis (TB) and HIV. Even in the present time, measles is more prevalent than many choose to believe. According to the Centers for Disease Control, approximately 170 cases of measles were reported in the United States in the first two months of 2015, a statistic just shy from the total number of cases for all of 2013.

Globalization increases the need for effective disease control. Dr. Moreno points out that whereas in past when disease transmission may have taken 7-‐8 days,

What are your plans for this summer? I will be working at the lab that I worked at last summer. It is an anesthesiology lab in the Med School (PI: Roderic Eckenhoff). I actually love talking about anesthesiology because it is so cool. When patients go under general anesthetics, we know it will work and they will come out alive, but we don’t actually know any of the molecular mechanisms behind how it works. We design derivatives of the anesthetics that will attach to proteins in the brain and fluoresce. That way we can actually isolate the different chemical mechanisms behind how anesthetics work. How did you find this job? I was actually just looking through lab jobs online. My advice for people looking to get involved in research is to not be afraid to just cold email a PI. Sometimes it just works out. What’s your favorite part about being on the Corporate Relations committee? The opportunity to reach out to other companies and startups.

I think start ups are really cool because they have unique challenges: how to build up a, workforce, how to stay focused, how to make a business plan and how to restructure that business plan. I am really excited about a corporate dinner with Tower Health, a startup that makes automated pill trays to help patients keep track of all the pills they need to take.

Favorite healthcare related class at Penn? BIOE575: Health Policy: Health Care Reform and the Future of the American Health System with Zeke Emanuel and Sandy Schwartz. I wanted to have a general idea of healthcare reform and health policy. It’s actually interesting because I also took ECON001 with Rebecca Stein and she is all about health economics. I went to a Rodin 24 session that she gave and she had a very different perspective than Zeke because she is more about equity and efficiency and she is more theoretical while Zeke is more practical. What do you think are the most interesting or innovative ideas in health care today? I would say anything that has to do with startups doing very niche things, solving little problems that are actually a very big deal that will end up saving the system a lot of money. Things like Tower Health’s pill tray or other home medical devices that will help the elderly connect to their family and nurses.

WUHC Spotlight

that timeframe has been dramatically reduced to perhaps 7-‐8 hours. To combat global health crises of hemorrhagic viruses, which affect multiple organ systems including the cardiovascular system and most notably include Ebola, positive change cannot be fully realized until the modern ICU and contact tracing are implemented in all corners of the globe. The role of the media, as either an informant or sensation-‐builder, cannot be forgotten either. The vaccine debate requires numerous bioethical considerations, and it is only a matter of time before the next pressing issue in public health pulls the attention of healthcare providers, politicians, and scientists alike.

By Jane Xiao Name: Gourab Sarker WUHC Committee: Corporate Relations Class/School/Major: SAS 2017, Biochemistry and Economics

Documents

WUHC March 2015 Newsletter