Fall 2012

StethoscoopOrgans: What Money Can, But Should Not, BuyWhat They Forgot to Teach Pre-Med StudentsSo You Want to be an MD... Then What?From Pills to Medical CareEating Disorders and Medical CareCan Female Doctors Really ‘Have It All’?

Cornell Pre-Medical Society

THE

CORNELL UNIVERSITY

StethOSCOOPthe

The StethoSCOOP is brought to you by the Cornell Pre-Medical Society’s Publication Committee. The StethoSCOOP’s mission is simple: To educate

pre-med students at Cornell with relevant issues, news, and events that will allow each of them to be a fully-fledged medical student and

physician. The Cornell Pre-Medical Society aims to be the hub of all things pre-med on Cornell University’s campus, as well as to promote the

union of all pre-medical student organizations on campus.

Editor-in-Chief: Vanessa Canosa

Layout Editor: Darwin Chan

Assistant Layout Editor: Ann Lei

Editors: Rachel ChuangDevon McMahonAriel Wampler

Writers:Erin BarlowRachel ChuangSachidhanand JayakumarAnn LeiDevon McMahonAriel Wampler

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What They

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Organs: What Money Can, but Should Not, Buy

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Organs What Money Can, but Should Not, Buy

A brilliant transplant surgeon has five patients, each in dire need of a different organ. Unfortunately, there are no organs available to perform any of these five transplant operations. A healthy young traveler comes in for a routine checkup. In the course of doing the checkup, the doctor discovers that his organs are compatible with all five of his dying patients. Suppose further that if the young man were to disappear, no one would suspect the doctor. Should the surgeon harvest the young man’s organs, ending his life in order that the other five patients may live?

By: Ariel Wampler

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This dilemma is sometimes posed in classes concerning medical ethics or moral psychology. An identical situation, of course, is rare or nonexistent in the real world. A doctor would have to perform many more tests to discover tissue compatibility, and the young man’s death would probably be noticed. But beneath the surface of this thought experiment lies a very real issue: limited availability of organs for transplant. Organized crime groups around the world have been implicated in organ trafficking, the practice of illegally obtaining and/or selling organs for transplantation. A 2010 report released by the World Health Organization (WHO) revealed that at least one organ is sold on the black market every hour. These suppliers are able to stay in business because demand is high: in the US alone, more than 114,000 people are waiting for organ transplants, and 18 people die every day because they did not receive an organ in time. The largest black market is for kidneys. Another troubling trend is that, even as organ transplant surgeries become safer and more successful, the number of donations is falling.

Transplant is a difficult and highly emotional issue, since it may involve the choice between ending one person’s life, and denying another person the chance to live. Once a choice has been made, there is no going back.

Some economists, ethicists, and scientists who examine this issue believe that the organ shortage, as well as the criminal activities of organ-harvesting rings, could be ameliorated by instituting a legal market for organs. Especially in the case of kidneys, where every person has two kidneys, but only needs one functioning kidney to stay healthy, they argue that both the seller and buyer of a kidney would be better off. Would establishing a legal market in organs be the “right” thing to do?

It may be true that with a legal market in place, more people who needed organs would receive them, but such a system would likely exploit poor populations. For a healthy person struggling to meet his or her expenses,

receiving a few thousand dollars for a kidney or a liver lobe could seem like a good idea, but what would happen 10 or 20 years down the road, if her remaining kidney unexpectedly failed…or if he contracted Hepatitis C, and the disease destroyed most of his liver? These people would then need a transplant and, unable to afford an organ for themselves on the new market, they would be left without recourse.

Exploitation of poor individuals who are already selling their organs out of desperation is rampant – whether they are approached by members of organized crime with false offers of compensation, or wealthy patients whose offers are simply too compelling to refuse. Additionally, unless this market were sufficiently regulated, it is likely that poor sellers may not receive all of the information which they need in order to provide informed consent for the procedure. If hospitals or doctors were allowed to share in the deal, a powerful conflict of interests could arise, and people could be duped into selling even if it was not in the best interests of their health.

If a legal market is not the answer, what can be done about the dire organ shortage? First, the US could follow the lead of countries such as Spain and Austria who have a “presumed consent” system for organ donation upon death. Currently, in the U.S. one must actively and explicitly provide consent to be a donor after death, while in countries with the aforementioned “opt out” systems, anyone who has not explicitly refused is a potential donor. A systematic review examining 26 studies and surveys published in 2008 suggested that a presumed consent system could increase the number of people on the donor registry.

Second, financial incentives (short of a market) for living donors – people who donate organs or parts of organs that are not necessary to sustain life and health – could be established. For example, the government could institute a deduction, similar to the charitable giving tax deduction, or an income tax credit to those generous enough to donate an organ. Such a system would not place a disproportionate burden

on poor and desperate individuals to be the organ providers, since people with higher incomes would receive more compensation (tax relief) for their donation.

Third, economic disincentives for organ donation could be offset. Insurance companies could be required to cover some or all transplant-related medical costs (many currently do not). Donors could be compensated for the income lost from the days taken off after the procedure. Additionally, potential donors could receive a guarantee that they would not lose their future insurance eligibility. When trying to encourage altruistic behavior, weakening the sentiment that “no good deed goes unpunished” can go a long way.

A parting thought on the issue: the largest slice of the organ transplant “pie” is in kidneys, and most of the need for kidney donations stems from patients with complications due to high blood pressure and diabetes. There will always be some patients with rare medical conditions whose only option, beginning at diagnosis, is transplant. But high blood pressure and diabetes are preventable conditions, and there are few, if any, good excuses for patients with these conditions to get so ill that they require a transplant. If transplants remain relatively rare, an incentive for people to stay healthy or carefully manage their chronic conditions would remain in place. Organ transplant is an intensive, costly procedure and an acute, rather than preventive, treatment option. Therefore, making transplant a less common occurrence through preventative medicine should be a top priority. If you, the aspiring medical professional, are ever asked to weigh in on a relevant policy proposal, please commit to ensuring that precious resources are not squandered, and to upholding the dignity and safety of all people.

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ForgotBy: Rachel

Chuang

As a freshman embarking on the pre-med track, I have heard a myriad of opinions ranging from “it’s really not that bad,” to “it’s ridiculously competitive.” Horror stories about the underhanded sabotage and competition between students have been told and retold. Yet, one general consensus has risen above the rest, one that has been repeated over and over again--Organic Chemistry is death.

what they

tudentsto teach pre-medS5

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Though this class may be the bane of every pre-med student, there must be a higher purpose to Organic Chemistry than the problem sets due next week. Why do we have to take courses like Organic Chemistry and General Physics that explore the highly specific and molecular levels of science? Are these classes actually applicable to the careers of medical practitioners?

Dr. Richard Chen, an internist practicing in Virginia, shares his perspective on these questions: “We MDs like to claim that we’re science-based, as opposed to, say, chiropractic where the spine is the immutable root of all pathology. Having a basic science background is useful... former colleagues without a science degree [have] less of a better grasp of certain concepts.” Medicine and science are very closely related, and often build on each other to enhance understanding of disease processes and develop novel treatments. Professor Chad Lewis, who teaches CHEM 3590 (Honors Organic Chemistry I) at Cornell, elaborates, “Organic chemistry is essential to understanding human health, and future medical progress continues to rely upon the design and application of molecular probes and drugs. The absence of fundamental knowledge of organic chemistry will excise an important aspect of the underlying molecular mechanisms of life.”

However, concerns have also been raised about the strict requirements necessary for medical school. Some have criticized the lack of emphasis on human biology in the myriad of required courses for medical school. Furthermore, several experts believe that the requirements themselves have not changed significantly since Abraham Flexner’s “Medical Education in the United States and Canada” paper was published in 1910, yet the scientific discoveries that have occurred since then, including the integration of genomics and DNA sequencing, are staggering both in number and in their effects on the research field. It would be reasonable to take these factors into account when constructing the pre-med curriculum.

A report published in 2009 by the Howard Hughes Medical Institute and the Association of American Medical Colleges, entitled “Scientific Foundations of Future Physicians,” outlines potential solutions. Rather than required courses, the report places a greater emphasis on “scientific competencies” in general areas. For the chemistry- and physics-related competency portion, the document states, “Apply major principles of physics and chemistry to explain normal biology, the pathobiology of significant diseases, and the mechanism of action of major technologies used in the prevention, diagnosis, and treatment of disease.” The hope is that these broader outlines will encourage both the universities to restructure their courses, and pre-med students to take more interdisciplinary courses.

The competencies would expand the application of college course content to the medical field. College classes should not only serve to increase the knowledge of a student but also broaden their perspectives and teach them

how to learn. Professor Lewis agrees with this idea: “The most important attribute that a Cornell student can gain is creative and critical thinking.” The aforementioned report emphasizes both a strong understanding of the material necessary to be a doctor and the ability to communicate effectively with patients. Dr. Chen concurs, “The challenge [of being a doctor] is to be able to analyze new data critically, then to implement the findings and convey it to a patient effectively.”

As evidenced by the format of the new 2015 MCAT, it is clear that these concerns have already been acknowledged. The requirements for medical school should reflect novel scientific advances. Regarding these requirements, ophthalmologist Dr. Soheila Rostami says, “I believe there are many things that we really don’t get exposed to during medical school. For example, many of us become practicing physicians and, as you know, that is a business as well. Many of us are so naïve, when it comes to the business side of medicine. We need to add this to the requirements in med school.”

The proposed educational reform, however, does not dispute the significance of courses such as Organic Chemistry and Physics. Dr. Chen believes that the benefits lie in the foundation of these courses: “For day to day practice, they’re the usually unseen foundations that underpin the clinical applications. For example, [that] the seasonal flu shot protects against four different strains, which differ by surface antigens which don’t confer cross-immunity, are biochemistry (and immunology) concepts.” Dr. Rostami adds, “Physics is so important in optics and ophthalmology. To be able to be a great ophthalmologist, you should be good in physics.”

It is very unlikely that Organic Chemistry will ever disappear from the requirements for medical school, though the focus may shift towards a more interdisciplinary approach and focus on “modern” studies including topics of genomics and personalized medicine. Dr. Chen concludes, “I’ll leave you with this analogy: running for the U.S. Presidency is an extraordinarily challenging job that is only tangentially related to actually being the President, but a required prerequisite.” tudents

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MD...By: Erin Barlow Then What?So You

Want toBe an

The to-do list of a pre-med student starts early: Volunteer hours? Clinical experience? Class requirements? MCAT prep? Check, check, check, check. Many pre-med students are so preoccupied with becoming med students that they don’t spend much time thinking about what happens afterwards. That’s okay–med students don’t pick a specialty until their third or fourth year of med school–but having an idea of what you want to do, even if it changes between now and then, gives you something to work towards.So what to do with that shiny new MD? Maybe you endeavor to become a world-renowned surgeon. But in case you don’t think a career as a surgeon or general physician is for you, I decided to investigate what else you can do with that degree. It turns out that MD jobs vary widely based on the amount of patient interaction, blood and gore, and salary. Here are some interesting, lesser-known professions.

1. Medical PathologistIf you’re friendlier with your microscope than with patients, this may be the job for you! A medical pathologist has minimal patient contact. The job is mostly lab work, though that’s not to say that the options are limited. There are several different types. Anatomical pathologists examine tissue samples to diagnose diseases–they often work at hospitals with surgeons, running lab tests on biopsies mid-operation. Clinical pathologists examine bodily fluids—such as blood, urine, and bone marrow—to identify the presence of drugs or poison and to determine the viability of transfusions or organ transplants. Pathologists can also perform research or work for blood banks, ensuring that the blood supply is safe. Some perks of being a pathologist include using innovative technology like electron microscopy and computer modeling, working with clinicians from all areas of medicine, and generally having better hours than clinicians. Salaries fall in the $220-250K range.

2. Medical ExaminerAlso called a forensic pathologist, an ME determines the cause of death. The position is closely related to that of a coroner, except that MEs are appointed physicians who specialize in forensic pathology, while coroners do not require an MD. An ME’s chief duties include performing autopsies, collecting data from the investigating officers and old medical records, and testifying in court. Most work is done in a lab, but MEs also spend time in the courtroom and sometimes at the crime scene. The job offers regular hours (the dead person isn’t going anywhere) with the exception of some urgent or high-profile cases. This career lacks breathing patients, but the job still has a large social component, as MEs must work with the police and also convince the court that their findings are valid. Perks include bringing criminals to justice, solving mysteries on a daily basis, and knowing the news before it breaks on television–because those are your findings. Plus, dead people complain less. Salaries depend on experience, rank (deputy vs. chief ME), location, and employer (state, government, military), and range widely from $100-200K.7

MD...3. RadiologistThis is another career that requires less patient interaction. Most of a radiologist’s job is done in an office: examining images, diagnosing the problem, and writing up reports. They study images obtained from x-rays, nuclear medicine, ultrasounds, mammography, computer tomography and MRIs, but most of the picture-taking and patient interaction is the technician’s job. Radiologists can work in large hospitals, in group practices, or as self-administered specialists. Advantages include more vacation time than physicians (8-12 weeks vs. 4-6 for physicians) and the ability to work from home by reading scans on a computer. Radiology also pays very well, with a salary range of $300-400K.

4. Addiction specialistIf you enjoy working with patients but don’t have the stomach for a blood-heavy job, the field of addiction medicine may be an option. A doctor in this area is still a practicing physician, but is more focused on psychology. The job entails prevention, evaluation, and treatment of addiction, with many jobs in rehabilitation. Physicians often train in another specialization first and then focus on patients with addiction-related health conditions within their original specialty. Jobs in addiction medicine can be clinical or involve public health, education, or research. The salary for addiction medicine alone is a bit lower than other professions ($70-100K), although it can be combined with other fields.

5. AnesthesiologistIf you don’t mind blood, but don’t want to wield the knife yourself, this career may be for you. The anesthesiologist’s main job is to put a patient asleep for surgery and keep them that way as long as necessary. They also perform historical and physical exams and monitor patients before, during, and immediately after surgery. Some advantages include the high demand for this profession, a limited patient relationship due to the short-term interactions (this one depends on your personal preference), and the salary. Anesthesiologists have some of the highest salaries of all professions, ranging between $250-420K with an average of about $337K.

Say you go through college and medical school and become a physician, but now you’re looking for a change. These careers require a bit of experience in the medical field: 1. Medical Consultant All those dramas on television? They need to be–to some extent–accurate. News shows covering medical issues? Someone needs to validate their claims. Contractors building a new hospital? They need advice from someone who works there. Big medical facilities use medical consultants to recruit or hire new physicians. Salary varies widely based on employer and experience, anywhere from $50-240K.

2. Professorship and Research Medical students are taught by medical doctors. New research is always on the horizon in the medical field. Generally, this career path entails first working at a hospital associated with a university, then getting involved in academic work–research, publishing, lecturing. After gaining the status of “senior lecturer,” you can apply for the position of professor. An associate professor in medicine earns an average salary of $107,000, while a full professor earns an average of $137,000.

3. Surgeon General If you want to aim high and love working with people, why not oversee the government’s Public Health Services? An MD and a good bit of ladder-climbing are required. The Surgeon General is the head of the Public Health Service Commissioned Corps and works to educate the public about important health issues, acts as the government spokesperson on health-related matters, and issues health warnings (such as those on cigarette packs). The salary is an envy-inspiring $450K.

So maybe you’re not exactly sure what you want to do in the medical field. Get some clinical experience. Explore. And fear not, future doctors, for you have plenty of options…

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PillsBy: Sachidhanand Jayakumar

As a result of the healthcare status quo in the United States, far too many Americans have an image resembling the former option. This pill-popping, short-term mindset is one of the major reasons that many chronic disease rates are increasing, even with major advances in medical and pharmaceutical technology. To successfully combat these diseases, the healthcare model itself needs to change.

The current statistics on chronic diseases are astounding. According to the CDC, 70% of deaths in the U.S. are caused by chronic diseases. Current trends indicate that disease rates will increase tenfold over the next decade and double again during the following decade for obesity, type 2-diabetes, and heart disease. The causes of these diseases have been traced mainly to the aggregation of unhealthy practices (such as inadequate exercise, bad nutrition, smoking, and alcohol consumption) over time. These risk factors all involve macroscopic lifestyle choices that people make, rather than the microscopic mechanisms that most other illnesses act through.

If these diseases can be influenced so much by the unhealthy choices that people make, then it should make sense that the best “cure” would be to avoid these choices in the first place. The major reason that patients, medical professionals, and the entire healthcare system cannot address this quandary is due to the current attitude that focuses on the direct treatment of immediate illnesses. Pharmaceutical companies and hospitals exemplify how deep this process is ingrained within the American mindset. According to a briefing done by the National Center for Health Statistics, prescription drug spending in the U.S. more than doubled to over $230 billion between 1999 and 2008. Not surprisingly, approximately 90% of the drugs for

people over the age of 60 and 10% of the drugs for younger adults were for chronic conditions. The resulting enormous profit conversely allows pharmaceutical industries to develop a significant advertising budget, often larger than the research budget itself, to promote their treatments. This investment, in turn, leads to an increased use of the drugs themselves, forming a never ending cycle of prescriptions and profit.

These solicitations have been shown to subconsciously (and illegally, as a result of kickbacks) influence the drugs that doctors prescribe to their patients. Treating existing conditions is very financially rewarding for those involved. Any legitimate change in this process towards an actual long-term health-oriented goal would remove the powerful position that pharmaceutical industries are in today. With the inclusion of money as an incentive, it is easy to see how a broken system can be so resistant to change.

However, attributing the complex problem of chronic disease prevention only to businesses in the medical industry is a vast oversimplification. The American population itself must be willing to change their own longstanding habits as well. Consider someone who decided to lose weight. Chances are that this person started off by eating a more balanced diet and exercising but was never satisfied by the gradual progress of this method.Instead they, like most Americans, probably turned to one of the many fad diets that promise drastic weight losses in just a few days. A similar mindset is seen in the clinical setting, where patients feel that the entire visit with the doctor has been a waste if they are not prescribed a drug that will instantly cure their symptoms.

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Pillsto Prevention

Situations involving the interpretation of health information to make medical and lifestyle judgments are grouped in the category of “health literacy.” Low health literacy is partially due to a lack of education on health issues but is also closely tied to defined cultural expectations of a certain population. With about 80 million Americans estimated to have low health literacy levels, these misinterpretations and resulting unhealthy choices present serious obstacles to preventative healthcare reform. Without first reeducating these people, any large scale change to the current medical system will be useless.

As healthcare involves so many different elements, there is not one unified method to promote lifestyle-based preventative reforms. Instead, a concerted effort between the medical community, the pharmaceutical industry, government, and patients themselves will be needed for such a change. Although the current state of the U.S. healthcare system is far from ideal, there have been small incremental advances that move in the right direction. For example, the recent Affordable Care Act of the Obama administration elevates the focus of preventative medicine to the national level. As a part of this plan, the first ever national council on disease prevention (the National Prevention Council) was created to organize future preventative programs and reforms. Notably, this act provided about $126 million specifically for the funding of more lifestyle and community based health education programs. These programs could play an important role in educating Americans about basic nutrition and exercise guidelines. Regardless of how successful the programs of the Affordable Care Act are, they are not nearly enough to transform the roots of the current system. Instead, what

these provisions demonstrate is a good starting point for the acceptance of prevention as a viable part of healthcare reform.

In addition to policy-based changes, there have been movements to target the businesses that indirectly promote unhealthy consumer behaviors in the first place. An example of this is the recently approved ban of sugary drinks larger than 16oz in NYC restaurants and entertainment locations. In terms of diet-related governmental actions, this was a radical law that targeted the extremely profitable food and beverage industry by imposing bans on a fairly commonplace product. Even though the health board of NYC justified the decision with the linkage between rising obesity rates and the consumption of sugary drinks, large soft drink companies like Coca-Cola and PepsiCo are still currently fighting to overturn this decision in court. This particular situation reveals not only the types of actions that are needed for real reform, but also the obstacles provided by businesses that profit from current unhealthy habits.

Thus, reform to a system as longstanding and integral as the current healthcare model will not happen overnight. Even gradual changes will appear impossible due to numerous conflicting parties. Regardless of such difficulties, a large-scale transformation of the current system to a preventative model should be pursued. If the end result can guarantee lower rates of disease, no amount of effort is too great for change.

What comes to mind when you think of going to a doctor’s appointment? Do you envision a white-coated

physician writing you a crumpled prescription? Or do you picture a person who encourages you to make healthy changes to your lifestyle?

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EatingDisordersan

d MedicalBy: Ann Lei

cAREMost of us Cornellians eat what we crave when we are hungry and then burn off the calories by running to class after oversleeping. Yet, even in a college

environment where “Freshman 15” jokes proliferate, 25% of students have purged after meals, and 91% of female students attempt to control their

weight through dieting. With anorexia nervosa alone contributing to a higher mortality rate than any other psychiatric illness, we need to be cognizant of

the symptoms, consequences, and care of all eating disorders (EDs), whether it is on campus now or in a medical clinic in the future.

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Common Eating Disorder Myths DebunkedMyth: Only females develop eating disorders.10% of ED patients are male. Although life-threatening consequences are the same for both genders, males are less likely to seek assistance because they find the illness less acceptable for their gender.

Myth: An ED can be treated by giving the patient a meal plan.Because EDs are a mental disorder, psychological treatment is often required: similar to the ineffectiveness of telling a depressed person to “cheer up,” simply assigning an ED patient a meal plan is not enough.

Myth: If you are on a diet, you have an eating disorder.Disordered eating and dieting are not synonymous. A person who overeats while on a weight loss plan will often feel guilty, but a person with an ED will be consistently haunted by the extraneous calories. Intensive preoccupation with food that interferes with normal living manners and social relationships often results as well.

Myth: ED patients only want to be thin.EDs are much more complicated than an intensive desire to be thin—in fact, sufferers may not have had body image problems to begin with. Instead, the ED is often a coping mechanism to deal with distress or other extreme emotions, and the root of the problem often needs to be discovered before the illness is completely cured. This disorder is also commonly found in Type A personalities, where perfection is often desired.

Myth: Once you recover from an ED, life returns to normal.EDs are not a one-time disease. Even if a recovered patient displays a healthy body weight and normal eating practices, there may still be internal battles (“Eat! Don’t eat!”). Those who recover can relapse, and additional assistance needs to be sought.

Myth: Social media and runway models trigger most EDs.Although they can be a factor, EDs are based on genetics, brain function, and environment; there is still ongoing research, but individuals with a family history of EDs living in more affluent locations (such as the U.S.) have been found to be more susceptible.

Types of Eating DisordersEDs are not limited to anorexia and bulimia. Although the current Diagnostic and Statistical Manual of Mental Disorders, DSM-IV, only includes the above two categories, the DSM-V, to be released in May 2013, includes lesser-known but equally destructive types of EDs. They include:

Exercise Bulimia:Excessive exercise (instead of purging) as a means of burning calories after a binge

Pica:Repetitive consumption of non-food substances for over one month

Rumination Disorder:Regurgitation and rechewing/reswallowing of food for over one month

Restrictive Food Intake Disorder:Avoidance of foods based on sensory factors (picky eating) or nutritive values. Orthorexia, though not officially categorized as an ED, is an obsession with healthy foods that can lead to malnourishment and anxiety

Binge Eating Disorder:Recurrent episodes of eating large amounts of food in a given amount of time; lack of control during this time period; eating until uncomfortably full; and feelings of disgust or guilt after the eating episode. To clarify, this disorder is different than taking seconds at dinner or unconsciously eating a large bag of chips.

Eating Disorder Not Otherwise Specified: EDNOS; disruptions in eating behavior that do not fit the criteria for other eating disorders, such as anorexic behavior within individuals of normal weight or night eating syndrome

Now what?You do not have to be a doctor or therapist to help someone with an ED. If you suspect your friend to be suffering, talk to him/her, and express your concern without a guilt-trip. If your friend is in denial, do not give up. Help him/her seek professional support before the physical and mental health consequences exacerbate. The National Eating Disorders Association (nationaleatingdisorders.org) provides resources for support options, self-diagnosis, and awareness.

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An opinion article entitled “Why Women Still Can’t Have it All” by Anne-Marie Slaughter went viral this past summer...

By: Devon McMahon

FemaleCan

Really Have It ?ALLDoctors

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Slaughter’s piece forced me to question how I, as a female pre-medical student, could both have a successful medical career and raise a family. Although men certainly face a similar dilemma, there is a certain expectation that women should be able to raise children and work in a high-powered job. This same expectation is much less rigid for men.

Only recently have women become heavily involved in the medical field. Although the first woman was admitted to medical school in 1847, women never comprised more than 10% of medical students until 1970, when the Association of American Medical Colleges (AAMC) rallied for equal rights in the medical field. By 2000, 24% of practicing physicians were women, and in 2003 more than half of medical school matriculates were women.

However, female physicians are still greatly underrepresented in academic and medical leadership positions, work part-time much more often than men, and tend to enter specialties that give more “flexible” hours. Nearly 60% of female physicians work in 6 specialties: Internal Medicine, Pediatrics, Family Medicine, Obstetrics/Gynecology, Psychiatry and Anesthesiology. These findings may be partially due to the fact that female doctors view spending time with their family as a higher priority than do male doctors.

Here is the average timeline for a woman looking to become a doctor, assuming she does not take time off: She will enter medical school at 22 and graduate at 26. Then, she must complete at least 3 years of internships and residencies lasting until age 29; at this point, she may be done with her training. Some specialties, however, require longer residencies and 1-2 year fellowships, so it may not be until well into her thirties that she will be an attending physician—finally—but still have all of the burdens and rigors of a high-power job. Many female doctors are therefore limited to waiting until their mid-thirties, when they are more settled in their professions, to have children. While this timeline may work for many women, it limits others who want to start a family earlier in life.

This is not to discourage women from pursuing medicine, but to have them consider the latent inequalities in medicine due to the struggle of both having a family and being a high-powered physician. But it certainly can be done. My mother is a successful physician with three children, and her four female colleagues all have families as well. Instead of trying to “have it all,” we young pre-med women must realize that we must make sacrifices to balance professional and family life.

Slaughter wrote that it is nearly impossible for women to successfully balance both a high-powered job and child rearing, at least within

the confines of America’s social and economic system. By telling young women that they cannot “have it all,” Slaughter insists that

aspiring female professionals have tremendous pressure to succeed in their familial and

professional lives.?14

Vanessa CanosaClass of 2013College: Arts & SciencesMajor: Biology & Society

Aside from being the StethoSCOOP’s editor-in-chief, Vanessa is a Biology Scholar, minors in Latin American Studies, and plays intramural soccer. She spent this past summer in her home state (NJ) assisting in clinical research on tobacco cessation, sepsis, transient ischemic

attacks, and monoclonal antibodies. She also shadowed healthcare professionals in a hospital in NJ and a private medical practice in Queens, NY. She volunteered at a free clinic in the Bronx, NY, where she interpreted for Spanish-speaking patients and took patient vitals. After leaving Cornell, she hopes to earn a master’s and become a physician assistant, perhaps specializing in pediatrics or pediatric surgery.

Rachel ChuangClass of 2016College: Arts & SciencesMajor: Biology

Rachel is interested in all things science, especially regarding its applications in global health. On the pre-med track, she hopes to become a pediatrician in the future. Rachel has performed research over previous summers at the Walter Reed Army Institute

of Research, and also was a senior editor for her high school journal that published independent student research. In her free time, Rachel enjoys drinking green tea and watching movies.

Ann LeiClass of 2016College: Human EcologyMajor: Nutritional Sciences

Ann was in Publications and yearbook all four years of school (major yerd right here), where she lived and breathed Adobe InDesign and Photoshop. She is interested in nutrition, cognitive disorders, and human physiological processes as a whole. You can usually find her sleeping in libraries, working out, or messing

with people through Photoshop.

Sachidhanand JayakumarClass of 2016College: Agriculture & Life SciencesMajor: Biology

Sachidhanand (you can call him Anand) is concentrating in neurobiology and behavior. After graduating from Cornell, he plans on going to medical school somewhere on the east coast. On campus, he has been involved in research in the Deitcher lab and the Linster lab. He also

is a Learn to Be/REACH tutor and a member of PATCH and the Cornell Pre-medical Society. For fun, Anand likes to go to the gym or play sports of any kind. He is particularly interested in martial arts and currently practices Aikido at Cornell.

Devon McMahonClass of 2015College: Arts & SciencesMajor: Biology; College Scholar

Devon minors in Global Health, conducts neurobiology research on campus, and is also interested in alternative medical practices. She can be reached at dem287.

Darwin ChanClass of 2013College: Arts & SciencesMajor: Biological SciencesMinor: East Asian Studies

Darwin has been continuing to layout for the StethoSCOOP ever since he stepped down as Editor-in-Chief. Wishing to continue its legacy beyond its inception, he takes an advisory

role for this edition, making way for Ann Lei to take the helm for the design.

Ariel WamplerClass of 2015College: Human EcologyMajor: Human Biology, Health & Society

In addition to writing and editing for the StethoSCOOP, Ariel is an undergraduate research assistant with the Laboratory for Rational Decision-Making, outreach chair and writer for Cornell’s student health

magazine The Student Body, Active Citizen and Collective representative for Alice Cook House, and PATCH mentor. Her lifelong dream is to become a physician, and she is pursuing both an M.D. and an M.P.H. Her interests extend into social justice, medical ethics, health policy and educational policy, neuroscience, psychology, and philosophy. Outside of academia, Ariel enjoys the classics of Western literature, baking elaborate desserts for her family, friends, and co-workers, hiking, skiing, and various crafts.

Erin Barlow Class of 2016

College: Arts & SciencesMajor: Biology; English

A native of Audubon, Pennsylvania, Erin aspires to earn an MD and become a trauma surgeon or a medical examiner–she’s not sure which. In the meantime, she divides her time between classes, her job with

the federal nematode lab at Cornell, and her various clubs. Her hobbies include reading, writing for the StethoSCOOP, tutoring, baking, and sword fighting with the Ring of Steel.

Contributors

ReferencesCover, Title PageGraphics: cornell.edu/univcomm/photography/aadcardsimages/0928_06_152.jpg, cardiology.medicine.ufl.edu/files/2012/01/heart_stethoscope.jpg

Organs: What Money Can, But Should Not, BuyGraphic: http://www.sciencedaily.com/releases/2009/01/090114200207.htmBILEFSKY, DAN. “Black Market for Body Parts Spreads in Europe - NYTimes.com.” The New York Times - Breaking News, World News & Multimedia. N.p., n.d. Web. 28 Nov. 2012. <http://www.nytimes.com/2012/06/29/world/europe/ black-market-for-body-parts-spreads-in-europe. html?pagewanted=1&_r=3&smid=fb-share>.“Body futures: the case against marketing human o... [Health Prog. 1987] - PubMed -NCBI.” National Center for Biotechnology Information. N.p., n.d. Web. 28 Nov. 2012. <http://www.ncbi.nlm.nih.gov/ pubmed/10282295>.“Declaration Opposes Transplant Commercialism,Transplant Tourism And Organ Trafficking.” Science Daily: News & Articles in Science, Health, Environment & Technology. N.p., n.d. Web. 28 Nov. 2012. <http://www.sciencedaily.com/releases/2008/08/ 080813183552.htm>.“Freakonomics: Human Organs for Sale, Legally, in Which Country?.” Freakonomics. N.p., n.d. Web. 28 Nov. 2012. <http://www.freakonomics.com/2008/04/29/ human-organs-for-sale-legally-in-which-country/>.“Growing market for human organs exploits poor.” Science Daily: News & Articles in Science, Health, Environment & Technology. N.p., n.d. Web. 28 Nov. 2012. <http://www.sciencedaily.com/ releases/2012/03/120312114028.htm>.“Organ Donation Statistics in the United States.” New York Organ Donor Network. N.p., n.d. Web. 10 Nov. 2012. <http://www.donatelifeny.org/about-donation data/#Data US1>.“Presumed Consent For Organ Donation Urged By Experts.” Science Daily: News & Articles in Science, Health, Environment & Technology. N.p., n.d. Web. 28 Nov. 2012. <http://www.sciencedaily.com/releases/2009/ 01/090114200207.htm>.Samadi, David B.. “Consequences of the Rise in Illegal Organ Trafficking.” Fox News. N.p., n.d. Web. 10 Nov. 2012. <http://www.foxnews.com/health/ 2012/05/30/consequences-rise-in-illegal-organ- trafficking/>.“Success rates for organ transplants are increasing, but organ donations are decreasing, study shows.”

Science Daily: News & Articles in Science, Health, Environment & Technology. N.p., n.d. Web. 28 Nov. 2012. <http://www.sciencedaily.com/ releases/2010/03/100322092051.htm>.

What They Forgot to Teach Pre-Med StudentsGraphic: http://www.chem.ucla.edu/harding/qiqi.JPGAlpern, R. J., Long, S., Åkerfeldt, K., Ares, M., Jr., Bond, J., Dalley, A. F., II... Silverthorn, D. (2009). Scientific Foundations for Future Physicians. Report of the AAMC-HHMI Committee. <http://www.hhmi.org/grants/pdf/08-209_AAMCHHMI_re port.pdf>Arnaud, C. H. (2009). Revisiting The Premed Curriculum. Chemical & Engineering News, 87(44), 35-38. <http:// pubs.acs.org/cen/education/87/8744education.html>Dienstag, J. L. (2008). Relevance and Rigor in Premedical Education. The New England Journal of Medicine, 359, 221-224. <http://www.nejm.org/doi/full/10.1056/ NEJMp0803098>Swaby, A. (2011, February 4). Premed proposal changes science classes. Daily Yale News. <http://www.yaledailynews. com/news/2011/feb/04/premed-proposal-changes- science-classes>

So You Want to be an MD... Then What?Graphic: http://radiology.georgetown.edu/slidingimages/IMG_2321.JPG“Forensic Medical Examiner: Salary and Career Information.” Education Portal. N.p., n.d. Web. 26 Nov 2012. <http://education-portal.com/articles/Forensic_Medical_ Examiner_Salary_and_Career_Information.html>.“About the Office of the Surgeon General .” Surgeon General.gov. U.S. Department of Health & Human Services. Web. 26 Nov 2012. <http://www.surgeongeneral.gov/about/index. html>.“Medical Examiner’s Salary.” Forensic Science Careers. N.p., n.d. Web. 26 Nov 2012. <forensicsciencecareers.net/medical- examiner/salary.html>.“Medical Pathologist: Job Description, Salary and Career Outlook.” Education Portal. N.p., n.d. Web. 26 Nov 2012. <http:// education-portal.com/articles/Medical_Pathologist_Job_ Description_Salary_and_Career_Outlook.html>.“Pathology is the medical specialty that provides a scientific foundation for medical practice .” Pathology: A Career In Medicine. Intersociety Council for Pathology Information, Inc., n.d. Web. 26 Nov 2012. <http://www.asip.org/Career/ index.htm>.“Physician - Anesthisiology.” Salary.com. Kenexa. Web. 26 Nov 2012. <http://www1.salary.com/anesthesiologist-Salary. html>.“Radiologist Career & Education Information.” Radiology Schools: Medical Imaging Education and Career Guide. QuinStreet, Inc.. Web. 26 Nov 2012. <radiology-schools. com/radiologist-overview.html>.“So You Want to Be a Medical Detective.” National Association of Medical Examiners. Avectra Inc., n.d. Web. 26 Nov 2012. <http://thename.org/index2.php?option=comdocman& task=doc_view&gid=14&Itemid=31>.“The Role of the Anesthesiologist.” Lifeline to Modern Medicine. American Society of Anesthesiologists. Web. 26 Nov 2012. <lifelinetomodernmedicine.com/Who-Is-An-

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References(continued)“What is a Medical Consultant?.” wiseGEEK. N.p., n.d. Web. 26 Nov 2012. <http://www.wisegeek.com/what-is-a-medical- consultant.htm>.“What is an Addiction Specialist?.” . American Society of Addiction Medicine, n.d. Web. 26 Nov 2012. <http://www.asam.org/ for-the-public/what-is-an-addiction-specialist>.Harrison, Hayley. “Health Care Consultant Salary.” eHow Health. N.p., n.d. Web. 26 Nov 2012. <http://www.ehow.com/ about_5282593_health-care-consultant-salary.html>.Santiago, Andrea. “Radiologist Career Profile .” About.com Health Careers. About.com, n.d. Web. 26 Nov 2012. <http:// healthcareers.about.com/od/physiciancareers/p/ Radiologist.htm>.Uthman, Ed. “Forensic Pathology Careers: Frequently Asked Questions.” N.p., 13 1999. Web. 26 Nov 2012. <http://

web2.airmail.net/uthman/forensic_career.html>.

From Pills to PreventionGraphic: http://www.vanderbilt.edu/vanderbiltnurse/wp-content/uploads/20110921DD012.jpgBerkman, Nancy D., et al. (2011). Low Health Literacy and Health Outcomes: An Updated Systematic Review. Annals of Internal Medicine, 155, 95-107. Gu, Qiuping, et al. (2010). Prescription Drug Use Continues to Increase: 2007-2008. NCHS Data Brief, 42, 1-8. Medical Billing and Coding (2011). Doctors on Drugs. <http://www. medicalbillingandcoding.org/doctors-on-drugs>National Center for Chronic Disease Prevention and Health Promotion (2009). The Power of Prevention. <http://www. cdc.gov/chronicdisease/pdf/2009-Power-of-Prevention. pdf>Peltz, Jennifer (2012). Soda Industry Sues to Block NYC’s Ban on Big Drinks. Time. <http://healthland.time.com/2012/10/13/ soda-industry-sues-to-block-nycs-ban-on-big-drinks>Trust for America’s Health (2012). F as in Fat: How Obesity Threatens America’s Future. <http://healthyamericans. org/assets/files/2012_f_as_in_fat_FINAL%20ES%209-22- 12.pdf>U.S. Department of Health and Human Services. Affordable Care Act: Laying the Foundation for Prevention. <healthreform. gov/newsroom/acaprevention.html>

Eating Disorders and Medical CareGraphic: http://www.jhsph.edu/sebin/v/j/thinspiration1.jpg“Eating Disorders.” National Institute of Mental Health, 08 Mar. 2012. Web. 19 Oct. 2012. <http://www.nimh.nih.gov/ health/publications/eating-disorders/index.shtml>.“Feeding and Eating Disorders.” Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association, 2012. Web. 19 Oct. 2012. <http://www.dsm5.org/ProposedRevision/Pages/ FeedingandEatingDisorders.aspx>.“Information and Resources.” National Eating Disorders Association. National Eating Disorders Association, 2012. Web. 19 Oct. 2012.

<http://www.nationaleatingdisorders.org/information- resources/index.php>.Schildhause, Chloe. “When Eating Healthy Turns Obsessive.” CNN. Cable News Network, 05 Jan. 2012. Web. 19 Oct. 2012. <http://www.cnn.com/2012/01/05/health/eating- healthy-obsessive/index.html>.Someah, Kathleen. Frequency of Eating Disorders in College and University Students. Eating Disorder Hope, 6 Aug. 2012. Web. 03 Nov. 2012. <eatingdisorderhope.com/ programs/colleges-and-universities/why-are-college- students-vulnerable-to-eating-disorders>.

Can Female Doctors Really ‘Have it All’?Slaughter, Anne-Marie. “Why Women Still Can’t Have It All.” The Atlantic, n.d. Web. 8 Nov 2012. “Women in Medicine.” American Medical Association. N.p., n.d. Web. 8 Nov 2012. <http://www.ama-assn.org/ama/ pub/about-ama/our-people/member-groups-sections/ women-physicians-congress/women-medicine-history. page>.

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