Fats: The Good, The Bad, and The Ugly

Fats are confusing. There are some good ones, a lot of bad ones, and it is hard to keep track of the ones you want and the ones you don’t. Hopefully, this article will help keep things straight.

The body contains three types of lipids. Lipids are a class of organic compounds that are insoluble in water. One of the least talked about but most important types of lipids in the body are phospholipids. Phospholipids are the main constituent of cell membranes and play an important role in determining what enters the cell and what is left out.

The second type of lipids are called sterols. Cholesterol is a sterol and is used by the body in the synthesis of hormones. Cholesterol is, of course, infamous for its links to cardiovascular disease. However, there are two types of cholesterol – “good” cholesterol and “bad” cholesterol. This classification is based on the type of lipoproteins in which the cholesterol is contained. Lipoproteins are essentially large droplets of fats. The core of lipoproteins is composed of a mix of triglycerides and cholesterol and this core is enclosed in a layer of phospholipids. There are five different types of lipoproteins, but the two types that are most known are low density lipoproteins (LDL) or “bad cholesterol” and high-density lipoproteins (HDL) or “good cholesterol.”

Bad cholesterol, in high quantities, accumulates in the walls of arteries, where LDLs are oxidized.           Oxidized LDL causes damage to the walls of arteries. This damage leads to inflammation which leads to a constriction of arteries (leading to high blood pressure) and to further accumulation of cholesterol, leading to the formation of plaques. These plaques further narrow arteries, decreasing the flow of blood and oxygen to tissues.

High density lipoproteins, or good cholesterol, on the other hand plays an important role in reverse cholesterol transport, a process by which excess bad cholesterol is transported to the liver for disposal. Good cholesterol also has anti-inflammatory and vasodilatory properties and protects the body from LDL-oxidative damage.

Perhaps unsurprisingly, fried food, fast food, processed meats, and sugary desserts lead to increased bad cholesterol levels while fish, nuts, flax seeds and – you guessed it! – avocados lead to increases in good cholesterol levels.

The final type of lipids in the body are triglycerides. Triglycerides are the fat in the blood. Any calories that are not utilized by the body are stored in the form of triglycerides. The effect of high levels of triglycerides on the heart have not been as well understood. Excessive triglyceride levels are typically accompanied by high (bad) cholesterol levels and research in the past couple of years has indicated a relationship between high triglyceride and risk for cardiovascular disease.

The fats that we consume, however, are not in the form of triglycerides. The fats that we consume are broken down and converted into triglycerides and cholesterol. The major dietary fats are classified into saturated fats, trans fats, monounsaturated fats, and polyunsaturated fats.

Saturated fats are fats whose molecules have no carbon-carbon double bonds. Saturated fats are fats to be avoided because they increase LDL levels by inhibiting LDL receptors and enhancing lipoprotein production. Saturated fats are solids at room temperature and are found in fatty beef, lamb, pork, butter, lard, cream, and cheese.

Trans fats are also bad fats. They are typically found in margarine, baked items, and fried food. They suppress chemicals that protect against the build up of plaques in artery walls, increase bad cholesterol and decrease good cholesterol.

Monounsaturated fats and polyunsaturated fats are fats that have one (mono) and many (poly) carbon-carbon double bonds in their molecules respectively. These fats are liquids at room temperature and are found in salmon, nuts, seeds, and vegetable oils. Polyunsaturated fats are associated with decreased bad cholesterol and triglyceride levels.

Keeping track of which fats are found in which food can seem intimidating, but foods that lead to increased good cholesterol levels are foods that are typically considered healthy – nuts, seeds, fish, fruits, and vegetables, while foods that lead to excessive bad cholesterol are foods that we are taught to avoid in excess anyway – such as processed and fatty meats, processed food, and fried food.

Resources:
Contains both information on what various types of fats are and also food that contains the respective fats: https://www.hsph.harvard.edu/nutritionsource/what-should-you-eat/fats-and-cholesterol/types-of-fat/
A guide to choosing healthy fats: https://www.helpguide.org/articles/healthy-eating/choosing-healthy-fats.htm
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5577766/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5586853/

A History of the Hippocratic Oath

The Hippocratic Oath is arguably one of the most famous oaths of ethics in our history. Originating in Ancient Greece, it centers around medical practitioners swearing, “by all gods and goddesses,” physicians will uphold various ethical standards in their medical practice. Contrary to popular belief, the oath does not actually contain the renowned phrase, “First, do no harm,” an expression that has now become synonymous with the oath itself. Dated back to the fifth and third centuries B.C., the oath is often attributed to the Greek doctor, Hippocrates, though scholars have contended that it could, instead, be a work of the Pythagoreans. While its oldest remaining fragments date back to AD 275, the oath has been continually rewritten and adapted over the centuries to better suit the values and beliefs of evolving cultures and ethical standards.

Following the collapse of the Roman Empire and its religious ideals, today’s “multiethnic, multicultural, and pluralistic world” no longer worships ancient divinities such as Apollo or Asclepius (Indla, Radhika, 2019). As history progresses, the Hippocratic Oath has faced ideological challenges due to new and emerging technology, that did not exist in the era of Hippocrates. For instance, the Hippocratic Oath did not take into consideration a patient in a vegetative state, a patient suffering from pain, a patient requesting for an abortion, or addressing other autonomous rights of a patient. Considering that technology has and continues to advance the ancientHippocratic Oath has faced many modern-day dilemmas.

Consequently, the period following World War II, saw one of the Hippocratic Oath’s most significant revisions: the Declaration of Geneva. During this period, the tradition of medical graduates reciting the Hippocratic Oath became more than a mere formality. As such, the World Medical Association (WMA) altered the oath in the 1960s to state that providers would “maintain the utmost respect for human life from its beginning.” Making the custom a more secular obligation, that the oath is not to be taken in the presence of any divine figures, but before only other people. This served as a test of a practicing physician’s ethical, moral, and emotional standards, an especially remained an important notion after the atrocities of WWII.

As a result of this, in 1964 the Hippocratic Oath faced further revision. These alterations are most notably addressed by Dr. Louis Lasagna’s 1964 revision of the oath, which cites that “[doctors] do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability.” Such changes represent the increasing humanization of the relationship between a doctor and a patient. Despite the controversies that have come with these changes, such alterations begin to represent the influence that cultural identities and contextual values demand on the form of the oath. In fact, in 1973, the US Supreme Court rejected the Hippocratic Oath as a guide to medical ethics by determining that the oath is unable to maintain changing medical ethics and codes. The final, most modified document of the Hippocratic Oath, known as “Pellegrino’s Precepts,” which functions as a set of principles. These precepts directly speak to doctors and are a “universal set of precepts about the nature of medicine” in contrast to the Hippocratic Oath.

In modern times, the Hippocratic Oath has essentially been replaced by more extensive and pragmatic ethical codes issued by national medical associations, such as the AMA Code of Medical Ethics, or the British General Medical Council’s Good Medical Practice. These documents offer a more comprehensive overview of the responsibilities and professional behavior expected of a doctor to their patients and to society, rather than to healing gods and other divinities. As such, in the United States, many of the medical schools use the Osteopathic Oath in place of the Hippocratic Oath. For instance, schools such as, New York Medical College, University of California, or Tulane, have had medical students vow to not discriminate against patients based on “gender, race, religion, or sexual orientation.” Hence, as time passes, many of today’s doctors face various ethical issues that are not included in the Hippocratic Oath. Therein lies the question, “is our society in a post-Hippocratic era?” With a modern society, continuing to evolve, physicians have begun question whether the Hippocratic Oath holds outdated principles. If so, how can medical students incorporate an evolving society to protect patients. Despite this, many providers argue that the Hippocratic Oath epitomizes ideologies of gratitude, beneficence, and humility.

While there is no direct punishment for breaking the Hippocratic Oath, a notable, modern equivalent is ‘medical malpractice’ which carries a wide range of punishments from legal action to civil penalties. Doctors who violate these principles are at risk of being subjected to disciplinary proceedings, including the loss of their license to practice medicine.

Overall, what began as an ethical principle in Ancient Greece saw itself transformed frequently through time as a result of contemporary ideals and beliefs. From a prominent idea to a mere formality, the importance of the Hippocratic Oath has fluctuated almost as much as its content. While it may no longer be the central ideal of medical ethics, its ideas have ultimately pioneered modern practices and formed the crux of what we now call medicine. Today, 100% of medical school graduates in the United States swear to some variation of the Hippocratic Oath; therefore, the responsibility to continue to pursue beneficence, compassion, and humility within the field of medicine maintains its utmost significance.

See the Emory Class of 2020 Hippocratic Oath at Emory School of Medicine!
“The Oath of Hippocrates”
As the ancient Greeks swore by their pagan gods, so do I solemnly affirm that as a student in medicine at Emory University, according to my ability and judgment, I will keep this oath and stipulation. I will consider dear to me those who have taught me this art and will impart the precepts and instruction of the profession to all those who qualify as students of the art and agree to the standards of the profession. I will follow that system of regimen, which according to my ability and judgment I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. Into whatever house I enter I will go into it for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption. Whatever in connection with my professional practice or not in connection with it, I see or hear in the lives of men and women which ought not be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret. While I continue to keep this oath inviolate, may it be granted to me to enjoy life and the practice of the art, respected by all people in all times, but should I trespass and violate this oath may the reverse be my lot.”
– Emory School of Medicine Class of 2020

Resources

15 Good Minutes: Hari Trivedi

After completing an undergraduate degree in engineering at Georgia Tech, Emory Assistant-Professor Dr. Hari Trivedi began medical school with an open mind about what field to specialize in. While exploring different fields, Trivedi began to grow interested in the intersection of medicine and technology. He eventually settled on his chosen field, radiology, after witnessing how it combined his interests in both medicine and engineering.

“During radiology rotations, I thought radiology was just so cool because radiologists get all the newest toys,” Trivedi said. “I remember seeing my first 3D reconstruction of a CT scan, and that’s when I was like, OK, this is really interesting and powerful stuff.”

Today, Dr. Trivedi is both a practicing radiologist as well as a researcher in the field. He has worked on innovative improvements to medical diagnostic procedures such as breast cancer screening. Much of Trivedi’s research involves using Artificial Intelligence (AI) algorithms to deliver faster and more reliable diagnoses from medical imaging. Trivedi’s work involves balancing the development time and accuracy of this technology to ensure it can be deployed within a reasonable time frame while providing accurate diagnoses. Getting innovations deployed so they can improve patient outcomes is something that Trivedi always tries to stay focused on.

“Deployment is something that’s often overlooked, as 99% of AI machine learning technology gets stuck in the lab, Trivedi said. “So, while getting it deployed and integrated to a healthcare system is extremely complicated, unless you take that step, you really haven’t necessarily created anything of value.”

Trivedi views being a practicing clinician as an advantage for his research, as it provides him with a firsthand look at clinical issues that could be addressed by new innovations. This dual role can also be a challenge however, with the added complexity juggling different responsibilities brings. Trivedi views a key component of successful research as keeping in mind the expertise of each individual involved with a given project.

“There’s a lot of people that need to come together for a project succeed, which can sometimes take time, but that persistence is the key,” Trivedi said. “As long you’re persistent and stay on the radar, I think people are generally very good about making sure things get done.”

Trivedi has also had success commercializing some of his innovations, a process he views as a “natural extension of utility.” Under this principle, Trivedi always tries to provide innovations for free to other researchers who can find use for it. In some cases, however, Trivedi has filed for protection of intellectual property and licensed it out to commercial entities if this is the only way to financially sustain the innovation. One example is Trivedi’s work on algorithms for the anonymization of medical data. The tool requires ongoing maintenance and support, which necessitates charging a fee for use. Any other proceeds from commercialization go to supporting the needs of the lab and future research.

“That’s the way we look at commercialization, as if we build something useful, we do everything we can to give it away for free, Trivedi said. “But if it’s not going to be sustainable by giving it away for free, then we would try to license it to the appropriate person and use those funds to support the project.”

For those also seeking to become researchers, Trivedi’s key piece of advice is filtering out the noise to focus on individual goals and pursuits. This means worrying less about what others are doing and striving more to maintain focus on one’s own projects. As Trivedi believes, there’s never going to be a lack of discoveries to be made, and every researcher can make their own unique contributions to the scientific community.

“No problem is every really solved, there’s always room to innovate,” Trivedi said. “Things that we do literally hundreds of thousands of times per year, they’re still not perfect. So, I’d recommend not staying fixated on what others are doing, and I’d rather focusing on actually fixing and solving a problem at hand.”

Hari Trivedi: https://med.emory.edu/directory/profile/?u=HMTRIVE

Four Women Who Made Major Contributions to Genetics and Medicine (Whose names you might not know)

Nettie Stevens: Discoverer of Sex Chromosomes

Women like Nettie Stevens, who were born in the early 1860s, didn’t have a plethora of career options to choose from. They could either be secretaries, or they could be teachers. Stevens went down the teaching route. What she really wanted to do, however, was continue her education. Eventually, at the age of 36, she saved up enough money from her teaching jobs, moved from Vermont to California, and enrolled in Stanford University, and later in Bryn Mawr college for her PhD.

Stevens entered the field of genetics at a time when the field was rapidly expanding. Mendel’s seminal work on the principles of inheritance had been rediscovered in 1900, and in a few short years, Thomas Morgan – who taught Stevens at Bryn Mawr – would go on to show that genes are carried on chromosomes. While this might seem unremarkable now, Morgan’s research provided physical evidence for the heredity described by Mendel. However, despite the increasing evidence that physical traits are determined by genes, scientists still believed that either the mother’s environment or the chemical balance of the cytoplasm of eggs determined sex.

Nettie Stevens’ research put the issue to rest. Stevens studied mealworms – insects that resemble garden grubs – and after spending endless hours peering through microscopes, found that during spermatogenesis, the 20 chromosomes of the mealworm form “9 symmetrical pairs and 1 unsymmetrical [pair] composed of [a] small chromosome and a much larger mate.” This asymmetrical pair, she observed, was replaced by a tenth symmetrical pair during the formation of egg cells. She also found that somatic (non-reproductive) cells of mealworms followed a similar pattern: 10 symmetrical pairs of chromosomes in females, and 9 symmetrical pairs and 1 asymmetrical pair in males. This discovery was conclusive proof that chromosomes – in the form of the X and Y chromosomes in most animals – were what led to sex determination, and not maternal characteristics.

Nettie Stevens unfortunately died of breast cancer at the age of 50, a mere four years after she discovered sex chromosomes. Her reputation – both then and now – does not match the significance of her research. Morgan, her mentor and professor, is considered the most influential figure in modern genetics and often gets credited for all chromosome-related discoveries. Morgan’s name appears frequently in relation to his research on chromosomes, but Nettie Stevens’ doesn’t.

Alice Ball: The chemist who developed a cure for leprosy

Alice Ball grew up around chemicals. Her grandfather, James Presley Ball, was a famous African American photographer. Chemicals used in developing photographic prints, such as silver, iodine, chlorine, and bromine were likely part of her life years before she entered a chemistry lab.

Ball was born in Seattle on July 24, 1892. Her family moved to Hawaii in 1903 hoping that the salubrious weather would alleviate her grandfather’s arthritis. Her family moved back to Seattle in 1905, following her grandfather’s death. She earned two bachelor’s degrees in Pharmaceutical Chemistry and the Science of Pharmacy in 1912 and 1914, respectively. She then decided to pursue a master’s degree at the College of Hawaii, now called the University of Hawaii, and eventually became the first female and first African-American chemistry professor at the College.

Ball became an expert in extracting active ingredients from plants, and caught the attention of Harry T. Hollmann, medical director of the Kahili Leprosy Hospital. He had been trying to treat leprosy patients but hadn’t been making much progress. In a pre-antibiotic world, there was no clear cure for leprosy, although a potential candidate had been known for years. Chaulmoogra had been used to alleviate skin diseases, including leprosy, in India and China for centuries. Eventually, in the 19th Century, Western doctors started experimenting with Chaulmoogra oil to see if it could be used to treat leprosy. But success had been limited. Ingestion had proven to be ineffective and injecting the oil had proven disastrous – the viscous oil clumped under the skin to form blisters, due to which the patient’s skin looked as though it “had been replaced by bubble wrap.” What doctors needed was a form of Chaulmoogra oil that could be absorbed by the body.

Enter Alice Ball, the 23-year-old chemist whose master’s thesis was on the extraction of the active ingredient from a root called the Ava root. In less than a year, Ball devised a way to create a water-soluble injectable form of Chaulmoogra oil.

Ball died shortly thereafter, on December 31, 1916, at the age of 24. It is unclear why she died, although it is possible that she could have gotten chlorine poisoning while teaching in the lab.

Ball did not live to see 84 patients in the Hospital get cured because of the extraction method she had developed. She was also not given due credit for her discovery, as Arthur Dean, president of the College of Hawaii, published Ball’s extraction technique as his own. In was only in 1922 that she got credit for her work, when Hollmann, the surgeon who had initially encouraged her to develop the drug, wrote about the extraction process and called it “The Ball Method.” The injectable form of Chaulmoogra oil became the principal method of treating leprosy until the 1940s. In 2000, then Hawaii Lieutenant Governor Mazie Horono declared February 29 Alice Ball Day.

Barbara McClintock: Discoverer of Transposons

From the time Barbara McClintock was a young girl, it was clear that she was not going to grow up to become a conventional woman. She preferred sports over dolls, and her mother even made her bloomers so that she would be able to play all the sports she wanted “unhindered by dresses.” As her desire to pursue higher education grew, however, her mother’s support of her idiosyncrasies became less enthusiastic. Worried that an academic daughter would be unmarriageable, she was reluctant to allow McClintock to go to college. Her father interfered, however, and McClintock went off to Cornell to pursue a degree in Agriculture.

By the time she graduated, McClintock became an expert at preparing cells for the microscope. She began studying maize and became so familiar with maize chromosomes that she noticed that certain sections of the chromosome broke off and reattached to different chromosomes and that this corresponded with changes in the coloration of the maize. McClintock called these regions controlling elements (they are now called transposons). This discovery greatly expanded what scientists believed that genes could do. Previously genes were thought to be stationary – like, as the popular analogy goes, beads on a string. McClintock developed a strong reputation in the scientific community and was elected president of the Genetics Society of America in 1945, becoming the first woman to serve in the position.

However, what McClintock really wanted to study was how genetic expression was regulated. It was a question that had plagued scientists for decades: how could neurons and skin cells can look so different despite having the same genetic code? McClintock hypothesized that if a transposon landed near a gene, it would turn off its expression, and turn it on when it left. She presented this theory at a prominent symposium in 1951, but her theory – lacking data to back it up – baffled scientists. McClintock withdrew from the scientific limelight after the symposium and didn’t publish her research after 1953. In 1983, Evelyn Keller published a popular biography of McClintock that brought McClintock back into the public consciousness. McClintock was awarded the Nobel Prize in Physiology or Medicine the same year – the first and only woman to receive an unshared Nobel Prize in the category. However, despite the honor, she never succeeded in proving the regulatory functions of transposons, and indeed, subsequent research showed that it is proteins such as transcription factors, promotors, enhancers, and repressors that control gene expression.

Tu Youyou: A cure for malaria

Tu Youyou was born in 1930 to a family that greatly valued education. At university, she trained under a phytochemist who taught her how to extract active ingredients from plants using appropriate solvents. After graduating, Youyou was recruited to the Institute of Materia Medica, Academy of Traditional Chinese Medicine. Her interest in traditional medicine had deep roots. Growing up, she had seen folk recipes being used to treat a variety of diseases and had seen that some of them were quite effective. The Institute of Chinese Materia Medica provided a unique environment for the combination of Traditional Chinese Medicine and Western medicine. It was an institution where historians, who poured over ancient recipes, and chemists and medical doctors, who had modern tools at their disposal, worked side by side.

It was under these conditions that in 1967, Youyou was tasked with developing a drug to treat chloroquine-resistant malaria. Many Chinese and American soldiers were dying due to malaria in Vietnam – and both the United States and China launched campaigns to develop a treatment, and Youyou was recruited to the Chinese campaign.

Youyou’s team collected over 2000 recipes based on over 600 herbs. One of the most promising candidates was Qinghao, the Chinese name for six herbs falling under the genus Artemisia. Handbooks detailing traditional recipes were helpful in refining their techniques of extraction. One recipe, for example, made Youyou’s team attempt a cold extraction instead of performing extractions at boiling temperatures, leading to better results. Youyou extracted the active ingredient from Artemisia annua and it proved to be effective against rodent malarias. In the absence of robust protocols on how to conduction clinical trials in China in the 1960s and 1970s Youyou and her team volunteered inject themselves to ensure that the active ingredient wasn’t toxic. The team then used the drug to treat 21 malaria patients and saw that their fever disappeared. Their drug was 100 percent effective.

Youyou was awarded the Lasker DeBakey Clinical Medical Research Award in 2011 and the Nobel Prize in Physiology or Medicine in 2014 for her work, which, the presenter of the Lasker award described as “arguably the most important pharmaceutical intervention in the last half-century.”

Check out our blog honoring five of Emory’s female inventors and their work here.

Sources:

Nettie Stevens

Alice Ball

Barbara McClintock

  • “Barbara McClintock and the discovery of jumping gene” by Sandeep Ravindran: https://www.pnas.org/content/109/50/20198

  • “’The Real Point is Control’: The Reception of Barbara McClintock’s Controlling Elements” by Nathaniel Comfort: https://www.jstor.org/stable/4331511?seq=1

  • The Tangled Field by Nathaniel Comfort

  • The Violinist’s Thumb: And Other Lost Tales of Love, War, and Genus, as Written by Our Genetic Code by Sam Kean1

Tu Youyou

15 Good Minutes: Ichiro Matsumura

For Emory Professor of Biochemistry Ichiro Matsumura, PhD, inspiration to pursue a career in research came from an unlikely source: a concussion. When Matsumura was in college at MIT, he got into a bike accident that left him hospitalized for several months. After being released from the hospital, Matsumura was prepared to retake all his courses from that semester over the summer. However, one of Matsumura’s professors, Harry Lodish, gave him the option to write a report from a list of topics instead of retaking the course, given that he had done well on the class’s first midterm. The topic Matsumura chose was evolution, which he would later dedicate his career to studying.

“That [summer] was what got me excited about evolution,” Matsumura said. “Eventually when I went to grad school a couple years later, I already knew I already who the leaders of the field were, and so I just applied to those specific departments.”

Matsumura credits that summer project with helping him identify key research questions. Given the field of molecular evolution was young at the time, Matsumura was able to read every issue of Molecular Biology and Evolution and learn the names of all the contributors in the field. Later as a grad student, Matsumura learned how to formulate hypotheses and design informative experiments. He would use these skills to apply for a competitive NSF postdoc fellowship, and to develop an independent research program within the lab of his advisor, Andy Ellington.

Today, Matsumura leads a lab at Emory that studies evolution on a molecular level. His work has yielded discoveries of proteins with pharmaceutical and industrial uses, as well as illuminated the evolutionary process within cells and microorganisms. Recently, Matsumura has explored what factors account for variation in how bacteria grows. When examining bacterial cultures with the same initial genotype, Matsumura found that the cultures develop variations, even if grown in similar environments. Eventually, he began to realize that these variations could not simply be accounted for by different copy numbers or multicopy plasmids. Instead, he was witnessing evolution taking place on a molecular level.

“If you think about how much a bacterium can replicate itself over say 30 Generations, it’s a lot of opportunity for mutation,” Matsumura said. And so especially with multicopy plasmids, you have so many copies per cell, so many generations, and so many cells per milliliter, it just sort of becomes inevitable that some of them start getting mutated.”

Matsumura’s work has implications for a wide range of topics, including novel gene therapy technologies. Gene therapy relies on the interstation of a “stressor DNA” into a cell as the impetus for genetic change that improves the health of the cell. Based on Matsumura’s findings regarding molecular evolution however, such changes on a genetic level can lead to unintended mutations. Matsumura is working on techniques that could prevent damaging consequences as a result of this process, by forcing the cell to express specific proteins. While he is currently exploring the technique using bacteria, it could potentially be used on human cells as well.

Balancing the need to protect intellectual property while publishing work has sometimes proved challenging for Matsumura, as he believes it can be for many scientists. While publishing work in a timely manner is essential for obtaining research grants, doing so can be considered a “public disclosure,” starting the clock on a limited amount of time to obtain a patent. To help augment his knowledge of the patent process, Matsumura took a class on intellectual property at Emory Law School, offered as part of a program where Emory faculty can take courses for free. There he worked with his professor to discuss which projects he was currently working on could be suitable for patenting.

“It, to some extent, falls upon the shoulders of us investigators to make a case and to prove that [an innovation] could of be value and therefore worth patenting,” Matsumura said. “And that’s not always an easy case to make.”

Given his long and successful career, Matsumura has two key pieces of advice for those seeking to follow his path. The first essential piece is worrying more about establishing strong working relationships than raw talent. Matsumura believes that he overestimated the role of measures such as test scores in predicting future success.

“You need a certain threshold of talent to get into grad school and to get that first job, but once you’re along a certain way, it really ends up becoming more a matter of personality that determines who succeeds and who doesn’t,” Matsumura said. “I did spend a fair amount of time when I was younger, thinking about what I’m good at and how good I am at those things, and I think I may have spent a little bit too much time thinking about that.”

The second key piece of advice that Matsumura would give is not being afraid of failure and learning from mistakes. He emphasizes willingness to learn the “right lessons,” as opposed to just the easy lessons from mistakes, as an important part of this process. Ultimately, learning from mistakes has been defining for Matsumura’s career path, even as he recognizes that he was privileged to receive the benefit of the doubt and the ability to learn from these mistakes.

“It’s really hard I think to go through life and to get everything right the first time, and so for me learning how to solve problems and make good decisions all requires doing things wrong, figuring out that I did them wrong, and trying to do better the next time,” Matsumura said. “Since I had to figure it out learning the hard way, at the very least, I think that I taught my younger self that that’s okay.”

Ichiro Matsumura: https://med.emory.edu/departments/biochemistry/research-labs/mastumura/index.html

15 Good Minutes: William Wuest

Antibiotics have been one of the most consequential innovations in human history, allowing us to treat a wide variety of bacterial diseases that could otherwise be damaging or fatal. However, bacterial resistant to these antibiotics is on the rise, necessitating a constant drive to discover new antibiotic drugs as older ones are rendered less effective. One of the scientists on this forefront of this push is Emory Associate Professor and Georgia Research Alliance Distinguished Investigator, William Wuest, PhD. Wuest runs a lab that is focused on finding novel antibiotics to fight bacterial infections. Recently he and his team have made several notable discoveries, including drugs that can be used against antibiotic-resistant staph (MSRA), as well as bacteria that can cause tooth decay and heart disease.

Wuest originally obtained a degree in chemistry/business from the University of Notre Dame. Between his PhD at the University of Pennsylvania and postdoctoral position at Harvard Medical School, he grew interested in antibacterial development. A major incentive for him to study this subject was the relative lack of interest by pharmaceutical companies in a field that had a growing need.

“The fact that humans have created compounds de novo, that are effective against specific diseases, and have saved countless lives is truly remarkable,” Wuest said. “However, companies’ recent lack of interest in antibiotics has left a convenient void for academics to fill.”

As Wuest’s career advanced, antibiotic-resistant bacteria became a growing problem. Today, these strains of bacteria infect over 2 million people worldwide each year and are responsible for 23,000 annual deaths. A 2014 study by KPMG estimated that 2050, antibiotic-resistant bacteria could cause more deaths than cancer. To combat this problem, Wuest and his team are always looking for new compounds with the potential to become antibiotic drugs. They start by looking at structures in nature that are known to kill bacteria. They then attempt to “strip down” the molecule in the lab to create a simplified form where it can be used in therapies, a process which Wuest says can be challenging.

“Although organic synthesis is a mature field, and we can create virtually any molecule we want, it is still a time consuming and frustrating practice,” Wuest said. “I’m fortunate to lead an incredibly talented group of graduate students, undergraduates, and postdocs at Emory who work very hard day-in and day-out toward these goals.”

Wuest’s work is uncertain by nature, as the outcomes of the trials his lab runs on new drugs are unpredictable. One time, for example, Wuest discovered a compound that appeared to be highly potent at killing Staph bacteria. It was later found, with further testing however, that the compound also damaged human cells, making it impossible to use as a therapy. To Wuest, however, such experiences are just part of his job and make it even more rewarding when he does find a successful antibiotic.

“To me, the most exciting part of every project is to see if our hypotheses are accurate,” Wuest said. “I am the type of person who always loves to be right, but in this field that outcome is typically rare.”

For those seeking a career in his field, Wuest emphasizes intellectual curiosity, particularly through reading scientific literature, as an essential quality to have. He also advises students and young scientists to network, saying such connections have broadened the scope of his own research.

“Our research has been expanding in ways I never would have thought possible through one-off meetings during seminar visits or a dinner after conferences,” Wuest said. “These collaborations have expanded our potential, leveraged our resources, and enabled my students to have broad training experiences.”

William Wuest: http://biomed.emory.edu/academics/faculty-detail.html?action=getFacultyDetail&gdbbsId=07FD72BF-FE9C-4F05-AC97-AB470D7DF98F

15 Good Minutes: Cassandra Quave

When most people think about medicine, plants are not what immediately jumps to mind. However, for Emory Assistant Professor Cassandra Quave, PhD, the relationship between plants and medicine is career-defining. Quave is an ethnobotanist, meaning she studies human interaction with plants and their potential medical properties. Her work has led to important discoveries including treatments for eczema and skin infections. Quave describes her research as investigating compounds on a fundamental level, derived from their source in plants. She and her lab then determine whether the compound has properties that would allow it to be used in medicine.

“In a single plant species, you have hundreds or thousands of unique molecules, and so there’s a lot of chemical diversity found in nature to still explore,” Quave said. “There are over 28,000 species of plants used by humans on earth for medicinal purposes, and we’ve barely scratched the surface in exploring their medical potential.”

Quave decided to pursue her career studying plants based on her interests in microbiology and nature. Today, in addition to her role as an Emory Professor, she also serves as a curator of the Emory Herbarium and as CEO of the start-up company PhytoTEK LLC. In her role at PhyoTek, which she co-founded, Quave helped the company discover innovative plant-based medications for fighting antibiotic-resistant drugs. Currently, PhytoTEK is working on the technology for a new line of medicated bandages.

Protecting the intellectual property of her innovations can be more complicated for Quave than it is for many other researchers. This is because plants themselves can only be patented in a narrow set of circumstances, while the medical use of compounds isolated or formulated from the plant can be patented more broadly. Quave’s company PhyoTEK holds one patent, and Quave has worked with Emory’s Office of Technology Transfer (OTT) to secure additional patents for innovations discovered through her academic research. Quave says working with OTT has generally been a smooth and quick process.

“I’ve been really impressed by Emory’s OTT because they’re pretty fast in getting provisional patents filed and then converting them when the year is up,” Quave said.

For those also hoping to pursue a career in ethnobotany or biology in general, Quave recommends that they polish their writing skills. She spends much of the time writing, from grant proposals to academic papers and a science memoir.

“Start writing earlier and practice writing,” Quave said. “Write a lot more grants because grants are what make the research possible. So just building skills in the field of scientific writing and communicating science from an early stage is really important.”

 

Ethics in Medicine: Dilemmas in Healthcare Part 2

The four principles of ethics discussed in Part 1 of this series are not always binding, but rather, should be applied in all circumstances unless there is a more important factor that must be considered for the greater good. While ethical codes are established as principles that a consensus of medical professionals believe in, they often do not address situations that occur on an individual basis. Two main issues in bioethics today are euthanasia and religious liberty in health care.

Euthanasia
There is an ethical dilemma in the choice of caring for individuals nearing the end of life for prolonged periods of time when there may be little benefit in doing so. Euthanasia is the process of a doctor ending someone’s life by painless means, which provokes debate about whether doctors should be able to deliberately end someone’s life with their consent. There are two main types of euthanasia: active euthanasia and passive euthanasia. Passive euthanasia is the less controversial type: it allows the patient or their family to withhold life-sustaining treatment such as opioid medications, a ventilator, or a feeding tube. Active euthanasia occurs when medical professionals or another person deliberately gives lethal drugs that end the patient’s life. In classical ethics, there is a moral difference between actively killing a patient and refraining from actions that would sustain the life of the patient. However, others argue that because both types of euthanasia are done with the intent of the patient’s death, there is no substantial difference between the two types if they are administered with proper consent. In 1990, the United States Supreme Court approved the use of passive euthanasia, and some states have adopted Death with Dignity Acts, allowing physicians to assist terminal patients in ending their life if they are expected to die within six months.

Religious Liberty in Healthcare
Addressing a patient or caregiver’s religious beliefs that may conflict with certain medical practices is also an ethical problem. This can involve a patient’s religious objection to procedures such as vaccination, or a doctor’s religious objection to treating someone whose lifestyle violates their religious beliefs. Many state laws include conscience clauses, which protects the rights of doctors and medical professionals to withhold treatment that violates their religious or moral values, such as abortion, sex reassignment, and euthanasia. In 2014, the Supreme Court ruled in Burwell vs Hobby Lobby that the government cannot force private companies to provide insurance that covers birth control methods if it violates the employer’s religious beliefs. Some activists and ethics professionals disagree with this Supreme Court decision and with the wide use of conscience clauses: they believe that the expansion of religious liberty for doctors could endanger some groups from receiving emergency care and decrease the availability of contraception for women.

To better address these ethical issues, many healthcare facilities establish an ethics committee that creates formal policies to better resolve issues. However, these ethical dilemmas will continue to be hotly contested at the personal, federal, and global levels.

Books About Ethical Dilemmas and the Practice of Ethics
For further exploration, here are four books widely acknowledged as innovative or informative in developing a more-complete understanding of medical ethics:

  • Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present by Harriet Washington
  • The Spirit Catches You and You Fall Down by Anne Fadiman
  • The Immortal Life of Henrietta Lacks by Rebecca Skloot
  • Bioethics: Principles, Issues, and Cases by Lewis Vaughn

Situations that create conflict between bioethical principles show how the study of bioethics is not always clear cut and has many contrasting opinions within the field. However, the improvements to health care that have resulted from the adherence to these principles show that bioethics is an integral part of creating a better and more equitable healthcare system. The study of bioethics may appear abstract and theoretical, but the forms, practices, and procedures you encounter at the doctor’s office or hospital are governed by the special standards of bioethics to ensure the best care and future for you and all patients.

References:

Ethics in Medicine: How Bioethics Builds a Framework for Providing Care Part 1

Part 1: The Foundation of Ethics in Healthcare

Determining ethical standards is a priority in any field that involves choices, experimentation, and human interaction. The healthcare industry is no exception. Medical staff aim to establish standards that encourage humane, morally-sound patient care and research. Implementing a system of ethics, or moral principles that determine what is right and wrong, is one way to regulate medical practices. However, creating one consistent ethical code across national healthcare is difficult, given that beliefs often differ across societies and cultures. So how does one determine the role of ethics in the healthcare field?

Bioethics refers to the ethics involved in medical and biological research and is often applied to healthcare settings as well. These are commonly used to guide professionals when they must make choices that cross into potentially subjective territory. Below, we explain the basics of bioethics and how they can be applied in healthcare settings.

Principles of Medical Ethics

Though bioethics researchers differ on the exact ethical standards healthcare professionals should follow, four principles from Thomas Beauchamp and James Childress explain common understandings of bioethics: respect for autonomy, non-maleficence, beneficence, and justice.

Respect for autonomy refers to the idea that a patient has the right to control their own body and the ability to make informed, voluntary decisions. This means that a patient’s decisions should be respected so long as they are able to think freely. For example, if individuals that follow certain religions refuse to undergo procedures like blood transfusions, this principle argues that their wishes should be respected given the assumption that they are rational individuals.

Nonmaleficence means that healthcare providers cannot intentionally harm a patient and any potential danger must be minimized as much as possible. In situations where harm is inevitable, it is the responsibility of the professional to choose the option that causes the least injury. This principle ties in with respect for autonomy when a patient makes the decision to abstain from life-saving treatment if the treatment would cause too much suffering or pain.

Beneficence states that medical staff members serve as a benefit to patients and are tasked with preventing the patient from experiencing harm. This principle differs from nonmaleficence in that although providers should never directly harm anyone, they can choose the patients they wish to benefit through permitting specific individuals into their practices or prioritizing the care of one over another. At times, beneficence can take precedence over respect for autonomy in situations when the patient cannot think independently, and medical providers must make the decision to help them without their consent.

The fourth principle, justice, asserts that individuals are equal and should be treated as such. This means that quality medical care and resources should be distributed evenly so that a certain demographic is not deprived of medical assistance and treatment. It also refers to the responsibility of healthcare professionals to adhere to legislation in their decisions. However, it can be argued that the principle of justice is not always applied in healthcare, as individuals who are of lower socioeconomic status or identify with minority races may receive unequal treatment.

The Hippocratic Oath

Another source medical practitioners use as a basis for ethics is the Hippocratic Oath. Originating from Ancient Greece, the oath emphasizes for those who swear by it to uphold ethical standards, including the popularized phrase to “first do no harm.” While many adaptations have been made, the 1964 version rewritten by Tufts University Academic Dean Louis Lasagna is used in many medical schools today. In this version, individuals swear to respect privacy, prevent disease, protect the environment, and view patients as human beings, among other criteria. The Hippocratic Oath remains a reminder in the medical community to uphold high standards of patient care and practice medicine ethically.

The study and practice of bioethics through its main principles of autonomy, non-maleficence, beneficence, and justice have improved the standards and quality of healthcare in all settings. In the next part of this Ethics in Healthcare series, we will explore how ethical issues in healthcare often arise when there is a conflict between the four principles.

12 Days of Christmas Invent

The most wonderful time of the year is officially here! You may usually count down the days until Christmas with an Advent calendar, but why not count down with an “Invent” calendar, too? Happy Holidays from the Office of Technology Transfer and these twelve days of festive inventions.

It’s beginning to look a lot like Christmas… with all of those twinkly lights strung up around the house! Would you believe that Christmas lights were actually invented by Thomas Eddison and his business partner Edward Johnson in 1882? The duo hand-wired 80 lights around Johnson’s revolving Christmas tree, but it didn’t become common practice until President Glover Cleveland requested to light the White House Christmas tree in 1895. https://www.loc.gov/everyday-mysteries/item/who-invented-electric-christmas-lights/

Let it snow, let it snow, let it snow… so you can have a chance to try out this Snowball Gun! Filed in 1947, U.S. Patent 2607333 contains a mechanism that transforms loose snow into small pellets for the best snowball fight ever. https://patents.google.com/patent/US2607333?oq=snowball

holiday graphicOn the third day of Christmas my true love gave to me…. A Santa Claus visit kit! US Patent 7258592B2 comes with everything you need to bring the magic of a visit from Santa to your kiddos on Christmas Eve–Santa sized boot stencil and all.
https://patents.google.com/patent/US7258592B2/en

You know Dasher and Dancer and Prancer and Vixen… and you know they need something to eat after flying around the world on Christmas Eve. U.S. Patent US20020128081 is a Reindeer Food Kit. https://patents.google.com/patent/US20020128081

Merry Christmas and Happy Hanukkah! U.S. Patent 20160215971A1 blends the style of a Christmas tree with a traditional Hanukkah candle holder for interfaith holiday celebrations. https://patents.google.com/patent/US20160215971

Rocking around the *artificial* Christmas tree! U.S. Patent 1654427 is a collapsible, artificial Christmas tree that probably looks similar to the one you use in your home today… even though it was filed all the way back in 1927! http://www.freepatentsonline.com/1654427.pdf

No matter what you stuff your stocking with, U.S. Patent US2536407A has got you covered! The Christmas stocking hanger is “designed for holding stockings suspended from a mantelpiece to be filled by Santa Claus on Christmas Eve.” https://patents.google.com/patent/US2536407A/en

He’s making a list, he’s checking it twice, and he’s gonna find out who’s naughty or nice… and with US Patent 20080299533A1, you can find out too! This Naughty or Nice Meter grades children on things like how well they brush their teeth and clean their room to see if they will end up with toys or coal in their stocking.
https://patents.google.com/patent/US20080299533A1/en

Take a trip down Candy Cane *history* Lane with me! Legend has it that Candy Canes were invented by a choirmaster at the Cologne Cathedral in Germany, in an effort to keep his young singers quiet during the Living Crèche ceremony. The choirmaster bent sugar sticks into shepherds’ crooks in honor of the occasion–and now the bent candies that we know and love today are the most popular holiday treat. https://www.history.com/news/candy-canes-invented-germany

Elves used to live at the North Pole, but now they live on the shelves of homes across the country. Elf on a Shelf, the Christmas staple that watches over children and reports back to Santa each night during the Holiday season, was invented by a stay-at-home mom and her two daughters back in 2005, after they themselves had used a sort of “elf on a shelf” as family tradition since the early 1970s!  https://www.huffpost.com/entry/the-elf-on-the-shelf-history_n_5a24c89be4b0a02abe920d71

This patent gives a whole new meaning to Holiday Magic! Officially called a “wand activated electric menorah,” U.S. Patent 6053622A is an innovative Menorah that is lit and extinguished with the flick of a wand. https://patents.google.com/patent/US6053622A/en

Sleigh bells ring… are you listening? U.S. Patent US5297324A, called the “fully rounded jingle bell making method,” streamlines the bell-making process so that they’re ready to ring all holiday long! https://patents.google.com/patent/US5297324A/en