Shraddha Chakradhar

It’s Finally Spring! Why Didn’t the Trees Die Over the Long Winter?

It’s been a long winter, but spring is finally in the air! Daffodils and hyacinths are peeping from the ground, the birds are busy in the bushes, and the trees are finally budding leaves! The fresh green shoots are such a welcome change from the drab brown hues we’ve become so accustomed to, although it makes you wonder: how do these trees manage to revive themselves year after year? Winter, with its drastic temperature drops, precipitation and wind, can be be unforgiving, so how do trees manage to survive the harsh environment?

The key to making it through winter is to prevent ice crystals from forming in any of the living parts of a tree— leaves, flowers, fruits, roots, and a small portion of the trunk. Trees have developed a few defense systems to protect against the formation of ice during the frigid winter months, especially in harsher climates. One of these is the shedding of leaves. Leaves are full of water-filled cells. In freezing temperatures, the water in these leaves would turn into ice, which would in turn destroy the cells. Despite millions of years of evolution, most living beings—plants and animals alike—have not developed a defense system against ice; its crystalline structure punctures through cell components. And so, every fall, in most of the northern United States, we see deciduous trees (trees like maple and oak) shed their leaves, thus eliminating one possibility of ice being formed within living cells.

“A ruptured cell is a dead cell,” said John Seiler, tree physiology expert and professor of forestry at Virginia Tech. “So anything trees can do to prevent a cell from rupturing will help ensure its survival into spring.”

Another tactic against ice, most common in conifers such as pines, firs and spruces, is the expulsion of water from living cells. These trees have needle-like leaves that hold less water than the broad, flat leaves that deciduous trees have and so don’t have to worry about shedding leaves. Instead, they begin to push water from the living cells within the trunk and branches to the spaces outside cells and replace the water with starchy sap. This sugary substance acts as a natural antifreeze, allowing for the tree’s protection against temperatures well below freezing. Of course, in northern parts of the country, some deciduous trees combine shedding leaves with this method of forming sugary sap, which is how we can enjoy maple syrup!

But what happens to the trees in parts of Alaska, Canada and the Arctic tundra?Or trees in the lower 48 during a particularly brutal winter? Apart from shedding leaves and stocking up on sap, some trees are capable of triggering a survival mechanism that seems to defy the laws of physics: supercooling. Water that stays in liquid form at temperatures as cool as -40ºC (where the temperature is also -40ºF) is considered supercooled. This is because of something called nucleation. If you’ve ever witnessed the beginning of water freezing over, you know that water begins to freeze at the edges of objects it touches. The perimeter of an ice cube tray, around the rocks in a pond, and so on. That’s because these foreign materials—the plastic of the tray, the rock surface—act like an anchor for the first frozen crystal, which then helps anchor consequent crystals. But without any of these anchors, or nucleating points, the water exists as a homogeneous mixture incapable of freezing exactly at 0ºC. It freezes closer to the -40ºC mark.

Trees like maple and elm are capable of triggering this supercooling effect when faced with particularly brutal temperatures. How they do this is by getting rid of any nucleating points. The shape of the cells are changed to prevent any foreign surfaces that could possibly act as an anchor to begin the freezing process.

While trees do employ these various defense mechanisms to protect against the harmful effects of ice, there are instances in which they succumb. Frost cracks (pictured below) are formed when ice builds up in the plumbing system of trees, known as the xylem. The xylem is largely non-living, so there is no major damage to the life of the tree, but much like freezing pipes bursting due to expanding ice, the trunk or branches which house xylem can burst if the ice outweighs the wood.

“It sounds like a gunshot when it happens,” said Frank Telewski, professor of plant biology at Michigan State University. “The tree cracks open under the pressure and exposes part of the trunk to the outside environment.”

While the frost crack in itself isn’t fatal, the exposure to the environment upon cracking leaves the few living cells within the trunk or branches susceptible to ice. Much like self-healing wounds in humans, trees form a layer of callus layer that often seals the crack and ensures the survival of the rest of the tree.

What’s also interesting about these defenses against ice is that they also prevent the trees from drying out during the winter. But the coast isn’t always clear: some trees have to worry about winter burn.

“It happens during those rare sunny days in winter,” explained Seiler. “The little water left in trees starts to evaporate because of the sun, but more water can’t be pulled up from the roots because the soil is frozen.” The result is a reddish-brown hue in coniferous trees. Entire stretches of trees in the Rockies, for instance, are susceptible to this condition, known as red belt disease.

With the exception of frost cracks and red belt disease, winters are usually fairly stable. An ice storm may cause damage due to the sheer weight of the ice that forms around trees, but snow serves to insulate the roots and cause little damage.

All these defense mechanisms are especially amazing considering that trees, and most plants in general, have no way of regulating temperature. So the temperature of the air around them is often the temperature within them. But thousands of years of evolution has allowed all kinds of trees to weather the harshest of winters. Dendrologists (scientists who study trees) have conducted experiments transplanting trees native to warm climates to colder climates. The health of these trees is often compromised, since they rely on defense mechanisms that they have long discarded. But when the days start to get longer and the ground thaws to let water flow through the trees, even these immigrant trees, along with their native cousins, finally come out of dormancy and signal to the world that they are ready for yet another season.

Originally published April 2014 on Beacon Reader.

The Ouch-Factor Behind a Flu Shot: Explained

Flu season is here! Here in the United States at least, flu season has been in full swing since October, with pharmacies and doctors’ offices posting signs encouraging people to get their flu shot. If you’ve ever had a flu shot (or any shot, for that matter), you know to expect some pain to go with that healthy dose of immunity. But what you may not know is why. And what’s even more surprising: the pain is good.

Despite the latest needles being significantly small, the size of a needle does make a difference when it comes to the amount of pain you may experience when getting a shot. Needle sizes, specifically how thick they are, are measured in gauges, with a lower gauge representing a thicker diameter and a higher gauge representing a thinner diameter. With flu shots, the most commonly used needles are between 20-gauge and 24-gauge, which represent diameters between 0.023 inches and 0.012 inches. The length of a needle, however, is much higher, ranging from between 1 inch to 1.5 inches.

One major difference between a shot and a pinprick is that a pin would not normally penetrate your skin as deeply as a shot does. Flu shots are typically administered intramuscularly, meaning that it penetrates past your skin layers, a subcutaneous layer of fat, and then reaches the muscle layer. Beginning in 2011, however, a subcutaneous method of administration has also been made available in which the needle is not inserted as deeply. There is no major difference in the two types, however, as far as immunity and side effects.

Needle gauges, lengths and penetration depth aside, the most important reason why a flu shot hurts is that your body is responding to the many agents within a flu shot. And many doctors believe that pain after getting a shot is actually a good sign. It’s a sign that everything is functioning like it should, with the body launching the expected attack against the inactivated viruses, or antigens, that are found within seasonal flu shots (the nasal spray version of the vaccination has live attenuated viruses, which are weakened but live forms of the microorganisms). When the body recognizes these antigens, the immune system launches a coordinated effort against them, by-products of which are the symptoms of an infection—soreness, inflammation, and in some cases, fever. These symptoms serve as signs not only to us at the organismal level that something is going on within the body, but also sound the alarm of an invasion to cells in the immune system.

A specialized type of white blood cells, T-cells, are regularly on patrol-duty, monitoring the blood stream for foreign particles and alerting the rest of the system if antigens are recognized. When antigens present themselves in the blood, antibodies are made by another type of specialized white blood cells known as B-cells. These antibodies are then dispatched to attack and destroy the antigens presented by the vaccine. The antibodies stick to the surface of the antigens, in a mechanism akin to solving a jigsaw puzzle. B-cells create an antibody that fits in specifically with the molecules in an antigen. By being locked into the antigen, the antibody is able to manipulate the antigen in such a way as to stop it from moving further within the body. In the process, the antibodies also alert other cells in the immune system to the presence of antigens.

In most cases, your body is successfully able to overcome the foreign agents, both at the time of vaccination and in case of a future infection. Only some of the B-cells that were involved in antibody production actually respond to the antigen. While many antibody-presenting B-cells are dispatched, some never get involved in the attack and instead become memory cells, ready to launch an attack the next time they spot the same enemy. Memory T-cells also function similarly, remembering the antigen from a previous encounter and launching an attack as soon as the antigen presents itself again in the future.

But that’s the thing: the flu shot changes from year to year, which explains why, even if you’ve been diligent in getting a shot every year, you still experience pain. Every year’s flu shot is a mix of what scientists have deemed that year’s mix of flu viruses to beware. They spend months preparing the solution, adding between three and four types of viruses to the vaccine. The vaccine is tested in cell cultures, animal models and, finally, humans before it is made commercially available. In many cases, these concoctions also have other chemicals, known as adjuvants, mixed in.

“Adjuvants are added to vaccines to make them more potent,” said Dr. Richard Malley, a pediatric infectious disease specialist at Children’s Hospital Boston. “Often, they are aluminum phosphate or aluminum hydroxide additives that drive a better immune response in people.” But a major side effect of adjuvants: pain. These adjuvants trigger inflammation and pain responses within the body but have the added benefit of boosting immunity.

Not surprisingly, the benefits of getting a vaccination far outweigh the costs. But if it helps, despite decades of administering and developing vaccines, pain is still one of the first things vaccine researchers take into consideration, according to Malley. So the next time you get a shot, think of the many fighting components in your body working to protect you, but most importantly, embrace the pain.

Originally published on Beacon Reader in December 2013

 

Violent World or Violent Media?

Col. Muammar el-Qaddafi, Libya’s overthrown dictator, was killed today near his hometown of Surt.
Nearly 3 weeks ago, Anwar al-Awlaki, a senior leader of Al-Qaeda was killed by a drone strike in Yemen.
At the end of July, a right-wing extremist planned and executed terrorist attacks in Norway, killing nearly 80 people.
In May, President Obama announced that al-Qaeda leader Osama bin Laden had been discovered and killed.

These are just a few of the events that have occurred in the past 5 months. The Wars in Iraq and Afghanistan, the Colombian Armed Conflict, the Somali Civil War, and several other international conflicts have been on going for several years.

Violence, no matter the reason behind it, is everywhere. Or is it? Could it just be the media hyping up the conflicts when the world is actually pretty safe?

Cultivation theory, in the field of communications, looks at the long-term effects of television viewing on people’s thoughts and ideas, and one of the ideas that arose out of the theory is the “Mean World Syndrome.” It claims that people who watch a lot of television today are more likely to think that the world is a terrible place because of media coverage of violent incidents.

“When I was a kid, my mom used to let me wander around the city where I grew up and ride my bike wherever I want,” said Boston University’s James Shanahan, Professor of Communication. “Now we would never let our kids do that because the perception is that it’s more dangerous, but the reverse is actually true. It was more dangerous for me to do that back then than it is today”

I found some proof to support the idea that media hypes up terrorist and other violent attacks in an article I read in The New Yorker a few weeks ago. Elizabeth Kolbert, in a piece titled “Peace In Our Time”  profiled Stephen Pinker (pictured on right) and his new book on the history of violence, The Better Angels of Our Nature: Why Violence has Declined, and asked for his take on the Norway shooting in July.

Clearly judging by the title, Pinker, a Harvard University professor of psychology, believes that violence in the world has declined. He also believes that the shooting was over-hyped. His argument, at least as showcased in Kolbert’s piece, is largely an historical one. He cites the fact that the European countries, for much of history, had been in constant, bloody war (100 years war, 30 years war, First and Second World Wars, to name a few),  but now Norway is not only one of the safest places in the world but is probably the safest it has ever been in the history of its existence. According to him, nearly 300 people in Norway die yearly from accidents, so why is the death of the 77 people in the shooting so important?

The answer: civilization. Civil-ization. As time went on, and people became more civil and educated (about everything), the way they began to think about others and behave towards others also changed. Literacy, the progress of civilization from feudal-states to more unified government, and the population burst are all reasons, according to Pinker, that contribute to people becoming more considerate of others.

There are several gaps in Pinker’s analysis, according to Kolbert (and I agree). For instance, he fails to mention historical evidence from anywhere except Europe. Even in regards to European history, he skips over the issue of colonialism, a pursuit that resulted in tremendous violence.

If there is evidence to support the fact that we live in a world that is less violent than in the past, why are we still affected by the events that unfold? Apart from the fact that we are human and we empathize with others? While education and civilization has allowed us to care about each other, it has also allowed us to be more technologically advanced. And much of this advancement is made in the field of weapons. It’s difficult for us to congratulate ourselves on becoming less like our feudal ancestors while simultaneously developing ways to destroy each other in more brutal ways than our ancestors did.

And it’s this paradox that is disturbing. When a terrorist attack or extremist gunman disturbs the peace, we are shocked into remembering the weapons available at our disposal despite the awareness against using them. We are reminded, as Kolbert wrote, that “hate, madness and cruelty haven’t disappeared, and they aren’t going to.”

Turning the Heat Down

A few days ago, being too lazy to cook, my fiance and I decided to try out a restaurant in the area. It was a hole-in-the wall Indian restaurant with a great Indo-Chinese menu.

Almost as soon as we took the first bite into our noodles, both of us impulsively reached for water. While the food was delicious, we had soon gone through two glasses of water each, we each had a runny nose, and the spice still lingered in our mouth. I remembered then that water doesn’t work to curb spice, and ordered some mango juice instead. And that did it. The spice began to dissipate.

Though I knew from friends and, well, personal experience that water doesn’t work to curb spice, I still didn’t know why. And the fact that milk is said to work better to tone down the heat? Why did that work? Most restaurants don’t have the option to order milk as your beverage of choice, so what do you do to relieve the spice?

After much research, I managed to find some answers. The molecule that causes spice is called capsaicin. Contrary to some opinion, capsaicin is NOT made in seeds of chili peppers. Rather, it’s produced in the fleshy white membrane that the seeds are attached to. But because capsaicin is in such high concentrations on the membrane, the spice is transferred to the seeds as well.

Red bell pepper with white placenta membrane and seeds attached 

This is what the capsaicin molecule looks like:

Note the long tail that the molecule has, i.e., everything to the right of the oxygen jutting down. This long tail, which is made up only of carbon and hydrogen atoms, is the reason that capsaicin is insoluble in water. It’s basically like an oil and water mix. The water does nothing but move capsaicin around your mouth, which is why sometimes you feel water aggravated the problem instead of alleviate it.

But the hydrocarbon tail also makes the molecule soluble in lipids, or fats. Contrary, again, to some opinion, milk and milk products are mainly helpful not because of their fat content, but because of the presence of a protein called casein. Like capsaicin, casein is also insoluble in water and soluble in fat. Like dissolves like, and so capsaicin dissolves easily in casein, dissipating the spice. So if milk is unavailable, look for other milk products like cheese and butter (If you’re at an Indian restaurant, ask for some ghee, or clarified butter; it’s a staple in every Indian household for this very use). Casein, or the lack of it, is also why some oily foods are still spicy. Chinese food mostly uses sesame and peanut oils and casein is found in animal, particularly mammalian, milk. Sesame, peanut and other vegetable oils still help because of their ability to dissolve capsaicin, but to a lesser degree than milk products.

So water doesn’t work, you don’t have any cheese or butter, but there are still a few other options to try. The first, luckily enough for some, is alcohol. Alcohol is fat-soluble. So it will dissolve capsaicin. And naturally, the higher the alcohol content, the more it will dissolve capsaicin. If you’re at Mexican restaurant and treat yourself to too much habanero, have some simple guacamole. The high fat content in avocados will help curb the spice.

And if all else fails, get some dessert. While they tend to be sweet, which will be a nice break for your mouth, they also tend to have a high fat content and will dissolve capsaicin.

Alzheimer’s Disease and Sleep

NPR’s Morning Edition is doing a “Fade to Darkness” series about Alzheimer’s Disease all week. To go along with it, I figured I’d write about this study I read a few weeks about Alzheimer’s and sleep.

Researchers at Washington University in St. Louis’ School of Medicine and Sleep Medicine Center have found an interesting trend in what they call a “marker” for Alzheimer’s Disease.

According to the study, the level of amyloid beta, the protein chain primarily responsible for the development of Alzheimer’s, fluctuates throughout the day. What’s particularly interesting about this new finding is that the fluctuation echoes the sleep-wake cycle.

Alzheimer’s Disease (AD) occurs when tangles of amyloid beta protein form plaques in the brain. These plaques form in existing tissue, and, depending on how advanced the disease is, disrupt functions of the brain and nervous tissue. This causes memory loss and other phenomena that we recognize as being symptomatic of AD.

Amyloid beta plaque in nervous tissue

While the trend had been previously observed in mouse models, this was the first study to observe it in human beings. Three different groups of people–people who had been diagnosed with amyloid plaques, people in the risk age group (over 60 years) with no plaques, and a younger, healthy group (mean age 35) that was not at immediate risk of developing plaques–were given lumbar punctures to extract cerebrospinal fluid and check for amyloid beta levels. The fluid was extracted every hour for 36 hours, and during this time period, the researchers also video recorded the subjects to look for possible connections between behavior and what the fluid levels reflected.

In regards to the link between sleep and amyloid beta levels, the researchers found that there was a 6 hour lag when compared to the sleep pattern. For instance, if the peak hour of sleep was at 4AM, then the lowest levels of amyloid beta were found to be at 10AM. Similarly, if peak hour of wakefulness was at 4PM, then highest levels of amyloid beta were at 10PM. They also found that this distinct peak-and-crest model was primarily in the healthy and non-plaque risk group. The model in the group with diagnosed plaques was relatively flat.

“As you age, your sleep is disrupted,” said Rachel Potter, research technician and one of the authors of the study, “and so what our study shows is that with people who are older, the more their sleep is disrupted, or the less sleep they get, the less their amyloid beta levels fluctuate.” And this likely means that there is more of a chance that the protein aggregates and forms plaques.

When asked if this meant that being deprived of sleep was an indication that you might be at risk for getting Alzheimer’s, Potter said that it was too soon to jump to conclusions. “For now, it’s just important to know that amyloid beta follows this pattern of fluctuation. Future studies will determine how important this pattern actually is.”

Boston Book Festival

Book lovers from all over the North East descended upon Copley Square yesterday to partake in the Boston Book Festival. Not even the chilly wind and threatening rain clouds could keep the fans from lining up outside the various panel locations to listen to their favorite authors speak. I was one of these people, giddy with the prospect of listening to famous authors speak, and better yet, getting my books signed by them (I have my priorities sorted, I know).

The most interesting panel I attended yesterday was “Frontiers of Science,” with Siddhartha Mukherjee, Lisa Randall, and Stephen Greenblatt, with WBUR’s Christopher Lydon as the moderator. Each of the panelists began the session with a brief introduction of their latest book. Greenblatt began with his book, The Swerve, and spoke about the connections between the humanities and the sciences. Randall spoke about her book, Knocking on Heaven’s Door, and Mukherjee, clearly the most popular of the three, spoke about his book, The Emperor of All Maladies.

What was most interesting to me, as a patron of both the humanities and the sciences, was the ease with which these three writers, (with some help from Lydon, of course) were able to see their own work in each others’ novels. Greenblatt’s The Swerve tells the story, among other things, of the ancient poet Lucretius’ idea of the world being made up of tiny particles that collide with each other in a “swerve-like” motion.  As a professor of English at Harvard, he likely does not work with scientific subjects on a regular basis, and yet Lisa Randall, a professor of theoretical physics at Harvard, was able to pick up from Greenblatt’s description of these “tiny particles” and apply it to work being done with the Large Hadron Collider in Switzerland. Similarly, Mukherjee, a cancer physician and professor at Columbia, identified the importance of fundamental particles in any system and described the role of genes in cancer development.

In the end, each of the writers emphasized the idea of continuity. Lucretius was working in the century before the Common Era, and yet his idea didn’t have any merit until 20th century experiments with nuclear and quantum physics proved his conjectures to be true. And just like atoms were found not to be the smallest part of matter, so too were cells proven not to be the smallest part of an organism. The discovery of genes and DNA revolutionized the field of medicine, especially of cancer.

And it is with the faith that science will eventually prove or disprove conjectures that Randall and Mukherjee take comfort in their (often bleak) work. Greenblatt, on the other hand, seemed like he was just happy to tell the audience a story that was still relevant today.

 

A Plague On Both Your Houses!

The famous words by Shakespeare (via Mercutio in Romeo and Juliet) are immortal, and so is, apparently, the plague’s influence. The plague, the Black Death, the one that Mercutio is referring to when he curses the Capulets and Montagues, is still around today. The same one that killed nearly half of the world’s population in the mid-14th century, plus or minus a few changes in the DNA structure. I know this now because I had to write a 600-word story about it this morning. I had between the hours of 9AM and noon to research and write a story about the Black Death. Needless to say, it was nerve-wracking. But I actually had a lot of fun doing it. For one, the topic was fascinating. As I was telling a colleague of mine, “I love medieval Europe and anything related to medieval Europe.” And second, I couldn’t afford to meditate for longer than a few seconds on the construction of a particular sentence. The urgency to get the story done and let little things go was refreshing from my usual routine of obsessing over using one word over another.

Anyway, I am posting my final product here. How do you think I did for 3 hours of work? (Bear in mind, we have thus far been giving a week to do something like this)

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A collaboration of scientists from Germany and Canada has sequenced what they call a “draft” of the genome of Yersinia pestis, the bacterium responsible for the Black Death in Europe. Their paper was published online in Nature on October 12, 2011.

In an interview for NatureVideo, University of Cambridge Historian John Hatcher said, “The Black Death was an epidemic on an unimaginable scale. It swept across Europe in the mid-14th century, killing…up to half of the population, 1 in 2 of the population in a space of 7 years.”

The collaborative team was led by Kirsten I. Bos of McMaster University in Ontario and Johannes Krause of the University of Tübingen in Germany. Using the remains of teeth and bones they found in an ancient burial ground for Black Death victims in East Smithfield outside London, England, the team was able to sequence and reconstruct the ancient DNA of Y. pestis.

Discovered in 1894 by scientist Alexandre Yesin of the Pasteur Institute, Y. pestis has been infecting both human and animal populations for centuries. It originally evolved as a harmless soil-dwelling organism. The pathogenic strain, however, is found in fleas, which spread it to rats, which in turn spread it to human beings. And this pathway was how the Black Death spread so rapidly.

While most people are familiar with the devastating effects of the Black Death, fewer still know that the bacterium continues to infect people today, albeit in a less severe manner. “Although we think of the [Black Death] plague as something that happened a long time ago and [it] decimated European populations then, it’s still very much an ongoing concern, and a very important pathogen today,” said senior editor of Nature Magdalena Skipper in the NatureVideo interview.

In a Nature podcast interview, Johannes Krause said that there were approximately 2,000 cases a year worldwide in countries like the United States and Mexico, parts of Africa, as well as Asian countries such as China and India.

What the researchers were interested to know, Krause revealed in the same podcast interview, was how different current strains of the bacteria are from the ancient strains. What they found was surprising:

“We found almost no difference between the ancient plague and the modern plague strains” said Krause.  The difference was a matter of a few positions in the DNA sequence. These few positions, he elaborated, are ancestral to the modern strain. In other words, all the strains of Y. pestis that affect humans today descended from the ancient plague’s strain.

Why this is surprising is because of the effect that these similar strains have on human populations. The Black Death killed half the existing population, whereas the plague today affects less than 1% of the world’s seven billion population.

The reason for the difference is that medieval Europe was exposed to the plague for the first time when it was “unleashed” according to Krause. They had no prior immunity to protect themselves against it. Other reasons for the severity of the Black Death lie in factors that distinguish the mid-14th century world from the modern world: factors such as difference in climate and environment, as well as social and lifestyle changes.

What we can learn from the study is how quickly a pathogen can wreak havoc on a population that has no previous exposure.

“Paradoxically, society was able to cope much better in the 14th century with deaths on this horrendous scale than we would be able to cope today” said John Hatcher. “Today we have such complex interconnections that anything on that scale today would cause complete chaos.”

The Doctor Recommends…better communication?

The idea that the healthcare you receive depends on where you live is not new. Access to health care, income level, education level and cultural beliefs are all factors that play into the healthcare that is available to you. But does this affect what doctors recommend to you?

A study conducted by a team of communication and public health researchers at Ohio State University found that when it comes to the human papillomavirus (HPV) vaccine, what doctors tell parents about the vaccine depends on where they live. The area that the team was interested in was Appalachian regions in West Virginia and Kentucky. The HPV vaccine, which was developed to prevent infection that led to cervical cancer, was of particular interest because of the high rates of cervical cancer in Appalachia.

To see what doctors in the area were doing to curb the rates of cervical cancer, the team decided to survey pediatricians in West Virginia and Kentucky’s Appalachian regions. They also surveyed pediatricians in the non-Appalachian counties of the two states as a comparison. Of the 334 pediatricians who
responded to the survey (129 in Appalachia and the rest out of Appalachia), the study found that the pediatricians in Appalachia were less likely to recommend the HPV vaccine to applicable patients.

“We think that either the pediatricians in Appalachia don’t know that their patients are at a higher risk for cervical cancer, or that they are hesitant to recommend the HPV vaccine because they may be met with difficulty in convincing the parents,” said Janice Krieger, PhD, assistant professor of communication at Ohio State about why there was such a disparity between Appalachian and non-Appalachian pediatricians.

Neither of the hypotheses that Krieger proposed is comforting. The real problem underlying the issue, according to her, is communication. Pediatricians in Appalachia need to be better informed about the HPV vaccine and its effects on their patient population. The pediatricians also need to do a better job of informing their patients regardless of the qualms that they may have.

This leads to larger questions: should doctors change their recommendations based on the overall patient population? If pediatricians in Appalachia know that their patients are likely not going to be able to afford the HPV vaccine, should they refrain from informing them about the vaccine’s effects? Should the doctors inform their patients anyway?

Atul Gawande on Coaching in the Professional World

I recently had the opportunity to attend Atul Gawande‘s session titled “Do Surgeons Need Coaches?” at this year’s New Yorker Festival in New York City. Being an avid reader of The New Yorker magazine and an admirer of Dr. Gawande’s work (both medical and literary), I was excited and tried to keep my ridiculous excitement in check as he sauntered onto the stage from a side door and waited for the applause to die before he spoke.

Dressed simply in a white shirt, jeans and a brown suede jacket, he began with an introduction, a request to not photograph him (my heart sunk a little) and then jumped into his speech about personal coaches. He got interested in the topic of coaching, he said, based on his interest in two other themes.

“Number one is complexity,” he said, “the feeling that we are in a world that is requiring us to know more, master more in order to make some of the basic functions in society…feasible. The volume of information and ability you have to have just to get through the day has exploded, and it seems to only be accelerating.”

The second theme that interested him is how he improves as a surgeon. Up until recently, his surgical career and his ability to be better at his job were rising steadily. However, of late, it had taken to look more like a “plateau.” He was still a good surgeon, he said, but there was no progress.

And that’s when he looked into not only his own profession, but other professions as well, to see how people improve. Based on his research, he arrived at two basic ways of how people get better at what they do/want to do: the teaching model and the coaching model. In the teaching model, people, including surgeons like Gawande, train for several years in a classroom-type setting/atmosphere and then are, essentially, on their own to implement what they learned in school and hopefully, along the way, improve their methods and technique. In the coaching model, which is used by professionals such as athletes, no matter how good the team or how good the individual player, a coach is always present and is always finding ways to improve the game.

Wondering why more professions didn’t take advantage of the coaching model, Gawande decided to take on a personal coach for himself. Dr. Robert Osteen, a retired surgical oncologist at Brigham and Women’s Hospital, Boston, agreed to come in and observe one of Gawande’s surgeries. “I actually thought it went extremely well,” said Gawande about the first operation he had Dr. Osteen observe, “but he had a dense notepad of comments to make.” Dr. Osteen pointed out that Gawande had neglected to notice small things, and that these small things were what made the difference when cutting complication rates.

“When I operate, I operate with magnifying loops so that I can see the nerves and other things that I’m operating around, but that means that I’m not aware of everything that is happening around the room.” Some of the things Dr. Osteen observed were that one of the nurses had trouble with some of the equipment, the anesthesiologist had a blood pressure problem during part of the operation, and the lights had swung out of the wound area for nearly 30 minutes. “I was oblivious to it because I was in my tunnel,” said Gawande, motioning with his hands to mimic the effect.

So what if Gawande got a personal coach who helped him improve?

Gawande’s argument is that the medical world, as it is currently set up, employs a teaching model when it should perhaps consider a coaching model. Instead of only worrying about the number of procedures conducted by a doctor, Gawande believes that quality of care is going to begin playing a larger role.

When Gawande spoke to Dr. Osteen about coming into his operating theatre more, he said, “I’ll pay you.” To which Dr. Osteen astutetly replied, “Are you kidding? I’ll pay you.” Osteen saw the value in the approach that Gawande took.Coaches help us to step back from our complicated world, to step back from the “tunnel,” look at the bigger picture, and reassess our strengths and weaknesses. Coaches give us a better understanding of how to function in our own world.

Now if only I could find a way to convince Atul Gawande to be my writing coach, I could save my writing career from possibly plateauing.

I got the screen before Gawande came on stage, but I wasn’t allowed to photograph him, so here’s a CC-licensed picture from another event.