On the verge of what some experts consider to be an Alzheimer’s crisis, scientists at the School of Medicine are revealing important details concerning the disease’s destructive neurological effects.

The eldest members of the baby boom generation, a significant segment of the United States population, will soon turn 60. Consequently, studies show that the prevalence of Alzheimer’s disease in the U. S. is likely to surge sharply upward in the upcoming decades, straining already overburdened health care systems.

In light of this crisis, the National Institute of Health (NIH) and other organizations are funding scientists like Lei Wang, a research associate in psychiatry at the School of Medicine, who are interested in the pathology of this disease.

Wang and colleagues at the Silvio Conte Center for Neuroscience Research and the Alzheimer’s Disease Research Center at the School of Medicine are trying to pinpoint crucial changes in the brain’s structure that can distinguish individuals who are aging normally from those with mild, early-stage Alzheimer’s disease. Using magnetic resonance imaging (MRI) technology, Wang and colleagues have identified brain structures that show significant abnormalities in Alzheimer’s patients.

Alzheimer’s disease is currently the number one cause of dementia, an umbrella term for progressive degenerative brain syndromes that effect basic cognitive functions like memory, emotions, thinking and behavior. Upon onset, “plaques” and “tangles” begin to permeate certain areas of the brain, disrupting signal pathways and altering normal brain functions.

Unfortunately, these “plaques” and “tangles” in the brain can only be observed post-mortem, via autopsy, so doctors cannot readily diagnose and treat the disease until symptoms manifest themselves in a given patient.

Wang and colleagues are approaching Alzheimer’s disease from an entirely different angle, namely by focusing on imaging a structure in the brain called the hippocampus. As humans age, this area of the brain gradually deteriorates and shrinks in size. After conducting brain scans on 18 Alzheimer’s patients and 26 normal individuals, the scientists noticed a pattern: in Alzheimer’s patients, the hippocampus loses size much more rapidly and undergoes significant changes in shape.

“There were changes in normal people, too,” said Wang. “But the changes were more pronounced in people with mild Alzheimer’s disease. At the start of the study, there were some differences between the two groups, but at the two-year follow-up, the pattern of the changes had spread to a wider region of the hippocampus in people with Alzheimer’s disease.”

Another recent study confirmed that Alzheimer’s diagnosis is posing a serious problem, concluding that four out of five Alzheimer’s patients were not diagnosed by their family physicians in the early stages of their disease. Considering that it may soon be possible to avert the severe consequences of Alzheimer’s altogether with early diagnosis, Wang and colleagues’ findings could play an important role in developing a tool for Alzheimer’s diagnosis and prediction.

This is one of scientists’ most desired goals: to characterize morphological changes in brain structures, such as the hippocampus, that can predict a patient’s future risk for Alzheimer’s disease. John G. Csernansky, director of the Conte Center, acknowledges the challenges ahead.

“I would say that it is our hope that these types of methods will one day be clinically applicable,” said Csernansky, “But to make that happen, we will eventually have to find differences between DAT [dementia of the Alzheimer's type] and other dementing diseases as well as between DAT and healthy aging.”

By the year 2030, the youngest of the baby boomers will be over 65 years old. By that point, according to a study published in the Archives of Neurology, the prevalence of Alzheimer’s disease in the U.S. is expected to increase by 70 percent, affecting a total of 7.7 million people.

Scientists from the Washington University School of Medicine and the Johns Hopkins University School of Medicine concluded that conception with IVF is six times as common among children with BWS as in the general population. This result expands the small but growing body of evidence that links IVF and birth defects.

IVF is a widely accepted and highly prevalent reproductive alternative for couples who, for biological reasons, cannot conceive a child of their own. Eggs are inseminated and fertilized in a laboratory, and later implanted in the mother’s uterus.

BWS is a rare disorder, with the cause believed to be genetic. Infants born with BWS suffer from overgrowth of various tissues and inherit an inflated risk of tumors and early-childhood cancer.

Michael DeBaun, an assistant professor of pediatrics at the School of Medicine and a physician at St. Louis Children’s Hospital, was the principle investigator involved with the BWS/IVF study.

“At this point, we simply have a strong association between BWS and IVF,” said DeBaun.

DeBaun and his colleagues from Johns Hopkins emphasized that the clinical applications for their findings are still vague. Their research is quite compelling, but still preliminary, and should serve only to stimulate this new area of medical research, not to influence anyone’s decisions concerning reproduction.

“We need additional data to verify our findings, and, if confirmed, to understand why there is an association,” said DeBaun.

Currently, less than one percent of babies born in the United States are conceived via reproductive-assisted technologies. However, in DeBaun’s registry of BWS cases, about five percent of the affected children had IVF births. Moreover, DeBaun feels this percentage could be an underestimate for the population at large.

Despite DeBaun’s results, the Society for Assisted Reproductive Technology remains incredulous, and is not convinced that IVF results in an increased incidence of birth defects. Their stance is supported by similar studies conducted on separate samples, which found no association between IVF and an increased incidence of deformities. They encourage couples not to let these initial investigations impact their reproductive decisions.

For many would-be parents, the slightly increased chance of birth defects might not be an influential argument when they are faced with the option of having a child or not having a child.

Yosuke Miyashita, a former Washington University student who is now a resident in the pediatrics department at Barnes-Jewish Hospital, cares for babies with birth defects and other disorders.

“Since I deal with birth defects on a regular basis,” said Miyashita. “I think it would be tough for me to choose the IVF option, assuming there was a real association with birth defects. Even if the risk was slight, and even if it was my only option.”

There are other explanations for the association. Other scientists offer a possible caveat to DeBaun’s conclusions: The relationship between IVF and BWS could, in reality, be due to a given couple’s infertility abnormalities, rather than being solely attributable to IVF.

Scientists also consider the possibility that the association could be due to age differences. Fertility patients tend to be older, on average, than parents using traditional pregnancy, which may place them in a higher risk category for birth defects.

Investigations of BWS genetics are focusing on a phenomenon called “imprinting”, in which only one of the genes inherited from a parent is functional, while the other is inactivated. Upon examining the DNA of his BWS patients, DeBaun has found “imprinting mutations,” which provides some biological data that strengthens his statistical association.

Over one million children worldwide have been born using assisted reproduction technologies like IVF.

The change was prompted by a wave of concerned medical students at a number of institutions who have refused to conduct such exams, citing an awareness of the rights of anesthetized patients. Effective the week of March 10, WUSM has now abandoned the practice of not obtaining explicit consent from its female patients.

Normally, a surgeon conducts a pelvic exam prior to gynecological operations. The controversy concerns students who practice their examination skills on the patient after the physician has completed the initial examination. This procedure is no longer for the benefit of the patient, but intended only to enhance the clinical skills of the medical student.

Vera Sharav, president of the Alliance for Human Research Protection, said that this is a practice about which patients should be informed.

“Evidently U.S. medical curricula do not include the admonition: thou shalt [sic] not touch a woman’s genitals without her consent,” said Sharav.

A pelvic examination involves placing two fingers inside a patient’s vagina to locate and examine her ovaries. Learning how to properly administer such an examination is a essential part of a medical student’s training.

Joni Westerhouse, executive director for medical communications at WUSM, has dealt with informing the public about this controversy.

“Women undergoing gynecologic surgery at WU Medical Center, and at all hospitals in the U.S.A., receive a pre-operative pelvic exam by the physician/surgeons,” said Westerhouse. “This exam is important for patient safety. For the women’s comfort, this exam is done after anesthesia.”

Both Rebecca P. McAlister, MD, the OB/GYN residency program director for WUSM, and James R Schrieber, MD, the OB/GYN department head for WUSM, declined to comment on the issue and directed all inquiries to the Medical Public Affairs Department.

“If a medical student has been assigned to assist with the case, they may perform a pelvic exam under the direction of the surgeon in charge,” said Westerhouse. “Previously, the consent form advised patients that students are part of the medical team and may be providing medical care, tests and procedures as assigned by the surgeon in charge. Effective one week ago, women are specifically asked if they consent to a pelvic exam by a medical student [if a student is part of the team].”

In the wake of this change, the public is questioning whether students are receiving adequate education about patients’ rights.

Jerry Chang, a fourth year medical student at WUSM, maintains that WU stresses those rights.

“We’re always very sensitive to the patient’s rights and their privacies, and we’re always very appreciative of their cooperation,” said Chang. “But, it’s always patients first. They are there for our learning, but their needs come before ours.”

Dr. Michael Gregory, a graduate of Tufts University School of Medicine, has conducted studies that suggest most women are not opposed to being a part of the medical students’ training process, as long as consent is obtained beforehand.

“It’s this paternalistic, patronizing view that the doctors know best,” said Gregory in a recent New York Times article. “We underestimate people’s incredible charity and their willingness to let us train. But I think that at a gut level, doctors understand that if they actually told patients that this was happening without their consent, people would be outraged.”

Today most medical students initially practice their clinical techniques on paid volunteers before examining actual patients. However, eventually examining real patients with real disorders is crucial to their training. The medical school hopes new consent policies will allow for this.

Redrawing the ethical boundaries of biomedical research, the House of Representatives passed a bill last week that outlaws all forms of human cloning.

Approved by a 241-155 margin, the bill’s fate will now be determined on the Senate floor. President Bush endorses the bill, and he is putting pressure on lawmakers to pass it.

If approved, this bill will criminalize radical groups, like the Realians, who have engaged in reproductive cloning, and other groups who might produce genetic replicas of adults. The bill would also affect researchers involved in therapeutic cloning, which involves producing stem cells to repair damaged tissue or conduct developmental research on degenerative diseases, such as Multiple Sclerosis and Parkinson’s Disease.

Any attempts to clone a human embryo could lead to imprisonment for up to 10 years and a $1 million fine. Research that involves human-cloning techniques is currently legal in the United States, but has been barred from receiving any federal funding.

These potential restrictions will extend far beyond the science itself. If the Senate approves the bill, all medications or cures derived from embryonic stem cell research would be prohibited from entering the country, preventing potential medical therapies from being sold legally in the U.S. and criminalizing patients who attempt to import medications. This last part of the bill has proven the most problematic for some lawmakers.

Washington University Law Professor of Ethics in Medicine Rebecca Dresser has examined the development of stem cell legislation.

“The bill that just passed the House is similar to the one that the House, but not the Senate, passed last session,” said Dresser. “Most observers doubt that the Senate will pass the bill this session.”

Lawmakers are being forced to make rigid decisions concerning increasingly controversial issues. Stem cell research involves experimenting with and manipulating the embryo, the source of human life. Proponents of this research believe that a ban would ignore the needs of patients whose lives may depend on stem cell research or tissue engineering.

WU has maintained a consistently firm position on the issue, which is stated in a public announcement the school published in 2002.

“WU supports somatic stem cell nuclear transfer-a separate and distinct procedure from human reproductive cloning-for the purpose of producing cells to repair damaged tissue or replace malfunctioning cells,” said the statement. “WU strongly opposes efforts to duplicate humans genetically through reproductive cloning and joins with other universities and scientific organizations in calling for a ban on human reproductive cloning.”

Somatic cell nuclear transfer involves removing the nucleus, or the DNA, from an unfertilized egg cell, and replacing it with a nucleus from a normal body cell. This creates an embryo, a single cell, while eliminating the fertilization process. The intention is never to produce a child, only stem cells, or young cells that have not yet transformed into organ-specific body cells.

This type of research does occur at WU. Josh Volgelstein, a graduate student and research assistant in a neurobiology lab at WU School of Medicine, feels it should continue.

“Given the promise of stem cell research for treating and perhaps curing a variety of debilitating diseases . . . research should not be limited, but include work on both human adult and embryonic stem cells,” said Vogelstein.

The majority of the science community agrees with him, as do 40 Nobel Laureates. The National Academy of Sciences, the American Association for the Advancement of Science, and several other organizations are also backing the research.

Opponents of stem cell research argue that it has shown minimal potential in medical studies, and that its continuation is not justified. Advocates claim that without federal funding, the benefits will not present themselves because, due to the massive amount of research that needs to be done, private institutions will remain reluctant to pursue ventures with such long term benefits.

Recent developments in tissue engineering sciences have opened the door for tissue construction methods that derive from adult stem cells, not embryonic stem cells, which could eventually alleviate this ethical crisis.

Embryonic stem cell research has been banned in Australia, while it continues in the United Kingdom, with the support of federal funding. A host of countries such as China and Sweden are rapidly moving forward with embryonic stem cell research, working under an international ethical agreement that the U.S refuses to sign.

At the most recent SU Senate meeting, senators heard a proposal for a policy which would standardize recycling and reduce waste across campus. The Sesquicentennial Environmental Initiative suggests that a challenge be issued to students, faculty, and staff members to urge compliance with the future policy. The second plank of the proposal would attempt to decrease the amount of contamination in recycle bins by supporting the current effort to place lists of recyclable materials above each bin to educate students about what should and should not be placed in each bin. The final portion of the initiative aims to reduce paper waste by increasing the use of double-sided printing and recycled paper by providing financial incentives to do so. Professors would also be encouraged to allow or endorse assignments with double-sided printing.
WUTV gears up for “Sweeps Week”

Beginning tomorrow, WUTV will begin a week of new television series and new episodes old favorites. The campus television station will also rerun some “classic” WUTV fare as part of WUTV “Sweeps Week.” On Saturday, there will be a new episode of “B-Side,” a show which aims at highlighting African-American culture. New shows premiering during the week include “Grandma’s G-Spot,” which will premiere Monday night at 9 p.m.; “F**khead,” premiering on Tuesday at 10:30 p.m.; and “Deerhead,” which will begin Wednesday at 9:30 p.m. Monday through Thursday there will also be new live episodes of WUTV’s morning news show, “Wake up Wash U.” Regular daytime programming will stay the same throughout the week. WUTV is located at channel 22 on all WU cable systems.

9:49 a.m., LARCENY-THEFT, MCMILLAN HALL-A staff member reported that 25 to 30 upholstered folding chairs and five to six folding tables were taken from the Old McMillan Cafe area, in addition to a chrome bread rack and a blue upholstered easy chair. Total value of theft is $5,290.

3:22 p.m., LARCENY-THEFT, WOHL CENTER-Student reported the theft of her purse from a chair in the Bear’s Den in Wohl Center. Student believes she left the purse around 1:30 p.m. and went back to Wohl Center around 3:10 p.m. when she noticed it was missing.

3:25 p.m., LARCENY-THEFT, WOHL CENTER-Employee reported the theft of $80 in cash from her unattended purse.

5:43 p.m., LARCENY-THEFT, BEAUMONT DORM-Student reported the theft of his laptop computer from his dorm room.

6:27 p.m., INFORMATION, PARK HOUSE DORM-A student reported damage to a mountain bike. Inspection of the bike revealed no evidence of tampering, but the chain and gears had rusted due to extreme weather conditions (snow).

Tuesday, February 11

5:44 p.m., LARCENY-THEFT, BEARS DEN-Lost purse was returned to the owner with the cell phone missing.

Wednesday, February 12

4:30 a.m., PROPERTY, UMRATH DORM-Found property.

11:52 a.m., MEDICAL, EARTH & PLANETARY SCIENCE-Construction worker was injured when he fell from a scaffold.

Due to a recent policy change, medical students will soon have to pass a national clinical skills examination to earn their degree.

The graduating class of 2005 will be the first to take this new exam, which will supplement the already mandatory written components of the United States Medical Licensing Examination (USMLE). Pre-medical students at Washington University will have to deal with the implementation of this policy in the coming years.

The change is motivated by surveys suggesting the majority of Americans believe that a doctor’s communication and examination skills are of critical importance. Further motivation draws on studies that link poor clinical skills to a higher incidence of malpractice suits and patient dissatisfaction.

Under the new exam structure, fourth-year medical students will be asked to examine and interact with a living person, an actor posing as a patient, who will simulate scripted, standardized symptoms. Students will be given the opportunity to perform a 15-minute physical examination, with extra time provided to record the results, the patient’s medical history, and diagnostic options. The criteria judging passing and failing scores have yet to be determined.

Dr. Allison Whelan, WU School of Medicine’s associate dean of curriculum, said she understands the rationale behind the obligatory testing.

“There has been an increase in attention to all areas of education,” said Whelan. “A judgment of a student’s competency should take into account all forms of knowledge. Written tests, alone, cannot do that.”

The USMLE has served as the lone measuring stick for medical students’ skills since 1964, when the previous clinical skills examination procedures were removed in favor of the more objective written assessment. Reinstating the practical exam may invoke a subtle shift in the mentalities of WUSM students, but the current curriculum will not change.

“At WUSM, we already focused on clinical skills,” said Whelan. “First, second, and third-year students must pass clinical skills exams on standardized patients. They conduct interviews and exams, and instructors give them feedback.”

Studying and working next door to Barnes-Jewish Hospital provides WU medical students more opportunities to hone their clinical skills and participate in hands-on learning.

Given the resources and the already clinically-focused curriculum of WUSM, some WU medical students have mixed feelings about the new exam.

“The students’ response to the new Clinical Skills Exam requirement is negative,” said Tiffany Deshazo, a first year WUSM student. “I am against the new requirement because my clinical skills are already evaluated by the faculty at WUSM. The additional level of administration will just increase the inefficiency and inaccuracy of the evaluation.”

Other medical students object to the sizable financial burdens of the new clinical component. In addition to application fees and travel expenses associated with the residency placement process, fourth-year medical students will now incur the expense of the additional exam, which includes the $1,000 exam fee and the cost of traveling to one of the five U.S. exam sites.

“Trying to objectify the skills you should have [is a good idea], but it adds a great deal to exam costs,” said Jerry Chang, a fourth-year student at WUSM. “Looking at the costs and benefits, I’m not really sure if it’s a good idea.”

Advocates of the examination stress that more thorough and comprehensive examinations beget more competent and quality physicians. According to the Web site of the Federation of State Medical Boards, Dr. James Thompson, executive vice president of the organization, said that a national standard of basic clinical capabilities is needed for the benefit of the American public.

Currently, clinical examinations are a standard component of the training and certification of numerous other health professionals, such as nurses and paramedics.

Students tend to believe that a successful WUSM candidate must have three majors, numerous journal publications, and MCAT scores in the upper 30s. But according to Dr. William Dodson, the assistant vice chancellor for WUSM admissions, other factors are also considered.

“Obviously, students need to excel academically, but most importantly, students need to display a caring and compassionate disposition and a strong value system,” said Dodson.

While the majority of applicants must showcase their virtues through essays, letters of recommendation, and interviews, WU undergraduates have the opportunity to supplement their qualifications with involvement in the WU and WUSM communities. This proves to be crucial in the application process.

“All else being equal, WU students have an advantage over other applicants,” said Dodson. “We usually know them, and we know their reputation.”

This is partly due to resources that the medical school offers to undergraduate students. Motivated students are provided with valuable skills and insights, as well as connections within the WU community. These resources include programs such as the nascent mini-medical school and the biology class Experiences in the Life Sciences.

Proof of the WU bias is evident in the statistics. Less than 3 percent of all non-WU applicants matriculated at WUSM last fall. In contrast, nearly 10 percent of WU applicants enrolled, while over 20 percent of them were accepted. This statistic may not seem favorable, but it is encouraging in light of the over 3,600 applications received last year for a class of 120.

Despite the statistics, there is still hesitation among undergraduates. Steve Bujarski, a junior on the brink of the application process, has ruled out WUSM.

“I doubt I would be accepted,” said Bujarski. “I would also feel somewhat intimidated. I would rather be comfortable and at a place that is a little less competitive.”

This sentiment is common on the Hilltop Campus. Due to the competitive nature of pre-med culture, students assume that WUSM will be a continuation of the academic stress experienced at WU.

“I have been constantly battling uphill for good grades,” said Bujarski. “I do not want to have that feeling for another four years, and I’m sure at a med school like WUSM, it would be more of the same.”

Though a pre-medical program can be taxing, there are ways to avoid falling prey to stress. Yosuke Miyashita, a fourth-year medical student at WUSM, made the transition from WU to WUSM and believes that undergraduates have some misconceptions.

“The curriculum at WUSM is not any more difficult than other medical schools,” says Miyashita. “The first year is very relaxed and entirely pass/fail. This helps build a relatively non-competitive, group-oriented environment.”

WU undergraduates may cross WUSM off their list for other reasons as well. Many simply opt for a change of scenery or relocate for economic reasons, such as the advantage of lower in-state tuitions. Also, state medical schools accept local residents in greater numbers than out-of-state applicants.

“Back home, school is cheap, and I have a much better chance of getting in,” said Bujarski.

Some private institutions, such as Duke University School of Medicine, have similar policies, which require admitting a certain percentage of in-state applicants.

However, Duke’s medical school also accepts a higher percentage of Duke undergraduates than non-Duke applicants, a trend that mirrors the situation at WU.

D„lek (pronounced die-a-lek), a three-piece experimental hip-hop crew from New Jersey, wants to punch you in the face with their music. They keep it loud-as-hell, raw, and intelligent, with a unique blend of traditional and experimental hip-hop. The trio’s first LP, From Filthy Tongue of Gods and Griots, superimposes elements of metal, jazz, psychedelia, and African music over strong bass beats and crushing percussion. Think Black Flag meets Public Enemy meets My Bloody Valentine.
D„lek consists of three main elements: D„lek, the group’s namesake and tortured emcee; Oktopus, the mind behind the mixers and samplers; and DJ Still, the unconventional manipulator of the turntable. D„lek himself spits a style that’s rhythmically steady and strong,like a freight train, starting slow and building in intensity, yet bordering on static monotony. The tone is serious, subtle, passionate, and socially conscious, and delivered nearly as spoken word. His rantings confront and confute. With lyrical commentary on race and responsibility, he reminisces on hip-hop culture and questions its current state. Take the hook from “Spiritual Healing” for example: “Who you pray to? my god, the black god / Who you pray to? my god, the brown god? / Who you pray to? my god, the white god? / You’re reaction’s kinda odd for a kid who loves to nod.” He comes across as dark, angry, and intelligent.
The soundscapes created by Oktopus and Still range from screaming distortion to layered, murky samples to ambient loops and electronic bleeps, cracks, and glitches. Layers of drums, synthesizers and strings build up, climax, and fall only to explode again. Lyrics and ambient textures fill in the gaps. Fueled by collaborations with artists such as Kid606, these boys provide the sonic backdrops that challenge the ear and are hard to digest.
The group put on its noisy display of avant-garde hip-hop last Tuesday, at the Hi Pointe Caf‚. D„lek’s set featured album tracks such as the hardcore “Spiritual Healing,” the noisy “Voices of the Ether,” and “Classical Homicide,” a track which ended with D„lek screaming “Amplify brainwaves to condense my thought / Bend the dark / Why question my art?” over screeching distortion.
The show begged for an adequate sound system. The Hi Pointe doesn’t really cater to acts that need quality at such a high volume, so much of the show was drowned in incomprehensible noise, screeching, and muddy vocals. Notwithstanding, everyone should witness the spectacle that is DJ Still. While I’m not entirely convinced of his skills, he certainly provides entertainment. He rarely scratched the record itself. Instead he slammed and scratched the needle on the record, blew on the needle, and talked into it. Um, right. Does anyone else do this? Yeah, it’s absurd, but more power to him. Furthermore, between beers, he got into furious bouts of head banging, slamming his enormous afro to within inches of his mixer, putting himself in constant risk of being knocked unconscious.
D„lek is new territory, people. Their music is deep and personal. They’re hardcore. They’re old school vs. experimental hip-hop. They sample Portishead and Massive Attack. Their sound is raw, dirty and pierced by strange noises. They alienate a lot of hip-hop fans by exploring new ground, but in the process welcome others. D„lek is nothing less than emotional satisfaction for metal and hip-hop fans alike. Their show may only have been C-worthy, but sometimes there’s nothing better than music that locks you in its room for improvement.