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Clifford Hudis, M.D. is Chief of the Breast Cancer Medicine Service and attending physician at Memorial Sloan-Kettering Cancer Center in New York City, where he is also a professor of medicine at the Weill Medical College of Cornell University. He is co-leader of the Breast Disease Management Team at MSKCC, co-chair of the Breast Committee of the Cancer and Leukemia Group B (CALGB), past chair of the Internet Services Committee and present chair of the Information Technology Committee of the American Society of Clinical Oncology (ASCO). He is also past president of the New York Metropolitan Breast Cancer Group and chair of the Scientific Advisory Board of the Breast Cancer Research Foundation.
Question: How has mapping the human genome influenced your field?
Clifford Hudis: So the mapping of the human genome was really the exciting effort of the past decade approximately and we were really excited that by doing this we would open up very specific directions for research, and I think like all good science it has led us to new frontiers but maybe not the ones that we’ve expected. The mapping of the human genome has not yet yielded a narrow “ah-ha” moment: This is the cause of breast cancer specifically or cancers in general. It has, however, taught us amazing things, amazing, about the heterogeneity, that is to say the variations, within the genome for people, that’s me to you, and even within people and even narrowly within tumors. So that has raised the level of complexity for us. It’s better to know that but I guess the short answer is no, the mapping of the genome has not yet yielded for us clinically relevant breakthroughs.
Question: What is the world’s biggest medical challenge?
Clifford Hudis: Well, that’s a really great question for an oncologist in a developed country because again the world’s biggest health challenge is probably pediatric illnesses like infectious diarrhea, malaria, and communicable diseases, and so if you wanted to ask me that same question in another way, “What is the biggest bang for the buck you get with your health care dollar?”, it’s investing in clean water, malaria nets and childhood immunizations around the developing world.
Card: How has science changed humanity?
Clifford Hudis: Yeah. Well, there was a lovely piece in the New York Times either Saturday or Sunday of this past week in the op ed that was written by an author reflecting on initially a request for one of his books from a soldier in Iraq or at least he was writing about this, but it was more broadly a plea for incorporation of science into everyday life and appreciation for it. And it’s a very funny paradoxical moment we have right now. We’ve never been more high tech. We rely on things like video cameras, cell phones, spinning platters of information, hard drives, and we’re willing to essentially not even learn how they work or even care. We want to see them almost as magical and they’re really not. They are all built by very carefully pursued scientific or upon scientifically-- scientific principles that are- have been carefully studied, and the reason I’m emphasizing that area is this. I think that we need to value science far more broadly in our population, in our education systems, than we heretofore have, and I think we have to have an appreciation for science and scientific method across society and across domains whether it’s communications, media, education, economics even or my narrow area of biological sciences. There is no advance that I take advantage treating my patients right now that isn’t born of the scientific method.
Question: What is the most exciting new technology you are working with?
Clifford Hudis: I think the most exciting technology remains actually the same technology that we were talking about when we discussed the mapping of the human genome. Our ability to drill down on and essentially dissect base pair by base pair the code of life, the DNA in our chromosomes, I think ultimately holds the key to everything, and if it doesn’t hold it in a very narrow, specific sense it holds it because it is events that are related to that code that matter. It is the what we call epigenetic events that we only now know about because of our ability to study the genome. I think that fundamentally this is the key to unlocking cancer and many other diseases.
Hudis says mapping the human genome was the most exciting effort of the past decade.
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Gender and sexual minority populations are experiencing rising anxiety and depression rates during the pandemic.
- Anxiety and depression rates are spiking in the LGBTQ+ community, and especially in individuals who hadn't struggled with those issues in the past.
- Overall, depression increased by an average PHQ-9 score of 1.21 and anxiety increased by an average GAD-7 score of 3.11.
- The researchers recommended that health care providers check in with LGBTQ+ patients about stress and screen for mood and anxiety disorders—even among those with no prior history of anxiety or depression.
Study findings<p>For the study, <a href="https://link.springer.com/article/10.1007/s11606-020-05970-4" target="_blank">published in the Journal of General Internal Medicine</a><em>, </em>Flentje and her team evaluated survey responses from nearly 2,300 individuals who identified as being in the lesbian, gay, bisexual, transgender, and queer (LGBTQ+) community. Most of the participants were white, while nearly 19 percent identified as a racial or ethnic minority. Multiple genders were represented with cisgender women (27.2 percent) and men (24.6 percent) making up a majority of the participants. Sixty-three percent had been assigned female at birth. For the most part, participants identified their sexual orientations as queer (40.3 percent), gay (36.5 percent), and bisexual (30.3 percent).</p><p>The JGIM study participants were recruited from the 18,000-participant <a href="https://pridestudy.org/" target="_blank">PRIDE Study</a> (Population Research in Identity and Disparities for Equality), which is the first large-scale, long-term national study focusing on American adults who identify as LGBTQ+. It conducts annual questionnaires to understand factors related to health and disease in this population. </p><p>Participants filled out an annual questionnaire (starting in June 2019) and a COVID-19 impact survey this past spring. Flentje noted that on an individual level, some people may not have experienced a big change in anxiety or depression levels, but for others there was. Overall, depression increased by a <a href="https://patient.info/doctor/patient-health-questionnaire-phq-9" target="_blank">PHQ-9 score</a> of 1.21, putting it at 8.31 on average. Anxiety went up by a <a href="https://www.mdcalc.com/gad-7-general-anxiety-disorder-7" target="_blank">GAD-7</a> score of 3.11 to an average of 8.89. Interestingly, the average PHQ-9 scores for those who screened positive for depression at the first 2019 survey decreased by 1.08. Those who screened negative for depression saw their PHQ-9 scores increase by 2.17 on average. As for anxiety, researchers detected no GAD-7 change among the study participants who screened positive for anxiety in the first survey, but did see an overall increase of 3.93 among those who had initially been evaluated as negative for the disorder. </p>
Risks among gender and sexual minorities<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="fc3fd1ae68b77bbbf58a6995638d6d65"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/EnUqDjCqg0A?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><p>The LGBTQ+ community is a vulnerable population to mental health concerns because of their fear of stigmatization and previous discriminatory experiences.</p> <p>Previous research by the Human Rights Campaign has found "that LGBTQ Americans are more likely than the <a href="https://medicalxpress.com/tags/general+population/" target="_blank">general population</a> to live in poverty and lack access to adequate medical care, paid <a href="https://medicalxpress.com/tags/medical+leave/" target="_blank">medical leave</a>, and basic necessities during the pandemic," said researcher Tari Hanneman, director of the health and aging program at the campaign.</p> <p>"Therefore, it is not surprising to see this increase in anxiety and depression among this population," Hanneman said in the release. "This study highlights the need for <a href="https://medicalxpress.com/tags/health+care+professionals/" target="_blank">health care professionals</a> to support, affirm and provide <a href="https://medicalxpress.com/tags/critical+care/" target="_blank">critical care</a> for the LGBTQ community to manage and maintain their mental health, as well as their physical health, during this pandemic."</p>
What should health care providers do?<p>The authors of the study recommend that health care providers check in with LGBTQ+ patients about stress and screen for mood and anxiety disorders in members of that community—even among those with no prior history of anxiety or depression.</p><p>As cases of COVID-19 continue to mount, the sustained social distancing, potential isolation, economic precariousness, and personal illness, grief, and loss are bound to have increased and varied impacts on mental health. Effective treatments may include individual therapy and medications as well as more large-scale coronavirus support programs like peer-led groups and mindfulness practices. </p><p>"It will be important to find out what happens over time and to identify who is most at risk, so we can be sure to roll out public health interventions to support the mental health of our communities in the best and most effective ways," said Flentje.</p>
What we know about black holes is both fascinating and scary.
- When it comes to black holes, science simultaneously knows so much and so little, which is why they are so fascinating. Focusing on what we do know, this group of astronomers, educators, and physicists share some of the most incredible facts about the powerful and mysterious objects.
- A black hole is so massive that light (and anything else it swallows) can't escape, says Bill Nye. You can't see a black hole, theoretical physicists Michio Kaku and Christophe Galfard explain, because it is too dark. What you can see, however, is the distortion of light around it caused by its extreme gravity.
- Explaining one unsettling concept from astrophysics called spaghettification, astronomer Michelle Thaller says that "If you got close to a black hole there would be tides over your body that small that would rip you apart into basically a strand of spaghetti that would fall down the black hole."
The team caught a glimpse of a process that takes 18,000,000,000,000,000,000,000 years.
- In Italy, a team of scientists is using a highly sophisticated detector to hunt for dark matter.
- The team observed an ultra-rare particle interaction that reveals the half-life of a xenon-124 atom to be 18 sextillion years.
- The half-life of a process is how long it takes for half of the radioactive nuclei present in a sample to decay.
A new study looks at what would happen to human language on a long journey to other star systems.
- A new study proposes that language could change dramatically on long space voyages.
- Spacefaring people might lose the ability to understand the people of Earth.
- This scenario is of particular concern for potential "generation ships".