CMDA September 2013 NewsLetter



Stem cells, tissues and regenerative medicine
Excerpted from “Stem cells mimic human brain,” Nature. August 28, 2013 — With the right mix of nutrients and a little bit of coaxing, human stem cells derived from skin can assemble spontaneously into brain-like chunks of tissue. “It’s a seminal study to making a brain in a dish,” says Clive Svendsen, a neurobiologist at the University of California, Los Angeles, who was not involved in the study. “That’s phenomenal.” A fully formed artificial brain might still be years away, he notes, but the pea-sized neural clumps developed in this work could prove useful for researching human neurological diseases.

In the latest advance, scientists developed bigger and more complex neural-tissue clumps by first growing the stem cells on a synthetic gel that resembled natural connective tissues found in the brain and elsewhere in the body. Then they plopped the nascent clumps into a spinning bath to infuse the tissue with nutrients and oxygen.

“The big surprise was that it worked,” says study co-author Juergen Knoblich, a developmental biologist at the Institute of Molecular Biotechnology in Vienna. The blobs grew to resemble the brains of fetuses in the ninth week of development. Under a microscope, researchers saw discrete brain regions that seemed to interact with one another. But the overall arrangement of the different proto-brain areas varied randomly across tissue samples — amounting to no recognizable physiological structure.

“The entire structure is not like one brain,” says Knoblich, adding that normal brain maturation in an intact embryo is probably guided by growth signals from other parts of the body. The tissue balls also lacked blood vessels, which could be one reason that their size was limited to three to four millimeters in diameter, even after growing for 10 months or more.



CMDA Member and Senior Fellow for Family Research Council David Prentice, PhD: “There have been numerous stories lately about using induced pluripotent stem (iPS) cells to form various tissues, including vascular endothelial cells for blood vessels, myocardial tissue for heart muscle regeneration and even brain tissue for study of normal and abnormal brain development.

“The iPS cells, because they are created from the patient’s own normal cells, could potentially provide tissues for personalized drug development or for transplant. There are still significant practical problems to overcome with iPS cells, including their penchant for growth, which may make them more suitable for laboratory study than for the clinic.

“But the ethics of the research is also significant. The iPS cell creation technique (for which Dr. Yamanaka won the Nobel Prize) does not rely on creation or destruction of human life—it does not use embryos, eggs or cloning techniques. Thus, it provides an ethical source of cells for study (as long as the molecular tools used for creation of the iPS cells are ethical, of course; i.e., not using aborted fetal tissue for DNA production, etc.). As more and more cellular and molecular techniques approach the clinic, this ethical consideration is very important if we are to maintain our stance for life. “Do no harm” applies not only to the patient treated, but to the origin of the treatment as well. We should reject any ethically-tainted treatments just as we would reject any bacterially-tainted or chemically-tainted drug or instrument.”

CMDA Ethics Statement on Stem Cell Research and Use
Scientific Demagoguery in the Stem Cell Wars by David Stevens, MD, MA (Ethics)

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Using social media in clinical practice
Excerpted from “Docs Need to Get Up to Speed, Social Media Advocate Says,” MedPage Today. August 15, 2013 — Bertalan Mesko, MD, PhD, is counting on old media to convince more clinicians about the value of new media. The clinical genomics specialist has just published a handbook on social media in clinical practice — and he hopes it will bring late adopters up to speed with their social-media-savvy colleagues, and even with some of their electronically empowered patients.

While “expert” patients voraciously pursue credible medical information and communities online, clinicians “usually lag behind,” Mesko, who is based in Budapest, said in an email exchange with MedPage Today. Instead of disdaining this kind of behavior, doctors need to see themselves as a gatekeeper of vetted online information and activities, he said.

“Social media provides us with a lot of opportunities, but only if we know the potential limitations and security issues. Acquiring such knowledge takes years, and my goal with the handbook was to shorten this time significantly for those medical professionals who would like to become a bit more digital, but at the same time use these online tools in a secure way,” said Mesko in an online engagement via email.

“I think communication methods in real life and in the online world are the same. If medical professionals understand this and create a proper online presence, as well as give their patients a chance to communicate with them through certain online channels, the doctor-patient relationship can become more efficient by saving time for both parties. Using digital technologies, especially social media, is now an integral part of medical communication, and as more and more patients use these platforms, their physicians must be able to deal with this in an evidence-based manner,” said Mesko.



CMDA Vice President and National Director of Campus & Community Ministries J. Scott Ries, MD: “Mention ‘social media’ during a conversation with one of your colleagues and observe the resulting reaction of the facial muscles. I predict you’ll identify a subtle pupillary dilation, upturning of the corners of the mouth and an increase in pace of speech…or else you’ll view a burrowing of the forehead creases, tightening of the lips and clenching of the jaw. When in past history has any other ‘tool’ ever evoked such emotional response from its users (or haters)?

“At its core, social media is indeed simply a tool—a forum to communicate, share ideas, explore information, engage conversation and create community. If you already embrace social media at some level, you won’t be surprised to hear that I’m more likely to be contacted via Facebook than email by students, residents and even some doctors.

“If you find yourself beset with the clenched jaw, here are a few things that might help you dip your toe in the social media waters without catching a cold.

  1. Recognize that social media does not equal Facebook. Not all of social media is Facebook. As social media expands, the relative amount of the landscape occupied by Facebook is diminishing. If Facebook seems daunting to you, choose another option to explore.
  2. Peruse areas of CMDA’s social media engagement. CMDA is actively engaged with social media with both the current and upcoming generations of doctors.
  3. Consider following just one blog, along with following their Twitter and/or Facebook posts. This will let you ease into the foray a bit without becoming overloaded.

For more practical insight into how to use social media, the benefits it can offer you and your practice and other information, check out Social Media in #Healthcare: Why You Should (Like) Social Media by Bill Reichart, MDiv.

“But won’t social media consume any vestiges of time remaining in our overloaded schedules? Only if we let it. It’s like when I was taking driver’s ed as an inexperienced 15-year-old. In attempting to pass a slow moving truck, I was hesitant to exceed the speed limit. Seeing the approaching car, the instructor promptly pushed her ‘instructor’s accelerator’ to quickly get us by the truck, while calmly saying ‘Control the car. Don’t let the car control you.’ So it is with social media. However you choose to engage, control it…don’t let it control you.”


Hardwired for empathy
Excerpted from “Study finds that our brains are hardwired for empathy, friendship,” Medical News Today. August 26, 2013 — Perhaps one of the most defining features of humanity is our capacity for empathy – the ability to put ourselves in others’ shoes. A new University of Virginia study strongly suggests that we are hardwired to empathize because we closely associate people who are close to us—friends, spouses, lovers—with our very selves.

“With familiarity, other people become part of ourselves,” said James Coan, a psychology professor in U.Va.’s College of Arts & Sciences who used functional magnetic resonance imaging brain scans to find that people closely correlate people to whom they are attached to themselves. The study appears in the August issue of the journal Social Cognitive and Affective Neuroscience.

Researchers found that regions of the brain responsible for threat response displayed little activity in the cases of shock to a stranger. However, when the threat of shock was to a friend, the brain activity of the participant became essentially identical to the activity displayed under threat to the self. “The finding shows the brain’s remarkable capacity to model self to others; that people close to us become a part of ourselves, and that is not just metaphor or poetry, it’s very real. Literally we are under threat when a friend is under threat,” Coan said.

This likely is the source of empathy, and part of the evolutionary process, Coan reasons. “A threat to ourselves is a threat to our resources,” he said. “Threats can take things away from us. But when we develop friendships, people we can trust and rely on who in essence become we, then our resources are expanded, we gain. Your goal becomes my goal. It’s a part of our survivability.”



CMDA Member and Executive Director of Lighthouse Network — “Some Christians have a hard time accepting science, associating science with Darwin, thus getting flustered thinking most science contradicts the Bible. Others really struggle accepting psychological sciences, associating it with Freud or thinking that psychotherapy is man worshipping man, trying to solve problems without God, or looking for an excuse for or to normalize aberrant behavior.

“But science is just the study of: 1) What God made; 2) Understanding how He designed it to function; and 3) Learning how to maximally steward it for His glory and our abundant living. Obviously, I am partial, but God’s two most incredible creations are the human mind and free will (our psychological process which produces decisions).

“As our Creator, like any good developer of a product, God gave us an awesome instruction manual, called The Holy BIBLE (Best Instruction Book for Living Everyday). Throughout the Bible, God clearly teaches us His design for us to be in relationships from the beginning in the Garden of Eden through our ultimate union with Him in the life after this in Heaven. Mark 12:30, the Greatest Commandment, instructs us to love God with all our heart, soul, mind and strength, but then to love others and ourselves (in healthy and Godly ways).

“This study reveals science about the circuitry God created for us to accomplish His command to engage in healthy and caring relationships. The missing piece science has a hard time quantifying, though, is the spiritual sphere, that spiritual part of man that is unique for each of us. Our spirit allows a special connection to God and a special connection to others. Unfortunately, Satan is always attacking our mind, but as we manage life the way the Bible instructs, circuitry for empathy, forgiveness and agape love grow as we carry out the Greatest Commandment and develop the mind of Christ.

“So engage the awesome science of our mind as it helps us understand how God designed us, but more importantly, how to steward our mind to glorify Him and live life abundantly. How you manage every minute is your decision, so choose well.”

“Cleaning Up” Marital Communication by William Curtrer, MD, and Sandra Glahn, ThM
Summer 2012 edition of Today’s Christian Doctor

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