STUDENT OSTEOPATHIC MEDICAL ASSOCIATION
VOLUME 4 • ISSUE 1
THE FUTURE D.O.
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DECEMBER 2025
EDITORIAL BOARD
Rhea is passionate about integrating technology, clinical medicine, and environmental studies. She worked as a data scientist before focusing on population health amongst our diminishing coastlines on the eastern seashore. Now, she brings that same attention to detail and passion for collaboration to SOMA and patient advocacy. She is so excited to serve our patient's healthcare needs in the future and be a voice for all.
THE FUTURE DO • VOL 4 • ISSUE 1
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Ahana's journey through medicine is driven by a love of research and advocacy. Growing up in San Diego, CA, she was inspired by the city’s rich biomedical landscape and developed a curiosity for the science behind medicine, while her passion for advocacy stems from her family's experiences navigating healthcare disparities. With a strong background in neurobiology-focused research and a passion for mentorship, she aspires to become a pediatric neurologist, continuing to champion vulnerable populations. In her free time, she enjoys baking, creating art, running, and all things spooky.
ALEXANDRA ZELLER (OMS-IV, Touro COM - HArlem) CO-EDITOR-IN-CHIEF LAYOUT & DESIGN
Funding for The Future DO is provided by the SOMA. Views expressed in The Future DO publications are solely those of the authors and do not necessarily reflect the opinions of the editorial board, The Future DO, or SOMA unless specified.
Ahana Chakraborty (OMS-III, CHSU COM) CO-Editor-In-Chief
Alexandra is deeply committed to advancing women’s health through research. She has a strong background in oncology research from institutions such as Memorial Sloan Kettering and Sidney Kimmel Cancer Center, with work focusing on ovarian and prostate cancer, liquid biopsy diagnostics, and health equity. She has co-authored multiple peer-reviewed publications and presented at national conferences. Alexandra aspires to become a gynecologic oncologist, aiming to integrate patient care with translational research to improve outcomes for women diagnosed with cancer. She enjoys spending weekends exploring Upstate with her husband and dogs, Reagan and Nori, and experimenting with new recipes from The New York Times Cooking collection.
CONTENTS
MEET THE EDITORIAL BOARD
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Rhea Agarwal (OMS-II, WVSOM) Contributing Editor
About the Cover Artist: Chesna Pokharel is a third-year osteopathic medical student at California Health Sciences University who combines her passions for medicine and art. Born and raised in the Bay Area as a first-generation immigrant, she draws inspiration from her community and experiences in healthcare. Her artwork explores themes of growth, learning, and healing, using abstract imagery to express the connections between knowledge, empathy, and patient care. Through her art, Chesna highlights the transformative impact of education and compassion in medicine.
Co-Editor-In-Chief Ahana Chakraborty Alexandra Steck Layout & Design Adriana Gonzalez-Borrell Caitlyn Nguyen Cèline Zalamea Editorial Board Rhea Agarwal Valerie Bakly Alex Biera Tanvi Chitre Nanak Pabla Viraj Padhiar Rebecca Slay Research Director Clayton Rawson On The Cover Roots of Healing Digital Illustration by Chesna Pokharel The Future DO is a magazine for the advancement and education of the osteopathic medical student. It is published biannually by the Student Osteopathic Medical Association (SOMA).
Editorial Board '25-'26.................................... Greetings from Editor-in-Chief....................... Editorial...................................................... Letter to the Editor......................................... Abstracts: Case Reports................................... Abstracts: QI & Public Health........................... Abstracts: Literature Reviews............................ Perspective Articles........................................ Message from the Research Director..................
Tanvi is an OMS-III with a passion for advocacy and narrative medicine. She is particularly interested in pediatrics and hopes to integrate her love of writing, communication, and patient-centered advocacy into her future career as a physician. Outside of school, she enjoys cooking, going to concerts, and spending time at the beach.
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Alex is currently an OMS-III at The University of the Incarnate Word School of Osteopathic Medicine (UIWSOM) in San Antonio, Texas. When not on rotation or studying, Alex enjoys her time serving as the Chief Information Officer for The Latino Medical Student Association Southwest Region. Outside of school and extracurricular obligations you can find this self-proclaimed foodie checking out the restaurant scene.
Rebecca Slay is a fourth-year osteopathic medical student attending Lincoln Memorial University – DeBusk College of Osteopathic Medicine in Harrogate, Tennessee. She earned a Bachelor of Science in Biology and minor in music from The University of Tulsa. This is her first year engaging as an editor for The Future DO. Rebecca is from Hot Springs, Arkansas and has dedicated much of her life to artistic pursuits as a musician – both as a pianist and percussionist – and is ecstatic to broaden those pursuits as a collaborator to showcase your experiences, ideas, and research! Rebecca is a member of multiple professional societies, including SOMA, AMA, ACOP, and CMDA. She is also proud to be an inductee of Omega Beta Iota and the Gold Humanism Honor Society. Rebecca is an aspiring Pediatrician and hopes to pursue a career in Neonatology in the future.
Alex Biera (OMS-III, UIWSOM) Contributing Editor
Born and raised in Toronto, Canada, Viraj developed a deep appreciation for community-centered healthcare, a passion that ultimately led him to the United States to pursue medicine. Before medical school, he earned a Master of Science in Aging and Health, which further strengthened his commitment to supporting vulnerable populations. As a third-year medical student at NSU-KPCOM, he is now interested in pursuing a career in anesthesiology, with a potential subspecialty in critical care, where he hopes to combine clinical precision with compassionate, patient-centered care. Outside of medicine, he enjoys spending time with his fiancé, exploring new restaurants and cafés, and staying active through various sports.
Tanvi Chitre (OMS-III, CHSU-COM) Contributing Editor
Nanak Pabla (OMS-II, ATSU SOM) Contributing Editor
Valerie Bakly (OMS-III, LECOM - Seton Hill) Contributing Editor
rebecca slay (OMS-IV, LMU-DCOM) Contributing Editor
viraj padhiar (OMS-III, NSU KPCOM) Contributing Editor
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Valerie is a third year osteopathic medical student at Lake Erie College of Osteopathic Medicine (LECOM) at Seton Hill. She is excited to be part of the editing team for The Future DO. She enjoys conducting research and volunteering at her local food bank, where she has always had a strong interest in improving access to nutritious food and promoting community health. Beyond academics, Valerie loves spending time outdoors: rock climbing, camping, and hiking.
Nanak earned her bachelor's degree, graduating Summa Cum Laude, from San Jose State University. Growing up in rural India, she developed a deep commitment to health equity and a passion for serving underserved communities which led her to join ATSU–SOMA as a first-generation medical student. Nanak’s interest in research began during her undergraduate years, when she contributed to a lab studying the regenerative properties of cardiomyocytes which inspired her to become actively involved in the National SOMA Research Committee. In her free time, Nanak enjoys trivia, hiking and stargazing.
Caitlyn is passionate about mentorship and advancing educational equity in medicine. She has worked with Heights Philadelphia on multiple initiatives, including serving as a mentor in a pilot program for high school students interested in STEM careers. Through Heights, she has also helped first-generation students navigate the college application process, securing acceptances to universities like Carnegie Mellon and Northeastern. Caitlyn also runs a college prep newsletter, making guidance more accessible to students with limited support. Caitlyn hopes to become an anesthesiologist and continue fostering mentorship and advocacy throughout her career. In her free time, she enjoys crocheting and watching Gilmore Girls.
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Adriana is a third year osteopathic medical student at BCOM. She is passionate about mentoring, teaching, and community engagement. When she isn't studying or volunteering, she enjoys baking, crafting, hiking, and reading nonfiction. Adriana hopes to build a career in pediatric medicine centered on connection, curiosity, and making healthcare feel less intimidating for children and their families.
ALEXANDRA ZELLER, CO-EDITOR IN CHIEF (OMS-IV, TOURO COLLEGE OF OSTEOPATHIC MEDICINE - HARLEM)
Caitlyn Nguyen (OMS III, PCOM) LAYOUT & DESIGN Editor
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Who Gets Left Behind? Equity in the Era of Precision Medicine
It is hard to believe that my three years working on The Future DO are coming to an end. What an incredible honor it has been to serve alongside my wonderful Co-Editor-in-Chief, Ahana Chakraborty, and our entire editorial board. When I first learned about The Future DO, I was immediately enamored by the idea that we could create a space where osteopathic medical students’ research, creativity, and voices could truly shine. As someone who firmly believes in the power of medical research to advance patient care, I continue to be inspired by the abstracts submitted each year and the students behind them. When Ahana and I met to discuss the issue for this year, we agreed on the importance of publishing topics that often get left out of conversations in medical school. The perspective pieces featured in our magazine continue to challenge assumptions, explore difficult conversations, and highlight the social, emotional, and ethical complexities that shape patient care. As I put together my final issue, I am struck by the brilliance, compassion, and inquisitiveness of the osteopathic medical community. I chose the theme for this issue, Precision for All: Equity in the Era of Personalized Medicine, because of medicine’s growing movement toward precision-based treatments, particularly within oncology. While attending a conference last month, I could feel the excitement in the room as a new immunotherapy was presented. The audience marveled at the results, captivated by the promise of innovation and extended survival, yet not once was the financial burden to patients discussed As future physicians, we will be tasked with balancing innovation and equity. Medical advancements only fulfill their purpose if patients can truly access them. During my first year working on this magazine, I wrote about financial toxicity and the immense burden healthcare costs place on patients and families. Years later, that topic feels just as relevant. As medicine becomes increasingly personalized and technology-driven, we must continue asking ourselves: who gets left behind? Precision medicine has the potential to transform healthcare in ways we once only imagined. But progress cannot simply mean creating better treatments; it must also mean creating a more equitable healthcare system. I hope this issue encourages readers to think critically not only about where medicine is going, but also about who we are bringing with us into that future. Finally, I want to thank every student, reviewer, artist, and contributor who has helped make The Future DO what it is today. It has been one of the greatest privileges of my medical school journey to help cultivate a platform dedicated to student scholarship, advocacy, creativity, and innovation. I leave this role incredibly proud of what we have built together and deeply optimistic about the future of osteopathic medicine. I am honored to pass this publication on to the next Editors-in-Chief, Tanvi Chitre and Zoe Trujillo, and I look forward to watching The Future DO continue to amplify student voices, inspire meaningful conversations, and push the future of medicine forward.
Cèline Zalamea (OMS-II, PNWU COM) LAYOUT & DESIGN Editor
EDITOR-IN-CHIEF
Adriana Borrell (OMS-III, BCOM) LAYOUT & DESIGN Editor
Cèline's experiences training in a rural community have shaped not only who she is, but also the kind of physician she hopes to become. Seeing how limited resources affect both patients and learners has pushed her toward advocacy and motivated her to speak up for communities that are often overlooked. Through SOMA, Cèline has been able to turn that commitment into meaningful work, both in representing students and in strengthening support for rural care. Additionally, serving on the SOMA research team has allowed her to bring a rural perspective into national projects, ensuring that the unique challenges faced by these communities are reflected in our data, discussions, and solutions.
"Personalization ...has the potential to address persistent disparities in cancer outcomes"
EDITORIAL
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About the Author Caitlyn is passionate about mentorship and advancing educational equity in medicine. She has worked with Heights Philadelphia on multiple initiatives, including serving as a mentor in a pilot program for high school students interested in STEM careers. Through Heights, she has also helped first-generation students navigate the college application process, securing acceptances to universities like Carnegie Mellon and Northeastern. Caitlyn also runs a college prep newsletter, making guidance more accessible to students with limited support. Caitlyn hopes to become an anesthesiologist and continue fostering mentorship and advocacy throughout her career. In her free time, she enjoys crocheting and watching Gilmore Girls.
Rethinking Screening: Why Radiology Needs a Personalized Approach
CAITLYN NGUYEN, (OMS-III, PCOM)
Preventive screening has long been a cornerstone of modern medicine. For decades, clinicians have relied on population-based guidelines to determine when imaging should be used to detect disease early. Yet as medicine moves toward greater precision and individualized care, the limitations of traditional screening strategies are becoming increasingly clear. While imaging guidelines are often applied ubiquitously across patient populations, recent research in breast and colorectal cancer screening highlight how personalized imaging strategies may improve outcomes while addressing disparities in healthcare access and effectiveness. Historically, screening recommendations for breast cancer have relied heavily on age-based guidelines. While age is an important risk factor, it is only one part of a much larger picture. Genetic predisposition, family history, breast density, and lifestyle factors all influence an individual’s likelihood of developing breast cancer. Despite this complexity, many screening programs still treat patients with vastly different risk profiles as though their screening needs are identical. Recent research examining risk-based breast cancer screening has begun to challenge this model. In a large clinical study comparing traditional annual screening to individualized risk-based approaches, researchers incorporated genetic information, clinical risk factors, and predictive models to determine screening frequency and modality. Women at higher risk received more intensive screening strategies, while those at lower risk were screened less frequently. Importantly, the risk-based approach performed as safely as annual mammography while reducing unnecessary imaging and interventions among lower-risk individuals. These findings suggest that screening strategies tailored to individual risk profiles may maintain cancer detection rates while minimizing overdiagnosis and patient burden. Personalization also has the potential to address persistent disparities in cancer outcomes. Colorectal cancer remains one of the leading causes of cancer-related deaths in the United States, and Black adults experience disproportionately higher incidence and mortality rates. Traditional screening approaches, including colonoscopy and stool-based testing, have not fully eliminated this gap. Structural barriers, differences in access, and patient preferences all influence whether individuals participate in screening programs. Research from the Harvey L. Neiman Health Policy Institute provides an example of how personalized approaches could improve screening effectiveness. Investigators analyzed several colorectal cancer screening strategies and found that CT colonography, a noninvasive imaging-based screening test, was the most cost-effective strategy for Black adults when real-world screening adherence was considered. Because CT colonography does not require sedation and is less invasive than colonoscopy, it may reduce barriers that prevent some patients from participating in screening programs. By accounting for differences in access and adherence, imaging-based strategies may help close disparities that traditional guidelines have struggled to address. These findings highlight an important shift in how radiology can contribute to patient care. Personalized medicine is often associated with genetics or targeted therapies, but imaging plays a critical role in tailoring screening strategies to individual patients and populations. Advances in imaging technology, data analytics, and artificial intelligence are increasingly enabling radiologists to move beyond simple detection toward sophisticated risk stratification. For osteopathic medical students, this evolution resonates strongly with the principles of osteopathic medicine. The osteopathic philosophy emphasizes treating the whole person and recognizing the interplay between biological, environmental, and social determinants of health. Personalized imaging aligns naturally with this perspective by acknowledging that patients’ health risks and the care they need are shaped by a wide range of individual factors. As healthcare systems continue to integrate precision medicine, radiologists will likely play an expanding role in designing and implementing personalized screening programs. This will require collaboration with primary care physicians, oncologists, public health researchers, and policymakers to ensure that new screening strategies are both evidence-based and equitable. For future physicians, the implications are significant. Radiology is often viewed primarily as a diagnostic specialty, but its role in preventive medicine is equally important. Personalized imaging strategies have the potential to improve early detection, reduce unnecessary procedures, and address longstanding disparities in care. By embracing individualized approaches to screening, radiologists can help ensure that advances in technology translate into more effective and equitable patient care.
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About the Author Bernice Diaz is a second-year osteopathic medical student at Touro College of Osteopathic Medicine in Harlem, NY. She earned her nursing degree from the University of Miami in 2014 before deciding to pursue medicine years later. She brings over a decade of clinical experience to her medical training and is actively involved in student-led mentorship and service initiatives on campus, including MedAchieve and the Latino Medical Student Association, as well as community health outreach. Her years as a nurse shaped an appreciation for interprofessional respect and patient-centered care. She plans to pursue internal medicine with a focus on health equity and patient advocacy.
In light of recent nursing strikes and ongoing healthcare workforce shortages, I write as a registered nurse and current osteopathic medical student to reflect on what these events can reveal to future physicians. These strikes reveal the advocacy nurses practice daily — speaking up for patients, for safe care, and at times for themselves when systems make it difficult. A lesson I carried into medical school from nursing was that advocacy is not only about raising concerns, but about whether someone is ready to listen. The strikes say out loud a reality on hospital floors: support for nurses, or lack thereof, directly affects patient safety. Amid these tensions in an evolving medical landscape, one of the most important lessons for future physicians is simple: respect your nurses. This is learned not in lectures but should be emphasized to every medical student. On the hospital floors, nurses are often the first to notice subtle changes, and whether those concerns are welcomed or dismissed shapes what happens next. A culture where nurses are comfortable speaking up and physicians are committed to listening is essential to good patient care. Even as medicine changes rapidly with technology, no innovative solution can replace the human element of collaboration. Let us be reminded that while workforce shortages, forces beyond the hospital walls, and the advances transforming medicine may be beyond our control, respect and clear communication with one another never are. The kind of physicians we become is reflected not only in our knowledge, but in how we treat the colleagues who help us care for patients. It all begins with respect.
"Waves of You: A Personalized Rhythm of Life" Artist: Stephie Thomas , OMS-III Lake Erie College of Osteopathic Medcine - Erie Campus
CASE REPORTS
"LET US BE REMINDED THAT WHILE WORKFORCE SHORTAGES, FORCES BEYOND THE HOSPITAL WALLS, AND ADVANCES TRANSFORMING MEDICINE MAY BE BEYOND OUR CONTROL, RESPECT AND CLEAR COMMUNICATION WITH ONE ANOTHER NEVER ARE."
Letter to the Editor: Respect Your Nurses: A Prerequisite for Better Care
BERNICE DIAZ (OMS-II, TOURO COLLEGE OF OSTEOPATHIC MEDICINE - HARLEM)
Ayham Alkiswani, Safiya Rasheed, Ruba Krichati, Mohammad Ansar Mughal MD University of the Incarnate Word school of osteopathic medicine alkiswan@student.uiwtx.edu
Introduction: Perforated diverticulitis typically presents with localized abdominal pain, most commonly in the left lower quadrant, along with systemic and peritoneal signs. We report an atypical case of perforated diverticulitis presenting with prolonged vague symptoms and no abdominal complaints, expanding the recognized clinical spectrum of this condition. Patient Description: A 69-year-old woman with a history of hypertension, hyperlipidemia, nutcracker esophagus, gastroesophageal reflux disease, and constipation presented after abnormal outpatient CT findings without abdominal symptoms. Findings: Initial CT imaging revealed a 7.9 × 6.2 cm rim-enhancing fluid collection with air-fluid levels in the left adnexa, initially concerning for tubo-ovarian abscess, along with left hydronephrosis likely due to mass effect. Subsequent ultrasound and MRI demonstrated a pelvic abscess adjacent to sigmoid diverticula with inflammatory changes, consistent with diverticular abscess and possible colovesical fistula, while excluding gynecologic malignancy. Treatment/Intervention: The patient underwent Hartmann’s procedure for perforated sigmoid diverticulitis with abscess and colovesical fistula, with subsequent clinical improvement and return to baseline. Conclusion: This case highlights that perforated diverticulitis may present without classic abdominal symptoms, even in patients with prior diverticular disease. Recognition of atypical presentations and prompt imaging are critical to avoid delays in diagnosis and management. Maintaining suspicion for serious intra-abdominal pathology in patients with persistent vague symptoms may improve outcomes.
ARachel Asaeda 1,2 , Victor Filogonio md2 , Anomadarshi Barua MD 2 1 Touro College of osteopathic medicine - harlem 2 New York City Health and Hospitals South Brooklyn Health, New York, New York, United States rasaeda@student.touro.edu
Reverse Takotsubo Secondary to Paraneoplastic Extra-Adrenal Pheochromocytoma
Introduction: Edwards syndrome (trisomy 18) is a rare condition often incompatible with life. Gastrointestinal complications of this syndrome are documented in infancy, however, motility disorders in adult survivors have not been previously reported. We present the first case of drug-induced intestinal ileus in a 29-year-old male with Edwards syndrome. Patient Description: A 29-year-old male with Edwards syndrome, hypothyroidism, severe intellectual disability, and contracted body habitus presented to the ED with constipation. After receiving prune juice at his group home, he had five non-bloody bowel movements prompting hospital presentation. He was on quetiapine 50 mg twice daily and benztropine 1 mg twice daily, both held on admission. Similar prior episodes were reported. Findings: Physical examination revealed significant abdominal distension. A nasogastric tube was placed in the ED, in which green-colored gastric fluid was collected. CT abdomen/pelvis suggested ileus or pseudo-obstruction. Repeat CT with contrast on hospital day 3 ruled out intraluminal obstruction and showed decreasing distension with generalized ileus pattern. Gastroenterology attributed the intestinal ileus to his psychiatric medications. Treatment/Intervention: No surgical intervention was required. Conservative management with nasogastric decompression, bowel rest, fluid resuscitation, and discontinuation of anticholinergic medications proved successful. The patient resumed oral intake with return of bowel function and was discharged after a 7-day hospitalization. Conclusion: This case expands the limited literature on adult trisomy 18 survivors and highlights medication- related gastrointestinal complications in this population. Clinicians caring for adults with Edwards syndrome should be aware of several key considerations, including overlapping medication side effects, especially anticholinergic effects, and the gastrointestinal manifestations of this syndrome, which require close monitoring. Establishing preventive strategies to minimize the risk of complications is essential to avoid unnecessary surgical interventions.
Exceptional Longevity in Edwards Syndrome Complicated by Ileus
Introduction: Despite advances in managing ulcerative colitis (UC), many patients remain refractory to and intolerant of standard immunosuppressive and anti-inflammatory therapies. Low-dose naltrexone (LDN) has been proposed as an off-label therapy for inflammatory conditions; however, evidence supporting its long-term use in UC remains limited. This case report describes a sustained long-term remission achieved with LDN monotherapy. Patient Description: This case describes a 78-year-old male diagnosed with UC in 2001. His past treatment history included azathioprine, oral and rectal mesalamine, hydrocortisone rectal foam, and Rowasa enemas, with inadequate disease control over nine years. The patient had no sustained response to conventional therapies and experienced ongoing symptoms and disease progression. Findings: Prior to LDN initiation, endoscopic evaluation demonstrated progressive disease involving up to 70 cm of friable colonic mucosa with ulceration and bleeding. Diagnostic findings were consistent with active UC. Treatment/Intervention: LDN 4 mg daily was initiated in 2010 as monotherapy at the patient’s request. He achieved complete symptom resolution and has remained off corticosteroids, immunomodulators, and biologic therapy. Serial colonoscopies over a 15-year period demonstrated sustained mucosal healing with no evidence of active inflammation. Conclusion: This case highlights an unusually prolonged clinical and endoscopic remission of UC achieved with LDN monotherapy. Given the chronic nature of UC, treatment-related adverse effects, and cost considerations, this case supports further investigation of LDN as a potential low-cost, well-tolerated therapy in select patients, highlighting a positive outcome of patient-initiated, shared decision-making.
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Unexpected Perforated Diverticulitis in an Asymptomatic Patient: A Case Report
Carter Spencer Edward Via College of osteopathic medicine - Virginia scarter01@vcom.edu
Sustained Long-Term Remission of Ulcerative Colitis With Low-Dose Naltrexone Monotherapy: A Case Report
Allison Huang1, Kaylin Back DO2, Emmanuel Nketiah MD2 1 Touro college of osteopathic medicine - Middletown 2 Garnet Health Medical Center, Middletown, NY ahuang13@student.touro.edu
Introduction: Takotsubo cardiomyopathy, or “broken heart syndrome,” is a transient left ventricular systolic dysfunction often precipitated by stress. The classic form involves apical ballooning, whereas the reverse variant demonstrates basal hypokinesis with apical hyperkinesis and is more common in younger patients. The mechanism involves catecholamine-mediated myocardial stunning, with rare cases linked to catecholamine-secreting tumors. Patient Description: A 23-year-old female with a history of type I second-degree AV block and iron deficiency anemia presented with two days of dull, nonradiating midsternal chest pain with intermittent palpitations and one episode of emesis and headache with onset twenty minutes prior to arrival. The patient denied using home medications or recreational drugs aside from iron supplementation. Findings: Vital signs and physical examination were unremarkable. Troponin was elevated (0.826; high-sensitivity 583) with nonspecific T-wave abnormalities on ECG. Echocardiogram showed LVEF 45-50% and cardiac catheterization revealed normal coronaries with reduced LVEF (35%) and structural findings consistent with reverse Takotsubo. Abdominal imaging demonstrated necrotic, enhancing para-aortic lymph node masses (largest 3.5 x 3.2 cm). Oncology labs showed normal tumor markers and biopsy confirmed extra-adrenal pheochromocytoma. Treatment/Intervention: The patient received aspirin and heparin for presumed NSTEMI and was started on carvedilol, sacubitril/valsartan, furosemide, and aspirin 81mg. The patient was discharged with cardiology follow-up and surgical follow-up for definitive resection of the extra-adrenal pheochromocytoma. Conclusion: Reverse Takotsubo cardiomyopathy accounts for 10-20% of cases and is more common in younger patients. This case highlights catecholamine excess from extra-adrenal pheochromocytoma as a reversible cause of myocardial dysfunction in young patients presenting with acute coronary syndrome-like symptoms, as earlier recognition can lead to prompt diagnosis, treatment, and recovery of cardiac function.
Moiz Alam, Nafisa Khalafalla, Mariya Kharodawala MD New York Institute of Technology college of osteopathic medicine - arkansas nkhalafa@nyit.edu
Grace Lee et al. Edward Via college of osteopathic medicine - louisiana glee@vcom.edu
Title: HPV associated Epidermodysplasia Verruciformis Presenting with Bowen’s Disease in an Elderly Male
Kikuchi-Fujimoto Disease in a 2-Year-Old Caucasian Child: An Extremely Rare Pediatric Presentation
Introduction: Hydroureteronephrosis is the dilation of the ureter, renal pelvis, and renal calyces. Cadaveric reports describing distal obstruction secondary to excessive bladder sediment are limited. This study analyzes compensatory morphological changes in the right ureter associated with bladder sediment-related dysfunction and provides detailed morphometric analysis of the bilateral kidneys and renal vasculature. Patient Description: This case study examined an 88-year-old female donor with history of tobacco use and Alzheimer’s dementia, whose cause of death was complications from end-stage COPD. Findings: Ureter and kidney measurements were collected and compared with normative datasets. Bilateral kidneys and ureters were in expected anatomical locations. The right kidney was slightly larger than the left kidney in volume. The right ureter was 20 cm in length with varying widths. The right ureteropelvic junction measured 3.7 cm compared to 1.35 cm on the left. Two strictures were present in the right ureter at the L3 vertebral level, narrowing it to 0.72 cm and 0.55 cm. At the aortic bifurcation and at the ureteric orifices of the bladder, the right ureter measured 1.04 cm and 0.83 cm while the left measured 0.4 cm and 0.63 cm respectively. Coronal sections showed dilation of the right renal pelvis and calyces with internal sedimentation. The bladder contained sediments and lacked rugae. Discussion/Conclusion: The findings suggest chronic obstructive etiology with compensatory dilation and ureteral narrowing, likely secondary to sediment passage. The absent bladder rugae correlates to long-standing urinary retention which would allow sediment accumulation and resultant obstruction. This case contributes to understanding hydroureteronephrosis-related anatomical changes and compensatory responses, elucidating the importance of identifying obstructive etiologies early on, avoiding the anatomical changes seen in this case.
mary katherine stewart, dylan ledbetter edward via college of osteopathic medicine - auburn mstewart01@vcom.edu
Expanding the Clinical Spectrum of PIEZO2 Intragenic Duplications: A Case of Congenital Sensory Neuropathy and Musculoskeletal Abnormalities
Introduction: Precision medicine is often defined by genomics, imaging, and targeted therapies; however, individualized care also relies on the clinician’s capacity to detect subtle physiologic changes. Few reports describe osteopathic palpation influencing early oncologic diagnosis. This case highlights how tactile diagnostic skill functioned as a form of precision medicine, prompting earlier investigation despite reassuring routine findings. Patient Description: A 79-year-old woman with a history of hypothyroidism and no prior gastrointestinal disease presented with one month of vague, non-localized abdominal discomfort without radiation. She had normal vital signs, no gastrointestinal red-flag symptoms, no personal or family history of gastrointestinal disease, and a negative colonoscopy at age 70, after which no further screening had been recommended. Findings: Osteopathic structural examination revealed localized tissue drag and a firm, mobile density in the mid-transverse colon region with associated fascial restriction. Persistent palpatory findings prompted advanced imaging, including contrast-enhanced computed tomography, which revealed a 5.9-cm ulcerated transverse colon mass with enterocolic fistula. Colonoscopy confirmed moderately differentiated MSI-H adenocarcinoma. Treatment/Intervention: The patient underwent surgical resection with negative margins. Postoperatively, OMT was used adjunctively to support lymphatic flow, pain control, and mobility, facilitating recovery. Conclusion: This case illustrates that osteopathic palpation can function as an equitable form of precision medicine that does not rely on expensive technology or access to tertiary centers. In populations where screening intervals, age cutoffs, insurance barriers, or social determinants may delay advanced diagnostics, the skilled hands of an osteopathic physician remain universally available. Colorectal cancer is the second leading cause of cancer death worldwide. By identifying its pathology before conventional clinical triggers emerged, palpatory assessment bridged a potential gap in care.
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Abraham E. Libman, Mikhail Volokitin, MD/DO, Julia Sun, Roya Mostafavi touro college iof osteopathic medicine - Harlem alibman2@student.touro.edu
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Introduction: PIEZO2 encodes a mechanosensitive ion channel essential for touch, proprioception, and interoception. Biallelic loss-of-function variants are known to cause a recessive mechanosensory neuropathy characterized by hypotonia, proprioceptive deficits, and skeletal abnormalities. While gain-of-function variants are associated with distal arthrogryposis syndromes, intragenic duplications of PIEZO2 are rarely reported. This case addresses a gap in the literature by describing a novel homozygous intragenic duplication and its associated phenotype. Patient Description: We present a nine-year-old male with global motor developmental delay, congenital hypotonia, microcephaly, short stature, distal muscle weakness, sensory neuropathy, and gait instability. His medical history included thoracolumbar neuromuscular scoliosis, bilateral cryptorchidism status post orchiopexy, chronic urinary incontinence, and early failure to thrive requiring gastrostomy tube support. He was born prematurely with neonatal respiratory distress syndrome and demonstrated persistent developmental delays despite multidisciplinary therapy. Family history was noncontributory. Findings: Neurologic examination revealed generalized hypotonia, distal lower extremity weakness, impaired proprioception, and sensory neuropathy. Musculoskeletal findings included scoliosis, pes planus, and hallux valgus. Chromosomal microarray identified a partial duplication of PIEZO2 at 18p11.22. Whole exome sequencing confirmed a pathogenic homozygous intragenic duplication. Both parents were heterozygous carriers. Treatment/Intervention: Management was supportive and multidisciplinary, including pediatric neurology, orthopedics, nutrition, and endocrinology. Interventions focused on optimizing motor function, monitoring scoliosis progression, and addressing growth and nutritional concerns. No disease-modifying therapies are currently available. Conclusion: This case represents a rare example of a homozygous intragenic PIEZO2 duplication causing a phenotype consistent with recessive mechanosensory neuropathy. Unlike previously reported loss-of-function variants, this duplication expands the mutational and phenotypic spectrum of PIEZO2-related disease. Recognition of this variant has important implications for diagnosis, genetic counseling, and future genotype–phenotype correlation studies.
Early Detection of Transverse Colon Adenocarcinoma Through Osteopathic Palpatory Skills: A Case Demonstrating Precision Beyond Technology
Introduction: Epidermodysplasia verruciformis (EV) is a rare genetic disorder characterized by increased susceptibility to specific human papillomavirus (HPV) strains and increased risk of non- melanoma skin cancers, particularly squamous cell carcinoma. Classic EV is familial and presents in childhood, whereas acquired EV occurs later in the setting of immunosuppression. This case describes a unique presentation of acquired EV that is associated with prior leprosy and highlights novel nail findings that may aid in clinical recognition. Patient Description: A 75-year-old male presented with chronic skin lesions involving the face, neck, and trunk. His past medical history was significant for leprosy treated with dapsone monotherapy approximately 30 years prior. He had a brother who passed away from solid organ malignancy. Findings: Physical examination showed multiple crusted and ulcerated plaques on the forehead and neck (across 1–2 years) and longstanding hypopigmented and erythematous macules on the abdomen. All 20 nails showed diffuse subungual hyperkeratosis with yellow discoloration. Biopsy of the plaques demonstrated full-thickness epidermal dysplasia consistent with Bowen’s disease (squamous cell carcinoma in situ). Biopsy of the macules showed features of EV, including orthohyperkeratosis, keratinocyte vacuolation, and nuclear atypia. HPV DNA testing was confirmatory, with negative fungal cultures. The patient was hepatitis B surface antigen positive. Treatment/Intervention: The patient was treated with oral isotretinoin 20 mg nightly and topical 5-fluorouracil 5% cream applied to affected plaques. Photodynamic therapy was not pursued due to institutional unavailability. The patient is undergoing close surveillance with regular follow-up. Conclusion: This case describes acquired EV in an elderly, immunocompetent male with a remote history of leprosy and multiple Bowen’s disease lesions. It highlights the need to consider EV in persistent atypical lesions, even without active immunosuppression. A novel finding was subungual hyperkeratosis with nail discoloration across 20 nails, which may expand the clinical spectrum of EV. Recognition of such features may aid earlier diagnosis and surveillance for malignant transformation. Further research is needed to determine whether ungual involvement is a consistent feature.
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Keirsten Templin, Alice Zhang, ELENA WATSON PHD, JODIE FOSTER DPT Ohio University Heritage of Osteopathic Medicine km565415@ohio.edu
© Canva
Introduction: Hydroureteronephrosis is the dilation of the ureter, renal pelvis, and renal calyces. Cadaveric reports describing distal obstruction secondary to excessive bladder sediment are limited. This study analyzes compensatory morphological changes in the right ureter associated with bladder sediment-related dysfunction and provides detailed morphometric analysis of the bilateral kidneys and renal vasculature. Patient Description: This case study examined an 88-year-old female donor with history of tobacco use and Alzheimer’s dementia, whose cause of death was complications from end-stage COPD. Findings: Ureter and kidney measurements were collected and compared with normative datasets. Bilateral kidneys and ureters were in expected anatomical locations. The right kidney was slightly larger than the left kidney in volume. The right ureter was 20 cm in length with varying widths. The right ureteropelvic junction measured 3.7 cm compared to 1.35 cm on the left. Two strictures were present in the right ureter at the L3 vertebral level, narrowing it to 0.72 cm and 0.55 cm. At the aortic bifurcation and at the ureteric orifices of the bladder, the right ureter measured 1.04 cm and 0.83 cm while the left measured 0.4 cm and 0.63 cm respectively. Coronal sections showed dilation of the right renal pelvis and calyces with internal sedimentation. The bladder contained sediments and lacked rugae. Conclusion: The findings suggest chronic obstructive etiology with compensatory dilation and ureteral narrowing, likely secondary to sediment passage. The absent bladder rugae correlates to long-standing urinary retention which would allow sediment accumulation and resultant obstruction. This case contributes to understanding hydroureteronephrosis-related anatomical changes and compensatory responses, elucidating the importance of identifying obstructive etiologies early on, avoiding the anatomical changes seen in this case.
QI & PUBLIC HEALTH
Structural Renal Adaptations to Distal Obstruction by Urinary Sedimentation: A Cadaveric Case Report
Introduction: Radiology remains one of the most competitive residency specialties in the United States, with publication in high-impact journals serving as a key metric for residency selection. However, osteopathic physician representation in radiology research leadership is not well defined. This study evaluated the proportion of osteopathic-affiliated first, senior, and total authors in leading U.S. radiology journals from 2005 to 2024. Methods: A bibliometric analysis was conducted of radiology journal articles published between 2005 and 2024. Authors were classified as osteopathic if affiliated with osteopathic medical schools or hospitals previously accredited by the American Osteopathic Association (AOA) for radiology residencies. Articles primarily authored by international contributors were excluded. Statistical analyses included ANOVA, chi-squared testing, and multivariate regression to identify factors associated with osteopathic authorship. Results: Among 17,054 articles reviewed, only 17 (0.1%) listed an osteopathic senior author. Articles with osteopathic senior authors had significantly more osteopathic co-authors and a higher proportion of osteopathic first authors (p < 0.001). These articles also involved larger research teams. Radiation Oncology and Radiology journals accounted for the majority of osteopathic senior authorship. Following the AOA-ACGME merger, there was a non-significant increase in articles with at least one osteopathic author. Multivariate regression demonstrated a strong association between osteopathic first and senior authorship. Conclusion: Osteopathic authorship in radiology journals remains limited, particularly at the senior level. Cross-institutional mentorship programs that pair osteopathic trainees with experienced radiology investigators, can enhance osteopathic representation. This would promote diverse clinical perspectives, foster inclusive academic advancement, and support the integration of osteopathic principles within imaging-centered patient care.
Rafia Baig1, Maimoona Mahek2, Fatima Nizamuddin3, Tej Patel4, Fawaz Syed4, Ibraheem Qureshi4, Haitham Elsamaloty MD1 1University of Toledo College of Medicine and Life Sciences 2Lake Erie College of Osteopathic Medicine 3University of Illinois at Chicago College of Medicine 4New York Institute of Technology College of Osteopathic Medicine mmahek06610@med.lecom.edu
Introduction: Early detection of autism spectrum disorder (ASD) improves developmental outcomes; however, families often face prolonged wait times for evaluation, especially those from underserved communities. Despite efforts to reduce waitlists, few resources exist to support families during this period. This study evaluated the impact of an informational brochure provided at the time of a positive autism screen on parental stress, self-efficacy, and knowledge of next steps. Methods: A brochure was developed using literature and expert consultation, which included information about ASD, next steps, and local resources. It was translated into Spanish with a Medical Spanish professor and written at an eighth-grade reading level. Parents of children referred for ASD evaluation by a pediatrician in Madera, California, an area with physician shortages and long wait times, were recruited. Surveys were completed before and after brochure review. Stress was measured using the Spielberger State-Trait Anxiety Inventory (STAI) and self-efficacy with the Brief Parental Self-Efficacy Scale (BPSES). Three additional questions assessed knowledge and confidence regarding next steps. Data collected from November 2023 to September 2024 were analyzed using paired t-tests. Results: Parents showed a 14% increase in self-efficacy and a 13.5% reduction in stress after reviewing the brochure. Statistically significant improvements were observed in understanding next steps and sense of calm. Knowledge of strategies to support development at home increased by 21.6%. Conclusion: A low-cost informational brochure may meaningfully support families navigating ASD evaluation delays within primary care settings.
Cortland Jell¹, Ariana Kaxon-Rupp¹, Edward Merino, PhD¹, Mohammed Rahman PhD¹, Michelle Perez MD² ¹California Health Sciences University, College of Osteopathic Medicine ²Camarena Health kaxon-rupp2582@chsu.edu
Radiology Publication Trends and Academic Affiliation from 2005 to 2024
Sarah Shehata, Ethan Kuss, Joseph Lin Ed. D California Health Sciences University, College of Osteopathic Medicine shehata0884@chsu.edu
Claire Belvardi, David Belvardi, Sydney Tobis Arkansas College of Osteopathic Medicine clmitchell@acheedu.org
Assessing the Impact of an Informational Brochure on Parental Stress, Self-Efficacy, and Understanding Following Pediatric Referral for Autism Diagnosis: A Pilot Study
Introduction: Maternal morbidity and mortality in the United States remain unacceptably high, with Arkansas consistently exceeding national benchmarks. Drivers of poor outcomes include gaps in contraception access, suboptimal chronic disease management, limited prenatal education, and inadequate postpartum follow-up. Cardiovascular disease is the leading cause of pregnancy-related death and is frequently exacerbated by delayed recognition and fragmented care. This literature review examines clinical and policy determinants of adverse maternal outcomes in Arkansas and identifies evidence-based opportunities for intervention. Methods: A structured literature review was conducted using peer-reviewed publications, state health reports, and policy analyses addressing maternal outcomes in Arkansas and comparable U.S. populations. Sources were synthesized across pre-pregnancy, prenatal, and postpartum domains, with focused evaluation of cardiovascular risk, healthcare access, and policy interventions including Medicaid expansion, telehealth implementation, and integration of doula and midwifery services. Results: Cardiovascular disease emerged as the leading cause of pregnancy-related death, with a substantial proportion classified as preventable. The postpartum period represented a high-risk interval, with significant mortality occurring weeks to months after delivery. Rural residence, socioeconomic disadvantage, racial inequities, and insurance instability further amplified risk. Evidence from multiple states suggests that extended postpartum Medicaid coverage, telehealth expansion, and incorporation of doula and midwifery care improve maternal outcomes. Conclusion: Preventable maternal mortality in Arkansas reflects remediable clinical and structural gaps. Equity-centered strategies that enhance cardiovascular screening, ensure postpartum care continuity, and expand supportive perinatal services are critical to improving maternal outcomes statewide and reducing preventable deaths.
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Reducing Preventable Maternal Deaths in Arkansas: Clinical Gaps, Postpartum Risk, and Policy Solutions
Introduction: Traditional anatomy instruction relies on cadaveric dissection, textbooks, and two-dimensional imaging, which may limit visualization of complex spatial relationships. Immersive technologies such as augmented reality (AR) offer three-dimensional, interactive models that may improve engagement and spatial understanding. The Microsoft HoloLens enables life-sized holographic anatomy visualization, yet evidence on its impact on learning and retention remains mixed, and qualitative data on student experiences are limited. This study explores first-year medical students’ perceptions of AR in anatomy education. Methods: A qualitative case study design was employed to explore students’ experiences with the HoloLens in anatomy learning. The participant group consisted of 12 students. Students were asked to complete semi-structured Zoom interviews guided by an eight-question protocol. All interviews were recorded, transcribed, anonymized, and then returned to participants for member checking to ensure accuracy. The data were analyzed using Braun and Clarke’s thematic analysis framework, and coding was conducted in NVivo to identify recurring patterns across the interviews. Results: Analysis revealed eight major themes. Students reported increased engagement, motivation, and collaboration due to the immersive, interactive features of AR. Participants described improved spatial awareness and conceptual understanding, particularly with three-dimensional visualization and anatomical layering. Some students perceived improved retention. Reported limitations included reduced anatomical realism, restricted model manipulation, physical discomfort, and technical challenges. Students emphasized that AR was most beneficial as a supplement, not a replacement, for traditional methods. Conclusion: HoloLens-based AR enhances engagement and spatial understanding in anatomy education but presents usability and realism constraints. Integrating AR with traditional anatomy instruction may optimize learning outcomes. Further research should explore its effects on performance and long-term retention.
An Exploratory Case Study on the Role of Virtual Reality in Enhancing Anatomy Education for First-Year Medical Students
LITERATURE REVIEWS
The Future DO publishes student abstract submissions and perspective articles twice annually. We welcome students to submit abstracts and articles for consideration to be featured in our next issue. Students are not required to be SOMA members to submit an abstract. In addition, TFDO will also be accepting student artwork for print either on the cover or within the body of the magazine! Stay tuned for email announcements from SOMA Weekly or check out our research website: www.studentdoresearch.org for updates and announcements. We look forward to receiving your submissions!
Disability and Heavy Drinking: An Analysis of BRFSS 2022 Data
Introduction: Heavy drinking, defined as consuming more than 14 drinks per week for men and more than 7 for women, contributes significantly to preventable health conditions. Individuals with disabilities face unique vulnerabilities due to barriers in healthcare access, social isolation, and associated stressors. Identifying the relationship between specific disabilities and heavy drinking is crucial for tailoring preventive care and interventions to this population. Background: This study explores the intersection of disability and heavy drinking using a large, nationally representative dataset. The goal is to address disparities and inform public health initiatives aimed at vulnerable populations. Methods: Data from the 2022 Behavioral Risk Factor Surveillance Survey (BRFSS) was analyzed using the CDC Web Enabled Analysis Tool (WEAT). Logistic regression assessed heavy drinking as the dependent variable, with six disability categories as independent variables: visual impairment, hearing impairment, cognitive difficulties, mobility challenges, self-care challenges, and independent living difficulties. Results were reported as odds ratios (ORs) with 95% confidence intervals (CIs) and p-values. Results: Cognitive impairment was a significant risk factor for heavy drinking (OR = 1.36, 95% CI: 1.26–1.46, p < 0.0001). Mobility challenges (OR = 0.69, 95% CI: 0.63–0.76, p < 0.0001) and difficulties completing errands independently (OR = 0.89, 95% CI: 0.80–1.00, p = 0.0447) appeared protective. Visual and hearing impairments and self-care difficulties showed no significant associations. Conclusion: Cognitive impairment increases the risk of heavy drinking, while mobility challenges and independent living difficulties are protective. Tailored interventions and accessible resources are needed to reduce heavy drinking and promote better outcomes for disabled populations.
INTERESTED IN HAVING YOUR WORK PUBLISHED IN THE FUTURE DO?
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JACOB WELCH Kentucky College of Osteopathic Medicine - University of Pikeville jacobwelch@upike.edu
Pooja Athalye, Nanak Pabla, BaoKhanh Nguyen A.T. Still University School of Osteopathic Medicine - Arizona sa214746@atsu.edu
Kayla Leiber, Robert Parker, PharmD Alabama College of Osteopathic Medicine leiberk9871@acom.edu
Introduction: The gut microbiome plays a critical role in human health. Despite its clinical relevance, research has disproportionately focused on male and nonmarginalized populations. Women, particularly postmenopausal women and American Indian populations, remain underrepresented. This limits generalizability and raises concerns about equitable translation of findings into clinical care. This review examines disparities in gut microbiome research and their implications for study design and patient care. Methods: A structured literature review was conducted using PubMed to evaluate representation across sex, age, and American Indian populations. Search term frequency and filters were applied to identify disparities. Peer-reviewed, open-access human studies using 16S rRNA sequencing were included. Selected studies were analyzed for microbiome composition differences, methodology, and clinical relevance. Results: Literature demonstrates biologically and hormonally mediated differences between male and female gut microbiomes, including changes associated with menopause. However, studies specifically examining postmenopausal women are limited. Research involving American Indian women is exceedingly scarce; only one study meeting inclusion criteria incorporated culturally appropriate methodologies and community engagement. The number of studies identified differed significantly by population group (χ² = 167.10, p < 0.000001), highlighting substantial underrepresentation of postmenopausal women and American Indian populations in gut microbiome research. Many studies also rely on small, cross-sectional samples without longitudinal follow-up, limiting clinical applicability. Conclusion: Underrepresentation of postmenopausal women and American Indian populations in microbiome research presents concerns for health equity. Intentional inclusion, culturally responsive methods, and expanded longitudinal studies are essential. Additionally, advocacy at institutional and policy levels is necessary to ensure microbiome research advances health equity and translates effectively to patient care.
Surgical Management of Eustachian Tube Dysfunction: Current Evidence and Gaps in Outcomes Research
Introduction: Over-the-counter hair and skin supplements frequently contain biotin, which can interfere with immunoassays using biotin–streptavidin binding. On susceptible cardiac troponin platforms, this interference may produce falsely low troponin values, potentially obscuring myocardial infarction diagnosis. Despite regulatory warnings, supplement use is inconsistently documented in acute care settings. This review summarizes evidence on biotin-associated troponin interference and strategies to reduce diagnostic risk. Methods: We conducted a focused narrative review using targeted PubMed searches (“biotin interference,” “troponin assay,” “immunoassay interference”) and reference list screening. Thirty-one relevant articles were included, comprising peer-reviewed studies, case reports/series, and laboratory or regulatory guidance. Sources were selected based on clinical relevance to emergency and inpatient workflows, emphasizing clinically significant interference and mitigation strategies. Results: Biotin exposure most consistently affected sandwich immunoassays by lowering reported analyte concentrations. Susceptibility varied by assay platform and circulating biotin levels. Reported cases often involved chest pain presentations with troponin values disproportionately low relative to symptoms or ECG findings. Diagnostic clarification occurred after identifying supplement use and repeating testing on an alternative platform or after a washout period. Common sources included multivitamins, hair/skin/nails products, and hair-growth supplements. Conclusion: Biotin-containing supplements represent a preventable source of troponin assay discordance. Routine supplement history screening, early laboratory consultation for discordant presentations, and repeat testing with biotin-resistant assays or delayed redraw may improve diagnostic safety. Incorporating supplement documentation into chest pain workflows offers a low-burden systems-level intervention.
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Biotin-Containing Hair and Skin Supplements and Risk of Falsely Low Troponin in Chest Pain Evaluations: Implications for Clinical Workflow
Disparities in Postpartum Contraception Access & Family Planning Among Marginalized Women
Underrepresentation in Gut Microbiome Research and Implications for Patient Care
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Winifred Chijioke Touro College of Osteopathic Medicine - MIDDLETOWN cchijiok@student.touro.edu
Julianna Lindquist1, JL Borgogna PhD1,2 1Touro College of Osteopathic Medicine - Montana 2Weissman Hood Institute at Touro - Montana jlindqui2@student.touro.edu
Introduction: Eustachian Tube Dysfunction (ETD) is a common condition associated with otologic and rhinologic symptoms that can significantly impair quality of life. While medical therapy is first-line treatment, patients with persistent symptoms may require surgical intervention. Balloon eustachian tuboplasty (BET) has emerged as a minimally invasive option for refractory ETD; however, variability in study design, outcome measures, and follow-up limits definitive conclusions regarding its effectiveness. This study reviews the current literature on BET to identify outcome trends and gaps in existing research. Methods: A qualitative literature review was conducted using PubMed and Scopus to evaluate surgical interventions for ETD, with a focus on BET outcomes. Articles published between 2010 and 2025 involving adult and pediatric patients were screened. Thirteen studies met inclusion criteria (i.e ETD, BET, surgical intervention, ETD management) and were reviewed for reported clinical outcomes, study heterogeneity, and identified research gaps. Results: Multiple randomized and pilot clinical trials report symptomatic improvement following BET, most commonly measured using Eustachian tube dysfunction questionnaire-7 (ETDQ-7). Long-term follow-up studies show improvement of symptoms in patient-reported outcomes. However, the literature was limited by small sample sizes, a limited number of studies, and reliance on subjective outcome measures. Conclusion: Current evidence supports BET as a treatment option for persistent ETD, but significant gaps remain, including limited long-term data, lack of standardized objective outcomes, and underrepresentation of diverse populations. Future research should prioritize standardized measures, broader population inclusion, and comparative surgical studies to better define BET’s role in ETD management.
Introduction: Precision medicine promises individualized contraceptive counseling tailored to patient preferences and medical history. However, personalized family planning remains inaccessible to marginalized populations facing structural barriers. Despite clinical guidelines emphasizing shared decision-making, disparities in postpartum contraception access persist across race, ethnicity, and insurance status. This literature review examines how social, cultural, and systemic drivers perpetuate inequities in postpartum family planning, even when precision counseling is available. Methods: Systematic search of PubMed, Scopus, and Web of Science identified studies published 2004-2024 examining postpartum contraception access and utilization patterns in marginalized populations. Studies addressing provider bias, insurance barriers, and intervention evaluations were included. Qualitative and quantitative research, policy analyses, and program evaluations were synthesized. Results: Black women and Medicaid-insured women experience provider-driven biases influencing method choice. Immigrant and refugee women face language barriers and insurance exclusion. Long-acting reversible contraception (LARC) uptake varies significantly by race (Black women: adjusted OR 0.68 vs White women) and insurance status. Restrictive sterilization consent policies disproportionately affect women of color. Historical coercive practices compound medical mistrust. Few interventions explicitly target equity gaps, though community-based counseling and Medicaid extension show promise. LGBTQ+ postpartum contraceptive needs remain understudied. Conclusion: Postpartum contraception disparities demonstrate how precision medicine fails without addressing equity. Personalized counseling is insufficient when structural barriers, insurance gaps, provider bias, and historical trauma prevent access to preferred methods. Reducing inequities requires culturally- tailored interventions, expanded coverage, coercion prevention accountability, and inclusive research. Precision for all demands that individualized care reach everyone, not just the privileged.
Nanak Pabla, Pooja Athalye, BaoKhanh Nguyen A.T. Still University School of Osteopathic Medicine - Arizona sa215220@atsu.edu
Thyroid Hormone and IGF-1 Signaling in Modulating Cardiomyocyte Cell Cycle Re-Entry After Cardiac Injury
Neonatal Outcomes Associated with Maternal Sleep Disorders During Pregnancy: A Scoping Review
Impact of the 2002 Women’s Health Initiative Study on Menopausal Hormone Therapy Prescribing in Younger Menopausal Women: A 20-Year Review of Trends and Clinical Implications
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Introduction: Sleep disorders, including insomnia, restless legs syndrome (RLS), and obstructive sleep apnea (OSA), are common in pregnancy and may contribute to adverse neonatal outcomes. This scoping review maps literature on maternal sleep disorders and offspring outcomes. Methods: PubMed and EMBASE were searched for studies (2016–2026) on pregnant humans with sleep disorders that reported neonatal outcomes, including preterm birth (PTB), small/large for gestational age (S/LGA), NICU admission, mortality, and APGAR scores. Screening and full-text review were conducted using Rayyan. Results: Forty-one studies, observational cohorts and case control analyses, were included. Maternal OSA was the most studied, followed by insomnia and RLS. Evidence linking maternal sleep disorders and neonatal outcomes was overall heterogeneous, though several patterns emerged. OSA was associated with congenital abnormalities and increased NICU admission, with inconsistent associations to PTB. Some studies linked maternal OSA to SGA, others to LGA, and some to both extremes. Emerging evidence suggests OSA is associated with neurodevelopmental delay and shortened telomeres in offspring. Insomnia was associated with SGA, increased NICU admission, and miscarriage, with variable links to low APGAR scores. RLS was linked to stillbirth, with mixed connection to PTB. Conclusion: Maternal sleep disorders are associated with adverse fetal and neonatal outcomes, though findings are heterogeneous. Maternal OSA shows the most consistent associations, while insomnia and RLS remain mixed. This highlights the need for standardized outcome definitions and prospective studies to clarify the impact of maternal sleep health on neonatal outcomes.
Uncovering the Drive: What Leads Patients with Trauma-Related Memory Loss to Seek Psychiatric Care
Introduction: The relationship between post-traumatic stress disorder and dissociation is well described in current literature, even leading to a dissociative subtype of the PTSD diagnosis being established in the DSM-5. Current literature estimates that about 38% of individuals with PTSD experience dissociative symptoms. Mental health care-seeking behaviors among patients are also generally well researched; however, little is known about how patients with trauma-related amnesia decide to seek psychiatric care. This review aims to examine the factors that lead patients experiencing memory loss following a traumatic event to seek psychiatric care. Methods: A systematic literature review was conducted across PubMed, Embase, CINAHL, and EBSCO with search terms including socioeconomic factors, memory loss, dissociation, adverse childhood experiences, psychological trauma, stress disorders, post-traumatic, and mental health services. Of the 458 articles screened, 112 met the inclusion criteria. Included studies focused on child and adult populations, psychological trauma, psychiatric care-seeking behaviors, and memory loss. Results: Various triggers of traumatic events, such as a similar physical environment or time of year, can lead to a physiologic response, often causing parts of the episodic memory to return. These episodes of traumatic response often lead patients to seek psychiatric care. There is substantial variation in the time interval between the traumatic event and help-seeking behaviors. The variation in symptom presentation, timing of symptom onset, type of trauma experienced, and social determinants of health create a unique set of barriers to accessing and seeking care in this vulnerable patient population. The main factors identified affecting symptom presentation were the relationship with the perpetrator, age during the traumatic events, and nature of the events, including war trauma, sexual abuse, domestic violence, and incestuous abuse. More stigmatized traumatic experiences led to a greater decrease in care-seeking behavior. Up to 60% of older adult sexual assault victims never disclosed their experiences, and 94% never sought mental health care. Stigma and gaps in memory between trauma occurrence and disclosure lead to a lack of validation, discouraging patients from seeking or continuing care. Conclusion: As providers, we need to be mindful of how we engage with patients who seek care several years or decades after a traumatic event to prevent them from continuing to slip through the cracks. Understanding the variation in the way these patients present will help to increase the likelihood of seeking care and increase their trust in mental healthcare to disclose these events and receive proper treatment. Initiating the conversation as providers and increasing screening tools can help increase care-seeking behavior among trauma-exposed individuals experiencing memory loss or dissociation.
Rachel Mays, Giana Davlantes, Vanessa Valdovinos, Jaclyn Samra, Natalie Ban, Robert Reynders do California Health Sciences University, College of Osteopathic Medicine mays2922@chsu.edu
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erica noe Rocky Vista University College of Osteopathic Medicine - Southern Utah erica.noe@ut.rvu.edu
Introduction: Adult mammalian cardiomyocytes have limited capacity to regenerate after cardiac injury due to cell cycle exit which contributes to irreversible myocardial loss and heart failure. In contrast, zebrafish and neonatal mammals retain the ability to regenerate cardiac tissue via cardiomyocyte proliferation, indicating that regenerative potential is developmentally suppressed rather than absent. Endocrine pathways including thyroid hormone (TH) and insulin-like growth factor-1 (IGF-1) play critical roles in postnatal cardiac maturation and may regulate this loss of proliferative capacity. This review aims to evaluate current evidence on how TH and IGF-1 signaling influence cardiomyocyte cell cycle dynamics following injury. Methods: A narrative literature review was conducted using PubMed and PubMed Central databases, with 14 studies included after screening 34 articles. Peer-reviewed experimental and review articles published between 2002-2025 were selected, focusing on cardiomyocyte proliferation, cardiac regeneration models, and TH and IGF-1 signaling pathways in zebrafish, neonatal, and adult mammalian hearts. Results: The literature demonstrates that a postnatal surge in triiodothyronine (T3) activates thyroid hormone receptors, promoting cardiomyocyte maturation, metabolic remodeling, binucleation, and irreversible cell cycle arrest. Experimental suppression of TH signaling prolongs neonatal cardiomyocyte proliferation. IGF-1 signaling supports cardiomyocyte survival and proliferation through PI3K–Akt–mediated pathways, with evidence suggesting interaction between TH and IGF-1 signaling in regulating regenerative capacity after injury. Conclusion: TH and IGF-1 signaling pathways are key regulators of cardiomyocyte maturation and proliferative potential. Understanding their opposing and interactive roles provides insight into endogenous barriers to adult cardiac regeneration and highlights endocrine modulation as a potential therapeutic strategy for myocardial repair post myocardial injury.
Introduction: The 2002 Women’s Health Initiative (WHI) study transformed the landscape of menopausal hormone therapy (MHT) prescribing by emphasizing cardiovascular and oncologic risks that prompted a widespread decline in clinical use. Subsequent analyses, however, have identified methodological limitations, including participant age bias, overgeneralization of findings, and a single drug regimen unrepresentative of current MHT formulations. Emerging evidence now supports the "timing hypothesis,” which posits that early MHT initiation, within ten years of menopause or before age sixty, confers a favorable benefit–risk profile in healthy women. Methods: A structured PubMed narrative review (1976–2024) was conducted using the terms menopause, hormone replacement therapy, estrogen, progestin, and prescribing patterns. Peer-reviewed studies were analyzed thematically and organized chronologically to evaluate physician attitudes, prescribing behaviors, and age stratified trends before and after the 2002 WHI study publication. Results: MHT prescribing declined approximately 80% following the 2002 WHI study, disproportionately affecting younger perimenopausal and early postmenopausal women. Despite subsequent evidence, including reanalysis showing reduced cardiovascular risk with initiation before age 60 or within 10 years of menopause, clinician hesitancy and knowledge deficits persist. Recent data suggest a gradual resurgence in MHT utilization, coinciding with telehealth expansion, individualized risk assessment, and renewed public discourse. However, disparities remain among racial and ethnic minorities and women with higher body mass index. Conclusion: Two decades post-2002 WHI study, educational and systemic barriers continue to limit evidence-based MHT use. Integrating updated research into medical education and clinical practice is essential to restore confidence, enhance shared decision-making, and advance equity in menopausal care.
Jade Sakelaris, Laura wolff Idaho College of Osteopathic Medicine lwolff@s.icom.edu
PERSPECTIVES
"Interwoven Systems" Artist: Abraham Libman, OMS-III Touro College of Osteopathic Medicine - Harlem
When Algorithms Fail: AI Bias and the Promise of Precision Reproductive Care
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Winifred Chijioke (OMS-III, touro COM - middletown)
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Imagine two women, both identical medical histories, identical symptoms, walk into prenatal appointments at different hospitals. One receives a comprehensive genetic screening panel and advanced imaging. The other receives a mental health referral and more invasive monitoring. What’s the difference? An AI-powered clinical decision support tool factored in their race, zip code, and insurance status rather than individualizing care based on medical need. This isn't a hypothetical scenario; it's the documented reality of artificial intelligence in healthcare today (Omar et al., 2025). Precision medicine promises to revolutionize reproductive care through personalized risk assessment and tailored treatment plans, but AI-driven tools are automating historical inequities instead of eliminating them. When Innovation Encodes Inequity Artificial intelligence has rapidly infiltrated reproductive healthcare, powering everything from preeclampsia prediction algorithms to contraception counseling platforms and genetic screening referral systems. These tools claim to deliver precision medicine at scale, individualized care informed by vast datasets and pattern recognition beyond human capability. A 2025 study revealed a troubling truth: AI medical tools systematically recommend different treatments based on patients' race, income, and housing status rather than clinical indicators.1 Black, unhoused, and LGBTQ+ patients received recommendations for more invasive procedures or mental health referrals, while high-income patients with identical symptoms were offered advanced imaging like MRIs and CT scans. The root cause lies in how these algorithms learn. AI systems train on historical medical data that reflects decades of structural racism, provider bias, and systemic barriers to care. My research on postpartum contraception access documented how Black women and Medicaid-insured patients experience provider-driven biases that influence contraceptive method recommendations. Research shows Black women have significantly lower odds of using high-efficacy reversible contraception compared to White women (adjusted OR 0.5), disparities that persist even after controlling for income and education.2 When these patterns become training data, algorithms further perpetuate this bias, encoding discrimination into clinical workflows under the guise of objectivity. Underrepresentation in research datasets compounds the problem. Most genomic databases remain overwhelmingly white and European-descended, leaving AI tools calibrated to patterns that may not apply to patients of color.3 Historical reproductive coercion, forced sterilizations, unethical experimentation, and family separation has generated justified medical mistrust in marginalized communities. That traumatic history becomes algorithmic fuel, teaching machines to repeat rather than repair past harms. The Real-World Stakes The consequences play out across reproductive healthcare domains. In genetic screening, AI determines which patients get referred for BRCA testing, hereditary cancer panels, or carrier screening. My research examining hereditary cancer testing equity among Hispanic and Latina populations revealed significant barriers to genetic counseling access driven by insurance coverage gaps, language barriers, and provider referral patterns. When these disparities train AI referral systems, algorithms may systematically under-refer patients based on zip codes associated with immigrant communities or Medicaid coverage, denying access to potentially life-saving precision diagnostics. Prenatal risk assessment tools present another critical concern. AI algorithms predicting preeclampsia or gestational diabetes risk may flag Black patients as "high-risk" based on racial categories rather than individualized biological markers, leading to over-surveillance and unnecessary interventions. Conversely, they may miss genuine risk factors in populations underrepresented in training datasets.3 My ongoing research on maternal mortality reveals that Black mothers die at three times the rate of white mothers, disparities driven by structural racism, not biological difference. AI tools trained on this data risk attributing systemic inequities to individual patients rather than addressing root causes. Contraception counseling algorithms raise particularly urgent ethical questions given reproductive healthcare's history of coercion. Clinical decision support tools that more aggressively recommend long-acting reversible contraception to certain demographic groups echo eugenic-era forced sterilizations and contemporary reports of coerced contraception in carceral settings. Demanding Accountability in Algorithmic Care Addressing AI bias in reproductive healthcare requires structural intervention, not incremental adjustments. First, training datasets must proportionally include underrepresented populations across race, ethnicity, insurance status, and geography. The FDA and regulatory bodies should mandate demographic diversity reporting for any AI tool used in clinical decision-making, with penalties for algorithms that widen rather than narrow health disparities.4 Second, transparency and accountability mechanisms must become standard. Healthcare institutions should publicly report algorithmic recommendations stratified by patient demographics, making bias visible rather than obscured within proprietary "black box" systems. Clinicians need training to recognize and override biased AI recommendations, maintaining human judgment as the ultimate authority in care decisions. Third, community oversight must shape AI development from the outset. Reproductive justice organizations, patient advocates, and representatives from historically marginalized communities should hold decision-making power, not advisory roles, in determining how precision medicine tools are designed, validated, and deployed. As research consistently demonstrates, health equity in precision medicine implementation is a public health imperative, not an afterthought.5 Finally, we must subject every AI tool to health equity impact assessments before clinical deployment, asking explicitly: Will this technology widen or narrow existing disparities? Will it expand access or create new gatekeeping mechanisms? Does it treat patients as individuals or reduce them to demographic categories? Precision Demands Justice As a woman of reproductive age having lived through the rise and fall of Roe, bearing witness to the changing landscape of women’s health, both legally and clinically, and with my lived experiences, I’m learning how structural barriers prevent personalized care from reaching marginalized communities. Each legal restriction, each clinic closure, each insurance denial becomes data, patterns that AI systems absorb and amplify without understanding the bias baked within them. Reproductive healthcare carries a painful legacy of inequity and coercion, from forced sterilizations to obstetric violence to contraceptive experimentation on Puerto Rican women and incarcerated individuals. When these historical patterns train tomorrow's algorithms, technology becomes a vehicle for perpetuating rather than correcting systemic harm. We cannot, with eyes wide shut, allow artificial intelligence to automate that history under the guise of innovation. True precision medicine in reproductive care means algorithms that recognize patients as individuals rather than proxies for racial or socioeconomic categories. It means technology that expands access rather than encoding historical gatekeeping. It means innovation is held accountable to the communities it claims to serve. Precision for all requires more than advanced algorithms; it demands intentional justice built into every line of code.
"True precision medicine in reproductive care means algorithms that recognize patients as individuals rather than proxies for racial or socioeconomic categories."
When I close my eyes, I can still see La Carpio, Costa Rica, with its narrow streets and children laughing outside homes built from whatever materials their families could find. Yet what stayed with me most was not the poverty, but the strength. My global health experience taught me more about resilience, gratitude, and humanity than any textbook ever could. As an osteopathic medical student, I have come to understand that health reflects the body, mind, and spirit, each shaped by lived experience. In La Carpio, that truth became real. Treating each person in the context of their daily reality felt just as important as understanding their biology. Long before I learned the term “precision medicine,” I saw what individualized care truly looks like. It is not only about advanced diagnostics or targeted therapies, but about understanding how environment, trauma, culture, and access shape health outcomes. Medicine extends beyond diagnosing and prescribing; often, healing begins when someone simply feels seen and heard. One encounter changed me forever. An older woman came into the clinic in tears, crippled by chronic back pain she had endured for over twenty years. As we treated her with medications, a back brace, and osteopathic manipulative medicine, I had the privilege of hearing her story. She described walking hundreds of miles to escape famine and war. She told me how she built her home from mud and brick, and how years of physical labor and emotional hardship had shaped the pain she carried in her body. By the end of her visit, she was crying again, not from pain this time, but from relief. She nearly ran out the door saying she was going home to dance with her husband, something they had not been able to do for decades. Watching her leave, I realized that being a physician is so much bigger than medicine alone. It also encompasses compassion, trust, and the willingness to understand someone’s full story. That experience reshaped how I think about the future of healthcare. Precision medicine promises treatments tailored to genetics, biomarkers, and individual risk profiles. These advances are exciting and hold enormous potential to improve outcomes. But in communities like La Carpio, the greatest barrier to health is often not the absence of cutting-edge therapies, but the absence of access itself. If personalized medicine is only available to those with resources, it risks widening the very disparities it hopes to solve. Equity must therefore be part of the discussion regarding precision medication. True personalization requires more than technology; it requires attention to social determinants of health, cultural humility, and systems designed to reach people where they are. As osteopathic physicians, we are trained to think holistically, to see how structure, environment, and experience interact. That philosophy naturally aligns with the ethical responsibility to ensure that innovation in medicine benefits everyone, not just a privileged few. I feel honored to have cared for such resilient and inspiring patients. It was the first time I saw the tangible impact of care I had given, and it reminded me why I chose this path. That experience continues to motivate me through every long day and sleepless night of training. I feel privileged to pursue a career where I can combine scientific advancement with empathy and use my education to make a meaningful difference in the lives of others. I left Costa Rica more grounded and more aware of the responsibility that comes with becoming a physician. La Carpio transformed how I see medicine and strengthened my commitment to practicing with both compassion and intention. As a future osteopathic physician, I hope to contribute to a future where personalized medicine is not just innovative, but inclusive. I realize that ambition was universal but opportunity was not, and advancing access in care can help close gaps rather than widen them. I will carry the lessons of La Carpio with me into every patient encounter. My goal is not only to treat disease, but to understand the person living with it. If I can help patients reclaim the parts of life that matter most to them, even if that simply means helping them dance again, then I will know I am practicing medicine the way it was meant to be practiced.
“The Precision of Being Seen ”
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"...being a physician is so much bigger than medicine alone. It also encompasses compassion, trust, and the willingness to understand someone’s full story. "
MIRANDA CLINTON (OMS-II, MICHIGAN STATE UNIVERSITY COM)
About the Author: Winifred Chijioke, BS is a medical student at Touro College of Osteopathic Medicine in Middletown, New York, and a 2024 National Medical Fellowships Johnson & Johnson Alliance Innovation in Medicine Scholar. She earned her Bachelor of Science in Medical Technology with a minor in Anthropology from Purdue University and completed clinical training at Indiana University Health Methodist Hospital. Prior to medical school, Winifred worked as a Medical Laboratory Scientist at LabCorp Drug Development, the CDC Foundation, and as a traveling MLS across the country, providing critical laboratory services in both urban academic centers and rural critical-access hospitals. Her clinical background informs her research focus on health equity, reproductive justice, and precision medicine disparities. Winifred's research examines systemic barriers preventing marginalized populations from accessing quality healthcare. As a Johnson & Johnson NMF Scholar, she conducts community-based research on preventive care access for underserved communities. As a 2026 START Program Fellow, she is conducting substance misuse research using national longitudinal datasets. Outside of medicine, Winifred enjoys history documentaries and podcasts, baking and cooking new recipes, and staying active, always aiming to hit her 10,000 daily steps. She's a kombucha enthusiast and Bolthouse Farms smoothie connoisseur.
Equity in Reproductive Precision Medicine: Who Benefits From Genetic Screening—and Who Is Left Out?
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ANJALI DHAWAN (OMS-II, TOURO COM - MONTANA) STEPHANIE SAWICKI (OMS-II, TOURO COM - MONTANA)
About the Author: Miranda Clinton is a second-year medical student at Michigan State University College of Osteopathic Medicine, where she serves as DMC Vice President for the Class of 2028. She is passionate about health equity, global health, and whole-person care, with a growing interest in emergency medicine. Her experiences in clinical training, leadership, and service with underserved communities have shaped her commitment to ensuring that advances in medicine, including personalized care, remain accessible to all patient populations. Miranda hopes to pursue a career in emergency medicine that allows her to care for diverse communities while working to reduce disparities in access and outcomes. She aims to emphasize that the most effective care considers the full context of a patient’s life. Outside of medicine, Miranda values community, mentorship, and opportunities to support fellow students as they navigate the challenges of medical training. She also enjoys going to the gym, yoga, and rockclimbing.
"True personalization ...requires attention to social determinants of health, cultural humility, and systems designed to reach people where they are"
"... biased genomic databases, and structural barriers threaten to turn ...access to personalized medicine into a privilege, rather than a universally beneficial experience."
At 12 weeks' gestation, a patient consented to expanded carrier screening, a test described as a routine component of modern prenatal care. A few weeks later, she learned that she was a carrier for a rare genetic condition, a result that required her partner to get tested and a genetic counseling appointment to be scheduled. Her insurance covered the genetic testing, but not the counseling. Because she lived in a rural area with limited internet access, the nearest specialist was hours away, and telehealth options were unavailable. Precision medicine had reached her; equity had not. This patient’s experience is not unusual. Women across the country are engaging in reproductive precision medicine – carrier screenings, prenatal testing, and expanded genetic panels – all of which promise early detection of diseases1. These tests are intended to enable informed reproductive decision-making, thereby expanding autonomy for the parties involved. However, innovation without the proper infrastructure to support it creates a dangerous gap. Unequal access, biased genomic databases, and structural barriers threaten to turn this access to personalized medicine into a privilege, rather than a universally beneficial experience. When access to follow-up care and counseling is unequal, precision medicine risks benefiting only those with financial stability, geographic proximity, and reliable health insurance coverage. Beyond issues of accessibility, the data underpinning reproductive medicine raise serious questions. The data in the genomic databases disproportionately represent those with European ancestry, leaving many racial and ethnic minorities underrepresented. This presents myriad issues for those from minority communities, as it leads patients to receive information that is categorized as variants of uncertain significance (VUS), implying the findings do not have enough evidence to be related to benign mutations or pathogenic ones. A VUS result does not provide actionable guidance and leaves patients uncertain, as there is often insufficient evidence to quantify risks, weigh options, or formulate an accurate prognosis. For those who are already experiencing structural barriers in healthcare and belong to marginalized communities, this ambiguity amplifies the anxiety that comes with genetic testing, negating the original goal of this testing, which is to inform reproductive choices and decisions. As carrier screenings and prenatal testing proliferate, they risk being perceived by patients as expected and routine, rather than optional. In reality, a provider’s time constraints lead to complex genetic concepts being condensed into quick explanations during clinical care, thereby potentially omitting information critical to patient care. When testing is framed as a standard of care without space for reflection and discussion, there is a risk of informed consent becoming another procedural step in the reproductive healthcare system, rather than a thoughtful decision made between a provider and their patient. Patients may agree to testing without recognizing the implications of this decision—not due to a lack of capacity, but rather due to a lack of time or support to have an in-depth conversation about the test results. While autonomy is often central to reproductive medicine, it cannot exist without the infrastructure to support it. When geographic isolation, language barriers, financial instability, socioeconomic disparities, and health literacy gaps impede a patient’s ability to process, understand, and act on genetic information, autonomy becomes conditional2. Precision medicine is a powerful tool, designed to enable healthcare professionals to benefit from the information it provides; this benefit is heavily contingent on the patient’s circumstances. Moving forward, as future osteopathic physicians, we must focus on whole-person care and interpret genetic information within the broader context of a patient and their lived experiences – cultural values, community support, access to medicine, and financial hardships. There is an opportunity for us to advocate for inclusive representation in research, provide meaningful genetic counseling, and create environments in which patients feel heard and supported when making significant decisions. Reproductive precision medicine has the power to transform the care offered to patients and expand reproductive autonomy, providing an opportunity to families that have never been available before. Innovation alone is not progress when several limitations remain unaddressed. Precision medicine cannot be defined by sequencing alone; it must ensure that a patient’s race, income, geography, and background do not affect their ability to interpret, understand, and act on the information received. As future osteopathic physicians, we are called to advocate for systems that honor a whole-person standard of care, and precision medicine is a great place to start.
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JOSHUA GULLACE (OMS-III, NYIT COM)
Who Pays for Reactive Reform? The Equity Cost of Metric Displacement
When COMLEX Level 1 and USMLE Step 1 went to a pass/fail system in 2022, medical education lost one of its primary sorting mechanisms.1 This change was meant to reduce burnout and refocus training on clinical learning rather than test preparation. Without an early standardized numerical score, the demand for differentiation migrated to other measurable activities such as Level 2/Step 2 scores, leadership, and most paradoxically research. This shift in what research was to students exemplifies Goodhart's Law: when a measure becomes a target, it ceases to be a good measure.2 Research output was supposed to signal intellectual curiosity and analytical rigor. Instead, it functions as a sorting variable disconnected from the qualities it was meant to represent, fueling an increasingly unstable arms race in research productivity.3 Recognizing the unsustainable spiral, the Association of American Medical Colleges imposed a new limit in 2023. Students were now limited to ten experiences on residency applications, with only three designated as "most meaningful".4 This constraint was set to function as a systemic governor, forcing students to prioritize longitudinal quality over raw accumulation. While the AAMC implemented these changes, major journals, including PLOS and Frontiers, have recently announced policies to automatically reject retrospective studies based solely on public datasets like NHANES.5 Editorial boards cite a proliferation of formulaic, potentially AI-generated manuscripts that report single associations without scientific rationale.5 The goal is to preserve rigor and filter out paper-mill behavior. Both institutions acknowledge the problem and attempt damage control, yet the scope of intervention does not match the scale of dysfunction. These reforms are fundamentally reactive, addressing symptoms without changing the underlying cause. The system still demands differentiation, and students continue optimizing their applications for whatever signals remain measurable. Beyond their limited scope, metric displacement and editorial gatekeeping create disproportionate barriers across institutions. Only 12 percent of osteopathic institutions receive significant external research funding.6 As a result, students at most osteopathic schools face more constrained pathways to demonstrate scholarly engagement compared to those at institutions with embedded faculty mentors, active grants, laboratory access, and proprietary datasets. This disparity in resources makes accessible research pathways particularly important. Public dataset research offered one of the most accessible and pilotable pathways for students and researchers alike to build their lab, their schools, and even their own reputation. When conducted with scientific rigor and meaningful interpretation, public dataset work can yield genuine contributions to the field of medicine. The problem journals aim to address is real, as low-effort studies reporting associations without context or novelty have proliferated. However, blanket exclusions risk closing an entire research modality rather than enforcing quality standards through peer review. The result may inadvertently privilege students with institutional access to large private datasets, stifling innovation as groups hold onto their own data collections, while simultaneously eliminating a pragmatic option for those without. Beyond institutional reforms, advocacy groups have sought legislative interventions to help address these structural inequities. The Fair Access in Residency (FAIR) Act of 2025 proposes transparency requirements for Medicare-funded programs7. Among these would be annual reporting of DO versus MD applicant numbers and acceptance rates, and formal affirmation that COMLEX-USA is accepted as equivalent to USMLE for screening.7 The Act does not mandate outcomes or quotas, instead pushing for accountability and forcing programs to justify criteria and making invisible disparities visible. These interventions from institutions, journals, and legislation limit the damage done but don’t change any of the underlying drivers. Residency selection still operates in a field of evolving research attempting to define what frameworks specifically predict patient-centered, proficient physicians, frameworks that dataset restrictions may now delay. In their absence, symptomatic treatments only redirect competitive effort to the next measurable signal, such as clerkship language, medical school notoriety, or other metrics that may correlate more with institutional access rather than student aptitude. The question is not whether students will compete, but whether the currency of competition has anything to do with patient care, and whether access to that currency is equitable across the profession.
About the Authors: Anjali Dhawan and Stephanie Sawicki are second-year medical students at Touro College of Osteopathic Medicine (TouroCOM) – Montana. Anjali holds a Bachelor of Science in Biology and a Master’s in Biotechnology from the University of San Francisco, and Stephanie earned her Bachelor of Science in Biology from Florida State University. Their interests include reproductive health, precision medicine, and health equity. They are committed to advancing the ethical and equitable implementation of genomic innovation through an osteopathic, whole-person approach to care.
"While autonomy is often central to reproductive medicine, it cannot exist without the infrastructure to support it. "
"...the scope of intervention does not match the scale of dysfunction"
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About the Author: Joshua Gallace is an Osteopathic medical student pursuing a career in Interventional Radiology, with a strong interest in image-guided procedural care and its role in improving patient outcomes. My academic work includes medical imaging research, applied machine learning, and clinical analytics, with projects spanning radiologic, dermatologic, and cardiopulmonary imaging focused on clinical integration, workflow optimization, and primary care support.
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Technological advancement has grown exponentially in the 20th and 21st centuries, and medical advancement has followed suit. At the end of the 20th century, advances in human genome sequencing changed personalized medicine from a theory and concept into a reality. Personalized medicine refers to a medical treatment approach that attempts to incorporate specific information and data about a patient’s genetics, lifestyle, and environment. Precision medicine is another term often used interchangeably with personalized medicine; however, to be more precise, it refers to how the data gathered in personalized medicine can be used to tailor treatment recommendations for specific groups rather than the individual. With this delineation in mind, challenges with equity in personalized medicine come from barriers to access on an individual level, while challenges with equity in precision medicine stem from barriers to access on a systemic level. When A. T. Still pioneered osteopathic manual treatment (OMT) in the late 19th century, personalized medicine had not yet become a formalized concept. Four foundational concepts form the basis of OMT practice: 1. The body is a unit, and the person is a unit of mind, body, and spirit, 2. The body is capable of self-regulation, healing, and maintenance, 3. Structure and function and interrelated, 4. Treatment is based on previously listed concepts. Essentially, personalized medicine is built into the framework of OMT, as it requires physicians to evaluate each person individually, through both thorough history-taking and palpation. It also requires osteopathic physicians to create a treatment plan specific to the history and exam findings, fulfilling a majority of the concept of personalized medicine. Where classic OMT falls short in personalized medicine compared to allopathic practice is the incorporation of modern genetic data. While genetic diagnoses and disorders are already broadly considered in OMT practice, the consequences of highly specific genetic data, such as epigenetics or SNPs, have not yet been adapted in standard OMT. This is related to the inherent problem in practicing osteopathic precision medicine. OMT takes a highly individualized approach that is ideal for personalized medicine, but it often lacks the standardized, systematic approach needed to generalize treatment recommendations to groups. To create a standardized, systematic approach, data must be gathered in a controlled fashion. As OMT is tailored to each patient’s unique presentation in each visit, treatment cannot be administered with the same parameters each time. In fact, treating the same issue in the same patient may require different techniques, timing, and pressure across different visits. While OMT has made advancements in the realm of personalized medicine, there is still significant opportunity to improve osteopathic precision medicine. Fortunately, new advanced medical technology can be used to fill the gap in data and further osteopathic precision medicine. Devices that monitor and record precise biometric data are becoming more widely available both to clinical practices and to patients in their daily life. Osteopathic physicians should implement these devices to quantify autonomic changes and treatment results in real time and to follow patients longitudinally. While personalized medicine is built into the foundation of osteopathic medicine, osteopathic physicians have to continue our research and integrate modern technology to create updated, evidence-based, specific recommendations in precision medicine.
"The question is not whether students will compete, but whether the currency of competition has anything to do with patient care, and whether access to that currency is equitable across the profession."
NATALIE NGUYEN (OMS-II, DES MOINES UNIVERSITY COM)
Personalized vs Precision Medicine: The Inherent Osteopathic Conflict
"...osteopathic physicians have to continue our research and integrate modern technology to create updated, evidence-based, specific recommendations in precision medicine"
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About the Author: Natalie Nguyen, DMU, OMS-II is a first-generation Vietnamese-American born and raised in southern California. Her focus as a future physician is on culturally competent, holistic care through community-based solutions.
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The Full Story - Why Medical Students Should Be Trained to Use Interpreter Services
As sisters growing up in a bilingual Bengali- and English-speaking household, we often helped our parents unpack the nuances of medical conversations after doctor’s visits. When they returned home, they sometimes turned to us for clarification. “What exactly did the doctor mean?” “What should I know about this new medication?”. We weren’t formally translating; we were filling in gaps. As medical students entering rotations at the hospital, we recognize even more that those gaps matter. Medical language is dense, nuanced, and requires more than partial understanding. Despite federal mandates for providers to offer qualified, trained, and impartial interpreters to patients with limited English proficiency (LEP), medical students receive little structured training on when and how to use professional interpreter services.1,2 In a consultation on the inpatient medical floors in the hospital, we approached a Spanish-speaking patient and her husband to gather history prior to presenting to the resident. Interpreter services were technically available, yet my classmates and I found ourselves unsure of the workflow—where the device was stored, how to connect efficiently, and how to manage the rhythm of the conversation once the interpreter joined. The encounter involved pauses and awkward transitions between us, the interpreter, and the patient’s family. In the absence of formal instruction, we rely on assumptions—about fluency, comfort, or efficiency—that can compromise clarity. Patients with LEP consistently experience measurable disparities in care, and the literature makes clear that language access is not simply a matter of convenience but of patient safety.3 LEP patients have poorer access to healthcare and worse clinical outcomes across multiple settings. For example, they demonstrate lower follow-up rates after emergency visits, higher rates of additional diagnostic testing, increased readmissions when interpretive services are not used, and poorer postoperative understanding of discharge instructions.4 Professional interpreter use is associated with lower clinical error rates compared to ad hoc interpreters such as family members or untrained staff. Despite strong evidence that professional interpreter use improves safety and quality of care, its implementation remains inconsistent in clinical settings.3 Medical students frequently observe that language services are not always used when they should be, and that conversations with patients who have limited English proficiency are often shorter or less detailed than those with English-speaking patients.5 These patterns raise important concerns about equity in communication and continuity of care. In the healthcare setting, students often observe that supervisors do not consistently use interpreter services, which may be due to practical hindrances including time constraints, workflow changes, or limited access. The hidden curriculum- lessons learned through observed behaviors or priorities of mentors- reinforces these practices and can leave students feeling uncertain about how and when to properly use these resources. To address this gap, educational interventions can be used to prepare and empower students when communicating with LEP patients. If we can integrate language access tools in OSCEs, mannequin patient simulations, clerkship orientations, and competency evaluations, students will have an understanding of the services that exist. When they are later placed in clinical interactions, medical students will be familiar with the resources available and residents can reinforce their proper use. Greater implementation of language tools will not only strengthen communication with patients who have language barriers, but also improve patient outcomes, and nurture the relationship between patient and provider. The osteopathic philosophy emphasizes the patient-centered approach, which involves understanding the patients’ full story. To deliver compassionate and patient-centered care, it is essential that we educate ourselves on effective communication tools and strategies that overcome language barriers, ensuring that patients receive the care that they deserve. Understanding patient concerns and involving them in their health management fosters shared decision-making and can strengthen the bond between a patient and their healthcare provider. The use of interpretation resources in medical education can better equip future physicians to communicate with their patients and reduce healthcare disparities between English-speaking and LEP patients.
"...it is essential that we educate ourselves on effective communication tools and strategies that overcome language barriers. "
NASHITAH ISLAM (OMS-III, TOURO COM - MIDDLETOWN) NOBAH ISLAM (OMS-II, NYIT COM)
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About the Authors: Nobah Islam, B.S., is a second year medical student at New York Institute of Technology College of Osteopathic Medicine (NYITCOM). When she’s not studying, she enjoys reading mystery books, painting, and spending time in nature or with friends and family. Nashitah Islam, M.S., is a third year medical student at Touro College of Osteopathic Medicine - Middletown. Her hobbies include baking, trying new restaurants, and exploring art museums. Growing up in Queens, NYC, they are both passionate about providing compassionate care to diverse patient populations who have limited access to healthcare.
ZUBAIR SHABBIR (OMS-II, WILLIAM CAREY UNIVERSITY COM) ALINA AKHTER (OMS-II, WILLIAM CAREY UNIVERSITY COM)
The Cost of Becoming a Doctor: When Loan Reform Deepens a Systemic Divide
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"To effectively serve low-income and underrepresented communities, we need physicians from similar backgrounds."
Growing up, I was taught that hard work and dedication were all that mattered. Study hard, sacrifice enough, and opportunity will follow. I believed this, until I attended my younger brother’s white coat ceremony in 2023. Midway through the ceremony, the dean asked all physicians in the audience to stand. More than half the room rose. As a first-generation immigrant from a blue-collar family, that moment solidified what I had sensed but never fully understood: medicine has long reflected a systemic socioeconomic divide. Access to the profession has never been evenly distributed, and recent federal loan reforms threaten to widen that gap even further. Achieving true equity in medicine means confronting not just who is admitted, but who has the means to embark on and complete the journey to becoming a doctor. The Wealth Gap in Medical School Admissions Socioeconomic privilege does not just accompany medical school admission, it predicts it. According to analyses of the Association of American Medical Colleges (AAMC) data, the median parental income of medical school matriculants far exceeds that of the average U.S. household.1 More than half of medical students come from the top income quintile, and nearly one-quarter come from families in the top 5 percent of earners, while students from the lowest income quintile account for only a small fraction of matriculants.2 Applicants from lower-income families are significantly less likely to be accepted than wealthier peers, even with comparable academic credentials.2 This is not due to a deficit of talent but rather a deficit of access. The high costs of MCAT prep and school applications, along with the time requirements of unpaid clinical experiences, like research or shadowing, let wealthier students focus on admissions, while low-income students must juggle these demands with wage work. What admissions committees may view as less competitive experiences often reflect economic necessity. Social capital is also a matter of considerable importance. Approximately one in five medical students has at least one physician parent, providing access to mentorship and insider guidance that first-generation applicants must navigate alone.3 The Rising Cost of Medical Education Even for those who gain admission, financial barriers continue to intensify. The AAMC reports that the median four-year cost of attendance approaches $286,000 at public schools and nearly $391,000 at private institutions when living expenses are included.4 For decades, federal lending programs helped low-income students afford this cost of attendance, but that support structure is now changing. Loan Reform and the “Co-Signer Wall” Beginning July 1, 2026, the federal Graduate PLUS loan program will be eliminated for new borrowers, replaced by a $200,000 cap on federal loans for professional students.5 Previously, Graduate PLUS loans allowed students to borrow up to the full cost of attendance. With public medical programs often exceeding $280,000 and private programs approaching $390,000, a $200,000 cap creates a funding gap of $80,000 to $190,000 per student. That gap must be filled by private lenders, which require credit checks and often a co-signer. For students from low-income families, parents may lack the income or credit history to secure six-figure loans, creating a “co-signer wall” where access depends on financial backing just as much as academic merit. Unlike federal loans, private loans typically lack Income-Driven Repayment and Public Service Loan Forgiveness protections. Students carrying substantial private debt, with higher interest rates, may also feel compelled to pursue higher-paying specialties, exacerbating both socioeconomic and geographic inequities in the physician workforce.6 This creates a twofold problem: fewer physicians entering primary care and in underserved areas. Equity in Training Shapes Equity in Care Medicine is becoming increasingly personalized, relying on understanding patients’ genetics, environments, and lived realities. This approach demands unique experience and perspectives from students of all backgrounds. To effectively serve low-income and underrepresented communities, we need physicians from similar backgrounds, as they not only better understand the challenges these patients face but are also more likely to return to and serve these communities.7 When financial barriers restrict entry, the workforce grows less reflective of the population it serves. Inequities in medical education influence where physicians practice and can leave gaps in care for underserved communities. Moving Forward The Graduate Plus loan changes that cap borrowing below actual costs shifts risk onto those least able to afford it. Policymakers should reconsider caps or ensure alternative federal protections. Medical schools must expand need-based scholarships, subsidized preparatory programs, and paid clinical opportunities. Admissions committees must recognize socioeconomic resilience as a strength, not a deficiency. This divide in medicine is not new. However, policies that create financial walls threaten to make it steeper. If we fail to address the true cost of becoming a physician, recent federal funding changes will not only change repayment structure, but deepen a systemic divide that medicine can no longer afford, and will ultimately serve to negatively impact patient populations.
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"Access to the profession has never been evenly distributed, and recent federal loan reforms threaten to widen that gap even further."
STEPHIE THOMAS (OMS-III, LECOM - ERIE)
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As I read the article “Unveiling the Disparities in the Field of Precision Medicine: A Perspective” by Morsi et al., I was reminded of William Osler’s famous words: “The good physician treats the disease, the great physician treats the patient who has the disease.” Both the article and Osler’s quote capture the essence of modern medicine: the importance of looking beyond the diagnosis to see the patient as a whole. The humanity of medicine is what makes this field so remarkable. Personalized medicine offers a powerful opportunity to advance patient care, but only if we address its shortcomings. We must continue striving for equity, ensuring that personalized medicine is inclusive of individuals from all socioeconomic and cultural backgrounds. Better care for all means designing medicine that reaches everyone, not just a select few. Before examining the article’s compelling points on the limitations of personalized medicine, it is important to clarify what this approach entails. Clinicians utilize a patient’s genetic data, social history, and lifestyle to guide decisions about medications and treatments. The article highlights how this approach has been successful in the early detection and treatment of diseases such as cancer, type 1 diabetes, and severe asthma. However, genomic data remain largely restricted to high-income countries, and individuals with low income or no insurance are often excluded from access to testing and advanced therapies. These disparities raise serious ethical concerns. Many pursue medicine because of a love of humanity and a desire to help others regardless of creed, religion, or the color of their skin. The amount of money in an individual’s wallet should not determine whether a patient has access to high-quality care. Discussing the ramifications of precision medicine and identifying disparities is therefore critical. By recognizing weaknesses, we can begin to find solutions that make personalized medicine a viable option for all individuals, not just those already well established in the healthcare system. While working in clinical settings, I have seen firsthand how limited access to healthcare diminishes a patient’s willingness to seek care promptly. During rotation I encountered a patient admitted with diabetic ketoacidosis after rationing his remaining insulin due to recent unemployment and loss of health benefits. He hesitated to seek medical attention because of financial concerns. Patients like him are often not considered when implementing precision medicine, and individuals from lower socioeconomic backgrounds may fall through the cracks. My experience with that patient mirrors the global barriers described in the article. Morsi et al. explain that, “Genetic disorders are still expensive because they are confined to private laboratories and are often outsourced. This is exemplified by Egypt’s breast cancer screening program which has trouble providing genetic testing owing to extremely high costs.1" Financial barriers limit access to potentially life-saving tools. In addition to cost, there is concern about adequate racial and ethnic representation in genetic studies, which can significantly impact treatment efficacy. As the authors note, “current carrier screening panels, while including over 1000 alleles for more than 200 illnesses, are primarily composed of alleles common to persons of European descent, limiting their utility for people of different ancestries.1" This disparity raises ethical concerns because it demonstrates how certain populations may disproportionately benefit from advancements in medical care while others remain underrepresented. As students, we are taught the four foundational ethical principles in medicine: autonomy, beneficence, nonmaleficence, and justice. Precision medicine directly implicates the principle of justice. When populations are underrepresented in genomic research, the resulting technologies cannot serve them effectively. We can hardly call precision medicine “precise” if vast groups of people are excluded from the data that guide its application. The article also draws attention to disparities in rural and underserved areas, the consequences of gender-blind research that overlooks differences in disease presentation, and privacy concerns related to potential data breaches. Additionally, there is fear that genetic information could be used by insurance companies to charge higher rates or deny coverage to high-risk individuals.1 As we grapple with these challenges, we are left questioning whether precision medicine is truly worthwhile. Although it requires meaningful improvement, its potential to revolutionize patient care is undeniable. The question is not whether precision medicine should advance, but how we ensure it evolves equitably. Solutions must be multifaceted. We need inclusive research, equitable implementation of findings, policy protections against discrimination, and expanded education efforts. The first step begins with open conversations about the shortcomings of precision medicine and a collective commitment to address them for the patients who inspired us to pursue this profession. Ultimately, achieving equitable precision medicine requires both rigorous science and an unwavering commitment to the humanity at the heart of medicine. Acknowledgment This reflective piece focuses on the article “Unveiling the Disparities in the Field of Precision Medicine: A Perspective” by Morsi et al. The author expresses gratitude for the opportunity to write about this important topic.
"The question is not whether precision medicine should advance, but how we ensure it evolves equitably."
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The Personal Side of Precision Medicine
About the Authors: Zubair Shabbir and Alina Akhter are second year medical students at William Carey University College of Osteopathic Medicine. Zubair, a New York City native, earned his degree in Chemistry from Fordham University and has prior clinical research experience in urology, hematology and sleep medicine. He is passionate about research and advancing medical science and plans to pursue anesthesiology with a focus on critical care. Alina, originally from Miami, Florida, graduated from Nova Southeastern University with a degree in Biology. She is passionate about serving underserved communities and intends to pursue obstetrics and gynecology with a focus on women’s health.
Meghan Warner (OMS-II, Edward Via College of Osteopathic Medicine – Carolinas Campus)
It was late on a Wednesday night when my partner’s phone buzzed with a notification from his MyChart account. Days earlier, he had discovered an unusual lump on a Friday evening, sought evaluation the next morning, and been referred for an ultrasound. The scan was completed on Monday. By midweek, the results were available. Instead of a phone call, he received a portal alert. He opened it alone. At 10 p.m., he read the words no patient ever wants to see: “Suspicion for malignancy.” As a first-year medical student, I understood what those words implied. As his partner, I felt the same fear and helplessness any loved one would. That night, my two worlds collided. The student in me wondered how often patients receive life-altering news this way, without preparation or support. The partner in me wished the system had offered him something gentler than a push notification. That experience forced me to think about something we rarely emphasize in medical training: not just the accuracy or timeliness of results, but the way those results are delivered. Electronic health records have transformed medicine. Patient portals allow individuals to access their information, message clinicians, and engage more actively in their care. For routine results, this transparency can be empowering. When news carries serious or life-changing implications, immediate release without context can feel less like empowerment and more like abandonment. Automatic release of imaging and laboratory reports means patients often encounter clinical language without explanation. Some wait hours or days before a clinician follows up. Others may never receive a call at all. While most physicians would never intentionally deliver bad news this way, the system frequently makes that decision on their behalf. As medicine continues its push toward personalization, it is worth asking how we define “precision.” The term often brings to mind genomics or individualized therapies. Communication, however, is also a core component of precision care. The right information delivered at the wrong time, or without support, can still cause harm regardless of how advanced the underlying science may be. What happened to my partner could occur in nearly any specialty. A portal message may contain an abnormal biopsy, suspicious mammogram findings, a CT scan revealing a mass, or a prenatal screening result that alters the course of a pregnancy. The setting varies, but the moment is the same: a patient opens a message, reads a clinical interpretation they were never trained to understand, and is left alone with its weight. I think often about that night. He sat reading the unfamiliar medical language, wondering whether it meant cancer and whether anyone would call. I was there to explain that “suspicion” did not mean certainty and to remind him that there were still steps ahead. Not every patient has someone beside them who can provide that context. Many are left sleepless, searching the internet for answers. This gap between information and explanation matters. A system designed to increase engagement can paradoxically lead to disengagement when patients feel overwhelmed or abandoned. Trust can erode, anxiety can escalate, and care may be delayed all because of how results were delivered. This is also where equity enters the conversation. Patient portals are not experienced equally. Some individuals have high health literacy, reliable internet access, and strong support systems. Others may struggle with medical terminology, have limited English proficiency, lack consistent follow-up, or face barriers to digital access. When systems assume all patients can receive and process information in the same way, existing disparities widen, particularly for those already marginalized within the healthcare system. Advocates of immediate result release rightly emphasize transparency and patient autonomy. However, personalization that works well only for patients with resources and support is not truly precise. If medicine is to achieve “precision for all,” personalization must extend beyond diagnosis and treatment; it should include how information is delivered. Certain results, particularly those with serious implications, should be communicated in ways that reflect patient vulnerability rather than default electronic settings. Medicine is built on trust. Patients trust clinicians not only to find answers, but to deliver them with care. That night, I was both a medical student and the partner of a patient. I saw how technology’s promise can outpace the human touch. I also saw the opportunity to do better. We cannot soften the reality of a suspicious finding, but we can soften how it reaches the patient. By rethinking result delivery, medicine can ensure patients are not only diagnosed quickly, but cared for thoughtfully. If personalized medicine is truly to be for all, our systems must protect patients across all backgrounds, not just those best equipped to navigate them.
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"... personalization must extend beyond diagnosis and treatment; it should include how information is delivered "
About the Author: Stephie Thomas is a third-year medical student at LECOM, where she is working toward her goal of becoming a physician. She graduated summa cum laude with a Bachelor of Science in Biology from Adelphi University, where she participated in biological research and held leadership roles as a Resident Assistant and an Honors College Mentor. During medical school, she has been involved in the Women’s Health and Medical Society as the Marketing Chair and was recognized as one of the Top 10 Volunteers in the Class of 2027 for her community service efforts throughout her time in medical school. In her free time, Stephie enjoys traveling, painting, and reading.
Precision Communication in the Age of Patient Portals
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Precision for All: Why Equity Must Be the Soul of Personalized Medicine
Clayton Rawson Noorda College of Osteopathic Medicine
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About the Author: Meghan Warner is a second-year osteopathic medical student at the Edward Via College of Osteopathic Medicine – Carolinas Campus, where she was recently named Student Doctor of the Year. She previously served as Vice President of her local Student Osteopathic Medical Association (SOMA) chapter and remains involved at the national level through SOMA’s Women’s Health Subcommittee. She is deeply engaged in community-based care through free medical clinics and outreach programs, experiences that have shaped her passion for service and advocacy. Meghan has also been involved in clinical and community-focused research, with interests spanning health education, ethics, and the evolving role of innovation in medicine. Outside the classroom, Meghan values mentorship, collaboration, and leadership development, and enjoys working alongside peers to build supportive learning environments. Her experiences in patient care, research, and student leadership continue to inform her approach to medicine, grounded in compassion, curiosity, and a commitment to lifelong learning.
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MESSAGE FROM THE RESEARCH DIRECTOR
There is a quiet contradiction unfolding in modern medicine. We are entering an era defined by precision. Genomic sequencing, targeted therapies, and predictive algorithms promise to tailor care to the individual in ways that were unimaginable just a decade ago. We can now identify molecular signatures of disease, anticipate treatment responses, and design interventions with unprecedented specificity. And yet, the more precise medicine becomes, the more we risk leaving people behind. Because precision without equity is not progress, it is exclusion. As osteopathic medical students and future physicians, we are uniquely positioned at this crossroads. We are being trained in a system that celebrates innovation, but we are grounded in a philosophy that demands inclusivity. Osteopathic medicine has always asked a different question: not just what works, but for whom does it work, and why? That question has never been more important. Precision medicine, for all its promise, is built on data. But data is only as representative as the populations it includes. Historically, many of the datasets driving genomic research and clinical trials have underrepresented minority populations, rural communities, and underserved groups. The result is a system that can deliver highly personalized care for some, while reinforcing uncertainty and inequity for others. A pharmacogenomic profile is only useful if it reflects your ancestry. An algorithm is only as accurate as the patients it was trained on. A targeted therapy only changes outcomes if you have access to it. Otherwise, personalization becomes a privilege. This is where osteopathic medicine offers something essential, not as an alternative to precision medicine, but as its necessary counterpart. We are trained to see the patient beyond the dataset. To understand that biology does not exist in isolation from environment, socioeconomic status, culture, or lived experience. We learn that structure and function are interconnected, but so too are access and outcome, trust and adherence, innovation and equity. Precision medicine tells us what is possible. Osteopathic medicine reminds us of responsibility. As Research Director for the SOMA, I have had the privilege of working alongside students who are not only advancing scientific discovery but are also asking harder, more meaningful questions. Who is included in this research? Who is missing? And what are we doing about it? Equity in precision medicine will not happen passively. It requires intentional design. It means diversifying clinical trials, not as an afterthought, but as a foundational priority. It means building datasets that reflect the full spectrum of human diversity. It means advocating for policies that ensure access to advanced diagnostics and therapies is not determined by zip code, income, or institutional affiliation. It also means recognizing that technology alone cannot solve disparities. We can sequence a genome in hours, but building trust in communities that have been historically overlooked or mistreated takes time. It takes presence. It takes listening. These are not barriers to precision medicine; they are prerequisites for it. This is where the osteopathic approach becomes not just relevant, but essential. We are trained to sit with patients, to understand their stories, to recognize that healing begins with connection. In an era increasingly driven by data, this human-centered approach is not outdated; it is transformative. It ensures that precision medicine does not become impersonal medicine. Because the goal is not just to treat disease more precisely. It is to care for people more completely. There will be moments in our training and in our careers where the pace of innovation feels overwhelming. Where the pressure to keep up with new technologies, new treatments, and new expectations feels constant. In those moments, it is worth remembering that progress is not defined solely by how advanced our tools become, but by how broadly their benefits are shared. If precision medicine is the future, then equity must be its foundation. Otherwise, we risk building a system that is more sophisticated, but not more just. Osteopathic medicine has always believed there is room for more in healthcare, more connection, more integration, more humanity. In the age of personalized medicine, that belief is not just relevant; it is necessary. To my fellow osteopathic medical students: this is our moment. We have the opportunity to shape not only how medicine advances, but who it advances for. To ensure that the next era of healthcare is not defined by who has access to precision, but by our commitment to making precision accessible to all. The true measure of innovation is not how cutting-edge it is. It is how many lives it reaches
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"Of all the forms of inequality, injustice in health is the most shocking and inhuman" ― dr. martin luther king
VOLUME 4 • ISSUE NO. 1
MAY 2026