Biomedical Research

How Does Blue Light Affect You?


The advent of artificial light has given us a way to have light without relying on the sun. We use this light to our convenience when we spend the later hours of our day inside our homes with artificial light from electronic devices. As the sunlight fades, the body starts to change to a night-time mentality, where melatonin levels increase, body temperature decreases, sleepiness increases, and appetite disappears. Even if we don’t sleep, the time spent in this relaxing state is rehabilitative. However, our modern world brings trouble. We are bathed by lights that have the same strong wavelength as the light we wake up to. As a result, our transition to night mentality has been postponed by hours.  Using computers, phones, and other electronic devices exposes us to varying levels of light. One of these is blue light, which can have a range of effects on us. 

Overview and Effects

The spectrum of visible light contains many different colors of light, varying from red, orange, green, blue, indigo, and violet. Rays at the red end of the visible light spectrum have longer wavelengths and thus less energy. In contrast, rays at the violet end of the visible light spectrum have smaller wavelengths and more energy. Blue light rays that have the shortest wavelengths are sometimes referred to as blue-violet or violet light. Blue wavelengths are helpful during daytime hours because they stimulate concentration, response times, and mood. However, these same things are also stimulated at night, which is not beneficial. Namely, increased exposure to blue light from electronics and lighting at night can change sleep patterns.

Your sleeping pattern is determined by your circadian rhythm, which is the 24-hour cycle of sleeping and waking. The length and time of this cycle determine many bodily functions. Everyone’s circadian rhythm is unique, but a few common trends are present. These are mainly the points that your body is optimized to throughout a 24-hour period. Light exposure, including blue light exposure, stimulates hormones that keep us active and awake throughout the day. When blue light is released at night, it blocks the release of melatonin, a sleep hormone that makes us tired. Disruptions in the circadian rhythm of your body can give rise to an array of sleeping issues. Overall, there are many negative consequences of a disrupted circadian rhythm.


Exposure to light suppresses the release of melatonin, a hormone that causes you to feel sleepy. Even dim light can interfere with the circadian rhythm and melatonin secretion of an individual. A mere eight lux, a level of visibility surpassed by most table lamps and about twice that of night lights, can have negative effects.  New studies show that exposure to blue light over long periods can lead to damaged eye cells. Light at night is part of the reason why so many people don’t get enough sleep. Even though the blue light you receive from a device pales in comparison to that from the sun, your devices are much closer to your eyes. There are some ways to reduce the negative effects of blue light. Beyond the 7 to 8 hours of sleep you’re trying to get every night, you can attempt to get three more hours of relative darkness. After dinner is a smart time to dim the lamps and avoid the bright blue screens. Further, you can replace lamps in your bedroom and bathroom with dimmer, longer-wavelength lights, start using blackout curtains to block the street lights that shine through your windows, and use an eye mask when it’s time to go to sleep.


Blue light is still necessary for us. It helps with our health by improving alertness, cognitive function, and brain health. The problem is that we are now interacting with unnatural levels of blue light, which can lead to health problems. One way to protect yourself is to use low red lighting for night lights because red light is less likely to change the circadian rhythm and to inhibit melatonin. You should also try and limit your screen time before you sleep and avoid looking at bright screens around two hours before bedtime. There are also many apps available that block blue light, such as the night shift setting. Your eyes are one of the most important sense organs, so taking care of them is vital and necessary.

Harshal Chinthala, Youth Medical Journal 2020


“Blue Light Has a Dark Side.” Harvard Health Publishing, Harvard University, May 2012,

Heiting, Gary. “Blue Light Facts: How Blue Light Affects Your Eyes.” All About Vision, AAV Media, LLC, Aug. 2020,

“What Is Circadian Rhythm?” Sleep Foundation, OneCare Media, 25 Nov. 2020, 

Biomedical Research

Tai Chi: The Martial Art of Healing


As we enter our later stages of life, it becomes even more crucial that we take good care of our bodies, whether it is maintaining a healthy diet or getting enough exercise every day.  However, there are many additional activities that can be done such as tai chi, which have a multitude of benefits, ranging from reducing the risk of falling to alleviating pain.  Tai chi is a Chinese martial art that emphasizes slow, flowing movements, meaning almost anyone is capable of doing it.

While growing older, we may notice that our muscles and bones become weaker, our reaction time is slower, and our focus is not as sharp as it used to be.  Tai chi is a simple and non-invasive method that has been shown to counter all of these issues.  Ph.D. Peter Wayne, an associate professor at Harvard Medical School and director of the Osher Center for Integrative Medicine, explains that adults over the age of 65 can see a 20% – 40% reduction in the risk of falls, even after a short six months of practicing tai chi.


A 2012 research paper by Cochrane, a British organization dedicated to cover medical research findings, found that about 30% of people over 65 years fall each year.  They pooled data from about 160 trials and over 79,000 participants, looking for methods that were the most effective in preventing seniors from falling.  One example of a method consisted of several groups and home-based programs working on strength and balance exercises.  In general, they found that any seniors that actively did exercises were less prone to falls and sustaining severe injuries.  

In addition, there is strong evidence that tai chi assists in strengthening our bones.  As we age, it is common for us to have osteopenia which is when our bones become brittle due to a lack of calcium.  Our body becomes unable to make new bone cells as fast as it reabsorbs old bone cells.  However, tai chi has been shown to stimulate bone growth which combats the effects of osteopenia.  

One research paper from the National Center for Biotechnology Information (NCBI) studied the health effects of tai chi on people with certain bone conditions such as knee osteoarthritis and bone mineral density loss.  This study recognized prior research that contained strong evidence for the beneficial effects of tai chi and sought to make a definitive claim.  

Like the paper from Cochrane, NCBI noted that tai chi does mitigate the effects of bone mineral density loss.  This research was a 24 week long program consisting of a diverse population from breast cancer survivors to diabetic older adults.  The constant use of the waist and slow full body movements were the two main features that attributed to slowing bone mineral density loss.  In addition, NCBI found that tai chi also helped with flexibility, increasing muscular strength, controlled breathing, regulating blood pressure, and balance.  This is especially beneficial to older adults with hypertension or high blood pressure and Parkinson’s disease which is known to cause loss of balance, stiffness, tremors and slow movement.  There was an in-depth look into specific forms of tai chi such as the Sun-style, composed of quick movements, and Yang-style which is the most common form associated with slow, stretching movements.  However, among the three tai chi forms, they all shared benefits, specifically relating to bone health.


Tai chi involves a variety of movements and emphasizes control over the body from breathing to balance.  It contains several exercises that require shifting weight and maintaining balance which is vital for many seniors.  Regardless of what style of tai chi is practiced, it has proven to be very beneficial.  From personal experience, some of my relatives have been practicing tai chi for decades and it has helped their physical and mental health tremendously.  Tai chi is a low impact form of exercise that people of any age are capable of performing.  From reducing the risk of falls to alleviating chronic pain such as knee osteoarthritis, tai chi has a variety of positive impacts on our health.

Kyle Phong, Youth Medical Journal 2020


Harvard Health Publishing, “Protect your bones with tai chi”, October 2020,

Cochrane Library, “Interventions for preventing falls in older people living in the community”, 12 September 2020,

Harvard Magazine, “Easing Ills through Tai Chi”, February 2010,

Medical News Today, “What are the health benefits of tai chi?”, 30 August 2018,

NCBI, “The Effect of Taichi Practice on Attenuating Bone Mineral Density Loss: A Systematic Review and Meta-Analusis of Randomized Controlled Trials”, 1 September 2017, 

Tai Chi Image 

Biomedical Research

Possibility of Life on Venus – Phosphine and Microbial Life


Since the dawn of history, mankind has been on the search for signs of life outside of Earth. Every quest past the boundaries of our knowledge, from studying microscopic organisms to the content of the moon, has been to quench our thirst for answers. Until recently, in the search for answers to life outside of Earth, Venus was largely overlooked, but a fascinating, recent finding could unleash and spark future studies on our neighboring planet.

Venus is our solar system’s hottest planet with average temperatures of 460 degrees Celsius (around 860 degrees Fahrenheit). Its atmosphere is composed primarily of carbon dioxide but also contains sulfuric acid. Venus’ atmosphere also is over 90 times denser than the Earth’s. This contributes to making Venus the hottest planet as the green-house effect is highly prevalent under these conditions.

With such stark differences between Earth and Venus, it is no wonder that scientists’ attention was turned to bodies that are more similar to Earth. However, recent detections of phosphine have ignited talk about the possibility of life on Venus.

Phosphine is a gas that on Earth is produced from biological processes such as bacteria in anaerobic environments or can be artificially manufactured. Structurally, it is three hydrogen atoms bonded to phosphorus. For scientists, it is the possibility of phosphine being emitted from biological processes that intrigues them since a biological process implies life. However, only twenty molecules of phosphine were found for every billion molecules, a relatively minute quantity. Nonetheless, there is phosphine, irrespective of the quantity, so perhaps mankind is a step closer to discovering extraterrestrial life. All of this boils down to one question: does the presence of phosphine indicate the presence of microbes and thus life on Venus?


Though phosphine may be produced from biological processes, some argue that the phosphine may have been produced in other ways. For example, Ngoc Truong and Jonathan I. Lunine authored a study in which “[they] hypothesize that trace amounts of phosphides formed in the mantle would be brought to the surface by volcanism, and then subsequently ejected into the atmosphere, where they could react with water or sulfuric acid to form phosphine.”

Others claim that phosphine may not be present on Venus’ surface altogether. A group of scientists challenged the finding of phosphine by re-analyzing ALMA data and finding the results “statistically unreliable.” In their paper, they explain how “ALMA observations presented by GRB20 provide several arguments to support the validity of their identification of the PH3 feature, including a comparison to the JCMT data and a test at offset frequencies. [Their] analysis, however, shows that at least a handful of spurious features can be obtained with [the other] method, and therefore conclude that the presented analysis does not provide a solid basis to infer the presence of PH3 in the Venus atmosphere.”

It is also important to note that Venus is not the first planet for phosphine to be found in; phosphine has been found in Jupiter, Saturn, and of course, Earth. What scientists are striving to understand, though, is whether the phosphine in Venus’ atmosphere is caused by geological, chemical, biological, or other processes. If phosphine was produced by the more exciting possibility, a biological process, it begs the question of how microbial life managed to arrive on Venus in the first place. One theory is that microbes appeared when Venus had oceans several hundred years ago, but after the oceans dried up, the microbes took refuge in the sky.


Although it may seem like these contradicting studies extinguish the chance of finding life on Venus, that is not the case. In researching and discovering anything, contradicting data and studies will be present, and even if the contradicting data proves to be correct, it is a healthy progression that advances our knowledge of science. For example, if future studies indeed establish phosphine is not a result of biological processes, then our understanding of science will improve. By the same token, if future studies prove the presence of phosphine in Venus’ atmosphere is a result of biological processes, our understanding of science will still improve.

Ultimately, though all of these findings are relatively new, one thing is certain: the search for life on Venus will develop and expand. NASA administrator Jim Bridenstine himself said it is “time to prioritize Venus.” Perhaps spacecraft in the near future may provide more information about the phosphine in the Venusian atmosphere. Until then, mankind will have to wait.

Saharsh Satheesh, Youth Medical Journal 2020


“All About Venus.” NASA, NASA, 2 June 2020,

Gough, Evan. “Maybe Volcanoes Could Explain the Phosphine in Venus’ Atmosphere.” Universe Today, 30 Sept. 2020,

“NASA Mulls Venus Mission after Recent Discoveries.” Yahoo! News, Yahoo!, 17 Sept. 2020,

O’Neill, Mike. “Signs of Life on Venus? What This Means for Earthlings.” SciTechDaily, 31 Oct. 2020,

O’Neill, Mike. “What Is Phosphine and Why Does It Point to Extra-Terrestrial Life Floating in the Clouds of Venus?” SciTechDaily, 22 Sept. 2020,

Patel, Neel V. “Not Finding Life on Venus Would Be Disappointing. But It’s Good Science at Work.” MIT Technology Review, MIT Technology Review, 30 Oct. 2020,

Re-Analysis of the 267-GHz ALMA Observations of Venus. 21 Oct. 2020,

Siegel, Ethan. “Don’t Bet On Aliens: Phosphine Is Amazing, But Doesn’t Mean ‘Life On Venus’.” Forbes, Forbes Magazine, 15 Sept. 2020,

Stirone, Shannon, et al. “Life on Venus? Astronomers See a Signal in Its Clouds.” The New York Times, The New York Times, 14 Sept. 2020,

Biomedical Research

Newly Discovered Gene Mutant Reveals New Mechanisms for Heart Failure


Dilated cardiomyopathy is a disease of the heart muscle where the ventricle of the heart stretches and dilates and can’t pump blood as well, usually starting in the left ventricle of the heart. While the cause of dilated cardiomyopathy often can’t be determined, numerous factors can cause the left ventricle to dilate and weaken, including diabetes, obesity, hypertension, alcohol abuse, certain cancer medications, cocaine use and abuse, infections, including those caused by bacteria, viruses, fungi, and parasites, exposure to toxins, such as lead, mercury, and cobalt, arrhythmias and complications of late-stage pregnancy. Ultimately, poor blood flow from the left ventricle can lead to heart failure. Additionally, enlargement of the left ventricle may make it harder for your heart valves to close, causing a backward flow of blood and making your heart pump less effectively. Dilated cardiomyopathy can also cause your heart to suddenly stop beating. 

Figure 1: This figure shows an illustration of a normal heart versus a heart affected by dilated cardiomyopathy. The differences are clear that a heart affected with dilated cardiomyopathy has thickened walls due to the enlargement of the left ventricle. 

About ten years ago, a pediatric cardiologist at Mayo Clinic, had traced this disease to a genetic mutation in a gene known as RBM20. This gene causes cardiomyopathy to affect patients ages as early as young adulthood. 

Analysis of Research and Study

Although in the past ten years, heart failure in the RBM20 form of cardiomyopathy was connected to the abnormal splicing of genes for proteins that help the heart’s muscles contract, the new research suggests that the mutant RBM20 actually damages the heart muscle cells. The damage is done through the buildup of pathological ribonucleoprotein granules which end up harming everything inside the healthy cells. This causes the formation of the new version of dilated cardiomyopathy. Dr. Tim Nelson MD, Ph.D., who is the research study lead author and director, and his team had created the first-ever large animal model. Their model was of a pig that was born with the human gene RBM20 for dilated cardiomyopathy. Their model includes a display of all the signs and symptoms of heart failure. Within months, the large animal model had allowed them to further look into the gene and study the development of dilated cardiomyopathy where on the contrary it takes more than 20 years for results to show for dilated cardiomyopathy in humans. 

Dr. Nelson and his team had conducted a simple staining test using pig heart tissue samples that contained RNA-binding protein. Their discovery was verified using a similar study conducted one decade ago using tissue samples from Dr. Olson, a pediatric cardiologist at Mayo Clinic, RBM20 dilated cardiomyopathy human patient tissue. 

Dr. Nelson and his team say that it is important to comprehend that there could be young children to adults who may be suffering from dilated cardiomyopathy due to the RBM20 gene mutant. Dr. Nelson says, “We have taken these findings back into the lab and developed cell cultures to test new therapeutics. The future of this research is focused on moving discoveries out of the lab and into clinical trials to make new therapies available to our patients. This research is a very important catalytic step to do that.” (Tim Nelson, MD, Ph.D., Study Lead Author, and Director, Todd and Karen Wanek Family Program for Hypoplastic Left Heart Syndrome, Mayo Clinic). 

Usually, the overload of protein granules in cells happens in the brain or the spinal cord. However, due to this recent discovery, it has now been found that overgrowth of protein granules in cells can also occur in the heart. However, the benefit of this is that the heart is a much larger and more accessible organ compared to the brain tissue or the spinal cord. Dr.Jay Schneider, MD, Ph.D., who is a Mayo Clinic cardiologist and first author of the study conducted says, “[…] we can study and develop therapies to prevent the buildup of these toxic granules at the beginning of life instead of waiting 50 years or more for a degenerative disease to appear clinically. This is a huge advantage that should accelerate drug discovery in ribonucleoprotein granule degenerative diseases of the heart and nervous system.” 


Dilated cardiomyopathy is the most common type of genetic heart disease, occurring mostly in adults 20 to 60. It affects the heart’s ventricles and atria, in the lower and upper chambers of the heart. However, new research shows that the new form of RBM20 dilated cardiomyopathy can also affect young adults and can lead to heart valve problems, arrhythmias, and blood clots in the heart. There is still much to be discovered on this new gene mutant and its effects causing heart failure. 

Samiksha Komatireddy, Youth Medical Journal 2020


[1] Henderson, Reviewed by Emily. “Research on Genetic Heart Disease Uncovers New Mechanism for Heart Failure.” News, 19 Nov. 2020,

[2] Ani. “Cellular Pathway of Genetic Heart Disease Similar to Neurodegenerative Disease: Health.” Devdiscourse, Devdiscourse, 19 Nov. 2020,

[3] “RWJBarnabas Health, Inc.” RWJBarnabas Health,

Biomedical Research

Telemedicine: A Virtual Visit


Telemedicine is the use of electronic communications and software by health care professionals to evaluate, diagnose, and treat patients at a distance. It includes a growing variety of applications and services using two-way video, e-mail, smartphones, wireless tools, and other forms of telecommunication technology. Patient consultations through video conferencing, transmission of still images, e-health including patient portals, remote monitoring of vital signs, continuing medical education are all considered a part of telemedicine.


During the admission of a patient to a hospital, the patient along with the family members have to bear a lot of expenses like traveling, medicine, and the stay in the hospital till the treatment is completed. Telemedicine provides a means to reduce this expenditure by contacting the doctors through electronic devices from their current location. The doctors can schedule appointments that notify the patient and give guidelines along with additional advice like curbing obesity rate and tobacco use by encouraging them to improve their lifestyle choices. It ensures regular follow-ups, reporting early warning signs even if the patient is in any part of the world. Proper and remote monitoring of the patient can be done along with solving queries to ensure they are on track. When patients are committed to their own healthcare goals, it leads to lower costs and improved health. Some studies also reveal that telemedicine patients score lower for depression, anxiety, and stress and have 38% fewer hospital admissions. In a doctor’s clinic or hospital, there are a lot of chances of transmission of infections or diseases from patient to patient or patient to doctor. By telemedicine, the risk of exposure and infection transmission is reduced.

It is also beneficial for the doctors, especially the primary care ones, to contact specialists irrespective of their location and communicate easily for a second opinion and detailed advice. This benefit provides improved access and consultation for better treatment. Telemedicine comes into play in a clinic setup where the doctor has a lot of overhead expenses like buying a clinic or if rented then paying the rent to the owner, examination beds for patient’s checkup, the need of various types of equipment and staff members for managing the clinic. Through telemedicine, the doctors can reduce this extra cost by attending most of the patients online who do not require a physical approach. This aspect ensures increased patient flow and revenue to doctors and reduced transport expenditure to the patients making it beneficial for both the doctors and the patients.


During the scheduled appointment the patient can have any of their family members present with them. If the age of the patient is 16 years or less, or if the patient has some mental conditions like dementia or physical disability due to an accident, then any one of the authorized family members is required to consult the doctor on the patient’s behalf, irrespective of the patient’s presence. At the time of the virtual visit, the doctor must first ensure the consent of the patient before proceeding with the consultation. Then the patient has to provide the doctor with their medical record, enumerating their present condition and the current symptoms to proceed with the best treatment according to the doctor’s advice. The doctor should evaluate and make a decision regarding the preferable consultation medium. Like in cases of appendicitis complaint physical examination is needed and telemedicine cannot be applied. A complaint of headache or fever may not always require a physical examination or audio-visual approach. But in cases of any allergy or any inflammation like Conjunctivitis, the doctor has to decide if a physical or telemedicine approach is needed. During the telemedicine visit disrobing of the patient is mostly never preferred unless there’s an utmost need or in a case where the patient wants an examination of a visible finding concerning them. In such a situation the patient can click a photo of the visible finding and send it to the doctor for the diagnosis. In a telemedicine setup, the first doctor patient consultation need not be an in-person consultation and the doctors can be contacted by the patients from any state. The doctors giving teleconsultation must be a registered practitioner with a degree of MBBS and above. The displaying of their registration number during all the consultation is necessary especially in cases of emails, Whatsapp messages, prescriptions, and on fee receipts.

If the teleconsultation with the patient does not take place over video, then the doctor cannot prescribe any drugs to the patient other than common over-the-counter medications such as paracetamol, O.R.S. solutions, cough lozenges, etc. 

Prescribing drugs for chronic diseases like asthma, diabetes, hypertension should be avoided in telemedicine consultation unless it is an addition to the earlier prescription of an in-person consultation of approximately less than six months ago. If a prescription is necessary then the teleconsultation should be done strictly via video. A prescription can be sent through any electronic medium such as email, Whatsapp as a photo, scan, or digital copy of a signed prescription or an e-prescription.


Telemedicine applications are used for delivering virtual health services from providers to patients. They include all-in-one software platforms to video chat and beyond some of which are widely in talks.

MD Live is an app that provides 24/7 access to doctors, dermatologists, psychiatrists, and counselors who are board-certified with an experience of 15years and above through a mobile app or an online website. Pieces of Advice for routine medical conditions like allergies, common cold, diarrhea, flu are given by well-trained physicians and treatment of depression, anxiety, eating disorders by psychiatrists.

Doctor on demand is being widely used especially in the United States to improve its healthcare system. The main advantage of this is it will reduce the waiting time of the patients who wait for almost 24days and above for the first appointment with the doctor and can connect face to face with doctors and specialists from multiple medical branches. It is free to join and payment is as per consultation which is proven to treat 90% of the common health issues.

Live Health ensures expert medical advice, diagnosis, treatment plans, and prescriptions along with the detailed profile of each doctor giving the choice to choose the doctor of one’s choice according to one’s needs with quite an affordable price.

Talkspace is known for its services to psychiatry and emotionally challenged patients. One can have unlimited talks and also send unlimited messages to your therapist within the privacy of your room and get one to two times messages reply per day. If one needs unlimited chats to get out of their rough times Sibly can also be one’s choice.

Teladoc is said to be ranked at the topmost for telemedicine services in Satisfaction and Customer Service with Direct by J.D. Power. It is also known to be working with 5% of the top-ranking medical specialists. It provides various services like everyday care, behavioral health, dermatology, nutrition, and women’s health doctors, integration with Apple HealthKit, e-Prescriptions, and video conferencing.

Fruit Street especially works on diabetic patients and patients aiming for weight loss. It notifies the patient at the start if they are fit for the program. It is a 12-week program with 26 video chat courses by a registered dietician. Along with the general services of telemedicine apps it has an additional feature of providing a free Fitbit for attending two classes.


Information and Communication Technologies has had a positive impact on the healthcare sector with the innovation of telemedicine in recent times. This impact is not only from a technology point of view but also from a socio-cultural and economic view. The reason lies upon various solutions of day to day challenges such as the demand for healthcare services, population aging, or management of large amounts of information. It is providing a convenient way to deliver and improve access to healthcare for non-emergency issues by saving time and money through online consultation. Thus, telemedicine technology is becoming a viable alternative to an in-person doctor visit.

Pratiksha Baliga, Youth Medical Journal 2020


[1]Heikkila, A. (2020, August 28). Why Telemedicine IS the Future of Healthcare. Retrieved November 10, 2020, from

[2]Telemedicine Benefits and Disadvantages: 10 Pros & Cons. (2020, October 01). Retrieved November 10, 2020, from

[3]Shukla, A., & Upadhyay, A. (2020, March 29). India’s new Telemedicine Practice Guidelines – Analysis and Do’s and Don’ts for Doctors offering teleconsultation. Retrieved November 10, 2020, from

[4]Top 17 Telemedicine Apps to Connect With Your Doctors Online. (2019, May 23). Retrieved November 10, 2020, from

[5]F., S. (2015, February 05). 34 Best Telemedicine Apps for Providers and Patients. Retrieved November 10, 2020, from

Biomedical Research

Placebos and The Placebo Effect in Clinical Trials


Something as simple as giving a sugar pill or a saline injection has proven to have beneficial effects for a patient. Because while the treatment itself has no therapeutic value, the patient’s belief that they are being medically treated or their trust in the physician can improve symptoms. That improvement of symptoms is called the placebo effect. Placebos come in various forms, and while an ethical controversy is attached to the use of placebos, it can’t be ignored that they play an important part in modern clinical trials and may play a part in future treatments.

Placebos in Clinical Trials

Currently, a drug must outperform a placebo in a clinical investigation and have “substantial evidence of effectiveness” to be approved by the FDA (Katz). However, treatments were not always held to this standard. In the past, placebos were not used in clinical trials or practice, but this changed after it became suspected that some cases of improved symptoms were not because of an effective drug or treatment but because of psychological factors–later identified as the placebo effect. Thus the placebo effect began to be taken into account during clinical trials for new drugs and treatments. Having control groups with placebos is critical in determining whether results are due to the treatment’s effectiveness or the placebo effect. 

Placebos ensure that the results obtained and symptoms reported by participants are due to the drug, and not because of any demand characteristics. The awareness of receiving a drug may result in subjects falsely reporting relief from symptoms of the disease, and not because of the drugs being tested. As a result, while the experimental group receives the drug, a control group is given a placebo that looks identical but is sugar or water-based, to ensure that all results are due to the drug, improving the validity of the study. Furthermore, to avoid researcher bias, most experiments use double-blind trials, where both researchers and participants are unaware of which group receives the placebo. This is optimal, as both the patients’ report of symptoms and the researcher’s analysis is uninfluenced by the knowledge of which participants were in what group, improving the reliability and validity of the study (“Placebo”). 

However, placebos are not limited to drugs or medication, with placebo surgery showing increasing success. Because the simple act of administering anesthesia or making an incision without any further operation being done has proved to play a role in determining the efficacy of procedures and surgeries. For instance, percutaneous coronary intervention (PCI) is done to treat angina- chest pain caused by reduced blood and oxygen reaching the heart, which is often treated by placing a stent to widen arteries. A 2018 ORBITA study questioned the effectiveness of the stent itself. In the study, participants with stable angina were randomly assigned into groups that would receive either PCI or a placebo procedure (where no stent was placed). After six weeks, their heart was put under stress through rigorous exercise, to test out the hypothesis of the placebo effect. The study found that the endpoint times of exercise of participants who had received PCI were no different than those who received the placebo procedure, alluding to the idea that the improvement of symptoms and reported success of PCI may be at least partially attributed to the placebo effect (Al-Lamee).

In the study, three participants in the placebo group experienced major bleeding, and other complications occurred (Al-Lamee). This brings up controversies over placebo surgery and the use of placebos themselves in studies and practice.

Ethical Evaluation

The controversy around placebos in research is because of the ethicality of the procedure itself. Because the participants in clinical trials that receive placebos act as controls, and while they may experience the ‘placebo effect’, they are still denied a drug that may have a higher success rate. In addition, critics argue that clinical trials involving placebo surgery result in unnecessary surgeries that run the same risks as regular procedures, as a cut is still made and anesthesia may still be used (Ford-Martin). For instance, in the ORBITA trial, the three placebo-receiving patients that had major bleeding experienced those risks. However, they only received the placebo procedure and can only experience the placebo effect, instead of the benefits of a stent or other procedures (Al-Lamee). Thus, critics argue that the use of a placebo created unnecessary risks and pain, for almost no benefit.

Therefore, there are guidelines for using placebos in clinical practice, and participant consent is a major focus because failure to obtain consent undermines the trust in a physician-patient relationship, affecting all future treatments for a patient. However, when consent is obtained, the given placebo may help relieve symptoms at least temporarily in situations where there is no well-known treatment. The placebo may even be effective when the patient knows that it will be used but doesn’t know when it was given or what exactly the placebo treatment looked like. 

For instance, in a study that had an open-lid placebo treatment for chronic low back pain, participants in the study were told they were receiving the placebo medication and made aware of its lack of active ingredients. Part of the group then continued the usual treatment for chronic low back pain, while another group also took the placebo medication as well as usual treatment. Participants reported their pain intensity by rating their pain levels on a scale of 0-10, in addition to rating difficulties in completing daily activities. At the end of the study, participants who had received the placebo reported a 30% reduction in usual pain levels despite being aware of the placebo and its effect, or lack thereof (Carvalho). While it may not be true for every case or condition, the placebo effect may still work even when patients are aware of its presence.


For all its controversies and debates on effectiveness, the placebo has shown to have a significant impact on treating patients for various conditions. A systematic review focusing on the effectiveness of placebo treatments for migraine prophylaxis showed 58% responded positively to sham surgery, and 22% responded positively to oral placebo medicine. Those that responded positively to the placebo treatments experienced a reduction in migraine frequency of at least 50% (Meissner).

The use of placebos has helped determine the efficacy of medications and procedures during clinical trials. The positive effects shown by placebos provide hope that the phenomenon known as the placebo effect can be developed into a viable form of treatment in the future. Therefore, despite our limited understanding of the phenomenon and the constant debate on its ethicality, the effectiveness of placebos cannot be questioned; and its use in clinical trials ensures that all drugs, procedures, and treatments are fully understood, before being introduced to the public.

Michelle Li, Youth Medical Journal 2020


Al-Lamee, Rasha et al. “Percutaneous coronary intervention in stable angina (ORBITA): a double-blind, randomised controlled trial.” Lancet (London, England) vol. 391,10115 (2018): 31-40. DOI:10.1016/S0140-6736(17)32714-9

Carvalho, Cláudia et al. “Open-label placebo treatment in chronic low back pain: a randomized controlled trial.” PAIN vol. 157,12 (2016): 2766-2772. DOI: 10.1097/j.pain.0000000000000700

Ford-Martin, Paula, et al. “Placebo Effect.” The Gale Encyclopedia of Alternative Medicine, edited by Deirdre S. Hiam, 5th ed., vol. 4, Gale, 2020, pp. 2101-03. Gale Health and Wellness, Accessed 31 Oct. 2020.

Katz, Russell. “FDA: evidentiary standards for drug development and approval.” NeuroRx : the journal of the American Society for Experimental NeuroTherapeutics vol. 1,3 (2004): 307-16. DOI:10.1602/neurorx.1.3.307

Meissner, Karin et al. “Differential effectiveness of placebo treatments: a systematic review of migraine prophylaxis.” JAMA internal medicine vol. 173,21 (2013): 1941-51. DOI:10.1001/jamainternmed.2013.10391

“Placebo.” The Gale Encyclopedia of Science, edited by K. Lee Lerner and Brenda Wilmoth Lerner, 5th ed., Gale, 2014. Gale in Context: Science, Accessed 31 Oct. 2020.

“Placebo Effect.” The Gale Encyclopedia of Psychology, edited by Jacqueline L. Longe, 3rd ed., vol. 2, Gale, 2016, p. 895. Gale in Context: Science, Accessed 31 Oct. 2020.”Use of Placebo in Clinical Practice.” American Medical Association, Accessed 31 Oct. 2020.

Biomedical Research

Bromelain: The Enzymes in Pineapple


Bromelain is an aqueous enzyme extract obtained from both the stem and fruit of the pineapple plant and it’s the cause of why your tongue may become irritated or hurt when eating pineapple. Bromelain contains a number of proteolytic enzymes, otherwise known as digestive proteins, and as many people often say, as you’re eating pineapple, it ‘eats’ you too.  Despite this, it has been proven to be quite functional within medicine, demonstrating, in vitro and in vivo, anti-edematous, anti-inflammatory, anti-thrombotic, and fibrinolytic activities.  This article will briefly explore bromelain’s uses within treating inflammatory diseases, specifically osteoarthritis.

Why Bromelain?

Although not a licensed medical product, having reviewed the mechanisms of action, bromelain has been shown to have a number of beneficial properties that include anti-inflammatory and analgesic actions, anti-oedematous, anti-thrombotic, and fibrinolytic effects [1].   

In Central and South America, pineapple has been used for centuries to treat indigestion and inflammation. And in the late 1800s, bromelain was first isolated from the pineapple and more recently, bromelain has been approved to treat swelling and inflammation after surgery, particularly sinus surgery in Germany.  Hence many scientists and physicians have pondered the efficacy and potential uses of bromelain within future therapeutics and treatments for other inflammatory conditions and diseases.  From an economic standpoint, bromelain being overtly found within pineapples can easily be accessed and extracted, minimizing any complex costs to produce any bromelain based products for the pharmaceutical market.

Bromelain for Inflammatory Disease

Bromelain, an extract from the pineapple plant, has been demonstrated to show anti-inflammatory and analgesic properties and was first reported to be of value to provide a safer alternative or adjunctive treatment for both rheumatoid arthritis and osteoarthritis patients in 1964 [2, 6].

Some studies suggest that bromelain as an anti-inflammatory agent works by increasing serum fibrinolytic activity which reduces plasma fibrinogen levels and decreases bradykinin levels which all result in reduced vascular permeability and thus reducing pain [2-4]. Thus is often used to reduce inflammation from tendonitis, sprains and strains, and other minor muscle injuries as well as reducing inflammation and pain after dental, nasal, and foot surgeries or trauma.  In addition, it controls prostaglandin levels and through modulation of certain immune cell surface adhesion molecules which play a role in the pathogenesis of arthritis [5]. However, further data is needed to clarify definitive mechanisms of its action.

Typically in modern-day medicine, knee pain from osteoarthritis is relieved through drugs like rutosid and trypsin as well as nonsteroidal anti-inflammatory drugs (NSAIDs), which are commonly used pain relievers, including ibuprofen, naproxen and diclofenac.  However, bromelain is a food supplement that may provide an alternative treatment to NSAIDs for patients with osteoarthritis that is found to be just as effective [2, 7,8].


The active factors involved can be biochemically characterized only in part.  However, due to its safety, efficacy and it is freely available to the general public in health food stores and pharmacies in the USA and Europe, and most obviously found in pineapples directly, bromelain is gaining acceptance among some as a phytotherapeutic drug.  The future for bromelain in medicine seems to be a promising one, but much more work is needed and many more clinical trials need to be done to administer it properly in an upscale setting, but bromelain, for now, will be easily accessible even without a prescription.

Nara Ito, Youth Medical Journal 2020


[1] Cooreman, W. M., Scharpé, S., Demeester, J., & Lauwers, A. (1976). Bromelain, biochemical and pharmacological properties. Pharmaceutica acta Helvetiae, 51(4), 73–97.

[2] Brien, S., Lewith, G., Walker, A., Hicks, S. M., & Middleton, D. (2004). Bromelain as a Treatment for Osteoarthritis: a Review of Clinical Studies. Evidence-based complementary and alternative medicine : eCAM, 1(3), 251–257.

[3] Kumakura, S., Yamashita, M., & Tsurufuji, S. (1988). Effect of bromelain on kaolin-induced inflammation in rats. European journal of pharmacology, 150(3), 295–301.

[4] Maurer H. R. (2001). Bromelain: biochemistry, pharmacology and medical use. Cellular and molecular life sciences : CMLS, 58(9), 1234–1245.

[5] Taussig, S. J., & Batkin, S. (1988). Bromelain, the enzyme complex of pineapple (Ananas comosus) and its clinical application. An update. Journal of ethnopharmacology, 22(2), 191–203.

[6] COHEN, A., & GOLDMAN, J. (1964). BROMELAINS THERAPY IN RHEUMATOID ARTHRITIS. Pennsylvania medical journal (1928), 67, 27–30.

[7]Cooreman, W. M., Scharpé, S., Demeester, J., & Lauwers, A. (1976). Bromelain, biochemical and pharmacological properties. Pharmaceutica acta Helvetiae, 51(4), 73–97.

[8]Walker, A. F., Bundy, R., Hicks, S. M., & Middleton, R. W. (2002). Bromelain reduces mild acute knee pain and improves well-being in a dose-dependent fashion in an open study of otherwise healthy adults. Phytomedicine : international journal of phytotherapy and phytopharmacology, 9(8), 681–686.

Biomedical Research

What is the Microbiome?


Microbes are small living creatures that are found all over us and that are too delicate to be seen by the naked eye. They can be found everywhere, on your water bottle, in the soil, in the air, and even inside your body. The human body is home to millions of these bacteria, also called microorganisms. Microbes can be split into six overarching groups: these include several species, including bacteria, archaea, fungi, protists, viruses, and other microscopic creatures. This population of single or multiple-celled species can be prokaryotes or eukaryotes, depending on whether they have a nucleus.

6 Types of Microbes

Microbes can be classified into six groups. The first of which are bacteria, which are usually unicellular, microscopic, prokaryotic organisms which reproduce by binary fission. The second type is fungi, which can be separated into yeasts and molds. Yeasts are typically unicellular, small, eukaryotic fungi that replicate asexually by budding. Molds are usually filamentous, eukaryotic fungi that replicate using the development of asexual reproductive spore. The third type is submicroscopic viruses, acellular infectious particles that can only replicate inside a living host cell. The fourth is protozoa, microscopic, eukaryotic organisms that lack a cell wall. And finally, the last group, algae, which are eukaryotic organisms that survive through photosynthesis.

Microbes and Humans

Since microbes are everywhere, humans have learned to live mutually alongside them. We offer them food and shelter, and they work for us. This partnership starts from the very beginning; as soon as we are born billions of bacteria cover our bodies. Mother’s milk, for example, contains special sugars that are designed to feed and sustain certain classes of microbes. Others act as a decoy, helping to amplify the immune response. In just around two years, a healthy community of microbes will have formed in a child. This is known as the microbiome.

The Microbiome

Each human being has its own special microbiome, composed of bacteria, viruses, fungi, and other species. We have three groups of visitors, both on and in our bodies. There are good microbes, which aid in digestion and absorption of calories. A second type is silent travelers who do their own thing and are respectfully dismissed. They free up space by being there to keep more hostile intruders in line. We also have more dangerous ones. Such as those which exist in our teeth and will and erode our teeth if we do not brush them. The main functions of the microbes in our body include regulating the immune system, supplying nutrients to our cells, and avoiding invasion by dangerous bacteria and viruses.

Importance in the Body

At first glance it may seem like the microbiome does not play a big role in your body. However, this is wrong, as the influence of the microbiome goes very far. The response to certain things is determined by the microbiomes in your body, such as how different people respond differently to different foods. The species in our intestine feed on various things, some of the fibers and leafy greens, other sugars and starches, and some of them enjoy greasy food like butter. Our gut is like a garden in which we continually decide what is going to expand and blossom. If we eat good food, we breed good bacteria that prefer healthy food. If we eat a lot of junk food, we’re going to breed the microbes that enjoy fast food. If you choose to eat more healthy food, healthier bacteria will multiply. If you choose to eat more unhealthy food the unhealthy microbes will multiply. They will then send signals to your brain asking for more of what it likes.  Scientists have observed that 90% of the body’s serotonin is produced in the gut. Other examples are bacteria that activate immune cells in the intestine such that they give a kind of alarm signal to the brain. Here, it stimulates immune cells that aid the brain heal from damage. New research is being done that even links microbes to behavioral patterns. In fact, in recent years, the gut microbiome has been linked to a plethora of diseases and disorders, from diabetes to autism to schizophrenia to obesity. 

Future Advancements

The future is uncertain as the new science surrounding the microbiome is still developing. Since the microbiome is linked to many conditions, there may be a way to create treatments by altering the microbiome. However, we need to figure out why some microbes are beneficial while others are not. The relationship between humans and microbes is one that has been fostered over many years. It is safe to say that we rely on microbes and they rely on us.


Harshal Chinthala, Youth Medical Journal 2020

Videvall, A., Brown, A., Xu, A., Shi, A., Jiang, A., Petrof, A., . . . Weiss, A. (2020, October 12). Microbiome. Retrieved October 27, 2020, from

Davis, N. (2018, March 26). The human microbiome: Why our microbes could be key to our health. Retrieved October 27, 2020, from

Jesus, E., Lee, J., & Wilke, C. (1969, December 31). Microbes. Retrieved October 27, 2020, from

Society, M. (n.d.). Microbes and disease: Microbes and the human body. Retrieved October 27, 2020, from

Biomedical Research

A Literature Review of Face Transplants


Composite tissue allotransplantation is a microsurgical technique where tissue from a donor is transplanted to a patient. Essentially, it is a combination of transplant and reconstructive surgery. Distinctly, these operations are primarily for quality of life, often in trauma or tumor patients, not necessarily for prolongment. At first, this was completed with hand transplants in France, 1998. However, facial transplantation is a new example and is used for both functional and aesthetic purposes. This technique is still rare, with only 11 human face transplants having been performed between 2005 and 2011. Moreover, these transplants are often partial [1].

In general, facial transplants and composite tissue allotransplantation have had issues with rejection, not dislike solid organ transplants. The immune system is alerted by organ antigens and proceeds to attack it. Most surprisingly, some patients experience split tolerance, in which different tissues from the same donor cause varying responses, possibly due to organ-specific antigens. The first composite tissue allotransplantation corroborated this. The skin of the donor hand was rejected, though the joints were spared. In addition, there are chronic rejection issues with maintaining blood vessels, which progressively narrow as the body rejects the organ. This can lead to thrombosis, then cell death. Infection may contribute to both of the aforementioned issues [2].


Nonetheless, there are solutions. In 2010, a full face transplant was performed on a 30-year-old male with a severe facial deformity from ballistic trauma. Unlike previous transplants, this included all facial units (forehead, nose, eyelids, cheeks, lips and chin). There were no intraoperative complications, but postoperative complications included acute rejection episodes and venous thrombosis. As a result, the immunotherapy treatment needed to be adjusted. Originally, the immunotherapy course consisted of thymoglobulin, prednisone, tacrolimus, and mycophenolate mofetil. The prednisone was tapered, but acute rejection occurred and they required a bolus of prednisone. Additionally, mycophenolate mofetil was replaced with Sirolimus. For the venous thrombosis, the patient’s anastomoses needed to be adjusted. From then on, the patient experienced few psychological issues, which facial transplants can be associated with. [1] 

Another 45-year-old woman received a face transplant after a gunshot wound. Prior to the transplant, the patient experienced social issues, with some strangers screaming and running away when they saw her face. In addition, she had difficulty eating and anosmia. As a result, past psychiatric history included treatment for depression and post-traumatic stress disorder. After treatment, the patient reported receiving more positive affirmations than before. Other factors in bolstering her self-esteem included social assimilation. Family members reaffirmed family ties by finding similarities between the new face and family traits. Notably, this patient reported a strong support system, which was found to be less common in patients with psychological issues [3]. 

Finally, a 28-year-old female qualified for a facial transplant in 2013 for aesthetic, psychological, and medical purposes. Specifically, this patient experiences neurofibromatosis, a genetic disorder causing tumors. The condition caused malformations in facial appearance and quality of life issues. Additionally, they resulted in psychological problems. However, the transplant was soon integrated into the patient’s quality of life [4]. 


Despite high risk and rejection issues, facial transplant patients appear satisfied with their quality of life. As a result, it is of importance that not only critical procedures are provided for by insurance or the government, but quality of life procedures are beneficial as well. In addition, psychological issues are a genuine concern for face transplants, especially with a body part as personal as the face. However, this level of psychiatric care may need to be extended to other procedures as well, especially ones affecting quality of life as this one does. While the healthcare system is designed to treat illnesses and issues, home life is often outside of its hands. Physicians take a social history to view factors that may impact treatment, but further research must be conducted into the management of resulting psychiatric issues. Based on the case reports, there was prior pharmacological management, but social integration was the greatest contributor to mental health. So, healthcare management research must open up to bolster clinical treatment.


Surgical techniques continue to advance as healthcare aims to both, prolong life and improve it. However, this includes further cooperation between specialties. In this case, that includes transplant surgery, reconstructive surgery, and even psychiatry. The field of composite tissue allotransplantation along with facial transplantation will hopefully continue as a higher case loader is needed to tease out further complications. Nonetheless, past cases have conveyed the ability to ameliorate rejection and psychiatric issues.

Aleicia Zhu, Youth Medical Journal 2020


  1. Barret, J. P., Gavaldà, J., et al. (2011). Full Face Transplant. Annals of Surgery, 254(2), 252-256. doi:10.1097/sla.0b013e318226a607
  2. Swearingen, B., Ravindra, K., Xu, H., Wu, S., Breidenbach, W. C., & Ildstad, S. T. (2008). Science of composite tissue allotransplantation. Transplantation, 86(5), 627–635.
  3. Coffman, K. L., Gordon, C., & Siemionow, M. (2010). Psychological outcomes with face transplantation: Overview and case report. Current Opinion in Organ Transplantation, 1. doi:10.1097/mot.0b013e328337267d
  4. Krakowczyk, Łukasz, et al. “Face Transplant in an Advanced Neurofibromatosis Type 1 Patient.” Annals of Transplantation, vol. 22, 2017, pp. 53–57., doi:10.12659/aot.900617.
Biomedical Research

Does Cell Phone Radiation Cause Cancer?


“Don’t use your phone so much. It will give you cancer!” This is the phrase that parents love to use to scare children into putting cellphones away. Knowing there is false news on social media, people don’t necessarily take this statement seriously. However, cell phones can increase the risk of cancer. It is a difficult thing to even digest, but when it is closely studied and put under investigation, the results are shocking. 

84% of teenagers and 53% of children 11 and older own a phone. On top of that, some sources say that around 81% to 95% of adults own a smartphone. Technology has grown to be a vital part of life. One cannot live without their phone for a mere day! Children need technology for school and adults need it for work. Virtually anywhere you go, there is technology present. Though the recommended amount of time to use a screen is 1 hour,  people go way beyond that. It is also a known fact that radiation is bad for us, though small amounts will not harm us terribly. There is natural radiation from rocks and the Earth itself, and there is radiation from technology. Certain amounts of radiation can have detrimental effects on the body. Cell phones give off a certain type of radiation known as “non-ionizing radiation” and though non-ionizing radiation is usually harmless with small health issues, exposure to this type of radiation for prolonged periods can contribute to ill health.  Multiple studies have proven that radiation from technology does increase the risk of cancer.


Scientists conducted an in-depth study that cost around 20 million dollars in 2018. The main idea was to see whether rats reacted to cell phone radiation. “NTP conducted two-year toxicology studies in rats and mice to help clarify potential health hazards, including cancer risk, from exposure to RFR like that used in 2G and 3G cell phones which operate within a range of frequencies from about 700–2700 megahertz (MHz). These were published as Technical Reports in November 2018,” (CPRFR). The scientists “expose laboratory rodents to high doses of cell phone radiation over their entire life span and see if they developed cancer as a result. Investigators found what they called “clear evidence” that cell phone radiation could cause a type of nerve tissue cancer called a malignant schwannoma in rats. They found that 6% of the male rats exposed to the highest dose of cell phone radiation developed malignant schwannomas in the heart, while 2 to 3% developed gliomas in the brain. None of the control rats (which did not receive radiation) developed either cancer (Memorial).

The type of cancer which was found in these rats is deadly and very rare to humans. If cell phones can increase the incidence of the disease, it is something to worry about. The data is all pointing to cell phones increasing the risk of cancer. As technology advances, so does the rate of cancer in teenagers from 15-19 years old and it has been rising from the mid-1970s to 2012. This data demonstrates that using cell phones for an extended period is detrimental to the health of people overall. 

Along with that, another study was done on the effects of cell phone radiation reacting to a certain genetic variation in people. There is a particular variation called single nucleotide polymorphisms (commonly known as SNPs). This gene increases the risk of cancer in the thyroid gland. This researcher looked at 900 people and tested how their genes reacted to the radiation. 4 of the gene types tested showed that people with that gene are more than 2 times more likely to experience problems such as thyroid cancer. Examining a total of 176 genes, they identified 10 SNPs that have an increased risk due to cell phone radiation.

“Our study provides evidence that genetic susceptibility influences the relationship between cell phone use and thyroid cancer,” said Yawei Zhang, M.D., Ph.D., a professor in the Department of Environmental Health Sciences at the Yale School of Public Health. “More studies are needed to identify populations who are susceptible to radiofrequency radiation (RFR) and understand exposure to RFR by different using patterns of cell phones.” According to the American Cancer Society’s recent report, there were nearly 53,000 new cases of thyroid cancer in the United States, resulting in 2,180 deaths. Thyroid cancer is three times more common in women and is diagnosed at a younger age than most other cancers,” (Thyroid).


These results clearly show that there is a strong correlation between the increase in technology usage and the increase in people diagnosed with cancer. When cell phones are such a vital part of our everyday lives, it might be difficult to cut it out completely. Reducing the amount of time we are on screens would be a good start. Though this is frightening, it truly is an important topic to discuss and more studies will be done soon.

Sai Datla, Youth Medical Journal 2020


“Thyroid Cancer, Genetic Variations, Cell Phones Linked in New Study.” ScienceDaily, ScienceDaily, 12 Feb. 2020,

Edward T. Creagan, M.D. “Is There a Connection between Cellphones and Cancer?” Mayo Clinic, Mayo Foundation for Medical Education and Research, 12 Dec. 2018,

“Demographics of Mobile Device Ownership and Adoption in the United States.” Pew Research Center: Internet, Science & Tech, Pew Research Center, 5 June 2020, 

Kamenetz, Anya. “It’s A Smartphone Life: More Than Half Of the U.S. Children Now Have One.” NPR, NPR, 31 Oct. 2019, 

“Non-Ionizing Radiation.” Non-Ionizing Radiation – an Overview | ScienceDirect Topics,

NRC: Natural Background Sources. 

“Cell Phone Radio Frequency Radiation.” National Institute of Environmental Health Sciences, U.S. Department of Health and Human Services, 

Memorial Sloan Kettering Cancer Center. “Do Cell Phones Cause Cancer?” Memorial Sloan Kettering Cancer Center, 20 May 2019,