DMEJ
Duke Medical Ethics Journal
Fall 2024 Blog Highlights
Margarita Krylova • October 6th
People love food—not just for its nutritional value, but because it activates reward mechanisms in our brains. Energy-dense foods, in particular, are encoded as highly rewarding. Unfortunately, for some individuals, particularly those struggling with debilitating illnesses like Alzheimer's dementia, the ability to enjoy food diminishes over time. Among people aged 65 and older, an estimated 6.9 million Americans are living with Alzheimer's dementia in 2024.1 This number is expected to triple by 2050 as life expectancy continues to increase.2 About 2.1% of these cases are likely to develop into advanced dementia, a progressive and incurable condition that's a leading cause of death in the United States.3 At this advanced stage, patients experience a decline in mental and physical abilities that can affect their ability to move, speak, eat, or drink. About 50% of these patients lose the ability to feed themselves within 8 years of diagnosis.4 For these individuals, the simple pleasure of enjoying a meal or a snack becomes impossible, often necessitating the use of feeding tubes—a form of medical technology that allows for the artificial supplementation of eating.
Rithvik Marri • October 14th
Who would’ve thought part of your digestive system could impact your brain? Since that discovery was made, it’s been a trend in recent years to study the connection between the gut and the brain, called the gut-brain axis. As connections between the brain and mental function are continuously being made, there is the potential to employ the gut-brain axis in mental health therapies. But like with any emerging field in medicine, it raises several ethical considerations that need to be worked through.
Kiara Lavana • October 14th
Every nine minutes, someone in the United States is diagnosed with Parkinson’s disease (PD) [1]. Despite tremendous progress in the field, the exact mechanisms behind its pathological initiation and progression is still unclear– how do alpha-synuclein proteins begin building up within dopamine-producing neurons in the brain? New research suggests that researchers may have been previously looking in the wrong place.
Enter the gut-brain axis (GBA). The GBA is a highly integrated network of nerves connecting the central and enteric nervous system. Recent research proposes a potential relationship between our gut bacteria and the neurons influencing neurodevelopment and neuroregeneration– the GBA serves as the link between these two systems [2].
Camille Krejdovsky • October 28th
While we might like to think we know ourselves and what we are made of, looking into the components that make up our bodies tells a different story. While estimates vary, it is clear that microorganisms make up a significant portion of our bodies, likely outnumbering human cells [1]. While “microbiome” has become a buzzword used in settings ranging from academic research to the probiotic section of the grocery store, this wasn’t always the case. When Antoine van Leeuwenhoek first observed microbiota under his handcrafted microscopes in the 17th century, he discovered what he called “little living animalcule”[2]. Little did he know, he would set the stage for the great advances in our understanding of the microscopic world of bacteria, viruses, archaea, and fungi now known as the microbiome.
Olivia Bassham • October 28th
Social media includes many websites and apps that allow users to post and interact with others digitally. They give people the chance to connect to others across the globe, no matter the distance [2]. Many popular forms of social media use an algorithm to personalize the content shown to users and show posts that users interact with frequently. As a result, it is easy for one person to spread information across thousands, even millions of other users. This information may or may not be verified or supported with facts, and could even be blatantly incorrect.
Sarah Croog • October 28th
When Heidi Guenther, a successful 22 year old ballerina, died suddenly from a heart attack caused by a severe eating disorder, it became apparent to the public that something had to change in the world of ballet [1]. It is no secret that young dancers often develop an unhealthy relationship with food. Growing up surrounded by mirrors in an environment that encourages perfectionist tendencies and comparison to others can wreak havoc on one’s mental health. Furthermore, there is a culture of thinness in ballet that can easily influence dancers even in the healthiest, most supportive of studios.
Ayan Jung • November 5th
1:12. 0:43. 0:21. Each morning, countless Americans open their New York Times app, fingers hovering over the Mini Crossword, ready to shave off mere fractions of a second from their personal best time — a daily ritual of racing against the clock, pursuing an elusive new record. Down to 0:19. Then 0:18. The thrill of watching the clock tick lower and lower.
Margarita Krylova • November 5th
In societies that champion health and well-being, what drives so many young lives towards a relentless pursuit of thinness, even to the brink of death? Anorexia nervosa (AN) is a severe psychiatric disorder associated with “aberrant patterns of feeding behavior and weight regulation, and deviant attitudes and perceptions toward body weight and shape”.1 In industrialized countries, eating disorders are the third most common chronic disease in female adolescents. In Western countries, the rate of AN is 0.3%.2 AN sees a high prevalence among adolescent females, yet it is multifaceted in its causation, with complex intersections of biology, psychology, and socio-cultural dynamics. Notably, this disorder has the highest mortality rate of any psychiatric condition: approximately 5% of individuals diagnosed with anorexia die within the first four years of diagnosis. Morever, AN is associated with various causes of death: suicide, pulmonary disease, diabetes, liver and other digestive disease, to shock and organ failure.3 While studies indicate that genetic factors account for approximately 40-50% of the risk for developing AN, social components still play a key role by exposing individuals to distinct environments that can lead them to developing this devastating eating disorder.4
David Axon • November 11th
For those with food allergies, every meal is a potential life-or-death situation. Yet throughout history, allergies were poorly understood and rarely treated. Reports from ancient China, Rome, Egypt, and Greece confirm that antibody-antigen interactions have existed for millenia, though the term “allergy” was only coined in 1906, by Clemens von Pirquet [1]. Despite their prevalence, scientists only came to understand the mechanisms behind allergies in the middle of the 20th century; in 1967, the crucial antibody immunoglobulin was identified. The modern standard of care, the EpiPen epinephrine auto-injector, was patented in 1977 and FDA approved in 1987 [1, 2]. Since then, the Epipen has revolutionized the treatment of severe anaphylactic shock and has saved countless lives. Nonetheless, epinephrine delivered via injection comes with challenges regarding needle use, administration complexity, and accessibility.
Daniel Sanwo • November 12th
Emerging research has highlighted the connection between gut microbiota and stress resilience, unveiling some of the unique ways in which our microbial inhabitants can shape our psychological responses to stress. We’ve known that the gut microbiome is a community of trillions of bacteria in the gastrointestinal tract and that it plays a pivotal role in maintaining mental health by influencing neurobiological mechanisms that regulate stress responses [3].
Stress triggers a cascade of biological reactions, activating the hypothalamic-pituitary-adrenal (HPA) axis, which regulates the release of stress hormones like cortisol. Chronic stress can lead to dysregulation of this axis, resulting in mental health disorders such as anxiety and depression [9]. Recent studies suggest that gut microbiota may help modulate this response, promoting stress resilience through various pathways.
Jaida Ciampi • November 12th
With the results from the recent presidential election, many are questioning how the country will change in the coming years. As political polarization increases, the potential shifts in policy from education, to economics, to environmental or abortion laws, has increased the contentiousness of politics. Among the most pressing concerns is how a transition from a Democratic to a Republican-led government might affect the nation’s food system, including factors such as the accessibility of nutritious food, the prices of groceries, and overall policy regulation.
Margarita Krylova • November 18th
In recent years, the concept of "clean eating" has gained significant traction, promising improved health and wellness through the consumption of whole and minimally processed foods. At its core, the movement advocates for diets rich in fruits, vegetables, whole grains and lean proteins, while avoiding processed foods. While the intentions behind clean eating are commendable, its broader implications deserve scrutiny—particularly the health benefits, socioeconomic factors, and potential for elitism.
Clare Williams • November 18th
For the last century, global stigmatization of heavier body types has progressively worsened. As a result, women of all age, race, ethnicity, and religion continue to face unrelenting pressures to meet social ideals of thinness. This often leads them to adopt hurtful social messages that associate weight gain with “failure, weakness, gluttony, laziness and other moral failings” [1]. Internalization of these societal expectations for body type is linked to damaging psychological and physical health outcomes.
Abida Chowdhury • November 18th
At Duke, we’re constantly exposed to cutting-edge research that reshapes our understanding of health. One area that has gotten significant attention recently is the gut microbiome. The gut microbiome is a complex community of bacteria, fungi, and viruses in your digestive tract. These microorganisms play an essential role in everything, from digestion and metabolism to your immune system and mental health. Taking care of your gut is key to feeling your best, and it turns out that one of the easiest ways to support a healthy gut is by eating colorful foods.
Here, we’ll explore how eating a variety of colorful fruits and vegetables can nurture your gut microbiome and promote overall health.
Lucas Hong • November 30
Food insecurity, unfortunately, is a too-common dilemma affecting millions worldwide everyday. But what exactly is it, and who does it predominantly affect?
Food insecurity is defined into two categories by the United States Department of Agriculture (USDA). The first category of food insecurity involves “reduced quality, variety, or desirability of diet and little or no indication of reduced food intake” [1], whereas the second category more severely involves “multiple indications of disrupted eating patterns and reduced food intake” [1]. Food insecurity is a national issue, yet it seems to predominantly affect low-income and unemployed households. According to the Economic Research Service (ERS) branch of the USDA, while the national average of food-insecure households was 13.5% in 2023, 38.7% of households with incomes below the federal poverty line were food-insecure [6]. Food insecurity rates were also considerably higher for “single-parent households, women living alone, and Black and Hispanic households” [6].