From our anonymous insider…
Dissection investigated the shoulder joint. Our upper limb is similar to our lower limb in bone and joint structure. However, while most of our weight is translated through bone in our lower limbs, most upper limb weight is translated through muscles, the most fascinating of which is serratus anterior. This muscle originates on the front of the upper ribs, wraps around the body, under the shoulder blade, to insert on the anterior side of the medial border of the scapula (shoulder blade). This “boxer” muscle pulls the shoulder blade against the thorax ensuring it slides along the back when other muscles act upon it.
Lectures continued the discussion of metabolic processes, including the role of lysosomes, the recycling centers of the cell. Extracellular debris, and cellular parts are trafficked to these small vesicles to be degraded by powerful enzymes. Our patient case was Hunter’s disease, a lysosomal storage disorder caused by a mutation or deletion in a lysosomal enzymes’ genetic code. There are only about 500 Americans afflicted with Hunter’s, which affects nearly every organ system and can result in heart valve malformation, respiratory problems, liver/spleen enlargement and severe neurodegeneration. Individuals suffering from Hunter’s, which typically manifests by age 2, frequently cannot speak or comprehend basic stimuli. Life expectancy varies from 10-20 years.
A pediatric geneticist described treating Hunter’s patients with Elaprase, a recombinant enzyme replacement therapy that replaces the mutated or absent lysosomal enzyme. This “orphan drug” costs over $300,000/year (see Forbes), but can’t get through the blood-brain barrier to enter the nervous system and improve neural development. The geneticist explained that orphan drug prices are passed on to private insurance companies at an undisclosed negotiated price, paid in full by Medicaid without negotiation, or are paid for by the manufacturer when the patient has no insurance. Shire reported worldwide 2015 Elaprase sales of $552 million (press release).
We were done every day before 5:00 pm. I studied 1.5-2 hours after class each day in preparation for the exams that are three weeks away. There is a medical school test prep industry that includes phone-based flashcard systems such as Anki and Firecracker ($300 for two years). I haven’t subscribed to any paid products yet because skimming through lecture slides and notes, then taking practice exam questions, is effective.
We got Labor Day off and our student affairs dean held a dinner party for those who stayed in town. We learned that for the past two years, approximately 20 percent of graduating students have gotten engaged to one another.
Statistics for the week… Study: 10-12 hours; Sleep: 6 hours/night; Fun: 3 nights out. Example fun: a Friday after-class soccer match followed by a BBQ with Jane’s family.
The Whole Book: http://tinyurl.com/MedicalSchool2020