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Updated: Nov 8

As we enter an age increasingly characterized by the widespread digitalization of our society, it’s no surprise that technology is becoming fundamentally woven into the fabric of healthcare systems. From patient portals with electronic health records to health apps and telemedicine, technology’s integration into medicine remains ubiquitous in almost every facet of the field. This shift has not only promoted accessible medical services for patients, but also emerged as a panacea to the calls for distancing during the COVID-19 pandemic. However, despite the improved health outcomes that technology enables, we cannot turn a blind eye to the inherent inequality imbued into these advancements. Put simply, an increased reliance on digital tools has the potential to exacerbate disparities between those with access to technology and those without. As a society, we need to collectively confront the reality that technology is emerging as a new-age determinant of human health.

In 2018, the Interdisciplinary Association for Population Health Science tagged digital literacies and internet connectivity as a “super social determinant of health” because of its relationship to other more traditional social influences on health, such as education, employment, and access to healthcare1. Most people depend on the internet constantly in their daily lives and as a result, technology is a major contributor to health outcomes. For example, reliable access to internet connection can connect patients with providers and reduce the burdens of distance and time. In 2021, the American Health Information Management Association Foundation reported that while more than “8 in 10 households with incomes above $100,000” had reliable access to “wired high-speed internet service at home,” households with incomes “below $25,000” average “5 in 10.”2,3 This digital divide threatens to widen gaps in healthcare within both urban and rural areas. To add to this disparity, many health professionals turned to telehealth services during the COVID-19 pandemic for both behavioral health and physical health services. Now, our healthcare systems rely on digital medicine more than ever. This growing reliance on digital tools serves as a perfect storm for new-age exclusion within the health field.

Is there a solution to this emerging health crisis? Physicians are encouraging healthcare systems to implement a “digital inclusion-informed” approach to mobile health that can take into account a community’s “level of access to devices” and support its patients in learning how to effectively use this technology 4. Regardless of the path forward, one fact remains unassailable: as tech companies expand their reach into the healthcare sector, the unwavering focus on patients and their healthcare needs must stand as the heart of all future healthcare endeavors.

Edited By: Mahi Patel

Designed By: Angie Huang

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Cold and uncomfortable metal recliner chairs, the screeching hums of drills, and blinding white lights comprise many kids’ worst nightmare – the dentist’s office. According to the Washington Post, 40 to 75 percent of people experience some form of anxiety when going to the dentist, often leading them to postpone or even cancel their appointments. This problem is particularly common in children, who’ve had poor dental experiences or consume media that portray dentists as scary. Addressing dental anxiety in children is crucial, as it can lead to improper teeth development and early tooth loss, underscoring the importance of effective treatment. Luckily, a technological remedy is growing increasingly popular: virtual reality.

Frequently encountered in the realms of gaming and entertainment, Virtual Reality (VR) employs wearable devices and sensors to craft an immersive, simulated environment for users. With VR, individuals now have the opportunity to visit the Eiffel Tower, swim with dolphins, and enter the magical world of Harry Potter all at their fingertips. Recently, dentists have introduced VR technology into their clinics, allowing both children and adults to wear VR technology. Thus far, the outcomes have been exceedingly favorable. Research indicates that virtual reality serves as an effective distraction technique for patients, significantly enhancing their comfort and even enabling them to find enjoyment in their dental experiences. Furthermore, this VR technology has the capacity to alleviate pain. A significant aspect of pain perception is psychological and demands conscious attention. Through the use of VR technology, patients are no longer fixated on the procedures being performed, resulting in a notable reduction in pain.

The benefits of VR in dentistry aren’t just limited to alleviating dental anxiety. VR technology can enhance precision in treatment planning, enabling dentists to scan and generate a model of a patient’s mouth prior to implant installation or commencing Invisalign treatment. These virtual models may be compared and used to track oral health progress over time. Additionally, VR can enhance patient education, using interactive methods to explain various oral diseases.

While the opportunities of VR in dentistry are boundless, there are certain limitations that must be considered. When using VR technology with younger patients, communication may be more difficult due to increased distractions. In fact, the use of VR may unintentionally promote the stereotype that dentists are scary and thereby necessitate distractions. Furthermore, a crucial part of dental clinics is the sterilization of all materials and instruments, so it is important to ensure that all VR technologies comply with these standards. Lastly, the use of VR raises ethical concerns, so it is important to receive consent before employing certain technologies. Despite these downsides, the role of VR in dentistry will continue to grow rapidly. It is only a matter of time before virtual reality becomes commonplace in dental clinics worldwide.

Edited by: AJ Adams

Designed By: Ashleigh Waterman


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“When I woke up just after dawn on September 28th, 1928, I certainly didn’t plan to

revolutionize all medicine by discovering the world’s first antibiotic, or bacteria killer. But I guess that's exactly what I did.” - Sir Alexander Fleming

On the 28th of September, 1928, Alexander Fleming returned home from his Scotland vacation to find his cultures of Staphylococcus bacteria invaded by a mystery mold. But to his surprise, Fleming found the mold to be inhibiting the growth of his bacteria. Within a few decades, Fleming used the antibacterial mechanisms of mold to provide revolutionary treatments. The world changed. Common infections no longer threatened the lives of humans and the average lifespan in industrialized countries increased by about thirty years. In 2011, Dr. Emmanuelle Charpentier and Dr. Jennifer Doudna discovered a relationship between repeated sequences of DNA and enzymes that cut DNA, or CRISPR. The world changed, again. Medicine went from treating symptoms to attacking the root of many illnesses, the human genome. However, because of the immense bioethical and social roadblocks, CRISPR demands a more careful evaluation by policymakers and researchers alike before widespread use. In the meantime, researchers should utilize the genetic readthrough capabilities of Fleming’s hundred-year-old phenomenon, antibiotics, as an alternative to CRISPR to treat underrepresented diseases in medicine and to provide ethically sound medical therapies.

Some of the harshest diseases like Epidermolysis bullosa and Duchenne muscular dystrophy stem from nonsense mutations, a misplaced stop codon that prevents full expression of proteins. Without proper formation, proteins are unable to perform their role resulting in a wide range of diseases. Uniquelly, patients diagnosed with rare diseases are underrepresented in healthcare for two primary reasons. Firstly, diseases caused by nonsense mutations are quite rare, decreasing any incentive for politicians to address rare diseases or for pharmaceutical companies to invest in research for them. More significantly, treating patients with diseases caused by nonsense mutations requires altering the human genome, which is costly and complicated. Thus, those suffering from nonsense mutations are left without treatments. However, antibiotics have the ability to read through nonsense mutations, or skip the nonsense mutation that prematurely terminates expression of the rest of the protein. Specifically, some antibiotics can read through these mutations by inserting amino acids where the stop codon exists, thereby allowing for a partial or fully functional protein to be produced. For example, researchers at USC’s Keck School of Medicine have used gentamicin, an antibiotic, to increase production of type VII collagen, a protein lacking in patients with Recessive Dystrophic Epidermolysis Bullosa, a severe variation of Epidermolysis Bullosa. With the implementation of antibiotics, the researchers found gene expression to have increased, some slightly and some to baseline. Such promising research is emerging in clinical trials testing antibiotics for other rare diseases. Antibiotics readthrough provides an efficient treatment for patients of rare diseases.

However, CRISPR may be able to provide treatments for rare disease patients. What makes antibiotic treatments more promising? It all has to do with ethics. The largest roadblock to widespread use of CRISPR is a single ethical question: “What is the fine line between improving and enhancing a patient?” Opponents of CRISPR argue that gene therapy cannot be implemented because of the ability for individuals to be enhanced above baseline, inevitably leading to consequences like producing super-soldiers, greater socio-economic disparities, and designer babies. Once more, antibiotic-induced readthrough therapy may prove a viable solution. Inherently, antibiotic-induced readthrough therapy is not able to improve a patient beyond baseline. Rather, the technology attempts to bring a patient back to what is considered “normal” expression of a protein. In other words, using antibiotics as an alternative to CRISPR ensures that ethical complications related to improving vs. enhancing are much less significant.

Efficient policy lags behind constant technological improvement demanding further delay of widespread use of CRISPR. However, patients with rare diseases caused by nonsense mutations cannot wait for treatments as they suffer. Thus, researchers must spend more time and resources understanding antibiotic-induced readthrough therapy as a potential alternative to CRISPR.

Edited by: Eric Lee

Designed by: Jackie No


1. Tan SY, Tatsumura Y. Alexander Fleming (1881-1955): Discoverer of penicillin. Singapore Med J. 2015;56(7):366-367. doi:10.11622/smedj.2015105

2. Adedeji WA. THE TREASURE CALLED ANTIBIOTICS. Ann Ib Postgrad Med. 2016;14(2):56-57.

3. Woodley DT, Cogan J, Hou Y, et al. Gentamicin induces functional type VII collagen in recessive dystrophic epidermolysis bullosa patients. J Clin Invest. 2017;127(8):3028-3038. doi:10.1172/JCI92707

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   Duke Medical Ethics Journal   

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