another piece of housekeeping:

After some debate, it's been done. We are now officially at www.jessguh.com. So for those of you still subscribed to the RSS feed guhster.weebly.com/1/feed -- that's disappearing and you should get on the feedburner wagon. For everyone who is subscribed via email or the feedburner RSS, everything will automatically migrate.

The year 1984 is probably most well known because of George Orwell. More relevant to me, it was the year I was born.  More relevant to researchers desperate to publish before they proverbially "perish," 1984 was the year that Helicobacter pylori was discovered.  With a brand new bacteria that nobody knew anything about, it was low hanging fruit for publishable data.  There's even a whole journal that is soley dedicated to H. pylori and it has a new issue every two months!  More recently, it's become clear that H. pylori is highly correlated to the development of gastric cancer and most experts believe that it's causative due to the chronic inflammation that can result from infection. However, it's important to note that only a minority of people infected with H. pylori will go on to develop gastric cancer.

In the medical student world, though critical and diagnostic thinking are highly emphasized, rote pattern recognition is just as important.  During our internal medicine rotation and board exam studying common scenarios are pounded into our brains.  Young African American woman with difficulty breathing? Sarcoidosis. Diabetic with an unhealing ulcer? Osteomyeolitis.  The list goes on and on. The Asian claim to fame? The Japanese man who eats lots of preserved foods.  He has gastric cancer.

But that's all I've been told. Basically, I can bubble in the right answer on a multiple choice test question. Nobody ever told me that gastric cancer used to be the second most deadly cancer in the world.  Nobody ever mentioned that though the incidence of gastric cancer has drastically decreased worldwide, it's happened disproportionately.  The incidence of gastric cancer in rich countries continues to drop, but even in the United States, according to SEER data, Asian Americans, Latin Americans, Black Americans, and Native American's have a much higher rate than other races.  And absolutely nobody ever told me that the 5 year survival rate is only 25%.

Earlier this year I did a rotation at Asian Health Services (AHS) in Oakland, CA. AHS is a non-profit primary care healthcare system that provides services to low-income, linguistically-isolated Asian Americans in Alameda County.  Part of my time there was spent reviewing the current research on screening for H. pyolori, gastric cancer, and Asian Americans. I could only find one study that actually studied gastric cancer in Asian Americans. It was an epidemiological study that found that rates of gastric cancer in Japanese families decrease in each subsequent generation after immigration.  One other study used Japanese Americans as a subset for analysis.  It was a cost-effectiveness analysis and they simply took data on white men in the United States and multiplied their risk by four.  I'm not sure that counts.
 
It's not surprising that though gastric cancer in Asians is common enough to warrant a board's question, there's been little research done on it in the United States.  Asian American's are nearly invisible when it comes to health research. The US Department of Health and Human Service's Healthy People, in their 2010 Asian Americans/Pacific Islanders: Defining a Baseline, reported that only 0.1% of published medical research articles even mention API populations. This, in combination with the model minority myth, only perpetuates and contributes to the false notion that the API population does not suffer from any health inequities. Despite this having been recognized for years, little has changed in medical research and issues in data collection and analysis still remain. 

This week is National Coming Out Week. And though we'll focus on celebrating the queer community, it's not a holiday.  And despite the fact that its whole existence is due to prejudice and hate, it's not a memorial.  When I was in high school, I started a Gay and Straight Alliance and I remember how big a deal National Coming Out Week was (though back then I think it was only a day). This was our chance to establish our presence. In an environment where any queer aspects of the curriculum were laundered and the social scene was assumed to be heterosexual, it was also our chance to challenge the norm.  With our pins prominently displayed and posters strategically hung, I remember feeling like we were walking into battle.  Long before "fierce" was campy, it was butch; and we were fierce.

As my aspirations to effect change have grown, so has the scale of my efforts.  The cynic in me says that efforts targeted at "small numbers of people" have no significant results.  The egoist in me says that my time is better spent elsewhere.  And yet I continue to advocate for grassroots change.  It turns out my hypocrisy is not only limited to telling my patients to exercise regularly.

A fellow activist and organizer once counseled me when I was complaining about how tired and burned out I was. "You need some inspiration," he said.

Last year, the business school gave out rainbow pins during National Coming Out week. By the end of the week, nearly every business student had one.  I didn't think much of it until a desperately closeted friend of mine said, "You know, seeing all these people walking around with pins -- even, like, the big footbally guys -- makes me feel like I could really come out and it would be ok."  Talk about warm and fuzzy.  Inspired by that, this year all of the queer organizations on campus came together for a button campaign targeted at the entire undergraduate and graduate student population. (See an interview with the organizer here!)

In high school things were pretty black and white for me: you either take a stand for justice or you don't. These days I feel overwhelmed by the complexities of everything. Now I'm concerned about unintentional consequences, participating in programs that are more colonial than empowering, marketing my message so that it can be heard, taking leadership without taking power, and building smart alliances without selling out.  But this button campaign... it builds a sense of community, it creates a sense of safety, and it establishes a presence. It's simple and it pleases me.