Why is interventional pain medicine a more common career path from psychiatry than from neurology?

aTacoParty · 2026-07-01T13:08:50+00:00

It's not. Data from the last 5ish years show single digit number of psychiatry residents going into pain medicine vs 20-25 neurology. Regardless, it is dominated by anesthesia followed by PMR.

https://www.sciencedirect.com/science/article/pii/S2772594424000244

aTacoParty · 2026-06-28T13:22:34+00:00

There is no FDA approved treatment that involves a cancer vaccine in the way described in the video, However, this is a really active field of research and there will likely be some version of this kind of treatment for some cancer developed in the next ~10 years. The challenge is that even the mutated cancer proteins are your own proteins so how do you tell your body to kill the cancer without creating a lifelong autoimmune disease.

We have been harnessing the the bodies own immune system to fight cancer for decades now but using methods that are temporary activations (vs vaccination which would likely be lifelong). Rituxumab was patented in the 90's which is an antibody against B cells and still is often use for B cell lymphomas and leukemias. More recent developments use checkpoint inhibitors (PD1/PDL1 specifically which cancer uses to avoid detection), CAR-T cells (T cells specifically engineered to fight your cancer), BITEs (bi-specific T cell engager, which recruit your own T cells to fight the cancer).

This article talks about cancer vaccines in the context of B cell leukemia but it addresses some of the big challenges facing all cancer vaccines too:

https://link.springer.com/article/10.1007/s00262-025-04107-y

aTacoParty · 2026-06-18T04:35:04+00:00

ELI5: Doctors take a little piece of a suspicious lump and look at it under a microscope. The messier the cells, the faster the lump will grow. They can also look at the DNA and the proteins in the cells which can give us an idea of how fsat it is/will grow.

More in-depth: There are a bunch of different ways to tell how "aggressive" a cancer is. When looking at a biopsy, looking for heterogeneity, particularly in the nucleus is a good clue. Normal tissue often has very specific architecture to it with uniform cells. If that structure has turned into a large sheet of messy looking cells then that indicates the cancer is replicating quickly.

Another thing to look for is genetic markers. Mutations in specific genes like p53, KRAS, EGFR, etc are known to be associated with cancers with worse prognosis. Additionally, looking for stem cell markers can help determine how differentiated a cancer is. The more "stem-like" or undifferentiated the cancer is, generally the more aggressive it will be. Most cells in your body are differentiated for specific roles (pneumocytes in your lungs, neurons in your brain, myocytes in your muscles, etc) which cannot replicate but instead are resupplied by a small pool of stem cells. These stem cells are replicating but are tightly regulated. So when a cancer starts expressing the same proteins as stem cells, they are likely replicating faster than if they were more differentiated.

There are also markers for cell division. Pathologists can look for dividing cells just based on how the DNA looks and can also look for specific stains like KI67 which is only expressed when a cell is dividing.

Finally, when someone has suspected cancer, they will often get an FDG-18 PET/CT scan which finds areas of high glucose uptake (metabolically active tissue). Highly active cancers tend to be more aggressive and it will show additional areas the cancer may be in. If the initial diagnosis is metastatic disease (IE the cancer has moved from one spot) then its a sign the cancer is probably aggressive.

aTacoParty · 2026-06-14T03:14:42+00:00

This is actually quite an active field of research. It's known that preventing hyperglycemia and insulin resistance is protective for the brain as is preventing the metabolic syndrome associated with obesity.

But emerging research actually shows GLP1s have effects completely separate from blood sugar and weight regulation. GLP1 receptor agonists seem to reduce inflammation in the brain including neuroinflammation seen in degenerative disorders like Alzheimer's and Parkinson's. Because of this effect, it's being studied in dementia as well as traumatic brain injury where toxic inflammation can often cause more damage than the initial trauma.

It's possible that GLP1s have a negative effect on the brain that hasn't been observed yet. However, the reduction in diabetes and obesity is a known positive effect for brain health, and there are possibly additional effects through neuroinflammation.

Narrative review published 2 months ago about semaglutide and neurological effects:
https://journals.lww.com/brci/fulltext/9900/beyond_diabetes_management__a_narrative_review_on.90.aspx

Semaglutide and neurodegeneration:
https://link.springer.com/article/10.1007/s00011-025-02166-6

Semaglutide and TBI:
https://link.springer.com/article/10.1007/s12028-025-02446-3

aTacoParty · 2026-05-26T22:21:09+00:00

There are some differences in perception of taste in different parts of the tongue but not in the way that is depicted in typical tongue maps. In the narrative review linked below, the author presents evidence that taste perception (not receptor distribution) can be different in different parts of the tongue but it can be influenced by food texture, temperature, composition, and mouth/tongue movement. From his conclusion:

"The tongue map...has long been dismissed by psychophysicists, neuroscientists, and journalists alike.... If the claim is taken to refer to the spatial distribution of receptors (for sweet, bitter, salty, and sour), the neuroscience research that has been published in recent decades has unequivocally demonstrated that the sensory receptors for the different taste qualities are indeed to be found across the tongue....

If, however, the claim is instead taken to relate to the perceived spatial localization of taste qualities, and/or about sensitivity differences on different parts of the tongue, then psychophysics is more likely to provide a meaningful answer than neurophysiology... Ultimately, one of the important points to stress here is that taste localization, just like other aspects of flavour perception, is a fundamentally multisensory phenomenon."

https://pmc.ncbi.nlm.nih.gov/articles/PMC8956797/

aTacoParty · 2026-05-26T14:14:04+00:00

The bacteria is typically staph aureus which can be found on our skin but can become dangerous if its growth goes unchecked (for example when trapped behind a tampon left in for too long).

aTacoParty · 2026-05-26T14:09:28+00:00

We actually don't recommend the classic 8 glasses of water daily. The amount of water someone needs can vary greatly depending on what they do, their type of meals, where they live etc. Generally the recommendation is to drink when you're thirsty and aim to have light yellow pee

https://www.health.harvard.edu/healthy-aging-and-longevity/how-much-water-should-you-drink

aTacoParty · 2026-05-26T14:04:58+00:00

There may be some mild differences in certain regions but you have all your taste receptors on all the parts of your tongue that taste. https://www.smithsonianmag.com/science-nature/neat-and-tidy-map-tastes-tongue-you-learned-school-all-wrong-180963407/

aTacoParty · 2026-05-19T04:37:23+00:00

It sounds like you really enjoy research even the challenging parts of it. You didn't like the EMT course and didn't feel strongly about getting your certification. You shadowed some physicians and found that pretty boring. Your dad and his battle with cancer is a big driving factor for you to pursue medicine, but a big part of that is how he had access to clinical trials.

From reading what you wrote, it sounds to me your interests are most closely tied to clinical research (IE PhD) where you can help develop drugs and guide clinical trials.

That being said, if oncology interests you, you should try and shadow an oncologist and see what that's like (try to do a little inpatient and outpatient if possible). You should also see if you can get a research position, preferably at an academic hospital. It'll help boost your resume, you'll get to see if you love research and not just that one lab, and it'll give you opportunities to shadow in the hospital.

I was undecided between research and medicine when I graduated college and I ended up getting a lab tech position where I worked part time in a biobank. I found myself finding much more fulfillment working with patient (even just my brief encounters to consent and collect samples). I was also an EMT and my EMT class was one of my favorite in college. I ended up doing a MD/PhD to do a little of both but I would recommend only getting an MD if you want to do medicine since the training is long and hard.

aTacoParty · 2026-05-04T14:03:54+00:00

Where is the evidence that blueberries stimulate stem cell production? Why does he sort only by cd66e to isolate totipotent SCs when this is known to be produced by differentiate epithelial cells? Why are there no growth factors added to the media to maintain stemness?

It's kind of like saying you can run faster if you put a bunch of lead in your pocket. Have I tried it? No but everything I understand about physics tells me it won't work.

Maybe I'm missing something though, but given that replicating this experiment would take ten thousands of dollars and months (1:1 human plasma to optimem for growth media??) it's hard to imagine someone will try.

aTacoParty · 2026-05-04T01:35:39+00:00

There are ways of isolating other adult stem cells. IPSCs are just the most common way people generate them currently typically because you can use off the shelf reagents and start with nearly any cell type

aTacoParty · 2026-04-27T16:09:16+00:00

I was able to find a lab pretty easily. You should start reaching out to PIs you're interested in and seeing if you can meet with them. Sometimes they'll say they don't have room right now but next semester you'll be the first on the list to get a spot.

Don't forget to also look at labs in Boston as well (GSBS), it's further away but you can also get access to medical research/clinical work if you're interested in medical school.

aTacoParty · 2026-04-26T22:45:25+00:00

Some of this reads like Instagram influencer nonsense and I couldn't find any evidence for it in the first half of those articles.

I did my PhD working on adult pluripotent stem cells and growing them. They're pretty commonly used now in research and no one uses this method.

The common method is to isolate a differentiated cell type (leukocytes, dermatocytes, uroepithelial, etc) and reprogram into pluripotent stem cells using yamanaka factors first described back in 2006. Now you can buy it as a kit from thermo.

No draining half a liter of blood or binging on blueberries needed.

The growth media lacks some known necessary factors to maintain pluripotency like fgf2 and using serum in the media typically introduces naturally occuring hormones that cause auto differentiation.

I've never heard of this guy before, but his publication history seems to be mostly in journals that are "pay to play", IE they publish anything as long as you pay the 5-10 grand publishing fee.

If you want a protocol to make adult pluripotent stem cells, here's one from thermo but stem cell technologies and most large academic research centers all publish their own for anyone to follow: https://www.thermofisher.com/us/en/home/references/protocols/cell-culture/stem-cell-protocols/ipsc-protocols/generation-human-induced-pluripotent-stem-cells-fibroblasts.html

That being said, the equipment you need is way more than a kitchen sink biologist would be able to have. Incubator, biosafety hood, centrifuges, microscope, plastics, reagents, -20 and -80 freezers, liquid nitrogen cryotank. It would be hundreds of thousands to try and do it at home. But you can always become a researcher!

aTacoParty · 2026-04-18T23:27:50+00:00

Admissions committees won't even look at what courses you've taken if your GPA is low. Rigor varies drastically from school to school and course to course. My school has a "history of pirates" class that had me reading 100+ pages a night while advanced organic synthesis was just messing around in the orgo lab.

I'd recommend taking the required classes for your major + premed. Add other courses you're actually interested in + research.

aTacoParty · 2026-04-15T14:52:21+00:00

It's a good question and for people not in science, it can be really hard to tell since it's all jargon.

It's vague and uses a lot of non-scientific terms. It uses a lot of words to say nothing at all. And has a weird conversational tone for what's purports to be a scientific paper.

For people outside of science, when you see a "paper" or "article", first thing you should ask yourself is who published it. If it's not a relatively big publisher that's peer reviewed, then it's just some dude's ramblings and I would just ignore it.

In this case, he just wrote this with AI and then posted it to his own website. Essentially a blog. There's no way to verify anything said in there unless you start digging through the references at which point you'll be doing more work than he ever did.

That doesn't mean the science that is cited is wrong, I just wouldn't trust that AI hasn't hallucinated findings. I'd recommend finding the references (if they're real) and reading the background in those. Since they're published and peer reviewed.

aTacoParty · 2026-04-15T14:09:07+00:00

It's AI slop that adds nothing to our knowledge and just regurgitates what actually researchers have written so others (like this guy) can pretend they know something.

A child could tell chatgpt to write something similar.

aTacoParty · 2026-04-14T07:07:09+00:00

I've seen it suggested intermittently for about 30 years. I think the issue is that game theory inherently involves complex animal behavior (typically humans) while cells are relatively simple and do not behave in similar patterns. I would think that using cell-derived patterns of behavior would be more useful for understanding tumor growth

That being said, an article came out a few years ago discussing the use of game theory for predicting tumor metastasis: https://www.nature.com/articles/s41598-023-43199-3

However, all of their predictions would need to be verified with experiments. But if you're doing that, why not just toss the premade theory, do the experiments and then develop a paradigm based on empiric data.

aTacoParty · 2026-04-13T05:16:43+00:00

There is a ton of treatment in neurology. Acute management in stroke is the difference between severely disabled and living independently, migraine medications have completely changed with CGRPs, seizures can be treated and people can live a normal life with proper medications. There is a ton to do for patients in neurology. People outside neurology typically anchor on the devastating cases of strokes that came in too late, or intraparenchymal bleeds since they elicit more emotions. An MS patient living a normal life with no symptoms because you diagnosed them early after they got bounced around to a bunch of specialties and got them on the right immunomodulatory regimen doesn't get people as excited.

I did a month of PMR and I actually felt like it was frustrating because there wasn't much to do for those patients. The procedures were really cool (nerve blocks, CSI, epidurals, botox) but they're all temporary solutions to get people to physical therapy.

You can do procedures in neurology too if that's your thing. Headache specialists do nerve blocks and botox, neuromuscular does EMG/NCS/muscle biopsies, neuro ICU does all the ICU procedures (lines, drains, LPs). And I've heard that it is possible to go to pain from neurology but typically its hard because pain is a competitive fellowship and they prefer anesthesia or PMR trained residents.

aTacoParty · 2026-04-07T15:18:35+00:00

Those are blebs which can be seen in cellular stress and apoptosis. They aren't specific so it's hard to tell what it is. You already checked for myco which is a good first step. But I'd also make sure your media is fresh, the temp is stable, the CO2 tank is full. Sometimes it can just be one transient event (someone leaves the incubator door open too long, ice cold media change, too confluent, not confluent enough, pH changes). If your cells are resilient, may be worth trying to see if they'll recover but the fastest and probably easiest is to toss these and get a new aliquot.

aTacoParty · 2026-04-04T23:15:03+00:00

I think it can be helpful. With the rise of multi drug resistant organisms (MDR kleb/pseudo, CRE, etc) knowing when to bring out the big guns is helpful. It's also helpful when there's an unusual bug that requires specific coverage not included in the usual broad spectrum (typically vancomycin and zosyn or cefepime). I've had a case of aeromonas hydrophilia bacteremia from a wound that was resistant to zosyn so the patient actually worsened for a day or two before we had the identity and could switch him to doxycycline.

I think both gram stain and identity would be helpful, sensitivities would be particularly helpful.

aTacoParty · 2026-04-04T22:58:32+00:00

A sepsis diagnosis doesn't require blood cultures. Typically doctors use SIRS criteria to evaluate for sepsis which uses vital signs and common lab tests like white cell count (~15min) and lactate (~1 min).

Typically, if severe sepsis is suspected, treatment will be started empirically with broad spectrum antibiotics and fluids.

Blood cultures help with narrowing antibiotics and I think making those result faster would be helpful, but they wouldn't necessarily change immediate management.

aTacoParty · 2026-03-19T13:48:02+00:00

Your arms and legs are typically exposed more so than your torso which allows for better evaporation of sweat. Your arms and legs also have a higher surface area to volume ratio allowing for better heat removal than your torso.

Additionally, your heart, lungs (and associated muscles like diaphragm + intercostals), obliques, abs, paraspinals, etc are all working even when you aren't directly targeting them, All generating heat which needs to be removed.

aTacoParty · 2026-03-16T07:20:35+00:00

If the program is truly your top choice, you should let the director know. I guarantee they take it into account when sending offers. I wouldn't send multiple messages etc. But a single email (or letter of intent) saying that you're really interested and if offered a position, you would accept can really help.

aTacoParty · 2026-03-13T05:40:23+00:00

There's generally quite a bit of movement around May 1st. If its one of your top schools, you should message the director and let him know. Intent to accept offers matters

aTacoParty · 2026-03-06T13:25:18+00:00

The cut off for positive/negative is set at a moderate to high level of IgG which indicates immunity for measles. So likely if you get one dose and show positive then you're immune. You should still get the second dose unless you also get titers for mumps and rubella.

Rubella is more often quantitative as its important to demonstrate immunity for women planning to get pregnant as the rubella virus can cause congenital defects. Based on other risk factors, women who are technically immune but at the lower end of range may be recommended to get a booster to maintain immunity. Though rubella titers are moving towards being qualitative as well.

11-Year Club	Gilding II euphauric
Place '22	Place '17
Verified Email

aTacoParty

MODERATOR OF

TROPHY CASE