While many patients may think “doctor knows best” when choosing between different medical procedures, a new study from the California HealthCare Foundation found that some of these decisions may be driven more by local physician preferences rather than clinical evidence.

In some California counties, the local rates of elective procedures are dramatically higher than neighboring areas. For example, a man newly diagnosed with prostate cancer who lives in Tracy, Calif., is 479 percent more likely to undergo internal radiation, i.e., brachytherapy, than the state average. (Click on the map above for rates in other counties.)

To make this data more useful to medical consumers, the study authors published an online interactive map that allows Californians to quickly determine if their region performs elective procedures at disproportionately higher rates than the rest of the state.

“We’re hoping these maps can push along conversations about how to improve health-care delivery,” said Laurence Baker, PhD, a consultant on this study and a professor of health research and policy at Stanford. “One thing that is often important is better communication between patients and doctors, particularly in cases where patients can have different preferences. Getting this information out there might help some conversations happen that could lead to better treatment decisions and health outcomes.”

This new version of the procedure map adds breast cancer, prostate cancer, and spine procedure rates and expanded data to include Medicare patients and younger populations enrolled in commercial plans, Medicaid patients, and the uninsured.

Previously: Heart bypass or angioplasty? There’s an app for that, New breast cancer finding suggests limiting surgery and Ask Stanford Med: Answers to your questions on prostate cancer and the latest research

Every day, doctors across the country take down reams of information about their patients. Those notes are a treasure trove of information about preventive treatments, side effects of drugs and drug interactions. But most of this information has been hard to access - until now.

In the past, researchers who really wanted the data have combed through individual records - which can be hundreds of pages - manually. When I worked as an epidemiologist at the California Department of Public Health, for example, I worked on a large study that looked at prenatal hospital records for infectious disease lab testing – and our team of a dozen researchers took months to go through a few hundred records. It’s not an efficient approach for most diseases medical researchers might want to study. Recently launched national efforts also recognize this limitation and call for turning data from regular doctor visits into data points to figure out what is best for patients.

So when I learned that Nigam Shah, MBBS, PhD, a biomedical informatics professor at Stanford, has been looking at ways to pull out information electronically from clinical notes, my ears perked up.

In a paper published today in the journal PLOS ONE, Shah and co-authors Nicholas Leeper, MD, a Stanford cardiologist and vascular medicine specialist, and Anna Bauer-Mehren, PhD, an informaticist who recently moved from Stanford to Roche Germany, used a new methodology to answer a nagging question about the safety of Cilostazol, the only drug with the American Heart Association’s highest effectiveness rating – Class 1A - for treating the symptoms of peripheral arterial disease, a condition that affects millions of Americans. Regulators fear the drug might have side effects on the cardiovascular system that could lead to death, so the drug has historically carried a “black-box warning.” As a result, the use of this drug has been limited.

Looking at a specialized system that includes health-research data from millions of patients seen at Stanford Hospital over 18 years, the researchers found no evidence that patients with peripheral arterial disease who took Cilostazol suffered the side effects about which doctors were worried, compared with patients who didn’t receive the drug. By querying these records, the researchers identified a subset of patients they felt were at highest risk – a group which is often excluded from company-sponsored trials – and found no evidence of the side effects.

Continue Reading »

A close friend recently told me about the post-traumatic stress disorder research of Stanford’s Emma Seppala, PhD, whom she knows from the yoga community in Madison, Wisc. (Seppela did her postdoctoral work there.) It was amazing stuff, I was told (and what a small world, I thought.)

And so, I was eager to hear yesterday about one of Seppala’s studies, which found that yoga-based breathing exercises dramatically decreased PTSD in veterans – and that the effect lasted a full one year after the study period.

As Brooke Donald reports:

Twenty-one male veterans of the Iraq and Afghanistan wars participated. Half took part in the intervention, a seven-day workshop that emphasized a set of breathing techniques from the Sudarshan Kriya Yoga practice. The rhythmic breathing patterns exercised during this practice are meant to relax participants physically and mentally, and reduce symptoms of anxiety, depression and stress.

“Some people think of it as yoga, but it’s really more breathing – an active breathing intervention,” Seppala explained.

Before and after the workshop, which lasted three hours a day, the veterans completed questionnaires about how they were feeling. They also underwent cognitive and physiological tests to measure how they responded to loud noises and other startling stimuli.

The questionnaires were given and the tests were taken again a month after the workshop, then a year after.

Seppala called the results “extraordinary.”

Traditional PTSD is not effective for a large chunk of veterans, Seppala said, and this study provides numbers to back up anecdotal evidence that yogic breathing techniques can be helpful. She hopes that “having the data will help move this kind of treatment forward in a more substantial way” and will garner the attention of policymakers.

Seppala, the associate director of the Center for Compassion and Altruism Research and Education here, is now preparing the study for publication. Her work and that of University of Wisconsin’s Richard Davidson, PhD, was recently featured in the documentary “Free the Mind.”

Previously: Using mindfulness therapies to treat veterans’ PTSD, As soldiers return home, demand for psychologists with military experience grows, Stanford and other medical schools to increase training and research for PTSD, combat injuries and Can training soldiers to meditate combat PTSD?
Photo of veteran Adam Burn practicing yogic breathing techniques by Linda Cicero

Ambassador Eric Goosby, MD, the nation’s AIDS “czar” and an infectious disease specialist who treated HIV/AIDS patients in the early days of the epidemic, will visit Stanford School of Medicine next Thursday, May 30, for a conversation on global health.

Early in his career, Goosby treated AIDS patients at San Francisco General Hospital, back in the days when there were limited options for treatment (I remember crossing paths with him then, as I was a writer with University of California-San Francisco and based at the hospital).

Goosby has since gone on to major positions within the Clinton and now, the Obama, administrations. As the U.S. Global AIDS Coordinator, he directs the President’s Emergency Fund for AIDS Relief (PEPFAR), the nation’s premier international AIDS program begun in 2003 under the Bush administration. In recent years, he has come under fire from activists who believe the Obama administration has fallen back on its commitment to the program, whose budget has remained constant after years of substantial increases.

But at the International AIDS Conference in Vienna in 2008, former President Bill Clinton defended Goosby before an audience of thousands, saying he’s a good man with the best of intentions.

In addition to his work with PEPFAR, Goosby is the U.S. liaison with the Global Fund to Fight AIDS, Tuberculosis and Malaria, the international public/private partnership that provides antiretroviral medication to patients in developing countries. Goosby also leads the new Office of Global Health Diplomacy at the State Department.

I’ve heard Goosby speak on several occasions and found him to be an engaging and inspiring speaker with a deep understanding of global health needs.

The Stanford program will be held at 5:45 p.m. at the Li Ka Shing Center for Learning and Knowledge on the medical school campus. It’s free and open to the public, though registration is required.

Previously: Video: Kaiser Family Foundation town hall with U.S. Global AIDS Coordinator and New AIDS czar a good fit

Yesterday marked the start of the Big Data in Biomedicine Conference at Stanford, and Dean Lloyd Minor, MD, was one of the first to address the audience of more than 300.

Outlining the “tsunami of data crashing into us” (including electronic patient records; DNA sequencing; and comprehensive biological data on the mechanisms of disease, treatment monitoring, clinical trials, pharmaceutical records, medical imaging and disease registries), Minor said we must now take the information we have to improve health care. And for this, he said, collaboration is key:

[Big data presents a] challenge that is so big and so complex that single individuals, or companies, or institutions – no matter how accomplished or illustrious – cannot solve it alone.

Explaining that the conference was arranged to encourage such collaboration among academic researchers and their partners in industry, he went on to describe big data’s four “grand challenges:”

Extending big data studies to a global scale. Much of the biological data that has been collected so far does not include global studies of multi-ethnic populations, or studies about both men and women. We need to expand our field of study.

Faster interpretation of data. We need to increase the speed and effectiveness of analysis through the use of existing and emerging technologies.

A better grasp of the interactions. We need an understanding not just of genes and proteins in isolation, but of the complex, multi-factorial networks in which they operate.

Training the next generation. We need to prepare scientists who will follow us in the fields of medicine, statistics, informatics, and engineering to continue to seek transformative change.

Ultimately, he said, it’s up to those people who “see this time as a unique opportunity,” and who want to convert the massive amounts of biomedical data into “practical, usable tools that relieve suffering, preserve health, and enhance life.”

As a reminder, the conference, which is being supported by the Li Ka Shing Foundation, will be webcasted today and tomorrow via the Big Data in Biomedicine website. We’re also live tweeting event proceedings on the @SUMedicine Twitter feed.

Previously: Big Data in Biomedicine conference opens this week, Atul Butte discusses why big data is a big deal in biomedicine, Strength in numbers: Harnessing public gene data to answer a diverse range of research questions, Mining medical discoveries from a mountain of ones and zeroes and The data deluge: A report from Stanford Medicine magazine
Photo of Dean Minor at conference by Saul Bromberger

Last month, a group of 150 Bay Area high-school students visited Stanford to attend a series of hands-on, interactive sessions and lectures on a diverse range of subjects including biodesign, virtual anatomy, neuroscience and cancer. Their visit was part of our annual Med School 101 event, a day-long medical education program designed to expose teens to ongoing research at the School of Medicine and get them excited about potential careers in medicine and science.

This gallery illustrates some of the students’ exciting experiences, from performing procedures on simulated patients to examining animal brain tissue samples. To see more images from the day, visit our full photo set on Flickr.

Previously: Bay Area students get a front-row seat to practicing medicine, scientific research, Image of the Week: Studying brains at Stanford’s Med School 101, Live tweeting sessions at Stanford’s Med School 101, Med school: Up close and personal, A quick primer on getting into medical school, Teens interested in medicine encouraged to “think beyond the obvious” and High-school students get a taste of med school

A short survey that asks patients to assess their walking ability could be helpful in predicting a person’s risk of cardiovascular disease, as well as mortality risks from any cause. That’s according to a Stanford study recently published online in the journal Circulation.

The Walking Impairment Questionnaire, also known as the WIQ, is currently used to predict risks of peripheral artery disease, a narrowing of the arteries that causes limited circulation to the limbs. The authors of this new study wanted to see if the WIQ, which can be filled out by patients while waiting for their doctor appointments, might be helpful in predicting other health risks.

“A 70-year-old patient’s ability to walk six minutes is a great predictor of cardiovascular risks,” said Kevin Nead, a Stanford medical student and the first author of the study. “But most people are seen in 15-minute doctor visits. They’re not going to be doing a walking test.” Perhaps, he reasoned, a subjective test like this 17-question survey could be used instead.

Nead and his colleagues, who examined questionnaire results from more than 1,700 patients, found that the use of the WIQ alone successfully predicted cardiovascular outcomes. In addition, when the survey was used in conjunction with other common clinical tests such as blood pressure measurements and blood tests, it significantly improved the ability to predict mortality not just from cardiovascular disease but from any cause.

“In an era of increasing expense for medical costs, this work suggests that the WIQ, an extremely simple and economical tool, may significantly improve our ability to prognosticate risk,” Nead told me.

Photo by timparkinson

This afternoon, leading figures from academia, industry, government and philanthropic foundations will gather at the Big Data in Biomedicine conference at Stanford to explore the vast opportunities for mining the growing volume of public health data and develop new ways to prevent, diagnose and treat disease.

The event runs today through Friday and features 32 speakers representing large information-technology corporations, startups, venture-capital firms and the research community. As a reminder, those unable to attend in person can tune in to the live webcast and submit questions for panelists by visiting the conference website.

Additionally, we’ll be live tweeting the conference keynote speeches by Anne Wojcicki, CEO and co-founder of personal-genetics company 23andMe (which starts around 1 PM Pacific time today) and David Ewing Duncan, author of Experimental Man, as well as other proceedings from the conference. You can follow the tweets on the @SUMedicine feed or by using the hashtag #bigdatamed.

Previously: Big Data in Biomedicine conference opens this week, Stanford computer scientist shows stem cell researchers the power of big data, Atul Butte discusses why big data is a big deal in biomedicine and Stanford and Oxford team up for conference on “big data’s” role in biomedicine

Science Insider took another look yesterday at the effects of the budget sequestration on research. After describing the potential harms of the NIH’s recently announced 5 percent budget cut - “part of a larger pattern of declining funding over the past decade” – reporter Jocelyn Kaiser points out another troubling aspect of sequestration:

NIH leaders say that the sequester’s most severe effect is the chilling message it sends to young scientists. In testimony last week, [NIH Director Francis Collins, MD, PhD,] quoted a former student who is finishing a Ph.D. at the Massachusetts Institute of Technology. She’s seen her role models struggle with funding. “I can’t erase the fear that this is my future,” Collins quoted her writing.

“We’re putting an entire generation of U.S. scientists at risk,” Collins warned. “If they go away, they won’t come back.”

Previously: Sequestration hits the NIH – fewer new grants, smaller budgets, NIH director polls Twitter for real-world responses to budget cutbacks and As budget sequester nears, a call for Congress to protect funding for scientific and medical research

Each year the National Science Foundation runs a video contest for young IGERT-funded scientists to communicate to the public about their research, and viewers are encouraged to vote for their favorite videos by liking them on Facebook.

One of the entries in this year’s contest comes from a group of Stanford graduate students who show how the brain plans movement and discuss their work on neural prostheses - biomedical devices for restoring movement to individuals with paralysis or lost limbs. The students, who are all part of the Stanford Center for Mind, Brain and Computation, conduct their work in the labs of electrical engineer Krishna Shenoy, PhD, whose research we’ve written about in the past, and Surya Ganguli, PhD, an assistant professor of applied physics.

The take-away message of the video, student Sergey Stavisky told me yesterday, is that “neural prosthetics are an exciting class of medical technology with the potential to improve the lives of individuals with paralysis,” but that to develop better ones, “we still need to learn a lot about the basic science of how the brain controls movement.”

The video, called “Neural Prosthetics: Understanding Reach Planning,” is worth checking out, as are many of the other entries, whose topics range from “virtual blood vessels” to the use of stem cells to revitalize skeletal muscle. Voting is open until 7 PM Pacific time Thursday.

Previously: Researchers find neurons fire rhythmically to create movement and Stanford researchers uncover the neural process behind reaction time
Via Erica Seigneur from NeuroTalk
Video still courtesy of Sergey Stavisky