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Immunology, Infectious Disease, Public Health, Research

Is honey the new antibiotic?

Is honey the new antibiotic?

3535805377_807788e3e1_z…Well, not quite. But recent research shows that honey does have infection-fighting properties surprisingly similar to the common antibiotic ampicillin. And even more importantly, honey worked just as well against bacteria that had developed a resistance to ampicillin, which is good news as the medical community raises awareness about antibiotic resistance.

The study, which was recently published in PLOS ONE, compared the effects of Canadian honey and ampicillin on E. coli bacteria. The most common kind of antibiotics – beta-lactams, which includes ampicillin – work by destroying the cell wall of a bacterium. This prohibits the bacterium from surviving, growing, and reproducing. In the experiment, the researchers used scanning electron microscopy to visualize the changes in the bacterial cultures’ cell structures. They saw that honey and ampicillin had similar effects on the shapes of the E. coli, that they affected it to a similar degree, and that honey had equal effects on normal and antibiotic-resistant E. coli.

As reported on the PLOS blog:

While scientists have yet to confirm the exact compounds responsible, the results of the above study support the idea that honey and ampicillin may have similar antibacterial efficacies, with possibly different mechanisms of attack.

But before you start smothering your toast with gooey goodness each morning or adding heaping spoonfuls to your tea, keep in mind that more research is needed to better understand the potential for honey’s medicinal use.

Previously: A look at our disappearing microbes
Photo by bionicgrrl

Addiction, Health Policy, Parenting, Pediatrics, Podcasts, Public Health

Discussing the American Academy of Pediatrics’ call to put the brakes on marijuana legalization

Discussing the American Academy of Pediatrics' call to put the brakes on marijuana legalization

A wave of changes in state laws on the use of marijuana for medicinal and recreational purposes has stirred the American Academy of Pediatrics. It’s taken 10 years for the AAP to update its policy on the legalization of marijuana, and they released its new one on Monday.

74381759_e5a563cf3d_zThe organization still opposes legalization but it has opened the door to reform in several ways. First, recognizing that minority kids bear the brunt of criminal penalties for pot use, they call for decriminalization. Second, they call for the U.S. Drug Enforcement Agency to reclassify marijuana from a Schedule 1 listing for controlled substances to a Schedule 2. This action would effectively allow more research to be conducted and in turn scientifically determine where marijuana is most effective as a treatment. A review by the federal government is currently underway.

I asked Stanford pediatrician Seth Ammerman, MD, the lead author of the statement, what the AAP was trying to achieve with its policy redo and why such a restrictive stance on legalization since the train for legalization – recreational and medicinal –  seems to have already left the “coffee house.”

In this 1:2:1 podcast, Ammerman cites major two concerns. First, if legalized and commercialized, marijuana will become a big business, and the same marketing efforts by tobacco companies that encouraged teens to take up cigarettes will lasso them to pot smoking. “Well, aren’t kids smoking pot already?” I asked. Ammerman fully realizes that any teen who wants pot can readily buy it – legalization, to the AAP, is an imprimatur. Secondly, Ammerman cited, as does the new policy statement, the compelling and growing scientific evidence that the brain in formation continues to gel through the teen years and into the 20s. Marijuana, just like alcohol and any other drug, is likely to play a lot of bad tricks as the prefrontal cortex solidifies.

As described in the policy paper:

New research has also demonstrated that the adolescent brain, particularly the prefrontal cortex areas controlling judgment and decision-making, is not fully developed until the mid-20s, raising questions about how any substance use may affect the developing brain. Research has shown that the younger an adolescent begins using drugs, including marijuana, the more likely it is that drug dependence or addiction will develop in adulthood.

Ammerman says that the AAP will follow closely what happens in states where marijuana has been legalized both for health and recreation, and it will look carefully at what future evidence suggests. Clearly, there’s still a lot of smoke around this issue.

Previously: To protect teens’ health, marijuana should not be legalized, says American Academy of Pediatrics
Photo by Paul-Henri S

Behavioral Science, Complementary Medicine, Mental Health, Parenting, Pediatrics, Research

Mindfulness and the fourth- and fifth-grade brain

Mindfulness and the fourth- and fifth-grade brain

Maths Homework

As a parent, this Time headline immediately grabbed my attention: “Mindfulness Exercises Improve Kids Math Scores.” But as I read the article, I learned that math scores were just one facet examined by the researchers and that mindfulness training was also shown to help children be less stressed and more caring.

The study, which was published in this month’s issue of Developmental Psychology, looked at a group of 99 fourth and fifth graders in British Columbia. For four months, half of the students were taught a pre-existing “personal responsibility” curriculum, while the rest learned about mindfulness through a program called MindUP that focuses on breathing exercises, mindful smelling and eating, and gratitude. The researchers then looked at cortisol levels, behavioral assessments, self-reports, along with those math scores. The article describes the results in more detail:

The results were dramatic. “I really did not anticipate that we would have so many positive findings across all the multiple levels we looked at,” says study co-author Kimberly A. Schonert-Reichl, a developmental psychologist at the University of British Columbia. “I was very surprised,” she says—especially considering that the intervention took place at the end of the year, notoriously the worst time for students’ self-control.

Compared to the kids in the social responsibility program, children with the mindful intervention had 15% better math scores, showed 24% more social behaviors, were 24% less aggressive and perceived themselves as 20% more prosocial. They outperformed their peers in cognitive control, stress levels, emotional control, optimism, empathy, mindfulness and aggression.

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Health Policy, Medical Education, Patient Care, SMS Unplugged

The downside of a free lunch: Incentives and the medical student

The downside of a free lunch: Incentives and the medical student

SMS (“Stanford Medical School”) Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

money on hook  smallDoctors are people, too, and they respond to incentives. That was the message we got from a recent health-policy class session that discussed various ways of paying doctors for their work, and how this can play a role in patient care. In an ideal world, physicians would be motivated only by what is best for their patients; however, the reality is that doctors, like all people, can be influenced by external factors such as money, autonomy, and time.

This got me thinking about the incentives that currently shape my life as a medical student. While we would all like to say that the choices we make are determined only by our own internal desire to maximize our learning and become the best future physicians possible, even the most idealistic student among us would have to admit that incentives, big and small, influence our decisions every single day.

On a day-to-day basis, incentives determine how we budget our time and focus our efforts. For example, given the huge demands on our time and our budgets, the promise of a free lunch provides a strong incentive for us to attend lunchtime seminars and panel discussions – even if the subject matter is not of immediate interest or relevance to us.

In class, because of the Pass/Fail grading system during our pre-clinical years, our external incentives are not our class grades, but instead the standardized board exam that will play an important role in our residency applications. Our collective ears perk up every time our professors say “This always shows up on the boards,” even if we are told that the particular information is rarely (if ever) applied in real-world clinical practice.

In the bigger picture, as we begin to explore various specialties and avenues for practicing medicine, it is impossible to ignore the reality that average salary, lifestyle, and autonomy vary hugely from one specialty to the next, and from one type of practice to another. Not feeling very passionate about private-practice urology? Does that change when you find out that urologists make about twice the annual salary of a family medicine doctor?

The reality is that our intrinsic motivations to make the world a better place by becoming the best possible physicians do not always align with the incentives that medical school, and the larger health-care system, provide. We are incentivized to spend time and effort on things that will not help us be better doctors, and in the long run we might even be incentivized to make decisions that will reduce the amount of good we can bring to the world. Is it the job of policymakers and medical educators to better align incentives to create the desired outcomes for our health-care system? Or do we, as future physicians, need to shoulder more responsibility to do the right thing, passing up the literal and figurative “free lunch” in the process?

Maybe there is an ideal middle ground for each of us – a place where the incentives align at least reasonably well with our own internal goals. In that case, one of our tasks as medical students for the next several years will be to find it.

Nathaniel Fleming is a first-year medical student and a native Oregonian. His interests include health policy and clinical research.

Photo by Tax Credits

Health and Fitness, Nutrition, Public Health

Why establishing a health baseline is a “critical starting point for achieving future health goals”

Why establishing a health baseline is a "critical starting point for achieving future health goals"

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Raise your hand if you want to be more successful at achieving health goals, such as losing weight or lowering your cholesterol levels, and maintaining a healthy lifestyle. Perhaps it’s time to consider creating a health baseline. “A health-care baseline is essentially where you are “at” on the broad, complex spectrum of physical, mental and emotional health,” explains Mary James, MD, an internal medicine physician at Stanford. “This can be a critical starting point for achieving future health goals.”

On Thursday, James will deliver an in-depth talk on the benefits of partnering with your primary care provider to establish a health baseline as part of the Stanford Health Library lecture series. Those unable to attend can watch the presentation online here.

In anticipation of the event, I contacted James to learn more about why its important to have a basis for comparison, beyond the ever-fluctuating number on your bathroom scale or if you’re able to fit into your skinny jeans, to use in measuring progress in meeting your health goals. Below she discusses how assessing the state of your health now can pay off in a longer, more active life in the future.

What is a health baseline?

Your baseline has two basic components: existing illness and potential future illness. Your current baseline has been shaped by your medical, social and family history and is constantly being influenced by common factors in everyday life. Although some components of your healthcare baseline are more modifiable than others, it is important to have an accurate understanding of your current health status.

Why is it important to determine your personal health baseline?

You may be thinking, “I’m healthy – I take no medications and never go to the doctor. Why should I start now?” There are two fundamental components to good health. They are: appropriate treatment for current illness and appropriate preventative care to reduce health decline in the future. While most people actively seek care for the former, we often forget about the latter. Although the data is mixed on whether “routine check ups” are beneficial, there is strong evidence behind many of the preventative maneuvers that are typically discussed and ordered at these visits. Taking appropriate preventative health-care steps can help you avoid the need for prescription medications, hospitalizations and procedures and can help ensure a longer, healthier life.

How can establishing a health baseline help you be more successful in reaching personal wellness goals?

Many wellness goals start with changes in diet and exercise. Your primary care provider can help determine how to start making these changes in a safe, effective manner. Are there exercises you should avoid due to chronic back pain? Is it okay to start running if you have high blood pressure? Is it safe for you to start a vegan diet? What is a safe amount of weight to lose?

Wellness also includes mental and emotional health. Your primary provider can help determine what treatment is most appropriate for common conditions such as depression and anxiety. Maybe you’ve been feeling “down” lately – is this true depression that warrants medical treatment, or is it safe try a new yoga or meditation class first? These are just a few of the many things that can be assessed and addressed as part of your health baseline. Together, you and your primary care provider can prioritize health problems and determine effective interventions.

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Humor, Medicine and Literature, Research, Science

Can science journals have beautiful prose?

Can science journals have beautiful prose?

5331998702_2e6ab9e5e8_zScientific journals are not known for being scintillating or inspiring reading. But could they be? A recent article in Nature elaborated on an online discussion started by Stephen Heard, an ecologist at the University of New Brunswick.

In a guest post on the Tree of Life science blog, Heard argued that snappier, livelier writing could attract and retain more readers. “Style and beauty are not incompatible with scientific writing,” he wrote. Papers could appeal to undergraduates, science writers, politicians, and the public.

But is a journal really an appropriate outlet for such writing? Blogs and commentaries might be better mediums for creativity and literary flair, as research articles often must adhere to a more rigid format and provide detailed descriptions of materials, methods and results. Participants in the online discussion have pointed out that clarity and order have a beauty in themselves, the inexorable logic on display in the progression from hypothesis to data to results. Others worried that stylishness would make science research less accessible to non-native speakers of English. Some mentioned (and critiqued) the conventional idea that whimsy and humor cover up flawed science and detract from clarity. And many others praised the idea of incorporating pleasure along with function.

In the original piece, Heard suggested three reasons scientists don’t write beautifully more often:

It could be that writing beautifully in scientific papers is a bad idea, and we know it. Perhaps readers don’t respect scientists who resist the conventional turgidity of our writing form. I don’t think this is true, although I’m aware of no formal analysis.

Or it could be that beauty is a good idea, but well-meaning reviewers and editors squash it. In my paper I argue that beauty (like humour) can recruit readers to a paper and retain them as they read; but that reviewers and editors tend to resist its use. But again, there’s no formal analysis, so I was forced to make both halves of that argument via anecdote.

Or it could be we just don’t have a culture of appreciating, and working to produce, beauty in our writing. I think this is most of the explanation: it’s not that we are opposed to beauty as much as it doesn’t occur to us that scientific writing could aspire to it.

He sees three ways this could change: scientists can add some whimsy to their own writing, leave it in others’ writing when editing, and praise it when they see it. He exclaims:

Wouldn’t it be great if there was an award for the best scientific writing of the year? I don’t mean the best science – we have plenty of awards for that – but the best writing to appear in our primary literature. Such awards exist for lay science writing; if one existed for technical writing I’d be thrilled to make nominations and I’d volunteer to judge.

Heard keeps his own science blog, Scientist Sees Squirrel.

Photo by Ashley Campbell

Cardiovascular Medicine, Patient Care, Stanford News

“This reinforced why I went into nursing”: The story of two nurses who resuscitated plane passenger

"This reinforced why I went into nursing": The story of two nurses who resuscitated plane passenger

Woo and BinghamStanford Health Care cardiac nurse coordinators Angela Bingham, RN, MSN, CNL, and Sophia Loo, RN, MSHCA, have cared for hundreds of patients with serious heart disease. And they’ve had access to sophisticated technology and colleagues who are skilled at teamwork. Then came the one time that none of that was at hand – and a life was at stake.

Last December, Loo and Bingham had just boarded a plane back home to San Jose from a national health-care conference when they heard a call for help. Both rushed forward and found a male passenger in obvious cardiac distress. They recognized instantly that he was near death, and what followed was a classic case of making the best of what they had.

In a story in yesterday’s Inside Stanford Medicine, Bingham and Loo share their experience and how much it meant to be able to do something they knew made a difference. “This reinforced why I went into nursing,” Loo told me for the story. “I was so humbled and grateful that I could do something; that Angela and I knew what to do.”

Photo by Norbert von der Groeben

Events, Immunology, Infectious Disease, Microbiology, Public Health

A look at our disappearing microbes

A look at our disappearing microbes

8146322408_5312e9deb2_zCould obesity, asthma, allergies, diabetes, and certain forms of cancer all share a common epidemiological origin? NYU microbiologist Martin Blaser, MD, thinks so – he calls these “modern plagues” and traces them to a diminished microbial presence in our bodies, caused by the overuse of antibiotics and the increased incidence of caesarian sections.

I attended a recent public lecture sponsored by UC Santa Cruz’s Microbiology and Environmental Toxicology department, during which the charismatic Blaser cited statistics about antibiotic use in childhood. Alarmingly, American children receive on average seventeen courses of antibiotics before they are twenty years old, taking a progressively bigger toll on their internal microbial ecosystems. We also have an unprecedented rate of c-sections – at nearly 33 percent. Babies delivered this way are deprived of contact with their mothers’ vaginal microbes, which in vaginal deliveries initiates the infant’s intestinal, respiratory, and skin flora. Breastfeeding has implications for beneficial bacterial transfer, too.

It’s not news that antibiotics are being overused – Stanford Medicine hosts an Antimicrobial Stewardship Program dedicated to this cause, and the CDC has been hosting a campaign for awareness about appropriate antibiotic use for several years, including their use in farm animals. (Seventy to eighty percent of antibiotic use takes place on farms to promote growth – that is, not for veterinary reasons.)

Overuse leads to antibiotic resistance, a serious problem. Meanwhile, research by Blaser and others – notably Stanford microbiologist David Relman, MD – has shown that abundant bacterial and viral life is essential to healthy bodies, and that imbalances in the microbial ecosystems that inhabit our gut play an important role in the chronic diseases of the modern age. Blaser said he is concerned that we’re going down a path where each generation has fewer and fewer species of microbes; part of his research is to compare human gut biodiversity in different parts of the globe, and people in remote areas of New Guinea have far more variety than those in Western nations.

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Mental Health, Neuroscience, Stanford News, Videos

Hope for the globby thing inside our skulls

Hope for the globby thing inside our skulls

While at the World Economic Forum annual meeting in Davos, neuroscientists Tony Wyss-Coray, PhD, and Amit Etkin, MD, PhD, had a webcast conversation with NPR correspondent Joe Palca as part of his series of conversations on brain science. During their conversation, Palca asked about the current state of treatment for mental health and neurodegenerative diseases (bad) and prospects for the future (better).

When asked the single most important thing people could do for their mental health, Etkin answered, “awareness”. He said people need to be aware of their mental health and know that help exists if they seek it out. Current treatments aren’t perfect, but they are better than no treatment at all.

They also discussed molecular tools for diagnosing degenerative diseases, and the goals of the Stanford Neurosciences Institute‘s Big Ideas in Neuroscience teams that the two co-lead to develop new diagnostics and treatments for mental health (Etkin) and neurodegenerative diseases (Wyss-Coray).

At the end, Palca summarized the wide-ranging conversation saying, “I think it’s a time of actually some hope. I feel quite positive that this globby thing that sits inside our skulls is being understood in enough detail to make some precise changes that can be helpful.”

Previously: Neurosciences get the limelight at DavosNeuroscientists dream big, come up with ideas for prosthetics, mental health, stroke and more

Global Health, Health Policy, In the News, Infectious Disease

President Obama and Indian Prime Minister praise partnership that led to rotavirus vaccine

President Obama and Indian Prime Minister praise partnership that led to rotavirus vaccine

Barack_Obama_talks_with_Narendra_ModiDuring his three-day visit to India, President Barack Obama issued a joint statement with Indian Prime Minister Narendra Modi praising the “highly successful collaboration” that led to the availability of a newly developed Indian rotavirus vaccine, which is expected to save 80,000 children in India alone each year.

The vaccine was developed with support from the Indo-U.S. Vaccine Action Program, co-chaired since 2009 by Harry Greenberg, MD, senior associate dean for research at the Stanford School of Medicine. Greenberg was the lead inventor of the first-generation vaccine for rotavirus, a severe diarrheal disease that kills between 300,000 and 400,000 children each in the developing world.

“This is the VAP’s biggest accomplishment to date,” Greenberg told me from Taiwan, where he is attending a conference. “The program really helped support the development of a new safe and effective rotavirus vaccine from the start to finish. And it’s the first time ever that a new vaccine was developed in a less developed country by and for that country and became licensed.”

The vaccine initiative, funded by the U.S. Public Health Service and the Indian government, was created in 1987 to help advance the development of new vaccines of importance to India. The NIH manages research grants in the United States for the vaccine program.

“The VAP has been the most successful, continuous program we have with India,” Roger Glass, MD, PhD, director of the NIH’s Fogarty International Center, wrote in an email from India to top NIH officials. “It’s amazing to me that this little research project on rotavirus with Harry Greenberg and George Curlin (former deputy director of NIH’s Division of Microbiology and Infectious Diseases) has turned into a real product that is being launched and will be used.”

A low-cost version of the vaccine, known as Rotavac, is being manufactured in India and was launched into the marketplace on Jan. 23, Greenberg said. It was the result of an unusual team effort involving diverse multinational groups of investigators from 13 institutions seeking to create a vaccine that was not only safe and effective, but also affordable enough for use in India and other low-income countries, Greenberg said. The Indian government is negotiating to purchase the vaccine for public distribution. The vaccine also will compete in the private market against at least two other commercially available vaccines.

In the joint statement, the two world leaders pledged continued support for the vaccine program, and Greenberg, who recently stepped down from his chairmanship, made an argument for now focusing the attention of the vaccine partnership on respiratory syncytial virus (RSV), a potentially serious lung disease that is prevalent in children in India and in other regions as well.

“RSV is an incredibly important pediatric pathogen all over the world, and there is now potential for great progress,” Greenberg said. “I suggested to VAP that it think about RSV as a new target for research. It has a huge public impact and it may well be that there are great advances to be made in the near future. I think that idea resonated with the people. We will see.”

Previously: Life-saving dollar-a-dose rotavirus vaccine attains clinical success in advanced India trial and Trials, and tribulations, of a rotavirus vaccine
Photo courtesy of The White House

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