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Medicine and Literature, Podcasts, Public Health, Science

Jonas Salk: A life

Jonas Salk: A life

Salk book coverIn 1954, Charlotte DeCroes stood in line with her fellow second graders in Kingsport, Tennessee and received the polio vaccine. Her Tennessee hometown was one of the test sites for what was then the largest and most significant clinical trial in the history of medicine. By the end of 1953, there were 35,968 reported polio cases, and the United States was desperate to solve this devastating illness. A survey at the time ranked fear of polio second only to fear of atomic warfare.

Fast forward to 2015. Charlotte Jacobs, MD, professor of medicine, emerita at Stanford, has written a highly acclaimed biography of the famed researcher/physician Jonas Salk, MD, who developed the polio vaccine. In this 1:2:1 podcast, she told me that her ten-year journey into Salk’s life was instigated partly because she couldn’t find a thorough autobiography on him, something she considered a historical lapse.

Jacobs has written a finely honed and balanced portrait – saluting Salk’s great accomplishment while not flinching from describing a man who was enigmatic, complex and all too human. She conducted more than a hundred personal interviews and spoke to two of his three sons along with his longtime private secretary. The dichotomies of his life are fascinating. While he was loved and lauded by the public and the media, he was a pariah in the scientific community – never appreciated, accepted or awarded. (His scientific colleagues thought he was a press hound, an impression that was fueled by the media’s adoring gaze – covers and feature articles in the most popular media of the time, including Life, Time, Colliers, Consumer Reports, Popular Mechanics and U.S. News and World Report.)

Today, with vaccine wars sweeping certain areas of the country, Jacobs reminds us of a time when a major public-health crisis engulfed the nation and of a hero who made a difference and changed the landscape of medical history. It’s worth remembering.

Previously: Charlotte Jacobs on finding “snippets during every day” to balance careers in medicine and literatureStanford doctor-author brings historic figure Jonas Salk to life and Prescribing a story? Medicine meets literature in “narrative medicine”

Infectious Disease, Public Health, Research, Stanford News

Hikers beware: New tick-borne disease discovered in Northern California parks

Hikers beware: New tick-borne disease discovered in Northern California parks

dan with wood rat 3Meet Dan Salkeld, PhD, a disease ecologist and friend, shown here looking for ticks on a wood rat from the San Francisco Bay Area. According to Popular Science, he has one of the worst jobs in science: tick collecting.

But thanks to the nitpicky diligence of Salkeld and co-author Eric Lambin, PhD, a senior fellow at the Stanford Woods Institute for the Environment, Bay Area residents now know that getting sick from a tick bite is a real and present danger — in a recent study published in PLoS One, the researchers found that 10.6 percent of young nymph ticks and 8.1 percent of adult ticks harbored the disease-causing bacteria Borrelia miyamotoi and/or Borrelia burgdorferi, the causative agent of Lyme disease. (See map below for tick collection areas.)

“We continue to be surprised by the number of ticks carrying Borrelia burgdorferi and Borrelia miyamotoi throughout the Bay Area, and we believe more research into the connections between human disease and strains and species of bacteria is critical,” said Salkeld. “It was astonishing that we could see such variety in tick ecology, ranging from low tick infection risk on one trail to high tick infection risk on another trail in the same park.”

First discovered in the United States in 2013, the most extensive analysis of Borrelia miyamotoi infections in U.S. residents was published in the July issue of Annals of Internal Medicine. In this study, 51 patients from the Northeast were found to be “frequently very ill” with fever, headache (often severe), muscle pain, fatigue and joint pain. Almost one quarter of the patients required hospitalization. The researchers also found that the miyamotoi infections were not reliably detected by the standard two-tiered Lyme blood test and these patients didn’t develop the hallmark sign of Lyme disease, the bullseye rash.

“This research offers some insights into the complexity of diagnosing patients with tick-borne diseases, and the need for medical professionals to be alert to the different symptoms of this newly discovered infection,” said Linda Giampa, executive director, of the Bay Area Lyme Foundation, which funded this study.

The Bay Area Lyme Foundation also funds a number of projects at Stanford’s Lyme Disease Working Group, which is exploring ways to improve diagnostic tests, evaluate the effectiveness of innovative therapies, expand clinical services and build greater public awareness of tick-borne diseases.

SFBay_Parks_PLoS-One

Previously: Stanford study finds Lyme disease among ticks in California parksAdd a tick check to your vacation checklistPiecing together the clues: Diagnosing and treating autonomic disorders
Photo courtesy of Bay Area Lyme Foundation; map from PLoS One

Chronic Disease, Neuroscience, Pain, Research, Stanford News

Study: Effects of chronic pain on relationships can lead to emotional distress

Study: Effects of chronic pain on relationships can lead to emotional distress

sad womanIt’s not surprising that people living with chronic pain often have high levels of emotional distress. The question that Stanford researcher Drew Sturgeon, MD, a postdoctoral pain psychology fellow in the Stanford Pain Management Center, recently aimed to determine was why. Is a patient’s depression or anger caused by his or her inability to do physical things or is it perhaps because pain can limit social relationships?

“What I hear from patients is that it’s not just that it hurts, but that the pain takes you away from things that matter to you – the things that are meaningful to you,” Sturgeon recently said.

To explore this further, Sturgeon and colleagues analyzed data from 675 patients who came into the Stanford pain clinic and filled out data sets for the national open source Collaborative Health Outcomes Information Registry, referred to as CHOIR. CHOIR is a registry that originated at the Stanford pain center to help improve the collection and reporting of data on pain.

The researchers examined both physical functioning and social satisfaction reported by chronic pain patients, since both have been shown to play a role in causing anger and depression. Their results — published online recently in the journal Pain — show that the effects of chronic pain on a patient’s social relationships can be a key trigger of depression and anger, even more so than the limits that pain can place on physical activity.

“My suspicion was that there was going to be a stronger frustration when [the pain] affects social relations,” Sturgeon told me. “Relationships are one of the strongest predictors of mood. If you’re an avid bicyclist and can no longer cycle, that’s frustrating. But if cycling is the primary source of your social relationships, that’s even more frustrating.”

“The conversation when you have a patient with chronic pain who is very depressed tends to [focus on] how we treat the pain,” he continued. “Perhaps considering how the pain is affecting the people around the patient is also important… This is something that as a field we haven’t been paying very good attention to.”

Previously: National survey reveals extent of Americans living with pain, Chronic pain: getting your head around it and Advances in pain research and treatment
Photo by rochelle hartman

Patient Care, Pediatrics, Public Health, Stanford News, Surgery

Story highlights teens’ life-changing weight loss

Story highlights teens' life-changing weight loss

Over on the Healthy, Happier Lives blog today: A look at how bariatric surgery, combined with a strict diet plan and exercise regime, benefited two San Jose, Calif. teens. The siblings lost a combined total of more than 200 pounds and in the process have reduced their risk of obesity-related medical complications and improved their quality of life. “It’s been a life-changing transformation,” Sophia Yen, MD, an adolescent medicine specialist with Lucile Packard Children’s Hospital, commented.

Previously: The challenges of dieting and the promises of bariatric surgery and Bariatric surgery may help protect teen patients’ hearts

Mental Health, Pediatrics, Public Health, Stanford News

Stanford psychiatrist: It’s my “mission to help people develop to their full potential”

Carrion talking to patientHow can a person fully develop his or her potential, regardless of life circumstances? This is the question that brought Stanford child and adolescent psychiatrist Victor Carrion, MD, to his work on child anxiety and mood disorders. Carrion, who also directs the Stanford Early Life Stress and Pediatric Anxiety Research Program at Lucile Packard Children’s Hospital, just won the Silicon Valley Business Journal‘s Excellence in Healthcare award for his dedication to this question.

In an article describing this honor, Carrion says he’s always wanted to go into medicine and explore human behavior. While he’s very proud of the advances his lab has made in understanding the impact of early life stress on behavior, he also notes that there remain significant barriers to mental health in the region, including stigma and accessibility of treatment.

One of the innovative programs Carrion has been involved in is a study on the effectiveness of a health and wellness program in the Ravenswood City School District in East Palo Alto. The program teaches kids about mindfulness and positive habits that encourage calm, focused attitudes; Carrion and his colleagues will follow student participants over the next four years, tracking cognitive function, academic strengths and weaknesses, behavior, and stress-related hormone levels.

Previously: Stanford researchers use yoga to help underserve youth manage stress and gain focusProlonged fatigue and mood disorders among teensYoga classes may boost high school students’ mental well-beingLucile Packard Children’s Hospital partners with high schools on student mental health programs and More evidence that chronic stress may increase children’s risk of obesity
Photo courtesy of Stanford Medicine News

Genetics, Research, Science, Stanford News

Annoying anemones shed light on coral reef biology

Annoying anemones shed light on coral reef biology

Bleached CoralI stopped by John Pringle’s office last week to hear about what he’s been up to. A lot! As we mentioned here a few months ago, Pringle, PhD, a professor of genetics who spent the first decades of his career studying yeast genetics and cell biology, has switched gears and is looking for ways to help corals — while continuing a lifetime of basic research.

Corals and the incredibly species-rich ecosystems they support are disappearing fast in nearly every part of the world’s oceans. Coral reefs protect coastlines, sustain rich fisheries and support some of the most species-rich habitats in the world. Yet, around the world, a third of all coral has died.

The first sign of stress is a fading, or “bleaching,” of the coral that reflects the loss of photosynthetic algae that live inside the coral. In a quest to understand the molecular underpinnings of bleaching in corals, Pringle and two colleagues at Stanford helped sequence the genome of a small sea anemone that serves as a model for corals. They report their work this week in PNAS.

I asked Pringle what they’d found. But first, he wanted to tell me about his colleagues Christian Voolstra, PhD, Sebastian Baumgarten, and others at the Red Sea Research Center, in Thuwal, Saudi Arabia, where much of the experimental work and analysis took place. Pringle said the center is part of the King Abdullah University of Science and Technology, or KAUST, a six-year-old university with top researchers from around the world and a $20 billion endowment.

Although it’s easy to mistake coral for some kind of weird rock, corals are animals. But lab animals they are not. They grow slowly, in large colonies of tiny individuals, die easily and retreat inside their hard coral quarters when they aren’t happy.

A better option, Pringle learned, was a sea anemone called Aiptasia. Aiptasia is a pest that drives aquarium hobbyists to distraction. It thrives in captivity, takes over aquaria, and is seemingly impossible to eradicate — in short, the perfect lab animal.

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In the News, Parenting, Patient Care, Pregnancy, Public Health, Women's Health

Low-tech yet essential: Why parents are vital members of care teams for premature babies

Low-tech yet essential: Why parents are vital members of care teams for premature babies

3297657033_081d4f3630_zThanks to recent advances in medicine, technology and research, most premature babies born in the United States face better odds of surviving than ever before. Yet, the number of premature births in the U.S. remains relatively high, with a rate that’s on par with that of Somalia, Thailand and Turkey.

For the parents of a premature baby, an early birth can transform what was supposed to be a happy event into a stressful one, says Henry Lee, MD, an assistant professor of pediatrics at Lucile Packard Children’s Hospital Stanford. In a recent U.S. News & World Report article penned by Lee, he discusses why it’s important for parents, and beneficial for the baby, when parents are active members of the child’s medical team:

Giving birth to a preemie, especially when it’s unexpected, leaves many parents feeling unprepared and helpless. But we make it clear very early. “You, the parent, are a critical part of our medical team.” That’s right. Even in the heart of Silicon Valley where we’re located, two of our biggest assets are decidedly low-tech workers: the baby’s mom and dad.

Including parents in the care of preemies is a standard that was unheard of in the early days of neonatology, but is now used in leading NICUs for one critical reason: It works.

Here’s an example of how parents contribute. Studies have shown that skin-to-skin care, also known as kangaroo care, can have beneficial effects on preterm neonates, including improved temperature and heart rate stability. In many NICUs, you will see babies – clad only in a diaper and covered by a blanket – placed prone position on the chest of either the mother or the father. This intimate method of care provides a preterm baby a natural environment for rest, growth and healing.

No matter when a baby is born, term or preterm, families know their children best. A parent’s contribution is critical to treating these most vulnerable of newborns.

Previously: How Stanford researchers are working to understand the complexities of preterm birthNew research center aims to understand premature birth and A look at the world’s smallest preterm babies
Photo by Sarah Hopkins

Grand Roundup

Grand Roundup: Top posts of August

Grand Roundup: Top posts of August

It’s time to look back at this month’s five-most read stories on Scope. They were:

Eating for good blood: Tips for boosting iron levels and hemoglobin: This entry from the Stanford Blood Center discusses hemoglobin levels and offers ways to boost levels prior to blood donation.

Stanford Medicine’s white coat and stethoscope ceremony, in pictures: The school’s white coat and stethoscope ceremony was held earlier this month, and photographer Norbert von der Groeben was there to capture some special moments.

Blacks, Hispanics and low-income kids with stomach aches treated differently in ERs: A recently published study found that certain children who came to the ER with stomach aches were less likely to receive imaging that could help their physicians diagnose serious conditions like appendicitis. These patients were also less likely to be admitted to the hospital for further care.

Exploring the benefits of pursuing anthropology and medicine: This piece captures the thoughts of two medical anthropologists who are pursuing PhD/MD degrees.

“What might they be interested in learning from me?” Tips on medical advocacy: As part of our Inspire series, a patient with Marfan syndrome talks about medical advocacy.I want to be a source of support and let patients know that they’re not alone and that there are better days ahead,” he writes.

Our most-shared story of the month: Exploring the benefits of pursuing anthropology and medicine

And still going strong – the most popular post from the past:

The mystery surrounding lung-transplant survival rates: A 2012 article in the San Francisco Chronicle provided a look at the challenges facing lung transplant patients and explored why a significant number don’t live beyond the five-year mark, despite improvements in survival rates.

Autism, In the News, Neuroscience

A tribute to Oliver Sacks, from a science writer

A tribute to Oliver Sacks, from a science writer

Library-stacksThe news this weekend of neurologist and writer Oliver Sacks’ death brought back a crystalline memory of myself at 18, searching through the library stacks for a copy of his 1973 book, Awakenings. I needed it because the brains did not show up.

An explanation is in order: The spring semester of my college-freshman biology class included a six-week lab elective. Of a few dozen elective options, I picked “The Brain” because the descriptive blurb said each student would get to dissect a sheep brain. I was a bit grossed out by the idea of a sheep brain in front of me on a tray, but my curiosity outweighed my squeamishness. I intensely wanted to examine a real brain.

However, on the first day of The Brain, our teaching assistant broke the bad news: No brains. The room moaned in dismay.

“I know,” he said. “I’m really sorry. To make it up to you, I’m going to let you each do a short report on anything you want, as long as it has some relationship to the brain.”

I had seen the movie version of Awakenings a few years earlier (with Robin Williams playing Sacks) and remembered my mom saying that there was a book, too, but that she had heard it was clinical and dull. Well, I thought, clinical isn’t so bad, and I can stomach dull if it lets me present a book report about a weird brain disease. The TA approved my topic, and off I went to the university’s biomedical library, where the long, dim, badly ventilated staircases gave me attacks of claustrophobia.

Up the dreaded stairs, through the overheated, papery-smelling stacks to the book itself: A library edition, small and lightweight in my hands, bound in an ugly turquoise cover. A book that, once I opened it, I could not put down. Yes, the writing was clinical – there were medical words, and patients were disguised behind names like “Miriam H.” – but dull? No. An adventure in the brain: patients who had been frozen for decades with post-encephalitic parkinsonian syndrome coming to life again when Sacks gave them a drug, only to slowly sink back into their freeze as the drug stopped working for them.

The main thing I remember thinking is: Eeeeeeee! I want to write stories like this! It did not seem like a dream that had any hope of being realized, since I had no intention of becoming a neurologist. I let the impulse go, prepared my Brain report (a success), and subsequently read many more of Sacks’ books – with great pleasure.

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In the News, Medical Education, Mental Health, Stanford News

An Rx for physician burnout

An Rx for physician burnout

artsy stethoscope - 250Burnout, which is characterized by emotional exhaustion, a sense of depersonalization and a lack of a sense of personal accomplishment, is on the rise among physicians and medical residents and students in the United States. A lengthy article (subscription required) published Friday in Time examines the growing problem and the movement to save physicians’ mental health:

Experts warn that the mental health of doctors is reaching the point of crisis—and the consequences of their unhappiness go far beyond their personal lives. Studies have linked burnout to an increase in unprofessional behavior and lower patient satisfaction. When patients are under the care of physicians with reduced empathy—which often comes with burnout—they have worse outcomes and adhere less to their doctors’ orders. It even takes people longer to recover when their doctor is down.

Many factors contribute to physician burnout, including long-hours, a high-pressure work environment, the stigma against weakness and mistreatment from higher-ranking physicians. Efforts are underway to change the culture of medicine and alleviate these sources of stress, and much of the story focuses on what’s happening here at Stanford:

In 2011, [Ralph Greco, MD, professor of surgery a Stanford,] Chaplain [Bruce Feldstein, MD,] and a few other colleagues, including [Arghavan Salles, MD, former chief resident of general surgery at Stanford], got together to discuss how to change things. “When people go somewhere new, they lose everything that was around them that supported them, and it’s very natural to doubt them- selves,” says Salles. “I had this idea that we could have sessions where people talk to each other, and then it wouldn’t be so lonely.”

They put together a program at Stanford to promote psychological well-being, physical health and mentoring. Every week, one of the six groups of surgery residents has a mandatory psychotherapy session with a psychologist. Each senior resident mentors a junior resident, and residents are given time for team bonding. Young doctors rarely have time to go see a doctor of their own, so the wellness team issues lists of doctors and dentists it recommends. And there’s now a refrigerator in the surgery residents’ lounge, stocked with healthy foods. They call the program Balance in Life.

“We knew we couldn’t necessarily prevent suicide—too complicated for us to solve it,” Greco says. “But we needed to feel we did everything we could do to prevent it, if we could.”

Previously: Stanford’s “time banking” program helps emergency room physicians avoid burnoutKeeping an even keel: Stanford surgery residents learn to balance work and lifeA call to action to improve balance and reduce stress in the lives of resident physicians and Program for residents reflects “massive change” in surgeon mentality
Photo by Lidor

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