As a scholar with ties in both humanities and medicine, I’m always interested when those realms intersect. Medical understanding of sexuality has been heavily influenced by social science and humanities research, and now a new frontier in sexuality studies, asexuality, is being pioneered at Stanford. 

Karli Cerankowski, PhD, who graduated from Stanford’s Program in Modern Thought and Literature last year and is a lecturer in Stanford’s Program in Writing and Rhetoric, is working on broadening our perception of healthy sexuality by including lower levels of sexual or romantic desire. Her work, recently spotlighted by Stanford News, traces people who might now identify as asexual through historical and pop cultural works, analyzing how they and society have interacted. She’s quoted in the Stanford News piece as saying that “society has normalized certain levels of sexual desire while pathologizing others. In a sense, it’s the social model that’s broken, not asexuals.”

Asexuality is a very new field of study, which exists under the wide umbrella of sexuality and gender studies. Cerankowski and her co-editor, Megan Milks, recently published the second book ever to be written on the topic. Thinking about the ways people experience their sexuality, desire, and gender informs how science and medicine understand optimal human health. Although sex and sexuality occupy a prominent place in our culture’s understanding of bodies, they are not prominent for every individual.

Cerankowski, again quoted in Stanford News, says:

If we recognize the diversity of human sexuality, then we can understand that there are some people who just don’t experience sexual attraction or have a lower sex drive or have less sex, and that doesn’t mean there is something wrong with them… We sort of prioritize sexual pleasure and sexual fulfillment in our lives, but we can think about the other ways that people experience intense pleasure, like when listening to music.

Pleasure and desire are important aspects of being human, but they don’t have to be tied to sex, or even to romance. On the wide spectrum of asexuality, there is room for those who engage neither in sex nor romance, as well as those who enjoy a romantic partnership and may engage in sex for reasons other than personal desire. This spectrum intersects with other aspects of sexuality that have also, though activism, become recognized as spectrums: sexual orientation, sexual identification, and gender identification.

Previously: Med students want more sexual health training, Changing the prevailing attitude about AIDS, gender and reproductive health in southern Africa and Living with disorders of sex development
Photo by trollhare

Do you do yoga, take probiotics, see a chiropractor, or follow a special diet? If so, you’re not alone; roughly 34 percent of Americans make use of complementary therapies, and these are among the most popular ways to do so.

You may have read about the CDC report (.pdf) that came out last month and showed the prevalence of complementary medical approaches among American adults. For more, check out this podcast from The Lancet, during which Josephine Briggs, MD, director of the National Center for Complementary and Integrative Health (NCCIH), and Richard Nahin, PhD, MPH, NCCIH’s lead epidemiologist, discuss the major findings of the report and some of the potential implications for public policy.

Previously: Study shows complementary medicine use high among children with chronic health conditions, More hospitals offering complementary medicine, Older adults increasingly turning to complementary medicine and Americans’ use of complementary medicine on the rise
Photo by lyn tally

In an article recently published in MedCity News, Kathryn Stecco, MD, a medical device entrepreneur who completed her residency in general surgery at Stanford, offers tips for women spearheading entrepreneurial endeavors in the medical technology industry. The piece is timely, as some have dubbed 2015 the “year of the technologically engaged patient.”

As Stecco writes, women with a medical background and an interest in technology have lots of opportunities, from working at small start-ups or large corporations to becoming a chief medical officer or finding a niche in law or finance. And, of course, they can start their own company. Unfortunately, though, few choose the latter option: Stecco notes in the piece that only three percent of technology companies are started by women.

To encourage more women to take the entrepreneurial leap, Stecco’s fundamental advice is to start with a big idea that fills a real unmet need. Beyond that, she suggests:

1. Pursue a practical solution:  Focus on products that are safe, effective and easy to use for both physician and patient. If the product doesn’t make physicians’ lives easier, they won’t use it. The product must produce meaningful clinical data that speaks for itself.
2. Build relationships – early – with clinicians: Medical entrepreneurs must be out in the field developing ties with physicians and getting their input early in the design process. No matter how well designed your product or how impressive your patents, physicians will have the last word on the usefulness of your product. They are vital to your success.
3. Be prepared to shift gears:  Don’t fall into the trap of becoming so enamored of an idea or a product that you lose sight of its real likelihood of succeeding in the marketplace. You must have the flexibility to move on to something else when changes in the environment cause the ground to shift under your feet and your plans to be upended.
4. Enjoy the ride!  Successful entrepreneurs make adversity the energy that fuels their creativity. They don’t learn their most valuable lessons in the classroom but in the trenches. They thrive on the long hours, the unpredictability, the rush that comes from building something important and valuable.

Previously: An online film festival for medtech inventors, Stanford alumni aim to redesign the breast pump and Medical technology entrepreneurs discuss challenges facing start-ups at Stanford event
Photo by jfcherry

This post is part of an ongoing series following a group of Stanford Biodesign fellows from India. The fellows will spend months immersed in the interdisciplinary environment of Stanford Bio-X, learning the Biodesign process of researching clinical needs and prototyping a medical device. The Biodesign program is now in its 14th year, and past fellows have successfully launched 36 companies focused on developing devices for unmet medical needs.

The first step in solving a medical challenge is identifying a problem in need of a solution. This seems intuitive, but often people start from the other direction – they’ve developed a technology and go looking for some way to apply it.

Learning that workflow is one thing that brought Shashi Ranjan to the Stanford Biodesign program from Singapore. “I was making devices but didn’t see them going into people,” he told me. “I wanted my technology to go into the real world.”

As the fellows encounter patients and doctors, they are compiling a list of existing medical needs.

Ranjan, along with Harsh Sheth, recently visited the Stanford South Asian Translational Heart Initiative run by Rajesh Dash, MD, PhD, to witness first-hand cardiovascular needs encountered by South Asians in the Bay Area. (The third member of their team, Debayan Saha, was at a different clinic that day.) After observing some patients, what became clear to the two is that lifestyle changes are a major barrier to improving cardiovascular disease risk in South Asians, just like in any other population.

Some of the problems they encountered appear obvious: How do you help people get more exercise and maintain a healthy weight? Develop a device to solve that and the team would help many more people than just patients with cardiovascular disease.

The two had also observed that many people who are overweight have sleep apnea, or short pauses in breathing during sleep, which can contribute to heart disease risk. The devices that exist to help sleep apnea look like cumbersome gas masks and aren’t conducive to a restful slumber. Several patients they observed don’t use the device regularly despite knowing that it could lower their risk of having a heart attack.

After observing patients, the pair added to their growing list of 300 plus medical needs a better air mask for sleep apnea, along with simplified screening for people who are at risk of heart disease. Patients at Dash’s clinic are asked to make routine visits for specialized bloodwork and other screenings. “Can we make the tests simpler but still effective, and available at the point of care?” Sheth asked.

I asked Dash why he wanted to work with Biodesign fellows like Ranjan and Sheth – their presence in the office visit certainly made the room tight and patients perhaps a tad uncomfortable. He told me that training people to make better medical devices is critical to providing good care.

The fellows from India are particularly valuable he said. “They learn how we are approaching the problem here then help find solutions that are effective in India.”

Over the next few weeks, the team will stop visiting clinics and will begin the arduous task of narrowing down their list of more than 300 observed medical needs to the one that will become the focus of their fellowship. (Four other teams are going through a similar process, and they’ll all present their prototypes at a symposium in June.)

Previously: One person’s normal = another person’s heart attack? and Biodesign program welcomes last class from India
Photo, of Shashi Ranjan and Harsh Sheth observing as Rajesh Dash, MD, meets with a patient, by Kurt Hickman

Learning that your teen has an eating disorder is baffling and deeply troubling news for parents. Our instincts are to protect and try to help our children out of the morass, but for decades, families were kept out of the treatment loop for teens with conditions like anorexia and bulimia.

The team at the Comprehensive Eating Disorders Program at Lucile Packard Children’s Hospital Stanford, led by psychiatrist James Lock, MD, PhD, is integrating the family into helping teens overcome their eating disorders. Lock recently sat down with the Stanford Medicine Newsletter for an informative Q&A about teen eating disorders.  He spoke about the historic reasoning for cutting parents out of treatment plans:

For most of the early 20th century, parents were erroneously blamed for mental illnesses in their offspring: So-called refrigerator mothers (those lacking warmth) caused autism, and overcontrolling parents caused anorexia nervosa, experts claimed. These ideas about causation are without foundation.

Research at Stanford and elsewhere has shown that parents can play a big role in helping their teens recover from eating disorders. For example, we have demonstrated that a specific family-based therapy is twice as effective as individual psychotherapy for treating anorexia nervosa.

And what to watch for in teens:

Warning signs include changes in eating patterns, skipping meals, increased driven exercise or discussion about weight, avoidance of desirable but calorically dense foods, refusing to eat with the family, vomiting, large amounts of food missing from the refrigerator and increased irritability and emotionality. If a parent sees these signs, it would be a good idea to make an appointment for an evaluation and consultation.

The full Q&A is worth a read.

Previously: Families can help their teens recover from anorexia, new study shows, A growing consensus for revamping anorexia nervosa treatment, Possible predictors of longer-term recovery from eating disorders, What a teenager wishes her parents knew about eating disorders and Research links bulimia to disordered impulse control
Photo by daniellehelm

Welcome to Biomed Bites, a weekly feature that introduces readers to some of Stanford’s most innovative researchers. 

In her family, Daria Mochly-Rosen, PhD, is the odd woman out: One parent and four of her siblings are architects.

But as the George D. Smith Professor in Translational Medicine at Stanford, Mochly-Rosen brings her family’s focus on space and design to her work as a biomedical researcher. “I’m looking at the cell as a physical space as a room or a building where things need to touch each other in certain ways,” Mochly-Rosen says in the video above.

She applies this lens of the world to address several basic research questions, including learning about how cells deal with stress. For a cell, stress isn’t a bad day at work or a rough commute home. Instead, its prolonged exposure to chemicals or physical forces that build up and impair cellular function.

In healthy cells, there are “lots of little machines” that reduce the stress, Mochly-Rosen said. In her lab, researchers work to enhance the efficacy of these built-in destressors and to capitalize on the cell’s existing machinery. She says:

We are really interested in finding ways to boost them up and to increase their activity so we can deal better with stresses that are associated with disease or even with simple aging.

And what we do there is we try to find small molecules — in other words, drugs — that will boost the system.

For example, Mochly-Rosen and her team have discovered a molecule that helps with the negative effects of alcohol and alcohol-related cancers.

Learn more about Stanford Medicine’s Biomedical Innovation Initiative and about other faculty leaders who are driving biomedical innovation here.

Previously: Why drug development is time consuming and expensive (hint: it’s hard), New painkiller could tackle pain, without risk of addiction and Stanford researchers show how hijacking an enzyme could help reduce cancer risk

When Atul Gawande, MD, MPH, witnessed the untimely and inevitable passing of patients, friends and his father, the shortcomings of our medical system’s approach to dying were revealed to him. As the noted author and surgeon told an overflow crowd at Stanford’s medical school earlier this week, he became inspired to “pick up my journalist’s pen” and explore questions about life and mortality that his elite medical education hadn’t equipped him to remedy.

Headlining the eighth annual Cynthia and Alexander Tseng, Jr., MD, Memorial Lecture, the former Stanford undergrad introduced his talk on end-of-life issues with the observation that begins his New York Times #1 book, Being Mortal: “I learned about a lot of things in medical school, but mortality wasn’t one of them.”

In a highly personal, and at times moving, talk, Gawande went on to discuss how decades of modern medical advances have changed our attitudes about dying and death. As fewer diseases and injuries pose life-threatening risks due to vastly improved medications and therapies, people simply expect to live longer. Well-being has become synonymous with longer and more robust life, supported at every stage by effective medical interventions, including a growing market of “lifestyle” rather than life-saving treatments.

Gawande argued that while health and medicine advances are of course positive, one consequence is that we have “medicalized our mortality” to the point where even terminally ill patients and their families look to their doctors for life-saving answers.

“Well, I didn’t [have the answers],” Gawande said.

Gawande said that medicine’s typical approach is to trade time and quality of life in the short term for longer life in the future, but the trade-off isn’t always a good one. For example, aggressive cancer treatment can be debilitating and painful, and often fails to prolong life, merely making the end of life miserable for patients.

In contrast, the goal of palliative care is to create the best possible day for patients today, regardless of what it means for the future. Studies show that for terminally ill patients palliative care improves quality of life, including people’s sense of control and empowerment over their lives. While these positive attitudes may be expected, palliative care practices reduce unwanted medical procedures (as well as costs) and have been shown to actually increase life span – by 25 percent in one study of late-stage lung cancer patients.

“If palliative doctors were a drug, the FDA would approve them,” Gawande told the audience.

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The scene: A group of medical students huddled around the iconic Robert Frank photograph Car Accident – U.S. 66, Between Winslow and Flagstaff, Arizona in the Cantor Center for the Visual Arts. They’re being led through an observation exercise by Sarah Naftalis, a doctoral student in art and art history at Stanford, as part of an innovative new medical school course supported by the Bioethics and Medical Humanities Scholarly Concentration.

Naftalis asks students what they see as she gestures to the photograph, which appears to have as its focal point four people standing out in a field, looking at something under a blanket on the ground. Several students note the people, the odd lumpiness of the blanket and the reduced horizon. Second year medical student Sam Cartmell says, “Well there may be more than four people,” and points to an odd contour at the shoulder of the lone female in the photograph. Cartmell’s observation sparks a lively debate, as his fellow students take turns looking closely at the work, seeking to discern what Cartmell has seen.

The concept behind this class is so important. If medical students can grasp these observation skills, it will really serve them well in their residencies and beyond.

That moment, explains Naftalis, illustrates the “productive ambiguities of art,” as well as the benefit of engaged close looking without “rushing to assign meaning to what we see.”

The practice of engaged close looking as a means to improve observational skills is a key goal of the course, which includes gallery sessions facilitated by doctoral students from the Department of Art and Art History at Stanford paired with a clinical correlate hour where School of Medicine faculty members applied the lessons of the art gallery portion to the clinical setting. Physicians from family medicine, orthopedics, dermatology, pathology and anesthesiology led discussions on a range of topics including narrative, body in motion, skin and tone, and death.

“The thematic organization was meant to inspire conversation across disciplines, by putting two takes on a similar theme in proximity to each other for two hours,” explains art history doctoral student Yinshi Lerman-Tan, who helped develop the course. “Bringing medicine into the space of the museum was a great aspect of the course – simply allowing different bodies of knowledge to exist under one roof. The medical students would sometimes use clinical vocabulary or concepts to describe works in the gallery, making for an interesting range of language in our discussions.”

Cartmell said one important take away for him from the course, which is called “The Art of Observation: Enhancing Clinical Skills Through Visual Analysis,” was learning to observe without jumping to interpretation. “I was surprised at how strong the impulse was to interpret the work, before I had actually observed the entire piece,” he says. The exercises the instructors led us through, describing what we saw objectively without commentary, really forced me to slow down and really see what was in front of me, without jumping to conclusions or interpretation.”

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Life in the air rescue business is highly unpredictable. You can spend many hours idling away the time in an obscure, basement office. But when an emergency call comes, you literally don’t have a second to grab a pen on the way out the door.

So it was on one November day, when I did a ride-along with Stanford’s illustrious Life Flight air ambulance service, the oldest in California. The team graciously agreed to let me accompany them on a flight for a story for Stanford Medicine magazine, whose current issue is focused on the role of time in medicine. Life Flight, I figured, would give me a sense of the split-second timing that can sometimes make a difference between life and death in an emergency situation. I was scheduled to fly with the crew in late October, but instead I spent that day learning about the service in what proved to be a leisurely day with no calls.

On my second ride-along day, it appeared that history was about to repeat itself when, just as my shift was about to end, the emergency call came in at 3:39 p.m. I became an eye witness to the rescue of a toddler who suffered a serious head injury when a heavy, ill-secured cabinet at her preschool crashed down on her head during naptime. The story was so dramatic that it made the local news. The school was shut down several days later by local officials because of code violations.

Things could have gone poorly for little Aeshna, the 3-year-old victim of the accident, who was left dazed, not fully conscious and vomiting as a result of her injury – clear signs of head trauma. She could have suffered significant bleeding in the brain and permanent brain damage – a prospect that was a major concern for her parents and caregivers.

The two Life Flight nurses, who have a breathtaking array of skills, and their veteran U.S. Navy pilot made it to the scene at the Fremont, Ca. preschool across the bay within 23 minutes of the call and were able to bring Aeshna back to Stanford for quick assessment and treatment.

You can read the minute-by-minute scenario of Aeshna’s rescue in the the magazine, which came out last week.

Previously: Stanford Medicine magazine reports on time’s intersection with health, Comparing the cost-effectiveness of helicopter transport and ambulances for trauma victims, Stanford Life Flight celebrates 30 years and Ask Stanford Med: Answers to your questions about wildnerness medicine
Illustration by Lincoln Agnew

SMS (“Stanford Medical School”) Unplugged was recently launched as 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.

A friend from home came to visit me a while back. I hadn’t seen this friend in years, so we traipsed off campus, to a café I love, and nursed our lattes as we caught up on each other’s lives. She told me about her recent travels, highlights from her college years, her plans for the next several months and more. And then she turned to me and asked me what I was up to these days. I described what my typical day was like – workout, go to classes, study, repeat.

When I was done, she asked – “So… outside of med school, what else are you involved in at Stanford? Start-ups? Student organizations? Research?”

I felt a slight flush come over my cheeks and found myself saying, almost sheepishly, “I’m mostly just focusing on med school.” Just. Just med school. 

We continued our chat, but when I came home later, my thoughts wandered back to that “just” and why I felt so guilty about not having many outside commitments in medical school.

I knew part of it was the knowledge that I had never been a one-task kind of girl. In high school, there was debate, science Olympiad, Indian classical dance, and more. In college, there was Camp Kesem, a fusion dance team and research. I poured hours and hours into each and every one of these activities, but something in me shifted when I came to medical school.

That mental transition was and continues to be such a difficult one for me. I know Stanford is an incredible place – with start-ups blossoming every which way and the word “innovation” being uttered somewhere on campus every minute (probably not an exaggeration). Everyone around me seems so impressive – with multiple research publications, various awards to their name, travels abroad to assist with surgeries, and so on. Don’t get me wrong, I love this passion at Stanford, this drive to change the world – it’s why I came here, and why I hope to stay here as long as possible.

But it’s also easy to look at every other person and wonder how they’re doing it all, and more than that, wonder why graduating  not only with an MD (after all, everyone in the class gets one of those!) but also a string of additional achievements, feels like the baseline expectation for med students.

In just a few weeks, my classmates and I are going to be done with our pre-clerkship years and those of us who aren’t taking one or more research years (myself included) will directly transition to clerkships. I can’t wait to spend hours speaking with patients, working in a team to figure out diagnoses, and brainstorming treatment plans. I can’t wait to experience that excitement when I realize what aspect of medicine I want to practice for the rest of my life and feel that puzzle piece slide snugly into place inside me.

And I can’t wait for the moment when I can leave out the “just,” to see that same friend and happily say, “I’m mostly focusing on med school. And I wouldn’t change a thing.”

Hamsika Chandrasekar is a second-year student at Stanford’s medical school. She has an interest in medical education and pediatrics.

Photo by Dr.Farouk