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Cardiovascular Medicine, Patient Care

One person’s normal = another person’s heart attack?

One person's normal = another person's heart attack?

Much has been written about calculating your BMI (or body mass index, the relationship between your height to your weight) and what it might indicate about your health.

Similarly, the glucose level in your bloodstream and what it says about your risk of diabetes.

What you don’t hear much about, and what I learned yesterday, is how much the meaning of those numbers can vary between people. A healthy BMI for one person might put another person at risk for heart disease.

I was visiting the Stanford South Asian Translational Heart Initiative run by Rajiv Dash, MD, PhD, along with some Biodesign fellows I’ve been following (more about that in a later post). By way of background on the clinic, Dash explained the high risk of heart disease in the South Asian population. (My colleague Becky Bach blogged about that risk last year.)

Dash said one challenge in helping South Asians avoid heart disease comes from the definition of “overwieight” and “diabetic”. Dash said that South Asians tend to have more fat per body weight, and so might have an acceptable BMI but still have an amount of fat that puts them at risk for heart disease. Similarly, a South Asian person who is pre-diabetic might benefit from diabetes medication.

“We see a lot of glucose levels that are technically normal but still troubling,” he told me. “Their risk of a cardiovascular event is almost as high as for someone who has diabetes.”

For a population that has four times more heart attacks in California than other ethnic groups, it seemed especially troubling that a mere definition might be preventing them from getting appropriate care.

That got me wondering how those numbers apply to other populations. Or to me.

I had my yearly blood work done recently and was pleased to see that everything was “normal”. I’m curious if in a decade people like Dash and others might have collected enough data to sway the way our values get reported. A set of numbers that is normal for my gender and ethnicity might trigger additional screening in another person, or be considered better than normal for someone else.

Previously: A ssathi (partner) to thwart heart disease in South Asians, Biodesign program welcomes last class from India

Bioengineering, Stanford News

Biodesign program welcomes last class from India

Biodesign program welcomes last class from India

Clark CenterIn January, three fellows from India arrived to Stanford to join the Biodesign program, which immerses clinicians, scientists, engineers and business people in the biodesign process for innovating successful medical devices.

What makes these three unique is that they’re the last class from the Stanford-India Biodesign program to visit home base, housed within the Clark Center and the interdisciplinary environment of Stanford Bio-X. The Indian program has been so successful that after this year they will become independent.

I’ll be following this final group of Indian fellows on their whirlwind tour of clinics, prototyping demos, brainstorming sessions, and courses on intellectual property and regulatory steps as they develop and prototype a medical device – and blogging about them along the way.

The three fellows I’ll be following – Debayan Saha, Shashi Ranjan, PhD, and Harsh Sheth, MD – all say they were drawn to the program in part because of its unique approach. Commonly, people develop medical devices and then look for a problem to apply it to. Or, they come up with a prototype that meets a real need, but don’t research the intellectual property or costs in advance and fail because of that oversight.

In the end, real needs are unmet.

In the Biodesign program, fellows first observe clinicians to learn what the needs are. Then they research the intellectual property, medical costs of the disease, and regulatory hurdles they would have to overcome before they ever start prototyping.

The end result has been 36 start-up companies and international programs in India, Singapore and Ireland all trying to replicate the process and meet their country’s own unique medical needs.

By June, Saha, Ranjan and Sheth will have developed a device prototype that solves a medical need in cardiovascular medicine, and that could potentially get to market. Sheth brings clinical expertise – he is a surgeon – while Ranjan and Saha both have engineering backgrounds.

So far, the group says their clinical visits have resulted in a list of more than 300 needs, which they say will grow before it shrinks down to the final one they decide to address. I’ll be documenting the process of whittling 300+ needs down to a single prototype, and interviewing leaders in Biodesign along the way.

For my next installment: The fellows visit a south Asian cardiovascular disease clinic run by Rajesh Dash, MD, PhD, and wonder if a device can change patient attitudes.

Previously: Biodesign fellows take on night terrors in children, Stanford Biodesign Program releases video series on the FDA system and A medical invention that brings tears to your eyes
Photo of the Clark Center by L.A. Cicero

Cancer, Research, Stanford News

The medical benefits of a little chemistry know-how

The medical benefits of a little chemistry know-how

molecules and beakers

I’ve been writing about medical science for close to 20 years now, and in that time I shudder to think how often I’ve written stories about basic science discoveries that could result in potential future drugs.

I wasn’t exaggerating in those stories. The scientists I had the pleasure of working with really were hopeful about the potential of treating patients. But developing a drug is a long and arduous process and not all discoveries lend themselves to drugs.

As I wrote in a story today:

The chemical in the pill we swallow has to survive the burbling acidic soup of our stomachs and the digestive enzymes capable of reducing steak and potatoes into tiny particles. Once in our bloodstream, a potential drug has to endure the liver’s attempts to detoxify it, and then reach the cell in question and – the hardest part – actually work.

Overcoming those obstacles and turning that discovery into a drug requires medicinal chemistry know-how as well as a detailed knowledge of the drug development and approval process, which aren’t skills in the toolbox of most biologists.

In today’s story, which describes a discovery in pancreatic cancer cells by gastroenterologist Anson Lowe, MD, that could result in a new drug for several different types of cancers, I also got to write about a new medicinal chemistry program started by Stanford ChEM-H.

ChEM-H is a relatively new interdisciplinary institute with a focus on bringing chemistry expertise to issues in human health. With their new medicinal chemistry program, the institute is hoping they can help people like Lowe fulfill the promise that I’ve written about in so many stories – that of turning a discovery into a drug that helps people.

Previously: Stanford ChEM-H bridges chemistry, engineering and medicine, Listening in on the Ras pathway identifies new target for cancer therapy, and New clues arise in pancreatic cancer from Stanford researchers
Photo from Shutterstock

Aging, Neuroscience, Stanford News, Stroke, Videos

Bio-X undergraduate student finds direction through research

Bio-X undergraduate student finds direction through research

Richie Sapp arrived to Stanford as an undergraduate already interested in studying neuroscience. After talking with several faculty members, he ended up working in the lab of Carla Shatz, PhD, director of Stanford Bio-X.

I interviewed Sapp recently for a series of stories I was working on about undergraduate research opportunities at Stanford. He had participated in a terrific summer program run by Bio-X. I was struck by a few things when we talked, one of which was Sapp’s sincere interest in helping people. He had grown up with a twin brother who had been born with hydrocephaly and as a result had learning delays and is on the autism spectrum. That experience shaped his interest in helping people with similar challenges.

Sapp said that through his experience in the lab he got more out of his undergraduate classes and learned a lot about where he wants to go with his life. He loves the research and discovery, but also wants to go the medical school before pursuing research. Without the experience provided by the Bio-X summer program he might not have known which direction to go.

“The experience of designing experiments and seeing a project through to the end is going to be important for me in whatever I do next,” he said.

Here is the full profile about Sapp, with more about his research experiences.

Previously: Drug helps old brains learn new tricks, and heal

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

Mental Health, Neuroscience, Stroke

Neurosciences get the limelight at Davos

Neurosciences get the limelight at Davos

IMG_0887Four faculty from the Stanford Neurosciences Institute have been in Davos for the past few days attending the World Economic Forum along with world leaders and economic illuminati. They were invited to form a panel about the recently announced Big Ideas in Neuroscience, which is a novel way of bringing faculty together around health challenges like stroke, neurodegenerative disease and mental health conditions. If this approach is successful it could help ease the crippling economic and emotional costs of those diseases.

Amit Etkin, MD, PhD, emailed me from the conference that attendees seem to be very excited and focused on the sessions, with lines out the door of people waiting for seating. The entire panel included Etkin, who co-leads a mental health team, Marion Buckwalter, MD, PhD, who leads a stroke collaboration, and Tony Wyss-Coray, PhD, and Anne Brunet, PhD, who are both part of the neurodegenerative disease team.

Tomorrow at 6 a.m. Pacific Time both Etkin and Wyss-Coray will be webcast live in conversation with NPR correspondent Joe Palca. That webcast is available on the World Economic Forum website.

Previously: Neuroscientists dream big, come up with ideas for prosthetics, mental health, stroke and more, Stanford expert responds to questions about brain repair and the future of neuroscience

Infectious Disease, Research, Science, Stanford News

Science Friday-style podcast explains work toward a universal flu vaccine

Science Friday-style podcast explains work toward a universal flu vaccine

I had the pleasure of teaching a class this fall to a group of mostly chemistry and chemical engineering graduate students, helping them improve their skills communicating about their science with the public. For her assignment, graduate student Julie Fogarty recorded this Science Friday-style segment on work taking place in the lab of chemical biologist and bioengineer James Swartz, PhD. Swartz and colleagues are trying to develop a universal flu vaccine that would eliminate the need to get a new vaccine each year – something all of us would probably appreciate. (Here I’m thinking about my colleague Michelle Brandt, who recently suffered the woes of not finding time to get her kids vaccinated.)

Julie’s brother Skyped in for his role as Science Friday host extraordinaire Ira Flatow in this segment, while Julie played the enthusiastic and articulate guest. It’s often difficult to explain complex science in audio format, but Julie does a fantastic job explaining the work in way that is very visual. I love her description of the flu virus as a little mushroom.

(A previous blog entry featured another student, Rhiannon Thomas-Tran, who produced a great video about her work.)

Previously: Working to create a universal flu vaccine, Graduate student explains pain research in two-minute video and How one mom learned the importance of the flu shot – the hard way

Pain, Science, Stanford News, Videos

Graduate student explains pain research in two-minute video

Graduate student explains pain research in two-minute video

Earlier this year I wrote about some fascinating research from the lab of chemist Justin Du Bois, PhD, who has been working with naturally occurring toxins with the goal of developing ways of combatting pain. This class of toxins is found in a number of poisonous animals, including the newts scurrying around Stanford campus, puffer fish and mollusks in red tides.

Now, graduate student Rhiannon Thomas-Tran, who has been working with Du Bois, produced a great video describing their approach, complete with some pretty creative drawings.

Previously: Toxins in newts lead to new way of locating pain

Neuroscience, Research, Stanford News

Building a bridge between education and neuroscience

Building a bridge between education and neuroscience

3537327425_d0c519ed1e_zIt wasn’t long ago that my kids could barely identify all the letters in the alphabet and now I have to yell at them to put down books and eat dinner. That transition, from identifying symbols to learning how to interpret them in math and reading, is something that involves creating new pathways in the brain.

Neuroscientists have long known that those changes must be taking place in the brain, but only recently has brain imaging been good enough to reveal where and how those changes are taking place. With that advance, neuroscientists and faculty in the School of Education are now starting to work together to better understand the changes and also come up with ways of using what’s learned in neuroscience to develop ways of helping kids who fall behind.

I recently wrote about a new education professor, Bruce McCandliss, PhD, who is pulling together the interdisciplinary team of faculty from across Stanford to build the educational neuroscience program here. From my story:

In one set of experiments, McCandliss used a type of brain imaging that reveals connections or tracts of neurons to look at the brains of kids who were good readers and others who showed signs of dyslexia. He found that the kids who were better readers had stronger brain connections in that region.

“There is a profound relationship between the way a person’s brain is organized and how well that person masters abstract intellectual skills, such as reading or mathematics,” he said.

In a follow-up study, he and a team that included Allan Reiss, the Howard C. Robbins Professor of Psychiatry and Behavioral Sciences and professor of radiology, found that kids with dyslexia who activate a particular brain region when trying to read went on to make much greater improvements in their reading ability. Kids who did not activate that region made very little reading gain after the age of 14.

“The hope is that by understanding the nature of these differences we might be able to tailor interventions for those individuals,” McCandliss said.

The people I talked with for my story all said that we have many years to go before discoveries made in the lab start showing up as personalized learning in the classroom. Still, it’s nice to think that some of the kids who are struggling with reading or math might one day be able to get help that’s based on what’s actually known about learning in the brain.

Previously: Learning how we learn to read, Study shows brain scans could help identify dyslexia in children before they start to read and Stanford study furthers understanding of reading disorders
Photo by John Morgan

History, Neuroscience, Research, Science, Stanford News

Illustration from 1881 resolves century-old brain controversy

Illustration from 1881 resolves century-old brain controversy

Figure2_WernickeThese days, a person can get through graduate school in the sciences practically without touching a physical publication. Most journals are available online going back decades. So it was a bit unusual when graduate student Jason Yeatman and postdoctoral scholar Kevin Weiner found themselves in the basement of Lane Medical Library trying to get to the bottom of a medical mystery.

It all started when Yeatman found a nerve pathway in brain images he’d taken as part of his work studying brain changes as kids learn to read.  This pathway didn’t appear anywhere in the available literature. He and Weiner became curious how this pathway – which clearly showed up in their work – could have escaped the notice of previous neuroscientists.

Their curiosity eventually led them back to an 1881 publication, still available in the basement of Lane Medical Library, where Carl Wernicke, MD, described identifying this brain pathway. Weier said, “That was a really cool experience that most people don’t have anymore, when you have to check your belongings at the door because the book you are about to look at is worth thousands of dollars per page. You are literally smelling 100 year-old ink as you find the images you have been searching for.”

Wernicke’s discovery contradicted theories by the eminent neuroanatomist at the time, Theodor Meynert, MD. I describe the controversy that led to this pathway expulsion from the literature in this Stanford News story:

Meynert strongly believed that all of the brain’s association pathways run from front to back – horizontal. This pathway, which Wernicke had called the vertical occipital fasciculus, or VOF, ran vertically. Although Yeatman and Weiner found references to the VOF under a variety of different names in texts published for about 30 years after Wernicke’s original discovery, Meynert never accepted the VOF and references to it became contentious before eventually disappearing entirely from the literature.

The group, whose work was published this week in the Proceedings of the National Academy of Sciences, says this was all more than just an exercise in curiosity. Psychologist Brian Wandell, PhD, in whose lab Yeatman was working, says it also shows the value of modern publishing methods, where making data available means scientists worldwide can try to reproduce results. He says it’s now less likely that a dispute could lead to a discovery being lost to history.

Image courtesy of PNAS

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