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Cardiovascular Medicine, Health Policy

Could trips to the barber be as good for your health as for your hair?

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The barbershop has been the subject of some interesting sociological and medical studies over the years. The man or woman that combs your hair and cuts your bangs, it turns out, has a way of shaping your opinions and behaviors as well.

A study published online yesterday in the Archives of Internal Medicine suggests that barbers might play a particularly important role in the lives of African-American men: helping them to better control high blood pressure problems.

According to the study release:

Barbers for 10 months offered blood pressure checks during men’s haircuts and promoted physician follow-up with personalized health education for customers with high blood pressure. This enhanced screening program markedly improved blood pressure levels among the barbershops’ patrons…

Uncontrolled hypertension is one of the most prevalent causes of premature disability and death among African-Americans. African-American men have the highest death rate from hypertension of any race, ethnic and gender group in the United States – three times higher than white men.

“What we learned from this trial is that the benefits of intensive blood pressure screening are enhanced when barbers are empowered to become healthcare extenders to help combat this epidemic of the silent killer in their community”,” said [Ronald Victor, MD] the Burns and Allen Chair in Cardiology Research. “Barbers, whose historical predecessors were barber-surgeons, are a unique work force of potential community health advocates because of their loyal clientele.”

The research was conducted by scientists at the Cedars-Sinai Heart Institute. The study will be published in print in Feb. 2011.

Photo by C. G. P. Grey

Stanford News, Stem Cells

Lorry I. Lokey Stem Cell Research Building to open on the Stanford campus

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Stanford might be lovingly referred to as “The Farm,” but it’s also home to research facilities that are as beautiful as they are high-tech.

The newest installation: The Lorry I. Lokey Stem Cell Research Building, which will be officially opened this Wednesday, is the largest dedicated stem cell research building in the country, measuring in at 200,000 square feet of floor space. Better yet for its 550 occupants, it was financed entirely with private funding, meaning the researchers it houses will be free from the “vagaries of embryonic stem cell politics.” Krista Conger writes in Inside Stanford Medicine:

The entire facility represents an unprecedented commitment to the promise of all types of stem cell research – from stem cells derived from embryos to induced pluripotent stem cells (or iPS cells) derived from fetal or adult tissues to cancer stem cells that give rise to tumors and cause disease relapses. Stem cell researchers have long maintained that it is critical to continue to conduct research on all types of stem cells, which have the capacity to become many types of cells and tissues, in order to move the field forward more quickly. Bringing all of these researchers under one roof will enable easy collaboration and data sharing, and together they can benefit from the advanced equipment and technical support available in the core facilities.

Previously: The largest stem cell research building in the U.S.
Photo by Mark Tuschman

Cardiovascular Medicine

Untrained marathoners may risk temporary heart damage

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After last week’s Nike Women’s Marathon, my Facebook page was peppered with celebratory status updates from runners. I was impressed, of course, that twenty thousand women would willingly run 26.2 miles through fog and rain in hilly San Francisco. But as I looked through photos of the event on my computer, wrapped in a blanket and sipping tea, I couldn’t help thinking that not running is a very nice activity.

Today, I found a tiny glimmer of justification for my laziness. Time’s Alice Park reports on a Canadian study (release) showing long distance events may pose certain risks for untrained runners in particular. In looking at 20 marathoners before, during and after a race, Eric Larose, MD and his team documented:

…many signs of a heart in distress, similar to the changes that might occur during a heart attack. In the runners, levels of an enzyme called troponin, which rises in response to a strained heart and reduced flow of blood, were highest immediately after the marathon. The pre-marathon imaging tests showed that the heart was functioning at below normal capacity, not pumping blood as efficiently and struggling to battle inflammation. All of these factors caused damage to the heart muscle. “There is temporary damage to the myocardium, not in all regions but in over 50% of the heart,” says Larose.

But it turns out the conclusion I was hoping for (running is bad; relaxing with book and hot drink is good) may not be justified:

While the results were sobering, the scientists were encouraged by the fact that at the three-month follow up, the damage induced by the marathon appeared to have dissipated, and the heart had resumed its normal functions. It’s still not clear whether the cumulative effect of running repeated marathons may eventually take a toll on the heart, but for now, the findings suggest that there may be a minimum fitness level needed beyond which the heart can bounce back from the strain of training and running a long race.

Minimum fitness level? That sounds like work.

Photo by iCanfoto

Aging, In the News, Men's Health, Women's Health

Why do women live longer? One man's best guess

old2.jpgWomen live longer than men. Why? The answer is certainly not that they endure less stress, as was once assumed when men went to work and women tended the home. Nor does it seem to be that women live healthier lives, given that they spend more of their old age in poor health.

The question might be better addressed from a wider biological perspective, the experimental gerontologist Thomas Kirkwood, PhD, recently wrote in Scientific American:

Under the pressure of natural selection to make the best use of scarce energy supplies, our species gave higher priority to growing and reproducing than to living forever. Our genes treated the body as a short-term vehicle, to be maintained well enough to grow and reproduce, but not worth a greater investment in durability when the chance of dying an accidental death was so great. In other words, genes are immortal, but the body – what the Greeks called soma – is disposable…

Could it be that women live longer because they are less disposable than men? This notion, in fact, makes excellent biological sense. In humans, as in most animal species, the state of the female body is very important for the success of reproduction. The fetus needs to grow inside the mother’s womb, and the infant needs to suckle at her breast. So if the female animal’s body is too much weakened by damage, there is a real threat to her chances of making healthy offspring. The man’s reproductive role, on the other hand, is less directly dependent on his continued good health.

Women’s bodies, Kirkwood hypothesizes, are better at repairing damage and warding off degenerative buildup. He notes there is evidence that castration can help the male body improve in these areas – but he wisely concludes that few “men – myself included – would choose such a drastic remedy to buy a few extra years.”

Photo by ifraud

Image of the Week

Image of the week: Bedbug

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The news just keeps getting worse on the bedbug front. Above, a digitally-colored scanning electron micrograph of Cimex lectularius shows the insect’s six jointed legs and “skin-piercing mouthparts.”

From a joint statement by the EPA and CDC:

Bedbugs cause a variety of negative physical health, mental health and economic consequences. Many people have mild to severe allergic reaction to the bites with effects ranging from no reaction to a small bite mark to, in rare cases, anaphylaxis (severe, whole-body reaction). These bites can also lead to secondary infections of the skin such as impetigo, ecthyma, and lymphangitis. Bedbugs may also affect the mental health of people living in infested homes. Reported effects include anxiety, insomnia and systemic reactions.

Photo courtesy of the Public Health Image Library, Centers for Disease Control and Prevention

Genetics, In the News, Research

Chronic disease: Genes matter, but so does environment

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We’re all familiar with the classic debate: Is it nature or nurture that most influences how our brains tick? Of course, a variation of that question is just as important in the study of the human body. Is health hardwired in our genetic makeup, or is it shaped by where we live, what we eat and what kind of cleaning agents we use?

Judging by the rivers of money flowing into genetic research, you might think the answer is that we’re hardwired. Not so, argue Stephen Rappaport, PhD, and Martyn Smith, PhD, in a Perspectives piece in Science:

Although the risks of developing chronic diseases are attributed to both genetic and environmental factors, 70 to 90 percent of disease risks are probably due to differences in environments. Yet, epidemiologists increasingly use genome-wide association studies (GWAS) to investigate diseases, while relying on questionnaires to characterize “environmental exposures.”

The researchers’ proposition? The development of an “exposome” – a catalogue of the combined exposures from all sources that reach the internal chemical environment of the human body. To tackle such an ambitious project, it’s crucial to develop a more cohesive view of environmental exposure, Rappaport and Smith write, by considering all biologically active chemicals in the internal environment. That means not just looking at water and air pollution, for example, but also taking into account chemicals produced by inflammation, oxidative stress, infections and gut flora.

Building an “exposome” would be as hard, if not harder, than sequencing the human genome, Katherine Harmon writes in Scientific American. But the work of Stanford’s Atul Butte, MD, PhD, could serve as a prototype:

[Butte’s] study, published in May in PLoS ONEscanned blood and urine samples of thousands of people for the presence of different chemical compounds, looking for correlates with type 2 diabetes. “I think that’s really a good example of what we should be able to do,” Rappaport says.

Previously: New associations between diabetes, environmental factors found by Stanford researchers
Photo by Peter Rosbjerg

Image of the Week

Image of the week: Your brain on love

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Passionate feelings of love activate reward systems in the brain and can block the sensation of pain, according to neuroimaging research published this week by Stanford professor Sean Mackey, MD, PhD.

The image above above is an fMRI scan from Mackey’s study. It shows the brain of a study subject exposed to acute experimental thermal pain, as he or she is viewing pictures of a loved one. Not sure what the colors mean? It’s complicated; check out the study for explanation.

Previously: Love blocks pain, Stanford study shows and Professor Sean Mackey discusses the painkilling power of love

Medical Education, Medicine and Society

Molly Carnes: Gender bias persists in academia

Think women have achieved equal footing in academia? Molly Carnes, MD, professor of medicine at the University of Wisconsin-Madison, begs to differ.

The cofounder of the Women in Science and Engineering Leadership Institute will be on the Stanford campus next Thursday, Oct. 21, to explain how assumptions about gender continue to shape institutional landscapes. Carnes’ talk, “Gender Equity in Academic Medicine and Science: Time for Institutional Change,” will run from 4 p.m. to 6 p.m. in the 2nd floor conference room of the Li Ka Shing Center for Learning and Knowledge. Registration is open to all Stanford students, trainees and faculty.

Carnes was kind enough to preview her talk with us in this Q&A.

Is gender bias in the life sciences any worse than it is in other academic disciplines?

That’s a good question. In biological sciences, because we’re beyond just a small minority of women, it at least confirms that the problem is not a pipeline problem as you could potentially say it is in math or engineering. In the biological, social and medical sciences, we’re way beyond being able to say that. The pipeline is flush with women, and at every level, where women may be evaluated or have the opportunity for advancement, they’re disadvantaged.

Can you give me a specific example from your own life, when as a woman you felt disadvantaged in your career?

I try not to focus on the negative, but I have had to go through three rather humiliating gender pay equity exercises, in which I was being paid considerably less than my male colleagues with fewer accomplishments. Each time it took a full year to argue for a raise. And that happens all the time. Study after study shows, even where males and females may have pretty comparable salaries at the entry level, as you get further along in the career, more toward leadership and high status positions, the salary differential becomes greater and greater. It’s just harder to see an accomplished woman as accomplished given the fact that gender is such a powerful status cue in our society.

In a 1999 study (.pdf), academic psychologists were handed a curriculum vitae that was assigned either a woman’s or a man’s name. The psychologists, whether male or female, were more likely to say they would hire the individual when the CV carried a man’s name. What does it say about the nature of bias that women discriminate against women?

It shows that bias is ordinary. We are all members of a society where things that are associated with men are of higher status. And even if we don’t consciously endorse or embrace the stereotypes, we’re all aware of them. Stereotypically, men are strong and independent and decisive; stereotypically, women are more docile and supportive and nice and gentle. So even though we know men and women who don’t fall into those norms, those stereotypes exist, and they creep into our decision making – particularly if there’s any ambiguity. Human minds are wonderful and efficient about functioning on partial information. It’s what puts us at the top of the food chain.

I’m a physician, and I tell physicians, the fact that you can function most of the time on partial information is what makes you a good doctor. But, in certain circumstances, those same processes can fail our conscious intention.

Just this week, you won a three-year grant to develop a video game that will “place faculty situations where they can recognize the self-defeating nature of implicit bias.” What’s the single best action universities can take right now to improve gender equity on campus?

Because we’re talking about a change in cultural norms and attitudes of our whole institution, you have to approach it as you would any kind of institutional change. So it has to be hit from multiple angles: You have to have leaders saying the matter is of urgent importance, and make sure they have the resources to follow through; and you have to work at changing the individual attitudes and behaviors of the people who drive change at an institution, which on campus would be the faculty.

When will you know you’ve been successful?

When the composition of all of our departments and leadership mimics the demographics of our country.

In the News, Medicine and Literature, Medicine and Society

Is sponsorship of health content on the web unethical? Journalism professionals weigh in

Does is strike you as odd that WebMD’s breastfeeding page is funded by Gerber Good Start? Or that Babble’s equivalent was previously sponsored by Similac? Would you find it disconcerting if you were a writer and your editor inserted links for baby lotion and commercial genetic testing in your blog on heart failure?

If you answered “yes” to any of those questions, you’re not alone; in fact, a recent Covering Health post claimed the creep of advertising into health content on the web has everyone from mommy bloggers to old-time journalists a bit worried.

Curious about that concern, I put a few questions to Ted Glasser, PhD, a Stanford communication professor who focuses on media ethics and responsibility, and Barbara Strauch, deputy science editor at the New York Times, who’s responsible for the paper’s health and medical coverage. Is there anything inherently unethical about sponsored health-related content? I wondered. Should health-related content be held to stricter standards given that consumers might substitute it for actual medical counsel?

“Sponsored content is a very bad idea,” Glasser told me:

…not because any particular writer will be corrupted by sponsorship but because over time it can create incentives for certain kinds of content and disincentives for other kinds of content. In short, sponsored content runs the risk of undermining the independence of judgment that has long been the hallmark of reputable journalism.

Strauch agreed:

The bottom line is, yes, I do see something wrong with having sponsored links in health content. Here at The Times, we certainly put links in articles but they are links that we choose ourselves and they are not paid for by others. We keep a line around the ads, too, to separate them from the content. And while I think there might be a special issue with health-related journalism since we are dealing with consumers who are sometimes making life and death decisions, I think this rule applies to ALL journalism. If we have sponsored links in a political story taking readers to a webpage of a politician who has paid us money, that is public relations, not journalism. I know this line is merging in some places. But in most cases that is a bad thing, not a good thing. It’s important that readers trust our information. Otherwise, what kind of service are we providing?

The key, concluded R.B. Brenner, a Stanford visiting lecturer and former editor at the Washington Post, is to maintain a wall between commerce and content. In the case of WebMD, for example, “the financial involvement of Gerber creates a serious perception problem,” he said. “How can I trust that Gerber’s interests are not somehow, even subconsciously, being favored? When you have trouble trusting the content because it might be influenced by the commerce, red flags should be raised.”

Nutrition, Obesity

Perinatal exposure to DDT byproduct ups risk of obesity

fat_baby.jpgIn case you needed another reason to dislike DDT, Spanish researchers have found that a byproduct of the infamous pesticide might be making us fat.

Their study, published online yesterday in the journal Environmental Health Perspectives, found babies whose mothers had higher levels of the chemical DDE (.pdf) in their blood were more likely to experience rapid growth in their first six months and to have a higher body mass index by 14 months.

The finding dovetails with a growing body of evidence that exploding obesity rates may have something to do with early exposure to endocrine disruptors, a class of chemicals that mimic hormones.

Frederick vom Saal, PhD, a University of Missouri-Columbia researcher who has performed similar experiments on mice, explained at the 2007 Annual Meeting of the American Association for the Advancement of Science:

Babies [exposed in the womb to endocrine disruptors] are born with a low body weight and a metabolic system that’s been programmed for starvation. This is called a ‘thrifty phenotype,’ a system designed to maximize the use of all food taken into the body. The problem comes when the baby isn’t born into a world of starvation, but into a world of fast food restaurants and fatty foods.

DDE specifically has been implicated in two previous studies, which showed moms whose breast milk had elevated levels of the chemical were more likely to have premature babies and have trouble breastfeeding. The organochlorine has no commercial use, but is released by the breakdown of DDT (banned in the U.S. in 1972 but still used in other countries). It persists in the environment and biomagnifies, accumulating in plants and fatty animal tissues.

People are exposed to small amounts of DDE in the foods they eat everyday, including leafy vegetables, root vegetables and fatty meat.

Photo by Badruddeen

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