The first inkling I had that statisticians could be the opposite of dull was last spring at Stanford’s Cancer Institute retreat. I was listening to the keynote speaker and thinking: (1) A statistician for the keynote? I hope I can keep my eyes open; and (2) What he’s saying is revolutionary! The speaker was Donald Berry, PhD, from the University of Texas M.D. Anderson Cancer Center, describing how to do clinical trials that get answers far quicker than traditional trials can. The audience was charged up – popping with questions during and after the talk.

Once I started paying attention, I noticed those “boring” statisticians were doing some of the coolest research we cover here, and that they’re changing the paradigm for drug discovery – or at least creating a new one.

Now my suspicions are confirmed.

Here’s how Stanford statistics professor Rob Tibshirani, PhD, puts it, in a post in the New York Times Bits blog today:

“Most of my life I went to parties and heard a little groan when people heard what I did,” says Robert Tibshirani, a statistics professor at Stanford University. “Now they’re all excited to meet me.”

The piece continues:

It’s not because of a new after-shave. Arcane statistical analysis, the business of making sense of our growing data mountains, has become high tech’s hottest calling.

To find out about the statistics boom, including what starting salaries for statistics grads are, and how hard it has become to get into Stanford’s statistics graduate program, read the whole piece.

Looking for more really good things to read? If you’re interested in medical stories, I bet you’ll find something in this list: The 10 most popular Stanford Medicine magazine stories published in 2011 (as determined by online page views).

1. When are you dead? – Resurgent form of organ transplantation raises a new question – by John Sanford
2. The woman who fell to Earth – A love story – by Ruthann Richter
3. Gender X – The battle over boy or girl – by Dianne Klein
4. The case of the disappearing liver disease – Uncovering an ordinary antibiotic’s secret power – by Erin Digitale
5. Bioethics at midlife – The dilemmas facing a field in flux – by Susan Ipaktchian
6. Peddling hope – Unproven stem cell treatments for sale in a country near you – by Krista Conger
7. Make your own cancer diagnostic test – It’s easier than you think – by Rosanne Spector
8. The unexpected – Cancer during pregnancy – by Erin Digitale
9. A kid again – After cancer takes its toll – by Erin Digitale
10. Khmer Rouge on trial – Can serving justice cure PTSD? – by Tracie White

Previously: Cancer’s next stage: A report from Stanford Medicine magazine, Surviving survival: The new Stanford Medicine magazine is out and New Stanford Medicine magazine explores bioethics

My favorite medical story this year managed to make me laugh about aging — a topic I’m seriously obsessed about. Thanks for that. Looking back at my other faves, I see it’s been a good year for medical stories chronicling discoveries, wrong turns and all. So without further ado, here are my top 10 long-form journalism reads for 2011. Aside from the first, they’re listed in no particular order. Oh, and one more thing: Stories from Stanford Medicine, which I edit, are not included. No playing favorites with my babies.

-What do a bunch of old Jews know about living forever? by Jesse Green, New York Magazine

-The human lake by Carl Zimmer, The Loom
The history and science of ecology and your inner microbial wilderness. A favorite bit: “So try to imagine for a moment producing an elephant’s worth of microbes. I know it’s difficult, but the fact is that actually in your lifetime you will produce five elephants of microbes.”

-The mouse trap by Daniel Engber, Slate
Why mice are not model models for humans.

-A victory in the war against cancer by Terence Monmaney, Smithsonian
Beautiful melding of stories about a driven cancer patient and the cancer researcher who brought us Gleevec.

-Study of a lifetime by Helen Pearson, Nature
What’s been learned by tracking the health and demographic details of thousands of British children born one week 65 years ago? As the story says: “Now, as the cohort members enter old age, the study offers a precious opportunity to understand how a lifetime of experiences might hasten or slow their decline — an urgent question for countries such as the United Kingdom and United States, whose populations are rapidly ageing and sickening.” Plus, odd bits like the heaviest babies were most at risk of breast cancer decades later, and that women with higher IQ reached menopause later in life.

-Should we all go gluten free? by Keith O’Brien, New York Times
I thought I knew what there was to know about the diet trend to go gluten-free but it turns out I had no idea.

-Led by the child who simply knew by Bella English, Boston Globe
About a boy who is a girl. A stunning story stunningly told.

-Don’t blame the usual suspect for cancer by Carlos Sonnenschein and Ana M. Soto, New Scientist
Two scientists explain how they’re thinking differently about cancer, and why other scientists should too.

-A drug that wakes the near dead by Jeneen Interlandi, New York Times
What happens when a drug nudges awake those who doctors had every reason to think would never really be conscious again?

-Inseparable by Susan Dominus, New York Times
Mind-boggling, both the story and its telling. Sensitive, gutsy reporting about conjoined twins.

It’s the best of times – and a most precarious time – for cancer research.

The new issue of Stanford Medicine magazine, a special report on cancer, explains that while data and insights pour in as never before, the efforts to prevent, treat and cure cancer are faltering. The big threats? A dysfunctional cancer clinical-trial system, disastrous drug shortages and a health-care system unable to deliver cancer care at an affordable price.

According to the head of Stanford’s Health Research and Policy Department Phil Lavori, PhD, (quoted in the report’s lead story):

Basic scientists have opened a fire hose of information. There are many, many good ideas. But there are real problems in the ways we test these ideas and bring the resulting therapies to patients. If we can’t resolve these, we’re risking an incredible opportunity to make progress.

Read the whole report for more, including:

• The lead piece on fighting cancer at a time of burgeoning data and circumscribed resources.
• A Q&A with Siddhartha Mukherjee, author of The Emperor of all Maladies: A Biography of Cancer.
• An account of a family wrestling with cancer during pregnancy.
• An article on cancer survivors’ need for special support — and how rarely they get it.
• A cancer patient’s perspective on palliative care.
• A how-to guide for developing a cancer diagnostic test with just an Internet browser, high school biology, basic statistics and a few thousand dollars.
• The story behind a push to reconsider a controversial treatment for metastatic, “incurable” breast cancer: high-dose chemotherapy.
• A quick look at some of Stanford’s recent cancer research discoveries.
• A take on new evidence showing that “good” stress might thwart cancer.

Previously: Surviving survival: The new Stanford Medicine magazine is out, New Stanford Medicine magazine explores bioethics and New Stanford Medicine magazine looks at the metamorphosis of the teaching hospital
Illustration by Anita Kunz

Back in March, radiation-protection specialist Shunichi Yamashita, MD, PhD, sparked outrage when he told people in Fukushima, Japan: “The effects of radiation do not come to people who are happy and laughing, they come to people who are weak-spirited.”

But earlier this week he explained the reasoning behind his statement in a Spiegel interview, and it’s not as completely crazy as it sounds:

“From animal experiments with rats we clearly know that animals who are very susceptible to stress will be more affected by radiation. Stress is not good at all for people who are subjected to radiation. Besides, mental-state stress also suppresses the immune system and therefore may promote some cancer and non-cancer diseases. That is why I told people that they also have to relax.”

His point about stress suppressing the immune system is reasonable. But, really, I think cheering up while radiation emissions continue from the damaged nuclear reactors is probably easier said than done.

In the interview, Yamashita goes on to discuss his plan to examine the health effects of the emissions on the region’s people. And he talks about his extensive studies of survivors of the Chernobyl reaction accident. It’s an interesting read.

When we decided to focus the summer Stanford Medicine magazine on life after a serious health crisis, I saw it as a great opportunity to publish dramatic, inspiring and useful stories. (See what you think of the story lineup. Or read the actual magazine, which ships today.)

What I didn’t realize at first was how important the issue has become in the United States. As I researched the topic, I discovered that we’re a nation of survivors, and becoming more so. One in 20 adults has survived cancer, one in 45 has survived a stroke, and every year hundreds of thousands survive a heart attack. The “survivor boom” is yet another burden on the health-care system – since severe illness often carries long-term physical and psychological consequences. But when you’re the one who’s sick, surviving is usually preferable to the alternative.

Previously: New Stanford Medicine magazine explores bioethics and New Stanford Medicine magazine looks at the metamorphosis of the teaching hospital

Word  is out about a new way to turn skin cells into brain cells, which is great for scientists trying to understand and cure neurological diseases. That’s because it’s much easier for researchers to get ahold of skin cells to use in their studies than brain cells. (Brain cell donors are understandably rare.)

The team, led by students and postdocs working with professor Gerald Crabtree, MD, found to its amazement that a combo of two particular snippets of genetic material called microRNA did the trick.

They published their study in the journal Nature today.

Previously: Human neurons from skin cells without pluripotency?

What happens when you mix fMRI with Shakespearean wordplay? How does the brain respond to grammatical twists – called functional shifts or word-class conversions – that give an existing word a new syntactic function (like verbing a noun, or hearting someone)?

David Pescovitz at Boing Boing blogged yesterday about a piece on “The Shakespeared Brain” by Philip Davis in the Literary Review:

Our findings begin to show how Shakespeare created dramatic effects by implicitly taking advantage of the relative independence – at the neural level – of semantics and syntax in sentence comprehension. It is as though he is a pianist using one hand to keep the background melody going, whilst simultaneously the other pushes towards ever more complex variations and syncopations.

In this example from The Winter’s Tale an adjective acts like a verb: Heavy thoughts are said to “thick my blood.”

Pretty synapsy, eh?

Photo by Plutor

Boasting time! As the editor of Stanford Medicine magazine, I’m happy to announce that Jonathan Rabinovitz and Tracie White have won writing awards for stories that ran in our pages last year. The awards come from the American Association of Medical Colleges, which presented them April 14.

Jonathan snagged the highest honor in the general staff writing category for “Transformers,” which examined the role teaching hospitals could play in the metamorphosis of American medicine. The story was published in the Summer 2010 issue of the magazine.

Tracie won for her first-hand account of the efforts of one Haitian hospital to cope with the aftermath of the 2010 earthquake. The story, “Valley of hope,” appeared in the same issue.

An article in today’s Inside Stanford Medicine shares some of the judges’ comments.

It’s still early days for electronic medical record systems, but a study published in Clinical Trials today shows how the VA Boston Healthcare System is using them to zero in on what treatments work best and get them to patients quicker. It’s a really smart, less costly way to do clinical trials – it guides doctors to switch to the best treatment even before the trial is completed.

Stanford biostatistician Philip Lavori, PhD, the study’s senior author, explains in an Inside Stanford Medicine article I co-wrote with Kris Newby:

Our idea is that if systems of care like the VA can integrate implementation of research results directly into care, we will keep the decision-making where it belongs. It brings medical decision-making back down to expert physicians and their patients, and out of the political realm.

The catch is this kind of trial is feasible only when a large group of physicians are all using a common electronic medical record system. Lavori told me that only two institutions are in a position to do this kind of study today: the VA and Kaiser.

Previously: The hurdles facing electronic medical records and Do electronic health records improve health? It’s complicated

When I was editing stories for the Stanford Medicine special report on clinical trials a few years back, a recurring theme was the enormous cost of bringing new drugs to market. A 2003 study led by Joseph DiMasi at Tufts Center for the Study of Drug Development arrived at $802 million – and this was the figure always cited to me by the researchers and administrators I interviewed.

Today David Ng blogged about a recent critique of the article on Boing Boing and the discussion has heated up. Reading the comments, I learned that Donald Light and Rebecca Warburton, the authors of the critique in Biosocieties, have published previously on this topic and DiMasi has rebutted their arguments. And now Tufts has issued a press release in response.

So what is the cost of drug development? Is it more than $800 million? Or closer to $40 million, as Light and Warburton propose? If like me, you lack the enthusiasm to analyze both papers to reach a conclusion, you’ll be happy to hear about bioscience venture capital blogger Bruce Booth’s crowdsourcing solution:

We can all debate what the right statistics are for the R&D costs to support a drug: direct costs per phase, time per phase, failure rates, etc It all depends on the drug itself, its safety profile, how many fumbles it has in development, what indications (diseases) it goes after, what the organizational overhead costs are, how bureaucratic your processes are, etc Venture-backed biotechs have a very different cost structure than a Big Pharma. Some firms build Fords and others build Cadillacs. So the median and mean are essentially meaningless; the ranges and distributions are more interesting.

With all the good online discussion, I thought I’d have some fun and throw a model into the mix to see if crowdsourcing can generate a better answer. The link is below the image.

If you’ve actually developed a drug, why not download the one or both of Booth’s models (he’s got two posted now), punch in your numbers and add your result to the mix?

Via Boing Boing, Life Sci VC and In the Pipeline

As editor, I’m always pleased when an article in Stanford Medicine magazine creates a buzz. And I’m especially glad when the story has the power to help people live healthier, happier lives.

The new issue includes one story that has opened up discussion about a topic that’s rarely aired – the anguish and controversy over “fixing” the sex of children born with ambiguous gender (a condition known as a disorder of sex development, or DSD). The usual approach in the United States has been to use surgery during infancy to make the sex clear cut – but now, as is detailed in our story by freelance writer Dianne Klein, this is being questioned.

The magazine came out just a few days ago, and we’ve already heard from readers thanking us for the article. One wrote to say:

Such articles are so important to get information out and share more than one side of the debate so maybe one day there won’t be so much secrecy and shame attached to DSDs.

And at least one major news outlet, ABC News, has used the article as a starting point for its own conversation on the issue.

I’m looking forward to seeing what comes next.

Previously: New Stanford Medicine magazine explores bioethics
Illustration by Gérard Dubois

The Harvard School of Public Health is hosting a forum today from 1 to 2 p.m. Pacific time on the public health response to the earthquake, tsunami and nuclear crisis in Japan.

It starts in moments – I’m planning to tune in.

What’s bioethics? It’s a field that didn’t exist 40 years ago but is central to today’s world of medicine. It’s a field that looks for answers to medicine’s virtually unanswerable ethical quandaries. And it’s the topic of the new issue of Stanford Medicine magazine, which just went online.

The stories in the theme package include:

Illustration by Gérard Dubois

When I started writing our article about a new paper by Randall Stafford, MD, PhD, on electronic health records, I thought the message was as straightforward as can be: Electronic health records are doing nothing to improve the quality of health care. But my editor wasted no time in showing me that the article (co-authored by Johns Hopkins medical student Max Romano, and published today in the Archives of Internal Medicine) was more nuanced than I’d first considered.

When it comes to technological change in a massive industry like medicine, the impact can take a very long time to show up. Even the contribution to the nation’s productivity of computers themselves took decades to become evident in economic statistics. This New York Times article from 2000 reports on the dawning of proof of computers’ productivity. It makes sense to me that the same slow change could come with electronic health records.

It would sure be nice if we could speed it up, though.