Published by
Stanford Medicine

Author

Addiction, Health Disparities, In the News, Public Health

Menthol cigarettes: How they’re being used by and marketed towards African Americans

Menthol pic - smallHere’s a scary statistic, included in a recently published Newsweek article: “Each year, smoking-related illnesses kill more black Americans than AIDS, car crashes, murders and drug and alcohol abuse combined, according to the Centers for Disease Control and Prevention (CDC).” And then there’s this: “More than four in five black smokers choose menthol cigarettes, a far higher proportion than for other groups… By mitigating the harshness of cigarettes and numbing the throat, menthol makes smoking more palatable, easier to start – and harder to quit.”

The article discusses advocates’ call for a ban on menthol cigarettes (all other flavored cigarettes were banned in 2009) before going on to describe the history of African Americans and menthol-cigarette use, and tobacco companies’ aggressive marketing tactics. (“The tobacco industry… positioned itself as an ally of the very community it was seducing,” writes Abigail Jones.) It also quotes Stanford’s Robert Jackler, MD, founder of Stanford Research into the Impact of Tobacco Advertising, who expresses his concerns with ads that appear in a prominent African-American publication:

…[Jackler] has analyzed Ebony magazines since the 1940s and discovered it ran 59 cigarette ads in 1990, 10 in 2011 and 19 last year.

Ebony published 21 articles about breast cancer and 11 about prostate cancer between 1999 and 2013 but did not publish a single full-length story on lung cancer in that 15-year period. “Tobacco advertising is a huge revenue stream,” says Jackler. “Ebony professes itself to be the so-called ‘heart and soul and voice of the African-American community,’ and it completely neglects smoking.”

Previously: E-Cigarettes: The explosion of vaping is about to be regulated, What’s being done about the way tobacco companies market and manufacture products, Menthol “sweetens the poison,” attracts more young smokers, Menthol cigarette marketing aimed at young African Americans and NPR’s Picture Show highlights Stanford collection of cigarette ads
Photo by Classic Film

Cancer, Research, Stanford News, Stem Cells, Videos

The latest on stem-cell therapies for leukemia

The latest on stem-cell therapies for leukemia

Leukemia research was the focus of a recent Google Hangout hosted by the California Institute for Regenerative Medicine; included in the conversation were Stanford’s Ravi Majeti, MD, PhD; Catriona Jamieson, MD, PhD, with the University of California San Diego; and Karen Berry, PhD, DVM, a CIRM science officer. In the words of CIRM blogger Kevin McCormack, “Between the three of them they painted an optimistic look at the state of stem cell research into leukemia, the progress we are making, and the obstacles we still have to overcome.”

Majeti, whose works focuses on a potential leukemia treatment using an antibody to a protein called CD47, begins talking around the 10-minute mark.

Previously: Blood cancers shown to arise from mutations that accumulate in stem cells and Leukemia prognosis and cancer stem cells
Related: Cancer roundhouse

Cancer, Patient Care

From the Scope archives: Asking the hardest questions/Talking with doctors while terminally ill

Last September, Scope/Inspire contributor Jessica Rice wrote about her experience being diagnosed with terminal lung cancer; as a follow-up to Rice’s piece, one of our physicians shared her thoughts on communicating with seriously ill patients. Rice, who also chronicled her journey on http://stageiv.wordpress.com, passed away last Friday. We’re re-publishing this entry in her memory.

***

Since becoming ill, I’ve learned that I have the innate ability to make doctors very uncomfortable – squirmy, even. It’s surprising because I had assumed medical professionals with decades of experience have fielded every possible question a patient might ask.

But I suppose I’m not a typical patient. In November 2011, I was diagnosed with stage IV lung cancer (bronchioloalveolar carcinoma, a subset of adenocarcinoma) with extensive spread to the mediastinal and hilar lymph nodes. At the ripe old age of 30, I joined a very exclusive club of young, non-smoking women with this rare cancer.

What I’m discussing with these doctors is no picnic. While there’s a sprinkling of terminally ill 30-somethings out there, we’re not a common sight in most oncology offices.

My biopsies were immediately tested for genetic mutation and found to be ALK+. Crizotinib had received FDA approval a few months earlier, so it was the logical first course of action. The pill was successful for three months before two things happened: toxicity set in, and my cancer grew resistant. Next, I tried two different chemo cocktails; both failed. I joined the LDK378 trial in November 2012 and had an excellent response. Unfortunately I experienced very painful side effects which led to dose reductions below protocol. I was likely getting booted from the trial and taking a break when I had a seizure this past June.

My MRI showed five brain tumors, along with small lesions I affectionately termed “brain lint.” After two CyberKnife sessions, a few tumors shrank, a couple grew, and five more sprouted from that innocent looking brain lint. It was time for whole brain radiation.

Through all this I’ve worked with more than a half-dozen doctors and surgeons. Some have impressed me, a couple seemed lacking in one area or another, and one even managed to capture my heart. Regardless, I’ve unintentionally made all of them uncomfortable at one time or another.

It could be my tough questions.

I consider myself a down-to-earth, logical creature; looking at the facts and hearing the truth is strangely comforting to me. This is why I recently asked, “What will dying be like if it’s the brain tumors that kill me? Will it be sudden, like a seizure with an uncontrollable brain bleed?” I had asked this question long ago in relation to lung cancer, but it now seems more likely that the brain tumors will lead to my demise.

Continue Reading »

Applied Biotechnology, Bioengineering, Global Health, In the News, Stanford News

Through his 50-cent microscope, Stanford engineer aims to “reach society in a very strong way”

Through his 50-cent microscope, Stanford engineer aims to "reach society in a very strong way"

Manu TED imageFoldscope, the ultra-low-cost paper microscope designed to aid disease diagnosis in developing regions, is back in the news. For a story appearing in today’s San Francisco Chronicle, writer Stephanie Lee talked with Stanford bioengineer Manu Prakash, PhD, and others about the invention:

“Manu Prakash is one of the most creative scientists and engineers and his invention is really original,” wrote Luke Lee, a bioengineering professor at UC Berkeley who works on global health problems, in an e-mail. “His elegant microscope is not only good for global health care, but also it will be a new educational tool to see the world.”

The Foldscope was two years in the making, starting with trips that Prakash and his graduate students took through India, Thailand, Uganda and Nigeria. The team met people who were suffering from infectious diseases but couldn’t afford conventional microscopes, which cost upward of $200, to diagnose their conditions.

“It was very clear that anything we came up with, if we can’t scale it to the cost it needs to be, it doesn’t really reach anywhere,” Prakash said.

Prakash went on to tell Lee, “This is not just an academic project. We happen to be in an academic setting, but we are trying to reach society in a very strong way.”

Previously: Free DIY microscope kits to citizen scientists with inspiring project ideas, Stanford bioengineer develops a 50-cent paper microscope, Stanford microscope inventor featured on TED Talk, Stanford bioengineer developing an “Electric Band-Aid Worm Test and Stanford bioengineers create an ultra-low-cost oral cancer screening tool
Photo by James Duncan Davidson/TED

Clinical Trials, Mental Health, Research, Stanford News

Examining an app’s effectiveness at helping those with PTSD

Examining an app's effectiveness at helping those with PTSD

Can a mobile app help people manage the symptoms of post-traumatic stress disorder? As some local readers may have heard on KCBS today (or may remember from a previous Scope entry), this is a question that a group of researchers here are studying.

I explain more about the app in a recent release:

The study involves the use of a Veterans Affairs-developed app designed to provide immediate help for patients’ symptoms. The app contains four sections: “learn,” which provides basic information about PTSD; “find support,” which helps users find professional care; “self-assessment,” which allows users to fill out a survey that measures PTSD symptoms; and “manage symptoms,” which provides tools to address acute symptoms such as insomnia and anger.

The VA-funded trial follows earlier research showing that the decrease in PTSD symptoms for those study participants who used the app for one month was significant when compared to participants in the control group who didn’t use the app. For this study, participants will use the app for three months and fill out online surveys at the start of the study and at the three-month follow-up.

The researchers are looking for 30 participants experiencing symptoms of PTSD; they must not be currently receiving care for the disorder and they must have either an iPhone or Android smartphone on which they can download the app being tested. Those interested in participating or learning more should contact study coordinator Nitya Kanuri at nkanuri@stanford.edu.

Previously: The remarkable impact of yoga breathing for trauma, Relieving stress, anxiety and PTSD with emerging technologies, Using a mobile-based app to help manage PTSD and Stanford and other medical schools to increase training and research for PTSD, combat injuries

Events, Medical Education, Stanford News

Med School 101 kicks off on Stanford campus today

Med School 101 kicks off on Stanford campus today

MS 101 lecture

As a reminder, our annual Med School 101 event kicks off this morning on the Stanford campus. At the day-long gathering, around 140 high school students from ten Bay Area high schools will participate in a variety of sessions on medicine and science-related topics at the Li Ka Shing Center for Learning and Knowledge.

We’ll be live tweeting two of the sessions: a talk on sleep and related disorders from Rafael Pelayo, MD, one of our leading experts; and a discussion on what it really takes to get into medical school from Charles Prober, MD, Stanford’s senior associate dean of medical education. Follow the coverage starting at 9 AM Pacific time on the @SUMedicine feed or by using the hashtag #SUMed101.

Previously: Live tweeting sessions at Stanford’s Med School 101
Photo from last year’s event by Norbert von der Groeben

Events, Medical Education, Stanford News

Live tweeting sessions at Stanford’s Med School 101

Live tweeting sessions at Stanford's Med School 101

MS 101 kids looking at brainsOn Friday, around 140 students from ten local high schools will once again come to the Stanford campus for our annual Med School 101 event.

This is the eighth year of the event, which is organized by the medical school’s Office of Communication & Public Affairs and sponsored by Stanford Hospital & Clinics and was designed to expose high-school students to medicine and related fields. At the day-long gathering, students will attend sessions at the Li Ka Shing Center for Learning and Knowledge on a range of medical and scientific topics, including disease-causing bacteria, food allergies, and traumatic brain injury.

We’ll be live tweeting two of the sessions: a talk on sleep and related disorders from one of our leading experts, and a discussion on what it really takes to get into medical school from Charles Prober, MD, Stanford’s senior associate dean of medical education. You can follow the coverage beginning at 9 AM Pacific time on the @SUMedicine feed or by using the hashtag #SUMed101.

Previously: Image of the Week: Studying brains at Stanford’s Med School 101, Bay Area students get a front-row seat to practicing medicine, scientific research, Med school: Up close and personal, A quick primer on getting into medical school, Teens interested in medicine encouraged to “think beyond the obvious” and High-school students get a taste of med school
Photo from last year’s event by Norbert von der Groeben

Medical Education, Medicine and Society

From the Scope archives: My parents don’t think I’m smart enough for family medicine

Tomorrow, medical students across the country, including those at Stanford, will find out where they’ll be doing their residency. In anticipation of the exciting event, known as Match Day, we’re re-publishing an entry penned last year by then-medical student Raymond Tsai. His candid and moving post was one of our most popular of 2013 and garnered comments from across the world. For the record, Tsai matched in family medicine at UCLA Medical Center (.pdf).

***

Raymond Tsai and Danica Lomeli hug after finding out that both will be attend UCLA March Day at Stanford on Friday, March 15, 2013. ( Norbert von der Groeben/ Stanford School of Medicine )I’m not sure why my parents were surprised when I told them that I was applying to go into family medicine. It seemed like a logical transition after spending six years working in public health and primary care before medical school, but from the perspective of Taiwanese immigrant parents, I couldn’t have made a more absurd career choice. I was confronted with comments such as, “Most people choose careers to make money – why aren’t you?” Even more jolting was when they asked, “Why are you throwing away years of hard work and accomplishments?” I was flabbergasted by the line of questioning, but they’re my parents, so I had to answer the fundamental question – why family medicine?

For me, the answer is simple: I went into medicine to improve the health of my community and our society, and when I think about the most pressing health issues facing our nation, it’s preventable lifestyle disease. According to the Centers for Disease Control and Prevention, more than 75 percent of our health-care costs and 7/10 of deaths stem from chronic diseases that are largely preventable.

As a medical profession, we’ve largely been unsuccessful at getting people to engage in healthy behaviors. Luckily that’s where family medicine doctors are uniquely positioned to succeed. For one, the family physician has the breadth of training to serve everyone in a community, and in doing so, can influence community behavior as a whole. This approach is vitally important since lifestyle choices are never made in the clinic; they’re made in communities based on social norms set by families and peers.

Second, as I’ve learned through my own journey of overcoming obesity by losing 40 pounds in the past year, so much of one’s ability to implement healthy lifestyles hinges on one’s sense of self-efficacy. Again, that’s where the family physician comes in. A family physician has the benefit of deep interpersonal relationships developed through continuity of care to more effectively cheerlead and coach a patient to success. If executed correctly, family medicine has the potential to succeed in promoting healthy lifestyles, improving community health, and actually preventing disease in ways we haven’t been able to before.

The potential for primary care to fix our society’s biggest health-care problem and to have a real impact on overall population health is why I’m choosing to go into this field. Increasingly, policy makers are turning towards primary care to fix a health-care system that’s becoming more expensive than we as a society can afford. As that happens, I want to be at the front lines leading the charge and developing impactful solutions.

When I told my parents this, their response was, “There are already a lot of smart people who trying to fix this problem and unable to find an answer – so what makes you think you can?” In essence, they don’t think I’m smart enough for family medicine. The problem that primary care has been charged to solve is so big that my parents don’t think I can do it.

Maybe my parents are right, but that won’t stop me from trying. Ignoring the issue doesn’t make it any less urgent. To communicate this to my parents, I responded with a Chinese proverb they taught me long ago, “Plugging up your ears so you don’t hear the fire alarm doesn’t mean there isn’t a fire.”

Previously: Matching into family medicine

In the News, Sleep, Technology

Exploring the benefit of sleep apps

Exploring the benefit of sleep apps

man sleeping in bedCan sleep-related apps be of benefit to the bleary-eyed masses? That’s the question explored today by the New York Times’ Molly Young, who sought the advice of one of our sleep experts for her story:

Browse the iTunes store or Google Play and you’ll find them by the dozen: offerings with names like SleepBot and eSleep, represented by icons of placid sheep or glowing moons. The offerings fall into two basic categories. One tracks sleep patterns through the smartphone’s accelerometer (the doodad that recognizes when your phone is upside-down), giving users a blueprint of their time in bed. The second promises to lull users to sleep with music, hypnosis or guided meditation.

If you’re the data-driven type, a sleep-tracking app surely appeals. By placing the phone next to you in bed and tapping a button, you record your movements and a sleep chart is created. But according to Dr. Clete Kushida, the medical director of the Stanford Sleep Medicine Center, these apps are hardly precise.

“Without EEG — brain wave activity — it’s very hard to tell different stages of sleep apart,” Dr. Kushida said. “People can stay still and the device will think the person’s asleep.” Still, “the advantage of these devices is that they can help individuals become more aware of a potential sleep problem,” Dr. Kushida said.

Previously: Why physicians should consider patients’ privacy before recommending health, fitness apps, A look at the “Wild West” of medical apps, Designing the next generation of sleep devices, Exploring the effect of sleep loss on health, Turning to an app to help your health and Stanford sleep expert offers evaluation of science behind one sleep device
Photo by dearoot

Parenting, Stanford News, Videos

Stanford patient celebrates son’s first birthday with help of her care team

Stanford patient celebrates son's first birthday with help of her care team

This touching video is a must-watch. The piece focuses on a young mom whose serious illness has kept her hospitalized for more than a month. When the patient’s care team learned of her son’s first birthday, they sprang into action and threw the little boy a party right then and there – ensuring that his mom wouldn’t miss this most important milestone.

“Some patients tug at your heart,” Hirut Truneh, the unit’s patient care manager, told Stanford Hospital’s Sara Wykes, who produced the video alongside Todd Holland. The video certainly tugged at mine.

Stanford Medicine Resources: