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Events, Patient Care, Precision health, Stanford News

A conversation on the promises and challenges of precision health

A conversation on the promises and challenges of precision health

At a Town Hall event here on campus earlier this week, three faculty members explored the prospects for precision health — health care whose goal is to anticipate and prevent disease in the healthy and precisely diagnose and treat disease in the ill. Among the speakers was Mary Hawn, MD, professor and chair of surgery; as my colleague Jennie Dusheck explained in an online article today:

[Hawn] discussed how precision health could help surgeons better understand their patients’ risk factors for surgery and mitigate those risks. “We know we aren’t going to get the same outcome from surgery for every single patient,” she said. Health-care providers have to know individual patients and what their individual risks might be. At the same time, providers need to be able to communicate that information to patients and their families, so they can make decisions that feel right to them. Ideally, Hawn said, “We can see what risks the patient is bringing to the table and mitigate those risks.”

“We surgeons have been humbled by biology. We think we can do a great operation, but in the end, the biology wins,” Hawn said. “So, knowing that upfront, we can have a much more frank conversation with a patient about how invasive, how radical an operation to have…”

In a panel discussion moderated by Lloyd Minor, MD, dean of the medical school, geneticist Michael Snyder, MD, and Mark Cullen, MD, a population-health scientist, also weighed in on how clinicians can take advantage of large health data sets and advances in genomics to benefit their patients.

Previously: How Stanford Medicine will “develop, define and lead the field of precision health”, At Big Data in Biomedicine, Stanford’s Lloyd Minor focuses on precision health, and Global health and precision medicine: Highlights from day two of Stanford’s Childx conference
Photo, of Mary Hawn and Mark Cullen (left), by Norbert von der Groeben

In the News, Medicine and Society, Palliative Care, Patient Care

In the wake of passage of new end-of-life law, a call to help those who don’t want to die

In the wake of passage of new end-of-life law, a call to help those who don't want to die

end-of-lifeAs discussed here and elsewhere, the big medical-related news last week was California’s new end-of-life law. After the law was signed, Karl Lorenz, MD, a professor of medicine at the Palo Alto Veterans Medical Center, and two of his Stanford colleagues wrote in the Sacramento Bee about an aspect of end-of-life care they say wasn’t addressed in the debate over the legislation: how to improve the situation for those very sick patients who don’t want assistance dying.

After writing that “most of us want an effective treatment for pain, not a life-ending prescription,” the authors ask:

Will our legislators advocate for better end-of-life care? Will they invest in quality measures and public reporting that help us choose a good and not just a shorter end? Will they fund an electronic registry so that patients’ decisions against life-sustaining treatment are readily available? Will they make transparent the financial incentives for more efficient end-of-life care or support training in palliative care for nurses, social workers and physicians?

Such solutions represent the investment that most of us need to avoid an end that we mostly don’t want…

Previously: Stanford bioethicist weighs in on California’s new end-of-life lawHow would you like to die? Tell your doctor in a letterStudy: Doctors would choose less aggressive end-of-life care for themselvesStanford experts weigh in on spate of “right to try” laws for the terminally illOn a mission to transform end-of-life care and The importance of patient/doctor end-of-life discussions
Photo by Shutterstock

Infectious Disease, Public Health, Stanford News

Experts and 8-year-olds agree: It’s worth getting a flu shot

Experts and 8-year-olds agree: It's worth getting a flu shot

smiley faceIf you’re around my young daughters these days and happen to mention the flu shot, you’re likely to get an earful. “We got ours too late last year and got really sick,” they’ll tell you (as I look down in embarrassment). “It’s really important to get one.” They also, not surprisingly, were not at all upset when I made an appointment – nice and early! – for them to get vaccinated a few weeks ago. They knew it would hurt, but in the words of my 8-year-old, “it’s worth it.”

My girls – the walking pro-flu shot billboards that they are – were the first people I thought of when I came across a Stanford BeWell article this week on – you guessed it – the importance of flu shots. In the piece, infectious disease expert Cornelia L. Dekker, MD, answers questions about influenza and last year’s flu vaccine (which failed to protect people against several strains of the flu), and she reminds local readers that shots are being offered on campus for students, staff and faculty for free.

Previously: How one mom learned the importance of the flu shot – the hard way and Ask Stanford Med: Answers to your questions about seasonal influenza
Photo by cignoh

In the News, Medicine and Society, Patient Care

Stanford bioethicist weighs in on California’s new end-of-life law

Stanford bioethicist weighs in on California's new end-of-life law

Earlier this week, California Governor Jerry Brown signed the controversial “End of Life Option Act,” which will take effect in 2016 and allow medically assisted suicide in the state. The news was the topic of KQED’s Forum yesterday, and Stanford bioethicist David Magnus, PhD, was one of the featured guests.

Magnus noted that the law is likely to affect a very small percentage of the population, and he thinks the debate surrounding it “reflects a much, much deeper problem in how we deal with communication and care at end of life. This isn’t really going to solve that problem…” Another show guest, Toni Broaddus, California campaign director of Compassion & Choices, agreed that more conversation between doctors and patients is needed, but said this can help: “We hope that what part of this law does, in addition to providing relief from those who need it at the end of life [is] create the room and the opportunity for doctors to talk with their dying patients about all of the options…”

The entire conversation is worth a listen.

Previously: How would you like to die? Tell your doctor in a letterStudy: Doctors would choose less aggressive end-of-life care for themselvesStanford experts weigh in on spate of “right to try” laws for the terminally illOn a mission to transform end-of-life care and The importance of patient/doctor end-of-life discussions

Pediatrics, Public Safety, Stanford News

A reminder to parents to be careful of open windows

A reminder to parents to be careful of open windows

7867279958_6d74bdf4f7_z croppedPreventing falls from windows may not be something that’s on the mind of every parent – especially this time of year. But as the Indian summer continues here in the Bay Area and elsewhere, windows in homes may be left open, leaving kids vulnerable to accidents.

Over on the Healthier, Happier Lives Blog yesterday, Daniel Imler, MD, assistant professor of pediatric emergency medicine, talked about injuries caused by falls, noting that the most common kinds are extremity fractures, traumatic brain injuries, and damage to the cervical spine. After saying that “window screens only offer minimal help,” he also outlined some preventive tips for parents:

Move furniture away from windows and prevent children from climbing over. Locking all closed doors and windows is a great preventative measure as well. If you do open a window safety locks can help keep the window open only 4 inches for safety. Some families choose to install windows that open from the top down on floors above the ground level.

Previously: A young child, a falling cabinet, and a Life Flight rescueCarseats save lives, but only if kids are buckled in and Rattled by one child’s injury, a whole family becomes accident-prone
Photo by Kalexander2010

Events, Medicine X

Stanford Medicine X, in pictures

Stanford Medicine X, in pictures

We’ve written extensively over the last six days about Stanford Medicine X and its sister conference, Stanford Medicine X | ED; you can see all the coverage in this category. And now, one last look at what transpired here.

More photos of Stanford Medicine events, people and places can be found on Instagram

Photos courtesy of Stanford Medicine X

Research, Science, Stanford News

#NextGreatDiscovery: Exploring the important work of basic scientists

#NextGreatDiscovery: Exploring the important work of basic scientists

Today, Stanford is launching a digital series, called #NextGreatDiscovery, to share the stories of some of the scientists doing groundbreaking basic research here. Through photographs and short videos, followers will get a taste of the work of these grad students, postdocs and professors – in fields ranging from computational structural biology to genetics to immunology – and hear about how important it is that this work continues. After all, basic science not only advances knowledge but has the potential to lead to great biomedical innovations.

Our series comes at a time where national funding for research is critically low, and some investigators are opting to leave academia in favor of industry positions that may not support fundamental research. What would we lose if more of these great minds chose different paths? What would go undiscovered? It’s something to keep in mind as you read this feature story, view our photos on Instagram, and follow #NextGreatDiscovery on Twitter.

Previously: The value of exploring jellyfish eyes: Scientist-penned book supports “curiosity-driven” research, Basic research underlies effort to thwart “greatest threat to face humanity” and Funding basic science leads to clinical discoveries, eventually
Photo by Peter van Agtmael/Magnum Photos

Events, Medicine X, Technology

From patient to entrepreneur: Three Medicine X panelists offer advice

From patient to entrepreneur: Three Medicine X panelists offer advice

patient panel

“Who better than to solve our problems in health care than the people who live it and breathe it every day?” That was the rhetorical question posed by Darla Brown, a panelist in a Saturday Medicine X session on patients as entrepreneurs. Brown, a cancer patient who co-created digital health company Intake.Me, and her two co-panelists, Molly Lindquist and Michael Seres, talked about how they took their health-related ideas from concept to reality and offered advice for the other big thinkers in the audience. Among the points made during their 45-minute session:

-Do your due diligence: As noted by Seres, a prolific patient blogger who founded the health tech start up 11Health, “there are thousands of patients who are solving real problems every day” but there may not be a widespread need for such solutions. In other words, a product or service that is helpful to one patient may not be appealing to many others. “Make sure you’re not the one person who wants this end solution,” said Lindquist, a breast cancer survivor and founder of Consano, a nonprofit crowdfunding platform for medical research.

-Talk, talk and talk some more: When exploring the validity of an idea, pick up the phone or hit the keyboard. “You don’t need to do big market research – just talk with other patients,” advised Brown. Lindquist agreed, noting that when she was thinking of starting Consano she reached out to numerous people in her professional and personal life. (She joked that when her number comes up on her friends’ cell phones these days, they likely think, “Oh, what does she want now?”) She said the ensuing conversations “helped vet the idea and the potential issues and benefits that would come from creating an organization.”

-Be able to communicate your product and its need: Especially when working with potential investors or donors, “being really solid in your mission and intent and being able to communicate that” is key, said Lindquist. Seres shared with the audience that his first investor gave him only a “tiny bit of money” and wanted Seres to show him he could be successful on a larger scale. “Ultimately you have to prove the business model and be clear on who your target audience is and whether [your idea] is big enough,” he said.

-Know there will be challenges: “I’ve been patient for more than 30 years. I felt I knew everything about my condition and my health and my journey,” but navigating the business world was a whole different ballgame, Seres said. (He later noted that he still doesn’t think of himself as founder of a technology company: “I’m just a patient providing a solution for a problem no one else” was working on.) But patients have resilience, he pointed out, and “given what you’re dealing with on a daily basis nothing is impossible.” Brown also offered the practical tip of reading The Business Model Generation, which she and Emily Lu, MD, (the panel’s moderator) consulted before starting Intake.Me.

Continue Reading »

Aging, Events, Medicine and Society, Medicine X, Stanford News

Living long and living well: A conversation on longevity at Medicine X

Living long and living well: A conversation on longevity at Medicine X


There were big-time laughs, and the expected misty eye or two, at today’s Medicine X session on aging and longevity. Natrice Rese, a retired personal support worker, began the conversation with a moving ePatient Ignite! talk about how life for many older adults is less than “golden.” She told the audience how difficult time spent in a nursing home or care facility can be: “So many people wait to be fed, wait to be dressed, wait to be undressed, wait to be taken outside… When you’re dependent on care from others, your life is reduced to a waiting game.”

Her mother found herself in one such place at the age of 85, and Rese recalled how her mom pulled her aside one day and said, “Don’t come near these places – it’s not good here.” Her mother was in the throes of Alzheimer’s and unable to offer further details, but “her words stay with me today,” Rese somberly told the audience.

Rese said her mom’s comments ultimately reinforced her desire to work to make sure older adults feel appreciated and are able to “create memories that matter.”

Fellow panelist Barbara Beskind is certainly doing that – and more. The 91-year-old former occupational therapist made headlines when she landed a job at Silicon Valley design firm IDEO. Appearing at the conference alongside Dennis Boyle, a partner and founding member of the firm, she goes to the office every Thursday and is now working on a variety of projects related to aging – including a redesigned walker.

Younger designers “can’t put themselves in the shoes of the elderly,” Beskind told USA Today earlier this year. “People who design for the elderly think they need jeweled pill boxes or pink canes. We need functional equipment.”

“I admire you,” Rese told Beskind during a panel discussion, after hearing about Beskind’s contributions. “You shouldn’t be one of a few – you should be one of many.”

Continue Reading »

Medicine X, Patient Care, Stanford News

Abraham Verghese: “There is no panacea for an investment of time at the bedside with students”

Abraham Verghese: "There is no panacea for an investment of time at the bedside with students"

As mentioned earlier today, the first-ever Medicine X|ED conference kicks off here tomorrow. Stanford’s Abraham Verghese, MD, known as a champion of bedside medicine, is among those delivering a keynote speech at the conference, and he recently gave a preview of his talk to the Wing of Zock blog. From the piece:

An overarching theme of Stanford MedX | ED this year is reaching the millennial learner. Of that cohort, Verghese notes that they learn well on their own and are well served by the flipped classroom model. “The paradox is on the wards,” he says. “The whole team ends up looking at the patient online—which is one person’s opinion, magnified—then going to see the patient, which can seem like an afterthought.” The at-your-fingertips accessibility of information means that health care providers focus on the “iPatient,” a term Verghese coined to denote this virtual representation of the patient, rather than the flesh-and-blood human before them.

“Although technology makes medical education ripe for innovation, it has introduced a complacency that the relationship is not important. There is no panacea for a one-on-one investment of time at the bedside with students. Medicine is an art and a science, but it is also a craft. There is much to be learned through apprenticeship, influence, mentorship, and modeling; we should reserve technology for evaluation,” Verghese says.

The increasing emphasis on empathy in patient care and the corresponding need to teach medical students to be empathetic further underscores the need for interpersonal education, Verghese says: “We can talk about empathy in the classroom but it’s much more effective through modeling. Students must see that people value and believe in these approaches.”

More news about the conference is available in the Medicine X category.

Previously: Medicine X 2015 kicks off this week with a focus on the theme “Great eXpectations”Stanford Medicine 25 Skills Symposium to focus on building leaders for the bedside medicine movement, A call for extended bedside manner training and Abraham Verghese discusses reconnecting to the-patient at the bedside

Stanford Medicine Resources: