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Medicine and Literature, Patient Care, Podcasts, Stanford News

Abraham Verghese: “A saintliness in so many of my patients”

Abraham Verghese: "A saintliness in so many of my patients"

Verghese lookingThere’s a quiet dignity that envelopes Abraham Verghese, MD. You can imagine other authors whose books have scaled to the top to be taken with themselves, hardly humble, but that’s not the case here. When you get to know him, you realize he’s a man of great depth, with a wonderful soul and a deeply felt sense of humanity. When he talks about treating patients it’s with reverence (“There’s a saintliness I saw in so many of my patients,” he told me) – as if each time he crosses the threshold into a patient’s room he’s entering hallowed ground.

Verghese has written two searing works of nonfiction: My Own Country, a paean to the young men he treated for HIV-AIDS when it was just emerging as a human scourge, and The Tennis Partner, a loving eulogy to a best buddy whose life went off the rails. Then the blockbuster novel Cutting for Stone: atop the New York Times best seller list for two years and selling more than one million copies. It’s a sweeping tale of how time transforms family – jolting the reader from the first page, where a Roman Catholic nun gives birth to twins boys and dies on the operating table. I read it during the height of the global economic chaos in 2009 and was transported each evening, thankfully, to another world outside of monetary meltdowns and fiscal maelstrom.

In this 1:2:1 podcast, Verghese and I talk about time’s impact on medicine, novels and life. (Time is the theme of the current issue of Stanford Medicine magazine.) About life, he tells me, “There’s a poignancy to living because we won’t live forever… As John Irving says in one of his books, ‘Life is a terminal condition. It’s about to run out on all of us…’ There’s no exception to that. And I think, in a way, that’s what makes life so beautiful.”

This podcast is accompanied by a Q&A with Verghese in the magazine.

Previously: Stanford Medicine magazine reports on time’s intersection with health, Abraham Verghese discusses stealing metaphors and the language of medicine at TEDMED, Stanford’s Abraham Verghese honored as both author and healer, Abraham Verghese’s Cutting for Stone: Two years as a New York Times best seller and Abraham Verghese at Work: A New York Times profile
Photo by Jason Henry

Health Policy, Patient Care, Podcasts

Steven Brill’s Bitter Pill

Steven Brill's Bitter Pill

Bitter PillA New York Times review called Steven Brill’s book, America’s Bitter Pill, “a thriller.” Brill’s tome on the building of the Affordable Care Act (ACA), aka Obamacare, “a thriller?” I thought. What recent treatise on the inner workings of public policy has garnered that sort of description? Didn’t the term “thriller” belong to writers like Paula Hawkins, Dean Koontz, Gillian Flynn and James Patterson? But Brill’s meticulous narrative of how Obamacare was constructed is a public-policy thriller, and the suspense he writes about is how the law was brought from broth to soup.

While Brill is hardly a public-policy advocate (he’s a long time investigative reporter), he does laud the president’s herculean effort to give millions of Americans access to affordable health care. He just doesn’t believe that any of the big “players” in health care – hospitals, device makers, insurance companies or pharmaceuticals –  felt a pinch of economic pain, and he sees America’s health care system still as an old “jalopy” financially out of control and enriching special interests.

The seed for the book was spawned in a 24,000-word article in TIME magazine in April 2013. A year later, while reporting on the rollout of the ACA, Brill was diagnosed with an aortic aneurysm – flipping the story and putting investigative reporter onto the operating table as a very real person needing cardiac surgery.

As he told NPR’s Terry Gross:

At that moment I wasn’t worried about costs; I wasn’t worried about a cost-benefit analysis of this drug or this medical device; I wasn’t worried about health-care policy. It drove home to me the reality that in addition to being a tough political issue because of all of the money involved, health care is a toxic political issue because of all of the fear and emotion involved.

At the end of my conversation I asked Brill if there was one question he’d been surprised that he’d not been asked during his media blitz, which began with a rollout by Lesley Stahl on CBS’ 6o Minutes.  “Yes,” he said, “you just touched on it.” How would his book had been different if he’d not had an aortic aneurism, a cardiac operation and become a patient? So how would Chapter One have begun?

I hope you’ll listen to my latest 1:2:1 podcast to hear what he has to say.

Addiction, Health Policy, Parenting, Pediatrics, Podcasts, Public Health

Discussing the American Academy of Pediatrics’ call to put the brakes on marijuana legalization

Discussing the American Academy of Pediatrics' call to put the brakes on marijuana legalization

A wave of changes in state laws on the use of marijuana for medicinal and recreational purposes has stirred the American Academy of Pediatrics. It’s taken 10 years for the AAP to update its policy on the legalization of marijuana, and they released its new one on Monday.

74381759_e5a563cf3d_zThe organization still opposes legalization but it has opened the door to reform in several ways. First, recognizing that minority kids bear the brunt of criminal penalties for pot use, they call for decriminalization. Second, they call for the U.S. Drug Enforcement Agency to reclassify marijuana from a Schedule 1 listing for controlled substances to a Schedule 2. This action would effectively allow more research to be conducted and in turn scientifically determine where marijuana is most effective as a treatment. A review by the federal government is currently underway.

I asked Stanford pediatrician Seth Ammerman, MD, the lead author of the statement, what the AAP was trying to achieve with its policy redo and why such a restrictive stance on legalization since the train for legalization – recreational and medicinal –  seems to have already left the “coffee house.”

In this 1:2:1 podcast, Ammerman cites major two concerns. First, if legalized and commercialized, marijuana will become a big business, and the same marketing efforts by tobacco companies that encouraged teens to take up cigarettes will lasso them to pot smoking. “Well, aren’t kids smoking pot already?” I asked. Ammerman fully realizes that any teen who wants pot can readily buy it – legalization, to the AAP, is an imprimatur. Secondly, Ammerman cited, as does the new policy statement, the compelling and growing scientific evidence that the brain in formation continues to gel through the teen years and into the 20s. Marijuana, just like alcohol and any other drug, is likely to play a lot of bad tricks as the prefrontal cortex solidifies.

As described in the policy paper:

New research has also demonstrated that the adolescent brain, particularly the prefrontal cortex areas controlling judgment and decision-making, is not fully developed until the mid-20s, raising questions about how any substance use may affect the developing brain. Research has shown that the younger an adolescent begins using drugs, including marijuana, the more likely it is that drug dependence or addiction will develop in adulthood.

Ammerman says that the AAP will follow closely what happens in states where marijuana has been legalized both for health and recreation, and it will look carefully at what future evidence suggests. Clearly, there’s still a lot of smoke around this issue.

Previously: To protect teens’ health, marijuana should not be legalized, says American Academy of Pediatrics
Photo by Paul-Henri S

Aging, Medicine and Society, Podcasts

Living loooooooonger: A conversation on longevity

Living loooooooonger: A conversation on longevity

Hourglass

As I age, I’m becoming more and more interested in how I can prolong a healthy life. I hope I have a long life but more importantly, I want a healthy one.  I’ve witnessed the other side. My father died in his late 80s; his final years ravaged by Parkinson’s. He was infantile and had bolts of anger and confusion. It wasn’t pretty. In her early 90s, my mother had a stroke. She passed away from heart complications after being aphasic for nearly a year. This 30-plus year English teacher lost all ability to converse in the final year of her life; she was reduced to incoherency. As I held their hands or fed them, I kept on telling myself, not me. This is NOT how I want to live my final days.

In recent years, aging research has been turned upside down. As Stanford bioethicist Christopher Scott, PhD, and his co-author, Laura DeFrancesco, PhD, write in Nature Biotechnology, it has a new face and it’s longevity:

How science approaches the questions of aging has changed. Lifestyle, environment, epidemiology, nutrition, genetics and the tools of big data are coming together in a host of new ways. The new approach – called longevity research – is an effort to extend the period of healthy life by slowing the biological process of aging.

I can see the scrawl on the wall: Aging research is dead. Long live longevity research.

Penn bioethicist and public-policy guru Zeke Emanuel, MD, stirred a recent debate about how long a viable  life when he thrust his body up against today’s immortality zeal of the baby boomer. In an Atlantic article entitled “Why I Hope to Die at 75,” he theorized that post-75, it’s all a pain. His article is a great read that might depress you if 75 is within focus, yet it poses one question clear for each of us: How do we want to live our final days on earth?

Will longevity research produce answers that quell the anxiety stirred by the belief that the aging process means everything is headed south? Scott and DeFrancesco signal that while aging research “failed to come up with any viable approaches, let alone therapies to forestall the ravages of aging,” longevity research in animal models “have shown that life span is indeed malleable, that it can be manipulated by genetics or the environment…” Is there a stairway to longevity emerging in science?

The Nature Biotechnology paper poses some fascinating questions as the science of longevity joins with a new generation of commercial entities that hope to seize its potential. To be sure, longevity research will need to avoid inflated hype. The authors say that Craig Venter, PhD, who has started a company, Human Longevity (HLI) is “….frustrated that the handful of fully sequences human genomes, including his own, has provided little insight into aging.” But I assume, as do the authors, that Venter’s bet is that there’s an abundance of sunshine down this path and science will emerge with ways to manipulate aging that will lead to better health and disease management. But when?

In my latest 1:2:1 podcast I take up these questions with Scott as the longevity era of science develops and matures. My colleague Krista Conger also authored a blog post earlier this week on Scott’s feature.

Previously: Golden years? Researcher explores longevity research and the companies banking on its success, Exploring the value of longevity with bioethicist Ezekiel Emanuel, Tick tock goes the clock – is aging the biggest illness of all? and Researchers aim to extend how long – and how well – we live
Photo by Michael Himbeault

Neuroscience, Podcasts, Science, Stanford News

Stanford neurobiologist Bill Newsome: Seeking gains for the brain

Stanford neurobiologist Bill Newsome: Seeking gains for the brain

14601014695_30cfe1972d_zBill Newsome, PhD, knows the brain perhaps as well as the back of his hand. The Stanford neurobiologist was vice chair of the federal BRAIN Initiative launched by President Obama, and he directs the Stanford Neurosciences Institute. From that spot, he’s just funded a first round of interdisciplinary grants to Stanford faculty that he calls “risk taking.”  The need, he told me in this just-published 1:2:1 podcast, is critical:

When biomedical research money gets tight, as it now is, the funding agencies tend to get conservative. Right now we have these talented faculty at Stanford, many of them young faculty. They’re at the most creative parts of their career.  They’re at a place where they’re thinking big and dreaming big. We wanted to create this mechanism to allow them to do that.

I asked Newsome about the greatest challenges for neuroscience in the next few years. He had one word: technology. “If we were to improve the technology… If we could read out signals from the human brain and read in signals, actually do the circuit-tuning in the human brain non-invasively, at a spatial scale on the order of a millimeter or less and with fairly rapid time, it would revolutionize neuroscience,” he said.

So paint the picture, I asked, and  look ten years out. What would you like to see as far as progress? He told me:

I would like to see fundamental, substantive change on at least one devastating neurological or psychiatric disease. I don’t really care which one. Give me Alzheimer’s. Give me autism. Give me depression. Give me Parkinson’s disease. At the end of 10 years, if we can really have a breakthrough in the understanding of what causes one of those diseases mechanistically and have a therapy that dramatically improves people’s lives… I would say, ‘It’s worth it. We’ve done our job.’

Any worries or words of caution? He laments the current state of federal funding for science and worries that fiscal constraints will squeeze out young star scientists. “How do you keep convincing talented people to come into the field?” he said. “We’re deprioritizing science… How do we convince our brightest, our best, that this is a field with a really bright future?”

Previously: Deciphering “three pounds of goo” with Stanford neurobiologist Bill Newsome, Neuroscientists dream big, come up with ideas for prosthetics, mental health, stroke and more, BRAIN Initiative and the Human Brain Project: Aiming to understand how the brain works, Brain’s gain: Stanford neuroscientist discusses two major new initiatives and Co-leader of Obama’s BRAIN Initiative to direct Stanford’s interdisciplinary neuroscience institute
Photo by Allan Ajifo

Mental Health, Podcasts

My descent into madness – a conversation with author Susannah Cahalan

My descent into madness - a conversation with author Susannah Cahalan

Cahalan illustrationWhen you talk to Susannah Cahalan on the phone, you’d never imagine that this is a woman who has been to hell and back. Without warning 5 years ago, she descended into a nightmare of paranoia, hallucinations, catatonia and near death. One moment she’s a journalist living the high wire life in the New York media world and the next, her brain is swimming in a world of severe mental illness without any diagnosis.

With the precision of an investigative journalist, Cahalan recreates what happened to her in the New York Times-bestselling memoir, Brain on Fire, My Month of Madness. There she describes the terror of what it’s like to be a patient without a medical diagnosis. A human being lost in a sea of clinical maybes. Violent, psychotic and considered a flight risk, she was all but a shadow of her former self.

Luckily, she did eventually find clinical clarity. The diagnosis: anti-NMDA receptor autoimmune encephalitis - a disease only discovered in 2007.

Cahalan’s back at work now at the New York Post. She’s writing book reviews, science and health articles, all with a new perspective. In this 1:2:1 podcast and Stanford Medicine magazine piece, I asked her if she was a different person now, and she told me you can’t go through something like this and not be. “It has changed everything.”

Previously: Stanford Medicine magazine traverses the immune system
Illustration by Joe Ciardiello

Behavioral Science, Pain, Podcasts

Chronic pain: Getting your head around it

Chronic pain: Getting your head around it

Less Pain cover - smallerI have to admit: When it comes to pain, I’m a total wimp. The few times I’ve approached anything near chronic pain was in my neck – the result from unilateral breathing as a lap swimmer. When I had the pain, I was obsessed with it, and it was a complete drag on my psyche. My painful experience gave me deep empathy for anyone who lives with chronic pain.

Beth Darnall, PhD, is a clinical associate professor at the medical school and a clinical psychologist at Stanford’s Pain Management Center. She has practiced this unique specialty – pain psychology – for the past 10 years, working with chronic pain sufferers to find alternative means to controlling their pain rather than being stuck in a downward spiral of opioid use. And she’s written a new book, Less Pain, Fewer Pills, where she details a methodical approach that enables one to get their “head” out from their pain.

Clearly it’s not all attitude, but a significant portion of pain is how we think about it and catastrophize it and therefore unknowingly give it strength. She told me in this 1:2:1 podcast that “early life trauma can lead to changes in the central nervous system and immune systems… that could prime someone to experience chronic pain later on.” She also said:

We have just pure genetics, an underlying predisposition to acquire chronic pain… But we also know that a person’s psychological makeup, what the person brings to the table, is a big predictor in terms of whether or not their pain resolves or whether it becomes entrenched.

I asked Darnall whether her role as a clinical psychologist helps patients rethink their pain. She told me, “A key message that I bring forward to the table is that pain isn’t something that just happens to us. Once we acquire chronic pain we are constantly participating with our pain in terms of our thoughts, our beliefs, our emotions, and our choices. If we can focus on that and optimize our control there, then we can set ourselves up to have the best response to all of the treatments that our doctors are going to be trying for us.”

If you suffer from chronic pain or know someone who does, I hope you’ll find this conversation with Darnall of value.

Previously: Stanford researchers address the complexities of chronic pain, Exploring the mystery of pain, Relieving Pain in America: A new report from the Institute of Medicine, Stanford’s Sean Mackey discusses recent advances in pain research and treatment and Oh what a pain

Podcasts, Stanford News

The amazing photographer Max Aguilera-Hellweg

The amazing photographer Max Aguilera-Hellweg

I had heard from Rosanne Spector, the editor of Stanford Medicine, that our design team had hired an East Coast photographer to shoot for the current surgery issue. It’s surgery, so of course we wanted vibrant pictures that tell their own story. But not until I interviewed Max Aguilera-Hellweg for this 1:2:1 podcast did I realize what an extraordinary photographer we hired and what an an amazing career he’s had to boot.

At 18, Aguilera-Hellweg apprenticed with famed Rolling Stone photographer Annie Liebovitz. Over the years, he’s shot photos for a multitude of international publications including Stern, Rolling Stone, The New Yorker, Esquire, the Washington Post, National Geographic and The New York Times. And he has one more credit to his name: MD. Yep. He’s a physician. At age 43 he received a medical degree from Tulane University with a specialty in internal medicine. He’s well-equipped to both shoot photos inside the OR and lend a hand in case of an emergency.

We asked Aguilera-Hellweg to shoot a panoply of photos for the issue, and they’re extraordinary. He also shot the cover – one that I think conveys the essence of what surgery is all about: the hands. So listen to this podcast and explore the amazing world of Max Aguilera-Hellweg: photographer, physician, Renaissance man.

Previously: Stanford Medicine magazine opens up the world of surgery

From August 11-25, Scope will be on a limited publishing schedule. During that time, you may also notice a delay in comment moderation. We’ll return to our regular schedule on August 25.

Podcasts, Stanford News, Surgery

Sherry Wren, MD – a surgeon's road home

Sherry WrenWhen I first met Stanford surgeon Sherry Wren, MD, I immediately liked her. The affinity was probably due to the fact that we’re both from the south side of Chicago. She’s a powerhouse personality. Down to earth. No pretensions. A surgeon who goes in for the toughest assignments. During her downtime she takes her expert surgical skills to the African bush for Doctors Without Borders and creates make-shift ORs in the most remote of locations. It’s clear she has a passion for her profession and also for life.

I don’t see Wren that often so I was surprised to learn earlier this spring about a serious disc injury she suffered that brought about a paralysis. Tracie White, one of our gifted writers who always gets to the essence of the people she writes about, has a feature article on Wren’s injury and recovery in the latest issue of Stanford Medicine. In it, Wren speaks candidly about losing the use of her hands and the real possibility she would never be able to return to the OR. Sherry is indefatigable so I wasn’t at all surprised in the end that she was victorious. But the road to get there wasn’t easy.

This is a survivors’ story about grit and determination. You’ll learn a lot about Sherry and her journey in Tracie’s story and in my latest 1:2:1 podcast, above.

Previously: Surgery: Up close and personal, Stanford Medicine magazine opens up the world of surgery and Stanford general surgeon discusses the importance of surgery in global health care
Photo by Max Aguilera-Hellweg

Media, Podcasts, Surgery

CNN's Sanjay Gupta, MD: journalist, surgeon, advocate

CNN's Sanjay Gupta, MD: journalist, surgeon, advocate

Gupta - smallWhen the history about medical marijuana’s path to legitimacy is written, CNN’s chief medical reporter Sanjay Gupta, MD, may be more than a footnote. Gupta famously authored a 2009 TIME magazine column decrying efforts to legalize marijuana for medicinal purposes. In a 180-degree turnabout in August 2013, he issued an apology and said he was wrong. He wrote that he didn’t look hard enough at the “remarkable research” indicating that for some illnesses marijuana provided a relief. He told me in this 1:2:1 podcast that while he’s cautious about the impact of marijuana on some brain and psychiatric disorders, he feels that the evidence is clear for certain diseases like epilepsy, neuropathic pain and muscle spasms brought on by MS that cannabis has the power to heal.

I wanted to talk to Gupta for this special issue of Stanford Medicine on surgery not only because of his controversial yea-and-nay positions about weed as medicine but because he’s also a neurosurgeon who still spends time with patients in and out of the OR  between covering health crises around the globe. And in recognition of his clinical and advocacy skills, he was also personally asked by President Obama to consider taking the position of U.S. Surgeon General. (He turned down the offer as the timing just wasn’t right for him.)

And what about this new campaign to Just Say Hello that he launched on Oprah.com? He tells me that if we were a friendlier society – neighbor greeting neighbor –  perhaps we could heal some of the loneliness out there and become a more civilized society.

I asked Gupta, since he travels internationally, whether there’s one universal truth that he finds all human beings seek. “Most everyone wants to do good by their bodies, understand health and how they can improve the health of their family members. I think that the desire for good health and desire for improved function is a universal thing,” he told me. And in his storytelling, what impact does he want to make with the viewer?  What does he want the audience to understand about the world as seen through his eyes?  He said:

If I can explain to them that as the bombs came raining down the same family that was driving their kids to school the day before, grocery shopping after that, stopping at a bank to withdraw some money, that they are now fleeing with whatever few possessions they could garner and run for the border… that they are a lot like families in your own neighborhood… That’s really important to me as a reporter.

Previously: Stanford Medicine magazine opens up the world of surgery and The vanishing U.S. surgeon general: A conversation with AP reporter Mike Stobbe
Illustration by Tina Berning

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