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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

Medicine and Society, Podcasts, Public Health

The vanishing U.S. surgeon general: A conversation with AP reporter Mike Stobbe

The vanishing U.S. surgeon general: A conversation with AP reporter Mike Stobbe

surgeon general drawing - small

There is currently no U.S. Surgeon General. Like everything else in Washington today, a confirmation vote by the U.S. Senate on President Obama’s choice, Harvard physician Vivek Murthy, MD, has been squashed by politics. Last spring, White House press secretary Jay Carney said that the administration was “recalibrating and assessing our strategy on moving forward with the nominee.” In March, The Hill newspaper reported that up to 10 Senate Democrats signaled they would oppose Murthy’s confirmation after the National Rifle Association made it clear Murthy’s support for bans of certain types of firearms and ammunition purchases made him an unthinkable choice.

Now if you’ve forgotten there even is a position called the U.S. Surgeon General post, think C. Everett Koop, MD, or Joycelyn Elders, MD. Koop and Elders were two recent appointees who used their bully pulpit to raise a national discussion about AIDS and teen pregnancy. (Both were  lightening rods within their respective administrations – Koop in Reagan’s and Elders in Clinton’s. Elders was eventually dismissed by the White House after wading into too many contentious issues.)

Does the position even matter anymore? Associated Press medical reporter Mike Stobbe thinks it does. He’s written a fascinating book (Surgeon General’s Warning, University of California Press) about the history of the position and those who served. The book explains how the surgeon general became the most powerful and influential public health officer in the country and how those powers were later stripped away. An excerpt from Stobbe’s book appears in the current issue of Stanford Medicine magazine, where he catalogs the ups and downs of the individuals who held the position. The strong ones and the weak ones. Those who made a difference and those who faded away in controversy or without making a mark on the nation’s public health dialogue.

He writes, “Surgeon generals have played that crusader role better and more often than any other national public health figure. Absent such a crusader, the public’s health is prey to the misinformation and self-interest of tobacco companies, snake-oil salesmen and other malefactors.” Listen to my 1:2:1 podcast with Stobbe to hear more of his thoughts.

Illustration, which originally appeared in Stanford Medicine, by Tina Berning

Mental Health, Podcasts

10% happier? Count me in!

10% happier? Count me in!

harrisDan Harris, author of 10% Happier – How I Tamed the Voice in My Head, Reduced Stress Without Losing My Edge, and Found Self-Help that Actually Works (whew, now that’s a mouthful) acknowledges that he’s not a new-agey spiritual kind of guy who you’d naturally find wandering in the tranquil waters of meditation. And across the phone line, when talking to him for my latest 1:2:1 podcast, I can tell. It’s clear he’s an Alpha Male who’s risen to the top in broadcast network news (co-anchor of Nightline and the weekend editions of Good Morning America) by not being laid back. So he might just be the right guy to take the world of meditation out of the “om” and bring it to a new audience. When I told him I thought he might be doing for mediation what Richard Nixon did for China – normalizing it – he laughed and said, “I love the analogy. It’s probably more flattering than I deserve, but it’s cool nonetheless.”

The success of 10% Happier is not something Harris envisioned. As he was writing it he kept telling his wife it was never going to find an audience: “No one is going to read it.” Yet he’s managed to spin out a wonderful tale about the life of a mega-skeptical agnostic journalist finding  peace, happiness and yes, fulfillment, in the land of self-help and meditation. Well, maybe not total serenity. He did have that little spat with a New York City taxi driver last week that caused his wife to remind him that he still has more steps to climb to reach the Zen state of Fudoshin. Nonetheless, Harris is happier no matter what the percentage; you get the distinct impression that he sees a lot more sunshine out there than rain. And who wouldn’t want that?

Harris thinks his worrier gene was inherited from his father, Dr. Jay Harris who he calls “a gifted wringer of hands and gnasher of teeth.” His mother, Dr. Nancy Lee Harris, was much more in the Zen mode: “…slightly mellower about her equally demanding medical career.” (Both his parents are alums of the Stanford School of Medicine.)

Interestingly, Harris tells me he believes that emerging science linking the practice of meditation to a wide range of physical and psychological advantages may lead to the next big public-health revolution. “Say that again,” I asked. “You think that meditation will lead to a revolution?” With no lack of uncertainty he replied:

Yeah, I do. As I’ve said, the science is really still in its early phases, but the science is really compelling. It shows… that this whole, almost laughably long list of benefits from lower blood pressure to boosted immune system to reduced release of the stress hormone cortisol, and then the neuroscience is just truly sci-fi.

When we wrapped up the podcast, Harris spoke highly about the groundbreaking work being done here at Stanford by neurologist James R Doty, MD. Doty is leading his own revolution in neurology and created the Center for Compassion and Altruism Research and Education (CCARE), to stimulate a rigorous multi-disciplinary scientific effort at understanding the neural, mental, and social bases of compassion and altruism.

Previously: Research brings meditation’s health benefits into focus, How being compassionate can influence your health, Study shows meditation may alter areas of the brain associated with psychiatric disorders and Ommmmm… Mindfulness therapy appears to help prevent depression relapse
Photo in featured entry box by J E Theriot

Neuroscience, Podcasts, Research, Stanford News

Young mouse to old mouse: “It’s all in the blood, baby”

Young mouse to old mouse: "It's all in the blood, baby"

A few days after his latest research hit the press, I sat with neurologist Tony Wyss-Coray, PhD, for a 1:2:1 podcast. He laughed when I mentioned the range of news headlines touting his Nature Medicine study (subscription required) that found blood plasma from young mice improves the memory and learning of old mice. One headline declared: “The Fountain of Youth is Filled with Blood.” Another flashed: “Vampires Delight? Young Blood Recharges Brains of Old Mice.”

Serendipitously Wyss-Coray’s paper coincided with the release of two similar studies from Harvard teams on the rejuvenating power of young blood. For the science press, it was a perfect confluence of red.

My colleague Bruce Goldman has followed Wyss-Coray’s research for several years. He’s also written about prior studies of Thomas Rando, MD, PhD, showing that the blood of young mice could stimulate old stem cells and rejuvenate aging tissue. Rando’s work laid the path for Wyss-Coray’s investigations.

Perhaps there’s something here that will be significant for human beings and actually lead to breakthroughs in treatments for a range of neurological brain disorders like Alzheimer’s. Wyss-Coray is circumspect. It’s a tall leap from mice to human beings, but he’s eager to make the jump in clinical trials.

Previously: The rechargeable brain: Blood plasma from young mice improves old mice’s memory and learning, Red light, green light: Simultaneous stop and go signals on stem cells’ genes may enable fast activation, provide “aging clock”, Old blood + young brain = old brain, Old blood makes young brains act older, and vice versa and Freshen up those stem cells with young blood

Health Costs, Health Policy, Podcasts, Stanford News

Considering the costs of treatment while making clinical decisions

Considering the costs of treatment while making clinical decisions

The headline of the front page New York Times article caught my attention: “Cost of Treatment May Influence Doctors.” The piece read in part:

Saying they can no longer ignore the rising prices of health care, some of the most influential medical groups in the nation are recommending that doctors weigh the costs, not just the effectiveness of treatments, as they make decisions about patient care.

The shift, little noticed outside the medical establishment but already controversial inside it, suggests that doctors are starting to redefine their roles, from being concerned exclusively about individual patients to exerting influence on how health care dollars are spent.

In reading further, I discovered that one of Stanford’s cardiologists, Paul Heidenreich, MD, was a c0-chair of the policy review that led to new guidelines from the American College of Cardiology and the American Heart Association. I thought it would be interesting to delve deeper in a 1:2:1 podcast with Heidenreich about why, as he told the Times, “we couldn’t go on just ignoring costs.” Did escalating health-care costs that are consuming GDP spur the action? Are these guidelines a threat to individual decision-making between a physician and patient? And, what role do patients have in these decisions? Shouldn’t they be included in potential key life-and-death verdicts?

I was also especially intrigued by a quote from the societies’ paper outlining the changes: “Protecting patients from financial ruin is fundamental to the precept of ‘do not harm.’ ” Hmm… a new take on the Hippocratic Oath that I’ve never considered.

Why the new guidelines?  Just consider for a moment the iconic rock lyrics of Bob Dylan. They say it all:

Come gather ’round people
Wherever you roam
And admit that the waters
Around you have grown
And accept it that soon
You’ll be drenched to the bone
If your time to you
Is worth savin’
Then you better start swimmin’
Or you’ll sink like a stone
For the times they are a-changin’

Previously: Personal essays highlight importance of cost-conscious medical decisions and Educating physicians on the cost of care

Global Health, Health Policy, Podcasts, Research, Stanford News

Foreign health care aid delivers the goods

Foreign health care aid delivers the goods

Eran Bendavid, MD, knows there’s a lot of debate about whether foreign aid for health care is really making an impact. So he and his colleague, Jay Bhattacharya, MD, PhD, devised a statistical tool to address a basic question: Do investments in health really lead to health improvements?

My colleague Ruthann Richter encapsulated the research in a recent article and blog entry. I followed up in a 1:2:1 podcast with Bendavid, and we started our conversation by talking about the perception that foreign aid is wasted and isn’t making significant inroads in changing the health-care trajectory in developing nations. Bendavid told me that the common perception of inefficiency was eroding confidence in foreign aid health care spending, so he decided to test it.

As Richter wrote, the researchers examined both public and private health-aid programs between 1974 and 2010 in 140 countries and found that, contrary to common perceptions about the waste and ineffectiveness of aid, these health-aid grants led to significant improvements with lasting effects over time. As Bendavid told Richter, “If health aid continues to be as effective as it has been, we estimate there will be 364,000 fewer deaths in children under 5. We are talking about $1 billion, which is a relatively small commitment for developed countries.”

Why are these dollars making an impact? Bendavid amplified to me what he told Richter: that foreign aid dollars were used effectively, largely because of the targeting of aid to disease priorities where improved technologies – such as new vaccines, insecticide-treated beds for nets for malarial prevention and antiretroviral drugs for HIV – could make a real difference.

Health aid in 1990 accounted for 4 percent of total foreign aid. It now accounts for 15 percent of all aid.

So something to cheer about when it comes to foreign aid. In health-care spending this study confirms it delivers the goods.

Previously: Foreign aid for health extends life, saves children, Stanford study finds and PEPFAR has saved lives – and not just from HIV/AIDS, Stanford study finds

Aging, Genetics, Neuroscience, Podcasts, Research, Stanford News

The state of Alzheimer’s research: A conversation with Stanford neurologist Michael Greicius

The state of Alzheimer's research: A conversation with Stanford neurologist Michael Greicius

My colleague Bruce Goldman recently wrote an expansive blog entry and article based on research by Mike Greicius, MD, about how the ApoE4 variant doubles the risk of Alzheimer’s for women. I followed up Goldman’s pieces in a podcast with Greicius, who’s the medical director of the Stanford Center for Memory Disorders.

I began the conversation by asking about the state of research for Alzheimer’s: essentially, what do we know? As an aging baby boomer, I’m interested in the differences between normal, age-related cognitive decline versus cognitive declines that signal an emerging disease. Greicius said people tend to begin losing cognitive skills around middle age:

Every cognitive domain we can measure starts to decline around 40. Semantic knowledge – knowledge about the world – tends to stay pretty stable and even goes up a bit. Everything else… working memory, short term memory all tends to go down on this linear decline. The difference with something like Alzheimer’s is that the decline isn’t linear. It’s like you fall off a cliff.

Greicius’ most recent research looks at the certain increased Alzheimer’s risk ApoE4 confers on women. As described by Goldman:

Accessing two huge publicly available national databases, Greicius and his colleagues were able to amass medical records for some 8,000 people and show that initially healthy ApoE4-positive women were twice as likely to contract Alzheimer’s as their ApoE4-negative counterparts, while ApoE4-positive men’s risk for the syndrome was barely higher than that for ApoE-negative men.

In addition to the increased risk of Alzheimer’s for women with the ApoE4 variant, I asked Greicius how he advises patients coming into the clinic who ask about staving off memory loss. At this point, he concedes, effective traditional medication isn’t really at hand. “Far and away our strongest recommendations bear on things like lifestyle and particularly exercise,” he said. “We know, in this case from good animal models, that physical exercise, particularly aerobic exercise, helps brain cells do better and can stave-off various insults.” So remember, a heart smart diet along with aerobic exercise.

One last question for Greicius: What about those cognitive-memory games marketed to the elderly and touted as salves for memory loss – do they have any benefit? He’s riled now: “I get asked that all the time, and smoke starts coming out of my ears.” He says the games are nothing more than snake oil.  His advice when he gets asked the question: “Give that money to the Alzheimer’s Association or save it and get down on the floor with your grandkids and build Legos. That’s also a great cognitive exercise and more emotionally rewarding.”

Previously: Having a copy of ApoE4 gene variant doubles Alzheimer’s risk for women but not for men, Common genetic Alzheimer’s risk factor disrupts healthy older women’s brain function, but not men’s and Hormone therapy halts accelerated biological aging seen in women with Alzheimer’s genetic risk factor

Genetics, Podcasts, Stanford News

Whole genome sequencing: The known knowns and the unknown unknowns

Whole genome sequencing: The known knowns and the unknown unknowns

A few years ago, when I spoke with Euan Ashley, MD, associate professor of medicine and of genetics, about the promise of genomics for diagnosing and treating diseases he agreed that the field was in the wild, wild west. Now, in my latest 1:2:1 podcast with him, I asked how would he describe this moment in time, when so much has changed so quickly in whole genome sequencing (WGS). First, he said, the costs of sequencing the genome have plummeted. “At the point we spoke we were just coming off the $20,000 genome,” he told me. “Which seems remarkable, because we’d just been at… $200,000, and before that at the $2 million genome. In looking around in science… in medicine, I have not seen a technology that has changed that much.”

Euan AshleyAshley recently published a paper that my colleague, Krista Conger, has written about; in it, Ashley and his fellow researchers, Michael Snyder, PhD, professor and chair of genetics, and Thomas Quertermous, MD, professor of medicine, analyzed the whole genomes of 12 healthy people and took note of the degree of sequencing accuracy necessary to make clinical decisions in individuals, the time it took to manually analyze each person’s results and the projected costs of recommended follow-up. Quite clearly, Ashley says, the study shows “there are still some challenges, not that these are non-solvable problems.”

Ashley often cites an infamous quote that Donald Rumsfeld, former Secretary of Defense, said when he was asked about the lack of evidence of Iraqi weapons of mass destruction, as he thinks the questions that Rumsfeld raised about WMDs are analogous to the field of genetics today. Ashley told me:

There are really a number of things that we really know that we know, because they’re genetic variants we’ve seen many times. Also, there are a number of known unknowns… which are genes that we know are a problem but maybe variants we haven’t seen before, so they look pretty suspicious… There [are] the complete unknowns, the unknown unknowns… Many genes about which we really do not know very much at this point in time.

Who would have thought Rumsfeld was laying out the future of WGS and not just WMD’s?

Previously: Assessing the challenges and opportunities when bringing whole-genome sequencing to the bedside, Coming soon: A genome test that costs less than a new pair of shoes, Stanford researchers work to translate genetic discoveries into widespread personalized medicine, New recommendations for genetic disclosure released, Ask Stanford Med: Genetics chair answers your questions on genomics and personalized medicine and You say you want a revolution
Photo of Euan Ashley by Mark Tuschman

Addiction, FDA, Health Policy, Podcasts, Public Health

E-Cigarettes: The explosion of vaping is about to be regulated

E-Cigarettes: The explosion of vaping is about to be regulated

E-cigarettes are about to get zapped. To date, across the globe, they’ve been largely unregulated – and their growth since they first came on the scene in 2007 has been exponential. Now, in the first big regulatory action that is sure to spur similar responses across the pond, the European Parliament approved rules last week to ban e-cigarette advertising in the 28 EU member nations beginning in mid-2016.  The strong action also requires the products to carry graphic health warnings, be childproof and contain no more than 20 milligrams of nicotine per milliliter. It’s expected that the U.S. Food and Drug Administration will soon follow suit and the days of great independence for e-cigarettes will come to a crashing halt. A few U.S. cities, Los Angeles most recently, have banned e-cigarettes in public spaces.

e-cigUntil recently, I was completely ignorant about the whole phenomenon of e-cigarettes. What is the delivery system? Where are they manufactured? Are they a safe alternative to smoking? And how are they being marketed and to whom? Well here’s an eye opener: According to the Centers for Disease Control and Prevention, e-cigarette usage more than doubled among middle and high school students users from 2011 to 2012. Altogether, nearly 1.8 million middle and high school students nationwide use e-cigarettes.

Robert Jackler, MD, chair of otolaryngology at Stanford Medicine, has long studied the effects of tobacco advertising, marketing, and promotion through his center, SRITA (Stanford Research Into the Impact of Tobacco Advertising). After years of detailing how tobacco use became ubiquitous in the U.S. he’s now tracking the marketing of e-cigarettes, and what he’s found probably won’t surprise you. The same sales techniques that brought about the explosive growth of tobacco use are being deployed again to make e-cigarettes look sexy, cool and defiant.

While there are claims by the e-cigarette industry that e-cigarettes are important tools to help people kick the tobacco habit, there’s little evidence to date to back up that claim. And Jackler isn’t completely sold on the notion that e-cigarettes will bring about a great cessation of tobacco smoking; he sees them more as a continuity product. He told me:

What the industry would like to see you do is when you go to a place that you can’t smoke, that you pick up your e‑cigarette and you vape, and you get your nicotine dose in the airport when waiting, or when you’re in your workplace, or when you’re even in school, and that way, when you leave school or the workplace, you go back to the combustible tobacco products.

Sorry if I’m a bit cynical, but as an ex-smoker I find it hard to believe that Big Tobacco – which is increasingly getting into the e-cigarette business – doesn’t also see vaping as a way to continue to keep smokers smoking. Bubble gum flavors and packaging designed to resemble lipstick containers! Who’s really being targeted here?

After my 1:2:1 podcast (above) with Jackler, I’m convinced we’ve been down this road before and it wasn’t pretty health-wise. More than 16 million Americans suffer from a disease caused by smoking. Listen to the podcast and you be the  judge about the true intentions of those promoting e-cigarettes.

Previously: Stanford chair of otolaryngology discusses federal court’s ruling on graphic cigarette labelsWhat’s being done about the way tobacco companies market and manufacture products and Image of the Week: Vintage Christmas cigarette advertisement
Photo by lindsay-fox

Cardiovascular Medicine, Podcasts

Dick Cheney on his heart transplant: “It’s the gift of life itself”

Dick Cheney on his heart transplant: "It's the gift of life itself"

Cheney2Dick Cheney has lived with chronic heart disease for virtually all of his adult life. At 37, as a young man running for the U.S. Congress in Wyoming, he had his first heart attack. His last – a fifth – occurred in 2010 and by then having taken advantage of everything medicine and technology had to offer, Cheney knew he was at the end of the road. And, remarkably, as the former vice president told me in this 1:2:1 podcast, he didn’t fear death:

I concluded that sooner or later, I was going to run out of technology, run out of new innovations and developments in the area of heart medicine… I  thought about it, I guess, I was at peace. It was not painful. It wasn’t surprising or frightening. I had come to that point where I fully expected that I had lived a wonderful and remarkable life. I had a tremendous family. I had everything a man could ask for.

Facing end stage heart failure, in the summer of 2010 he received a left ventricular assist device commonly known as an LVAD. But he knew the device wouldn’t be enough. A transplant was the only option that would set aside decades of heart ailments and give him something he had thought was impossible: longevity. Twenty months later, at 71 years old, a late night phone call informed him a donor had been found. Life for Dick Cheney would begin anew.

Now, nearly two years after his transplant, Cheney and his cardiologist, Jonathan Reiner, MD, have written a book about his history of heart ailments, Heart: An American Medical Odyssey. As we were putting together the current issue of Stanford Medicine – a special on cardiology – it made sense to include an interview with Cheney, and so I pursued one.

Cheney launched the book last fall with a number of high-profile media interviews starting with Sanjay Gupta’s on CBS’ 60 Minutes. We spoke a few days before Thanksgiving when family matters were in the press. I decided not to repeat the buzz questions that had already consumed the press at the time – the Homeland scenario or whether his years of service in the White House afforded him special access to health care unavailable to everyone else. I pursued a different line.

This wasn’t the taciturn Cheney that I had feared as an interviewer. He was pensive, reflective and clearly extremely grateful that he was able to have this extension on life. His co-author Reiner told him that a heart transplant is a spiritual experience so I asked Cheney what’s been his? He told me:

It’s the gift of life itself… After you’ve been through all of the procedures and so forth and then anticipating death and finding your life has been extended that it’s miraculous… You have a sense that after you’ve been through all of  that, everything else is small. You don’t sweat the small stuff… A friend of mine asked me when I told him it was a spiritual experience: “Does that mean now, that you’re a Democrat?” I told him, “Well, not that spiritual.”

I closed the interview with a final question. What if he learned he had the heart of a liberal Democrat? Well, you’ll have to listen to the podcast or read the Q&A to find out his response.

Previously: Mysteries of the heart: Stanford Medicine magazine answers cardiovascular questions
Illustration, which originally appeared in Stanford Medicine magazine, by Tina Berning

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