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Cardiovascular Medicine, Chronic Disease, Stanford News

Born with high cholesterol

high cholesterol illustrationOn a Friday morning last October, I drove to the East Bay to meet with a fellow who I had been told had quite a story to tell. I met Scott Radabaugh in a coffee shop in San Ramon – a tall, dark-haired man with a weightlifter’s physique and an eagerness to unburden himself of the many troubles he’d suffered as a result of his genetic predisposition to high cholesterol. This was no garden-variety high cholesterol, but the kind of numbers that put people at serious risk of heart attack at a relatively young age.

We talked for more than 2 ½ hours as Radabaugh, 46, detailed his surgeries – his quadruple bypass and the surgery to clear a clogged vessel in his neck – as well as his ongoing anxiety about when the next heart event might strike.

“I’m on hyper alert,” he told me for a story that appears in Stanford Medicine magazine’s new issue. “Once I have chest pains, it may be time…What’s scary is that I don’t go anywhere without nitroglycerin or aspirin [to help defuse a blood clot or heart attack]. I think about my own mortality many times a day.”

Radabaugh had learned just three years ago that he had inherited a gene for high cholesterol, a condition known as familial hypercholesterolemia (FH). People with FH are born with high cholesterol – yes, babies can suffer from high cholesterol. And the harmful substance begins building up in the arteries from that time forward.

Unfortunately, Radabaugh had passed the gene on to his three children, and he felt some guilt in that. All of the children, as well as Radabaugh himself, are taking medication to help prevent heart problems and are careful in their eating habits. The disease, I learned, is relatively common in the U.S. population, though few people are aware it. As an advocate with the FH Foundation, a nonprofit patient organization, Radabaugh is hoping to change that – and to help others avoid some of the heartache he’s experienced himself.

Previously: Mysteries of the heart: Stanford Medicine magazine answers cardiovascular questions and Hope for patients with familial hypercholesterolemia
Illustration, which originally appeared in Stanford Medicine magazine, by Lincoln Agnew

Chronic Disease, Health Costs, Patient Care, Stanford News

Stanford Coordinated Care: A team approach to taming chronic illness

Stanford Coordinated Care: A team approach to taming chronic illness

team handsNearly two years ago, Stanford began an experiment in medical care, a novel way to bring down the extravagant costs of health care while improving people’s health and their experience with the system. If you ask Shelly Reynolds, RN, one of the first patients to benefit, she will tell you it’s been a wild success.

“They hold me accountable for my own health, which is great,” she told me for my recently published Inside Stanford Medicine story. “Physically and emotionally, I’m healthier than I was before.”

And the experiment is costing less, according to initial figures.

The experiment is called Stanford Coordinated Care, a clinic aimed at helping those who consume the lion’s share of health care dollars. These are patients with chronic illnesses, like diabetes or asthma, who often wind up in emergency rooms or in the hospital because their conditions aren’t being well-managed.

The clinic helps them gain control over their health through a personalized approach by a team of caregivers who are available day or night and who give them the tools and support to manage their conditions at home. It focuses on the patients’ goals and what is important to them.

“It’s easy to make a diagnosis of diabetes, but it can be hard for a person to manage day by day,” Ann Lindsay, MD, one of the clinic co-directors, commented. “We help patients in developing a plan. We support it, and we empower them along the way.”

The clinic is the brainchild of Arnold Milstein, MD, a professor of medicine at Stanford and nationally known health care innovator. He developed a model, called the “ambulatory caring ICU,” which was tested successfully in several major pilot sites around the country. He wanted to bring the model to Stanford and recruited the husband-and-wife team of Alan Glaseroff, MD, now a professor of medicine at Stanford, and Lindsay, who had led one of the sites in California’s Humboldt County.

The clinic now has more than 200 patients, all employees and their families at Stanford University and Stanford Hospital & Clinics. Glaseroff calculates that among the first 27 patients treated in the first six months of the clinic’s opening in May 2012, it saved about $420,000, a 39 percent decline in costs from the previous six months, when patients were receiving care elsewhere. He said the numbers are still small and that research is under way to determine if the model is effective in reducing costs, improving outcomes and promoting patient satisfaction.

Initial findings show patient satisfaction at 100 percent. Reynolds is a good example: Working with Lindsay, she has developed a plan to effectively manage her asthma and her back pain and keep her out of the emergency room. She no longer feels like “a number” in the health care system and says having support from Lindsay has made all the difference: “For the first time in a long time,” she told me, “I felt that someone was looking out for me, advocating for me. It was such a relief.”

Previously: Focusing on the whole person to treat chronic disease – and cut costs, At-home program aimed at helping patients with chronic illness and Innovative Stanford clinic to support chronic care patients
Photo (modified from original) by bibendum84

Cancer, Stanford News, Stem Cells

Stanford among the beneficiaries of major gift from Ludwig Cancer Research

Stanford among the beneficiaries of major gift from Ludwig Cancer Research

Daniel K. Ludwig was a reclusive, self-made billionaire and a friend of President Richard Nixon who took the president’s “War on Cancer” to heart. In his will, Ludwig left his entire fortune to cancer research. Now, the New York-based Ludwig Cancer Research is announcing one of the largest gifts ever made to cancer by an individual donor: $540 million to be shared by six leading cancer centers nationwide.

The beneficiaries include the Ludwig Center for Cancer Stem Cell Research and Medicine at Stanford, which will receive $90 million to spur its innovative work on cancer stem cells, which are believed to drive the growth of many cancers. The center, founded in 2006, has received $150 million from Ludwig Cancer Research to date.

Irving Weissman, MD, the center’s director, said Ludwig was willing to invest in cancer stem cells at a time when there was great controversy in the medical community about the role of these cells – and whether they existed at all.

“The Ludwig was absolutely critical to taking this very high-risk research into a real and rapid understanding of cancer cells,” said Weissman, the Virginia and D.K. Ludwig Professor for Clinical Investigation in Cancer Research at Stanford. As a result of the Ludwig support, he said, “We have taken many of our understandings of cancer stem cells into potential therapeutics.”

Weissman and his colleagues at the Ludwig center have discovered that virtually all human cancers express a protein known as CD47, which functions as a “don’t-eat-me-signal” to fend off potential attacks from the immune system. They have developed an antibody against CD47 which has been shown to attack a wide range of solid tumors. The scientists plan to begin a clinical trial in early 2014. They also plan to test it in combination with other antibodies to see if there is a synergy that will make it even more effective, Weissman said.

With Ludwig support, Weissman is also moving forward with clinical trials with a therapy that could dramatically improve survival rates for women with metastatic breast cancer. The innovative approach was tested more than 15 years ago in a small group of women, 33 percent of whom are still alive and well. With the standard treatment, the survival rate after 15 years is just 7 percent, Weissman said. The trial was discontinued by the sponsoring company but with Ludwig support, Weissman and his colleague, Judith Shizuru, MD, an associate professor of medicine, have obtained the rights to the process and plan a larger trial in 2014. “We need urgently to take this forward,” he said.

Previously: Single antibody shrinks or eliminates human tumors in mice at Stanford and Cancer stem cell researchers are feeling the need for speed
Photo of Irving Weissman in featured entry box by Flynn Larsen

Neuroscience, Stanford News

Stanford Nobelist receives hero’s welcome home

Stanford Nobelist receives hero’s welcome home

Sudhof surprise party - 560

Three days after winning the Nobel Prize in Physiology or Medicine, neuroscientist Thomas Südhof, MD, flew back to Stanford late last week to a hero’s welcome, with cheers and applause from about 60 fellow scientists, including many of his postdocs and graduate students who gathered outside his office. Südhof entered on a plastic red carpet into a hallway adorned with fuchsia streamers and red and yellow balloons. He surveyed the cheering crowd, speechless.

“Can I go to work now?” he said, grinning.

But his lab mates at the Lorry I. Lokey Stem Cell Research Building were not about to let him off that easily. There were champagne toasts in plastic cups, cameras flashing and postdocs and grad students angling to get a shot of themselves with their now-famous mentor. They had gone to some lengths for the celebration, even using red balloons on a whiteboard to create a mock presynaptic terminal, part of the brain’s communication system and the focus of Südhof’s award-winning research.

Südhof, a neuroscientist and professor of molecular and cellular physiology, had been on the road to a conference in a small hilltop town in Spain Oct. 7 when he first heard the news of the award from the Nobel’s communications officer. He had flown in the night before to Madrid and had been driving for more than four hours, in search of the town of Baeza, where he was due to deliver a lecture that afternoon on the synapses in the brain, which help neurons communicate the messages that underlie our thoughts, emotions and activities.

“I was exhausted and it was a little frustrating because Google Maps said it would take three hours, and I had been driving four hours already, so I thought it was my colleague calling asking me where I was.” But when the Swedish-accented voice of Adam Smith delivered the Nobel news, “It wasn’t exactly something I expected,” he told the crowd.

His lab members draped him in a red feather boa and gold paper crown and presented him with giant red cup and a bottle of Dom Pérignon. They called him a “superstar.”

“I’m just the administrator,” he said. “You guys are the superstars.”

Later that afternoon, Südhof was feted by several hundred colleagues who gathered in the Beckman Center lobby on the med school campus in his honor. His colleague Brian Kobilka, MD, winner of the 2012 Nobel Prize in Chemistry, warned him about the after-effects of Nobel-hood.

“From the very first day, my e-mail hit above 1,000 and I’ve never caught up since,” Kobilka said. “Unfortunately I have the compulsion to answer.”

Then there were the autograph seekers everywhere, trailing his limo in Sweden and besieging him with phone and email requests. One graduate student sent him a lumpy Fed-Ex envelope with two baseballs, asking him to autograph them, though Kobilka knows nothing about the sport. “I signed them and sent them back,” he shrugged.

“It’s going to be an amazing, crazy experience,” Kobilka told Südhof. “You deserve it. It might throw you off balance for a while, but I’m confident it won’t be for long.”

Previously: For award-winning scientist, a finished experiment is like a piece of completed art, The lure of research: How Nobel winner Thomas Südhof came to work in the basic sciences, Celebrate good (Nobel) times – come on!, Discussing the brain in Spain: Nobel Laureate Thomas Südhof addresses the media, Stanford’s Thomas Südhof wins 2013 Nobel Prize in MedicineStanford’s Thomas Südhof wins 2013 Nobel Prize in Medicine and Stanford’s Brian Kobilka wins 2012 Nobel Prize in Chemistry
Photo by Nathan Huang

Chronic Disease, Public Health, Research, Stanford News, Women's Health

Large federal analysis: Hormone therapy shouldn’t be used for chronic-disease prevention

Large federal analysis: Hormone therapy shouldn't be used for chronic-disease prevention

woman in windowFor years, women were misled into believing that menopausal hormone therapy was a fountain of youth, a way to counter the chronic diseases of aging, such as heart disease and dementia. But after 15 years of trials and follow-up, the Women’s Health Initiative has delivered the final blow to use of the therapy for disease prevention.

A synthesis of all WHI studies, involving more than 27,000 women, reinforces previous findings that there are many risks in taking hormone therapy and precious few benefits. The new report, published in today’s Journal of the American Medical Association, included women with a uterus who were given estrogen with progesterone, as well as those without a uterus who were given estrogen alone. The women were between the ages of 50 and 79 at the start of the study.

Among women in the estrogen-progestin group, the risks were higher for coronary heart disease, breast cancer, stroke, pulmonary embolism, gallbladder disease, urinary incontinence, and in those 65 or older, dementia. The benefits included decreased hip fractures, diabetes and reduced menopausal symptoms such as night sweats and hot flashes. In the estrogen-only group, the risks and benefits were more balanced, with increased risks of stroke and blood clots, and dementia in women aged 65+, and reduced risk of hip and other fractures.

“What we found initially has not changed, despite more than a decade of new analyses which have taken into consideration questions and controversial issues raised by individual scientists and professional organizations that continue to believe menopausal hormone therapy is good for women - particularly younger women,” Marcia Stefanick, PhD, a professor of medicine at Stanford and one of the study’s co-authors, told me.

She said it is clear menopausal hormone therapy should not be used to prevent diseases of aging. Younger, healthy women in early menopause may still opt to use the therapy to manage their symptoms but shouldn’t look to it as a disease prevention tool, she and her colleagues conclude.

Stefanick has been a leader in the NIH-funded initiative since its outset in 1994. She said it’s important to include women in NIH-funded clinical trials to ensure that there is enough evidence to prescribe any kind of drug that is widely used, whether it is hormones or other treatment. Earlier this year, Stefanick co-founded a School of Medicine-wide center known as the Stanford WSDM Center (Center for Health Research on Women & Sex Differences in Medicine), which encourages study of sex differences in cells, tissues, animal models and human health outcomes, with an emphasis on women’s health.

Previously: No long-term cognitive effects seen in younger post-menopausal women on hormone therapyA call to advance research on women’s health issuesNew findings on aspirin and melanoma: Another outcome of the Women’s Health Initiative, Exploring sex differences in the brain and Women underrepresented in heart studies 
Photo by Alfonso Jimenez

Research, Stanford News

Nesting improves mouse well-being, could aid research studies

Nesting improves mouse well-being, could aid research studies

A new study confirms what Joseph Garner, PhD, and his colleagues have long suspected – that laboratory mice are healthier, more fertile and have better welfare when they have the means to build a nest, which reduces stress and helps them naturally warm themselves.

Garner has done a series of studies in these mice not only to enhance their living conditions and well-being, but also to improve the results of research studies. Laboratory mice now are routinely housed in cold conditions, so the animals expend much of their energy trying to keep warm. This changes their physiology and may compromise the outcome of research studies, says Garner, an associate professor of comparative medicine at Stanford. But given the means to build a nest, the mice will thrive, producing more pups that are healthier and more likely to survive, he and his colleagues report in a study out this week.

In the study, the researchers gave pairs of mice from three of the most commonly used strains a few different living options. Some got a bed alone, while others got a bed, plus a choice of one of two different materials for building nests. The nest-builders proved to be healthier in many respects – good news for the mice, as well as for the research labs that maintain them. Garner told me:

This is a great example of how ‘good welfare is good business.’ The mice with nesting material produced more pups per litter, the pups reached a healthy weight faster, the mortality of the pups is reduced, and the mice used less food.

Providing mice with nesting material is very cost-effective for commercial mouse breeders, he says. For the most commonly used mouse strain, laboratories that invest 60 cents in nesting material over six months will gain an additional $273 on average in pups, he calculates. But it’s not just mice and mouse breeders that stand to benefit:

For a scientist on campus, this means that you can reduce the cost of breeding mice because you need fewer breeding pairs to produce the mice you need, and those mice will be healthier, better quality mice. So this is a great incentive for all of us to do the right thing and invest in enrichment for our mice.

The study, a collaboration with Brianna Gaskill and researchers at the Charles River laboratory, appears online in PLoS One.

Previously: Stanford researcher’s easy solution to problems of drug testing in mice and Keeping lab mice warm could save costs, benefit scientific research

Medicine and Society, Pain, Patient Care, Public Health, Stanford News

A physician’s personal odyssey with chronic pain

A physician’s personal odyssey with chronic pain

Philip Pizzo, MD, former dean of Stanford’s medical school was preparing to head to Washington, D.C. to meet with top federal health officials when he leaned down in his office and felt the sharp sting of pain. It would be the beginning of a long odyssey into the world of chronic pain – the very subject he had planned to go to Washington to discuss.

The chair of an Institute of Medicine panel on pain, Pizzo and his colleagues had issued a report in late 2011 calling for a transformation in approaches to pain, which affects more than 100 million Americans. Suddenly he would find himself among the afflicted as he sought the opinions of multiple physicians and underwent four MRI’s, turning increasingly despondent as the months dragged on with no diagnosis.

My hope is that by sharing my personal story, it will generalize the discussion and create more dialogue about the realities that 100 million people face…

“I could easily still have been one of the many tens of thousands or millions facing chronic pain without explanation, because I had been through all the standard testing,” he said in an interview. “I had four MRI scans and none showed the lesion that ultimately contributed to my finding. The reality was because I am a physician and I kept saying, ‘Gee, there is something wrong that hasn’t been found,’ people were responsive.”

In writing about the experience in today’s New England Journal of Medicine (subscription required), Pizzo says the specialists he encountered were often circumscribed in seeking answers. He told me, “While it’s not an indictment of the medical system, it’s a reality that many have faced – physicians and providers are rushed, specialization is so significant that many people think within narrow boundaries. They don’t leap beyond their own expertise. That is another thing we have to challenge ourselves with - to think beyond the usual.”

As time wore on, he said, at least one physician would suggest that his condition was largely psychological - essentially “all in your head.”

“What I experienced is what many do when you get beyond the point when conventional tests aren’t revelatory. The medical community gets frustrated – gee we can’t find anything – and begin to think maybe there are other things happening, some suggestion perhaps that it was distress or depression… It’s easy for physicians to say you are depressed and that’s why you have pain. But it’s important to recognize that patients may be depressed because they have pain.”

A marathon runner with boundless energy and a perennially upbeat attitude, Pizzo indeed had become clinically depressed as a result of his disabling condition. But once the underlying cause of the chronic pain was diagnosed and treated – albeit with a major surgical procedure – that depression immediately lifted, along with the pain. Ultimately, it was an unusual test - an imaging study that tracked the path of the sciatic nerve - that unearthed the source of his distress, a congenital condition involving compression of the nerve.

After the surgery, Pizzo learned another valuable lesson for physicians - that not all patients respond well to opioids, typically the drugs of choice for control of severe pain. He proved highly sensitive to the medications and landed in intensive care.

Today, Pizzo is back to running and working full-time in his office on the medical school campus. In writing his personal story, he says he hopes to draw more physician attention to the overwhelming problem of chronic pain in the United States.

“My hope is that by doing this, it will generalize the discussion and create more dialogue about the realities that 100 million people face, many of whom don’t have the opportunity to have their voices expressed.”

Previously: The high cost of pain: Medical school dean testifies on problem to U.S. SenateA call to fight chronic-pain epidemic, No pain, no gain. Not!, Relieving Pain in America: A new report from the Institute of Medicine and Researching ways to “heal the hurt”

Addiction, Mental Health, Research, Stanford News

Stop-smoking program aids recovery of psychiatric patients, study finds

Stop-smoking program aids recovery of psychiatric patients, study finds

While smoking has been in decline in recent years in this country, one group where it remains endemic is among psychiatric patients, who often die prematurely of tobacco-related disease. Practitioners have long thought that smoking could be a useful tool in therapy, calming patients and helping them cope with stress. They also feared that if psychiatric patients were asked to quit, it could interfere with treatment.

But those assumptions are challenged by a new study led by a Stanford researcher, which shows that quitting smoking may be beneficial for these patients. Judith Prochaska, PhD, MPH, and her colleagues at University of California, San Francisco found that a stop-smoking program in hospitalized psychiatry patients aided their recoveries and reduced the chance that they would be hospitalized again for their psychiatric problems.

“This is a very low-cost, brief intervention that helped patients quit smoking and offers evidence that it may have helped their mental health recovery,” said Prochaska, associate professor of medicine with the Stanford Prevention Research Center.

Michael Fiore, MD, MPH, director of the University of Wisconsin Center for Tobacco Research and Intervention and a leader in national policy for tobacco treatment, said:

This paper by Dr. Prochaska and colleagues provides powerful evidence that evidence-based tobacco dependence treatments can substantially increase quit rates among psychiatric inpatients. We know that psychiatric patients smoke at very high rates and are at tremendous risk from their smoking. Thus, the findings hold promise to make an important, real-world contribution to the health of these patients.

The researchers offered stop-smoking treatment to 224 patients at UCSF’s Langley-Porter Psychiatric Institute, a smoke-free, locked unit for acute care. Half participated in a stop-smoking intervention that included a meeting with a counselor, written and electronic materials and the availability of a 10-week supply of nicotine patches. The other half received usual care – a pamphlet about the hazards of smoking and information on how to quit.

At the end of 18 months, 20 percent of those in the treatment group had quit smoking, compared to just 7.7 percent in the control group. Moreover, what was unexpected and striking is that 44 percent of those in the treatment group were rehospitalized, compared to 56 percent in the control group.

“I think some of the therapeutic contact that addressed tobacco dependence and supported participants with this major health goal may have generalized to feeling better about their mental health condition,” Prochaska said.

The study is published online today in the American Journal of Public Health.

Global Health, Infectious Disease, Public Health, Stanford News

Stanford pump project makes clean water no longer a pipe dream

Stanford pump project makes clean water no longer a pipe dream

Dhaka water lake - smallBefore Amy Pickering, PhD, left Bangladesh, she stuffed a bright green, 70-pound iron water pump into her suitcase, carefully bolstering a key piece of her research project, which aims to improve the health and save the lives of children in the Dhaka slums.

Pickering and her colleagues at Stanford, including an energetic group of students, have found a way to attach a chlorine doser to the pump, which is typical of the communal pumps used in the slums, to effectively purify the water. They have spent this summer in Bangladesh laying the groundwork for a large-scale study of the new device, which they hope will help decrease rates of diarrhea and improve weight gain among slum children.

In talking to project director Steve Luby, MD, for a Stanford Medicine story about the initiative, I learned that this approach is a radical departure from what has come before, as most water purifying systems in the developing world, like household disinfecting kits, put the burden on residents to clean their own water at home. Fewer than 10 percent take advantage of this option, he says, because it requires too much of a change in behavior. This latest pump system is a passive one, so people don’t have to do anything at all to get treated water – just turn on the communal pump, he says.

The need for such a system could not be more compelling:  Tens of thousands of children in Bangladesh die every year of diarrhea, mostly caused by drinking water fouled by debris and human waste. A microbe that might have minimal impact on a child here in Palo Alto, Calif. could be devastating to a chronically exposed, undernourished child in the Dhaka slums, where some four million people live.

“If you talk to people in these communities, almost all of them will be able to tell you about somebody they know who has died of diarrhea. So mothers are very familiar with the problem,” says Luby, a professor of medicine who is also a fellow at the Stanford Woods Institute for the Environment.

Luby spent eight years in Bangladesh with the U.S. Centers for Disease Control and Prevention and found the people in the South Asian country very warm and welcoming. But the residents suffer under crushing environmental problems, including poor water quality, he says.

“Water is a very important resource that is not being well-managed, at the risk of all humanity,” he told me. While agricultural interests are depleting the ground water in the region, surface water is being used as a garbage dump for sewage and industrial waste, he says.

The Stanford project is a hopeful one, however, as it shows how a group of engineers with expertise and entrepreneurial spirit can work together to improve the environment and better the lives of people halfway across the world.

Previously: Factoring in the environment: A report from Stanford Medicine magazine, Researchers reveal promising advancement in the way water is purified, Waste not, want not, say global sanitation innovators, A story of how children from Calcutta’s poorest neighborhood became leaders in improving health and Simple, cheap measures can prevent most needless deaths worldwide
Photo, of a washing area in a Dhaka compound, by Amy Pickering

Global Health, Sexual Health, Stanford News, Women's Health

Stanford and PSI researchers test safer, more convenient post-partum IUD inserter

Stanford and PSI researchers test safer, more convenient post-partum IUD inserter

Stanford’s Paul Blumenthal, MD, MPH, and his colleagues at Population Services International have won a grant from “Saving Lives at Birth: A Grand Challenge for Development” to expand testing of a simple, safe post-partum IUD inserter for women in the developing world.

In a July 31 presentation that resembled a high-school science fair, the group presented its proposal in Washington, D.C. to a team of judges, who picked it from among some 400 submissions, said Blumenthal, a professor of ob-gyn at Stanford and PSI’s medical director. The $250,000 seed grant will enable the researchers to test the device on a much larger scale among women in India.

The device provides “one-stop-shopping” for women seeking a long-term form of birth control. A woman can deliver a baby in the hospital, then have the device inserted either immediately after giving birth or sometime over the next 24-48 hours. Blumenthal told me:

It simplifies a process which has been complicated until now. We think it will show it is safer in terms of less contamination. And it will be much easier for clinicians to learn and a LOT more convenient. You can take it out of the package, insert it and call it a day, compared to the forceps routine clinicians have been using up to now.

Currently, physicians both in the United States and the developing world use forceps to insert the IUD into the fundus of the uterus, then remove the forceps, hopefully, without accidentally extracting the IUD. This process requires a very skilled clinician, can be painful for the woman and increases the possibility of infection. For those reasons, the device has not achieved widespread use, Blumenthal said.

The latest device is “unbelievably simple” and will likely improve access to birth control for women in the developing world, he said:

This could be a way to mainstream this approach, particularly for women in rural areas or those who have difficulty accessing family planning methods once they’ve given birth. It might be hard for them to access a method, so a post-partum IUD offers them one-stop-shopping. They go home with a method that could last them for 10 to 12 years.

The device can be manufactured in India for just 75 cents, “which is a pretty good deal,” Blumenthal said.

“Saving Lives at Birth” is a partnership between the U.S. Agency for International Development, the Bill & Melinda Gates Foundation, the governments of Norway and Canada and the U.K.’s Department for International Development.

Previously: Stanford study: Women in developing world benefit from quick, effective cervical cancer testPromoting the use of IUDs in the developing worldStanford ob-gyn Paul Blumenthal discusses advancing women’s health in developing countries and Gates Foundation grants aim to improve health in developing countries

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