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The benefits and costs for scientists of communicating with the public

The benefits and costs for scientists of communicating with the public

twitter_bird_sketch_Shawn_CampbellToday’s researchers are under immense pressure to produce scientific results in the form of peer-reviewed journal articles—and do it on tighter and tighter budgets. And although there’s a myth that scientists don’t like talking to the media or interacting with non-scientists, many researchers consider it part of their jobs to explain their research to the general public, either through interviews with reporters or social media.

But does this “science-splaining” take valuable time away from research that results in journal articles? A new study highlighted by science writer Matt Shipman at his blog Communication Breakdown suggests that, in fact, it might help by boosting the number of times a paper is cited by other researchers. The findings were published in the most recent issue of Journalism and Mass Communication Quarterly. Shipman writes:

This is only the latest article to link news coverage of research to scientific impact (I’ve written about related research here and here), but the new paper does a few things I haven’t seen before. First, it looks at a number of public communications approaches (including working with reporters, blogging and talking to nonscientists) and whether social media mentions affect their impact. Second, the researchers used Jorge Hirsch’s h-index as their metric for measuring scientific impact in the context of public outreach efforts.

Study results showed that that researchers who talked to reporters were more likely to have a higher h-index, though science bloggers and those that talked to nonscientists did not see a similar boost. Being mentioned on Twitter appears to act as an amplifier of that effect for both scientists who talked to reporters and for scientists who talked to nonscientists, but not for science bloggers.

So although science outreach might seem like a distraction from producing research results, it could turn out to be one more brick that builds a researcher’s legacy.

Previously: Scientists preferentially cite successful studies, new research shows, John Ioannidis discusses the popularity of his paper examining the reliability of scientific research, Listening to elephants, communicating science, and inspiring the next generation of researchers, Hawkeye Pierce (i.e. Alan Alda) teaches scientists how to better communicate about their work, and Chris Mooney: Use science to identify effective science communicators
Image by Shawn Campbell

Cancer, Global Health, Health Policy, Infectious Disease, Public Health

Treating an infection to prevent a cancer: H. pylori and stomach cancer

Treating an infection to prevent a cancer: H. pylori and stomach cancer

Hpylori-pic-thumb-460x385-2092

The number of newly diagnosed stomach cancer cases in the United States is less than a tenth of the number of prostate cancer cases or breast cancer cases, which may be part of the reason it doesn’t get the same attention as breast and prostate cancer. But the mortality rate is much higher for stomach (or gastric) cancer. Nearly 11,000 Americans will likely die from gastric cancer this year, with only 28 percent of cases surviving five years or more. For comparison, the five-year survival rate for prostate cancer is nearly 99 percent and for breast cancer, it’s more than 89 percent.

On a global scale, an estimated 700,000 people will die from gastric cancer this year, as Stanford infectious disease specialist Julie Parsonnet, MD, and her co-authors note in a Viewpoint piece in the most recent issue of the Journal of the American Medical Association. The authors also point out that worldwide, about 77 percent of gastric cancer cases are linked to chronic infections of Helicobacter pylori, a helix-shaped bacteria that was identified in the early 1980s and found to be linked to gastric ulcers a few years later, as well as to gastritis, an inflammation of the stomach lining that is a precursor to stomach cancer.

Researchers are still trying to understand exactly how H. pylori causes cancer or even how it colonizes the gastrointestinal track – they believe it’s picked up via food or water. Until recently, there was a dearth of randomized clinical trials that looked at the effectiveness of screening and treatment for H. pylori as a method for preventing stomach cancer.

Ignoring gastric cancer in the hope that it will soon disappear is not a tenable health policy

In the opinion piece, the authors describe the recommendations of a working group that met in December 2013 at the behest of the International Agency for Research on Cancer. Taking the burden of the disease and the availability of treatment options in consideration, the group considered gastric cancer “a logical target for intervention,” according to the authors of the JAMA piece. They go on to write:

Screening and treatment for H pylori is generally acceptable and affordable. An inexpensive serological test can determine who may be infected, with a sensitivity and specificity that could be sufficient for population-based prevention programs. Low-cost treatment regimens using 2 or 3 generic antibiotics plus a proton pump inhibitor for 7 to 14 days can eradicate the infection in more than 80% of cases, depending on the antibiotic resistance patterns of H pylori within the population. Economic modeling studies indicate that H pylori screening and treatment strategies are cost-effective under a large range of assumptions about effectiveness and costs. However, the models are limited by reliance on observational data rather than randomized trial results, by a lack of information on possible adverse effects of treatment, and by limited data from lower-income countries.

Researchers still have many gaps in their understanding of the best methods to prevent stomach cancer, but several trials may answer some of those questions in the coming decade.

Stomach cancer is not the only cancer known to be linked with an infection. Doctors routinely test whether women who come in for a PAP smear are infected with the human papilloma virus (HPV), which is linked to cervical cancer. Chronic hepatitis B and C infections are known to be linked to liver cancer. In time, screening for H. pylori to prevent stomach cancer may become routine. Until then, Parsonnet and her coauthors say in their conclusion, “Ignoring gastric cancer in the hope that it will soon disappear is not a tenable health policy.”

Previously: Researchers identify potential drug target in ulcer bug that infects half the world’s population, Good-bye cancer, good-bye stomach: A survivor shares her tale and Image of the Week: Helicobacter pylori colonizing the stomach
Photo by Shuman Tan and Lydia-Marie Joubert

In the News, Public Health

Healthy gut bacteria help chicken producers avoid antibiotics

Healthy gut bacteria help chicken producers avoid antibiotics

chicks for productionIf you watch TV, you’ve probably seen actress Jamie Lee Curtis selling Activa, Dannon’s probiotic yogurt – or perhaps you’ve  taken probiotic supplements to help you recover after a nasty intestinal infection. Probiotics are microorganisms that are thought to help improve the bacterial balance in our guts. It’s not clear whether they are effective in humans, but they do appear to work in chickens.

Recently, the third-largest chicken producer in the nation, Perdue Farms, announced that it had eliminated almost all antibiotics from its farm operations – a move that has been in the works at the company for a dozen years. As NPR’s The Salt blog recently reported, the company has turned, instead, to probiotics to help keep the chickens healthy:

“As we took antibiotics out of the feed, we put some other things in, such as probiotics,” says Bruce Stewart-Brown, an executive at Perdue Farms. “We’ve increased the amount of probiotics by five times over the past five years. It’s a significant part of our program.”

Since the 1970s, farmers have given low doses of antibiotics to livestock animals to help them grow faster and bigger, a practice called “sub-therapeutic” use. And for almost as long, the practice has been viewed with suspicion by many concerned that it may encourage antibiotic resistance. Approximately 15-17 million pounds of antibiotics are given to livestock in the U.S. every year, according to Stuart Levy, MD, of Tufts University, director of the Alliance for the Prudent Use of Antibiotics.

In December, the FDA asked antibiotic producers to label their drugs so that they did not promote “sub-therapeutic” doses to fatten animals and earlier this month, the White House issued a report on combatting antibiotic resistance. One of the criticisms of the plan was that it didn’t make strong recommendations for reducing sub-therapeutic use of antibiotics in livestock animals.

Probiotics are a more expensive intervention than sub-therapeutic antibiotics, but offer an alternative – at least in chickens, as The Salt reports:

Stewart-Brown says that he was initially skeptical about probiotics. “Eight years ago, I would have said that they’re not working in poultry. They’re not very useful. Today, I’m saying that they are useful. Expensive, but useful. “Chickens that got probiotics stayed healthier and grew faster than birds that didn’t.

Perdue’s experiment with probiotics is probably the largest of its kind among commercial producers. How they fare may be a bell weather of what’s to come for other agricultural livestock producers and provide them with a route away from antibiotic overuse.

Previously: Interactive online map helps researchers track spread of antibiotic-resistant bacteria and Some unlikely sources for antibiotics
Photo by Loaf

Aging, In the News, Neuroscience, Stanford News

Exercise and your brain: Stanford research highlighted on NIH Director’s blog

Exercise and your brain: Stanford research highlighted on NIH Director’s blog

B0007367 Thigh muscle fibrilsThomas Rando, MD, PhD, who studies stem cells in muscle and longevity, and Tony Wyss-Coray, PhD, who studies the immune system’s impact on the brain, were awarded an NIH Director’s Transformative Research Award to study the slew of molecules that muscles release and how they help muscle cells communicate with other cells. (Rando and Wyss-Coray call this cellular communication network “the communicome.”) The onset of both depression and Alzheimer’s disease have been shown to be delayed with exercise, and Rando and Wyss-Coray theorize that molecules released by muscles during exercise may be the key to understanding how exercise can affect brain function so profoundly and so beneficially.

Today on the NIH Director’s blog, Francis Collins, MD, highlighted the Stanford duo’s research:

To study the communicome, Wyss-Coray and Rando will use a technique called parabiosis to couple the circulatory systems of physically active mice with mice that are less active. If the “couch potato” mice benefit from the blood of the active mice, then the team will analyze the blood to find the responsible factor(s).

This is definitely high-risk high-reward research. It won’t be easy, but finding molecules that mimic exercise’s brain-boosting effects may open the door to new ways of preventing or treating age-related cognitive declines and a wide range of other neurological conditions. This is especially important for people for whom it is difficult or even hazardous to exercise because of conditions such as arthritis, osteoporosis, and Alzheimer’s disease and other forms of dementia.

Earlier this year, Wyss-Coray published a study showing that older mice that received transfusions of younger mice’s blood improved their brain function. That study was based in part on Rando’s previous research showing that young mouse blood could activate old stem cells and rejuvenate older tissue. Their new collaboration may shed more light on the molecular mechanisms behind such observations.

Previously: Young mouse to old mouse: “It’s all in the blood, baby”, The rechargeable brain: Blood plasma from young mice improves old mice’s memory and learning, “Alert” stem cells speed damage response, say Stanford researchers and Red light, green light: Simultaneous stop and go signals on stem cells’ genes may enable fast activation, provide “aging clock”
Photo, of thigh muscle fibrils, by David Gregory & Debbie Marshall, via Wellcome Images

Global Health, In the News, Infectious Disease, Public Health

Expert panel discusses challenges of controlling Ebola in West Africa

The rapidly growing Ebola outbreak in West Africa is not only overwhelming the health systems of the countries involved, but the World Bank recently warned that it could trash the economies of Liberia, Guinea, and Sierra Leone – the countries that have seen the most cases. Since the first confirmed case in December 2013 in Guinea, almost 5,000 people have become infected with the virus in five countries and about half of them have died. On September 16, President Obama committed 3,000 military personnel to help fight the outbreak, along with other resources.

This morning, KQED’s Forum hosted a panel of Ebola experts, including Michele Barry, MD, director of Stanford’s Center for Innovation in Global Health. The panel discussed some of the challenges this outbreak poses. One issue is the enormous need for resources to control an outbreak of this momentum and magnitude. The WHO estimates it will take about a billion dollars to contain and by some estimates, it will require 1,000 international health care workers to train national, local clinicians.

Barry discussed the prospects for Zmapp, an experimental drug to treat Ebola -“a cocktail of monoclonal antibodies” according to Barry – for helping to curb the disease. She said that besides the lack of human clinical data on the effectiveness of this drug, the difficulty producing the drug also slows down plans to use the medication in the field. She went on to say:

I do have optimism for containing the virus. What I don’t have optimism for is the long-term trajectory of the Liberian healthcare workforce. It’s been actually decimated. I think there are wonderful people there working on it on the ground, but actually, there’s only a only a couple hundred doctors and a serious percentage of them have died—as well as nurses, in this battle against Ebola.

She elaborated on her concerns for the long-term problems for controlling epidemics in general:

I think there are short-term problems, but then I would urge people to start – and I know many people are – to think about long term issues. The long term issues of when you have a WHO that’s had its budget decimated, and its pandemic and epidemic division disbanded. That needs to be strengthened. When you have a workforce in Africa of only – I mean they have 25 percent of the disease burden but only four percent of the workforce. That needs to be strengthened. So there are long term issues of control for future epidemics.

She also suggested that a global health worker reserve corps could be assembled, a fund to strengthen health systems could be established, much like The Global Fund to fight AIDS, Tuberculosis and Malaria, and the UN could take a more active role in large infectious disease epidemics.

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Applied Biotechnology, Immunology, Infectious Disease, Research, Technology

Artificial spleen shown to filter dangerous pathogens from blood

Artificial spleen shown to filter dangerous pathogens from blood

79118_webOur spleens filter out toxins from our blood and help us fight infections. But serious infections can overpower our bodies’ ability to fight them off, especially among older adults whose immune systems are weaker. Now, a research team led by Donald Ingber, MD, PhD, of Harvard has come up with an artificial “biospleen” that can trap bacteria, fungi and viruses and remove them from circulating blood. Science Magazine describes the device in a news story:

The team first needed a way to capture nasties. They coated tiny magnetic beads with fragments of a protein called mannose-binding lectin (MBL). In our bodies, MBL helps fight pathogens by latching onto them. Ingber and colleagues showed that the sticky beads could grab a variety of microbes in the test tube.

With that key challenge out of the way, the researchers were ready to design the rest of the system. They engineered a microchiplike device a little bigger than a deck of cards that works somewhat like a dialysis machine. As blood enters the device, it receives a dose of the magnetic beads, which snatch up bacteria, and then fans out into 16 channels. As the blood flows across the device, a magnet pulls the beads—and any microbes or toxins stuck to them—out of the blood, depositing them in nearby channels containing saline.

The researchers first tested their device with donated human blood tainted with bacteria. They found that filtering the blood through the device five times could eliminate 90% of the microbes.

The device improved survival rates in rats and may decrease the incidence of sepsis, a dangerous side effect of severe infections. The researchers also found that the device could filter the total volume of blood in an adult human – about 5 liters or (1.3 gallons) – in about five hours.

Previously: Our aging immune systems are still in business, but increasingly thrown out of balance
Image, of the magnetic MBL-coated nanobeads beads capturing pathogens, from Harvard University Wyss Institute

Cancer, In the News, NIH, Research, Stanford News, Women's Health

NIH Director highlights Stanford research on breast cancer surgery choices

NIH Director highlights Stanford research on breast cancer surgery choices

The director of the NIH, Francis Collins, MD, this morning weighed in on a topic that has garnered much attention lately: the type of surgery that women diagnosed with breast cancer choose. The post, found at the NIH Director’s blog, describes a recent study by Stanford researchers published earlier this month in the Journal of the American Medical Association that examined survival rates after three different types of breast cancer surgery for women diagnosed with cancer in one breast: a lumpectomy (removal of the just the affected tissue, usually followed by radiation therapy), a single mastectomy (removal of the whole affected breast), and double mastectomy (removal of the unaffected breast along with the affected one.)

In a previous post we wrote in detail about the study and the finding that the number of double mastectomies in California have increased dramatically. However, except for women with the BRCA1 or BRCA2 genes, the procedure does not appear to improve survival rates for women who undergo the surgery compared with women who choose other types of breast surgery. Collins notes:

It isn’t clear exactly what prompted this upsurge in double mastectomy, which is more expensive, risky, and prone to complications than other two surgical approaches. But [researchers] Kurian and Gomez suggest that when faced with a potentially life-threatening diagnosis of cancer in one breast—and fears about possibly developing cancer in the other—women may assume that the most aggressive surgery is the best. The researchers also said it’s also possible that new plastic surgery techniques that achieve breast symmetry through bilateral reconstruction may make double mastectomy more appealing to some women.

Despite its recent upsurge in popularity, the study found double mastectomy conferred no survival advantage over the less aggressive approach of lumpectomy followed by radiation.

Collins also points out that the slightly worse survival rates of women who undergo single mastectomies probably reflect the fact that poorer women were more likely to have this surgery and is evidence of yet another health disparity linked to economic status.

Previously: Breast cancer patients are getting more bilateral mastectomies – but not any survival benefit

Health Policy, Public Health, Stanford News

Defining a “public-health emergency” in an age of complex health threats

Defining a “public-health emergency” in an age of complex health threats

MHE_-_KBH_Brandvaesen_-_HAZMAT_3aWhen chemicals used in coal mining were spilled into the Elk River in West Virginia in January, the governor declared a state of emergency the same day. When the H1N1 influenza virus was discovered in 2009, President Obama declared a national public-health emergency. In both cases, people were willing to comply with government orders (don’t drink the water, speed up vaccine production) in order to get an impending health threat under control.

But what happens when the health threat isn’t imminent? Or if it has no clear end-point? In a perspective piece in the most recent issue of the New England Journal of Medicine, Stanford public-health law scholar Michelle Mello, PhD, JD, and her co-authors delve into just such questions. They describe Massachusetts Governor Deval Patrick’s unusual step in March to declare a public-health emergency in order to control the state’s recent opioid-addiction epidemic – 40 people had died from heroin overdoses in four months. The move allowed public-health authorities to take several steps to address the problem, including monitoring prescription use and release funds for addiction treatment. Few states have taken such drastic steps to control drug use problems, though, and it raises questions about what exactly constitutes a public health emergency. In the piece, the authors write:

Patrick’s unusual invocation of emergency public health powers, which are traditionally reserved for infectious disease outbreaks, natural disasters, or acts of terrorism, offers an opportunity to consider some important questions. Should widespread injuries, such as those caused by opiates or motor vehicle crashes, be viewed as public health emergencies? Should chronic health conditions such as hypertension or obesity be similarly categorized? When should normal lawmaking processes, and the typical rights afforded to individuals and entities, be suspended to protect public health?

Although there may be benefits – drawing public attention to an important problem, access to critical funding sources, even mustering military personnel (for example, the National Guard was deployed to deal with the Elk River chemical spill) – there are drawbacks as well. Emergency powers give the government unprecedented leeway, as the authors note, they “sit largely outside the ordinary structures of checks and balances.” The authors go on to describe some of the pitfalls of declaring public-health emergencies:

Most important, concerns about due process are amplified when emergency orders restrict individual freedoms and property rights. The notion that highly coercive measures such as mandatory blood tests, quarantines, or property seizures could be imposed for common threats without democratic procedures and full due process offends our constitutional values. The lack of clear triggering thresholds for terminating emergency powers is particularly troubling, creating the possibility that critical legal protections might be suspended indefinitely.

Government officials rarely invoke public health emergencies, partly due to their out-sized power. The authors note, though that Patrick’s invocation “sets a troubling precedent” for a power that should be used with caution.

Photo by hebster

Emergency Medicine, Health Policy, In the News, Patient Care, Research, Stanford News

Exploring how the Affordable Care Act has affected number of young adults visiting the ER

Exploring how the Affordable Care Act has affected number of young adults visiting the ER

ER sign - 560

One of the earliest – and most popular – parts of the Affordable Care Act allowed young adults to stay on their parents insurance until their 26th birthday. This week, Stanford researchers led by Tina Hernandez-Boussard, PhD, published a paper in the journal Health Affairs that tracked emergency room visits in California, New York and Florida for two age groups: 19 to 25 year olds – the group affected by the new requirement -  and 26 to 31 year olds for comparison. The researchers examined ER visits for the two years prior to the ACA requirement (2009 and 2010) and one year after the requirement went into effect (2011). Their findings showed that in 2011, 19- to 25-year-olds had slightly fewer ER visits – 2.7 per 1,000 people -compared to the older group.

The researchers calculated that the drop in ER use means more than 60,000 fewer visits for 19- to 26-year-olds across the three states  in 2011. They also found that the  largest relative decreases in ER use were among women and blacks.

post on Washington Post‘s Wonkblog covered the study and discussed further findings:

The researchers had another finding that seems just as important. While the total number of ER visits among the under-26 group was down, about the same number of people still went to the ER. The distinction here is that young adults with chronic conditions, who have greater care needs, probably now had better access to non-ER care settings, so their number of visits to the ER decreased. But the finding also suggests that healthy young adults, who might have shunned health insurance before, still continued to see the ER as a place for seeking out routine care, according to the study. Further, insurance likely makes those ER visits cheaper, which could actually increase how much people use the ER, the researchers wrote.

Hernandez-Boussard and her colleagues concluded in their paper, “As EDs face capacity challenges, it is important to consider how to meet the broad underlying needs of young adults through other channels and ensure the needed availability of these alternative health services.”

Previously: Abraham Verghese on health-law battle: “We’ve worried so much about the process, not the patient”
Photo by Eric Staszczak/KOMU

Podcasts, Public Safety, Science, Science Policy, Stanford News

The risks of tinkering with dangerous pathogens

The risks of tinkering with dangerous pathogens

In an effort to understand new and rare infectious diseases, researchers often use recombinant DNA technology to create novel strains in the lab. In 2012, researchers did just that, creating strains of the H5N1 influenza virus that were transmissible between mammals, setting off a debate about the ethics of creating viruses that were potentially more dangerous than those that occurred naturally.

Earlier this year, in July, a group called the Cambridge Working Group convened to continue discussing these questions. David Relman, MD, a biosecurity expert at Stanford, is a member of the group and spoke to Paul Costello about the risks and benefits of lab-created pathogens. Highlights of their conversation are in a piece in the most recent issue of Inside Stanford Medicine, where Relman notes:

My greatest fear is that someone will create a highly contagious and highly pathogenic infectious agent that does not currently exist in nature, publish its genetic blueprint, allow it to escape the laboratory by accident, or else enable a malevolent person or persons to synthesize the agent with the intention of releasing it in a deliberate manner. Although these may be unlikely scenarios, they could have catastrophic consequences, which is why I and others feel that we need to sensitize everyone to these possibilities and decide how to manage these risks ahead of time. I want to be clear: I am not opposed to laboratory work on dangerous pathogens, especially if they are known to exist in nature. Rather, I am opposed to high-risk experiments and, in particular, those that seek to create novel, dangerous pathogens that cannot be justified by well-founded expectations of near-term, critical benefits for public health — benefits that clearly outweigh the risks, and benefits that cannot be achieved through other means.

But not all researchers advocate the same level of caution. A few weeks after the Cambridge Working Group formed, another group called Scientists for Science to advocate in favor of using recombinant versions of pathogens in order to understand them better. Relman says that the two groups are probably not as far apart as they appear. He says he fully supports studying disease-causing bacteria, but:

The place where we may disagree is on whether we are willing to acknowledge that there may be experiments — probably few and far between — that perhaps ought not to be undertaken because of an unusual degree of risk. Just because a scientist can think up an experiment doesn’t mean it should be performed.

Relman elaborates on these topics in the 1:2:1 podcast with Costello above.

Previously:  How-to manual for making bioweapons found on captured Islamic State computer, Microbial mushroom cloud: How real is the threat of bioterrorism? (Very) and Stanford bioterrorism expert comments on new review of anthrax case

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