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Ask Stanford Med, Chronic Disease, Grand Roundup, Stanford News

Stanford physician Sanjay Basu on using data to prevent chronic disease in the developing world

Stanford physician Sanjay Basu on using data to prevent chronic disease in the developing world

Basu and RosenkranzThere’s a new health policy challenge in developing countries. Though many see chronic conditions like type-2 diabetes and heart disease as problems plaguing the wealthiest nations, “Nearly 80 percent of the deaths worldwide from these two diseases are coming from the developing world,” says Sanjay Basu, MD, PhD, an assistant professor of medicine at the Stanford Prevention Research Center.

But Basu is working to change this statistic, and his efforts just won him the $100,000 George Rosenkranz Prize for Health Care Research in Developing Countries. Administered by Stanford’s Center for Health Policy/Center for Primary Care and Outcomes Research at the Freeman Spogli Institute for International Studies, the award will help fund Basu’s large-scale data collection project in India. With a data set from over 65,000 people, Basu hopes to improve type-2 diabetes screening in the country, leading to better treatment and detection of the disease.

A researcher focused primarily on global development and human health, Basu is also an internal medicine physician with a master’s in medical anthropology and a doctorate in epidemiology. In the following Q&A, he discusses his current research interests and plans for the future.

How did you first become interested in global health policy and the developing world?

As a child, our family went back and forth between the United States and India, and the contrasts in daily life were striking and overwhelming. There is a sense in many parts of India that life is a privilege, and a constant struggle to maintain.

Your research in India will involve data collection and mathematical modeling, which sounds rather abstract. How does this work translate into real-world improvements in people’s health?

Our research serves as a bridge between the clinical science of how to prevent and treat disease, and the detailed operations of how to actually deliver better prevention and treatment in the real world. What we specifically do is combine biological and clinical data with data on program reach, budgets, and operations. In other words, we might learn how to build a car in a textbook, but our models look at how to make the car factory operate optimally so that the product, in the end, is drivable. We’ve worked closely with both government agencies and non-governmental groups to deliver programs in real-world populations, and to continuously improve those programs over time. For example, our work on how to introduce better tobacco control programs in India has actually resulted in recent legislation that has lowered tobacco use in some critical parts of the population.

What’s different about approaching chronic disease prevention in India versus in the United States?

The sheer size and diversity of the population is one big difference. India is four times the size of the United States, and far more diverse. There is simultaneously malnutrition and obesity, starvation and type-2 diabetes, vitamin deficiency and heart attacks – often in the same city. That means designing programs for a country – or a province, or even a city – requires a lot of attention to complicated perverse outcomes that may happen. For example, we’ve looked into reducing sodium intake as a strategy to lower hypertension and cardiovascular disease. But we also have to make sure that we don’t generate iodine deficiency since salt is the major delivery strategy for iodine and, unlike the United States, iodine deficiency is a serious concern in India.

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Ask Stanford Med, Chronic Disease, Clinical Trials, Patient Care

Ask Stanford Med: A focus on scleroderma

Ask Stanford Med: A focus on scleroderma

Melissa Warde’s life was forever changed 21 years ago when, at the age of 15, she was diagnosed with scleroderma. At the time, little was known about the chronic connective tissue disease, which involves the hardening and tightening of the skin and fibers that provide the framework and support for the body. “I knew from that day forward, I could sit back and wait for the disease to progress or I could, to the best of my ability, work to control the disease within myself,” Warde said during an Ask Stanford Med Google+ Hangout last week. “I knew I had to have a cheerful disposition, despite the tragedy that I was dealt, and of course having a positive attitude really helped me to focus on the winnings of life.”

During the live conversation, Warde was joined by Lorinda Chung, MD, director of the Scleroderma Center and co-director of the Multidisciplinary Rheumatologic Dermatology Clinic at Stanford, and Karen Gottesman, patient services director for the Scleroderma Foundation of Southern California, for a panel on scleroderma research and progress being made to enhance patients’ quality of life.

Chung opened the discussion with an overview of recent modifications to the disease criteria used in diagnosing scleroderma. Since no two cases of scleroderma are alike, the disease can often be difficult to diagnosis. However, early detection (.pdf) is critical for improving patient outcomes. Under the new criteria, physicians are directed to look for symptoms such as puffy fingers, capillary changes in the nail folds or Raynaud’s disease, which is present in 90 percent of patients with systemic sclerosis. Chung said:

Previously, patients really had to have significant, pretty obvious, skin tightening in order to meet the classification criteria. Or have interstitial lung disease or pulmonary fibrosis, which is scarring in the basis of the lungs, in order to meet the criteria.

These new classification criteria will enable rheumatologists, who may be less experienced in scleroderma, to detect early signs and then refer [patients] appropriately for an accurate diagnosis.

Following Chung’s update on the modifications to the disease criteria, Gottesman spoke about how patients can mange stress related to learning they have a rare, incurable disease and continue living life to the fullest. She advised:

Really learn to be your own advocate. Part of that means educating yourself, not only on all the different aspects of the disease, but also on what type of scleroderma you have so you are aware of possible symptoms that come up.

I think what scares a lot of patients and is really stressful is when you hear of a disease that doesn’t have a cure. But you have to keep in mind that there are hundreds of diseases without cures and we have a lot of treatments in the toolbox to treat the symptoms. At the end of the day you have to learn to co-exist with the disease and that process is really different for every single patient.

Being a proactive patient, Gottesman said, also means being a compliant patient and following through on properly taking any prescribed medications, completing physician recommended tests and other instructions from health-care providers. She said, “If you have a different game plan in mind, then you really need to be upfront [with your doctor] about what it is you need and what you think you want to do, so that you can communicate. That will help you in the long run.”

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Ask Stanford Med, Autoimmune Disease, Chronic Disease

Join Ask Stanford Med for a live discussion about scleroderma on Wednesday

Join Ask Stanford Med for a live discussion about scleroderma on Wednesday

hands_laptop_033114Although scleroderma is derived from the Greek words meaning “hardness” and “skin,” its symptoms affect far more than patients’ epidermis. The complex, rare disease can cause damage to the vascular system, lungs, kidneys and gastrointestinal tract with potentially life-threatening consequences.

On Wednesday at 4:30 PM Pacific time, we’ll be hosting an Ask Stanford Med Google+ Hangout about scleroderma research and progress being made to enhance patients’ quality of life. The live video discussion was organized in partnership with the Scleroderma Foundation and Inspire, a company that builds and manages online support communities for patients and caregivers.

Our panel of special guests includes Lorinda Chung, MD, director of the Scleroderma Center and co-director of the Multidisciplinary Rheumatologic Dermatology Clinic at Stanford; Karen Gottesman, patient services director for the Scleroderma Foundation of Southern California; and Melissa Warde, who was diagnosed with scleroderma at age 15 and has lived with the disease for more than two decades.

Panelist will address a range of topics, including:

  • Recent modifications to the disease criteria used in diagnosing scleroderma
  • The importance of patients being screened for pulmonary hypertension
  • The use of rating skin-thickness progression to help determine prognosis
  • A patient’s perspective on participating in a clinical trial
  • Efforts to develop online tools that enhance quality of life
  • Tips on how patients can live life to the fullest despite this debilitating disease

To participate in the discussion, watch the broadcast on the Stanford Medicine YouTube channel. A link to the hangout will also be tweeted on the @SUMedicine feed and posted on the School of Medicine’s Facebook page once the broadcast begins. Only panelists will be featured on screen, so audience members don’t need to be camera ready to join the conversation.

The public is welcome to submit questions for panelists in advance of the discussion by posting them in the comments section below before 3 PM Pacific time tomorrow (Tuesday). Questions can also be submitted during the live video discussion via Twitter using the hashtag #AskSUMed.

Previously: Save the date: Ask Stanford Med Google+ Hangout on Scleroderma April 2Another piece of the pulmonary-hypertension puzzle gets plugged into place, Patients with rare diseases share their extraordinary stories and Restoring hand function with surgery 
Photo by Judit Klein

Ask Stanford Med, Autoimmune Disease, Chronic Disease

Save the date: Ask Stanford Med Google+ Hangout on Scleroderma April 2

Save the date: Ask Stanford Med Google+ Hangout on Scleroderma April 2

Updated 03-25-14: Readers are welcome to submit questions for our panelists in the comments section below. We’ll collect questions until 3 PM Pacific time on April 2. A selection of the questions will be answered during the live video conversation, which will be broadcast on the Stanford Medicine YouTube channel starting at 4:30 PM Pacific time. A future blog entry will provide details on how to watch the Google+ Hangout.

***

3-17-14: An estimated 300,000 Americans are living with scleroderma, a chronic connective tissue disease that is generally classified as one of the autoimmune rheumatic diseases. While hardening of the skin is the most visible manifestation of scleroderma, symptoms of the disease vary greatly among patients and the effects range from mild to life-threatening. Researchers are still working to determine the cause of scleroderma, and currently there is no cure for the disorder.

To foster conversation about this complex, rare disease, we’re partnering with the Scleroderma Foundation and Inspire, a company that builds and manages online support communities for patients and caregivers, for a Google+ Hangout about scleroderma research and progress being made to enhance patients’ quality of life. Among the panel of special guests are:

  • Lorinda Chung, MD, director of the Scleroderma Center and co-director of the Multidisciplinary Rheumatologic Dermatology Clinic at Stanford. Chung is actively involved in clinical, translational, and epidemiologic research on systemic sclerosis and related connective tissue disease, and she’s the principal investigator on a number of clinical trials of new potential therapies for scleroderma patients.
  • Karen Gottesman, patient services director for the Scleroderma Foundation of Southern California. Both a patient and a long-standing patient advocate, she is author of The First Year – Scleroderma, An Essential Guide for the Newly Diagnosed. Gottesman is also a member of the Scleroderma Patient-centred Intervention Network (SPIN), an international consortium of scientific researchers and clinicians organized to develop, test and disseminate psychosocial interventions to improve the quality of life for scleroderma patients worldwide.

Audience members are welcome to submit questions during the live video discussion via Twitter using the hashtag #AskSUMed. Please save the date and join us on April 2 at 4:30 PM Pacific Time.

Previously: Another piece of the pulmonary-hypertension puzzle gets plugged into place, Rules for living with a chronic illness, Patients with rare diseases share their extraordinary stories and Restoring hand function with surgery

Ask Stanford Med, Autoimmune Disease

A closer look at the autoimmune disease vasculitis

When various forms of news media last week reported the cause of death of Harold Ramis, the writer/director/actor, as complications from the “rare autoimmune disorder vasculitis,” I can promise you there were many people who read that and said, “Huh?” for very personal reasons. These are people who, like me, knew that these reports weren’t quite right. Vasculitis is actually a family of at least 15 forms of this disease group and one not so rare when all those who have some form (perhaps as many as 3 million) are added together.

Research and clinical trials on vasculitis have been carried on in a handful of centers around the world. One long-time investigator in this area, also a teacher and clinician, is here at Stanford: Cornelia Weyand, MD, PhD, division chief of immunology and rheumatology. Wayand’s e-mail box was flooded last week, so we asked her to answer some basic questions here about the vasculitis family.

I understand the vasculitides are a family of diseases. Is there something all forms have in common?

A diagnosis of vasculitis means that there is inflammatory disease in the blood vessels.

All organ systems in the body have blood vessels. Therefore, all organ systems can be affected by vasculitis. Blood vessels provide oxygen and nutrients to the tissues. Inflamed blood vessels have a tendency to become blocked. In that case, the tissues do not get blood supply anymore, causing serious complications. In some cases, the inflamed blood vessel bursts, causing life-threatening bleeding. This complication is particularly serious if the body’s largest blood vessel, the aorta, is affected. A leak in the aorta is incompatible with life.

What insights into vasculitis have we gotten from research?

My research team has been involved in vasculitis research for the last decade. We have been trying to find answers to the questions most patients ask at one point in the course of their disease:

A. Why did I get this disease?

Vasculitis results from a faulty immune response. Cells of the immune system attack the blood vessel and cause tissue injury. The blood vessel responds to the attack by either closing up or by rupturing. We have been able to identify the immune cells that initiate and sustain vasculitis. Remarkably, cells that induce disease are identical to cells that protect the body. We have also learned that blood vessels have specialized sensor cells in them that keep a dialogue with the immune system and start the inflammation.

B. How can my disease be treated or prevented?

We cannot prevent vasculitis, but since the disease takes a course of flares and remission, we may be able to prevent the next disease flare.

Vasculitis is treated by suppressing the immune system. One of the most effective drugs is cortisone. Some patients need it in large doses and we are very cognizant of side effects.

We have devoted our research effort to develop new means of therapy. To accomplish that goal, we have developed a system in which we can induce vasculitis and then test new therapies. This system involves the transplantation of human blood vessels into mice. If such mice are supplied with immune cells from our patients, vasculitis develops in the engrafted blood vessel. We can treat that inflammation in the mice and can easily take a biopsy from the blood vessel to check what we have achieved and how therapy actually works.

C. How do you know whether my disease is active or not?

This is one of our greatest challenges as we take care of our patients. We cannot just go and take a tissue biopsy of our patients every time they come and see us. We have a research project in place which is aimed at developing biomarkers of vasculitis in a blood sample. We isolate out the immune cells of the patient and, by applying cutting edge technology, we assess these immune cells to get information how likely or unlikely these cells would cause inflammation.

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Ask Stanford Med, Health and Fitness

When it comes to holiday exercise, “something is better than nothing”

When it comes to holiday exercise, "something is better than nothing"

snowy run

Worried about maintaining your work-out routine during this busy holiday season? In a 2011 Scope Q&A, Joyce Hanna, associate director of Stanford’s Health Improvement Program, offered some tips on how to stay fit and active this time of year. When asked for suggestions on how to squeeze in a work-out amongst travel and festivities, she had this to say:

Chances are you’ll find that in spite of your good intentions there are times when you just won’t have time to do your planned exercise program. The most important thing to remember is that something is better than nothing. A study done at Stanford showed that breaking up a 30 minute exercise time into three shorter ten-minute segments produced significant health benefits.

I suggest to friends and family a “talk while we walk” date instead of a coffee or lunch date. Take advantage of the walking you’re doing while shopping. Walk briskly! Take the stairs, park far away, schedule meetings outside the office, walk down the hall to deliver a message instead of sending an e-mail, set a timer every 30 minutes to stand up and move. If you resist having an all-or-nothing attitude toward exercise, you’ll find that you can maintain your fitness level over the holidays.

Previously: A full workout in just seven minutes? Science says so!, Boosting willpower and breaking bad habits, Stanford nutritionist offers tips for eating healthy during the holidays, How to stay fit and active this holiday season and What you can do in thirty minutes a day
Photo by michael_bielecki

Ask Stanford Med, Medical Education, Patient Care, Research, Stanford News, Technology

Clinical informatics gains recognition as new medical sub-specialty

Clinical informatics gains recognition as new medical sub-specialty

diversityClinical informatics, a field at the intersection of clinical medicine and information technology, has reached a new milestone: Physicians can now become board-certified in this medical sub-specialty. Christopher Longhurst, MD, who is the chief medical information officer at Lucile Packard Children’s Hospital Stanford and the leader of a new Stanford clinical informatics fellowship training program for physicians, talked with Scope about where this field has been and where it’s going.

First off, what exactly is clinical informatics?

In clinical informatics, we leverage information technology to improve outcomes for patients. Research has been done in this area since 1960s and 70s, but what’s different now is the ubiquitous nature of computing devices. Everybody has access to information and communications technologies. The majority of U.S. hospitals are implementing an electronic health record.

And yet electronic health records are not something most front-line doctors are really excited about – they can be seen as disruptive to the patient-care process. I really think we have yet to deliver on the promise of electronic health records. There’s a tremendous opportunity to use data in those records to build a health care system that can make personalized care recommendations and automatically learn from patients.

How is clinical informatics changing the way that medical discoveries are made?

The idea when I was in grad school was that randomized trials were the gold standard for medical evidence. But, increasingly, people are recognizing that this “level A” evidence is cost-prohibitive to generate. And the subjects are so narrowly selected that the results are not always generalizable. I know what medication to give a white male in his 50s because of high blood pressure, but what if I have a different kind of patient?

So a lot of people are advocating for a shift away from traditional trials, toward using enormous, anonymized data sets gleaned from existing electronic medical records. The idea is that you can make valid conclusions based on retrospective research if the data set is large enough.

That’s why we want to create a “patients like mine” button in every electronic health record that would essentially allow real-time comparative effectiveness studies. Then, if you’re treating a 40-year-old, half-Vietnamese, half-black woman for high blood pressure, you can instantly generate a similar cohort and see which medications have provided the best outcomes for those patients.

A “patients like mine” button would also help us start to understand what questions doctors ask. Today, we don’t always know what physicians’ information needs are. If we start to collect this meta-data, we can better focus randomized controlled trials so that they match doctors’ biggest questions.

How does Stanford lead the field?

Stanford is often considered the place where clinical informatics all started. The father of this field, Ted Shortliffe, MD, PhD, was a graduate student at Stanford when, in the 1970s, he wrote a software program called MYCIN to make decisions about prescribing antibiotics. MYCIN performed better at those decisions than your average internist. Shortliffe came back to Stanford in the early 80s and founded the division of medical informatics, now the Stanford Center for Biomedical Informatics Research, starting the Masters and PhD programs.

More recently, we have a really solid history of finding unique ways to use and study electronic medical records: For instance, we’ve provided automatic daily updates to parents whose infants are hospitalized in our neonatal intensive care unit, reduced unnecessary use of blood transfusions, assisted in selecting the appropriate IV fluid to give to kids and more, all under this one umbrella.

We have nine physicians who received the new board certification, placing us among the largest programs in the country.

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Ask Stanford Med, Complementary Medicine, Nutrition, Pain

Ask Stanford Med: Pain expert responds to questions on integrative medicine

Ask Stanford Med: Pain expert responds to questions on integrative medicine

rolfing2Sometimes the best medicine is staying healthy. As more Americans look for ways to improve their health, prevent disease and manage pain, the subject of complementary practices may enter more conversations between patients and physicians. So for this installment of Ask Stanford Med, we asked Emily Ratner, MD, clinical professor of anesthesiology, perioperative and pain medicine and co-director of medical acupuncture and the resident wellness program at Stanford, to respond to questions on integrative medicine. Her answers appear below.

As a reminder, these answers are meant to offer medical information, not medical advice. They’re not meant to replace the evaluation and determination of your doctor, who will address your specific medical needs and can make a diagnosis and provide appropriate care.

Mary says: Please speak about the efficacy of integrative medicine to alleviate multi-point pain from a variety of causes (ITP, OA, aging). A relative has doctor fatigue as well, and is not interested in anything else.

Integrative Medicine (IM) may be defined as the combination of conventional and nonconventional modalities chosen by a patient and physician in a patient-centered decision-making process in order to achieve the best outcome for an individual. Patients often seek nonconventional modalities when conventional medicine techniques are unable to achieve a particular goal, often pain relief or pain management. As a general rule, multi- and inter-disciplinary measures are often most helpful in relieving suffering from pain. These may include five general categories of nonconventional modalities, although there is overlap amongst the different types:

  • Mind-body medicine: meditation, hypnosis, biofeedback, guided imagery, yoga
  • Biologically based practices: uses substances found in nature – herbs, foods, vitamins, supplements
  • Manipulative/Body-based practices – massage, chiropractic/osteopathic manipulation
  • Whole medical systems: Traditional Chinese Medicine (includes acupuncture), Ayurveda, naturopathy
  • Energy Medicine – Reiki, Healing/Therapeutic touch, Qi Gong, acupuncture, yoga

Depending on patient preference, available resources in the community and other factors, a decision is made where to begin. I often recommend acupuncture as a place to start, closely followed by a mind-body medicine technique, as my experience is that stress plays a large role in either pain or the perception of pain. However, it largely depends on the individual’s needs and preferences.

Scope Editor asks: A recent study of herbal products found that most of those examined contained contaminants, substitutions and unlisted fillers among their ingredients. What are the implications of these findings, and how can consumers protect themselves when buying supplements?

This is a significant issue that highlights the need for increased supplement regulation, although the study to which you refer has been criticized for some of its conclusions. While FDA regulations for supplements are a bit stricter than for foods, the regulations are far less comprehensive than those for pharmaceutical agents.

That being said, product contamination with heavy metals, undisclosed pharmaceutical agents (especially in products from outside the U.S.), and inaccurate product ingredient amounts plague this field.

Until improved regulatory procedures are instituted, I suggest looking at a reputable database that independently tests these products, such as ConsumerLab.com. This and other independent organizations add their seal of approval to product labels that have tested either the products or the manufacturing practice involved in production of the substance. Look for the Consumer Lab seal or other seals: cGMP (current Good Manufacturing Practice), USP (United States Pharmacopeia), or NSF (another independent lab).

Some experts note that specific stores have strict quality control for their products – like Sam’s Club, Costco, Whole Foods – but I typically look up each individual product on a database (I use consumerlab.com) prior to recommending it.

Another option is to consult with a trained Integrative Medicine practitioner who has access to these databases and is knowledgeable about these products.

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Ask Stanford Med, Cardiovascular Medicine, Health Policy, In the News, Technology

Stanford expert weighs in on new guidelines for statin use

statinsAs you may have read, the American Heart Association and the American College of Cardiology recently released a new set of guidelines for lowering cholesterol, along with an online risk-assessment calculator. But two independent reviewers found that the calculator’s design was flawed, overestimating many people’s risk for heart problems and potentially driving an over-prescription of statin drugs. (Their comments were posted today on The Lancet.) Controversy about the guidelines and online tool raised questions at the recent annual meeting of the American Heart Association and prompted a press briefing yesterday in which the two issuing organizations stood in support of the risk calculator.

Earlier this year, Mark Hlatky, MD, professor of health research policy and of cardiovascular medicine at Stanford, released a different sort of heart-related calculator, comparing five-year outcomes for two heart-disease interventions. I posed some questions to Hlatky about the the new online tool and guidelines; his answers appear below.

What are your thoughts on the design of the online risk calculator released with the new guidelines?

I’ve tested the spreadsheet in the guideline and agree that the risk estimates appear to be high. There are several possible reasons for this, but a key change is that the current version is to predict the risk of heart attack AND stroke, not just heart attack. So by design all the numbers are higher than prior calculators.

The other issue is that they have used different data than the prior “Framingham risk calculator” to produce these numbers, so there may be additional differences in the estimates from the ones everyone has been using.

New York Times piece includes comments from Johns Hopkins’ Michael Blaha, MD, who notes that the data sets used, from the 1990s, were too old to be accurate in determining how risk factors such as cholesterol level and blood pressure could lead to heart attacks and strokes in today’s population. Do you agree?

The overall risk of coronary disease in the population has been decreasing over time, so using older data to predict current risk might over-estimate the risk.  This is only a problem if the lower risk is due to factors OTHER than improvements in the traditional cardiac risk factors. For example, rates of smoking have gone down, so overall population risk is going down too. But that’s not necessarily a problem for the risk calculator because smoking is included in the calculator. But if all smokers have been smoking less, the risk attached to being a smoker today might be lower than the risk of being a smoker years ago.

What do you think are the implications of this controversy – for doctors, patients, and the medical research review process?

The controversy might confuse the public, so it’s a shame it couldn’t have been avoided. The review process appears to have been flawed, since this criticism was leveled earlier in the development of the guideline.

On a more substantive level, the risk level is now set so low (7.5 percent over 10 years) that many people in the population who have “optimal risk factor levels” (systolic blood pressure 110 or below, total cholesterol 170 or below, HDL cholesterol of 50 or above, no diabetes and non-smoker) would targeted for statin treatment simply on the basis of their age.  The calculator puts men age 63 and older with “optimal risk factor levels” at elevated risk, and all women age 71 and above with “optimal risk factor levels” at elevated risk. It’s a little hard for many to accept that everyone above a certain age should be on a statin, and there’s no direct evidence to back up this pretty sweeping recommendation.

Previously: Heart bypass or angioplasty? There’s an app for that, Exploring the cost-effectiveness of statin use among kidney patientsWider statin use may be cost-effective way to prevent heart attack, strokeNew test for heart disease associated with higher rates of procedures, increased spending and Stanford researcher cautions against widespread use of statins
Photo by AJC1

Ask Stanford Med, Complementary Medicine

Ask Stanford Med: Pain expert taking questions on integrative medicine

organic produce and Whole FoodsIntegrative medicine – the combination of traditional Western medicine with evidence-based, complementary approaches to health improvement, symptom management and disease prevention – encompasses many disciplines. The National Center for Complementary and Alternative Medicine (NCCAM), one of the 27 members of the National Institutes of Health, oversees scientific research and informs decision-making in the area. NCCAM’s mission “to define, through rigorous scientific investigation, the usefulness and safety of complementary and alternative medicine interventions and their roles in improving health and health care” is upheld by a number of academic medical centers, including Stanford’s Center for Integrative Medicine.

If you’ve downed a spoonful of fish oil, taken vitamins or probiotics, visited a chiropractor, or engaged in deep breathing to manage pain, you’ve experienced a practice of integrative medicine. But for many, there’s a shroud of mystery around the subject, and while peer-reviewed research studies have been conducted on some aspects of the discipline, other practices require further study.

So for this edition of Ask Stanford Med, we’ve asked Emily Ratner, MD, a clinical professor of anesthesiology, perioperative and pain medicine and co-director of medical acupuncture and the resident wellness program at Stanford, to respond to your questions on integrative medicine.

Ratner’s research interests include the use of acupuncture to manage medical conditions and to address pain and side effects from surgery and cancer. She also studies physician and trainee burnout and resilience.

Questions can be submitted to Ratner by either sending a tweet that includes the hashtag #AskSUMed or posting your question in the comments section below. We’ll collect questions until Sunday, November 10 at 5 p.m.

When submitting questions, please abide by the following ground rules:

  • Stay on topic
  • Be respectful to the person answering your questions
  • Be respectful to one another in submitting questions
  • Do not monopolize the conversation or post the same question repeatedly
  • Kindly ignore disrespectful or off topic comments
  • Know that Twitter handles and/or names may be used in the responses
  • Ratner will respond to a selection of the questions submitted, but not all of them, in a future entry on Scope.

Finally – and you may have already guessed this – an answer to any question submitted as part of this feature is meant to offer medical information, not medical advice. These answers are not a basis for any action or inaction, and they’re also not meant to replace the evaluation and determination of your doctor, who will address your specific medical needs and can make a diagnosis and give you the appropriate care.

Previously: Director of Stanford Headache Clinic answers your questions on migraines and headache disordersStudy shows complementary medicine use high among children with chronic health conditions,Ask Stanford Med: David Spiegel answers your questions on holiday stress and depressionReport highlights how integrative medicine is used in the U.S. and Americans’ use of complementary medicine on the rise
Photo by ASSOCIATED PRESS

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