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Applied Biotechnology, Ask Stanford Med, Clinical Trials, Research, Stanford News

SPARKing a global movement

SPARKing a global movement

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Many academic researchers are tenacious, spending years in the lab studying the processes that lead to human diseases in hopes of developing treatments. But they often underestimate how difficult it is to translate their successful discovery into a drug that will be used in the clinic.

That’s why Daria Mochly-Rosen, PhD, founded SPARK, a hands-on training program that helps scientists move their discoveries from bench to bedside. SPARK depends on a unique partnership between university and industry experts and executives to provide the necessary education and mentorship to researchers in academia.

In recent years, Stanford’s program has sparked identical programs throughout the world; at TEDMED 2015, Mochly-Rosen described this globalization. I recently spoke with her about the SPARK Global program, which she co-directs with Kevin Grimes, MD, MBA.

How has SPARK inspired similar programs throughout the world?

We’ve found our solution for translational research to be particularly powerful. Of the 73 completed projects at Stanford, 60 percent entered clinical trials and/or were licensed by a company. That’s a very high accumulative success rate. So I think it has showed other groups that we have a formula that really works – a true partnership with academia and industry. It’s the combination of industry people coming every week to advise us and share lessons learned and our out-of-the-box, risk-taking academic ideas that makes SPARK so successful.

We feel that what we’ve learned is applicable to others. Kevin and I also feel very strongly that universities need to take responsibility to make sure inventions are benefitting patients. So we’re trying to do our part.

How do you and Dr. Grimes help develop the global programs?

When a university asks about our program, we invite them to come visit us for a couple of days so they can talk to SPARKees (SPARK participants), meet SPARK advisors and watch our weekly meeting. Sometimes they also ask Kevin and I to come to their country to help set up a big event or assist in other ways. If they begin a translational research program at their institution, we offer for them to be affiliated with SPARK Global. Everyone is invited.

There are now SPARK programs throughout the world, including the United States, Taiwan, Japan, Singapore, South Korea, Australia, Germany and Brazil. We are also working with other countries, including Norway, Israel, Netherlands, Poland and Finland, to help them start a program.

Do researchers in other countries face the same challenges as those in the U.S. when developing new drugs?

There are many common challenges. And there are also some advantages and challenges that are different in other places. So it’s a mix, both within and outside the U.S.

There are several key components to the success of translation research. It’s important to have a good idea. It’s even more important to have good advisors from industry to help develop the idea. And it’s very important that the people involved are open-minded and not inhibited by hierarchical structures. In some places, there is a big problem with hierarchy – particularly in parts of Europe and East Asia. In some cultures, it’s also difficult to get experts to volunteer and academics can’t afford to pay multiple advisors. Also, some universities don’t have a good office of technology to help with patent licensing, which can be a major challenge.

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Ask Stanford Med, Pregnancy, Women's Health

A look at hypertension in pregnancy

A look at hypertension in pregnancy

Most people know that hypertension, or high blood pressure, is a common condition. What many might not know is that it’s also one of the most common complications in pregnancy: It is prevalent in 5-10 percent of pregnant women.

In a recent Q&A session, Sandra Tsai, MD, MPH, spoke with BeWell at Stanford about this condition and its effects:

Hypertension in pregnancy — especially the more severe forms (preeclampsia and eclampsia) — increases the risk for complications such as placenta abruption, acute kidney injury, and death. Longer-term, women diagnosed with hypertension in pregnancy are at risk for future cardiometabolic diseases — including hypertension, diabetes, stroke, and heart attacks.

Tsai also delved into ways to prevent hypertension and discussed her own work in this area:

Lifestyle behaviors — such as a healthy diet, regular exercise, starting pregnancy with a normal weight — may reduce, but may not entirely prevent, a woman’s risk for developing hypertension in pregnancy.

I am interested in helping women maintain a healthy weight throughout pregnancy. Women who start their pregnancy with excess weight are at increased risk for gaining more weight than the Institute of Medicine recommends. If these women can remain within the weight gain guidelines, they may be at less risk of developing pregnancy complications such as gestational hypertension and preeclampsia.

Alex Giacomini is a social media intern in the medical school’s Office of Communication and Public Affairs. 

Previously: Attending to signs of preeclampsia in late-stage pregnancy and The importance of knowing your blood pressure level in preventing hypertension

Ask Stanford Med, Pain, Patient Care

Headache 101: On migraines, pain medicine and when to visit a doctor

Headache 101: On migraines, pain medicine and when to visit a doctor

stress-543658_1280I’m a stomachache gal; when something is troubling me, my tummy lets me know. So I’ve always felt a mixture of curiosity and puzzled empathy for those who suffer from frequent headaches or migraines — how odd and awful that must be.

As the founding director of Stanford’s Headache and Facial Pain Clinic, and a migraine sufferer himself, Robert Cowan, MD, is well-positioned to offer headache guidance (and insight for outsiders like me).

He recently chatted with writer Sara Wykes for an Inside Stanford Medicine piece on migraines, pain medicine and more. Here’s Cowan:

A migraine is much more than a headache. It occurs on average one to four times a month. Unlike a tension headache, it is often accompanied by nausea or vomiting. Its pain is intensified by physical activity and is so severe it interferes with daily activities. About 30 percent of migraineurs — people with migraine — have a warning that consists of neurologic signs, or auras, they experience before the migraine episode begins. The most commonly experienced aura is visual, during which patients see small, colored dots, flashing bright lights or multicolored zigzag lines that may form a shimmering crescent-like shape.

The best way to cope with migraines and other headaches is not to keep pounding pills, Cowan cautions:

The vast majority of headaches should not be treated with opioids or any other pain medications. It depends upon what kind of medicine you are taking, of course, but a good rule of thumb is not to take any pain medication more than two days in any week, and no more frequently than recommended on the label or as prescribed. If you need more medication to control pain, you should consult a physician. Overuse of acute medications can actually increase the frequency of your headaches.

Cowan says the best approach to minimizing headaches may be to pay attention and log symptoms such as irritability or a food craving that may appear right before a headache starts. “You may begin to see patterns that were not readily obvious,” he advises.

Previously: Study examines trends in headache management among physicians, More attention, funding needed for headache care and Director of Stanford Headache Clinic answers your questions on migraines and headache disorders
Photo by geralt

Ask Stanford Med, Pediatrics, Surgery

Surgery to find your voice: A Q&A with a pediatric otolaryngologist

Surgery to find your voice: A Q&A with a pediatric otolaryngologist

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When we’re in a noisy restaurant, it’s really difficult to hear my young niece speak. She can only talk very quietly, because she has a paralyzed vocal cord.

Like many children born very premature, the nerve going to her vocal cord was likely damaged when she had heart surgery soon after she was born. Her inability to be heard frustrates her, especially now that she is in school. However, a rare surgery may bring her the hope of a near-normal voice.

Stanford surgeons recently began performing laryngeal reinnervation surgery, which essentially rewires the paralyzed vocal cord with a new nerve supply. I recently spoke with Anna Messner, MD, a professor of otolaryngology and pediatrics who sees patients at Lucile Packard Children’s Hospital Stanford, about laryngeal reinnervation surgery.

What standard surgical procedures are used to treat unilateral vocal cord paralysis?

In general, the surgical procedures bulk up the paralyzed vocal cord to move it towards the midline of the body, making it easier for the other vocal cord to compensate and close. There are two standard surgeries. We can do injection laryngoplasty, where we inject a substance into the paralyzed vocal cord to thicken it. Unfortunately, this procedure often needs to be repeated multiple times, if it works at all. We can also insert a medialization implant in teenagers and adults, but this doesn’t work for growing kids. If we put an implant into a 2-year-old, it wouldn’t be an appropriate size when he is 10.

How does laryngeal reinnervation surgery work?

No matter what we do, we can’t make the vocal cord move. We can never make it perfect again. What we can do is hook up one of the other nerves in the neck to the recurrent laryngeal nerve that goes to the vocal cord. And that helps some new nerve fibers go to the vocal cord, making the vocal cord stronger and thicker. As a result, the voices on these kids improve significantly.

The surgery itself is fairly straightforward and only takes about an hour. The children typical go home the same day or just stay overnight, and they feel back to normal in a couple of days. But then we have to wait five to six months for the nerve fibers to grow before we can see real improvement in the voice. The only downside is that it takes a long time to see the effects of the surgery.

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Addiction, Ask Stanford Med, Health Policy, Public Health, Stanford News

Is a proposed ban on smoking in public housing fair?

Is a proposed ban on smoking in public housing fair?

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Cigarette smoking kills nearly half a million Americans each year, making it the leading preventable cause of death in the United States.

So the Department of Housing and Urban Development thinks it’s time to ban cigarette smoking from some 1.2 million subsidized households across the nation.

HUD Secretary Julián Castro unveiled a proposal last week intended to protect residents from secondhand smoke in their homes, common areas and administrative offices on public housing property.

“We have a responsibility to protect public housing residents from the harmful effects of secondhand smoke, especially the elderly and children who suffer from asthma and other respiratory diseases,” Castro said, adding the proposed rule would help public housing agencies save $153 million every year in health-care, repairs and preventable fires.

Stanford Law School professor Michelle Mello, PhD, JD, who is a core faculty member with Stanford Health Policy, has researched and written about this issue extensively, including in a 2010 article in The New England Journal of Medicine.

In a piece published yesterday, I asked Mello about her views on the federal smoking ban proposal. A sampling of the Q&A:

What would be the greatest benefit to banning smoking in public housing?

There are lots of benefits, but to me the greatest benefit is to the 760,000 children living in public housing. Although everyone knows that secondhand smoke exposure is extremely toxic, not everyone knows how much children in multiunit housing are exposed — even when no one in their household smokes. Research shows that smoke travels along ducts, hallways, elevator shafts, and other passages, undercutting parents’ efforts to maintain smoke-free homes. Also, chemicals from cigarette smoke linger in carpets and curtains, creating hazardous “third-hand smoke” exposure that especially affects babies and small children.

Beth Duff-Brown is communications manager for Stanford Health Policy.

Photo by Getty Images iStock

Ask Stanford Med, Sleep, Stanford News

Brains that go bump in the night: Stanford biologist talks about parasomnias

Brains that go bump in the night: Stanford biologist talks about parasomnias

“The witching hour… was a special moment in the middle of the night when every child and every grown-up was in a deep, deep sleep, and all the dark things came out from hiding and had the world all to themselves.”
-Roald Dahl, The BFG

nightmareIn folklore and literature, the sleeping hours represent a state of heightened vulnerability, a time when the “ghoulies and ghosties, and long-leggedy beasties” roam free and wreak havoc. Today, neuroscientists are unraveling the biological underpinnings of nightmares, night terrors, and other sleep disturbances.

Recently, I had the chance to sit down to discuss these nighttime phenomena with biologist H. Craig Heller, PhD, a member of the Stanford Neurosciences Institute and an expert in the neurobiology of sleep.

What are parasomnias and what causes them to occur?

Parasomnias include nightmares, night terrors, and sleepwalking — the really bizarre aspects of sleep.

Normal sleep phasing, timing, and coordination require smooth transitions between wake, non-REM sleep, and REM sleep. When the integration is imperfect, the pathologies of sleep may occur.

For example, sleep paralysis is caused by an inappropriate transition between REM sleep and wakefulness. During REM sleep the cortex is activated, so to keep the body asleep, inputs and outputs are blocked — your body becomes paralyzed. Sleep paralysis occurs when REM paralysis persists as you return to wakefulness. You are coming out of a paralyzed state in which you are freely associating, and this can lead to hallucinations that you’re being restrained.

The opposite can also happen: During REM sleep, motor inhibition can be lost, and you can act out your dreams — which can be violent.

In your mind, what’s the scariest sleep disorder?

Sleepwalking. Sleepwalking occurs during NREM sleep, and in contrast to nightmares or violent movements that can occur during REM sleep, sleep walking is more an extension of normal waking behavior, but you are not aware of what you are doing. As a result, sleep walkers can get into dangerous situations.

In one case, a guy sleepwalked out of his house during winter in Minnesota, before eventually returning to his home and to bed. The next morning, he woke up, pulled back the covers, and found his feet seriously frostbitten. They were a mess. You would think he would be in tremendous pain, but he didn’t wake up.

Also, in cold places in the winter, kids can sleep walk out of the house and freeze to death. In one case a child was found dead in the morning just curled up in a snowdrift immediately outside his house. Some apparent suicides may even be cases of sleepwalking.

You mentioned that people can act out their dreams if the REM sleep paralysis is lifted or not activated – is this phenomenon the same as sleep walking?

No, it’s not the same. Loss of motor inhibition during REM usually results in dramatic, extreme movements, whereas sleep walkers are more likely to act in ways that are simple extensions of normal waking behavior. Sleep walkers may eat and maybe even drive a car and not remember it the next morning. Those with REM sleep disorders are acting out the bizarre context of nightmares.

One of my teaching assistants had a particularly dramatic experience: One night she was dreaming that she was being chased by a giant cockroach; she stood up on her bed and started to run, and she ran right off the bed and into the bureau and broke her back.

In some cases, people dream they are fighting an enemy, so they’ll punch or kick the person in bed with them. There are court cases involving murder and the defense is that the individuals were asleep. Court decisions have gone both ways. In one episode, a woman was dreaming she was being attacked, and when her father came into her room to wake her, she got a gun that was in the bedside drawer and shot him.

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Ask Stanford Med, Patient Care

Diagnostic errors: “A complex problem that requires a many-pronged, multi-level attack”

Diagnostic errors: "A complex problem that requires a many-pronged, multi-level attack"

A landmark Institute of Medicine report released last last month showed that despite dramatic improvements in patient safety over the last 15 years, diagnostic errors have been the critical blind spot of health-care providers.

Kathryn McDonald, executive director of Stanford’s Center for Health Policy/Center for Primary Care and Outcomes Research, is a member of the committee that wrote the report, “Improving Diagnosis in Health Care.” I recently spoke with her about the report’s findings and also got her suggestions for limiting one of the most overlooked health-care dilemmas today. Among our Q&As:

Q: You outline eight goals that physicians and health-care providers should follow in their diagnostic practice. Which do you believe are the most significant?

McDonald: They are all important. I know that isn’t a satisfying answer, but this is a complex problem that requires a many-pronged, multi-level attack from education to payment system reforms. We tried to be bold and aspirational, while grounded in the existing evidence. I guess if I had to underscore a goal where I am most optimistic that it will make a difference in the short run, I’d point to the teamwork one. There is a growing evidence base that the benefits of teamwork accrue to all members of the team, so this recommendation has the potential to be a win-win for all involved. Improving diagnosis is quite challenging, partly because making a diagnosis is a collaborative effort and involves many, often iterative, steps — few simple ones. These steps can unfold over time, across different health-care settings, and usually involve diagnostic uncertainty. All the moving parts, all the different types of expertise, all the people involved, well that’s a call for teamwork. This IOM report and the challenge of improving diagnosis puts health-care organizations on the hook for ensuring that health-care professionals have knowledge and skills to engage in effective teamwork — both interprofessionally and intraprofessionally. And the goal doesn’t stop there. We also recommended, as part of this first goal, that health-care professionals and organizations should partner with patients and their families as diagnostic team members, and facilitate patient and family engagement in the diagnostic process, aligned with their needs, values and preferences.

Beth Duff-Brown is communications manager for the Center for Health Policy and Center for Primary and Outcomes Research (CHP/PCOR).

Previously: Better communication between caregivers reduces medical errors, study finds

Ask Stanford Med, Health and Fitness, Nutrition, Obesity, Precision health, Stanford News

A Stanford physician takes a precision health approach to living a healthier lifestyle

A Stanford physician takes a precision health approach to living a healthier lifestyle

timthumbNearly 70 percent of Americans ages 20 or older are overweight or obese, including Larry Chu, MD, a Stanford anesthesiologist and executive director of Medicine X.

Chu, who has struggled with his weight for over a decade, knew he was overweight but didn’t think it was a serious threat to his health. This changed during a routine doctor’s visit. As he explains in a podcast, Chu was shocked to learn that lab results showed he was at high risk for stroke and heart attack. He decided to take action and launch precision:me, a personal blog project chronicling the first 90 days of his journey to live a healthier lifestyle.

Why most of us try to slim down by shunning carbs, stepping up our exercise routines and secretly weighing ourselves each morning, Chu is tracking his health data using a range of gadgets and other tools and sharing the every detail of his progress publicly on his blog. He is also posting photos and podcasts.

Below Chu discusses why he choose to take this unique approach to achieve his weight-loss goals, how he hopes it will inform the broader conversation about obesity and its potential to demonstrate the value of digital tools in enhancing personal health.

What was the catalyst for precision:me?

One of the misconceptions about obesity is that it is a lifestyle disease and if people would only eat less and move more they would be fit. In my case, this is a health journey I have been struggling with since my residency training at Stanford. Using precision health tools to address obesity is a new approach that we are focusing on in precision:me. Stanford has recently announced exciting plans for precision health. I thought it was a good time to share how we at Medicine X see precision health as a novel approach that individuals and their providers can use today to tailor precise and individualized care. It is a very practical and personal dive into developing and implementing a precise plan to modify my diet and metabolic profile to forestall the development of more significant chronic diseases, such as diabetes and heart disease, using data and analytics provided through digital health tools and expert medical, nutritional and fitness collaborators.

Why did you decide to make all of your health data available online for public consumption?

It was an easy and difficult decision at the same time. There is incredible stigma associated with obesity, which we discuss on the precision:me website. Being overweight or obese is a subject that many of us find difficult to talk about. Sharing information can make it easier to start a dialogue. Advances in precision health at Stanford and around the world will depend upon patients sharing their personal health data in a secure and protected fashion with researchers. By sharing my data with the public, I hope to help everyone see what it is like to live with obesity as a condition, break down misconceptions and misperceptions about the disease, and help shine a light on the value of sharing data to help others.

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Aging, Ask Stanford Med, Chronic Disease, Neuroscience, Women's Health

Exploring Alzheimer’s toll on women

Exploring Alzheimer’s toll on women

Julianne Moore AlzheimersIn last year’s “Still Alice,” Julianne Moore’s portrays a woman beset by early-onset Alzheimer’s Disease. It’s fitting that the academy-award winning film (Moore garnered a Best Actress award for her role) about Alzheimer’s features a woman as the central character because the illness disproportionately affects women.

The BeWell@Stanford blog recently featured a Q&A with Stanford neurologist and Alzheimer’s researcher Michael Greicius, MD, MPH about Alzheimer’s and women. The piece covers the effects of the disease, but I was intrigued to read about the challenges for caregivers of people with the disease (who are also disproportionately women):

Most of the caregivers of people with Alzheimer’s Disease are women. Do you have any advice for them in terms of how they can take care of themselves while taking care of a loved one with the disease?

This gets to the damned-if-you-do, damned-if-you-don’t aspect of AD and women. On the one hand, women are more likely to develop AD; on the other hand, they are also more likely to find themselves as the primary caregiver for someone with AD. It is now well known that caring for someone with AD has a powerful, negative impact on physical and emotional well-being. Particularly as the disease progresses and patients require more care, there is a large physical toll taken when, for example, having to lift patients out of a chair or off the toilet or out of bed. Sleep becomes fractured for the patient. which means it becomes fractured for the caregiver.

Some of the questions also dealt with the fact that despite the recent advances in Alzheimer’s research, we still don’t completely understand how the disease works or how it can be prevented:

What can we do to reduce our risk for developing the disease?

We do not know of anything that definitely reduces a person’s risk of developing Alzheimer’s, although there is strong data to suggest that regular aerobic exercise and a heart-smart diet will reduce risk. Head trauma is an important risk factor for AD and another type of dementia, so minimizing exposure to head trauma can also reduce risk of AD. Numerous companies make explicit or implicit claims about their “nutraceutical” or vitamin or “brain-training” software being able to stave off AD. None of these claims are true and most, if not all, of these purveyors are modern-day snake-oil salesmen and saleswomen.

But Greicius is optimistic and pointed out that Stanford recently became an NIH-sponsored Alzheimer’s Disease Research Center, which means we can build upon Stanford’s past “ground-breaking Alzheimer’s research.”

Previously: Are iron, and the scavenger cells that eat it, critical links to Alzheimer’s?Alzheimer’s forum with Rep. Jackie Speier spurs conversation, activismScience Friday explores women’s heightened risk for Alzheimer’s and The toll of Alzheimer’s on caretakers
Photo by Maria Morri

Ask Stanford Med, Bioengineering, Cardiovascular Medicine, Stanford News, Technology

The next challenge for biodesign: constraining health-care costs

The next challenge for biodesign: constraining health-care costs

This post is part of the Biodesign’s Jugaad series following a group of Stanford Biodesign fellows from India. (Jugaad is a Hindi word that means an inexpensive, innovative solution.) The fellows will spend months immersed in the interdisciplinary environment of Stanford Bio-X, learning the Biodesign process of researching clinical needs and prototyping a medical device. The Biodesign program is now in its 14th year, and past fellows have successfully launched 36 companies focused on developing devices for unmet medical needs.

5445002411_0f22229afd_z 300Founder and director of the Stanford Biodesign Program Paul Yock, MD, describes himself as a “gismologist.” His inventions include a balloon angioplasty system that is in widespread use and many other devices primarily related to ultrasound imaging of the vascular system. I recently spoke with him about the program he helped found, the iterative biodesign process, and the ongoing relationship with the Stanford-India Biodesign Program.

What’s next for the Stanford Biodesign Program?

We’ve been really pleased with the results of the Biodesign Program so far in terms of being able to take newcomers into the process, then repeatedly and reliably seeing good ideas coming out and seeing patients getting treated from those good ideas.

The challenge is that the world has changed profoundly since we founded this program. There’s no question that new technologies – despite being good for patients – contribute to escalation of health-care costs. We are in a phase of reinventing our process to take into account the fact that the sickest patient in the system is the system itself. We have to invent technologies that help constrain costs. We will need to modify the process of needs-finding not only to look for important clinical needs but important value needs as well. Inventors in general don’t like thinking about economics and so we have to not only figure out how to update the process but also figure out how to make it attractive for our fellows to learn and practice.

Could the India fellows help you incorporate affordability into the process?

One of the big reasons we decided to do the India program in the first place was to shock our system into thinking about really affordable technology innovation. It is remarkable how good our fellows from India are at thinking this way and how immersed they have been from an early age with value-based design and invention.

Affordability is very much a part of the Indian culture and technology innovation is clearly something that we are very good at here. I think we have only started to capitalize on the fusion of their culture and ours. I think there is a hybridization here that really is going to be cool. Our grand strategy is to have a number of different platforms – it could be companies, incubators, or other experiences – where our fellows can get a deep exposure in India. We aren’t fans of parachuting people in for two weeks to invent something good to give to India. What we really want to do is have trainees get a deep experience in what it’s like to invent and develop technologies in that setting to influence the way we invent here.

How did you arrive at the drawn out, iterative process the fellows use to identify medical needs they want to address?

There’s a long tradition of what is called user centered design that says if you want to design a product you need to talk to the user and understand what their needs are. That’s essentially where our process starts. What’s fundamentally different with health care is that there isn’t just one user. There’s this really complex network of stakeholders who influence whether a technology will actually make it into patient care. You can’t just design for the patient because there are also the doctors, nurses, hospitals, insurance companies, regulatory agencies and financers to name a few. To make it all still more complex, this whole system is in tremendous flux because of health-care reform.

So what we’ve done is blow out the needs characterization stage to take all these stakeholders into account in a rigorous way, up front, before any inventing happens.  There’s also a bit of psychology at play here. In health care it is really easy to fall in love with the first need that comes your way. Looked at in isolation, pretty much any clinical need looks compelling. You need to put in a disciplined process, a semi-quantitative way of weighing one need against the other in order to make a good decision about which need to pursue. It is easier to get rid of the one you thought you loved if it really doesn’t meet the criteria you set out.

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