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Events, Global Health, Health Disparities, Health Policy, Podcasts

An optimist’s approach to improving global child health

An optimist’s approach to improving global child health

Globally, more than six million children die before their fifth birthday each year, most having been born into poverty. While great strides have been made over the last few decades in reducing global child mortality, some countries, like Pakistan, have lagged behind. Today, Pakistan has the third-highest infant mortality rate in the world and some of the worst child health and social indicators in the world.

In a new 1:2:1 podcast, Paul Costello, chief communications officer for the medical school, talks with Anita Zaidi, MD, an internationally renowned pediatrician and director of the Enteric and Diarrheal Diseases Program at the Bill & Melinda Gates Foundation, about the state of child health in her home country of Pakistan and what it takes to lift a nation up. The conversation was adapted from a recent global health seminar sponsored by the Center for Innovation in Global Health.

In speaking to an audience of Stanford students and faculty prior to her talk with Costello, Zaidi described herself as a “relentless optimist” who always takes the “glass half full” perspective. In looking back from 1990 to now, she said Pakistan has made some progress in reducing child mortality, but not as much as what it could have achieved.

Perhaps the biggest barrier to Pakistan’s progress stems from gender inequalities and the poor status of maternal health.

“Women are very marginalized in Pakistan, which affects their health and child mortality,” said Zaidi. “Unless we address those issues, [child health] is a tough problem to take care of… The citizens of Pakistan have a very big role to play.”

In 2013, Zaidi became the inaugural recipient of the $1 million Caplow Children’s Prize for her work in one of Karachi’s poverty stricken fishing communities, Rehri Goth, to save children’s lives. Through her work in Rehri Goth, she saw first hand the complex issues that impact whether a child will live to age five or not. In areas of extreme poverty, like Rehri Goth, improving primary healthcare is not enough.

“There’s no source of income. There are more than 10 kids in a family. Even if their newborn isn’t dying, the child dies at two or three months of age because there’s nothing to eat,” said Zaidi. “You realize there is this sub-population of extremely high-risk individuals, who need more than primary healthcare…They actually need some poverty alleviation types of interventions, food subsidies, to get them out of that.”

So, what does it take to lift a nation up? For Zaidi: “Girls getting educated will change the world, and more and more girls are getting education. We know that [education] one of the strongest predictors of improving child health outcomes.”

Rachel Leslie is the communications officer at Stanford’s Center for Innovation in Global Health.

Previously: Pediatric health expert Alan Guttmacher outlines key issues facing children’s health todayCountdown to Childx: Global health expert Gary Darmstadt on improving newborn survival and Training program helps dramatically reduce stillborn rates in developing countries

Events, Global Health, Health Policy, Public Health, Stanford News

Using innovation to improve health in the developing world

Using innovation to improve health in the developing world

Ramano RaoHow can Silicon Valley-style know-how help improve health and lift up the lives of the poor in the developing world? That question was the focus of a panel discussion among four distinguished speakers last week at a Stanford conference on global development and poverty.

Panelist Ramana Rao, MD, described one technologically-based solution he helped develop with colleagues in Hyderabad, India:  a 911-type emergency care system which now serves some 750 million people across the South Asian country.

Though the system, users can call a single number – 108 – to summon an ambulance and team of skilled providers who can provide treatment en route to the nearest hospital.  The system, a public-private partnership known as GVK EMRI (Emergency Management and Research Institute), uses advanced call center technology, in which trained operators typically respond to calls within the first ring and relay them immediately to paramedics and emergency medical technicians on ambulances in the field, Rao told an audience of more than 200 people at the Stanford Graduate School of Business.

The system uses Google maps to help quickly locate patients. And the designers have introduced a mobile device app, which can be easily downloaded to call the service and which can be used to track the location of a caller during the first hour, the critical “golden hour” for treating trauma patients, he said.

Panel moderator Paul Yock, MD, PhD, noted the system is far more effective than the fragmented, 911 emergency system in the United States. “It’s a marvelous example of technology leap-frogging what we do here in this country,” said Yock, founder and director of Stanford Biodesign.

The Indian system was made possible in part by the soaring popularity of cell phones in India, used by 950 million people, including the poor.

“The mobile phone has been the most transformational technological advance in the developing world in the last 15 years,” noted panelist Rajiv Shah, MD, administrator of the U.S. Agency for International Development.

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Addiction, Cancer, Events, Health Policy, Medicine and Society, Public Health

The devil you know: Experts discuss the public-health consequences of e-cigarettes

The devil you know: Experts discuss the public-health consequences of e-cigarettes

e-cigarettesHow do we reduce health risk in the face of harm that can’t be eradicated completely? That’s the question that the medical school’s dean, Lloyd Minor, MD, presented to the audience at Monday’s Health Policy Forum on e-cigarettes — a topic about which he said “intelligent and reasonable people can disagree.”

E-cigarettes are a heavily contested subject in the public-health community. Panelists at this event debated whether the recently developed devices hold promise to help long-time smokers move away from combustible cigarettes, or whether they carry the worrisome potential to re-normalize smoking.

All panelists agreed that those under 21 shouldn’t be using any nicotine delivery devices, and they shared a goal of minimizing general use of harmful health products. They disagreed, however, on what the advent of e-cigarettes means to the accomplishment of those goals.

David Abrams, PhD, a Johns Hopkins clinical psychologist specializing in health psychology, addictions, and tobacco-use behavior, described himself as a harm reductionist. He argued that as an alternative mode of nicotine delivery, e-cigarettes pave the way for saving lives by helping addicted smokers not use traditional cigarettes.

“I do think the evidence is very solid that they are dramatically less harmful than cigarettes…because they absolutely have very low, almost undetectable levels or trace amounts of the top eight carcinogens that are found in cigarettes and they have no carbon monoxide,” he explained.

But a lack of extensive research makes Stanford’s Robert Jackler, MD, and Bonnie Halpern-Felsher, PhD, question whether vaping is actually safe — and a prevalence of candy-flavored e-liquids leaves them concerned for the potential for harm to youth.

“Let me point out that you can smoke [combustible cigarettes] for many years before you get chronic destructive lung disease,” said Jackler, who leads a Stanford research team studying the impact of tobacco advertising, marketing, and promotion. “So while I agree… that they are safer, the presumption that they are safe for teenagers to adopt as opposed to combustible tobacco, we won’t know that for decades.”

In the meantime, he worries that “we’re experimenting with the lungs of teens.”

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Ebola, Events, Global Health

From bedside to patient: an Ebola survivor’s remarkable journey

From bedside to patient: an Ebola survivor's remarkable journey

Crozier in Sierra LeoneWhen Ian Crozier, MD, volunteered to treat Ebola patients in West Africa last year, he couldn’t possibly have imagined that he would become a case report in the New England Journal of Medicine and a living example of the serious, long-term consequences of Ebola infection.

Crozier described to a Stanford audience last week his extraordinary journey of survival from Ebola infection after suffering a shutdown of his vital organs and several hemorrhagic strokes.

“If I you had told me on day one that I would develop multisystem organ failure and asked me to predict my chances of survival, I would have said my chances were zero,” he told a School of Medicine audience of more than 100 people. “They [the Emory caregivers] really changed the game… I really think they were walking on the moon, but in a different kind of space suit.”

Crozier, who was a World Health Organization volunteer physician in Sierra Leone, was evacuated to Emory University Hospital in Atlanta, where he spent 6 weeks undergoing intensive treatment. As he began to recover from the infection, he had to relearn some basic functions, such as walking and talking.

Two months after he was discharged from the hospital, he was beset by serious eye problems and was found to be harboring billions of viral particles in his left eye. The infection also left him with some hearing loss and ringing in the ears, sleep issues and some neurologic complications, including seizures and short-term memory loss.

But none of this was apparent during his talk, in which he delivered a detailed, rapid-fire discussion of his remarkable medical journey.

“It must be odd to hear me talking about my own case… in what may seem a detached manner,” he told the audience. “This was not theoretical. I’m standing here, and I’m alive, and yet I’ve described some of the worst disease we’ve seen with Ebola.”

Colin Bucks, MD, a Stanford emergency physician who was a volunteer in Liberia during the Ebola crisis, says Crozier’s experience has given him a new perspective on how best to treat infected patients. Previously it was not standard practice to put patients on ventilators or dialysis machines, as Crozier was, as these were considered impractical and ineffective.

“It made me endorse the aggressive treatments that were previously considered futile,” Bucks told me during Crozier’s visit to Stanford. “So I consider his case pivotal in the way we view this disease.”

Crozier’s visit was sponsored by the Stanford Center for Innovation in Global Health, Stanford Immunology and the Stanford Medical Scientist Training Program.

Previously: Ebola: It’s not overBack home from Liberia, Stanford physician continues to help in fight against EbolaStanford physician shares his story of treating Ebola patients in Liberia and Experience from the trenches in the
Photo, of Ian Crozier with children in Sierra Leone, courtesy of WHO

Big data, Events, Precision health, Stanford News

Sino-U.S. Symposium brings researchers to Stanford to discuss precision health, big data

Sino-U.S. Symposium brings researchers to Stanford to discuss precision health, big data

LSINO-US panelistsast week, more than 300 health researchers from China and the United States converged at Stanford for the ninth Sino-U.S. Symposium on Medicine in the 21st Century. At this two-day event, health experts, thought leaders and entrepreneurs, including Lloyd Minor, MD, dean of the School of Medicine, and Jerry Yang, the Taiwanese-born co-founder of Yahoo, shared their knowledge of genomics, medical apps, and other topics related to this year’s theme: Big data in health care.

Minor kicked the symposium off saying, “We have the opportunity to harness the power of genomic data and electronic medical records, and to deliver better care, more personalized care for acute illness and, perhaps even more importantly, to predict and prevent disease before it even occurs — thereby moving the focus of medicine from sick care firmly toward health care.”

My colleague describes highlights from the event, including a discussion of how mobile devices can play a larger role in health care, in an online news story:

In China, clinics are so crowded that people line up in the morning to get a lottery number to be seen, [Alan Yeung, MD, professor of cardiovascular medicine] said. Yet, 1.3 billion people there own a smartphone that can potentially help monitor health. Globally, he said, 4.8 billion people own a cellphone.

“We could score someone’s risk of a heart attack and, depending on their risk factors, give them medications that would lower their risk,” said Yeung. “The idea at the end of the day is instead of one patient coming to a clinic, health-care providers come to a small clean room to monitor tens of thousands of patients and see who is in trouble.”

Cloud computing that was monitoring people’s heart rate, heart rhythm, blood pressure and glucose levels, for example, could light up when heart attack risk factors started to shoot up for a particular person. “We could schedule a quick call and find out what’s up,” said Yeung, “and then change whatever the problem is before they become entrenched in their habits.”

Previously: A conversation on the promises and challenges of precision healthHow Stanford Medicine will “develop, define and lead the field of precision health”At Big Data in Biomedicine, Stanford’s Lloyd Minor focuses on precision health and A look at the MyHeart Counts app and the potential of mobile technologies to improve human health
Photo of event panelists by Norbert von der Groeben

Events, Patient Care, Precision health, Stanford News

A conversation on the promises and challenges of precision health

A conversation on the promises and challenges of precision health

At a Town Hall event here on campus earlier this week, three faculty members explored the prospects for precision health — health care whose goal is to anticipate and prevent disease in the healthy and precisely diagnose and treat disease in the ill. Among the speakers was Mary Hawn, MD, professor and chair of surgery; as my colleague Jennie Dusheck explained in an online article today:

[Hawn] discussed how precision health could help surgeons better understand their patients’ risk factors for surgery and mitigate those risks. “We know we aren’t going to get the same outcome from surgery for every single patient,” she said. Health-care providers have to know individual patients and what their individual risks might be. At the same time, providers need to be able to communicate that information to patients and their families, so they can make decisions that feel right to them. Ideally, Hawn said, “We can see what risks the patient is bringing to the table and mitigate those risks.”

“We surgeons have been humbled by biology. We think we can do a great operation, but in the end, the biology wins,” Hawn said. “So, knowing that upfront, we can have a much more frank conversation with a patient about how invasive, how radical an operation to have…”

In a panel discussion moderated by Lloyd Minor, MD, dean of the medical school, geneticist Michael Snyder, MD, and Mark Cullen, MD, a population-health scientist, also weighed in on how clinicians can take advantage of large health data sets and advances in genomics to benefit their patients.

Previously: How Stanford Medicine will “develop, define and lead the field of precision health”, At Big Data in Biomedicine, Stanford’s Lloyd Minor focuses on precision health, and Global health and precision medicine: Highlights from day two of Stanford’s Childx conference
Photo, of Mary Hawn and Mark Cullen (left), by Norbert von der Groeben

Events, Patient Care, Public Health

During Stanford talk, U.S. Surgeon General calls for creation of a “culture of prevention”

During Stanford talk, U.S. Surgeon General calls for creation of a "culture of prevention"

Dean’s Lecture with Dr. Vice Admiral Vivek Hallegere Murthy at Berg Hall, Li Ka Shing Center at the Stanford University Campus on Wednesday, October 7, 2015. ( Norbert von der Groeben/ Stanford School of Medicine )

Updated 10-23-15: Video of this talk is now available here.


10-13-15: “In few other places in the world would the son of a rural farmer from India be asked by the President to serve the health of an entire nation,” remarked U.S. Surgeon General and Vice Admiral Vivek Murthy, MD, MBA, as he opened the latest Dean’s Lecture here last Thursday.

In making the remark, Murthy recalled the words spoken to him by Vice President Joe Biden, when Murthy became the nation’s 19th Surgeon General and the first of Indian descent.

“My story is part of the immigrant story that makes up America,” he said, describing his childhood with highly supportive parents who emigrated from India and settled in Florida, where Murthy and his sister worked weekends in their parents’ primary care clinic.

The experience led Murthy to medical school at Harvard — “I tried to come to Stanford, but it was vetoed by my mother, who was afraid of earthquakes”—followed by an extraordinary list of pursuits that included founding the nonprofit Doctors for America and biotech startup TrialNetworks.

Murthy’s background is now helping to inform his work as surgeon general, which has brought him to places all across the country during his ten-month tenure. He said his travels have reinforced two main themes: America faces an overwhelming burden of disease that is largely preventable, yet many Americans are beginning to lose faith in their ability to improve their own health.

“We invest relatively little in prevention and pay for it much later, often in the form of chronic illness — but that is something we can change,” he noted.

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Events, Neuroscience, Science, Stanford News, Stem Cells

Stanford Neuroscience Institute’s annual symposium captured on Storify

Stanford Neuroscience Institute's annual symposium captured on Storify

IMG_0246When I talked to William Newsome, MD, PhD, director of the Stanford Neurosciences Institute, about its annual symposium last week, he told me one of the pleasures of directing the institute is getting to pick speakers whose science he really likes.

We captured tweets, images and videos from those speakers on our Storify page, and they make it clear that Newsome has very diverse tastes. Topics ranged from aging and mental health policy to virtual reality for mice.

From Stanford, geneticist Anne Brunet, PhD, discussed her work on aging, particularly how stem cells in the brain change with age. Engineer Krishna Shenoy, PhD, described how his lab was reading signals from the brains of paralyzed people and using those to drive computer cursors or prosthetic limbs. Others discussed machine learning, new technologies for imaging the brain, the genetics of mental health disorders, and insights into how smells illicit behaviors in flies.

It’s worth a look at the Storify page to get a sense of the breadth of work encompassed under the banner of neuroscience.

Previously: “Are we there yet?” Exploring the promise, and the hype, of longevity researchMy funny Valentine – or, how a tiny fish will change the world of aging research and Stanford researchers provide insights into how human neurons control muscle movement
Photo of Krishna Shenoy by Matt Beardsley

Events, Medicine and Society, Stanford News

Anna Deavere Smith explores “crossing the line” of being sick and dying

Anna Deavere Smith explores "crossing the line" of being sick and dying

ADSThe New York Times has written that Anna Deavere Smith, playwright, actress and professor, is the “ultimate impressionist. She does people’s souls.” It was Jonathan King’s soul that Smith summoned up at the Jonathan King Lecture on campus earlier this week. The lecture series, celebrating its 25th year, honors King, who earned a master’s degree and PhD in computer science at Stanford and who became an advocate for patients’ rights after his cancer diagnosis in 1989. The series was created by friends and family to honor King’s memory and to carry on his message of “walking in the shoes of your patients.”

The event opened with a video of King during his life and battle with cancer, including portions of a talk he gave to medical students in which he said, “There is a line that divides people who have passed over to the condition I am in from everybody else.”

Smith weaved those words throughout her performance, as she brought to life patients she had interviewed in the course of her research for her landmark one-woman show “Let Me Down Easy.” Those real life patients included Hazel Merritt, a diabetic patient who had compelling reasons to refuse dialysis treatment; Ruth Katz, former associate dean of administration at Yale Medical School; Ann Richards, former Governor of Texas; and Eduardo Guerro, a patient who said, “You can’t turn dying into a picnic.”

What medical professionals CAN do however, Smith said, is recognize the whole person in the patient. “Take in everything they are, and that starts when you walk in the room and touch the patient,” Smith said. She then echoed King’s advice saying, “Get as close to your patients as possible.”

Smith also addressed the “line” that King referred to. “There is a matter of, of… aloneness for those who have passed over that line, and we can do better as humans and as a society to work to get over it. We need to imagine crossing that line, because we are all human, and we are all going to die.”

In the Q&A portion of the lecture, medical student Arunami Kohli thanked Smith for her moving performance and asked her how she got patients to speak so candidly. Smith’s answer: “I have found when people are in crisis, they want to restore their dignity, and when they do, they are so eloquent, they sing. Just remember to give patients that opportunity, to restore their dignity.”

Jacqueline Genovese is assistant director of the Medicine & the Muse Program within the Stanford Center for Biomedical Ethics. The center hosts the Jonathan King Lecture.

Previously: Actor Anna Deavere Smith on getting into and under the skin of a character

Events, Patient Care, Stanford News

At first-ever Stanford Medicine 25 Symposium, a focus on bedside medicine and a call for community

At first-ever Stanford Medicine 25 Symposium, a focus on bedside medicine and a call for community

Stanford 25 event attendeesOn his first day as an attending physician at Stanford, Abraham Verghese, MD, noticed something unusual. “I was struck by the fact that the house staff were spending a great deal of time wedded to their computers,” he recalled. “And it was not their doing. They didn’t sign on to do that.”

His experience reflects an increasingly common trend in modern medicine: With the introduction of new medical technologies­­, physicians today find themselves spending more time at the monitor and less time at the bedside.

Verghese recounted his story to a packed room of physicians and clinical educators who had traveled to Stanford from places as far flung as Brazil and Australia to attend the inaugural Stanford Medicine 25 Symposium.

The two-day event provided attendees with the tools to foster and encourage a robust bedside medicine culture at their home institutions.

The time is right, said Verghese. Today, many physicians and educators are advocating for a more hands-on approach to medicine. At the same time, an increasing number of bedside medicine programs are popping up at universities and hospitals worldwide: “I’m hoping that this is the moment when we all come together, and we stay together and connected in this effort to take what we all believe are fundamental and important skills – important to the welfare of the patient, important to practice cost-effective medicine, important in choosing wisely – and we form a community with solidarity around that theme.”

Throughout the symposium, participants learned the basics of evidence-based physical diagnosis from Steve McGee, MD, author of a textbook of the same name and a professor of medicine at the University of Washington. They learned how to schedule and program consistent teaching rounds, and how to incorporate technology without losing connection with the patient. They also heard from Andrew Elder, MD, professor of medicine at Edinburgh University and Junaid Zaman, MD, a postdoctoral researcher at Imperial College London and Stanford, about the MRCP PACES examination – a high stakes clinical exam that all medical school graduates in the UK must pass to continue their postgraduate education, an exam run and administered by Elder.

During an afternoon panel, experts from Johns Hopkins, Stanford, the Seattle VA, and the University of Alabama, Birmingham discussed ways to create a bedside medicine culture. Ideas included inviting master clinicians to teach at the bedside and hosting regular workshops. But, the panelists agreed, the support of community is critical. “It’s really hard to build a bedside medicine experience,” noted Brian Garibaldi, MD, of Johns Hopkins. “Community is key.”

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