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Cancer, Dermatology, FDA, Health Policy, In the News, Public Health

Experts call on FDA for a “tanning prevention policy”

Experts call on FDA for a "tanning prevention policy"

6635416457_a62bfeb09d_zIndoor UV tanning beds are known carcinogens that are responsible for many cases of skin cancer, which is the most commonly diagnosed form of cancer in the U.S. A recently issued Call to Action to Prevent Skin Cancer from the U.S. Surgeon General states that “more than 400,000 cases of skin cancer [8% of the total], about 6,000 of which are melanomas, are estimated to be related to indoor tanning in the U.S. each year” while “nearly 1 out of every 3 young white women engages in indoor tanning each year,” making indoor tanning a serious public health issue.

In a JAMA opinion piece published yesterday, Darren Mays, PhD, MPH, from the Georgetown University Medical Center‘s Department of Oncology, and John Kraemer, JD, MPH, from Georgetown’s School of Nursing and Health Studies, argued that the FDA needs to step up its regulatory approach and restrict access to this technology – due to its limited therapeutic benefits and known damaging effects.

In 2011, California was the first state to ban access to indoor UV tanning beds to minors. The authors assert that “state-level policies restricting a minor’s access to indoor tanning devices are effectively reducing the prevalence of this cancer risk behavior among youth,” but argue that regulation at the federal level is in order:

Like tobacco products, a national regulatory framework designed to prevent and reduce indoor tanning could reduce public health burden and financial costs of skin cancer. …from a public health perspective the indoor tanning device regulations are not commensurate to those of other regulated products that are known carcinogens with very little or no therapeutic benefit.

However, the likelihood of this regulation taking place is questionable:

FDA did not leverage its authority last year to put a broader regulatory framework in place, which could have included a national minimum age requirement and stronger indoor tanning device warning labels… Critical factors seem to be aligning for such policy change to take place, but additional momentum is needed to promote change at a national scale. The US national political environment makes more expansive regulation by either FDA or Congress seem unlikely in the near future.

The authors concluded with a call for organizations other than governments to help build momentum on toward a “national indoor tanning prevention policy.” For example, they said, universities could implement “tan-free” campus policies similar to the “tobacco-free” campaign.

Previously: More evidence on the link between indoor tanning and cancers, Medical experts question the safety of spray-on tanning productsTime for teens to stop tanning?, Senator Ted Lieu weighs in on tanning bed legislation and A push to keep minors away from tanning beds
Photo by leyla.a

Cancer, Health Policy, In the News, Public Health, Women's Health

Health hazards in nail salons: Tips for consumers

Health hazards in nail salons: Tips for consumers

3044578995_fe5151de75_zAfter exercise class the other day, my friend asked if I wanted to grab coffee and get our nails done. With nail salons on what seems like every block, having a manicure or pedicure is as easy as grabbing a latte. You don’t need an appointment and you’re done in less than an hour.

But this convenience comes at a cost. A recent investigative report in the New York Times exposed the not-so-bright side of nail salons. The articles have raised awareness of poor working conditions and health risks, and they’ve generated a vigorous public dialogue.

“It got people talking and that’s a good thing,” said Thu Quach, PhD, MPH, a research scientist at the Cancer Prevention Institute of California and research director at Asian Health Services.

An epidemiologist, Quach has spent much of her career studying harmful chemicals in nail care products and their health impacts on nail salon workers, a vulnerable workforce that is mainly comprised of low-income immigrants. In research studies she has conducted over time, Quach identified symptoms commonly experienced by salon workers, including dizziness, rashes, and respiratory difficulties, and more serious reproductive health effects and cancer.

“Unfortunately, the risks associated with chronic, long-term exposure to chemicals used in nail products have been little studied,” Quach said. “We know workers are exposed every day and their health is at risk – this is an important focus of my ongoing research.”

The California Healthy Nail Salon Collaborative (CHNSC), convened through Asian Health Services, educates salon owners, workers and consumers about health and safety issues, and advocates for stronger protections for all. Quach, who has been a CHNSC member since its inception, works closely with other members to address worker health and safety using an integrated approach of community outreach, research, and policy advocacy to address health and safety. The CHNSC has worked at the local, state, and federal level to promote changes.

Encouraging counties and cities to adopt the healthy nail salon program is a first step in their local approach. Participation is voluntary and to date three counties and one city have committed: Alameda, San Francisco, San Mateo, and Santa Monica. These counties provide training and formal recognition for salons that participate. Santa Clara has the program in the works and many salons throughout the state participate in healthy initiatives on their own.

In addition to local municipalities taking action, some manufacturers have stepped up to omit the “toxic trio” – dibutyl phthalate, toluene and formaldehyde – from their formulations. But despite rising awareness of the health hazards posed by these chemicals, many products still contain them and there is no regulatory oversight.

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Biomed Bites, Clinical Trials, Health Policy, Videos

The mathematics of clinical trials: A career

The mathematics of clinical trials: A career

Welcome to Biomed Bites, a weekly feature that introduces readers to some of Stanford’s most innovative researchers.

Math was Philip Lavori‘s first intellectual love. After earning his PhD in mathematics at Cornell University, Lavori spent his time solving tricky calculations. But the disconnect between the world of pure mathematics, and the messy outside world where people were living and dying started to bug him.

“It soon became obvious to me that I would have enormous interest in doing research that would have direct benefits to human beings,” Lavori says in the video above.

He began offering his skills as a consultant to physicians, where he discovered a new intellectual love.

“I’ve found the problems that arose in the design of clinical trials were problems that I could attack with my mathematical skills…. That quickly led to an entire career.”

Now Lavori is chair of the Department of Health Research and Policy, and he co-directs the Stanford Center for Clinical and Translational Research and Education (Spectrum).

Learn more about Stanford Medicine’s Biomedical Innovation Initiative and about other faculty leaders who are driving biomedical innovation here.

Previously: Survey confirms that small number of U.S. adults, children participate in research studies, A faster, better, cheaper clinical trial (electronic record system not included) and Re-analyses of clinical trial results rare, but necessary, say Stanford researchers

Global Health, Health Disparities, Health Policy, In the News, Medicine and Society

Why millions lack access to surgery: A conversation with Stanford surgeon Thomas Weiser

Why millions lack access to surgery: A conversation with Stanford surgeon Thomas Weiser

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In the United States, many routine surgeries are just that: routine. They may or may not correct the condition, but the likelihood of death or of life-changing complications are minimal.

But if you live in a poorer nation, surgery — even a cesarean birth — is quite risky and hard to procure. For as many as 5 billion people, these basic procedures are out of reach, according to a recent report by the Lancet Commission, the focus of a recent Scope post and many other news articles.

There are numerous reasons for this surgical gap, as Stanford surgeon Thomas Weiser, MD, who contributed to the report, explains in an Inside Stanford Medicine Q&A.

First, surgery “requires a strong and continuous supply chain, highly technical skills and ongoing training, and intensive management to organize such services,” Weiser said. In addition, most aid programs focus on a specific disease, while surgery is a therapy, leaving it outside the bounds of most international development programs, he said.

So what does the future hold? Weiser is optimistic:

I hope that these findings and the new data presented in the commission report will increase attention and awareness of the vital role surgical care plays in a health system. Ideally, we will see increased leadership from organizations like the WHO and the World Bank in the form of attempts to standardize data collection, identify high-performing health systems, publicize successful programs and promote their adoption and replication in other health settings, and support improved investments in surgical capacity and quality improvement as a way to strengthen the health system more generally.

Previously: Billions lack surgical care; report calls for change, Stanford Medicine magazine opens up the world of surgery and Global health expert: Economic growth provides opportunity to close the “global health gap”
Photo by skeeze

Events, Global Health, Health Policy, Pediatrics, Stanford News, Videos

Rajiv Shah discusses efforts to end preventable child deaths worldwide at Childx

Rajiv Shah discusses efforts to end preventable child deaths worldwide at Childx

The inaugural Childx conference was held here this month, and video interviews featuring keynote speakers, panelists and moderators are now on the Stanford YouTube channel. To continue the discussion of driving innovation in maternal and child health, we’ll be featuring a selection of the videos this month on Scope.

More than six million children under the age of five die from preventable diseases each year. During this year’s Childx conference, Rajiv Shah, MD, the former administrator of USAID, told the crowd, “I do think it’s possible to end preventable child death.”

In the video above, he explains how innovations in drug development, diagnostics and vaccines are among the solutions that are effectively reducing child mortality rates around the world. But there is still more that can be done. Using global health data to see in real-time where children are dying because of a lack of vaccines and places children are suffering as a result of poor health care, Shah said, could assist in more efficiently directing resources to these areas and other pockets of need. Watch the full interview with Shah to hear more about why he thinks ending preventable child death is achievable in the next 20 years.

Previously: Childx speaker Matthew Gillman discusses obesity prevention, Pediatric health expert Alan Guttmacher outlines key issues facing children’s health today, “It’s not just science fiction anymore”: Childx speakers talk stem cell and gene therapy and Global health and precision medicine: Highlights from day two of Stanford’s Childx conference

Addiction, Health Policy, Pain, Public Health

Unmet expectations: Testifying before Congress on the opioid abuse epidemic

Unmet expectations: Testifying before Congress on the opioid abuse epidemic

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My recent trip to Washington D.C. to speak before a congressional subcommittee on the problem of opioid misuse was all about unmet expectations.

First of all, I never expected to get invited to testify for the U.S. Congress. A 2012 article I wrote in the New England Journal of Medicine on the problem of doctors over-prescribing opioids to patients was picked up by Washington Post journalist Charles Lane in a piece he did, “The legal drug epidemic,” which was subsequently read by Alan Slobodin, chief investigative counsel for the House Committee on Energy and Commerce. Slobodin then sent a message to my in-box asking to “discuss the opioid abuse problem.” I almost deleted it as a hoax. But Keith Humphreys, PhD, my mentor and chief of the mental health policy section in our department, assured me it was real.

Second, not really understanding how government works beyond what I learned from the animated musical cartoon “I’m Just a Bill” when I was seven years old, and being a regular reader of the New York Times, which has almost convinced me that everyone in Washington is against everyone else and nothing ever gets done, I prepared myself for the possibility that various members of the committee might just be looking for sound bites to support their pre-ordained opinions. I was wrong.

Slobodin and his staff were curious, earnest, intelligent, and dedicated to understanding the opioid problem at the deepest level. At the hearing itself, where I and other experts testified on the problem of opioid misuse, overdose, and addiction, Congressman Tim Murphy (R-PA), and Congresswoman Diana DeGette  (D-CO) didn’t go for each other’s jugular like a couple of vampires out of Twilight, which I thought might happen. Instead, they were courteous, collegial, and again, struck me as truly dedicated to ameliorating the problem of addiction in this country.

Third and finally, I didn’t imagine that my testimony would make much of a difference, yet some of my suggestions were picked up by members of the committee, including Bridgette DeHart, a senior policy advisor for Congresswoman Yvette D. Clarke (D-NY). DeHart is a whip-smart young woman who in ten minutes of conversation conveyed to me her sophisticated understanding of the opioid epidemic. She talked about incorporating one of my suggestions – mandating physician education on the use of Prescription Drug Monitoring Databases (PDMDs) at the time of DEA-licensure – into a larger bill that Clarke and her team are working on.

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Global Health, Health Disparities, Health Policy, Patient Care, Public Health, Surgery

Billions lack surgical care; report calls for change

Billions lack surgical care; report calls for change

In this country, we take it for granted that we will have access to needed surgeries, whether it’s the repair of a broken leg or an operation to remove an infected appendix or a malignant tumor. But for as many as 5 billion people – or two-thirds of the world’s population – these basic procedures are out of reach.

A major new report by the Lancet Commission sheds light on this enormous surgery gap and argues that building surgical infrastructure in low- and middle-income countries is critical both from an economic, as well as a human, perspective.

“Surgery hasn’t been part of the dialogue with respect to health system strengthening. It’s been a hugely neglected item,” said Stanford trauma surgeon Thomas Weiser, MD, who contributed to the 58-page report. The commission includes 25 leading experts from the fields of surgery and anesthesia, with contributions from more than 110 countries.

In its report, the commission notes that in 2010, nearly one-third of all deaths (16.9 million) were attributable to conditions readily treated by surgery, such as appendicitis, hernia, fractures, obstructed labor, congenital abnormalities and breast and cervical cancer. That is more than the number of deaths from HIV/AIDS, tuberculosis and malaria combined. And although there have been many gains in global health in the last 25 years, the quality and availability of surgical services in many regions have stagnated or declined, while the demand for surgery continues to rise.

“The global community cannot continue to ignore this problem – millions of people are already dying unnecessarily, and the need for equitable and affordable access to surgical services is projected to increase in the coming decades, as many of the worst affected countries face rising rates of cancer, cardiovascular disease and road accidents,” said Lars Hagander, MD, of Lund University in Sweden and one of the lead authors.

Weiser and his colleagues provide new estimates of the global shortfall, calculating that some 143 million additional surgeries are needed to save lives and prevent disability, with the largest number of neglected patients living in South Asia (57.8 million), East Asia (27.9 million) and southern sub-Saharan Africa (18.9 million).

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Events, Health Policy, Pediatrics, Stanford News

Innovating for kids’ health: More from first day of Stanford’s Childx

Innovating for kids' health: More from first day of Stanford's Childx

Childx table“We are at the precipice of massive change in health care.”

That was the message from pediatrician Alan Greene, MD, speaking during a Thursday afternoon session on accelerating innovation in child and maternal health at Stanford’s inaugural Childx conference. (The conference continues today and will be live tweeted from @StanfordMed.)

Greene, a practicing pediatrician who in 1995 launched one of the very first websites to provide patients with health information, knows a thing or two about innovating in health care. “Patients are the biggest underused resource in medicine, and moms and their kids are the biggest underused resource in pediatrics,” he said, noting that the idea for his website came from the parents of his patients.

The kind of innovation he anticipates in medicine is happening elsewhere in society first, Greene said. Car service Uber and accommodation website Airbnb have rapidly become global leaders not because they own fleets of cars or chains of hotels but because “they have used people, existing resources, data and software to create this magic that just sprung out of nowhere, seemingly,” he said. Now, we’re on the verge of parallel changes in crowd-sourced medicine, for instance with patients now able to contribute their data to research through the quantified-self movement and with user-oriented collaborative medicine, which will allow patients not just to participate in research but also to help shape the research questions.

After Greene’s presentation, three Stanford scientists spoke about their approaches to innovation. Daria Mochly-Rosen, PhD, described Stanford’s SPARK program, now in its ninth year, that she launched to help scientists take their medical innovations past the “valley of death” – the gap between research and clinical use that kills many good ideas before they help patients. To date, the program has moved an impressive 57 percent of its projects to companies for clinical trials or pre-clinical trial work, or to clinical trials that are being conducted at Stanford itself.

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Events, Health Policy, Pediatrics, Public Health, Research, Stanford News

“What we’re really talking about is changing the arc of children’s lives”: Stanford’s Childx kicks off

"What we're really talking about is changing the arc of children's lives": Stanford's Childx kicks off

Childx Guttmacher

Stanford’s Childx conference got off to a great start today. Shortly after Lloyd Minor, dean of the medical school, welcomed the attendees, keynote speaker Alan Guttmacher, MD, director of the Eunice Kennedy Shriver National Institute of Child Health and Development, took the stage to talk about how scientific research needs to evolve to continue to advance children’s health.

Pediatric research has reached an inflection point, Guttmacher said. “I really believe the fundamental questions we need to ask are different,” he said. “This isn’t about health in a narrowly defined way. What we’re really talking about is changing the arc of children’s lives, and the medical model is useful but not sufficient.”

He mentioned several successes from the history of pediatric medicine, including large reductions in infectious disease, better care for preterm babies, and the “Back to Sleep” public health campaign that cut newborn deaths from SIDS by more than half. But he also highlighted several areas where children’s health now needs research that goes beyond a strictly medical approach to integrate social and environmental factors, such as learning how to prevent preterm birth, help children with autism and intellectual and developmental disabilities participate more fully in society, understand how children’s lives are changed by cyberbullying, and make medical and ethical decisions about the possible use of newborns’ genomic data.

He anticipates that this type of research will bring new strength to pediatricians’ interactions with patients and their families. “I would hope that the pediatric practice of the future, in terms of anticipatory guidance, won’t be about the next six weeks, six months or even six years of [the child’s] life; it’ll be about the next six decades,” he said.

“We need to be a society that values children,” Guttmacher concluded, adding that we should view children as a shared societal responsibility and also a shared societal investment. He challenged the audience of pediatric researchers to ask themselves, “What do we need to do to … change the nature of research that would make real change, not just small blips, in the lives, especially of kids in the United States and globally?”

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Addiction, Events, Health Policy, Stanford News

Stanford Health Policy Forum to focus on balancing benefits and costs of prescription opioids

Stanford Health Policy Forum to focus on balancing benefits and costs of prescription opioids

6284740462_c1d824cbb7_zNationwide deaths from drug overdose have been steadily increasing since 1990 and are a leading cause of injury death. More than half of drug overdose deaths in the United States are related to pharmaceuticals and 71 percent of these involve prescription painkillers, according to the latest figures from the Centers for Disease Control and Prevention.

In California, the number of deaths involving opioid prescription medications has risen almost 17 percent in the past nine years. As a result, policymakers are struggling to develop methods to reduce the risk of such medications while making sure patients that rely on them for pain management have access.

On April 9, the School of Medicine will host a forum examining the challenges of balancing the benefits and costs of prescription opioids and discussing potential solutions. The event is part of the Stanford Health Policy Forum series and will be moderated by Paul Costello, the medical school’s chief communications officer. Stanford addiction medicine expert Anna Lembke, MD, and pain medicine expert Sean Mackey, MD, PhD, will participate in the forum.

For our local readers: The event, which is free and open to the public, will run from 12:30-2 p.m. in Berg Hall at the Li Ka Shing Center for Learning and Knowledge.

Previously: Stanford addiction expert: It’s often a “subtle journey” from prescription-drug use to abuse, Why doctors prescribe opioids to patients they know are abusing them, Do opium and opioids increase mortality risk? and How to combat prescription-drug abuse
Photo by Erin DeMay

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