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Aging, History, Medicine and Literature, Medicine and Society, Stanford News

Stanford humanities scholar examines "the youngest society on Earth"

Stanford humanities scholar examines "the youngest society on Earth"

Young and old faces Over the past decades, our society has undergone a process of “juvenescence” that, according to Stanford professor Robert Harrison, PhD, makes it the “youngest on Earth.” For the first time in human history, he says, “the young have become a model of emulation for the older population, rather than the other way around” (as quoted in Stanford Report). The post-war period “has unleashed extraordinary youthful energies in our species and represents one of the momentous revolutions in human cultural history.”

Harrison is a professor of Italian literature whose new book Juvenescence: A Cultural History of Our Age examines the cultural forces that have brought about this development. The term “juvenescence” draws on the biological concept of neoteny, or the retention of juvenile characteristics through adulthood. Harrison’s research spans literature, philosophy, and evolutionary science.

His basic argument is that “juvenescence” can refer to either a positive or a negative change, and it isn’t clear which more accurately describes our current situation. The positive sense is one of cultural rejuvenation, while the negative one denotes juvenilization. Harrison explains, citing examples from his book:

Rejuvenation is about recognizing heritage and legacy, and incorporating and re-appropriating historical perspective in the present – like the Founding Fathers did when they created a new nation by drawing on ancient models of republicanism and creatively retrieving many legacies of the past… Unlike rejuvenation, juvenilization is characterized by the loss of cultural memory and a shallowing of our historical age.

…I feel ambivalent about where we are culturally in this age of ours.  It is hard to say whether we are on the cusp of a wholesale rejuvenation of human culture or whether we are tumbling into a dangerous and irresponsible juvenility.

Several aspects of our society suggest juvenilization. Most citizens of the developed world today enjoy the luxury of remaining childishly innocent about what they operate, consume, and depend on in daily life, while “in terms of dress codes, mentality, lifestyles and marketing, the world that we live in is astonishingly youthful and in many respects infantile.” Our culture’s emphasis on innovation and change honors the youthful drive that brings renewal and progress, but, without firm roots in the stability and wisdom of older generations and longstanding institutions, this risks being a meaningless chase after novelty. Youth’s genius is a luxury that requires solid foundations.

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History, Neuroscience, Research, Science, Stanford News

Illustration from 1881 resolves century-old brain controversy

Illustration from 1881 resolves century-old brain controversy

Figure2_WernickeThese days, a person can get through graduate school in the sciences practically without touching a physical publication. Most journals are available online going back decades. So it was a bit unusual when graduate student Jason Yeatman and postdoctoral scholar Kevin Weiner found themselves in the basement of Lane Medical Library trying to get to the bottom of a medical mystery.

It all started when Yeatman found a nerve pathway in brain images he’d taken as part of his work studying brain changes as kids learn to read.  This pathway didn’t appear anywhere in the available literature. He and Weiner became curious how this pathway – which clearly showed up in their work – could have escaped the notice of previous neuroscientists.

Their curiosity eventually led them back to an 1881 publication, still available in the basement of Lane Medical Library, where Carl Wernicke, MD, described identifying this brain pathway. Weier said, “That was a really cool experience that most people don’t have anymore, when you have to check your belongings at the door because the book you are about to look at is worth thousands of dollars per page. You are literally smelling 100 year-old ink as you find the images you have been searching for.”

Wernicke’s discovery contradicted theories by the eminent neuroanatomist at the time, Theodor Meynert, MD. I describe the controversy that led to this pathway expulsion from the literature in this Stanford News story:

Meynert strongly believed that all of the brain’s association pathways run from front to back – horizontal. This pathway, which Wernicke had called the vertical occipital fasciculus, or VOF, ran vertically. Although Yeatman and Weiner found references to the VOF under a variety of different names in texts published for about 30 years after Wernicke’s original discovery, Meynert never accepted the VOF and references to it became contentious before eventually disappearing entirely from the literature.

The group, whose work was published this week in the Proceedings of the National Academy of Sciences, says this was all more than just an exercise in curiosity. Psychologist Brian Wandell, PhD, in whose lab Yeatman was working, says it also shows the value of modern publishing methods, where making data available means scientists worldwide can try to reproduce results. He says it’s now less likely that a dispute could lead to a discovery being lost to history.

Image courtesy of PNAS

History, Medicine and Society, Research, Stanford News

Stanford Egyptologist discovers that public health care has ancient roots

Stanford Egyptologist discovers that public health care has ancient roots

Anne Austin

Anne Austen, PhD, a post-doctoral researcher in Stanford’s history department, recently conducted the first detailed study of human remains at what is now called Deir el-Medina, an ancient town outside of the Valley of the Kings in Egypt. She found that these Egyptians likely had state-sponsored health care with “modern” benefits like paid sick days and clinics. They also felt a strong pressure to do grueling work, yet took care of their disabled and infirm.

Austen works in the relatively new field of osteo-archaeology, which enables researchers to deduce details about people’s daily lives from their skeletal remains. Archaeologists have always been interested in how remains are positioned relative to the rest of the site, but Austen tested the bones themselves to determine what diseases the people were experiencing, and then contextualized that information within the copious written records from Deir el-Medina in its heyday, when it was a bustling village of workers building the pyramids. She has added a new dimension to the picture of ancient medicine and care already gleaned from this uncommonly literate group’s receipts, personal letters, bills, prayers, and lawsuits, found on shards of clay or scraps of papyrus.

During her current tenure in the Andrew W. Mellon Fellowship of Scholars in the Humanities, she is continuing the PhD research she conducted in 2012 while at UCLA. In a Stanford News piece, she commented, “The more I learn about Egypt, the more similar I think ancient Egyptian society is to modern American society. Things we consider creations of the modern condition, such as health care and labor strikes, are also visible so far in the past.”

Austin thinks that research about Egyptians is particularly compelling for thinking about today’s questions of wellness and social responsibility because they thought of health and disease in ways surprisingly similar to our own. In contrast to the Greeks, who, as Austin points out in the article, thought of disease as an imbalance of the body’s four fluid humors, Egyptians thought of disease as a contamination, a foreign substance that must be purged. This is essentially analogous to modern germ theory. Furthermore, they negotiated the question that underlies much current American discussion about healthcare: Who is responsible for whose health, and why? Austen explains:

At Deir el-Medina, we see two health care networks happening. There’s a professional, state-subsidized network so the state can get what it wants – a nice tomb for the king. Parallel to this, there’s a private network of families and friends. And this network has pressure to take care of its members, for fear of public shaming, such as being divorced for neglect or even disinherited.

Photo courtesy of Anne Austin

Genetics, History, Immunology, Research, Science, Stanford News

Knight in lab: In days of yore, postdoc armed with quaint research tools found immunology's Holy Grail

Knight in lab: In days of yore, postdoc armed with quaint research tools found immunology's Holy Grail

charging knightA human has only about 25,000 genes. So, it’s tough to imagine just how our immune systems can manage to recognize potentially billions of differently shaped microbial or tumor-cell body parts. But that’s precisely what our immune systems have to do, and with exquisite precision, in order to stomp invading pathogens and wanna-be cancer cells and leave the rest of our bodies the heck alone.

How do they do it?

Stanford immunologist Mark Davis, PhD, tore the cover off of immunology in the early 1980s by solving that riddle. As I wrote in  “The Swashbuckler,” an article in the latest issue of Stanford Medicine, T cells are one of two closely related, closely coordinated workhorse-warrior cell types that deserve much of the credit for the vertebrate immune system’s knack of carefully picking bad guys of various stripes out of the lineup and attacking them:

[Q]uite similar in many respects, B cells and T cells are more like fraternal than identical twins. B cells are specialized to find strange cells and strange substances circulating in the blood and lymph. T cells are geared toward inspecting our own cells for signs of harboring a virus or becoming cancerous. So it’s not surprising that the two cell types differ fundamentally in the ways they recognize their respective targets. B cells’ antibodies recognize the three-dimensional surfaces of molecules. T cells recognize one-dimensional sequences of protein snippets, called peptides, on cell surfaces. All proteins in use in a cell eventually get broken down into peptides, which are transported to the cell surface and displayed in molecular jewel cases that evolution has optimized for efficient inspection by patrolling T cells. Somehow, our inventory of B cells generates antibodies capable of recognizing and binding to a seemingly infinite number of differently shaped biological objects. Likewise, our bodies’ T-cell populations can recognize and respond to a vast range of different peptide sequences.

In the late 1970s, scientists (including then-graduate student Davis, who is now director of Stanford’s Institute for Immunity, Transplantation and Infection) unraveled the genetic quirks behind B cells’ ability to recognize a mind-blowingly diverse  set of different pathogens’ and tumor-cells’ characteristic molecular shapes. As a follow-on, Davis and a handful of colleagues – working with what would today be considered the most primitive of molecular-biology tools – isolated the gene underlying the T-cell receptor: an idiosyncratic and very important surface protein that is overwhelmingly responsible for T cells’ recognition of myriad pathogen- and cancer-cell-specific peptide sequences. And they figured out how it works.

The result? (Again from my article:)

With the T-cell receptor gene in hand, scientists can now routinely sort, scrutinize, categorize and utilize T cells to learn about the immune system and work toward improving human health. Without it, they’d be in the position of a person trying to recognize words by the shapes of their constituent letters instead of by phonetics.

Previously: Stanford Medicine magazine traverses the immune systemBest thing since sliced bread? A (potential) new diagnostic for celiac disease, Deja vu: Adults’ immune systems “remember” microscopic monsters they’ve never seen before, Immunology escapes from the mousetrap, Immunology meets infotech and Mice to men: Immunological research vaults into the 21st century
Photo by davidmclaughlin

Global Health, History, HIV/AIDS, Infectious Disease

A doctor’s dilemma: to help or hold back from treating dangerous infections

If, like me, you’ve wondered why a doctor or nurse would decide to volunteer to help patients with often fatal infectious diseases like Ebola, The New York Times Magazine ran an essay today by Stanford physician and author Abraham Verghese, MD, MACP, in which he addresses, among other issues, the tension for clinicians between self-preservation and the impulse to help.

We doctors feel the pull. But each of us has reasons to stay back, reasons that get bigger as we age

He begins with his time treating patients in a hospital in India, detailing his encounters with tuberculosis, malaria, and filariasis among other diseases, but his description of his fear of and his reflections of his encounter with his first rabies patient is poignant:

I felt terribly sorry for this man who was old enough to be my father. Squatting by his mat, I was ashamed of my earlier fear and hesitation. I was glad to spend some time with him. By the next morning he was comatose and convulsing. By nightfall, he’d transcended the mortal world.

He  goes on to discuss his work with HIV patients in the 1980s, and the fear that surrounded the disease at the time. Many physicians donned full protective gear, even though researchers had determined, even in the early days of the epidemic, that the disease wasn’t spread via casual contact. Verghese connects these fears to current fears about Ebola, but doesn’t blame physicians who are cautious. He also documents his own impulses:

I have the urge to sign up, to head to Liberia or Sierra Leone; the call for doctors seems personally addressed to me. When I tell my mother, who is in her 90s, that I am thinking of volunteering in West Africa, she clutches my hand and says: “Oh, no, no, no. Don’t go!” I’m secretly pleased.

….

We doctors feel the pull. But each of us has reasons to stay back, reasons that get bigger as we age: children, partners, parents, grants.

Verghese captures the conundrum facing doctors and nurses who want to help, but who are – for a  variety of reasons – pulled away.

Previously: Ebola: This outbreak is differentStanford physician shares his story of treating Ebola patients in Liberia and Dr. Paul Farmer: We should be saving Ebola patients

History, Medicine and Society, NIH, Public Health

"Don't go to bed with a malaria mosquito:" exploring World War II medical posters

"Don't go to bed with a malaria mosquito:" exploring World War II medical posters

After exploring Stanford’s collection of historical medical images last week after a tour of the School of Medicine, I got hooked. Hooked on historical medical images — a quirky interest tailor-made for the internet. Turns out the National Institutes of Health’s U.S. National Library of Medicine maintains a massive image library, one that includes some fabulous propaganda posters from World War II, including the lady mosquito with the alluring proboscis (above).

Others in the World War II poster collection focus on venereal diseases, recruiting nurses and doctors, encouraging blood donations and even curbing noise or visiting the dentist.

And that’s just World War II posters. Its Flickr collection is tantalizing, kicking off with a series of medical oddities reminiscent of Philadelphia’s Mütter Museum. It’s quite addictive – just warning you.

Previously: A trip down memory lane: Stories from the early days of the School of Medicine, #ACT4NIH seeks stories to spur research investment and Examining the impact of psychological distress on soldiers’ spinal injuries
Images courtesy of U.S National Library of Medicine

Aging, Health and Fitness, History, Neuroscience

Walking and aging: A historical perspective

Walk on by_flickrThe evidence that exercise helps stave off mental decline in elderly people has been mounting for several years now, but an article by Wayne Curtis in The Atlantic today puts this research in perspective by looking back a century at Edward Payson Weston’s walk from San Francisco to New York in 1909, when Weston was 70.

Curtis notes that the field of gerontology, the study of aging, had been around for less than a decade at that point. Most scientists thought brain cells were not capable of regenerating – something we know today that they’re most definitely capable of – and doctors were of the mind that too-vigorous exercise could harm mental acuity. Popular reaction to Weston’s trek is documented through newspaper accounts of the day:

A column in the Dallas Morning News admitted that many considered Weston’s walk from ocean to ocean “foolishness” and “an idle waste of time.” But, the writer asked, was it “preferred to the needless senility into which far too many men begin to drift at the period of three score years and 10?”

Curtis eventually moves into recent decades and details some of the recent research into how moderate to vigorous walking can actually improve mental acuity in several populations, including Alzheimer’s patients:

The results [of one long-term study], published in the journal Neurology, were sweeping and conclusive: Those who walked the most cut in half their risk of developing memory problems. The optimal exercise for cognitive health benefits, the 
researchers concluded, was to walk six to nine miles each week. That’s a mile to a mile and a half a day, without walking on Sundays if you’re inclined to follow Weston’s example of resting on the Sabbath. (This study concluded that walking an additional mile didn’t help all that much.)

I have to admit I’m glad I live in this century and not in Weston’s time. I don’t think I have the fortitude he showed in bucking popular opinion – or, to be honest, in walking.

Previously: Even old brains can stay healthy, says Stanford neurologistExercise and your brain: Stanford research highlighted on NIH Director’s blog and The state of Alzheimer’s research: A conversation with Stanford neurologist Michael Greicius
Photo by  Stefano Corso

Events, History, Medical Education, Medical Schools, Stanford News

A trip down memory lane: Stories from the early days of the School of Medicine

A trip down memory lane: Stories from the early days of the School of Medicine

When Philip Pizzo, MD, came to interview for the position of dean of Stanford’s medical school in 2000 he stayed in a nearby hotel. Taking a cab each day to campus for interviews, Pizzo would ask the driver to take him to the School of Medicine. Not one driver knew where to go, recounted Drew Bourn, PhD, while leading a recent architectural tour of the School of Medicine.

At the time the dean’s office was buried in a courtyard of the Stone Building and hidden from street view. But now the medical school has a face, the stately Li Ka Shing Center for Learning and Knowledge, which will soon have a twin to the east. Within a decade or so, a new, matching building will replace the research building currently beside it.

This was just one of the many stories Bourn shared about the first medical school on the West Coast, which has its roots in Illinois, where physician Elias Samuel Cooper, MD, diced up cadavers of executed criminals to teach surgery.

The Gold Rush brought him west, and soon the Cooper Medical College sprouted up in San Francisco, before aligning with Stanford and moving south to the Farm in the 1950s.

Its first building was the current hospital, known as the Stone Building not for its construction material, but for its architect, Edward Durrell Stone, a famous midcentury architect who designed Radio City Music Hall, among many other national and international works.

Lest I steal all of Bourn’s best bits — including how Stone met an Italian fashion writer on a plane, and before landing convinced her to marry him — I’ll leave it to you to enjoy the experience on your own. Local readers: Bourn offers tours regularly — the next is Nov. 12 at 2 PM — free and open to all. All who want to spend an enjoyable hour learning, that is.

For more fun photos, check out the Stanford History Medical Center’s Flickr collection.

Previously: Stanford building houses one of the world’s largest medical simulation facilities, Stanford’s Clark Center, home to Bio-X, turns 10 and A new era in education at Stanford’s Medical School
Photos from Stanford History Medical Center

 

Clinical Trials, History, Immunology, Infectious Disease, Research

Stanford scientists strive to solve centuries-old puzzle: Why are young children so vulnerable to disease?

Stanford scientists strive to solve centuries-old puzzle: Why are young children so vulnerable to disease?

512px-Gabriël_Metsu_-_The_Sick_Child_-_WGA15091

Several months ago, Stanford immunologist Mark Davis, PhD, went for a stroll in Union Cemetery in Redwood City, Calif. (not far from the Stanford campus). Graves there date from the Civil War-era and Davis, who’s currently immersed in a study of childhood immunity, was intrigued.

“In the early years, you see entire families — mom, dad, and then a whole bunch of children’s headstones,” Davis told me. “It really brought home to me how differently we live now that we just take for granted a kid will survive and grow up.”

Vaccines arrived and childhood survival rates soared. Yet young children remain much more vulnerable to infectious diseases than adults. Why?

Davis and his team think vaccines trigger a set of changes that strengthens children’s immune systems — allowing them to ward off diseases they haven’t even heard of before. That’s why the researchers are conducting a group of studies, all focused on revealing new details about the immune system’s response to the flu vaccine. They need participants, particularly young children who have never received a flu vaccine before. They also need older children and twins. All participants will receive a licensed flu vaccine that will help protect from influenza this coming winter.

Davis and colleagues plan to investigate the children’s development of two types of immune cells — memory T and B cells — that are specialized to recognize certain foreign invaders. Interestingly, adults have T cells that spot diseases they’ve never been exposed to, such as HIV, Davis said. Yet newborns lack these specialized cells, leaving them vulnerable to infection.

“Somewhere between birth and adulthood we see the appearance of these memory T cells without having the particular disease,” Davis said. “It’s a real puzzle.”

Davis suspects that routine vaccines and infections may spur the development in children of a broad spectrum of memory T cells, ones that recognize all sorts of diseases. One study plans to follow children for several years, perhaps revealing how, and when, the children develop a full compliment of these memory T cells, Davis told me.

The studies are possible thanks to the development of new analytical techniques, according to virologist and immunologist Harry Greenberg, MD, who is working with Davis on the influenza studies.

“We’ve been studying influenza for half a century, but these new assays developed in the last five years offer hope we can develop better ways of protecting more people,” Greenberg told me.

More information about the flu vaccine studies and the Stanford-LPCH Vaccine Program is available here or (650) 498-7284.

Becky Bach is a proud graduate of the UC Santa Cruz Science Communication Program (go Banana Slugs!) and a science-writing intern at the Office of Communications and Public Affairs.

Previously: Q&A about enterovirus-D68 with Stanford/Packard infectious disease expert, Gut bacteria may influence effectiveness of flu vaccine and Side effects of childhood vaccines are extremely rare, new study finds
Photo by Gabriel Metsu

History, In the News, Stanford News

Remembering Kenyan statesman and Stanford medical school alumnus Njoroge Mungai

Remembering Kenyan statesman and Stanford medical school alumnus Njoroge Mungai

MungaiOn a visit to Kenya in 2005, I spent an extraordinary afternoon with Njoroge Mungai, MD, one of the country’s elder statesmen and a 1957 graduate of Stanford medical school. It was one of the most memorable experiences of that trip, so it was with bittersweet sentiment that I learned over the weekend that Mungai had passed on at the age of 88.

Mungai was one of the founders of modern Kenya and served the young East African country in many leadership capacities, including ministers of defense, foreign affairs, health and environment and natural resources. He helped establish the nation’s regional health care system, as well as its first medical school, which is based at the University of Nairobi.

I met Mungai on a trip to Kenya with my longtime friend and documentary photographer Karen Ande, in which we were interviewing families and children affected by AIDS. We had just spent several days with orphaned teens who were taking care of young siblings in a gritty slum neighborhood of Nairobi.

We then headed to the outskirts of the capital city to Mungai’s 45-acre estate, where he was growing roses for export. We were greeted in the expansive foyer by a stuffed lion as Mungai, a slim dapper man in a grey suit, arrived from a side door, his cane quietly tapping the floor.

We had expected perhaps an hour of his time for an interview for Stanford Medicine magazine, but it stretched well into the afternoon. After drinks on the patio, he invited us to a sumptuous buffet in a room peppered with photos of him with some of the world’s great leaders of the time.

With the air and caution of a diplomat, he told us stories of his life – from his humble beginnings as the son of a cook to his schooling in South Africa and the United States and his leadership in the revolution that led to the establishment of the Kenyan nation in 1963.

A cousin of the first Kenyan President Jomo Kenyatta, Mungai was particularly proud of his role in helping Kenya maintain a neutral stance while the world powers were creating chaos in neighboring countries in their eagerness to carve out their positions in Africa. He was also proud of his work in bringing the United Nations Environment Program to Kenya, the only country outside the West where the world organization has a presence.

We left him in the fading light of day with four dozen beautiful roses, a gift from a very gracious man.

Photo by Karen Ande

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