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Addiction, In the News, Pain, Public Health

Stanford addiction expert: It’s often a “subtle journey” from prescription-drug use to abuse

Here are some frightening facts you might not know: Drug overdose death rates in the United States have more than tripled since 1990, with the majority of drug-related deaths caused by prescription drugs. And as of 2010, about 18 women in the U.S. die every day of a prescription painkiller overdose. Prescription-drug abuse, which we’ve written about extensively here on Scope, is a very real and pressing issue – and it was the focus of a recent Forum on KQED-FM.

Among the panelists on Friday’s show was Stanford addiction psychiatrist Anna Lembke, MD, who made the important point that most people who end up addicted to prescription painkillers didn’t start out “looking for a buzz” and that most doctors who prescribe the drugs are merely trying to help their patients. As she explained to listeners:

The problem with… prescription opioids is that they actually do work for pain initially… But for most people, after you take them every day for let’s say a month or more, [you] build up tolerance where they stop working so then you need more of the same drug to get the same effect and it escalates on like that. I really think the process is insidious, both for the patients who become addicted and the doctors who prescribe them. It happens in a subtle journey – when all of the sudden [patients are] using them not just for pain but also maybe to relax themselves, to lift their mood, to be able to go out to a party if they’re feeling anxious, and the doctors continue to prescribe them because they started out working, the patients were happy [and] their function improved. The dose is escalating, but they want to keep the patient happy for all kinds of reasons.

The entire conversation is worth a listen.

Previously: Why doctors prescribe opioids to patients they know are abusing them, Patients’ genetics may play a role in determining side effects of commonly prescribed painkillers, Report shows over 60 percent of Americans don’t follow doctors’ orders in taking prescription meds and Study shows prescribing higher doses of pain meds may increase risk of overdose and Prescription drug addiction: How the epidemic is shaking up the policy world

In the News, Public Health, Sleep

A window of time for better sleep

A window of time for better sleep

SleepThe only time I consider myself a “morning person” is when I have jet lag. But I’ve learned that if I’m in bed by 10:30 PM, I can be relatively cordial and not hit the snooze button the next morning.

Based on my own sleep patterns, it didn’t surprise me to read in a recent Time article that the time we go to bed affects the structure and quality of our sleep. As described in the piece, there’s a shift that occurs from non-REM, deep sleep, to the lighter dream-inspired REM sleep, and it happens during the night regardless of what time we go to bed. But going to bed late will deprive us of some of the deep non-REM sleep that replenishes the brain and body. Writer spoke with several sleep experts and reports:

When it comes to bedtime, [Matt Walker, PhD, head of the Sleep and Neuroimaging Lab at the University of California, Berkeley], says there’s a window of a several hours – roughly between 8 PM and 12 AM – during which your brain and body have the opportunity to get all the non-REM and REM shuteye they need to function optimally. And, believe it or not, your genetic makeup dictates whether you’re more comfortable going to bed earlier or later within that rough 8-to-midnight window, says Dr. Allison Siebern, associate director of the Insomnia & Behavioral Sleep Medicine Program at Stanford University.

“For people who are night owls, going to bed very early goes against their physiology,” Siebern explains. The same is true for “morning larks” who try to stay up late. For either type of person- as well as for the vast majority of sleepers who fall somewhere in between – the best bedtime is the hour of the evening when they feel most sleepy.

Siebern goes on to suggest trying out different bedtimes, plus making sure to wake up at roughly the same time every morning. These two factors can help maximize our natural sleep cycles and help prevent us from hitting the snooze button.

Previously: Stanford docs discuss all things sleep, “Sleep drunkenness” more prevalent than previously thought and Mindfulness training may ease depression and improve sleep for both caregivers and patients 
Photo By: FloodG

Behavioral Science, In the News, Research

Does non-conformity fuel creativity?

Does non-conformity fuel creativity?

IMG_8143When you think about it, visionaries and inventors like Steve Jobs and Steve Wozniak became as well-known for bucking the system and creating controversy as they were for Apple computers. And Galileo Galielei, who was pivotal in the development of modern astronomy, spent the last years of his life under house arrest for his divergent scientific views.

Historically, innovation and acceptance have not gone hand in hand. A recent article in Psychology Today looks at three studies that theorize about the idea that social rejection, for people who have an independent self image, may fuel creativity.

From the piece:

Across three studies, Sharon Kim, Lynne Vincent, and Jack Goncalo explicitly rejected participants by telling them they were not selected to be in a group. In another condition, they told participants they would join the group after completing some tasks. After either being rejected or accepted, participants were then given 7 minutes to complete a measure of creativity called the Remote Associations Test (RAT), in which they were asked to find a word that connects three seemingly unrelated words (e.g., fish, mine, and rush; see answer at the end)…

…The results suggest that rejection may not merely be a result of the unconventionality of creative people but that the actual experience of rejection may promote creativity. What’s more, the effects depend on a person’s self-concept. For those who are highly invested in belonging to a group by affirming their feelings of independence, rejection may constrain them. But for those scoring sky high in a need for uniqueness, the negative consequences of rejection on creativity may be mitigated and even reversed.

All of these results suggest that rejection may not merely be a result of the unconventionality of creative people but that the actual experience of rejection may promote creativity. What’s more, the effects depend on a person’s self-concept. For those who are highly invested in belonging to a group by affirming their feelings of independence, rejection may constrain them. But for those scoring sky high in a need for uniqueness, the negative consequences of rejection on creativity may be mitigated and even reversed.

While rejection and isolation aren’t pleasant, and are actually things many of us actively avoid, it seems there could be great benefit in becoming aware of how we respond to these things. Do we let them define us or use them to our advantage to stimulate growth and self-esteem?

Previously: To get your creative juices flowing, start movingMedicine X symposium focuses on how patients, providers and entrepreneurs can ignite innovation and Stanford Medicine X partners with IDEO to create design challenge
Photo By: Lloyd Dangle

Big data, Evolution, Genetics, In the News, Research, Science, Stanford News

Flies, worms and humans – and the modENCODE Project

Flies, worms and humans - and the modENCODE Project

It’s a big day in comparative biology. Researchers around the country, including Stanford geneticist Michael Snyder, PhD, are publishing the results of a massive collaboration meant to suss out the genomic similarities (and differences) among model organisms like the fruit fly and the laboratory roundworm. A package of four papers, which describe how these organisms control how, when and where they express certain genes to generate the cell types necessary for complex life, appears today in Nature.

From our release:

The research is an extension of the ENCODE, or Encyclopedia of DNA Elements, project that was initiated in 2003. As part of the large collaborative project, which was sponsored by the National Human Genome Research Institute, researchers published more than 4 million regulatory elements found within the human genome in 2012. Known as binding sites, these regions of DNA serve as landing pads for proteins and other molecules known as regulatory factors that control when and how genes are used to make proteins.

The new effort, known as modENCODE, brings a similar analysis to key model organisms like the fly and the worm. Snyder is the senior author of two of the papers published today describing some aspects of the modENCODE project, which has led to the publication, or upcoming publication, of more than 20 papers in a variety of journals. The Nature papers, and the modENCODE project, are summarized in a News and Views article in the journal (subscription required to access all papers).

As Snyder said in our release, “We’re trying to understand the basic principles that govern how genes are turned on and off. The worm and the fly have been the premier model organisms in biology for decades, and have provided the foundation for much of what we’ve learned about human biology. If we can learn how the rules of gene expression evolved over time, we can apply that knowledge to better understand human biology and disease.”

The researchers found that, although the broad strokes of gene regulation are shared among species, there are also significant differences. These differences may help explain why humans walk, flies fly and worms slither, for example:

The wealth of data from the modENCODE project will fuel research projects for decades to come, according to Snyder.

“We now have one of the most complete pictures ever generated of the regulatory regions and factors in several genomes,” said Snyder. “This knowledge will be invaluable to researchers in the field.”

Previously: Scientists announce the completion of the ENCODE project, a massive genome encyclopedia

In the News, Public Health, Sleep

Stanford docs discuss all things sleep

Stanford docs discuss all things sleep

“Drowsiness is red alert!” is a phrase coined by Stanford’s William Dement, MD, PhD, who is often referred to as the “Father of Sleep Medicine.” It’s also a phrase he wrote on the wall of KQED’s green room this morning as a guest on Forum. Dement, along with Stanford sleep expert Rafael Pelayo, MD, and UC  Berkeley’s Matthew Walker, PhD, discussed sleep, or lack thereof, in the United States.

KQED ForumDuring the hour-long segment, the panel weighed in on the detrimental effects that poor sleep has on people’s physical and mental health, and took numerous calls from listeners. The experts also emphasized that quality, not just quantity, of sleep is important. “You should wake up feeling refreshed,” Pelayo told listeners. “You don’t leave restaurants feeling hungry, [so] you should not wake up in the morning feeling tired.”

Previously: Stanford researcher examines link between sleep troubles and suicide in older adults, Catching some Zzzs at the Stanford Sleep Medicine Center, Exploring the effect of sleep loss on healthCatching up on sleep science and Thanks, Jerry: Honoring pioneering Stanford sleep research
Related: Sleep legend Dement keeps last class wide awake
Photo by Margarita Gallardo

Behavioral Science, In the News, Sleep, Stanford News

“Sleep drunkenness” more prevalent than previously thought

"Sleep drunkenness" more prevalent than previously thought

sleep_drunkennessA phenomenon known as “sleep drunkenness” may be more prevalent than previously thought, affecting as many as 1 in 7 adults, Stanford researchers report in a new study. That means as many as 36 million Americans experience this potentially problematic sleep condition, in which they are awakened suddenly in a confused state and may be prone to inappropriate behavior, poor decision-making, or even violence.

In interviews with nearly 16,000 adults aged 18 to 102, the researchers found that within the previous year, 15.2 percent had experienced the condition, also known as confusional arousal, with more than half saying they had at least one episode a week.

Stanford psychiatrist and sleep expert Maurice Ohayon, MD, DSc, PhD, said he was surprised at the extent of the problem and particularly the length of time that people reported feeling confused and disoriented following a sudden awakening, whether at night or from a daytime nap.

“I was thinking maybe 30 seconds, a minute or two minutes,” Ohayon told me. “When you ask people, 60 percent said it lasted more than 5 minutes. And one third said it was 15 minutes or more. A lot of things can happen in that time.

“The concern is that people in a job of security, such as engineer, may misjudge the situation because their memory is impaired. Their judgment is not taking into account the environment around them, so they will probably have a bad response. The response will not be adapted to the environment,” said Ohayon, a professor of psychiatry and behavioral sciences and the study’s first author.

He noted that the 1979 Three Mile Island nuclear disaster, the worst nuclear incident in U.S. history, was exacerbated in part by poor decision-making on the part of an engineer who had been awakened suddenly from a nap. He also cautioned that airline pilots, who may nap during a break, may not be efficient for 5 or 10 minutes after being awakened and should take their time before resuming control of an aircraft.

Among those who are most prone to the condition are those with sleep disorders, such as sleep apnea or those who sleep less than 6 hours or more than 9 hours a night, as well as people with certain psychiatric disorders, such as major depression, anxiety and alcohol dependence, the researchers found. Ohayon said he was surprised to discover a strong link between the condition and the use of antidepressants, which likely modify sleep architecture and may contribute to a greater incidence of the condition. Though there is a common perception that people who take sleep medications to help them fall asleep may be confused when they wake up, that was not found to be the case, he said.

More than a third of the people in the study who experienced confusional arousal also said they had hallucinations, and 14.8 percent reported sleep-walking, sometimes accompanied by violent behavior.

“People during confusional arousal can become violent because they are awakened suddenly,” Ohayon said. “They are not happy. They are confused. They may feel aggression toward their partner or the people who have awakened them.”

He said people who experience frequent episodes of confusional arousal should consult with a physician for evaluation and possible treatment. And he urged further study of the problem, which has received little scientific attention.

The study appears in the August 26 issue of the journal Neurology.

Photo by katiecooperx

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

From August 11-25, Scope will be on a limited publishing schedule. During that time, you may also notice a delay in comment moderation. We’ll return to our regular schedule on August 25.

Behavioral Science, Health and Fitness, In the News, Pediatrics, Research

Regular exercise may help young girls struggling with depression

Regular exercise may help young girls struggling with depression

Girls running Scope Blog

Staying physically fit may help keep depression at bay for young girls, a study recently presented at the annual meeting of the American Psychological Association in Washington D.C. showed. On Thursday, the findings were reported in an article in U.S. News & World Report that pointed to a trend between fitness levels and depression in sixth grade girls.

“We don’t know exactly why there is a link [between fitness levels and depression], but it’s probably a number of things,” Camilio Ruggero, PhD, lead researcher and assistant professor at the University of North Texas, said in the article. “It might be better self-esteem, healthier weight or getting more positive reinforcements that go along with being active, and/or it could be more biological. We know certain proteins and hormones associated with less depression respond to increased exercise.”

The article goes on to say that the trend between fitness levels and depression in boys was not as statistically significant. Although the findings could not show a direct link between the two, they do suggest that for middle school children, staying active and being physically fit is an important piece of the puzzle for emotional well-being.

Previously: Using fMRI to understand and potentially prevent depression in girls, Yoga classes may boost high school students’ mental well- being and Lucile Packard Children’s Hospital partners with high schools on student mental health programs
Photo by Sangudo

In the News, Pediatrics, Stanford News, Surgery, Transplants

Parents’ heroic effort help 12-year-old daughter receive a new heart and lungs

Parents' heroic effort help 12-year-old daughter receive a new heart and lungs

Fewer than 10 children received a heart-lung transplant in the United States last year. One of them was 12-year-old Katie Grace Groebner, who was diagnosed with pulmonary hypertension in 2008 and given a year to live.

Determined to save their daughter’s life, Katie Gracie’s parents sold their house in Minnesota and most of their belongings and moved to the Bay Area so she could be treated by Jeffrey Feinstein, MD, director of the Center for Pulmonary Vascular Disease at Lucile Packard Children’s Hospital Stanford.

As reported in the NBC Bay Area segment above, the Groebners understandably call Katie’s doctors and nurses “heroes,” but Feinstein says it’s the other way around. “You want to find a hero? Talk about the parents,” he says in the video. “If you look at the amount of work that I did, compared to amount of work Katie Grace’s parents did? There’s no comparison.”

Previously: Living long term with transplanted organs: One patient’s story, Stanford study in transplant patients could lead to better treatment, Anatomy of a pediatric heart transplant and ‘Genome transplant’ concept helps Stanford scientists predict organ rejection

In the News, Public Health, Research, Science, Stanford News, Technology

NPR highlights Google’s Baseline Study and what it might teach us about human health

NPR highlights Google's Baseline Study and what it might teach us about human health

Late last month, my colleague reported on Stanford partnering with Google [x] and Duke on a research study to better understand the human body. On the most recent edition of NPR’s Science Friday, project collaborator Sanjiv Sam Gambhir, MD, PhD, professor of radiology at Stanford, discussed the project and joined Jason Moore, MD, professor of genetics at Dartmouth College, in a segment called “Will big data answer big questions on health?”

According to Gambhir, what makes the new project unique is the focus on understanding the baseline of healthy human beings. Will it ultimately yield meaningful data about what makes us healthy? Listen here for the researchers’ thoughts.

Previously: Stanford partnering with Google and Duke to better understand the human body

Stanford Medicine Resources: