In the News

Here’s something to reflect on this Valentine’s Day. A recent study shows that Americans’ deep-seated regrets most often involve personal relationship mishaps, not missed career opportunities.

In the study (subscription required), researchers surveyed 500 U.S. adults about their biggest disappointments in life and then analyzed their remorse to identify what parts of their lives were most directly impacted. Healthland reports:

Study participants were asked to describe regrets that they considered both strong and weak, along with the situation that surrounded the regret. Analysis revealed that regrets involving love — think ending a relationship or cheating — rankle more than those related to less intimate choices such as dropping out of college or quitting a job. The study, published online last week in the journal Social Psychological and Personality Science, reported that love regrets outnumbered work regrets by more than 2 to 1 — 56% to 20% — in some of the comparisons. The more intense a regret, the more likely it was to be connected to personal relationships.

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What that means in general is that being bad at keeping in touch with old friends or forgetting to buy Valentine’s chocolates for your sweetie has the potential to make you feel worse — much worse — than making a mistake at work. “As you are thinking about how to feel good about your life, the thing you will feel most strongly about is protecting and strengthening your personal relationships,” says [Neal Roese, PhD, a marketing professor at the Kellogg School of Management at Northwestern University].

Previously: How social ties can influence our health, happiness
Photo by Chris Sloan

Shortly after New Year’s Day, NPR science reporter Richard Harris lost his voice. After research and consultation with (and I’m guessing on this point) an otolaryngologist, he discovered he was suffering from unilateral vocal fold paralysis. He writes on Shots:

The disruptive cases, like mine, are often caused by a surgeon who accidentally nicks the nerve that controls the left vocal cord. That nerve actually travels down into the chest, so it’s potentially in harm’s way during heart surgeries. That kind of medical boo-boo is known in the trade as “iatrogenic,” which I guess is what the ancient Greek physician Hippocrates would have said when he meant “oops.”

I hadn’t had chest surgery over winter break, and a CT scan revealed no obvious cause. So doctors call my kind of case “idiopathic.”

Thankfully, Harris received a treatment that restored his voice. He recounts the whole story on Shots and even includes “before and after” voice samples in the entry. It’s fascinating and well worth reading.

Here’s to a speedy recovery, Richard.

As much as I would love to lose 20 pounds in six weeks, you won’t find me signing up for of one of the latest weight-loss fads called the “HCG diet.” The Human Chorionic Gonadotropin diet is one that requires that you inject yourself daily with a hormone produced by pregnant women (a product that is only licensed for fertility treatment, not weight loss) and that you restrict yourself to eating only 500 calories a day. Neither thing is appealing to me.

Experts have concerns about – and are skeptical of – the potentially dangerous diet, as well. As John Morton, MD, director of bariatric surgery and surgical quality at Stanford Hospital & Clinics, told viewers in a recent KTUV-TV report:

“I would say the mind is a very powerful thing. And I would say there’s a big placebo effect occurring here.”

For more on HCG, FDA has information on its website.

Doctors and health-care professionals are increasingly talking to patients about how physical activity can benefit their health and recommending that they regularly exercise. That’s according to a new report from the National Center for Health Statistics at the Centers for Disease Control and Prevention.

The report examined trends in the prevalence of U.S. adults receiving advice to exercise among those who had seen a health professional in the past 12 months. WebMD reports:

In 2010, 1 in 3 adults who saw a doctor or other health care professional was advised to increase their physical activity as a means of maintaining or improving their health. That’s a significant increase over 2000, when less than a quarter of consultations included such advice.

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It’s an important development, the report indicates, because patients listen to their doctors. According to a 2008 study, overweight patients were nearly five times more likely to exercise if their doctors counseled them to do so. They were even more likely to keep active if their doctor followed up with them after the initial prescription.

Other key findings include:

• Among adults aged 85 and over, the percentage receiving advice to exercise nearly doubled between 2000 (15.3%) and 2010 (28.9%)
• Receiving advice to exercise increased for adults with hypertension, cardiovascular disease, cancer, and diabetes
• Adults who were overweight or obese had the largest percentage point increases over the decade 2000–2010 in being advised to exercise
• At each time point, women were more likely than men to have been advised to exercise.

Previously: Study shows benefits of exercise for patients with chronic health conditions, How physical activity influences health, Stanford cardiologist discusses the importance of exercise and nutrition for heart health and Researchers find link between fitness and cognition
Photo by JERVIS_PICS

Today, President Obama welcomed more than 100 students from across the country for the second annual White House Science Fair, an opportunity that gave the students a chance to show off their research projects. Angela Zhang, a local high school senior who took the top prize at the Siemens Competition in Math, Science and Technology back in December, was among the participants. Zhang, who was mentored by Stanford radiologist Zhen Cheng, PhD, won a $100,000 scholarship for what one scientist called “a Swiss army knife for cancer treatment” — a multifunctional nanoparticle that combines treatment and imaging in a single unit. In the video above, she describes her work to CBS News.

Previously: I know what you did this summer: High-school interns share their experiences at Stanford, Stanford med school’s training programs in full swing, Stanford summer research intern named finalist in national science competition, A look at the Stanford Medical Youth Science Program and A prescription for improving science education

After a lifelong battle with eczema, I went gluten-free about a year ago on the suggestion of a nutritionist – and my skin condition immediately cleared up. So I was interested to read a Wall Street Journal article on gluten and a panel of experts’ work to develop a new classification system for gluten-related disorders. Melinda Beck writes:

The proposal defines a spectrum of illnesses based on the kind of immune defenses people mount to gluten, from wheat allergies to autoimmune responses, such as celiac disease, in which the body mistakenly attacks its own tissue.

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The experts also propose a third category for “gluten sensitivity,” in which patients report the same symptoms as celiac disease but test negative for telltale antibodies. Some doctors have dismissed such complaints as imaginary, or fueled by the boom in gluten-free foods.

“Confusion about gluten sensitivity has been rampant,” says Alessio Fasano, director of the University of Maryland’s Center for Celiac Research and a co-author of the proposal, published this week in the journal BMC Medicine. “That prompted a few of us to say, ‘Let’s put some facts on the table to assess what’s known and what’s not known.’”

As noted in the article, the American Gastroenterological Association has stated that research on how many people suffer from gluten sensitivity, and to what degree, is needed before official guidelines can be devised.

Previously: Stanford study shows lack of criteria for diagnosing food allergies, Experts debate the “squishy science” of food allergies and Jennifer Schneider Chafen discusses food allergy research on Science Friday
Photo by Robyn Lee

A story today in the San Jose Mercury News examines the challenges faced by young hospice and palliative care physicians, many of whom are in their early to mid-30s, in treating patients that are typically 30 years their senior.

In the piece, April Dembosky explains the driving forces behind the specialty’s generational gap, programs such as Stanford’s Hospice and Palliative Medicine Fellowship that are helping medical students and recent graduates gain the necessary skills to more effectively communicate and treat patients, and the approaches that some young doctors take to overcome the age differences. She writes:

About 12 percent of the doctors certified in hospice and palliative care in 2010 are now 36 or younger, according to the latest data available from the American Board of Medical Specialties. That percentage doubled in two years and is expected to dramatically grow under new rules that prevent older doctors from being grandfathered into the specialty. Starting this year, doctors must complete a one-year training fellowship in palliative medicine, a position that offers a meager salary that few mid-career doctors will opt for.

Stanford’s fellowship program is one of about 70 similar programs formed in recent years, and among the first launched.

As much as they gain medical skills and knowledge, trainees say they learn how to handle themselves with patients, either by assuming the role of a grandchild or just being humble.

“Sometimes it is scary to know you are much younger than your patient,” said Domingo Maynes, 30, a resident with the program. “But by putting myself in their shoes and talking to the family, I can start to wrap my hands around the intangibles.”

Previously: Documentary film captures story of Korean War veteran turned health-care advocate

The first page was startling. A Catholic nun dies giving birth to conjoined twins. And so begins the epic journey of Abraham Verghese’s sweeping novel, Cutting for Stone.

The Stanford professor of medicine spent eight years writing the novel which begins in Ethiopia during the waning days of Emperor Haile Selassie’s regime and ends, climactically, in a gritty urban hospital in New York City.

The critics have swooned. More than a million copies have been sold, and this week Cutting for Stone celebrates its 104th week on The New York Times’ best seller list.

Good novels entertain you. Great novel transport you. I personally have to thank Abraham for giving me a reprieve from the economic malestrom of 2009. I started reading Cutting for Stone during the height of the downturn and it transported me elsewhere. It allowed me to escape the dreary financial angst of obsessing over the fate of my 401K.

The author, a friend, is one of the most unassuming people you could meet. Far from a braggadocio. He teaches medical students here at Stanford about a vanishing art: the hands-on bedside exam. He’s trying to remind students that there’s a human being in the bed behind the razzle-dazzle technology of today’s medicine.

I recently asked Abraham if he ever imagined the novel would be so successful?  He said:

The most honest answer is yes. I imagined it, tried to visualize it – in fact I had a poster made up for me eight years ago with a mock cover and it said, “60 weeks on the NYTimes list” among other things. And before I sat down to write, I would look at that cover and remind myself that I was aiming to write a big book.  That I had big ambitions for the tale I wanted to tell. Now that is a far cry from knowing it would actually happen.

When I asked him how it felt to be on the Times list for so long, he told me:

I feel humbled by what has happened with the book and the way book clubs in particular have picked it up. Dorothy Allison, the great American writer, says that “fiction is the great lie that tells the truth about how the world lives.” I think there is some universal truth, some note that I hit with this story that resonates for a lot of people. It’s just a wonderful thing.

So what’s next?

I am taking my time, thinking of another story I might work on. I am not in a hurry. I love my day job and it serves as the inspiration for whatever comes next.

Previously: How Abraham Verghese writes, Hands on: Abraham Verghese teaches bedside skills, Abraham Verghese at Work: A New York Times profile, How a battle with Napoleon helped Abraham Verghese write his novel and Physicians turn to books to better understand patients, selves

For your Friday afternoon enjoyment, Wired Science ran an interesting slide show yesterday showing their picks for the 16 best science visualizations of 2011. This video is one of the visualizations, taken from the game “Powers of Minus Ten,” that allows:

…players to zoom into a person’s hand, explore the world at different magnifications and learn about the human body (in the screenshot above, a cellular-level magnification shows dividing cells).

So, if you’re up for some pretty pictures, I recommend heading over to Wired Science and taking a look.

Insufficient insurance payments, administrative hassles tied to insurance claims and rising business and malpractice insurance expenses are among the most commonly cited contributing factors to the shortage of rural doctors in America.

Despite the challenges, a hospital in Kansas has had success getting medical professionals to come to its small town by adopting an innovative recruiting approach. As Shots reports, the hospital appeals to people who want to handle “problems most commonly found in third-world countries:”

…[Hospital CEO Benjamin Anderson] offers potential candidates eight weeks off to do missionary work overseas. Because he’s found that a doctor who is willing to sleep on a cot in the Amazon or treat earthquake victims in Haiti is ready to serve in rural Kansas. He calls it mission-focused medicine.

“When you recruit a mission-focused provider, they want to see the ghettos,” he says. “They want to know that there’s no Spanish-speaking provider in more than a one-hour drive. They want to see houses that are falling down, widows that are uncared for. They want to know that there’s need and that by them coming there, they would fill a disparity that would otherwise not be filled. So we reversed it.”

It worked. Last July, Dr. Dan Shuman and his family moved here from the Austin, Texas, area. The difference between here and all the other needy areas was his ability to continue his missionary work in Haiti and Mexico during his eight weeks off. But Shuman says Ashland’s own challenges were equally attractive.

Previously: Medical schools create programs to address physician shortage in rural United States, Newspaper series examines rural health-care challenges and Nun discusses health care in rural America

We wrote yesterday about a UC San Francisco paper calling for the regulation of sugar. So what does Stanford nutrition consultant Jo Ann Hattner, RD, think about villianizing the sweet stuff? Her thoughts were included in today’s San Francisco Chronicle:

…Not all scientists agree that sugar should shoulder the entire burden for the chronic diseases afflicting modern Americans.

The inability of a congressional “super committee” to deliver a budget proposal has endangered the U.S. medical research enterprise and the potential discovery of future treatments, warns School of Medicine Dean Philip Pizzo, MD, in a commentary published in today’s San Jose Mercury News.

In the piece, Pizzo discusses how the committee’s inaction is forcing lawmakers to make considerable cuts to domestic programs, including research sponsored by the National Institutes of Health, and how reducing this investment will likely slow advancements in medical research that ultimately improve Americans’ health. He writes:

Consider the evidence: The death rates for heart disease and stroke have fallen by 60 percent and 70 percent, respectively, since World War II. Over the past 15 years, the incidence of cancer is down by 11.4 percent among women and 19.2 percent among men because of better detection methods and more effective treatments. Today, individuals diagnosed in their 20s with HIV — once considered a death sentence — may receive antiretroviral therapy and live to age 70 or beyond. These and other advances in our health have been built on basic scientific research — work that may not have had a clear application when it was conducted but which opened the way to a better understanding of human biology. This knowledge then was translated into new tools or devices to diagnose, treat and prevent disease.

For instance, today’s lifesaving treatments for HIV were built upon advances in a basic understanding of how the immune system works. I witnessed this personally when I began my own work in pediatric AIDS, which would not have been possible without the basic science discoveries about retroviruses that took place more than a decade before HIV was even known. Similarly, at Stanford, work aimed at understanding how immune cells recognize antibodies ultimately led to a groundbreaking treatment for non-Hodgkin’s lymphoma, as well as other debilitating conditions.

As Pizzo goes on to say, the improvements to human health are only part of the equation. Medical innovation and discovery are also vital to jobs and economic recovery.

Previously: The economic benefits of publicly funded medical research, Report: NIH investments created $68 billion in economic activity last year, Academic medical centers bring billions to the economy and New initiatives show how federal stimulus dollars advance scientific and medical research

In second grade I got influenza and was bedridden for a week. On the advice of Mrs. Pils, our school librarian, my mom brought home a book for me to read: “Turi of the Magic Fingers,” a coming-of-age-cavekid tale that left me forever curious about our evolutionary past.

It turns out that the chain of matings that led up to us is multi-branched, as this story in today’s New York Times explains. Rather than a smooth chronological descent from a point-source somewhere in Africa, our DNA has been cobbled together from not only northward-bound Cro Magnon migrants but also at least two sets of folks they encountered, and apparently vanquished, on the way: Neanderthals in Europe, and Denisovans in Siberia.

And a lucky thing, too. Work by Stanford immunologist Peter Parham, PhD, reprised in the Times article, suggests that immunologically relevant snippets of DNA of Neanderthal and Denisovan origin that we mongrelized moderns retain to this day have proven instrumental in protecting us from diseases to which Cro Magnons hadn’t been previously exposed.

From the Times piece:

The value of the interbreeding shows up in the immune system, Dr. Parham’s analysis suggests. The Neanderthals and Denisovans had lived in Europe and Asia for many thousands of years before modern humans showed up and had developed ways to fight the diseases there… When modern humans mated with them, they got an injection of helpful genetic immune material, so useful that it remains in the genome today. This suggests that modern humans needed the archaic DNA to survive.

Nobody’s saying it was love – no doubt more of a club-carrying-caveboy-meets-cowering-conquered-cavegirl thing – but the resulting hybrid vigor has perhaps been the saving grace of today’s human race.

Previously: Humans owe important disease-fighting genes to trysts with cavemen and Humans share history – and a fair amount of genetic material – with Neanderthals
Photo by kevin dooley

Can a sophisticated imaging technique be used to determine whether someone is lying? That’s the intriguing question explored in a Scienceline piece yesterday. And for those interested in more on the issue, Stanford’s Hank Greely, JD, an expert on neuroscience and the law, discussed fMRI technology and the ethical questions surrounding its use in an in-depth 2010 NPR interview.

Previously: Functional magnetic resonance imaging could serve as lie-detector test in civil trial

The challenges facing pediatric surgeons was the focus of a recent segment on KQED-FM’s QUEST. During the show, Sanjeev Dutta, MD, described such challenges as “plumbing problems:”

Dutta is a pediatric surgeon at Lucile Packard Children’s Hospital, in Palo Alto, where he operates on children with these and other problems. He says often, the instruments he uses when he does these surgeries weren’t built for tiny babies. They were made for adults.

“We struggle with instruments that were never designed for the type of patient we are working on, and we adapt.”

Dutta says the issue here isn’t safety. Most of these surgeries are, by now, pretty routine. But pediatric surgeons have to improvise in ways other surgeons don’t.

The segment also highlighted how pediatric surgeons, including Dutta, are collaborating with engineers from SRI International to create tools more appropriately sized for tiny patients.