Published by
Stanford Medicine

Category

In the News

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

In the News, Medical Education, Medical Schools, Stanford News

Rethinking the traditional four-year medical curriculum

Rethinking the traditional four-year medical curriculum

In an effort to meet the needs of medical students, physicians and patients, a number of universities are considering ways to shorten the traditional four-year medical curriculum without compromising quality of care. The New York Times reports that “a recent, unpublished survey of 120 medical schools, conducted by the New York University School of Medicine, found that 30 percent were considering or already planning to start three-year programs” and notes that the American Medical Association is among those advocating for such innovative approaches. Denise Grady writes:

More than a dozen medical schools already have programs to move students more quickly from the classroom to the clinic, but by shortening premedical studies rather than medical school. Among them are Albany Medical College, Northeast Ohio Medical University and the medical schools at Boston University, Drexel, George Washington, Howard, Jefferson, Meharry and Northwestern. Gifted high school seniors or early college students are guaranteed admission to medical school if they perform well during freshman year of college. Combined bachelors/M.D. programs have been around for half a century, but these students complete both degrees in six or seven years instead of the usual eight.

“I absolutely think it’s doable,” said Dr. Charles G. Prober, senior associate dean for medical education at Stanford School of Medicine, which is considering such a program. Well-designed programs to accelerate doctors’ training “don’t send them out prematurely, but send them out with adequate tools, recognizing that they will grow,” said Dr. Prober, who writes and speaks extensively on medical education reform. “Real learning begins when you are actually beginning to take care of patients, doing what you were trained to do.”

While research is scant, a few studies show promising results. Comparisons of graduates of three-year programs at the University of Calgary and McMaster University to graduates of four-year Canadian medical schools found “equivalent performance.” And a small study at Marshall University in the 1990s, which for almost a decade incorporated fourth-year requirements with the first year of residency in family practice, declared it a success for “carefully selected candidates.”

Indeed, educators make clear that not all students can handle the accelerated curriculum. Dr. Prober notes that with the explosion of medical information, students more than ever must learn to work smart, figuring out what they need to memorize and how to find out the rest. Part of the education process today is learning to collaborate and tap the expertise of others.

Previously: A closer look at using the “flipped classroom” model at the School of Medicine, Combining online learning and the Socratic method to reinvent medical school courses, Rethinking the “sage on stage” model in medical education and Stanford professors propose re-imagining medical education with “lecture-less” classes

Addiction, In the News, Public Health, Public Safety

Can the “24/7 sobriety” model reduce drunken disorderly conduct and violence in London?

beer_london_pubIn an article published yesterday in the Telegraph, Stanford addiction expert Keith Humphreys, PhD, discusses how public officials in London are turning to the United States’ “24/7 sobriety” model in an effort to reduce repeat offenders convicted of alcohol-related crimes. The program, which combines mandatory sobriety and daily breathalyser tests, was created under Humphreys’ guidance. He writes:

Research by the RAND Corporation – a US-based non-profit global policy think tank – found that 24/7 sobriety dropped repeat drink driving arrests by 12 per cent. The same study also yielded a pleasant surprise: domestic violence arrests dropped by 9 per cent, despite not being a focus of the programme. Removing alcohol from the lives of criminals can apparently have radiating benefits beyond those directly related to their most recent offence.

In light of its positive results, judges across the U.S. have been adopting the 24/7 sobriety approach. This week, under the leadership of Mayor Johnson and his team, a pilot of the programme will be launched in South London. Leaping the pond will come with some challenges, particularly around delivering sanctions swiftly within the constraints of British law, but local tailoring of innovations is always an essential part of making them spread.

In any event, with over one million alcohol-related assaults occurring nationally each year and many London boroughs being regularly marred by violence and disorder on weekend evenings, the time for new approaches to binge drinking criminal offenders has clearly arrived. The judges and probation officers who are undertaking this pilot should be applauded for refusing to accept the status quo.

Previously: Text messages after ER visit could reduce young adults’ binge drinking by more than 50 percent, Study shows legal drinking age of 21 saves lives and reduces health risks for young adults, Alcoholism: Not just a man’s problem and Stopping criminal men from drinking reduces domestic violence
Photo by Paul Downey

Cancer, Health Costs, In the News, Stanford News, Videos

TV spot features a more humane approach to late-stage cancer care

Updated 8-4-14: The video is no longer posted on the Al Jazzera website, but the online story is still available.

***

7-30-14: Is it possible to cut the costs of late-stage cancer care by 30 percent and provide a much better experience for patients?

That’s the question that recently brought an Al Jazzera America TV news crew out to the VA Palo Alto Health Care System, to interview patients enrolled in a new Stanford-designed pilot study on cancer care. You can watch their 9-minute video on this topic here.

The guiding principle behind this cancer-care program is this: Make sure that patients are fully informed about survival odds and treatment side effects well before they’re on the brink of death, when emotions overwhelm the decision-making skills of patients, their families and clinicians.

“Eighty percent of all cancer patients express a desire to die at home, yet only 10 percent do,” says Manali Patel, MD, the VA hospital oncologist running this study. “These end-of-life conversations, which typically take two hours in the beginning and require many follow-on conversations, are too hard, time-consuming and draining for a busy oncologist to do well.”

For these life-and-death discussions, patients are assigned personal care coaches who help them understand the big picture — treatment side effects, survival odds and pain-relief options. They also have access to a 24-hour symptom-management hotline and an option for in-home chemotherapy.

Architects of this new cancer care model, working with Arnold Milstein, MD, at Stanford’s Clinical Excellence Research Center, estimate that this program will lead to fewer unwanted treatments and expensive emergency room visits, saving the overall heath-care system money, while at the same time improving patient quality of life.

Previously: Communicating with terminally ill patients: A physician’s perspective, Identifying disparities in palliative care among cancer and non-cancer patients, Uncommon hero: A young oncologist fights for more humane cancer care, The money crunch: Stanford Medicine magazine’s new special report and New Stanford center to address inefficient health care

Cancer, Dermatology, In the News, Public Safety, Research, Stanford News

A closer look at new research showing disproportionate rates of melanoma in Marin County

Last week, Cancer Prevention Institute of California/Stanford Cancer Institute researcher Christine Clarke, PhD, shared results of a new report (.pdf) showing that a county in California has higher numbers of melanoma skin cancer than the rest of the state. On this morning’s Forum Clarke joined two other guests, including Stanford dermatologist Susan Swetter, MD, director of the Pigmented Lesion and Melanoma Program at the Stanford Cancer Institute, to discuss the research and to offer skin safety and screening tips for the summer.

It’s worth a listen – especially if you live in the county just north of San Francisco.

Previously: Melanoma rates exceed rates of lung cancer in some areasWorking to protect athletes from sun dangers, As summer heats up take steps to protect your skin, Stanford study: Young men more likely to succumb to melanoma, New research shows aspirin may cut melanoma risk and Working to prevent melanoma

In the News, Nutrition, Research

How much caffeine is really in one cup of coffee?

How much caffeine is really in one cup of coffee?

coffee_beansPrevious research has shown that regularly drinking coffee could offer a number of health benefits, including reducing prostate cancer risk, improving symptoms related to Parkinson’s disease, staving off the development of Alzheimer’s, decreasing diabetes risk and providing antioxidants.

But too much caffeine can make you jittery, disrupt your sleep and, potentially, shorten your life span. So it’s often recommended that you drink coffee in moderation, which is defined as two or three eight-ounce cups of brewed or drip coffee.

The problem with recommending a certain number of cups, reports Scientific American, is that new research shows the caffeine and caffeoylquinic acid (CQA) content can vary greatly depending on the type and preparation of the coffee. From the piece:

Results showed that the caffeine-to-CQA ratio in espressos ranged from 0.7–11, depending on the preparation conditions. With serving volumes from 13–104ml, it’s no wonder that Crozier says ‘cup of coffee is an exceedingly variable unit. To estimate health benefits using cups may be very difficult,’ – and inadvisable in epidemiological studies.

But what are CQAs? Beans contain various (poly)phenols, including 3-, 4- and 5-O-caffeoylquinic acids, the main phenolic compounds in coffee. Epidemiological studies have suggested the link between the lower risk of type 2 diabetes, cardiovascular diseases, and endometrial and hepatocellular cancer in habitual coffee consumers might be due to the presence of CQAs in coffee. They sound like super-compounds, but that’s a big ‘might’, and research continues.

Whilst the biological effects of CQAs are uncertain, one thing we do know about them is they are more sensitive to roasting than caffeine. The bean or blend also affects the caffeine-to-CQA ratio. Arabica and Robusta are the most common bean types and the latter contains twice as much caffeine as the former.

The article highlights the need to better inform consumers about the actual amount of caffeine in coffee and the need for more research on the health benefits of coffee.

Previously: How the body’s natural defenses help protect cells from toxins in everyday foods and flavorings, What is coffee?, For new moms, coffee scores a point: Caffeine doesn’t seem to interfere with baby’s sleep in study and Does coffee lower the risk of prostate cancer?
Photo by Nina Matthews

In the News, Mental Health, Research

How are flight attendants affected by plane disasters?

How are flight attendants affected by plane disasters?

airplaneA few nights after the recent plane crash in Ukraine, I ran into an acquaintance who was heading to Europe later in the week. “It feels weird to fly,” she told me, comparing it to how she felt about boarding a plane for the first time after the 9/11 attacks 13 years ago. I could relate: During my first post-9/11 flight, I was jittery and uneasy the entire way from San Francisco to Minneapolis. (It didn’t help that I was flying alone, in the darkened cabin of a red-eye.)

If plane crashes and tragedies like the one in Ukraine can leave passengers feeling unsettled (or worse), how might they affect people who take to the skies on an almost daily basis? In a piece on The Atlantic yesterday, writer Rebecca Rosen reported on the work of Jeffrey M. Lating, PhD, a professor of psychology at Loyola University Maryland who has studied this issue. Rosen writes:

For flight attendants who worked at American Airlines on 9/11, the rates [of PTSD] were… just over 18 percent. This number is so high, Lating says, it is comparable to the rates seen among people living south of Canal Street in Manhattan, the neighborhoods closest to Ground Zero.

Lating and his colleagues found no statistical difference in probable PTSD rates between West Coast flight attendants and East Coasters, who were much more likely to have known the flight attendants killed on 9/11. For flight attendants, it seems that the trauma they experience following a crash comes not only from the loss and tragedy itself, but also from a deep sense of vulnerability. A follow-up study in 2006 found similarly high rates of probable PTSD at another airline, further suggesting that “it didn’t matter what airline you worked for,” says Lating. “The virulent factor in this was, ‘I wonder if I could possibly be next.’ ”

Those fears can make just doing one’s job as a flight attendant incredibly challenging. Many suffering from PTSD try to avoid sights and triggers that recall the initial trauma. But for flight attendants, those reminders are unavoidable, part of the work itself. To have to work through that anxiety, all the while servicing others and maintaining a sense of calm on a flight— “you could imagine how uncomfortable that would be,” Lating say

Previously: 9/11: Grieving in the age of social media and What 9/11 has taught us about PTSD
Photo by epsos.de

Stanford Medicine Resources: