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Clinical Trials, In the News, Research, Stanford News, Technology

Lights, camera, action: Stanford cardiologist discusses MyHeart Counts on ABC’s Nightline

Lights, camera, action: Stanford cardiologist discusses MyHeart Counts on ABC's Nightline

GMA shoot - 560

Apple’s new ResearchKit, and Stanford Medicine’s MyHeart Counts iPhone app, were highlighted on ABC’s Nightline on Friday. Michael McConnell, MD, professor of cardiovascular medicine and principal investigator for the MyHeart Counts study, was interviewed, telling business correspondent Rebecca Jarvis around the 4-minute mark that the app will “definitely” change the way his job works. “It gives us a whole new way to do research,” he explained. “Traditionally reaching many people to participate in research studies is quite challenging. The ability to reach people through their phone is one major advance.”

Previously: Build it (an easy way to join research studies) and the volunteers will comeMyHeart Counts app debuts with a splash and Stanford launches iPhone app to study heart health
Photo by Margarita Gallardo

In the News, Pain, Patient Care, Research

More benefit than bite: Potential therapies from “pest” animals

More benefit than bite: Potential therapies from "pest" animals

512px-Scary_scorpionA painful spider bite can make you question why such creatures exist. Yet just because “pests” like spiders, scorpions, and snakes lack the appeal that kittens and puppies possess, it doesn’t mean they aren’t important or useful.

Yesterday, an article from Medical News Today drove this message home by highlighting some of the medical benefits we derive from six of the creatures we tend to complain the most about. As writer Honor Whiteman explains in the story, scientists are exploring ways to use toxins and substances produced by so-called pest animals, such as spiders scorpions, and reptiles, to treat chronic pain, repair nerves, and develop new ways to kill the human immunodeficiency virus.

From the piece:

In 2013, MNT [Medical News Today] reported on a study published in Antiviral Therapy, in which researchers revealed how a toxin found in bee venom – melittin – has the potential to destroy human immunodeficiency virus (HIV).

The investigators, from the Washington University School of Medicine, explained that melittin is able to make holes in the protective, double-layered membrane that surrounds the HIV virus. Delivering high levels of the toxin to the virus via nanoparticles could be an effective way to kill it.

A more recent study published in September 2014 claims bees may also be useful for creating a new class of antibiotics. Researchers from the Lund University in Sweden discovered lactic acid bacteria in fresh honey found in the stomachs of bees that has antimicrobial properties.

The story cites several other potential uses for venoms and animal-derived substances, such as my favorite example, Gila monster spit:

In 2007, a study by researchers from the University of North Carolina at Chapel Hill School of Medicine revealed how exenatide – a synthetic form of a compound found in the saliva of the Gila monster, called exendin-4 – may help people with diabetes control their condition and lose weight.

The compound works by causing the pancreas to produce more insulin when blood sugar is too high. In the study, 46% of patients who were given exenatide in combination with diabetes drug metformin had good control of their blood sugar, compared with only 13% of control participants.

As Whiteman explains in the article, many of these potential medical treatments are still in the early stages of development. Yet some therapies, such as the synthetic version of the compound found in Gila monster saliva, exenatide, are already in use, offering hope that other animal-derived medical treatments may be available in the future.

Previously: Tiny fruit flies as powerful diabetes modelFruit flies headed to the International Space Station to study the effects of weightlessness on the heartBiomedical Indiana Jones travels the world collecting venom for medical research and Tarantula venom peptide shows promise as a drug
Photo by H Dragon

Ethics, Genetics, History, In the News, Medicine and Society, Microbiology, Stanford News

Stanford faculty lend voices to call for “genome editing” guidelines

Stanford faculty lend voices to call for "genome editing" guidelines

baby feetStanford law professor Hank Greely, JD, and biochemist Paul Berg, PhD, are two of 20 scientists who have signed a letter in today’s issue of Science Express discussing the need to develop guidelines to regulate genome editing tools like the recently discovered Crispr/Cas9. Researchers are particularly concerned that the technology could be used to alter human embryos. From the commentary:

The simplicity of the CRISPR-Cas9 system enables any researcher with knowledge of molecular biology to modify genomes, making feasible many experiments that were previously difficult or impossible to conduct. […]

We recommend taking immediate steps toward ensuring that the application of genome engineering technology is performed safely and ethically.

We’ve written a bit here before about the Crispr system, which essentially lets researchers swap one section of DNA for another with high specificity. The potential uses, for both research or therapy, are touted as nearly endless. But, as Greely pointed out in an email to me: “Making babies using genomic engineering right now would be reckless – it would be unknowably risky to the lives of those babies, none of whom consented to the procedure. For me, those safety issues are paramount in human germ line modification, but there are also other issues that have sparked social concern. It would be prudent for science to slow down while society as a whole discusses all the issues – safety and beyond.”

The list of others who signed the commentary reads like a veritable who’s who of biology and bioethics. It includes Caltech’s David Baltimore, PhD; U.C. Berkeley’s Michael Botchan, PhD; Harvard’s George Church, PhD; and George Q. Daley, MD, PhD; University of Wisconsin bioethicist R. Alta Charo, JD; and Crispr/Cas9 developer Jennifer Doudna, PhD. (Another group of scientists published a similar letter in Nature last Friday.)

The call to action echos one in the 1970s in response to the discovery of the DNA snipping ability of restriction endonucleases, which launched the era of DNA cloning. Berg, who shared the 1980 Nobel Prize in Chemistry for this discovery, organized a historic meeting at Asilomar in 1975 known as the International Congress on Recombinant DNA Molecules to discuss concerns and establish guidelines for the use of the powerful enzymes.

Berg was prescient in an article in Nature in 2008 discussing the Asilomar meeting:

That said, there is a lesson in Asilomar for all of science: the best way to respond to concerns created by emerging knowledge or early-stage technologies is for scientists from publicly-funded institutions to find common cause with the wider public about the best way to regulate — as early as possible. Once scientists from corporations begin to dominate the research enterprise, it will simply be too late.

Previously: Policing the editor: Stanford scientists devise way to monitor CRISPR effectiveness and The challenge – and opportunity – of regulating new ideas in science and technology
Photo by gabi manashe

In the News, Patient Care, Research, Videos

Researchers develop bandage that senses bedsores before they appear

Researchers develop bandage that senses bedsores before they appear

Bedsores have been the bane of immobile patients, and their doctors, for decades. In the 19th century, the consequences of these skin lesions were so severe they were said to herald death. Today, doctors and medical processionals are trained to prevent these dying patches of skin, and the serious septic infections associated with them, by ensuring that patients do not sit or lie in the same position for too long, but this method is imperfect.

Now, researchers from the University of California, Berkeley and the University of California, San Francisco have developed a new bandage that senses dying skin cells before they’re visible to the human eye. This bandage could help doctors and medial professionals detect bed sores in their earliest stages when they can easily be healed, according to a press release:

“By the time you see signs of a bedsore on the surface of the skin, it’s usually too late,” said Dr. Michael Harrison, a professor of surgery at UCSF and a co-investigator  of the study. “This bandage could provide an easy early-warning system that would allow intervention before the injury is permanent. If you can detect bedsores early on, the solution is easy. Just take the pressure off.”

As associate professor Michel Maharbiz, PhD, explains in the video above, the cellophane-like bandage works by using a network of electrodes to detect the changes in electrical signals associated with dying cells. “The genius of this device is that it’s looking at the electrical properties of the tissue to assess damage. We currently have no other way to do that in clinical practice,” said Harrison.

Previously: New medicine? A look at advances in wound healingResearchers turn to spider webs to design improved medical tape and The human condition

Complementary Medicine, In the News, Mental Health, Neuroscience, Research

An oasis of peace in “the 500 channel universe”: Research on mindfulness and depression

An oasis of peace in "the 500 channel universe": Research on mindfulness and depression

1135112859_45dc222725_zEarlier this month, the American Psychological Association issued a feature on mindfulness and depression, highlighting research that suggests mindfulness is an effective way to ameliorate and treat mood disorders, particularly recurrent depression. Some of the featured research suggests a strong neurological basis for the association.

Zindel Segal, PhD, a psychologist at the University of Toronto who is quoted in the article and who was on the three-person team that created Mindfulness-Based Cognitive Therapy (MBCT), wonders if all the attention mindfulness is now receiving is part of a backlash against “the 500 channel universe” of distractions in modern society. It’s not a pill that can be taken and done with, though – it’s a restructuring of mental attitude that requires maintenance. Through MBCT, people learn to pay attention to sensations and feelings rather than evaluative thoughts.

The studies in the review suggest that MBCT works at least as well as medication to prevent recurrence, that it is effective for peri-natal depression, and that it may work especially well for people with histories of relapse or depression stemming from childhood. A brief prepared for the Department of Veterans Affairs found that mindfulness approaches were most effective against depression compared to other health conditions.

I found the neuroscience particularly interesting: Part of the reason for MBCT’s effectiveness may be that practicing mindfulness increases connectivity and tissue density in certain areas of the brain. This is a classic example of neuroplasticity – the idea that neurological pathways can adapt and change throughout one’s life.

Norman Farb, PhD, a neuroscientist at the University of Toronto, distinguishes two forms of self-reference that activate different areas of the brain: extended/narrative self-reference, which links experiences across time, and momentary/experiential self-reference, which is centered on the present. Mindfulness exercises emphasize the present, in contrast with destructive narrative patterns of thought common in those suffering from stress, anxiety, and depression. In Farb’s study, fMRI results show that regular mindfulness practice strengthens areas of the brain that focus on the moment. It suggests that although we habitually integrate these two forms of self-reference, they can be neurally dissociated through attentional training.

Neural differences may have effects even when someone is not actively engaging in mindfulness: A study led by Veronique Taylor at the University of Montreal showed that the experienced meditators has less activity in narrative self-referential areas than novice meditators even in a resting state. Another study led by Harvard University neuroscientist Sara Lazar, PhD, showed that over the course of an 8-week mindfulness stress reduction program, the gray matter in participants’ amygdala shrank in density, while density increased in areas related to sustained attention and emotion regulation. The amygdala is implicated in anxiety as well as depression, which correlates with the finding that the participants’ stress levels decreased.

According to the feature, Segal has been impressed with the dramatic rise in popularity of meditation over the past 20 years, which “resonates with people’s desires to find a way of slowing down and returning to an inner psychological reality that is not as easily perturbed,” he says. Perhaps most encouragingly, mindfulness practice has no adverse side-effects or contraindications, so I would expect to see more research into its efficacy, which could be good for all of us in our “500 channel universe.”

Previously: Mindfulness training may ease depression and improve sleep for both caregivers and patients, Using mindfulness-based programs to reduce stress and promote health, Using mindfulness therapies to treat veterans’ PTSD, How mindfulness-based therapies can improve attention and health and Study shows mindfulness may reduce cancer patients’ anxiety and depression.
Photo by ronsho

In the News, Men's Health, Mental Health, Parenting, Pregnancy, Research

Examining how fathers’ postpartum depression affects toddlers

Examining how fathers' postpartum depression affects toddlers

Zoe walking with GilPostpartum depression doesn’t only affect moms, and new research shows that fathers who suffer from it have just as great an effect on their kids as depressed mothers do. As described in a press release from Northwestern University late last week, toddlers who have a depressed parent of either sex can experience emotional turmoil that manifests both internally and externally, through behaviors such as hitting, sadness, anxiety, lying, and jitteriness.

Most previous studies on the consequences of postpartum depression have focused only on women; this study (subscription required), published in Couple and Family Psychology: Research and Practice, is one of the first to examine how toddlers are affected by depression in either parent. It was led by Sheehan Fisher, PhD, professor of psychiatry at Northwestern University’s Feinberg School of Medicine.

As quoted in the release, Fisher states:

Father’s emotions affect their children. New fathers should be screened and treated for postpartum depression, just as we do for mothers… Early intervention is the key. If we can catch parents with depression earlier and treat them, then there won’t be a continuation of symptoms, and, maybe even as importantly, their child won’t be affected by a parent with depression.

Data for the study was collected from nearly 200 couples; questionnaires were administered both in the first few months after their child’s birth, and when their child was three years old. The forms were completed by each partner independently. Parents who reported signs of postpartum depression soon after the birth of their child also showed these signs three years later – the symptoms didn’t self-resolve. The questionnaire also asked about fighting between parents, which, interestingly, did not contribute to children’s emotionally troubled behaviors as much as having a depressed mother or father did.

Fisher stated in the release that depressed parents may smile and make eye contact less than parents who are not depressed, and that such emotional disengagement may make it hard for the child to form close attachments and healthy emotions.

Previous studies have shown that fathers are at a greater risk of depression after the birth of a child than at any other time in a typical male’s life.

Previously: A telephone lifeline for moms with postpartum depression, 2020 Mom Project promotes awareness of perinatal mood disorders, In study, health professionals helped prevent postpartum depressionDads get postpartum depression too and A call for depression screening for pregnant women, moms
Photo by Michelle Brandt

Behavioral Science, In the News, Medicine and Society, Research

Research prize for helping make mice comfy – and improving science

Research prize for helping make mice comfy - and improving science

OLYMPUS DIGITAL CAMERAA Stanford researcher has won accolades for a research paper that could help ease the lives of millions of laboratory mice – and improve the outcomes of research studies.

Joseph Garner, PhD, an associate professor of comparative medicine, and his colleagues observed that mice are routinely housed in cold conditions, which put stress on the animals. The mice compensate with physiologic changes that can skew the results of laboratory studies. For instance, temperature has been shown to affect immune function and tumor development in mice, among other factors. So cold stress in mice raises concerns not only for animal welfare but also for science.

Garner and his colleague, Briana Gaskill, PhD, proposed a simple solution: Give the animals some nesting material, and they’ll build a cozy home to regulate their temperatures. These comfy mice would be more physiologically comparable to humans, making them better research subjects, the researchers said. But one obstacle to adopting this simple solution was the question of how much nesting material is enough? In their prize-winning experiment, the researchers asked the mice how much nesting material they needed to give up a warm cage for a cold cage with a nest. The scientists found that between 6 and 10 grams of nesting material could effectively reduce cold stress in the animals – a standard now starting to be adopted in labs around the world.

The paper, published in 2012 in PLoS One, won a high commendation recently from the National Centre for the Replacement, Refinement & Reduction of Animals in Research, a leading, UK-based scientific organization that supports research which aims to minimize the need for animals in research and improve animal welfare.

The group said that the research results “have the potential to positively impact the welfare of millions of laboratory mice all over the world.”

Garner and Gaskill both traveled to London to receive the prize.

Previously: Stanford students design “enrichments” for lions, giraffe and kinkajou at the San Francisco Zoo, Nesting improves mouse well-being, could aid research studies and Stanford researcher’s easy solution to problem of drug testing in mice
Photo, which originally appeared in Stanford Medicine magazine, by Brianna Gaskill

CDC, Ebola, Global Health, In the News, Infectious Disease

All hands on deck: Doctor answers call to work on largest Ebola epidemic in history

DSCN0895 cropped and resizedIn the nearly 70-year history of the Centers for Disease Control and Prevention (CDC) only three disasters called for an “all hands on deck,” Level 1 emergency response – Hurricane Katrina in 2005, the H1N1 pandemic of 2009 and the Ebola epidemic of 2014. This Ebola epidemic – the largest one in history – was the first assignment for Christopher Hsu, MD, PhD, from the Epidemic Intelligence Services (EIS) officer training program at the CDC.

As an EIS officer in the Division of High-Consequence Pathogens and Pathology at CDC, Hsu investigates and studies deadly and exotic pathogens like chikungunya, monkeypox, rabies and Ebola.

Given Hsu’s work on disease at CDC, I was surprised to learn that the topic of his prestigious three-year fellowship at Stanford was cancer, not infectious disease. I asked Hsu about this and what it’s like working on the largest Ebola epidemic in the world. He summed it up this way: “I get to work with very deadly and interesting diseases. I travel, see new cultures and am immersed in my work. I’m not just studying the disease; I’m in the jungle, studying the disease where it began with the people from that region. It’s a great honor to be in that position.”

Hsu’s switch from studying cancer to investigating infectious disease sounds drastic, but it wasn’t much of a stretch, he explained. Hsu earned a PhD in veterinary pathobiology studying interspecies disease transmission before he began studying cancer at Stanford. “I enjoyed the work, but I also recalled some savvy advice a mentor once said to me, ‘you excel where your passion lies.’ I realized I lacked the fire in the belly.”

DSCN0828 cropped and resized-2When Hsu told his peers and mentors at Stanford he wanted to study infectious disease, Philip Pizzo, MD, former dean of the medical school and a specialist in oncology and infectious diseases, supported his decision. “I am very grateful to him,” Hsu said. “He probably doesn’t realize this, but he was a huge influence on where I am today after Stanford.”

Two years later, Hsu and his cohort of EIS officers, affectionately nicknamed “the Ebola Class,” learned the 2014 Ebola outbreak had just been classified as a Level 1 emergency. CDC Director Tom Frieden, MD, MPH, visited Hsu’s class and personally asked them to take up the call to work on Ebola. Hsu’s cohort was a mix of physicians, nurses, veterinarians, and scientists with specialties ranging from malaria to violence prevention, but after Frieden’s visit, their professional interests no longer mattered. “We decided we were all working on Ebola in some capacity,” Hsu said.

Many of the EIS officers in Hsu’s Ebola class have completed one or two 30 to 90-day deployments to prevent and control Ebola in West African countries with widespread transmission (Guinea, Liberia and Sierra Leone), or in one of the other countries where Ebola occurred in the past. Hsu describes his disease fieldwork as part detective work and part disease control. “I investigated who was sick, what their symptoms were and who had contact with them,” Hsu said.

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In the News, Infectious Disease, Nutrition, Pediatrics

Raw milk still a health hazard, says Stanford doctor

Raw milk still a health hazard, says Stanford doctor

MoooooooIn spite of looser regulations around the sale of unpasteurized milk, it’s still unsafe to drink. That’s the message from Stanford pediatric infectious disease expert Yvonne Maldonado, MD, who is quoted in a new story on Today.com about the relaxation of raw-milk regulations in West Virginia and Maine.

In the United States, each state writes its own rules for in-state sales of raw milk, and they vary — a lot. Until last week, West Virginia required all dairy products sold in the state to be pasteurized, or heated briefly to kill germs. The state’s new laws allow for “cow shares,” in which individuals can pay to share ownership of a cow in exchange for some of the cow’s unpasteurized milk. Maine, meanwhile, is considering relaxing its license regulations on farmers who sell milk directly to consumers. (Other states take different approaches, ranging from entirely banning raw milk sales to allowing it in retail stores.)

Raw-milk aficionados claim that unpasteurized dairy products are safe and have health benefits.

Not so fast, says Maldonado, who was the lead author of the American Academy of Pediatrics’ 2013 policy statement discouraging the consumption of raw milk. In the Today.com story, she explains:

“People want to be more responsible for their sustainable environment and what they are putting into their bodies but they conflate the two issues because natural doesn’t always equal healthy,” says [Maldonado].

… “Our recommendations are evidence-based and there is no scientific evidence that drinking raw milk is better than drinking pasteurized milk and milk products,” says Maldonado, an infectious disease expert and pediatrician at Lucile Packard Children’s Hospital. “But we do see a very large number of diseases and illnesses from raw milk and raw milk products and the infections can be just horrible,” causing diarrhea, fever, cramps, nausea and vomiting, and some may even become systemic.

Previously: Stanford pediatrician and others urge people to shun raw milk products and Stanford study spoils hopes that raw milk can aid those who are lactose-intolerant
Photo by Steven Zolneczko

Health Costs, Health Policy, In the News, Medicine and Society

“From volume to value:” Stanford expert to discuss Medicare reform in free webinar

Big changes are ahead for Medicare, the largest payer in the U.S. health-care system. By 2018, Medicare aims to tie at least half of all payments to the quality or value of care received, not the quantity of services rendered. Many critics of the existing system claim that it incentivizes doctors to do more procedures, which do not in the end improve health.

A panel of experts will discuss changes in how we pay for care, and whether payment reforms can improve quality while lowering costs, in a free public webinar this Thursday at 10 AM Pacific time. Heading the panel is Stanford’s Arnold Milstein, MD, MPH, director of the Clinical Excellence Research Center. That center focuses on new methods of health-care delivery that substantially reduce health spending while improving outcomes.

More details, including the link to register, can be found on the Reporting on Health website. The webinar is free and made possible by the National Institute for Health Care Management Foundation.

Previously: Medicare reforms cut costs and improve patient careExperts discuss high costs of healthcare and what it will take to improve the systemAnalysis: the Supreme Court upholds the health reform act (really) and Views on costs and reform from the “dean of American health economists” and New Stanford center to address inefficient health care delivery

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