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Events, In the News, Public Safety, Stanford News

Stanford biomedical community shows support for those affected by police violence

Stanford biomedical community shows support for those affected by police violence

group on ground - 560

Scores of biomedical students, researchers, faculty and staff  staged a “die-in” yesterday to protest excessive police violence against people of color.

Clad in black “BlackLivesMatter” t-shirts, demonstrators lay down on the medical school’s Discovery Walk while listening to Martin Luther King, Jr.’s “I Have a Dream” speech. The demonstration was organized by the Biomedical Association for the Interest of Minority Students (BioAIMS.)

The demonstration also featured two large posters that prompted viewers to complete the statement “I am privileged because…” or “I have a dream…”

Organizers said they were motivated to stage the demonstration because they felt there wasn’t enough conversation about the issue on the Stanford campus.

The Stanford community is comprised of people with a variety of backgrounds, who come from all sorts of communities, organizer and graduate student Jesus Madrid said. “Do we want to forget what it’s like outside?”

The demonstrators pointed out that violence against minorities is very relevant to biomedical researchers and doctors. “People getting killed is absolutely medically relevant,” said graduate student and organizer Tawaun Lucas.

In addition, it takes widespread societal awareness that extends beyond racial groups to promote change, the organizers said.

BioAIMS president Julie Huang said the group was pleased with the turnout, which topped 150 people.

A few voices from the demonstration:

“On a campus like this, we do need to focus on issues that are globally important.”
Sheri Krams, PhD, associate professor of surgery

“I’m new here, and I wanted to inform myself. In Austria, we absolutely have police violence against minorities.”
—Alex Woglar, PhD, postdoctoral research fellow in developmental biology

“It could have been any of us.”
—Tawaun Lucas, graduate student and member of BioAIMS

BioAIMS intends to keep the dialogue ongoing by hosting a series of upcoming events, including “Transitions into Privilege,” a forum scheduled for Thursday, Jan. 22 from 12-1 PM in the fourth floor reading room at the Li Ka Shing Center for Learning and Knowledge.

Previously: Community violence can increase risk of heart disease, What happens when people witness violence and death? and Gun safety addressed by editorials in three JAMA journals
Photo by David Purger

CDC, Chronic Disease, Health Policy, In the News, Infectious Disease, Public Health

To screen or not to screen for hepatitis C

Hep CIn the past few years, newer, more effective treatments have been introduced for hepatitis C – a disease that can lead to chronic liver problems and in the worst cases, liver cancer. In 2012, the Centers for Disease Control and Prevention recommended screening for the disease in anyone born between 1945-1965, since about three-quarters of cases occur in this age group, the Baby Boomers. Last year, the World Health Organization also called for more screening for the disease.

But in a recent analysis piece in The BMJ (formerly the British Medical Journal), several scientists, including Stanford epidemiologist John Ioannidis, MD, DSc, lay out the case that universal screening in this age group may not be warranted. A story in the San Francisco Chronicle today quotes Ioannidis:

“The question is whether these aggressive screening policies are justified and whether they would result in more benefit than harm,” said Dr. John Ioannidis...“We know very little about the potential harms of these drugs, especially in the long-term. And we don’t know how they will translate into long-term benefits.”

Ioannidis and his colleagues suggest that instead of rolling out widespread screening programs, researchers, as soon as possible, start a randomized trial to test the usefulness of screening and who may benefit from it.

On top of the medical uncertainties of the new treatments, they’re expensive, costing about $84,000 for the 12-week treatment. But they’ve been shown to cure patients of their hepatitis C infections at the end of that 12 week stint. Not all people who contract the disease will develop chronic infections, but a majority – two-thirds -will. Twenty percent of those cases will go on to develop severe liver disease.

Advocates of universal screening say that the new screening strategy could identify many people who don’t know they’re sick – symptoms from hepatitis C chronic infections can take years to manifest. But Ioannidis and his colleagues note that many people will get unnecessary treatment and that the long-term uncertainties of the treatment should be taken into consideration.

Previously: Despite steep price tag, use of hepatitis C drug among prisoners could save money overallA primer on hepatitis CFor patients with advanced hepatitis C, benefits of new drugs outweigh costsDrugs offer new hope for hepatitis C and Program examines hepatitis C, the “silent epidemic”
Photo of hepatitis C virus by AJ Cann

In the News, Medical Education

Future MDs and PhDs: Follow your passion – or don’t

Future MDs and PhDs: Follow your passion - or don't

Rock_Climbers_on_High_Neb,_Stanage_Edge_-_geograph.org.uk_-_752673I don’t think I could explain my “passions” with a straight face. The word itself seems so trite – but one that must be pulled out for cover letters and interviews, I thought.

Not to say I don’t get the sentiment. Passion seems like a key ingredient of any worthwhile pursuit – and a word that career counselors, particularly ones who counsel future MDs and PhDs, likely dish out quite liberally.

Yet they shouldn’t necessarily do so, Stephanie Eberle wrote recently in an essay in InsideHigherEd.

Eberle leads the career counseling center at Stanford’s School of Medicine, and anytime someone tells her they want to follow their “passion,” she demands a definition:

While being passionate about something may inspire you to strive longer and harder toward success, it does not mean you will actually be successful. Nor does this mean success will be worth it in the end. Plenty of starving actors, divorced faculty members, and depressed venture capitalists exist, despite their passion.

Likewise, she argues, one can have a perfectly pleasant career with very little passion at all. One woman became a doctor to support her family in India. Or a man who became an accountant to save up for a pleasurable retirement. And a job might wind up sparking a bit of passion sometimes.

Eberle also notes that career development is much more complex than thinking about passion – it’s a “lifelong process, the culmination of myriad decisions about how your interests, skills, and values connect to real-world opportunities.”

She sums up with some sage advice: “We spend about one-third of our lives strutting and fretting at work, hoping for that one, passionate hour upon the stage. For life to signify something, don’t follow your passion. Instead focus on the many hours which make up that life and trust the process ahead.”

Previously: Stanford’s senior associate dean of medical education talks admissions, career paths, Starting a new career in academic medicine? Here’s a bible for the bedside: The Academic Medicine Handbook and Former professional ballet dancers find a thriving second career in science
Photo by Andy Beecroft

In the News, Medical Education, Stanford News, Surgery

Program for residents reflects “massive change” in surgeon mentality

Program for residents reflects "massive change" in surgeon mentality

Black Read, M.D, Cara Liebert, M.D, Micaela Esquivel, M.D, and Julia Park , M.D. all are  Stanford School of Medicine surgery resident taking part in the ropes course on Tuesday, September 9, 2014, as a  team-building exercise on the Li Ka Shing Center lawn on Stanford University campus. ( Norbert von der Groeben/ Stanford School of Medicine )

“The old-school surgeon mentality is that surgery is your life. The very existence of the program is an acknowledgment that a cultural shift is occurring.” Those are the thoughts of Lyen Huang, MD, a fourth-year resident, about Balance in Life, a Stanford Medicine program designed to offer support to its surgical residents. We’ve written about it on Scope before, and the current issue of San Francisco Magazine now also provides a look.

Explaining that surgical residents are “under enormous pressure to learn quickly and produce good patient outcomes—all while working 80-hour weeks on little sleep,” writer Elise Craig outlines Balance in Life’s offerings for residents: a fridge filled with healthy snacks, happy hours and team-building events, mentorships and friendly nudges to go to the dentist or doctor. And, she writes:

If having surgical residents take time away from the operating room for lawn games sounds a little juvenile, consider this: Recent surveys conducted by the American College of Surgeons found that 40 percent of surgeons reported burnout, 30 percent screened positive for depression, and almost half did not want their children to follow in their professional footsteps.

Some snacks and an afternoon ropes course might not sound like much, but [Ralph Greco, MD, the professor of surgery who helped build the program] and his residents argue that the unique program reflects a massive change.

Previously: New surgeons take time out for mental health, Using mindfulness interventions to help reduce physician burnout and A closer look at depression and distress among medical students
Photo, from a Fall 2014 team-building activity, by Norbert von der Groeben

Big data, In the News, Patient Care, Pediatrics, Stanford News

Examining the potential of big data to transform health care

Examining the potential of big data to transform health care

Updated 1-6-15: The piece also aired this week on NPR’s All Things Considered.

***

9-29-14: Back in 2011, rheumatologist Jennifer Frankovich, MD, and colleagues at Lucile Packard Children’s Hospital Stanford used aggregate patient data from electronic medical records in making a difficult and quick decision in the care of a 13-year-old girl with a rare disease.

Today on San Francisco’s KQED, Frankovich discusses the unusual case and the potential of big data to transform the practice of medicine. Stanford systems-medicine chief Atul Butte, MD, PhD, also weighed in on the topic in the segment by saying, “The idea here is [that] the scientific method itself is growing obsolete.” More from the piece:

Big data is more than medical records and environmental data, Butte says. It could (or already does) include the results of every clinical trial that’s ever been done, every lab test, Google search, tweet. The data from your fitBit.

Eventually, the challenge won’t be finding the data, it’ll be figuring out how to organize it all. “I think the computational side of this is, let’s try to connect everything to everything,” Butte says.

Frankovich agrees with Butte, noting that developing systems to accurately interpret genetic, medical or other health metrics is key if such practices are going to become the standard model of care.

Previously: How efforts to mine electronic health records influence clinical care, NIH Director: “Big Data should inspire us”, Chief technology officer of the United States to speak at Big Data in Biomedicine conference and A new view of patient data: Using electronic medical records to guide treatment

Ethics, Health Policy, In the News, Medicine and Society, Research

Watching your spouse die on a TV reality show: De-identification as a myth, in death and life

Watching your spouse die on a TV reality show: De-identification as a myth, in death and life

Much biomedical research relies on the idea of “de-identification.” The Common Rule, the federal regulation on human subjects research, applies, as a general matter, if the researchers make some kind of intervention with the research subject or if they use “identifiable private information” about the research subject. But the “Private information must be individually identifiable (i.e., the identity of the subject is or may readily be ascertained by the investigator or associated with the information) in order for obtaining the information to constitute research involving human subjects.”

De-identification doesn’t mean that no one will recognize the research subjects’ identity. Federal regulation says the researchers must not be able to ascertain it readily.

If the private information was not collected by the researcher (it comes from someone’s medical record or was collected as part of someone else’s research) and the research subject’s identity is not known to and cannot “readily be ascertained” by the researcher, it doesn’t count. No consent is required, no IRB review is required – it isn’t “human subjects research.”

And why should it be? If no one knows it is you, you cannot be hurt, or so the argument goes.

[Last Friday], the New York Times published an extraordinary article entitled “Dying in the E.R., and on TV Without His Family’s Consent” by Charles Ornstein, a reporter for ProPublica. It recounted how Anita Chanko, a 75-year-old widow, watching an ABC reality television show, NYMed, suddenly realized that she was watching her husband’s death in the emergency room. More than a year earlier, the 83-year-old man had been hit by a garbage truck while crossing the street and had died in the NewYork-Presbyterian hospital. The televised version blurred his face, but not the face of the surgeon, the description of the accident, or the sound of her late husband’s voice, asking “Does my wife know I’m here?”

At no time were any of the family told  that Mr. Chanko’s treatment was being filmed or asked their consent to its use on television.

The dead man’s widow and children were traumatized. One of their sons wrote in a complaint “I had to unnecessarily relive my father’s death at your hospital a second time, while knowing that the public at large was able to — and continues to be able to — watch my father’s passing, for the purposes of what can only be described as drive-by voyeuristic ‘entertainment.’ ”

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Genetics, In the News, NIH, Public Health, Research

The genomics revolution and the rise of the “molecular stethoscope”

The genomics revolution and the rise of the “molecular stethoscope”

ATCGBack in 2012, Stanford bioengineer Stephan Quake, PhD, and colleagues sequenced the genome of a fetus using only a maternal blood sample for the first time. Technology Review later recognized the work as one of the “10 Breakthrough Technologies 2013.”

In a recently published opinion piece (subscription required) in the Wall Street Journal, Quake and Eric Topol, MD, a professor of genomics at the Scripps Research Institute, discuss the method and how it exemplifies the potential of the genomics revolution to provide scientists and clinicians with a new type of stethoscope that allows one to see “inside the body at the molecular level.” They write:

The prenatal molecular stethoscope is the first truly widespread clinical application to result from the human-genome project. The National Institutes of Health has an opportunity to build on this new knowledge of “alien” DNA in healthy individuals, and determine whether it may change their clinical course—the molecular-stethoscope approach. Meanwhile, whole genome sequencing of the germ-line, or native, DNA from populations is under way, with seven ongoing world-wide projects, each sequencing the native DNA from 100,000 or more individuals. It’s projected that nearly two million people will be sequenced by 2017.

Already, the scientific literature is brimming with new applications of the molecular stethoscope. Two studies in the New England Journal of Medicine in December showed that more than 10% of healthy people over age 65 carried so-called somatic mutations in their blood cells, and that these individuals had more than a tenfold increased risk of subsequently developing a blood-based cancer.

Previously: Stanford-developed eye implant could work with smartphone to improve glaucoma treatmentsA simple blood test may unearth the earliest signs of heart transplant rejection and Step away from the DNA? Circulating *RNA* in blood gives dynamic information about pregnancy, health
Photo by Stefano

Biomed Bites, In the News, Research, Stem Cells, Technology, Videos

“It gives me the chills just thinking about it”: Stanford researcher on the potential of stem cells

"It gives me the chills just thinking about it": Stanford researcher on the potential of stem cells

Welcome to the last Biomed Bites of 2014. We’ll be continuing this series next year — check each Thursday to meet more of Stanford’s most innovative biomedical researchers. 

If you watch this video and aren’t moved by the passion and conviction of Stanford biologist Margaret Fuller, PhD, then email me. Seriously, I’ll try to talk some sense into you. Because Fuller’s enthusiasm for biomedicine is downright contagious. This is a professor who you want to teach biology.

Fuller, a professor of developmental biology and of genetics, works with adult stem cells, and she’s palpably gleeful about their potential to improve the health of millions.

“I was really struck and inspired by a recent article in the New York Times,” Fuller says in the video above. She’s talking about “Human Muscle Regenerated with Animal Help,” a 2012 piece that told the story of Sgt. Ron Strang, a Marine who lost part of his quadriceps in Afghanistan. Yet here is Strang, walking, thanks to the donation of a extracellular matrix from a pig. This paper-like sheet secreted signals instructing his stem cells to come to the rescue and build new muscle. “It was amazing,” Strang told the Times reporter. “Right off the bat I could do a full stride, I could bend my knee, kick it out a little bit…”

“This is really amazing,” Fuller agrees. “It gives me the chills just thinking about it. This is the kind of knowledge and advances of the basic work that I do… The hope is that understanding those underlying mechanisms will allow people to design small molecules and other strategies that can be used to induce our own adult stem cells to be called into action for repair.”

Learn more about Stanford Medicine’s Biomedical Innovation Initiative and about other faculty leaders who are driving biomedical innovation here.

Previously: Center for Reproductive and Stem Cell Biology receives NIH boost, Why the competition isn’t adult vs. embryonic stem cells and Induced pluripotent stem cell mysteries explored by Stanford researchers

In the News, Patient Care, Pediatrics, Stanford News

Fifty-plus years of Sunshine: Long-time Stanford neonatologist discusses his career

Fifty-plus years of Sunshine: Long-time Stanford neonatologist discusses his career

sunshineWith a name like Dr. Sunshine, parents should know their premature babies are in good hands. On yesterday’s Forum, neonatologist Philip Sunshine, MD, discussed the fifty-plus years he’s been caring for preemies. At 84, he’s still at it, working 30 hours in a step-down nursery at Lucile Packard Children’s Hospital Stanford. (He jokingly told host Michael Krasny, “I do all the stuff the young people don’t want to do.”)

During the hour, Sunshine, a 2015 “Legends of Neonatology” honoree, talked about the changing field of neonatology, including his views on the ever-growing popularity of home births (“Home deliveries are for pizzas only,” he quipped, referencing a pin his former classmate always wore). He also read e-mails and took calls from listeners – many of whom thanked him for saving their children’s lives (30,000 and counting).

Previously: Eightysomething “neonatology superhero” still at itA pioneer of modern-day neonatology and Neonatologist celebrates 50 years of preemie care
Photo courtesy of Lucile Packard Children’s Hospital Stanford

Aging, In the News, Neuroscience, Research, Science, Stanford News

Stanford research showing young blood recharges the brains of old mice among finalists for Science Magazine’s Breakthrough of the Year

Stanford research showing young blood recharges the brains of old mice among finalists for Science Magazine's Breakthrough of the Year

ballot box

Stanford research showing that an infusion of young blood recharges the brains of old mice is one of the finalists for Science magazine’s annual contest for People’s Choice for Breakthrough of the Year. Today is the last day to cast your vote. Click here if you’d like to support the work, which could lead to new therapeutic approaches for treating dementia.

Several months ago, I had the pleasure of helping break the news about this great piece of research. So, let’s face it, I take a certain amount of pride in the amount of news coverage it received and the attention it’s getting now.

But the real credit goes to Stanford neuroscientist Tony Wyss-Coray, PhD, along with his able lead author Saul Villeda, PhD, and colleagues. This important discovery by Wyss-Coray’s team revealed that infusing young mice’s blood plasma into the bloodstream of old mice makes those old mice jump up and do the Macarena – and perform a whole lot better on mousey IQ tests.

Infusing blood plasma is hardly a new technique. As Wyss-Coray told me when I interviewed him for my release:

“This could have been done 20 years ago….You don’t need to know anything about how the brain works. You just give an old mouse young blood and see if the animal is smarter than before. It’s just that nobody did it.”

And after all, isn’t that what breakthroughs are all about? It’s still too early to say, but this simple treatment – or (more likely) drugs based on a better understanding of what factors in blood are responsible for reversing neurological decline –  could someday turn out to have applications for Alzheimer’s disease and much more.

At last count, the Wyss-Coray’s research is neck-and-neck with a competing project for first place. If you think, as I do, that a discovery with this much potential deserves a vote of confidence make sure to take a moment this afternoon to cast your virtual ballot.

Previously: The rechargeable brain: Blood plasma from young mice improves old mice’s memory and learning, Old blood makes young brains act older, and vice versa and Can we reset the aging clock, once cell at a time?
Photo by FutUndBeidl

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