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Addiction, Health Policy, In the News

Stanford addiction expert: “The country needs to spring into action” on heroin epidemic

Stanford addiction expert: "The country needs to spring into action" on heroin epidemic

What’s underlying today’s heroin epidemic and what can be done about it? That was the focus of the opening hour of KQED’s Forum yesterday morning, and Stanford addiction expert Keith Humphreys, PhD, was one of the panelists who weighed in on the issues. He talked about the connection between painkiller addiction and heroin use, the differences between heroin addicts these days versus those in the 1970s, and the use of Naloxone, which can reverse the effects of opioids. Noting that California recently passed a bill that makes this medication available at pharmacies, he said, “I would encourage anyone who is at risk for overdose, or loves someone who is at risk for overdose to get Naloxone.”

Humphreys also referenced the relative lack of resources that goes into studying the heroin epidemic: “We don’t seem to have the will to take this problem on the way we need to… The country really needs to spring into action. We did on AIDS, and we are not doing it here.”

Previously: Heroin: The national epidemic and A focus on addiction, the country’s leading cause of accidental deathIncreasing access to an anti-overdose drug and A reminder that addiction is a chronic disease

In the News, Medicine and Society, Palliative Care, Patient Care

In the wake of passage of new end-of-life law, a call to help those who don’t want to die

In the wake of passage of new end-of-life law, a call to help those who don't want to die

end-of-lifeAs discussed here and elsewhere, the big medical-related news last week was California’s new end-of-life law. After the law was signed, Karl Lorenz, MD, a professor of medicine at the Palo Alto Veterans Medical Center, and two of his Stanford colleagues wrote in the Sacramento Bee about an aspect of end-of-life care they say wasn’t addressed in the debate over the legislation: how to improve the situation for those very sick patients who don’t want assistance dying.

After writing that “most of us want an effective treatment for pain, not a life-ending prescription,” the authors ask:

Will our legislators advocate for better end-of-life care? Will they invest in quality measures and public reporting that help us choose a good and not just a shorter end? Will they fund an electronic registry so that patients’ decisions against life-sustaining treatment are readily available? Will they make transparent the financial incentives for more efficient end-of-life care or support training in palliative care for nurses, social workers and physicians?

Such solutions represent the investment that most of us need to avoid an end that we mostly don’t want…

Previously: Stanford bioethicist weighs in on California’s new end-of-life lawHow would you like to die? Tell your doctor in a letterStudy: Doctors would choose less aggressive end-of-life care for themselvesStanford experts weigh in on spate of “right to try” laws for the terminally illOn a mission to transform end-of-life care and The importance of patient/doctor end-of-life discussions
Photo by Shutterstock

In the News, Medicine and Society, Patient Care

Stanford bioethicist weighs in on California’s new end-of-life law

Stanford bioethicist weighs in on California's new end-of-life law

Earlier this week, California Governor Jerry Brown signed the controversial “End of Life Option Act,” which will take effect in 2016 and allow medically assisted suicide in the state. The news was the topic of KQED’s Forum yesterday, and Stanford bioethicist David Magnus, PhD, was one of the featured guests.

Magnus noted that the law is likely to affect a very small percentage of the population, and he thinks the debate surrounding it “reflects a much, much deeper problem in how we deal with communication and care at end of life. This isn’t really going to solve that problem…” Another show guest, Toni Broaddus, California campaign director of Compassion & Choices, agreed that more conversation between doctors and patients is needed, but said this can help: “We hope that what part of this law does, in addition to providing relief from those who need it at the end of life [is] create the room and the opportunity for doctors to talk with their dying patients about all of the options…”

The entire conversation is worth a listen.

Previously: How would you like to die? Tell your doctor in a letterStudy: Doctors would choose less aggressive end-of-life care for themselvesStanford experts weigh in on spate of “right to try” laws for the terminally illOn a mission to transform end-of-life care and The importance of patient/doctor end-of-life discussions

Genetics, In the News, Mental Health, Neuroscience, Research, Stanford News

Bright Young Mind: Stanford postdoc featured as a top young scientist

Bright Young Mind: Stanford postdoc featured as a top young scientist
100315_nobels_rajasethupathy_resizedYoung researchers don’t always get the accolades they deserve, so I was delighted to see a recent story that’s bucking this trend. This week Science News released its list of “10 scientists who are making their mark,” and Stanford neuroscientist Priya Rajasethupathy, MD, PhD, a postdoctoral research fellow in the lab of Karl Deisseroth, MD, PhD, was featured among them.

Rajasethupathy was nominated for this honor by another group of outstanding scientists: Science News polled 30 Nobel Prize winners to learn which young researchers are doing work that’s worth watching.

Rajasethupathy’s research on how memories are made and stored caught their eye because she’s found that long-term memories may leave lasting marks on DNA. (Her work “has been called groundbreaking, compelling and beautifully executed,” according to the piece.) By studying sea slugs, she and her colleagues have also identified a tiny molecule that may be involved in memory.

Now Rajasethypathy is expanding on this early work and investigating the neural circuits involved in memory recall. To do this, she’s exploring specific genetic mutations to see if they result in abnormal memory behavior. This work may offer insights into neurological disorders, she explains.

Previously: Exploring the role of prion-like proteins in memory disordersNo long-term cognitive effects seen in younger post-menopausal women on hormone therapy and Individuals’ extraordinary talent to never forget could offer insights into memory
Photo by Connie Lee; courtesy of Pryia Rajasethupathy

In the News, Medicine and Society, Nutrition, Parenting, Research, Women's Health

Research elaborates on how moms can protect their daughters’ body image

Research elaborates on how moms can protect their daughters' body image

6945839301_9d61091329_zIt’s been my experience that women struggle with their body image at some point on the way from girlhood to womanhood – this may be brief and exploratory, or get tangled with eating disorders and other destructive behaviors. When I had a period of bulimia in my early 20s, I reflected on (among other things) my mother’s relationship with food and body image, and so some new research from Ben-Gurion University in Israel struck a chord.

Maia Maor, PhD, a sociologist, and Julie Cwikel, PhD, a professor of social work and director of the Center for Women’s Health Studies and Promotion, invited adult mother-daughter pairs to reflect on various strategies the mothers used to instill resilience about body image in their daughters. The researchers identified five methods commonly used to resist or reject negative and oppressive messages about body image:

  1. Filtering: being cautious and sensitive regarding body image issues 
  2. Transmitting awareness of the dangers of eating disorders, which can cause illness and death
  3. Positive reinforcement, using affirmative language in regard to their daughters’ bodies
  4. Discussion: providing tools for criticism of dominant body-related messages
  5. Positivity: shifting the focus of food and body-related discussions away from weight loss and towards health and taking pleasure in food. 

In a press release from last week, Maor explained that “the focus on protective strategies was intended to achieve two goals: to emphasize the positive in mother-daughter relationships and to identify a repertoire of strategies available to parents and allied health professionals who wish to help their daughters or young women build a stable, positive body image.”

Feelings about food and bodies have long chains of intergenerational transmission. According to the release, “some of the mothers in the study recalled how their own mothers’ negative comments to them about eating too much led them to associate food with guilt and bad feelings. They raised their own daughters by instead talking about the quality of food, importance of food choices and its relationship to developing respect for their own bodies.”

The study appears in the journal Feminism & Psychology.

Previously: Incorporating the family in helping teens overcome eating disorders, Stanford study investigates how to prevent moms from passing on their eating disorders, Promoting healthy eating and a positive body image on college campuses, What a teenager wishes her parents knew about eating disorders, and Social website shown to boost teen girls’ body image
Photo by Thanasus Anastasiou

Chronic Disease, Health and Fitness, In the News, Nutrition, Obesity, Stanford News

A conversation about the diabetes epidemic

A conversation about the diabetes epidemic

On this morning’s KQED’s morning radio show, Forum, several doctors including Stanford’s Bryant Lin, MD, discussed how diabetes is affecting the health of millions of people globally.

A recent study in the Journal of the American Medical Association estimated that about half of all adults have diabetes (diagnosed or undiagnosed) or pre-diabetes. Lin and his fellow panelists talked about how changes in our diet and lifestyle have fueled the number of diabetic cases, as well as how genetics can tip the odds against certain patients. Lin mentioned that Asians have a higher rate of diabetes than whites, for example.

Like Lin, I have a family history of diabetes. (Like Lin, I’ve also struggled to maintain my weight). That history has made me keenly interested in staying abreast of recent findings about diabetes – and I surprised to hear that among young people, high rates of liquor consumption is influencing diabetes rates. It’s not just soda intake that we have to watch out for.

Another surprising finding that Lin described was that for pre-diabetics, taking Metformin, a drug that helps control diabetes and blood sugar, can help stave off full-blown diabetes. Eventually, it may become routine to prescribe this medication in certain populations, but Lin said that guidelines haven’t caught up with this aspect of diabetes care.

Other factors at play, Lin noted, include the role of the microbiome in promoting or protecting people from diabetes. And people who undergo bariatric surgery for weight management often find their diabetes is cured, but doctors don’t understand exactly why that’s the case.

Despite the staggering number of people affected, it’s clear that we still don’t understand all the complex factors that influence this disease.

Previously: Faulty fat cells may help explain how Type 2 diabetes beginsThe role of nutrition in diabetes prevention and managementThe importance of regular exercise in delaying and treating diabetes and Examining the role of exercise in managing and preventing diabetes

Ethics, Global Health, Health Policy, In the News, Medicine and Society, Public Health

Thinking about “culture” as part of global well-being

Thinking about "culture" as part of global well-being

5294003888_300b57c958_zEffective and ethical global-health initiatives involve some acknowledgement of culture – that is, they take into account local practices, beliefs, and circumstances, and they recognize that medicine is not “one size fits all.” A recent post on the blog Anthropological Observations takes this one step further, asserting that “culture” should be seen as something that is always changing, rather than a static fact to be accounted for. As a medical and cultural anthropologist pursuing a PhD, I couldn’t agree more.

Culture is often seen as a barrier to health by global-health professionals, as in “it’s not part of the local culture to visit clinics” or “cultural beliefs about how medication works make patients non-adherent to drug regimens: they take pills when they experience symptoms instead of at regular intervals.” Such observations are useful and can help adapt health initiatives to specific locales. However, this attitude can also be paternalistic and limiting because it doesn’t give people credit for being able to adapt to new information or situations.

The post’s author, Ted Fischer, PhD, a professor of anthropology at Vanderbilt University who has been advising the WHO’s project on the cultural contexts of health, writes:

A human-centered approach to health and wellbeing should adopt contemporary understandings of culture as dynamicfuture oriented, and driven by agency. We in anthropology now see culture as much more of a fluid process, a process rather than a thing. Cultural actors are always improvising, actively creating meaning out of the resources at hand.

He concludes that it is more accurate is to see culture as an opportunity for health, instead of an obstacle to it.

Previously: Exploring the benefits of pursuing anthropology and medicine, What other cultures can teach us about managing postpartum sleep deprivation, Exhibit on health and medicine among indigenous cultures opens at US National Library of Medicine and It’s a small world after all: Global health field takes off in the US
Photo by Onasil Bill Badzo

In the News, Media, Medical Education, Medicine and Society, Science

Wikipedia calls for more scientists to participate

Wikipedia calls for more scientists to participate

3204073130_417b9dc56a_z Wikipedia’s volunteer editors hosted the first Wikipedia Science Conference in London last week to urge scientists to participate in editing the massive online encyclopedia. Scientists often view Wikipedia as a “Wild West” because anyone can edit the pages, reports a piece in Nature, but in reality Wikipedia is a community of “ultra-pedants” obsessed by getting the facts right.

Martin Poulter, PhD, the main convener of the conference, is quoted as saying that many posts are already high quality, but professional academics, scientists, and publishers could improve the information in their field of expertise. He refers to a “cultural barrier” that includes a disinclination to participate in the “admittedly petty discussions” that sometimes crop up around Wikipedia edits. Alex Bateman, PhD, another organizer quoted in the article, adds that Wikipedia articles are written organically, sentence by sentence, which is very different than the research paper process. “There have to be changes from both sides. That’s what we’re discussing,” says Poulter.

One proposed project is to improve the Wikipedia biographies of famous scientists, starting with the fellows at The Royal Society, Britain’s pre-eminent scientific institution. The Society has agreed to take on a “Wikipedian in residence” to spearhead these efforts, which are aimed at reassuring scientists about the quality of Wikipedia articles. Another successful partnership is with the European Bioinformatics Institute, which maintains databases on protein and RNA families that have benefitted greatly from Wikipedia contributions. Wikipedia also maintains a page listing articles that need expert scientific attention.

But the benefits go both ways, says Poulter, who thinks academia can benefit from engaging with Wikipedia’s transparent process of knowledge curation. “Wikipedia is an opportunity to recapture some of the academic ethos that has been weakened by the commercial sector,” he is quoted as saying. “If you’re working in the open, you release all your data, your drafts and everything, and you invite comments from the start, rather than only after a process which is hidden away from the public.”

Previously: Science for popular audiences is not just “adding to the noise”Anthropologist discusses Wikipedia’s implications for health information, Is medical information on Wikipedia a public health problem?, How a “culture of permission” prevents doctors from being active in social media and ScienceRoll: What happens when pharma companies edit Wikipedia?
Photo by Johann Dréo

Genetics, In the News, Pregnancy, Research, Science, Women's Health

Maternal-fetal “chimera” cells: What do they actually do?

Maternal-fetal "chimera" cells: What do they actually do?

1292733380_3e6815a6d1_zAfter a woman is pregnant, fetal cells linger in her body long after her baby is brought out into the world. They cross the placenta and congregate in her thyroid, breasts, brain, scars… and elsewhere. The phenomenon is called “fetal microchimerism,” a reference to the hybrid monster of Greek mythology that strikes me as both whimsical and menacing.

But what do these cells do? An entertaining and informative National Geographic blog post highlights a recent review study published in BioEssays that seeks to answer this question. The evidence we have so far is contradictory and messy, not yielding much in the way of patterns: Sometimes cells collect more in diseased tissues, other times in healthy ones. But when viewed through an evolutionary lens, things start to make sense, argue the paper’s authors. These cells allow a baby to inadvertently influence her mother’s body in her own interest, which is sometimes – but not always – in the mother’s interest, too.

Writer Ed Yong explains:

Some of those changes, like faster healing, benefit the mother too. Others may not. For example, foetal cells could stimulate the breast to make more milk, either by releasing certain chemical signals or by transforming into glandular cells themselves. That’s good for the baby but perhaps not for the mother, given that milk takes a lot of energy to make—mothers literally dissolve their own bodies to create it. And if the foetal cells start dividing too rapidly in the breast, they might increase the risk of cancer.

Similarly, the thyroid gland produces hormones that control body temperature. If foetal cells integrate there and start dividing, they could ramp up a mother’s body heat, to a degree that benefits her baby but also drains valuable energy. And again, if they divide uncontrollably, they might increase the risk of cancer. Indeed, thyroid cancer is one of the only types that’s more common in women than men, but is not a reproductive organ like the ovaries or breasts.

Such influences would have developed gradually over hundreds of millions of years in a subtle evolutionary contest between mother and fetus – it is in the mother’s interest for the fetus to do well, but not to monopolize all her resources, so it’s not unlikely that mothers evolved counter-measures. The paper authors don’t have any conclusions yet, but their point is that within this evolutionary framework, it makes sense that fetal cells both help and harm the mother.

Previous research on microchimerism has only asked about such cells’ presence, not their function. The paper’s authors hope to organize a workshop to test some of the hypotheses they proposed, which means gathering microchimeric fetal cells and sequencing their genes, then working out which of the mother’s genes they are activating and whether these correlate with any traits like milk production or temperature. The possibilities for further research are immense:

And then, there’s the matter of cells that travel in the other direction—from the mother to the foetus. What do they do in their new homes? These paths can get even more complicated. It’s possible that the cells from one foetus can travel into its mother, hide out, and then into a sibling during a later pregnancy. “At one point, we started trying to draw family trees, and trying to work out where all the microchimerc cells could be going,” says [co-author Athena Aktipis, PhD]. “It got really messy.”

Previously: How a child’s cells may affect a mother’s long term health
Related: The yin-yang factor
Photo by Simone Tagliaferri

Aging, In the News, Infectious Disease, Public Health, Research

Does the flu vaccine really help the elderly?

EM_of_influenza_virusMost years, senior citizens are among the groups hit hardest by flu, which is why doctors recommend all people over 65 get vaccinated. But accurately measuring how well the vaccine does at preventing severe disease and deaths isn’t as straightforward as it is in younger populations.

A lot of factors complicate getting accurate information on the number of flu cases among older adults and the vaccine’s role at preventing them, and some have argued that current estimates of the flu vaccine’s effectiveness are overblown because they don’t account for such factors. For example, sometimes patients are left unvaccinated because they are already medically frail and struggling with a lot of other health issues. So simply counting the number of deaths among unvaccinated patients versus vaccinated patients might not paint an accurate picture.

Last month, a study led by Vincent Mor, PhD, of Brown University, looked a little closer at the vaccine to assess its effectiveness. The research team analyzed 10 years of Medicare claims for nursing home residents, taking advantage of a built-in variation.

Because the flu virus changes over time, the vaccine has to be updated every year to fight against the strains that are circulating that year. Some years, the vaccine matches what’s circulating better than other years. (Last year, in the 2014-2015 season, the vaccine strain didn’t match the flu viruses infecting people very well.)

If the vaccine isn’t effective in elderly patients, then we shouldn’t see any difference in flu cases from year to year. But Mor and his colleagues found that the better the vaccine strain matched the circulating viruses, the better the vaccine was at protecting elderly nursing home residents. They argue that this indicates that the vaccine protects people living in nursing homes from serious outcomes associated with influenza infection.

This isn’t an approach we can take with other types of vaccines. It’s only possible because the flu vaccine changes from year to year. “What we’ve used is the randomness of the match,” Mor said in a statement. “Ours is the first study to, we think, come up with an unbiased approach.”

Though this study probably won’t settle the controversy about how well the vaccine works in older people, it does offer a different way to look at the question. A variety of other novel approaches are probably what it will take to get a handle on this hard-to-understand aspect of influenza.

Previously: Science Friday-style podcast explains work toward a universal flu vaccine, Study: Pregnancy causes surprising changes in how the immune system responds to the flu and Gut bacteria may influence effectiveness of flu vaccine
Photo by Cynthia Goldsmith

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