In the News

Much has been written about the tragic events in Boston on Monday, but I have to draw attention to a New Yorker piece detailing how the doctors and nurses at area hospitals leapt into action to treat victims’ war-like injuries. Atul Gawande, MD, describes what happened at the hospitals that afternoon, and his take on why people there worked with such “grim efficiency”- and why, in turn, so many victims survived – is compelling:

…Something more significant occurred than professionals merely adhering to smart policies and procedures. What we saw unfold was the cultural legacy of the September 11th attacks and all that has followed in the decade-plus since. We are not innocents anymore.

The traumatic events at yesterday’s Boston Marathon have many of us bracing ourselves for what might be coming next. And, as explained in a Healthland piece, this feeling of being on high alert is a result of how our brain processes traumatic experiences.

As writer Maia Szalavitz explains, “when the brain is under severe threat, it immediately changes the way it processes information, and starts to prioritize rapid responses.” While this behavior is important to our survival, it can be be harmful to our health if it persists after the threat has passed. So what can we do to help each other heal from the tragedy and reduce the risk of those most affected from developing post-traumatic stress disorder (PTSD)? Szalavitz writes:

Fortunately, our brains are designed to modulate fear responses and at least 80% of people exposed to a severe traumatic event will not develop PTSD. Studies show that the more support, altruism and connection people share, the lower the risk for the disorder and the easier the recovery. Because such interactions aren’t always easy in the immediate aftermath of a harrowing experience, Hollander is investigating whether medications based on oxytocin— a hormone linked with love and parent/child bonding— might help to ease this connection.

If fear short circuits the brain’s normally logical and reasoned thinking, social support may be important in rerouting those networks back to their normal state. Which is why the selflessness and altruism we see in the wake of terror attacks is often the key to helping us to process and overcome the shock of living through them.

Szalavitz’s message of using compassion to combat fear was echoed in this TED blog post, which encourages people to “look for the helpers” as we process what happened yesterday, and in Mashable’s list of touching acts of kindness at the marathon.

Previously: Can social media improve the mental health of disaster survivors?, Grieving on Facebook: A personal story and 9/11: Grieving in the age of social media
Photo by Alex E. Proimos

Chronic sleep problems affect an estimated 70 million Americans, according to the latest data from the Centers for Disease Control and Prevention. Among those who have trouble sleeping soundly is KQED reporter Scott Shafer, so he recently spent the night at the Stanford Sleep Medicine Center to better understand what was keeping him from resting easy.

Shafer describes his experience staying overnight at the clinic and analyzing his sleep results with Stanford’s Rafael Pelayo, MD, in a new segment on the California Report. In describing what it’s like to snooze at a sleep clinic, he says:

It was time to get ready for bed, no small thing at the Sleep Medicine Center. I went to my room — called simply Sleep 18. Technician Robert Tognoli hooked me up with 28 wires in all — attached to my legs, my head, my abdomen – all of it designed to sense and measure my breathing, eye motions, blood oxygen, snoring, leg and chest movements.

Tognoli told me the wires would monitor the phases of my sleep, when I dreamed and if there were any “interruptions to my sleep architecture,” as shown by my brain waves. Then he stuck all the wires into a box that he hung around my neck. Next, he turned on a machine that blew air to dry the glue holding the wires attached to my head. Finally, I was ready to hit the sack. How did I sleep, and what story did all those wires tell?

Listen to the full segment to find out what Shafer learned from spending a night at the clinic and why it can be tricky to accurately evaluate one’s quality of sleep without having a lot of data.

Previously: Stanford center launches Huffington Post blog on the “very mysterious process” of sleep, Study: Parents may not be as sleep-deprived as they think, Exploring the effect of sleep loss on health and How lack of sleep affects the brain and may increase appetite, weight gain
Photo in featured entry box by Juan Antonio Flores Segal

I’m ashamed to admit that the study of statistics was regarded (at least by me) as a necessary evil when I was in graduate school. I vaguely remember one course that attempted to teach a lecture hall of sleepy, stressed-out students how to calculate p values, the differences between retrospective, prospective and case-control studies, and the nuances between sensitivity and specificity. And don’t even get me started on odds ratios. Can you tell I’m still a bit fuzzy? In fact, I keep a reference guide at my desk for help (which I have to consult embarrassingly often).

Statistics might be dull, but there’s no denying its importance in scientific research – and the fallout when scientists fail to appreciate its power. Now, Stanford researcher John Ioannidis, MD, DSci, (of the “Why most published research findings are false” fame) has joined forces with Marcus Munafo, PhD, and others at the University of Bristol to publish a new study in in Nature Reviews Neuroscience (subscription required) delineating the statistical flaws in many published neuroscience studies. Essentially, the researchers found that, although many scientists realize that an under-powered study (for example, one with too few study subjects to adequately capture the phenomena being investigated) is less likely to find statistically significant results, they don’t necessary realize the converse: that any statistically significant finding from such a study is less likely to represent a true effect.

Stellar science blogger Ed Yong explains the sobering implications in an excellent post today:

Statistical power refers to the odds that a study will find an effect—say, whether antipsychotic drugs affect schizophrenia symptoms, or whether impulsivity is linked to addiction—assuming those effects exist. Most scientists regard a power of 80 percent as adequate—that gives you a 4 in 5 chance of finding an effect if there’s one to be found. But the studies that Munafo’s team examined tended to be so small that they had an average (median) power of just 21 percent. At that level, if you ran the same experiment five times, you’d only find an effect on one of those. The other four tries would be wasted.

But if studies are generally underpowered, there are more worrying connotations beyond missed opportunities. It means that when scientists do claim to have found effects—that is, if experiments seem to “work”—the results are less likely to be real. And it means that if the results are actually real, they’re probably bigger than they should be. As the team writes, this so-called “winner’s curse” means that “a ‘lucky’ scientist who makes the discovery in a small study is cursed by finding an inflated effect.”

I encourage you to read all of Ed’s post, which includes multiple comments from Ioannidis, Munafo and other researchers uninvolved in the study. It’s a fascinating analysis of why many studies are designed as they are, and it discusses some of the obstacles that must be overcome to improve their fidelity. And don’t overlook the comment stream, which is currently hosting a rich discussion among scientists in the field.

Previously: NIH funding mechanism “totally broken” says Stanford researcher, Research shows small studies may overestimate the effects of many medical interventions and Animal studies: necessary but often flawed, says Stanford’s Ioannidis
Photo by futureshape

A recent blog entry on the Huffington Post focuses on an issue I haven’t seen much written about: the role of caregivers in the clinical-trial process. Noting that the caregiver “is the closest and most constant observer of the patient,” writer Tory Zellick outlines how caregivers can help study investigators by, for example, reporting any side-effects or changes experienced by their loved one during the trial. She also offers a few suggestions, courtesy of the National Alliance for Caregiving, on how trial leaders can better partner with caregivers:

• Speak not only in patient-centered language, but also caregiver-centered language. For example, when discussing protocol, ask the caregiver whether she is able and/or willing to perform certain duties.

• Support the caregiver in figuring out the most effective and realistic way to comply with protocol requirements.

• Explain the medical jargon used throughout the clinical trial. The caregiver needs to understand what the researcher is saying, so as to effectively communicate this information to the patient.

• Guide the caregiver on being an effective observer– explicitly stating what to look out for, how to identify it and how to respond to it.

• Prepare the caregiver and patient for the emotional aspect of ending treatment, at the conclusion of a clinical trial.

Previously: Advice for caregivers and patients about clinical trials and Clinical trials: My next good chance

New findings analyzing Internet search data for major mental illnesses shows that seasonal weather changes may have a larger impact on such health conditions than previously believed.

In the study (.pdf), researchers used Google’s public database of queries to identify and monitor users’ searches for mental-health disorders, including anxiety, eating disorders, schizophrenia, ADHD, bipolar and obsessive compulsive disorder (OCD), in the United States and Australia from 2006 through 2010. According to a release:

The research showed eating disorder searches were down 37 percent in summers versus winters in the U.S., and 42 percent in summers in Australia. Schizophrenia searches decreased 37 percent during U.S. summers and by 36 percent in Australia.

Bipolar searches were down 16 percent during U.S. summers and 17 percent during Australian summers; ADHD searches decreased by 28 percent in the U.S. and 31 percent in Australia during summertime. OCD searches were down 18 percent and 15 percent, and bipolar searches decreased by 18 percent and 16 percent, in the U.S. and Australia respectively.

Searches for suicide declined 24 and 29 percent during U.S. and Australian summers and anxiety searches had the smallest seasonal change – down 7 percent during U.S. summers and 15 percent during Australian summers.

While some conditions, such as seasonal affective disorder, are known to be associated with seasonal weather patterns, the connections between seasons and a number of major disorders were surprising. “We didn’t expect to find similar winter peaks and summer troughs for queries involving every specific mental illness or problem we studied, however, the results consistently showed seasonal effects across all conditions – even after adjusting for media trends,” said James Niels Rosenquist, MD, PhD, a psychiatrist at Massachusetts General Hospital.

The work appears in the latest issue of American Journal of Preventive Medicine.

Previously: Sweating the small stuff may harm your mental health and Ask Stanford Med: David Spiegel answers your questions on holiday stress and depression
Via The Atlantic
Photo by Tom Hilton

Adam de la Zerda, PhD, likes to tell his students that the sky’s the limit – something he most likely told himself many times over. At just 28 years old, he already has a pretty impressive laundry list of accomplishments: He’s co-founder of a Silicon Valley startup, he was recently listed in Forbes magazine’s “30 under 30″ in science and health care, and he has garnered numerous other awards, including ones from the Damon Runyon Cancer Research Foundation and the National Institutes of Health.

A story in today’s Inside Stanford Medicine profiles the young Stanford faculty member and a technology he developed called photoacoustic molecular imaging, which allows researchers to see cancerous tumors hiding under tissues. As writer Elizabeth Devitt explains, the imaging technique holds promise for cancer detection and other diseases:

The unique advantage of photoacoustic molecular imaging is that it allows scientists to see tumors hiding under other tissues and structures. It can also outline tumor boundaries during surgery, which helps surgeons see what to cut out and what to leave in — avoiding mistakes either way. “It’s like having Superman vision,” said de la Zerda.

“There may be a million different things we can do with this,” he added. “We can study basic tumor biology. We can monitor the treatment of cancer patients. We can even apply this technique to diseases other than cancer.”

Previously: Stanford structural biologist named one of Forbes Magazine’s 30 under 30 rising stars
Photo by Norbert von der Groeben

In case you haven’t yet seen it, the front page of today’s New York Times features a piece on the world of “pseudo-academia,” where less-than-reputable journals and conferences “masquerade”  as highly competitive ones and stand to fool both scientists and consumers. Gina Kolata writes:

Steven Goodman, a dean and professor of medicine at Stanford and the editor of the journal Clinical Trials, which has its own imitators, called this phenomenon “the dark side of open access,” the movement to make scholarly publications freely available.

The number of these journals and conferences has exploded in recent years as scientific publishing has shifted from a traditional business model for professional societies and organizations built almost entirely on subscription revenues to open access, which relies on authors or their backers to pay for the publication of papers online, where anyone can read them.

…

But some researchers are now raising the alarm about what they see as the proliferation of online journals that will print seemingly anything for a fee. They warn that nonexperts doing online research will have trouble distinguishing credible research from junk. “Most people don’t know the journal universe,” Dr. Goodman said. “They will not know from a journal’s title if it is for real or not.”

Previously: Defending researchers who publish studies behind a paywall and Researchers shouldn’t hide their work behind a paywall, argues scientist

I admit to a certain sense of mounting dread about the news of the new H7N9 influenza virus arising in China. And the never-ending supply of Tweets (alarmist and otherwise) are not helping one little bit. That’s why I appreciated this article posted today by Wired reporter and author Maryn McKenna (she’s sometimes referred to as Scary Disease Girl, due to her focus on global health and infectious diseases).

McKenna breaks the current news down into a quick primer, based on her past experiences reporting on that ‘other bird flu’ H5 N1 (remember that one?) ten years ago. She follows with a caution to beware– or at least to be aware– of the sources of news of this quickly moving story, and an explanation of some peculiarities in Chinese media that may hamper or distort reporting. She also draws a parallel between what’s happening now with H7N9 and H5N1– pointing out that the latter never erupted in humans as it was first feared. Says McKenna:

And H7N9 might not, as well. It is far too soon to say, despite the rapidly escalating case count and the reports — which came in while I was writing this — of a possible animal reservoir in pigeons and a possible human-to-human case. I have been writing about flu and possible pandemics since 1997 — for what it’s worth, I wrote the first story in the US in 1997 about that first H5N1 case in Hong Kong — and so at this early point, what I most want to say is this: We all love scary diseases. (If you didn’t, you wouldn’t be reading this blog.) But there is a fog of war in disease emergencies, just as there is in military ones, and it is very easy to get lost in it.

It will take a while for this story to become more clear. Anticipating that, I want to suggest some things to think about as you follow the news.

She ends with this great advice:

[...] Don’t assume that everyone who is loading information onto their blogs or pushing it onto Twitter is doing it in a sharing spirit of helpfulness. There are people — you can see this already — who are opportunistically using this to feed their egos, angle for jobs, or generally to stir up trouble. More than ever, it’s important to be skeptical about the sources of the information you consume.

McKenna makes it easier for us to practice what she preaches by listing several reputable news sources–traditional, web-based and, even on, Twitter– that should be reliable sources of information. You can follow McKenna on Twitter at @marynmck.

Previously: “Superbug” author discusses dangers, history and treatment of MRSA and Image of the week: What H5N1 looks like

Your “breathprint,” the chemical composition of each exhale, may hold potential as a new medical diagnostic tool, according to research recently published in PLOS ONE.

In the small study, Swiss researchers used a technique known as mass spectrometry to analyze the molecules in participants’ breath samples. As reported in the New Scientist:

The team was interested in metabolites, compounds produced by the body’s metabolism. The molecules are volatile and small enough to pass from the blood into airways via the alveoli in our lungs, so are present in our breath – albeit in miniscule amounts, sometimes less than one molecule per billion molecules of air.

The team found that metabolites in individuals’ breath remained “constant and clear”, says Swiss Federal Institute of Technology professor [Renato Zenobi, PhD].

…

Zenobi’s team can identify compounds in breath immediately, so our breathprint could be used to detect signature metabolites associated with disease, giving an instant diagnosis. In a preliminary study, Zenobi has shown that breath samples can reveal whether people have chronic obstructive pulmonary disease.

While more research is needed to understand how breathprints might be used in a clinical setting, the research is noteworthy in light of the growing body of scientific showing a variety of unique biological identifiers, including microscopic ecosystems that exist in the human body, could offer insights into our personal health.

Photo by Sean Friend