Published by
Stanford Medicine

Category

In the News

Events, Global Health, Health Policy, In the News, Infectious Disease, Public Health

Interdisciplinary campus panel to examine Ebola outbreak from all angles

Interdisciplinary campus panel to examine Ebola outbreak from all angles

Ebola_091914

Scientists have estimated that the West Africa Ebola epidemic will take another 12-18 months to control and will infect hundreds of thousands of more people during that time. In an opinion piece published last week in the Los Angeles Times, Michele Barry, MD, director of Stanford’s Center for Innovation in Global Health, discussed how the outbreak got so out of control and explains why the “world needs a new approach to solving massive international health crises and preventing future ones.”

Tomorrow on the Stanford campus, Barry will participate in an interdisciplinary forum focusing on the health, governance, security and ethical dimensions of the epidemic. Additional speakers include Doug Owens, MD, a general internist and director of the Center for Health Policy/Primary Care Outcomes Research; microbiologist David Relman, MD, a fellow at the Center for International Security and Cooperation; Stephen Stedman, deputy director at the Center on Democracy, Development and the Rule of Law; and Paul Wise, MD, MPH, a child health specialist and core faculty member of the Center for Health Policy/Primary Care Outcomes Research. Drawing on their diverse backgrounds, the panelists will offer unique perspectives from their respective fields on the latest developments in addressing the outbreak.

The event will be held at 4 PM local time at the Bechtel Conference Center in Encina Hall and is free and open to the public. Conference organizers will also be live tweeting the panel; you can follow the coverage on the @FSIStanford Twitter feed, or by using the hashtag #EbolaForum.

Previously: Expert panel discusses challenges of controlling Ebola in West AfricaShould we worry? Stanford’s global health chief weighs in on Ebola, Biosecurity experts discuss Ebola and related public health concerns and policy implications and Stanford global health chief launches campaign to help contain Ebola outbreak in Liberia
Photo by European Commission DG ECHO

Health Costs, Health Policy, In the News, NIH, Public Health, Science Policy

Research investment needed now, say top scientists

Top scientists made the case for continued investment in basic science and engineering earlier this week by unveiling a new report, “Restoring the Foundation: The Vital Role of Research in Preserving the American Dream” by the American Academy of Arts and Sciences.

Here’s why this is important: Federal investment is needed to power innovation engines like Stanford’s School of Medicine, and if that money gets funneled to roads, the military, Medicare, or any of a variety of other uses, fewer jobs, and fewer discoveries, could result. From the report:

Unless basic research becomes a higher government priority than it has been in recent decades, the potential for fundamental scientific breakthroughs and future technological advances will be severely constrained.

Compounding this problem, few mechanisms currently exist at the federal level to enable policy-makers and the research community to set long-term priorities in science and engi­neering research, bring about necessary reforms of policies that impede progress, or facilitate stronger cooperation among the many funders and performers of research…

Stanford President John Hennessy, PhD; biochemist Peter S. Kim, PhD; and physicist (and former U.S. Secretary of Energy) Steven Chu, PhD, are among the scientific rock-stars who co-authored the report.

For an excellent piece on the political debate surrounding the report’s release, check out the coverage in Science here. NPR also recently aired a series that colorfully illustrates the effects of research cutbacks, including a piece on a patient suffering from ALS, and a profile of several underemployed scientists.

Becky Bach is a former park ranger who now spends her time writing or practicing yoga. She’s a science writing intern in the Office of Communications and Public Affairs. 

Previously: More attention, funding needed for headache care, “Bold and game-changing” federal report calls for $4.5 billion in brain-research funding, Federal investments in research and higher education key to U.S. maintaining innovation edge

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

No one wants to talk about dying, but we all need to

No one wants to talk about dying, but we all need to

“Dying in America is harder than it has to be.”

That’s the headline of one of the stories published following the release of the Institute of Medicine’s 500-page report titled “Dying in America.” The report tackles head-on the difficult topic of how to provide individualized, appropriate care for patients with advanced serious illness in a country that is grappling with out-of-control health care costs.

Patients should, and can, take control of the quality of their life through their entire life, choosing how they live and how they die

Its conclusion: The system needs a major overhaul.

“Our current system is broken,” said David M. Walker, co-chair of the 21-member committee that authored the report and former U.S. Comptroller General from Bridgeport, Conn. “It does not result in the type of quality of care that people deserve and desire and it’s much more costly. Systematic changes are needed for more compassionate, affordable care.”

No easy solutions exist, the authors said at an hour-long press conference announcing the release of the report yesterday. Instead, they plan to spend the next year getting their message out to the public with far ranging goals for change: from more comprehensive coverage of palliative care by medical insurance, to more hours of palliative care education in medical and nursing schools, to improved communication between health care providers and their patients about their end-of-life care choices – along with a payer-system that reimburses for those conversations.

It’s a controversial topic that broke out into the public debate five years ago during the passage of the Affordable Care Act, when opponents of the bill claimed that a proposal for Medicare to reimburse doctors for counseling patients about living wills and advance directives would lead to bureaucrats setting up “death panels” to determine who deserved care.

But it’s also a topic that can no longer be ignored, authors of the report said. Too many Americans are suffering unnecessarily and as the elderly population continues to grow with the aging of the baby boom generation, these problems will continue to multiply.

“For most people, death does not come suddenly,” said Philip Pizzo, MD, co-author of the report and former dean of Stanford’s medical school, in an email to me discussing the conclusions of the report. “Instead, dying is a result of one or more diseases that must be managed carefully and compassionately over weeks, months, or even years, through many ups and downs.”

Physicians and other health care professionals can provide well-rounded care at the end of life to relieve patient pain, maximize functioning, alleviating emotional stress, and ease the burden of loved ones – all in a manner that is consistent with individual choices, he said.

“Patients should, and can, take control of the quality of their life through their entire life, choosing how they live and how they die,” Pizzo said.

But it’s not happening today.

“Studies show that doctors want to die in comfort at home at the end of life, but subject patients to high-intensity ineffective treatments,” he said. “Why?”

Previously: Study: Doctors would choose less aggressive end-of-life care for themselves, Former School of Medicine dean named to expert panel to reform end-of-life care in America, Communicating with terminally ill patients: A physician’s perspective and On a mission to transform end-of-life care

Global Health, In the News, Infectious Disease, Public Health

Expert panel discusses challenges of controlling Ebola in West Africa

The rapidly growing Ebola outbreak in West Africa is not only overwhelming the health systems of the countries involved, but the World Bank recently warned that it could trash the economies of Liberia, Guinea, and Sierra Leone – the countries that have seen the most cases. Since the first confirmed case in December 2013 in Guinea, almost 5,000 people have become infected with the virus in five countries and about half of them have died. On September 16, President Obama committed 3,000 military personnel to help fight the outbreak, along with other resources.

This morning, KQED’s Forum hosted a panel of Ebola experts, including Michele Barry, MD, director of Stanford’s Center for Innovation in Global Health. The panel discussed some of the challenges this outbreak poses. One issue is the enormous need for resources to control an outbreak of this momentum and magnitude. The WHO estimates it will take about a billion dollars to contain and by some estimates, it will require 1,000 international health care workers to train national, local clinicians.

Barry discussed the prospects for Zmapp, an experimental drug to treat Ebola -“a cocktail of monoclonal antibodies” according to Barry – for helping to curb the disease. She said that besides the lack of human clinical data on the effectiveness of this drug, the difficulty producing the drug also slows down plans to use the medication in the field. She went on to say:

I do have optimism for containing the virus. What I don’t have optimism for is the long-term trajectory of the Liberian healthcare workforce. It’s been actually decimated. I think there are wonderful people there working on it on the ground, but actually, there’s only a only a couple hundred doctors and a serious percentage of them have died—as well as nurses, in this battle against Ebola.

She elaborated on her concerns for the long-term problems for controlling epidemics in general:

I think there are short-term problems, but then I would urge people to start – and I know many people are – to think about long term issues. The long term issues of when you have a WHO that’s had its budget decimated, and its pandemic and epidemic division disbanded. That needs to be strengthened. When you have a workforce in Africa of only – I mean they have 25 percent of the disease burden but only four percent of the workforce. That needs to be strengthened. So there are long term issues of control for future epidemics.

She also suggested that a global health worker reserve corps could be assembled, a fund to strengthen health systems could be established, much like The Global Fund to fight AIDS, Tuberculosis and Malaria, and the UN could take a more active role in large infectious disease epidemics.

Continue Reading »

Applied Biotechnology, Bioengineering, Global Health, In the News, Stanford News

Stanford bioengineer among Popular Science magazine’s “Brilliant 10”

Stanford bioengineer among Popular Science magazine’s “Brilliant 10”

prakash-popsci

Manu Prakash, PhD, a prolific inventor of low-cost scientific tools, has been named one of Popular Science magazine’s “Brilliant 10” for 2014 – an award that recognizes the nation’s brightest young minds in science and engineering.

In the last year Prakash has introduced two novel science tools made from everyday materials.

The first was a fully functional paper microscope, which costs less than a dollar in materials, that can be used for diagnosing blood-borne diseases such as malaria, African sleeping sickness and Chagas. It can also be used by children — our future scientists — to explore and learn from the microscopic world.

The second was a $5 programmable kid’s chemistry set, inspired by hand-crank music boxes. Like a music box, users crank a wheel that feeds a strip of hole-punched paper through the mechanism. When a pin hits a hole, it activates a pump that releases a precise, time-sequenced drop of a liquid onto a surface. This low-cost device can be used to test water quality, to provide affordable medical diagnostic tests, or to design chemistry experiments in schools.

The inventions are brilliant in both their elegant simplicity and their use of emerging technologies, such as 3D printers, microfluidics, laser cutters and conductive-ink printing.

“In one part of our lab we’ve been focusing on frugal science and democratizing scientific tools to get them out to people around the world who will use them,” Prakash told Amy Adams in a recent Stanford News story. “I’d started thinking about this connection between science education and global health. The things that you make for kids to explore science are also exactly the kind of things that you need in the field because they need to be robust and they need to be highly versatile.”

Sometimes, just for the fun of it, I’ll wander over to the Prakash lab to check out the team’s new inventions. They never fail to impress.

I heartily agree with the Popular Science editors on this year’s choices for the Brilliant 10: “Remember their names: they are already changing the world as we know it.”

Previously: Manu Prakash on how growing up in India influenced his interests as a Maker and entrepreneur, Dr. Prakash goes to Washington, The pied piper of cool science tools, Music box inspires a chemistry set for kids and scientists in developing countries and Free DIY microscope kits to citizen scientists with inspiring project ideas
Illustration courtesy of Popular Science magazine

Cancer, In the News, NIH, Research, Stanford News, Women's Health

NIH Director highlights Stanford research on breast cancer surgery choices

NIH Director highlights Stanford research on breast cancer surgery choices

The director of the NIH, Francis Collins, MD, this morning weighed in on a topic that has garnered much attention lately: the type of surgery that women diagnosed with breast cancer choose. The post, found at the NIH Director’s blog, describes a recent study by Stanford researchers published earlier this month in the Journal of the American Medical Association that examined survival rates after three different types of breast cancer surgery for women diagnosed with cancer in one breast: a lumpectomy (removal of the just the affected tissue, usually followed by radiation therapy), a single mastectomy (removal of the whole affected breast), and double mastectomy (removal of the unaffected breast along with the affected one.)

In a previous post we wrote in detail about the study and the finding that the number of double mastectomies in California have increased dramatically. However, except for women with the BRCA1 or BRCA2 genes, the procedure does not appear to improve survival rates for women who undergo the surgery compared with women who choose other types of breast surgery. Collins notes:

It isn’t clear exactly what prompted this upsurge in double mastectomy, which is more expensive, risky, and prone to complications than other two surgical approaches. But [researchers] Kurian and Gomez suggest that when faced with a potentially life-threatening diagnosis of cancer in one breast—and fears about possibly developing cancer in the other—women may assume that the most aggressive surgery is the best. The researchers also said it’s also possible that new plastic surgery techniques that achieve breast symmetry through bilateral reconstruction may make double mastectomy more appealing to some women.

Despite its recent upsurge in popularity, the study found double mastectomy conferred no survival advantage over the less aggressive approach of lumpectomy followed by radiation.

Collins also points out that the slightly worse survival rates of women who undergo single mastectomies probably reflect the fact that poorer women were more likely to have this surgery and is evidence of yet another health disparity linked to economic status.

Previously: Breast cancer patients are getting more bilateral mastectomies – but not any survival benefit

Emergency Medicine, Health Policy, In the News, Patient Care, Research, Stanford News

Exploring how the Affordable Care Act has affected number of young adults visiting the ER

Exploring how the Affordable Care Act has affected number of young adults visiting the ER

ER sign - 560

One of the earliest – and most popular – parts of the Affordable Care Act allowed young adults to stay on their parents insurance until their 26th birthday. This week, Stanford researchers led by Tina Hernandez-Boussard, PhD, published a paper in the journal Health Affairs that tracked emergency room visits in California, New York and Florida for two age groups: 19 to 25 year olds – the group affected by the new requirement -  and 26 to 31 year olds for comparison. The researchers examined ER visits for the two years prior to the ACA requirement (2009 and 2010) and one year after the requirement went into effect (2011). Their findings showed that in 2011, 19- to 25-year-olds had slightly fewer ER visits – 2.7 per 1,000 people -compared to the older group.

The researchers calculated that the drop in ER use means more than 60,000 fewer visits for 19- to 26-year-olds across the three states  in 2011. They also found that the  largest relative decreases in ER use were among women and blacks.

post on Washington Post‘s Wonkblog covered the study and discussed further findings:

The researchers had another finding that seems just as important. While the total number of ER visits among the under-26 group was down, about the same number of people still went to the ER. The distinction here is that young adults with chronic conditions, who have greater care needs, probably now had better access to non-ER care settings, so their number of visits to the ER decreased. But the finding also suggests that healthy young adults, who might have shunned health insurance before, still continued to see the ER as a place for seeking out routine care, according to the study. Further, insurance likely makes those ER visits cheaper, which could actually increase how much people use the ER, the researchers wrote.

Hernandez-Boussard and her colleagues concluded in their paper, “As EDs face capacity challenges, it is important to consider how to meet the broad underlying needs of young adults through other channels and ensure the needed availability of these alternative health services.”

Previously: Abraham Verghese on health-law battle: “We’ve worried so much about the process, not the patient”
Photo by Eric Staszczak/KOMU

In the News, Mental Health, Public Safety

Will a steel net under the Golden Gate Bridge deter would-be jumpers?

Will a steel net under the Golden Gate Bridge deter would-be jumpers?

Golden Gate BridgeThe Bridge Rail Foundation estimates that there have been almost 1,600 suicide deaths from the Golden Gate Bridge since it opened in 1937, and the San Francisco’s Golden Gate Bridge Board of Directors recently approved $76 million in funding to install a 20-foot-wide steel net to deter suicide jumpers.

In a piece on the Washington Post’s Wonkblog, Stanford’s Keith Humphreys, PhD, examined the effectiveness of bridge barriers on suicide prevention, writing that “a half century of experience and evidence supports an optimistic view.” He highlights several small studies before writing:

Because suicide by jumping is a mercifully rare event, most studies of barriers have small samples, making findings unstable and the difference between the Toronto study and other research unsurprising. Statistically, a more reliable result would come from combining the findings across all prior studies.  When Dr. Jane Pirkis of the University of Melbourne led such a “meta-analysis” in 2013, she and her colleagues found that on average barriers reduce suicides by 86% at the barrier site, and that jumping suicides at other nearby sites rise by 44%.  The net benefit is a 28% decrease in suicides by jumping per year.

Dr. Pirkis’ findings bode well for the success of San Francisco’s suicide barrier, which is expected to be installed in about three years.  Even if the net has only the average level of effectiveness, it would have saved a life a month in 2013 alone, as well as sparing the families of the deceased years of mental and emotional anguish.

Jen Baxter is a freelance writer and photographer. After spending eight years working for Kaiser Permanente Health plan she took a self-imposed sabbatical to travel around South East Asia and become a blogger. She enjoys writing about nutrition, meditation, and mental health, and finding personal stories that inspire people to take responsibility for their own well-being. Her website and blog can be found at www.jenbaxter.com.

Previously: Stanford researcher examines link between sleep troubles and suicide in older adults and Stanford’s Keith Humphreys on Golden Gate Bridge suicide prevention: Get the nets

Applied Biotechnology, In the News, Infectious Disease, Microbiology, Public Safety

How-to manual for making bioweapons found on captured Islamic State computer

Black DeathLast week I came across an article, in the usually somewhat staid magazine Foreign Policy, with this subhead:

Buried in a Dell computer captured in Syria are lessons for making bubonic plague bombs and missives on using weapons of mass destruction.

That got my attention. Just months ago, I’d written my own article on bioterrorism for our newspaper, Inside Stanford Medicine. So I was aware that, packaged properly, contagious one-celled pathogens can wipe out as many people as a hydrogen bomb, or more. Not only are bioweapons inexpensive (they’ve been dubbed “the poor man’s nuke”), but the raw materials that go into them – unlike those used for creating nuclear weapons – are all around us. That very ubiquity, were a bioweapon to be deployed, could make fingering the perp tough.

The focal personality in my ISM article, Stanford emergency-medicine doctor and bioterrorism expert Milana Trounce, MD, had already convinced me that producing bioweapons on the cheap – while certainly no slam-dunk – was also not farfetched. “What used to require hundreds of scientists and big labs can now be accomplished in a garage with a few experts and a relatively small amount of funding, using the know-how freely available on the internet,” she’d said.

This passage in the Foreign Policy article rendered that statement scarily apropos:

The information on the laptop makes clear that its owner is a Tunisian national named Muhammed S. who joined ISIS [which now calls itself "Islamic State"] in Syria and who studied chemistry and physics at two universities in Tunisia’s northeast. Even more disturbing is how he planned to use that education: The ISIS laptop contains a 19-page document in Arabic on how to develop biological weapons and how to weaponize the bubonic plague from infected animals.

I sent Trounce a link to the Foreign Policy article. “There’s a big difference between simply having an infectious disease agent and weaponizing it,” she responded in an email. “However, it wouldn’t be particularly difficult to get experts to help with the weaponization process. The terrorist has a picked a good infectious agent for creating a bioweapon. Plague is designated as a Category A agent along with anthrax, smallpox, tularemia, botulinum, and viral hemorrhagic fevers. The agents on the Category A list pose the highest risk to national security, because they: 1) can be easily disseminated or transmitted from person to person; 2) result in high mortality rates and have the potential for major public-health impact; 3) might cause public panic and social disruption; and 4) require special action for public-health preparedness.”

Islamic State’s interest in weaponizing bubonic plague should be taken seriously. Here’s one reason why (from my ISM article):

In 1347, the Tatars catapulted the bodies of bubonic-plague victims over the defensive walls of the Crimean Black Sea port city now called Feodosia, then a gateway to the Silk Road trade route. That effort apparently succeeded a bit too well. Some of the city’s residents escaped in sailing ships that, alas, were infested with rats. The rats carried fleas. The fleas carried Yersinia pestis, the bacterial pathogen responsible for bubonic plague. The escapees docked in various Italian ports, from which the disease spread northward over the next three years. Thus ensued the Black Death, a scourge that wiped out nearly a third of western Europe’s population.

Previously: Microbial mushroom cloud: How real is the threat of bioterrorism? (Very) and Stanford bioterrorism expert comments on new review of anthrax case
Photo by Les Haines

Addiction, In the News, Pain, Public Health

Stanford addiction expert: It’s often a “subtle journey” from prescription-drug use to abuse

Here are some frightening facts you might not know: Drug overdose death rates in the United States have more than tripled since 1990, with the majority of drug-related deaths caused by prescription drugs. And as of 2010, about 18 women in the U.S. die every day of a prescription painkiller overdose. Prescription-drug abuse, which we’ve written about extensively here on Scope, is a very real and pressing issue – and it was the focus of a recent Forum on KQED-FM.

Among the panelists on Friday’s show was Stanford addiction psychiatrist Anna Lembke, MD, who made the important point that most people who end up addicted to prescription painkillers didn’t start out “looking for a buzz” and that most doctors who prescribe the drugs are merely trying to help their patients. As she explained to listeners:

The problem with… prescription opioids is that they actually do work for pain initially… But for most people, after you take them every day for let’s say a month or more, [you] build up tolerance where they stop working so then you need more of the same drug to get the same effect and it escalates on like that. I really think the process is insidious, both for the patients who become addicted and the doctors who prescribe them. It happens in a subtle journey – when all of the sudden [patients are] using them not just for pain but also maybe to relax themselves, to lift their mood, to be able to go out to a party if they’re feeling anxious, and the doctors continue to prescribe them because they started out working, the patients were happy [and] their function improved. The dose is escalating, but they want to keep the patient happy for all kinds of reasons.

The entire conversation is worth a listen.

Previously: Why doctors prescribe opioids to patients they know are abusing them, Patients’ genetics may play a role in determining side effects of commonly prescribed painkillers, Report shows over 60 percent of Americans don’t follow doctors’ orders in taking prescription meds and Study shows prescribing higher doses of pain meds may increase risk of overdose and Prescription drug addiction: How the epidemic is shaking up the policy world

Stanford Medicine Resources: