Medicine and Literature

Growing up, a lot of my friends were into Star Trek. They read Heinlein, Clarke and Bradbury. (I, on the other hand, liked reading plays like Death of a Salesman or the authors Sinclair Lewis and F. Scott Fitzgerald.) I often felt lost in space when conversations with my buddies ventured into the terrain of the Vulcans.

So it was with a lot of apprehension and a bit of anxiety that I took on an interview with the celebrated sci-fi writer Vernor Vinge for the latest issue of Stanford Medicine magazine, which includes a special report on big data in medicine. We thought it would be interesting to get Vinge’s perspective since he’s been prescient about some aspects of where the world of big data is headed.

So bear with me if my ignorance or lack of reverence seeps through. I did find our conversation fascinating. Though I have to admit, I didn’t understand it all. I got lost somewhere in “the singularity.” Look it up!

We’ve condensed the longer conversation into a Q&A in the magazine – a deeper dive is available as a podcast.

Live long and prosper. See, I am not totally hopeless.

Wired Science has a nice, succinct slideshow highlighting a selection of important scientific texts. Among them, of course, is Gray’s Anatomy. Tanya Lewis writes:

Without the work of intellectual giants like Einstein, Newton and Darwin, we might still be in the dark ages. But how many scientists still read the dust-ridden texts where these luminaries first expounded their theories? Thanks to the internet, you no longer have to hunt down these yellowing tomes in a moldy library vault. Here’s the story of 9 famous publications that spun the scientific world off its orbit.

If you have a few minutes, it’s worth looking through.

Photo from Gray’s Anatomy from Wikimedia Commons

A fascinating report was posted earlier today about the Stanford School of Medicine’s Arts, Humanities & Medicine Program. The article, written by Corrie Goldman, provides a closer look into the initiative and how it allows students at the medical school to explore their creativity and artistic passions through the study of art, music and literature. Goldman writes:

The aim, as described on the program website is to “enhance our understanding of the contextual meanings of illness, health care, and the human condition.

The piece includes a very nice profile of Meghan Galligan, a first year Stanford medical student who uses the program to incorporate her musical passions into her work with patients:

Through the Biomedical Ethics and Medical Humanities Scholarly Concentration (BEMH), Galligan, a classically trained concert pianist and vocalist, has read King Lear and listened to Gustav Mahler compositions.

She also has read essays written by cancer survivors and heard a presentation by a man who made a documentary film about living with Huntington’s Disease in “The Human Condition,” a BEMH course taught by Dr. Larry Zaroff.

Galligan said the reflective nature of class discussions encouraged her to consider existential questions that her patients might face, such as, “How do I live my life and make a difference after I’ve been diagnosed with a serious illness?”

Stanford medical students also have the opportunity to receive a Medical Scholars Research Grant, encouraging them to broaden their perspectives toward medicine, arts, humanities and ethics.

Previously: A plan to expand educational offerings to “anyone, anywhere” and Stanford dean discusses changing expectations for medical students

Over on Thriving, the blog of Children’s Hospital Boston, physician Clarie McCarthy, MD, takes a closer look at the impact of unpublished research in shaping physicians and patients’ understandings of new medical treatments and therapies.

In the post, she highlights a recent Pediatrics article (subscription required) showing how separately searching published and unpublished studies about the use of serotonin receptor inhibitors to reduce repetitive behaviors of autism leads to conflicting answers on whether such a treatment is effective. Additionally, a recent study (subscription required) that analyzed 3,428 other studies involving children found that results were unavailable for more than half. McCarthy writes:

As a pediatrician, this worries me. I’m making medical decisions for my patients based on less than half of the information out there?

There is a database, ClinicalTrials.gov, where researchers are supposed to “register” their studies before they even start. That way, there is a record of it–and even if they stop it, or if it never gets published, there is a way to at least know it existed and find out more about it. Unfortunately, not all studies get registered. Many journals, including Pediatrics, won’t publish a study unless it was registered–if all journals would do that, maybe all researchers would register their studies.

This doesn’t mean that you can’t trust medical research. Medical research has brought us antibiotics and heart surgery and drugs that cure many cancers; medical research saves and improves countless lives every single day. But it does mean you have to be a savvy and skeptical consumer of health information. It means that you need to ask questions, learn about the sources of the information, read widely and–always–talk to your doctor before you make a health decision based on a study.

Previously: Studies reveal that what studies reveal can be wrong
Photo by Giulia Forsythe

In some circles, I’m simply a PIO, or public information officer, for a major university. But my job includes a healthy dose of science journalism. Every day I try to write about research and science in a way that’s interesting and informative to an audience that may not have specialized science training. It’s a fun and rewarding challenge.

Writing today in The Last Word on Nothing blog, science writer Erika Check Hayden points out a Kickstarter project called Matter that warmed my heart. The project was conceived by two reporters (Jim Giles and Bobbie Johnson) interested in supporting long-form science journalism. According to the project website:

MATTER will focus on doing one thing, and doing it exceptionally well. Every week, we will publish a single piece of top-tier long-form journalism about big issues in technology and science. That means no cheap reviews, no snarky opinion pieces, no top ten lists. Just one unmissable story.

The project’s fund raising goal was $50,000. So far they’ve raised nearly $140,000.  As Erika points out:

First, this is an astonishingly positive statement about the future of science journalism. I gave to the project because Jim is a friend and former coworker, and because I love good science journalism and want to support it. The fact that so many other people also apparently feel the same way says that there is a healthy demand for science journalism – a welcome statement in light of the beating that the journalism industry, and science journalism in particular, have taken in recent years.

Second, I’m thrilled to see someone injecting science journalism into the “future of journalism” conversations that have been thriving elsewhere for quite a while now. Experiments such as the Knight News Challenge have not had much of an impact on science journalism – they were largely meant to help backfill the huge void in local news coverage left by the decline of newspapers, and many of the folks leading the future-of-journalism conversations these days come from mainstream broadcast, magazine and newspaper outlets where science journalism was never a major part of the picture. We science journalists have eagerly embraced new technologies for conducting and disseminating our work. But until now, we haven’t led the conversation about new models for funding that work.

There’s still a few hours left before the fund raising stops. I’m planning to show my support and keep the total climbing. How about you?

Previously: The influences of medical press releases on news coverage quality, Inaccuracies in science journalism are obnoxious at best, potentially dangerous at worst, and The need to reboot science journalism on the web.

The first page was startling. A Catholic nun dies giving birth to conjoined twins. And so begins the epic journey of Abraham Verghese’s sweeping novel, Cutting for Stone.

The Stanford professor of medicine spent eight years writing the novel which begins in Ethiopia during the waning days of Emperor Haile Selassie’s regime and ends, climactically, in a gritty urban hospital in New York City.

The critics have swooned. More than a million copies have been sold, and this week Cutting for Stone celebrates its 104th week on The New York Times’ best seller list.

Good novels entertain you. Great novel transport you. I personally have to thank Abraham for giving me a reprieve from the economic malestrom of 2009. I started reading Cutting for Stone during the height of the downturn and it transported me elsewhere. It allowed me to escape the dreary financial angst of obsessing over the fate of my 401K.

The author, a friend, is one of the most unassuming people you could meet. Far from a braggadocio. He teaches medical students here at Stanford about a vanishing art: the hands-on bedside exam. He’s trying to remind students that there’s a human being in the bed behind the razzle-dazzle technology of today’s medicine.

I recently asked Abraham if he ever imagined the novel would be so successful?  He said:

The most honest answer is yes. I imagined it, tried to visualize it – in fact I had a poster made up for me eight years ago with a mock cover and it said, “60 weeks on the NYTimes list” among other things. And before I sat down to write, I would look at that cover and remind myself that I was aiming to write a big book.  That I had big ambitions for the tale I wanted to tell. Now that is a far cry from knowing it would actually happen.

When I asked him how it felt to be on the Times list for so long, he told me:

I feel humbled by what has happened with the book and the way book clubs in particular have picked it up. Dorothy Allison, the great American writer, says that “fiction is the great lie that tells the truth about how the world lives.” I think there is some universal truth, some note that I hit with this story that resonates for a lot of people. It’s just a wonderful thing.

So what’s next?

I am taking my time, thinking of another story I might work on. I am not in a hurry. I love my day job and it serves as the inspiration for whatever comes next.

Previously: How Abraham Verghese writes, Hands on: Abraham Verghese teaches bedside skills, Abraham Verghese at Work: A New York Times profile, How a battle with Napoleon helped Abraham Verghese write his novel and Physicians turn to books to better understand patients, selves

Looking for more really good things to read? If you’re interested in medical stories, I bet you’ll find something in this list: The 10 most popular Stanford Medicine magazine stories published in 2011 (as determined by online page views).

1. When are you dead? – Resurgent form of organ transplantation raises a new question – by John Sanford
2. The woman who fell to Earth – A love story – by Ruthann Richter
3. Gender X – The battle over boy or girl – by Dianne Klein
4. The case of the disappearing liver disease – Uncovering an ordinary antibiotic’s secret power – by Erin Digitale
5. Bioethics at midlife – The dilemmas facing a field in flux – by Susan Ipaktchian
6. Peddling hope – Unproven stem cell treatments for sale in a country near you – by Krista Conger
7. Make your own cancer diagnostic test – It’s easier than you think – by Rosanne Spector
8. The unexpected – Cancer during pregnancy – by Erin Digitale
9. A kid again – After cancer takes its toll – by Erin Digitale
10. Khmer Rouge on trial – Can serving justice cure PTSD? – by Tracie White

Previously: Cancer’s next stage: A report from Stanford Medicine magazine, Surviving survival: The new Stanford Medicine magazine is out and New Stanford Medicine magazine explores bioethics

My favorite medical story this year managed to make me laugh about aging — a topic I’m seriously obsessed about. Thanks for that. Looking back at my other faves, I see it’s been a good year for medical stories chronicling discoveries, wrong turns and all. So without further ado, here are my top 10 long-form journalism reads for 2011. Aside from the first, they’re listed in no particular order. Oh, and one more thing: Stories from Stanford Medicine, which I edit, are not included. No playing favorites with my babies.

-What do a bunch of old Jews know about living forever? by Jesse Green, New York Magazine

-The human lake by Carl Zimmer, The Loom
The history and science of ecology and your inner microbial wilderness. A favorite bit: “So try to imagine for a moment producing an elephant’s worth of microbes. I know it’s difficult, but the fact is that actually in your lifetime you will produce five elephants of microbes.”

-The mouse trap by Daniel Engber, Slate
Why mice are not model models for humans.

-A victory in the war against cancer by Terence Monmaney, Smithsonian
Beautiful melding of stories about a driven cancer patient and the cancer researcher who brought us Gleevec.

-Study of a lifetime by Helen Pearson, Nature
What’s been learned by tracking the health and demographic details of thousands of British children born one week 65 years ago? As the story says: “Now, as the cohort members enter old age, the study offers a precious opportunity to understand how a lifetime of experiences might hasten or slow their decline — an urgent question for countries such as the United Kingdom and United States, whose populations are rapidly ageing and sickening.” Plus, odd bits like the heaviest babies were most at risk of breast cancer decades later, and that women with higher IQ reached menopause later in life.

-Should we all go gluten free? by Keith O’Brien, New York Times
I thought I knew what there was to know about the diet trend to go gluten-free but it turns out I had no idea.

-Led by the child who simply knew by Bella English, Boston Globe
About a boy who is a girl. A stunning story stunningly told.

-Don’t blame the usual suspect for cancer by Carlos Sonnenschein and Ana M. Soto, New Scientist
Two scientists explain how they’re thinking differently about cancer, and why other scientists should too.

-A drug that wakes the near dead by Jeneen Interlandi, New York Times
What happens when a drug nudges awake those who doctors had every reason to think would never really be conscious again?

-Inseparable by Susan Dominus, New York Times
Mind-boggling, both the story and its telling. Sensitive, gutsy reporting about conjoined twins.

To commemorate the New England Journal of Medicine’s 200th anniversary, the publication has launched an essay contest seeking submissions about how the Internet and social media will change the future of health care. According to the NEJM release:

In the last twenty years, there have been profound changes in how information is communicated. The internet and social networking have enabled everything from romance to revolution. In the healing arts, this change has transformed how the public accesses and uses health-related information. What used to rest solely in the hands of medical professionals now is easily accessible in the public domain. This paradigm shift brings with it benefits and challenges.

As future members of the medical profession and current users of these communications vehicles, you are uniquely poised to apply and evaluate the impact of these evolving methods of information exchange on the art and science of medicine.

We are asking you:

In the last twenty years, the internet and social networking have brought profound changes in how information is communicated. How can we harness this technology to improve health?

The contest is open to undergraduate students considering a career in medicine, medical students and residents. Prizes include invitations to attend the journal’s anniversary symposium and up to $1,000 in travel stipends. Submissions start Dec. 1 and will close after 600 essays have been submitted.

Previously: Non-profit org looking for compelling stories on health-care costs and Contest seeks personal stories on health-care costs
Via Medgadget

A splash of acrylic paint on canvas. An overture from Mozart. A stanza of Rilke’s poetry.

Each of these artistic endeavors helps patients heal in a strange environment: the hospital. Studies have shown that patients who participate in the creative arts, whether painting, writing, or listening to music, experience a reduction in adverse physiological and psychological outcomes. But the creative arts can also help health care practitioners to better understand and appreciate the experiences of patients, according to Audrey Shafer, MD, director of the Program on Arts, Humanities, and Medicine and the keynote speaker at an Arts Program event at Stanford Hospital & Clinics yesterday.

During her talk she described how each of us, to varying degrees, has had direct experience as patients, as caregivers or as witnesses to the suffering of close family members or friends. And Shafer, a practicing anesthesiologist, explained how arts in the medical setting can give health care practitioners unique insight:

A doctor or nurse may know about the pathophysiology of broncho-constriction in asthma and how to administer beta-adrenergic agonists – but what about the experience of not being able to breathe, or how instability in the home life may be precluding regular medication routines? Arts in health care can really give a glimpse into that experience.

In reading literature we come to appreciate the nuances of illness, the many presentations, the ambiguities and incompleteness of treating chronic illness, the implications of the particulars.

You need the science, absolutely, but you also gain from the art.

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