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In the News, Media, Medicine and Society, Public Health, Research, Science

Science for popular audiences is not just “adding to the noise”

Science for popular audiences is not just "adding to the noise"

4787885058_d174638233_zIf you’re reading this blog, chances are you’re a fan of popular science – i.e. scientific research made accessible to people who aren’t professional academics. Many academics, myself included, are also in favor of taking cutting-edge knowledge and sharing it broadly with the public.

But some scientists hesitate to share their work on forums like blogs and other social media. According to a recent SciLogs post, they worry that their knowledge might be wrong or incomplete, be misinterpreted, or just add more static to the internet’s noise. But, as the post lays out, those who think about such things are precisely those who should be publishing for broader audiences. Those who publish misinformation are not stopping to question the quality of the knowledge they broadcast; doubt and the recognition of ignorance are the hallmarks of true scientists. Adding even a small amount of high-quality research to the “science media ecosystem” helps.

Moreover, much of the public seems to have little trust in media, much trust in scientists, and is more receptive to information that acknowledges uncertainty. So bring on the science blogs!

Previously: Can science journals have beautiful prose?, The disturbing trend of science by press release, Science rapper “busts a move” to explain Nobel discovery, Science writer Deborah Blum on blogging: “There were so many smaller stories I wanted to tell” and Veteran blogger offers tips for starting a science blog
Photo by Robin Bray-Hurren

In the News, Media, Medical Education, Medicine and Society, Myths, Pregnancy, Research

Reality TV influences perspectives on pregnancy, study shows

Reality TV influences perspectives on pregnancy, study shows

272417047_806faa2243_zA new University of Cincinnati study on the influence that television programs have on pregnant women has found that most women are more affected by TV representations of childbirth than they think.

The study, funded by the NSF and conducted by Danielle Bessett, PhD, assistant professor of sociology, followed a diverse group of 64 women over the course of two years and investigated how they understood their television viewing practices related to pregnancy and birth. It found that class, as measured by education level, had the greatest influence on whether a woman acknowledged television as a significant source of pregnancy-related information. Highly educated women and those who worked outside the home were more likely to dismiss TV, while those with less education and who were unemployed or took care of children at home were more likely to report watching and learning from such shows as TLC’s “Baby Story” and “Maternity Ward” and Discovery Health’s “Birth Day.”

The particularly interesting finding is that TV portrayals affect women’s perceptions even when they don’t believe they have an influence. Bessett developed the term “cultural mythologies of pregnancy” to describe how TV, film, media, and word of mouth create expectations about “the way things are.” Most reality TV and fictionalized programming presents childbirth as more dramatic and full of medical interventions than the majority of births really are, and these images made a lasting impression on women.

As quoted in the press release, Bessett says, “Hearing women –– even women who said TV had no influence on them –– trace their expectations back to specific television episodes is one of the few ways that we can see the power of these mythologies.” Many women mentioned pregnancy representations they had seen long before they got pregnant.

Women who reported watching TV considered it part of a comprehensive childbirth education program and would often evaluate the programs’ reliability, while women who disavowed television saw it as entertainment or education for children, likely from a desire to be seen as valuing science and medical expertise.

“If we believe that television works most insidiously or effectively on people when they don’t realize that it has power, then we can actually argue that the more highly educated women who were the most likely to say that television really didn’t have any effect on them, may in the end actually be more subject to the power of television than were women who saw television as an opportunity to learn about birth and recognized TV’s influence,” hypothesizes Bessett.

“This research implies that many women underestimate or under-report the extent to which their expectations of pregnancy and birth are shaped by popular media,” concludes Bessett, suggesting that “scholars must not only focus on patients’ professed methods for seeking information, but also explore the unrecognized role that television plays in their lives.”

Previously: New reality shows shine harsh light on teen pregnancy and Study: TV dramas can influence birth control use
Photo by johnny_zebra

Global Health, Medical Education, Medicine and Society, Patient Care, Public Health

Exploring the benefits of pursuing anthropology and medicine

Exploring the benefits of pursuing anthropology and medicine

3470650293_60b27d6539_zAs a PhD student in medical anthropology, and having come from a very “medical family,” pursuing an MD has been a kind of shadow-dream of mine. For a year or two in high school, I was convinced that neonatology was the path for me; now I’m a doula and research the culture of childbirth.

Some people do live the double dream, and I recently interviewed two of them: Jenny Miao Hua at the University of Chicago and Rosalind Franklin University’s Chicago Medical School, and Stanford’s Amrapali Maitra, both of whom are medical anthropologists pursuing PhD/MD degrees. (Amrapali has brought an anthropological perspective to Scope through our SMS Unplugged series.)

The two came to their joint degree from different sides: Hua was an anthropology student interested in Chinese medicine and the body, while Maitra was enrolled in medical school and became serious about understanding the social context of illness. Each intends to pursue internal medicine, and each, incidentally, has family connections in the site she chose to research. We talked shop for quite a while, and what I found most interesting was their thoughts on what anthropology brings to clinical practice:

Maitra: On the broadest level, anthropology gives you an immense empathy for your patients and allows you to see them as people. It sounds cliché, but with the focus on efficiency and evidence-based medicine that has taken over American biomedical practice, even the most kind and caring individual can lose [his or her] empathy. And the kind of empathy you get from anthropology is not just sympathizing with the person, but really understanding where they’re coming from, historically and because of their life position: why they live in a certain neighborhood or have a certain diet. It allows you to think creatively about what they’re able to do or not do in pursuing their own health.

Hua: With anthropological training, students understand the various ways pathologies are dependent on larger socioeconomic forces. As a practicing physician, the person who comes through the door is never a textbook patient, so within a very short amount of time you have to pick up on this deep history, and when you’re not careful you end up stereotyping and profiling. Anthropology brings a more nuanced way of thinking about patients: they’re not just uniform biological entities, but hybrids of biology, society, and culture.

Maitra: I’ve seen so many clinic visits where I can tell, as the anthropologist in the room, that the attending physician and patient just have completely different agendas. There are simple questions like those Arthur Kleinman has laid out, asking what about the pain bothers her, why she thinks she’s having it, what she hopes to get out of the encounter. I see some doctors use these, and their visits go so much better. They’re able to build an alliance with their patient that’s very therapeutic.

That’s anthropology on the individual level, but on another level it allows you to recognize that certain things are trends. It allows you to think systematically about different kinds of structural violence. For example, why is it that so many people whose occupation is picking strawberries come in with knee and back pain issues? Treating pain is not going to solve the problem. It’s about getting to the root of the occupational hazards of being a farm worker.

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Global Health, Health Costs, Health Policy, Medicine and Society, Research

Chinese clinicians use inpatient visits to compensate for drug revenue loss

Chinese clinicians use inpatient visits to compensate for drug revenue loss

For decades, many doctors in rural China boosted their incomes by both recommending and selling drugs, often at steep markups. With mounting evidence of overprescription, in 2009 the Chinese national government largely banned markups, undermining doctors’ financial incentive to over-provide them. Instead, the government provided physicians with a subsidy to compensate for the loss in profits.

Since then, a number of scholars have examined the effects of the policy. But no one has looked at the unintended consequences — until now.

In a study published today in Health Affairs, a team of researchers found the policy had the unintended consequence of boosting hospitalizations and the provision of inpatient care.

“When you have a regulation that affects pricing, it’s like pushing a balloon in in one place — then it pops out in another,” said Grant Miller, PhD, director of the Stanford Center for International Development, senior fellow at the Freeman Spogli Institute for International Studies and an associate professor of medicine. The first author is Hongmei Yi, PhD, program manager of FSI’s Rural Education Action Program in China.

The team, which also includes Scott Rozelle, a senior fellow at FSI, examined data from rural Chinese clinics between 2007 and 2011. They found clinics that were most heavily reliant on drug revenues before the policy change more than doubled their provision of inpatient services when compared with the clinics least reliant on drug revenues before the change. These centers also experienced little change in revenue, which indicates they were able to offset the losses of drug revenue with income from inpatient stays.

Based on their analysis, the team also believes that this increase is not driven by demand for inpatient services, Miller said.

By also surveying and conducting follow-up phone interviews with patients, the researchers also found some evidence that clinics may be artificially boosting their inpatient tallies to increase their compensation from the government.

He said he was not surprised the policy had unexpected ramifications. “Humans are adaptive creatures and doctors are not categorically different than the rest of us. If you take away a source of livelihood, it’s not surprising they found another way to make it up.”

Rural primary care doctors in China “are also not at the top of the economic pyramid,” Miller said.

Health-care reform is on the national agenda in China and it’s possible that this study could inform future policies, Miller said. “It raises a much broader set of questions about how you design in a more holistic way a proper set of incentives for providers,” he said.

Previously: Seeking solutions to childhood anemia in China, Better school lunches — in China and Stanford India Health Policy Initiative fellows are in Mumbai — come follow along

Health Disparities, Medical Education, Medicine and Society, Public Health, Science

Stanford Medical Youth Science Program for underrepresented students expands and deepens

Stanford Medical Youth Science Program for underrepresented students expands and deepens

unnamedThe Stanford Medical Youth Science Program (SMYSP) is a 5-week summer residential program for rising high school juniors and seniors interested in science and medicine. The students, who come from underrepresented and low-income backgrounds, have an opportunity to experience the medical profession from the inside out. This year’s program concluded late last month with a graduation ceremony in which the students presented their scientific research projects on health disparities and advocacy to an audience of their parents and supporters.

A few weeks ago, I had the chance to speak with the program’s longtime director, Judith T. Ned, EdD, who told me SMYSP has come a long way since it was co-founded 28 years ago by Stanford epidemiologist Marilyn Winkleby, PhD, MPH. This is Ned’s 14th year running the show. She has made lot of beneficial changes and expansions, many of which happened since we last featured SMYSP in 2010, without losing sight of the program’s purpose: to expose these kids to the fields of science and medicine while increasing workforce diversity in the health professions.

Each year, 12 boys and 12 girls are selected for the program, all of whom come from 20 counties surrounding Stanford. “The goal is to really provide services and opportunities to students who are in our backyard, if you will,” Ned told me. The students have a well-rounded curriculum – not only do they attend lectures by leading academics and industry professionals, anatomy lectures and labs (with cadavers!), and twice-weekly clinical internships, but they have non-clinical days where they investigate departments like hospital food service, security, and art therapy. “We want to show them that it takes multiple people in multiple areas to really make the hospital function. Most of the time, many of my students serve as translators for their parents when they go into the hospital. This is the flip side: the provider’s perspective, not the patient’s. It’s been an interesting experience to see them switch mindsets.”

Programming includes SAT prep, “game shows” to improve knowledge retention, and evening workshops that include leadership development and performing arts. Ned wants the students to know that “you can take a well-rounded liberal arts education, get into medical school, and still practice your craft, embracing both sides of your identity.” Community service is also a key feature of the program, such as the beautification project they did at the East Palo Alto YMCA the Saturday before our interview.

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Humor, Media, Medicine and Society, Neuroscience, Research, Stanford News

Did extraterrestrials chew up my news release, or does artificial intelligence still have a ways to go?

Did extraterrestrials chew up my news release, or does artificial intelligence still have a ways to go?

UFO

Almost two years ago, in a Scope blog entry titled “Can Joe Six-Pack compete with Sid Cyborg?” I posed the question: “Just how long will it be before we can no longer tell our computers from ourselves?”

I think it’s safe to say we’re not there yet. Either that, or extraterrestrials have been reading my news releases and finding them puzzling.

Last week we put out a news release I’d written about a dramatic discovery by Stanford radiologists Mike Zeineh, MD, PhD, Brian Rutt, PhD, and their colleagues. In brief, they’d analyzed postmortem slabs of brain tissue from people diagnosed with Alzheimer’s, compared them with equivalent brain-tissue slabs taken from people who’d died without any Alzheimer’s-like symptoms, and noticed some striking and intriguing differences. In a key brain region essential to memory formation, Zeineh and Rutt had spotted – only in Alzheimer’s brains, not normal ones – iron deposits engulfed by mobile inflammatory cells. This observation’s potentially big implications were plenty newsworthy.

It so happened that, on the day we issued the release, a high-powered five-day-long meeting on Alzheimer’s sponsored by the eponymous Alzheimer’s Association was in session in Washington, D.C. As a result, many of the brain-oriented science writers to whom my news release was targeted were preoccupied.

I was a little anxious about that. So, the other day, I turned to my favorite search engine to see if the release had managed to get some traction in the popular press. As I’d feared, the Washington conference had sucked up a lot of the oxygen in the earthly neuroscience arena.

But apparently, the release had done better in Outer Space. I saw that it had been picked up by, for example, Red Orbit (a website that I’ve always assumed, based on its name, emanates from Mars).

My eyes were next drawn to a link to an unfamiliar outfit called AZ News, which bills itself in a tagline as an “International Online News Site.” I clicked on the link, and saw a news report with the same title as my release. I started reading the text below.

The first words were: “In autopsy mind hankie from people not diagnosed with Alzheimer’s…” I don’t know what an “autopsy mind hankie” is, but I suspect it’s a mind-blower.

I checked our release. That’s not what I’d written at all. What I’d said was, “In postmortem brain tissue from people not diagnosed with Alzheimer’s…”

It seemed pretty clear that the release had been translated into some language – I had no idea which – and then, for some reason, reverse-translated back into English. I read on.

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Ethics, In the News, Medicine and Society, Science, Science Policy, Sports, Stanford News

Stanford expert celebrates decision stopping testosterone testing in women’s sports

Stanford expert celebrates decision stopping testosterone testing in women's sports

Female track and field athletes no longer need to have their natural testosterone levels below a certain threshold to compete in international events, the so-called “Supreme Court of sports”, the Court of Arbitration for Sport, ruled Monday.

Katrina Karkazis, PhD, a Stanford senior research scholar who was closely involved with the case, got the news on Friday, while she was in a San Francisco dog park. “What a day!” she said. “I was madly refreshing my email — I thought we were going to lose… I just started screaming and crying.”

Karkazis, who is an expert on ethics in sports and also gender, said she spent a year of her life working on the case.

She served as an advisor to 19-year-old sprinter Dutee Chand, who challenged the regulation that female athletes must have certain testosterone levels or undergo medical interventions to lower their testosterone to be allowed to compete against women in events governed by the International Association of Athletics Federations (IAAF), the international regulatory body of track and field.

The ruling suspends the IAAF’s testing regimen for two years, but Karkazis expects the decision will lead to permanent changes in women’s sports, including a reevalution by the International Olympic Committee.

“I’m thrilled,” Karkazis said. She said she was also surprised. “I didn’t think it was our time. I thought there were still too many entrenched ideas about testosterone being a ‘male hormone’ and it not belonging in women.”

Karkazis gained international attention after penning an op-ed in The New York Times in 2012 when the IAAF and the International Olympic Committee crafted a new policy banning women with naturally high levels of testosterone from competing.

“You can’t test for sex,” Karkazis said. “It’s impossible. There’s no one trait you can look at to classify people. There are many traits and there are always exceptions.”

She said that now women who have lived and competed their entire lives as women will be eligible to compete, a default policy she believes is sufficient to ensure a level playing field.

Previously: “Drastic, unnecessary and irreversible medical interventions” imposed upon some female athletes, Arguing against sex testing in athletes and Is the International Olympic Committee’s policy governing sex verification fair?
Photo by William Warby

Infectious Disease, Medical Education, Medicine and Society, Public Health, Stanford News, Videos

Online curriculum helps students and public learn about influenza

Online curriculum helps students and public learn about influenza

Stanford’s Flu Crew, which administers flu vaccines in and around the Stanford community, has had many successes over the last few years, which we’ll highlight in a post later this week. One achievement I thought deserved special attention is an innovative curriculum on influenza created by former medical student Kelsey Hills-Evans, MD, now an internal medicine resident at Harvard. Her online videos, such as the one above (which is the first in the series), are accessible not only to Flu Crew’s student participants but the public at large.

The videos were produced via a partnership with Khan Academy and built on the flipped classroom model championed by Charles Prober, MD, senior associate dean of medical education. They also received the Shenson Bedside Innovation Award in 2013. Rishi Desai, MD, a Stanford pediatric infectious disease physician and medical fellow at Khan Academy, supervised Hills-Evans’ efforts and told me in an email that Hills-Evans and the Flu Crew “put together some really amazing videos explaining everything from the basics of influenza to common misconceptions and fears that people have about the flu vaccine. They deserve all of the credit for the idea and execution of the project.”

Hills-Evans tried to keep each video under five minutes: “I wanted it to be a quick, high-yield snapshot of information that people could watch in one sitting and not easily forget.” She shared more details with me over email:

What did you aim to convey in these training videos? How did you imagine your audience? 

I wanted our student volunteers to come away from the training with enough general knowledge about influenza to answer nearly any question that patients might have. We equipped them with knowledge about its history, how it genetically changes over time, the clinical symptoms, the vaccine’s risks and benefits, specific patient populations, and even a section on flu shot myths. Our last video was meant for students to become public-health advocates equipped with facts and counter-arguments to some of the most common excuses people have for not protecting themselves with the flu vaccine.

For these general info videos, I was really aiming to be accessible to the general public. The topics are all applicable to the lay person, so I tried my best to stay away from clinical jargon. I wanted people to come away from the training with a better understanding of how dangerous influenza can be – many people shrug at the flu as a bit worse than a winter cold, but it kills tens of thousands of people every year. In addition, there are so many myths generated by popular media and the public about the illness itself (i.e., “I got a stomach flu” which is never actually an influenza virus) and especially about vaccines. It was important to me that we make these videos public so more individuals could be informed.

For the sections meant only for clinical personnel, our priority was to train the members of the Stanford Flu Crew, but I also wanted this component to be exportable to other medical programs. It was meant to teach students to deliver the best intramuscular (IM) injections possible. We’ve been told countless times that our method for IM injections yields extremely high patient satisfaction and nearly pain-free injections (some say “the best flu shot they’ve received”).

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Humor, In the News, Medical Education, Medicine and Literature, Medicine and Society, Patient Care

Graphic medicine takes flight

Empathy-Ian-Williams-510x438A recent blog post on Somatosphere sparked my interest in the role that comics can play in the study and delivery of health care, an emerging field called “graphic medicine.” The term was coined by UK-based Ian Williams, MD, who is an artist and independent humanities scholar as well as a physician. He recently launched a website of the same name.

The post introduces a few new books that just came out on the subject: Graphic Medicine Manifesto, a collaborative work by six health-care professionals and humanities scholars, and Ian Williams’ The Bad Doctor. It also describes how comics can open us up to new ways of seeing in ways that text alone cannot:

Comics allow us to ask how we can “orient” ourselves… toward the potentiality of images and away from the systematizing effects of text alone… [Comics use] images and imagistic thinking as a way to see a different mode of existence.

Since it’s an anthropology blog, it suggests that a “graphic medical anthropology” would be a great way to accomplish the anthropologist’s goal of “seeing structure, complexity, nuance, emergence, and multiplicity simultaneously.” We anthropologists often try to achieve this goal with complicated metaphors and theories, but perhaps the old adage about a picture being worth a thousand words holds true in this case.

The post notes that drawings can provide an experience of self-reflection for the artist, and can inspire readers to readily and easily respond with their own experience, making the work more of a dialog. They can introduce “theoretical orientations” in ways that are more accessible, and can expose power relations in ordinary lived experience. Ordinary lived experience is particularly well conveyed by comics; they showcase the mundane and make it meaningful. They can take those “ordinary, chronic and cruddy moments” and convey what it’s like to be part of our society.

Previously: Cancer Ninja fights patient misinformation, one cartoon at a time, Using graphic art to understand the emotional aspects of disease, A comic look at 12 medical specialties, Economist to explain health reform through graphic novel, and Webcomic xkcd gets medical
Illustration by Ian Williams, “Autography as Auto-Therapy: Psychic Pain and the Graphic Memoir.” Journal of Medical Humanities 2011, reposted from Somatosphere

Health Policy, In the News, Medicine and Society, Pediatrics, Stanford News

Stanford researchers analyze California’s new vaccine law

Stanford researchers analyze California's new vaccine law

CA vaccine photoWhat do California, West Virginia and Mississippi have in common? Stumped?

Thanks to a recent law signed by California Gov. Jerry Brown, these three states now have strict vaccine policies that require children to be vaccinated before entering school, unless they have a medical exemption. The new requirements eliminate religious and philosophical exemptions.

Stanford’s Michelle Mello, JD, PhD, and David Studdert, LLB, ScD, (along with co-author Wendy Parmet, JD) heralded the change in a New England Journal of Medicine commentary published this week. From a Stanford News release:

“The move represents a stunning victory for public health that affects not only California schoolchildren, but the prospects for strengthening vaccination requirements nationwide,” they wrote.

The new laws come in the wake of a measles outbreak that started at Disneyland last year. It fueled a nationwide debate about the merits of vaccines, and of the large number of children unvaccinated due to parental objections.

The new California law requires all children enrolled in private and public schools and day-care facilities to be vaccinated against measles, whooping cough and several other diseases.

Yet the law is sure to face challenges, particularly from opponents who say it violates their religious rights. In addition, a lack of enforcement may weaken the law’s ability to ensure widespread protection.

Nonetheless, California’s new law is worth celebrating, they say:

“Although California politics may be distinctive, its experience with SB277 teaches us that even strong opposition can be overcome with the right combination of astute public education, political strategy and legislative fortitude,” they wrote. “Fewer vaccination exemptions and vaccine-preventable illnesses would be accomplishments that other states would find difficult to ignore.”

Previously: A discussion of vaccines, “the single most life-saving innovation ever in the history of medicine”, Science Friday-style podcast explains work toward a universal flu vaccine and Side effects of childhood vaccines are extremely rare, new study finds
Image by Niyazz

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