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Medicine and Society, Patient Care, Technology

Advice for young doctors: Embrace Twitter

Advice for young doctors: Embrace Twitter

9093733888_79ccacf171_zYoung doctors have to juggle a huge workload, so it’s not surprising that many don’t use Twitter or other social media. But Brian Secemsky, MD, an internal medicine resident at the University of California, San Francisco recently wrote a story on Huffington Post outlining the benefits of the twitter-verse for young physicians. He notes that Twitter can serve as a good source of medical knowledge and writes:

By choosing a good mix of these medical profiles, especially those that tweet links to high-yield content, you are able to create an individually tailored and constantly updated curated source of medical information, freely available at any time.

(@StanfordMed is one of those profiles, in our humble opinion)

He also points out that Twitter is a good way for up-and-coming physicians to interact with others in their specialty and a place to for them to voice opinions about topics important to them. Also, these days, doctors have a presence online whether they plan to or not, so it’s best to take control of that image. Secemsky writes:

Whether you like it or not, your professional image will likely end up on the Internet. It may be through the increasing patient use of physician rating websites or your own institution displaying your professional profile and accomplishments. It will be difficult to avoid the impact of the online community in your medical career.

Previously: How can health-care providers better leverage social media to improve patient care?More reasons for doctors and researchers to take the social-media plungeSubjects for doctors to avoid when using social media, How, exactly, can Twitter benefit physicians? and How can physicians manage their online persona? KevinMD offers guidance
Photo by Kooroshication

Aging, History, Medicine and Literature, Medicine and Society, Stanford News

Stanford humanities scholar examines “the youngest society on Earth”

Stanford humanities scholar examines "the youngest society on Earth"

Young and old faces Over the past decades, our society has undergone a process of “juvenescence” that, according to Stanford professor Robert Harrison, PhD, makes it the “youngest on Earth.” For the first time in human history, he says, “the young have become a model of emulation for the older population, rather than the other way around” (as quoted in Stanford Report). The post-war period “has unleashed extraordinary youthful energies in our species and represents one of the momentous revolutions in human cultural history.”

Harrison is a professor of Italian literature whose new book Juvenescence: A Cultural History of Our Age examines the cultural forces that have brought about this development. The term “juvenescence” draws on the biological concept of neoteny, or the retention of juvenile characteristics through adulthood. Harrison’s research spans literature, philosophy, and evolutionary science.

His basic argument is that “juvenescence” can refer to either a positive or a negative change, and it isn’t clear which more accurately describes our current situation. The positive sense is one of cultural rejuvenation, while the negative one denotes juvenilization. Harrison explains, citing examples from his book:

Rejuvenation is about recognizing heritage and legacy, and incorporating and re-appropriating historical perspective in the present – like the Founding Fathers did when they created a new nation by drawing on ancient models of republicanism and creatively retrieving many legacies of the past… Unlike rejuvenation, juvenilization is characterized by the loss of cultural memory and a shallowing of our historical age.

…I feel ambivalent about where we are culturally in this age of ours.  It is hard to say whether we are on the cusp of a wholesale rejuvenation of human culture or whether we are tumbling into a dangerous and irresponsible juvenility.

Several aspects of our society suggest juvenilization. Most citizens of the developed world today enjoy the luxury of remaining childishly innocent about what they operate, consume, and depend on in daily life, while “in terms of dress codes, mentality, lifestyles and marketing, the world that we live in is astonishingly youthful and in many respects infantile.” Our culture’s emphasis on innovation and change honors the youthful drive that brings renewal and progress, but, without firm roots in the stability and wisdom of older generations and longstanding institutions, this risks being a meaningless chase after novelty. Youth’s genius is a luxury that requires solid foundations.

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History, Medicine and Society, Research, Stanford News

Stanford Egyptologist discovers that public health care has ancient roots

Stanford Egyptologist discovers that public health care has ancient roots

Anne Austin

Anne Austen, PhD, a post-doctoral researcher in Stanford’s history department, recently conducted the first detailed study of human remains at what is now called Deir el-Medina, an ancient town outside of the Valley of the Kings in Egypt. She found that these Egyptians likely had state-sponsored health care with “modern” benefits like paid sick days and clinics. They also felt a strong pressure to do grueling work, yet took care of their disabled and infirm.

Austen works in the relatively new field of osteo-archaeology, which enables researchers to deduce details about people’s daily lives from their skeletal remains. Archaeologists have always been interested in how remains are positioned relative to the rest of the site, but Austen tested the bones themselves to determine what diseases the people were experiencing, and then contextualized that information within the copious written records from Deir el-Medina in its heyday, when it was a bustling village of workers building the pyramids. She has added a new dimension to the picture of ancient medicine and care already gleaned from this uncommonly literate group’s receipts, personal letters, bills, prayers, and lawsuits, found on shards of clay or scraps of papyrus.

During her current tenure in the Andrew W. Mellon Fellowship of Scholars in the Humanities, she is continuing the PhD research she conducted in 2012 while at UCLA. In a Stanford News piece, she commented, “The more I learn about Egypt, the more similar I think ancient Egyptian society is to modern American society. Things we consider creations of the modern condition, such as health care and labor strikes, are also visible so far in the past.”

Austin thinks that research about Egyptians is particularly compelling for thinking about today’s questions of wellness and social responsibility because they thought of health and disease in ways surprisingly similar to our own. In contrast to the Greeks, who, as Austin points out in the article, thought of disease as an imbalance of the body’s four fluid humors, Egyptians thought of disease as a contamination, a foreign substance that must be purged. This is essentially analogous to modern germ theory. Furthermore, they negotiated the question that underlies much current American discussion about healthcare: Who is responsible for whose health, and why? Austen explains:

At Deir el-Medina, we see two health care networks happening. There’s a professional, state-subsidized network so the state can get what it wants – a nice tomb for the king. Parallel to this, there’s a private network of families and friends. And this network has pressure to take care of its members, for fear of public shaming, such as being divorced for neglect or even disinherited.

Photo courtesy of Anne Austin

In the News, Medicine and Society, Mental Health, Pediatrics

Advice and guidance on teen suicide

Advice and guidance on teen suicide

12389778613_ed6496a72f_zNot again, I thought as I read the opening line of a recent Palo Alto Weekly op-ed: “As a community we are grieving.” Reading further, my fears were confirmed: Now, additional teens have died by suicide in this California city.

A handful of years ago, I was a reporter for the Weekly. I was so grateful to cover city government, rather than schools — what a pressure cauldron, I thought at the time. As a teen, I too struggled with perfectionism, the drive to earn straight As and attend a top college, while excelling at extracurriculars. How awful to be surrounded by others like me, I thought.

Of course this is a one-dimensional glimpse at the problem. Suicides aren’t explained by perfectionism or academic stress and they certainly aren’t a Palo Alto-only problem. Shashank Joshi, MD, a child psychiatrist with Lucile Packard Children’s Hospital; Palo Alto Medical Foundation physician Meg Durbin, MD; and Sami Harley, a mental-health specialist, discuss this and other issues in a piece written to offer guidance to the saddened community. “Suicide does not have a single ’cause.’ Many factors and life circumstances must be taken into account,” they write.

They go on to clarify misperceptions about depression, an underlying condition that can make suicide or suicidal thoughts more likely:

Depression isn’t something you can or must just ‘deal’ with on your own… Though positive thinking can be an important part of having a healthy and resilient life, positive thinking by itself does not treat clinical depression. Talk therapy with antidepressant medications, if needed, are the only proven treatments for teen depression.

These local experts have held depression education and suicide-prevention training sessions with several thousand students at the two Palo Alto public high-schools since 2010. “Solutions must come from all those who interact with youth, including schools, parents and family, friends, medical and mental health providers, community and faith leaders and mentors,” they conclude.

Previously: “Every life is touched by suicide:” Stanford psychiatrist on the importance of prevention, Lucile Packard Children’s Hospital partners with high schools on student mental health programs  and Volunteers watch train crossings to prevent suicides
Photo by jimmy brown

Events, Global Health, HIV/AIDS, LGBT, Medicine and Society

Changing the prevailing attitude about AIDS, gender and reproductive health in southern Africa

Changing the prevailing attitude about AIDS, gender and reproductive health in southern Africa

5015384107_517a74d0b5_zDuring the 1990s and early 2000s, HIV/AIDS pummeled through southern Africa killing thousands. Although the epidemic has abated somewhat, the disease is still spreading through certain communities, including the lesbian, gay, bisexual, transgender and intersex (LGBTI) population.

In Zimbabwe, where homosexuality is illegal and President Robert Mugabe has actively spoken out against the LGBTI community, health-care provider Caroline Maposphere works behind the scenes, trying to change the prevailing attitudes and laws without sparking a homophobic backlash like that in Uganda. Maposphere, who serves as a nurse, midwife, chaplain and gender advocate, will visit the Stanford campus this evening to discuss her efforts.

“She tells great stories about how you deal with the kind of social and community issues that lie around HIV prevention and gay and lesbian health issues in a very homophobic and resource-poor environment,” said David Katzenstein, MD, a Stanford infectious disease specialist who met Maposphere in 1992 while working on the Zimbabwe AIDS Prevention Project.

Preventing the spread of HIV in Zimbabwe isn’t as simple as handing out condoms or launching an education campaign, although those are key strategies, said Maposphere. The nation is poor, has few health-care facilities of any kind and LGBTI rights are non-existent. The traditional southern Africa culture view of homosexually, which was sometimes attributed to witchcraft, further complicates the issue.

“It’s very difficult to reach out with services to groups that are not coming out in the open,” Maposphere said. ”We try to reach out and remove some of the barriers through discussion rather than being outright confrontational.”

Maposphere often encounters LGBTI individuals who feel they have been shunned by God and have been excluded from their churches in the predominantly Christian nation. In an effort to offer spiritual guidance as well as health care, she earned a college degree in theology and hopes to explore the religious aspects of her work while at Stanford.

In addition, Maposphere is planning to connect with gay-rights activists here and learn effective methods for countering homophobia in her native country. ”I’m very hopeful that things will change,” she said.

The free discussion begins at 7:30 PM in the Vaden Education Center on the second floor of the health center on campus.

Previously: Remembering Kenyan statesman and Stanford medical school alumnus Njoroge Mungai, In poorest countries, increase in midwives could save lives of mothers and their babiesSex work in Uganda: Risky business and In Uganda, offering support for those born with indeterminate sex
Photo by Remi Kaupp

Ethics, Health Policy, In the News, Medicine and Society, Transplants

Moving the needle on organ donation

Moving the needle on organ donation

For the thousands of people on organ donation lists, news of an available heart, or lungs, or liver can’t come soon enough. But many don’t get that call in time. According to a new feature on The Atlantic’s website, 21 people die waiting for a transplant every day. That works out to more than 7,600 patients every year.

Unfortunately unless you’re personally touched by the issue… you don’t really think about it

Although many people say they support organ donation, in many countries, only a minority actually register as organ donors. (“Unfortunately unless you’re personally touched by the issue, unless you have a child that gets a virus and suddenly needs a new heart, you don’t really think about it,” one expert says in the piece.) It’s a paradox many people in the field are trying to unravel. The reasons they’ve uncovered so far include mistrust of medical professionals: Some people believe that if a medical team finds out that you’re an organ donor, they won’t work as hard to save your life, in order to harvest your organs. And how much TV a person watches can influence how much he or she trusts doctors. One study found that people who watched more of the TV series Grey’s Anatomy were more likely to mistrust doctors and nurses.

Religion also influences the picture, probably because of concepts of bodily integrity in the afterlife. Catholics are less likely to donate their organs, even though the Vatican officially supports organ donation.

So what can be done about the organ shortage? Some groups are working on solutions, as highlighted in the piece:

“What we’re trying to do in New York is move the cultural needle on the issue,” says Aisha Tator, executive director of the New York Alliance for Donation. “Organized tissue donation should be a cultural norm like we did with bike helmet and seatbelt interventions.” Her organization isn’t the only one. Throughout the United States there have been a smattering of recent educational campaigns and studies on their efficacy. Campaigns have targeted the young, the oldnursesDMV employees, and ethnic minorities who tend to donate less than white Americans or white Brits.

Another, more drastic change is to shift the U.S.’s current opt-in system to one that requires people to opt-out. Many experts point to Spain, which has an opt-out system – and one of the highest rates of organ donation. But the logistics of such a system would probably be difficult, best, to implement.

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Events, Health Costs, Health Policy, In the News, Medicine and Society, Stanford News

Experts discuss high costs of health-care – and what it will take to change the system

Experts discuss high costs of health-care - and what it will take to change the system

4386861133_5e79734a6f_zNew York Times reporter Elisabeth Rosenthal, MD, visited Stanford this week for a Health Policy Forum, “Can we put a price on good health? Controlling the cost of health care,” with Stanford health-policy researcher Doug Owens, MD.

Those who attended looking for answers, easy fixes, or a master villain were out of luck. Instead, attendees gained insight into a convoluted system that all agree is broken, yet no one has the total power, or know-how, to fix. Here’s Rosenthal:

The issues and the problems are so diffuse… There’s the tendency to be very reductionist – ‘Oh, it’s the hospital, it’s the insurance companies, it’s pharma’… We’re all so codependent and it’s all so intertwined.

Finances dictate what we do and the incentives are so powerful. The message to patients is that we’re responsible too.

So that complimentary coffee you might get in a hospital lobby? Not actually free, Rosenthal said. She knows: While reporting for the well-known series “Paying Till It Hurts” she has talked to scores of patients and doctors and insurance representatives and policy-makers.

The main problems with the American health-care system are cost, quality and access, Owens said. The Affordable Care Act improved access, yet did little to lower costs or improve quality, he said.

And costs will continue to escalate if all the players remain most responsive to economic pressures, Rosenthal said. “Physicians feel like their income is being squeezed. Hospitals are better prepared to push back, and hospitals and physicians are looking to recoup some of that lost income in other ways. What’s lost in that very real tug of war is that patients are held hostage in the middle. That’s what’s distressing,” she said.

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Behavioral Science, Cardiovascular Medicine, Medicine and Society, Research, Stanford News

The lonely are more likely to die. But why?

The lonely are more likely to die. But why?

11317715623_e27537b3f3_zLoneliness isn’t healthy — most everyone knows that. But why exactly does isolation lead to disease, or even death? Stanford researcher Sylvia Kreibig, PhD, set out to answer that question by digging through data from the Heart and Soul Study, an inquiry that followed more than 1,000 coronary heart disease patients for about 10 years, starting in 2000.

Turns out that socially isolated patients are 61 percent more likely to die in any given year than other patients, Kreibig and her team found. Yet you don’t need many friends to stave off the ill effects of solitude. Those with at least one to three regular contacts fared no better than the most-social butterfly. Even tossing in factors that affect mortality such as age and weight didn’t affect general conclusion: friendless folks die sooner. But why?

Kreibig’s team, which included Stanford psychologist James Gross, PhD, delved deeper to figure it out.

It isn’t depression. Depression is independently related to mortality, but it couldn’t explain the link between solitude and risk of death. Instead, Kreibig and colleagues found a strong link between several behavior factors such as smoking, omega-3 concentration (a representative of diet quality), and medication adherence and isolation.

“If you are more integrated, you have people around that look after you and care for you, making sure you’re eating healthy foods, not smoking and taking medications as directed,” Kreibig told me. “You yourself as a patient actually have a lot of control over factors that affect your health… Just by integrating some salmon into your diet, you have a better chance of survival.”

The team classified 1,019 patients into four categories of social integration (low, medium, medium-high and high), based on whether or not they had a partner, strength of linkages with family and friends and membership in religious congregations and community groups. Patients in the low category were more likely to smoke, eat unhealthy foods and skip their medications, the study found.

She cautioned that the study, which appears in this month’s issue of Psychosomatic Medicine, demonstrated correlation, not causation. In addition, the patients were primary male and, as they suffered from heart disease, could be affected differently than healthy, or younger, patients.

Next, Kreibig said she plans to examine the emotions related to social isolation and their effect on health.

Previously: The importance of human connection as part of the patient experience, How social media and online communities can improve clinical care for elderly patients and How loneliness can impact the immune system
Photo by Alex Krasavtsev 

Cancer, Genetics, Medicine and Society, Research, Stanford News, Women's Health

Screening could slash number of breast cancer cases

Screening could slash number of breast cancer cases

dna-163466_1280Should every newborn baby girl be genetically screened to prevent breast cancer? Obviously, that isn’t cost-effective — yet. But if it were, would it be worthwhile?

A previous study said no. But research published today in Cancer Epidemiology, Biomarkers & Prevention by Stanford researchers suggests otherwise.

Led by senior author Alice Whittemore, PhD, the team examined 86 gene variants known to increase the chances of breast cancer. They created a model that accounted for the prevalence of each variant and the associated risk of breast cancer. Each possible genome was then ranked by the likelihood of developing breast cancer within a woman’s lifetime.

“It was quite a computational feat,” Whittemore told me.

Working with Weiva Sieh, MD, PhD; Joseph Rothstein, PhD; and Valerie McGuire, PhD, the team found that the riskiest top 25 percent of gene combinations predicted 50 percent of all future breast cancers.. Those women would then have the opportunity to get regular mammograms, watch their diets and make childbearing and breast-feeding decisions with the awareness of their higher risk. Some women might even select, as Angelina Jolie did quite publicly, to have their breasts removed.

“The main takeaway message is we can be more optimistic than previously predicted about the value of genomic sequencing,” Whittemore said. “But we still have a way to go in preventing the disease.”

“Our ability to predict the probability of disease based on genetics is the starting point,” Sieh said. “If a girl knew, from birth, what her inborn risk was, she could then make more informed choices to alter her future risk by altering her lifestyle factors. We also need better screening methods and preventative interventions with fewer side effects.”

“We want to focus on those at the highest risk,” Whittemore said.

Previously: Despite genetic advances, detection still key in breast cancer, NIH Director highlights Stanford research on breast cancer surgery choices  and Breast cancer awareness: Beneath the pink packaging 
Photo by PublicDomainPictures

Health Costs, Health Policy, Medicine and Society, Public Health, Research, Stanford News

Competition keeps health-care costs low, Stanford study finds

Competition keeps health-care costs low, Stanford study finds

The term market competition usually sparks a mental image of business suits and ties, not white coats and stethoscopes. Yet even the health-care system plays by the rules of the economic market place.

A new study, conducted by Stanford researchers Laurence Baker, PhD; M. Kate Bundorf, PhD; and colleagues, provides important evidence that less competitive health-care markets are more likely to charge higher prices for office visits. The article was published today in The Journal of the American Medical Association.

There’s a push through the private sector and through Medicare to encourage the formation of larger practices, which could improve the efficiency of the health-care system, said Bundorf.  The researchers sought to understand what effect these larger practices have on health-care spending.

To make the comparisons, the researchers used a database to establish the prices paid by PPOs for the most commonly billed office visits within 10 physician specialties. Next, they adapted a standard economic competition measure to calculate physician practice competition for different U.S. regions.

As I wrote in a release today:

Studying a measure that averaged prices across multiple types of office visits, in their most conservative model, being in the top 10 percent of areas with the least competition was associated with 3.5 to 5.4 percent higher mean price. The researchers point out that in 2011, privately insured individuals in the United States spent nearly $250 billion on physician services. In that context, these small percentage increases could translate to tens of billions of dollars in extra spending.

The study’s findings show the importance of developing policies that will encourage a balance between the quality of care and health-care spending. As Baker explained, “Sometimes it can be tempting to say our goals for the health care system should be only about taking care of patients and doing it as well as possible – we don’t want to worry about the economics. But the truth is we do have to worry about the prices because the bill does come even if you wish it wouldn’t.”

Previously: What’s the going rate? Examining variations in private payments to physicians

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