Published by
Stanford Medicine

Category

Medicine and Society

Cardiovascular Medicine, Health and Fitness, Medicine and Society, Research

Study questions safety of excessive exercise for heart attack survivors

Study questions safety of excessive exercise for heart attack survivors

Scope runningA recent article in PsychCentral highlighted findings published in the Mayo Clinic Proceedings offering more evidence that extreme exercise for heart attack survivors could put them at a higher risk for a cardiovascular event.

Paul Williams, PhD, staff scientist for the Life Sciences Division of Lawrence Berkeley National Laboratory, and Paul Thompson, MD, a cardiologist at Hartford Hospital, conducted a long-term study looking at the relationship between exercise and cardio-disease related death in about 2,400 physically-active heart attack survivors. The study reported on data taken from the National Walker’s and Runners’ heath studies at Lawrence Berkeley Laboratory.  From the piece:

“These analyses provide what is to our knowledge the first data in humans demonstrating a statistically significant increase in cardiovascular risk with the highest levels of exercise,” say Williams and Thompson.

“Results suggest that the benefits of running or walking do not accrue indefinitely and that above some level, perhaps 30 miles per week of running, there is a significant increase in risk.

Competitive running events also appear to increase the risk of an acute event.”

However, they point out that “our study population consisted of heart attack survivors and so the findings cannot be readily generalized to the entire population of heavy exercisers.”

On the other end of the spectrum, the journal also included research from Spain related to mortality in elite athletes. The investigation included over 42,000 top athletes, of which 707 were women, and examined the beneficial health effects of excessive exercise, particularly in decreasing cardiovascular disease and cancer risk. Senior investigator Alejandro Lucia, MD, PhD, said in the article, “What we found on the evidence available was that elite athletes (mostly men) live longer than the general population, which suggests that the beneficial health effects of exercise, particularly in decreasing cardiovascular disease and cancer risk, are not necessarily confined to moderate doses.”

With the majority of Americans still at risk for obesity, cardiovascular disease and diabetes, regular moderate exercise is still recommended by these researchers. As Hippocrates, the father of medicine, once said, “Everything in excess is opposed to nature.”

Previously: Study reveals initial findings on health of most extreme runners, The exercise pill: A better prescription than drugs for patients with heart problems?, Examining how prolonged high-intensity exercise affects heart health and Study reveals initial findings on health of most extreme runners
Photo by: Matthias Weinberger

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.

***

From August 11-25, Scope will be on a limited publishing schedule. During that time, you may also notice a delay in comment moderation. We’ll return to our regular schedule on August 25.

Genetics, Humor, Medicine and Society, Science, Stanford News

Using epigenetics to explain how Captain America and the Incredible Hulk gained their superpowers

Using epigenetics to explain how Captain America and the Incredible Hulk gained their superpowers

When I was kid I used to watch the Incredible Hulk on TV and wait for Bruce Banner to fly into a rage, his muscles inflating like balloons, pants torn to shreds while his entire body turns green as he transforms into the Hulk. As I grew up, and learned more about the advances in genetics, it never occurred to me that cutting-edge genome-editing techniques could explain the scientific principles behind the Hulk’s metamorphosis or his fellow Marvel Comics star-spangled hero Captain America. In a recent Stanford Report story,  Sebastian Alvarado, a postdoctoral research fellow in biology, creatively applies the concepts of epigenetics to illuminate the process by which average Joes become superheroes.

As Alvarado notes in the piece and above video,  over the past  70 years scientists have developed tools for selectively activating and deactivating individual genes through chemical reactions, a process termed epigenetics. Similar to flipping on a light, switch gene expression can be “turned on” or “turned off. “We have a lot of genome-editing tools – like zinc finger nucleases, or CRISPR/Cas9 systems – that could theoretically allow you to epigenetically seek out and turn on genes that make your muscles physically large, make you strategically minded, incredibly fast, or increase your stamina,” he said.

In the case of Captain America, the process of deliberately switching on and off genes could offer a real-world explanation as to how scrawny Steve Rodgers gained extraordinary, strength, stamina and intelligence after being injected with “Super Solider Serum” and then blasted with  “Vita-Rays.” When it comes to Bruce Banner, a little more creative license is required. Alvarado’s theory is:

First, when gamma radiation hits DNA, it breaks the molecule’s double-stranded, ladder-like helix, a process known as chromothripsis. Your body can repair a few breaks without significant loss of function.

If many breaks occur – say, if you were caught in a giant gamma explosion – the repairs can become sloppy, and new instructions can be keyed into the genetic code. Alvarado suggested that it’s possible that when Banner’s DNA reassembled after the initial blast, it now included a handful of epigenetic switches. Instead of the switches being activated by light, however, the hormones produced when Banner is angry might flip the genetic switches to reconfigure his DNA to transform him into the big, green Hulk.

As for the Hulk’s skin turning green, anyone who has suffered a nasty bruise has firsthand knowledge of the process that might be behind this transformation. When you bruise, red blood cells at the point of injury die and the oxygen-carrying molecule on their surface, hemoglobin, begins to break up. One of hemoglobin’s metabolites, Alvarado said, is a molecule called biliverdin, which can make the blood appear green and is responsible for the avocado hue at the edge of a bruise.

Giant gamma explosion and epigenetics aside, there’s one question that has scientifically stumped Alvarado: How do the Hulk’s pants stay on after every transformation?

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.

***

From August 11-25, Scope will be on a limited publishing schedule. During that time, you may also notice a delay in comment moderation. We’ll return to our regular schedule on August 25.

Ethics, Genetics, Medicine and Society

Film documents rise and fall of a genome matching service – and poses tough ethical questions

Film documents rise and fall of a genome matching service - and poses tough ethical questions

Jesse_01When I think of “science fiction,” I picture three-eyed aliens with purple-and-gold tentacles — not the disturbing demise of a man, and a company, depicted in the film “The Perfect 46.”

Nor do I expect to ponder the ethics of a company that strives to produce genetically “pure” children.

Yet this is precisely the type of science fiction filmmaker Brett Ryan Bonowicz dished up to a sold-out Stanford crowd last week. Following the film, an all-star panel of genetics experts fielded questions.

The film’s premise is simple, and alluring. People can send their sequenced genome, along with their partner’s,  in to a company called The Perfect 46 and allow its proprietary algorithm to figure out if their children will be born genetic-defect free — or not.

“Jesse [Darden, the company’s CEO] wasn’t going to cure the diseases, he would just breed them out. It made a lot of people uncomfortable,” said one of the characters in the film.

So uncomfortable, in fact, that the company, and its leader Jesse Darden, played with a standout performance by actor Whit Hertford, unravels quite thoroughly – with Darden’s painful personal and professional demise forming the meat of “The Perfect 46’s” somewhat-tortured plot.

For me, the ethical quandary is a no-brainer: perfect – what fun is that? My husband and I are both far from perfect, and if we had a perfect child, it certainly wouldn’t be anything like us.

More seriously, however, the film poses thorny questions about the future of consumer genetics, a boom-and-bust field that’s both promising and terrifying. “The Perfect 46” doesn’t answer these questions, but the post-screening panelists delved into some of them.

During the talk, the experts made  it clear the technology featured in the film isn’t there – yet. Right now, if scientists sequence a genome , they don’t know the meaning of the many versions, or allele , of the gene that pop up. “Often, we don’t know if it’s disease-causing or not,” said panel member Michael Snyder, PhD, Stanford professor and chair of genetics.

Although the film takes place in the “near future,” corporations that provide basic genetic screening are already available, the experts said. And corporations may not be providing adequate counseling for potential parents, panel member Sandra Lee, PhD, a senior researcher at the Stanford Center for Biomedical Ethics, pointed out.

The Stanford-heavy audience seemed to dig the movie, but I thought the film would be more effective if its lessons were a little subtler and its pace a bit quicker.

Still, the questions it asks are real, even pressing, and not science-fictiony at all.

Becky Bach is a former park ranger who now spends her time writing, exploring, or practicing yoga. She’s currently a science writing intern in the medical school’s Office of Communication & Public Affairs.

Previously:Stanford patient on having her genome sequenced: “This is the right thing to do for our family”, Stanford geneticist discusses genomics and medicine in TEDMED talk, New recommendations for genetic disclosure released and A conversation about the benefits and limitations of direct-to-consumer genetic tests
Screenshot of movie courtesy of Clindar

From August 11-25, Scope will be on a limited publishing schedule. During that time, you may also notice a delay in comment moderation. We’ll return to our regular schedule on August 25.

Ethics, Events, Health Policy, Medicine and Society, Public Health, Transplants

Stanford Health Policy forum on organ-donation crisis now available online

Stanford Health Policy forum on organ-donation crisis now available online

The latest Stanford Health Policy Forum, which focused on ways to end our country’s organ-donor shortage, is now available online. More than 100,000 Americans currently need organ transplants, and the panelists discussed a variety of solutions for solving the problem. Among the ideas brought to the table was a compensation system for donors – an option that was also the focus of an article in today’s San Francisco Chronicle.

Previously: At Stanford Health Policy Forum, panelists dig into the issue of organ donationHow can we end the donor organ shortage?, Stanford visiting professor and founder of kidney-exchange program wins Nobel economics prize and One gift saves three young lives 

Medicine and Society, Podcasts, Public Health

The vanishing U.S. surgeon general: A conversation with AP reporter Mike Stobbe

The vanishing U.S. surgeon general: A conversation with AP reporter Mike Stobbe

surgeon general drawing - small

There is currently no U.S. Surgeon General. Like everything else in Washington today, a confirmation vote by the U.S. Senate on President Obama’s choice, Harvard physician Vivek Murthy, MD, has been squashed by politics. Last spring, White House press secretary Jay Carney said that the administration was “recalibrating and assessing our strategy on moving forward with the nominee.” In March, The Hill newspaper reported that up to 10 Senate Democrats signaled they would oppose Murthy’s confirmation after the National Rifle Association made it clear Murthy’s support for bans of certain types of firearms and ammunition purchases made him an unthinkable choice.

Now if you’ve forgotten there even is a position called the U.S. Surgeon General post, think C. Everett Koop, MD, or Joycelyn Elders, MD. Koop and Elders were two recent appointees who used their bully pulpit to raise a national discussion about AIDS and teen pregnancy. (Both were  lightening rods within their respective administrations – Koop in Reagan’s and Elders in Clinton’s. Elders was eventually dismissed by the White House after wading into too many contentious issues.)

Does the position even matter anymore? Associated Press medical reporter Mike Stobbe thinks it does. He’s written a fascinating book (Surgeon General’s Warning, University of California Press) about the history of the position and those who served. The book explains how the surgeon general became the most powerful and influential public health officer in the country and how those powers were later stripped away. An excerpt from Stobbe’s book appears in the current issue of Stanford Medicine magazine, where he catalogs the ups and downs of the individuals who held the position. The strong ones and the weak ones. Those who made a difference and those who faded away in controversy or without making a mark on the nation’s public health dialogue.

He writes, “Surgeon generals have played that crusader role better and more often than any other national public health figure. Absent such a crusader, the public’s health is prey to the misinformation and self-interest of tobacco companies, snake-oil salesmen and other malefactors.” Listen to my 1:2:1 podcast with Stobbe to hear more of his thoughts.

Illustration, which originally appeared in Stanford Medicine, by Tina Berning

Events, Medicine and Society, Stanford News

On death and dying: A discussion of “giving news that no family members want to hear”

On death and dying: A discussion of "giving news that no family members want to hear"

The standing room only crowd at the Stanford Humanities Center had come to hear physicians read their own writing about the most difficult of topics: “I Am Afraid I Have Bad News: Death and Dying in Medicine.” The enthusiastic response to the topic demonstrated the interest in and need for such a forum. “This is a topic we just don’t talk about enough, in medicine and in society,” said Ward Trueblood, MD, a member of Stanford’s Pegasus Physician Writer’s group who curated the event.

Trueblood’s own experiences as a trauma surgeon, particularly during the Vietnam War, affected him deeply. “When I went to medical school, they didn’t teach you about death and dying,” he explains. Trueblood has found writing to be a powerful way to process his experiences. His memoir, Blood of the Common Sky: A Young Surgeon in Vietnam, will be published this year, and his book of poetry To Bind Up Their Wounds is available on Amazon. Trueblood appreciated being able to give fellow physicians an opportunity to share their experiences with death and dying through personal poetry and essays.

Gregg Chesney, MD, a critical care fellow, read two poems, including “Lost in Translation”:

In trying to explain how “she hit the floor with a thud”

now means “she never woke up

and never will,” something was lost.

Yes, that is her heart tracing its beat across the monitor, but that swollen tangle

of blood, wrapped and knotted at the base of her brain

has pressed the leafless stalk of her medulla and left her

brain dead.  There is no one-more-test, no

chance-for-recovery, but at 2am, rendered in secondhand Mandarin,

that point might be missed, or left to dangle precariously,

soured and unplucked,

as he works out how to raise a 3 year-old on his own.

As Chesney finished the poem, his six-month old son cooed in his mother’s arms. The irony of the moment was not lost on the audience, as they contemplated the fate of the young father in Chesney’s poem.

Bruce Feldstein, MD, Stanford’s hospital chaplain, read “At My Father’s Bedside,” in which he shared what he had learned from his patients with his dying father:

The moment itself is peaceful, I’m told. No fear. Simply letting go. Smooth, like a hair being pulled from milk… You know, we human beings have been dying for a long time. Your body has a natural wisdom built right in for shutting itself down. The body knows just what to do. And there are medicines along the way to keep you comfortable.

During the Q&A session, an audience member asked Feldstein if there was anything he wished patients knew about their physicians. “Yes, how much doctors care,” Feldstein responded. “And that this effects them too. How difficult it can be to be the medical professional in that instance, giving news that no family members want to hear about their loved one.”

Continue Reading »

Medicine and Society, Pregnancy, Research

Study offers clue as to why parents of daughters are more likely to divorce

Study offers clue as to why parents of daughters are more likely to divorce

poppy2Here’s something that caught my attention this morning (likely because I’m the mom of two girls): A new study provides a possible reason behind reports that parents with firstborn daughters are more likely to divorce than those with firstborn sons. According to researchers from Duke and University of Wisconsin-Madison, it could be due to girls being “hardier than boys, even in the womb.”

A recent university release further explains:

Throughout the life course, girls and women are generally hardier than boys and men. At every age from birth to age 100, boys and men die in greater proportions than girls and women. Epidemiological evidence also suggests that the female survival advantage actually begins in utero. These more robust female embryos may be better able to withstand stresses to pregnancy, the new paper argues, including stresses caused by relationship conflict.

Based on an analysis of longitudinal data from a nationally representative sample of U.S. residents from 1979 to 2010, Hamoudi and Nobles say a couple’s level of relationship conflict predicts their likelihood of subsequent divorce.

Strikingly, the authors also found that a couple’s level of relationship conflict at a given time also predicted the sex of children born to that couple at later points in time. Women who reported higher levels of marital conflict were more likely in subsequent years to give birth to girls, rather than boys.

“Girls may well be surviving stressful pregnancies that boys can’t survive,” Hamoudi said. “Thus girls are more likely than boys to be born into marriages that were already strained.”

The intriguing findings appear in the journal Demography.

Image courtesy of Michelle Brandt

Medical Education, Medicine and Society, SMS Unplugged

The woman in the elevator: dealing with death in medical training

The woman in the elevator: dealing with death in medical training

SMS (“Stanford Medical School”) Unplugged was recently launched as a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

flowersAlmost every patient I meet gives me the gift and curse of forcing me to confront a new side of my own vulnerability. I see new ways to die, new ways to suffer, new kinds of setbacks or losses. Of course, very little of this knowledge is technically new: My mother taught me that everyone dies, life isn’t fair, and so on. But since starting clinical training, what is new is the intimacy with which I live that knowledge.

On my neurology rotation, I was sent to examine a little boy in the ICU who had become unresponsive. I will never forget what I saw when I lifted his eyelids. His right pupil was rapidly changing shape from lumpy oval, to diamond, to a slit like a cat’s eye.

I alerted my attending, who somberly explained that that the boy’s brain was probably herniating – in other words, it was under so much pressure that it was being pushed into places it shouldn’t go. A few minutes later, a CT scan showed massive bleeding in his brain. The neurosurgeons were called, but determined they couldn’t save his life. As we left, a curtain was pulled in front of the room.

A few minutes later, already back to work in other parts of the hospital, my team stepped into an elevator. Before the door could close, a young woman ran in behind us. As the elevator ascended, she sunk to the ground and wailed, “Am I going to lose my baby? Please don’t let me lose my baby.” When the doors opened, she sprinted toward the ICU. With horror, I realized the woman was my patient’s mother. Her baby was already gone.

The next morning was a gorgeous Saturday. I had the weekend off so I put on my grungiest clothes and headed to my community garden plot, determined to separate myself from the week’s experiences. Weeds had crept in during a few especially difficult clinical months. I placed a shovel in the dirt, put all my weight on it – and it didn’t budge. I tried again, but the soil wouldn’t yield. I discarded the shovel and reached to pull a huge weed. The dead branches crinkled off in my hand, roots still entrenched in the hard, dry California earth. I sat down among the weeds, defeated, face in my hands.

A woman working another plot – a fellow student gardener I had never met – walked over and asked, “Are you okay?”

“I’m just not strong enough to do this. I should give up my plot.”

“I’ll help you clean it up,” she offered.

“Thanks… Sorry… I’ve just had a bad week.”

“Lots of final exams?”

“No. But I watched a little kid die yesterday.”

My new friend didn’t miss a beat. She knelt down, gave me a hug and said, “You are strong enough. Let’s get your garden cleaned up.”

I believed her, and kept gardening. I proudly told myself I had found an outlet to successfully cope and put the horrible experience behind me.

But it turns out things like watching that child die aren’t processed and compartmentalized so neatly, and can come back to haunt even the best and most personal times. A few months later, on the night before my daughter was born, my husband and I arrived at the hospital full of excitement, and stepped onto the elevator on our way to Labor and Delivery. But as the doors slid shut, I couldn’t suppress the mental image of the last time I rode that same elevator: a desperate young woman on her knees, repeating “Am I going to lose my baby?” For the thousandth time in medical school, I knew the fragility of my own blessings.

I have come to believe that coping doesn’t mean finding a way to separate “personal” life from “professional” experiences. There is no healthy coping mechanism that will let me walk away from experiences like this unaffected. Instead, I just keep telling stories like this one over and over – to myself, my friends and family, and now you – hoping that in the retellings I will find some meaning, some wisdom, some gratitude, or some peace.

Jennifer DeCoste-Lopez is a final-year Stanford medical student applying to residency in Pediatrics this year. She was born and raised in Kentucky and went to college at Harvard. She currently splits her time between clinical rotations, developing a new curriculum in end-of-life care, and caring for her young daughter.

Photo courtesy of Jennifer DeCoste-Lopez

Ethics, Genetics, Medicine and Society, Parenting, Pediatrics, Stanford News

Genome testing for children: What parents should consider

Genome testing for children: What parents should consider

Genome testing: Would you do it?

Okay, next question: Would you have your child’s whole genome tested?

In the recent issue of Stanford Medicine News, Louanne Hudgins, MD, chief of medical genetics and director of perinatal genetics at Lucile Packard Children’s Hospital Stanford, weighs in on the issue: “I strongly advise parents against whole-genome testing for their children unless performed in the context of a medical evaluation following formal counseling regarding its utility, limitations and possible unrelated findings,” she said.

In the piece, Hudgins comments on privacy and ethics considerations, and explains why what we partially know (for instance, if your child is found to have a gene predisposing him or her to a disease) can sometimes provide more cause for worry or false hope than helpful or conclusive information.

The whole piece (a short one) is worth a read.

Previously: Stanford patient on having her genome sequenced: “This is the right thing to do for our family”, Personal molecular profiling detects diseases earlier, Stanford geneticist discusses genomics and medicine in TEDMED talk and Medical practice, patents, and “custom children”: A look at the future of reproductive medicine

Medicine and Society, Science, Stanford News, Technology

Residential learning program offers undergrads a new approach to scientific inquiry

Residential learning program offers undergrads a new approach to scientific inquiry

SIMILE studentsTwenty-two Stanford freshmen spent the last school year living, studying and socializing immersed in scientific inquiry. In its inaugural year, the residential education program SIMILE: Science in the Making Integrated Learning Environment drew interest from and selected a diverse group representative of the student body, many of whom don’t intend to become physicians or scientists or even plan to major in related fields. SIMILE students take pre-major requisites including writing, rhetoric and breadth requirements focused on the historical, cultural and social contexts of science. They also complete hands-on projects, attend field trips and regularly interact with faculty and guest lecturers in the program. Housed in the all-freshman Burbank House with ITALIC (Immersion in the Arts: Living in Culture), SIMILE students attend lectures and discussion sections in-house and have some shared activities with the new arts-focused residential academic program there.

A recent Stanford Report piece notes:

In the fall, Paula Findlen, [PhD,] a professor of Italian history and director of SIMILE, and Reviel Netz, a professor of classics, team-taught Inventing Science, Technology and Medicine. The class explored how those scientific fields emerged from the human desire to understand nature – empirically, mathematically and philosophically – and to control the environment.

Findlen said the program offered a “big picture view” of how human interactions have changed over the centuries, using history as the lens to understand the invention of science, technology and medicine.

“Fundamentally, SIMILE is a program about the history of knowledge,” she said.

Previously: Exploring global health through historical literatureThoughts on the arts and humanities in shaping a medical career and Intersection of arts and medicine a benefit to both, report finds
Photo by Jeremy Moffett

Stanford Medicine Resources: