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Medicine and Society, Stanford News

Stanford network launched to connect musicians, music lovers

Stanford network launched to connect musicians, music lovers

Minor playing celloThis week marks the launch of the Stanford Medicine Music Network, an online meeting place for musicians in the Stanford health-care community looking to share their love of music. An e-mail invitation went out yesterday from SMMN (pronounced “summon”) co-founders, asking for musicians and music lovers to join in to build community and provide opportunities for other musicians to play and perform with them.

The goal of the network is for musicians to eventually perform in the surrounding communities, particularly in schools and nursing homes where music has been cut back or is not available. There’s more about SMMN in this Inside Stanford Medicine story.

Jacqueline Genovese is assistant director of the Arts, Humanities, and Medicine Program within the Stanford Center for Biomedical Ethics.

Previously: Intersection of arts and medicine a benefit to both, report finds, What physicians can learn from musicians, More than medicine: Medical students embrace their artistic passions through unique program, The benefits of the arts to both patient and practitioner and Stanford neurologist rocks out for science
Photo of Lloyd Minor, MD, dean of the School of Medicine, by Mark Hanlon

Events, Medicine and Society, Stanford News

Stanford Medicine community gathers for Health Matters event

Stanford Medicine community gathers for Health Matters event

Health Matters attendeeWhere else can you spend a Saturday morning learning from an NFL Hall of Famer what to look for when you suspect a concussion in your child, getting unique perspectives from a Pulitzer Prize-winning author about the biography of cancer or listening to tips on maintaining your cognitive health from an expert in the field?

On Saturday, Stanford Medicine hosted a free community day at the Li Ka Shing Center for Learning and Knowledge. Members of the communities surrounding the Stanford campus came to interact with School of Medicine faculty leaders, hear about the latest discoveries in medicine and explore an interactive pavilion that highlighted advances in medical technology, disease prevention and treatment. This year’s Health Matters, which also featured a Med School Morning program for teens, attracted more than 500 guests to the Stanford campus for a day of learning, fun and exploration.

The event featured keynote speaker Siddhartha Mukherjee, MD, PhD, Pulitzer Prize winning author of the New York Times bestseller The Emperor of All Maladies. Mukherjee, who attended Stanford as an undergrad, shared his view of cancer being one of humanity’s greatest challenges and discussed the long-recorded history of the disease. Mukherjee, speaking from a stage in the Berg auditorium – named after his mentor, the Nobel Prize-winning chemist Paul Berg, PhD – eloquently described cancer as “a disease in which normalcy and illness are intertwined.” But also remarked that, “There is hope as we enter the age of targeted therapy.”

Young and SteinbergOther Stanford Medicine faculty gave presentations on topics ranging from sleep health and dementia prevention to big data for biomedicine and mental health and well-being. One highly attended session included neurosurgeon Gary Steinberg, MD, PhD, and former San Francisco 49er Steve Young. The two, who discussed sports-related concussions and brain injuries, also introduced the new Stanford Concussion and Traumatic Brain Injury Center. Set to open in the coming year, the center will provide a national center for the treatment of athletes, veterans and the community with state-of-the art diagnostic technology and availability 24 hours a day, seven days a week. Young said of the new center, “The fact that local parents will now have a resource,24/7 to bring their child and get some real help – that’s a really good thing.”

girl with FoldscopeIn addition to attending sessions, many explored the Health Pavilion exhibits featuring interactive displays from throughout Stanford Medicine. Guests were excited to see up-close the work of Manu Prakash, MD, PhD, to get hands-on with his revolutionary “Foldscope” and learn more about it’s potential applications. The Stanford Clinical Anatomy division’s virtual and 3D imaging technologies were a hit among kids and adults alike.  But the favorite of the day seemed to be Stanford Life Flight and their crew who, in celebration of the program’s 30-year anniversary, gave tours of the helicopter to many lucky guests.

To learn more about the program and speakers and view recordings of some of the sessions, visit the event website. For information on future community events and to hear more about wellness topics and medical innovations at Stanford Medicine, follow @StanfordHealth on Twitter.

Eileen DiFranco is director of communications and media in the Office of Medical Center Development at Stanford.

Previously: Stanford Life Flight celebrates 30 years, Stanford Medicine to open its doors to community during Health Matters event, Stanford bioengineer develops a 50-cent paper microscope and Cancer’s Pulitzer Prize winner: Siddhartha Mukherjee, MD
Photos by Alex Johnson

Clinical Trials, Health Disparities, Medicine and Society, Research

High rates of incarceration among black men could be skewing study results

High rates of incarceration among black men could be skewing study results

prison bars

Few headlines have grabbed my attention like this one did today: “Doctors can’t research the health of black men, because they keep getting sent to prison.” The Vox article focused on a new Yale study that, in the words of writer Dara Lund, “suggests that some of the biggest medical studies of the last few decades may have seriously distorted data on African-American men.”

For the study, researcher Emily Wang, MD, MAS, and colleagues examined fourteen long-term trials that began enrolling participants between 1972-2000. They concluded that the high rates of incarceration among black men at this time (as of 2001, one in six black men had been incarcerated) “may have accounted for up to 65 percent of the loss to follow-up among black men in these studies.” Why is this important? As the researchers describe in the paper, which appears in Health Affairs:

The implications of having a disproportionate number of black men drop out of prospective cohort studies because of incarceration are significant, even though the differences between loss to follow-up are not always large or significantly different between black men, white men, black women, and white women. Conditions such as cardiovascular disease and sickle cell disease are more common in black men than in white men and have complex factors that influence morbidity and mortality. This makes it important for analysts to have access to a large number of cases so that they can adjust for possible confounders.

And:

The likely high association between imprisonment and being lost to follow-up in these studies may yield underpowered and biased estimates for black men. Furthermore, participants who are incarcerated are more likely to be sick than are participants who have never been incarcerated. This difference increases the likelihood that disease rates and progression of disease in blacks and black-white disparities will be underestimated.

One possible solution, Wang and her co-authors note, is for incarcerated people to be allowed to continue their participation in a study. But Lind reports that “for now, there doesn’t appear to be much momentum behind [this].”

Previously: NPR explores the need for improving diversity in clinical trials, Study shows deaths from acute leukemia higher in minority patients, A conversation with Augustus White, a pioneer for underrepresented minorities and Surgeon’s memoir calls for an end to health disparities
Photo by Martin Fisch

Cancer, Medicine and Society

A doctor recounts his wife’s battle with cancer: “My knowledge was too clear-eyed”

We’ve written before about doctors becoming patients – but what happens when it’s the physician’s partner who becomes seriously ill? Over the weekend I came across a beautifully written, raw New York piece in which Memorial Sloan Kettering physician Peter Bach, MD, describes his late wife’s fight with cancer. He writes:

When Ruth was first diagnosed with breast cancer, friends would routinely comment to us along the lines of “It’s so good Peter knows so much about this disease.” But others disagreed, imagining I suffered more from my knowledge. Whether I was better or worse off I kept filing away as a pointless academic debate, like wondering if Edna Pontellier’s death in The Awakening was a resignation or a liberation, or whether Batman would ever just get over it. But in the lobby of my hospital, I knew the answer: My knowledge was too clear-eyed. I couldn’t pretend for another day or hour or minute that there were good days ahead.

Bach later describes the moment he knew the end was near:

We were sitting at a coffee shop when the light caught her just right and I saw it. I tried for a few moments to keep talking about whatever topic we had landed on, but I discreetly texted a friend of mine from college, also a doctor, in medicalspeak to share the terrible news—“scleral icterus.”

I couldn’t hold it in anyway. “Your eyes are yellow,” I blurted out.

She was stunned, and slightly panicked. “Why?” she asked. And then something totally unexpected—“What do they do about it?” I seized on this, my escape hatch from having to talk about her liver failing. I said I didn’t know, we’d have to ask. Another lie.

The yellowing, first of the whites of the eyes, later of the skin, is like the check-engine light turning on. The yellowing itself is irrelevant; it means bad things are happening inside. It meant her brain would soon become addled with toxins that at one time her liver could have cleared easily. She was near the end.

My phone pinged. My doctor friend, holding the medical jargon: “Oh [f**k].”

The full piece is worth a read.

Previously: A Stanford physician’s take on cancer prognoses, Both a doctor and a patient: Stanford physician talks about his hemophilia and Red Sunshine: One doctor’s journey surviving stage 3 breast cancer

Events, Medicine and Literature, Medicine and Society, Stanford News

Inside Abraham Verghese’s bag, a collection of stories

Inside Abraham Verghese's bag, a collection of stories

What’s inside Abraham Verghese’s medical bag? Visit the Smithsonian Institution’s National Museum of Natural History to see. Verghese, MD, vice chair for the theory and practice of medicine and a physician at Stanford, is one of the notable Indian Americans featured in the exhibition “Beyond Bollywood: Indian Americans Shape the Nation,” which runs through August 2015 in D.C. and then will tour the U.S.

An article in The Caravan dives into the diversity and complexity of experiences lived by Indian Americans in the United States and opens this way:

IN JOHNSON CITY, Tennessee, in 1982, an Ethiopia-born, India-trained medical resident named Abraham Verghese coveted Dr Steven Berk’s doctor bag. He saved enough money to purchase one for himself, then rubbed it with neatsfoot oil to approximate the well-worn, talismanic quality of his mentor’s bag. Verghese then filled it with his kit—eye drops, calipers, prescription pads—and his hopes of assimilating into the American medical establishment.

Verghese’s bag, one of the exhibition’s hundreds of objects on display, is coupled with the physician-author’s memories from earlier in his career: “I had to ask someone how to tie my tie with a thinner knot so I could fit in,” the article notes. “And the only way I could eat the bland hospital food was to put Tabasco sauce on everything.”

The piece continues:

Verghese’s words capture the familiar dual imperative of immigrant life: on the one hand, fitting in, with a tie knot of appropriate girth; on the other, maintaining one’s tastes, through the strategic application of chilli-approximating Tabasco. His story reminds us that even blue- and white-collar immigrants have to negotiate resistance to the perceived “Third World invasion” of the United States, whether through neutralising accents or by softening the stiffness of difference with neatsfoot oil.

Previously: Abraham Verghese shares what’s in his lab coatStanford’s Abraham Verghese honored as both author and healer,  Stanford’s Abraham Verghese = “today’s most creative person” and Abraham Verghese’s Cutting for Stone: Two years as a New York Times best seller

Medical Education, Medicine and Society, Patient Care, SMS Unplugged

Bridging the disconnect in health care

Bridging the disconnect in health care

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.

Moises connection sketchMy family has always expressed that they’re proud of what I’m doing – the funny thing is, they go on to say that they’re unsure of exactly what I do.

My parents know I’m studying medicine and that this means I’ll be a doctor. What they don’t get is where in the process I am, what specializing means or what I’m talking about most of the time when I share stories from school. Perhaps the unfamiliarity results from them not being exposed to the general structure of professional training, or it could be that the U.S. health-care system is simply a bit confusing. I’ve tried explaining to my aunts and uncles the process of going from college to medical school to residency. “Okay,” they respond, “but when can we call you Dr. Gallegos?” Adding one more ingredient to the mix, I took a year away from medical school to get a second degree.

Even though I’m not “Dr. G” yet, four years of medical and public-health training are worth something. I know enough to be helpful on a medical team, in patient encounters and to my family. Having family members approach me with medically related questions is both empowering and humbling. My family has played a large role in the support system that has helped me get to where I am today; to pay back by sharing some of the knowledge and skill I’ve gained along the way feels great. I have to remind them constantly that I’m not in a position to offer definitive advice, but they still appreciate the context-framing guidance from my simplified explanations. A doctor yet or not, I’m a resource for them to better understand their health and how to maintain it.

These family experiences remind me of one of the reasons I felt an urge to enter medicine: the disconnect. My parents, aunts, uncles and majority of cousins are first generation in the United States. They come from meager means and little exposure to medical care and health education. As such, they haven’t had the most positive experiences in pursuit of health care. Growing up, I witnessed plenty of challenging encounters between my family and health-care providers. Without the need to assign blame, I think several negative experiences were reflective of a mutual misunderstanding. My family being unsure about the functionality of the health-care system and the meaning of illness likely didn’t help the provider, who was unaware of my family’s need for extra guidance, education and reassurance. A patient labeled non-compliant may better be characterized as non-adherent – the difference is understood when the disconnect is acknowledged.

This last point is ever so important regarding the Affordable Care Act. Many people in the U.S. haven’t had the chance to develop an understanding of the health-care system or grasp what constitutes good or bad health. New access to health-care coverage doesn’t mean that people will magically be able to navigate the system. In my career I hope to carry the lesson my family has helped me learn: As a health-care provider, I must consider the level of understanding of my patients so that I don’t exacerbate, but rather bridge, the disconnect on matters of health.

Moises Gallegos is a medical student in between his third and fourth year. He’ll be going into emergency medicine, and he’s interested in public-health topics such as health education, health promotion and global health.

Events, Medicine and Society, Stanford News

Medical students and author Khaled Hosseini share their muse with Stanford community

Medical students and author Khaled Hosseini share their muse with Stanford community

"Giving UP! "Say Something" by A Great Big World at An evening with Medicine and the Muse at Paul and Mildred Berg Hall, Li Ka Shing Center at Stanford School of Medicine on Wednesday, April 16, 2014   ( Norbert von der Groeben )When best-selling author Khaled Hosseini, MD, took the stage at Stanford’s recent Medicine and the Muse symposium, he smiled, shook his head and said, “Those student performances were amazing. I am not sure how I can follow that.” The performances Hosseini referred to were those of numerous medical students and included a soulful dance set to the song “Say Something” by Great Big World, an emotional spoken word poem, a performance of Chopin, a documentary film clip, an opera singer, and a playful dueling instrumental performance featuring an Indian drum and violin.

In addition to these performances, art and photography created by medical students was on exhibit in the lobby of the Li Ka Shing Center for Learning and Knowledge. One art piece was a tree adorned with thank-you notes written to patients by several fourth-year students. One note read:

It’s unfair that all I can say is “Thank you”
Because I learned and benefited from…
your pain
your illness
your despair
your secrets
your body and mind and spirit
I am honored to have had a chance to care for you, learn from you, and witness your resilience

Hosseini himself had a chance to see one of his former patients, who came to the event and brought his medical record for Hosseini to sign. “I guess I did all right for you,” Hosseini laughed, “You are here.”

Before the book-signing, the overflow crowd was silent and attentive as Hosseini answered questions about his writing and Afghanistan posed by Paul Costello, chief communications officer for the School of Medicine. Hosseini shared that as a 15-year old coming to America from Afghanistan, he struggled. “To be a 15-year old in an American high school, not knowing how to speak English. That was tough. I was invisible.” When Costello asked Hosseini about his hope for Afghanistan, particularly after the April 5 elections, he said, “I hope there is a new future for Afghanistan. A future of peace, not war. Did you know that 64 percent of the Afghan population is under the age of 24? And their heroes are people like Steve Jobs… There is so much more to the country of Afghanistan than what is portrayed on television.”

Several students and spouses in attendance were also veterans of the U.S. War in Afghanistan. Shannon Barg, who served in the U.S. Army as a Blackhawk helicopter pilot and is participating in a writing workshop for student veterans sponsored by the Arts, Medicine and Humanities program, brought the copy of The Kite Runner she had read “over and over” in Afghanistan for Hosseini to sign. “That book was so important to me over there,” she said. “I can’t believe I had this chance to meet him.”

A conversation with Khaled Hosseine  and Paul Costello meets during an evening with Medicine and the Muse at Paul and Mildred Berg Hall, Li Ka Shing Center at Stanford School of Medicine on Wednesday, April 16, 2014   ( Norbert von der Groeben )Hosseini also shared his writing routine. “I write every day. Writing is very blue collar. You have to show up every day, and you have to put the work in.”

When asked about his days as a physician, Hosseini joked that his patients would spend more time talking to him about his books than about their ailments. “So I had to step down, for the sake of their health.” Although he derived satisfaction from helping patients as a medical doctor, Hosseini believes he can perhaps have a further reach with the humanitarian work his writing allows him to pursue. He has established the Khaled Hosseini Foundation to bring humanitarian assistance to the people of Afghanistan, building shelters for refugee families and providing economic opportunities, education, and health care for women and children of Afghanistan, and he recently wrote about his work with Syrian refuges in a New York Times op-ed.

“We are all part of humanity,” Hosseini said, “And we should try to help one another.”

Jacqueline Genovese is assistant director of the Arts, Humanities, and Medicine Program within the Stanford Center for Biomedical Ethics. Medicine and the Muse 2014 was made possible by the generous support of Stanford School of Medicine, the Medicine & the Muse Medical Humanities Program, Stanford Center for Biomedical Ethics, the Biomedical Ethics and Medical Humanities Scholarly Concentration, the Drs. Ben and A. Jess Shenson Funds, and a Stanford Arts Institute SPARK Grant.

Previously: Intersection of arts and medicine a benefit to both, report finds and Stanford’s Medicine and the Muse symposium features author of “The Kite Runner”
Photos by Norbert von der Groeben

Events, Medicine and Literature, Medicine and Society

Intersection of arts and medicine a benefit to both, report finds

Intersection of arts and medicine a benefit to both, report finds

An article today on Cleveland.com notes that, at least in Northeast Ohio, collaboration between medicine and the arts benefits both camps as well as the region’s economic health. A preliminary report from the non-profit Community Partnership for Arts and Culture looks at ways art and medicine enrich one another in Cleveland and provides recommendations for enhancing those partnerships. From the news piece:

The report identifies four principal ways in which the art and medicine intersect productively:

• The use of arts and culture in medical settings;

• Participatory programs that involve patients and communities in activities and therapies that promote positive medical outcomes and general wellness;

• The potential shown by arts and culture to serve as a rallying point from which public health and social equity can be addressed; and

• The enrichment of medical training.

Meanwhile, at Stanford, art and science lovers prepare for this evening’s Medicine and the Muse symposium, featuring author Khaled Hosseini, MD. Stay tuned for a recap on Scope next week.

Previously: Stanford’s Medicine and the Muse symposium features author of “The Kite Runner”, Literature and medicine at life’s end and Thoughts on the arts and humanities in shaping a medical career

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

Breaking down happiness into measurable goals

Breaking down happiness into measurable goals

sunflowersSo you want to be happy. Can you be more specific? A study published in the Journal of Experimental Social Psychology found that concrete, rather than abstract, goals for happiness tend to be more successful. Jennifer Aaker, PhD, Stanford social psychologist and marketing professor, and colleagues performed six field and laboratory experiments and found that participants who performed specific acts of kindness – such as recycling or making someone smile – reported greater happiness than participants whose prosocial goals were less precise – such as helping the environment or people more broadly.

From a Stanford News article:

The reason is that when you pursue concretely framed goals, your expectations of success are more likely to be met in reality. On the other hand, broad and abstract goals may bring about happiness’ dark side – unrealistic expectations.

Acting directly and specifically in service to others brings greater happiness to the giver, the study found. The piece continues:

For example, an experiment involving bone marrow transplants focused on the whether giving those who need bone marrow transplants “greater hope” – the abstract goal – or giving those who need bone marrow transplants a “better chance of finding a donor” – the concrete goal – made a giver more happy.

The answer: Helping someone find a donor resulted in more happiness for the giver. This, the researchers wrote, was driven by givers’ perceptions that their actual acts better met their expectations of accomplishing their goal of helping another person.

Previously: Study shows happiness and meaning in life may be different goalsAre you happy now? Stanford Roundtable spotlights the science of happiness and wellbeing and Stanford faculty and students launch social media campaign to expand bone marrow donor registry
Photo by Iryna Yeroshko

Medical Education, Medicine and Society, Stanford News

Studying the humanities to address “the messiness of human life”

Studying the humanities to address "the messiness of human life"

Life’s problems and people are often complex, ambiguous and soft to the touch. This holds true even in the medical sciences and professions that require precision in data collection and analysis; critical thinking skills and a broad, flexible world view are therefore necessary components of a balanced education. The School of Medicine‘s dean, Lloyd Minor, MD, explains in a recent op-ed for the Stanford Daily why anyone invested or even interested in medicine should pay attention to the humanities.

From the piece:

Consider the child with autism or the adult with Alzheimer’s disease. A physician can make a diagnosis but cannot offer a cure or a satisfying answer to the question “why?” Even for conditions that we can prevent or treat, patient behavior can significantly impact the success or failure of an intervention. For the hypertensive patient, no amount of prescribed medication will impact the social factors that may be inhibiting lifestyle modification. The specificity of scientific interventions does not account for the messiness of human life.

We as physicians heal best when we listen to and communicate with our patients and seek to understand the challenges they face in their lives. The perspectives on illness, emotions and the human condition we gain from literature, religion and philosophy provide us with important contexts for fulfilling these roles and responsibilities.

Previously: Becoming Doctors: Stanford med students reflect and share experiences through podcastsThoughts on the arts and humanities in shaping a medical careerEncouraging alternative routes to medical school and Stanford dean discusses changing expectations for medical students

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