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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

Medicine and Society, Stanford News

Man on a mission: Working to help veterans who have lost limbs

Man on a mission: Working to help veterans who have lost limbs

vet - smallerThe student riding the Segway stands out on the bicycle-laden Stanford campus. His short hair and erect bearing suggest he is a veteran. The prosthetic legs that extend from his torso to the Segway stand confirm it.

I had seen Dan Berschinski one day on campus and asked Tim Hsia, student president of the Military Connected Network, if he could introduce me. Berschinski, I learned, had just finished his first year at the Stanford Graduate School of Business – and he’s on a mission. As was highlighted in a CBS News story last fall, he’s at Stanford to learn how to grow his current business into a thriving enterprise, hopefully one that employs veterans with disabilities.

Ever since he woke up in Walter Reed National Military Medical Center after having his legs blown off by an improvised explosive device (IED) in Afghanistan, the West Point graduate has been thinking of ways to help veterans.

“Look, I was an officer,” he told me recently. “I couldn’t sit there feeling sorry for myself. My soldiers were still in Afghanistan, still getting killed. And the hospital was full of guys with injuries as bad or worse than mine.” Berschinski was sitting with me at a campus cafe, his Segway and cane propped against the door. The fact that he’s able to walk on his prosthetic legs is a miracle, although, he said with a small laugh, his doctors were hesitant to use that word. “Let’s just say that nobody with my injury has ever walked out of Walter Reed,” he said, hands firmly placed on his thighs.

Berschinski’s right prosthetic leg attaches to his hip – there was nothing left of his leg to salvage. On his left side, he must force the portion of his thigh that is left into a sleeve. He explained this all to me matter-of-factly. In fact, Berschinski is quick to point out that he feels lucky. Pointing to his left hand, which is missing a finger and is marked by a large portion of a skin graft, he said, “Hey, they were able to save this hand. If they hadn’t, I would be a triple amputee.” Shaking his head, Dan continued, “Those guys have it rough.”

The use of IEDs and the length of the wars in Iraq and Afghanistan mean that there are veteran amputees in numbers not seen since the Civil War. But in a society where only less than 1 percent of the population participated in those wars, these veterans are somewhat invisible. Berschinski is out to change that by raising the visibility of veterans who have lost limbs. In addition, he wants to shine light on civilian amputees, particularly children, who often cannot afford prosthetics. He serves on the board of the Amputee Coalition, using what he describes as this “new change in my life” to help others who he believes aren’t as fortunate as he. “I have the advantage of being cared for by the government. I have access to cutting edge prosthetic limbs and care. Most people don’t have that.”

Asked if he has advice for current medical students who might be treating patients who have lost limbs, he was quick to answer. “Yes. Your optimism, and your support are critical. Yes, the medical skills are important. But you have to understand that patients are looking to you for hope. And don’t ever underestimate the willpower of your patients. Certainly don’t give up on them.”

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

Previously: Battling hearing loss on and off the battlefield and Stanford graduates partner with clinics in developing countries to test low-cost prosthetic
Photo courtesy of Dan Berschinski

Addiction, In the News, Medicine and Society, Research, Stanford News

As AA approaches 79, a look at its effectiveness for sobriety

As AA approaches 79, a look at its effectiveness for sobriety

stairsAlcoholics Anonymous, a nonprofessional, international fellowship for people who have had a drinking problem, is approaching 79 years of existence. This morning, Keith Humphreys, PhD, a Stanford addiction expert, writes in Washington Post‘s Wonkblog about how medical experts have viewed the organization during its tenure and what can be made of results from studies measuring AA’s effectiveness.

From the piece:

For most of the 12-step fellowship’s existence, professionals in the addiction field held widely varying opinions of its value. Some praised AA as an extremely valuable resource for people seeking recovery, but others viewed it as unsophisticated folk medicine and even a bit cultish. Other tensions emerged from turf issues: Medical professionals can be dismissive of – at times even hostile to – those they consider well-intentioned amateurs. Just as some obstetricians resent midwives, some addiction treatment professionals looked down on the non-professional AA members in their midst.

Humphreys notes that results from Project MATCH, the largest study of alcohol-dependence treatment, and a subsequent randomized clinical trial have changed some skeptics’ minds. More from the piece:

Studies such as these dramatically reduced the ranks of AA critics among scientists. AA’s value is still questioned in a few quarters, but as Harvard Professor of Psychiatry John Kelly [PhD] notes, this is becoming less true as the years go by: “The stronger scientific evidence supporting the effectiveness of AA is relatively new. It takes time for evidence to disseminate into clinical practice as well as into broader society.”

Previously: What’s the best way to handle the chronically intoxicated?, Examining how addiction in the U.S. has changed over the last decade and A discussion of the history and effectiveness of Alcoholics Anonymous
Photo by Kristin Charles-Scaringi

Aging, Health Policy, Medicine and Society, Podcasts, Research, Stanford News

More on doctors and end-of-life directives

More on doctors and end-of-life directives

Earlier this week, my colleague wrote about a study showing that the majority of doctors surveyed said they would forgo aggressive end-of-life care for themselves. Now, in the latest 1:2:1 podcast, researcher VJ Periyakoil, MD, director of palliative care education and training at the medical school, talks in depth about the study and why doctors appear to want one thing for themselves at the end of life and quite another for their patients.

Previously: Study: Doctors would choose less aggressive end-of-life care for themselves

Medicine and Society, Mental Health, Technology

Reflections on dying, contained in 140 characters

Reflections on dying, contained in 140 characters

A piece on Medium.com shows how boundaries, such as the 140-character limit of a tweet, can provide stability and comfort during times of uncertainty. Writer Amber Adrian describes how Twitter’s forum provided a structure for the expansive emotions she experienced as her father lay dying as Thanksgiving 2012 approached. On the microblogging service, she was also able to record in vivid detail what her family experienced – from the mundane to the morbid, comical, sweet and tragic final moments, stretched out across a series of tweets – and receive support from friends and family who shared memories of her dad.

Tweets from the piece, which Medium notes is a five-minute read:

Medical directive overturned by unanimous family consent. Morphine at the ready. All right, Great Beyond. Let’s get this party started.

Now that the drugs have stopped and people aren’t prodding him every hour, Dad’s sense of humor is coming back. His puns: as bad as ever.

My one rant: Absurd that we have the death penalty but we can’t help along someone we love who desperately wants out of a broken body.

Dad always made the Thanksgiving turkey. Brined in booze and stuffed with cornbread and fresh herbs. I never got the recipe. Damn it.

“I’m excited for you, Dad. You’re about to go on an adventure.” Boom. My brother nails it.

Previously: The role of social media in end-of-life conversations and Grieving on Facebook: A personal story

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

Stanford Medicine Resources: