Published by
Stanford Medicine

Category

Medicine and Society

Bioengineering, Global Health, Medicine and Society, Research, Stanford News, Technology

National Geographic: “Emerging Explorer” Manu Prakash helping “lead a new age of discovery”

National Geographic: "Emerging Explorer" Manu Prakash helping "lead a new age of discovery"

Prakash in Nigeria - 560

As I’ve gotten busier, and my life has moved online, I’ve let most of my magazine subscriptions lapse. All except for National Geographic, which both my husband and I continue to enjoy each month.

With its storied history, familiar yellow cover, knock-your-socks-off photography and carefully crafted science and social science features, I consider it a good use of precious paper (and pennies).

So I was psyched to hear that Stanford’s own Manu Prakash, PhD, has been named by the publication as one of 14 2015 National Geographic Emerging Explorers. Prakash is most well-known for the Foldscope, a low-cost paper microscope that has been sent to 130 countries, but he’s also working on constructing a small-scale chemistry kit and on a variety of other projects. As summarized in a National Geographic article, he “specializes in what he calls ‘frugal science,’ designing inexpensive laboratory instruments that can spread science and medical opportunity around the world.”

Thanks to the Explorers program, he’ll gain $10,000 to support his research and a year in the international spotlight. As indicated in the article, expectations of him and the other winners are high:

“Our Emerging Explorers are inspiring young visionaries who are looking at ways to remedy global problems and are undertaking innovative research and exploration,” said Terry Garcia, National Geographic’s chief science and exploration office. “They will help lead a new age of discovery.”

Here’s to looking forward to year of innovative “frugal sciences” creations from the Prakash lab.

Previously: Microscopes for the masses: How a Stanford bioengineer is helping everyone “think like scientists”, Miniature chemistry kit brings science out of the lab and into the classroom or field, Stanford bioengineer among Popular Science magazine’s “Brilliant 10″Manu Prakash on how growing up in India influenced his interests as a Maker and entrepreneur and Stanford bioengineer develops a 50-cent paper microscope
Photo, of Manu Prakash and a group of children in Nigeria, courtesy of Prakash

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

When physicians work together, costs can rise

When physicians work together, costs can rise

97187153_16040f08b7_zOnce upon a time, patients received care from a local doctor, who usually worked alone or with a few partners. Now, most physicians belong to large practices, which have standardized procedures and costs.

These mergers have been greeted warmly by regulators and the public, who believe that larger groups can take advantage of economies of scale. But these alignments could also give physicians greater bargaining power with insurers, a move that could push costs up, according to a new study by Stanford researchers.

Eric Sun, MD, an instructor of anesthesiology, perioperative and pain medicine, working with senior author Laurence Baker, PhD, investigated the fees charged by orthopedic surgeons for knee replacements between 2001 and 2010. They also ranked how concentrated physicians’ health-care markets scored on a commonly used index.

They found that physicians’ fees in markets with a high concentration of physician groups rose $168 compared to fees in the least concentrated markets — a jump of 7 percent.

The research has implications for the Affordable Care Act, which encourages physicians to join alliances. “The point is not to say that consolidation is a bad thing,” Sun concluded in our press release on the study. “But as we think about encouraging these kinds of mergers, we really want to weigh the costs against the benefits.”

The study appears in the June issue of Health Affairs.

Previously: Health-care policy expert Arnold Milstein weighs in on Medicare’s plan to prioritize “value over volume”, Steven Brill’s Bitter Pill and What’s the going rate? Examining variations in private payments to physicians
Photo by Waldo Jaquith

Big data, Events, Medicine and Society, Precision health, Public Health, Stanford News

How Stanford Medicine will “develop, define and lead the field of precision health”

How Stanford Medicine will "develop, define and lead the field of precision health"

15313-a-healthy-young-woman-stretching-outdoors-pvPrecision health was the theme of the day here on Friday, with Dean Lloyd Minor, MD, describing to a standing-room-only crowd at a Town Hall event how Stanford Medicine will continue to lead and excel in this area.

Minor, along with colleagues Amir Dan Rubin, president and CEO of Stanford Health Care, and Christopher Dawes, president and CEO of Stanford Children’s Health, offered faculty, staff and students a glimpse of the future of precision health here.

The vision has seven primary tenets, Minor explained:

  • Stanford Medicine will lead a transition from diagnosis and treatment toward prediction and prevention
  • It will develop new scientific advances and paradigms
  • It will bridge the gap between basic scientific research and clinical care
  • It will transform clinical care to emphasize compassion and quality
  • It will deliver quality health care at excellent value
  • It will train the biomedical leaders of today and tomorrow
  • It will develop and share its advances globally

Stanford Medicine’s focus in this area came about as part of a strategic planning process and taps Stanford’s strengths in data science, fundamental bioscience research and specialized care in areas such as cancer, Minor said. It also capitalizes on the nationwide focus on precision medicine, which took center stage in January when President Barack Obama introduced a Precision Medicine Initiative to establish a national system capable of delivering treatments tailored to individual patients.

Precision health includes precision medicine but boldly expands its focus. Precision medicine provides personalized treatments once illness occurs; in contrast, precision health aims to prevent and predict illness, maintaining health and quality of life for as long as possible. Precision health draws on data science tools to translate volumes of research and clinical data into information patients and doctors can use.

A recent Inside Stanford Medicine article described the benefits of such widespread access to data:

Physicians and researchers can better predict individual risks for specific diseases, develop approaches to early detection and prevention, and arm clinicians with information to help them make real-time decisions about the best way to care for patients.

Continue Reading »

Ethics, Imaging, Medicine and Society, Neuroscience, Research, Stanford News, Technology

Hidden memories: A bit of coaching allows subjects to cloak memories from fMRI detector

Hidden memories: A bit of coaching allows subjects to cloak memories from fMRI detector

11501949224_dac2b41c91_zImagine the usefulness of knowing if someone is drawing on a memory or experiencing something for the first time. “No, officer, I’ve never seen that person before.” 

That’s possible, using an algorithm that interprets brain scans developed by a team of Stanford researchers led by psychology professor Anthony Wagner, PhD. But according to a Stanford Report articleit’s also possible to fool that same program when subjects are coached to hide their memory.

The program, or decoder, capitalizes on the complexity of memory, which taps many different regions of the brain. They use functional magnetic resonance imaging (fMRI) to view which parts of the brain are active.

Hoping to illustrate the limits of their own creation, the researchers asked 24 study participants to study a series of faces. The next day, they exposed them to some of the same faces mixed with entirely new faces:

“We gave them two very specific strategies: If you remember seeing the face before, conceal your memory of that face by specifically focusing on features of the photo that you hadn’t noticed before, such as the lighting or the contours of the face, anything that’s novel to distract you from attending to the memory,” said Melina Uncapher, PhD, a research scientist in Wagner’s lab. “Likewise, if you see a brand-new face, think of a memory or a person that this face reminds you of and try to generate as much rich detail about that face as you can, which will make your brain look like it’s in a state of remembering.”

With just two minutes of coaching and training, the subjects became proficient at fooling the algorithm: The accuracy of the decoder fell to 50 percent, or no better than a coin-flip decision.

The new study shows that imaging technology alone will not be able to “pull about the truth about memory in all contexts,” Wagner said. And, as pointed out in the article, he “sees [the results] as potentially troubling for the goals of one day using fMRI to judge ‘ground truth’ in law cases.”

Previously: Memory of everyday events may be compromised by sleep apnea, The rechargeable brain: Blood plasma from young mice improves old mice’s memory and learningResearchers explore the minds of man’s best friend using fMRI technology, Using fMRI for lie detection and Brain scan used in court in potential fMRI first
Photo by David Schiersner

Cancer, In the News, Media, Medicine and Society

Oncology hashtag project aims to improve accuracy of online communication about cancer

Oncology hashtag project aims to improve accuracy of online communication about cancer

6399145505_49e812a63d_zThere’s lots of talk about the need for doctors to communicate better with their patients, and social media is taking off as a medium for doing so. At this year’s meeting of the American Society for Clinical Oncology, which ends in Chicago today, Matthew Katz, MD, a radiation oncologist at the University of Texas’ MD Anderson Center, exhibited a poster displaying a new series of hashtags for different types of cancer. There are at least 20: #leusm for leukemia, #melsm for melanoma, #blcsm for bladder cancer, etc. Patients and doctors alike can use them to be more accurate and specific in sharing information.

As reported in a MedCity News piece, Katz is a big believer in social media as a way for patients and doctors to communicate. He developed the hashtags to provide better access to reliable, high-quality health information for both patients and providers, and he’s quoted as saying:

Hashtags are a filter that can make it possible to make Twitter less noisy. Twitter has a lot of discussion of healthcare, but finding reliable information is not as easy… Patient-physician engagement is important, but the purpose is not to enhance therapeutic relationships. The disease-specific tags may be a way to adapt Twitter’s open platform to focus conversations and bring people together for education, advocacy and support.

Katz’s “cancer tag oncology” is based on research begun in 2013, which found that a wide variety of people did use the Twitter hashtags. Katz also founded Rad Nation, an online community of radiation oncologists.

Previously: Upset stomachs and hurting feet: A look at how people use Twitter for health information, Finding asthma outbreaks using Twitter: A look at how social media can improve disease detection, Advice for young doctors: Embrace Twitter, Twitter 101 for patients, and How using Twitter can benefit researchers
Photo by Michael Coghlan

Health Disparities, Health Policy, In the News, Medicine and Society, Women's Health

Report: Health-care industry needs to focus on women

Report: Health-care industry needs to focus on women

16755600997_ca15a76fcf_zThe health-care industry needs to pay much more attention to women. That’s the argument laid out in a recent piece on MedCity News, which shared findings of a survey (.pdf) from the Center for Talent Innovation. That report shows that women make the majority of health-care decisions but are inadequately equipped to do so, and it calls on health-care companies, which are increasingly oriented towards consumers, to bridge that gap.

According to the survey, which included more than 9,200 respondents from the U.S., U.K., Germany, Japan, and Brazil, 94 percent of women make decisions for themselves and 59 percent make decisions for others; when working moms are considered separately, 94 percent make decisions for others. And yet, 58 percent of these decision makers lack confidence in their decision making.

The report says this is due to “three profound famines”: lack of time, lack of knowledge, and lack of trust. Seventy-seven percent of women don’t know what they need to do to stay healthy; 62 percent lack the time. Only 38 percent of working mothers passed a “health literacy quiz,” and the report showed that women are unlikely to trust online information (31 percent), their insurance companies (22 percent), or pharmaceutical companies (17 percent).

The report suggests that health-care companies need to understand women in the context of their family and career responsibilities, which is quite different from standard male-based “life stage analysis.” Moreover, they need to understand that women think about health more broadly than freedom from illness and health risks. Fully 79 percent said that health means “having spiritual and emotional wellbeing,” while 77 percent called it “being physically fit and well rested.”

An excellent place to start change is the management structure of health-care companies, the report suggests. Despite being the “CMOs” (Chief Medical Officers) for their families, women are underrepresented in other “C-level” roles in these companies:

We find that, while the health-care industry employs a large number of female professionals, their ideas, insights, and capabilities haven’t been fully supported, endorsed, and promoted. Without women in power, women’s ideas don’t get the audience they deserve, because… leaders only see value in ideas they personally relate to or see a need for.

MedCity news writer Nina Ruhe sums up another area for improvement. “Doctors, insurance companies and pharmaceutical companies can start instilling trust in women again by letting them know exactly what they should know in regards to their personal health and the health of their families,” she writes.

Ethics, Health and Fitness, Medicine and Society, Orthopedics, Patient Care, Sports

Thinking through return-to-play decisions in sports medicine

Thinking through return-to-play decisions in sports medicine

2913800550_7fc291c915_zIn an opinion piece appearing in the AMA Journal of Ethics today, two Stanford physicians – Michael Fredericson, MD, and Adam Tenforde, MD – explore the ethics of how doctors should advise patients recovering from an injury.

Consider this scenario, the case which opens the piece:

Jordan is a 17-year-old senior in high school who has been his football team’s star quarterback, led his team to two state championships, and has a real possibility of receiving a full scholarship to a top college sports program next year. In his last session of summer training camp, Jordan took a fierce hit… [an MRI] showed that Jordan had a torn labrum in his right shoulder that would require surgery and months-long recovery, meaning that he would miss the rest of his final season.

[His physiatrist] had known instances in which this particular type of injury ended a quarterback’s athletic career. She had also read about a few cases in which athletes recovered fully from the injury. Since so much of recovery depends on the injured person’s following the rehabilitation and physical therapy plans, [she] wanted Jordan to approach his injury with the optimism that adherence to the plan would enable him to return to athletics. At the same time, she did not want to hold out false hope that might keep Jordan focused exclusively on football when, in the long term, that might not be the best use of his senior year.

The most important part of what we’re trying to convey when treating athletes is that as team physicians our goal is the health and well being of the athlete

When college scholarships and admissions decisions are on the line, a doctor’s recommendations affect more than her patient’s physical health. How to weigh the different interests at stake? Fredericson and Tenforde make clear that medical decisions must prioritize the long-term health of the athlete. When I interviewed him, Fredericson, a professor of orthopedic surgery, director of PM&R Sports Medicine, and team physician for Stanford Athletics, told me:

The most important part of what we’re trying to convey when treating athletes is that as team physicians our goal is the health and well being of the athlete. Ultimately, we are the ones who are trying to protect their health. Sports physicians have gotten a bad rap; people think we’re trying to help coaches, or help athletes at the expense of their overall or long term well being. We might push the process to help try to get them better more quickly, but ultimately we have their long-term best interests in mind.

Continue Reading »

Behavioral Science, Ethics, Events, Medicine and Society, Mental Health

Anger: The most evil emotion or a natural impulse?

Anger: The most evil emotion or a natural impulse?

5846841745_f2f620c5d3Anger isn’t good for your health. It spikes your heart rate, exacerbating heart conditions and anxiety. It leaves an ugly residue, a sensation of unease and aggression and it can lead to violence against others or oneself.

But in the west, we have an uneasy relationship with this powerful emotion, said Owen Flanagan, PhD, co-director of the Center of Comparative Philosophy at Duke University and speaker at the annual Meng-Wu lecture hosted by the Stanford Center for Compassion and Altruism Research and Education last week.

In the United States and Europe, some anger is considered justified, even necessary for healing after one is wronged, Flanagan said. It’s natural, just a part of our constitution. An appropriate amount of anger is expected, a sign that you care. Flipping out because your barrista took too long making your latte? Probably not okay. But yelling at a driver who rear-ended you while texting? Certainly.

Not in Asia, Flanagan said. There, in accordance with Buddhist traditions, anger is right up there with hatred as the worst emotion, something that should be eliminated as soon as it arises.

Flanagan said he and other academic colleagues posed a question to the Dalai Llama several years ago: If you find yourself in a public place with a very bad person, like Hitler, before the atrocities have started, what should you do? Westerners would say anger was AOK, as was perhaps even murder. After conferring with his colleagues, the Dalai Llama said yes, murdering Hitler would be justified to prevent a very bad karmic causal chain. But anger? Absolutely not.

One could argue that even Hitler’s behavior was a byproduct of his genes, his upbringing, the surrounding society, Flanagan told the audience.

Flanagan said he still hasn’t figured out his own views toward anger. “Anger is a destructive emotion, but it might be a necessary emotion. I’m still not sure about that.”

But in the U.S., we don’t always live in accordance with our own traditions, Flanagan said. “We give ourselves sloppy permissions all over the place to be very angry people. That’s something that’s just not good.”

To counter anger, Flanagan offers several tips, drawn from both western and eastern traditions. First, embrace an emotion that is incompatible with anger, such as gratitude. Or reflect on your own insignificance and the transitory nature of the harm: This too will pass. “Astronomy is a good antidote to taking yourself too seriously,” Flanagan said.

In a longer term, Seneca suggests that it helps to “live among people who teach the children that anger is always bad.”

But is it even possible to completely eliminate anger? Some argue no, even babies express a form of frustration or discontent that could be a sign of inner anger. Or, we could all be conditioned by society, learning to be angry as soon as we’re born.

Previously: Bright lights breed stronger emotions, study finds, Is it possible to control one’s emotions? and Study suggests emotions may trump mind in matters of self-control while meditating
Photo by katmary

Big data, BigDataMed15, Events, Medicine and Society, Research, Stanford News, Technology

A look back at Stanford’s Big Data in Biomedicine

A look back at Stanford's Big Data in Biomedicine

Ashley - 560

We reported many of the happenings at last week’s Big Data in Biomedicine here on Scope. Writer Bruce Goldman was also in attendance for the three-day event, and he captured the conversation in a just-published Inside Stanford Medicine piece.

Previously: At Big Data in Biomedicine, Stanford’s Lloyd Minor focuses on precision healthAt Big Data in Biomedicine, Nobel laureate Michael Levitt and others talk computing and crowdsourcingExperts at Big Data in Biomedicine: Bigger, better datasets and technology will benefit patientsOn the move: Big Data in Biomedicine goes mobile with discussion on mHealth and Big Data in Biomedicine panelists: Genomics’ future is bright
Photo of Euan Ashley, MD, welcoming conference attendees last Wednesday, by Saul Bromberger

Big data, BigDataMed15, Events, Medicine and Society, Microbiology, Research, Technology

At Big Data in Biomedicine, Nobel laureate Michael Levitt and others talk computing and crowdsourcing

At Big Data in Biomedicine, Nobel laureate Michael Levitt and others talk computing and crowdsourcing

Levitt2Nobel laureate Michael Levitt, PhD, has been using big data since before data was big. A professor of structural biology at Stanford, Levitt’s simulations of protein structure and movement have tapped the most computing power he could access in his decades-long career.

Despite massive advances in technology, key challenges remain when using data to answer fundamental biological questions, Levitt told attendees of the second day of the Big Data in Biomedicine conference. It’s hard to translate gigabytes of data capturing a specific biological problem into a form that appeals to non-scientists. And even today’s supercomputers lack the ability to process information on the behavior of all atoms on Earth, Levitt pointed out.

Levitt’s address followed a panel discussion on computation and crowdsourcing, featuring computer-science specialists who are developing new ways to use computers to tackle biomedical challenges.

Kunle Olukotun, PhD, a Stanford professor of electrical engineering and computer science, had advice for biomedical scientists: Don’t waste your time on in-depth programming. Instead, harness the power of a domain specific language tailored to allow you to pursue your research goals efficiently.

Panelists Rhiju Das, PhD, assistant professor of biochemistry at Stanford, and Matthew Might, PhD, an associate professor of computer science at the University of Utah, have turned to the power of the crowd to solve problems. Das uses crowdsourcing to answer a universal problem (folding of RNA) and Might has used the crowd for a personal problem (his son’s rare genetic illness).

For Das, an online game called Eterna – and its players – have helped his team develop an algorithm that much more accurately predicts whether a sequence of RNA will fold correctly or not, a key step in developing treatments for diseases that use RNA such as HIV.

And for Might, crowdsourcing helped him discover other children who, like his son Bertrand, have an impaired NGLY1 gene. (His story is told in this New Yorker article.)

Panelist Eric Dishman, general manager of the Health and Life Sciences Group at Intel Corporation, offered conference attendees a reminder: Behind the technology lies a human. Heart rates, blood pressure and other biomarkers aren’t the only trends worth monitoring using technology, he said.

Behavioral traits also offer key insights into health, he explained. For example, his team has used location trackers to see which rooms elderly people spend time in. When there are too many breaks in the bathroom, or the person spends most of the day in the bedroom, health-care workers can see something is off, he said.

Action from the rest of the conference, which concludes today, is available via live-streaming and this app. You can also follow conversation on Twitter by using the hashtag #bigdatamed.

Previously: On the move: Big Data in Biomedicine goes mobile with discussion on mHealthGamers: The new face of scientific research?, Half-century climb in computer’s competence colloquially captured by Nobelist Michael Levitt and Decoding proteins using your very own super computer
Photo of Michael Levitt by Saul Bromberger

Stanford Medicine Resources: