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Aging, Events, Medicine and Society, Medicine X, Stanford News

Living long and living well: A conversation on longevity at Medicine X

Living long and living well: A conversation on longevity at Medicine X


There were big-time laughs, and the expected misty eye or two, at today’s Medicine X session on aging and longevity. Natrice Rese, a retired personal support worker, began the conversation with a moving ePatient Ignite! talk about how life for many older adults is less than “golden.” She told the audience how difficult time spent in a nursing home or care facility can be: “So many people wait to be fed, wait to be dressed, wait to be undressed, wait to be taken outside… When you’re dependent on care from others, your life is reduced to a waiting game.”

Her mother found herself in one such place at the age of 85, and Rese recalled how her mom pulled her aside one day and said, “Don’t come near these places – it’s not good here.” Her mother was in the throes of Alzheimer’s and unable to offer further details, but “her words stay with me today,” Rese somberly told the audience.

Rese said her mom’s comments ultimately reinforced her desire to work to make sure older adults feel appreciated and are able to “create memories that matter.”

Fellow panelist Barbara Beskind is certainly doing that – and more. The 91-year-old former occupational therapist made headlines when she landed a job at Silicon Valley design firm IDEO. Appearing at the conference alongside Dennis Boyle, a partner and founding member of the firm, she goes to the office every Thursday and is now working on a variety of projects related to aging – including a redesigned walker.

Younger designers “can’t put themselves in the shoes of the elderly,” Beskind told USA Today earlier this year. “People who design for the elderly think they need jeweled pill boxes or pink canes. We need functional equipment.”

“I admire you,” Rese told Beskind during a panel discussion, after hearing about Beskind’s contributions. “You shouldn’t be one of a few – you should be one of many.”

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Events, Medical Education, Medicine and Society, Medicine X, Patient Care

Medicine X | Ed keynote speaker: “Networks are fundamental to what it means to be human”

Medicine X | Ed keynote speaker: "Networks are fundamental to what it means to be human"

Larry Chu's jacketToday marked the opening of the first-ever Medicine X|Ed conference, a two-day event dedicated to delving into important issues related to medical education in the digital world. The aim of the event is to help attendees understand the medical learners of today and to shed light on how technology and social media affect the way future doctors learn and interact with patients.

Larry Chu, MD, Stanford anesthesiologist and executive director of Medicine X|Ed and Medicine X, got the conference rolling, bounding onstage sporting a life-sized image of his dog, Zoë Chu, on the back of his suit jacket. “We want to create a culture of health where everyone is trusted and respected for their expertise,” he told attendees. “Join us in the future of imagining medical education…”

Chu’s infectious enthusiasm set the tone for the day of TED-style talks, learning labs and panel discussions that emphasized the value of shared knowledge and the importance of doctors and patients informing and educating one another. Howard Rheingold, the opening keynote speaker and bestselling author of several books, underscored the importance of networked patients with a simple yet powerful opening.

“I’m really happy to be here,” he told the audience. “I’m a cancer survivor, so I really mean that. I’m grateful to my oncologist and to a network of people online, some of whom I knew before, and many of whom I did not know before.”

“I was diagnosed with cancer in 2010,” he continued. “It was a kind-of an embarrassing cancer, anal cancer, but I knew I’d need to talk about it.”

Howard Rheingold on stageRheingold started a blog, called Howard’s Butt, where he could turn to other networked patients for information and support. “It became an important source of catharsis for me,” Rheingold explained. “I came back from a treatment, and I needed to get my feelings out. I’ve been cancer-free for 5 years, and [this experience] gave me a deep appreciation for the power of social media.”

“Networks are fundamental to what it means to be human,” Rheingold said. “When you face a crisis, you need to connect with other people. Technology enables this in a way that wasn’t possible before.”

Yet, networked patients face some pitfalls too, Rheingold cautioned. “Cyberchondria” (where patients Google their disease, and what they find online is worse than what they actually have) and overconfidence are two big issues. Networked patients need to learn how to separate the bad information from the good, and they need to evaluate how much they really know, he explained. “I call it crap detection,” Rheingold said. Being a networked patient, as well as being a doctor that works with the networked patient, takes time and practice, he said.

After his talk Rheingold told me, “Many doctors and physicians don’t get or understand the networked patient. But there’s an emerging group of physicians that are attuned to this.” He looked around at the packed conference hall and said, “By virtue of being here, people are interested… This is how things start.”

More news about the conference is available in the Medicine X category. Those unable to attend the event in person can watch via webcast; registration for the Global Access Program webcast is free. We’ll also be live tweeting the keynotes and other proceedings from the conference; you can follow our tweets on the @StanfordMed feed.

Photo of Larry Chu (top) by Holly MacCormick; photo of Howard Rheingold courtesy of Stanford Medicine X

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

Lessons from the parking lot: How roles in medicine define relationships

Lessons from the parking lot: How roles in medicine define relationships

Stanford Medicine Unplugged (formerly SMS Unplugged) is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week during the academic year; the entire blog series can be found in the Stanford Medicine Unplugged category.

parking lotI was about halfway through my family medicine rotation, and I felt like I was hitting my stride. It was almost the end of the day on a Thursday, and I only had one patient left to see – I’ll call her Mary. Mary had a complaint of hearing loss but was otherwise healthy.

I had seen patients with similar issues during the rotation, and I was confident that this encounter would go smoothly. Of course, I was often uncertain about the best way to treat patients – but I came to learn that what was more important was that I established good relationships with them. Even though I always introduced myself as a medical student, many patients assumed I was a doctor and treated me like one. They told me their problems and asked me questions about how to solve them. I was happy to have these conversations: I felt like I got to know my patients and was able to help them.

So as I knocked on the door to see Mary, I expected to have a productive encounter – and I did. There are a lot of possible causes for hearing loss, including serious neurologic disorders and systemic syndromes, but one common cause of hearing loss is glaringly simple: earwax build-up. I looked in Mary’s ears, and sure enough, there were balls of wax sitting in the canals.

As I explained this to her, one of the medical assistants came in to complete the process of flushing her ears and getting the wax out. Afterwards, Mary and I talked briefly about some of the things that could have led to the buildup.

Mary was deeply appreciative throughout the encounter. Even though she had a relatively simple problem, she constantly thanked me for helping her out as we wrapped up. Since she was the last patient of the day, I left the exam room, gathered my things, and headed out of the clinic. My ego was riding high because she had been so effusive in her praise.

Then, as I was pulling out of the parking lot, a car cut me off. When I looked, it turned out the driver was Mary! She honked as she drove by, and then for good measure, she rolled down the window and flipped me off.

I’m fairly sure Mary didn’t realize I was the driver that she had just cut off. Regardless, my initial response was something along the lines of comical outrage. I had just helped her! We had bonded! How could she do that?!

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Aging, Medicine and Society, Mental Health, Patient Care

Stanford longevity design winner brings dementia place setting into production

Stanford longevity design winner brings dementia place setting into production

eatwellprimaryHelping people live not just longer but better lives is the goal of Stanford’s Center on Longevity, and last year it held a Design Challenge to scope out great ideas for doing so. The winner of that competition is no longer just a design; Eatwell is moving into production.

Eatwell, a place setting for those with cognitive and motor impairments from dementia, features subtle alterations to the colors, textures, weight, and shape of traditional dishes and cutlery. For example, bright colors make food more appetizing, and blue surfaces make it less likely that users will confuse their food with the dish. Slanted bottoms help keep food together and make it easier to scoop, and weighted bottoms with skid-resistant texture make spills less likely. There are even placemat attachments for a napkin to catch drips.

I recently corresponded with Eatwell’s designer, Sha Yao, via email while she was in Asia overseeing the manufacturing of her innovative product. The 20 design features of the 9-piece set emerged from a four-year research process involving one-on-one observation and volunteering in adult day care centers. “Along the way,” Yao told me, “I had many opportunities to come in contact with people who work with people with Alzheimer’s. I did more than a hundred mock-ups and asked my target users to give me feedback.”

Yao was surprised by the number of things caregivers have to be aware of. “Our loved ones may have visual impairment, and they may have depth perception problems with gripping things in front of them. Simple tasks can become difficult for them and I didn’t even know that before I did research on it and watched them struggle to eat.”

Although Yao has worked on a variety of products while completing her MFA in industrial design, this is the first project she developed from an idea to mass-production. Her impetus was a close connection with her grandmother, who took care of Yao and her sister as children while their parents worked.

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In the News, Medicine and Society, Nutrition, Parenting, Research, Women's Health

Research elaborates on how moms can protect their daughters’ body image

Research elaborates on how moms can protect their daughters' body image

6945839301_9d61091329_zIt’s been my experience that women struggle with their body image at some point on the way from girlhood to womanhood – this may be brief and exploratory, or get tangled with eating disorders and other destructive behaviors. When I had a period of bulimia in my early 20s, I reflected on (among other things) my mother’s relationship with food and body image, and so some new research from Ben-Gurion University in Israel struck a chord.

Maia Maor, PhD, a sociologist, and Julie Cwikel, PhD, a professor of social work and director of the Center for Women’s Health Studies and Promotion, invited adult mother-daughter pairs to reflect on various strategies the mothers used to instill resilience about body image in their daughters. The researchers identified five methods commonly used to resist or reject negative and oppressive messages about body image:

  1. Filtering: being cautious and sensitive regarding body image issues 
  2. Transmitting awareness of the dangers of eating disorders, which can cause illness and death
  3. Positive reinforcement, using affirmative language in regard to their daughters’ bodies
  4. Discussion: providing tools for criticism of dominant body-related messages
  5. Positivity: shifting the focus of food and body-related discussions away from weight loss and towards health and taking pleasure in food. 

In a press release from last week, Maor explained that “the focus on protective strategies was intended to achieve two goals: to emphasize the positive in mother-daughter relationships and to identify a repertoire of strategies available to parents and allied health professionals who wish to help their daughters or young women build a stable, positive body image.”

Feelings about food and bodies have long chains of intergenerational transmission. According to the release, “some of the mothers in the study recalled how their own mothers’ negative comments to them about eating too much led them to associate food with guilt and bad feelings. They raised their own daughters by instead talking about the quality of food, importance of food choices and its relationship to developing respect for their own bodies.”

The study appears in the journal Feminism & Psychology.

Previously: Incorporating the family in helping teens overcome eating disorders, Stanford study investigates how to prevent moms from passing on their eating disorders, Promoting healthy eating and a positive body image on college campuses, What a teenager wishes her parents knew about eating disorders, and Social website shown to boost teen girls’ body image
Photo by Thanasus Anastasiou

Ethics, Global Health, Health Policy, In the News, Medicine and Society, Public Health

Thinking about “culture” as part of global well-being

Thinking about "culture" as part of global well-being

5294003888_300b57c958_zEffective and ethical global-health initiatives involve some acknowledgement of culture – that is, they take into account local practices, beliefs, and circumstances, and they recognize that medicine is not “one size fits all.” A recent post on the blog Anthropological Observations takes this one step further, asserting that “culture” should be seen as something that is always changing, rather than a static fact to be accounted for. As a medical and cultural anthropologist pursuing a PhD, I couldn’t agree more.

Culture is often seen as a barrier to health by global-health professionals, as in “it’s not part of the local culture to visit clinics” or “cultural beliefs about how medication works make patients non-adherent to drug regimens: they take pills when they experience symptoms instead of at regular intervals.” Such observations are useful and can help adapt health initiatives to specific locales. However, this attitude can also be paternalistic and limiting because it doesn’t give people credit for being able to adapt to new information or situations.

The post’s author, Ted Fischer, PhD, a professor of anthropology at Vanderbilt University who has been advising the WHO’s project on the cultural contexts of health, writes:

A human-centered approach to health and wellbeing should adopt contemporary understandings of culture as dynamicfuture oriented, and driven by agency. We in anthropology now see culture as much more of a fluid process, a process rather than a thing. Cultural actors are always improvising, actively creating meaning out of the resources at hand.

He concludes that it is more accurate is to see culture as an opportunity for health, instead of an obstacle to it.

Previously: Exploring the benefits of pursuing anthropology and medicine, What other cultures can teach us about managing postpartum sleep deprivation, Exhibit on health and medicine among indigenous cultures opens at US National Library of Medicine and It’s a small world after all: Global health field takes off in the US
Photo by Onasil Bill Badzo

In the News, Media, Medical Education, Medicine and Society, Science

Wikipedia calls for more scientists to participate

Wikipedia calls for more scientists to participate

3204073130_417b9dc56a_z Wikipedia’s volunteer editors hosted the first Wikipedia Science Conference in London last week to urge scientists to participate in editing the massive online encyclopedia. Scientists often view Wikipedia as a “Wild West” because anyone can edit the pages, reports a piece in Nature, but in reality Wikipedia is a community of “ultra-pedants” obsessed by getting the facts right.

Martin Poulter, PhD, the main convener of the conference, is quoted as saying that many posts are already high quality, but professional academics, scientists, and publishers could improve the information in their field of expertise. He refers to a “cultural barrier” that includes a disinclination to participate in the “admittedly petty discussions” that sometimes crop up around Wikipedia edits. Alex Bateman, PhD, another organizer quoted in the article, adds that Wikipedia articles are written organically, sentence by sentence, which is very different than the research paper process. “There have to be changes from both sides. That’s what we’re discussing,” says Poulter.

One proposed project is to improve the Wikipedia biographies of famous scientists, starting with the fellows at The Royal Society, Britain’s pre-eminent scientific institution. The Society has agreed to take on a “Wikipedian in residence” to spearhead these efforts, which are aimed at reassuring scientists about the quality of Wikipedia articles. Another successful partnership is with the European Bioinformatics Institute, which maintains databases on protein and RNA families that have benefitted greatly from Wikipedia contributions. Wikipedia also maintains a page listing articles that need expert scientific attention.

But the benefits go both ways, says Poulter, who thinks academia can benefit from engaging with Wikipedia’s transparent process of knowledge curation. “Wikipedia is an opportunity to recapture some of the academic ethos that has been weakened by the commercial sector,” he is quoted as saying. “If you’re working in the open, you release all your data, your drafts and everything, and you invite comments from the start, rather than only after a process which is hidden away from the public.”

Previously: Science for popular audiences is not just “adding to the noise”Anthropologist discusses Wikipedia’s implications for health information, Is medical information on Wikipedia a public health problem?, How a “culture of permission” prevents doctors from being active in social media and ScienceRoll: What happens when pharma companies edit Wikipedia?
Photo by Johann Dréo

Health Disparities, Medicine and Society, Parenting, Pediatrics, Public Health, Stanford News

Stanford med student helps turn pediatrics waiting room into a center for school-readiness

Stanford med student helps turn pediatrics waiting room into a center for school-readiness


For many low-income children, a pediatrician is the only professional they interact with before they start kindergarten. This fact inspired Jecca Steinberg, a second-year Stanford medical student and Schweitzer Fellow, to think about how that interaction could improve these children’s school readiness, which often lags behind that of their peers. If these kids could be equally well-prepared for kindergarten, their potential for economic mobility would skyrocket.

Now, in an innovative collaborative effort, the pediatrics waiting room of Fair Oaks Health Center in Redwood City, Calif. is being turned into a learning center. According to previous research conducted by the Stanford Pediatric Advocacy Program, the clinic’s patient population includes more than 900 low-income children between the ages of 2 and 5; surveys indicate that only 31 percent participated in any kind of formal pre-school education and 82 percent were not school-ready by kindergarten.

In collaboration with Neel Patel, MD, the medical director at the clinic, Steinberg reached out to Stanford art practice lecturer Lauren Toomer, MFA, who volunteered her time and talent to produce a mural that will transform the drab waiting room into a space for learning opportunities. The mural incorporates letters, numbers, shapes, and images of the Redwood City community, as well as three interactive learning panels. Patel generously donated the funds for the supplies. See the prototype above; the actual mural will be finished by early October.

In a recent phone conversation, Steinberg explained to me that the mural project is one component of a larger project called Kinder Ready, which is part of Stanford’s Pediatric Advocacy Program led by Lisa Chamberlain, MD, MPH, and Janine Bruce, DrPH. (The work at Fair Oaks Clinic has been led by Stanford pediatrics residents Jaime Peterson, MD, and Ashley Case McClary, MD.) I asked her more about their efforts:

How did you get involved in this work?

I’d say my entire motivation for entering the field of medicine is centered on providing opportunities for socioeconomic mobility, and although health is an incredibly important aspect of that, it can’t be viewed in a vacuum as a solution. So these interdisciplinary efforts touch on everything I’m passionate about. For my first-year Stanford Medical Scholars research project, called community based participatory research, I set up a series of focus groups with low-income parents to talk to them about their conceptions of school readiness: what they think a role of a parent is, and how they think a pediatrician could help them.

Currently I help screen children for their school-readiness level, and I work with the parents to teach them different activities that they can do at home to promote their children learning. I’ve been working with Dr. Patel to include activities and interventions in well-child visits that parents can take home with them. We set them up with library cards, let them know about parent-child reading hours and mommy-and-me classes in the community, and make it easier to get a hold of books and other learning materials.

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In the News, Media, Medicine and Society, Public Health, Research, Science

Science for popular audiences is not just “adding to the noise”

Science for popular audiences is not just "adding to the noise"

4787885058_d174638233_zIf you’re reading this blog, chances are you’re a fan of popular science – i.e. scientific research made accessible to people who aren’t professional academics. Many academics, myself included, are also in favor of taking cutting-edge knowledge and sharing it broadly with the public.

But some scientists hesitate to share their work on forums like blogs and other social media. According to a recent SciLogs post, they worry that their knowledge might be wrong or incomplete, be misinterpreted, or just add more static to the internet’s noise. But, as the post lays out, those who think about such things are precisely those who should be publishing for broader audiences. Those who publish misinformation are not stopping to question the quality of the knowledge they broadcast; doubt and the recognition of ignorance are the hallmarks of true scientists. Adding even a small amount of high-quality research to the “science media ecosystem” helps.

Moreover, much of the public seems to have little trust in media, much trust in scientists, and is more receptive to information that acknowledges uncertainty. So bring on the science blogs!

Previously: Can science journals have beautiful prose?, The disturbing trend of science by press release, Science rapper “busts a move” to explain Nobel discovery, Science writer Deborah Blum on blogging: “There were so many smaller stories I wanted to tell” and Veteran blogger offers tips for starting a science blog
Photo by Robin Bray-Hurren

In the News, Media, Medical Education, Medicine and Society, Myths, Pregnancy, Research

Reality TV influences perspectives on pregnancy, study shows

Reality TV influences perspectives on pregnancy, study shows

272417047_806faa2243_zA new University of Cincinnati study on the influence that television programs have on pregnant women has found that most women are more affected by TV representations of childbirth than they think.

The study, funded by the NSF and conducted by Danielle Bessett, PhD, assistant professor of sociology, followed a diverse group of 64 women over the course of two years and investigated how they understood their television viewing practices related to pregnancy and birth. It found that class, as measured by education level, had the greatest influence on whether a woman acknowledged television as a significant source of pregnancy-related information. Highly educated women and those who worked outside the home were more likely to dismiss TV, while those with less education and who were unemployed or took care of children at home were more likely to report watching and learning from such shows as TLC’s “Baby Story” and “Maternity Ward” and Discovery Health’s “Birth Day.”

The particularly interesting finding is that TV portrayals affect women’s perceptions even when they don’t believe they have an influence. Bessett developed the term “cultural mythologies of pregnancy” to describe how TV, film, media, and word of mouth create expectations about “the way things are.” Most reality TV and fictionalized programming presents childbirth as more dramatic and full of medical interventions than the majority of births really are, and these images made a lasting impression on women.

As quoted in the press release, Bessett says, “Hearing women –– even women who said TV had no influence on them –– trace their expectations back to specific television episodes is one of the few ways that we can see the power of these mythologies.” Many women mentioned pregnancy representations they had seen long before they got pregnant.

Women who reported watching TV considered it part of a comprehensive childbirth education program and would often evaluate the programs’ reliability, while women who disavowed television saw it as entertainment or education for children, likely from a desire to be seen as valuing science and medical expertise.

“If we believe that television works most insidiously or effectively on people when they don’t realize that it has power, then we can actually argue that the more highly educated women who were the most likely to say that television really didn’t have any effect on them, may in the end actually be more subject to the power of television than were women who saw television as an opportunity to learn about birth and recognized TV’s influence,” hypothesizes Bessett.

“This research implies that many women underestimate or under-report the extent to which their expectations of pregnancy and birth are shaped by popular media,” concludes Bessett, suggesting that “scholars must not only focus on patients’ professed methods for seeking information, but also explore the unrecognized role that television plays in their lives.”

Previously: New reality shows shine harsh light on teen pregnancy and Study: TV dramas can influence birth control use
Photo by johnny_zebra

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