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Behavioral Science, Complementary Medicine, Neuroscience, NIH, Patient Care, Research

“Tranceformation:” David Spiegel on how hypnosis can change your brain’s perception of your body

4254170454_4f55755317_zWhen we think of cognitive function, we usually think of having the power to alter our reasoning, while we passively respond to our perceptions. What if we could do the inverse: manipulate our perception, while merely responding to reasoning and language? That is the basic neurological explanation of hypnosis, says David Spiegel, MD, director of the Center on Stress and Health and medical director of the Center for Integrative Medicine.

Spiegel spoke on new research in hypnosis yesterday morning during the Integrative Medicine Research Lecture Series presented by the National Center for Complementary and Integrative Health (NCCIH). Despite its Greek etymology, hypnosis does not involve going to sleep; it’s more like a narrowing of attention. “Hypnosis is to consciousness what a telephoto lens is to a camera,” Spiegel explained.

When hypnotized, you put outside of awareness what would normally be in consciousness (dissociation), and become less likely to judge what people tell you (suggestibility). The idea of this often makes people nervous, because we’re evolved to respond to nuanced social cues. But a growing body of scientific evidence suggests that overcoming this nervousness can yield a wealth of health benefits.

Hypnosis can be an effective method for managing pain, and treating anxiety and stress-related disorders. Past studies have shown that people hypnotized before operative care have a shorter procedure time and a significant reduction in intraprocedural complications, such as hypoxemia and vomiting. One study showed that in select cases “hypnosis as sole anesthesia works extremely well,” Spiegel said.

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CDC, Complementary Medicine, Medicine and Society, NIH, Podcasts

Podcast explores Americans’ use of complementary medicine

Podcast explores Americans' use of complementary medicine

5007651053_935ec0fd58_zDo you do yoga, take probiotics, see a chiropractor, or follow a special diet? If so, you’re not alone; roughly 34 percent of Americans make use of complementary therapies, and these are among the most popular ways to do so.

You may have read about the CDC report (.pdf) that came out last month and showed the prevalence of complementary medical approaches among American adults. For more, check out this podcast from The Lancet, during which Josephine Briggs, MD, director of the National Center for Complementary and Integrative Health (NCCIH), and Richard Nahin, PhD, MPH, NCCIH’s lead epidemiologist, discuss the major findings of the report and some of the potential implications for public policy.

Previously: Study shows complementary medicine use high among children with chronic health conditions, More hospitals offering complementary medicine, Older adults increasingly turning to complementary medicine and Americans’ use of complementary medicine on the rise
Photo by lyn tally

Imaging, In the News, NIH, Pregnancy, Research, Women's Health

NIH puts focus on the placenta, the “fascinating” and “least understood” organ

NIH puts focus on the placenta, the "fascinating" and "least understood" organ

ultrasoundLast week, the NIH announced its support for an initiative to study how new technologies can shed light on the placenta’s function and health during pregnancy. Considering how crucial the placenta is to not only the health of a woman and her fetus during pregnancy, but also to the lifelong health of both, it’s surprising to hear the NIH call it “the least understood human organ.”

Currently, doctors and scientists can only gather information about the placenta by using ultrasounds and blood tests, and by examining it after delivery. What if new sensors could track how well blood, oxygen, and nutrients are flowing to the fetus, or if new imaging technologies could assess how well the placenta is attaching to the uterine wall? What if biotechnology could assess the effects of environmental factors on the placenta, such as air pollution, maternal diet, and medications?

Better understanding and monitoring of this temporary organ promises to improve maternal and child health. Placental issues can contribute to negative pregnancy outcomes such as preeclampsia, gestational diabetes, preterm birth, and stillbirth, and they’ve also been linked to a higher risk of heart disease later in life, for both mother and child.

This is the third and largest funding announcement for the NIH’s Human Placenta Project, led by the NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development and cosponsored by the NIH’s National Institute of Biomedical Imaging and Bioengineering.

Calling the placenta a “fascinating organ” and the “lifeline that gives us our start in the world” Alan E. Guttmacher, MD, director of the NICHHD, also said in an NIH press release:

We hope this funding opportunity will attract a broad range of researchers and clinicians to help — placental biologists, obstetricians, and experts in imaging, bioengineering, and other arenas… For researchers who want to apply their skills in an area of medicine that isn’t being looked at as much as both scientific opportunity and human health warrant, this is a wonderful chance.

Previously: Placenta, the video game, The placenta sacrifices itself to keep baby healthy in case of starvation and Program focuses on the treatment of placental disorders
Related: Too deeply attached and A most mysterious organ
Photo by thinkpanama

Mental Health, NIH, Pregnancy, Research, Women's Health

Women who have a stillbirth are more likely to experience long-term depression, study shows

Women who have a stillbirth are more likely to experience long-term depression, study shows

5614885964_e75f4261b2_zAny serious loss requires grieving time, and the birth of stillborn child is no exception. However, a recent study suggests that women who have experienced a stillbirth should be monitored for depressive symptoms well after the standard six-month grieving period – up to three years, in fact. Among women who have given birth and who have no history of depression, women who have had a stillbirth are at significantly higher risk of developing long-term depression.

The research was conducted by the NIH’s Stillbirth Collaborate Research Network (SCRN), which defines stillbirth as the death of a baby at or after the 20th week of pregnancy. It occurs in 1 out of 160 pregnancies in the United States, a surprisingly high ratio.

This study is the first to show definitively that women who have no history of depression may face a risk for it many months after a stillbirth

From 2006-2008, the researchers enrolled nearly 800 women from 59 hospitals across the U.S., around a third of whom had delivered a stillbirth (with the other two-thirds having had delivered a healthy baby). In 2009, the women were asked to complete a questionnaire designed to gauge whether they were experiencing symptoms of depression.

After accounting for other factors related to depression and stillbirth among the more than 76 percent of women who did not have a history of depression, the researchers found that women who had a stillbirth were twice as likely to have a high depression score compared to women who had a live birth. This difference was even greater among those responding to the questionnaire 2-3 years after they had delivered, at nearly nine times as likely.

In an NIH article, author Carol Hogue, PhD, director of the Women’s and Children’s Center at Emory University’s Rollins School of Public Health in Atlanta and first author of the study, said, “Earlier studies have found that women with a history of depression are especially vulnerable to persistent depression after a stillbirth, even after the subsequent birth of a healthy child,” but this study is the first to show definitively that women who have no history of depression may face a risk for depression many months after a stillbirth.

The study appears in the March issue of the journal Paediatric and Perinatal Epidemiology.

Previously: 2020 Mom Project promotes awareness of perinatal mood disordersLosing Jules: Breaking the silence around stillbirth, A call to break the silence of stillbirth and Pregnancy loss puts parents’ relationship at risk
Photo by Gates Foundation

Genetics, NIH, Research, Science, Stanford News

Project Roadmap: Mysteries of the epigenome revealed

Project Roadmap: Mysteries of the epigenome revealed

Let’s hear it for large, international collaborations! Hot on the heels of the ENCODE Project (well, in research time anyway) comes the National Institutes of Health’s Roadmap Epigenomics Project, which is geared toward understanding how chemical tags on DNA and its associated proteins determine how each cell uses the information in the genome to develop its own identity. One of the leaders of the massive project was geneticist Anshul Kundaje, PhD, who helped to analyze the huge amounts of data generated by labs around the world as they studied more than 100 adult and fetal human tissues.

The work is published today in Nature in the form of a large package of papers. Kundaje is the first author of the main paper; Nature has also published a nice summary of all the papers in the issue and produced a musical video to explain the project.

From our release:

The problem [of picking and choosing from a genome’s worth of information] is somewhat like being handed a list of all the ingredients available in a well-stocked kitchen without any idea of how to combine them. Tossing a few of them together, willy-nilly, into a baking dish and popping it into the oven isn’t likely to yield anything edible. But with a well-written recipe telling you how much and when to mix together flour, sugar, eggs and butter, you can turn out a perfect cake or fantastic waffles.

The completion of the Human Genome Project gave biologists the list of ingredients to which every cell has access. The Roadmap Epigenomics Project outlines the recipes and shows how cells use these ingredients to generate their own special sauce. By comparing and contrasting these cellular recipes, researchers can begin to draw parallels among cell types and even predict which cells might be involved in specific traits and diseases.

As a proof of principle, Kundaje and others showed in one of the companion papers that, based on the epigenomic maps shared among cells, the immune system is likely to play a larger role in the development of Alzheimer’s disease than previously thought.

Previously: Scientists announce the completion of the ENCODE project, a massive genome encyclopedia , Red light, green light: Simultaneous stop and go signals on stem cells’ genes may enable fast activation, provide “aging clock” and Caught in the act! Fast, cheap, high-resolution, easy way to tell which genes a cell is using

Health Disparities, NIH, Research, Stanford News, Women's Health

Stanford professor encourages researchers to take gender into account

Stanford professor encourages researchers to take gender into account

SchiebingerAs a scientist, I’m trained to look for biases that can cause unreliable results. This is why I feel so disheartened every time I read about scientific studies that fail to take sex and gender differences into account.

These differences, and the work of Londa Schiebinger, PhD, a Stanford professor of the history of science, were the focus of a recent Stanford Report article. In the piece, Schiebinger, who directs the Gendered Innovations in Science, Health & Medicine, Engineering, and Environment, explains that ignoring the biological differences between males and females is a form of gender bias that can have catastrophic results:

…Experiments done in women may not have been tested first in female mice or rats — “a potentially dangerous situation,” Schiebinger said.

Recent studies have shown that 80 percent of rodent drug studies are conducted using male models. This means that not only are females left out, but that research sees nothing unique to females in the initial stages of research.

“We’re missing the opportunity to build our foundation of knowledge of just about every biological system more accurately at the outset, which should be a fundamental goal of science,” said Marcia Stefanick, research professor of medicine in the Stanford Prevention Research Center and of obstetrics and gynecology and co-director of the Gendered Innovations project.

Incorporating gender and sex differences in the design of a scientific study is not only good science, it can make the end product more effective. Shiebinger’s latest endeavor is to help scientists understand when and how to address gender biases in their research. This goal is the focus of a new initiative she’s leading with support from the U.S. National Science Foundation and the European Commission.

Shiebinger admits that there’s much work to do, but her efforts, and those of others in the field, are paying off. As mentioned in the piece, the EU Research and Innovation program last winter identified 137 fields of science and technology that could be improved by gender analysis. “…Eyes have been opened – and we will not return to a world that ignores gender,” Shiebinger said.

Previously: A look at NIH’s new rules for gender balance in biomedical studies, Why it’s critical to study the impact of gender differences on diseases and treatments, Stanford Gendered Innovations program offers tools for improving scientific research, Study shows many heart devices receive FDA approval without adequate testing on women and Women underrepresented in heart studies
Photo by Daniel Pozo

Big data, NIH, Research, Videos

Fly through the inside of a mouse lung

Fly through the inside of a mouse lung

Take a 50-second ride through the inside of an adult mouse lung in this video created by Rex Moats, PhD, scientific director at Children’s Hospital Los Angeles. A post published today on the NIH Director’s Blog describes the animation and points out that the video is a prime example of how scientists are using big data to make biomedical research more accessible to the public:

We begin at the top in the main pipeline, called the bronchus, just below the trachea and wind through a system of increasingly narrow tubes. As you zoom through the airways, take note of the cilia (seen as goldish streaks); these tiny, hair-like structures move dust, germs, and mucus from smaller air passages to larger ones. Our quick trip concludes with a look into the alveoli — the air sacs where oxygen is delivered to red blood cells and carbon dioxide is removed and exhaled.

… [Moats] created this virtual bronchoscopy from micro-computed tomography scans, which use X-rays to create a 3D image. The work demonstrates the power of converting Big Data (in this case, several billion data points) into an animation that makes the complex anatomy of a mammalian lung accessible to everyone.

Speaking of the power of big data, the Big Data in Biomedicine conference returns to Stanford May 20-22. For more information about the program or to register visit the conference website.

Previously: Big data = big finds: Clinical trial for deadly lung cancer launched by Stanford study and Peering deeply – and quite literally – into the intact brain: A video fly-through

Imaging, Mental Health, Neuroscience, NIH, Research, Stanford News

Study: Major psychiatric disorders share common deficits in brain’s executive-function network

Study: Major psychiatric disorders share common deficits in brain's executive-function network

marble brainPsychiatric disorders, traditionally distinguished from one another based on symptoms, may in reality not be as discrete as we think.

In a huge meta-analysis just published in JAMA Psychiatry, Stanford neuroscientist and psychiatrist Amit Etkin, MD, PhD, and his colleagues pooled the results from 193 different studies. This allowed them to compare brain images from 7,381 patients diagnosed with any of six conditions – schizophrenia, bipolar disorder, major depression, addiction, obsessive-compulsive disorder, and a cluster of anxiety syndromes – to one another, as well as to brain images from 8,511 healthy patients.

Compared with healthy brains, patients in all six psychiatric categories showed a loss of gray matter in each of three separate brain structures. These three areas, along with others, tend to fire in synchrony and are known to participate in the brain’s so-called “executive-function network,” which is associated with high-level functions including planning, decision-making, task-switching, concentrating in the face of distractions, and damping counterproductive impulses.

The findings call into question a longstanding tendency to distinguish psychiatric disorders chiefly by their symptoms

(“Gray matter” refers to information-processing nerve-cell concentrations in the brain, as opposed to the “white matter” tracts that, like connecting cables, shuttle information from one part of the brain to another.)

As Etkin told me when I interviewed him for the news release we issued on this study, “these three structures can be viewed as the alarm system for the brain.” More from our release:

“They work together, signaling to other brain regions when reality deviates from expectations – that something important and unpredicted has happened, or something important has failed to happen.” That signaling guides future behavior in directions more likely to obtain desired results.

The studies of psychiatric patients that Etkin’s team employed all used a technique that yields high-resolution images of the brain’s component structures but can say nothing about how or when these structures work or interact with one another. However, that kind of imaging data was available for the healthy subjects. And, on analysis, those healthy peoples’ performance on classic tests of executive-function (such as  asking the test-taker to note the color of the word “blue,” displayed in a color other than blue, after seeing it briefly flashed on a screen) correlated strongly with the volume of gray matter in the three suspect brain areas, supporting the idea that the anatomical loss in psychiatric patients was physiologically meaningful.

The findings call into question a longstanding tendency to distinguish psychiatric disorders chiefly by their symptoms rather than their underlying brain pathology – and, by implication, suggest that disparate conditions may be amenable to some common remedy.

As National Institute of Mental Health Director Thomas Insel, MD, told me in an interview about the study, the Stanford investigators “have stepped back from the trees to look at the forest and see a pattern in that forest that wasn’t apparent when you just look at the trees.”

Previously: Hope for the globby thing inside our skulls, Brain study offers intriguing clues toward new therapies for psychiatric disorders and Study shows abnormalities in brains of anxiety-disorder patients
Photo by Philippe Put

Big data, Clinical Trials, FDA, NIH, Research, Science

Transparency in clinical trials: The importance of getting the whole picture

Transparency in clinical trials: The importance of getting the whole picture

New rules for clinical trials Scope blog 2015.02.02Last week, the Journal of the American Medical Association ran a Viewpoint article from Francis Collins, MD, PhD, director of the National Institutes of Health and Kathy Hudson, PhD, deputy director of NIH, about the U.S. Health and Human Services’s plans to beef up transparency of clinical trials of FDA-regulated drugs and devices.

As they write, the rate of results-sharing for clinical trials is fairly dismal. Some of the reasons for this go beyond researchers; for example, it’s extremely difficult to get negative results published in scientific journals. Collins and Hudson point out that another avenue exists for sharing summary results: NIH’s ClinicalTrials.gov website. But even there, less than one-third of researchers had shared results within four years of the end of their studies. Collins and Hudson are critical of this lapse in data sharing:

Without access to complete information about a particular scientific question, including negative or inconclusive data, duplicative studies may be initiated that unnecessarily put patients at risk or expose them to interventions that are known to be ineffective for specific uses. If multiple related studies are conducted but only positive results are reported, publication bias can distort the evidence base. Incomplete knowledge can then be incorporated into clinical guidelines and patient care. However, one of the greatest harms from nondisclosure of results may be the erosion of the trust accorded to researchers by trial participants and, when public funds are used, by taxpayers.

The new rules make the expectations to report some summary details about clinical trials, including adverse events, explicit. Although NIH has always encouraged sharing of summary results, the rules haven’t always been explicit. Now that there will be detailed guidance, the penalty for not complying will be harsher:

Thus, with the implementation of clearer requirements, augmented support materials and resources, and facilitated reporting, the NIH expects that investigators and sponsoring organizations will have the necessary tools to provide accurate, complete, and timely trial results submissions. However, for grantees who are subject to the amendments act and fail to comply after sufficient notification, the law is clear that NIH and other federal funders of clinical trials must then withhold further funding for the grant and any future grant to the grantee. In addition, the timely reporting of clinical trials will be taken into consideration during review of subsequent applications for funding.

The proposed changes to the regulations are currently in the public comment period, which will end in a few weeks, on February 19. After a review of the comments (and possible revisions), a final rule will likely be issued in a few months time. Once the rule goes into effect, it will be interesting to watch how this changes the research process for new NIH and FDA-regulated studies.

Previously: Shake up research rewards to improve accuracy, says Stanford’s John IoannidisRe-analyses of clinical trial results rare, but necessary, say Stanford researchersHow important is it to publish negative results?Researchers call for “democratization” of clinical trials data and A critical look at the difficulty of publishing “negative” results
Photo by U.S. Department of Defense

Genetics, In the News, NIH, Public Health, Research

The genomics revolution and the rise of the “molecular stethoscope”

The genomics revolution and the rise of the “molecular stethoscope”

ATCGBack in 2012, Stanford bioengineer Stephan Quake, PhD, and colleagues sequenced the genome of a fetus using only a maternal blood sample for the first time. Technology Review later recognized the work as one of the “10 Breakthrough Technologies 2013.”

In a recently published opinion piece (subscription required) in the Wall Street Journal, Quake and Eric Topol, MD, a professor of genomics at the Scripps Research Institute, discuss the method and how it exemplifies the potential of the genomics revolution to provide scientists and clinicians with a new type of stethoscope that allows one to see “inside the body at the molecular level.” They write:

The prenatal molecular stethoscope is the first truly widespread clinical application to result from the human-genome project. The National Institutes of Health has an opportunity to build on this new knowledge of “alien” DNA in healthy individuals, and determine whether it may change their clinical course—the molecular-stethoscope approach. Meanwhile, whole genome sequencing of the germ-line, or native, DNA from populations is under way, with seven ongoing world-wide projects, each sequencing the native DNA from 100,000 or more individuals. It’s projected that nearly two million people will be sequenced by 2017.

Already, the scientific literature is brimming with new applications of the molecular stethoscope. Two studies in the New England Journal of Medicine in December showed that more than 10% of healthy people over age 65 carried so-called somatic mutations in their blood cells, and that these individuals had more than a tenfold increased risk of subsequently developing a blood-based cancer.

Previously: Stanford-developed eye implant could work with smartphone to improve glaucoma treatmentsA simple blood test may unearth the earliest signs of heart transplant rejection and Step away from the DNA? Circulating *RNA* in blood gives dynamic information about pregnancy, health
Photo by Stefano

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