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Behavioral Science, Neuroscience, Podcasts

Advice for changing health behavior: “Think like a designer”

Advice for changing health behavior: "Think like a designer"

When listening to our latest 1:2:1 podcast, featuring a conversation with Kyra Bobinet, MD, MPH, two things jumped out at me. First, Bobinet, an expert in design thinking and behavioral change who says she “leads by my curiosity,” has a very cool personal story, and second: We shouldn’t be so hard on ourselves when we struggle to make positive health changes. In short, it’s not us – it’s a design flaw.

The interests of Bobinet, CEO and founder of a design firm using neuroscience to change behavior, can be traced back to medical school, when she was exposed to a program that taught health education in juvenile hall. “I became fascinated by the behavioral patterns of gang members who had violent pasts and came in and out of the system,” she says. These gang members vowed to stay out of jail when they were released but yet “two days later they were immersed” in their old lives and back in trouble. “Why is that happening? And how is that different than me saying I don’t want to eat french fries during Lent but then doing so the second day?” she wonders aloud.

Not long after, an experience with a patient wound up changing the trajectory of her career. During residency she saw a man with gout who had taken meth just three days prior. Bobinet had only ten minutes in clinic with him, and he only mentioned the drug use during the tail end of their conversation, before she had a chance to probe into it. “He changed my life,” she says. “I was so interested in the behavior that led to the medical condition – I [realized I] didn’t want to write prescriptions for the condition anymore, I wanted to focus on the behavior.” She went on to public health school from there.

In the podcast, Bobinet, who also teaches courses on patient engagement and empowerment in the Stanford AIM Lab with Larry Chu, MD, goes on to talk a lot more about behavior and what she has learned through extensive research of patients and caregivers. She talks about her new book, Well Designed Life, which lays the groundwork for those looking to design the changes they want to see in their life, and she offers more advice and words of encouragement for people who are struggling to, say, stay on a diet or quit smoking. “Think like a designer,” she says. Your failed attempt at making positive change “was just a version, just a protoptype… That was something that didn’t work – but it’s not you, it’s the design… And you have to redesign what will grab your attention now.”

Previously: Designing behavior for better health

Events, Global Health, Health Disparities, Health Policy, Podcasts

An optimist’s approach to improving global child health

An optimist’s approach to improving global child health

Globally, more than six million children die before their fifth birthday each year, most having been born into poverty. While great strides have been made over the last few decades in reducing global child mortality, some countries, like Pakistan, have lagged behind. Today, Pakistan has the third-highest infant mortality rate in the world and some of the worst child health and social indicators in the world.

In a new 1:2:1 podcast, Paul Costello, chief communications officer for the medical school, talks with Anita Zaidi, MD, an internationally renowned pediatrician and director of the Enteric and Diarrheal Diseases Program at the Bill & Melinda Gates Foundation, about the state of child health in her home country of Pakistan and what it takes to lift a nation up. The conversation was adapted from a recent global health seminar sponsored by the Center for Innovation in Global Health.

In speaking to an audience of Stanford students and faculty prior to her talk with Costello, Zaidi described herself as a “relentless optimist” who always takes the “glass half full” perspective. In looking back from 1990 to now, she said Pakistan has made some progress in reducing child mortality, but not as much as what it could have achieved.

Perhaps the biggest barrier to Pakistan’s progress stems from gender inequalities and the poor status of maternal health.

“Women are very marginalized in Pakistan, which affects their health and child mortality,” said Zaidi. “Unless we address those issues, [child health] is a tough problem to take care of… The citizens of Pakistan have a very big role to play.”

In 2013, Zaidi became the inaugural recipient of the $1 million Caplow Children’s Prize for her work in one of Karachi’s poverty stricken fishing communities, Rehri Goth, to save children’s lives. Through her work in Rehri Goth, she saw first hand the complex issues that impact whether a child will live to age five or not. In areas of extreme poverty, like Rehri Goth, improving primary healthcare is not enough.

“There’s no source of income. There are more than 10 kids in a family. Even if their newborn isn’t dying, the child dies at two or three months of age because there’s nothing to eat,” said Zaidi. “You realize there is this sub-population of extremely high-risk individuals, who need more than primary healthcare…They actually need some poverty alleviation types of interventions, food subsidies, to get them out of that.”

So, what does it take to lift a nation up? For Zaidi: “Girls getting educated will change the world, and more and more girls are getting education. We know that [education] one of the strongest predictors of improving child health outcomes.”

Rachel Leslie is the communications officer at Stanford’s Center for Innovation in Global Health.

Previously: Pediatric health expert Alan Guttmacher outlines key issues facing children’s health todayCountdown to Childx: Global health expert Gary Darmstadt on improving newborn survival and Training program helps dramatically reduce stillborn rates in developing countries

Podcasts, Stanford News

Lloyd Minor shares his vision for Stanford Medicine, talks about its “paradigm‑shifting advances”

Lloyd Minor shares his vision for Stanford Medicine, talks about its "paradigm‑shifting advances"

It’s been almost three years since Lloyd B. Minor took helm of Stanford’s medical school as dean, and he talks about his time here and his plans for the future in a new 1:2:1 podcast. Saying “this is an extraordinarily exciting place to work – a place where it’s easy to get out of bed in the morning with enthusiasm about what lies ahead in the day,” Minor goes on to talk about Stanford Medicine’s vision to lead the biomedical revolution, the promise of precision health, and his commitment to diversity. He also discusses Stanford’s many strengths, including the interdisciplinary nature of the work done here (“our ethos is one that really does encourage collaboration”) and our researchers’ drive to do big things: “For sure, there’s a role for incremental advances, but our unique strength [is in] being able to come up with paradigm‑shifting advances.”

Previously: How Stanford Medicine will “develop, define and lead the field of precision health”At Big Data in Biomedicine, Stanford’s Lloyd Minor focuses on precision healthStanford Medicine’s Lloyd Minor on re-conceiving medical education and A closer look at Stanford Medical School’s new dean

Podcasts, Precision health, Research, Stanford News

Big data holds great promise for medicine – but what about for the patient-doctor relationship?

Big data holds great promise for medicine – but what about for the patient-doctor relationship?

Big data is opening up all kinds of doors in health and medicine. Genomics and other ‘omics, wearable technologies, combining detailed patient datasets for precision medicine – the possibilities seem endless.

In the most recent episode of Raw Data, a new podcast produced by Worldview Stanford, my co-producer Mike Osborne and I explored the landscape of big data in medicine. We had the opportunity to interview several Stanford researchers, including Michael Snyder, MD, who talked to us about his working taking the quantified self to the extremeEuan Ashley, MD, who explained to us the promise that wearables hold for early diagnosis of cardiovascular disease; and Sylvia Plevritis, PhD, who discussed how patient datasets are revolutionizing cancer biology research.

Talking to these researchers offered an eye-opening dive into the intersection of big data and health and excited my imagination and optimism. But at the same time, a question lingered for both Mike and me. If algorithms can diagnose us accurately and help make decisions about treatment, what is the role of the human doctor in this scenario?

We were invited to the recent Stanford Medicine 25 Skills Symposium led by Abraham Verghese, MD, and to gain perspective on that question, we talked to physicians from all around the world. The doctors there were not anti-big-data in any way; in fact, they all agreed that data will greatly benefit the practice of medicine. But we heard many anecdotes about how the presentation of that data to doctors – via computers and tech devices – can intrude on the doctor-patient relationship, and take away from the trust and empathy that we can only find in human connection. It struck me that there’s a clear parallel with the wider grumbles about ever-present smartphones and technology intruding on every day, human moments.

Putting together this episode was a true pleasure. I look forward to a future in which we all receive early diagnoses, and precision health and treatment. At the same time, I agree with the Stanford Medicine 25 group that there are some parts of medicine that can’t and shouldn’t be handed over to a computer or an algorithm. We are human patients, and at the end of the day, we need human physicians to participate in the healing process.

Leslie Chang is the social media producer for Worldview StanfordRaw Data is supported by the Stanford Cyber Initiative and can be found on iTunes and SoundCloud.

Previously: Stanford Medicine 25 Skills Symposium to focus on building leaders for the bedside medicine movementWhat is big data?Experts at Big Data in Biomedicine: Bigger, better datasets and technology will benefit patientsRising to the challenge of harnessing big data to benefit patients and ‘Omics’ profiling coming soon to a doctor’s office near you?

Global Health, Podcasts, Public Health

It all comes down to truth: Stanford med student digs in on public-health campaigns

It all comes down to truth: Stanford med student digs in on public-health campaigns

While interning in the World Health Organization’s media unit in Delhi this summer, Stanford medical student Michael Nedelman found himself contemplating a question many public health officials and advertisers have struggled with for years: What makes an effective public-health campaign?

Much of the global burden of disease is associated with behaviors that are recognized as being detrimental to health, but – as Nedelman points out in an editorial called Fire with Fire – our current approach to public-health messages and health warnings doesn’t seem to be working.

Take smoking for example. In the 1990s, teen smoking was on the rise, despite the egregious statistics and daunting warnings that tobacco kills. But rather than scaring teens away from smoking, the national “truth” campaign took an unconventional approach. “Instead of dialing up the emotion of their ads, the truth campaign appealed to a different set emotional sensibilities, like humor, and let teens arrive at their own conclusions,” writes Nedelman.

In the editorial and three-part podcast episode (the first of which is above), Nedelman dissects the common “fear-based” trap that cause many public-health advertisements to fall flat and takes a deeper look at campaigns like the “truth” anti-smoking crusade that have been successful in changing behavior and compelling the public to care.

Nedelman is currently taking a year off from medical school to serve as the Stanford-ABC News Global Health and Media Fellow. Tune in for future episodes from his podcast series, Acoustic Nerve, here.

Rachel Leslie is the communications officer at Stanford’s Center for Innovation in Global Health.

Previously: A behind the scenes look at the Stanford-ABC News Fellowship in Media and Global HealthUN’s top health official: Anti-tobacco efforts can lead to better health “in every corner of the world”Study shows anti-tobacco programs targeting adults also curb teen smoking and Europe launches campaign to get young smokers to stop

Pediatrics, Podcasts, Public Safety, Women's Health

Jimmy Carter: The final campaign

Jimmy Carter:  The final campaign

People Jimmy CarterShortly after leaving the White House in 1980, Jimmy and Rosalynn established the Carter Center. It is from there that their efforts at “waging peace, fighting disease and building hope” – the center’s mission – have been launched.

Along with his global travels to advance democracies around the world, his projects in global health, and his time building for Habitat for Humanity, Jimmy Carter is also a prolific writer. He’s written twenty-eight books. One of his most recent – A Call to Action, Women, Religion, Violence, and Powerdetails the discrimination that women and girls face worldwide. Widely recognized for his Christian beliefs and noted as a Sunday school teacher for more than 70 years – Carter challenges those who use religious texts to deny women equality. In a Call to Action, he writes, “Women and girls have been discriminated against too long in a twisted interpretation of the word of God.”

For the latest Stanford Medicine, a special on issue on pediatric research and care, I spoke with Carter about girls and women’s equality – an issue that he said would receive his highest priority in his final years. But this summer brought disturbing health news, and a different priority has entered his life: treating metastatic cancer that has spread to his brain.

I worked in the Carter White House. Like many others who served there, I wasn’t prepared for this news – we viewed Jimmy Carter to be indestructible. Even the word “cancer” in regards to Carter seems oxymoronic when you know firsthand his indomitable spirit and boundless energy.

I spoke with him for this 1:2:1 podcast and Q&A before his diagnosis. Later in the summer, I followed up with an email wishing him well and a speedy recovery, and he responded: “Thanks, Paul. I am at ease, and grateful. Jimmy”

And then late last month, just two days before Carter’s 91st birthday, Habitat for Humanity announced that his medical team approved his traveling to Nepal in November to build a home there. (Note from editor: Habitat for Humanity has cancelled the trip due to safety concerns.) Talk about an indomitable spirit and boundless energy.

Previously: Stanford Medicine magazine tells why a healthy childhood matters and Lobbying Congress on bill to stop violence against women
Illustration by Gérard DuBois

Addiction, Podcasts, Public Health

Heroin: The national epidemic

Heroin: The national epidemic

4132006028_1fbf0b4076_zWhen I think of New England, I don’t naturally conjure up an image of heroin. Yet today, many cities and towns in the bucolic northeast are facing a heroin epidemic. Clearly at odds with the image of the Atlantic Ocean lapping at seaside resorts, Maine, Vermont, New Hampshire and Massachusetts are each seeing disturbing trends. Illustrating the magnitude of the problem engulfing his state, Vermont’s Governor Pete Shumlin devoted his entire 2014 State of the State address to what he called “a full blown heroin crisis.”

Across the country too, heroin death are skyrocketing: According to the Centers for Disease Control, more than 8,000 Americans died of heroin-related overdoses in 2013 – nearly three times as many as those who died in 2010.

So what’s fueling the explosion of heroin use? Stanford addiction expert Keith Humphreys, PhD, told me in this 1:2:1 podcast that it’s largely propelled by the huge number of prescriptions for opioid pain killers. According to the National Institute on Drug Abuse, more than 2 million Americans abuse prescription pain killers – and Humphreys says when the pills run out, many turn to heroin as a cheaper alternative and an equivalent high.

Recognizing the rippling toll on communities and families across the nation, the Obama administration announced a new program in August to combat the trafficking and use of the drug.  The Washington Post first reported the plan, saying that the initiative will pair public health officials and law enforcement in an effort to shift the emphasis from punishment to the treatment of addicts.

After hearing the heroin crisis also popping up in conversations from several presidential candidates during their jaunts to New Hampshire, I turned to Humphreys to dig deeper into the issue. In addition to being a professor of psychiatry and behavioral sciences at Stanford, Humpreys also spent a year in the White House Office of Drug Policy as a senior policy advisor during the first year of the Obama administration.

Previously: Assessing the opioid overdose epidemicA focus on addiction, the country’s leading cause of accidental deathWhy doctors prescribe opioids to patients they know are abusing them and Do opium and opioids increase mortality risk?
Photo by Lauri Rantala

Medicine and Literature, Podcasts, Public Health, Science

Jonas Salk: A life

Jonas Salk: A life

Salk book coverIn 1954, Charlotte DeCroes stood in line with her fellow second graders in Kingsport, Tennessee and received the polio vaccine. Her Tennessee hometown was one of the test sites for what was then the largest and most significant clinical trial in the history of medicine. By the end of 1953, there were 35,968 reported polio cases, and the United States was desperate to solve this devastating illness. A survey at the time ranked fear of polio second only to fear of atomic warfare.

Fast forward to 2015. Charlotte Jacobs, MD, professor of medicine, emerita at Stanford, has written a highly acclaimed biography of the famed researcher/physician Jonas Salk, MD, who developed the polio vaccine. In this 1:2:1 podcast, she told me that her ten-year journey into Salk’s life was instigated partly because she couldn’t find a thorough autobiography on him, something she considered a historical lapse.

Jacobs has written a finely honed and balanced portrait – saluting Salk’s great accomplishment while not flinching from describing a man who was enigmatic, complex and all too human. She conducted more than a hundred personal interviews and spoke to two of his three sons along with his longtime private secretary. The dichotomies of his life are fascinating. While he was loved and lauded by the public and the media, he was a pariah in the scientific community – never appreciated, accepted or awarded. (His scientific colleagues thought he was a press hound, an impression that was fueled by the media’s adoring gaze – covers and feature articles in the most popular media of the time, including Life, Time, Colliers, Consumer Reports, Popular Mechanics and U.S. News and World Report.)

Today, with vaccine wars sweeping certain areas of the country, Jacobs reminds us of a time when a major public-health crisis engulfed the nation and of a hero who made a difference and changed the landscape of medical history. It’s worth remembering.

Previously: Charlotte Jacobs on finding “snippets during every day” to balance careers in medicine and literatureStanford doctor-author brings historic figure Jonas Salk to life and Prescribing a story? Medicine meets literature in “narrative medicine”

Neuroscience, Podcasts

Remembering Oliver Sacks, “sleuth of the mind”

Remembering Oliver Sacks, "sleuth of the mind"

Oliver Sacks drawingIn memory of well-known neurologist and author Oliver Sacks, MD, who died yesterday: A look back at a lengthy conversation he had with us in 2012. For this 1:2:1 podcast, Paul Costello, chief communication officer for the medical school, spoke with Sacks about the discoveries Sacks made while writing his book The Mind’s Eye, and how Sacks was grappling with his ocular cancer.

My favorite part, as excerpted in an issue of Stanford Medicine magazine, was a quote of hope from Sacks: “I will say to patients, “I’m not sure that I can cure you or I can help this directly. But let’s think about other ways of living, other ways of doing things, and think positive.”

Illustration by Joe Ciardiello

Aging, Podcasts, Public Health, Research, Stanford News

Stanford doctor on a mission to empower patients to talk about end-of-life issues

Stanford doctor on a mission to empower patients to talk about end-of-life issues

Each year, about 2.6 million people die in America. Although past research has shown that 7 out of 10 of us prefer to die at home, an estimated 70 percent of people die in the hospital, nursing home or long-term care facility. The disconnect between where people die and how they would prefer to spend their final days often happens because loved ones and doctors don’t know their end-of-life wishes. Only 20 to 30 percent of Americans have completed advanced directives.

It’s not easy to talk about death, and the terminology used in advance directives can be confusing. I remember having to complete the form with my husband shortly before the birth of my first child. Despite having been in a relationship for 12 year, we had never discussed end-of-life issues. Imagining the scenarios that might lead to either of us being in a life-threatening situation was an extremely emotional exercise — especially as we awaited our son’s arrival. Did we want doctors to use every intervention possible to save our life? What if it meant sacrificing our quality of life? Did we want to be on life support? If so, how long?

We eventually turned to a friend, who was also a physician, to help us sort through the process. But we didn’t talk to our own primary care doctors and, to this day, our doctors have never asked us if we have an advance directive or about our end-of-life preferences. And this isn’t unusual. Recent research from VJ Periyakoil, MD, director of Stanford’s Palliative Care Education and Training, shows that most doctors struggle to talk with patients about what’s important to them in their final days, particularly if the patient’s ethnicity is different than their own.

In the latest 1:2:1 podcast, Periyakoil discusses her study findings and why it’s critical for all adults to complete an advance directive and initiate a conversation about their end-of-life wishes with their doctor and family. To get these conversations started and help patients navigate the emotionally-charged process, she launched the Stanford Letter Project, which provides templates in a range of languages asking patients simple questions about how they want to die.

Listen to the full podcast to learn more about the project and hear from Stanford Letter Project users about how they want to spend their final days.

Previously: How would you like to die? Tell your doctor in a letterIn honor of National Healthcare Decisions Day: A reminder for patients to address end-of-life issues, Study: Doctors would choose less aggressive end-of-life care for themselves and On a mission to transform end-of-life care

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