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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

Neuroscience, Podcasts

What the world needs now: altruism/A conversation with Buddhist monk-author Matthieu Ricard

What the world needs now: altruism/A conversation with Buddhist monk-author Matthieu Ricard

Ricard - smallerSandwiched between trips to the titans of Silicon Valley – Facebook, Google, Salesforce and LinkedIn – and prior to an evening conversation with Stanford neurosurgeon James Doty, MD, Buddhist monk Matthieu Ricard, PhD, met with me to talk about his new book, Altruism – The Power of Compassion to Change Yourself and the World.

Ricard is on a cross-country speaking tour spreading his belief of how “altruism is the vital thread that can address the main challenges of our time, from economic inequality to environmental sustainability, from life satisfaction to conflict resolution.”

The French native is an internationally bestselling author (an earlier book, Happiness, A Guide to Developing Life’s Most Important Skill, was a huge global success), a scientist with a PhD in molecular genetics, and a photographer. The new book is a tome and perhaps even a salve for these turbulent times when the seams of the world seem to be tearing apart.

Ricard is a gentle man. He resides in a monastery outside Katmandu that sustained significant damage when an earthquake devastated Nepal in April. (His foundation, Karuna-Shechen, is raising funds for disaster relief.) At the age of 20, he went to India to meet the great masters of Tibetan Buddhism. He returned again in 1972, to study full time and lead a contemplative life, often times in isolation for long stretches of time. I asked him if the life of solitude was difficult; he told me it’s a question he’s frequently asked.

In this 1:2:1 podcast, we spoke about the intersection of neuroscience and meditation and the enormous growth of mindfulness in the U.S. I wondered whether he thought mindfulness was becoming too commoditized. For instance, would the world be better off with mindful drone operators? He thinks not. I also asked him about his purpose in life. But the main focus of the interview is his new book and his view that now is the time to spread altruism as the world desperately needs it and is primed to respond.

Ricard left the Bay Area over the weekend moving on to Los Angeles, Washington and New York to spread the word and demonstrate altruism in action.

Previously: From suffering to compassion: Meditation teacher-author Sharon Salzberg shares her story and His Holiness the 17th Karmapa discusses the nature of compassion
Photo by Raphaele Demandre

Mental Health, Podcasts, Stanford News

New frontiers for psychiatric illness

New frontiers for psychiatric illness

brain statueI started my recent conversation with Stanford psychiatrist and neuroscientist Amit Etkin, MD, PhD, with the March 24 crash of the Germanwings aircraft. The pilot, now known to have had a history of depression, was on an apparent suicide/homicide mission, killing 150 passengers when he crashed the plane in the French Alps. I wondered, could this tragedy in any way serve as a teachable moment to help de-stigmatize mental illness? Was it possible at all in the midst of a senseless horror to also have any constructive dialogue about mental illness?

I guess I already knew the answer, but Etkin confirmed it. He told me that when a horrendous event occurs like this, someone has to accept blame, and “that already colors the conversation you will have.” It’s not like when an admired public figure discloses a mental disorder and a conversation about mental illness can potentially enlighten the issue.  The sheer tragedy, Etkin said, overwhelms any attempt to educate or lessen the stigma about mental illness.

We went on to talk about the plasticity of the brain and its ability to recover, and a lot about the progress in brain research and why he believes we’re well into a new area of discovery that will reap benefits. And I asked him what Freud would think about this moment in time in psychiatry. Would the father of modern psychiatry see progress in the field if he were transported to today?

Freud, as a clinician, would be disappointed that “we’re not even close to cures now compared to 100 years ago when he lived,” Etkin responded. Freud’s early work, said Etkin,”was to actually try to understand the brain basis with the very, very rudimentary science at the time, of the things he saw clinically. I think that would make him happy – that now there’s a connecting of things grounded in the brain that there wasn’t a couple of decades ago. This is really a relatively new development with brain imaging.”

Etkin does offer great hope and believes the advances in the treatment of mental disorders that are well underway will be transformative in the future:

I think we are now at the point in psychiatry and in neuroscience relative to behavior and emotion where we finally have some of the tools we need to answer the questions that we want to answer and [are] no longer as limited by not having had those tools… Asking questions with the right tools will allow very, very big questions to be answered.

Previously: Study: Major psychiatric disorders share common deficits in brain’s executive-function networkHope for the globby thing inside our skulls, My descent into madness – a conversation with author Susannah CahalanBrain study offers “intriguing clues toward new therapies” for psychiatric disorders and Searching for better PTSD treatments
Related: Brain power: Psychiatry turns to neuroscience
Photograph of a Federico Carbajal Raya sculpture by Victor Vargas Villafuerte

Genetics, Pediatrics, Podcasts, Research, Stem Cells

Countdown to Childx: Stanford expert highlights future of stem cell and gene therapies

Countdown to Childx: Stanford expert highlights future of stem cell and gene therapies

RoncaroloNext month’s inaugural Childx conference will bring a diverse group of experts to Stanford to discuss big challenges in infant, child and maternal health. Today, in a new 1:2:1 podcast interview, stem cell and gene therapy expert Maria Grazia Roncarolo, MD, provides an interesting preview of a once-controversial area of research that will be featured at the conference.

Roncarolo talks about the history and future of stem cell and gene therapy treatments, which have recovered from tragic setbacks such as the 1999 death of 18-year-old Jesse Gelsinger in an early gene therapy trial. The early problems forced researchers to reevaluate what they were doing, with the result that the entire field has reemerged stronger, she explains:

I would say that there were major problems, that we underestimated the complexity that it takes to manipulate the genome, and to introduce a healthy gene to fix a genetic disease. However, from these mistakes and from these tragedies, we learned a lot. We were really forced as doctors, and more importantly, as scientists, to go back to the bench and develop better technologies and to understand more of what was required. … [Today] we use better vectors — which are the carriers to introduce the healthy gene — we know much more about what we have to do to prepare the patient to receive the gene therapy, and we also learned that we need to do a very careful monitoring of the patients to really understand where the gene lands in the genome.

At the Childx conference, Roncarolo will moderate a panel on “Definitive Stem Cell and Gene Therapy for Child Health,” hosting such guests as GlaxoSmithKline’s senior vice president of rare diseases, Martin Andrews, and Nadia Rosenthal, PhD, founding director of the Australian Regenerative Medicine Institute.

Information about registration for Childx, being held here April 2–3, is available on the conference website.

Previously: Stanford hosts inaugural Childx conference this spring and Stanford researchers receive $40 million from state stem cell agency
Photo by Norbert von der Groeben

Cancer, Podcasts, Stanford News

Stanford neurosurgeon/cancer patient Paul Kalanithi: “I can’t go on. I will go on.”

Stanford neurosurgeon/cancer patient Paul Kalanithi: "I can't go on. I will go on."

Kalanthi and childEditor’s note: Paul Kalanithi passed away on March 9, after this post was published.

Frankly, I didn’t quite know how to begin my conversation with Paul Kalanithi, MD. How do you talk to a 37–year-old man about his terminal illness and facing death? A conversation with someone so young who’s the father of a small child is supposed to be ebullient, not dark.

Kalanithi, a Stanford Medicine neurosurgeon and fellow with Stanford Neurosciences Institute, was diagnosed with advanced stage lung cancer in 2013. His illness is terminal. While he’s hopeful that a treatment may extend his life, there is no cure. He faces big questions and small ones. And he wonders: “How do I talk about myself – in the present, past or future tense? When someone says, ‘See you next year,’ will I?”

It all began with back pain, night sweats, weight loss and fever. His neurosurgical training prepared him for what he reviewed on his CT scan. Metastatic cancer. He responded well to his initial treatment plan, but a second round of chemotherapy last spring led to a number of complications and setbacks. Though he finished his residency he’s now taking time off to recover and regain his strength. He remains hopeful about a return to neurosurgery, yet he has to prepare for an end. He’s spoken with a palliative-care expert. He’s mulling the existential questions and trying to grapple with moving on while not giving up. He takes comfort in the words of the Irish novelist and playwright, Samuel Beckett: “I can’t go on. I can go on.” They’ve become sort of his mantra.

Still, he knows he faces the inevitable and whether it’s a year, two years or five, terminal is the diagnosis. He’s trying to find a way to leave a trail of bread crumbs to his life so his child will know she was loved deeply when his presence is all but a shadow.

I spoke with him last November for a 1:2:1 podcast while he was in the throes of writing a book proposal. It was hard for me at points in our conversation to keep it together as our talk pried open my own grief over my brother’s death to cancer at age 48.

Kalanithi also wrote a beautiful piece for Stanford Medicine magazine. It’s magical. It’s lyrical. It touches the heart. And it’s clear, no matter what his health status, no matter what the outcome, he will live on.

Previously: Stanford Medicine magazine reports on time’s intersection with health, For this doctor couple, the Super Bowl was about way more than football, A neurosurgeon’s journey from doctor to cancer patient, Stop skipping dessert:” A Stanford neurosurgeon and cancer patient discusses facing terminal illness and No one wants to talk about dying but we all need to
Photo by Gregg Segal

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