When I first met Stanford surgeon Sherry Wren, MD, I immediately liked her. The affinity was probably due to the fact that we’re both from the south side of Chicago. She’s a powerhouse personality. Down to earth. No pretensions. A surgeon who goes in for the toughest assignments. During her downtime she takes her expert surgical skills to the African bush for Doctors Without Borders and creates make-shift ORs in the most remote of locations. It’s clear she has a passion for her profession and also for life.
I don’t see Wren that often so I was surprised to learn earlier this spring about a serious disc injury she suffered that brought about a paralysis. Tracie White, one of our gifted writers who always gets to the essence of the people she writes about, has a feature article on Wren’s injury and recovery in the latest issue of Stanford Medicine. In it, Wren speaks candidly about losing the use of her hands and the real possibility she would never be able to return to the OR. Sherry is indefatigable so I wasn’t at all surprised in the end that she was victorious. But the road to get there wasn’t easy.
This is a survivors’ story about grit and determination. You’ll learn a lot about Sherry and her journey in Tracie’s story and in my latest 1:2:1 podcast, above.
When the history about medical marijuana’s path to legitimacy is written, CNN’s chief medical reporter Sanjay Gupta, MD, may be more than a footnote. Gupta famously authored a 2009 TIME magazine column decrying efforts to legalize marijuana for medicinal purposes. In a 180-degree turnabout in August 2013, he issued an apology and said he was wrong. He wrote that he didn’t look hard enough at the “remarkable research” indicating that for some illnesses marijuana provided a relief. He told me in this 1:2:1 podcast that while he’s cautious about the impact of marijuana on some brain and psychiatric disorders, he feels that the evidence is clear for certain diseases like epilepsy, neuropathic pain and muscle spasms brought on by MS that cannabis has the power to heal.
I wanted to talk to Gupta for this special issue of Stanford Medicine on surgery not only because of his controversial yea-and-nay positions about weed as medicine but because he’s also a neurosurgeon who still spends time with patients in and out of the OR between covering health crises around the globe. And in recognition of his clinical and advocacy skills, he was also personally asked by President Obama to consider taking the position of U.S. Surgeon General. (He turned down the offer as the timing just wasn’t right for him.)
And what about this new campaign to Just Say Hello that he launched on Oprah.com? He tells me that if we were a friendlier society – neighbor greeting neighbor – perhaps we could heal some of the loneliness out there and become a more civilized society.
I asked Gupta, since he travels internationally, whether there’s one universal truth that he finds all human beings seek. “Most everyone wants to do good by their bodies, understand health and how they can improve the health of their family members. I think that the desire for good health and desire for improved function is a universal thing,” he told me. And in his storytelling, what impact does he want to make with the viewer? What does he want the audience to understand about the world as seen through his eyes? He said:
If I can explain to them that as the bombs came raining down the same family that was driving their kids to school the day before, grocery shopping after that, stopping at a bank to withdraw some money, that they are now fleeing with whatever few possessions they could garner and run for the border… that they are a lot like families in your own neighborhood… That’s really important to me as a reporter.
There is currently no U.S. Surgeon General. Like everything else in Washington today, a confirmation vote by the U.S. Senate on President Obama’s choice, Harvard physician Vivek Murthy, MD, has been squashed by politics. Last spring, White House press secretary Jay Carney said that the administration was “recalibrating and assessing our strategy on moving forward with the nominee.” In March, The Hill newspaper reported that up to 10 Senate Democrats signaled they would oppose Murthy’s confirmation after the National Rifle Association made it clear Murthy’s support for bans of certain types of firearms and ammunition purchases made him an unthinkable choice.
Now if you’ve forgotten there even is a position called the U.S. Surgeon General post, think C. Everett Koop, MD, or Joycelyn Elders, MD. Koop and Elders were two recent appointees who used their bully pulpit to raise a national discussion about AIDS and teen pregnancy. (Both were lightening rods within their respective administrations – Koop in Reagan’s and Elders in Clinton’s. Elders was eventually dismissed by the White House after wading into too many contentious issues.)
Does the position even matter anymore? Associated Press medical reporter Mike Stobbe thinks it does. He’s written a fascinating book (Surgeon General’s Warning, University of California Press) about the history of the position and those who served. The book explains how the surgeon general became the most powerful and influential public health officer in the country and how those powers were later stripped away. An excerpt from Stobbe’s book appears in the current issue of Stanford Medicine magazine, where he catalogs the ups and downs of the individuals who held the position. The strong ones and the weak ones. Those who made a difference and those who faded away in controversy or without making a mark on the nation’s public health dialogue.
He writes, “Surgeon generals have played that crusader role better and more often than any other national public health figure. Absent such a crusader, the public’s health is prey to the misinformation and self-interest of tobacco companies, snake-oil salesmen and other malefactors.” Listen to my 1:2:1 podcast with Stobbe to hear more of his thoughts.
Dan Harris, author of 10% Happier – How I Tamed the Voice in My Head, Reduced Stress Without Losing My Edge, and Found Self-Help that Actually Works (whew, now that’s a mouthful) acknowledges that he’s not a new-agey spiritual kind of guy who you’d naturally find wandering in the tranquil waters of meditation. And across the phone line, when talking to him for my latest 1:2:1 podcast, I can tell. It’s clear he’s an Alpha Male who’s risen to the top in broadcast network news (co-anchor of Nightline and the weekend editions of Good Morning America) by not being laid back. So he might just be the right guy to take the world of meditation out of the “om” and bring it to a new audience. When I told him I thought he might be doing for mediation what Richard Nixon did for China – normalizing it – he laughed and said, “I love the analogy. It’s probably more flattering than I deserve, but it’s cool nonetheless.”
The success of 10% Happier is not something Harris envisioned. As he was writing it he kept telling his wife it was never going to find an audience: “No one is going to read it.” Yet he’s managed to spin out a wonderful tale about the life of a mega-skeptical agnostic journalist finding peace, happiness and yes, fulfillment, in the land of self-help and meditation. Well, maybe not total serenity. He did have that little spat with a New York City taxi driver last week that caused his wife to remind him that he still has more steps to climb to reach the Zen state of Fudoshin. Nonetheless, Harris is happier no matter what the percentage; you get the distinct impression that he sees a lot more sunshine out there than rain. And who wouldn’t want that?
Harris thinks his worrier gene was inherited from his father, Dr. Jay Harris who he calls “a gifted wringer of hands and gnasher of teeth.” His mother, Dr. Nancy Lee Harris, was much more in the Zen mode: “…slightly mellower about her equally demanding medical career.” (Both his parents are alums of the Stanford School of Medicine.)
Interestingly, Harris tells me he believes that emerging science linking the practice of meditation to a wide range of physical and psychological advantages may lead to the next big public-health revolution. “Say that again,” I asked. “You think that meditation will lead to a revolution?” With no lack of uncertainty he replied:
Yeah, I do. As I’ve said, the science is really still in its early phases, but the science is really compelling. It shows… that this whole, almost laughably long list of benefits from lower blood pressure to boosted immune system to reduced release of the stress hormone cortisol, and then the neuroscience is just truly sci-fi.
When we wrapped up the podcast, Harris spoke highly about the groundbreaking work being done here at Stanford by neurologist James R Doty, MD. Doty is leading his own revolution in neurology and created the Center for Compassion and Altruism Research and Education (CCARE), to stimulate a rigorous multi-disciplinary scientific effort at understanding the neural, mental, and social bases of compassion and altruism.
Earlier this week, my colleague wrote about a study showing that the majority of doctors surveyed said they would forgo aggressive end-of-life care for themselves. Now, in the latest 1:2:1 podcast, researcher VJ Periyakoil, MD, director of palliative care education and training at the medical school, talks in depth about the study and why doctors appear to want one thing for themselves at the end of life and quite another for their patients.
A few days after his latest research hit the press, I sat with neurologist Tony Wyss-Coray, PhD, for a 1:2:1 podcast. He laughed when I mentioned the range of news headlines touting his Nature Medicinestudy (subscription required) that found blood plasma from young mice improves the memory and learning of old mice. One headline declared: “The Fountain of Youth is Filled with Blood.” Another flashed: “Vampires Delight? Young Blood Recharges Brains of Old Mice.”
Serendipitously Wyss-Coray’s paper coincided with the release of two similar studies from Harvard teams on the rejuvenating power of young blood. For the science press, it was a perfect confluence of red.
My colleague Bruce Goldman has followed Wyss-Coray’s research for several years. He’s also written about prior studies of Thomas Rando, MD, PhD, showing that the blood of young mice could stimulate old stem cells and rejuvenate aging tissue. Rando’s work laid the path for Wyss-Coray’s investigations.
Perhaps there’s something here that will be significant for human beings and actually lead to breakthroughs in treatments for a range of neurological brain disorders like Alzheimer’s. Wyss-Coray is circumspect. It’s a tall leap from mice to human beings, but he’s eager to make the jump in clinical trials.
The headline of the front page New York Timesarticle caught my attention: “Cost of Treatment May Influence Doctors.” The piece read in part:
Saying they can no longer ignore the rising prices of health care, some of the most influential medical groups in the nation are recommending that doctors weigh the costs, not just the effectiveness of treatments, as they make decisions about patient care.
The shift, little noticed outside the medical establishment but already controversial inside it, suggests that doctors are starting to redefine their roles, from being concerned exclusively about individual patients to exerting influence on how health care dollars are spent.
In reading further, I discovered that one of Stanford’s cardiologists, Paul Heidenreich, MD, was a c0-chair of the policy review that led to new guidelines from the American College of Cardiology and the American Heart Association. I thought it would be interesting to delve deeper in a 1:2:1 podcast with Heidenreich about why, as he told the Times, “we couldn’t go on just ignoring costs.” Did escalating health-care costs that are consuming GDP spur the action? Are these guidelines a threat to individual decision-making between a physician and patient? And, what role do patients have in these decisions? Shouldn’t they be included in potential key life-and-death verdicts?
I was also especially intrigued by a quote from the societies’ paper outlining the changes: “Protecting patients from financial ruin is fundamental to the precept of ‘do not harm.’ ” Hmm… a new take on the Hippocratic Oath that I’ve never considered.
Why the new guidelines? Just consider for a moment the iconic rock lyrics of Bob Dylan. They say it all:
Come gather ’round people
Wherever you roam
And admit that the waters
Around you have grown
And accept it that soon
You’ll be drenched to the bone
If your time to you
Is worth savin’
Then you better start swimmin’
Or you’ll sink like a stone
For the times they are a-changin’
Eran Bendavid, MD, knows there’s a lot of debate about whether foreign aid for health care is really making an impact. So he and his colleague, Jay Bhattacharya, MD, PhD, devised a statistical tool to address a basic question: Do investments in health really lead to health improvements?
My colleague Ruthann Richter encapsulated the research in a recent article and blog entry. I followed up in a 1:2:1 podcast with Bendavid, and we started our conversation by talking about the perception that foreign aid is wasted and isn’t making significant inroads in changing the health-care trajectory in developing nations. Bendavid told me that the common perception of inefficiency was eroding confidence in foreign aid health care spending, so he decided to test it.
As Richter wrote, the researchers examined both public and private health-aid programs between 1974 and 2010 in 140 countries and found that, contrary to common perceptions about the waste and ineffectiveness of aid, these health-aid grants led to significant improvements with lasting effects over time. As Bendavid told Richter, “If health aid continues to be as effective as it has been, we estimate there will be 364,000 fewer deaths in children under 5. We are talking about $1 billion, which is a relatively small commitment for developed countries.”
Why are these dollars making an impact? Bendavid amplified to me what he told Richter: that foreign aid dollars were used effectively, largely because of the targeting of aid to disease priorities where improved technologies – such as new vaccines, insecticide-treated beds for nets for malarial prevention and antiretroviral drugs for HIV – could make a real difference.
Health aid in 1990 accounted for 4 percent of total foreign aid. It now accounts for 15 percent of all aid.
So something to cheer about when it comes to foreign aid. In health-care spending this study confirms it delivers the goods.
Nobel Laureate and Stanford Professor Roger Kornberg, PhD, discusses the importance of language, the benefits of frequent failure and how he developed the art of focusing deeply on a problem in the latest edition of the Nobel Prize Talks podcast series.
The conversation was recorded during last month’s Nobel Prize Inspiration Initiative, a global program that brings Nobel Laureates to universities and research centers to inspire and engage young scientists, the scientific community and the public. During the event, Kornberg participated in a panel discussion on how to create an innovative environment and delivered a lecture, entitled “The End of Disease.”
The podcast is available for free on the Nobel Prize website and iTunes. In the interview, Kornberg talks about the stage in his life when he came to terms with the reality that he would not be able to tackle several large scientific problems at once. Although he majored in English Literature, Kornberg had a strong desire to be an expert in a range of fields so he studied mathematics, chemistry, government and other subjects at the graduate level. But when he entered graduate school he decided to take a more focused approach. He said:
It was very apparent to me that I was entering another world. I would have to choose one thing and do it with all the capacity I could bring to bear, and it troubled me. But I recognized the necessity to do that in order to succeed and I did it almost immediately and in a single-minded manner. It didn’t bear fruit immediately. It took some years before I had an original idea of significance. But it finally came and I am convinced it was a result of this complete absorption in the problem.
Kornberg won the 2006 Nobel Prize in Chemistry “for his studies of the molecular basis of eukaryotic transcription.”
The FDA announced today its plans to regulate e-cigarettes. The news comes as little surprise to many, including Robert Jackler, MD, chair of otolaryngology at Stanford Medicine, who studies the effects of tobacco advertising, marketing, and promotion through his center, the Stanford Research Into the Impact of Tobacco Advertising. I asked Jackler this morning what he thought of the FDA’s plan, and he had this to say:
While I welcome the FDA proposal to deem electronic cigarettes as tobacco products under their regulatory authority, I’m disappointed with the narrow scope of their proposal and the snail’s pace of the process. Given its importance, I’m particularly troubled by the FDA’s failure to address the the widespread mixing of nicotine with youth-oriented flavorings (e.g. gummy bears, cotton candy, chocolate, honey, peach schnapps) in electronic cigarettes products. Overwhelming evidence implicates such flavors as a gateway to teen nicotine addiction [which] led the FDA to ban flavors (except for menthol – which is presently under review) for cigarettes in 2009. Give the lethargic pace of adopting new regulations, a generation of American teens is being placed at risk of suffering the ravages of nicotine addiction.
In a podcast last month, Jackler spoke in-depth about the rise of, and problems with, e-cigarettes. If you haven’t yet listened, now is a great time to.