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Global Health, LGBT, Public Health, Public Safety, Women's Health

Advocating for the rights of women and LGBT individuals in the developing world

Advocating for the rights of women and LGBT individuals in the developing world

Randy Barry - smallLast spring, I traveled to Washington, D.C. for my first experience as a citizen-activist, lobbying in Congress for the rights and well-being of women and LGBT individuals in the developing world. I recently returned there to see some of the impact of that work – crucial new appointees, new legislators in support of key issues and new words of encouragement from both sides of the political aisle.

I visited Washington as part of a 170-person delegation from the American Jewish World Service (AJWS), an international organization that promotes human rights and seeks to end poverty in developing countries. Our goal was to advance several initiatives, including passage of the International Violence Against Women Act, and changes to ensure that U.S. foreign contracts and foreign aid programs do not discriminate against LGBT individuals.

I was thrilled to hear a talk by Randy Berry, the State Department’s first-ever Special Envoy for the Human Rights of LGBT Persons, who assumed the new post in February. Just a year ago, AJWS had made the appointment of a special envoy one of its priority issues, and many of us, myself included, had met with our Congressional representatives to push for the position. I had been motivated by my experiences as an AJWS Global Justice Fellow in Uganda in 2014, when we met with LGBT activists who were living in a climate of terror because of the country’s impending anti-gay law. We heard stories of people who had been raped, beaten, harassed, evicted from homes and jobs and subjected to summary arrest.

I realized it was important to make LGBT rights a priority issue for U.S. foreign policy. Berry, the new U.S. envoy, said AJWS had been a “prime mover” in the creation of his new office – gratifying news indeed. He said he views LGBT rights as a “core human rights issue.”

“We are talking about equality, and it should go hand-in-hand with what we are doing in gender equality and in the disabled community,” he told us. “One of the most disturbing elements of discrimination is that it’s the first step to denying one’s humanity.”

He acknowledged that he has a daunting job ahead; while the U.S. is making swift progress on gay rights, these rights are just as swiftly being eroded in other parts of the world. Nearly 80 countries now criminalize same-sex behavior, with penalties that include death or life in prison. Yet the fact that the U.S. has made so much progress in recent decades suggests it’s possible to change the climate elsewhere as well, he said.

“Who would have dreamed 20 years ago that we would be where we are today in the United States,” he said. “I am sitting here today with the support of the State Department, the president and members on both sides of the aisle.”

We also saw progress on the International Violence Against Women Act, which would make ending violence against women worldwide a top U.S. diplomatic and development priority. Violence against women and girls is alarmingly pervasive, with as many as one in three being beaten, coerced into sex or subjected to other abuse in her lifetime.

The legislation was reintroduced in the House of Representatives in March with a record 18 co-sponsors, including many more Republicans than in the past. On the morning of our lobbying visits, we heard from seven Members of Congress, including Chris Gibson (R-NY), Richard Hanna (R-NY) and Lee Zeldin (R-NY), all of whom expressed strong support for the bill. David Cicilline (D-RI) described a trip to Liberia in which he met a group of young girls who had been subjected to “hideous, indescribable sexual violence.”

“It made me realize we need to do everything we can to change the lives of these young girls,” he told us.

I couldn’t agree more.

Previously: Stanford study shows many LGBT med students stay in the closetChanging the prevailing attitude about AIDS, gender and reproductive health in southern AfricaLobbying Congress on bill to stop violence against womenPreventing domestic violence and HIV in Uganda and Sex work in Uganda: Risky business
Photo of Randy Berry by Ruthann Richter

Big data, Events, Public Health, Research

Big Data in Biomedicine conference kicks off today

Big Data in Biomedicine conference kicks off today

14243103692_67ec6354f0_zThe third annual Big Data in Biomedicine conference kicks off today on the Stanford campus. The three-day event brings together thought leaders from academia, information technology companies, venture capital firms and public health institutions to explore opportunities for extracting knowledge from the rapidly growing reservoirs of health and medical information to transform how we diagnose, treat and prevent disease.

The year’s program will cover the intersection of disciplines as widespread as genomics, population health, neuroimaging and immunology; it will also touch on crowdsourcing, ethical and legal issues and “learning” health systems. Delivering the opening keynote will be Sharon Terry, president and CEO of Genetic Alliance. Other keynote speakers include Kathy Hudson, PhD, deputy director for science, outreach and policy at the National Institutes of Health; France Córdova, PhD, director of the National Science Foundation; Michael Levitt, PhD, professor of structural biology at Stanford and recipient of the 2013 Nobel Prize in Chemistry; and Lloyd Minor, MD, dean of Stanford’s School of Medicine.

Those unable to attend in person can tune in to the live webcast via the conference website. We’ll also be live tweeting the keynote talks and other proceedings from the conference; you can follow the coverage on the @StanfordMed feed or by using the hashtag #bigdatamed.

Previously: Countdown to Big Data in Biomedicine: Leveraging big data technology to advance genomics, Countdown to Big Data in Biomedicine: Mining medical records to identify patterns in public health and Harnessing mobile health technologies to transform human health
Photo from the 2014 Big Data in Biomedicine conference by Saul Bromberger

Cancer, Health Policy, In the News, Public Health, Women's Health

Health hazards in nail salons: Tips for consumers

Health hazards in nail salons: Tips for consumers

3044578995_fe5151de75_zAfter exercise class the other day, my friend asked if I wanted to grab coffee and get our nails done. With nail salons on what seems like every block, having a manicure or pedicure is as easy as grabbing a latte. You don’t need an appointment and you’re done in less than an hour.

But this convenience comes at a cost. A recent investigative report in the New York Times exposed the not-so-bright side of nail salons. The articles have raised awareness of poor working conditions and health risks, and they’ve generated a vigorous public dialogue.

“It got people talking and that’s a good thing,” said Thu Quach, PhD, MPH, a research scientist at the Cancer Prevention Institute of California and research director at Asian Health Services.

An epidemiologist, Quach has spent much of her career studying harmful chemicals in nail care products and their health impacts on nail salon workers, a vulnerable workforce that is mainly comprised of low-income immigrants. In research studies she has conducted over time, Quach identified symptoms commonly experienced by salon workers, including dizziness, rashes, and respiratory difficulties, and more serious reproductive health effects and cancer.

“Unfortunately, the risks associated with chronic, long-term exposure to chemicals used in nail products have been little studied,” Quach said. “We know workers are exposed every day and their health is at risk – this is an important focus of my ongoing research.”

The California Healthy Nail Salon Collaborative (CHNSC), convened through Asian Health Services, educates salon owners, workers and consumers about health and safety issues, and advocates for stronger protections for all. Quach, who has been a CHNSC member since its inception, works closely with other members to address worker health and safety using an integrated approach of community outreach, research, and policy advocacy to address health and safety. The CHNSC has worked at the local, state, and federal level to promote changes.

Encouraging counties and cities to adopt the healthy nail salon program is a first step in their local approach. Participation is voluntary and to date three counties and one city have committed: Alameda, San Francisco, San Mateo, and Santa Monica. These counties provide training and formal recognition for salons that participate. Santa Clara has the program in the works and many salons throughout the state participate in healthy initiatives on their own.

In addition to local municipalities taking action, some manufacturers have stepped up to omit the “toxic trio” – dibutyl phthalate, toluene and formaldehyde – from their formulations. But despite rising awareness of the health hazards posed by these chemicals, many products still contain them and there is no regulatory oversight.

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NIH, Obesity, Public Health, Research

Capturing the metabolic signature of obesity

Capturing the metabolic signature of obesity

scale_weightWorldwide obesity rates have more than doubled since 1980, and today the majority of the global population live in areas where being overweight kills more people than being underweight, according to data from the World Health Organization. But new research that provides a comprehensive view of the metabolic signature that may correlate with obesity could help scientists develop more effective ways to manage and prevent obesity, and it offer insights into how variability in genes, environment, metabolism and lifestyle affect our health individually.

As reported today on the NIH Director’s Blog:

The new analysis uncovered changes to 29 molecular metabolites, or biomarkers, that correlated with obesity in 1,880 people from the United States. Most of those biomarkers—25 to be exact—also turned up in the urine of obese people from the other side of the Atlantic, offering confirmation that the findings represent a shared metabolic signature of obesity.

Several of the biomarkers are byproducts of what a person eats, which may reflect differences in the diets of obese and non-obese people. For example, urine from obese people was more likely to contain a metabolite that comes from eating red meat, while thinner folks were more likely to have a metabolite indicative of citrus fruit consumption.

However, not all of the biomarkers were directly related to food. Some appeared to stem from widespread changes in kidney function, skeletal muscle, and metabolism that may occur as a person packs on extra pounds. And, intriguingly, nine of the biomarkers significantly associated with obesity weren’t even produced by the human body, but rather by the trillions of microbes that live inside our guts. Those microbial partners play important roles in the breakdown of essential vitamins, amino acids, and protein. In fact, recent research findings suggest that a significant portion of obesity risk may be explained by the activity of gut microbes. This discovery adds to mounting evidence, spurred in recent years by the NIH-funded Human Microbiome Project, for the intricate and essential role of microbes—collectively known as the microbiome—in many aspects of our health.

The piece goes on to say that the findings also “raise the intriguing possibility that people might one day be able to visit their health-care providers, receive a blood or urine test, and leave with precise, individualized information regarding their risk” for obesity and other health issues.

Previously: Childx speaker Matthew Gillman discusses obesity prevention, Discussing how obesity and addiction share common neurochemistry, Stanford team awarded NIH Human Microbiome Project grant and Obesity is a disease – so now what?
Photo by Matthew

Addiction, Health Policy, Pain, Public Health

Unmet expectations: Testifying before Congress on the opioid abuse epidemic

Unmet expectations: Testifying before Congress on the opioid abuse epidemic

capitol and Rayburn - 560

My recent trip to Washington D.C. to speak before a congressional subcommittee on the problem of opioid misuse was all about unmet expectations.

First of all, I never expected to get invited to testify for the U.S. Congress. A 2012 article I wrote in the New England Journal of Medicine on the problem of doctors over-prescribing opioids to patients was picked up by Washington Post journalist Charles Lane in a piece he did, “The legal drug epidemic,” which was subsequently read by Alan Slobodin, chief investigative counsel for the House Committee on Energy and Commerce. Slobodin then sent a message to my in-box asking to “discuss the opioid abuse problem.” I almost deleted it as a hoax. But Keith Humphreys, PhD, my mentor and chief of the mental health policy section in our department, assured me it was real.

Second, not really understanding how government works beyond what I learned from the animated musical cartoon “I’m Just a Bill” when I was seven years old, and being a regular reader of the New York Times, which has almost convinced me that everyone in Washington is against everyone else and nothing ever gets done, I prepared myself for the possibility that various members of the committee might just be looking for sound bites to support their pre-ordained opinions. I was wrong.

Slobodin and his staff were curious, earnest, intelligent, and dedicated to understanding the opioid problem at the deepest level. At the hearing itself, where I and other experts testified on the problem of opioid misuse, overdose, and addiction, Congressman Tim Murphy (R-PA), and Congresswoman Diana DeGette  (D-CO) didn’t go for each other’s jugular like a couple of vampires out of Twilight, which I thought might happen. Instead, they were courteous, collegial, and again, struck me as truly dedicated to ameliorating the problem of addiction in this country.

Third and finally, I didn’t imagine that my testimony would make much of a difference, yet some of my suggestions were picked up by members of the committee, including Bridgette DeHart, a senior policy advisor for Congresswoman Yvette D. Clarke (D-NY). DeHart is a whip-smart young woman who in ten minutes of conversation conveyed to me her sophisticated understanding of the opioid epidemic. She talked about incorporating one of my suggestions – mandating physician education on the use of Prescription Drug Monitoring Databases (PDMDs) at the time of DEA-licensure – into a larger bill that Clarke and her team are working on.

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FDA, In the News, otolaryngology, Public Health, Science Policy

With e-cigarettes, tobacco isn’t the only danger

With e-cigarettes, tobacco isn't the only danger

16546091210_99279fd110_zE-cigarettes are far from safe, Robert Jackler, MD, writes in a strongly worded op-ed that appeared over the weekend in the San Jose Mercury News.

Most at risk are teens and tweens, enticed by flavors ranging from cotton candy, gummy bear and root beer to peanut butter cookie. (An aside: Can you imagine a hardened, pack-a-day smoker deciding to curb his or her harmful habit by switching to cotton candy-flavored e-cigarettes?)

Interestingly, these flavors, which are thought to be safe in foods may be upping the harmfulness of the e-cigs; after all, the lungs process chemicals much differently than the stomach does. (Remember popcorn lung? In the early 2000’s, a group of workers at a microwave popcorn plant fell ill after inhaling too much of the flavoring agent, diacetyl, used to give popcorn its buttery taste.)

From Jackler’s piece:

In 2009, to reduce youth smoking, the FDA banned flavors (other than menthol) from traditional cigarettes. Fearing regulatory action, the e-cigarette industry response has echoed the playbook of the tobacco industry. One brand went so far as to commission a study which, not surprisingly, arrived at the improbable finding that flavors do not appeal to the young. The industry argues that flavored e-cigarettes should be allowed because they have not been proven unsafe.

Jackler goes on to warn of the progressive nature of lung damage — e-cigarette smokers may be accumulating harm well before they notice a problem.

Previously: Raising the age for tobacco access would benefit health, says new Institute of Medicine report, How e-cigarettes are sparking a new wave of tobacco marketing, E-cigarettes and the FDA: A conversation with a tobacco-marketing researcher and E-Cigarettes: The explosion of vaping is about to be regulated
Photo by Jonny Williams

Global Health, Health Disparities, Health Policy, Patient Care, Public Health, Surgery

Billions lack surgical care; report calls for change

Billions lack surgical care; report calls for change

In this country, we take it for granted that we will have access to needed surgeries, whether it’s the repair of a broken leg or an operation to remove an infected appendix or a malignant tumor. But for as many as 5 billion people – or two-thirds of the world’s population – these basic procedures are out of reach.

A major new report by the Lancet Commission sheds light on this enormous surgery gap and argues that building surgical infrastructure in low- and middle-income countries is critical both from an economic, as well as a human, perspective.

“Surgery hasn’t been part of the dialogue with respect to health system strengthening. It’s been a hugely neglected item,” said Stanford trauma surgeon Thomas Weiser, MD, who contributed to the 58-page report. The commission includes 25 leading experts from the fields of surgery and anesthesia, with contributions from more than 110 countries.

In its report, the commission notes that in 2010, nearly one-third of all deaths (16.9 million) were attributable to conditions readily treated by surgery, such as appendicitis, hernia, fractures, obstructed labor, congenital abnormalities and breast and cervical cancer. That is more than the number of deaths from HIV/AIDS, tuberculosis and malaria combined. And although there have been many gains in global health in the last 25 years, the quality and availability of surgical services in many regions have stagnated or declined, while the demand for surgery continues to rise.

“The global community cannot continue to ignore this problem – millions of people are already dying unnecessarily, and the need for equitable and affordable access to surgical services is projected to increase in the coming decades, as many of the worst affected countries face rising rates of cancer, cardiovascular disease and road accidents,” said Lars Hagander, MD, of Lund University in Sweden and one of the lead authors.

Weiser and his colleagues provide new estimates of the global shortfall, calculating that some 143 million additional surgeries are needed to save lives and prevent disability, with the largest number of neglected patients living in South Asia (57.8 million), East Asia (27.9 million) and southern sub-Saharan Africa (18.9 million).

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Events, Health Disparities, Medical Education, Medicine and Society, Public Health

An ounce of action is worth a ton of theory: Med student encourages community engagement

An ounce of action is worth a ton of theory: Med student encourages community engagement

IMG_0775Right after graduating from Stanford, Steve (Suk) Ko moved to East Palo Alto with some friends who were also recent graduates. They put all their effort into becoming engaged in their new community, starting and running a tutoring program out of their apartment – which could get really crowded, judging by the pictures he showed last week while speaking to undergraduates interested in public health.

Soon after making East Palo Alto his new home, Ko started medical school at Stanford and continued his service work throughout. “We at Stanford are good at thinking and debating, but less good at action,” Ko said during this talk. “I felt some guilt about indulging in socioeconomic affluence when there was this community right next door.”

Ko’s talk was part of the Primary Care, Public Health, and Health Disparities Lecture Series sponsored by Stanford’s Center of Excellence in Diversity in Medical Education, which aims to produce leaders who can eliminate national-health inequities. Ko shared his personal experience and offered three points of advice:

1). Never lose what makes you special. 

If you’re thinking about how to improve public or global health, “don’t fake it – do what you’re passionate about.” This will lead you in the right direction. As for medical school applications, there are all kinds of ways to have a “research background,” he said.

For Ko, a Korean ethic of hard work and his Christian faith enabled his interest, experiences, and goals in public health. During an undergraduate service learning trip to Oaxaca, Mexico, he shadowed an OB/GYN at a public hospital and was moved both by the beauty of birth and the limited opportunities these newborns faced. Born resource poor and in a society with high gender inequality, “this baby girl had not made a single choice, but 99 percent of her life was already decided,” Ko said. He wanted to think about health in a broader context.

2). An ounce of action is worth a ton of theory.

Last summer, Ko implemented a 5-week summer meal program in East Palo Alto that served kids and their families. The suggestion to focus on food insecurity came from Stanford pediatrician Lisa Chamberlain, MD, Ko’s mentor. The YMCA, Stanford Medicine, and Revolution Foods supported the project, which served 270-370 kids and 4-30 adults every day, and provided a total of 2,525 take-home meals. Ko said it’s “like pulling teeth” to get kids to eat healthy food, but shaping tastes early is key to forming long-term habits. The team ran both quantitative and qualitative analyses of the program, gathering insights like that families are hungrier in bad weather because those who work outdoors or in construction cannot earn money, and that libraries could be great food distribution points.

One of Ko’s most rewarding recent memories was when several of the high-school students he works with made a documentary film about East Palo Alto. They wanted to challenge its unfair portrayal in the news media – although it had the highest homicide rate in the country in 1992, gentrification is now starting to be a bigger problem than crime. “The 90’s were a long time ago,” the students pointed out.

3). Community engagement is difficult, and therefore a privilege.

It was very hard for Ko to gain the trust of his adult neighbors (he says kids are easy: just smile at them). After living there for years, he felt gratified last week when he was ill and a neighbor brought him soup. Trust comes slowly; you have to prove you’re there for the long haul. Even so, circumstances are just hard – what do you do when a student tells you a family member just died from gang violence? Ko coped with the emotional and physical difficulty through his faith and by finding joy in the process, not the outcomes.

One of the audience members asked a question about “white knight syndrome” – the problematic idea that someone from a different community is able (and welcome) to storm in and fix everything. Ko agreed that good intentions can hurt vulnerable people. Temporary involvement doesn’t require accountability and invites the community to be jaded and skeptical, focusing on the impact of the last person/organization. For this reason, it can be much better to join an existing project than to start a new one, he said. But above all, Ko favors humility and a sense of wonder, not just going in and”fixing it”.

Previously: A quiz on the social determinants of health, Stanford researchers use yoga to help underserved youth manage stress and gain focus, Med students awarded Schweitzer Fellowships lead health-care programs for underserved youth, Nutrition and fitness programs help East Palo Alto turn the tide on childhood obesity and Doctors tackling child hunger during the summer
Photo, of Steve Ko (right) and Marcella Anthony of Stanford Medicine’s Community Outreach, by Andrea Ford

 

Big data, Chronic Disease, Public Health, Research

Finding asthma outbreaks using Twitter: How social media can improve disease detection

Finding asthma outbreaks using Twitter: How social media can improve disease detection

Asthma_inhaler_useWant to know if bad air has sparked an asthma epidemic in your neighborhood? Well, you’ll have to wait several weeks using traditional epidemiologic methods, a time lag that makes prompt response efforts quite tricky.

Or, perhaps you can just check out your Twitter feed.

A team led by Sudha Ram, PhD, at the University of Arizona found that a model that aggregates Twitter data, Google searches, air quality data and asthma-related emergency room visits can predict outbreaks with 70 percent precision. It’s big data in action.

As Ram comments in a press release:

The CDC gets reports of emergency department visits several weeks after the fact, and then they put out surveillance maps. With our new model, we can now do this in almost real time, so that’s an important public health surveillance implication.

With that information, hospitals could beef up their staff and health care workers could reach out to at-risk populations.

In the future, Ram said she plans to examine diseases with greater geographic and temporal variability such as chronic obstructive pulmonary disease (COPD) and diabetes. Her research was published in a special issue of the Institute of Electrical and Electronics Engineers Journal of Biomedical and Health Informatics.

Previously: Advice for young doctors: Embrace Twitter, Mining Twitter to identify cases of foodborne illness and Text messages about asthma could help children breathe easier 
Via MedCity News
Photo by Wikimedia

Big data, Clinical Trials, Ethics, Public Health, Research, Stanford News

The public wants easier ways to participate in medical research, study shows

The public wants easier ways to participate in medical research, study shows

Informed consent, the time-consuming process for obtaining permission to conduct health-care research on a person, was developed long before computers, the Internet and smartphones. Last year, when government regulators proposed to add an even greater burden of paper, red tape and so-called patient protections to this process, a team of bioethicists cried foul. And they took the issue to the public via a cross-sectional survey study that was published today in the Annals of Internal Medicine.

What the survey respondents said surprised them: Keep the permissions simple, but always ask permission, even when the research only involves anonymized medical records.

“The good news was that most people said that they would accept simpler approaches to granting permission, even verbal permissions, if requiring written agreements would hinder this type of comparative-effectiveness research,” study author Mildred Cho, PhD, associate director of the Stanford Center for Biomedical Ethics, said in our press release.

Bioethicists from Stanford and the University of Washington are on the leading edge of addressing the ethical challenges of evolving research methods, where researchers will increasingly use data from wearable devices, electronic medical records, genomic databases and other sources to help improve our population’s health.

In an editorial accompanying Cho’s article, John Lantos, MD, from Children’s Mercy Hospitals and Clinics, summarized the importance of the study:

Cho and colleagues challenge us to think of a better way. Autonomy should mean participatory engagement. Respect for persons should mean empowering them to develop the rules. It is time to ask whether a system in which the fundamental principle is ‘respect for persons,’ can continue to ignore the preferences of many of the persons it claims to respect.

As a next step, the bioethicists will be developing media-rich tools to explain the risks and benefits of research that uses electronic medical records and stored biological samples. For example, the video above was developed to explain the concept of informed consent to survey respondents unfamiliar with research terminology.

Previously: Build it (an easy way to join research studies) and the volunteers will comeHarnessing mobile health technologies to transform human health and Video explains why doctors don’t always know best
Video by Booster Shot Media

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