Published by
Stanford Medicine

Category

Public Health

Big data, BigDataMed15, Precision health, Public Health, Research, Videos

How the FDA is promoting data sharing and transparency to support innovations in public health

How the FDA is promoting data sharing and transparency to support innovations in public health

Keynote talks and presentations from the 2015 Big Data in Biomedicine conference at Stanford are now available on the Stanford YouTube channel. To continue the discussion of how big data can be harnessed to improve the practice of medicine and enhance human health, we’re featuring a selection of the videos on Scope.

At the 2014 Big Data in Biomedicine conference, Taha Kass-Hout, MD, chief health informatics officer for the U.S. Food and Drug Administration, announced that the federal agency was launching OpenFDA, a scalable search and big-data analytics platform. In May, he returned to the Big Data in Biomedicine stage to offer an update on the initiative and discuss how the FDA is continuing to foster access and transparency of big data in government.

During his talk, Kass-Hout shared some eye-popping statistics about the information available through OpenFDA. The platform houses close to 70,000 product labels for pharmaceuticals; nearly four million reports on adverse events or malfunctions of medical devices; 41,000 records on recalls of foods, pharmaceuticals or devices and over four and a half million reports of adverse events or side-effects of drugs.

He outlined future plans to build a similar public, cloud-based platform to compliment the Obama Administration’s Precision Medicine Initiative. Watch the full talk to learn more about these exciting efforts to unlock the rapidly growing reservoir of biomedical data and spur innovation in public health.

Previously: A look at the MyHeart Counts app and the potential of mobile technologies to improve human health, Discussing patient participation in medical research: “We had to take this into our own hands,” A look at aging and longevity in this “unprecedented” time in history, Mining Twitter to identify cases of foodborne illness and Discussing access and transparency of big data in government

Public Health, Public Safety, Research, Sports

Study shows football helmet safety tests may not capture common cause of concussions

Study shows football helmet safety tests may not capture common cause of concussions

boy-164286_1280The football helmet is perhaps the most iconic piece of safety equipment there is, but we’re just now beginning to understand how helmets can — and should — protect the brain.

Blows that rotate the head are known to cause brain trauma, yet a new Stanford study (subscription required) has found that this kind of movement isn’t included in the tests currently used to evaluate a football helmet’s safety.

In the study, bioengineer David Camarillo, PhD, and his team investigated the types of head movements that cause concussions using computer models of the brain and data collected from Stanford football players wearing mouthguards instrumented with accelerometers (device that measures changes in velocity).

Using the computer model, they found that the brain’s movement increases when the head oscillates (moves back and forth) at 15-20 hertz and it completes a single oscillation in about 50 milliseconds. The field data from the accelerometers showed that the players typically experience head oscillations around 20 hertz.

When the research team compared these results to the scenarios used to test the safety of football helmets, they found a mismatch. The standard tests used to evaluate football helmet safety (acceleration tests and a test that drops a helmet-wearing dummy head from various heights) fail to include the rotational movements known to cause concussions; they also generate faster head oscillations (100 hertz); and measure head acceleration for only 15-36 milliseconds.

“The problem with having a model that doesn’t re-create what players actually experience in the field, is that you could optimize a helmet to perform well in the drop test that unintentionally performs poorly in the field,” said Fidel Hernandez, a doctoral candidate in mechanical engineering and one of the study’s lead authors, in a Stanford News story.

This is a big deal because roughly 70 percent of football players in the United States who rely on helmets to keep their head’s precious cargo safe are under the age of 14, and they receive, on average, a whopping 240 hits to the head each season.

Camarillo and his team hope their findings can be used to make more realistic and useful helmet tests.

Previously: Stanford bioengineers and clinicians team up to shed light on how concussions affect the brainForces at work in concussions more complicated than previously thought, new Stanford study revealsNow that’s using your head: Bike-helmet monitor alerts emergency contacts after a crash and Study shows concussion recovery may take longer for female, younger athletes
Image courtesy of Pixbay

Infectious Disease, Medical Education, Public Health, Research, Stanford News

A how-to guide on “galvanizing medical students” to administer flu vaccines

A how-to guide on "galvanizing medical students" to administer flu vaccines

image001Stanford’s Flu Crew, an initiative that gets medical students out into the campus and greater community administering flu vaccines, recently published a paper validating the importance of such initiatives for medical education and public health, and enumerating its best practices so other programs can follow in its footsteps.

Rachel Rizal and Rishi Mediratta were Flu Crew’s co-directors when we first wrote about their work in 2012. Rizal is now a fifth-year student and Mediratta a pediatrics resident at Stanford. They are lead authors on the article, “Galvanizing medical students in the administration of influenza vaccines: the Stanford Flu Crew,” which appears in the journal Advances in Medical Education and Practice.

I learned a lot about Flu Crew in an email exchange with Rizal, Mediratta, and a host of people they said were instrumental in this accomplishment. Catherine Zaw, a Stanford undergraduate who is a co-author on the recent paper, told me,”The Flu Crew concept has already spread to a couple of schools around the Bay Area, including UCSF, and I hope that with the publication of the paper, more medical schools will consider adopting it.”

The article is essentially a blueprint for replicating Flu Crew in other institutions. It describes Flu Crew’s innovative online-based curriculum, created by former Stanford medical student Kelsey Hills-Evans, MD (which she discussed in a post earlier this week). It lays out the planning needed to coordinate vaccination events, which in their case involves the medical school, undergraduate volunteers, the Vaden Student Health Center, Stanford’s Occupational Health Clinic, and community institutions like churches, libraries, and homeless shelters. And finally, it explains the impact on medical students’ attitudes to population health, as one of its main goals as a service-learning program is to provide students with experience in public health and patient interactions early on in their career.

Imee DuBose, MPH, who worked as operations manager at Occupational Health and was inspired by the “impressive professionalism” of Flu Crew’s student leadership to shift her career to student advising, told me: “As a public health professional, I see Flu Crew promoting community health through collaboration, and as a student affairs professional, I see student development and growth – this project combines the best of both worlds.”

Rizal and Mediratta’s successors for the two-year director position, Lauren Pischel and Michael Zhang, were also co-authors. Pischel explained that she thinks public health and preventative medicine are incredibly important in medical education.

“Campaigns like this link the individual you see sitting before you in clinic with the health of the population at large,” she said “I would like to see this paper be used to talk about how we can effectively integrate public health teaching and experience into medical school. There is quite a bit of room to grow in this direction.”

Previously: Stanford Medicine grads urged to break out of comfort zoneAn ounce of action is worth a ton of theory: Med student encourages community engagementFrenemies: Chronic cytomegalovirus infection boosts flu vaccination efficacyFlu Near You campaign aims to improve monitoring of flu outbreaks, vaccinations and Student “Flu Crew” brings no-cost flu vaccinations to the community
Related: The Flu Crew: Med students provide vaccinations to the community
Photo, of medical student Lichy Han administering a flu vaccine to Dean Lloyd Minor, MD, in 2012, courtesy of Imee Diego DuBose

Infectious Disease, Medical Education, Medicine and Society, Public Health, Stanford News, Videos

Online curriculum helps students and public learn about influenza

Online curriculum helps students and public learn about influenza

Stanford’s Flu Crew, which administers flu vaccines in and around the Stanford community, has had many successes over the last few years, which we’ll highlight in a post later this week. One achievement I thought deserved special attention is an innovative curriculum on influenza created by former medical student Kelsey Hills-Evans, MD, now an internal medicine resident at Harvard. Her online videos, such as the one above (which is the first in the series), are accessible not only to Flu Crew’s student participants but the public at large.

The videos were produced via a partnership with Khan Academy and built on the flipped classroom model championed by Charles Prober, MD, senior associate dean of medical education. They also received the Shenson Bedside Innovation Award in 2013. Rishi Desai, MD, a Stanford pediatric infectious disease physician and medical fellow at Khan Academy, supervised Hills-Evans’ efforts and told me in an email that Hills-Evans and the Flu Crew “put together some really amazing videos explaining everything from the basics of influenza to common misconceptions and fears that people have about the flu vaccine. They deserve all of the credit for the idea and execution of the project.”

Hills-Evans tried to keep each video under five minutes: “I wanted it to be a quick, high-yield snapshot of information that people could watch in one sitting and not easily forget.” She shared more details with me over email:

What did you aim to convey in these training videos? How did you imagine your audience? 

I wanted our student volunteers to come away from the training with enough general knowledge about influenza to answer nearly any question that patients might have. We equipped them with knowledge about its history, how it genetically changes over time, the clinical symptoms, the vaccine’s risks and benefits, specific patient populations, and even a section on flu shot myths. Our last video was meant for students to become public-health advocates equipped with facts and counter-arguments to some of the most common excuses people have for not protecting themselves with the flu vaccine.

For these general info videos, I was really aiming to be accessible to the general public. The topics are all applicable to the lay person, so I tried my best to stay away from clinical jargon. I wanted people to come away from the training with a better understanding of how dangerous influenza can be – many people shrug at the flu as a bit worse than a winter cold, but it kills tens of thousands of people every year. In addition, there are so many myths generated by popular media and the public about the illness itself (i.e., “I got a stomach flu” which is never actually an influenza virus) and especially about vaccines. It was important to me that we make these videos public so more individuals could be informed.

For the sections meant only for clinical personnel, our priority was to train the members of the Stanford Flu Crew, but I also wanted this component to be exportable to other medical programs. It was meant to teach students to deliver the best intramuscular (IM) injections possible. We’ve been told countless times that our method for IM injections yields extremely high patient satisfaction and nearly pain-free injections (some say “the best flu shot they’ve received”).

Continue Reading »

Cancer, Health Policy, NIH, Public Health

Draining the cancer swamp

Draining the cancer swamp

4011473415_46405053bd_zThere’s an old adage that applies to many difficult situations that we face in life: When you’re up to your armpits in alligators, it’s difficult to remind yourself that you should have drained the swamp.

I’ve come to view cancer as a vicious predator lurking in dark waters, eager to attack one out of two of us in our lifetimes. Cancer is the second most common cause of death in the United States.

Looking at the current national funding model for cancer research, I wonder if society has lost track of a vital goal: preventing cancer, not just treating it. Wouldn’t it be better if we prevented cancer in the first place? Cancer prevention would reduce the devastating physical, psychological, emotional, social and economic burden placed on patients, their families and their friends.

As he stepped down from the role of Director of the National Cancer Institute, Harold Varmus, MD, spoke about the deep complexity of cancer and the tremendous amount of basic research that needs to be done. While recognizing the need for clinical testing, he also called for more pioneering discoveries into who gets cancer, where and why.

The financial constraints facing scientific research force us to make difficult choices. Right now, our current health-care model prioritizes “identifiable individuals” over “statistical individuals.” Identifiable individuals are those real persons in distress who have been diagnosed with cancer. They need treatment, and we are highly motivated to help cure them. The cost of doing so, however, is high: The average monthly cost of cancer treatment has more than doubled to $10,000 over the last decade. Of course, we are willing to pay the costs – these victims are our mothers, our fathers, our sons and our daughters.

Statistical individuals are those who may be at risk, but they may not know it. They may never know that scientific research “rescued” them from a devastating disease. Through prevention measures enacted by individuals themselves (e.g., getting more exercise, avoiding tobacco use) or by society (e.g., limiting chemical exposures in the environment, banning the use of tanning beds for minors), these individuals may be able to escape the scourge of cancer.

When making choices about where to invest limited dollars, it is so much easier to say “no” to statistical people rather than real people.

I don’t advocate taking money away from cancer treatment, but I do advocate a greater investment of federal dollars in research that leads to reducing the incidence of cancer in the healthy population. By tracking and analyzing patterns and trends of cancer, we can identify potential risk factors and inform individuals and communities about positive changes they can make toward living cancer-free lives.

It is estimated that over 50 percent of the 585,720 cancer deaths in the U.S. in 2014 were related to preventable causes. As such, federal dollars directed toward statistical individuals will save both money and lives.

We need to drain the swamp. Our ultimate societal goal shouldn’t be to treat cancer more effectively, but to prevent it altogether. We need to intervene as early as possible in the trajectory of cancer. By doing so, we will greatly reduce the extent and depth of human suffering.

Donna Randall, PhD, is chief executive officer of the Cancer Prevention Institute of California.

Photo by William Warby

Health Disparities, Mental Health, Pediatrics, Public Health

Stanford study of mental illness in incarcerated teens raises policy questions

Stanford study of mental illness in incarcerated teens raises policy questions

depressionMental illness is an even bigger problem for jailed teenagers than experts previously realized.

That’s the take-away message from a Stanford study, publishing today in the Journal of Adolescent Health, which compared 15 years’ worth of hospital stays for adolescents in California’s juvenile justice system with hospitalizations of other California kids and teens. Experts already knew that juvenile inmates are more likely than other young people to have mental health problems, but the new study gives fresh perspective on the scope of the issue.

The research team, led by Arash Anoshiravani, MD, an adolescent medicine specialist at Lucile Packard Children’s Hospital Stanford, looked at 15 years of hospital-stay data for California’s 11- to 18-year-olds. From a total of almost 2 million hospitalizations, about 11,000 were for incarcerated youth.

Of these 11,000 hospital stays, 63 percent were due to mental-health diagnoses. In contrast, just under 20 percent of the hospital stays by adolescents from the general population were prompted by mental illness. Hospital stays were also longer for the incarcerated teens, suggesting more severe illness.

However, the kinds of diagnoses were pretty similar between the two groups, with depression and substance abuse the most common. From our press release about the new study:

The types of diagnoses suggest that many incarcerated teens’ mental health problems developed in response to stressful and traumatic childhood experiences, such as being abused or witnessing violence, Anoshiravani said.

“They’re regular kids who have had really, really horrible childhoods,” he said, adding that he hopes the new data will motivate social change around the problem.

“We are arresting kids who have mental health problems probably related to their experiences as children,” he said. “Is that the way we should be dealing with this, or should we be getting them into treatment earlier, before they start getting caught up in the justice system?”

Previously: Online health records could help high-risk teens, study finds, Lucile Packard Children’s Hospital partners with high schools on student mental health programs and Increasing awareness and advocacy of emotional disorders with mental health first-aid programs
Photo by ryan melaugh

Dermatology, Public Health, Stanford News

It’s never too early to protect your skin from sun damage

It's never too early to protect your skin from sun damage

I’m not ashamed to admit that I dork out for Disneyland. I was there a few weeks ago, wearing a Minnie Mouse T-shirt and sprinting from one thrill ride to the next. But this trip was different in one respect: I made sure to apply a broad-spectrum sunscreen to my face and limbs before heading into the Magic Kingdom and then brought along the tube so that I could reapply it throughout the day.

Growing up, I was happy that my skin picked up a tan easily, with only occasional sunburn. As an adult, I watched the evidence pile up about the hazards of sun exposure and tried to remember to use sunscreen in the summer months when I was outside for long periods of time. But after speaking with several Stanford dermatologists for a story about skin protection for the recent issue of Stanford Medicine magazine, I resolved to be more vigilant year-round.

As my story notes, one in five Americans will develop skin cancer in their lifetime. One good way of warding off that threat is to use a broad-spectrum sunscreen, many of which are now much lighter and less greasy that the sunscreens of old.

“Your sunscreen should be considered your facial lotion,” dermatology professor Susan Swetter, MD, told me. “It works to moisturize the skin as well as to prevent photoaging and skin cancer.”

The story also includes tips for protecting your skin and for encouraging children to develop good skin-protection habits at an early age. Parents seem to be taking the message to heart: As I made my way through the crowded streets of Disneyland, one scent stood out among all of the others. The unmistakable smell of sunscreen.

Previously: This summer’s Stanford Medicine magazine shows some skinBeat the heat – and protect your skin from the sunWorking to protect athletes from sun dangers and The importance of sunscreen in preventing skin cancer
Illustration by Aleksandar Velasevic

In the News, Pediatrics, Public Health, Stanford News, Technology

Water-conscious hospital will debut in 2017 with expansion of Lucile Packard Children’s Hospital

Water-conscious hospital will debut in 2017 with expansion of Lucile Packard Children’s Hospital

hospital-expansion-exterior-stanford-childrensPlaces where people live and work tend to use a lot of water, and hospitals are no exception. According to the U.S. Environmental Protection Agency’s 2012 report on water use in public buildings, hospitals rank third in water use just behind senior care facilities and hotels.

Now, the Lucile Packard Children’s Hospital Stanford is working to buck this trend with a new expansion that will use the latest water and energy-saving techniques and tools. This 521,000 square foot addition, which will open in 2017, is predicted to use about 38 percent less water than a comparable hospital.

This sustainable approach to building design began long before the current drought situation in California made water conservation a top priority. “In 2008, when we started planning, we knew there was not enough rainfall to sustain even the most efficient hospital’s needs,” said Robin Guenther, lead designer of the expansion project, in a recent post on the Healthier, Happy Lives blog.

In the piece, Guenther and her team discuss some of the expansion’s energy saving features, including shade structures that reduce the building’s heat gain from the sun and moving the hospital’s data center to the roof where it can be cooled by a wind-powered ventilation system instead of by air conditioning. According to Guenther, these modifications will make the building’s thermal energy consumption about 60 percent less than the average hospital in Northern California.

“Sustainability is a guiding principle in everything we do,” Christopher G. Dawes, president and chief executive officer of the hospital, commented. “Everyone on our team shares in this commitment. It’s part of being a good neighbor and a member of the larger community, and ensuring we’re doing the best thing possible when it comes to preserving all of our environmental resources.”

Previously: Green roofs are not just good for the environment, they boost productivity, study shows and From the Stanford Medicine archives: A Q&A with actor Matt Damon on water and health
Image courtesy of Lucile Packard Children’s Hospital Stanford

Public Health, Research, Stanford News

Study sheds light on physicians testifying in court that smoking didn’t cause cancer

addict-84430_1280 (1)A small group of board-certified physicians helped defend the tobacco industry in more than 50 cases by providing expert testimony that years of heavy smoking did not cause the head and neck cancers of the individual plaintiffs despite overwhelming scientific evidence to the contrary.

This is the finding of a study led by Robert Jackler, MD, professor and chair of otolaryngology-head and neck surgery at Stanford. From a press release I wrote on the research, which was published today in the journal Laryngoscope:

 “I was shocked by the degree to which these physicians were willing to testify, in my opinion in an unscientific way, to deny a dying plaintiff — suffering the aftermath of a lifetime of smoking — of a fair trial,” said Jackler, referring to the physicians cited in the study as a “pool of experts willing to say over and over again that smoking didn’t cause cancer.”

In previous research, Jackler has written about the tobacco industry’s influence on public health through advertising, marketing, manipulation, and promotion. But most of his research up to this point has focused on the past. In this study Jackler turned to the present day. He read through thousands of publicly available expert-witness depositions and trial testimony from Florida courtrooms from 2009 to 2014 and took a hard look at the accuracy of the testimony. In his study, he states that testimony was remarkably similar from case to case and was “faithful to the tactical narrative that there are many, many causes of head and neck cancer — and that factors other than smoking must have caused the plaintiff’s disease.” But as I wrote in our release:

An obvious fallacy of this argument lies in the fact that literally billions of nonsmoking people are exposed regularly to gasoline fumes, use cleaning solvents, eat salted fish or live in urban environments. Were these causative factors for head and neck cancer, with even a minute fraction of the potency of tobacco, the rate of head and neck cancer among nonsmokers would be much greater than what has been observed.

The study, which includes a review of the scientific literature, said this testimony is just inaccurate:

“The tobacco industry identifies the best experts that money can buy, trains them in their well-honed narrative to manufacture doubt in the minds of the jury and makes use of them over and over in case after case,” the study said. Given the ethical traditions of medicine, it seems likely that these physicians believe their well-compensated testimony on behalf of tobacco companies occurs in the shadows, out of view of their families, friends and professional colleagues, Jackler said.

Previously: What’s being done about the way tobacco companies market and manufacture productsHey doc, got a light? Research highlights Big Tobacco’s long history with the medical community and Throat doctors manipulated by Big Tobacco
Photo by PublicDomainPictures

Infectious Disease, Media, Public Health, Stanford News

Stanford doctor-author brings historic figure Jonas Salk to life

Stanford doctor-author brings historic figure Jonas Salk to life

JacobsStanford professor emerita Charlotte Jacobs, MD, spent the past decade with the ghost of polio vaccine creator Jonas Salk, MD, the subject of her second biography, Jonas Salk: A Life. She dug through archives, conducted over a hundred interviews and read countless first-hand accounts and period news.

But she still had a difficult time choosing the opening scene for her book, the first written biography of the man hailed as an international hero for his role in ending the polio epidemics that ravaged the world during the first half of the 20th century.

Should she start with start with Salk’s humble beginnings as a child born to poor Jewish immigrants in New York City, dive into the life-saving research that propelled him to fame and antagonized his scientific peers, or begin at the end of his life, when he was striving to regain his prestige by seeking an HIV vaccine?

The choice for Jacobs became clear when, during a dinner at a writers’ residency, she described her book and its subject to her fellow participants. As the mostly younger writers quietly nodded, Jacobs realized they not only didn’t know who Salk was, they had no idea of the scope or severity of the polio epidemics. Jacobs, a child during the 1950’s, has chilling memories of this time.

Salk book cover“It was a fear that hovered over us every summer,” Jacobs recalled, “no matter what you did — eat your vegetables go to church, mind your mother — you could be the crippler’s next victim. And it was mostly children who caught the disease.”

Jacobs begins her book, excerpted in the new issue of Stanford Medicine, with a vivid account of the New York City 1916 outbreak. That year, in New York state alone, 8,900 people were infected, 2,400 died and many of the survivors were paralyzed or crippled.

The book has received numerous positive reviews. While Jacobs is happy with the attention, she is most excited for her audience to learn about the remarkable work that Salk and his team did in developing the vaccine and how the American public, through the March of Dimes, funded and carried out the first vaccine trials.

“This trial was run by volunteers; housewives collected the data,” she said. “Never before, and never again, has the public itself conducted a trial of this magnitude.”

Having read the excerpt in Stanford Medicine, I’m eager to read more.

Kim Smuga-Otto is a student in UC Santa Cruz’s science communication program and a writing intern in the medical school’s Office of Communication and Public Affairs.

Previously: This summer’s Stanford Medicine magazine shows some skinHenry Kaplan’s crusade against Hodgkin’s disease, TED Talk discusses the movement to eradicate polio, and Researchers tackle unusual challenge in polio eradication
Photo by Max Aguilera-Hellweg

Stanford Medicine Resources: