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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

Health Costs, Health Policy, Public Health, Research

Is it time to compensate kidney donors?

Is it time to compensate kidney donors?

7272346858_ce4d2c871d_o_flickr_Tareq_560x372SalahuddinA recent New York Times blog entry editorialized on the worldwide shortage of transplant kidneys, raising the question of whether it’s time to compensate kidney donors to meet the growing need. The blog echoed the debate that is emerging in the United States among some doctors, medical societies, and groups that oversee organ transplants.

Taboos against paying for transplant organs are powerful. But these may be overcome by necessity, since the demand for transplant kidneys is growing at an alarming rate largely due to kidney failure from diabetes, high blood pressure and obesity-related diseases. According to the National Kidney Foundation, 450,000 Americans are on dialysis and the severe shortage of transplant kidneys in the U.S. results in 12 patient deaths each day.

In sum, having the government compensate kidney donors would be a win-win-win situation

Laying the groundwork for change, a collaboration of nephrology and finance experts, including Philip J. Held, PhD, a Stanford consulting professor of nephrology, performed a comprehensive cost-benefit analysis of a proposed government program for kidney donor compensation. In a study published last week in the American Journal of Transplantation, the authors estimate the shortage of transplant kidneys would be eliminated within five years if the government compensates living kidney donors $45,000 and the estates of deceased donors $10,000. The proposed compensation would also include an insurance policy against any health problems that might result from the donation.

The authors’ analysis shows that the benefits of a donor compensation program would greatly exceed the costs for society in general and taxpayers in particular. The researchers calculate the monetary value of a longer and healthier life for each kidney recipient at $1.3 million, with the added bonus of saving $1.5 million for not needing expensive dialysis treatments. After subtracting from these benefits the cost of transplants, society would enjoy a net welfare gain of $1.9 million over the lifetime of each kidney recipient. Since taxpayers currently pay about 75 percent of the cost of both dialysis and kidney transplants, this represents a taxpayer savings of about $400,000 per kidney recipient.

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Cardiovascular Medicine, Public Health, Research, Stroke

In study, work stress linked to stroke risk

In study, work stress linked to stroke risk


High-stress jobs are known to be associated with increased risk of cardiovascular disease. A research study published last week in the journal Neurology now indicates that work stress also increases the risk of stroke, especially for women.

Dingli Xu, MD, and his research team from Southern Medical University in Guangzhou, China performed a comprehensive statistical analysis of six previous research studies on job stress and stroke risk; the studies included a total of 138,782 participants who were followed for three to 17 years. For the work they classified jobs into one of our four categories, based on the amount of control workers have over their jobs and the psychological demand of their jobs:

  • Passive jobs with low control and low demand, such as janitors and other manual laborers
  • Low-stress jobs with high control and low demand, such natural scientists and architects
  • High-stress jobs with low control and high demand, such as waitresses and nursing aids
  • Active jobs with high control and high demand, such as physicians, teachers and engineers

Xu’s team determined that people with high-stress jobs had a 22 percent increased risk of all types of stroke compared to people with low-stress jobs, while there was no increased relative risk of stroke for people with passive or active jobs. The increased risk associated with a high-stress job compared to a low-stress one was found to be even greater at 58 percent for ischemic strokes, the most common type of stroke.

Analyses were also performed separately for women and men, including more than 126,459 women and only 12,323 men. Women with high-stress jobs had a 33 percent higher risk of all types of stroke than women with low-stress jobs. However, no significant increase in relative stroke risk was seen for men with high-stress jobs, most likely due to the limited number of men included in the studies.

Similarly, the researchers calculated the increased incidence of stroke in the population associated with high-stress jobs to be 4.4 percent overall and 6.5 percent for women.

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Events, Patient Care, Public Health

During Stanford talk, U.S. Surgeon General calls for creation of a “culture of prevention”

During Stanford talk, U.S. Surgeon General calls for creation of a "culture of prevention"

Dean’s Lecture with Dr. Vice Admiral Vivek Hallegere Murthy at Berg Hall, Li Ka Shing Center at the Stanford University Campus on Wednesday, October 7, 2015. ( Norbert von der Groeben/ Stanford School of Medicine )

Updated 10-23-15: Video of this talk is now available here.


10-13-15: “In few other places in the world would the son of a rural farmer from India be asked by the President to serve the health of an entire nation,” remarked U.S. Surgeon General and Vice Admiral Vivek Murthy, MD, MBA, as he opened the latest Dean’s Lecture here last Thursday.

In making the remark, Murthy recalled the words spoken to him by Vice President Joe Biden, when Murthy became the nation’s 19th Surgeon General and the first of Indian descent.

“My story is part of the immigrant story that makes up America,” he said, describing his childhood with highly supportive parents who emigrated from India and settled in Florida, where Murthy and his sister worked weekends in their parents’ primary care clinic.

The experience led Murthy to medical school at Harvard — “I tried to come to Stanford, but it was vetoed by my mother, who was afraid of earthquakes”—followed by an extraordinary list of pursuits that included founding the nonprofit Doctors for America and biotech startup TrialNetworks.

Murthy’s background is now helping to inform his work as surgeon general, which has brought him to places all across the country during his ten-month tenure. He said his travels have reinforced two main themes: America faces an overwhelming burden of disease that is largely preventable, yet many Americans are beginning to lose faith in their ability to improve their own health.

“We invest relatively little in prevention and pay for it much later, often in the form of chronic illness — but that is something we can change,” he noted.

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Cancer, Public Health

Why are so many lives affected by cancer?

rope bridgeI’m a regular reader of The New York Times obituaries. I don’t read them because I’m a morbid person; rather, the obituaries offer me a window into history reflected through the lives of accomplished individuals.

One day in August, I was struck by the photos accompanying obituaries of three women, who all appeared to be relatively young. The 59-year old was co-founder of a nonprofit, Common Sense Media, committed to helping families navigate through entertainment, media and technology arenas. The 64-year old was an Olympic Equestrian medalist winning the U.S. title of rider of the year three times. And the 56-year old was a Harvard scholar and artist whose work explored myth, mystery and identity.

Each shared another characteristic besides a relatively early death: cancer.

These losses of life – far too early – brought back memories of the opening words of a story set more than 300 years ago: “On Friday noon, July twentieth, 1714, the finest bridge in all Peru broke and precipitated five travelers into the gulf below.” That was from Thornton Wilder’s 1927 novel, The Bridge of San Luis Rey. In this story, a friar, who observed the collapse of the rope bridge, wanted to know about the events that led up to each person being on the bridge at that time. Through extensive interviews, he was determined to understand the circumstances that led to their deaths.

A similar question haunts us in 2015: Why will one of every two of us, on average, “fall off the bridge” – that is, have our lives impacted by cancer? Over the past few decades, we’ve gained knowledge that allows for a safer life journey. We know that one half of cancers can be prevented by measures such as not smoking, protecting against excessive sun exposure, getting regular prostate check-ups, lowering obesity, reducing alcohol consumption and engaging in regular exercise.

We appear to be making progress. A recent report revealed that fewer people in the greater San Francisco Bay Area are getting cancer, and fewer are dying from it. More specifically, in the most recent 25-year period for which data are available, the occurrence of all new cancers combined declined by 13.2 percent.

Such news is encouraging. Yet, while advances in cancer treatment may allow more of us to cross our bridges safely and to help us heal if we fall, we must do better. We haven’t yet unlocked the mysteries of cancer. Indeed, the task is more daunting than we ever imagined; we now know that there are more than 200 diseases that we call cancer. We need to look for answers with large-scale genomics (looking at the structure and mapping of genes), bioinformatics (analyzing complex data, such as genetic codes) and computational biology (using data to study relationships in the biological system). We need to develop a better understanding of health disparities (across socially disadvantaged populations) and to drill down to an individual’s unique molecular and genetic characteristics.

For asking troubling questions which threatened authority, the friar in The Bridge of San Luis Rey was tried by the Inquisition and burned at stake. I would only hope that those of us who are probing deeply to prevent the scourge of cancer will be treated more kindly by society (and, especially, by funding agencies).

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

Infectious Disease, Public Health, Stanford News

Experts and 8-year-olds agree: It’s worth getting a flu shot

Experts and 8-year-olds agree: It's worth getting a flu shot

smiley faceIf you’re around my young daughters these days and happen to mention the flu shot, you’re likely to get an earful. “We got ours too late last year and got really sick,” they’ll tell you (as I look down in embarrassment). “It’s really important to get one.” They also, not surprisingly, were not at all upset when I made an appointment – nice and early! – for them to get vaccinated a few weeks ago. They knew it would hurt, but in the words of my 8-year-old, “it’s worth it.”

My girls – the walking pro-flu shot billboards that they are – were the first people I thought of when I came across a Stanford BeWell article this week on – you guessed it – the importance of flu shots. In the piece, infectious disease expert Cornelia L. Dekker, MD, answers questions about influenza and last year’s flu vaccine (which failed to protect people against several strains of the flu), and she reminds local readers that shots are being offered on campus for students, staff and faculty for free.

Previously: How one mom learned the importance of the flu shot – the hard way and Ask Stanford Med: Answers to your questions about seasonal influenza
Photo by cignoh

Patient Care, Public Health

Survey of e-patients offers insights on patient engagement and access to health care

Survey of e-patients offers insights on patient engagement and access to health care

6842253071_a9b35831c0_zPeople who seek out medical information and want to have a more active role in their health care are increasingly becoming the norm. To learn more about this growing community of engaged patients, Inspire, the largest online community of e-patients in the United States, surveyed 13,633 of their members, representing 100 countries on six continents.

The results of the company’s survey were recently released in the online report “Insights from Engaged Patients: An analysis of the inaugural Inspire Survey” (link to .pdf). Among the key findings:

  • About 55 percent of patients are “well-prepared for their doctor’s visits” and bring a buddy to assist with their appointment. (As one survey participant reported, “The more I inform myself with accurate information on the medications taken, or the medications available, the more I am able to have meaningful conversations with the doctors concerning treatment.”)
  • 52 percent of patients are largely responsible for initiating conversation with their physicians about potential new treatments.
  • Two-thirds of patients use social networks as a source of information and support for their health conditions.
  • Half of all patients reported having difficulty with the affordability of their medications at some point in their life.
  • 72 percent of U.S.-based patients reported experiencing some increase in their healthcare costs.

You might think that since the people surveyed were members of an online health community, they’d all be savvy, avid users of every kind of heath app and gadget. Nope. Instead, 72 percent of survey-takers reported they’d never used a smartphone app for their health-care needs. Moreover, less than half of the people surveyed reported feeling that such an app would be useful to them.

The rest of the report, which illustrates there are clear barriers that prevent people from adopting health-care technology and from getting the care and medications they need, is worth a read. (And, as a reminder, we’ve partnered with Inspire on a patient-focused series that appears here once a month.)

Previously: Engaging and empowering patients to strive for better health“What might they be interested in learning from me?” Tips on medical advocacy and A wake-up call from a young e-patient: “I need to be heard”
Photo by UW Health

Health and Fitness, Public Health, Research

Study shows taking short walks may offset negative health impact of prolonged sitting

Study shows taking short walks may offset negative health impact of prolonged sitting

3046594832_cc702e6266_zWhile most of us know that sitting for prolonged periods of time can be detrimental to our health, sometimes, despite our best intentions, we’re locked into our seats by other circumstances. Perhaps you’re on a long flight with lots of turbulence and, even though our activity tracker is buzzing us to stand up, the fasten seatbelt sign forces you to ignore the alerts. Or maybe you’re at a daylong workshop or training and the opportunities to stretch your legs are few and far between. But recent research suggests that you may be able to counteract such periods of prolonged sitting with a short walk.

In the small study published in Experimental Physiology, researchers at the University of Missouri and University of Texas at Arlington compared the vascular function of a group of healthy men at the beginning of the project, after sitting for six hours and again once they completed a short walk. Results confirmed that when you sit for the majority of an eight-hour work day, blood flow to your legs is significantly reduced. The findings also showed “that just 10 minutes of walking after sitting for an extended time reversed the detrimental consequences,” lead author Jaume Padilla, PhD, said in a release.

In addition to keeping your vascular system in good working order, walking can boost your creative inspiration. A past Stanford study showed a person’s creative output increased by an average of 60 percent when he or she was walking.

Previously: Does TV watching, or prolonged sitting, contribute to child obesity rates?, More evidence that prolonged inactivity may shorten life span, increase risk of chronic disease, Study shows frequent breaks from sitting may improve heart health, weight loss and How sedentary behavior affects your health
Photo by Laura Billings

Events, Medicine X, Patient Care, Precision health, Public Health

At Medicine X, talking about owning one’s data and about patient-tailored health care

At Medicine X, talking about owning one's data and about patient-tailored health care

Matthew Might on stage - 560Health care that’s tailored to you and taking ownership of your health data were the themes of the morning yesterday at Medicine XLloyd B. Minor, MD, dean of the medical school, got the conversation rolling by defining precision health, and in a session that followed, several speakers shared stories that illustrated various aspects of this area.

In a presentation cleverly called “Can medical ‘selfies’ save us?” Steven Keating, a graduate student at MIT, began by explaining to attendees why it’s important to monitor your own health. Several years ago doctors detected a slight abnormality in Keating’s brain; they told him to “monitor it” and he took this advice to heart. He requested copies of his medical records, learned about the brain and paid close attention to how he was feeling, he explained. “Then I started smelling whiffs of vinegar,” he said.

Keating urged doctors to conduct an MRI and discovered he had a brain tumor (about the size of a lemon) that would need to be surgically removed. Keating told the audience that his interest and engagement in his own health care wound up saving his life.

Next, Claudia Williams, senior advisor for health innovation and technology at the White House Office of Science and Technology Policy, took the stage to discuss the Precision Medicine Initiative that was launched this January by President Obama’s Administration. The initiative, she said, is “about moving away from the one-size fits all approach and moving toward one that tailors [care] to your specifics.” To do this, the National Institutes of Health is now inviting people to join a cohort of one million individuals (or more) that will contribute biological samples and data to advance researchers’ understanding of heath and disease.

Many people have said they would participate in this initiative if they could get their own medical records back, Williams said. “Building trust and accountability” is a key part of this initiative, she said, noting that “If you want encrypted email data, you have the right to it.”

Having access to data from this initiative, especially genomic data, could help patients learn which drugs will be most effective for them and help people with rare diseases learn more about their illness, Williams told me during a post-panel interview.

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FDA, Health Policy, Nutrition, Pediatrics, Public Health, Research, Stanford News

How much Bisphenol A is okay?

How much Bisphenol A is okay?


A new study came out this week that happened to remind me of one of my pet peeves about certain biomedical studies — choosing an “outcome” measure that doesn’t tell you what you really want to know. The study, which was led by Stanford postdoctoral fellow Jennifer Hartle, DrPH, and estimated the amount of BPA a child is exposed to in the course of a normal school day, was great. But her description of EPA safety tests on the plastics component Bisphenol A, or BPA — done back in the 1980s — made me think back to earlier work by University of California, Berkeley biologist Tyrone Hayes, PhD.

In the 1990s, the agricultural herbicide atrazine was safety tested by exposing frogs to low doses of atrazine as they developed from eggs to tadpoles to frogs. The adult frogs didn’t die or show obvious deformities such as extra legs, so the pesticide was deemed safe. But Hayes took a closer look and, in 2002, found that even at very low levels of atrazine exposure, male frogs were producing eggs instead of sperm.

So no gross deformities if you just looked at the frogs for 30 seconds. But in fact the animals had experienced a dramatic change in their health and biology. The lesson is that, in biology, sometimes the right outcome measure is something you have to really look for. There is a lot more to the Hayes-atrazine story.

But back to the current study: Hartle and her colleagues turned their attention to national school breakfast and lunch programs, which provide nutritious meals to 30 million kids every year but also deliver small amounts of BPA, an estrogen mimic that messes with hormones. Children’s meals are disproportionately packaged in tiny one-meal containers. Those tiny packages of apple sauce and juice have a greater BPA-emitting surface area than a big carton or can for the amount of food. And school kids often eat meals off plastic trays with plastic forks and spoons. For children who eat a lot of meals at school, it can add up.

According to Hartle’s paper, appearing today in the Journal of Exposure Science and Environmental Epidemiology, the question isn’t whether the kids are getting BPA in their meals — they are — but whether any of them are getting doses of BPA that could affect their long-term health. Based on those 1980s studies, the EPA estimates that BPA is safe at chronic exposure levels below 50 μg per kilogram of body weight per day. Happily, Hartle and her colleagues found that children are getting far less than that — as little as 0.0021 μg for a low-BPA breakfast to 0.17 μg for a high-BPA lunch. Everything should be hunky-dory, right?

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