Public Health

A new online anthology aims to provide psychologists, economists, anthropologists, sociologists and other scientists with the latest research methods and tools to address the nation’s obesity epidemic, rise in chronic diseases and other public health challenges.

The free resource, called e-Source, was created by the Office of Behavioral and Social Sciences Research at the National Institutes of Health (NIH) in partnership with New England Research Institutes. The anthology includes contributions from international experts and offers authoritative answers to methodological questions as well as sets quality standards for the research community. According to an NIH release:

Behavioral and social science has broad appeal and impact, and the program was developed to reach a wide audience of researchers, within the NIH, nationally and internationally. The Web-based interactive collection consists of 20 interactive chapters with new features including a discussion forum and enhanced note-taking capabilities. The twenty chapters cover a range of topics, but are accessible to all users, including those with limited familiarity of concepts such as how to conduct a qualitative analysis. The concepts are supported with interactive exercises and a full set of references linked to abstracts in PubMed, a library of citations for scientific journals.

The program includes chapters under five major categories relevant to behavioral and social science. “Setting the Scene” introduces major concepts in design and planning of social and behavioral science research. “Describing How” addresses methodologies used to explain how something occurs (for instance, learning how a disease is distributed in a population by conducting a survey or an observational study). “Explaining Why” provides guidance on qualitative methods appropriate for describing why something occurs. “What Works” explores research methods that can evaluate whether one treatment is better than another and whether there are cost differences (for example, a brand drug versus a generic medication). “Emerging Issues” addresses challenges in behavioral and social science research.

The site was developed with the intention of providing a foundation of methods but with the expectation that it will evolve with public health trends. Future topics could include the effects of living in a particular neighborhood, the impact of differences in language and lifestyles and the science of writing questions.

Previously: NIH launches online tool providing information about the availability and scientific basis of genetic tests, National Library of Medicine Archives on the web, Scientific social networks aim to promote collaboration, accelerate discoveries

I’m a big fan of a piece of pending California legislation, AB 2109, that is designed to increase vaccination rates among children enrolling in school and daycare. Right now, instead of showing vaccination records upon enrollment, parents who have chosen not to vaccinate are permitted to sign an exemption form stating they have made their choice because of their personal beliefs. A post on About.com’s Pediatrics blog explains how the new law, if passed, will change that:

Instead of simply signing a personal belief vaccine exemption form on their own, parents will be required to have a written statement signed by a health practitioner that says the parent was given information about the benefits and risks of immunizations and the risks of certain vaccine-preventable diseases.

… “With the increase in outbreaks of common vaccine preventable diseases in California and nationally, now more than ever, parents need to get the right information about vaccines before exempting their children from immunization,” said Jeff Goad, Pharm D., President of the California Immunization Coalition. “This legislation simply mandates that parents receive accurate information about the risks and benefits of vaccines and the diseases they prevent before making decisions about not vaccinating their children.”

I feel strongly about this legislation in part because I write about the kids that this law is designed to protect: infants who are too young to receive vaccinations and children whose medical conditions make vaccination unsafe. Kids whose lives have been saved by organ transplantation, for instance, can’t be vaccinated because of the immune-suppressing drugs they must take to keep their transplants healthy. These children rely on the “herd immunity” conferred by high vaccination rates to protect them from potentially deadly infectious diseases such as measles and whooping cough. The new law would ensure that parents will learn about their role in building “herd immunity” – the importance of vaccinating to protect not just their own kids but also others – before they choose to forgo vaccines.

That leads to the second reason I feel strongly about this legislation: I’m a mom. Interviewing families whose children are dangerously ill has given me a real appreciation for how fortunate I am to have a healthy child. I think it’s part of my civic duty to make sure my toddler won’t spread germs that endanger the lives of the most fragile members of our community.

If you live in California, here’s a source for information about how to support the pending law.

Previously: “Herd immunity” causes dramatic drop in infant chicken pox, Washington state starts school year with tougher requirements for vaccine exemptions, How to save $83 billion? Vaccinate and Unvaccinated children may pose a public health risk
Photo by Jill A. Brown

Dude, where’s the emergency room?

A new study published in Health Affairs shows that 80 percent of college students consume alcohol, and half of those acknowledge having had at least one drinking-related blackout. Researchers at University of Wisconsin-Madison followed nearly a thousand participants from five schools, using hospital visits to measure the degree and frequency of college binge drinking, and as reported by Shots:

About one-third of the students ended up in the emergency room at least once during the two-year study. Not all their injuries were drinking-related, but the students who said they had had blackouts were more likely to end up at the hospital. Injuries included cuts, broken bones and head injuries.

Besides putting their health at risk, college students who binge drink and black out are spiking the cost of cleaning up after the party. The study concludes:

We calculate that on a large university campus having more than 40,000 students, blackout-associated emergency department visit costs would range from $469,000 to $546,000 per year. We conclude that blackouts are a strong predictor of emergency department visits for college drinkers and that prevention efforts aimed at students with a history of blackouts might reduce injuries and emergency department costs.

Previously: Study estimates hospitalizations for underage drinking cost $755 million per year, CDC binge-drinking study demonstrates cell phones’ value in research, Using Facebook to assess alcohol-related problems among college students and Fighting binge drinking on campus
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Last year, a Centers for Disease Control and Prevention report (.pdf) showed that only a small percentage of U.S. hospitals provided the necessary support for breastfeeding moms, and its authors argued there was a clear need for better in-hospital support for new moms. Jane Morton, MD, whole-heartedly agrees.

Morton, a clinical professor of pediatrics at Stanford, recently presented a Grand Rounds talk titled “Is Pumping Out of Hand? Game-Changing Research About Breastmilk Expression” at Lucile Packard Children’s Hospital. During the presentation, she discussed her work teaching moms how to breastfeed successfully and underscored the need for health-care workers to better educate women about breastfeeding techniques.

Below Morton discusses her research findings related to increasing breastmilk production, nursing premature infants and electric pump vs. hand pumping.

What motivated you to begin researching the effectiveness of breastfeeding techniques?

Years ago, when I first began private practice, I had one after another motivated mothers end up with problems. There were no teachers or mavens to learn from. So it became a personal quest – one with many rewards.

Why have hand expression techniques been an under-utilized skill among new mothers?

In many medical arenas, there’s been a drift away from bedside hands-on evaluation towards reliance on technical devices. When a $1,500 pump is pushed into the room, a new mother would assume this is state-of-the- art technology. Often, the most available care provider is inexperienced and uncomfortable teaching techniques that involve touching the breast. Odd, since the same staff member may feel comfortable with obstetrical manipulations.

Your research (subscription required) shows there are significant differences in milk production between electric pumping and hand expression. What factors contribute to increased milk production when mothers use hand expression techniques?

When a baby removes milk, the infant uses a combination of suction and the stripping action of the jaw and tongue. Suction alone is less effective at removing more viscous milk such as colostrum, or fat-rich breast milk.  In comparison, the massaging action used with hands-on pumping and hand expression, the two manual techniques demonstrated in our research, is much more effective.

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We’re all familiar with the litany of disclaimers and warnings that accompany pharmaceutical ads: the hurried voice-over of possible side effects that inevitably follows a scene of a smiling woman breathing deeply in an allergen-filled meadow or a couple running hand in hand on a tropical beach toward a distant romantic hideaway. Often the list seems almost comically long and dire.

But what do you do if you’re on the medication and experiencing a symptom that is inexplicably not included in the droning monologue? How do you know if it’s a true side effect? According to our release on the topic today:

Unfortunately, there’s no easy answer. Clinical trials are designed to show that a drug is safe and effective. But even the largest trials can’t identify irksome or even dangerous side effects experienced by only a tiny proportion of those people taking the drug. They also aren’t designed to study how drugs interact with one another in the human body – a consideration that becomes increasingly important as people age and their medicine cabinets begin to overflow.

Now Stanford bioengineer and geneticist Russ Altman, MD, PhD, and graduate student Nicholas Tatonetti have devised a way to sift through the mountains of data collected by the Food and Drug Administration after a drug is approved to identify never-before-suspected side-effects and drug interactions. The research is published today in Science Translational Medicine:

Although the FDA has its Adverse Event Reporting System for doctors, patients and drug manufacturers to use after the agency has approved a drug, many of the more than 4 million reports in the database are little more than anecdotal – there’s no way to tell whether the fever, rash, dizziness, seizure or other unwanted reaction was a true side effect of the drug, a result of a combination of medications or even a simple fluke of circumstance (maybe the patient had a cold or other undiagnosed medical condition at the time of the event).

Tatonetti found that he could identify true side effects and adverse drug interactions by carefully matching groups of patients in the FDA database. Patients on similar medications are likely to share medical and environmental traits that make them good controls for one another. The researchers have created two publicly available databases of their work, named OFFSIDES and TWOSIDES, respectively:

So far the OFFSIDES database includes an average of 329 new adverse events for each of the 1,332 drugs included in the system. (The average number of adverse events listed on a drug’s package insert is 69.) The TWOSIDES database identifies 1,301 adverse events, resulting from an analysis of 59,220 pairs of drugs that cannot be clearly assigned to either drug alone.

“This is a testament to the value of huge data sets,” said Altman. “They allow us to throw out a lot of cases. When you start with millions of pieces of information, you can be pretty rigorous about weeding out those that don’t match. And if you can arrive at even just a few hundred well-matched cases, that can give a good statistical comparison.”

One interesting (and alarming) bit of information to come out of the study is that patients taking both a class of antidepressant called an SSRI and a common class of high blood pressure drug called thiazides are significantly more likely to experience a worrisome cardiac side effect called prolonged QT intervals than those taking either drug alone.

Previously: Unexpected drug interactions identified by Stanford data mining
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Public policy issues related to women’s health care have garnered a considerable amount of media attention lately. Carrie Frederick, MD, MPH, who is working in Washington D.C. during her Stanford Family Planning Fellowship, has been in the thick of the national debate. Below she discusses her work with the American College of Obstetricians & Gynecologists on advocating to improve contraception coverage for women.

What main issues have you been working on during your fellowship?

During fellowship, I have been advocating for more universal contraceptive coverage in health plans. By thism I mean ensuring that all women have insurance coverage for all contraceptive methods, without cost-sharing, whenever a contraceptive is requested. Many people are now familiar with the rule that all insurance companies cover contraception with no cost-sharing under the Affordable Care Act. Those provisions will start to take effect in August 2012. However, currently many women either do not have contraceptive coverage in their insurance plan or have to pay significant portions of the expense for their contraception. Other women who are uninsured may only qualify for contraceptive coverage within the first six weeks after a birth.

I am also conducting clinical research to determine the best methods of contraception for women who have had bariatric surgery. We have a lot to learn about how obesity, weight loss, hormonal changes and changes in digestion in these women affect the efficacy of certain methods to prevent unintended pregnancy.

The controversy over one aspect of the Affordable Care Act, whether and when religiously affiliated employers must offer comprehensive contraceptive coverage in their insurance plans, has dominated headlines during your fellowship. What are some of the greatest misconceptions surrounding this component of the health law?

In 2011, the Institute of Medicine (IOM) issued evidence-based recommendations regarding which services should be part of the “essential benefits package” in the Affordable Care Act. The IOM determined that one of the essential benefits was contraception, and in recognition of the enormous personal and public health benefit of family planning, it recommended that the full range of FDA-approved contraceptives be covered with no cost-sharing.

The U.S. Department of Health and Human Services accepted the IOM’s recommendation, and required that under the ACA all insurance companies provide full contraceptive coverage with no cost-sharing, but allowed a narrow exemption for churches and other religious charities if they had moral objections to contraception. The U.S. Conference of Catholic Bishops requested a broader exemption that would apply to religiously-affiliated employers like hospitals and schools. The Obama administration declined to broaden the exemption, and instead determined that if a religiously affiliated employer had an objection, the insurance company itself would directly provide contraceptive coverage to the insured.

The controversy has been centered around the idea of “religious freedom” and whose freedom is more important: that of the employer, or the employee. The fact is that over 99 percent of women use contraception at some point in their life, and 98 percent of Catholic women have used contraception. Religiously affiliated hospitals and schools employ millions of women in the United States, so if they were permitted to exclude this coverage from their insurance plans, many women would have to either pay out-of-pocket or go elsewhere for their contraception.

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As of January 1, minors in the Golden State are banned from indoor UV tanning. California is the first in the nation to restrict this artificial bronzing process for those 18-years-old and under, and 18 states are now considering a similar ban.

A USA Today story reports on the issue, with writer Tracy Lowe explaining that most states already require parental consent for teens who tan to use indoor UV facilities. But a complete ban for all minors is stronger, and something that many feel is important:

“As parents, we don’t provide permission slips to our children to smoke cigarettes or drink liquor,” [Maryland State Sen. Jamie] Raskin, a Democrat, said. “As a matter of public health, we should take electronic tanning devices off the table for children.”

As it turns out, tanning is also an important issue to Stanford experts. Susan Swetter, MD, professor of dermatology, and colleagues at the Stanford Cancer Institute, for example, have been vocal in their belief that tanning bed usage and other recreational tanning likely has contributed to a dramatic increase in melanoma cases among California girls and women. And melanoma is the deadliest type of skin cancer.

Previously: State Senator Ted Lieu weighs in on tanning-bed legislation, New law: No more tanning beds for California teens, A push to keep minors away from tanning beds, Intense, rapid sun tanning may increase skin cancer risk
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On a recent tromp through the airport, I did something I haven’t done in a while: deliberately took the stairs instead of the escalator. For a while, I regularly eschewed moving walkways, elevators and escalators to increase my level of daily activity. But lately I have grown lazy.

Perhaps I would be more successful at changing my behavior if the sign pictured above, which is are part of a New York City public health campaign, were adopted nationally. The signs were introduced in 2008 and sport the slogan “burn calories, not electricity” to encourage people to take the stairs when possible.

A post published today in the Atlantic reports that recent research (subscription required) suggests the signs are proving useful in helping New Yorkers make healthier decisions. Neil Wagner writes:

Signs were posted in a three-story health clinic, an eight-story affordable housing building, and a 10-story academic building. Stair and elevator trips in these buildings were then recorded, for nine months at the health clinic and housing site and briefly at the academic building.

Nine months after the signs were posted, stair use was still up: total stair use was up 43 percent at the housing site and stair climbing alone was up by over 20 percent at the health clinic.

Instead of removing the signs at the study’s end, they were left in place, where they remain today. New York City now gives out similar signs to any manager of a public or private building who requests them, free of charge. So far, over 26,000 have been distributed.

Previously: Making the healthy choice a fun choice
Photo by: Cedric Maion

As we’ve previously written about on Scope, research at Stanford has shown that patients who have undergone Roux-en-Y gastric bypass surgery can have a positive effect on family members’ weight loss.

A segment today on NPR’s Morning Edition examines how social influences can fuel weight loss. On the show, John Morton, MD, MPH, associate professor of surgery and director of bariatric surgery at Stanford Hospital & Clinics, discuses how a patient’s gastric bypass surgery can encourage family members to change their lifestyle habits. He said:

We all gather around the table to enjoy a meal together and we learn lessons when we do that… Just like you impart morals to your sons and daughters, you can do the same thing around the dinner table as well and it can be good or bad; we see that all the time.

The story goes on to point out that results (subscription required) from similar studies support Morton and colleagues’ findings:

[Brown University researcher Tricia Leahey, PhD,] investigated a team-based weight loss competition in Rhode Island. This is an annual state-sponsored competition that joins individuals to compete against one another to see which team loses the most weight.

Teams range from four to 11 people and can include family members, but also friends and co-workers. After 12 weeks, Leahey found that those that lost the most weight were on the same team, suggesting “significant social influence.” In fact, the more people reported feeling peer influence to lose weight and exercise more, the more weight they lost.

Similar to the Stanford study, the average weight loss of the biggest losers hovered around 5 percent of their initial body weight.

Previously: The challenges of dieting and the promises of bariatric surgery, Stanford expert weighs in on study comparing gastric bypass and banding, Study finds family members of weight-loss-surgery patients also shed pounds and Study hints at benefits of weight-loss surgery for less obese patients
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As many of us have experienced, chronic stress can take a toll on your emotions and ability to think clearly. Now findings published in Neuron offer new insights into how chronic stress may affect the brain during adolescence and adulthood.

In the study (subscription required), University of Buffalo researchers analyzed whether repeated stress negatively influenced glutamate receptors in juvenile rats. Glutamate signaling plays an important role in prefrontal cortex (PFC) function. According to the university release:

[The] study involved male rats at an age corresponding to human adolescence–a period when the brain is highly sensitive to stress.

When the rats were exposed to repeated stress, they lost glutamate receptor expression and function in the prefrontal cortex, a region of the brain that controls working memory, decision-making and attention and doesn’t fully mature until age 25.

This loss significantly impaired the adolescent rats’ ability to remember and recognize objects they had previously seen. Similarly stressed adult rats, however, did not experience the same cognitive deficit.

…

[R]esearchers also report that by disrupting the enzymes that trigger loss of glutamate receptor expression they were able to prevent the cognitive impairment induced by repeated stress. As a result, they have discovered that there may be a way to prevent chronic stress’ detrimental effects.

Previously: Stanford’s Robert Sapolsky talks stress and the brain, Study suggests anticipation of stress may accelerate cellular aging, Workplace stress and how it influences health, How work stress affects wellness, health-care costs, Robert Sapolsky discusses stress physiology, Can stress increase risk of neurodegenerative diseases? and No surprise here: Anger and stress are bad for your health
Photo by Michael Clesle

This Sunday, we turn our clocks ahead and collectively as a nation each lose an hour of sleep. In this one night, we’ll generate a 300 million-hour national sleep debt and accumulate over a billion hours of lost sleep during the adjustment to daylight savings time. And as a consequence, on the Monday following the time change, there will be a 17 percent increase in roadway accidents.

In transportation, sleep loss kills, injures, and costs billions of dollars.

National Sleep Awareness Week, March 5 through 11, highlights the tragedies that can result from fatigue and operating vehicles. Poor judgment, lack of situational awareness, and slowed responses are just some of the consequences of not getting enough sleep.

In 2009, five people were killed when their tired bus driver operating a 34-passenger vacation charter failed to negotiate a curve on Highway 101 in Monterey County. Some of the passengers noticed his drowsiness during the journey, but no one said anything.

The hour we lose when clocks are set forward each spring offers our already sleep-deprived country a mere glimpse into the bigger picture of operating vehicles while fatigued. Every year, an estimated one million highway crashes are likely fatigue-related, with loss of life and injuries in the thousands.

Last week, the National Sleep Foundation (NSF) released its annual Sleep in America® Poll and the results are staggering. When it comes to the people America relies on to transport us safely, a significant number say that sleepiness has caused safety problems on the job. One in five pilots admits that they’ve made a serious error while flying. One in six train operators and truck drivers say that they have had a “near miss” due to sleepiness.

These NSF findings are consistent with decades of investigations performed by the National Transportation Safety Board (NTSB).  The NTSB has identified fatigue in accidents across all modes of transportation and has made about 200 safety recommendations on fatigue. For this reason, fatigue has been on the NTSB’s Most Wanted List of transportation safety improvements for 22 years. But are we any safer?

The societal wakeup call is just beginning to be answered. For example, less than two months ago, new federal regulations for pilots and commercial truck drivers were issued. While representing the most significant changes in more than 70 years, the rules in these two areas do not go far enough.

The sad fact is that for all the information we have on the perils of fatigue, America still accepts – even glamorizes – pushing the sleep envelope. But when it comes to operating any kind of vehicle, fatigue can be deadly and reducing these risks is everyone’s responsibility: companies, the government, individual operators, and travel consumers.

This year when we all spring forward, lose an hour in some other part of your life: Get the sleep you need and then maintain that sleep amount throughout the year. Your life and lives around you depend on it.

The Hon. Mark R. Rosekind, ’77, PhD, is a Member of the National Transportation Safety Board and an internationally recognized expert in the field of sleep and fatigue science.

Today, an estimated 15 million people in the United States are morbidly obese — that is, 50 to 100 percent, or 100 pounds, above their ideal body weight. And though obesity-prevention programs are starting to take root, it will be roughly two decades for these efforts to begin yielding results, John Morton, MD, MPH, told me recently. “You end up losing a generation,” he said. “What do you do for people right here, right now?”

During a recent interview, Morton, one of the nation’s top weight-loss surgeons, reflected on the challenges of obesity in America and how bariatric surgery may be part of the solution for some. You can read what he had to say in my Q&A on the Stanford Hospital & Clinics website.

What especially struck me was his discussion of the body’s natural resistance to losing weight:

Look at the levels of ghrelin, the so-called hunger hormone, in a person who lost weight on a diet, and you’ll see they are much higher than before. Levels of another hormone, leptin, which suppresses hunger and speeds up metabolism, are lower. Your body’s not stupid. It knows you have lost weight and will do everything in its power to get that weight back.

He also highlighted how bariatric surgery can cut down on obesity-related disease, saying that “the real eye-opener is the improvements to diabetes”:

 A 2001 study showed an 82 percent resolution rate of diabetes in morbidly obese patients who underwent laparoscopic gastric bypass surgery. They were able to stop taking medications — no Metformin, no Actos, no insulin, no Byetta — and that happened very quickly. This is where bariatric surgery certainly can make a difference.

Morton added that weight-loss surgery is now very safe, “especially compared to the risks of extreme obesity.”

Previously: Stanford expert weighs in on study comparing gastric bypass and banding, Study finds family members of weight-loss-surgery patients also shed pounds, Study hints at benefits of weight-loss surgery for less obese patients, Study: Outpatient bariatric surgery appears risky and Bariatric surgery may help protect teen patients’ hearts
Photo by -Paul H-

Earlier this week, a federal judge declared unconstitutional new rules that would have required tobacco companies to display graphic images on packs of cigarettes.

At issue were regulations published by the U.S. Food and Drug Administration last year mandating tobacco companies affix large warning labels to cigarette packages, cartons and advertising. The labels, which are meant to shock consumers and dissuade them from smoking, include images such as a man exhaling cigarette smoke through a tracheotomy hole.

When I read about the ruling, I contacted Stanford Chair of Otolaryngology Robert Jackler, MD, whose ongoing research into the history of tobacco company advertising has resulted in several published studies, to get his thoughts. He responded:

Judge Leon’s decision states that the graphic images mandated by the FDA are “neither factual nor accurate.” However, it is an indisputable fact that smoking causes an enormous toll of both disease and death – indeed it is the leading cause of preventable death in America. It is hard to imagine what logic could consider a visual depiction of tobacco caused diseases such as lung cancer and heart attack anything but factual and accurate. The images resonate with my first hand experience as a physician and, no doubt, that of innumerable families whose loved ones have suffered the tragedy of tobacco caused disease.

Judge Leon ruled the graphic warning “unconstitutionally compelling speech.” Using this logic, does he advocate banning the skull and crossbones traditionally placed on deadly poisons and replace if with a small and inconspicuous typeface placed discretely on the side of the bottle? The fact that text warnings are notably less effective than visually striking ones is the reason that the tobacco industry prefers them. Over 40 countries around the world require large, visually compelling, graphic warning on tobacco products often using imagery considerably more striking than those adopted by the FDA.

Congress passed the Family Smoking Prevention and Tobacco Control Act of 2009, which assigned oversight of tobacco to the FDA. In Sec. 201 it states: Cigarette package health warnings will be required to cover the top 50 percent of both the front and rear panels of the package, and the nine specific warning messages must rotate randomly over the course of the year. These messages must be accompanied by color graphics showing the negative health consequences of smoking cigarettes.

Previously: Hey doc, got a light? Research highlights Big Tobacco’s long history with the medical community, The smoking gun of the Iron Lady: Margaret Thatcher’s relationship with the tobacco industry, Throat doctors manipulated by Big Tobacco and NPR’s Picture Show highlights Stanford collection of cigarette ads, Image of the Week: A new cigarette warning and A conversation about the FDA’s new graphic health warnings for cigarettes
Photo by C.K. Koay

Given my history of writing about – and my passion for - this issue, I couldn’t let more time go by without flagging a recent Time Healthland piece on the health benefits of breastfeeding. In the article Bonnie Rochman highlights a “quietly worded statement” in which the American Academy of Pediatrics earlier this week called breastfeeding a “public health issue and not only a lifestyle choice.” And she explains why that’s such a big deal:

Much of the statement on infant nutrition doesn’t differ radically from previous versions. But the recognition on behalf of the group’s 60,000 pediatricians that breast is best for mom, baby and the nation’s general well-being is creating buzz in the breast-feeding community.

…

At Best for Babes, which promotes support for breast-feeding, co-founder Danielle Rigg praised the AAP for equating breast-feeding with public health. “In framing it that way, it becomes all of our responsibility — not just moms — to provide both the infrastructure and the social support to see to it that as many moms and babies as possible can do it,” she says. “If we can do it for breast cancer, we can do it for breastfeeding.”

Dr. Richard Schanler, chair of the AAP’s section on breast-feeding and director of neonatology at Cohen Children’s Medical Center in Long Island, is even more candid. “It’s not should I or shouldn’t I?” says Schanler. “Of course you should. It’s important for the health of your baby. And it’s important for your health too.”

Previously: More breastfeeding support needed in hospitals, Victory for nursing moms: IRS now says breastfeeding is a medical expense, Surgeon general calls for more breastfeeding support and Breastfeeding called a “secret weapon to save billions of dollars”
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To make it easier to navigate the rapidly changing landscape of genetic tests, the National Institutes of Health introduced the Genetic Testing Registry (GTR) today.

The free online tool was developed as a public database to assist health-care professionals to better understand patients’ diseases and researchers to close gaps in scientific knowledge. It also aims to help consumers struggling to decipher the complex world of genetic testing. According to an NIH release:

Genetic tests currently exist for about 2,500 diseases, and the field continues to grow at an astonishing rate. To keep pace, GTR will be updated frequently, using data voluntarily submitted by genetic test providers. Such information will include the purpose of each genetic test and its limitations; the name and location of the test provider; whether it is a clinical or research test; what methods are used; and what is measured. GTR will contain no confidential information about people who receive genetic tests or individual test results.

Genetic tests that the Food and Drug Administration has cleared or approved as safe and effective are identified in the GTR. However, most laboratory developed tests currently do not require FDA premarket review. Genetic test providers will be solely responsible for the content and quality of the data they submit to GTR. NIH will not verify the content, but will require submitters to agree to a code of conduct that stipulates that the information they provide is accurate and updated on an annual basis. If submitters do not adhere to this code, NIH can take action, including requiring submitters to correct any inaccuracies or to remove such information from GTR.

In addition to basic facts, GTR will offer detailed information on analytic validity, which assesses how accurately and reliably the test measures the genetic target; clinical validity, which assesses how consistently and accurately the test detects or predicts the outcome of interest; and information relating to the test’s clinical utility, or how likely the test is to improve patient outcomes.

Previously: What personal DNA testing can reveal about your potential health and future well-being, Could patients’ knowledge of their DNA lead to better outcomes?, A conversation about the benefits and limitations of direct-to-consumer genetic tests, Controversial class primes students in genomics, Stanford TA weighs in on what students learned by being genotyped and Stanford students discuss studying their own genotypes
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